Social Impact LIVE: Nabila El-Bassel on Reducing Opioid Deaths in New York State

October 23, 2019 @ 4:30 pm

Richard Hara is joined by University Professor Nabila El-Bassel to discuss her most ambitious project to date: a plan to reduce opioid overdose fatalities by at least 40 percent within four years in 15 of the most burdened counties in New York State.


Richard Hara: Hello, I’m Richard Hara and this is Social Impact LIVE, a weekly conversation with members of the Columbia School of Social Work Community. I’m pleased to welcome to our program today Dr. Nabila El-Bassel. Dr. El-Bassel is the Willma and Albert Musher Professor of Social Work and Director of the Social Intervention Group, a multidisciplinary center focused on developing and testing prevention and intervention approaches for HIV, drug use and gender-based violence and disseminating effective solutions for these problems to local, national and global communities.

Dr. El-Bassel is also a Director of the Columbia University Global Health Research Center of Central Asia, a team of faculty scientists researchers and students in New York and Central Asia working to address health and social issues through research, education, training, policy and dissemination in that part of the world. Her work has been extensively funded by the National Institute on Drug Abuse and the National Institute of Mental Health including most recently a landmark $86 million grant from NIDA to support research intended to reduce deaths from opioids in New York State. Dr. El-Bassel, welcome to Social Impact LIVE.

Nabila El-Bassel: Thank you.

Richard Hara: I’m looking forward to talking to you about your grant and how you and your colleagues are leading the effort to combat the opioid epidemic. But before I do so, I noticed in your bio that in addition to your master’s and doctorate in social work, you also have a bachelor’s in social work degree. So I’m wondering, did you know then that social work was going to be your life’s path?

Nabila El-Bassel: You’re right, my BA is in social work, my master’s degree is in social work, I’m a PhD in social work. And from the beginning when I was in high school, my teachers told me that I like science, but also I like to look at social issues and they told me you’ll be a great social worker and I started exploring what’s social work, and I started really looking into what a BA would offer me, and I started my education with a BA in social work. But I always was interested in research in social work to understand social issues and coming up with evidence-based solution to social problems, so I continue in this line of research.

Richard Hara: Yeah, so and you’ve got an incredible history and record of research, and can you tell me a little bit more about the research that you’ve done here?

Nabila El-Bassel: My research began when I was doing my PhD, and it focuses on HIV prevention, substance abuse prevention and gender-based violence. And I work with my colleagues to establish the Social Intervention Group that focuses mainly on producing evidence-based solution to these problems. So — and we design many different interventions, disseminated them in the community to address the co-occurring issues of substance use, HIV and violence against women.

Richard Hara: Okay. So this center is not focused solely on, what, pure research, right? But how do we apply research? How is it implemented in the communities?

Nabila El-Bassel: We — the center focuses on producing evidence-based solution to social problems. We use good science to work with the community to come up with solutions to social problems and substance use —

Richard Hara: I see.

Nabila El-Bassel: — HIV, gender-based violence. And we care, the team at the Social Intervention Group and myself, we care about producing intervention, prevention and implement them in real world settings using the best science. And our interventions that we design approximately 11 evidence-based interventions have been identified by CDC as best practices.

Richard Hara: Best practices, okay. Well, so — and — so, presumably this is what we’re tapping into now as part of this grant and research project that you’ve been tasked with, with regard to the opioid crisis?

Nabila El-Bassel: The HEALing Community Study is really an extension of what the Social Intervention Group has been engaged in. It’s about really — a community-based research is about implementation research. And the aim of the community’s healing project is reducing overdose deaths in 40% in 67 counties or communities over three years.

Richard Hara: So, okay, let me get that straight then. The goal and aim of this is to reduce opioid deaths from overdose by 40%?

Nabila El-Bassel: Absolutely.

Richard Hara: In three years.

Nabila El-Bassel: Over three years in 67 counties, yeah.

Richard Hara: How are you going to do that?

Nabila El-Bassel: How we are going to do that? That’s really a good question.

Richard Hara: Okay.

Nabila El-Bassel: The plan is to work with all the communities to implement evidence-based practices. We’re not designing a new interventions or treatment, but we are taking a treatment that found to be efficacious to deal with the opioid epidemic and implement them into the communities. For example, we care about overdose prevention and Naloxone distribution. We care about — caring about medication for opioid use disorder, getting into the people that need them and other evidences practices that we want to get them into the community.

