Category: Education

Opioid Response Project Team Focus: Onslow County

Co- Author: Mary Parry


Sparked by the UNC Opioid Response Project, a local effort formed in Onslow County and conversations about launching a collaboration began. Before long, around 30 agencies and partners were on board, eager to build a community team focused on solutions. “Because of the Opioid Response Project grant, we were able to launch our Strategic Opioid Advanced Response Team (SOAR),” said Sophia Hayes, project coordinator with the Onslow County Health Department. “We’re now partnering with physicians, mental health specialists, religious groups, and others, working with a shared purpose. It’s exciting!”

The team’s initial goal was increasing education and awareness. They began by offering a survey to find out how much the community knew about drug problems in the county. They also distributed educational materials, offering local statistics and resources for treatment to help more people seek help when they need it. The outreach response was strong. “We received 400 survey responses and handed out materials to 2,000 people,” said Hayes.  “We’re also working on a public service announcement to help this information spread further.”

The team hosts and participates in community events to broaden awareness in the county. One event featured a speaker on the long-term effects of opiates. Provider trainings are also planned, educating the medical community on alternatives to subscribing opioids, policies surrounding opioids, and other emerging topics like the use of CBD oil. These trainings are intended to help patients, too. “There are a lot of worries around prescribing and treatment that we can help alleviate by better educating our community,” said Victoria Reyes, community relations officer with the Onslow County Health Department.

Team leaders point to the Opioid Response Project grant as instrumental in helping them reach people in a targeted way. Becoming more strategic on social media and offering local content specific to Onslow County helped the community better understand the opioid epidemic and the resources available to people in need of support.

The SOAR Team’s initial work in the community has been well-received, but stigma creates a barrier for residents who need help but fear judgment. To help remove this barrier, the team started a Naloxone Take Home Program, allowing residents to pick up the opioid overdose reversal medication at the pharmacy for no cost. “Our EMS also leave take-home kits after cases involving overdose, trying to remove the barrier of stigma,” said Hayes. “This helps more people access Naloxone, but it does skew our data since this Naloxone use is underreported.”

Moving into 2020, Onslow’s SOAR Team works on turning survey results into new opportunities for education and collaboration. With help from the Onslow County Manager, a crisis continuum group joined the team and partners from Carteret County connected as well. Community partners share stories that convey the impact of the SOAR Team’s work, which helps spread the word and build momentum for their efforts.

Because of their early success as part of the Opioid Response Project, the City of Jacksonville received a Comprehensive Opioid Abuse Program grant (COAP) worth $900,000 over a 3-year period. “We’re starting to be able to look beyond the early stages of this work into next year, three years out, and into the future, which is very exciting,” said Hayes.

With continued funding in place, the SOAR Team hopes to provide peer support specialists in the community, who are people with lived experiences that offer valuable input to team leaders. They are also trusted messengers within the community, attending work groups and faith-based gatherings to broaden awareness. “This work is near and dear to their hearts and their impact is real,” said Reyes. “Funding for peer support specialists is needed so that we can provide resources like transportation. In a county like Onslow, where people are so spread out, a lot of travel is required to get to sober living and detox facilities.”

Providing equal access to treatment drives members of the SOAR Team. Coming together with this shared purpose, community leaders are thankful for the opportunity to do this work together. “The support we have received through the Opioid Response Project has been great, providing some structure and helping us uphold the collaboration so it can grow and reach further across our county,” said Reyes.

Learning and networking at forums through the Opioid Response Project has been extremely valuable to the learning and planning process, according to team leaders. “Even though we all live in different areas of the state, we’re all dealing with the same issue,” said Hayes. “Access to leaders in different counties has been both helpful and reassuring as we continue on this path, helping our community respond to the opioid epidemic.”

The team is excited to think about how far they have come because of their collaboration. “We have had tremendous attendance and participation by local leaders, which has been a terrific benefit to our team,” said Hayes. “It has made a tremendous difference in our progress. We look forward to continuing this important work.”

To learn more about the Opioid Response Project coordinated by the ncIMPACT Initiative, please visit: https://www.sog.unc.edu/opioidresponseproject

 

Opioid Response Project Team Focus: Cumberland County

Co-Author: Mary Parry


The Cumberland-Fayetteville Opioid Response Team (C-FORT) emerged from a task force first organized by former Fayetteville Mayor Nat Robinson. The task force brought stakeholders together to begin to discuss strategies for tackling the local opioid epidemic. When the UNC School of Government launched the Opioid Response Project, team members were eager and excited to participate in an opportunity to continue their work and expand their impact using the Collective Impact model.

