STRATEGIC PLAN APRIL 2018

STRATEGIC PLAN APRIL 2018

LANCASTER COUNTY JOINING FORCES INFORMATION DISCLAIMER Lancaster Cunty Jining Frces emphasizes the principles f transparency, accuntability, cllabratin, and partnership. We are wrking t cllect and share current, cmplete, and accurate infrmatin with the cmmunity. This is a cllective effrt, and cmmunity and stakehlder participatin has been crucial in the prcess f preparing and reviewing this dcume nt and will cntinue t be vital t all f ur strategies and effrts. We welcme and will respnd t additinal infrmatin shared with us frm cmmunity members and rganizatins. This dcument summarizes the cnditins in ur cmmunity and establishes a framewrk t guide the crdinated actins f Lancaster Cunty Jining Frces. While the infrmatin presented in this dcument is meant t be as cmprehensive as pssible, we recgnize that it is nt fully exhaustive and is based nly n infrmatin available up t this pint in time. At the time f publicatin, all infrmatin in this dcument is current up t February 2018. As a cuntywide initiative, Jining Frces is cntinually adapting t effectively respnd t the immediate and lng-term needs f the cmmunity in the midst f the piid crisis. We envisin this strategic plan as a dynamic, living dcument that will be updated with addendums as new infrmatin, data, and resurces becme available. We will cntinue t actively seek cmmunity feedback and engagement t evaluate and reevaluate cmmunity cnditins, ur gals, and the effectiveness f ur effrts. All feedback is valuable. If any individual, rganizatin, r calitin has infrmatin r resurces that is currently nt reflected in this dcument, please reach ut t us by email. All Lancaster Cunty data, events, resurces, and Jining Frces materials are regularly updated and publicly available n the Jining Frces website. This strategic plan will be updated annually and made available n ur website as well. HOW TO CONTACT JOINING FORCES Visit www.lancastercuntyjiningfrces.rg Email cntact@lancasterjiningfrces.rg Call (717)544-3800 WHERE TO GET HELP In an emergency, call 911 Need t find a detx facility? Call (866)769-6822 Need infrmatin r referrals? Call Cmpass Mark at (717)299-2831 PAGE 2 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES TABLE OF CONTENTS INFORMATION DISCLAIMER... 2 EXECUTIVE SUMMARY... 4 OUR MISSION... 5 OUR GUIDING PRINCIPLES... 5 OUR PARTNERS... 6 WHAT IS THE ISSUE?... 7 WHAT IS OUR FRAMEWORK FOR ACTION?... 16 UNDERSTANDING OUR CURRENT STRENGTHS, WEAKNESSES, OPPORTUNITIES & THREATS... 18 WHAT DO WE ALREADY HAVE?... 19 HOW ARE WE ALREADY BUILDING ON OUR ASSETS?... 31 WHAT ELSE NEEDS TO BE DONE?... 32 WHAT ARE OUR GOALS?... 37 HOW ARE WE COLLECTING & MEASURING DATA?... 39 APPENDIX A. ACKNOWLEDGEMENTS... 43 APPENDIX B. STRENGTHS, WEAKNESSES, OPPORTUNITIES & THREATS (SWOT) ANALYSIS RESULTS... 46 APPENDIX C. ASSET MAPS... 49 APPENDIX D. GOAL DETAIL... 62 APPENDIX E. SHORT-TERM OUTCOME MEASURES... 73 REFERENCES... 75 PAGE 3 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES EXECUTIVE SUMMARY In 2017, Lancaster Cunty Jining Frces launched as a cmmunity cllabrative with the primary aim t supprt and crdinate cuntywide effrts t reduce the number f deaths frm piid and herin verdses. Jining Frces brings tgether key stakehlders, including cmmunity members, t strengthen existing initiatives acrss all sectrs; identify and address gaps in services and resurces; and implement unified, cmprehensive strategies fr preventin, interventin, and mnitring. Opiid-related verdse deaths cnstitute a serius public health cncern acrss the United States. The crisis at hand encmpasses piid misuse, piid use disrders, and the assciated mrbidity and mrtality, including verdse deaths. In respnse t the piid crisis, the federal United States gvernment declared a natinal public health emergency in Octber 2017, and the State f Pennsylvania declared a statewide disaster emergency in January 2018. Lancaster Cunty is nt alne in this crisis, but it displays a higher rate f drug-related verdse deaths than the natinwide average. In 2017, there were 168 drug-related verdse deaths in Lancaster Cunty. 14 Per capita, this is apprximately 31 deaths per 100,000 peple. Frm 2014 t 2017, the number f verdse deaths in Lancaster Cunty increased 180%. This strategic plan prvides an in-depth examinatin f the cntext and challenges related t piid verdse at a natinal and lcal level. T effectively plan and implement effrts t reduce verdse deaths, Jining Frces recgnizes the imprtance f cmmunity engagement, mbilizatin, and cllabratin. T date, we have cnducted cmmunity frums, meetings, interviews, and fcus grups t accurately assess ur cmmunity-wide capacity t cmbat this issue and t determine ur cmmunity needs and pririties (see Appendix A fr a full list f participating rganizatins t date). In this dcument, we explre the current strengths and assets, weaknesses and gaps acrss Lancaster Cunty. This cmmunity is hme t many resurces, preventin prgrams, treatment services, and recvery supprts. Hwever, there are gaps, unmet cmmunity needs, and pprtunities fr imprvement. Overall, there must be a targeted, crdinated, and cmprehensive apprach t enhance ur respnse t the piid crisis. We will utline cncrete strategies based n research that will imprve ur ability t prevent piid misuse, respnd t piid use disrders, and decrease the likelihd f piid-related verdse deaths. Jining Frces aligns these strategies with research and evidence-based practices, especially thse utlined by the Substance Abuse and Mental Health Services Administratin (SAMHSA) and the Centers fr Disease Cntrl and Preventin (CDC). The pririties f Jining Frces are: 1. Enhance data cllectin and disseminatin 2. Supprt and strengthen evidence-based preventin and interventin prgrams 3. Implement cmprehensive strategies t unify messaging and saturate the cmmunity with infrmatin 4. Imprve patient safety by encuraging and supprting a cultural change within the medical cmmunity regarding piids 5. Increase access t and utilizatin f treatment services and recvery resurces 6. Strengthen cmmunity awareness, mbilizing effrts, and partnership develpment PAGE 4 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES OUR MISSION The missin f Jining Frces is t supprt and crdinate effrts t reduce deaths frm piids and herin in Lancaster Cunty. OUR GUIDING PRINCIPLES Cllabratin and partnership Transparency and accuntability Recgnizing and building n cmmunity strengths Cmmunity engagement and mbilizatin Strategic, systematic, multi-level methds Data-driven planning and evaluatin Implementing effective, research- and evidence-based prgrams and practices (see belw) INTRODUCTION TO EVIDENCE-BASED PRACTICE The Evidence-Based Preventin and Interventin Supprt Center, r EPISCenter, has develped a tl t describe prgrams and practices alng a cntinuum f cnfidence (see Figure 1). In this case, the level f cnfidence refers t hw cnfident we are that a prgram r practice will lead t imprved utcmes. Jining Frces supprts the implementatin f research- and evidence-based prgrams and practices. Hwever, in rder t meet diverse cmmunity needs in emergent situatins, innvative, prmising appraches may be apprpriate when used with careful cnsideratin and review. A majrity f ur assessments and strategies in this dcument will emphasize research- and evidence-based prgrams. FIGURE 1. CONTINUUM OF CONFIDENCE PAGE 5 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES OUR PARTNERS JOINING FORCES STEERING COMMITTEE COMMUNITY GROUPS In additin t the rganizatins and calitins n the steering cmmittee, Jining Frces wrks in cperatin with lcal cmmunity mbilizing grups and nn-prfit rganizatins, including: ASAP Lititz Lancaster Harm Reductin Prject Clumbia Life Netwrk Manheim Twnship Cmmunity Life Task Frce Dnegal Substance Abuse Alliance Penn Manr Bridges Task Frce Elanc Calitin fr a Drug Free Cmmunity Prject Lazarus f Lancaster Cunty Elizabethtwn Area Cmmunities that Care Slanc Family Life Netwrk Ephrata Cares The Gate Huse Factry Ministries The Mix at Arbr Place Lancaster Cmmunities that Care The RASE Prject PAGE 6 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES WHAT IS THE ISSUE? This sectin highlights piid-specific infrmatin and statistics t lk clsely at piid verdse deaths and the related issues f piid misuse and piid use disrders. Hwever, we recgnize that this particular crisis is situated within a brader cntext. In sme parts, we will explre this brader cntext by discussing the verarching issue f substance use disrders and assciated data, risk factrs, and prtective factrs. While addressing the immediate threats related t the piid crisis, we als lk t lng-term changes by building ur cmmunity capacity t address all substance use disrders, the rt causes, and the assciated stigma. By planning and implementing strategies fr change that g beynd piids, ur cmmunity can be prepared t respnd as substance use trends may change and t prevent r mitigate new crises that may emerge. TERMS First, it is imprtant t identify cmmnly used terms and the terminlgy used fr the purpses f this dcument. Jining Frces will actively emply language that is medically accurate, nn-stigmatizing, and persn-first (i.e. persn with an piid use disrder). CO-OCCURRING DISORDERS are diagnsable when at least ne mental health disrder (i.e. depressin, anxiety, pst-traumatic stress disrder, etc.) and at least ne substance use disrder ccur simultaneusly. OPIOIDS are a class f drugs that include the illegal drug herin and piids that are cmmnly available by prescriptin as pain relievers. Prescriptin piids can include natural piids (i.e. mrphine and cdeine), semisynthetic piids (i.e. xycdne, hydrcdne, and mrphine), methadne, and sme ther synthetic piids (i.e. tramadl and fentanyl). The CDC identifies and tracks fur categries f piids: herin, natural and semisynthetic piid analgesics, methadne, and ther synthetic piid analgesics. Fr the purpses f this strategic plan, we will mst cmmnly use the term piids t refer t all categries f piids. The term prescriptin piids is used t refer t all pharmaceutically manufactured piids, as they are typically btained in a way that riginated with a prescriptin. OPIOID ADDICTION is typically synnymus with severe piid use disrder. It is a chrnic disease that mst severely affects the brain s reward, mtivatin, and memry prcesses. This manifests in a cmplex cnditin with bilgical, psychlgical, and scial cmpnents and impairments in behaviral cntrl and scial and emtinal functining. In recvery circles, addictin is typically self-defined and identified. In this paper, the term piid use disrder will be used mre ften than addictin t be mre encmpassing. OPIOID DEPENDENCE is a physical state in which an individual is reliant n piids t prevent physical withdrawal symptms. Typically, dependence is als assciated with a develpment f piid tlerance, requiring higher amunts f the drug t btain the same effects. While it can be a symptm f piid misuse r use disrder, dependence can ccur independently. OPIOID MISUSE ccurs when an individual takes piids in any way nt directed by a dctr (i.e. in a larger quantity than prescribed r withut a prescriptin, as in nn-medical recreatinal use). OPIOID OVERDOSE ccurs when an individual cnsumes a txic quantity f piids in excess f what the bdy can prcess. During an verdse, the brain s piid receptrs becme verwhelmed and affect the bdy s central nervus system, which slws and eventually stps breathing and heart rate. Overdses can be fatal r nnfatal and are mst ften unintentinal. PAGE 7 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES OPIOID USE DISORDER is a specific substance use disrder, classified in the Diagnstic Statistical Manual f Mental Disrders, 5 th Editin (DSM-5) by recurrent use f piids that causes significant distress r impairment in daily living. Sme symptms f piid use disrder include a strng desire t use piids, inability t cntrl r reduce use, piid tlerance r dependence, and cntinued use despite adverse effects n health r scial functining. Opiid use disrders may be classified by severity as mild, mderate, r severe. SUBSTANCE USE DISORDERS are characterized in the DSM-5 by the recurrent use f alchl and/r drugs that results in clinically significant impairments in health, scial functining, and vluntary cntrl ver substance use. Substance use disrders are typically classified by the type f substance used (i.e. piid use disrder r alchl use disrder) and by level f severity (i.e. mild, mderate, r severe). Substance use disrders are clinically diagnsable, and this term will be used instead f substance abuse in this plan. BACKGROUND Opiid-related verdses cnstitute a serius natinal public health cncern. In recent decades, the rates f piid use, misuse, use disrders, and verdse deaths have significantly increased. 6,24,25,33 The rate f piid-related verdse deaths in the United States increased 500% per capita between 1999 and 2016. 6 The increase in piid-related verdse deaths has been driven by a steady increase in prescriptin piid verdses and large recent surges in illicit piid verdses 5,14,17,33,34 (see Figure 2). Since the late 1990s, there has been a dramatic increase in the prescribing f piids fr chrnic, nncancer pain. 12,25 Frm 1999 t 2010, the increase f verdse deaths mirrred the increase in piid prescribing. 12,33 The availability f herin and ther illicitly manufactured piids have als significantly increased in recent years as these illicit frms f piids have increased in purity and ptency. 27,33,34 FIGURE 2. TOTAL OVERDOSE DEATHS INVOLVING OPIOIDS, BY TYPE OF OPIOID, UNITED STATES, 2000-2016 5 PAGE 8 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES Prescriptin piids are mst cmmnly prescribed fr chrnic pain relief. 26 While prescriptin piids may be safe when taken fr a shrt perid and clsely mnitred by a medical prvider, there is als risk fr dependence, misuse, disrdered use, and verdse. 12,26 Prescriptin piids cntinue t be invlved in mre verdse deaths than any ther drug. 5,12 In 2016, almst half f all piid verdse deaths invlved a prescriptin piid. 5,14 The mst cmmn types f prescriptin piids invlved in verdse deaths include methadne, xycdne, and hydrcdne. 33,34 Data shws that recent surges in piid verdses are related t herin, fentanyl, and fentanyl-related substances. 24,25,33,34 Fentanyl and fentanyl-related substances are particularly lethal synthetic cmpunds and are increasingly manufactured illegally and mixed with herin r ther drugs. 25,27 The increased availability f fentanyl and increased purity f herin significantly cntribute t the risk f verdse and the dramatic increases in the ttal numbers f drug verdse deaths. 5,27 STATISTICS Natinal data, primarily cllected by the CDC and SAMHSA, is an imprtant tl t understand piid use disrder and verdse. The CDC reprts drug-related verdse death data frm the Natinal Vital Statistics System (NVSS). Fr the purpses f this strategic plan, the number f piid-related verdses is used as an indicatr t track utcmes at the lcal level. The Lancaster Cunty Crner s Office is the primary surce f lcal drug-related verdse death data. All f this available data demnstrates the scpe f the issue, and future data will used t evaluate the effectiveness f effrts in Lancaster Cunty. One f the main pririties f Jining Frces is t cllect data and disseminate infrmatin t the public n its website. A Jining Frces member has been dedicated t identify apprpriate utcme and prcess measures, track prgress, and publicly reprt this infrmatin n a quarterly basis. A SNAPSHOT OF THE UNITED STATES Drug verdse is nw the leading cause f unintentinal injury death in the United States, and it is the leading cause f death amng peple under age 50. 33 Accrding t the CDC, the number f piid verdse deaths has grwn t such an extent that it is influencing verall mrtality rates. In 2015 and 2016, life expectancy in the United States drpped fr tw years in a rw, fr the first time since the 1960s. 15 Drug verdses, amng all unintentinal injuries, replaced lung disease as the third leading cause f death f peple in the United States in 2016. 15 A majrity f drug-related verdse deaths invlve sme frm f piid, including legally prescribed piids and illicitly manufactured piids like herin and fentanyl. 6,14,23 The CDC reprts that there were 63,600 ttal drug-related verdse deaths in 2016. Abut tw-thirds, ver 42,200, f these invlved piids. On average, 115 peple die every day in the United States due t piid-related verdses. 6,7,14 It is als imprtant t nte that reprted statistics likely underrepresent the actual number f piid verdse deaths. It is difficult t track data related t drug verdse deaths because in abut 20% f verdse fatality cases, the death certificate des nt identify specific substances invlved. 5,43 It is als cmmn fr piids t be used in cmbinatin with ther drugs in cases f verdse, s it is difficult t PAGE 9 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES determine which drugs caused death, nly which drugs were invlved. 43 Additinally, it is estimated that fr every fatal piid verdse, there are apprximately 30 nnfatal verdses, but these numbers are even mre difficult t track. 11 Since 1999, piid verdse deaths have ccurred mst ften in peple 25 t 54 years ld. Amng this age grup, the age-adjusted rate f drug verdse deaths was abut 35 per 100,000 peple in 2016 cmpared t the verall average f 19.8 per 100,000 peple. 14 In 2016, the rate f verdse death amng men is almst duble the rate amng wmen. 14 The fllwing infrmatin highlights figures frm the 2016 Natinal Survey n Drug Use and Health. 37 This ffers the mst recent natinwide data n issues related t mental health and substance use. OPIOID MISUSE Opiid misuse refers t any nn-medical use f piids. This can include using prescriptin piids nt as directed by a dctr r any use f illicit piids, such as herin. 13 In 2016, abut 11.8 millin peple aged 12 r lder misused piids in the United States, including peple wh misused prescriptin pain relievers and peple wh used herin. 13,37 It is estimated that abut 1 in 4 peple wh are prescribed piids misuse them. 25,26 Hwever, the majrity f peple wh misused prescriptin piids used them withut a prescriptin at least nce in the past year. The mst cmmn reasn reprted fr piid misuse was t relieve pain. 13 Prescriptin piid misuse is a risk factr fr herin use. 25,26 In 2016, 5.6% f peple wh had misused prescriptin piids als used herin, while 67.6% f peple wh had used herin als misused pain relievers. 37 Accrding t the CDC, amng individuals wh recently began t use herin, mre threequarters reprt that they misused prescriptin piids prir t using herin. 26 OPIOID & SUBSTANCE USE DISORDERS In 2016, ver 20 millin peple aged 12 r lder wh met the diagnstic criteria fr any substance use disrder. Apprximately 15.1 millin peple meeting the criteria fr an alchl use disrder, while abut 7.4 millin peple had a drug use disrder. Of peple with a substance use disrder, ver 2 millin peple in the United States had an piid use disrder in 2016. 37 Amng all peple wh used prescriptin piids, abut 16.7% reprted a prescriptin piid use disrder. 13,37 A persn wh is prescribed lw dses f piids is 15 times mre likely t develp an piid use disrder than smene wh has nt been prescribed piids. Smene wh is prescribed high dses f piids are 122 times mre likely t develp an piid disrder than smene wh has nt been prescribed piids. 16 CO-OCCURING DISORDERS It is als imprtant fr us t highlight c-ccurring mental illness and substance use disrders, as they cmmnly ccur tgether and present cmplex symptms. 20,22,31,41 Individuals with a substance use disrder are 2.7 times mre likely t have a mental illness than the general ppulatin. Additinally, individuals with a mental illness are 3.4 times mre likely t have a substance use disrder than the general ppulatin. 37 In 2016, a ttal f 8.2 millin adults had a mental illness and a substance use disrder that ccurred simultaneusly, r c-ccurring disrders. 37 The cnnectin between mental health and substance use disrders is explred further when we discuss risk factrs. PAGE 10 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES A SNAPSHOT OF LANCASTER COUNTY & PENNSYLVANIA As f 2016, Pennsylvania is currently ranked furth highest in the natin in the rate f deaths due t drug verdse 5,7 (see Figure 3). The rate f drug-related verdse deaths in Pennsylvania significantly increased frm 26.7 per 100,000 in 2015 t 37.9 deaths per 100,000 peple recrded in 2016. 7 This far exceeds the natinal rate f drug-related verdse deaths f 19.8 per 100,000 reprted in 2016. 5,7 FIGURE 3. AGE-ADJUSTED RATES OF DRUG OVERDOSE DEATHS BY STATE IN 2016, PER 100,000 7 KEY United States (19.8) 6.4 t 12.1 12.5 t 16.8 17.6 t 21.8 22.2 t 27.4 28.7 t 52.0 Pennsylvania (37.9) Many cunties in Pennsylvania experience drug-related verdses at higher rates than the natinal average, with the highest rates f verdse bserved in Western Pennsylvania and Philadelphia (see Figure 4). 9,10,28,29 In 2016, the rate f drug-related verdse deaths in Lancaster Cunty was ranked the 47 th highest in the state, with 22.3 verdse deaths per 100,000 peple. 10 FIGURE 4. RATES OF DRUG-RELATED OVERDOSE DEATHS IN PENNSYLVANIA IN 2016, PER 100,000 10 KEY Highest 25% Lwest 25% PAGE 11 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES In 2016, drug-related verdse deaths in Pennsylvania ccurred mst frequently amng individuals between 25 and 34 years ld. Apprximately 70% f drug-related verdse deaths in Pennsylvania ccurred in men, and 77% f all decedents were white. 10 In 2016, the Lancaster Cunty Crner s Office 17 reprted that the median age f verdse deaths in Lancaster Cunty was 36 years ld, and a majrity f verdse deaths ccurred amng white males. In 2017, Lancaster Cunty experienced 168 fatal drug-related verdses, r apprximately 31 verdse deaths per 100,000 peple. 17 While sme individuals may be at an increased risk fr verdse, this is an issue that affects all f Lancaster Cunty. By lking at the gegraphic distributin f verdse deaths, we see that virtually all municipalities in Lancaster Cunty are affected by verdse (see Figure 5). 17 FIGURE 5. MAP OF OVERDOSE FATALITIES IN LANCASTER COUNTY IN 2017, BY MUNICIPALITY 17 KEY NUMBER OF OVERDOSES 21 t 50 16 t 20 8 t 15 4 t 7 2 t 3 0 t 1 2016 POPULATION DENSITY Tract Peple per square mile 116,000 t 618,125 22,000 t 116,000 4,000 t 22,000 1,000 t 4,000 0 t 1,000 The rates f drug-related verdse deaths cntinue t grw in Pennsylvania and Lancaster Cunty. Between 2015 and 2016, there was a 37% increase in the number f drug-related verdse deaths in Pennsylvania. Acrss all cunties, the change in deaths frm 2015 t 2016 varied and ranged frm a 37.5% decrease t a 300% increase. 10,11 In Lancaster Cunty, the number f drug-related verdse deaths in increased 45% frm 2015 t 2016. This is cmpared t a 33% increase frm 2014 t 2015. 10,11 PAGE 12 STRATEGIC PLAN 2018

