Successful strategies for_community_change_part2_final


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Advocacy Workshop, National Rx Drug Abuse Summit, April 2-4, 2013. Successful Strategies for Community Change - Part 2 presentation by Fred Wells Brason II and Connie M. Payne.

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Successful strategies for_community_change_part2_final

  1. 1. Successful  Strategies  for  Community  Change,  Part  2   Fred  Wells  Brason  II   CEO,  Project  Lazarus     Connie  M.  Payne    Execu=ve  Officer,  Statewide  Services,   Administra=ve  Office  of  the  Courts  
  2. 2. Learning  Objec=ves    1.  Outline  strategies  for  community  coali=ons   to  protect  their  health.  2.  Explain  the  role  naloxone  can  play  as  part  of  a   comprehensive  overdose  preven=on   program.  3.  Outline  the  considera=ons  and  partnerships   that  must  be  made  in  the  early  stages  of   planning  and  implemen=ng  an  Adult  Drug   Court.  
  3. 3. Disclosure  Statement    •  Fred  Brason  has  a  financial  rela=onship  with   proprietary  en==es  that  produce  health  care   goods  and  services.  This  rela=onship  are  with:   Purdue  Pharma  and  Covidien.    •  Connie  Payne  has  no  financial  rela=onships   with  proprietary  en==es  that  produce  health   care  goods  and  services.    
  4. 4. Preventing  opioid  poisonings  Promoting  responsible  pain   management  
  5. 5. Our Partners and Sponsors
  6. 6. COLLABORATION   Project Lazarus believes that communities are ultimately responsible for their own health and that every drug overdose is preventable. We are a non-profit organization that provides training and technical assistance to community groups and clinicians throughout North Carolina and beyond. Using experience, data, and compassion we empower communities and individuals to prevent drug overdoses and meet the needs of those living with chronic pain. “A PUBLIC HEALTH APPROACH TO OVERDOSE PREVENTION” STATEMENT OF R. GIL KERLIKOWSKE, DIRECTOR OFFICE OF NATIONAL DRUG CONTROL POLICY EXECUTIVE OFFICE OF THE PRESIDENT AUGUST 23, 2012“Project Lazarus is an exceptional organization—not only because it saves lives in Wilkes County, but also because it sets a pioneering example in community-based public health for the rest of the country.”
  7. 7. Uninten=onal  Poisoning  Deaths  by  County:  N.C.,  1999-­‐2009   Prepared by Project Lazarus fwith an Sta=s=cs,   Source:  N.C.  State  Center   or  Health   unrestricted educational grant1from Purdue by   Vital  Sta=s=cs-­‐Deaths,   999-­‐2009  Analysis   Pharmapidemiology  and  Surveillance  Unit   Injury  E LP, NED1013563/31/13 7
  8. 8. Cost  of  Hospitaliza=ons  for  Uninten=onal   Poisonings:  NC,  2008   •  Average  cost  of  inpa=ent  hospitaliza=ons      for  an  opioid  poisoning*:                $16,970.   •  Number  of  hospitaliza=ons  for  uninten=onal      and  undetermined  intent  poisonings**:      5,833   •  Es=mated  costs  in  2008:  $98,986,010   Does  not  include  costs  for  hospitalized  substance  abuse   *Agency  for  Healthcare  Research  and  Quality   **  NC  State  Center  for  Health  Sta=s=cs,  data  analyzed  and  prepared  by  K.  Harmon,  Injury  and   Violence  Preven=on  Branch,  DPH,  01_19_2011   Source: NC CSRS
  9. 9. Survey  Profile  of  NC  Coun=es   Local  Health  Departments  89  Departments/100  Coun=es   78%  Response  
  10. 10. Traditional interventions intended to prevent drug abuse have not been able to stop overdose deaths in North Carolina.
  11. 11. Survey: NC County Health DirectorsCommunities lack of information, tools and leadership to prevent ODs. Source: 2011 Project Lazarus Health Director Survey
  12. 12. Differences in opioid utilization suggest complex phenomena that are independent of pharmacology. Large cities have relatively fewer peoplereceiving opioids than small counties. Areas with the highest opioid prescribing also have the highest poverty. Source: NC CSRS and US Census
  13. 13. THE HUBI.  Public Awareness – is particularly important because there are widespread misconceptions about the risks of prescription drug misuse and abuse. It is crucial to build public identification of prescription drug overdose as a community issue. That overdose is common in the community, and that this is a preventable problem must be spread widely.II.  Coalition Action - A functioning coalition should exist with strong ties to and support from each of the key sectors in the community, along with a preliminary base of community awareness on the issue. Coalition leaders should also have a strong understanding of what the nature of the issue is in the community and what the priorities are for how to address it.III.  Data and Evaluation - The early data that you will need includes certain health related information like number of emergency department visits and hospitalizations due to overdose, number of overdose deaths, number of providers in the county who actively use the PDMP, number of prescriptions and recipients for opioid analgesics dispensed and other controlled substances.
