Phases of Intervention
The Communities That HEAL (CTH) intervention was created by a team of opioid-overdose reduction experts from academic and medical institutions in the four states where the HEALing Communities Study took place: Ohio, Kentucky, Massachusetts, and New York. The CTH is a step-by-step process that puts community members at the center of all decision making and action to reduce overdose deaths. The intervention mirrors similar programs that have worked in communities to inspire change. The CTH stands apart from other approaches to community overdose reduction in two important ways:
- The CTH is a data-driven approach, meaning that community members are presented with current information about the extent to which overdose death are happening in their area to inform their selection of evidence-based practices.
- The CTH is a community-engaged approach, meaning that public health officials assist and empower communities to make choices, coordinate action, and put practices into place that will effectively reduce overdoses.
PreparationActivity 0.1: Identify or Develop Community Coalitions Working to Address the Overdose Crisis
Overview
Identify existing coalitions in your community who are working to address the overdose crisis. This can be done in three ways:
- Leveraging existing coalitions or other established community advisory groups.
- Convening members from existing community coalitions and agencies that are impacted by or are addressing the opioid overdose crisis.
- Creating a new coalition, if no others exist.
Timeline
- 4-6 months
Activity 0.2: Conduct a Landscape Analysis
Overview
A landscape analysis helps us better understand the resources, assets, and barriers that may affect Communities That HEAL program implementation. The landscape analysis is designed to:
- Describe the assets of and gaps in the community that are relevant to implementing the Communities That HEAL program.
- Support collaboration with the coalitions as they make decisions about what types of programs are needed or could be enhanced in their communities and what organizations or groups may need to be engaged.
- Help coalitions generate a list of potential organizations and groups to partner with.
Timeline
- 1-5 months
Activity 0.3: Review and Become Familiar with Community Engagement Principles and Practices
Overview
Core coalition members and leaders participate in community engagement trainings to build and expand their community engagement skills.
Timeline
- 2-3 months
Activity 0.4 Begin Initial Activities for Communication Campaigns
Overview
Review the HEALing Communities Study communication campaign materials for your community. The main objectives of the communication campaigns are to reduce stigma, encourage treatment, and provide naloxone to reverse opioid overdoses.
Timeline
- 6-8 months
Additional Phase 0 Resources
Publications Related to Phase 0
- Community advisory board members’ perspectives on their contributions to a large multistate cluster RCT: A mixed methods study
- Community engagement to implement evidence-based practices in the HEALing communities study
- Health communication campaigns to drive demand for evidence-based practices and reduce stigma in the HEALing communities study
Getting StartedActivity 1.1: Setting Your Coalition Up for Success
Overview
Coalitions (or subgroups within a coalition) establish a charter or another form of partnership agreement for Communities That HEAL implementation. This phase includes:
- Setting protocols for communication among members of the coalition and other collaborators;
- Determining how to integrate existing community efforts to address the opioid crisis into the ORCCA model;
- Setting expectations for coalitions’ relationships with other collaborators, such as the partner organizations; and
- Establishing a protocol for managing requests for support from organizations not represented on the coalition.
Timeline
- 2 months
Activity 1.2: Recruit Champions, Introduce Data-Driven Decision-Making Approach, and Initiate Review of Landscape Analysis Data with Coalition
Overview
This task focuses on:
- Identifying and engaging coalition members who are willing to serve as champions and in leadership positions to help implement the Communities That HEAL intervention.
- Orienting coalition champions and leaders to the Communities That HEAL interventions.
- Engaging coalition members in reviewing the landscape analysis data to ensure an accurate and comprehensive assessment of services and resources for each community.
- Filling the key roles in communication, data, and the three ORCCA objectives to support implementation.
Timeline
- 3 months
Activity 1.3: Review Evidence-based Strategies from the ORCCA Menu
Overview
The Communities That HEAL Training Plan ensures that coalition members and leaders have the knowledge and skills to participate fully in meetings and carry out their roles. The Phase 1 training modules serve as a prelude to more in-depth discussions around surveillance, treatment, implementation, and evaluation.
Timeline
- 1 month
Activity 1.4: Introduce ORCCA and Evidence-Based Practices
Overview
Review:
- ORCCA
- The menu of evidence-based practices (EBPs) with coalitions to address coalitions’ questions about the ORCCA menus.
Getting Organized
Overview
In Phase 2, community coalitions will
- Review and discuss the evidence-based practice (EBP) strategies and the strategy selection process.
- Develop a shared vision for implementing EBPs, which can facilitate data review and action planning in subsequent Communities That HEAL phases.