NUMBER OF DEATHS LANCASTER COUNTY JOINING FORCES Frm 2014 t 2017, the number f drug-related verdse deaths has increased 180% in Lancaster Cunty (see Figure 6). This shws a steady upward trend in the number f drug-related verdse deaths, largely driven by verdses invlving piids, including prescriptin and illicit piids. 10,11,17,28 FIGURE 6. TOTAL NUMBER OF DRUG-RELATED OVERDOSE DEATHS IN LANCASTER COUNTY, 2014 TO 2017 10,11,17 180 160 140 120 100 80 60 40 20 0 168 117 80 60 2014 2015 2016 2017 YEAR OPIOID-RELATED OVERDOSE DEATHS IN PENNSYLVANIA In 2016, 85% f all drug-related verdse deaths in Pennsylvania invlved sme frm f piid, either illicit r prescribed by a dctr. 28 In 2016, fentanyl and fentanyl-related substances were the mst frequently identified substances in all drug-related verdse deaths in Pennsylvania, identified in abut 52% f all drug-related verdse deaths. Herin was the secnd mst frequently identified substance, in abut 45% f all drug-related verdse deaths. 10 Frm 2015 t 2016, there was an increase f 130% in the number f fentanyl mentins and a 23% increase in the number f herin mentins in fatal verdse txiclgy reprts in Pennsylvania verall. 10,11 OPIOID-RELATED OVERDOSE DEATHS IN LANCASTER COUNTY In Lancaster Cunty, a majrity f drug-related verdse deaths invlved sme frm f piid in 2016. Herin was the mst cmmnly reprted substance in drug-related verdse deaths in 2015 and 2016. 10,11 Of all drug-related verdse deaths in 2016 in Lancaster Cunty, abut 53% invlved herin, and 40% invlved fentanyl. Frm 2015 t 2016 in Lancaster Cunty, there was a 170% increase in the number f fentanyl mentins and a 15% increase in the number f herin mentins in fatal verdse txiclgy reprts. 10 EMERGENCIES & HOSPITALIZATIONS LANCASTER COUNTY The Lancaster Cunty-Wide Cmmunicatins Center 18 reprts annual data n the number f emergency calls and dispatches fr a variety f issues in Lancaster Cunty. Accrding t this data, verdse- and PAGE 13 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES pisning-related calls fr Emergency Medical Services increased significantly frm 2010 t 2017. Frm 2014 t 2016, there were ver 5,000 calls t 911 related t drug verdses. In 2017 alne, there were 2,584 emergency medical services dispatches fr verdses r pisning, and there were 1,386 plice dispatches fr verdses r pisning. 18 The Pennsylvania Health Care Cst Cntainment Cuncil reprted that the hspitalizatin rate fr piid verdse was 29.6 per 100,000 Lancaster Cunty residents in the calendar year 2016. Statewide, the average hspitalizatin rate fr piid verdses was 31.1 per 100,000 Pennsylvania residents. Reginally, neighbring cunties shw cmparatively lwer rates f hspitalizatin: Berks Cunty 25.4, Chester Cunty 24.7, and Yrk Cunty 28.8 per 100,000 residents. 28 In Lancaster Cunty, 10.5 per 1,000 nenatal stays were substance-related. 28 RISK FACTORS Risk factrs are any persnal r external characteristics that increase the likelihd that an individual may experience a particular utcme. 19 Effective preventin and interventin effrts can fcus n reducing the presence f risk factrs r mitigating their effects. Anyne wh uses prescriptin piids is at risk fr verdse, as is any individual wh uses herin r fentanyl at any time. 39 Mst, but nt all, peple wh experience an verdse have a histry substance misuse r disrdered use. Peple with piid dependence have the highest risk f verdse. 44 Peple with piid use disrders are at a high risk fr verdse, especially fllwing perids f reduced use and reduced tlerance. Peple wh use illicit piids, inject piids, use piids in cmbinatin with ther sedating substances, r take high dses f prescriptin piids are als at a heightened risk f verdse. 14,44 Use f illicit piids, alne r with ther substances, can increase the risk f verdse because these frms f piids are unregulated and have becme increasingly ptent. 27,33 Fentanyl and fentanyl-related substances are much mre ptent than ther piids, leading t especially high levels f risk f verdse and death. 27 Research has identified numerus factrs that increase the risk f substance use disrders. 19,28 It is helpful t examine the risk factrs related t substance use disrders in general, beynd piid use disrders alne. Sme f the mst significant risk factrs related t substance use disrders include: Family histry f substance use disrders Lack f parental supprt r supervisin Family cnflict r vilence Child abuse, neglect, and ther adverse childhd experiences Limited access t resurces r psitive activities Lw neighbrhd/cmmunity attachment Neighbrhd pverty r vilence Lw educatinal cmmitment r achievement Rebelliusness r lw self-cntrl Antiscial behavir (i.e. aggressive behavir r pr scial skills) Friend r peer use f drugs Perceived lw risk assciated with drug use Trauma and traumatic stress High perceived availability f drugs, The 2015 Pennsylvania Yuth Survey (PAYS) reprts that 36% f yuth in Lancaster Cunty are at high levels f risk fr substance use issues. Statewide, the PAYS risk level amng yuth in Pennsylvania is abut 39.8%. This indicates that mre than ne in three yuth in Lancaster Cunty and Pennsylvania display substantial risk factrs. 28 PAGE 14 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES MENTAL HEALTH & SUBSTANCE USE ISSUES As previusly described, peple with mental health disrders are mre likely than peple withut t experience a substance use disrder, and peple with substance use disrders are mre likely than peple withut t experience mental health disrders. 37 It is imprtant fr us t discuss the cnnectins between mental illness and substance use disrder because these frequently ccur simultaneusly, ptentially psing barriers t treatment, recvery, and verall well-being. 20,22,31,42 C-ccurring mental health and substance use disrders affect ver 8 millin peple natinwide. Anxiety, depressin, and traumatic stress can be predictive f alchl r substance use disrders, and abut 1 in 5 peple with an anxiety r md disrder have a c-ccurring substance use disrder. 37 Bth substance use disrders and mental illnesses have bilgical, psychlgical, and scial cmpnents and determinants, and the relatinship between these disrders is ften cmplex and intertwined. 20,31,39 Mental illness des nt necessarily cause substance use disrders, r vice versa. Hwever, there are pathways that cnnect mental illness and substance use. Fr example, mental illness may increase the chances f substance use as a frm f cping. Additinally, substance use r misuse may increase r exacerbate the risk r severity f mental illnesses and their symptms. 31,39 Mental illness and substance use disrders have cmmn risk and prtective factrs as well as barriers t treatment. 20,22,31 Sme f the mst recgnized factrs that cntribute t bth mental illness and substance use disrders are predispsing genetic vulnerabilities and envirnmental triggers, especially trauma and traumatic stress. 31 Trauma frequently underlies c-ccurring disrders. A histry f trauma is strngly assciated with bth mental health and substance use disrders. 31 PROTECTIVE FACTORS Prtective factrs are persnal r external cnditins that decrease the likelihd an individual may experience a particular utcme. A variety f prtective factrs mitigate the risk f piid misuse, use disrders, and verdse. Many evidence-based interventins aim t enhance prtective factrs and resilience in rder t buffer risk factrs and reduce piid misuse and its related cnsequences. Fr the purpses f this dcument, we bradly categrize prtective factrs as individual behaviral and cgnitive factrs, family and peer factrs, and cmmunity factrs. INDIVIDUAL FACTORS 19,28 Psitive temperament and self-cntrl Healthy cping skills Perceived risk assciated with drug use Emplyment r educatinal attainment FAMILY & PEER FACTORS 19,28 Family and peer supprt and attachment Parental supervisin COMMUNITY FACTORS 19,28 PAGE 15 STRATEGIC PLAN 2018 Psitive scial engagement Lw perceived availability f drugs Self-efficacy, r belief in ne s ability t cntrl what happens and adapt t change Psitive scial and cmmunicatin skills Family and peer sbriety Cmmunity nrms, beliefs, and standards that discurage substance use Schls characterized by academic achievement, student invlvement, and investment in students Available and accessible supprts and resurces Opprtunities fr invlvement in psitive activities

