BER BERNALIL ALILLO O COUNT COUNTY OPIOID AB OPIOID ABUSE USE ACCOU CCOUNT NTABILITY ABILITY SUMMIT SUMMIT “Turning the Curve on Opioid Abuse in Bernalillo County” NMPHA Annual Conference April 2, 2014 Marsha McMurray-Avila Coordinator, Bernalillo County Community Health Council
BERNALIL BER ALILLO O COUNTY COUNTY OPIOID OPIOID ACCOUNT CCOUNTABI BILITY LITY INITIA INITIATIV TIVE E TIME TIMELINE INE (F (Fall ll 2012 – Fall ll 2014) October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014 IMPLEMENTATION TEAMS INTERIM UPDATE MEETING PRIMARY June 2014 PREVENTION OVERDOSE SUMMIT SUMMIT #1 COORDINATING PREVENTION PLANNING September COMMITTEE COMMITTEE 19, 2013 TREATMENT SUMMIT #2 LAW Fall 2014 ENFORCEMENT/ CRIMINAL JUSTICE/ PUBLIC SAFETY DATA TEAM
WORKING IN COLLECTIVE IMPACT REQUIRES A MINDSET SHIFT OLD WAY NEW WAY • Technical • Adaptive Problem-Solving Problem-Solving • Credit • Credibility • Silver Bullet • Silver Buckshot Adapted from John Kania
COLLECTIVE IMPACT: WHAT IT TAKES 1. Achieve a perpetual state of simultaneous planning and doing 2. Allow for the “shock of the possible” 3. Pay attention to relationships 4. Listen, listen, listen for how to respond to unanticipated results 5. Adopt an attitude of “burning patience” Adapted from John Kania
RESULTS-BASED ACCOUNTABILITY has two parts: Population Accountability about the well-being of WHOLE POPULATIONS For communities – cities – counties – states – nations Performance Accountability about the well-being of CUSTOMER POPULATIONS For Programs – Agencies – Service Systems
RESULTS-BASED ACCOUNTABILITY (RBA) RESULT What is the desired change in population well-being? HEADLINE INDICATOR What data – tracked as a trend over time - would best indicate change toward the desired result? (This represents what we want to “turn the curve” on.) STORY BEHIND THE CURVE What are the root causes and multiple forces at work causing the trend? What additional information/data is still needed? (This is the “research agenda”) WHAT PARTNERS NEED TO BE INVOLVED? Who needs to be at the table and who’s missing? WHAT WORKS? (WHAT WOULD IT TAKE TO “TURN THE CURVE”?) What can each partner contribute? What are some no cost/low cost ideas that can be worked on right away?
Potential Indicators Law Law Enf Enfor orcement/ cement/ Prevention Cr Criminal iminal Just ustice/ ice/ Indicator Public Saf Public Safety ety Rate of reported use Indica Ind icator tor of heroin/painkillers Recidivism rates at to get high among MDC (within 1 and 3 youth in last 30 days HEADLINE HEADLINE years) INDICATOR INDICA #/rate of overdose deaths associated with opioid Har Harm m Reduction eduction Trea eatment tment Ind Indica icator tor Indica Ind icator tor use in Bernalillo County # of heroin overdose #/rate of deaths & Naloxone hospitalizations for OD reversals with any opioid involvement
INDICATORS AND PERFORMANCE MEASURES • Indicators as used here are specifically related to the well-being of the population - are we getting better or getting worse as a population? • Performance measures track data related to the performance of the system and/or specific programs. o How much was done? o How well was it done? o Is anyone better off?
