Scott Formica Social Science Research & Evaluation, Inc.

Transcription

1 Developing Your MOAPC Strategic Plan: Selecting and Prioritizing Intervening Variables and Strategies March 18, :00am to 11:30am Webinar Presentation Scott Formica Social Science Research & Evaluation, Inc.

2 Background for Today s Webinar All 13 MOAPC Clusters/Large Municipalities/Public Health Districts* submitted Part I of the Strategic Plan on January 8, 2014 and were approved to move on to Part II. Data were extracted on the areas in which sites felt that they needed additional assistance from BSAS/MassTAPP. Most common theme, by far, was the intervening variable (IV) selection and prioritization process identified by 8 of 13 sites. Intervening Variables: factors that have been identified through research as being strongly related to and influencing the occurrence and magnitude of substance use and related risk behaviors and their subsequent consequences. These variables are the focus of prevention interventions, changes in which are then expected to affect consumption and consequences. (SAMHSA SPF-SIG Cross-Site Evaluation Community Level Instrument, 2009) *Hereafter referred to as sites to save space and help preserve my sanity. 2

3 Webinar Objectives Provide an overview (from your preliminary plans and the literature) of the steps involved in prioritizing intervening variables and selecting strategies as they relate to your final MOAPC strategic plans due April 30, Provide an opportunity for peer exchange and a chance to ask questions directed to MassTAPP TA providers, the state evaluators, and/or BSAS. Make the connection between Prioritized Ivs Selection of appropriate strategies. Share resources to help assist you with these steps of SAMHSA s Strategic Prevention Framework (SPF) and the development of the April strategic plan deliverable. 3

4 IVs MOAPC Strategic Plan Part I Requirements The first part of the MOAPC strategic plan submission asked you to write a little about your process for collecting data on and prioritizing IVs and told you to completely ignore strategies for the moment. Specifically, each site was asked: 1. How have you been collecting or do you plan to collect data on IVs as they relate to opioid consumption and opioid use consequences? 2. How do you plan to prioritize IVs in your site (i.e., what process will you use or have you used)? 4

5 IVs Identification, Collection, and Prioritization So what can we learn from looking across these 13 early plans about identifying, collecting, and prioritizing IVs? I came up with four big questions in this area 1. How have sites approached IV data collection? What questions have guided these efforts? 2. What consumption and consequence IVs have sites identified to pursue? 3. What prioritization criteria have sites proposed to enlist? What questions have guided this process? 4. What decision-making processes have sites proposed to enlist? How are final decisions being made? 5

6 IVs Identification/Collection Where have sites turned to identify/generate IV data? Key stakeholder interviews (11) Focus groups (11) Surveys youth, community, BRFSS, key stakeholder (7) Death certificates; geographical mapping OD locations by zipcode (2) Pharmacy data; PMP data (2) Police and EMS data demos; location; history; context (2) TX provider data demos; history; context (1) MDPH data (1) Prevalence of substance abusing parents (1) Note: This is exhaustive of what sites wrote but is not necessarily exhaustive of what they are actually doing. It is based on what they chose to highlight. Source: MOAPC Strategic Plans Part I (n=13) 6

7 IVs - Sample Key Stakeholder Questions Boston: Describe the opioid misuse situation in terms of how severe the problem is; how the problem has changed over time; the target groups including age, gender, race/ethnicity who are misusing opioids; the consequences of misuse across the lifespan; when and where misuse occurs; and risk factors that drive opioid misuse. Quincy: Is there something about this area or the South Shore that makes more people likely to use prescription drugs or heroin? Is there a community attitude or characteristic that you think contributes and, (b) Have you noticed patterns in availability of prescription drugs and heroin in the past 6 months? Cambridge: Assess problem in community; what is currently occurring to prevent opioid misuse and abuse? Revere: nature and extent of problem; definition of the target population(s); factors that affect the problem IVs. Source: MOAPC Strategic Plans Part I (n=13) 7

8 IVs - Selected Consumption IVs Considered What were some early consumption-related IVs that sites identified in their plans? Perception of harm/risk Peer norms/approval Close friends who use/abuse Parental approval/disapproval Parental involvement Parent knowledge/education/awareness Availability/Ease of Access/Storage Community norms favorable to use Again, this is not an exhaustive list, it is based on what sites chose to highlight. Good representation across the individual, peer, family, and community domains. Source: MOAPC Strategic Plans Part I (n=13) 8