LANCASTER COUNTY JOINING FORCES WHAT IS OUR FRAMEWORK FOR ACTION? Jining Frces aims t address piid use cncerns and piid-related verdse with a strategic, cmprehensive, evidence-based apprach t meet immediate needs in this crisis, build ur cmmunity capacity, and establish lng-term strategies fr preventin and lasting healthy utcmes. Fr ur cllective actins, the fllwing framewrk serves t guide assessments f the current strengths, resurces, and gaps in ur cmmunity; the planning f interventin strategies; the implementatin f these strategies; and nging evaluatin. The Cntinuum f Care mdel is the fundatin f ur framewrk fr actin (see Figure 7). This is a cmprehensive apprach develped by the Institute f Medicine and SAMHSA 38 that ges beynd a traditinal treatment-nly cntinuum f care t integrate all levels f health prmtin, preventin, and interventin t prevent and mitigate substance use disrders and supprt sustained recvery and lngterm wellness. FIGURE 7. CONTINUUM OF CARE Health prmtin strategies create cnditins in the envirnment that prmte healthy living and reinfrce all preventin and interventin effrts. Preventin is a crucial cmpnent acrss all stages f the cntinuum. The range f preventin effrts aims t enhance prtective factrs and reduce the risk f substance use disrders, verdse, and ther adverse utcmes. Treatment and recvery services assist individuals wh have experienced substance use issues thrugh clinical interventins and cmmunity-based supprt services. Evidence-based interventin prgrams and services can help individuals with substance use disrders t recver, heal, and live prductive and healthy lives. Fr this strategic planning prcess, Jining Frces incrprates SAMHSA s Strategic Preventin Framewrk (see Figure 8) as a way t integrate the Cntinuum f Care acrss all planning and implementatin effrts. 36 The Strategic Preventin Framewrk is data-driven and fcused n ppulatin-level change fr peple f all ages. This is intended t guide preventin effrts acrss all PAGE 16 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES sectrs thrugh diverse cllabrative partnerships. This is a cntinuus prcess that requires cnstant evaluatin f cmmunity cnditins and implementatin prcesses and utcmes. Fr successful preventin effrts, the Strategic Preventin Framewrk utlines a prcess f: Assessing needs and identifying prblems Building capacity and engaging stakehlders Priritizing issues and planning strategies Selecting and implementing effective interventins Evaluating utcmes and quantifying challenges and successes 36 Our cmmunity-wide effrts will target preventin and interventin strategies at universal, selected, and indicated levels; develp preventin activities in multiple cntexts (i.e. schls, cultural r recreatinal IMPLEMENT PLAN settings, faith-based grups, and neighbrhds); utilize crss-system cllabratin fr cnsistent and cmprehensive plicies and practices; and build n the existing strengths in individuals, families, and the cmmunity envirnment. Evidence-based cmmunity-wide strategies depend n infrastructure, data, crdinated effrts, and multi-level tactics. Jining Frces will align its effrts with recmmendatins frm the CDC and SAMHSA fr systematic change effrts t address the piid epidemic and prevent piid verdses:8, 38,40 Imprve patient safety and encurage prescribers and dispensers t use the state Prescriptin Drug Mnitring Prgram (PDMP) and CDC guidelines fr prescribing piids Prvide public educatin and encurage prviders, persns at high risk, family members, and ther cmmunity members t learn the signs f piid use disrder and manage piid verdse Implement effective strategies and ensure access t preventin, treatment, and recvery services Cllabrate with public safety and encurage the public t call 911 if smene is experiencing an piidinduced verdse Ensure ready access t nalxne Cllect and analyze timely and cmprehensive data T imprve patient safety, Jining Frces is encuraging the adptin f the CDC s 8 guidelines fr prescribing piids fr chrnic pain in primary care, emergency departments, and hspital inpatient settings. Fr medical prviders, sme f the clinical messages f these guidelines are: FIGURE 8. STRATEGIC PREVENTION FRAMEWORK EVALUATE ASSESS NEEDS Discuss benefits and risks and the availability f nn-piid therapies with patients Check PDMPs fr high dses and prescriptins frm ther prviders Start with lw dses and increase slwly if needed Screen patients fr piid use disrder and arrange fr treatment fr piid use disrder if needed Visit the CDC website fr the full guidelines fr prescribing piids and additinal infrmatin. BUILD CAPACITY PAGE 17 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES Sme f the mst successful strategies t reduce the number f deaths frm piids and herin include the use f plicies that enhance statewide prescriptin drug mnitring prgrams (PDMPs) and regulate pain management practices. In Flrida, New Yrk, Tennessee, and Oregn, regulatins and regular use f PDMPs have resulted in decreased rates f verdse and verdse deaths. Oregn has implemented sme f the mst cmprehensive preventin strategies by requiring PDMP use, requiring prir authrizatins fr methadne, ensuring training and access t nalxne, and training dctrs in safe and effective pain management. They saw a 38% decrease in prescriptin piid verdse deaths between 2006 and 2013, and a 58% decrease in methadne-specific verdse deaths in the same perid. 6 UNDERSTANDING OUR CURRENT STRENGTHS, WEAKNESSES, OPPORTUNITIES & THREATS A Strength, Weaknesses, Opprtunities and Threats (SWOT) analysis was emplyed t audit the strengths, weaknesses, pprtunities, and threats in the Lancaster Cunty cmmunity. This is an analysis f factrs that influence the missin f Jining Frces in Lancaster Cunty. It als prvides a structured framewrk t determine which verall strategies will best align with the cmmunity needs and the resurces and capabilities that exist in the cmmunity. Strengths are the qualities that enable us t accmplish the missin and gals f Jining Frces and sustain success and imprvements in the future. Weaknesses are the qualities that will prevent Jining Frces frm accmplishing its missin. These weaknesses have the ptential t prevent success and grwth. The envirnment in which Jining Frces perates may als present pprtunities that enable successful implementatin f strategies. Threats arise when uncntrllable cnditins in external envirnment jepardize ur ability t achieve ur gals. They cmpund vulnerability when they relate t the weaknesses. In a cmmunity frum n August 3, 2017, key stakehlders and cmmunity members cllectively cmpleted a SWOT analysis t assess multiple sectrs and settings acrss Lancaster Cunty (see Appendix B). The sectrs and settings assessed in this SWOT analysis are: Treatment services fr substance use disrders Hspitals, prescribers, dispensers, health systems, and emergency medical services Services fr mental health and c-ccurring Recvery supprt services disrders Faith-based rganizatins and resurces Schls Law enfrcement Wrkplaces Cmmunity Fur key themes emerged frm this cmmunity SWOT analysis: Lancaster Cunty is full f resurces but there is pprtunity fr imprvement and need fr expanded access t resurces There is a need t reduce the stigma assciated with substance use disrders and mental illness There is a lack f awareness abut substance use disrders and the resurces and services that exist There is a need fr expanded crdinatin between services fr treatment and recvery PAGE 18 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES WHAT DO WE ALREADY HAVE? Lancaster Cunty has a strng presence f supprtive services and resurces that are assets in the fight t reduce piid verdses, and there are strengths acrss all levels f the cmmunity. One f the cre principles f Jining Frces is t recgnize that there are substantial assets that already exist in Lancaster Cunty and t enhance and leverage these assets t meet cmmunity needs. The existing assets in ur cmmunity are the fundatin f ur wrk. Fr the purpses f this plan, we identify assets as the peple, places, services, and resurces within the cmmunity that strengthen ur missin. This sectin takes inventry f existing resurces and supprts in the cmmunity and describes them as they align with each categry alng the Cntinuum f Care mdel. Fr the purpses f this paper, we highlight resurces and services alng the Cntinuum f Care fr clarity and t target ur effrts apprpriately. While we highlight each piece f this framewrk separately, it is imprtant t nte that the integratin f these pieces is crucial fr an effective, cmprehensive apprach. Thrughut this sectin, we highlight sme specific examples f prgrams and services, but we d nt include all that exist. Asset maps are used thrughut this sectin t illustrate the gegraphic distributin f ur cmmunity assets and resurces. Enlarged versins f these maps and the crrespnding details f items pltted n the maps can be fund in Appendix C. HEALTH PROMOTION HEALTH PROMOTION REFERS TO A PROCESS THAT SUPPORTS COMMUNITY CONDITIONS THAT IMPROVE OVERALL WELL-BEING AND THE ABILITY OF INDIVIDUALS TO WITHSTAND CHALLENGES. HEALTH PROMOTION STRATEGIES CREATE AN ENVIRONMENTAL CONTEXT THAT REINFORCES THE ENTIRE CONTINUUM. Health prmtin initiatives include the numerus public awareness campaigns and ther health prmtin effrts currently perated by several cmmunity calitins, health systems, and nn-prfit rganizatins in Lancaster Cunty. These initiatives identify and implement strategies t prmte a cmmunity envirnment that supprts individuals in health, wellness, and recvery. SOUTH CENTRAL OPIOID AWARENESS COALITION is a reginal calitin that brings tgether health systems; hspitals; medical, dental, and behaviral health prviders; pharmacists, and healthcare prfessinal assciatins and rganizatins t address the piid crisis thrugh awareness, educatin, and actin. These widespread effrts target large-scale changes in plicy and practice and supprt the develpment f individual knwledge and skills. LANCASTER COUNTY RECOVERY ALLIANCE is a grassrts calitin made up f cmmunity members, including peple in recvery, friends and family members, service prviders, law enfrcement, faith-based rganizatins, and ther allies. This grup encurages a recvering lifestyle and a cmmunity envirnment that facilitates recvery thrugh awareness, advcacy, and access. LET S TALK, LANCASTER is a cllective impact partnership dedicated t imprving mental health and well-being in Lancaster Cunty. Their wrk targets systemic changes t reduce stigma, ensure access t services, enhance the integratin between physical health and behaviral health, and increase the capacity t treat c-ccurring mental illness and substance use disrders. PAGE 19 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES LIGHTEN UP LANCASTER COUNTY is a calitin fcused n creating a cmmunity that supprts healthy lifestyles, especially physical activity and healthy eating. Their effrts prmte and enhance pprtunities fr verall wellness in the cmmunity. LIVEWELL LANCASTER COUNTY COALITION is a cllabrative f cmmunity members, businesses, and health and human service rganizatins wrking tgether t imprve health and wellness in Lancaster Cunty. This started in 1990 as the Lancaster Health Imprvement Partnership. Nw, LiveWELL crdinates a cmprehensive system f health and wellness effrts fr Lancaster Cunty t Feel, Eat, Build, Mve, and Breathe WELL. This takes the frm f initiatives t prevent and reduce tbacc use; imprve access t nutritius fds; imprve the envirnment t supprt healthy utdr activities; increase physical activity; and engage the cmmunity t advance mental well-being. Fr these effrts and the daily wrk f the cunty s health systems, the cllectin f data is crucial as the fundatin fr decisin making and setting health pririties. LiveWELL facilitates the cmpletin f the Cmmunity Health Needs Assessments and Cmmunity Health Imprvement Plans and Updates fr Lancaster Cunty. COMMUNITY MOBILIZING GROUPS There are numerus grassrts rganizatins and cmmunity calitins in Lancaster Cunty wrking t increase awareness, supprt advcacy, and prvide resurces t prevent and address substance use disrders and piid verdses in gegraphically distributed areas acrss the cunty. These grups can address cmmunity-specific pririties t enhance pprtunities fr recvery and well-being amng yuth and families. Cmpass Mark serves as a resurce fr many f these cmmunity mbilizing grups t prmte their grwth and the implementatin f research-based practices. COMMUNITY MOBILIZING GROUPS This map illustrates the cmmunities thrughut Lancaster Cunty that have established rganized effrts t prevent and address substance use disrders and drug-related verdse. Thirteen cmmunity calitins receive supprt and technical assistance frm Cmpass Mark. There are additinal calitins and grups that have cuntywide reach, including: Prject Lazarus f Lancaster Cunty, Lancaster Cunty Recvery Alliance, and the Lancaster Cunty Recvery Huse Calitin. LANCASTER COUNTY ANTI-HEROIN TASK FORCE Beginning in 2016, a grup f cncerned mayrs thrughut the cunty came tgether t address the crisis f piid-related verdses. This grup planned and presented a series f cmmunity-based frums with panel speakers frm law enfrcement, medical cmmunity, and the recvery cmmunity. T date, 14 frums have been presented, with ver 1000 residents in attendance. PAGE 20 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES UNIVERSAL PREVENTION UNIVERSAL PREVENTION IS THE BROADEST APPROACH TO PREVENTION THAT TARGETS ENTIRE GROUPS OR THE WHOLE POPULATION. THESE STRATEGIES AIM TO CHANGE THE SOCIAL CONTEXT THAT INFLUENCES KNOWLEDGE, ATTITUDES, AND BEHAVIOR. SCHOOL-BASED PREVENTION & SUPPORT PROGRAMS Schls are uniquely psitined t prvide a fundatin fr substance use preventin effrts in the cmmunity. These institutins can actively prevent substance misuse and substance use disrders by targeting the reductin f risk factrs and the enhancement f prtective factrs. Many schls in SCHOOL-BASED PROGRAMMING Lancaster Cunty implement specific strategies t prevent substance use issues and prvide supprt fr students and their families. Safe, effective, evidence-based practices are crucial fr the success f these prgrams, as ther preventin prgrams can be harmful and encurage risky behavir. Examples f evidence-based preventin prgrams include LifeSkills, Lins Quest, and Prject Twards N Drug Abuse. LifeSkills is a substance use preventin prgram that addresses scial, psychlgical, cgnitive, and attitudinal factrs. This curriculum enables students t develp greater self-esteem, effectively cpe with anxiety, and increase their cmpetencies t reduce health risk behavirs. Lins Quest is an educatinal prgram designed t help students in grades K-12 develp life skills and psitive cmmitments t their families, schls, peers, and cmmunities. Prject Twards N Drug Abuse is a classrm-based drug abuse preventin curriculum implemented at the high schl level. Students, ages 14 t 19, are educated n the cnsequences and misperceptins assciated with drug use. AFTER SCHOOL PROGRAMS & RECREATIONAL ACTIVITIES Fr yuth, after schl prgrams and recreatinal activities prvide pprtunities t frm psitive scial relatinships with peers and healthy habits. Addtinally, these prgrams and activities prvide adult supervisin and allw children and yuth t frm psitive mentring relatinships with adults. Lancaster Cunty has multiple prgrams acrss the cunty that are perated thrugh schls and ther lcal rganizatins. Research shws that yuth wh have pprtunities fr psitive scial engagement and have psitive peer and adult relatinships are less likely t misuse substances r develp substance use disrders. WORKPLACE PROGRAMS Wrkplaces in Lancaster Cunty are wrking t supprt emplyees with substance use disrders and prevent future substance use. Sme examples f available supprts include emplyee assistance prgrams (EAP) that prvide funding fr cunseling services, and sme may prvide additinal supprt PAGE 21 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES fr lnger-term prblems. Business leaders in the cmmunity are actively invlved with cmmunity mbilizing effrts t supprt their emplyees and cmmunities. Sme wrkplaces als actively apply drug-free wrkplace plicies. HEALTHCARE POLICIES & PRACTICES Healthcare prfessinals have been respnding t the piid crisis thrugh plicy and direct practice. The State f Pennsylvania implemented new laws in 2017 t imprve piid prescribing and dispensing practices. Additinally, the state began utilizing a Prescriptin Drug Mnitring Prgram (PDMP). This is a tl that prvides an infrmatin gateway fr pharmacists and dctrs wh prescribe piid medicatins. They are nw required t use the PDMP t determine whether a patient is receiving treatment with piid medicatins frm anther prvider. Medical prfessinals are als expected t refer a patient fr treatment fr substance use disrders when apprpriate. Health systems in Lancaster are taking steps t prvide pain management care fr chrnic pain in a way that reduces the risk f piid misuse and disrdered use. Prescriptin drug drp-ff lcatins acrss the cunty allw individuals t dispse f unused prescriptin medicine safely. There are 26 drp-ff lcatins in the cunty, including 21 drp-ff bxes lcated in plice departments and 6 pharmacies that accept unused prescriptins. The CDC and Pennsylvania Department f Human Services have utlined specific prescribing practices with the primary gal t imprve patient safety when prescribing piids. DRUG DROP-OFF LOCATIONS LAW ENFORCEMENT Lcal law enfrcement fficials wrk t prtect public safety and respnd in cases f emergency. Plice departments acrss Lancaster Cunty are first respnders t piid-related verdses and prvide direct interventins. Acrss the cunty, plice fficers are being trained t carry and administer nalxne t reverse the effects f piid verdse. Additinally, the Lancaster Cunty Drug Task Frce is a cuntywide frce f selected detectives wh perate cperatively with lcal, state, and federal law enfrcement agencies t cllect infrmatin, mnitr, and respnd t the selling and distributin f illegal drugs. PAGE 22 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES SELECTIVE PREVENTION SELECTIVE PREVENTION METHODS TARGET INDIVIDUALS WITH HEIGHTENED BIOLOGICAL, PSYCHOLOGICAL, OR SOCIAL RISK FACTORS FOR THE DEVELOPMENT OF SUBSTANCE USE DISORDERS. STUDENT ASSISTANCE PROGRAMS (SAP) The primary gal f the Student Assistance Prgram is t identify issues that pse barriers t student success. These barriers can range frm truancy, illness and academic failure as well as mental health and substance use cncerns. SAP teams are cmprised f prfessinally trained faculty including cunselrs, teachers, nurses, and administratrs wh wrk t prvide schl and cmmunity supprt that prmte psitive utcmes. Once referred by a persn in the schl r cmmunity, SAP teams engage parents in the planning f supprt fr their child. As necessary, students may be recmmended t prfessinal assessrs fr evaluatin f pssible mental health and substance use issues. Cmpass Mark prvides SAP team certificatin training and technical assistance thrughut Lancaster Cunty. Funding fr SAP trainings and assessments is prvided by the Lancaster Cunty Drug & Alchl Cmmissin. PA Cunseling Services is the Cunty-funded prvider f assessment services. Carn Treatment Centers prvides assessment services in three schl districts and perates independent f funding frm the Cunty. FAMILY-BASED SUPPORT & EDUCATION PROGRAMS There are a variety f prgrams that serve family members f individuals with substance use disrders. Sme examples include educatinal prgrams, supprt grups, 12-step prgrams, and sme treatment prgrams incrprate a family-centered apprach. There are targeted supprt prgrams fr the children f adults with substance use disrders that wrk t mitigate risk factrs and enhance their prtective factrs. One such prgram is Celebratin Place, a prgram fr the children f parents wh are actively invlved in a prgram called Celebrate Recvery. Children ages 5 t 13 learn, at an age apprpriate level, hw t break ut f cycles that lead t addictin and develp healthy ways t cpe with the unique addictin-related situatins that their parents face. COBYS Family Services ffers Celebrating Families! This is an evidence-based, cgnitive-behaviral supprt grup mdel fr families in which ne r bth parents have chrnic substance use issues. This prgram is designed t supprt all family members, including children ver the age f 3, t strengthen recvery, develp healthy family living skills, increase resiliency factrs, and decrease risk factrs. Anther example f a family-based supprt prgram is the Strengthening Families Prgram (SFP), fr parents and yuth aged 10 t 14. This is a widely used 7-sessin, family-fcused prgram that enhances parenting skills specifically nurturing, setting limits, and cmmunicating as well as adlescent substance refusal skills. SFP is an evidence-based prgram that shws reductins in tbacc, alchl, and drug use as well as prescriptin drug misuse. Cmpass Mark uses a Family Services Advcate prgram t supprt the children f incarcerated parents by helping them maintain healthy relatinships and build resilience and prtective factrs. Nurse-Family Partnership is a preventin prgram that uses trained nurses t prvide an intensive hme visitatin interventin fr at-risk, first-time mthers during pregnancy. This prgram prvides PAGE 23 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES nging educatin and supprt t imprve pregnancy utcmes and infant health and develpment while strengthening parenting skills. Nurse-Family Partnership is prvided in Lancaster Cunty by Penn Medicine Lancaster General Health and WellSpan Ephrata Cmmunity Hspital. MENTAL HEALTH SCREENINGS Early detectin f mental illness is ne way t mitigate adverse utcmes, and effective treatment fr mental illness als decreases the likelihd f substance use disrders. There are initiatives acrss the cunty t address unmet mental health needs thrugh screening and referrals fr treatment. One example is Teen Hpe, a depressin and suicide risk screening prgram in Lancaster Cunty middle and high schls. Teen Hpe is perated by the Samaritan Cunseling Center and began in 2013. This initiative implements depressin and suicide screenings in specific grades within schl districts helps t identify students with high risk f depressin and/r suicide. As illustrated n this map, Teen Hpe is present in 6 public schl districts, as well as Lancaster Mennnite Schl (LMS) in Lancaster Cunty. The Schl District f Lancaster cnducts a similar screening fr students. Primary care ffices acrss Lancaster Cunty are als currently implementing depressin screenings in rutine ffice visits using the Patient Health Questinnaire (PHQ-9). The PHQ-9 is a multipurpse instrument fr screening, diagnsing, mnitring, and measuring the severity f depressin. Primary care prviders can assist their patients with their mental health needs, which, in turn, psitively affects their physical health. INDICATED PREVENTION INDICATED PREVENTION INCLUDES EARLY INTERVENTION EFFORTS TO TARGET INDIVIDUALS WHO SHOW MINIMAL BUT DETECTABLE SIGNS OR SYMPTOMS OF SUBSTANCE MISUSE OR SUBSTANCE USE DISORDER. Indicated preventin strategies may include early interventin services and methds f harm reductin t meet the needs f individuals with emerging symptms and avert the prgressin f substance misuse t substance use disrder. EARLY INTERVENTION PROGRAMS Lancaster Cunty ffers sme early interventin prgrams t prvide supprt and redirectin in the early stages f substance use issues. One example f this is Cmpass Mark s Student Skills fr Life, a grup educatinal interventin fr yuth experimenting with alchl r ther drugs and preventin fr any adlescent r cllege-age ppulatin. The prgram prvides experiential life skills training and may include parenting classes and referrals t drug & alchl assessments when apprpriate. HARM REDUCTION PROGRAMS In Lancaster, there are sme prgrams that perate t reduce the harmful cnsequences assciated with substance use issues. Sme methds f harm reductin include HIV testing and prviding infrmatin abut needle safety. In Lancaster Cunty, there are a number f healthcare prviders wh ffer free r reduced cst HIV testing. Jining Frces has begun t disseminate infrmatin abut the prper use and dispsal f needles and syringes. The Lancaster Cunty Prisn, White Deer Run, and The Retreat all prvide vivitrl injectins at the time f discharge fr individuals with piid use disrders wh may be at risk fr piid verdse. This PAGE 24 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES is a vluntary injectin prvided t individuals as they are discharged frm these facilities t utpatient treatment t mitigate the risk f relapse and verdse. NALOXONE Nalxne (als referred t by the brand name Narcan) is an piid antagnist medicatin that is used t reverse the effects f an piid verdse t prevent death. This is ne f the mst direct methds f decreasing verdse-related deaths. Access t nalxne has been expanded due t a cuntywide standing rder fr take-hme dses f nalxne, which is a prescriptin written fr and accessible by the general public. Nalxne can be btained at mst lcal pharmacies thrugh this standing rder r a prescriptin frm a family dctr. Cmmunity individuals wh are at risk fr verdse r in a psitin t assist an individual at risk, including friends and families, are recmmended t have access t this medicatin. Since 2014, law enfrcement fficers, emergency medical respnders, fire fighters, ther first respnders, and prfessinals at schls and rganizatins have been authrized t administer nalxne in the case f piid verdse. Acrss the cunty, peridic trainings are prvided fr prfessinals and cmmunity individuals t learn t administer nalxne effectively. Prject Lazarus and ther rganizatins perate these trainings in accrdance with state guidelines. Lancaster Cunty is participating in the PCCD Nalxne Prject. This prvides nalxne fr trained first respnders. The Lancaster Cunty District Attrney s Office is the crdinating entity fr the distributin f nalxne thrugh this grant at the lcal level. CASE IDENTIFICATION CASE IDENTIFICATION IS THE PROCESS BY WHICH INDIVIDUALS ARE IDENTIFIED AND DIAGNOSED WITH SUBSTANCE USE DISORDERS. THIS IS ESSENTIALLY THE POINT OF ENTRY INTO THE TREATMENT PROCESS. A typical prgressin f events is that an individual wh has been identified at-risk thrugh screening is referred t a prfessinal behaviral health prvider wh is able t diagnse substance use disrders and related issues. While this is a prcess embedded within the utilizatin f treatment, there are sme clear examples f prgrams that facilitate entry int treatment in Lancaster Cunty. INFORMATION & REFERRAL SERVICES In Lancaster Cunty, call centers prvide infrmatin and cnnectins t resurces fr individuals wh are seeking services r infrmatin. United Way 2-1-1 prvides general infrmatin and referrals fr individuals with a variety f needs related t health and human services. Cmpass Mark ffers specialized infrmatin and referral services fr individuals with substance use cncerns t cnnect them t apprpriate supprt and/r treatment services. White Deer Run serves as a clearinghuse fr inpatient detxificatin and inpatient rehabilitatin services. Their call center cmpletes brief assessments via phne t determine the apprpriate level f care. Based n an individual's assessment and their eligibility fr funding r insurance cverage, White Deer Run searches fr an pening at an apprpriate treatment lcatin. Crisis Interventin is a cuntywide respnse t mental health crises. This call center primarily addresses mental health emergencies, such as suicidal thughts and self-harming behavir. While PAGE 25 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES substance use issues are nt their primary target, they cnduct brief evaluatins t determine whether drug and alchl treatment r mental health treatment is apprpriate. If they are unable t assist with certain issues related t substance use, they refer individuals t specific resurces. EMERGENCY DEPARTMENT WARM HANDOFF PROGRAM In partnership with The RASE Prject, all 4 emergency departments (EDs) in Lancaster Cunty have implemented warm handff prgrams t respnd t piid verdse cases. Every patient wh enters the ED after an piid verdse has the pprtunity t meet with a RASE recvery specialist, an individual wh is in lng-term recvery frm substance use disrder. A RASE specialist is n-call arund the clck t meet patients in the ED and prvide infrmatin, supprt, and mtivatin t seek treatment if the patient is ready. In cases in which a patient is interested in seeking treatment, RASE specialists prvide direct referrals and walk individuals thrugh the treatment prcess. D&A MOBILE ASSESSMENTS In Lancaster Cunty, state-licensed utpatient drug and alchl treatment prviders wh are funded by the Lancaster Cunty Drug and Alchl Cmmissin are able t cnduct evaluatins t determine the need fr services and apprpriate level f care. Brief screenings can be cmpleted ver the phne, and full evaluatins are typically dne in persn at utpatient clinics. Hwever, fr individuals wh cannt physically travel t an utpatient clinic (i.e. individuals in an inpatient mental health setting), utpatient prviders can cnduct mbile assessments by traveling t the individual. PRISON DOOR-TO-DOOR PROJECT The Lancaster Cunty Prisn is wrking in cperatin with the Lancaster Cunty Drug and Alchl and The RASE Prject t transfer individuals with substance use disrders directly frm the prisn t inpatient rehabilitatin prgrams. Recvery supprt specialists frm RASE assist in the transfer t prvide peer supprt and facilitate the transitin. At the time f this reprt, abut 25 peple are entering treatment directly frm prisn each mnth. COURTS, PROBATION & PAROLE The Lancaster Cunty Curt f Cmmn Pleas began peratin f the adult treatment curt, Drug Curt in 2005 based n natinal research and prgram mdels. This initiative was the culminatin f the cperative effrts between several cunty and curt agencies. The Drug Curt team, led by the Drug Curt Judge, is cmpsed f members f these agencies including a treatment prvider, prbatin fficer, Drug Curt crdinatr, Assistant Public Defender, and Assistant District Attrney. The Drug Curt currently includes an average f 50 participants at any given time, wh enter the prgram based n a high level f risk r need at the time f their initial evaluatin. Participants in Drug Curt must cmplete an intensive prgram that includes drug and alchl treatment, supervisin r prbatin appintments, frequent drug testing, judicial review hearings, cmmunity service, and ther pr-scial activities. Lancaster Cunty Adult Prbatin & Parle supprts the implementatin f Drug Curt and ffers supprt and mnitring fr participants. This entity is nw wrking in direct cllabratin with The RASE Prject t supprt individuals recvering frm substance use disrders with peer recvery supprt specialists. PAGE 26 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES TREATMENT FOR KNOWN DISORDERS STANDARD TREATMENT FOR INDIVIDUALS WITH KNOWN DISORDERS INCLUDES SERVICES UTILIZED FOR DIAGNOSED SUBSTANCE USE OR MENTAL HEALTH DISORDERS, SUCH AS INPATIENT OR OUTPATIENT TREATMENT. Behaviral health treatment services are a key piece in the cntinuum f care. There are inpatient, residential, and utpatient treatment services in Lancaster Cunty. The apprpriate level f care depends n the severity and cmplexity f a given substance use disrder. In cases f severe r chrnic substance use disrder, an individual typically enters the treatment prcess directly int detxificatin and/r inpatient treatment. At all levels, treatment interventins implement strategies such as medicatin, cunseling and ther supprtive services t btain and maintain sbriety, physical and mental health, and healthy scial functining. At any level, treatment may be integrated fr c-ccurring mental health and substance use disrders. The integratin f services is part f a cmplete and effective cntinuum f care. DETOXIFICATION FACILITIES In Lancaster Cunty, there are 2 inpatient treatment centers that prvide detxificatin (detx) services. These facilities prvide a medically supervised space fr detx, which is ften necessary fr piid use disrders. There is a ttal f 55 detx beds in the cunty. There are 48 detx beds at The Retreat fr men and wmen; and there are 7 detx beds at White Deer Run fr men nly. White Deer Run is the nly detx facility in the cunty that accepts medical assistance and cunty funding fr lw-incme individuals. DETOX & SHORT-TERM INPATIENT SERVICES INPATIENT TREATMENT SERVICES There are 3 state-licensed facilities in Lancaster Cunty that prvide shrt-term inpatient treatment (less than 30 days), White Deer Run, The Retreat, and Nuestra Clinica Residencial. White Deer Run and Nuestra Clinica als ffer lng-term residential treatment (mre than 30 days). Lng-term residential treatment services are explred further in the next sectin. The Retreat ffers inpatient rehabilitatin services t men and wmen. White Deer Run and Nuestra Clinica accept medical assistance and cunty funding fr services. These 2 treatment facilities serve nly men. Nuestra Clinica is equipped t prvide bilingual and bicultural services in Spanish. These inpatient treatment services als typically prvide treatment fr c-ccurring mild mental illnesses. Transprtatin is prvided t treatment facilities at the time f intake, and transprtatin is als typically prvided at the time f discharge. It is imprtant t nte that many individuals seek inpatient treatment services utside f their cunty f residence. At times, this is a strategic chice, in rder t disrupt unhealthy patterns and relatinships. There are a number f inpatient treatment prviders in the regin that serve individuals frm Lancaster Cunty. PAGE 27 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES OUTPATIENT TREATMENT encmpasses several levels f therapeutic care, including partial hspitalizatin, intensive utpatient, and general utpatient services. At the time f this reprt, there are abut 20 state-licensed utpatient treatment lcatins in Lancaster Cunty. These prviders ffer a range f services, including evaluatins, treatment planning, supprt grups, and individual, grup, cuples, and family therapy. A treatment plan may include additinal treatment, including medicatin assisted treatment (MAT), t cmbat piid use disrders. Individuals with c-ccurring mental illness and MAT PROVIDERS substance use disrders may see a cunselr primarily fr mental health while als addressing sme substance use issues. Sme mental health cunselrs in the cunty are certified t als prvide cunseling fr substance use disrders r wrk clsely with drug and alchl treatment prviders. Accrding t research, the mst effective treatment methd fr c-ccurring disrders is integrated treatment. Fr example, sme prviders are equipped t prvide cmprehensive utpatient services that integrate treatment t simultaneusly address substance use disrders and mental illness. MEDICATION ASSISTED TREATMENT (MAT) is the use f medicatins in additin t behaviral therapies and cunseling t treat and sustain recvery frm piid use disrders. These medicatins relieve withdrawal symptms and psychlgical cravings. Accmpanied by cunseling and behaviral therapy, MAT prgrams prvide a safe and cntrlled level f medicatin t vercme piid use disrders. In Lancaster Cunty, there are 41 lcatins that are authrized t prvide buprenrphine (subxne), 9 lcatins that are authrized t prvide vivitrl, and 1 lcatin that prvides methadne maintenance. Addictin Recvery Systems (ARS) f Lancaster prvides methadne, buprenrphine, and vivitrl maintenance in additin t utpatient cunseling. CARE COORDINATION The recmmendatins fr MAT include care crdinatin, which includes nging mnitring and therapeutic supprt fr individuals participating in MAT. Tw rganizatins in Lancaster have been awarded Centers f Excellence grants, the utpatient clinic, T.W. Pnessa, and the Penn Medicine Lancaster General Health system. These grants are administered thrugh the Pennsylvania Department f Human Service, and Medicaid HealthChices funds treatment services fr individuals with piid use disrders. The primary gal f these prgrams is t increase timely access t treatment and supprt services. COEs are respnsible fr prviding MAT and supprt services with cmprehensive care management. At T.W. Pnessa, a certified recvery specialist is part f the care management team. Additinally, the Drug & Alchl Cmmissin and PerfrmCare wrk t crdinate services and enhance treatment access. The RASE Prject ffers care crdinatin services related t vivitrl and buprenrphine MAT. This prgram crdinates services with the prescribing physicians. Fr individuals prescribed these medicatins, the care crdinatin prgrams ffer cmprehensive supprt thrugh mnitring, referrals fr ancillary services, cunseling, supprt grups, and mentring. This apprach als helps t build an envirnment that facilitates recvery. PAGE 28 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES TREATMENT FOR YOUTH WITH SUBSTANCE USE DISORDERS YOUTH TREATMENT SERVICES Mst utpatient substance use treatment prviders d nt accept clients under the age f 18, and there are currently n specialized adlescent treatment ptins in Lancaster Cunty. Hwever, there are sme utpatient treatment prviders wh wrk with yuth under the age f 18 with substance use disrders in Lancaster Cunty. There is ne residential treatment prgram fr yuth in Lancaster Cunty that serves adlescent males in the delinquent system. LONG-TERM TREATMENT INVOLVEMENT IN STRUCTURED, LONG-TERM TREATMENT HAS THE OVERARCHING GOAL TO REDUCE RELAPSE AND RECURRENCE OF USE. Fr the purpses f this paper, lng-term treatment refers t lng-term residential treatment services that last fr mre than 30 days. This may include lng-term inpatient r residential treatment in additin t structured halfway huses. RESIDENTIAL TREATMENT SERVICES There is a ttal f 7 lng-term residential treatment lcatins in Lancaster Cunty, r thse that ffer inpatient treatment prgrams fr lnger than 30 days. The Gate Huse ffers lng-term residential treatment in the frm f cmmunity-based halfway huses. Individuals may enter these gender-separate hmes after cmpleting detx and/r inpatient rehabilitatin prgrams. The Gate Huse is currently perating tw huses in Lancaster Cunty, and they LONG-TERM RESIDENTIAL SERVICES ensure a cntinuum f treatment fr residents thrugh individual, grup, and family cunseling, 12-step grup invlvement, and additinal vcatinal and life skills supprt. Sme residential prgrams in Lancaster Cunty ffer specialized services. Fr instance, Gaudenzia Vantage serves pregnant and parenting wmen with up t 2 children in a cmprehensive lng-term residential treatment prgram. The Spanish American Civic Assciatin perates a lngterm residential treatment prgram in the frm f a halfway huse that is specifically fr Latin men. This is PAGE 29 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES a specialized bilingual and bicultural prgram. They als crdinate treatment and educatinal prgrams fr individual residents. Mans Huse is a residential treatment center that prvides lng-term treatment and rehabilitatin services fr adlescent males. This cmprehensive prgram is fr adlescent males wh are adjudicated in the delinquent justice system. AFTER-CARE & RECOVERY AFTER-CARE INCLUDES ONGOING SUPPORT SERVICES AND RESOURCES FOR SUSTAINED RECOVERY AND RELAPSE PREVENTION. RECOVERY COMMUNITY ORGANIZATIONS The RASE Prject is cmprised entirely f individuals frm the recvery cmmunity and exists t supprt the recvery cmmunity. RASE prvides advcacy, peer supprt, care crdinatin, supprt grups, educatin classes, and cmmunity events. In Lancaster, RASE als has a physical ffice lcatin in which individuals seeking treatment r supprt in recvery can drp-in t receive assistance. They als ffer varius trainings t prfessinals and cmmunity individuals. This prgram aims t facilitate healthy living and lng-term recvery lifestyles. 12-STEP MEETING LOCATIONS Anther recvery cmmunity grup in Lancaster Cunty is the 521 Club. This lcatin ffers a sber space fr individuals t meet fr 12-step meetings, scial and fellwship time, and recvery-based activities and events. SUPPORT & MUTUAL SELF-HELP GROUPS Lancaster Cunty ffers a variety f grup meetings fr nging supprt fr individuals in recvery r cnsidering recvery, including 12-step prgrams such as Alchlics Annymus (AA), Narctics Annymus (NA), and Al-Ann. These prgrams ffer a framewrk fr the recvery prcess and nging peer supprt thrugh meeting attendance and spnsrship. Many peple find these grups a vital part f their lng-term recvery, and active invlvement can reduce the risk f relapse. There are a variety f types f meetings, including sme that d nt fllw the 12-step mdel, such as Refuge Recvery, a prgram based n a Buddhist apprach. Celebrate Recvery is a faith-based prgram which aims t help recvering addicts becme selfempwered abut their health issue and learn healthful ways t cpe with addictin in rder t prevent relapses and live a better life. RECOVERY HOUSES & SOBER LIVING HOMES T supprt individuals in their recvery, there is a netwrk f recvery huses and sber living hmes in Lancaster Cunty. Oftentimes, an individual will be discharged frm inpatient rehabilitatin r residential treatment t a sber living envirnment t enhance the pprtunities fr sustained recvery. PAGE 30 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES Mst recvery huses have specific criteria fr residents, such as maintaining sbriety, invlvement in treatment and 12-step prgrams, and educatin r emplyment. A number f recvery huse management rganizatins recently frmed a calitin t address issues such as standardizatin and quality mnitring. The Capital Area Behaviral Health Cllabrative (CABHC) recgnizes abut 25 recvery hmes in Lancaster Cunty that meet certain standards. In ttal, there are currently ver 40 recvery huses and sber living hmes in Lancaster Cunty. Accrding t available infrmatin, there are at least 21 hmes fr wmen and 26 hmes fr men. HOW ARE WE ALREADY BUILDING ON OUR ASSETS? When Jining Frces was established, the partnership started wrking t address immediate cmmunity needs in the midst f the piid crisis. This wrk has been nging, and the strategic planning prcess has ccurred simultaneusly. While this is nt the typical rder f peratins, this is nt a typical set f circumstances. Beginning in August 2017, there were significant needs in the cmmunity that the partners f Jining Frces culd begin t address by crdinating effrts and building n existing resurces. T date, the wrk f Jining Frces includes: Assessing cmmunity cnditins fr data-driven planning, including evaluatins f existing data and cmprehensive analyses f cmmunity assets, needs, and pprtunities fr imprvement Streamlining data cllectin and serving as a central repsitry fr Lancaster Cunty specific data t infrm planning and implementatin effrts and track utcmes Saturating the cmmunity with unified messaging and prviding free infrmatinal materials fr widespread distributin Supprting the implementatin f emergency department (ED) warm handff prgrams, evidence-based schl preventin prgrams, cmmunity-based preventin effrts, and the prisn dr-t-dr prject Expanding nalxne access, prescriptin drug drp-ff lcatins, and the utilizatin f the PDMP and prescribing guidelines Prviding a website t serve as the hst f Lancaster Cunty specific data, infrmatin, resurces, and ther materials PAGE 31 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES WHAT ELSE NEEDS TO BE DONE? Overall, the cunty has made significant strides t prvide services and meet cmmunity needs in respnse t the piid crisis. Hwever, ur effrts can be strengthened. Mving frward, ur strategies and gals are based n a cmprehensive analysis f gaps and pprtunities fr imprvement in the resurces, prgrams, and plicies in Lancaster Cunty. A gap analysis illustrates the differences between ur current cnditins and the desired utcmes. In ther wrds, we are lking fr the pprtunities fr imprvement in ur cmmunity respnse t the piid crisis. By identifying the existing gaps in services, resurces, and ther cmmunity factrs, ur gals and strategies can accurately reflect cmmunity needs and wrk t address these gaps. Fr the purpses f this strategic plan, this gap analysis explres unmet needs and gaps in resurces, plicies, and practices. Cmmunity and stakehlder input is at the center f this analysis. T assess the cnditins and needs f ur cmmunity, we start by examining ur strengths as identified by the SWOT analysis and asset inventry. Key infrmant interviews and a cmmunity frum were used t review the asset inventry and subsequently identify and discuss the cmmunity gaps and pprtunities fr grwth. Jining Frces held its third quarterly cmmunity frum n February 2, 2018. Attendees included a multidisciplinary grup f stakehlders and cmmunity members (see Appendix E fr full list f attendees). The purpse f this frum was t review nging effrts, prvide feedback, and discuss the gaps and ways t imprve the respnse t piid verdse in Lancaster Cunty. At the cmmunity frum, ur gap discussin was cmpleted in small grups during a breakut sessin. The Cntinuum f Care served as the framewrk fr this discussin and analysis. Attendees selected discussin grups based n their interest r expertise, aligned with ne f the fllwing categries: Health prmtin Preventin (including universal, selective, and indicated preventin) Case identificatin Treatment (including standard and lng-term treatment) After-care and recvery Each grup f stakehlders addressed the fllwing questins: What assets are we missing [in ur assets inventry]? What gaps d yu see? What barriers exist t clsing thse gaps? The fllwing sectin highlights the mst significant gaps and cmmunity needs identified by cmmunity stakehlders and reflects cmmunity cnditins as f February 2018. PAGE 32 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES GAPS & CONTRIBUTING FACTORS BY CATEGORY Despite nging effrts, there are unmet cmmunity needs. Sme f the resurces and services we identified in the previus sectin may nt be available r accessible by all peple wh may need them cuntywide. Additinally, there are sme services r recmmended effrts that have nt yet been implemented. Here, we utline the mst significant gaps, cmmunity needs, and any cntributing factrs by the categries f the Cntinuum f Care. This infrmatin is a prduct f ur cmprehensive analysis f cmmunity cnditins and discussins with cmmunity stakehlders. GAPS IN HEALTH PROMOTION Lack f evidence-based infrmatin disseminated n the influence f healthy behavirs (i.e. nutritin, physical activity) and mental health and substance use disrders Limited awareness and actin t address substance use disrders in faith cmmunities despite high level f ptential fr psitive invlvement Limited appraches t address substance use disrders in diverse cultural cntexts (i.e. cmmunities f clr, refugee cmmunities) CONTRIBUTING FACTORS Limited prgramming that integrates physical health and mental health/substance use disrders High levels f stigma in faith-based arenas Stigma, limited cultural cmpetence Lack f health prmtinal activities and supprt in schls Limited time and funding Limited access t prgrams t address scial determinants f health (i.e. pverty) Limited funding GAPS IN UNIVERSAL PREVENTION Limited public awareness f substance use disrders, risk factrs, and hw t get help Nt all students receive evidence-based preventin prgramming in schl and in nn-traditinal learning settings (i.e. cyber schl, hmeschl, and Plain cmmunity schls) Limited accessibility t prescriptin drug drp-ff lcatins and lack f cmmunicatin by dctrs fr individuals t utilize drpffs with unused medicatin Lack f standardizatin in the use f PDMP and prescribing guidelines Lack f universal preventin prgrams utside f schl t address ther ppulatins (i.e. senirs, adults, early childhd) N current messaging frm health care prfessinals in the cunty abut medical/recreatinal marijuana legalizatin CONTRIBUTING FACTORS Stigma; lack f educatinal prgrams Lack f time and funding in schls; difficulty reaching nn-traditinal students Peple may be uncmfrtable ging t plice statins fr drp-ffs; gegraphic distributin; limited awareness Onging effrts t standardize and streamline Limited prgramming in settings utside f schl New plicy changes; lack f research; stigma PAGE 33 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES Limited alternative treatments fr pain management that are accessible and affrdable Lack f insurance cverage GAPS IN SELECTIVE PREVENTION Gaps in screening fr mental health and substance use disrders in primary care, pain management, and ther settings Limited supprt and preventin prgrams t address risk factrs amng individuals at high risk Lack f supprtive prgrams fr children and families that may be at-risk r affected by substance use disrders CONTRIBUTING FACTORS Stigma; lack f integratin with physical health care; lack f time Lack f funding Lack f funding; gegraphic accessibility t existing prgrams GAPS IN INDICATED PREVENTION Limited access t harm reductin prgrams (i.e. safe needle exchanges) Limited access t nalxne fr first respnders and individuals at risk f verdse Lack f evidence-based prgrams fr early interventin t address substance use issues CONTRIBUTING FACTORS Plicies/laws; lack f resurces and funding fr harm reductin High cst f nalxne; n reimbursement; limited grant funding Lack f funding and resurces GAPS IN CASE IDENTIFICATION Limited infrmatin and referral prgrams t facilitate entrance int treatment 24/7 N safe places where individuals can g in persn fr help and links t treatment utside f the ED Difficulty identifying wmen wh are at risk r shwing signs f substance use disrders fr treatment r supprt Limited slts and lng wait times fr treatment, especially MAT N warm handff and limited supprt fr individuals wh chse nt t g t the ED after verdse CONTRIBUTING FACTORS Lack f funding Lack f funding and resurces Child prtective services plicies that create fear and uncertainty Lack f resurces and available prviders Limited funding and available peer recvery specialists PAGE 34 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES GAPS IN STANDARD & LONG-TERM TREATMENT CONTRIBUTING FACTORS Limited access t treatment by lcatin and affrdability Limited private insurance cverage; lack f transprtatin ptins Lack f detx beds fr individuals with public insurance r cunty funding Cst f detx peratin; zning and public ppsitin t new facilities Limited access t medicatin assisted treatment Lack f available prviders Lack f inpatient treatment fr wmen with children Lack f funding Lack f treatment ptins fr adlescents with substance use disrders Recent clsing f specialized yuth treatment prvider Difficult transitins between levels f care Lack f cmmunicatin between prviders Limited case management and care crdinatin services that can ensure a cntinuum f care Lack f treatment integratin fr c-ccurring mental illness and substance use disrders Limited lng-term residential treatment services, especially fr special ppulatins (i.e. yuth, wmen with children) Limited availability f lng-term residential treatment husing (i.e. halfway huses) Lack f insurance cverage fr lng-term residential treatment (i.e. inpatient treatment fr mre than 30 days, halfway huses) Lack f funding Plicies and separate reimbursement systems Lack f funding Zning restrictins; lack f funding available Plicies and insurance cverage GAPS IN AFTER-CARE & RECOVERY Limited recvery supprt specialists, mentrships, and cmprehensive recvery supprt Lack f cmmunity awareness abut recvery prgrams and their significance Limited jb pprtunities and sustainable incme fr individuals in recvery CONTRIBUTING FACTORS N insurance cverage; lack f funding Stigma; lack f educatin Stigma; limited wrkplace plicies that supprt individuals in recvery Limited accessibility f supprt meetings and ther resurces Lack f transprtatin; gegraphic distance Limited number f recvery huses and sber living hmes that accept individuals prescribed MAT r psychtrpic medicatin Lack f awareness Limited recvery supprts fr adlescents and lder adults Limited resurces Lack f supprt fr families and lved nes Limited resurces Limited accessibility f recvery husing High cst f living; gegraphic distance PAGE 35 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES SUMMARY OF GAPS & OPPORTUNITIES T summarize ur examinatin f cmmunity strengths and needs, the mst significant gaps and pprtunities are identified and highlighted here. Fr clarity, these gaps and pprtunities can be divided int 2 main categries: EXISTING EFFORTS THAT SHOULD BE EXPANDED There are prgrams, plicies, and resurces that already exist in Lancaster Cunty but d nt prvide full cverage. In this case, these effrts must be expanded t meet the cmmunity needs. Increase access t nalxne in recvery huses and t cmmunity calitins Implement evidence-based schl preventin prgrams cunty-wide Prmte the Jining Frces website as a cmmunity resurce Increase awareness thrugh prmtinal campaigns and educatin fr cmmunity members Increase screening fr substance use disrders in hspitals and medical utpatient facilities Ensure smth transitins t treatment and recvery services (including hspitals, schls, prisn, etc.) Streamline use f PDMP and prescribing guidelines by embedding in electrnic health recrds Expand access t prescriptin drug dispsal mdalities Increase crdinatin and navigatin f supprtive services (i.e. treatment, recvery supprt, and scial services) Increase ease f access t the fllwing: Detx Medicatin assisted treatment (MAT) Treatment fr adlescents Inpatient treatment fr wmen with children Recvery supprt specialists Recvery husing and halfway husing RECOMMENDED PRACTICES THAT SHOULD BE IMPLEMENTED There are evidence-based practices that Lancaster Cunty des nt currently have, r has nt yet widely implemented, but implementing these practices is recmmended t reduce piid use cncerns and piid-related verdse deaths. Advcate fr insurance cverage and funding fr treatment and recvery services Increase access t alternative treatments fr pain management Supprt the implementatin f state-level quality and safety measures fr recvery husing certificatin Develp strategies t increase cmmunicatin between mental health and substance use prviders t enhance crdinatin f care Develp strategies t address transprtatin barriers t utpatient treatment PAGE 36 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES WHAT ARE OUR GOALS? Fr the purpses f this 5-year strategic plan, ur gals are aligned with a cmprehensive examinatin f natinal and lcal data; cmmunity assets and gaps; current emerging, best, and evidence-based practices; and additinal prfessinal recmmendatins. The verarching, lng-term gal f Jining Frces is t reduce the number f deaths frm piid-related verdses in Lancaster Cunty. Based n natinal prjectins, we may nt see a reductin in deaths until 2023. All Jining Frces shrtterm and intermediate gals, bjectives, strategies, and actin steps cntribute t this verarching gal. Fr each gal, ur detailed strategies, tactics, utcme indicatrs and measures, and the identified respnsible parties are listed in Appendix F. GOAL 1: STRENGTHEN EVIDENCE-BASED PREVENTION & INTERVENTION EFFORTS WE WILL AIM TO: Engage and assist schls in identifying and implementing evidence-based preventin prgramming and plicies Expand access t prescriptin drug take-back lcatins Prmte prper prescriptin drug dispsal Increase access t nalxne and apprpriate educatin and training Supprt and expand warm handffs with certified recvery supprt specialists GOAL 2: SATURATE THE COMMUNITY WITH UNIFIED MESSAGING WE WILL AIM TO: Develp and disseminate cnsistent messaging, accurate infrmatin abut piids, and where t get help Educate cmmunity grups, calitins, rganizatins, and emplyers Strengthen cmmunity awareness, mbilizing effrts, and partnerships Implement cunty-wide marketing and public awareness campaigns Prvide up-t-date infrmatin n the Jining Frces website and print materials fr cunty-wide disseminatin PAGE 37 STRATEGIC PLAN 2018