  14. 14. Coalition Development Community forums must be repeated to motivate the necessary stakeholders to take action. Community coalitionsmust be provided tools tomake their own strategic plans and design locallyappropriate interventions.
  15. 15. COMMUNITY ENVIRONMENTAL Family SITUATION Peers Schools Military Medical Individual HumanTribal Biological Service Psychological Faith Social Media Spiritual Civic Courts Youth Senior Law Treatment Services Enforcement Local Gov’t/Health
  16. 16. The WHEELCommunity Education - efforts are those offered to the general publicand are aimed at changing the perception and behaviors around sharingprescription medications, and improving safety behaviors around theiruse, storage, and disposal. “Prescription medication: take correctly, store securely, dispose properly and never share.”Prescriber Education - Chronic pain is recognized as a complicatedmedical condition requiring a substantial amount of knowledge and skillfor appropriate evaluation, assessment, and management. Reached viaCME, Lunch and Learn, Grand Rounds, Webinars, Medical CaseManagement Meetings – Prescribers Toolkit 1) Pain Agreements 2) Use of PDMP 3) Urine Screens 4) Assessment modalities - SBIRT a. Treatment options and local referral network
  17. 17. Hospital Emergency Department (ED) Policies - it is recommended thathospital EDs develop a system-wide standardization with respect toprescribing narcotic analgesics as described in the Project Lazarus/Community Care of NC Emergency Department Toolkit for managingchronic pain patients: 1) Embedded ED Case Manager 2) “Frequent fliers” for chronic pain, non-narcotic medication and referral 3) No refills of controlled substances 4) Mandatory use of PDMP 5) Limited dosing (10 tablets)Diversion Control - Supporting patients who have pain, particularly thosewho are treated with opioid analgesics, is an important form of diversioncontrol: take correctly, store securely, dispose properly and never share. - Law Enforcement, Pharmacist and Facility training on forgery,methods of diversion and drug seeking behaviorPain Patient Support - In the same way that prescribers benefit fromadditional education on managing chronic pain, the complexity of living withchronic pain makes supporting community members with pain important. “Proper medication use and alternatives”
  18. 18. Harm Reduction – Naloxone rescue medication to reverse opioid overdose A script gives patients specific language that they can use with their family to talk about overdose and develop an action plan, similar to a fire evacuation plan.
  19. 19. Harm Reduction – Naloxone rescue medication to reverse opioid overdoseThe North Carolina Medical Board has issued a statement supporting the use ofnaloxone to prevent overdoses: “…The prevention of drug overdoses is consistent withthe Board’s statutory mission to protect the people of North Carolina. The Boardtherefore encourages its licensees to cooperate with programs like Project Lazarus intheir efforts to make naloxone available to persons at risk of suffering opioid drugoverdose.”AMA, June 19, 2012 “Fatalities caused by opioid overdose can devastate families andcommunities, and we must do more to prevent these deaths,” said Dr. Harris.“Educating both physicians and patients about the availability of naloxone andsupporting the accessibility of this lifesaving drug will help to prevent unnecessarydeaths.”NADDI supports nasal naloxoneThe National Association of Drug Diversion Investigators (NADDI) has taken a positionto encourage law enforcement agencies to adopt policies that would allow officers tocarry nasal naloxone with them to administer to individuals involved in a an opioidoverdose. Proper training and certification by the proper authority of each state helps toensure proper use of nasal naloxone on those in distress due to a drug overdose.
  20. 20. Drug treatment and RecoveryAddiction treatment, especially opioid agonist therapylike methadone maintenance treatment or office basedbuprenorphine treatment, has been shown to dramaticallyreduce overdose risk. Unfortunately, access to treatmentis limited by two main factors:•  Availability and accessibility of treatment options,•  Negative attitudes or stigma associated with addiction in general and drug treatment.