Richard Hara: Okay. So, actually, let me take a step back for a moment here and — so that I can better understand the scale and scope of the problem. What are we dealing with? And maybe, what — what don’t we understand about this crisis that is different about previous drug crises? Yeah.

Nabila El-Bassel: Yeah, the overdose problem is huge. If you look at the data, only in 2017, 70,000 people in the United States died from the overdose death. And the problem is affecting all level of people, and if you look at the history of the epidemic, from 1990 to 2010 most people died from a prescription drug use, overdose — they died because of prescription drugs.

Richard Hara: Yep, yeah.

Nabila El-Bassel: And from 2010 to 2013 we see a different phase of the epidemic. Most people died because of heroin use, they switched from prescription drug use to heroin. And then from 2013 till now we are seeing a different epidemic, we’re seeing really a serious epidemic because of synthetic drug use like Fentanyl, which is 50 to 100 times more potent than heroin. So we are really facing a very, very serious problem of overdose death in our communities.

Richard Hara: Mm-hmm, is it true that though there’s been a slight decrease in recent years? And is that , I mean, sort of misleading or what are your thoughts?

Nabila El-Bassel: You’re asking a very good question, and by asking me misleading, I’m ready to celebrate, to be honest with you I’m not ready to celebrate and I’ll give you a sense. CDC published a report about the overdose death, rate of overdose death in 2018, a difference between 2017 and 2018. And they said, wow, there is a reduction of 5% of overdose deaths.

Richard Hara: Mm-hmm, okay.

Nabila El-Bassel: And, but if you really dig into the data, you’ll see that most of the reduction of death is because of prescription drug use, it’s not because of the synthetic drugs that they use. And so it’s too early to celebrate, it seen reduction, yes we see instead of 70,000 people died in 2017 the CDC reported in 2018 there were 68 to 500 people died from overdose deaths, but most of the reduction of rate of death is because of prescription drug use and not because of the use of Fentanyl that we are facing now, which is serious, a serious problem that affecting our communities.

Richard Hara: Okay. So there are different facets to this epidemic to the problem of overdoses and so on. So — so what is your approach going to be? I know you’re focusing mainly on New York State, correct in your work?

Nabila El-Bassel: Let me give you a background about the HEALing Community Study.

Richard Hara: Great.

Nabila El-Bassel: It’s about 67 communities, not only New York State, but Massachusetts, Kentucky, Ohio, and New York State.

Richard Hara: Mm-hmm, okay.

Nabila El-Bassel: So there are four states will be involved in this study and there are 67 counties or communities that are engaged in this.

Richard Hara: Okay, all right. So — so what’s going to happen? Are you going to be going to these counties and bringing information? Are you going to be working with local groups to brainstorm? How is this all going to work?

Nabila El-Bassel: These are really great questions. So, in New York State we have 16 counties that will be involved in the study, 8 of the 16 counties will be randomized to, we call it Wave 1, which we start now. Wave 1, we deliver the intervention to Wave 1 and two year late — two years later we will deliver the intervention to Wave 2 for the additional 8 counties. The additional 8 counties in two years from now they’ll get a better intervention because we will be working on delivering an intervention that will be improved and getting it into the Wave 2. In fact, today we found out who the counties are from Wave 1 and the intervention will start very soon. So we’re very excited to be part of it.

Richard Hara: So the intervention, so to speak, is something that can actually change over time and develop and evolve.

Nabila El-Bassel: So, let me give you a sense of the intervention.

Richard Hara: Okay.

Nabila El-Bassel: So, the intervention is bringing evidences practices to address the opioid epidemic in the counties. But one really amazing piece of the intervention is involving the community in making decision what is the best approach for each county. When we go to a county we will work with existing coalitions and the coalitions in each county, the coalition consist of governmental officials, providers, and also of people with lived experiences. And this coalition decides what would be the best thing for the community, are we going to go first with overdose prevention? Are we going to be training medical providers to provide a medication for opioid use disorder? So the coalition is the backbone of what need to be delivered.

The most important piece of this approach is that we use evidence-based solutions to the issue, meaning that we will bring in a data to the coalition to make data driven decisions. We use dashboard for visualization of the data. We will do landscape analysis of what services exist in the community, and what gaps exist in the communities. It is up to the coalition to make a decision what needs to be done for each community. And the health commissioners or mental health commissioners in each county are also heavily involved and also are the backbone of delivering this kind of approach.