LANCASTER COUNTY JOINING FORCES GOAL 3: ENCOURAGE & SUPPORT CULTURAL CHANGE WITHIN THE MEDICAL COMMUNITY WITH REGARD TO OPIOIDS WE WILL AIM TO: Equip healthcare prviders with data and tls needed t imprve piid prescribing, including utilizatin f the PDMP and CDC prescribing guidelines Educate prviders abut recmmended prescribing guidelines and ther tls Standardize piid prescribing metrics t effectively track prgress and imprvements in prescribing practices Supprt the use f alternative treatments fr pain management GOAL 4: IMPROVE ACCESS TO TREATMENT & RECOVERY SUPPORT & INCREASE UTILIZATION OF SERVICES WE WILL AIM TO: Increase the number f publicly-funded detx beds in Lancaster Cunty Enhance warm-handff prgrams and navigatin services t supprt effective entries int treatment. Supprt the use f evidence-based therapy mdalities t address mental health and substance use issues Reduce barriers t treatment and recvery services Jining Frces implements a crdinated and multi-level apprach t reduce the risk f piid-related verdse deaths in Lancaster Cunty. These gals, bjectives, strategies, and actin steps will guide ur wrk. Thrughut this prcess, ur methds and utcmes will be regularly mnitred and evaluated t infrm future gal planning and implementatin. Due t the cmplexity f this issue, ur effrts must be respnsive and flexible, and may be mdified based n ur analyses f prcess measures, new cmmunity cnditins, r emerging research. It is critical that we nt lse sight f systemic, scial, and envirnmental risk factrs that cntribute t this epidemic. Our actins must acknwledge the imprtance f individual mental well-being, while extending ur reach t create fundamental plicy and system changes. This strng fcus is required t achieve and sustain reduced verdse deaths in Lancaster Cunty. We lk t the future t prevent and mitigate the effects f trauma and ther risk factrs s that ur cmmunity can effectively address the rt causes f all substance use disrders. Cmmunity-level changes will build prtective and resiliency factrs t manage this current epidemic and establish cmmunity cnditins that supprt verall well-being and lng-term recvery. PAGE 38 STRATEGIC PLAN 2018

