Technical Assistance Center (TAC)

Technical Assistance Center (TAC)

Manual

Janice L. Pringle, PhD

University of Pittsburgh

School of Pharmacy

Program Evaluation and Research Unit (PERU)

In collaboration with

The Pennsylvania Commission on Crime and Delinquency

Table of Contents

Introduction: What is the Technical Assistance Center and How Can It Help Your Community Fight Overdose? 3

A. How to Use This Manual 5

B. Why a Coalition? 7

C. Describing Your Community 8

D. Obtaining Your Data 8

E. Determining Your Community’s Readiness to Have an Impact on Overdose Deaths 9

F. Selecting Your Coalition Members 10

G. Developing Your Coalition Vision Statement 10

H. Selecting Your Coalition Leadership 11

I. Conducting Productive Meetings 11

J. Assessing Your Coalition’s Health 11

K. County Overdose Elimination Framework 12

L. Selecting Your Evidence-Based Interventional Strategies 12

M. Building an Impact Model 13

N. Developing and Using a Strategic Plan 15

O. Developing an Evaluation Plan 16

P. Finding Evaluation Assistance 16

Q. Current Situation Assessment 16

R. County Dashboard Framework 17

S. Sustainability: Developing a Grant Application 17

Glossary. 21

References 25

Appendices 26

Appendix I: County Overdose Elimination Framework 27

Appendix II: Current Situation Assessment 29

Appendix III: County Dashboard Framework 46

Appendix IV: Assessment Worksheets 48

A.1. Describing Your Community and Community Factors Checklist 49

A.2. Data Available to Your Community 53

A.2.1. Potential Sources of Data 54

A.2.2. A Guide For Analyzing Community Data 57

A.3. Community Readiness Assessment 60

Appendix V: Capacity Worksheets 62

C.1. Potential Coalition Members and Roles 63

C.2. Creating a Vision Statement (And a Greater Purpose) 65

C.3. Leadership Questionnaire 67

C.4. Coalition Health Assessment 69

C.5. Ascertain Available Resources and Support 79

C.6. Determine Community Activation Level 80

Appendix VI: Planning Worksheets 81

P.1. Identify Potential Evidence-Based Intervention Strategies 82

P.2. Develop Impact Model 90

P.3. Develop a Strategic Plan 91

Appendix VII: Implementation Worksheets 95

I.1. Determine Relevant Community Connections 96

I.2. Develop an Effective Communication Plan 97

I.3. Implement Strategies Supporting Continuous Quality and Fidelity 99

Appendix VIII: Evaluation Worksheets 101

E.1. Develop an Evaluation Plan 102

E.2. Measure Progress 104

Appendix IX: Sustainability Worksheets 105

S.1. Secure Funding Resources 106

S.2. Develop a Sustainability Plan 107

S.3. Obtain Continued Community Support 108

Introduction: What is the Technical Assistance Center and How Can It Help Your Community Fight Overdose?

Mission: The Pennsylvania Heroin Overdose Prevention Technical Assistance Center (TAC) will be the first ever resource and technical assistance hub for all counties within the Commonwealth of Pennsylvania. Based out of the Program Evaluation and Research Unit (PERU) at the University of Pittsburgh School of Pharmacy, the TAC will assist counties and communities in planning, developing, implementing, and sustaining community-based initiatives for reducing overdose throughout Pennsylvania.

Activities: Through the TAC, PERU will continue to develop and expand the OverdoseFreePA.org website, which contains a wealth of information regarding overdose prevention strategies, interventions, data, and resources. The website includes a growing database of overdose death data within Pennsylvania, which will expand to cover all 67 counties in Pennsylvania. This data provides insight into the causes and populations affected by overdose and is sortable to provide relevant information to interested audiences.

The TAC staff will coordinate with county and community representatives to conduct assessments of current strengths and liabilities for addressing overdose in each community using a systems focused framework they have developed and tested. Results of this assessment will guide the development of a customized evidence-based strategic plan to address the community’s current state of overdose and overdose deaths. Technical assistance will continue to each community as they implement and sustain their efforts to reduce overdose deaths.

Finally, TAC staff will assist the PCCD with developing Requests for Proposals (RFPs) and evaluating applicants for funding awards to support the above efforts toward reducing overdoses and overdose deaths.

