Category: Health

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

Opioid Response Project Team Focus: Wilkes County

Co-Author: Mary Parry


An early analysis of the local opioid crisis identified stigma reduction as an obvious need when the Healthy Wilkes: Community Opioid Prevention & Education Team first began working with the Opioid Response Project coordinated by the ncIMPACT Initiative at the UNC School of Government. “There is stigma around seeking treatment. There is stigma related to attitudes about joblessness,” said Heather Murphy, Executive Director of The Health Foundation in Wilkesboro. “Stigma is a major roadblock to connecting people who are struggling with the help they desperately need.”

Murphy leads a team of community advocates, first responders, and other professionals whose work is impacted by the opioid crisis. Together, with the help of UNC School of Government leaders, they are setting goals and adapting their own work to improve the community’s overall response to the epidemic. The team points to helpful trainings led by School of Government faculty as a primary reason for their early success working as a team to tackle local issues. “In the system of care, we have people with different roles trying to communicate and improve the system, like law enforcement, judicial, medical, and social workers,” said Murphy. “Collective impact is designed to change relationships among people and we’re benefitting from the expertise of the UNC School of Government, guiding us through our collective impact work.”

The ability to bring different community leaders together to discuss problems and solutions is invaluable, according to Murphy. Through their collaboration, the Wilkes team is helping staff at the local department of social services understand that medication assisted treatment shouldn’t necessarily be a barrier between parents and their children. They’re helping health care providers change the way they see the opioid crisis, through suggested readings, like “Dope Sick” by Beth Macy.

Another area of focus for the Wilkes team is adverse childhood experiences. According to a Stanford study on the impact of childhood trauma on life expectancy and overall health in adulthood, childhood trauma can shorten life expectancy by up to 20 years. Within the Wilkes team, a group of trained individuals help victims cope with childhood trauma. The “Reconnect for Resilience” group helps victims learn to regulate their own nervous systems. “It’s kind of like a ‘keep calm and carry on’ approach to dealing with stress,” said Murphy. “We need more professionals in the community to become trauma informed and trauma sensitive.”

The Wilkes team is also expanding the work of its harm reduction group, developing strategies to minimize impacts on people in the community while work to address the opioid crisis is underway. The team would like to see more businesses distribute Naloxone and hopes attorneys will soon be done parsing through language in North Carolina’s Good Samaritan Laws which sometimes prevents people from administering Naloxone. The Wilkes team also supports increased availability of syringe exchange programs. “When we started, Wilkes didn’t have a needle exchange program yet,” said Murphy. “We do now, and our hospital is expanding one at its Care Connection Pharmacy, too.”

Medication Assisted Treatment (MAT) is another option for addressing the opioid crisis, helping addicted patients with medication that blocks brain receptors expecting continued opioid use, paired with behavior therapy to help patients adapt. Doctors cannot prescribe MAT without special certification, which limits options for patients seeking care. While current medical school graduates from UNC-Chapel Hill are now certified, there are many physicians practicing across the state who are not yet certified. Murphy says some physicians worry that being certified to treat substance use disorder will impact how their general patient population views their practice, pointing back to the challenge of stigma reduction as a focus of the group’s work.

Leaders in Wilkes County attribute their work with the UNC Opioid Response Project to opening up new avenues of opportunity in their ongoing efforts to tackle the opioid crisis. “Because of this work, we’re more prepared to take advantage of a growing number of other offerings, said Murphy. “We have received a federal grant to help provide more treatment services for pregnant women. And we were in a position to participate in the Appalachian Regional Commission Listening Tour, which covers Work to Recovery programs in the vast Appalachian region, including Ohio and Kentucky.”

The Wilkes team is proud to have been selected for the UNC Opioid Response Project. While the long-term struggles of a community experiencing such a high incidence of opioid addiction is indeed challenging, Murphy says it’s an honor to have been chosen, knowing that UNC School of Government leaders see value in the county’s existing leadership and capacity to affect change. “Yes, our work is difficult,” said Murphy. “But, if you’re going to do the work and do it well, you can’t shy away from the difficult problems. Our team is excited by the progress we have already made, and about our ability make a difference.”

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

 

 

 

Drinking Water Incident Response Toolkit Now Available Online

Co-Author: Maddie Shea


On July 16, 2019, the ncIMPACT Initiative launched the North Carolina Drinking Water Incident Response Toolkit online and presented a webinar introducing the toolkit. You can view a recording of the webinar online. The toolkit includes a guide for pre-incident planning, customizable tools for local governments, information on mutual aid, communication tools, essential information on drinking water and its regulation, and an appendix of additional resources.

Drinking water incidents such as floods, infrastructure failures, or contaminations may create real or perceived threats to the safety of drinking water across North Carolina. One highlight from the toolkit is the section on pre-incident planning. Any local community can be vulnerable to experiencing a drinking water incident. As such, this guide was developed to help local governments be as prepared as possible to respond if and when incidents occur. The guide is based on the principles that preparation is crucial, that it should be inclusive and collaborative, and that local issues and needs vary.

The guide:

  • Highlights the need for a local champion,
  • Provides example invitation lists and letters,
  • Offers a sample tabletop exercise,
  • Includes sample discussion questions, and
  • Recommends a list of considerations for pre-incident planning meetings.

The ncIMPACT Initiative and the School of Government convened and staffed the Drinking Water Working Group with support from a grant from the North Carolina Policy Collaboratory. The Drinking Water Working Group guided development of this toolkit and resources to assist local governments when they must respond to drinking water incidents. We are grateful to the membership of the working group for their time and expertise.

