paper Ahm

Progress:

· Each member should choose two community partners as a basis for the assignment (we can narrow it down to a smaller number of partners from there)

· Everyone should submit an idea for how the funds should be spent (We only need two, because the assignment requires that one of them is a recovery residence).

· Take a page/section to write your contributions and include your name. Example:

Your Name

Partners: Organization 1, Organization 2

Fund Usage: Buying Stuff

1. Cover letter

2. Introduction Epidemiology & Background of the Opioid Crisis in the USA and KY

3. Coalition Building -- Why the need for the coalition? What will it be called?

4. Who are the key agency stakeholders, why included, roles/function, one representative each?

5. Two other local community stakeholders not associated with a public/private health agency

6. Which agency will be the lead agency and why?

7. Maybe this could be summarized in a table. See example below

8. Describe any governance & structural characteristics

9. Breakdown of cost and finance

10. How you will evaluate the effectiveness of your proposal?

11. We also need someone to do the final formatting and to create one cohesive document

Start Below:

Whitney

#5 Two other local community stakeholders not associated with a public/private health agency

Website used PFA: https://www.ipfcc.org/bestpractices/opioid-epidemic/index.html

Websites used IWG: https://www.ruralhealthinfo.org/topics/opioids

https://www.safetyandhealthmagazine.com/articles/17679-new-tool-aimed-at-helping-rural-community-leaders-target-opioid-abuse

Partners: 1.) The Patient and Family Advisor (PFA) Summit on the Opioid Epidemic. Held on June 10, 2018.

2.) The Rural Opioid Federal Interagency Working Group (IWG).

· Fund Usage: PFA: highlight programs and responses that reflect the partnership with patient and families, strengthen skills for collaboration in the future

· Fund Usage: IWG: for background information, supporting rural communities, creating surveys and providing trainings

The opioid epidemic refers to a very serious public health issue coming from the rapid increase of prescription and nonprescription opioid drugs. Even now, there has been a significant lack of structured partnerships with patients and families in developing national, regional, state, local, etc. Organizational strategies to address this epidemic at hand. As a result, programs are continuing without any contributions from people who are directly impacted by the issue. Almost 80 participants attended the PFA summit which consisted of patients, family members, members of the community and more. The other participants represented the organizational agencies form the national, state and local levels doing work to address the epidemic. The PFA has many partner organizations that works with families to address the epidemic. These include Partnerships in Research, Peer Support and Educations Models of Partnership, Partnerships in Organizational Health Care Quality and Safety Improvement. To handle the situation, the PFA suggests building on successful existing partnerships, prepare families and patient who have experience, prepare other stakeholders to foster a supportive environment for partnerships with families and patients and creating incentives for partnerships. By doing these, the individuals will need to receive training with those in the health profession. The PFA Summit showed the power and possibilities that come with the responsibility of handling the opioid epidemic. Collaborative action will be required and educating people on the crisis. Funding will be necessary for training, creating supportive environments and even having additional training sessions for collaborative work.

The IWG works to address the opioid crisis in rural communities by improving coordination of and reducing potential overlap among federal responses. This group was established in May of 2018 and is co-chaired by the Office of National Drug Control Policy and the US Department of Agriculture. The group uses the Rural Community Action Guide which provides background information, action steps and practices that can help address the opioid use in rural communities. This group needs funding to improve coordination among federal agencies according to USDA. More than 300,000 Americans have died from opioid related overdoses since 2000, and nearly 75% of farmers and farm workers say they have been directly affected by this crisis. Furthermore, 3 out of 4 (75%) of farmers report that it is easy to obtain a large number of opioids or painkillers without having a prescription in their communities. This group was created to have the USDA partner to create this guide to help them find the federal resources that can help the community respond. The IWG works to provide a forum for Federal Agencies to collectively advance environmental justice principles.

The opioid overdose epidemic is a widespread public health emergency. It has contributed to an increase in emergency department visits, non-fatal overdoses but many fatal ones. It has also contributed to widespread outbreaks of infectious diseases linked to intravenous drug use. These things burden public health with the substantial economic costs from death, hospital and emergency visits and lost productivity for the individual. Local stakeholders in the community should recognize the epidemic to be a significant source of concern and to national emergency.

Ahmed Questions 4, 6,7

Partners:

Fund Usage:

Manmeet

Partners:

1)Maternal opiate substance treat program (MOST)program

2)PATHWays provides Second chance for pregnant moms struggling with substance use disorder

Fund Usage: PATHWay can use 50% of the budget to set up the satellite units all over the state for pregnant and work force, inpatient for detox then starting long term recovery treatment.