9 IVs - Selected Consequence IVs Considered What were some early consequence-related IVs that sites identified in their plans? Mixing/concomitant use Barriers to calling 911; witnesses leaving scene Loss of tolerance Fluctuations in purity/potency Prior history (overdose; IDU) Treatment involvement Age; gender; race/ethnicity Prescriber willingness to prescribe drugs Lack of employment Attitudes around pain and pain management Good balance between user characteristics, use patterns, contextual/situational variables, and organizations/systems. Source: MOAPC Strategic Plans Part I (n=13) 9

10 IVs - Sample Prioritization Criteria What criteria did sites identify as the primary means by which they plan to sort, organize, and prioritize their list of IVs? Importance (6) Changeability (4) Feasibility (4) Capacity (3) Readiness (3) Resource availability (3) Supported by data qualitative and quantitative (2) Cultural Competence (1) Evaluability data available (1) Fit (1) Potential for unintended consequences (1) Sustainability (1) Wisdom of Practice (1) Source: MOAPC Strategic Plans Part I (n=13) 10

11 IVs - Sample Prioritization Criteria Questions This is an example from the Gloucester cluster on how you might frame a set of questions on multiple criteria: Is the risk/protective factor identified independently by multiple sources? How reliable and valid is the data supporting it? Have local changes in the variable produced changes in use? How actionable is the variable? Is it feasible to address the variable within the time frame of this grant? Are other efforts in place to change this variable? Is there capacity and resources available or that could be developed to address the intervening variable? Source: MOAPC Strategic Plan Gloucester Cluster 11

12 IVs Sample Decision-Making Processes Which groups/bodies are making the final decisions on IVs? Small group of cluster/steering committee representatives attempt to reach consensus based on available evidence (7) Regional leadership team given CAPT review from guidance document; summary of regional themes presented to team. Each member ranks top 3 based on prioritization questions and professional/personal experience; Consensus by summation of the rankings and group discussion for further refinement. IV Workgroup makes recommendations to steering committee and they solicit additional input from larger group of key community stakeholders. (2) IV Workgroup makes recommendations to steering committee for final decisions. (1) Source: MOAPC Strategic Plans Part I (n=13) 12

13 IVs What do you need to do now? Two sub-sections in the April 30 th strategic plan deliverable ask you to close the loop on the IV piece. Section 1.2a/b asks you to describe: The results of the IV data collection process that you described earlier in the January deliverable, including: All IVs investigated data on each variable and the source of evidence Gaps in the IV data available that you feel limit your understanding of the issue and how you plan to address these gaps moving forward Additional information that you think would help the reader understand how the assessment of IV data was conducted. Section 3.2a/b asks you to describe: The final set of intervening variable(s) from section 1.2a/b including how this list was selected from among the larger list of variables considered. 13

14 IVs Ideas, Tips, and Resources Don t feel like you are tied to the literature for identifying IVs. This is still a relatively nascent area of study. There are more holes than bridges in this literature. There is a danger that starting from a list will be self-fulfilling you will find what you are looking for rather than finding the major factors that operate in your community however weakly they may be supported by the current research literature. There is a lack of consistent terminology, even within the literature. 14

15 IVs Ideas, Tips, and Resources Once you have identified the major IVs in your site then turn to reviews of the literature to determine whether or not it has been linked to consumption/consequences. Targeting IVs in the literature, even when the evidence is weak, is more likely to result in change than targeting local factors that the literature does not indicate are associated with use/consequences. If it does not appear in a list of a review, it is worth going into the literature yourself or asking for help from BSAS/MassTAPP. 15

16 IVs What lists or resources are out there? Consumption IVs SAMHSA s CAPT Prescription Drug Abuse and Misuse Pages Beyond the Warning Label: Identifying and Prioritizing Risk and Protective Factors for Non-Medical Use of Prescription Drugs (Webinar) Risk and Protective Factors Associated with Non-Medical Use of Prescription Drugs: A Review of the Literature ( ) Consequence IVs MOAPC website (masstapp.edc.org) Resource Library Risk and Protective Factors and Opioid Overdose Quick Topics MOAPC--Intervening Variables And Strategies (Overdose Prevention) 16