Richard Hara: So what I’m imagining is that, here you are with your working group and you’ve got all of this information on evidence-based interventions and so on prevention, treatment, etc. You’re going to be taking this package, so to speak, to local communities and working with the groups there to determine what the priorities might be and so on. The data that you bring, or is the data coming from the community as far as, you know, what the needs are and so on and putting all of that together, deciding what the next steps are going to be as far as this project is concerned?

Nabila El-Bassel: The first step of doing our work is to inform the community or the coalition about existing intervention. So what we’re doing is landscape, data collection about the assets of the community, what services exists. And then doing about the gaps, what gaps exist in the community, and bring them to the coalitions. And the coalition members know what’s happening because they’re also from the community.

Richard Hara: Okay.

Nabila El-Bassel: They will also inform us what we need to do and it’s a reciprocal relationship. But we will bring in this data to the coalition as well as there are many, many existing data around that we want to connect to the data and bring them to the coalition. And the coalition members will say, we need to pursue this kind of solution for our community and the solution may vary across county.

Richard Hara: Yeah, yeah. So when you speak of a coalition, is this a formal body? I mean, who’s participating in these coalitions and how do they get in, so to speak?

Nabila El-Bassel: You ask me very good question, and really the coalition consist of community members, people with lived experiences, health providers and social services providers, a health commissioner, governmental officials, they all meet with a lot of experience and doctors who understand the issues, people from the criminal justice system who care about the criminal justice system, they all have a lot of experience and knowing their communities. And they understand what is need to be done, so they meet all together, they bring their ideas. And with the data that we will be providing they can make data driven decisions.

Richard Hara: Okay.

Nabila El-Bassel: One important piece is in each county the health commissioner or the mental health commissioner will be involved in the group. So — and we are working with the health commissioners to hire staff from the counties to be able to deliver this intervention through the coalition. It’s really about the community voices, about the community. And we are leveraging on existing coalition, we’re — there are counties that they have their own coalition, and we are working with the mental health and health commissioners to leverage on the existing power of the community.

Richard Hara: Okay. Okay, so this is a model that draws from your previous work I think, nationally and internationally in your career. And now you’re working with these coalitions, you’ve got also on the academic side, right, not just people from the School of Social Work faculty and students, but also from other schools and disciplines here within Columbia University?

Nabila El-Bassel: Yes. The problem is complex, and in order to address it you really need different disciplines and expertise to get together to address the issue. So, I’m so delighted that our school the School of Social Work here is leading it MDPI, and I have my colleagues who are from the Social Intervention Group leading it. But also we have a faculty from data institute, we have faculty from the School of Public Health. We have colleagues from CUNY University and NYU. We have system scientists, addiction scientists, public health type people, people with big data, we’re really all getting together to really address the issue and that’s the beauty of the research. We’re really tackling it from different perspective, different science. And I tell you, honestly, really, I’m so excited about it from day one when we wrote the grant until we got the funding and start working together. The power of the science is amazing. And Columbia University has a lot of really powerful scientists capitalizing on the existing resources at the university.

Richard Hara: Okay. I have a follow up question but I also want to remind our audience that we reserve a little time at the end of the program for some Q&A. So if you’ve got some questions, please write them into the chat box and we’ll try to pass them along to Dr. El-Bassel. Yeah, so my head is spinning now. I’m thinking about all of these people, all of these players, the coalition, you’ve got the academic, you’ve got the government piece and maybe, yeah, the opportunities is that we have a — we can coordinate a strategic response, right, by bringing together all these stakeholders. But, again, how are you going to do it? You know, how — how do you provide that kind of leadership to such a heterogeneous, right, group of stakeholders?

Nabila El-Bassel: Let me say that the Social Intervention Group has been doing this work for almost 25 years. We built a great infrastructure, the school. We have great faculty from the School of Social Work who are involved in it. And also, we the school committed to resources and committed to help us to build the infrastructure, so that’s really very helpful. So, if — we are ready for this huge undertaking, given the expertise we have and the vision of the Social Intervention Group. In addition, we hire an amazing project — a senior project director who understand the community and she really is powerful in knowing who to hire and what to hire. So, we hire amazing staff and we’re in the process of hiring more. So, it’s a collective effort, collective vision, and it cannot be done by one person.