HOW ARE WE COLLECTING & MEASURING DATA? Overarching Outcme Gal: Reduce Deaths frm Opiids and Herin Number f Overdse Deaths in Lancaster Cunty Data Surce Lancaster Cunty Crner 2017 2018 Ttal Q1 Q2 Q3 Q4 Ttal 168 17 (as f 2/27) 0 Prcess Evaluatin Measures Awareness Data Cllectr 1 Number f Impressins 899 1.1 Number f billbard impressins 1.2 Number f new visitrs t website 295 1.3 Number f returning visitrs t website 142 Penn Medicine 1.4 Number f website hits frm direct address (lancasterjiningfrces.rg) 202 Lancaster General 1.5 Number f website hits frm link n ther rganizatin website 91 Health 1.6 Number f website hits frm brwser search 131 1.7 Number f website hits frm scial media 30 1.8 Number f material requests frm the website 8 1.9 Number f general inquiries frm the website 0 2 Organizatins distributing materials (Number distributed by each) 55460 Cmpass Mark (includes Cmmunity Calitins) 11721 D & A Cmmissin 3790 Drug Task Frce 0 EMS 1700 Faith Based Outreach 21030 Lancaster Chamber 1520 Lancaster Cunty Recvery Alliance 600 Let's Talk, Lancaster 2700 Mayr's Assciatin 0 Penn Medicine/LG Health 7749 Pharmacists 1950 Plice Departments 300 Prisn/Prbatin and Parle 2350 Suth Central PA Opiid Awareness Calitin 50 2017 2018 Ttal Gal Q1 Q2 Q3 Q4 Ttal PAGE 39 STRATEGIC PLAN 2018

