Engaging the Great Circle: a qualitative study of the Confederated Tribes of Grand Ronde’s mobile medication unit

Figures & data

Figure 1. Great Circle mobile van.

Figure 2. Great Circle mobile van brochure.

Table 1. Staff results.

Theme	Subtheme	Example Quote
The driving force	Desire to create a “great circle” of wellness accessible to all community members.	“We operate as a culturally sensitive and a culturally diverse organization. The Tribe realizes they are a part of a larger community—a Great Circle. We are part of a larger community, and we help everyone” (Staff 05).
	Catalysts for the unit’s creation included increases in overdose deaths and rural transportation barriers among Tribal members.	“People are dying, they are killing themselves. We are saving lives. … What really becomes the ah ha moment is when they have a family member, or we have a Tribal member that everybody knows … overdose. All of a sudden, the light bulb goes off and people are like, we got to do something about this. … We are doing something. This is how you can help. Once that happens and [members] realize they can be a part of that healing process by helping people get connected to services.” (Staff 04).
Establishing networks	Initial Tribal approvals and support for the mobile unit.	“I have never had that kind of support anywhere I have worked. It is because the membership is us. It’s our families. It’s our people. It becomes our connection to our membership. The [Tribal council’s understanding of] the importance of being able to provide these services is amazing … My Tribal council supported our ability to bring on these services and the mobile unit. I can’t say enough about how much that means, having a Tribal council that supports all of the good work that we are doing. They have been critical to making this happen.” (Staff 04)
	Building and maintaining community relationships	“Few states had experience with the operation and management of MMUs. It is all new and every situation is unique. We [The Great Circle Recovery OTP director and I] thought about how to develop the OTP and where to locate the OTP for the most impact.” (SOTA)
Implementation and impact	MMU operations, implementation barriers, and facilitators.	“If they have an appointment, we can see that on the screen and we remind them that day or ask, ‘did you go to it?’ If not, let’s re-schedule and get you back on your schedule. If they are not going to counseling appointments, the counselors will put a stop check to have a session before they receive a dose. We do that right there with a cell phone.” (Staff 02).
	Reduced stigma associated with opioid agonist therapy.	“A lot of the younger [Tribal members] are afraid of being seen getting treatment … because there’s a big stigma around addiction and with their culture … they don’t believe in the medication. … With the mobile unit we’ve helped people overcome that feeling. They feel they are getting the help that they need in a way that is good for them. … They are not afraid of getting treatment anymore.” (Staff 02)

Table 2. Patient results.

Theme	Example Quote
MMU’s professional and “caring” environment.	“I met the people on the mobile van. They were so sweet and so nice. I was excited and nervous and scared, but they made it so easy. It made me feel very comfortable. The next day they picked me up and made [methadone induction] easy and pleasant. Very caring. Which means a lot to me.” (Patient 1)
Accessible location saves on time and transportation costs.	“Well, obviously the location. Just the way it’s set up is really nice, too. You know, it’s just easy-peasy. The location-- they use, there’s parking, there’s not a problem with that. The staff is super nice. So, it just feels very welcoming to like, it’s fast. I am always at the Salem place way longer than I am at the mobile, you know, waiting. It’s very efficient I feel like, too.” (Patient 6)
Critiques and suggestions including culturally responsive ancillary services	“I think that if we had like you know, wheelchair accessible or easier way to get into it-- it would be a lot better…’Cause that’s kind of what sometimes stops me is having to climb up the steps to get in there.” (Patient 5)