The HCS is a multi-site trial that evaluated the impact of the Communities That HEAL (CTH) intervention compared with usual care in wait-list communities. See the full protocol here. This page includes all HCS publications as indexed in PubMed.
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:
Select a phase below to reveal more resources within each sub-phase.
Phase 0 prepares communities to collaborate with local coalitions and other community partners to implement the Communities That HEAL program. There are four activities in Phase 0, outlined below.
Phase 0 – General References
Identify existing coalitions in your community who are working to address the overdose crisis. This can be done in three ways:
A landscape analysis (LA) helps us better understand the resources, assets, and barriers that may affect Communities That HEAL program implementation. The LA is designed to:
Core coalition members and leaders participate in community engagement trainings to build and expand their community engagement skills.
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.
During Phase 1, coalitions establish a charter and are introduced to the Opioid-Overdose Reduction Continuum of Care Approach (ORCCA). There are four activities in Phase 1, outlined below.
General References
Coalitions (or subgroups within a coalition) establish a charter or another form of partnership agreement for Communities That HEAL implementation. This phase includes:
This task focuses on:
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.
Review:
In Phase 2, community coalitions will
Phase 2 General References
Coalitions can review the Opioid-Overdose Reduction Continuum of Care Approach (ORCCA) menus of implementation that correspond to three evidence-based practices (EBP) strategies:
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:
Coalitions can also reference the Technical Assistance Guide (TAG).
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.
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: General References
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).
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.
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.
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
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:
Phase 4 has three activities, outlined below.
Phase 4: General ReferencesCoalitions 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:
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.
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.
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.
Phase 5 involves developing implementation plans for selected evidence-based practice (EBP) strategies, implementing EBP strategies, and implementing and monitoring activities for Campaigns 2 and 3.
Phase 5: General References
This task involves building on the action plans developed under Phase 4 to detail how partner organizations will execute the specific EBP 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.
Using implementation plans as a guide, partner organizations will implement selected EBP strategies with support from community coalitions working to reduce overdose deaths. Partner organizations can also access implementation resource 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.
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 EBP strategy is not as feasible as anticipated or community data indicate that an EBP 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.
During phase 5, coalitions can assess and review Campaign 1 and, plan, implement, and monitor activities for Campaigns 2 and 3.
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: General References
Hiring and training community members to implement the Communities That HEAL intervention helps support long-term evidence-based practice (EBP) strategy implementation and leads to improved health outcomes (Johnson et al., 2017). Moreover, hiring and training personnel to support EBP implementation can also help position communities and partner organizations to sustain EBPs. Although Communities That HEAL focuses on addressing the opioid crisis, trained community and coalition members can apply the community-driven intervention model to a variety of health and social problems.
As communities make progress on key Communities That HEAL components, the focus of training and technical assistance should shift to sustainability.
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.
NIH HEAL Initiative and Helping to End Addiction Long-term are service marks of the U.S. Department of Health and Human Services.