NCADD Juneau Strategic Plan · Web viewStrategic Planning Grant Intent Overview/abstract Assessment...

NCADD Juneau Strategic PlanStrategic Prevention Framework – Partnerships for SuccessNon-medical Use of Prescription Opioids and Heroin Use

TABLE OF CONTENTS

Acknowledgements…………………………………………………………………………………. iStatement of Grant Intention………………………………………………………………………. iiOverview………………………………………………………………………………………........... iiiAssessment…………………………………………………………………………………………… 1Capacity Building……………………………………………………………………………………...8Strategic Planning…………………………………………………………………………………….15Implementation……………………………………………………………………………………….26Evaluation……………………………………………………………………………………………...36Appendices……………………………………………………………………………………………44

ACKNOWLEDGEMENTS

ACKNOWLEDGEMENTS

The National Council on Alcohol and Drug Dependence in Juneau wishes to thank the many community agencies and stakeholders who participated in various phases and in different capacities throughout the strategic planning process, including participation in Opioid Workgroup meetings, participation on special committees, participation in planning meetings, and simply reviewing draft documents and plans. Participants represent the following groups and organizations:

Advisory Board on Alcoholism and Drug Abuse Juneau Re-Entry Coalition Gastineau Human Services Southeast Alaska Regional Health Consortium Central Council Tlingit and Haida Indian Tribes of Alaska Rainforest Recovery Center Alaska Division of Public Health Juneau Alliance for Mental Health Inc.

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GRANT INTENT

Statement of Grant IntentionThe PFS grant is intended to prevent non-medical use of prescription opioids (NMUPO) among 12-25 year olds and heroin use among 18-25 year olds across Alaska. PFS sub-recipients will place the majority of their focus on the prevention/reduction of NMUPO and heroin use, if required, through the implementation or amendment of local policies, practices, systems, and environmental change. The primary focus population is 12-25 year olds – which can be reached both in and/or outside of the school setting. Secondary focus populations (e.g., parents, prescribers, etc.) can be served provided that the effects of any services delivered to these groups are likely to have an impact on past 30-day use of prescription opioids among 12-25 year olds and heroin use among 18-25 year olds in the community.

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OVERVIEW/ABSTRACT

Overview/ AbstractJuneau, Alaska is a city of approximately 32,000 people located in Southeast Alaska. Juneau is an isolated landmass, accessible only by boat or plane, hemmed in by mountains, ice, or water on all sides. The city is the state capital and serves as a regional hub for commerce, transportation, and government activity. Because of this, many federal, state, and tribal operations are based in Juneau. According to the 2010 US Census, 35% of the population is under the age of 24, roughly 33% percent is age 25-44, and 25% is 45-64. The racial breakdown of the city and surrounding borough is approximately 70% Caucasian, 12% Native Alaskan, 6% Asian, and 5% Hispanic and Latino. The median household income as of 2010 was just over $62,000.

To reduce NMUPO and heroin use, NCADDJ have identified contributing factors and intervening variables in Juneau. For heroin use, contributing factors include (1) lack of knowledge among adults regarding the relationship between NMUPO and heroin use, (2) lack of knowledge among adults about the risks of heroin use, and (3) lack of patient knowledge of resources for disposal and/or behavior health supports. Intervening variable includes the perceived risk of harm. For NMUPO, community factors include (1) lack of knowledge among adults about risks of easy social access to Rx opioids, (2) lack of knowledge among adults about how to prevent social access to Rx opioids, (3) lack of convenient and/or recognized sites for adult community members to dispose of Rx opioids safely, (4) lack of patient knowledge of resources for disposal and/or behavioral health supports, (5) lack of knowledge in community on what constitutes an opioid/addictive properties, (6) Education/engagement with providers and prescribers, and (7) empowering prescribers.

Chosen strategies for heroin use include promotion of the RRC OBOT program, a media campaign, and the creation of an online resource. Strategies for NMUPO include a media campaign, pharmacy distribution campaign, creation of an online resource, a media campaign, prescribers pledge campaign, and promotion of CDC prescribing guidelines.

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ASSESSMENT

1.1. Assessment Data on Priority AreasNCADDJ’s data collection plan for the assessment was designed to portray the magnitude of the non-medical use of prescription opioids (NMUPO) and heroin use in Juneau by gathering and interpreting qualitative data, including data collected through surveys and interviews of community stakeholders, and through collecting and analyzing multiple sources of existing quantitative data. A combination of primary and secondary data sources was used for the assessment, and Juneau Opioid Workgroup discussions were used to help prioritize data collection efforts.

Partnering with local organizations and leaders to enhance data quality was a vital step in NCADDJ’s data collection process. Multiple community partners helped to identify key individuals and groups for interviews and surveys, aided in meeting facilitation, interviews, focus groups, and survey implementation, and offered invaluable local insight into the issues of non-medical use of prescription opioids and heroin use in Juneau.