The webinar was presented by:

For more information, please contact:

Jill Moore, Associate Professor, UNC School of Government moore@sog.unc.edu 

Emily Williamson Gangi, Policy Engagement Director, ncIMPACT Initiative emily.gangi@unc.edu

 

Decreasing Cost and Increasing Quality: Value-Based Care Could Improve Communities

Co-Author: David Brown


According to the America’s Health Rankings by United Healthcare, North Carolina ranks 33rd in the country. As the ncIMPACT Initiative works alongside North Carolina stakeholders to solve complex problems, we increasingly hear concerns about how the state’s health outcomes affect community economic vitality. It is important to fit these conversations into the context of the changing health systems around us. As a patient, citizen, and community member, you may hear a repetitive term in this context: value-based care. What is it? What solutions does it promise, and what potential problems could it cause?

 

What is Value-Based Care?

In a granular sense, value-based care refers to health care programs based on incentives: care providers should have a financial stake in basing their care on patient outcomes rather than the number of tests, procedures, or other interventions (sometimes called volume-based care). In the case of Medicare, where the transition to value-based care is occurring most prominently, the federal government hopes that aligning provider reimbursements more closely to health outcomes will ultimately result in better care for individuals, better health for populations, and lower costs for everyone. Other valued-based reimbursement programs administered by the federal government include the Skilled Nursing Facility Value- Based Purchasing Program and the Home Health Value-Based Purchasing Model. This is part of a steady transition toward value-based care at the national level.

 

The Challenge of Health Costs

Everyone knows – often from experience – that health care can be costly. Some drivers of health care costs are obvious: investments in highly trained personnel and highly specialized equipment; the chronic nature of some diseases; and the willingness to spend almost any amount to prolong life and avoid pain. Little can be done about these cost drivers in our current system. However, much can be done to control costs by incentivizing preventive care, minimizing complications from chronic diseases, modernizing medical record-keeping to avoid unnecessary tests and procedures, and treating diseases and other ailments that tend to occur together as a single health problem, rather than as multiple.

Transitioning to a system where health outcomes are prioritized over the number of appointments and procedures makes intuitive sense, but there are pitfalls to avoid on the road to value-based care. Measuring health outcomes is complicated and lacks an agreed-upon methodology across providers. Further, a system that dis-incentivizes proliferating appointments and tests runs the risk of denying aggressive care to patients for whom it may be appropriate. In addition, there may be a long learning curve as everyone from major hospitals and insurers to small private practices adjusts to the new world of value-based care. Finally, any change that increases reporting requirements is likely to divert providers’ time away from more patient-focused tasks.

Further, hand-offs between specialists as part of a comprehensive care plan are more likely to be successful than if the patient has to seek out each provider on his own. The ultimate goal of improved health means fewer hospital stays and, in the case of a Medicare or Medicaid recipient, lower costs for the government. And if provider reimbursements are tied to improved health, rather than the number of interventions, the incentives for the provider might be higher for patients with a higher likelihood of improved health outcomes.

 

The Potential for a Promising Response: NCCARE 360

Advanced medical record keeping will become increasingly important with the move to value-based care. NCCARE 360 is a new statewide coordinated care effort that will electronically track, connect, and refer patients through an accountable care  network. This is a person-centered approach in which community members and providers in North Carolina will have access to:

  • A statewide resource directory
  • A community resource repository
  • A referral platform

Experts have recently established that while around 20% of health determinants are around access to healthcare, the other 80% are referred to as the Social Determinants of Health (SDOH). NCCARE 360 will allow for a team of providers and social organizations to track health outcomes of a patient together, with a comprehensive care plan that works in real time. Not only will the patient be a part of an accountable care community, they will also have access to services not typically associated with medical care: housing services, access to healthy foods, domestic violence services, and other SDOH resources.

Image result for social determinants of health graphic

The promise of cost savings, greater efficiency, and better health outcomes will speed the adoption of value-based care in the coming years, as will legislation and regulations that require it. But providers and patients alike will need to be vigilant to ensure that the dollar-related outcomes are not prioritized over those related to patient health and well-being. NCCARE 360 gives an opportunity to impact health outcomes from a person-centered, community approach, creating accountability. NCCARE 360 will be implemented in every county in North Carolina by the end of 2020.

 

For more information, visit:

https://www.ncdhhs.gov/about/department-initiatives/healthy-opportunities/nccare360

 

Image result for nccare 360

 

Opioid Response Project Featured in University Gazette

Read coverage in the University Gazette at:

https://gazette.unc.edu/2019/04/10/opiod-response-project-helping-nc-communities-fight-opiod-epidemic/

To achieve the collaborative, multi-faceted approach so crucial to tackling the opioid crisis in North Carolina, the UNC School of Government offers an intensive two-year collaborative learning model that provides direct support to ten North Carolina communities enacting an integrated and innovative policy and practice response to their local opioid crises.

The Opioid Response Project, coordinated by the School’s ncIMPACT Initiative, complements health and policy efforts at the state and local levels by working with communities to implement evidence based practices. Each participating community receives funds for a project manager and implementation of selected strategies. This program is produced in partnership with the generosity of Blue Cross NC. For more information about this partnership, click here.

 

 

 

Opioid Epidemic Ignores Boundaries in North Carolina

At its recent NC Rural Assembly titled “Claiming Our Future,” the NC Rural Center offered an important discussion on the opioid epidemic in North Carolina. Introduced by Dr. Anu Rao-Patel from Blue Cross Blue Shield of NC, the session began with sobering statistics — including the fact that drug overdoses are now the leading cause of accidental death in NC (ahead of vehicular crashes). According to Centers for Disease Control and Prevention estimates, the cost of unintentional opioid related overdose deaths in NC totaled $1.3 billion in 2015.

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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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