SAFE Solutions - User contributions [en]

System Building

2025-01-29T23:08:44Z

Mlabrie21:

While not part of the traditional Institute of Medicine's (IOM) Continuum of Care model, systems building strategies allow community leaders to build big picture vision, address underlying values, and change the source of conditions. This may include strategies that support your broader work, such as building public awareness and momentum around your movement, broadening and engaging your coalition, supporting advocacy efforts, applying data performance approaches, and leading policy change.

The themes addressed below are tightly linked to issues addressed across the full spectrum of the IOM Continuum of Care, and the reader is strongly encouraged to read the overview articles in each of the other five SAFE Solutions menus (prevention, early intervention, treatment, harm reduction, and recovery).

Three clusters of system-building articles are outlined. The first menu, "Principles of Systems Thinking," addresses the methodology of system building and creates a foundation for all of the other articles. The second menu details each of the five phases of SAMHSA's Strategic Prevention Framework (SPF). The last menu addresses themes introduced in the articles on systems thinking principles as they apply across the Continuum of Care and throughout the SPF phases.

Principles of Systems Thinking include:
*"[[Systems Change Science]]" explains the methodology of systems thinking and change generally and its importance in addressing fundamental root causes to improve outcomes, rather than symptoms of a problem.
*"[[Apply a Multi-Sectoral Approach]]" covers the breadth of agencies and stakeholders to engage in the kind of community-wide systems change initiative needed to end the substance use crisis.

Solutions which focus on the SPF include:
*"[[Collect and Share Data]]" covers the first of the five SPF phases, assessment, and the need to collect, share, and monitor data at the local level in order to implement a data-driven approach.
*"[[Build Capacity]]" addresses the second SPF phase and provides methods for new and mature coalitions to deploy to improve community impact.
*"[[Plan, Implement, and Evaluate]]" addresses the last three phases of SPF and highlights the way in which the three are interrelated.

The third menu, "Cross Cutting Strategies," are strategies that should be applied across the entire Continuum of Care and includes:
*"[[Apply a Health Equity Lens]]" addresses how determinants and conditions by which people are born are impacted by substance use and how to apply a health equity lens in all approaches, so that all people have access to high-quality health. This article is under development for release in 2025.
*"[[Intersectionality and Addressing Disparities]]" addresses the enhancement of protective factors linked to substance use prevention and approaches in other intersecting areas like domestic violence, gun violence, suicide, and a variety of others. It specifically addresses disparities and unequal distribution across various groups of people impacted by substance use and highlights key needs. This is an article under development for release in 2025.
*"[[Mobilize Community Champions]]" focuses on applying motivational interviewing at the community scale and building champions outside of a coalition. This is an article under development for release in 2025.
*"[[Advocate for Policy Change]]" addresses various strategies and levels of engagement for changing policy at the local, state, and federal levels.
*"[[Understand Funding and Identify Your Resources]]" highlights various funding sources and strategies for funding and sustaining community efforts. This is an article under development for release in 2025.
*"[[Build Awareness and Education]]" focuses on communications tactics for educating the general public and elevating your community efforts. This is an article under development for release in 2025.
*"[[Reduce Stigma]]" defines the various types of stigma and examines strategies for stigma reduction in the prevention, treatment, and recovery domains.

Support Key Legislative and Policy Changes

2025-01-29T23:07:20Z

Mlabrie21: Mlabrie21 moved page Support Key Legislative and Policy Changes to Advocate for Policy Change

#REDIRECT [[Advocate for Policy Change]]

Advocate for Policy Change

2025-01-29T23:07:19Z

Mlabrie21: Mlabrie21 moved page Support Key Legislative and Policy Changes to Advocate for Policy Change

= Introductory Paragraph =

Educating policymakers and the general public about the legislative or policy changes necessary to create community change is an important step to addressing substance misuse. Policies help states and local communities in three important ways:

*Providing direct funding to communities for treatment and other services.
*Improving access and/or affordability of care to individuals in need of assistance.
*Removing barriers that prevent or limit the use of best practices across government agencies.

Many organizations may be opposed to strategies that appear to be lobbying because of their grant commitments. However, advocacy and lobbying are two distinct activities and there are clear ways that communities can be advocates without engaging in lobbying. Policy change can take place at all levels of government. This page will provide information about how policy changes typically take place, as well as some examples of federal, state, and local laws that have helped local communities.