“The C-FORT team is a pretty motivated group with quite an action plan,” said Melissia Larson, C-FORT Project Manager. “The team is made up of 90-100 community leaders, 25-35 of which are actively involved, working to address needs in the community.”

Improving post-overdose response is one of the focuses of the team. It was obvious to community leaders that more needed to be done, but there was not enough staff in place to collect all of the necessary data to take action. Because of the team’s work, a pocket guide is now being released to help patients who refuse transport. The guide, distributed by first responders, contains information to help patients understand where they can access services in the community.

Community education is another important component of C-FORT’s work. Committee members implemented a survey to better understand attitudes and awareness about the opioid epidemic in Cumberland County. The survey will gauge the community’s understanding of the availability and purpose of Naloxone, the medication used to counter the effects of an opioid overdose. The team will wrap up survey collection in January 2020, and results will inform the content and strategies behind an upcoming community education campaign.

“The roadblock initially keeping us back from collecting information and launching projects was funding,” said Larson. “We had an action plan and strategies that were great, but we needed the money.” C-FORT developed their action plan as part of the Opioid Response Project with support from the UNC School of Government.

As a result of their promising work, the C-FORT team was recently awarded a federal grant, offering the county $900,000 over a three-year period. The team will start receiving funding in early 2020 and will begin implementing its action plan, including a media campaign and hiring staff to help with the post-overdose response in the community.

“Because of our participation with the UNC Opioid Response Project, we have been able to really pull this team together and employ a community coordinator,” said Larson. “That has been critical to our success and will really help propel us going forward.”

The C-FORT team describes their involvement with the Opioid Response Project as educational and rewarding. After identifying early strategies, teams were encouraged to set goals and objectives, then move on to key performance indicators, helping them realize their goals. “The School of Government had a game plan, helping each team walk away with an action plan,” said Larson. “It’s exciting now to see those plans start coming together.”

Bringing together 10 teams from across North Carolina has made it easier for team members to share information and participate in networking that might not otherwise be possible. These discussions are helping local leaders save time and avoid reinventing the wheel as they work quickly to tackle similar issues in their communities.

“Thanks to the UNC Opioid Response Project, the C-FORT team now has a strong action plan that takes into consideration all of the different facets of the opioid problem,” said Larson. “We have learned about the importance of including workforce development in our action plan. We know that joblessness is a problem linked with opioid addiction, and now we have an opportunity to include that in our action plan.”

As the new year begins, the C-FORT team is excited to be hiring three full-time staff. “Being selected for funding was a big win for us,” said Larson. “Now, we’re looking forward to the many small wins along the way that will pave the way toward achievement of our goals.”

The C-FORT team is working hard to become the creative and recovery-ready community they see as necessary to tackle the opioid epidemic. Because of the team’s involvement in the Opioid Response Project, they are already seeing that start to happen. “One of our members with Methodist University recently reported the launch of recovery meetings on campus beginning in January 2020,” said Larson. “It’s exciting that our members can get the energy and inspiration they need to feel empowered to start a conversation with their chain of command, helping to launch projects that will become an important part of our community’s success.”

To learn more about the Opioid Response Project coordinated by the ncIMPACT Initiative, please visit: https://www.sog.unc.edu/opioidresponseproject

Accountable Care Communities Offer An Opportunity to Address Healthcare Disparities at the Systems Level

In a previous blog post, which you can find here, ncIMPACT shared information around NCCARE 360, an interdisciplinary referral tool being implemented in the state of North Carolina’s medical care systems. As we continue to research impacts of the health of a community, we find it increasingly important to look at the way data around how changes become integrated with existing cultural norms and daily lives of community members in North Carolina. NCCARE 360 is part of an effort to implement a model of Accountable Care Communities (ACCs).

ACCs

ACCs aim to address health at the community level through addressing the social drivers of health and looks at health on a systems level to better coordinate healthcare with a wide variety of stakeholders within a community. This coordination includes involving non-traditional partners in health initiatives, such as faith communities and academic researchers. ACCs have an underlying value of authentic community engagement. In the context of the ACC model, it is not enough to go into communities and give out information. Stakeholders must work alongside communities to create a power dynamic that gives community members agency and self-determination. Under the ACC model, the goal is to elevate the voices of community members who are most impacted by health disparities. For example, specific race groups are more likely to experience disparities within population health–those voices need to be amplified within this model.