  21. 21. Can coalitions help reduce Rx drug abuse?•  Counties with coalitions had 6.2% lower rate of ED visits for substance abuse than counties with no coalitions (but this could be due to random chance)•  However, counties with a coalition where the health department was the lead agency had a statistically significant 23% lower rate of ED visits (X2=2.15, p=0.03) than other counties.•  In counties with coalitions 1.7% more residents received opioids than in counties without a coalition.•  Coalitions may be useful in reducing the harms of Rx drug abuse while improving access to pain medications at the same time.•  More professional coalitions may have a greater impact on reducing Rx drug harms.
  22. 22. Wilkes  County  NC  ! RESULTS   Fred  Wells  Brason  II   26  
  23. 23. The overdose death rate dropped 69% in two years after the start of Project Lazarus and the Chronic Pain Initiative.
  24. 24. Wilkes County Opioid Prescribing Wilkes County had higher than state average opioid dispensing during theimplementation of Project Lazarus and the Chronic Pain Initiative. Access to prescription opioids was not dramatically decreased. Source: NC CSRS
  25. 25. Wilkes County Overdose Script History In 2011, not a single OD decedent had an opioid prescription from a Wilkes County prescriber. The fundamental risk:benefit ratio for opioids can be altered for the better through a community-wide approach.
  26. 26. NC Statewide Collaborative Kate B. Reynolds Charitable Trust - Office of Rural Health NC Alliance for Health Community Care NC Project Lazarus* – Governors Institute for SA – UNC Injury and Prevention Research Center*(includes NC Div. of Public Health CDC Transformation Grant and MAHEC CMS InnovationsGrant)NC Medical Board/NC Medical Society/NC Hospital AssociationNC College of Emergency Physicians/Family Practice/Physicians AssistantsNC Div. MHDDSAS/OTP’s/PDMPSBI/NC Sheriffs AssociationCarolinas Poison CenterDental SocietyFQHCPrevention OrganizationsCoalitions
  27. 27.                           Dr. Mike Lancaster mlancaster@N3CN.orgFred Wells Brason IIFWBrason2@projectlazarus.orgRobert Wood Johnson Community Health Leader Award 2012 Additional efforts underway in NM, VA, TN, OH, MD, ME, OK, etc.
  28. 28. SUCCESSFUL  STRATEGIES    FOR  COMMUNITY  CHANGE   Part  2     Thursday,  April  4,  2013   9:45  am  –  10:45  am       April  2  –  4,  2013   Omni  Orlando  Resort     at  ChampionsGate  
  29. 29. LEARNING  OBJECTIVES  •  Outline  the  considera=ons  and  partnerships   that  must  be  made  in  the  early  stages  of   planning  and  implemen=ng  an  adult  drug   court.    •  Outline  the  considera=ons  and  partnerships   necessary  to  develop  a  mutualis=c   rela=onship  between  community  coali=ons   and  local  adult  drug  courts.  
  30. 30. DISCLOSURE  STATEMENT  Nothing  to  disclose  
  31. 31. WHAT  IS  DRUG  COURT:  briefly  •  Mission:  to  stop  the  abuse  of  alcohol  and  other   drugs  and  related  criminal  ac=vity  •  Creates  communica=on  and  rela=onship  between   criminal  jus=ce  system  and  treatment  system  •  Benefits:   –  For  society:    lower  recidivism,  breaking  cycle  of   addic=on  and  CJ  involvement,  etc.  etc.   –  For  defendant:    sobriety,  possible  dismissal  of  charge   (diversion),  reduce  =me  on  proba=on,  lesser  penalty,   reunifica=on  with  family/friends  •  More  info:        
  32. 32. 10  KEY  COMPONENTS    DCs  across  country  (&  interna=onally)  operate   under  10  Key  Components          #10.    Forging  partnerships  among  drug  courts,   public  agencies,  and  community  based   organiza=ons  generates  local  support  and   enhances  drug  court  program  effec=veness.  Components  #1-­‐#9:  
  33. 33. ADULT  DRUG  COURT  TEAM  •  Judge   •  Circuit  Court  Clerk  •  Treatment   •  Proba=on  Officer   •  Community  •  Prosecutor   Representa=ves  •  Defense  Amorney   •  Voca=onal  Rehabilita=on  •  Law  Enforcement   Representa=ve  •  Case  Manager   •  GED  Representa=ve  