= Key Information =

'''Initial Steps for Policy Advocacy'''

In order to bring about policy changes through laws or ordinances, any group of citizens must be able to become a "constituency of consequence" to those with the ability to create and change policy. This can be accomplished with a number of different advocacy approaches, as highlighted below. A few key principles to change policy at any level of government include:

*Have clear policy objectives. The more specific and narrow the objective the better. If the policy goals are too broad or general, it is easy for legislators to object on that basis.
*Support your position. Have research and data to support why the policy change would be beneficial. For example, if seeking to improve harm reduction through the creation of a needle exchange program, data should be provided on expected lives that will be saved, reduced medical costs, improved linkages to care, and other benefits.
*Build a coalition. It is important to build a network of support to increase political clout. Identification of other groups with aligned goals could be willing to take action in order to achieve policy objectives. For example, advocacy for a needle exchange program could receive support from harm reduction organizations including hospitals, community health organizations and professionals, the recovery community, families in support of recovery, the treatment community, and potentially many others.
*Know the opposition. If a policy change hasn't happened, it is likely that opposition exists. It is important to learn why policymakers may be hesitant to make a certain change, including what groups oppose the policy and why. Learning about the other side is critical to developing an effective advocacy strategy. Overcoming opposition may require education, effective counterarguments, financial resources, and increased public awareness.

*Identify champions. The most successful efforts resulting in desired policy changes are led by individuals who are passionate about the issue. Identifying and working with champions in the state or local government is a big key to success. It is important to have people "on the inside" that can hold hearings, develop legislation, utilize input and information from stakeholders, and provide insight on the process.
*Every voice matters. Individuals or groups with minimal advocacy experience are often intimidated by the process. It is important for them to remember that those "in power" are there because they were elected to serve. Lawmakers across all levels of government represent the people of their states, districts, cities, and towns. Those representing the people need to hear the concerns of all those they represent -- who have a constitutional right to petition the government to be heard.

After taking the initial steps delineated above, the next step is to identify and implement a set of strategies which will grow public and political support for those policies. Approaches and specific strategies are almost innumerable, but taking action always requires communication and messaging which effectively educates and influences. ''Grassroots Advocacy'' generally refers to engaging the public to actively educate and promote a desired policy objective. Communication occurs through letters, emails, calls to legislators, rallies, social media campaigns, letters to the editor, and other forms of messaging campaigns designed to put political pressure on policymakers to enact desired changes. ''Direct Lobbying'' refers to direct communication and meetings with policy makers, including governors, mayors, county executives, and the legislative branch. This key activity provides the opportunity to meet with decision makers and their staff to gauge the receptiveness of the policymakers and to discuss the desired policy goals, benefits, support, and potential points of opposition. Opportunities for direct lobbying often take place during the legislative session, which varies from jurisdiction to jurisdiction. Some advocates and interest groups will organize a "lobby day" where members converge in Washington, state capitols, or with local legislative bodies to advocate for desired policy objectives. When the legislative body is not in session, advocates can meet with their representatives at their local offices.

'''Lobbying Rules and Restrictions'''

Lobbying rules vary widely between levels of government and across all states. Therefore, it is important to know how lobbying is defined and what the restrictions are in specific jurisdictions. Some fundamentals include:

* 501(c)3 organizations (tax-exempt nonprofits) have some restrictions on lobbying in the government.

* The IRS defines direct lobbying as: "A direct lobbying communication is any attempt to influence any legislation through communication with: Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation" and as "Referring to specific legislation and reflects a view on such legislation."

* The IRS defines grassroots lobbying as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof."

* Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation."

'''The Legislative Process'''

Governments at all levels will frequently create their own set of policy goals to address a particular issue. This has been true for several public health issues including the current opioid epidemic. This process typically involves bringing numerous stakeholders together to provide education and input in coordination with government representatives who initiate the process and finalize the set of policy objectives. States and localities vary widely on what types of laws are implemented across multiple policy areas. <ref>https://www.fda.gov/media/147152/download</ref> The legislative process varies between different levels of governments and in jurisdictions across the country. There are typically several steps in the process that provide opportunities to influence policymakers, such as when they are in session. Some states and localities have relatively short time frames to consider and pass new laws or ordinances, while other states and the federal government are in session for many more weeks throughout the year. It is important to know when the actual work of policy development and consideration takes place.