Sources of Assessment Data: Primary Data Sources

Community Survey 248 surveys completed on Heroin and Prescription Opioid Use

Community Readiness Assessment 4 key stakeholder interviews conducted on NMUPO 5 key stakeholder interviews conducted on heroin use

Youth Survey (99 surveys) Focus Group

Secondary Data Sources Alaska Bureau of Investigation, Division of Alaska State Troopers (2015) Alaska Youth Risk Behavior Survey (2015) Alaskan Aids Assistance Association (2016) Center for Behavioral Health Research and Services (2016) State of Alaska Epidemiology (2015) Alaska Prescription Drug Monitoring Program (2016) Alaska Department of Commerce, Community, and Economic Development

(2016) Juneau Police Department (2016) Young Adult Substance Use Survey (2016) Alaska Health Facilities Data Reporting Program (2015) Juneau School District (2016-2017 school year) Bartlett Regional Hospital (2009-2016)

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ASSESSMENT

Rainforest Recovery Center (2010-2015) U.S. Census, 2010

Extent of the Problem

Prescription opioid-related emergency room discharges accounted for 0.6% of all emergency room discharges in Juneau in 2015. This closely reflects the statewide opioid-related emergency room discharge rate of 0.5% for the same year. Juneau aligns with statewide trends in other areas as well. Opioid-related discharges in Juneau were 42.6% male and 57.4% female; versus 45.9% male and 54.1% female statewide. Over 21% of opioid-related discharges statewide were patients aged 12-25 years old. Juneau reported less than half that rate at 10.3% total discharges for the same age range, differing significantly from the statewide rate. Over half of these discharges in Juneau were among Caucasian patients at 55.9%, versus 62.1% Caucasian statewide. Locally, 36.8% of discharge patients were Alaska Native, up from the statewide rate of 22%.

The Heroin and Prescription Opioid Use Survey created by NCADDJ included questions about heroin and prescription opioid consumption, perceptions, contributing factors, and consequences of use. The survey was administered to 248 respondents in the Juneau area. While the survey results are represented below, due to the age demographic of survey respondents, the project’s Opioid Workgroup chose to interpret these results with caution (the average age of the 248 respondents was 42 years old).

The survey results revealed the following concerning consumption of prescription opioids among 248 respondents:

o Almost half (47.2%) reported knowing someone who abuses prescription pain medications

o 13.1% report having ever abused prescription pain medicationso About a third (32.4%) report having ever taken a prescription pain

medication from a friend or relative that was not prescribed to them

YRBS data revealed that Juneau traditional high school students who have taken a prescription drug without a prescription in their life to be 15.5%, minimally higher

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ASSESSMENT

than the statewide rate of 14.6%. Juneau high school students reported taking prescription opioids without a prescription in the past 30 days at slightly higher than the state average, while reporting lifetime use of heroin at 1.9%, compared to 2.2% across Alaska, again following the general statewide consumption trend.

Per data from January 2009 to October 2016 the Rainforest Recovery Center (RRC), the Bartlett Regional Hospital treatment center for people experiencing substance abuse and other dependence disorders, has served approximately 703 people with an opiate use disorder. Approximately 57% (404) were female and 43% (299) were male. 35% (247) identified as being some part Alaska Native and most patients served were Caucasian at 57% (403). The rest of the population identified as Asian, African American, Hispanic, or Pacific Islander. 72% of the population was between the ages of 18 and 35 with the highest number of admissions at age 25. 16% of the population report being homeless while 84% report living in a private residence. Approximately 16 women were served who were pregnant (4%). 54% (378) reported being IV drug users. Employment status ranges from Disabled 14% (96), Unemployed 64% (450), Employed full or part time 15% (106), to Student, Seasonal, and Homemaker. 68% (479) reported being never married single, 12% (85) reported being married, 11% (76) reported being divorced, and 9% (63) reported being cohabitating, separated, or widowed.

Figure A. Heroin and Opiate Admissions in Residential Treatment (Rainforest Recovery Center)

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ASSESSMENT

2009 2010 2011 2012 2013 2014 2015 2016

2616

28

4731 31

21

4759

68 6779 75

5946

17

Heroin and Opiate Admissions in Residential Treatment

(Rainforest Recovery Center)

Heroin Other Opiates/Synthetics

In 2016, the Alaskan AIDS Assistance Association, also known as “Four A’s,” reported 594 exchange visits in Juneau. The Four A’s Syringe Access Program (FASAP) provides access to sterile syringes and other safer injection supplies for injection drug users. Of those visits, 406 individuals were male and 186 were female (2 unknown), approximately 62% were Caucasian and about 30% were Alaska Native or American Indian, and almost half (45%) were under the age of 29. 88 were first time visits to the program in 2016.1 A breakdown of the exchange visits by age for 2016 is provided in Figure B.

