Designing Multisector Approaches to Addressing the Opioid Epidemic

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1 Designing Multisector Approaches to Addressing the Opioid Epidemic Mary Ann Cooney Association of State and Territorial Health Officials Ron Bialek and Jack Moran Public Health Foundation ASTHO Winter Leadership Summit December 7, 2017

2 The Opioid Epidemic & Leveraging Community Partners

3 Learning Objectives Discuss strategies and actions state and territorial leaders can take to encourage statewide stakeholders to engage in the fight to reduce the opioid problem Develop and use a driver diagram as a roadmap for change

4 Surgeon General s Report on Alcohol, Drugs, and Health % of those addicted get treatment 1 person dies every 19 minutes from opioid or heroin overdose The economic impact of drug and alcohol misuse and addiction is $442 Billion/year (Diabetes is $245 Billion) Every $1 invested in viable treatment options for substance abuse disorders saves $4 in healthcare costs and $7 in criminal justice costs

5 Opioid Crisis Costs Exceed $95 Billion Per Year Source: Rhyan, Corwin, The Potential Societal Benefit of Eliminating Opioid Overdoses, Deaths, and Substance Abuse Disorders, Altarum Center for Value in Health Care, November 16, 2017.

6 Chief Health Strategist What is it? What is expected in this role? Articulating a clear message Briefing Sheet Building the coalition Developing willingness to tackle the issue Leading and facilitating the coalition

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8 Willingness Problem Description: Low Low Hanging Fruit Been Done Before and Did Not Make a Difference Problem Not In My Control Community Coalition No Control Medium Need For A Team Some Control Quick Win and Improved Performance Internal Team Problem In My Control I Can Do It With Help Control High Solvable Difficult Broken Problem Perception

9 Discussion 1 What are the driving and restraining forces for State and Territorial Leaders to developing and engaging an action-oriented coalition of statewide stakeholders to combat the opioid problem?

10 Future State: Action- Oriented State Coalition Combating the Opioid Problem Force Field Diagram Driving Forces Restraining Forces Current State:

11 Discussion 1 What are the driving and restraining forces for State and Territorial Leaders to developing and engaging an action-oriented coalition of statewide stakeholders to combat the opioid problem?

12 Population Health Driver Diagram Overview

13 Driver Diagrams Developed Antibiotic Stewardship Diabetes Enhancing Physical Activity HIV/AIDS Neonatal Absence Syndrome Vector Control Zika Drinking Water Quality Weight Management Behavioral Health

14 What Is A Population Health Driver Diagram? A population health driver diagram is used to identify primary and secondary drivers of a community health improvement objective Serves as a framework for determining and aligning actions that can be taken across multiple disciplines for achieving the objective Relies on public health, healthcare, and other sectors to work collaboratively rather than competitively Grounded in the belief that public health and healthcare are more effective when they combine their efforts to address a health issue than when they work separately Population health driver diagrams can be used to tackle challenges at the crossroads of multiple sectors Helps reduce the silo effect

15 What Is A Population Health Driver Diagram? A tool to show a potential change process across many sectors of a community Shows the relationship between the AIM, goals to be achieved, the primary drivers that contribute directly to achieving desired change, and the secondary drivers that are necessary to achieve the primary drivers A guide for the state or community health improvement team to the appropriate actions to take to achieve their AIM Helps the team to have a shared view of the theory of change in a system

16 What Is A Population Health Driver Diagram? A population health driver diagram represents the team members thinking on theories of cause and effect in the system what changes will likely cause the desired effects It sets the stage for defining the how elements of a project the specific changes or interventions that will lead to the optimum desired outcome It helps in defining which aspects of the system should be measured and monitored, to see if the changes/interventions are effective, and if the underlying causal theories are correct

17 50,000 Foot View Goals 20,000 Foot View 30,000 Foot View 10,000 Foot View

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19 Process to Develop and Implement a Population Health Driver Diagram Start Small, Think Big, and Scale Fast Come up with the right: metrics to be used baseline improvement goals timeline Then think forward about the mid- to long-term of what you want to fundamentally change and where you want to get to Once you ve got clear objectives, strategy-led initiatives can develop and progress quickly.

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21 Tennessee Department of Health (TDH) - Perinatal Health In 2015 the TDH contracted with the University of Tennessee, Department of Public Health, to conduct a community-participatory process to contribute to a statewide health improvement plan The priority health issue selected was Neonatal Abstinence Syndrome (NAS) in East Tennessee Goal was to identify leading perinatal health challenges and potential solutions, within a six month timeframe Those involved in the process were: University of Tennessee Knox County Health Department (KCHD) East Tennessee Regional Health Office (ETRHO) Members of the East Tennessee Regional Health Council and the Knox County Community Health Council Draft driver diagram was developed by the University and KCHD Stakeholders meeting held with 70 participants to finalize the driver diagram Article published in the JPHMP in 2017, A Population Health Driver Diagram to Address Neonatal Abstinence Syndrome

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24 Discussion 2: Driver Diagram Overview Driver diagrams can be used to plan improvement project activities. They provide a way of systematically laying out aspects of an improvement project so they can be discussed and agreed on. A driver diagram organizes information on proposed activities so the relationships between the AIM of the improvement project and the changes to be tested and implemented are made clear. A driver diagram has three columns - Outcome, Primary Drivers and Secondary Drivers.

25 TITLE: Population Health Driver Diagram for Combating the Opioid Crisis AIM STATEMENT Encourage statewide stakeholders to engage in an action-oriented coalition to reduce the opioid problem PRIMARY DRIVERS SECONDARY DRIVERS Goals

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27 Summary Remember Driver Diagrams are living documents. They can and should be modified as you test your theories of improvement and learn what drivers and interventions are important for achieving your desired results. As a Population Health Driver Diagram evolves, it helps to capture the learning that the participants have uncovered about the initiative.

28 Summary Population health improvement projects can lose momentum or derail because transformation at the state or community levels requires navigating often difficult economic, social, cultural, and political terrain. Population Health Driver Diagrams help overcome these hurdles to progress that can be entrenched or unpredictable in any project since we can test and retest theories of improvement. Population Health Driver Diagrams provide all stakeholders the opportunity to be involved, have their ideas of change considered, and these ideas possibly tested to determine the impact to the issue.

29 Resources For Multisector Approaches Solving Population Health Problems Through Collaboration, R. Bialek, L. Beitsch, and J. Moran; Taylor and Francis, 2017 The Transformative Community Coalition Health Leader: The Catalyst for Comprehensive Improvement of Community Health, J. Moran; Taylor and Francis, Release Date: March 2018

30 Want to Continue the Conversations?... Jack Moran, Ron Bialek,

31 Additional Driver Diagrams

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