*'''Sponsors and Early Support.''' In any legislative body, a successful policy enactment starts with one or more members of the legislative body drafting legislation that would bring about the desired change. Members can do this individually or as a group. A group of members that introduce a legislative proposal are typically referred to as sponsors or "original" sponsors of the proposal. Other members can then sign on in support of the bill as co-sponsors. Effective advocacy can help build momentum for a bill during this process. The more sponsors and cosponsors, the better. It is also extremely beneficial to have early supporters from both political parties - especially at the state and federal level. Bipartisan support, and support among a broad base of members at the local level, can show other members that the bill is not likely to be controversial. It is also especially helpful to have support for the proposed legislation from key leaders of the committees with jurisdiction. Advocates can provide their champions within the legislature with all of the supporting information and research to help their champions in the legislative body attract as many co-sponsors as possible and to respond to questions or objections as they arise.
*'''Committee Process.''' Typically, legislative proposals are taken up by the committee (or committees) of jurisdiction. Actual consideration of a proposal often takes place after one or more committee hearings on the proposal. This often involves hearing from witnesses in support of, and potentially in opposition to, a given proposal. Written testimony is also included in the public record to provide additional information to both the public and the legislators. The hearing process provides another opportunity for advocates to testify as witnesses and/or provide information to be included in the record. Hearings can take place in front of the full committee or by a sub-committee which oversees the specific policy area impacted. After the hearing process, the bill may be taken up by the full committee for consideration. Although the bill can be altered by the manager of the bill at any time, consideration by the committee is the first time lawmakers have an opportunity to propose amendments to the proposal. These amendments are voted and adopted, or not adopted, by a majority vote. Following the amendment process the committee chair can call for a final vote on the legislation. If passed, the bill can move to the full legislative body for consideration. Advocacy efforts can move quickly during the committee process, as unexpected challenges may surface due to an unfriendly amendment that might weaken the bill and the policy impact desired. It is important to work with allies to carefully track this process and respond to any negative developments.

*'''Consideration by the Full Body.''' At the local level, there is a single body that approves local legislative proposals. This is typically a Board of Commissioners or other duly elected body. At the state and federal levels, there are two legislative chambers, with delegates and senators at the state level, and the House and Senate at the federal level. The process is usually relatively simple at the local level. Legislation (or ordinance) proposals are taken up at regularly scheduled meetings where a debate occurs, amendments are offered, and the proposals are voted on. Often, the chief executive at the local level has a vote along with the other members. At the state and federal level, the process is more complex. A bill has to pass both chambers before it can be reconciled, voted on again by both bodies, and sent to the Governor or President for signature. While on the floor, members can again offer amendments that can be voted on individually or "en bloc" as two amendments in one. Typically, more controversial amendments will be voted on by individual basis. Assuming the bill passes, it is sent to the other body for consideration. A similar or identical bill may be in process in that other chamber already, or it may be that no companion legislation exists. In the latter case the chamber that did not originate the bill will take up the version that was passed in the other chamber. When a bill does pass both chambers, there are almost always differences that must be worked out. The committee chairs will select a reconciliation committee with a bi-partisan group of legislators from both chambers to accomplish this. Assuming any differences can be worked out, the bill then goes back to the floor of each chamber for a final vote. If passed, the bill is finally referred to the Governor or President. As with the Committee process, advocacy must continue throughout the time in which a bill is considered by the full legislative body. At the state and federal levels, this can be a challenge with many steps involved and a larger number of legislators to contend with - some of whom may not be supportive. Again, it is critical to stay in constant contact with supporters within the legislative body to keep track of potential harmful amendments and keep count of likely supporters within the full body. At times advocacy efforts need to be focused on a handful of legislators who have reservations or are undecided.

*'''Potential Veto and Override.''' Governors and the President may veto a bill passed by the state and federal legislators. If the vote on final passage was close, it is unlikely that the bill will be taken up again, as a two-thirds majority is needed to override a veto. If the original vote approached the two-thirds number, there is a better chance to find the supporters needed for a successful override.

*'''Continued Funding (Budget and Appropriations).''' Even when a law or ordinance is passed and signed by the chief executive, advocacy efforts often do not end. This is due to the fact that legislation containing funding to implement programs is authorized (usually for a period of years), but there is still a budget and appropriations process that must be monitored over the authorization period. Typically, the executive branch of government produces an annual budget that reflects their policy and spending priorities. This budget may or may not be approved by the legislative body. After this point the legislative body will take up annual appropriations bills, which set spending levels for all agencies and their programs. These bills often work through the regular order of other legislation, but sometimes will have a different, often expedited process. It is important for community coalitions and advocates to understand that funding for the agencies and programs they support can change through each step of the budget and appropriations process. There is a need to stay vigilant to ensure that full funding is achieved. Advocates must stay in touch with their champions in the executive branch and legislature to keep informed of any changes and be ready to advocate just as vigorously in order to restore any proposed cuts in funding.

= Impactful Federal, State, and Local Policies =

The policy inventory below provides examples on what has been successful in a variety of policy initiatives. It begins with four major federal actions, then provides five types of state initiatives organized by specific topic. An example from Illinois on a successful advocacy process is included in the Promising Practices section of this article.