Figure B: Age Groups of all FASAP Participants, 2016 (n=594)

1 Alaskan AIDS Assistance Association, Four A’s Syringe Access Program, 2016

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ASSESSMENT

20160

50

100

150

200

250

300

22

248

215

97

111

19 & Under

20-29

30-39

40-49

50-59

Age Unknown (1)

Health Disparities Statement:

Based on the data, the community voiced concerns related to retail availability of prescription opioids and the increase in heroin use. The graduated relationship between prescription opioids and heroin use appear in conversations with key stakeholders, focus group members, and the national data. Data gathered from the YRBS, focus group, and stakeholders identified concerns about the heightened risk for NMUPO and heroin use among Native youth- the YRBS revealed a seven-percent gap in harm perception of heroin use between White and Native youth in Juneau. Additionally, the Alaskan AIDS Assistance Association reported 594 needle exchange visits in Juneau. Of those visitors accessing the program, 62% were Caucasian and about 30% were Alaska Native or American Indian. Prescription opioid-related emergency room discharges accounted for 0.6% of all emergency room discharges in Juneau in 2015. Of these, 36.8% of discharge patients were Alaska Native, compared to the statewide rate of 22%.

1.2. Vision Statement Related to Priority Area(s)

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ASSESSMENT

The vision of the Juneau Opioid Work Group is to “empower, collaborate, and engage with our neighbors, friends, and families to prevent and respond compassionately to the epidemic of opioid misuse in our community. Through this, we will improve community safety and general well-being.”

1.3. Assessing Intervening Variables and Community Factors Linked to Priority AreasIn effort to reduce NMUPO and heroin use in Juneau, NCADDJ sought out the community factors that contribute to the substance abuse behaviors. The prioritization process involved coalition members considering the assembled data, as well as their experiences, and engaging in a dialogue on the factors specific to Juneau that contribute to the misuse of prescription opioids and heroin.

The SPF-PFS model is structured such that the community factors contributing to NMUPO and heroin use are subjected to a prioritization process, accounting for importance and changeability measures of the selected factors. Prioritization was conducted over five separate meetings, as well as ongoing discussions with the scoring group. The prioritization process began in broad terms—brainstorming as a coalition to identify factors—and became increasingly specified as discussions continued. The coalition’s process utilized criteria such as trends (over time, as well as trends in factor frequency from differing data sources), severity, and source validity. The initial brainstorming yielded eight community factors for consideration.

A select group of coalition members, representing State agencies, tribal agencies, and substance treatment professionals were then tasked to bring the list of eight community factors down to a range of 2-4. Following facilitated discussion, the core group was asked to score each of the community factors on a prioritization worksheet using a four tier, low-to-high scale. The scores assessed both intangible and epidemiological criteria, which consider topics such as readiness, changeability, severity, and resources as well as the magnitude of the issue and national comparison. The scoresheet is intended to illuminate the degree to which a given community factor can and should be addressed by the community. The four-tier system gives points according to importance—a very high rating yields seven points, a high rating five, a medium three, and a low rating, one. The two criteria are weighted so that epidemiological criteria comprise 66% of the score, while intangible makes up 34%.

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ASSESSMENT

The community factors were chosen as follows: Lack of knowledge among the adult population about risks of easy social access to prescription opioids, lack of knowledge in the community about how to prevent social access to prescription opioids, lack of convenient and/or recognized sites for community to dispose of prescription opioids safely, a lack of access to disposal and behavioral health supports, limited community knowledge of what constitutes an opioid and what their risks are, a need for a structured prescribing program for providers to adhere to (including prescribing guidelines, CDC best practices, patient instruction), and patient education (including risk of misuse and proper disposal).

In choosing the community factors, the coalition considered both local and national data to inform the prioritization process. Results from YRBS data, local stakeholder interviews, local focus groups, reports from the CDC, and other peer-reviewed studies were the primary sources used for gathering information in the investigation.

Regarding prioritizing community factors, gaps existed in data surrounding the gross number of opioids prescribed in Juneau, and how that number compares to other communities across Alaska and nationally, as well as the main sources of the prescriptions. While the work of the coalition is not impeded by operating without this information, working with area healthcare providers, private practices, and local pharmacies will allow this data to be collected in the future. 1.4. Technical Assistance Needs Related to Assessment

Training and technical assistance will be provided to project directors and other staff as needed throughout the life of the grant through the State of Alaska. Anticipated TA includes focus group training, survey tips, data analysis, and other technical assistance related to data collection and assessment.

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CAPACITY BUILDING

2.1. Community and Key Stakeholder Involvement

Key stakeholders who are involved in the PFS project include representatives from pharmacies, local physicians, community foundations, assembly members, law enforcement, state legislators, area service providers, public health professionals, substance abuse professionals, representatives of state agencies, and other elected officials.

NCADDJ plans to engage members of the general community by maintaining active communication and through continuously sharing project updates and results. Project results will be shared with the coalition and community in numerous ways and through multiple channels. It is anticipated that by regularly sharing project results and progress, community readiness will continue to increase, as well as the likelihood for project sustainability and increased community involvement. Methods may include written reports, brochures, presentations, newspaper articles, attendance at local meetings, and/or radio interviews. The Project Coordinator will oversee communication, and key Juneau Opioid Workgroup members will also be provided with appropriate tools and language and enlisted to assist in these communications. Key outlets for effective sharing of results are described below:

NCADDJ PFS Monthly MeetingsNCADDJ will hold quarterly community meetings that include updates on collaborative community efforts, activities, and partnerships. These meetings will offer an opportunity to provide regular updates to existing and potential community stakeholders on project outputs, outcomes, and next steps.