Richard Hara: Okay, all right so you’ve got a team working on this. And if things go well, right, it’s three years, four years, how long is this?

Nabila El-Bassel: It’s a four year study.

Richard Hara: It’s a four year study. What happens beyond that? Are there plans or is it kind of assess as we go along?

Nabila El-Bassel: So, the plan is really to sustain this program, so that’s why we’re creating the coalitions, we’re working with governmental officials. So when we’re done with this study, they’ll be sustained. And if it works, this study or this kind of approach, a community based approach, will be taken to different counties that are not involved in the research and implement the same model. Also, I’m really excited because if we succeed, this model that we’re creating that is evidence-based, science-based can be applied to other epidemics. And I’m looking forward to be implemented in the United States and other countries because there is power into science and community coming together to solve the issue.

Richard Hara: Yeah. And, so my question is, so how are we as social workers kind of uniquely positioned, right, to do this kind of work and to contribute, right, to such a large scale project?

Nabila El-Bassel: I think the model we’re using fits so well with the profession. Our profession is about really producing evidence based approaches and implement in real world settings. And if you look at our mission at Columbia and other school is really about creating intervention and prevention, working with the community and community-based research implementation science are part of the profession. And that’s really exactly why I think this kind of research fits so well with the profession. It’s really — it’s our value, it’s about working with the community, by the community coming up with solutions and implement them in real world, so it fits well with the professions values.

Richard Hara: I guess it can’t be emphasized enough, right? We don’t — we don’t treat communities as subjects, right, or they’re collaborators.

Nabila El-Bassel: Yeah, when we saw the RFA to apply for this funding, the team at the Social Intervention Group meet and said, this fits so well with social work, this is exactly what we want. We know how to do community-based research. We know how to involve the community in science. We know how to do implementation research. We’ve done addiction research, we’ve done HIV research, and all of these issues are all connected. And we run to write the application and we brought with other scientist who care about the issues.

Richard Hara: And the implications for us as a School of Social Work and for social work education in general, is this — what are your thoughts?

Nabila El-Bassel: Yeah, and let me say that so far a huge number of master’s students and PhD students are involved in this process and learning with us and working with us. We have a training program T32 that’s funded by NIDA. We have a number of pre-docs and post-docs are involved. We have faculty from the school who are involved with the research and we bring in our expertise into the classroom to — I’m talking about the model. We have visiting faculty from social work and other fields are coming to learn about this. So there’s so much excitement about the plan and the approach that we’re taking in the profession. To say, honestly, School of Social Work Columbia University is the best place to do it, given our interests and our vision to evidence-based practices and also about implementation research. So we — we fit the formula to do this kind of research.

Richard Hara: Yeah. No, it’s an exciting time to be here at the school to be a part of what does feel like a watershed moment, right, in terms of the work that we’re doing and the impact that we’re having out there on people’s lives. So thank you for that, and I would be remiss if I didn’t mention a recent honor that you were named as a University Professor here at Columbia University, the highest academic honor that the university can bestow. So congratulations for that.

Nabila El-Bassel: Thank you.

Richard Hara: And I was just hoping you could obviously a long and storied career that’s far from over. But looking back a little bit, what’s giving you the most satisfaction being in social work, being an educator, researcher, practitioner, everything?

Nabila El-Bassel: I think it’s going back to your first question, why I’m doing a social work and why I studied my BA in social work, my master degree in social work. It’s really about coming up with evidence-based solutions to social problems. And we are facing a very serious problem, continue to face with the opiates epidemic, and what gives me really a satisfaction is that I can use my skills, my knowledge to work hard to address the problem. But also, I’m so excited to be working with students and faculty to share what I know and to build the future together, and to promote evidence-based approaches and use good science and multidisciplinary approach at our school and the faculty. And I’m very committed to the school, so that’s — I’m so satisfied with where I am and where I’m going with my career.

Richard Hara: Well, thank you so much. I wanted to turn to some questions from our audience if we could now. Could you describe some of the specific strategies and evidence-based practices you’re contemplating employing in regards to this crisis? You mentioned science-based solutions, but I’m curious what exactly some of these might be.