'''Biden-Harris Drug Policy Priorities.''' On April 1, 2021, President Biden and Vice President Harris released their administration's Drug Policy Priorities for the upcoming year. President Biden made clear that addressing the overdose and addiction epidemic was an urgent priority for his administration. Specific objctives included: <ref>https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf?fbclid=IwAR2TBk34U_XRqlqK_pAYnUd_9f7zY3IbCQI9KxI6S5eYeRJdFzl9B09hZ84&utm_source=Faces+%26+Voices+of+Recovery&utm_campaign=1c12da631e-november-2020-advocacy-policy_COPY_01&utm_medium=email&utm_term=0_3410cda480-1c12da631e-382685157</ref>

*Expanding access to evidence-based treatment
*Advancing racial equity issues in drug policy
*Enhancing evidence-based harm reduction efforts
*Supporting evidence-based prevention efforts to reduce youth substance use
*Reducing the supply of illicit substances
*Advancing recovery-ready workplaces and expanding the addiction workforce
*Expanding access to recovery support services

'''Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis'''

*Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
*Mandate prescriber education
*Require that all modes of MAT are offered at every licensed MAT facility and that decisions are based on what is best for the patient.
*Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
*Provide model legislation for states to allow Naloxone dispensing via standing orders, as well as requiring the prescribing of Naloxone with high-risk opioid prescriptions;
*Equip all law enforcement in the United States with Naloxone to save lives
*Develop and disseminate Fentanyl detection sensors
*Support and fund interstate sharing of PDMP data
*Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
*Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses versus physical health diagnoses.

'''Federal SUPPORT Act.''' Section 7151, Building Communities of Recovery, amends the Building Communities of Recovery (BCOR) program that was first authorized in the Comprehensive Addiction and Recovery Act (CARA) of 2016 by redefining “recovery community organization” as an organization that mobilizes resources within and outside of the recovery community, including through a peer support network. This section authorizes $5 million for each of FY 2019-2023. Additionally, Section 7031, National Recovery Housing Best Practices, amends part D of title V of the Public Health Service Act to authorize the Secretary of HHS to identify or facilitate the development of best practices for operating recovery housing. The Secretary is directed to bring together a wide variety of stakeholders to develop best practices for recovery housing.

'''The Affordable Care Act of 2010''' supports mental health and substance abuse treatment.

'''Prevention and Reduced Access to Prescription Medications'''

*New Jersey - New Jersey's Prescription Monitoring Program. <ref>https://www.njconsumeraffairs.gov/pmp/</ref>
*California (Alameda County) - Local ordinances that require drug manufacturers to establish and fund a drug disposal program. <ref>https://library.municode.com/ca/alameda_county/codes/code_of_ordinances?nodeId=TIT6HESA_CH6.53ALCOSADRDIOR</ref>
*Connecticut - Statute enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement. <ref>https://www.cga.ct.gov/2016/ACT/pa/2016PA-00043-R00HB-05053-PA.htm</ref>
*Illinois - Statute enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions. <ref>https://www.ilga.gov/legislation/publicacts/99/PDF/099-0480.pdf</ref>

'''Harm Reduction'''

*AmfAR Opioid & Health indicators Database - Syringe Access Locations. <ref>https://opioid.amfar.org/indicator/num_SSPs</ref>
*National Harm Reduction Coalition - Resources for Syringe Access and Policy. <ref>https://harmreduction.org/issues/syringe-access/landscape-report/</ref>
*Rhode Island - Fentanyl Testing Strip Program. <ref>https://preventoverdoseri.org/fentanyl-test-strips/</ref>

'''Access to Treatment and Protecting Treatment Services'''

California legislation has a process for reducing treatment fraud and waste. <ref>https://www.hmpgloballearningnetwork.com/site/behavioral/news-item/policy/calif-bill-targets-profiteering-addiction-treatment-dialysis-industries</ref>

'''Criminal Justice Reform and De-criminalization.'''

* Good Samaritan Laws provide immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose. The Policy Surveillance Program provides an interactive database of current Good Samaritan Laws in the U.S. All 50 states and Washington D.C. have Good Samaritan Laws in place. <ref>https://www.ncbi.nlm.nih.gov/books/NBK542176/</ref>

*Oregon - State Initiative to De-criminalize almost all narcotics: Measure 110, passed by a majority of statewide voters in November 2020, decriminalizes the possession of marijuana and small amounts of "harder" drugs including cocaine and methamphetamine and reduces criminal penalties for larger amounts.