Local MediaLocal newspapers offer opportunities for press releases and in-depth coverage of NCADDJ PFS efforts, Additionally, local radio stations offer opportunities for PSAs.

Juneau AssemblyReports to the City Assembly offer further opportunities for communication of project outcomes to the community. Assembly meetings are broadcast on the local radio station.

Community PresentationsPresentations can be made to key stakeholder groups in the community including Rotary, school staff, and health and human service providers about project outcomes. Presentations can also be given at organization board meetings and staff meetings

Internet

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CAPACITY BUILDING

Project outcomes will be shared via the project’s website and Facebook page

The Juneau Community Health FairBartlett Regional Hospital sponsors an annual health fair that is well attended by community members

2.2. Structure and Functioning

The Juneau Opioid Work Group brings together professionals in the community to provide input and insight on how opioid misuse and heroin use is being addressed in their respective fields. The primary venue for collaboration is at monthly coalition meetings, where each attendee provides an update, as well as solicits help and support from other group members. The coalition meetings are structured in a collaborative way, with each member doing their part to reach agreements, nurture meaningful dialog, and work toward common goals.

When decisions related to PFS milestones need to be made, the PFS coordinator outlines the relevant steps that need to be taken and reinforces the need to maintain fidelity to the PFS grant requirements. Decisions on smaller initiatives, (i.e. those that do not have generally prescribed formulas for determining the outcome) are reached with input from either the coalition or the core committee. The merits of any given option are debated in an open setting, and a consensus is reached among the group present (or the members engaged in settling the question at hand).

While the Juneau Opioid Work Group has worked tirelessly in its mission to prevent NMUPO and heroin use, it has not done so without its share of challenges. The group was formed in late 2015, and the SPF-PFS grant work began in September 2016. A major transition occurred in PFS management in May of 2017 with the onboarding of a new PFS coordinator. Volatility in management resulted in reduced capacity for coalition building that the framework relies on. While the coalition remains committed and confident in its ability to carry out the PFS grant requirements, the group has been hampered by the stops and starts resulting from staffing changes and difficulties in coalition building.

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CAPACITY BUILDING

Additionally, the Juneau Opioid Work Group was created in 2015 as a response to multiple overdose deaths of young people in the community. These events galvanized many agencies and stakeholders and brought them to the table to address the issues facing the community. Since then, the energy in the community has shifted somewhat, a reality noted by many in stakeholder interviews, and attributed to the tragic, catalyzing events that precipitated the group’s formation. The coalition has struggled with member attrition, and is working to combat the attrition, as well as the shifts in energy, by re-establishing connections with prior coalition meeting attendees. This is being done through meeting face-to-face with stakeholders and outlining the specific ways in which their agency can contribute to the development and implementation of initiatives within the community.

Figure C. NCADDJ PFS Organizational Chart

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CAPACITY BUILDING

2.3. Core Planning CommitteeThe Core Planning Committee was comprised of four coalition members, in addition to the grant coordinator, who had been present and active in coalition activities and represented multiple local agencies. Group members included Teri Tibbett, of the Advisory Board on Alcohol and Drug Abuse, Erin Maloney, of Rainforest Recovery Center, Claire Geldhof, Public Health Nurse with the State of Alaska, Don Haberger of the Juneau Re-Entry Coalition, Linda Landvik of NCADDJ, and Tina Deasis-Wright of the Central Council Tlingit and Haida Indian Tribes of Alaska (CCTHITA). The committee was formulated with a focus on inviting stakeholders in the community who represented a wide variety of interests and diverse perspectives. The Core Committee faced challenges related to general logistics, making Committee meetings that were separate from regular Coalition meetings difficult. Additionally, Committee members had varying levels of engagement with the process of strategy

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selection, resulting in stratified levels of buy-in among committee members. These challenges resulted in delays in coming to resolutions and with general decision making.

While the Committee faced challenges related to logistics and engagement, the primary challenge of the Committee was the turnover in grant management that made assembling and utilizing a Core Planning Committee less effective than it potentially could have been. The reality of time constraints limited the group’s ability to grow organically, which in turn impacted the Committee’s final efforts. As a unit, the Committee was ultimately able to work well together and address the interests of the community in efficient and functional ways given the context and barriers related to shifting personnel and time-constraints.

2.4. Capacity-Building Needs Related to Priority Areas

The community has a robust network of stakeholders that are engaged in trying to prevent and treat the non-medical use of prescription opioids and heroin use facing Juneau. The community’s strength is found in the active involvement of tribal health organizations, community leaders, law enforcement, social service organizations, among other key sectors, all of whom work closely with State and local officials to identify issues that need to be addressed in the community. As the capital of Alaska, Juneau’s proximity to the legislative body allows for effective and convenient collaboration between stakeholders and the State. In addition to proximity, the State’s urgency in dealing with the opioid crisis is a large asset in the effort to establish prevention strategies as it brings heightened community awareness to the issue. The ongoing, concerted effort by the Governor, Legislature, and city assembly to address the opioid crisis has helped to legitimize and invigorate the work done by stakeholders and community agencies.