17 IVs Rating Criteria Revisited High Importance Low Importance High Changeability Step 3 in the MOAPC Guidance Document (pages 25-29) discuss prioritizing IVs. Emphasis is on Importance and Changeability the latter includes many of the sub-categories we have discussed (e.g., readiness, resources, suitable evidence-based interventions, time required for change to occur) Other potential criteria include: Directionality can you interpret the change? Resource/Need gap are resources already going to this? Political will is there political/public will to address this factor? Distance is the IV proximal enough to affect change/measure? Low Changeability 17

18 IVs Prioritization Process Revisited CHANGEABILITY Importance High Low High Low Intervening Variables Feasibility Criteria Data Availability Preventability Low peer disapproval Lack of parental knowledge High Social Availability 18

19 IVs Additional Things to Consider Efficiency and Synergy Linkages between intervening variables Multiple IVs that can be impacted by a single intervention Is the IV related to other health or behavioral health issues? For example, it is also an IV for alcohol or tobacco use? Appropriateness Has the IV been shown to be linked to consumption or consequences with the group that you are targeting? Age? Gender? Race/Ethnicity? SES? Urban, Suburban, Rural? Etc. Etc. Etc. Acceptability Did the process and final decision-making process provide adequate opportunity for community input? Are there missing segments? Was the assessment comprehensive and inclusive? 19

20 Strategies Strategic Plan Requirements Sections 3.2a and 3.2b. of the April 30 th strategic plan deliverable ask you to describe your strategy selection process and to identify your proposed strategies, including: The final set of IVs from section 1.2a/b including how this list was selected from among the larger list of variables considered. The specific target population(s) for opioid consequences The list of strategies you propose to implement The rationale for each selected strategy (conceptual fit, practical fit, link to research) The cultural competence of the selection process and the selected strategy or strategies. The potential sustainability of the selected strategy or strategies. Bullets #1 and #4 draw an implicit link between IVs and strategies. Why? Prioritized IVs Strategies 20

21 Strategies Connection Between IVs/Strategies Intervening Variables: factors that have been identified through research as being strongly related to and influencing the occurrence and magnitude of substance use and related risk behaviors and their subsequent consequences. These variables are the focus of prevention interventions, changes in which are then expected to affect consumption and consequences. (SAMHSA SPF-SIG Cross-Site Evaluation Community Level Instrument, 2009) If you cannot demonstrate how B in the logic model DIRECTLY addresses A your plan will be returned to you. Problem identified by BSAS: Local manifestation of the problem: Outcomes Intervening Variable (A) Strategy (B) Target Group Outputs Short- Term Intermediate Long-Term 21

22 MOAPC Logic Model Example Problem identified by BSAS: Misuse/abuse of opioids and unintentional deaths/non-fatal hospital events associated with opioid poisoning. Local manifestation of the problem: 10% of local high school students in grades 9-12 report past 30 day misuse of prescription opioids. Intervening Outcomes Variables Strategy Target Group Outputs Short-Term Intermediate Long-Term Low perception of harm/risk of misuse of prescription opioids among 9-12 th graders. Rx opioid prevention curriculum infusion in all high school wellness classes All 9 th -12 th grade students attending Smithtown high school. Number of teachers trained to deliver the curriculum Number of sessions delivered per classroom Number of students reached. Significant prepost increase in knowledge of effects of Rx opioids on the body among 9-12 th graders exposed to curriculum. Significant prepost increase in perception of harm/risk of misuse of prescription opioids among 9-12 th graders exposed to the curriculum. Decrease in the % of 9-12 th grade students who report past 30 day misuse of prescription opioids. 22

23 Strategies What lists or resources are out there? Consumption Strategies (selected list) SAMHSA s CAPT Prescription Drug Abuse and Misuse Pages What s the Prescription? Strategies and Interventions to Prevent the Non- Medical Use of Prescription Drugs (Webinar) Strategies and Interventions for Reducing Non-medical Use of Prescription Drugs: A Review of Literature ( ) MOAPC Guidance document ONDCP Prescription Drug Abuse Page Trust for America s Health Report 23

24 Strategies What lists or resources are out there? Consequence Strategies (selected list) MOAPC website (masstapp.edc.org) Resource Library Risk and Protective Factors and Opioid Overdose Quick Topics MOAPC--Intervening Variables And Strategies (Overdose Prevention) MOAPC Guidance Document SAMHSA s Opioid Overdose Prevention Toolkit Toolkit/SMA

