Using CommunityBased Participatory Evaluation to Reduce Opioid Overdoses
Using Community-Based Participatory Evaluation to Reduce Opioid Overdoses Presenters: Leslie Aldrich, MPH Danelle Marable, MA Erica Clarke, MA
MGH Center for Community Health Improvement Collaborates with community and hospital partners to build and sustain healthier communities, and to enhance the hospital's responsiveness to patients and community members from diverse backgrounds.
Community Based Participatory Evaluation (CBPE) Our Definition: To continually assess and evaluate community based programming or interventions using CBPR principles within the Strategic Prevention Framework model.
CBPR Principles n n n n Recognizes community as a unit of identity Builds on strengths and resources within the community Facilitates collaborative partnerships Mutual benefit of all partners Promotes co-learning and empowering process Cyclical and iterative process Addresses health from both positive and ecological perspectives Disseminates findings and knowledge gained to all partners Israel, B. et. al. (1998).
Strategic Prevention Framework SAMHSA
Community Based Participatory Evaluation Assessment Infrastructure Implementation Measure fidelity and effect of program Profile population needs, resources, and readiness to address needs and gaps Formulize community values Evaluation & Stakeholders Collect qualitative and quantitative data at every step Community Ownership Capacity/ Partnerships Measure capacity in coalition And in community to address needs Planning Reciprocal Relationships Develop Logic Model Discuss feasibility of Strategic Plan. Define standards of success Collaboration Aldrich, L. , Silva, D. , Marable, D. , Sandman, E. , & Abraham, M. (2009). Using Community-Based Participatory Evaluation (CBPE) Methods as a Tool to Sustain a Community Health Coalition. The Foundation Review, 1 (1), 146 -157.
What is a Community Coalition? n n n “An organization of individuals representing diverse organizations, factions or constituencies who agree to work together in order to achieve a common goal” (Feighery and Rogers, 1989, p. 4) “An organization of diverse interest groups that combine their human and material resources to effect a specific change the members are unable to bring about independently” (Brown, 1984, p. 4) “By these definitions, coalitions are interorganizational, cooperative, and synergistic working alliances” (Butterfoss, Goodman & Wandersman, 1993, p. 316)
Why CBPE works well with Coalitions… n n n Fits well with Coalition Framework, processes and guiding principles Stakeholders already at the table Focus is on building, supporting and sustaining relationships
Mass. CALL 2 – Opioid Overdose Prevention n Federal block grant (SAMHSA) issued to states to identify and respond to a substance abuse or mental health concern Massachusetts combed data and pinpointed a need to reduce opioid overdose throughout the state Revere & Charlestown awarded $80 - $100, 000 to assess Opioid Overdoses in their communities and create a strategic plan to address the issue
Charlestown Substance Abuse Coalition (CSAC) Presenter: Danelle Marable Additional Authors: Beth Rosenshein Toni Weintraub Susan Crowley
Assessment Data Sources n Quantitative Data: v n MA Registry of Vital Records and Statistics, MA Division of Health Care Finance and Policy, MA Bureau of Substance Abuse Services, MGH Patient Data, Charlestown Recovery House Hotline, Boston Police Department, Boston EMS Qualitative Data: 29 Key Stakeholder Interviews Sectors: substance abuse & Hep C prevention/treatment providers, first responders, criminal justice, health centers, emergency department, hospitals, family members, persons in recovery, active users v 4 Focus Groups Sectors: Family members, persons in recovery, residents of housing developments v
Opioid Overdose Prevention Committee n n Began with Community Forum June ‘ 08 Meetings every 2 weeks, Wednesday 10 am & 6 pm Staff & Consultants met in weeks between Sectors: community residents, recovery community, health care providers, outpatient and residential substance abuse treatment providers, criminal justice system, public housing residents, public housing management
Utilization of OOPC n n Identified stakeholders & resources in community, participated in interviews, recruited of interviewees/focus group members, provided community/program level data Interpreted/validated data, identified data gaps, analyzed/prioritized intervening variables, selected strategies
Quantitative Data Summary n Demographics: n n Prevalence of fatal/non-fatal opioid overdoses: n n n 7 deaths and 120 non-fatal unintentional poisonings in an acute care setting occurred from 2004 -2006 95 ED visits & 113 Inpatient visits with opioid abuse, dependence, and/or poisonings in 2006 Opioid: n n Deaths from opioids - White, English speaking between the ages of 20 -44 Heroin, also mixing with benzodiazepines Treatment: n In FY 2006, 673 people were admitted to SA treatment services from Charlestown. n 66% of those admitted were due to heroin use, 7% other opioids
Selecting Key Intervening Variables & Strategies n n n Large sticky paper on walls with intervening variable on each Each person given 10 dots to ‘vote’ Voted on each of the 5 questions asked Variables with highest number of votes became focus Reviewed strategies that could effect variables in a timely manner
Intervening Variables & Selected Strategies Intervening Variables n n n Price, Purity and Availability Concomitant use (Especially Opiates and Benzos) Changes in tolerance/ Relapse Access to Care and services after an OD Barriers to calling 911 during an OD (Especially due to fear of police involvement and housing eviction) Selected Strategies n n Use Community Health Worker/Disease Management Model to work with families and recovering addicts to educate and link to services in order to reduce overdose Convene city-wide collaborative to address issues regarding barriers to calling 911
