HSRI report finds service gaps in Forsyth County behavioral-health system; recommends lower‑barrier treatment, peer support and better outreach

Dr. Bevin Croft of the Human Services Research Institute (HSRI) told the Forsyth County Board of Commissioners that a recently completed needs‑and‑gap analysis finds a robust network of providers but persistent gaps in access, workforce capacity and culturally responsive services.

"Forsyth County is resource rich and explanation poor," Croft said, summarizing recurring feedback from community listening sessions and interviews. HSRI used four public listening sessions, targeted interviews and county Medicaid utilization data to compare local prevalence and service availability.

The study identified three tiers of recommendations. In the short term, HSRI urged the county to inventory information assets and develop a coordinated communication strategy — combining searchable online directories with grassroots outreach through faith communities and community events — so residents can more easily learn what services they qualify for. Croft said communities often need both technology and boots‑on‑the‑ground outreach to reach people who do not access services through conventional channels.

HSRI also recommended expanding peer‑support roles and providing light technical assistance for clinics to integrate peers effectively. "Peer support is an evidence‑based practice," Croft said, noting a local peer‑run organization, Green Tree, as an existing asset to build on.

The report flagged racial and ethnic disparities in treatment: Croft reported that Black residents are substantially overrepresented in intensive outpatient substance‑use treatment but underrepresented in methadone‑based medication‑assisted treatment (12 percent), and Latino residents are underrepresented across substance‑use treatment programs. "Something is — there is a disparity here," she said, and HSRI recommended targeted outreach and culturally responsive program design to close the gap.

HSRI’s tier‑two recommendations include expanding supported employment services (in partnership with vocational rehabilitation and local employers) and lowering barriers to medication‑assisted treatment (MAT). Croft emphasized federal guidance encouraging an array of MAT delivery models, including lower‑barrier options that do not require intensive daytime counseling for enrollment.

On criminal justice reentry, HSRI recommended establishing a process to initiate MAT for people while detained in the Forsyth County Detention Center. "When a person is in jail, that's an opportunity to initiate treatment," Croft said; HSRI noted the county currently continues doses for people already on MAT but does not have a routine initiation process in custody.

The report also documented long waits for home‑and‑community‑based services: HSRI cited more than 800 people on the Innovations Waiver wait list, with an average wait time of nearly eight years and roughly two‑thirds of those families not receiving Medicaid services while they wait. Croft recommended improving navigation and interim supports for those families.

Board members asked about concrete models (Croft cited Wake County's interactive searchable site as one example) and about outreach to faith and community leaders. Commissioners and staff said the county intends to use the findings to guide opioid settlement planning and other behavioral‑health investments.

The presentation closed with HSRI calling for longer‑term work to expand same‑day treatment capacity, coordinate multiple mobile crisis teams to better serve youth, and build provider competency for people with co‑occurring intellectual and developmental disabilities and mental‑health conditions.

The county asked HSRI for its full report and next steps for implementation; commissioners thanked Croft and indicated the study would inform strategic planning and grant priorities.