- Develop a distribution plan for the first communication campaign.
- There are two activities in Phase 2, outlined below.
Phase 2: Getting Organized Road Map
Activity 2.1: Discuss Opioid-Overdose Reduction Continuum of Care (ORCCA) Menu Options and Decision Procedures for Selecting Evidence-Based Strategies
Overview
Coalitions can review the Opioid-Overdose Reduction Continuum of Care Approach (ORCCA) menus of implementation that correspond to three evidence-based practices (EBP) strategies:
- Overdose education and naloxone distribution (OEND),
- Medications for opioid use disorder (MOUD), and
- Safer prescribing
Coalitions may need to adopt a more focused and refined decision-making process for EBP selection during Phase 2. Strategy selection will vary based on community needs, feasibility, readiness, desirability, stage of current implementation, and expected impact. The selection process will require an understanding of:
- The rationale for emphasizing the EBPs,
- The difference among menu options, and
- How to evaluate anticipated risks and benefits of different approaches with different populations in different settings.
Coalitions can also reference the Technical Assistance Guide (TAG).
Timeline
- 1 month
Activity 2.2: Develop a Distribution Plan for the Communications Campaign
Overview
Collaborate with community coordinators, community advisory board members, program managers, community engagement facilitators, communication champions, subcommittee or coalition members, and partner organizations to develop a plan for disseminating materials for each communication campaign (1– Naloxone, 2 – Stigma, and 3 – MOUD). Distribution plans are “living documents” that are regularly revisited and updated throughout the campaign.
Timeline
- 3 months
Additional Phase 2 Resources
Community Profiles and Data Dashboards
Overview
Phase 3 focuses on collaborative development of a community-tailored profile and data dashboard. The data synthesis work completed in Phase 3 will inform community action planning. There are five activities in Phase 3, outlined below.
Phase 3: Community Profile and Data Dashboard Road Map
Activity 3.1: Create Community Profiles
Overview
The community profile is a summary of baseline conditions and trends in opioid overdose fatalities that can be developed using local-level epidemiologic data and landscape analysis data on resources and barriers for Communities That HEAL implementation across multiple sectors (e.g., public health, behavioral health, and criminal legal).
Timeline
- 2-3 months
Activity 3.2: Create Data Dashboards
Overview
This task is the starting point for drafting a data dashboard for each community. Community-tailored dashboards are data visualization(s) to support decision making and monitoring based on community-specific study metrics and other community-tailored data.
Timeline
- 1-3 months
Activity 3.3: Map the Existing Services and Programs to Opioid-Overdose Reduction Continuum of Care Approach (ORCCA)
Overview
Working together, the community coalitions will review the community profile, map the community’s existing resources and services for people at high risk for opioid overdose to the three Opioid-Overdose Reduction Continuum of Care Approach (ORCCA)-required evidence-based practices (EBPs) (e.g., EBPs for naloxone, medications for opioid use disorder, and safer prescribing), and identify data and service gaps.
Timeline
- 1-4 months
Activity 3.4: Engage Coalitions on Data Visualizations
Overview
Data champion(s) facilitate one-on-one and group meetings with coalition members and partners organizations to deliver EBPs. The purpose of these meetings is to
- Share and provide training on the dashboards;
- Gather feedback on effective visualization resources from key stakeholders, and
- Develop or improve data-sharing relationships across community organizations.
Timeline
- 1-4 months
Activity 3.5: Implement Communications Campaign in Partnership with Coalitions
Overview
Implement and monitor the Campaign 1 distribution plans drafted in Phase 2.
Timeline
- 3-4 months
Additional Phase 3 Resources
- Communication Campaigns | HEALing Communities Study
Publications Related to Phase 3
Community Action Planning
Overview
In Phase 4, community coalitions develop Opioid-Overdose Reduction Continuum of Care Approach (ORCCA)-specific goals and select evidence-based practice (EBP) strategies. EBP strategies target the service gaps outlined in the community profile. Coalitions—and partner organizations, when possible—will work together to prioritize EBP strategies for community action plans based on feasibility and impact. When engaging partner organizations in the selection process, give attention to potential conflicts of interest. In general, strategies that are both high impact and highly feasible should have top priority for selection. At least five strategies from the three EBP menus are recommended for implementation to address the following areas:
- One for overdose education and naloxone distribution,
- Three in different areas for medications for opioid use disorder (MOUD) intended to enhance the care cascade (i.e., expanding access to treatment, increasing linkage to care, and increasing retention on MOUD), and
- One for safer opioid prescribing/dispensing.
