2 Thomas McLellan, PhD, Founder and Chairman of the Board, Treatment Research Institute, former Deputy Director of the Office of National Drug Control Policy Velma V. Taormina, MD MSE FACOG, Medical Director, Gaston County Department of Health and Human Services William Gross, MPH, William A. Gross, Consulting staff, Gaston Community Health Care Commission Barbara Hallisey, MSW, LCSW, Associate Clinical Services Director, Partners Behavioral Health Management 3 1
How states and communities are addressing the national opioid epidemic How to identify and gain participation of agencies to address the opioid crisis and about the progress a coalition has realized in less than two years Understand how to use complex data to create baseline measures and to track progress in impacting the crisis Identify Strategic Planning processes that build collaboration with multiple entities to comprehensively address a complex health epidemic 4 Addiction & The Community: What can Communities do to Reduce Misuse and Addiction A.Thomas McLellan 5 6 2
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Too many organizations are working in isolation from one another Collective Impact brings people together, in a structured way, to achieve greater change than is possible on an individual basis Excellent model for any complex social, health or environmental problem 31 Building Blocks of Collective Impact Common Agenda Backbone Support Mutually Reinforcing Activities Shared Measurement Continuous Communication 32 33 11
34 Components for Success Governance & Infrastructure Strategic Planning Community Involvement Phase 1 Initiate Action Identify champions & form cross-sector group Map the landscape & use data to make case Facilitate community outreach Phase 2 Organize for Impact Create infrastructure (backbone & processes) Create common agenda (goals & strategy) Engage community and build public will Phase 3 Sustain Action & Impact Facilitate & refine Support implementation (alignment to goals and strategies) Continue engagement & conduct advocacy Evaluation & Improvement Analyze baseline data to identify key issues and gaps Established shared metrics (indicators, measurement, & approach) Collect, track, and report progress (process to learn and improve) 35 Guide Vision and Strategy Support Aligned Activities Establish Shared Measurement Practices Build Public Will Advance Policy Mobilize Funding 36 12
Ranks 74 th of 100 NC counties in geographical size, but 7 th in population just west of Charlotte About 217,000 residents, home to more than 700 churches Once a leading textile manufacturer, Gaston County s mill system largely disappeared by 1990, but the influences of this culture remain a powerful force 37 Measure for the period 2011-2015 Gaston County North Carolina High school graduate or higher, persons 25 years + 82.9% 88.5% Bachelor s degree or higher, persons age 25+ 19.0% 28.4% Median household income, 2015 dollars $42,429 $46,868 Per capita income in past 12 months, 2015 dollars $22,828 $25,290 With a disability, under age 65 years 12.1% 9.6% 38 Gaston gained national attention in the 1980s as the Dilaudid capital of the US (most per capita prescriptions) Multigenerational use of pain killers and benzodiazepines Tough manual labor, higher rates of injury and disability, higher unemployment & poverty, lower rates of education 39 13
Gaston County s opioid problem arises from multiple needs and pathways = It is complex For years it was seen as the LME-MCO s problem to deal with or fix But, something changed: the number of opioid deaths grew, opioid misuse and abuse moved from the shadows to a visible to a communitywide health problem, and our old methods were not working So, the community was faced with the question: What will we do? 40 41 42 14
43 The complexity of this question was articulated at a town hall meeting organized by Gastonia City Councilman, Robert Kellogg, in March 2016 Over 100 persons attended, heard presentations, and asked questions of the panelists; this conversation clearly articulated great community pain and need Attendees included senior staff from CaroMont and the Gaston Community Healthcare Commission As a result, the Healthcare Commission decided to focus on the opioid epidemic 44 April 2016, 36 key local leaders attended the first one The honesty and humility of the conversation struck a chord that affirmed the severity of the situation and the need for action May 2016, 24 physicians, pharmacists and behavioral health providers convened to begin a Responsible Opioid Prescribing Leadership Team Later in May 2016, 39 attended the second one 45 15
To engage professional and lay leaders from across the county to collaboratively develop and conduct programs that will: prevent the onset of addiction to controlled substances, assure the adoption of safe opioid prescribing practices, assure comprehensive drug treatment and mental health services for all persons in need, and deliver professional and community education in support of these outcomes. 46 Promote collaboration among its member organizations Receive and discuss reports from Coalition committees to assure comprehensive focus in considering problems, analyses, and recommended actions Avoid unintended consequences by testing activities, analyzing and deliberating the results, securing additional insights, and developing successful programs Raise community expectations for the Coalition and continually engage new stakeholders to achieve our mission Hold Coalition members and organizations accountable for full engagement and follow through 47 Approved by the Gaston Controlled Substances Coalition on July 22, 2016 48 16
Steering (12 members) Controlled Substances Policy Adoption Community Education & Prevention Treatment Linkages Additional Standing & Ad-hoc as needed Clergy Opioid Outreach Medicine Take-Back 49 Four key stakeholders: one hospital system, one LME-MCO, one FQHC, one Health Department CEO s of key stakeholder organizations get along, respect each other, and work together to achieve shared goals Stakeholders have a history of collaboration that continues to grow Stakeholders provide resources to the Coalition 50 Critical organizations from other sectors are actively involved: EMS, law enforcement, private practitioners, behavioral heath providers, MAT providers, clergy, harm reduction/syringe exchange agency and specialists on their staffs Members of affected families All people who participate in Coalition, committee, and subcommittee meetings are considered members 51 17
Chairpersons run strong and regular meetings. Meetings are designed to promote engaging conversation and deliberations What if is strongly encouraged We push beyond customary and traditional thinking We focus on primary, secondary, and tertiary prevention Backbone staff ensure structure & excellent documentation 52 Discover human, professional, and organizational strengths, needs and opportunities Engage community members Engage professionals and their organizations Develop program concepts find organizations to take the lead Develop program concepts GCSC takes the lead 53 Be open Be transparent Be honest Be accountable to Gaston County and its residents Recognize addiction as a chronic disease Maximize existing resources Collaborate and avoid unnecessarily redundant programming 54 18
Reach out to us with any questions, or ideas for improvement bhallisey@partnersbhm.org 55 19