*Washington State - Law Enforcement Assisted Diversion. <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx#:~:text=The%20Law%20Enforcement%20Assisted%20Diversion,behavioral%20health%20needs%20or%20poverty.</ref>

'''State Policy Plans to Address the Opioid Epidemic'''

* Rhode Island's Strategic Plan on Addiction and Overdose. <ref>https://health.ri.gov/news/temp/RhodeIslandsStrategicPlanOnAddictionAndOverdose.pdf</ref>
*Massachusetts’s Recommendations of the Governor's Opioid Working Group. <ref>https://www.mass.gov/lists/governors-opioid-addiction-working-group</ref>

= Available Tools and Resources =

*'''SAMHSA''' has an Evidence-Based Practices Resource Center committed to improving prevention, treatment, and recovery support services for mental and substance use disorders. The Center provides communities, clinicians, policy-makers and others with the information and tools to incorporate evidence-based practices into their communities or clinical settings. <ref>https://www.samhsa.gov/resource-search/ebp?utm_source=SAMHSA&utm_campaign=d562f4d6eb-EMAIL_CAMPAIGN_2024_03_14_04_39&utm_medium=email&utm_term=0_-d562f4d6eb-%5BLIST_EMAIL_ID%5D</ref> SAMHSA's South-Southwest Prevention Technology Transfer Center (PTTC) Has published "The Ins and Outs of Advocating for Policy Change" <ref>https://pttcnetwork.org/the-ins-and-outs-of-advocating-for-policy-change/</ref> as well as "The Ten Do’s and Don’ts of Successful Legislative Advocacy." <ref>https://pttcnetwork.org/news/the-ten-dos-and-donts-of-successful-legislative-advocacy/</ref>
*'''The US Department of Health & Human Services''' has published "Guidebook for State by State Opioid Prescribing Guidelines." <ref>https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf</ref>
*'''The National Council For Behavioral Health''' advocates for mental health and substance use policies. <ref>https://www.thenationalcouncil.org/policy-agenda/</ref>
*'''The National Harm Reduction Coalition''' advocates for numerous harm reduction approaches. <ref>https://harmreduction.org/</ref>
*'''The National Association of Counties''' has published "The Principles for the Use of Funds From the Opioid Litigation" -- a nationally recognized guidance for states, counties, and cities receiving money from the lawsuits against entities that contributed to the opioid epidemic. The planning principles, coordinated by faculty at the Johns Hopkins Bloomberg School of Public Health, can help jurisdictions create a foundation for effective spending of the monies to save lives from overdose. <ref>https://www.naco.org/resource/principles-quick-guide-removing-policy-barriers</ref>
*'''The Network for Public Health Law''' provides leadership in the use of law to protect, promote, and improve health and health equity through non-partisan legal technical assistance and resources, collaborating with a broad set of partners across sectors to expand and enhance the use of practical legal and policy solutions. <ref>https://www.networkforphl.org/</ref> It provides an online webinar titled, "Fighting for Public Health: How Do We Strengthen Public Health Advocacy at Local, State, and National Levels?" <ref>https://www.networkforphl.org/resources/fighting-for-public-health-how-do-we-strengthen-public-health-advocacy-at-local-state-and-national-levels/</ref>
*'''The Legislative Analysis and Public Policy Association (LAPPA)''' has published "State of the States: Legislative Roadmap for Reducing Overdose Deaths and Increasing Access to Treatment (the Roadmap)," which is a guide for state leaders on the most effective approaches to addressing the current drug epidemic. <ref>https://files.constantcontact.com/9b9edb2e701/6fe81aeb-e7b3-49f9-8b98-e5060d133156.pdf</ref> LAPPA also offers "Drug Checking Equipment, Needles/Syringes, and Drug Paraphernalia: Summary of State Laws" <ref>https://legislativeanalysis.org/wp-content/uploads/2024/01/Drug-Checking-Equip-Needles-Syr-and-Drug-Paraphernalia-Summary-of-State-Laws.pdf</ref> and "Naloxone: Summary of State Laws." <ref>https://legislativeanalysis.org/wp-content/uploads/2022/09/Naloxone-Access-Summary-of-State-Laws.pdf</ref>
*'''FedUp!''' is a grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids. FedUp! accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies. <ref>https://feduprally.org/</ref>
*'''Grassroots Unwired''' provides an overview of grassroots advocacy. <ref>https://www.grassrootsunwired.com/grassroots-advocacy/</ref>
*'''Model Law Virtual Knowledge Labs''' is a virtual learning series that provides state and county leaders with an opportunity to deepen their awareness and understanding of how model laws can assist jurisdictions in addressing substance use disorders and concomitant issues. <ref>https://legislativeanalysis.org/model-law-virtual-knowledge-labs/</ref>
*'''Reasons Foundation''' has published the "Drug Legalization Handbook." <ref>https://reason.org/wp-content/uploads/drug-legalization-handbook.pdf</ref>