Nabila El-Bassel: I’ll talk about three approaches that we’re taking. The first one is overdose prevention and Naloxone distribution. So this is a strategy that we will be working with the community to deliver them everywhere. We want to get to places where people don’t get Naloxone or people who don’t have access to overdose prevention, the criminal justice, homeless shelter, emergency department and deliver these strategies into these settings, so high risk places.

Secondly, we want to enhance or improve access to medication for opioid use disorder. As you know, the number of doctors who are trained to prescribe medication for opioid use disorder is so low. Only 5% of the doctors are — have waiver to prescribe this medication. So you want to be assured that people get the medication they need and access them, and hopefully the coalition decide that we need to emphasize an increasing number of health providers that can prescribe medication. So we know that more people access them, and there are other strategies, but these are two major ones.

Richard Hara: Mm-hmm, and the different players that need to be involved and to —

Nabila El-Bassel: And the players, and it’s up to the community if that’s where they want to start, but they’re — what I mentioned earlier, we are going to use evidence-based practices that are around and —

Richard Hara: Okay, yeah. Next question, I’m curious why New York State was selected for this study. Ohio, which is one of the other site seems to have a much worse opioid epidemic. Will your findings in New York State be used to help Ohio relevance to other states?

Nabila El-Bassel: That’s a good question. If you look at the statistics, in 2017 approximately 3400 people died from overdose death in New York State, and a large number of the people around 3000 died from overdose death in New York State. One of the requirements of selecting the counties that we want to — we are working with is that they have to meet several criteria. One of them, they have to be heavily impacted by the epidemic, and they have to have at least a 25% rate of overdose death or 100,000. And also, we were required to recruit at least 30% of the county to be rural counties. So all these counties meet these criteria as well as in Ohio or in Massachusetts or in Kentucky, they need to meet these criteria. So there are really counties that impacted heavily by the epidemic.

Richard Hara: I see, I see. Can you say when this intervention will take place in Kentucky and which counties were selected? Are you involved with other —

Nabila El-Bassel: Yes it’s a single study.

Richard Hara: It’s a single study, okay.

Nabila El-Bassel: It’s a single study, it’s 67 counties that are involved. We are looking at it as one study, although when we wrote the application we wrote as a different four studies, but now we are one. I don’t — I cannot really list the counties in Kentucky, but the counties meet the same criteria as I mentioned earlier, and they have to be impacted heavily by the epidemic.

Richard Hara: Yeah, yeah so they’re trying to get a range of — or cover different populations, different parts of the state and again to collect enough data to usefully project to other states and other counties.

Nabila El-Bassel: Right and they have to meet the criteria for 25 — the rate of overdose 25 per 100,000 in a given year.

Richard Hara: Okay, yeah so that certain level.

Nabila El-Bassel: Yeah.

Richard Hara: Yeah, okay. Could you discuss a couple of the evidence-based interventions beyond Naloxone distribution and Meth on the west coast polysubstance use specifically Methamphetamine and Heroin Fentanyl is a big issue, okay. I’m wondering what your thoughts are about the barriers to applying evidence-based interventions to polysubstance use. I think the last part of it, yeah.

Nabila El-Bassel: Yeah, I think we cannot ignore that the use of Methamphetamines and crack cocaine are really serious epidemics in all the counties, the 67 counties that we’re going to work with. And focusing only on the opioids without addressing the poly drug use is not going to solve the full question. So we’re addressing in our approaches also Methamphetamines and other drug use and poly drug use. Clearly we really now use of Fentanyl mixed with not only heroin but crack cocaine mixed with Fentanyl, and so we cannot address this issue and we will continue looking at the interaction of other than opioids with our approaches to address the epidemic.

Richard Hara: Okay, so definitely incorporating that into the total treatment.

Nabila El-Bassel: Yeah.

Richard Hara: I would love to learn some of the differences between the two waves of intervention. It sounds as though the Wave Two implementation will have more research behind it since it occurs two years later. But are there any other key differences you know of right now?

Nabila El-Bassel: So, Wave One will begin the intervention in a few months which as I mentioned earlier, we already know which county is going in Wave One. We’ll deliver this integrated evidence-based interventions, and then two years later we will go to the 8 additional counties and deliver a better intervention because we’ll learn more during these two years so the intervention would be really stronger. At the same time we are building data systems in the Wave Two to be really ready to work with the community on coming up with evidence-based interventions. We need to build the data systems in the 8 counties, so we’ll still be working with the 8 counties.