3)Coalition Building -- Why the need for the coalition? What will it be called?

· Coalition to Stop Opioid Crisis : The Coalition to Stop Opioid Crisis (CSOC) brought together a diverse range of mental health, substance use disorder, health care professional organizations united and communities around common policy goals to reduce opioid overdose deaths. Together, CSOC aims to elevate conversation around opioid overdose and works to enact meaningful and comprehensive policy change that supports prevention, treatment, and remission and recovery services.

· The coalition identifies the following priorities:

· Coordinate efforts between law enforcement, the legal system, and treatment.

· Increase access and utilization of naloxone to save lives.

· Increase community awareness to reduce stigma.

· Educate individuals and families about addiction and overdose, particularly those at high-risk, and all persons in contact with high-risk individuals, and those with an OUD or addiction.

· Increase access and utilization of substance use disorder treatment programs.

It can have the following committees

Naloxone Subcommittee

· Responsible for distributing Naloxone kits to various first responders throughout County.

· To save lives through the distribution of Naloxone and to promote awareness.

Coordination Subcommittee

· Facilitate coordination between the court system and law enforcement, and to let the various stakeholders involved with the coalition know that there is support for people in recovery with family, housing, economic, legal needs.

Treatment Subcommittee

· To take an active part in the community and to collaborate with others to remove barriers for individuals seeking treatment.

· To assist with early identification and treatment to reduce complication.

· To help with behavioral health.

Education and Publicity Subcommittee

· To help public and professional awareness of this issue.

· To educate the staff to be better prepared and have better understanding of the disease and its complexities.

· To provide education on the needed services to have a healthy lifestyle.

Anti-Stigma Subcommittee

· By creating safe spaces for individuals to come forward and get help.

8)Describe any governance & structural characteristics

Federal characteristics:

Funds should be used based on these five-point strategy made by HHS.

· Better addiction prevention, treatment, and recovery services

· Better data

· Better pain management

· Better targeting of overdose reversing drugs

· Better research

Our program should have the following areas to satisfied five-point strategy made by HHS.

· Overdose prevention and naloxone distribution

· Reducing opioid overprescribing and improving safe opioid use

· Community-guided prevention

· Harm reduction

· Engagement and linkage to services

· Access to FDA-approved medications for opioid use disorder

· Reducing unmet treatment need

· Recovery support

· Provider education and training

Structural characteristics.

· Collaboration of practices such as behavioral health, primary care, and other care professionals work better to achieve goals. The collaboration should be driven by the shared concept of the team care. The integrated practices should have formal and informal meeting to support integrated model of care. This should help to communicate consistently at system, team, and individual levels. This model should have an in-depth understanding of roles and culture.

· Substance use should be screened and monitored in primary care

· address full spectrum of problems

· use EHR, clinical coordination, patient, health IT treatment options including patient portals, HIEs, technology delivered treatments

· Addresses medical problems with focus on whole person wellness

· Medications readily available.

· Performance and outcomes measurement, ongoing quality improvement.

· 12-step and other RSS, social network innovations

Dylan (Robert)

Partners: Recovery Kentucky (could be used as the primary Recovery Residence option); KORE Kentucky Opioid Response Effort (May be an excellent option as the “lead agency”, given its tight knit pre-existing partnerships and connections to the federal government through SA MHSA

Fund Usage: Expand Recovery Kentucky (at least 60% of the budget) to include more counties with Rehabilitation Centers; allocate funding to the expansion of help hotlines, access to Narcan, and access to clean needles and needle/drug disposal units (I.e., drug disposal units should not be a police/sheriff's department led operation).

Annessa

I. Partners: PAR Mission: People Advocating Recovery is a statewide group of concerned individuals working to eliminate barriers to recovery from addiction.

PAR Vision: Our vision is a Kentucky free of stigma and barriers to recovery.

People Advocating Recovery (PAR) was founded as Kentucky’s statewide recovery community organization in 2002, gaining non-profit status in 2006. People in recovery and allies had been coming together in the state as part of Join Together’s Demand Treatment project and developed an Angel’s Program to provide outreach to people in emergency rooms because of addiction-related issues.

Following a Recovery Ambassador advocacy training, conducted by the Johnson Institute, the group formed PAR to bring forward an advocacy and public awareness focus. While relatively few new state dollars had been budgeted in the past 20 years, addiction problems were calling attention to the need for more treatment and recovery options.

