A Health Foundation’s “More Equitable Approach” to Substance Use Disorder

Homeboy Industries, an Elevance grantee, operates a substance abuse and recovery services program, and offers job training and employment. Photo courtesy of Homeboy Industries.

Opioids continue to ravage communities across the country, resulting in a grim and steady climb in overdose deaths last year, according to preliminary statistics. Chicago and San Francisco alone saw record numbers of opioid-related overdose fatalities in 2023. 

Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health, assumed deaths from opioid overdoses would go down as COVID ebbed. “So to me, it is very concerning that these numbers remain so elevated,” she told CNN.

In the face of this health crisis, philanthropic funding for substance use disorder and treatment has remained lackluster at best. As IP has reported, after two of the country’s largest health foundations stopped funding in this area, only a handful of national funders have stepped in to fill the void.

The Elevance Health Foundation is one of those, as my colleague Paul Karon reported in 2022 when the foundation announced a $13 million commitment to community mental health programs, with a particular focus on substance use disorder. In all, the Elevance Health Foundation (formerly the Anthem Foundation) committed to providing $30 million to that effort over three years.

Last September, as part of its commitment, Elevance provided close to $20 million in grants to address substance use disorder in populations that are typically overlooked. Grantees include Homeboy Industries, an L.A.-based gang rehabilitation and reentry program, LA Family Housing, which supports homeless adults and children, and the Downtown Women’s Center, which finds housing for middle-aged women and gender diverse people experiencing homelessness. Other grantees include the Chris Atwood Foundation, which provides recovery support services in Northern Virginia and Washington, D.C., and Shatterproof, a national organization that works to improve treatment for substance use disorder and reduce stigma, a major barrier to recovery.

Individuals with gang and criminal justice involvement, as well as those experiencing homelessness, too often lack access to effective substance use disorder treatment — and they are among those who need it most. 

“By funding programs and building partnerships that focus on improving the health of socially vulnerable populations, the Elevance Health Foundation is working to bring a more equitable approach to addressing substance use disorder,” said Lance Chrisman, the foundation’s president.

Recovery and connection

Father Gregory Boyle likes to say that Homeboy Industries is “in the business of second chances.” Boyle, a Jesuit priest, founded the organization in 1988; it is now the largest gang rehabilitation and reentry program in the world. Homeboy Industries provides job skills training and employment (including jobs in the organization’s popular bakery, Homegirl Cafe, and close to a dozen other social enterprises). It also provides legal and educational services, tattoo removal and a program for both perpetrators and victims of domestic violence. 

Drug and alcohol dependence, as well as mental health issues, are common among people who walk through the doors at Homeboy Industries, but few have ever had sustained access to effective treatment. Homeboy Industries’ comprehensive program for mental health and substance use disorder aims to address the underlying issues that fuel and exacerbate both.

“Mental health and substance use treatment is expensive and difficult to access for most Americans, and it's even more so for our target population: formerly gang-involved or incarcerated individuals who are living on the margins,” said Donna Harati, vice president of wellness and community care at Homeboy Industries.

“We know that people with mental health challenges are also overrepresented in the criminal legal system, where they have scarce access to treatment that could help put them on the path to healing and recovery,” Harati said. “Most of our participants have experienced adverse early childhood experiences and really severe traumas. Our commitment is to seeing and treating the whole person and recognizing the deep racial inequities across housing, access to quality education, physical health and economic opportunities.”

The funding from Elevance Health — $300,000 over three years — supports Homeboy Industries’ substance abuse and recovery services program, which was recently renamed “Recovery and Connection,” according to Harati. “Our foundational value at Homeboy is kinship, and so everything we do is relational,” she said. “Our approach to addressing substance use is also based on relationships and fostering that kind of accompaniment as people are navigating various challenges and obstacles in their lives.”

There is evidence that Homeboy’s approach makes a difference. Starting in 2008, UCLA researchers followed Homeboy Industries participants and found that compared to the 2-in-3 recidivism rate typical for people incarcerated in California, only 1 in 3 participants ended up back in jail. The researchers, Todd Franke and Jorja Leap, told UCLA Blueprint that Homeboy’s comprehensive wraparound services are key to its success. “What our research shows,” Leap said, “is that Homeboy has created a therapeutic community through its emphasis on the relational.”

Moving the bar in a positive direction

The Elevance Health Foundation is currently circulating a request for proposals around substance use disorder with a focus “on programs that include prevention, crisis response and harm-reduction strategies, and reduce barriers to trauma-informed approaches,” according to its website.

Elevance says it works closely with nonprofits that submit proposals for funding. “It is a very stringent process, but I always tell our nonprofit partners that no grant exits our process looking the same as it came in — it comes out better,” Chrisman said. “There's a lot of back and forth: We aren't just a funding resource, we are a partner. We ask questions like: If we did this, could we serve more people? If we did this, would we have better results? We feel like by rolling up our sleeves and being a community partner, we're able to make extremely strong grants.”

Elevance launched its three-year, $30 million funding commitment in July of 2021, and Chrisman is confident the foundation will meet and likely exceed that spending goal in July of this year. The foundation appears to be committed to continuing its support for programs, like Homeboy Industries, that are working to address the causes of opioid addiction, and to heal some of the damage. It has already started evaluating its existing programs and planning next steps; final strategy decisions will be up to the board of directors. 

“The plan right now is to fulfill our existing commitments by July and then, by 2025, to announce our new commitments and focus areas,” Chrisman said. “But my instinct right now is, we will just enhance what we're already doing.”

Elevance’s commitment to this deeply underfunded area is laudable, and it’s also backing other causes that get relatively little philanthropic attention in the U.S., like maternal health. But the fact remains that this grantmaker, and others that address substance abuse and addiction, are exceptions to the rule. Asked why more funders aren’t willing to tackle the issue, though, Chrisman seemed optimistic that this could change.

“Historically, this has been a challenging issue — behavioral health and substance use disorder,” he said. “There are so many different topics and areas of need under that umbrella, and we didn't necessarily have the data. Where do you begin? How do you know you're making progress? I think over the past three to five years, we've seen major improvement in that area for folks to build on, and that's what we're trying to do. We're trying to apply science to the art of grant giving, to use the data, share that information and partner with the subject matter experts that are in the community making a difference. We’re trying to get them the resources they need so that we can move the bar in a positive direction.”