= Promising Practices =

'''Capitol Hill Day''' is an annual event sponsored by CADCA (Community Anti-Drug Coalitions of America). It is an opportunity for participants in the National Leadership Forum to meet with their members of Congress (2 Senators and 1 member of the House of Representatives) to discuss national substance use prevention policy priorities and substance use issues in their local community. <ref>https://forum.cadca.org/chd.cfm</ref>

'''Illinois.''' The following illustrates some of the partnerships and strategies used to pass an important piece of legislation. Illinois SB2928 is a current law with the common name "Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. <ref>https://ilga.gov/legislation/billstatus.asp?DocNum=2928&GAID=12&GA=98&DocTypeID=SB&LegID=79014&SessionID=85</ref>It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. The lead Project Coordinator Bill Gentes, has as a result, been awarded CADCA's Advocate of the Year. The following steps were used in the creation, adoption, and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

*Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one reviews current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
*Partnering with Local Law Enforcement - As stated by Gentes at an interview "“circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you what that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process. "In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more.
*Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference.
*Securing Public-Private Partnerships - Walgreens was approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be an issue with a need to review current laws regarding drug disposal. This increased the capacity of the project and accompanying police force in collection efforts.
*Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support.
*Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments.

= Sources =

Effective Action Planning and Implementation

2025-01-29T23:07:01Z

Mlabrie21: Mlabrie21 moved page Effective Action Planning and Implementation to Plan, Implement, and Evaluate

#REDIRECT [[Plan, Implement, and Evaluate]]

Plan, Implement, and Evaluate

2025-01-29T23:07:01Z

Mlabrie21: Mlabrie21 moved page Effective Action Planning and Implementation to Plan, Implement, and Evaluate

 

= Introductory Paragraph =

The last three steps in the SPF approach build upon the Assessment phase in which community-specific needs are identified and sufficient Capacity-Building has occurred to be able to implement solutions. The Planning, Implementation, and Evaluation phases are tightly interwoven. Since all three phases utilize the Assessment data in an integrated way, they are presented together in this single article. The Planning phase can be summarized as using the buy-in and wisdom of the coalition members to prioritize which goals ''can be'' realistically achieved and which actions ''should be'' implemented. Since the Evaluation phase will provide metrics on the effectiveness of those actions and progress towards those goals, it is important for planning priorities to be established with evaluation processes and outcomes in mind. If the Planning phase fully engages the coalition membership, there is likely to be more buy-in and accountability during the Implementation phase, as well as a deeper celebration of successful outcomes in the Evaluation phase.

= Key Information =

'''Planning'''

Substance misuse is a complex problem which a community can address by numerous strategies. An action plan requires the coalition to make choices about which solutions to implement. The specific approaches different communities will choose to take varies widely. The by-word for the planning process is prioritization which helps to simplify both the complexities of the task at hand and to focus on achieving results. Realizing that the Planning phases is the mid-point of the five SPF phases provides an opportunity to use two navigational points -- the data-driven and outcomes orientation of SPF. The data-driven component is based upon the Assessment phase and ensures that Implementation choices are grounded in the current needs of the community and not upon previous efforts, which may feel subjectively easier, but be less objectively effective. The outcomes component ensures that the Planning phase identifies strategies can be measured in the Evaluation phase, that they are based upon best practices, and that they align to S.M.A.R.T. goals. This acronym stands for Specific, Measurable, Achievable, Relevant, and Time-Bound. A small number of optimal SMART goals will drive the Implementation phase and can be developed by the coalition by balancing three simple criteria -- ''impact'' and ''capacity'' and ''timing'':

*Impact. The Assessment phase will invariably identify numerous gaps and additional service needs. Since the coalition cannot provide solutions to all problems at once, it is useful to identify those outcomes which are immediately achievable. If certain coalition members are skeptical that any level of change is likely on a certain potential goal, then it may be better to shift focus to goals which will have more buy-in. Some of this may be influenced by what coalition members feel that the community-at-large will be most likely to support. Working on strategies which will have the highest impact helps the coalition to have successes which can build traction for more success.

*Capacity. When formulating an action plans, it is important that expectations are realistic and that select actions which are prioritized can be achieved by the coalition. It is important for communities to consider planning for small and early wins first, so that tangible progress will keep participants energized and motivated. Part of creating an achievable action plan is identifying and securing any financial and other resources that are necessary. There are a variety of funding sources that support planning and programs. These include local, state, or federal government grants, funding through philanthropic organizations, and support from the business community or fundraising campaigns. The action plan should identify steps to secure financial resources to meet their goals and objectives. More funding is not always feasible, so coalitions may need to consider alternate, innovative avenues in their action plans.