PAR’s legislative advocacy agenda has included increasing funding for indigent treatment, restoration of voting rights to ex-felons, seeking increased placement of recovering persons on state policy advisory boards, and working for pre-trail diversion programs. PAR has developed effective partnerships other advocacy groups, such as Kentuckians for the Commonwealth, the Catholic Conference of Bishops, and the League of Women Voters. PAR’s partnership with the Restoration of Voting Rights Coalition (ROVRC), housed at Kentuckians for the Commonwealth, has fostered a fruitful collaboration.

In the beginning PAR functioned as a strictly volunteer organization. There are now six PAR chapters, with two more developing and 7000 members. Individual chapters each have a seat on the Board and “at large” Board members are selected for their disparate points of view and varied political affiliations. In 2009, with support from the Health Foundation of Greater Cincinnati, PAR moved into a new stage of development with a volunteer Board and a paid Executive Director. This has increased its ability to advocate in the state capitol of Frankfort and elsewhere, to raise awareness of recovery needs and options around the state, and to assist in chapter development. In 2011, PAR broadened its capacity to deliver training and technical assistance to educate Kentuckians about peer and other recovery support services by establishing the PAR-ATC (Advocacy Training Center). Funding is in part from KORE.

Funding usage: 25% of funds for increasing indigent treatment, restoration of voting rights to ex-felons active in recovery programs, and increasing of presence of trained recovery counselors in emergency departments.

II. The Kentucky Opioid Response Effort (KORE) Mission: seeks to expand and sustain a comprehensive, equitable recovery-oriented system of care to end the opioid epidemic that has reached into every community in Kentucky.

Kore Vision: Through the administration of federal funding from the Substance Abuse and Mental Health Services Administration, KORE supports the implementation of evidence-based prevention, treatment and recovery supports to effect change at the state, community, family, and individual levels. KORE-funded partners and services model policies and practices grounded in best practice and compassion and include projects focused on:

· Overdose prevention and naloxone distribution

· Reducing opioid overprescribing and improving safe opioid use

· Community-guided prevention

· Harm reduction

· Engagement and linkage to services

· Access to FDA-approved medications for opioid use disorder

· Reducing unmet treatment need

· Recovery support

· Provider education and training

Fund Usage: I agree with Dylan on this. KORE is a key lead agency for allocating funds for many of the smaller community intervention programs in the state of KY due to their association with SAMASHA. I believe they should be one of the 3 selected.

Budget & Finance

The Coalition to Stop Opioid Crisis (CSOC) maintains a $1.18 million budget allocated toward the advancement of the Coalition’s agenda and directives. This funding was sourced from the University of Kentucky, in the amount of $1 million, and the Kentucky Cabinet for Health and Family Services as part of the KORE initiative, in the amount of $180,000. While the money vested to this Coalition amounts to $1.18 million, the UK grant stipulates that it is to be allocated over the course of 4 years, therefore the entire sum will be divided as such.

Section 1: Budget Overview

The following charts depict the broad categories of budget allocation for the total sum of $1.18 million; without timeline considerations.

Figure 1.1: In accordance with the goals of the CSOC, the budget will be defined within the boundaries of the 4 listed categories, with “Rehabilitation & Treatment” being the largest allocation.

Figure 1.2: This indicates subcategories within each of the 4 primary categories by which the budget will be divided. Each highlighted section of the stratified bar graph corresponds with the percentage that each subcategory is allocated out of the whole budget.

Section 2: Definition of Budget Categories

1. Rehabilitation & Treatment: This category includes budget allocations for the expansion of publicly funded rehabilitation and treatment facilities, both “inpatient” and “outpatient”, the expansion of coverage for those who are unable to afford treatment or are un- or underinsured (in conjunction with pre-existing programs), and the expansion of access to emergency Narcan doses, Suboxone prescriptions, and new, sterile needles for those struggling with addiction to injected opioids.

2. Education & Prevention: This includes community outreach through marketing campaigns and educating the public of the dangerous effects of prolonged opioid use, abuse, and overdose. It also includes informing the public about how to know the signs of drug addiction, where to seek more information and treatment, how to dispose of prescription drugs and other substances. Further, this category also includes intervention and diversion as a means of working to prevent opioid abuse and overdose. Intervention funding will be directed toward efforts to compassionately intervene in existing cases through resources offered by various partners, while diversion funding will be for diverting substances away from public access by improving anonymous disposal methods.

3. Research & Targeted Response: The research portion of this category will focus on collecting opioid use data through various partners across the state and supporting the process through small financing efforts, particularly in underrepresented parts of the state. This will also play an important role in evaluating CSOC’s performance and outcomes. The population-based response potion of the category will focus on directing a significant amount of funding toward specific populations which the data indicates are in need of more support.