25 Strategies Identification You are not limited to the resources listed on the previous slide provided that you can supply evidence of the effectiveness of any strategies that do not appear in any of these resources. Start with the intervening variable not with the strategy. If you can t find an appropriate strategy consider looking at strategies that have been linked to the IV for other behavioral health issues. 25

26 Strategies Consumption Strategy Overview Education Enforcement Disposal Monitoring Source: ONDCP (2011). Epidemic: Responding to America s Prescription Drug Abuse Crisis. 26

27 Strategies Consumption Strategy Overview Comprehensive Universal Targeted Alaska Community Preventive Intervention Community mobilization Environmental strategies School-based education School- and family-based prevention School-based Online Utah Rx Pain Medication Program Media messaging Provider Training Expectancies Source: SAMHSA s CAPT (2013). Strategies and Interventions for Reducing Non-medical Use of Prescription Drugs: A Review of Literature ( ).

28 Alaska Community Prevention Intervention 1 28

29 Utah Rx Pain Medication Program - Media 29

30 Utah Rx Pain Medication Program Provider Training 1-hour presentations to groups of primary care providers (PCPs) included: County-specific data Six practices for safe prescribing Clinical guidelines for prescribing opioids Other resources and tools PCPs encouraged to access Utah s Prescription Drug Monitoring Program (PDMP) website 1. Source: Cochella, S. & Bateman, K. (2011). Provider Detailing: An Intervention to Decrease Prescription Opioid Deaths in Utah. Pain Medicine, 12: S73 S76. 30

31 Strategies The case of universal interventions Among universal interventions not specifically directed toward Rx drug misuse, it is important to consider ones that: 1. Effectively address multiple risk and protective factors common among many different types of substance misuse; 2. have demonstrated cross-over effects on diverse outcomes, such as conduct problems and health-risking sexual behaviors; and 3. have shown positive effects among higher-risk populations. Source: Spoth, R., Trudeau, L., Shin, C., & Redmond, C. (2008). Long-term effects of universal preventive interventions on prescription drug misuse. Addiction, 103: Spoth, R., Trudeau, L., Shin, C., Ralston, E., Redmond, C., Greenberg, M., & Feinberg, M. (2013) Longitudinal Effects of Universal Preventive Intervention on Prescription Drug Misuse: Three Randomized Controlled Trials With Late Adolescents and Young Adults. American Journal of Public Health, 103(4):

32 Strategies Overdose Prevention MassCALL2 Pre-Event Strategies During Event Strategies Post-Event Strategies Provide training/info on OD prevention and risk factors Identification of individuals atrisk for OD through screening by healthcare providers Train healthcare providers on making referrals for opioiddependent patients Provide training/information on OD recognition and response (including the use of nasal Narcan, rescue breathing, etc.) Reduce barriers to contacting EMS in the event of an overdose Provide TX information, referrals, and/or linkages with support services and follow-up for OD victims Brief motivational interviewing to promote entry into TX First responders distribute information on TX options to OD victims refusing medical transport Provide incarcerates with a history of opioid use referrals to community TX services upon release.

33 Strategies OD Prevention MassCALL2 Priority Groups/Settings Priority Groups for Intervention Active Users Friends and family members of users Leaving treatment Currently on maintenance therapy Released from prison with a history opioid use Undergoing detoxification History of prior overdose. Providers/Settings Healthcare professionals First respondents/emts Treatment professionals Criminal justice system Probation system Law enforcement system Outreach/social workers Health promotion advocates

34 Strategies Selection Criteria Step 3 in the MOAPC Guidance Document (pages 27-29) discuss strategy selection. Emphasis is on: Evidence of linkages between the targeted intervening variable(s) and the proposed strategy Conceptual fit Practical fit 34

35 Strategies Fit Conceptual Fit How has the strategy been tested with the identified target population or if it has not how can it be generalized to the target population? How will implementing this strategy in your local community help you achieve your anticipated outcomes? Practical Fit Resources (cost, staffing, access to target population, etc.) Collaborative/Coalition Climate (fit with existing prevention/reduction efforts, willingness to accept new programs, buy-in of key leaders, etc.) Community Climate (community attitude toward the strategy, buy-in of key leaders, etc.) Sustainability of the strategy (community ownership, renewable financial support, community champions, etc.) 35