*Timing. Once the coalition agrees to an action plan, it is important to create timelines to complete each activity. As steps are taken to address both short- and longer-term goals, trust is built between the members working toward a common outcome. The timelines need to be reasonable and achievable. Having a range of timelines helps keep members engaged and have a sense of accomplishment. Some coalitions will have short-term goals that can be achieved in 30 or 60 days, mid-term goals that are several months out, and long-term goals that can be expected to take a year or more.

The following guidelines are useful in developing an action plan:

*Ensure that a diversity of populations within a given community are served. Due to differences in language, culture, and experiences, communities addressing any public health issue must develop action plans that can achieve desired outcomes for all people within the community.
*Include a variety of strategies to work across the continuum of care, with implementations in prevention, recovery, and access to treatment services.
*If the coalition is large enough to have a sub-committee to perform the Assessment phase and to develop a suite of possible interventions, then they should engage the full coalition in the process of prioritizing the specific strategies to implement.
*If possible include strategies which impact broad systemic and policy changes.
*Strategies should increase awareness, build education, enhance skills, build capacity, improve access, or fill gaps.
*Action plans are living documents and will need to be constantly reviewed and revised to address the new realities and lessons which are learned through the Evaluation phase. Decision makers need to be willing to experiment and constantly adjust the approaches they take. Even at the local level, aspects of the substance use epidemic change, sometimes quite rapidly. Leaders need to continually collect and analyze data in order to detect these changes and make adjustments.

''' Implementation'''

During the Implementation phase of SPF, a set of action items can be added to achieve the intended outcome of each SMART goal. Many community coalitions, especially those with a large number of members, will break into working groups or committees around each SMART goal to delineate details implementation objectives. Naturally, those members who are subject matter experts and work in specific fields can take the lead in implementing specific strategies. It is important for all participants to know what part of the action plan they are responsible for leading. This lays the groundwork of expectations between members and trust that each participant will carry out their portion of the plan. These responsibilities should be clearly spelled out in writing so there is no confusion or misunderstanding. Although one coalition member may be helping to coordinate the activities of other members, it is the responsibility of each member to be accountable and help achieve progress. For example, even coalition members who are not tasked with a specific strategy can still help to track milestones, maintain community momentum, and update key community stakeholders as progress is made. As work proceeds on implementing the plan, a process begins whereby actions are taken, effectiveness is assessed, and modifications to the plan are made. The constant evaluation of progress is an ongoing effort. Often, goals are added and changed, and sometimes changes are made in those responsible for implementing parts of the plan. It is important to have the expectation from the start that almost nothing goes exactly as planned. If focus and prioritization are the by-words for planning, the by-words for implementation are accountability and flexibility.

'''Evaluation'''

Three verbs which summarize the Evaluation phase are calibrate, celebrate, and communicate. The calibration involves evaluation of what worked well during implementation, what did not work, and what can be learned to launch a new SPF cycle of assessment, capacity-building, planning, and implementation. Celebration uses the documentation of even small wins for coalition members to share successes and to build positive momentum to achieve continued progress. The communication of evaluation results can be used to report outcomes back to funders and to advocate for the coalition mission with local and state decision-makers.

There are two types of evaluations -- process evaluations and outcome evaluations:
*Process evaluation ensures accountability and that the implementation was done with fidelity. This focus is primarily on outputs, such as number of classes offered or number of Naloxone kits distributed, and is often required for purposes of grant funding or communication with stakeholders. Did the coalition do what it said it was going to do? Were the activities within the action plan implemented? The identification of any action steps that were not implemented is likely to lead to an examination of staffing or resource issues, leadership, communication, and sustainability.
*Outcome evaluation measures effectiveness and focuses on impact. They employ change detection or pre-post measures which compare current conditions to baseline conditions. This is a process in which measurable progress towards the short-term or mid-term outcomes can be documented. Revision of long-term outcomes can be evaluated at this time as well. It should be noted that impact can also be documented through qualitative data. Often a compelling story can be told that is useful in promoting advocacy efforts. The conditions surrounding substance use are complex and documenting progress may be best served through the use of a narrative that is articulated by a variety of community members most affected by the action plan.

Solid action and evaluation plans outline a series of performance indicators which can be used to track progress towards SMART goals. Generally, the performance management process has four components:
*Identify appropriate performance indicators to determine markers of success.
*Conduct performance measurement, leveraging available data and collect new data to measure short-term and longer-term outcomes.
*Monitor and report performance management data, insights, challenges, and successes.
*Quality improvement uses evidence of limited results or setbacks as learning opportunities to be used to improve strategies and action plans.