4. Discretionary: This is the smallest portion of the budget and will be set aside for various CSOC operating expenses, minor projects, programmatic grants, and other financial obligations which may arise over the course of 4 years.

Section 3: Financial Breakdown

Category	Sub-Category	Partner(s)	Total Allocation (Per year)	Total Allocation (4-year total)
Rehabilitation & Treatment	Facility Expansion	Recovery Kentucky; MOST Program	$73,750	$295,000
	Coverage Expansion	KORE; PAR	$44,250	$177,000
	Resource Expansion	KORE; PATHWays; Pharmaceutical companies	$29,500	$118,000
Education & Prevention	Community Outreach	Opioid Response Network; PAR; PFA; IWG	$29,500	$118,000
	Intervention-Diversion	Recovery KY; PATHWays; First Responders	$29,500	$118,000
Research & Targeted Response	Data Collection	UK; KYCHFS; IWG	$14,750	$59,000
	Population-Based Response	Various (Depending on nature of response)	$44,250	$177,000
Discretionary	Miscellaneous Expenses	Various	$29,500	$118,000

Section 3: Expenditure Examples

The following are examples of how the allocations may be spent in an effort to advance CSOC’s mission. These examples are tentative and may be subject to change based on availability and other initiatives.

1. Rehabilitation & Treatment: The allocated funding in this category will go directly to the expansion of existing facilities, call centers, and treatment programs that currently exist through Recovery Kentucky. Nearly $75,000 every year for 4 years will supplement existing operational functions, as well as to offer additional coverage (in conjunction with pre-existing programs) for those in need of treatment who cannot otherwise afford it. Further, an annual $29,500 will go toward the annual purchase of 500 doses ($37.50 per dose) of Narcan through the company’s direct purchaser’s site (www.narcan.com), as well as the bulk purchase of sterile safety syringes/needles, which will all be made available at partner organizations at no cost to the public.

2. Education & Prevention: $29,500 will be annually allocated over the 4-year period directly to marketing efforts, including commercials and advertisements, presentations at primary schools and colleges, the production of educational materials, and other community outreach methods. Further, an additional $29,500 will be devoted annually to drug disposal drives and the installation of permanent disposal systems from Stericycle.

3. Research & Targeted Response: Nearly $15,000 annually will be devoted to the dissemination of surveys and data collection processes through partnerships with UK and other organizations. $44,250 will be used to target specific populations who are found through that research to be in greater need of support in fighting the opioid epidemic by enhancing funding in other categories accordingly.

4. Discretionary: This will include $118,000 over the 4-year period devoted specifically to cover various expenses and special programs provided by CSOC.

Evaluation

Ensuring the effective use of the generous budget afforded to CSOC, various evaluation methods will be engaged to assess the outcomes of CSOC efforts. As a part of the Research category, $14,750 will be annually allocated to the process of data collection over the 4-year period, which will serve as the primary point of reference for the evaluation.

The process for evaluating CSOC’s performance will be as follows:

1. In the first year, prior to any actions taken by the Coalition, data will be collected from across Kentucky regarding opioid use, addiction and overdose metrics, rehabilitation and treatment metrics, and current education and prevention metrics. This will be benchmarked against the national averages for the same criteria in order to establish a precedent for later evaluation.

2. At the end of year 1 and every subsequent year-end, the same data will be collected and a relevant statistical analysis (funded by the discretionary budget) will be performed and prepared as an infographic which will be used as a marketing promotion for CSOC, should the data reveal positive improvement over the previous year (see next point).

3. Improvements will be based on statistically significant advancements to the following questions:

a. Did opioid abuse decrease from year-to-year relative to CSOC funding?

b. Did more individuals utilize rehabilitation services that received CSOC funding?

c. Were more drugs and substances disposed in CSOC funded disposal systems and programs?

d. When surveyed, how many Kentuckians were aware of the resources and treatments available to them from CSOC funds and partnerships?

e. Did the number of opioid overdose related deaths decline in areas of Kentucky where Narcan and support services were made available by CSOC funds?

f. Did medical facilities indicate a decrease in blood-borne pathogens, such as Hepatitis and HIV, in areas where sterile needles/syringes were provided at no cost by CSOC funding?

If a majority of those questions can be answered with a statistically significant, positive trend, then CSOC will receive a positive rating for that calendar year.

4. At the end of the 4-year period, a total cost-benefit analysis will be performed based on how CSOC made use of its funding versus improvements in Kentucky’s opioid epidemic. This will be compared to the contemporaneous national averages for relevant data, with an above-average score indicating success for CSOC.