Update Since Assessment n Hired Community Health Worker Part of OOPC n Community resident, known to many n Has substance abuse counseling certificate n Connections made with detox & residential treatment services and jails/prisons n n 911 task force in talks with police and housing developments to clarify policies n Good Samaritan Law
City of Revere & Revere CARES Coalition Presenter: Erica Clarke Additional Authors: Leslie Aldrich Susan Crowley
Assessment Data Sources n Quantitative Data: v n MA Registry of Vital Records and Statistics, MA Division of Health Care Finance and Policy, MA Bureau of Substance Abuse Services, Revere Board of Health, MGH Patient Data, Cataldo EMS Data for Revere Qualitative Data: v 26 Key Stakeholder Interviews Sectors: subst. abuse & HIV/AIDS prevention/treatment providers, first responders, criminal justice, board of health, health centers, media/communications, schools, emergency department, hospitals, family members, persons in recovery v Revere CARES Coalition Opiates Task Force
Opiates Task Force n n First formed in 2004 - as a response to recent local opioid overdose deaths Sectors include: police, fire department, ambulance, mental health & substance abuse treatment, schools, criminal justice, Suboxone providers, family members, health centers Re-engagement of Coalition’s Opiate Task Force through Mass. CALL 2 grant 5 meetings from August 08 – January 09 n n Assessment & Capacity/Partnerships: Identified stakeholders, participated in interviews, recruited interviewees, provided community/program level data Planning & Implementation: Interpreted/validated data, identified data gaps, analyzed/prioritized intervening variables, selected strategies
Quantitative Data Summary n Demographics: n n Prevalence of fatal/non-fatal opioid overdoses: n n Heroin, also mixing with benzodiazepines Treatment: n n n 26 deaths and 194 non-fatal unintentional poisonings in an acute care setting occurred from 2004 -2006 Causes of overdoses: n n Deaths from opioids – Typically White, English-speaking, men between the ages of 25 -54 In 2007, 1196 people were admitted to SA treatment services from Revere. 54% of those admitted were due to heroin use, 26% other opioids, and 45% injected drugs Admission rate for SA treatment for injection use of heroin increased from 2003 to 2006 Emergency Department Visits: n In 2007, Revere’s rate of opioid-related ED visits was greater than that of Boston
Selecting Key Intervening Variables & Strategies n n n Task Force reviewed grid of most common intervening variables (12 total) identified in data/interviews. Evaluators facilitated the group discussion of each variable where criteria for prioritization was discussed. Notes were taken on discussion and 6 IV’s rose to the top. Once IV’s were prioritized, the group selected strategies most appropriate for the community.
Intervening Variables & Selected Strategies Intervening Variables n Mixing drugs – particularly benzodiazepines, alcohol, cocaine n Users have misconceptions about risks of OD/addiction n Users do not call 911 for fear of arrest n Opioid use after a period of non -use/Loss of tolerance n Previous non-fatal overdose n Underlying/co-morbid mental health issues Selected Strategies n Educational Trainings for users, bystanders (friends and family) & providers n Outreach to Users and Bystanders Data Source: Key Stakeholder Interviews, Prioritized by Task Force n OD Risk factors for OD, OD prevention/management strategies, recognize the signs of OD, emphasize the need to contact EMS n Provide info on Narcan and where to receive more training on it in order to carry and administer it n Outreach to active users on the street and in homes in the community
Update Since Assessment n 6 Trainings implemented since May: 2 Provider trainings – 31 participants n 4 User & Bystander trainings – 96 participants n n Outreach/Trainers: 2 Outreach Workers/Trainers – 10 hours per week n 1 Peer Educator – 2 to 5 hours per week n
Benefits of the CBPE approach in the Mass. CALL 2 Assessment Based on capacity of the coalitions and community readiness, the CBPE approach resulted in a thorough assessment and realistic implementation plan that complimented the task force/committee goals Stakeholders were engaged and had ownership of data Capacity/Partnerships: Forging relationships, collaborations in preparation for implementation of the plan Planning: Identification of intervening variables, strategies and implementation plan appropriate for community, based on resources, readiness, etc. New stakeholders involved engagement of some TF/Committee members to the larger Coalition Hired those involved in assessment to implement strategies
Concluding Points n n CBPE is an effective way of incorporating evaluation into coalition work and provides the highest quality of data for strategic planning and coalition development. CBPE can help build relationships and encourage stakeholder involvement leading to increased capacity.
References Brown, C. (1984). The Art of Coalition Building: a Guide for Community Leaders. The American Jewish Committee, New York. Butterfoss, Goodman & Wandersman (1993). Community Coalitions for Prevention and Health Promotion. Health Education Research, 8, 315 -330. Feighery and Rogers (1989). Building and Maintaining Effective Coalitions. Published as Guide No. 12 in the series How-To Guides on Community Health Promotion. Stanford Health Promotion Resource Center, Palo Alto, CA. Israel, B. , Schulz, A. , Parker, E. , & Becker, A. (1998). Review of Community-Based Research: Assessing Partnership Approaches to Improve Public Health. Annu. Rev. Public Health, 19, 173 -202. Strategic Prevention Framework. U. S. Department of Health & Human Services Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP).
Acknowledgements n n n n Revere CARES Opiate Task Force OOPC in Charlestown Interview & focus group participants Anne Marie Tesora Shari Sprong Margie Henderson DPH and BPHC
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