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Thomas McLellan, PhD, Founder and Chairman of the

Board, Treatment Research Institute, former Deputy Director of the Office of National Drug Control Policy

Velma V. Taormina, MD MSE FACOG, Medical Director, Gaston County Department of Health and Human Services

William Gross, MPH, William A. Gross, Consulting staff, Gaston Community Health Care Commission

Barbara Hallisey, MSW, LCSW, Associate Clinical Services Director, Partners Behavioral Health Management

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How states and communities are addressing the national opioid epidemic

How to identify and gain participation of agencies to address the opioid crisis and about the progress a coalition has realized in less than two years

Understand how to use complex data to create baseline measures and to track progress in impacting the crisis

Identify Strategic Planning processes that build collaboration with multiple entities to comprehensively address a complex health epidemic

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Addiction & The

Community:

What can Communities do to

Reduce Misuse and Addiction

A.Thomas McLellan

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Too many organizations are working in isolation from one another

Collective Impact brings people together, in a structured way, to achieve greater change than is possible on an individual basis

Excellent model for any complex social, health or environmental problem

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Building Blocks of Collective Impact

Mutually Reinforcing

ActivitiesShared Measurement

Common Agenda

Continuous

Communication

Backbone Support

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Components

for Success

Phase 1

Initiate Action

Phase 2

Organize for Impact

Phase 3

Sustain Action &

Impact

Governance &

Infrastructure

Identify champions

& form cross-sector

group

Create infrastructure

(backbone & processes)

Facilitate & refine

Strategic

Planning

Map the landscape

& use data to make

case

Create common agenda

(goals & strategy)

Support implementation

(alignment to goals and

strategies)

Community

Involvement

Facilitate community

outreach

Engage community and

build public will

Continue engagement

& conduct advocacy

Evaluation &

Improvement

Analyze baseline

data to identify key

issues and gaps

Established shared

metrics (indicators,

measurement, &

approach)

Collect, track, and

report progress

(process to learn and

improve)

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Guide Vision and Strategy

Support Aligned Activities

Establish Shared Measurement Practices

Build Public Will

Advance Policy

Mobilize Funding

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• Ranks 74th of 100 NC counties in geographical size, but 7th in population … just west of Charlotte

• About 217,000 residents, home to more than 700churches

• Once a leading textile manufacturer, Gaston County’s mill system largely disappeared by 1990, but the influences of this culture remain a powerful force

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Measure for the period 2011-2015 Gaston

County

North

Carolina

High school graduate or higher, persons 25 years + 82.9% 88.5%

Bachelor’s degree or higher, persons age 25+ 19.0% 28.4%

Median household income, 2015 dollars $42,429 $46,868

Per capita income in past 12 months, 2015 dollars $22,828 $25,290

With a disability, under age 65 years 12.1% 9.6%

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Gaston gained national attention in the 1980s as the Dilaudid capital of the US (most per capita prescriptions)

• Multigenerational use of pain killers and benzodiazepines

• Tough manual labor, higher rates of injury and disability, higher unemployment & poverty, lower rates of education

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• Gaston County’s opioid problem arises from multipleneeds and pathways = It is complex

• For years it was seen as the LME-MCO’s problem to dealwith or fix

• But, something changed: the number of opioid deathsgrew, opioid misuse and abuse moved from the shadows to a visible to a communitywide health problem, and our old methods were not working

• So, the community was faced with the question: What will we do?

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• The complexity of this question was articulated at a town hall meeting organized by Gastonia City Councilman, Robert Kellogg, in March 2016

• Over 100 persons attended, heard presentations, and asked questions of the panelists; this conversation clearly articulated great community pain and need

• Attendees included senior staff from CaroMont and the Gaston Community Healthcare Commission

• As a result, the Healthcare Commission decided to focus on the opioid epidemic

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• April 2016, 36 key local leaders attended the first oneThe honesty and humility of the conversation struck a chord that affirmed the severity of the situation … and the need for action

• May 2016, 24 physicians, pharmacists and behavioral health providers convened to begin a Responsible Opioid Prescribing Leadership Team

• Later in May 2016, 39 attended the second one

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To engage professional and lay leaders from across the county to collaboratively develop and conduct programs that will: • prevent the onset of addiction to controlled

substances, • assure the adoption of safe opioid prescribing

practices, • assure comprehensive drug treatment and mental

health services for all persons in need, and • deliver professional and community education in

support of these outcomes.

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• Promote collaboration among its member organizations• Receive and discuss reports from Coalition committees to

assure comprehensive focus in considering problems, analyses, and recommended actions

• Avoid unintended consequences by testing activities, analyzing and deliberating the results, securing additional insights, and developing successful programs

• Raise community expectations for the Coalition and continually engage new stakeholders to achieve our mission

• Hold Coalition members and organizations accountable for full engagement and follow through

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Approved by the Gaston Controlled Substances Coalition on July 22, 2016

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• Steering (12 members)

• Controlled Substances Policy Adoption

• Community Education & Prevention

• Treatment Linkages

• Additional Standing & Ad-hoc as needed

◦ Clergy Opioid Outreach

◦ Medicine Take-Back

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• Four key stakeholders: • one hospital system, • one LME-MCO, • one FQHC, • one Health Department

• CEO’s of key stakeholder organizations get along, respect each other, and work together to achieve shared goals

• Stakeholders have a history of collaboration that continues to grow

• Stakeholders provide resources to the Coalition

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• Critical organizations from other sectors are actively involved: • EMS, • law enforcement, • private practitioners, • behavioral heath providers, • MAT providers, • clergy, • harm reduction/syringe exchange agency…and

specialists on their staffs• Members of affected families• All people who participate in Coalition, committee, and

subcommittee meetings are considered members

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• Chairpersons run strong and regular meetings.• Meetings are designed to promote engaging

conversation and deliberations … “What if” is strongly encouraged

• We push beyond customary and traditional thinking • We focus on primary, secondary, and tertiary

prevention• Backbone staff ensure structure & excellent

documentation

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• Discover human, professional, and organizational strengths, needs and opportunities

• Engage community members

• Engage professionals and their organizations

• Develop program concepts … find organizations to take the lead

• Develop program concepts … GCSC takes the lead

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• Be open• Be transparent• Be honest• Be accountable to Gaston County and its residents• Recognize addiction as a chronic disease • Maximize existing resources • Collaborate and avoid unnecessarily redundant

programming

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Reach out to us with any questions, or ideas for improvement bhallisey@partnersbhm.org

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