Phase 4 has three activities, outlined below.
Phase 4: Community Action Planning
Activity 4.1: Set Community Goals
Overview
Coalitions can draw on the landscape analysis data, community profiles, HCS modeling data, and the ORCCA menus to inform goal setting through engaged consensus discussions. Goal setting considerations should include:
- Geographic access disparities
- High-risk areas and populations
- Racial/ethnic inequalities
Communities’ goals should also align with the overarching goal to reduce opioid overdose deaths and should target identified gaps in the provision of opioid overdose education and naloxone distribution (OEND), MOUD, and safer opioid prescribing.
Timeline
- 1 month
Activity 4.2: Select ORCCA Strategies that Align with Community Goals
Overview
Coalitions will discuss and prioritize EBP strategies that (1) align with the ORCCA-specific goals developed under the previous task, (2) address the gaps identified through review of the community profile and data presented on dashboards, and (3) are high impact and highly feasible. To the extent possible, coalitions should engage potential partner organizations in discussions of potential strategies.
Timeline
- 1-2 months
Activity 4.3: Create a Community Action Plan
Overview
Community coalitions will build on previous Phase 4 tasks of developing ORCCA-specific goals and prioritizing EBP strategies to draft an action plan. Action plans will summarize coalition goals, high-priority EBP strategies, and the target timeframe for implementation. Action planning should include discussions about sustainability. When possible, partner organizations should be engaged in the action planning process. As communities move through Phase 5, action plans may need to be revisited and revised based on lessons learned during EBP implementation or evolving community needs.
Timeline
- 1-2 months
Additional Phase 4 Resources
Implement and MonitorActivity 5.1: Develop Initial Implementation Plans for Selected Evidence-based Strategies
Overview
This task involves building on the action plans developed under Phase 4 to detail how partner organizations will execute the specific evidence-based strategies they agree to implement, with support from coalitions. Implementation plans should be developed for each community’s selected/prioritized opioid-overdose reduction continuum of care approach (ORCCA) strategy and can be developed at the intervention site or organizational level.
Timeline
- 2-3 months
Activity 5.2: Implement ORCCA Evidence-based Strategies
Overview
Using implementation plans as a guide, partner organizations will implement selected evidence-based strategies with support from community coalitions working to reduce overdose deaths. Partner organizations can also access implementation resources for each EBP strategy in the ORCCA technical assistance guide. Partner organizations monitor and learn from implementation efforts, they may identify opportunities to improve the implementation of EBP strategies and can work with coalitions to modify implementation plans as needed.
Timeline
- 9-11 months
Activity 5.3: Share Lessons and Resources
Overview
Coalition members will troubleshoot implementation problems with partner organizations and provide technical assistance as needed to facilitate optimal implementation of EBPs. If implementation challenges arise that indicate a particular evidence-based strategy is not as feasible as anticipated or community data indicate that an evidence-based strategy is less impactful than initially expected, partner organizations and coalitions may work together to update EBP strategy selection following steps from Phase 4. As strategies are revised, related action and implementation plans should be updated.
Timeline
- 9-11 months
Activity 5.4: Monitor Communication Campaign Activities in Partnership with Your Coalition
Overview
During Phase 5, coalitions can actively monitor and evaluate the communication campaign building on strategies outlined in Activity 3.5.
Timeline
- 11 months
Sustainability Planning
Overview
The main objective of Phase 6 is to create a sustainability plan led by the coalition. The goal is to implement evidence-based strategies for reducing opioid overdoses by utilizing and building upon the existing infrastructure in your community. Your coalition may decide to integrate these evidence-based strategies with existing substance use intervention models or community health planning processes, such as Communities That Care, Community Health Needs Assessments, or Community Health Improvement Plans.
Phase 6: Sustainability Planning Road Map
Activity 6.1: Support Sustainability through Training and Technical Assistance
Overview
As communities make progress on key Communities That HEAL components, the focus of training and technical assistance should shift to sustainability.
Timeline
- 11-17 months, ongoing
Activity 6.2: Support Development of Coalition-Driven Sustainability Plans
Overview
A coalition-driven and -supported sustainability plan is critical. As communities progress to Phase 5 of the intervention, coalitions and partner organizations will be gaining insights from EBP strategy implementation. This is a good time to orient coalitions to the sustainability plan task. Coalitions and partner organizations can work to develop a first draft of a sustainability plan; within 6 months, they can finalize and begin implementing their sustainability plans.
Timeline
- 2-6 months, ongoing