For more information or to request technical assistance, please complete the TAC Request Form available at http://overdosefreepa.org, use the form on the next page, or contact us at:

PA Heroin Overdose Prevention TAC

University of Pittsburgh School of Pharmacy

5607 Baum Boulevard, 432

Pittsburgh, PA 15206

412-383-2006

The Pennsylvania Heroin Overdose Prevention Technical Assistance Center

County Overdose Prevention Coalition

Regional Training Participation Interest Form

Please complete and return this form to the TAC along with a copy of a signed Memorandum of Understanding (MOU) or other organizational documents.

Organization Name: ______

Primary Contact: ______

County: ______

Address: ______

City/State/Zip: ______

Phone: ______Email: ______

Preferred Training Month: (circle) June July August September

Preferred Training Region: (circle) NW SW NC SC NE SE

Coalition Vision: ______

Note – the vision should be an ideal vision which will inform all of the coalition’s activities. Ex. “We will work to eliminate overdoses in ______County.”

Coalition Mission: (Preliminary):

______

Please verify that your coalition presently has participation/representation from the following domains (4 at minimum):

_____ SCA

_____ CJAB

_____ County Coroner/Medical Examiner

_____ County Health Department (if applicable)

_____ Law Enforcement/Criminal Justice

_____ EMS/First Responders

_____ County Medical Society

_____ MOU/Organizational Document Copies Attached

A. How to Use This Manual

This manual has two functions. First, it provides background information regarding what is known about how to prevent overdoses and how to organize that knowledge. Second, it provides questionnaires, worksheets, checklists, and guiding principles that can be used to apply this knowledge towards the development of a community-specific strategic plan that could effectively guide a community towards reducing overdoses and overdose deaths.

Please note that the TAC staff will provide your community with ongoing technical assistance regarding how to use the information in this manual.

This manual will guide your group to develop or enhance a coalition to reduce overdose deaths within your community. Because each community has unique characteristics, no single coalition will look the same. The resources in this manual will help your group to understand the current overdose phenomena in your community and the most effective people, resources, and strategies to enlist in the fight against overdose deaths. Worksheets and resource links will assist you as you assess your community, use available data resources to identify the scope of the overdose issue, form or develop your coalition and leadership, select your evidence-based strategy or strategies, and evaluate your coalition’s effectiveness.

The processes for guiding your community towards reducing overdose deaths is based both on SAMHSA’s Strategic Prevention Framework, shown in Figure 1 (SAMHSA, n.d.) and a Framework for Guiding System Transformation, Figure 2, (Diamond, 2015) developed at the Program Evaluation and Research Unit (PERU). The System Transformation Framework is used to develop and enhance the effectiveness of an organization in order to maximize its ability to achieve its selected purpose. The Framework is intended to provide a guide to system transformation around one domain: the vision or greater purpose of the organization. This domain influences four other domains regarding the function of the organization: (1) culture or employee/members’ values, beliefs and assumptions about their work; (2) behavior or how employees/members’ handle relationships, power, decision-making, conflict, and learning; (3) structure or how the organization is designed so lines of communication in the organization can facilitate decisions and innovations; and (4) the use of performance measurements for system improvement. Ultimately, these domains are continually managed by the facility leadership and are influenced by external learning (methods to provide learning and skills development to the workforce) and internal learning (systematic processes used to improve organizational functioning), which can continuously transform the organization toward its intended vision.

Figure 1. SAMHSA Strategic Prevention Framework

Figure 2. System Transformation Framework

This manual walks your community through how to apply both of these processes and includes worksheets to assess your community, obtain data to guide your selection of evidence-based practices (EBPs) which are best matched to the data, select and implement strategies to address overdose deaths, and maintain a healthy coalition.

Table 1: Appendices and Worksheets

Stage / Resources and Worksheets / Appendix /
Supplemental / County Overdose Elimination Framework
Current Situation Assessment
County Dashboard Framework / Appendix I
Appendix II
Appendix III
Assessment / Describing Your Community and Community Factors Checklist
Data Available to Your Community
Community Readiness Assessment / Appendix IV: A.1.
Appendix IV: A.2.
Appendix IV: A.3.
Capacity / Potential Coalition Members and Roles
Creating a Vision Statement (and a Greater Purpose)
Leadership Questionnaire
Coalition Health Assessment
Ascertain Available Resources and Support
Determine Community Activation Level / Appendix V: C.1.
Appendix V: C.2.
Appendix V: C.3.
Appendix V: C.4.
Appendix V: C.5.
Appendix V: C.6.
Planning / Identify Potential Evidence-Based Intervention Strategies
Develop Impact Model
Develop a Strategic Plan / Appendix VI: P.1.
Appendix VI: P.2.
Appendix VI: P.3.
Implementation / Determine Relevant Community Connections
Develop an Effective Communication Plan
Implement Strategies Supporting Continuous Quality and Fidelity / Appendix VII: I.1.
Appendix VII: I.2.
Appendix VII: I.3.
Evaluation / Develop an Evaluation Plan
Measure Progress / Appendix VIII: E.1.
Appendix VIII: E.2.
Sustainability / Secure Funding Resources
Develop a Sustainability Plan
Obtain Continued Community Support / Appendix IX: S.1.
Appendix IX: S.2.
Appendix IX: S.3.

