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Community Overdose Action Team

State: OH Type: Model Practice Year: 2019

Goal(s) and objectives of practice The growing drug epidemic has been identified as a priority health concern in Montgomery County Ohio, and efforts to address it through community collaboration and partnership are ongoing. In the fall of 2016, PHDMC, Montgomery County Commission and ADAMHS partnered together to create the Community Overdose Action Team (COAT). The COAT is a multidisciplinary action team that includes individuals from following disciplines: state and local elected officials, public health, local and state law enforcement, Drug Enforcement Administration, fire/EMS, criminal justice, emergency management, healthcare, pharmacy board, medical board, substance prevention and treatment professionals, harm reduction, coroner's office, academia, business owners, child welfare, recovery housing owners, grassroots advocacy agencies, those in recovery, family members and citizens. Its primary goal is to reduce the number of fatal and non-fatal drug overdoses in Montgomery County. Community members and organizations participate in one of eight branches of the structure with the following objectives: Prevention - Prevent substance misuse from starting and identify those who have already begun to misuse substances and intervene early. Treatment and Recovery - Expand access to treatment and community support programs. Illegal Drug Supply - Decrease the supply of illegal opioids and other illicit substances. Response Develop emergency plans to respond to individuals in crisis or a large casualty event of mass overdoses at one time in Montgomery County. Increase collaboration with police and fire/EMS in responding to overdose calls. Harm Reduction - Increase capacity of harm reduction programming (example: syringe exchange, naloxone distribution, etc.) to effectively provide overdose prevention and engage individuals in support services. Prescription Opioids - promote best practices for opioid prescribing; raise awareness and knowledge about the dangers of opioids. Criminal Justice - Expand access to and utilization of treatment options in the criminal justice system. Education and Information Raise awareness and knowledge of the dangers of opioids and illicit drug misuse by implementing public awareness activities. The COAT structure also includes: Steering Committee The Steering Committee is led by one of the Montgomery County Commissioners. It is comprised of community leaders, including elected officials, from federal, state and local public entities as well as private organizations throughout Montgomery County. The Steering Committee meets quarterly and acts as an advisory committee to guide the overall vision and direction of the COAT. Backbone Support The Backbone Support guides the vision and strategies, approves the Incident Action Plans and assists with mobilizing resources for the branches as needed. Planning Section The Planning Section guides the development of the 30-day Incident Action Plans. Operations Section The Operations Section provides technical assistance to the branches for implementation of the Incident Action Plans. Joint Information Center The Joint Information Center is comprised of several county agency Public Information Officers who create common messaging for the public, respond to media requests, assist with increasing public awareness of the issue and convene monthly media briefings. Data Committee The Data Committee's role is to monitor opioid use and opioid related morbidity and mortality. The Data Committee members include epidemiologists from public health, university researchers, and county and private agency data analysts. The Data Committee provides the branches with needed data to support implementation of efforts. The Data Committee also produces bi-yearly reports for the public as well as weekly surveillance on the number of unintentional overdose deaths in the county. What did you do to achieve the goals and objectives? Steps taken to implement the program In August 2016, Montgomery County Commissioners convened a county-wide training on the Collective Impact Model” to develop guidance for collaboratives to work together under common goals and promote intergovernmental cooperation and coordination in addressing shared problems. In September 2016, Montgomery County Commissioners organized a community-wide forum to request community stakeholders to convene and work together to address the opioid epidemic. Public Health - Dayton & Montgomery County and Montgomery County Alcohol, Drug Addiction and Mental Health Services have taken the lead to coordinate these efforts. In November 2016, the Community Overdose Action Team was fully operational. Process milestones included: Collect data on the opioid epidemic Public Health Dayton & Montgomery County began to collect data on unintentional drug overdose deaths in 2010. Complete the Community Health Improvement Plan - Public Health Dayton & Montgomery County facilitated the completion of the Community Health Improvement Plan in 2015. One of the top three health priorities for the county was Behavior Health. Although Behavioral Health was identified as a priority, the plan