Prcess Evaluatin Measures Data Cllectr 2017 2018 Ttal Gal Q1 Q2 Q3 Q4 Ttal 1 Number f presentatins by individuals in recvery 32 Cmpass Mark Lancaster Cunty Recvery Alliance 10 RASE 22 2 Number f educatinal prgrams held by emplyers, schls, cmmunity events, and faith-based rganizatins (facilitated/led by a Jining Frces partner) 45 Cmpass Mark 41 Lancaster Chamber 1 Penn Medicine/LG Health 3 3 Number f peple reached by educatinal prgrams 9042 Cmpass Mark 8852 Lancaster Chamber 63 Penn Medicine/LG Health 127 4 Number f prviders educated abut recmmended guidelines and the use f Suth Central PA tls t aid in the apprpriate prescribing fr acute/chrnic pain (in Lancaster Opiid Awareness 201 Cunty). Calitin Educatin 5 Number f cntinuing medical educatin (CME) events held regarding recmmended guidelines and the use f tls t aid in the apprpriate prescribing fr acute/chrnic pain (in Lancaster Cunty). Suth Central PA Opiid Awareness Calitin 6 Number f schls ffering evidence-based substance abuse preventin prgrams 35 Cmpass Mark 17 Penn Medicine/LG Health 18 7 Number f children receiving evidence-based substance abuse preventin educatin 4363 (FY17 t date) Cmpass Mark 593 Penn Medicine/LG Health 3770 2 PAGE 40 STRATEGIC PLAN 2018

Prcess Evaluatin Measures Data Cllectr 2017 2018 Ttal Gal Q1 Q2 Q3 Q4 Ttal 1 Number f emergency calls where Nalxne was administered 728 EMS Cuncil 728 (thrugh 11/27/17) Plice Departments 2 Number f patients receiving piid prescriptins written Suth Central PA Opiid Awareness Calitin 3 Number f patients receiving piid prescriptins >100 mme per day Suth Central PA Opiid Awareness Calitin 4 Number f MAT prviders in Lancaster Cunty 4.1 Number f buprenrphine maintenance prviders Penn Medicine/LG 41 4.2 Number f vivitrl maintenance prviders Health 9 4.3 Number f methadne maintenance prviders 1 5 Number f drp-ff sites fr unused medicatins Drug Task Frce 21 6 Number f peple served by Cmpass Mark's Drug and Alchl Infrmatin Center Cmpass Mark 1227 7 Number f calls t 2-1-1 fr substance misuse/abuse related needs United Way 118 8 Number f prescriptin drug lckbxes distributed Drug Task Frce 1653 Behavir Change PAGE 41 STRATEGIC PLAN 2018

Prcess Evaluatin Measures Data Cllectr 2017 2018 Ttal Gal Q1 Q2 Q3 Q4 Ttal 1 Number f Hspitals that have warm handff Suth Central PA Opiid Awareness 4 Calitin 1.1 Prtcl develped fr inpatient identificatin and referral Suth Central PA Opiid Awareness Calitin 1.2 Prtcl develped fr warm handff pst-inpatient discharge Suth Central PA Opiid Awareness Calitin 2 Number f cmmunity calitins receiving technical assistance t implement evidence-based preventin initiatives Cmpass Mark 13 3 Number f public schl districts that participate in the Pennsylvania Yuth Survey (PAYS) n=16 Cmpass Mark 16 4 Number f meetings held with legislatrs (legislative visits) 3 Cmpass Mark D & A Cmmissin Drug Task Frce EMS Cuncil Lancaster Chamber Lancaster Cunty Recvery Alliance 3 Let's Talk, Lancaster Plice Departments 5 Number f detx beds available in Lancaster Cunty D&A Cmmissin 7 6 Prtcl develped and implemented fr universal prescribing f nalxne with Suth Central PA piid prescriptins Opiid Awareness Calitin 7 Number f municipalities with plice departments equipped with nalxne 59 8 Number f treatment prviders equipped with nalxne D&A Cmmissin (phne survey) 8 9 Number f recvery supprt prviders equipped with nalxne D&A Cmmissin (phne survey) 10 Plicy & Systems Change 10 Resurce center develped fr management f chrnic pain with pain specialist and neurpsych supprt t implement multimdal pain plan. 11 Prtcl develped and implemented fr acute pain management fr the fllwing cmmn pain diagnses in an effrt t prvide alternative treatment plans fr pain management and limit piid prescribing: 11.1 Lw back pain 11.2 Pst-perative 11.3 Dental 11.4 Headache Suth Central PA Opiid Awareness Calitin Suth Central PA Opiid Awareness Calitin PAGE 42 STRATEGIC PLAN 2018

APPENDIX A ACKNOWLEDGEMENTS Thank yu t all cmmunity members, stakehlders, and key infrmants wh have participated in ur quarterly cmmunity frums, grup cnversatins, and individual interviews t prvide invaluable infrmatin and feedback in this assessment and planning prcess. PREPARED BY JULIA RESSLER, MSW-MPH CANDIDATE Intern, Penn Medicine Lancaster General Health Cmmunity Health & Wellness ALICE YODER, MSN, RN Chair, Lancaster Cunty Jining Frces Facilitatr, Suth Central PA Opiid Awareness Calitin Directr, Penn Medicine Lancaster General Health Cmmunity Health & Wellness JESSICA KLINKNER, MPH, CHES Health Prmtin Specialist, Penn Medicine Lancaster General Health Cmmunity Health & Wellness ROSEMARY SEARCH, BSN, RN Health Prmtin Specialist, Penn Medicine Lancaster General Health Cmmunity Health & Wellness SEAN CURRY, MPH CANDIDATE Intern, Penn Medicine Lancaster General Health Cmmunity Health & Wellness CONTRIBUTORS & REVIEWERS MAYOR TIM BRADLEY Mayr, Munt Jy Brugh Chair, Lancaster Cunty Anti-Herin Task Frce DALE BRICKLEY, PhD Senir Directr f Innvatin & New Service Develpment, WellSpan Philhaven C-Chair, Let s Talk Lancaster Behaviral Health Prvider Actin Team BRETT COLE, BS Deputy Directr f Supervisin Services, Lancaster Cunty Prbatin & Parle DARRELL FISHER President, Lancaster Cunty EMS Cuncil EMS Chief, New Hlland Ambulance Assciatin SARAH FRITZ, MA Cmmunity Outreach Crdinatr, Lancaster Cunty District Attrney s Office NICOLE HAGEN, MS Crdinatr, Let s Talk Lancaster ANDREA HEBERLEIN, MSW Lead Directr f Cmmunity Impact, United Way f Lancaster Cunty RICK KASTNER Executive Directr, Lancaster Cunty Drug & Alchl Cmmissin ERIC KENNEL, MPA Executive Directr, Cmpass Mark SHERRIFF CHRIS LEPPLER Sherriff, Lancaster Cunty Sherriff s Office TERI MILLER-LANDON, MSW Deputy Directr f Administratin, Lancaster Cunty Prbatin & Parle MAYOR RICHARD MORIARTY Mayr, Millersville Brugh Chair, Lancaster Cunty Mayrs Assciatin COMMISSIONER JOSHUA PARSONS Cmmissiner, Lancaster Cunty SCOTT THEURER Chair, Lancaster Cunty Recvery Alliance HEATHER VALUDES, MS Advcacy Directr, Lancaster Chamber PAGE 43 STRATEGIC PLAN 2018

JOINING FORCES COMMUNITY FORUMS & ORGANIZATIONS REPRESENTED TO DATE COMMUNITY KICKOFF MEETING Date: August 3, 2017 Lcatin: Pennsylvania Cllege f Health Sciences QUARTERLY COMMUNITY FORUM 1 Date: Nvember 3, 2017 Lcatin: Pennsylvania Cllege f Health Sciences QUARTERLY COMMUNITY FORUM 2 Date: February 2, 2018 Lcatin: Pennsylvania Cllege f Health Sciences ORGANIZATIONS REPRESENTED Affilia Hme Health AmeriHealth Caritas Anti-Herin Task Frce ARS f Lancaster ASAP Lititz Beam Cnsulting Bird-in-Hand Crpratin Brugh f Clumbia CHI St. Jseph Children s Health Cindy Stewart fr Mayr f Lancaster City f Lancaster COBYS Family Services Cmpass Mark Cunty f Lancaster Dnegal Substance Abuse Alliance East Earl Twnship Plice Department Elements Behaviral Health Elizabethtwn Area Cmmunities that Care Elizabethtwn Plice Department Family First Health GOAL Prject Gd Wrks Recvery Healthy Beginnings Plus Lancaster General Health Physicians Lancaster Harm Reductin Prject Lancaster Health Center (SuthEast Lancaster Health Services) Lancaster Online Lancaster Ostepathic Health Fundatin Let s Talk, Lancaster Lngenecker s Hatchery, Inc. Medicatin Infrmatin Services Mental Health America f Lancaster Cunty Millersville University Mravian Adult Day Services Naaman Center OBH Life Cunseling Services Office f Cngressman Llyd Smucker Office f Senatr Pat Tmey Partnership fr Public Health Penn Medicine Lancaster General Health Pequea Valley Schl District PerfrmCare Pinnacle Treatment Centers Rehab After Wrk Schl District f Lancaster Snyder Funeral Hmes PAGE 44 STRATEGIC PLAN 2018

INGROUP Assciates Lancaster City & Cunty Medical Sciety Lancaster Chamber Lancaster Cunty Adult Prbatin & Parle Services Lancaster Cunty Behaviral Health & Develpmental Services Lancaster Cunty Children & Yuth Lancaster Cunty Clerk f Curts Lancaster Cunty District Attrney s Office Lancaster Cunty Drug & Alchl Cmmissin Lancaster Cunty Drug Task Frce Lancaster Cunty EMS Cuncil Lancaster Cunty Mayr s Assciatin Lancaster Cunty Prisn Lancaster Cunty Public Defender s Office Lancaster Cunty Recvery Alliance Lancaster Family YMCA Suth Central PA Opiid Awareness Calitin St. Thmas Episcpal Church T.W. Pnessa & Assciates The Gate Huse The Hershey Cmpany The Ranch Pennsylvania The RASE Prject United Disabilities Services United Way f Lancaster Cunty UPMC Pinnacle Water Street Missin Health Services WellSpan Ephrata Cmmunity Hspital WellSpan Philhaven White Deer Run Treatment Center Yga fr Recvery YWCA Lancaster In additin, numerus cmmunity members have participated in Jining Frces meetings and quarterly cmmunity frums withut representing an rganizatin. PAGE 45 STRATEGIC PLAN 2018

APPENDIX B STRENGTHS, WEAKNESSES, OPPORTUNITIES & THREATS (SWOT) ANALYSIS RESULTS Jining Frces Cmmunity Kickff Event Date: August 3, 2017 Lcatin: Pennsylvania Cllege f Health Sciences These tables shw raw data, as written by participants during the SWOT analysis. This has been incrprated int ur discussins f assets and gaps. While this cntributes t ur understanding f cmmunity cnditins, these respnses alne d nt necessarily reflect ur cmprehensive assessment. Strengths Pennsylvania Yuth Survey (PAYS) data cllectin Cmmitted teachers Weakness Lack f time Lack f cnsistency in messaging SCHOOLS Key Themes Opprtunities Early identificatin and interventin Educating teachers abut resurces available Threats Funding fr prgrams Stigma Strengths Willingness t help Agencies and calitins are willing t cllabrate and invlve Law Enfrcement in strategies Drug Curt/Treatment Curt Weakness Lack f surces fr referrals Individuals unable t access treatment due t lack f treatment beds Strengths Trained prfessinals Resurces have increased ver time LAW ENFORCEMENT Key Themes Opprtunities Prvide individuals with infrmatin abut treatment and rehabilitatin services Medicatin assisted treatment (MAT) in prisns Threats Stigma Safety cncerns Cst f legal services SERVICES FOR MENTAL HEALTH/CO-OCCURRING DISORDERS Weakness Unhealthy cping behavirs and self-medicatin Awareness f mental health and hw t access services Key Themes Opprtunities Better integratin f physical and mental health services Reduce stigma and raise awareness Threats Lack f access t psychiatry/medicatin management Stigma PAGE 46 STRATEGIC PLAN 2018

Strengths Resurces and treatment lcatins have increased ver time Weakness Services are fragmented, lack f crdinatin f treatment and resurces Strengths Strng cmmunity with already established vlunteers Weakness Placing blame n individuals, mral judgments Strengths Many resurces and services exist in the cmmunity Centers f Excellence fr treatment Drug Curt/Treatment Curt Weakness Lack f supprt fr reentry int emplyment Strengths Crdinating and cming tgether Cmmunicatin between schls, hspitals, calitins Strng cnnectins thrughut cmmunity Weakness Nt enugh representatives f cmmunity in the rm Lack f awareness f substance use disrders and resurces TREATMENT FOR SUBSTANCE USE DISORDERS Key Themes FAITH-BASED ORGANIZATIONS Key Themes RECOVERY SUPPORT SERVICES Key Themes COMMUNITY Key Themes Opprtunities Wrld Health Organizatin mdel Redefine 30-day treatment mdel Threats Lack f sustained funding fr treatment Refusals f treatment Opprtunities Use cmmunity t educate, increase awareness, and reduce stigma Threats Alienatin f members Stigma Opprtunities Increase awareness f services supprting recvery and transitins Threats Funding fr treatment Stigma High levels f burnut amng peer recvery supprt prfessinals Opprtunities Identify tp pririties Training fr vlunteers r laypersns Increase awareness Expand screenings Threats Funding Stigma and negative steretypes PAGE 47 STRATEGIC PLAN 2018

Strengths Prescribing guidelines already exist State PDMP has been implemented Weakness Lack f availability f services Lack f educatin HOSPITALS/PRESCRIBERS/DISPENSERS/ HEALTH SYSTEMS/EMERGENCY MEDICAL SERVICES Key Themes Opprtunities Cnsistent messaging Educatin Threats Lack f standardizatin Lack f funding Strengths Emplyee Assistance Prgrams (EAP) Chamber f Cmmerce invlvement Weakness Lack f financial investment High-stress wrk envirnments WORKPLACES Key Themes Opprtunities Increase awareness and supprt fr individuals with substance use disrders Wrk with insurance prviders Threats Lack f funding Stigma PAGE 48 STRATEGIC PLAN 2018

APPENDIX C ASSET MAPS The fllwing maps were created with infrmatin available as f January 1, 2018. FIGURE 1. COMMUNITY MOBILIZING GROUPS FIGURE 1. DETAIL ASAP Lititz Clumbia Life Netwrk Elanc Calitin fr a Drug Free Cmmunity Elizabethtwn Area Cmmunities that Care Ephrata Cares Factry Ministries Manheim Twnship Cmmunity Life Task Frce Dnegal Substance Abuse Alliance Penn Manr Bridges Task Frce Slanc Family Life Netwrk Lancaster Cmmunities that Care Prject Lazarus f Lancaster Cunty Lancaster Cunty Recvery Alliance Lancaster Cunty Recvery Huse Calitin PAGE 49 STRATEGIC PLAN 2018

