Mountain Top Cares Coalition (MCC) is a peer-run organization in Greene County, New York, linking residents who have substance use disorders to treatment, health care, and other critical resources to support recovery. The organization’s mission centers on facilitating connections to providers for individuals in recovery across 12 rural communities in the Catskill Mountains. MCC’s staff, consisting of volunteers and one part-time paid staff member, bridge critical gaps in access to treatment and services for substance use disorders in a region with high rates of opioid use and opioid overdose deaths. Many of the program’s participants face stigma about their substance use, so MCC facilitates partnerships with key community stakeholders to leverage local resources and promote education about recovery. With the majority (55 to 65 percent) of MCC’s program participants having current or previous justice involvement, the organization supports continuity of care for program members through strategic partnerships with local physical and behavioral health providers, law enforcement, the jail, and the Greene County Regional Treatment Court.

The need for treatment support in MCC’s service area is great. New York State’s most recent Opioid Annual Report ranks Greene County as having the seventh-highest opioid health burden among the state’s 62 counties. Health burden is measured by deaths resulting from opioid use, non-fatal hospital emergency department visits, and hospital discharges involving opioid use. The county is among those with the highest rates in the state for admissions to state-certified opioid treatment programs.[i]

With an estimated population of 47,188, Greene County is the most rural county in its district, and it has the highest poverty rate (12.6 percent).[ii] Greene County ranks among the least healthy counties in the state as measured by length and quality of life, health behaviors, access to clinical care, and social, economic, and environmental factors. The ratio of mental health providers to population is 1 to 1,150, versus the statewide ratio of 1 to 330. Similarly, the proportion of primary care physicians to people is 1 to 2,640, while the statewide ratio is 1 to 1,190.[iii] All of these factors compound challenges related to connecting individuals with needed services and sustaining them.

Raising awareness about the level of need in the region for resources to address opioid use is an integral part of the organization’s mission. MCC operates in various towns, villages, and hamlets, with populations ranging from 258 to 2732 people.[iv] Despite small populations, outreach can be challenging; the total service area spans several hundred square miles, and potential candidates for services are often geographically isolated. For some individuals interested in engaging in MCC’s programs but concerned about stigma, living in a small community can be a barrier to care due to privacy concerns. Before the COVID-19 pandemic, MCC hosted public meetings to engage community partners such as law enforcement, physical and behavioral health agencies, business owners, landlords, the local treatment court, prospective volunteers, and other residents to expand their reach and address stigma in the community. These programs are now being reintroduced.

Peers and Volunteers

Peers with lived experience comprise the core members of MCC’s Care Team and are certified by the Alcoholism and Substance Abuse Providers of New York (ASAP) as Certified Recovery Peer Advocates (CRPA). The Care Team’s CRPAs provide direct services to individuals experiencing substance use disorders and foster partnerships with local organizations that can contribute resources or refer clients. MCC President Jonathan Gross says, “The backbone of Mountain Top Cares is the CRPA Corps…. They are focusing on one person at a time in the community with boots on the ground, going door-to-door, to businesses, to apartment buildings, to people whom they know in the community. The MCC CRPAs are locals with lived experience and can bridge the gap with mountain folk often isolated and distrustful of government and organizations. Trust is the key to beginning the recovery journey. Trust and word of mouth is our greatest recruitment tool.”

As volunteers, MCC’s Care Team members contribute diverse skills to the organization’s programming while expanding reach through a network of partners. While COVID-19 disrupted much of the direct support they’ve historically provided, the MCC team members are resuming efforts as COVID-related restrictions decrease. They plan to provide a wide range of services, including reviving jail in-reach, driving individuals to appointments, facilitating support group sessions and training, and hosting community events, such as a recent hiking trip for at-risk youth.

As residents of the Mountain Top communities, MCC’s CRPAs have first-hand knowledge of local barriers to receiving care and support for substance use disorders, and they leverage this knowledge in how they help navigate those barriers. For example, knowing that broadband and cell phone coverage are not consistently available throughout the region, the CRPAs use their knowledge of locations with service to access teleservices for their clients.

Prior to Greene County’s opening of an operational jail in August 2021, MCC CRPA devised an in-reach process for identifying Mountain Top community members in neighboring Albany County’s jail-based medication-assisted treatment program. Once found, the CRPAs help those individuals prepare for returning home. As in many communities, lack of transportation continues to be a barrier to accessing services and supports. During COVID-19, MCC’s Care Team provides rides for their program members when possible. The organization plans to expand the network of volunteers who can safely offer transportation.

Taking Multiple Approaches

As indicated by their public meetings to increase knowledge and stem stigma around opioid use and treatment, MCC considers the community’s involvement key and approaches work there from multiple angles. MCC operates a naloxone training initiative, through which they have trained over 100 people to administer naloxone and distributed approximately 140 naloxone kits to police departments and other agencies in the area. They also developed the Recovery-Friendly Workplace Initiative, resulting in several local business owners employing individuals referred by MCC.  They are currently facilitating a Women in Recovery workgroup, which has 5 participants completing a 12-week course and the next course ready to begin. Finally, the organization partners with the local community college to offer two scholarships for MCC program participants.

Looking forward, MCC has several new projects in planning. With guidance and funding from the HEALing Communities Study, they are working on installing naloxone kiosks in the region, which residents who have received training to administer naloxone can use to access an emergency dose of the medication to treat someone who is experiencing an opioid overdose. MCC will also be offering “Beyond Violence,” a gender-specific, 16-week violence prevention course for women in the Greene County Regional Treatment Court program that addresses the role of trauma in substance use, violence, and justice involvement among women; they have one referral from the court system already. Finally, with a new opioid treatment court implemented in the region, MCC expects to work with the dedicated opioid treatment court peer. Peers support individuals through the program and ensure they are connected to the services they need to continue their recovery after graduation. Between reviving its pre-pandemic services and these additions, MCC hopes to make recovery support readily accessible no matter how remote the communities they serve.

[i] New York State Department of Health Annual Opioid Report. (2020).

[ii] 2019-2021 Community Health Needs Assessment Implementation Strategy Community Health Improvement Plan and Community Service Plan for Columbia and Greene Counties, NY and its Hospital. (2019).

[iii] County Health Roadmaps and Rankings. (2021). County Health Roadmaps and Rankings.

[iv] New York 2010: Population and Housing Unit Counts. (2012). 2010 Census of Population and Housing.

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