included 3 year goals. Decrease the number of unintentional drug overdose deaths - Montgomery County's unintentional drug overdose deaths increased from 127 deaths in 2010 to 351 deaths in 2016. Coordinate local efforts to respond to the increase of drug overdose deaths - In September 2016, Montgomery County leaders convened to coordinate a county-wide emergency response utilizing the Incident Command System(ICS) framework to align resources. Eight Operations Branches were created based on national and state strategies identified as best practice to respond to the opioid crisis. Develop the response structure - In October 2016, Operation Branch co-leads were identified. These co-leads were identified as subject matter experts in their area or profession and identified to hold the knowledge, skills and abilities to lead the branch efforts. Implement the response structure - In November 2016, The Community Overdose Action Team (COAT) was fully operational under an ICS framework with eight operations branches and operating under 30 Incident Action Plans. Over 200 individuals were recruited to serve as COAT members. Collect and analyze data to assist in data driven decisions The Data Unit if the COAT was developed to convene partner agencies and increase data sharing. The Data Unit produces bi-annual reports to inform the COAT of progress to population health objectives. Public Health Dayton & Montgomery County also publishes a Poisoning Death Review Report yearly. In April 2018, the COAT moved to 60 day operational periods, but all eight branches remain active. ???????Any criteria for who was selected to receive the practice (if applicable)? Over 200 individuals from participating agencies, citizens and those in recovery sit on one of the eight branches of the COAT. The branches are responsible for creating action items that are aligned with national and state strategies, which is produced and reported through Incident Action Plans every 60 days. What was the timeframe for the practice where other stakeholders involved? The COAT was developed as an emergency response and was operational within three months of the time that development began. Stakeholders were involved from the beginning. What was their role in the planning and implementation process? What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s) Montgomery County agencies and residents were ready for action and there was a willingness to volunteer time, align efforts and consider pooling of resources to address the opioid epidemic. Although there were multiple coalitions that were in existence and responding to the crisis, there was little to no alignment among efforts and little change in population health was observed. The COAT did not take the place of current collaboratives, but aligned all goals and objectives under one common agenda that is based on national and state strategies that have demonstrated effectiveness. The ICS provided Montgomery County with an operation structure to align resources and force collaboration. Public Health Dayton & Montgomery County (PHDMC) wanted to elevate the crisis to an emergency, so we took an active role in filling key positions that were needed for coordination. The key positions included: Backbone Support co-leads; Operations Section and Planning Section leads; Data Committee co-leads and Joint Information Center co-leads. PHDMC staff recruited COAT members and sit on all branches. Any start up or in-kind costs and funding services associated with this practice? Please provide actual data, if possible. Otherwise, provide an estimate of start-up costs/ budget breakdown. The Community Overdose Action Team did not require any new local financial assistance. The COAT structure allowed for collaboration and alignment to occur with organizations to address gaps in services and address any duplication in services. The COAT members have also worked together to diversify funding opportunities and increase state and federal grant funding. Several collaborative partnerships have developed. Over $11 million dollars of state and federal funding has been secured for new programs. Additionally, a reallocation of $3.5 million dollars of local funding contributed to program enhancement and/or expansion. The cost of implementation of the Community Overdose Action Team (COAT) was minimal. Montgomery County agencies and residents were ready for action and there was a willingness to volunteer time, align efforts and consider pooling of resources to address the opioid epidemic. No new personnel positions were created for the COAT, but reallocation of personnel time was required to stand up the National Incident Command framework in which Public Health Dayton & Montgomery County and Montgomery County Alcohol, Drug Addiction and Mental Health Services (ADAMHS) took an active role in filling key positions that are needed for coordination. The key positions included: Backbone Support co-leads; Operations Section and Planning Section leads; Data Committee co-leads and Joint Information Center co-leads. Each of these positions require an average of 5 to 15 hours per week. The strength of the National Incident Command framework is that it can be increased or decreased based on the need of the community.