Table 1. Capacity Planning Table

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CAPACITY BUILDING

Area of Growth/Capacit

y Need

How it will be

addressed

Who is Responsible

?

Timeline Measure of Success

Need for more members of the faith community to participate in coalition and bring additional perspective/resources

Linda and Riley will engage leadership of interfaith partners in Juneau to see if they can appoint a representative

Linda Landvik

Riley Neff Warner

October coalition meeting

Representative(s) from faith community become regular JOWG contributor

Need for City to take a more visible role in addressing opioid crisis

Riley will meet with Assembly to educate and suggest areas to get involved. Look into having the City draft a resolution declaring an emergency.

Riley Neff Warner

September 15th-ongoing

Presentation to Juneau Assembly, action by Assembly in form of resolution or other JOWG involvement (regular meeting attendance)

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CAPACITY BUILDING

Area of Growth/Capac

ity Need

How it will be

addressed

Who is Responsibl

e?

Timeline Measure of Success

Members of the JOWG (specifically Core Committee) work on expanding cultural competence

Training on risk factors specific to Alaska Natives, impact of intergenerational trauma, cultural healing practices, etc.

Riley Neff Warner

Tina DeAsis-Wright

Linda Landvik

Core Committee

March 1st 2018

Completed training or seminar on risk factors specific to Alaska Natives for opioid misuse

Retain and expand partnership between JOWG and JPD

Develop relationship with contact at JPD and create internal action plan for ways prevention efforts can be framed to assist law enforcement

Riley Neff Warner

Don Haberger

November 1st, 2017

Co-Sponsorship of heroin/NMUPO media campaign

JPD rep attending JOWG meetings

2.5. Technical Assistance Needs Related to

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CAPACITY BUILDING

CapacityTraining Opportunities for Coalition Members

In an effort to increase the capacity of the community to address NMUPO and heroin use, NCADDJ plans to provide related training opportunities to the community and to coalition members. Examples include:

Training in Community Readiness Assessment for key coalition members and other interested community members

Training in culturally sensitive approaches to prevention, recovery, and wellness in October, 2017

Wellness training for coalition members and other interested community members in October, 2017

The Project Coordinator and an additional coalition member will attend a behavioral health marketing training on developing effective marketing campaigns to influence health outcomes in February, 2018 and will provide an overview of this training and its key components to the project’s Opioid Workgroup, as well as act as a resource for the subject on an ongoing basis in the community

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STRATEGIC PLANNING

3.1. Planning ProcessStrategic planning occurred from June, 2017 – August, 2017 following the required protocol of the Strategic Prevention Framework Partnerships for Success Grant (SPF-PFS) from the State of Alaska. Strategic planning incorporated numerous discussions and brainstorming sessions of the project’s Opioid Workgroup from the onset of the project, as well as specific criteria required by SPF-PFS. While community members and other partners developed a wide array of recommended strategies and activities, it should be noted that not all of these fit into SPF-PFS grant guidelines or the project timeline, and thus are not included in this strategic plan. However, NCADDJ recognizes the importance of honoring and documenting these components as they are rooted in a great collective wealth of community history, understanding, and knowledge. A summary of all suggested strategies and activities are were documented in the planning process. It is hoped that through the work of the NCADDJ, together with capacity building activities described on pages 14-15, a strong foundation will be created from which activities not included in this strategic plan can be collaboratively launched in the community beyond the life of the SPF-PFS grant funding, which ends in July 2020.

3.2. Planning to Address Priority Areas

To reduce NMUPO and heroin use, NCADDJ have identified contributing factors and intervening variables in Juneau. For heroin use, contributing factors include (1) lack of knowledge among adults regarding the relationship between NMUPO and heroin use, (2) lack of knowledge among adults about the risks of heroin use, and (3) lack of patient knowledge of resources for disposal and/or behavior health supports. Intervening variable includes the perceived risk of harm. For NMUPO, community factors include (1) lack of knowledge among adults about risks of easy social access to Rx opioids, (2) lack of knowledge among adults about how to prevent social access to Rx opioids, (3) lack of convenient and/or recognized sites for adult community members to dispose of Rx opioids safely, (4) lack of patient knowledge of resources for disposal and/or behavioral health supports, (5) lack of knowledge in community on what constitutes an opioid/addictive properties, (6) Education/engagement with providers and prescribers, and (7) empowering prescribers.

In accordance with SPF specifications, the Juneau Opioid Work Group has made a

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STRATEGIC PLANNING

point of identifying health disparities related to NMUPO and heroin use in the community. The community assessment identified that Native Alaskan youth show a higher risk for heroin use than other populations in Juneau. Additionally, primary data suggests Alaska Natives comprise a percentage of opioid-related ER discharges in Juneau that exceeds their demographic proportion of the community. Addressing specific needs of the Alaska Native community has been a key component of strategy discussions. Efforts to integrate those needs, while guarding against stigmatization, will be a focus of further work done by the Coalition.