FIGURE 2. SCHOOLS IMPLEMENTING EVIDENCE-BASED PREVENTION PROGRAMS PAGE 50 STRATEGIC PLAN 2018

FIGURE 2. DETAIL Schl Name Akrn Elementary Bainbridge Elementary Bear Creek Schl Buchanan Elementary Burrwes Elementary Centerville Elementary Clay Elementary Clumbia Jr/Sr High Schl Cnestga Elementary De Run Elementary Dnegal Intermediate Dnegal Junir High Schl Dnegal High Schl E.R. Martin Schl East High Elementary East High Street Elementary East Petersburg Elementary Elizabethtwn Middle Schl Ephrata High Schl Ephrata Intermediate Schl Ephrata Middle Schl Fultn Elementary Fultn Elementary Garden Spt High Schl Hamiltn Elementary Hand Middle Schl Hans Herr Elementrary HC Burgard Elementary Hempfield High Schl Highland Elementary Jhn Beck Elementary Jhn Bnfield Elementary JP McCaskey High Schl Lcatin Akrn Bainbridge Elizabethtwn Lancaster Lancaster Lancaster Ephrata Clumbia Cnestga Manheim Marietta Munt Jy Munt Jy Lancaster Elizabethtwn Elizabethtwn East Petersburg Elizabethtwn Ephrata Ephrata Ephrata Ephrata Lancaster New Hlland Lancaster Lancaster Lancaster Manheim Landisville Ephrata Lititz Lititz Lancaster Kissel Hill Elementary Kraybill Campus (LMS) LaFayette Elementary Lancaster Mennnite Main Campus Landis Run Intermediate Schl Landisville Middle Schl Lela Elementary Letrt Elementary Lincln Middle Schl Lititz Elementary Lcust Grve Campus (LMS) Manheim Central High Schl Manheim Central Middle Schl Manheim Christian Manheim Twnship High Manr Middle Schl McCaskey High Schl East Mill Rad Elementary Muntville Elementary New Danville Campus (LMS) Our Lady f Angels Penn Manr High Schl Resurrectin Parchial Reynlds Middle Schl Rheems Elementary Rss Elementary Martin Meylin Middle Schl Warwick Middle Schl Washingtn Elementary Whartn Elementary Wheatland Middle Schl Cnestga Christian Schl Lititz Munt Jy Lancaster Lancaster Lancaster Landisville Lela Washingtn Br Lancaster Lititz Lancaster Manheim Manheim Manheim Lancaster Lancaster Lancaster Elizabethtwn Muntville Lancaster Clumbia Millersville Lancaster Lancaster Rheems Lancaster Lancaster Lititz Lancaster Lancaster Lancaster Mrgantwn PAGE 51 STRATEGIC PLAN 2018

FIGURE 3. PRESCRIPTION DRUG TAKE-BACK LOCATIONS PAGE 52 STRATEGIC PLAN 2018

FIGURE 3. DETAIL Facility Name Lcatin Clumbia Br PD 308 Lcust St. Clumbia, PA 17512 Suthern Reginal PD 3284 Main St. Cnestga, PA 17516 East Earl Twp PD 128 Tdday Dr. East Earl, PA 17519 Darrenkamps Pharmacy 191 S. Ridgeview Rd. Elizabethtwn, PA 17022 Nrthwest Reginal PD 155 Merts Dr. Elizabethtwn, PA 17022 Slan's Nrlanc Pharmacy 428 Clverleaf Rd. Elizabethtwn, PA 17022 Ephrata PD 124 Suth State St. Ephrata, PA 17522 West Lampeter Twp. PD 852 Village Rd. Lampeter, PA 17537 East Lampeter Twp. PD 2259 Old Philadelphia Pike Lancaster, PA 17602 Lancaster C. Adult Prbatin 40 East King St. Lancaster, PA 17602 Lancaster C. Sheriff's Dept. 50 Nrth Duke St. Lancaster, PA 17603 Manheim Twp. PD 1825 Municipal Dr. Lancaster, PA 17601 West Hempfield Twp. PD 3401 Marietta Ave. Lancaster, PA 17601 East Hempfield Twp. PD 1700 Nissley RD. Landisville, PA 17538 Lititz Br PD 7 Suth Brad St. Lititz, PA 17543-1401 Manheim Br PD 211 N. Charltte St. Manheim, PA 17545 Slan's Manheim Pharmacy 73 S. Main St. Manheim, PA 17545 Millersville University PD 237 N. Gerge St. Millersville, PA 17551 Darrenkamps Pharmacy 945 E. Main St. Munt Jy, PA 17552 Munt Jy Br PD 21 E. Main St. Munt Jy, PA 17552 Slan's Munt Jy Pharmacy 61 E. Main St. Munt Jy, PA 17552 Slan's Muntville Pharmacy 2 Cllege Ave. Muntville, PA 17554 New Hlland PD 436 East Main St. New Hlland, PA 17557 Nrthern Lancaster C. Reginal PD 860 Durlach Rd. Stevens, PA 17578 Strasburg Br PD 145 Precisin Ave. Strasburg, PA 17579 Quarryville Br PD 300 St. Catherine St. Quarryville, PA 17566 PAGE 53 STRATEGIC PLAN 2018

FIGURE 4. DETOX & SHORT-TERM INPATIENT TREATMENT LOCATIONS FIGURE 4. DETAIL Organizatin Name Lcatin Detxificatin Inpatient Treatment Nuestra Clinica Residencial (Spanish American Civic Assciatin) Lancaster X Retreat Premier Addictin Treatment Center Ephrata X X White Deer Run Lancaster X X PAGE 54 STRATEGIC PLAN 2018

FIGURE 5. MEDICATION ASSISTED TREATMENT (MAT) PROVIDERS PAGE 55 STRATEGIC PLAN 2018

FIGURE 5. DETAIL Organizatin Name Address Subxne/ Methadne Vivitrl Buprenrphine Maintenance Abbeyville Family Medicine 101 Abbeyville Rad, Lancaster X Addictin Recvery Systems f 2192 Embassy Drive, Lancaster Lancaster X X X Buck Family Medicine 34 Fawn Drive, Quarryville X Center City Family Health 38-42 West Orange Street, Lancaster X Cllege Avenue Family Practice 250 Cllege Avenue, Lancaster X Cmprehensive Care 554 Nrth Duke Street, Lancaster X Cunty Line Family Medicine 5360 Lincln Highway, Gap X Crked Oak Family Medicine 1655 Crked Oak Drive, Lancaster X Dwntwn Family Medicine 540 Nrth Duke Street, Lancaster X East Petersburg Family Medicine 5665 Main Street, East Petersburg X Elsie Shenk Outpatient Center 211 East Mifflin Street, Lancaster (Gaudenzia) X Ephrata Health Pavilin 175 Martin Avenue, Ephrata X Family & Maternity Medicine 694 Gd Drive, Lancaster X Gearty and Skiles Cunseling 107 East Lcust Street, Ephrata X X Gearty and Skiles Cunseling 321 Market Street, Lancaster X X Lancaster Freedm Center 436 Nrth Lime Street, Lancaster X Lincln Family Medicine 1635 West Main Street, Ephrata X Lititz Family Medicine 562 West Secnd Avenue, Lititz X Lititz Family Medicine - Kissel Hill 51 Peters Rad, Lititz X Manheim Family Medicine 700 Lancaster Rad, Manheim X Manheim Family Medicine - 544 Nrth Penryn Rad, Manheim Pleasant View X Manr Ridge Family Medicine 2113 Manr Ridge Drive, Lancaster X Manr Ridge Family Medicine - 701 Nrth Duke Street, Lancaster Dwntwn X Mastrpietr & Assciates Family 2145 Nll Drive, Lancaster Medicine X Munt Jy Family Medicine 1001 Crnerstne Drive, Munt Jy X Naaman Center 248 Maple Avenue, Quarryville X X Naaman Center 39 West Vine Street, Lancaster X X Naaman Center 4600 East Harrisburg Pike, Elizabethtwn X X Naaman Center 835 Hustn Run Drive, Gap X X New Hlland Family Medicine 676 East Main Street, New Hlland X Nrlanc Family Medicine 418 Clverleaf Rad, Elizabethtwn X Nuestra Clinica (SACA) 545 Pershing Avenue, Lancaster X Parkesburg Family Medicine 950 Suth Octrara Trail, Parkesburg X Penn State Medical Grup General 2301 Clumbia Avenue, Lancaster Internal Medicine X PAGE 56 STRATEGIC PLAN 2018

Penn State Medical Grup Suth 2605 Willw Street Pike, Willw Lancaster Street X Quentin Family Medicine 1701 Crnwall Rad, Lebann X Randali Centre 2207 Oregn Pike, Lancaster X Sutheast Lancaster Health Services 333 Nrth Arch Street, Lancaster X Sutheast Lancaster Health Services 625 Suth Duke Street, Lancaster X Strasburg Family Medicine 1135 Hampden Drive, Strasburg X Susquehanna Cunseling 591 Stnehenge Drive, Lititz X Susquehanna Family Medicine 1159 River Rad, Marietta X T.W. Pnessa and Assciates 410 Nrth Prince Street, Lancaster Cunseling Services X The RASE Prject 131 East Orange Street, Lancaster X X Twin Rse Family Medicine 306 Nrth 7th Street, Clumbia X UPMC Pinnacle Lititz 1500 Highlands Drive, Lititz X Walter L. Aument Family Health 317 West Chestnut Street, Center Quarryville X WellSpan Internal Medicine 446 Nrth Reading Rad, Ephrata X Willw Street Family Medicine 222 Willw Valley Lakes Drive, Willw Street X PAGE 57 STRATEGIC PLAN 2018

FIGURE 6. LONG-TERM RESIDENTIAL TREATMENT FACILITIES FIGURE 6. DETAIL Organizatin Name Lcatin Lng-Term Residential Treatment (ver 30 days) Gate Huse fr Men Muntville X X Gate Huse fr Wmen Lititz X X Vantage (Gaudenzia) Lancaster X Mans Huse (DARS) Clumbia X Nuestra Clinica Residencial (SACA) Lancaster X Retreat Premier Addictin Treatment Center Ephrata X White Deer Run Lancaster X Halfway Huse PAGE 58 STRATEGIC PLAN 2018

FIGURE 7. SUPPORT & MUTUAL SELF-HELP GROUPS PAGE 59 STRATEGIC PLAN 2018

FIGURE 7. DETAIL Organizatin Address AA Al-Ann NA 521 Club 2400 Butter Rad, Lancaster X Ascensin Lutheran Church 600 Penn Grant Rd, Willw Street X BASE, Inc. 447 S Prince Street, Lancaster X Bellevue Presbyterian Church 810 Newprt Rd, Gap X Bethany Presbyterian Church 23 N West End Ave, Lancaster X X Bethel Outreach Center 512 E Strawberry Street, Lancaster X Brightside Opprtunity Center 515 Hershey Ave, Lancaster X Calvary Church 1051 Landis Valley Rd, Lancaster X Chiques United Methdist Church 1215 E Main Street, Munt Jy X X Christ Lutheran Church 125 E High Street, Elizabethtwn X Cleman Chapel Rute 501, 1980 Furnace Hills Pike, Brickerville X Cmmunity Bible Church 331 Andersn Ferry Rad, Munt Jy X Cmmunity Mennnite Church 328 W Orange Street, Lancaster X X Cngregatin Shaarai Shmayim 75 East James Street, Lancaster X Crnerstne Baptist Church 80 W Brubaker Valley Rd, Brickerville X Cvenant Methdist Church 110 N Mulberry Street, Lancaster X Crssrad Brethren in Christ Church 800 Dnegal Springs Rd, Munt Jy X Ebenezer Baptist Church 701 N Line Street, Lancaster X Emmanuel Lutheran Church 540 W Walnut St, Lancaster X Emmanuel United Methdist Church 30 N Church St, Brwnstwn X Ephrata Cmmunity Hspital 169 Martin Ave, Ephrata X Faith United Methdist Church Fruitville Pike & Kser Rd, Lititz X First Presbyterian Church 101 S. Decatur St, Strasburg X First Presbyterian Church 140 E Orange Street, Lancaster X First Presbyterian Church 7 Marietta Ave, Munt Jy X First Refrmed Church 40 E Orange St, Lancaster X X First United Methdist Church 29 E Walnut Street, Lancaster X X First United Methdist Church 5th & Walnut Sts, Clumbia X Grace Evangelical Church 131 Terrace Ave, Ephrata X Grace Evangelical Church Rute 272 & Fultn Street, Akrn X Grace Lutheran Church 517 Nrth Queen St, Lancaster X Grup Muddy Creek Lutheran Church 11 Muddy Creek Rd, Rute 272, Denver X UPMC Pinnacle Lititz 1500 Highlands Drive, Lititz X Hempfield United Methdist Church 3050 Marietta Ave, Lancaster X X Hly Spirit Lutheran Church 3131 Clumbia Ave, Lancaster X X Hpe United Methdist Church 3474 Rthsville Rd, Ephrata X Lancaster General Hspital 555 N Duke Street, Lancaster X Lancaster YWCA 110 N Lime St, Lancaster X Lighthuse Assembly f Gd 105 Earland Rd, New Hlland X Lititz Church f the Brethren 300 W Orange Street, Lititz X Little Britain Presbyterian Church 255 Little Britain Church Rd, Peach Bttm X Manheim Brethren in Christ 54 Nrth Penryn Rd, Manheim X Marietta Cmmunity Chapel 1125 River Rd, Marietta X X Millersville University 51 Lyte Rd, Millersville University X Mravian Church 8 Church Square, Lititz X New Hlland United Methdist Church 120 W Main St, New Hlland X X New Hpe Church 351 Market Street, Marietta X Old Mill Building Rthsville Rd & Piersn Rad, Lititz X Otterbein Methdist Church N. Queen & Clay St, Lancaster X Ptter Huse - Millersville University 214 N. Prince St, Millersville X X PAGE 60 STRATEGIC PLAN 2018

Presbyterian Church 360 Lcust St, Clumbia X Redeemer Lutheran Church 500 Pearl St, Lancaster X X Rss Street Methdist Church 312 E Rss Street, Lancaster X Salem United Church f Christ 2312 Marietta Ave, Lancaster X Smithville Church f Gd Rute 272 & Pennsy Rd, New Prvidence X Spanish American Civic Assciatin (SACA) 545 Pershing Ave, Lancaster X St. Anthny's Church 501 E Orange Street, Lancaster X St. Catherine f Siena Church 955 Rbert Fultn Hwy, Quarryville X St. Edwards Episcpal Church 2453 Harrisburg Pike, Lancaster X St. James Cathlic Church 505 Wdcrest Ave, Lititz X X St. Jhn Neumann Church 601 E. Delp Rd, Lancaster X St. Jhn's Episcpal Church 321 W Chestnut St, Lancaster X X St. Jhn's United Church Of Christ 432 E Reading Rd, East Earl X St. Jseph's Church 400 St. Jseph's Street, Lancaster X St. Luke United Church f Christ Orange St & Marietta Ave, Lancaster X St. Luke's Episcpal Church 209 S Market Street, Munt Jy X St. Paul's United Church Of Christ 4th & Church Sts, Quarryville X St. Paul's United Church Of Christ 50 N Main St, Manheim X St. Paul's United Methdist Church 398 N Lcust Street, Elizabethtwn X St. Paul's United Methdist Church 100 W Main St, Muntville X St. Peter's Lutheran Church 10 Delp Rd, Lancaster X St. Peter's United Church Of Christ 816 Buchanan Ave & Cllege Ave, Lancaster X St. Thmas Episcpal Church 301 Saint Thmas Rd, Lancaster X Trinity Church 450 W Main Street, Muntville X Trinity Lutheran Church 31 S Duke Street, Lancaster X Trinity United Church f Christ 2340 State St, East Petersburg X X Trinity United Methdist Church 422 Main Street, Denver X United Church f Christ 247 S Market Street, Elizabethtwn X United Methdist Church 210 Market St, Lititz X United Methdist Church Duke & Walnut Sts, Lancaster X Universalist Unitarian Church f Lancaster 538 W Chestnut St, Lancaster X Wagnwrks Apartments 920 Plane Street, Clumbia X Willw Street United Church f Christ 2723 Willw Street Pike, Willw Street X X Zin Church f Millersville 317 N Gerge St, Millersville X Zin Lutheran Church 18 Quarry Rd, Leacck-Lela-Bareville X Zin Lutheran Church 435 Main Street, Akrn X X Zin Lutheran Church High & Hazel Streets, Manheim X Zin United Church f Christ 900 Winter Hill Rd, Strasburg X Zin United Church f Christ Winterhill & Old Rds, New Prvidence X PAGE 61 STRATEGIC PLAN 2018

APPENDIX D GOAL DETAIL GOAL 1: STRENGTHEN EVIDENCE-BASED PREVENTION & INTERVENTION EFFORTS OBJECTIVE 1 Increase the percentage f public schls ffering evidence-based substance use preventin prgrams frm 50% (57) t 75% (85) by 2023. N=115 schls. OUTCOME INDICATORS Number f children receiving evidence-based substance abuse preventin educatin. Baseline: As f January 1, 2018, 4363 students in Lancaster Cunty received evidence-based prgramming in the 2017-2018 schl year. STRATEGY ACTION STEP MEASURED BY OWNER GOAL CONTRIBUTORS 1.1 Engage and assist schls in identifying and implementing evidencebased preventin prgramming and plicies Distribute Best Practices fr Chsing Schl Based Preventin brchures Educate schl leaders n evidence-based, schl/family-based preventin curricula Train schl staff t implement prgrams Number f brchures distributed Number f meetings held with superintendents, curriculum crdinatrs, r wellness cuncils t intrduce and r supprt schl-based preventin prgram Number f schls that utilize internal staff fr curriculum Cmpass Mark, Penn Medicine Lancaster General Health Cmpass Mark, Penn Medicine Lancaster General Health Cmpass Mark, Penn Medicine Lancaster General Health Prvide staff t facilitate instructin Number f schls that utsurce curriculum instructin Cmpass Mark, Penn Medicine Lancaster General Health COBYs ALIGNMENT WITH EVIDENCE-BASED PRACTICES Facilitate and engage schls in prviding evidence-based practice prgrams in schls (SAMHSA) RECOMMENDED POLICY CHANGES Advcate fr funding fr primary preventin prgramming in schls PAGE 62 STRATEGIC PLAN 2018