What did you find out? To what extent were your objectives achieved? Please re-state your objectives. Its primary goal is to reduce the number of fatal and non-fatal drug overdoses in Montgomery County. Community members and organizations participate in one of eight branches of the structure with the following objectives: Prevention - Prevent substance misuse from starting and identify those who have already begun to misuse substances and intervene early. Treatment and Recovery - Expand access to treatment and community support programs. Illegal Drug Supply - Decrease the supply of illegal opioids and other illicit substances. Response – Develop emergency plans to respond to individuals in crisis or a large casualty event of mass overdoses at one time in Montgomery County. Increase collaboration with police and fire/EMS in responding to overdose calls. Harm Reduction - Increase capacity of harm reduction programming (example: syringe exchange, naloxone distribution, etc.) to effectively provide overdose prevention and engage individuals in support services. Prescription Opioids - promote best practices for opioid prescribing; raise awareness and knowledge about the dangers of opioids. Criminal Justice - Expand access to and utilization of treatment options in the criminal justice system. Education and Information – Raise awareness and knowledge of the dangers of opioids and illicit drug misuse by implementing public awareness activities. Since its inception, the COAT has developed, expanded, or enhanced over 50 programs and services to meet the need of the branch priority areas. The COAT structure has also allowed for collaboration and alignment to occur with organizations to address gaps and reduce any duplication in services. The COAT members have worked together to diversify funding opportunities and increase state and federal grant funding. Since its inception, over $11 million dollars have been secured for new or existing programs. Additionally, a reallocation of $3 million dollars of local funding contributed to program enhancement and/or expansion. Some of the results/outcomes are highlighted: A Joint Information Center was created to ensure consistent messaging. Monthly media briefings are held to inform the public of key initiatives. Overdose alert system of created to inform first responders of increases in overdoses. Develop mutual aid agreements among law enforcement and fire/EMS departments to assist in response efforts. Sheriff's Office began coordinating law enforcement blitzes to target high drug trafficking neighborhoods. Sheriff's Office began coordinating faith based town hall meetings to engage the faith based community in efforts. Youth Led Prevention Programs increased from 5 to 8 programs. Over 400 people have been trained in Generation Rx, medication safety training, and over 40 people have become trainers. Alternatives to Pain Management Education was sent out in the Montgomery County water bills through Environmental Services reaching 80,000 county residents. Increased subacute (residential) detoxification beds from 8 to 14, which increased capacity from 415 to 730 people per year. Developed ambulatory (outpatient) detoxification services that are 24 hours 7 days per week. Over fifty Peer Recovery Specialists have been trained and certified. Recovery Alliance of Montgomery County was created to build alliance and alignment of the county recovery organizations. Developed policy templates for Fire/EMS and Law Enforcement departments to furnish Naloxone to the public. Expanded syringe services from 1 to 3 sites. These sites also now furnish naloxone to the public. Twenty-four of 29 law enforcement departments are now administering naloxone. Screening, Brief Intervention and Response to Treatment (SBIRT) training is now offered to prescribers and SBIRT has been implemented in one school system and will expand to 7 in 2019. Kettering Health Network developed PAUSE. PAUSE is a pathway for physicians and pharmacists to manage chronic or benign pain. It is about taking a moment to pause and consider alternatives to opioids Montgomery County Juvenile Court established a Family Treatment Court to work with families with drug addicted parents and reduce the risk of youth entering into the foster care system. Montgomery County Common Pleas Court has implemented a mental health court. Quick Response Teams have expanded from one team to eight to respond to individuals after an overdose. Wellness to Work Program was launched to assist employers in developing drug free workplace polices and support assistance for those who are addicted. Families of Addicts support meetings have increased from one time per week to three and attendance now averages 75 individuals per week. Think Again” media campaign to education as well as confront the stigma around addiction. Mobile target advertising was completed in high risk zip code areas. # Voices Project was launched by Indigo Life Media to convey stories of hope from those in recovery. Over 3000 Overdose Support Toolkit postcard packets were distributed to fire/EMS and the Quick Response Teams. These packets include local resources information on how to seek help. Yearly data report and a six-month data report was created by the Data Committee GetHelpNow App launched, which is a free app to find resources for addiction and mental health. Over 10,000 drug disposal deactivation pouches were distributed in the community. Developed a curriculum and trained high school athletic trainers on prevention opioid misuse among student athletes. Dayton was chosen as a DEA 360 site. Partnered with Drug Enforcement Agency for Drug Take Back Day. DEA 360 Youth Dance Program with DCDC was implemented at Ruskin and West Wood Elementary Schools. Revived and Renewed: Addiction from a Child's Perspective” video