Chosen strategies for heroin use include:

promotion of the RRC OBOT program, a media campaign, and the creation of an online resource

Strategies for NMUPO include:

a media campaign, pharmacy distribution campaign, creation of an online resource, a media campaign, prescribers pledge campaign, and promotion of CDC prescribing guidelines

In choosing the strategies for preventing and reducing heroin use in Juneau, NCADD decided on implementing a media campaign as well as an online resource to address the demonstrated gap in knowledge in the community on the perception of risk of harm for heroin use. The efforts of the Coalition indicated that a sustained campaign of educating the community on risks of heroin use through various media channels and through the creation of a reliable online source for facts on heroin risks would effectively address the community factors and intervening variable of

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STRATEGIC PLANNING

the perception of risk of harm. Moreover, the online resource and media campaign will both contribute to fulfilling the required strategy of instituting an awareness campaign.

The promotion of the Rainforest Recovery Center Office-Based Opioid Therapy (OBOT, commonly known as MAT) is a strategy chosen to reflect the standard of care for opioid addiction, and a SAMHSA-approved practice for reducing the potential for relapse in opioid abuse.

Strategies for addressing the NMUPO included a media campaign and online resource, which meets the required PFS strategy of an awareness campaign for NMUPO. In order to address the required strategy of a drug take-back campaign, the Coalition had to take into consideration the constraints of Juneau’s geography when devising the plan. Currently, the Juneau Police Department oversees a prescription drug disposal site that is accessible 24/7 for members of the community. However, it was made clear that their ability to dispose of collected prescriptions is outpaced by the disposals themselves, due in part to the infrequent rate at which the DEA is willing to receive shipments of collected prescriptions and the prohibitive cost of shipping prescriptions out of town. Working to reconcile the need for a drug take-back campaign with the limited resources available to effectively implement one, the Coalition devised a plan wherein pharmacies in Juneau will distribute prescription disposal kits with fulfilled opioid prescriptions, as well as a pamphlet outlining the importance of safe disposal, risks of opioid diversion, and behavioral health supports that are available in the community to combat opioid addiction. This strategy was conceived of using recommendations for action from the Johns Hopkins University report entitled “The Prescription Opioid Epidemic: An Evidence-Based Approach” which outlines the need for “clear and consistent guidance on safe disposal of prescription drugs” as well as expanded access to drug take-back programs.

The community strategies of a “prescribers pledge” campaign and the institution of CDC prescribing guidelines both focus on the prescribing policy that all Juneau prescribers adhere to the CDC prescribing recommendations. This strategy is also

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sourced from the Johns Hopkins study referenced above. The two strategies are designed to address private prescribers in Juneau, as well as the institutional sources of opioids: the city-owned hospital and the tribal health consortium. The “prescribers pledge” campaign will be used to publicize the involvement of the community’s medical providers in the fight against opioid misuse, while creating prescriber buy-in as stakeholders engaged in combatting the epidemic.

Cultural Competence (understanding of project area cultural considerations, such as local demographics, economics, community dynamics, etc.), will be carefully considered throughout the life of this project. Being respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of the diverse population groups in Juneau is paramount. NCADDJ will account for cultural competence by learning more about the diverse populations it serves; drawing on community-based values, traditions, and customs; and working with persons from these populations to plan, implement, and evaluate their strategies.

Sustainability is reflected in both the project’s vision and its core values. Goals and activities overlap and key components for sustainability of prevention efforts are woven throughout this strategic plan and especially focus on building strong partnerships and offering training opportunities, increasing community readiness and knowledge, and ensuring that project activities support long-lasting prevention efforts in the community.

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STRATEGIC PLANNING

Action Plan: Increase Patient Knowledge of Resources

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Action Plan: Increase Understanding of Risks of NMUPO/heroin use

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STRATEGIC PLANNING

Action Plan: Support Prescribers, Providers, and other Stakeholders in Juneau with Education Initiatives

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3.3. Logic Models

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Figure D. NMUPO Logic Model

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STRATEGIC PLANNING

Figure E: Heroin Use Logic Model

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3.4. Technical Assistance Needs Related to Strategic Planning and Logic Model(s)

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STRATEGIC PLANNING

As the project moves forward, it is anticipated NCADDJ will need technical assistance in several areas related to logic model components and strategic planning. TA will be requested to help the coalition continually monitor data assessment efforts related to community strategies and community factors. Assistance in evaluating community strategies will enable NCADDJ to determine whether the strategies chosen to address Juneau’s community factors are proving effective, while assistance in data assessment regarding community factors will strengthen the coalition’s ability to monitor variability in the reasons why opioid misuse/abuse and heroin use is occurring in the community. It is the hope of the coalition that TA provided in these areas will help keep the project focused and manageable given the limited life of the grant, in addition to assisting NCADDJ sustain a consistent focus within the community throughout the project.