Richard Hara: Of course.

Nabila El-Bassel: But we’re not delivering the intervention but we will be working on others.

Richard Hara: Okay. How will the project consider cultural competency and cultural humility as it’s implemented across states? How will this project help to identify and address some of the underlying issues to the epidemic? So I’m not sure cultural and underlying issues are one and the same, but your thoughts about that?

Nabila El-Bassel: Yes, I mean the two questions — the two components of the question are really are great and are very, very, very important. Yes, cultural — competency is an integral part of how we train the researchers to work in every county, how we train the coalitions and it’s an integral part of the process of implementing the research. There will be protocols on cultural competencies integrated into our approach. In terms of the second part of the question, clearly, we need to be looking at the root causes of the problems, poverty, level of access to care, stigma. And stigma is really an integral part of our intervention. Stigma reduction in the community, stigma reduction by the health providers in the healthcare system, stigma from family members of people who are impacted by the epidemic will be integrated in the intervention itself. So, it’s really part of what we need to do to reduce one of the major drivers of the epidemic. But homelessness is another issue, there are — and the criminal justice is another issue. Criminal justice, we will be working bringing treatment into the criminal justice system. We’re also interested in linking people from the criminal justice system into the healthcare system and into obtaining the treatment they need. But I cannot deny that there are really causes that remain, we need to look at poverty, homelessness and other issues that are the main causes of the problem.

Richard Hara: But the interventions don’t directly address them?

Nabila El-Bassel: We’re not addressing poverty or —

Richard Hara: Yeah, right.

Nabila El-Bassel: But, we’re really trying to be everywhere and get people who need support and help to link them to care. We know that the — many people in homeless shelters or soup kitchens, people who are in the community supervision programs, people in jails and prisons, they live with — they have no link to care, no link to housing, so that’s part of our intervention to be able to help the population that needs support.

Richard Hara: Yeah, and finding the right channels to go through.

Nabila El-Bassel: Exactly.

Richard Hara: Okay. Let me see. Got a few more questions if we’ve got time, I see that NIDA is recommending that, “medication should be combined with behavioral counseling” for “whole patient approach known as medication assisted treatment.” What behavioral counseling approaches are you considering as part of this project?

Nabila El-Bassel: Yeah, that’s really a good question. There are evidence-based behavioral interventions that are found to be able to help people to deal with depression and mental health issues and that we will be integrated into the approach. So all the behavioral intervention that have found to help people to be able to feel better and to understand their needs will be integrated into the program.

Richard Hara: Okay. In addition to the discussed interventions, are you considering higher level policies at the state level that can help to address the social determinants of the opioid epidemic? There is emerging evidence pointing to the impacts of poor socioeconomic status conditions leading to opioid overdose, and the policies that can support socioeconomic opportunities, right, that promote health and well being. So, is there a policy component here?

Nabila El-Bassel: The first that we are going to be focusing on some policies, and I’ll give you an example of an issue. One policy issue is data about the opioid epidemic are not connected. There are so many data sets that are not connected, and because the data are not connected, it’s very hard to come up with policy changes. For example, data from the emergency room is not connected with the criminal justice system. Data from primary care is not connected. And we are working on a policy legislation to come up with an approach where all the data can be connected and help to come up with policy implications to address the opioids epidemic. So that’s one of the policies that New York site is involved in.

Richard Hara: It seems to be an essential first step.

Nabila El-Bassel: It is an essential step if we want to improve policies.

Richard Hara: Yeah, yeah. Last question, how many social workers will you be hiring and where can people apply for these jobs?

Nabila El-Bassel: We will be hiring a lot. Please follow our website, and we look forward to hire more people. It’s a stage where we are in the process of hiring social workers and scientists and a lot of opening for a new energy. And we need all the support and we need all the people who are interested in the topic to work together to address it.

Richard Hara: Okay. Well, once again, Dr. El-Bassel, thank you so much for joining us here today at Social Impact LIVE.

Nabila El-Bassel: Thank you very much. Thank you.

Richard Hara: That concludes today’s episode. We will be joined next week by CSSW faculty member Ronald Mincy to discuss the challenges, men of color face, in seeking and completing college degrees. So, have a great week. See you next time, bye.