  35. 35. STEERING  COMMITTEE  MEMBERS  •  Principle  drug  court  partners/team   members;    •  Community  leaders  and/or  those   passionate  about  recovery,  involved  in   the  community  AND  who  follow  through  •  Variety  of  disciplines/professions    
  36. 36. STEERING  COMMITTEE  •  Members  with  strong  involvement  in  other   community  coali=ons/  organiza=ons    •  May  form  non-­‐profit  501(c)(3)  •  Assists  in  policy  guidance/advice  for  DC  •  Assists  in  variety  of  life-­‐skills  educa=on  •  Conduit  for  fundraising  &  resources          
  37. 37. STEERING  COMMITTEE:  FORMING  •  Educa=on  and  buy-­‐in:  coali=ons/agencies  must   be  educated  re  drug  courts  –  requirements,   accountability,  etc.    •  Most  helpful:    judge  taking  staff/case  manager   to  meet  with  community  leaders  •   Also  helpful:    other  DC  team  members  and   staff/case  manager  mee=ng  with  organiza=ons    •   Invite  community  leaders  to  DC  gradua=ons  
  38. 38. NO  STEERING  COMMITTEE;   No  problem  Research  local  community  coali=ons  •  Check  with  Secretary  of  State  website  re  501 (c)(3)  corpora=ons  •  Ask  known  organiza=ons,  churches,  Salva=on   Army,  Proba=on  Officers,  United  Way    Develop  a  list  of  resources  •  Specific  people  •  Specific  groups/organiza=ons  
  39. 39. MUTUAL  BENEFITS   DRUG  COURT   COMMUNITY  -­‐  Funding  for  gradua=ons,   -­‐  A  project  that  truly  helps   special  events   &  changes  lives    -­‐  Loca=on  for  community   -­‐  Receives  community   service  hours   service  work/hours  -­‐  Educates  community  re   -­‐  Staff  can  present  on   addic=on   substance/alcohol  abuse,  -­‐  Group  able  to  educate/   treatment,  educa=on   discuss  variety  of  life-­‐ skills    
  40. 40. ADDITIONAL  BENEFITS,  a  glimpse    Community  has  more  ci=zens  who:   –  Pay  taxes   –  Pay  child  support   –  Do  not  u=lize  jail  space    Drug  Court  has  more  ci=zens  who:   –  Understand  addic=on  as  a  disease   –  Understand  necessity  for  treatment  resources   –  Are  willing  to  hire  DC  par=cipants  
  41. 41. ADDITIONAL  BENEFITS,  specifics        Saved  town  of  Mt.  Washington  over  $3,000  by   volunteering  to  repair  and  paint  city-­‐owned  offices    Mt.  Washington  Mayor  so  pleased,  3  other  nearby   towns  have  asked  to  partner  with  Drug  Court    DC  grads  have  been  asked  to  join  coali=ons;  helps   maintain  energy  &  involvement  with  substance   abuse  issues    DC  grads  hired  by  community  service      sites  
  42. 42. ADDITIONAL  BENEFITS,  specifics    Annual  community  sponsored  drug-­‐free  and  drug-­‐ free  awareness  events   –  Fatherhood  Ini=a=ve  (held  at  state  park  each  May)   –  Spring  clean-­‐up  (PRIDE  –  Personal  Responsibility  in  a   Desirable  Environment)   –  Easter  egg  hunt   –  Christmas  meal  and  giqs    Par=cipants  and  staff  volunteer  to  set-­‐up,  clean-­‐up,   “man”  booths,  etc.    -­‐  now  fes=vals                                       request  par=cipant  involvement  
  43. 43. ADDITIONAL  BENEFITS,  specifics  DC  provides  speakers  to  share  their  stories:  •  Police  Department  training  –part  of  the  new   recruit  training  is  to  amend  DC  and  amend   substance  abuse  &  addic=on  training    •  Faces  of  Substance  Abuse  Conference    •  Paren=ng  groups  in  need  of  a  specific  substance   abuse  topic  •  Agency  for  Substance  Abuse  Preven=on  (ASAP)  •  Mayor’s  Alliance        
  44. 44. ADDITIONAL  BENEFITS,  specifics  5K  DRUG  AWARENESS  RUNS:  Run  for  Recovery  Run  Away  from  Drugs  –      DC  par=cipant  Jesse  H.;  drug  of  choice  -­‐  oxycon=n;  other   drugs-­‐  cocaine,  benzos  and  alcohol  –  addict  nearly  20  yrs    While  in  DC  &  in  recovery,  approached  local  UNITE  Board  to   start  a  5k  run  to  raise  substance  abuse  awareness  &   preven=on    Run  is  now  in  its  5th  year  
  45. 45. BOTTOM  LINE  Rela=onships  
  46. 46. CONTACT  INFORMATION     Connie  M.  Payne   Execu=ve  Officer   Statewide  Services  Kentucky  Administra=ve  Office     of  the  Courts