Sustainability of project efforts is also important. TA will be requested in order to help the coalition plan for sustainability and integrate key components of sustainability of prevention efforts. A special focus for NCADD’s sustainability plan will be on building and maintaining strong partnerships and continuing to offer training opportunities as outlined in earlier section of the strategic plan, as well as increased community readiness and knowledge, and ensuring that project activities support prevention efforts in the community beyond the life of the grant.

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IMPLEMENTATION

4.1. Implementation of Strategies

Strategy Action Plans for Juneau Online Resource:

Strategy Action Plans for Institution of CDC Prescribing Guidelines:

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IMPLEMENTATION

Strategy Action Plans for Media Campaign:

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IMPLEMENTATION

Strategy Action Plans for Pharmacy Distribution Campaign:

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Strategy Action Plans for Prescriber Pledge Campaign:

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Strategy Action Plans for RRC OBOT (MAT) Program:

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4.2. Technical Assistance Needs Related to

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IMPLEMENTATION

ImplementationTechnical assistance will be requested for implementation of several key strategies including the media campaign, the creation of an online resource, the pharmacy distribution campaign, and promotion of CDC prescribing guidelines. While an exhaustive list of TA components that will be needed is not known at the time of writing this report, several key aspects are known. Types of TA services NCADDJ anticipates being useful during strategy implementation include (1) information dissemination via the Juneau Online Resource website, including the generation of mailing lists and content, (2) collaboration opportunities designed to foster lessons learned through implementation across PFS grantees, (3) online events including courses, webinars, and mediated teleconferences related to strategy implementation, (4) in-person trainings focused on media campaign design and implementation, whether via small learning communities or across PFS grantees, and (5) other technical assistance including 1:1 coaching for the NCADDJ PFS coordinator and other key implementation staff, group informational sessions, facilitated implementation planning, and resource sharing.

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EVALUATION

5.1 Evaluation of Strategies (NMUPO) Evaluation of a Multi-Level Media Campaign to Increase Knowledge about Risks of Social Access and Ways to Prevent Social Access to

Rx OpioidsGoal: Reduce Rx Opioid Misuse/Abuse

Community Factor: Lack of community knowledge among adults about risks associated

with easy access to Rx opioids

Intervening

Variable:Social

availability of Rx opioids

Intervening

Variable: Perceived

Risk of Harm from Rx Opioids

CSAP Category:Information

Dissemination

Strategy Focus Population:Adults 18 +

Community Factor: Lack of knowledge among adults about how to prevent social access to

Rx opioids

Community Factor: Lack of knowledge in community on what

constitutes an opioid/addictive properties

Key Strategy Outcomes Indicators Method/Measure

Multi-level media campaign to:

1. Increase knowledge about risks associated with easy access to Rx opioids

2. Increase knowledge about ways to reduce social access to Rx opioids

3. Increase safe storage, monitoring, and disposal of Rx opioids

1. # and reach of awareness products disseminated (posters, other media, etc) [P]

2. % of adults who have seen messages about safe storage and disposal of Rx opioids [P]

3. % adults reporting safe storage and monitoring of Rx opioids (or intentions) [O]

4. % adults reporting disposing of Rx opioids safely (or intentions) [O]

1. Activity tracking

2.Dissemination tracking

3. Quarterly random survey of 100 adults


[O] Outcome indicators; [P] Process Indicators

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EVALUATION

Evaluation of the Pharmacy Campaign to Increase Awareness and Use of Safe Disposal Sites and Increase Knowledge Among Adults about how

to Prevent Social Access to Rx Opioids

Community Factor: Lack of

knowledge among adults about how to

prevent social access to Rx opioids

Intervening Variable:

Social availability of Rx opioids

CSAP Category to create safe disposal sites: Environmental


CSAP Category to promote safe disposal sites: Information dissemination

Community Factor: Limited knowledge/access for adult community members to dispose of Rx Opioids safely

CSAP Category increase knowledge about risks: Information dissemination


Increase safe disposal sites to:

1. Increase access to safe disposal sites

Pharmacy campaign to:

2. increase awareness of safe disposal sites3. Increase use of safe disposal sites4. Increase knowledge about ways to reduce social access to Rx opioids

1. # disposal sites created # days open [P]

2. # and reach of awareness products [P]

3. % of adults aware of at least one local safe disposal site [O]

4. # of visitors and/or pounds of Rx pills discarded at site [O]


2. Dissemination tracking

3.Quarterly random survey of 100 adults


[O] Outcome indicators; [P] Process IndicatorsEvaluation of a Juneau Online Resource to Increase Awareness of

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EVALUATION

Resources for Disposal and/or Behavioral Health Supports

Community Factor:

Limited access to resources for

disposal and/or behavioral health

supports


Perceived risk of harm from Rx Opioid

Abuse/Misuse

CSAP Category: Information

Dissemination

Strategy Focus Population:

Youth and Adults 12-25

Key Strategy Outcomes Indicators Method/MeasureCreate Online Resource guide to:

1. Increase awareness to safe disposal sites2. Increase awareness of behavioral health services

1. % of adults aware of at least one local safe disposal site

2. % of youth and adults aware of at least one behavioral health service center

1. Quarterly random survey of youth and adults

Evaluation of Institutional Adherence to CDC Prescribing Guidelines

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EVALUATION

Community Factor:

Lack of structured prescribing program

for providers to engage and utilize


Easy access to Rx opioids through retail sources

CSAP Category:Environmental

Strategy Focus Population:Adults 18-25


Establish institutional adherence to CDC prescribing guidelines to:

1. Increase number of primary health settings establishing and adhering to CDC prescribing guidelines

1. % of prescribers in primary health settings reporting adherence to CDC prescribing recommendations

2. % of patients presenting to physician’s offices with non-cancer pain symptoms or pain related diagnoses (including acute and chronic pain) receiving an opioid prescription

3. # of primary health settings using CDC prescribing recommendations

1. Prescriber survey


5.2 Evaluation of Strategies (Heroin Use)Evaluation of Promotion of Rainforest Recovery Center Office Based

Opioid Treatment (RRC OBOT) Program

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EVALUATION

Community Factor:

Lack of knowledge among adults about connection between NMUPO and heroin

use


Perceived risk of harm from heroin

use


Dissemination


Community Factor:

Lack of knowledge among adults about risks of heroin use


Promotion of RRC OBOT program to:

1. Increase knowledge among adults about the connection between NMUPO and heroin use

2. Increase knowledge among adults about the risks of heroin use

1. Adults participating in OBOT program reporting NMUPO as a risk factor for heroin use

2. Adults participating in OBOT program reporting knowing the short and long-term effects of heroin use

1. Quarterly OBOT survey

Evaluation of a Media Campaign to Increase Knowledge about the Connection between NMUPO and Heroin Use

Community Factor: Lack of knowledge among adults about

connection between NMUPO and heroin use

Intervening

Variable:Perceived

risk of harm of


Dissemination


Community Factor: Lack of

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EVALUATION

knowledge among adults about risks of heroin use

heroin use

Community Factor: Limited access to resources for

disposal and/or behavioral health supports


Media campaign to:1. Increase knowledge among adults about the connection between NMUPO and heroin use

2. Increase knowledge among adults about the risks of heroin use

3. Increase safe disposal of syringes

4. Increased knowledge of behavioral health supports

1. % of adults in the community reporting NMUPO as a risk factor for heroin use

2. % of adults in the community reporting knowing the short and long-term effects of heroin use

3. # and reach of awareness products disseminated (posters, other media, etc)

4. % adults reporting disposing of syringes safely (or intentions)

5. % adults reporting knowing at least one behavioral health support provider




Evaluation of a Juneau Online Resource to Increase Awareness of Resources for Disposal and/or Behavioral Health Supports

Community Factor:

Limited access to resources for disposal

and/or behavioral health supports


Perceived risk of harm from heroin

use

CSAP Category: Information

Dissemination


Key Strategy Outcomes Indicators Method/MeasureCreate Online Resource guide to:

1. Increase awareness to safe disposal sites

1. % of adults aware of at least


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EVALUATION

2. Increase awareness of behavioral health services3. Increased safe disposal of syringes

one local safe disposal site/needle exchange program

2. % adults aware of at least one behavioral health service center

3. # of visitors and/or # of syringes discarded or exchanged at site



5.3 Technical Assistance Needs Related to Evaluation

Ongoing evaluation assistance will be provided by NCADDJ’s contracted evaluator, Strategic Prevention Solutions, Inc., and by the Data and Evaluation Technical Assistance Liaison (DETAL) team provided through the PFS project. The DETAL team will provide technical assistance and trainings, where necessary, related to the evaluation requirements outlined in the evaluation section of the PFS Guidance Document created by UAA Center for Behavioral Health Research and Services (CBHRS) evaluators. Other process and outcome evaluation assistance will be provided by Strategic Prevention Solutions.

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EVALUATION

As NCADDJ enters into the second year of the PFS project in Juneau, it is focused on mobilizing process and outcome evaluation, as highlighted in the evaluation plans, in an effort to show progress over the next fiscal year. In general, the Coalition will be focused on implementing the chosen strategies as intended and on providing the most reliable and valid evaluation data (e.g., surveys). NCADDJ will also focus on fine tuning their selected evaluation methods to ensure they are putting available resources into the project and evaluation activities in an efficient manner, rather than over-extending or spreading resources too thin.

A note on data collection: Due to time constraints and logistics leading up to the strategic planning report, a detailed, precise data collection plan was not finalized. Although a data collection plan is not required for inclusion in the PFS strategic plan report, NCADDJ recognizes the utility of developing such a plan that specifies measures, frequency of collection, sources of data, necessary contacts and agreements, persons responsibility for each measure, and other relevant notes. NCADDJ also recognizes the usefulness of a robust data collection plan in the event of staff or coalition turnover as the project progresses, and to maintain data collection consistency. The Coalition will finalize their detailed data collection plan in the coming weeks after submission of the strategic plan.

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APPENDICES

Appendices

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APPENDICES

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APPENDICES

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APPENDICES

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APPENDICES

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APPENDICES

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