GOAL 1: STRENGTHEN EVIDENCE-BASED PREVENTION & INTERVENTION EFFORTS OBJECTIVE 2 Expand access t prescriptin drug dispsal mdalities by 2023. Baseline and frmalized prcess t be determined. OUTCOME INDICATORS Ttal weight f drugs cllected in take-back bxes. STRATEGY ACTION STEP MEASURED BY OWNER GOAL CONTRIBUTORS 2.1 Expand access t prescriptin drug take-back lcatins. Increase number f physical lcatins at municipal buildings and pharmacies Number f take back lcatins Lancaster Cunty Sheriff Pharmacy Assciatin (SCPA Opiid Awareness Calitin) Expand accessibility f existing take-back lcatins Number f hurs available per week Lancaster Cunty Sheriff 2.2 Prmte prper prescriptin drug dispsal Distribute infrmatin and prmte the use f prescriptin drug take-back lcatins Explre prmtin and/r distributin f dispsal bags with prescriptins Number f rack cards distributed Creatin f feasibility study/white paper Penn Medicine Lancaster General Health Penn Medicine Lancaster General Health Cmpass Mark (includes Cmmunity Calitins), D&A Cmmissin, EMS, Lancaster Chamber, Lancaster Cunty Recvery Alliance, Let's Talk, Mayr's Assciatin, Pharmacy Assciatin, Law Enfrcement, Prbatin & Parle, Suth Central PA Opiid Awareness Calitin Pharmacy Assciatin ALIGNMENT WITH EVIDENCE-BASED PRACTICES Cnnect affected individuals and families t apprpriate recvery resurces and cmmunity educatin (1,3) Prvide technical assistance fr Cmmunity Calitins t advance evidence-based prgrams and best practices (3) PAGE 63 STRATEGIC PLAN 2018

GOAL 1: STRENGTHEN EVIDENCE-BASED PREVENTION & INTERVENTION EFFORTS OBJECTIVE 3 Increase percentage f first respnder agencies (plice, fire, EMS) that receive nalxne (acquired with grant funding) frm 14% (16) t 100% (118) by 2023. OUTCOME INDICATORS Number f emergency respnse events where nalxne was used Number f first respnders reprting nalxne dses administered STRATEGY ACTION STEP MEASURED BY OWNER GOAL CONTRIBUTORS 3.1 Increase access t nalxne and apprpriate educatin and training Facilitate distributin f nalxne t individuals, families, prfessinals and rganizatins Lcate funding and ther channels fr increased access t nalxne fr first respnders Number f dses distributed Ttal grant dllars received Cunty f Lancaster Cunty f Lancaster EMS, Law Enfrcement, Prbatin and Parle, Suth Central PA Opiid Awareness Calitin EMS, Law Enfrcement, Prbatin and Parle, Suth Central PA Opiid Awareness Calitin ALIGNMENT WITH EVIDENCE-BASED PRACTICES Equip law enfrcement with Nalxne tlkits and Nalxne administratin educatin (CDC, SAMHSA, DOJ) Facilitate the distributin f Nalxne and/r infrmatin t individuals and families dealing with piid addictin (CDC, SAMHSA) RECOMMENDED POLICY CHANGES Advcate fr funding fr nalxne fr first respnders, individuals, and families dealing with piid addictin. PAGE 64 STRATEGIC PLAN 2018

GOAL 1: STRENGTHEN EVIDENCE-BASED PREVENTION & INTERVENTION EFFORTS OBJECTIVE 4 Increase percent f individuals wh receive warm handff in emergency department. OUTCOME INDICATORS Percent f individuals wh accept the warm handff in the emergency department. The RASE Prject will be prviding data fr this measure. STRATEGY ACTION STEP MEASURED BY OWNER GOAL CONTRIBUTORS 4.1 Supprt and expand warm handffs with certified recvery supprt specialists Ensure that current warm handff prgram has the apprpriate capacity t handle referrals/requests Number f certified recvery supprt specialists RASE Prject Suth Central PA Opiid Awareness Calitin ALIGNMENT WITH EVIDENCE-BASED PRACTICES Cnnect affected individuals and families t apprpriate recvery resurces and cmmunity educatin (SAMHSA) Develp capacity fr referring patients with substance abuse issues t evidence-based addictin care and ER warm handff (SAMHSA) PAGE 65 STRATEGIC PLAN 2018

GOAL 2: SATURATE THE COMMUNITY WITH UNIFIED MESSAGING OBJECTIVE 1 Increase the number f impressins frm 56,359 (2017) t 100,000 annually by 2023. OUTCOME INDICATORS Ttal number f impressins STRATEGY ACTION STEP MEASURED BY OWNER GOAL CONTRIBUTORS 1.1 Develp and disseminate cnsistent messaging, accurate infrmatin abut piids, and where t get help 1.2 Educate cmmunity grups, calitins, rganizatins, and emplyers 1.3 Strengthen cmmunity mbilizing effrts, and partnerships Cntinue t identify and utilize cnsistent messaging via key cmmunicatin channels Cntinue t distribute infrmatin regarding prper use, strage, and dispsal f prescriptin drugs Cntinue t distribute infrmatin abut where t get help fr piid misuse, dependence, r use disrder Prvide educatinal prgrams fr cmmunity members abut a variety f issues related t substance use disrders, piids, and verdse preventin Prvide infrmatin t individuals, families, and rganizatins abut the warning signs f an verdse and what t d Cntinue t prvide technical assistance t cmmunity calitins and rganizatins t advance evidence-based prgrams, best practices, and mbilizing effrts Cntinue t hld and expand Quarterly Frums Disseminate infrmatin t diverse cmmunity stakehlders and rganizatins PAGE 66 STRATEGIC PLAN 2018 Number f materials distributed Number f rganizatins distributing materials Number f educatinal prgrams held by emplyers, schls, cmmunity events, and faith-based rganizatins Number f peple reached by educatinal prgrams Number f cmmunity mbilizing grups receiving technical assistance Number f rganizatins participating in Quarterly Frums Penn Medicine Lancaster General Health Cmpass Mark Cmpass Mark Penn Medicine Lancaster General Health Cmpass Mark (includes Cmmunity Calitins), D& A Cmmissin, EMS, Lancaster Chamber, Lancaster Cunty Recvery Alliance, Let's Talk, Mayr's Assciatin, Pharmacy Assciatin, Law Enfrcement, Prbatin and Parle, Suth Central PA Opiid Awareness Calitin D & A Cmmissin, EMS, Lancaster Chamber, Lancaster Cunty Recvery Alliance, Let's Talk, Mayr's Assciatin, Pharmacy Assciatin, Law Enfrcement, Prbatin and Parle, Suth Central PA Opiid Awareness Calitin Cmpass Mark, D&A Cmmissin, EMS, Lancaster Chamber, Lancaster Cunty Recvery Alliance, Let's Talk Lancaster, Mayr's Assciatin, Pharmacy Assciatin, Law Enfrcement, Prbatin and Parle, Suth Central PA Opiid Awareness Calitin

1.4 Implement cuntywide marketing and public awareness campaigns 1.5 Prvide up-t-date infrmatin n the Jining Frces website and print materials fr cunty-wide disseminatin Engage members f recvery cmmunity t share their experiences Launch a billbard campaign in key lcatins thrughut Lancaster Cunty Cntinue t maintain a cmprehensive website with publicly accessible cunty-wide data, infrmatin, and resurces Cntinue t make data and tracking measures publically available n the Jining Frces website. Number f presentatins by individuals in recvery Number f recveryriented cmmunity events Number f participants in recvery-riented cmmunity events Number f Jining Frces billbards in Lancaster Cunty Number f website impressins Lancaster Cunty Recvery Alliance Penn Medicine Lancaster General Health Penn Medicine Lancaster General Health RASE Prject, Cmpass Mark ALIGNMENT WITH EVIDENCE-BASED PRACTICES Distribute infrmatin t the cmmunity n the apprpriate use, strage and dispsal f prescriptin piids (SAMHSA) Cnnect affected individuals and families t apprpriate recvery resurces and cmmunity educatin (SAMHSA) Prvide technical assistance fr Cmmunity Calitins t advance evidence-based prgrams and best practices (SAMHSA) Facilitate disseminatin f infrmatin fr recvery and preventin in the faith-based cmmunity and link individuals and families t lcal resurces. (SAMHSA) Educate emplyers n the issue, the ptential impact n their bttm line, and share best practices and resurces. (SAMHSA) Prvide resurces t emplyers n signs and symptms f impaired emplyees, best practices in EAP prgrams, wrkplace plicies, etc. (SAMHSA) Prvide pprtunities fr individuals in recvery t share their stries in an effrt t increase awareness and decrease stigma (SAMHSA) PAGE 67 STRATEGIC PLAN 2018

GOAL 3: ENCOURAGE & SUPPORT CULTURAL CHANGE WITHIN THE MEDICAL COMMUNITY OBJECTIVE 1 Decrease the piid dispensing rate per 1,000 residents as measured by the Pennsylvania Prescriptin Drug Mnitring Prgram (PDMP) and reprted n the PDMP Interactive Data Reprt. 2017 baseline 161.5. Targets t be determined by Pennsylvania PDMP. OUTCOME INDICATORS Percent change in number f dispensins. Dispensing rate in cmparisn t reginal, state, and natinal statistics. STRATEGY ACTION STEP MEASURED BY OWNER GOAL CONTRIBUTORS 1.1 Equip healthcare prviders with data and tls needed t imprve piid prescribing, including utilizatin f the PDMP and CDC prescribing guidelines 1.2 Educate prviders abut recmmended prescribing guidelines and ther tls 1.3 Standardize piid prescribing metrics t effectively track prgress and imprvements in prescribing practices 1.4 Supprt the use f alternative treatments fr pain management Develp resurce center fr management f chrnic pain with supprt t implement multimdal pain plans Encurage prviders t avid cncurrent piid and benzdiazepine prescribing Supprt plicies t limit the number f piid prescriptins and the number f piids in each prescriptin Increase capacity fr referrals fr patients with substance use issues r disrders t utpatient r inpatient treatment Standardize the way prviders educate patients abut the prper use, strage, and dispsal f prescriptin piids Prvide educatin/cme events fr prviders abut recmmended guidelines and tls t aid in apprpriate prescribing Standardize and supprt the use f PDMP registry Develp and utilize metrics t track prvider piid prescribing and ther factrs Develp and implement prtcl develped fr acute pain management fr cmmn pain diagnses t prvide alternative treatment plans and limit piid prescribing Prvide targeted educatin and pain management resurces fr prviders and patients Resurce center created Number f prviders educated Metrics develped Prtcl develped Suth Central PA Opiid Awareness Calitin Suth Central PA Opiid Awareness Calitin Suth Central PA Opiid Awareness Calitin Suth Central PA Opiid Awareness Calitin PAGE 68 STRATEGIC PLAN 2018

ALIGNMENT WITH EVIDENCE-BASED PRACTICES Implement multimdal pain plans whenever pssible and reduce the number f piids used (CDC) Opiids are nt first line therapy and shuld be used in cnjunctin with nnpiid/nnpharmaclgical therapies fr chrnic pain (SAMHSA) Develp capacity fr referring patients with substance abuse issues t evidence-based addictin care and ER warm handff (SAMHSA) Assess ptential risks f actins f patient prir t prescriptin (CDC) Check PDMP registry (SAMHSA) Educate prviders n use (and availability) f multimdal pain plans whenever pssible t reduce the number f piids used (CDC) Educate prviders t avid cncurrent piid and benzdiazepine prescribing (CDC) RECOMMENDED POLICY CHANGES Advcate fr insurance cverage f alternative treatments fr pain management PAGE 69 STRATEGIC PLAN 2018

GOAL 4: IMPROVE ACCESS TO TREATMENT & RECOVERY SUPPORT & INCREASE UTILIZATION OF SERVICES OBJECTIVE 1 Increase number f publically funded detx beds frm 7 t by 2023. OUTCOME INDICATORS Number f publically funded detx beds in Lancaster Cunty. Percent f D&A detx placements within Lancaster Cunty. STRATEGY ACTION STEP MEASURED BY OWNER GOAL CONTRIBUTORS D&A Cmmissin ALIGNMENT WITH EVIDENCE-BASED PRACTICES Prvide supprt fr treatment and recvery prgrams (CDC, SAMHSA) RECOMMENDED POLICY CHANGES PAGE 70 STRATEGIC PLAN 2018

GOAL 4: IMPROVE ACCESS TO TREATMENT & RECOVERY SUPPORT & INCREASE UTILIZATION OF SERVICES OBJECTIVE 2 Increased access t treatment by 2023. Targets t be determined. Data prvided by Lancaster SCA and Capital Area Behaviral Health Cllabrative, Inc. OUTCOME INDICATORS STRATEGY ACTION STEP MEASURED BY OWNER GOAL CONTRIBUTORS 2.1 Expand warmhandff prgrams and navigatin services t supprt effective entries int treatment. Prmte infrmatin abut where t get help, such as 211, Cmpass Mark, and ther surces f infrmatin and referrals Number f calls t 2-1-1 fr substance use issues. Number f calls t Cmpass Mark fr substance use issues. Number f calls t White Deer Run fr substance use issues. Cmpass Mark, D&A Cmmissin United Way 2-1-1 Supprt and expand Prisn Dr t Dr Prject Number f individuals served by the Prisn Dr t Dr prgram Prisn/Prbatin & Parle D&A Cmmissin Evaluate ED warm-handff and feasibility f expanding t hspital inpatient discharge Prmte utilizatin f Student Assistance Prgrams within schls Number f individuals served by the ED warm handff prcess Number f students successfully referred int treatment frm SAP team Penn Medicine Lancaster General Health Cmpass Mark, Penn Medicine Lancaster General Health EMS, Law Enfrcement, Prbatin and Parle, Suth Central PA Opiid Awareness Calitin D&A Cmmissin 2.2 Supprt the use f evidence-based therapy mdalities t address mental health and substance use issues Prvide educatin and supprt fr prviders t administer MAT Streamline cnnectins t cunseling, treatment, and ther resurces fr individuals with substance use disrders and c-ccurring disrders Number f MAT Prviders Number f Certified Recvery Supprt Specialists. Number f screening and referrals fr mental health and substance use issues Penn Medicine Lancaster General Health Let s Talk Lancaster Suth Central PA Opiid Awareness Calitin PAGE 71 STRATEGIC PLAN 2018

2.3 Reduce barriers t treatment and recvery services Regularly assess and develp strategies t address barriers t treatment Barrier assessment D&A Cmmissin Let s Talk, Suth Central PA Opiid Awareness Calitin ALIGNMENT WITH EVIDENCE-BASED PRACTICES RECOMMENDED POLICY CHANGES Cnnect affected individuals and families t apprpriate recvery resurces and cmmunity educatin (SAMHSA) Develp capacity fr referring patients with substance abuse issues t evidencebased addictin care and ER warm handff (SAMHSA) Strengthen pre-trial drug diversin prgrams t ffer individuals the pprtunity t enter int substance use treatment (SAMHSA, DOJ) Prvide supprt fr treatment and recvery prgrams (CDC, SAMHSA) Increase screening by Primary Care Prvider fr anxiety, depressin & stress, and streamline cnnectins t cunseling and ther resurces fr c-ccurring cnditins (SAMHSA) Advcate fr funding fr Student Assistance Prgrams. Advcate fr funding and insurance cverage fr treatment and recvery services. Increase the availability f financial assistance fr treatment. PAGE 72 STRATEGIC PLAN 2018

APPENDIX E SHORT-TERM OUTCOME MEASURES Organizatin/Calitin Cntributing t Measure Reducing Deaths frm Opiids & Herin: Shrt Term Measures Suth Central PA Opiid Awareness Calitin Lancaster Cunty Recvery Alliance Anti-Herin Task Frce Cmpass Mark Plice/ Crrectins/ Curts Lancaster Chamber Let's Talk Lancaster Lancaster Cunty Drug & Alchl Cmmissin Lancaster EMS Cuncil Number f materials distributed Prper Use, Strage and Dispsal f Prescriptins X X X Prescriptin Take Back Pstcards X X X X X X X D & A Brchure X X X X X X X Green Wallet Cards X X X X X X X Number f external links t website Number f website hits Opiid dispensing rate per 1000 residents Number f educatinal prgrams held at emplyer sites X X X Implementatin f advcacy prgram t increase cverage fr treatment and recvery services X X Number f Nalxne Kits distributed X X Number f Lancaster Cunty businesses with EAP Prgrams X X Percentage f patients screened fr depressin in primary care setting X X PAGE 73 STRATEGIC PLAN 2018