ABSTRACT
This paper presents a qualitative evaluation of how Opportunity Zones (OZs) have attracted capital and economic development to highly distressed neighborhoods in West Baltimore. Based on 76 interviews with community and government officials, program managers, developers, businesses, and fund managers, we assess the strengths and weaknesses of OZs in West Baltimore and Baltimore City. We find that OZs are stimulating new investment conversations and building local economic development capacity. However, we also find OZs fail at oversight and community engagement, do not spur new development, and are a missed opportunity to incentivize actors and institutions critical to revitalizing distressed neighborhoods. To spur development in distressed neighborhoods, OZs require reporting standards, the removal of non-distressed census tracts, dollars for education and infrastructure, the incorporation of Community Development Financial Institutions, and incentives for non-capital gains holding investors.
ABSTRACT
BACKGROUND: With the onset of the COVID-19 crisis, many federal agencies relaxed policies regulating opioid use disorder treatment. The impact of these changes has been minimally documented. The abrupt nature of these shifts provides a naturalistic opportunity to examine adaptations for opioid use disorder treatment in primary care. OBJECTIVE: To examine change in medical and behavioral health appointment frequency, visit type, and management of patients with opioid use disorder in response to COVID-19. DESIGN: A 14-item survey queried primary care practices that were enrolled in a medications for opioid use disorder statewide expansion project. Survey content focused on changes in service delivery because of COVID-19. The survey was open for 18 days. PARTICIPANTS: We surveyed 338 clinicians from 57 primary care clinics located in California, including federally qualified health centers and look-alikes. A representative from all 57 clinics (100%) and 118 staff (34.8% of all staff clinicians) participated in the survey. MAIN MEASURES: The survey consisted of seven dimensions of practice: medical visits, behavioral health visits, medication management, urine drug screenings, workflow, perceived patient demand, and staff experience. KEY RESULTS: A total of 52 of 57 (91.2%) primary care clinics reported practice adaptations in response to COVID-19 regulatory changes. Many clinics indicated that both medical (40.4%) and behavioral health visits (53.8%) were now exclusively virtual. Two-thirds (65.4%) of clinics reported increased duration of buprenorphine prescriptions and reduced urine drug screenings (67.3%). The majority (56.1%) of clinics experienced an increase in patient demand for behavioral health services. Over half (56.2%) of clinics described having an easier or unchanged experience retaining patients in care. CONCLUSIONS: Many adaptations in the primary care approach to patients with opioid use disorder may be temporary reactions to COVID-19. Further evaluation of the impact of these adaptations on patient outcomes is needed to determine whether changes should be maintained post-COVID-19.