 

 

Health Inequities by Race

In fact, the data suggests that many health initiatives have historically neglected or taken advantage of specific race populations, such as the Native American and African American communities (see Black-White Disparities in Health Care Report, released by the American Medical Association[1]). Racial disparities in health begin even at the stage of conception. African American babies are more than twice as likely to die during childbirth than white or Hispanic babies in North Carolina. While white babies die at a rate of 5.4% in North Carolina (comparable to the Hispanic rate of 5.5%), Black babies die at a rate of 12.4% (see figure below from NCDHHS).

 

 

Maternal mortality rates are alarming in general, but when analyzed by race, it is evident that Black mothers have a totally different experience during pregnancy and childbirth than their racial counterparts. In 2013, in the state of North Carolina, the maternal mortality rates for Black and white women was almost the same, with the white racial category making a large jump up in rates and the Black racial category briefly falling. However, since then, the numbers have since diverged once more. Today, a Black woman in North Carolina is 3x as likely to die from giving birth than a white woman. From 1999-2013, Black women accounted for 49% of the deaths due to childbirth in the state of North Carolina, while African Americans make up 22% of the state’s population (https://schs.dph.ncdhhs.gov/data/maternal/).

While working with the Kate B. Reynolds Charitable Trust on their targeted health strategies, our interviews with experts repeatedly brought up the importance of cultural competency at the systems level to address disparity. For example, one anonymous interviewee we spoke with mentions struggles with healthcare perceptions for older African American men:

“He grew up in a time where he knew studies were being done on Black people. Telling him he needs to go to the doctor brings up distrust for him. Entering into those large facilities, he’s not inclined to do that. He needs a provider that looks like him and be able to come to a place that feels safe.”

 

These disparities are alarming and to begin addressing these health inequalities, research and reports indicate that strategically culturally appropriate care, community capacity building, and homegrown community leader involvement will all need to be present as a start to making the state’s health system more culturally appropriate. These non-traditional partnerships implemented in Accountable Care Communities will require a breaking down of walls for everyone involved–silos will need to be removed for an integrated community care system.

For more guidance on implementing the ACC model, please see the following guide, provided by Kate B. Reynolds Charitable Trust and Duke Endowment, visit http://nciom.org/nc-health-data/guide-to-accountable-care-communities/

 

 

[1] https://www.ama-assn.org/about/ama-history/history-african-americans-and-organized-medicine

 

 

 

Does Prekindergarten Push against the Curve of Community Change?

What happens when a room full of county commissioners, school board members, and early childhood practitioners spend the day diving deep into the data on preschool education with the state’s leading child development researchers? They start digging into how prekindergarten programs for four year olds push against the curve of community change.

On September 25, 2017, the Thinking Big for Small People group gathered in Chapel Hill for a day of training and reflection. The broader context for this gathering was the North Carolina General Assembly’s decision to increase funding for the state’s standard pre-K program delivered in each county, known as “NC Pre-K,” in its budget for the next two years. Program attendees spanned a continuum of familiarity with pre-K. Some came from communities with a great deal of curiosity, but no consensus about whether they would expand pre-K. Other communities had already set a goal for granting universal access to pre-K.

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How Is the NC Pre-K Program Delivered in Each County?

NC Pre-K is a state-funded pre-kindergarten program administered by the Division of Child Development and Early Education within the North Carolina Department of Health and Human Services. The program serves eligible four-year-olds via classroom-based education in a variety of public and private settings governed by NC Child Care Rules. The state generally limits eligibility for NC Pre-K to children from families whose gross income is at or below 75 percent of North Carolina’s median income. In addition, up to 20 percent of the program can consist of children from families above the income ceiling who exhibit certain risk factors, such as limited English proficiency or a developmental disability. A later blog post will discuss the NC Pre-K program in more detail.

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What You Told Us in the ncIMPACT Planning Survey

We launched ncIMPACT in 2017 to help public officials in North Carolina navigate critical policy challenges across a wide range of topics, including health, education, economic development, criminal justice, public finance, and the environment. As we planned this new initiative, we wanted to hear from practitioners and other citizens about the most vexing policy issues in their community and in the state as a whole, and what we could do to help. As such, in January 2017 we drafted an online survey and distributed it with the assistance of various peer associations and a targeted Twitter campaign. Over the course of two months, we received 154 responses to our survey. Please read on for an analysis of our results.

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