was launched to highlight the impact of addiction on Children. Eleven Conversations For Change events were held. These events are open to the public to learn about treatment and other community resources and receive Narcan training. Resource page www.opioidassist.com was developed. Expansion of 2 new residential services and 7 recovery houses. Implemented court ordered diagnostic assessments within the county jail. Implemented medication assisted treatment in the county jail. Expansion of Narcan distribution from one entity, Project DAWN, to Public Health – Dayton & Montgomery County and police departments who now furnish Narcan to the public. Public Health – Dayton & Montgomery County Sanitarians developed Exposure to Unknown Substances” in response to businesses requesting information on procedures to follow if employees are exposed to fentanyl. Health officials also began to train businesses on procedures to furnishing Narcan on site. Bridget's Path began operation to provide inpatient medical care for drug-exposed newborns. Public Health – Dayton & Montgomery County developed a community based treatment team to serve individuals who are addicted and due to barriers to treatment cannot engage in an office based treatment program. The treatment is offered in the home of the individual. Implemented a county-wide notification system that notifies treatment providers if a client has overdosed and entered into an emergency room. Did you evaluate your practice? List any primary data sources, who collected the data, and how? (if applicable) List any secondary data sources used. (if applicable) List performance measures used. Include process and outcome measures as appropriate. Describe how results were analyzed. Were any modifications made to the practice as a result of the data findings? Data is collected and analyzed by the COAT Data Committee and Public Health Dayton & Montgomery County Epidemiologists. The data collected and analyzed include: Poisoning Death Review Data: Overdose trends by month and year Demographic information on individuals who have died Health conditions of individuals who have died Criminal history of individuals who have died Drugs involved in overdose deaths Incident of overdoses and county of residence Years of potential life loss Data Committee Review of Data: Drug overdose death data Drug overdose emergency department visits Drug overdose law enforcement calls Harm reduction initiatives data – naloxone distribution and syringe services Drug seizure and forfeitures Prescription opioids Treatment data provided by the Alcohol, Drug Addiction and Mental Health Services Overdose and intervention trends by quarter Data Sources Include: Montgomery County Alcohol, Drug Addiction & Mental Health Services (ADAMHS), CarePoint Syringe Services, Dayton Metropolitan Medical Response System, Dayton Police Department Narcotics Bureau, EpiCenter Syndromic Surveillance, Montgomery County Coroner's Office, JusticeWeb Criminal Justice, Miami Valley Bulk Smuggling Task Force, Montgomery County Regional Dispatch, Regional Agencies Narcotics and Gun Enforcement (R.A.N.G.E.) Task Force The data is provided to the Epidemiology at Public Health – Dayton & Montgomery County and is analyzed in aggregate in bi-annual and annual reports. The findings in these reports result from the compilation and interpretation of multiple data sets from the COAT partner agencies. The reports describe changes in unintentional drug overdose deaths and identify drug overdose and intervention trends. The data is reported out to all the branches of the COAT, to county coalitions and to the public. The data is used by the COAT branches and drives data driven decisions to identify gaps and measure progress of implemented strategies. Since the inception of the COAT, many new programs have been implemented based on data.
Lessons learned in relations to practice. Identify a proposed structure and have a plan for implementation Identify key goals and objectives in advance Engage key leaders and officials and educate these individuals on the need Incident Command Structure can be used as a key resource and can be scaled to the needed response. Partners have moved from only an emergency response to developing prevention strategies. Lessons learned in relation to partner collaboration. Aligning efforts under one structure has yielded many positive outcomes. Key partners have learned to work together and have increased service delivery where needed and have decreased a duplication of services. Did you do a cost/benefit analysis? If so, describe. No cost/benefit analysis has been completed to date, but preliminary numbers for the first six months of 2018 show we are making progress. Between January-June 2017 and January-June 2018, the number of overdoses decreased according to the following five indicators: Overdose Emergency Department Visits ?73% (2,590 to 705) EMS Overdose Runs ?68% (1,383 to 438) Law Enforcement Overdose Calls ?66% (2,239 to 761) Drug Overdose Deaths ?65% (379 to 132) Naloxone Doses Administered by EMS ?60% (1,790 to 715) The Community Overdose Action Team members have completed many accomplishments since its inception in 2016, and this collaborative, community-wide approach will continue make an impact in combating the problem of addiction in our community. ???????Is there sufficient stakeholder commitment to sustain the practice? Describe sustainability plans. Public Health – Dayton & Montgomery County, as well as its key partners confirms its long-term commitment to the COAT with sustainability as a priority. Sustained funding for this program will be sought through a commitment from the COAT partners and funding through the Human Services Levy, as well as state and federal funding opportunities.
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