BERNALIL BER ALILLO O COUNTY COUNTY OPIOID OPIOID ACCOUNT CCOUNTABI BILITY LITY INITIA INITIATIV TIVE E TIME TIMELINE INE (F (Fall ll 2012 – Fall ll 2014) October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014 IMPLEMENTATION TEAMS INTERIM UPDATE MEETING PRIMARY June 2014 PREVENTION OVERDOSE SUMMIT SUMMIT #1 COORDINATING PREVENTION PLANNING September COMMITTEE COMMITTEE 19, 2013 TREATMENT SUMMIT #2 LAW Fall 2014 ENFORCEMENT/ CRIMINAL JUSTICE/ PUBLIC SAFETY DATA TEAM
SUMMIT SUMMIT PLA PLANNING NNING COMMITTEE COMMITTEE Focused on identifying recommendations, indicators, panelists and format for first Summit. ~20 multi-sectoral members representing: • Advocates, community activists, drug policy analysts, data analysts • Albuquerque Health Care for the Homeless • Bernalillo County Community Health Council • Bernalillo County Department of Substance Abuse Programs/MATS • Bernalillo County Urban Health Extension • City of Albuquerque Division of Health & Human Services • Heroin Awareness Committee (Healing Addiction in Our Community) • Molina Healthcare • New Mexico Department of Health – Health Promotion • New Mexico Department of Health – Office of Injury Prevention • New Mexico Department of Health – Turquoise Lodge • Presbyterian Healthcare Services • UNM Prevention Research Center for Education Policy Research • UNM Preventive Medicine • UNM Urban Health Partners – Pathways to a Health Bernalillo County • UNM Center for Alcoholism, Substance Abuse & Addictions (CASAA) • UNM RWJF Health Policy Center
BERNALIL BER ALILLO O COUNTY COUNTY OPIOID OPIOID ACCOUNT CCOUNTABI BILITY LITY INITIA INITIATIV TIVE E TIME TIMELINE INE (F (Fall ll 2012 – Fall ll 2014) October 2012 -------------September 2013 ------------------>December 2013 ---------------------------->June 2014-->Fall 2014 IMPLEMENTATION TEAMS INTERIM UPDATE MEETING PRIMARY June 2014 PREVENTION OVERDOSE SUMMIT SUMMIT #1 COORDINATING PREVENTION PLANNING September COMMITTEE COMMITTEE 19, 2013 TREATMENT SUMMIT #2 LAW Fall 2014 ENFORCEMENT/ CRIMINAL JUSTICE/ PUBLIC SAFETY DATA TEAM
SUMMIT #1 September 19, 2013 Convened 150 multi-sectoral stakeholders to hear panelists, review recommendations and get commitment to follow-up work over next two years
Four Implementation Teams with volunteers from Summit - plus others - meet monthly to: strategize and act on implementing recommendations for their specific area , including identifying decision- makers who are key players to bring to the table select indicator(s) as target to measure desired outcome(s) and to develop baseline "report card" inventory available services/gaps in their area, identifying need for additional resources provide ideas for next Summit
PRIMARY PREVENTION IMPLEMENTATION TEAM What works or would work to "turn the curve" on this problem? RECOMMENDATIONS FOR ACTION • Develop and implement prevention framework for the county using SAMHSA SA Prevention Framework, NMPED "Building State Capacity" plan, with tools for community coalitions, schools, faith-based institutions and workplaces • Expand access to drug counseling services for high school and middle school students including referrals and how Medicaid could support • Support policies to expand evidence-based early childhood support programs, including home visiting focusing first on low-income families • For pain control, promote evidence-based alternatives for Rx opioids • Reduce supply of Rx opioid pain medication by increasing access to and usage of Prescription Monitoring Program database AND prescribing guidelines to limit over-prescription of opioids • NEW: Inventory and evaluation of existing programs • NEW: Access to mental health care (which could possibly be part of the Treatment Team work as well)
HARM REDUCTION/OVERDOSE PREVENTION IMPLEMENTATION TEAM What would work to "turn the curve" on this problem? RECOMMENDATIONS FOR ACTION 1. Make availability of naloxone normal and universal • Distribute naloxone to persons being released from MDC and their families o Build on existing programs o Learn from existing models/pilots o Provide training for inmates, families, MDC staff and P&P officers • Restructure P&P policies to allow for parolees to have naloxone rescue kits while on parole* • Assure all police officers are carrying naloxone and trained in its use • Support implementation of authorization allowing pharmacists to prescribe naloxone o Support development of MCO reimbursement mechanisms for kits and education/consultation o Assure naloxone rescue kits are stocked at all pharmacies • Advocate for all providers to co-prescribe naloxone with opioid pain meds for chronic pain management • Make naloxone and training available to agencies with outreach programs for injection drug users, treatment centers and methadone clinics* • Make naloxone available at all public health offices as walk-in sites o Normalize naloxone as service o Assure services are user-friendly
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