Figure 3. TAC Implementation Diagram

B. Why a Coalition?

A coalition is a group of individuals or organizations who work together to address a problem in the community (Center for Prevention Research and Development, 2006). The coalition may include existing organizations such as social service agencies, government agencies, or community groups, or may be formed by individuals who share a common concern. Research on overdose prevention strategies shows that community coalitions can be very effective at implementing changes that promote health in the community (Albert et al., 2011). One of the strongest effects of a coalition approach is the ability to change the environment in the community by increasing awareness of overdose-related issues that also result in changes in the community’s attitudes and beliefs regarding overdose. This evolution then yields targeted changes in community systems that are needed to support the application of specific evidence-based practices to reduce overdose. In summary, coalitions help to form links between organizations and individuals at various levels in the community to leverage their resources toward reducing overdose deaths (University of Kansas Work Group for Community Health and Development, 2015).

C. Describing Your Community

Identifying characteristics of your community helps you to understand factors which will influence your ability to affect change within your community. The composition of your coalition, strategy selection, collaboration opportunities, and selection of evidence-based practices are enhanced when you choose them with the overall character of the community in mind.

Your coalition should represent views of the various stakeholders affected by overdose issues and provide opportunities for participation to as broad a section of your population as possible. Consider demographic, cultural, economic, and social factors in your community to ensure that your strategy is inclusive and represents the community as a whole. Size, population, urban or rural location, and resource availability are factors which will influence your approach. Also, consider any specific subpopulations within your community (age, gender, race and ethnicity, religion, veteran status, etc.) You will need to identify where, when, and in which population segments overdose is more of a risk.

Use the Describing Your Community and Community Factors Checklist to characterize your community (see Appendix IV: A.1.)

D. Obtaining Your Data

Data about the incidence and prevalence of drug use, overdose, and overdose deaths in your community will help you understand the scope of the problem and identify possible solutions.

The PA Heroin Overdose Prevention TAC collects data on overdose deaths in Pennsylvania through the OverdoseFreePA.org Overdose Death Data registry. County coroners or medical examiners submit case information through a secure access website to provide an almost real time picture of overdose deaths by county. Information includes age group, race, gender, type(s) of drug(s) contributing to death, and zip codes of incidence and residence (if available). This information helps community members to know who is affected by overdose in their community. Single County Authorities (SCAs), coroners, and medical examiners should contact the TAC for guidance on how to submit overdose data.

Other data sources for information on the scope of overdose deaths include national and state data sets and local data sources such as law enforcement agencies, healthcare facilities, or emergency medical services (EMS) agencies. Identifying the types of healthcare practitioners, hospitals and clinics, human service agencies, substance use disorder (SUD) treatment facilities, recovery support groups, education resources, and criminal justice facilities in your community will help you to obtain information about available resources and identify gaps in existing services or unmet needs.

Data on non-fatal overdoses can help you identify risk factors or intervening variables for overdose, but it is not always easy to obtain. You may be able to acquire this information from local law enforcement, healthcare, or EMS agencies to help provide a total picture of overdose risk in your community, but standard data collection methods remain a challenge.

Use the Data Available to Your Community and Potential Sources of Data worksheets to identify what data on overdoses is currently available for your community and potential sources for this data. Utilize resources such as contact lists for state or county organizations or individuals which can help provide additional data or sources for your coalition. (See Appendix IV: A.2. for worksheets.)

E. Determining Your Community’s Readiness to Have an Impact on Overdose Deaths

“Readiness” refers to your community’s capacity to initiate and implement change. Some groups or segments of your community may not be aware that overdose is an issue. Other groups may deny that this problem exists or that it doesn’t need to be solved (because it is not severe enough, or because they believe time and resources could be better spent elsewhere). Even if the community is aware and wants to take action, views about the appropriate interventions and solutions to your overdose problem will also vary (University of Kansas Work Group for Community Health and Development, 2015).