The evaluation process guides the coalition in developing its strategies and tracks the effectiveness of each strategy over time. It will be up to each community to decide what data to collect and report, and what data should be made public. The identified lead should determine the frequency of data collection and coordinate collection efforts to regularly monitor data. The data report should educate and drive informed decision-making. For example, data used to track the number and locations of overdoses can provide the community with the knowledge of where overdoses are taking place and what hot spots exist. This allows a community to focus resources where they are needed by adding or expanding services like those related to prevention, harm reduction, and connection to services through peers or other means. Other parts of the data report may include available treatment and recovery housing beds, Naloxone distribution numbers, and the frequency of prescribed MAT in various settings. Continued communication and sharing of data is key. This will lead to greater collaboration between agencies which share data as well as other community stakeholders. Often new partnerships are forged when the data reveals what needs to be addressed.

Analysts may choose a variety of methods for sharing their data, including Geographic Information Systems (GIS), line graphs, bar charts, tables, and pie charts. Charts and graphs should be developed with the audience in mind -- easy to read, aesthetically pleasing, well-labeled, and include the totals for columns and rows. Only the most important information should be illustrated in order to keep the report simple. It is critical to use care when displaying and illustrating data in order to maintain a balance between accurately displaying data and creating an effective visualization. Communities have a variety of options for data support. Investments in off-the-shelf software systems are available for purchase and can be used to monitor data from various state and local organizations and to track system performance indicators and outcomes over time. If there is limited funding available, communities can use spreadsheet or database software, such as Microsoft Excel or Access.

'''Sustainability'''

The SPF process requires cultural competency and sustainability to be considered in all five phases. The first theme is addressed in more detail in the SAFE Solutions article titled, “Apply a Health Equity Lens.” The second is detailed in “Understand Funding and Identify Resources.” However, a few notes regarding sustainability are addressed here. Financial resources were mentioned above, regarding the Planning phase. By taking sustainability into account, planning should address the realistic capacity to maintain efforts to be implemented.

Within the Implementation context, the non-financial aspects of sustainability become apparent. Although, typically sustainability is thought of in terms of monetary resources, it also includes consideration of human capital. The training provided and the skills developed during implementation are vital to the sustained success of any coalition. Accounting for and rewarding the members of the coalition as a resource facilitates the retention of their service.

The Evaluation phase links to sustainability in two ways. First, the outcome measures create the context to document return on investment (ROI) of funds allocated during the Implementation phase. Second, the evaluation provides information on the way forward. What efforts are worthy of sustaining in the next SPF cycle?

= Impactful Federal, State, and Local Policies =

SAFE Solutions is an ever-growing platform.  Currently limited information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Available Tools and Resources =

* '''SAMHSA''' provides a summary of best practices in planning, implementation, and evaluation in its "Guide to SAMHSA’s Strategic Prevention Framework" <ref>https://www.samhsa.gov/sites/default/files/20190620-samhsa-strategic-prevention-framework-guide.pdf </ref>

*'''SAFE Project.''' Coalitions can use the SAFE Solutions dashboard to help lead discussions on which strategies to implement within their community. <ref>https://www.yoursafesolutions.us/</ref> The Community Playbook includes a template for building an action plan and for setting S.M.A.R.T. goals. <ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/</ref>

*'''The National Association of County and City Health Officials (NACCHO)''' has published a report with Joslyn Levy & Associates titled "Specifying Monitoring and Evaluation Measures for Local Overdose Prevention and Response Strategies: A Toolkit." <ref>https://mys.mapyourshow.com/mys_shared/naccho2024/handouts/NACCHO_SpecifyingMonitoring&EvaluationMeasures_Toolkit2024_FINAL.pdf</ref>

*'''The National Implementation Research Network''' has public health implementation as one of its four focus themes. <ref>https://nirn.fpg.unc.edu/</ref>

*'''The UNC Center for the Business of Health''' has launched the "From Settlement to Solutions" website, which is a comprehensive resource for the use of evidence-based opioid settlement funds, based on community conversations. This North Carolina case study consolidates best practices, research, policy trackers, and tools, providing a centralized hub for quick and easy reference. <ref>https://cboh.kenaninstitute.unc.edu/opioid-project/</ref>

*'''Research Meta-Analysis.''' Although it is dated, Durlak and DuPre (2008) is worthy of review because it provides a review of over 500 research findings on the implementation process. <ref> Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41(3/4), 327–350. Retrieved from https://www.researchgate.net/publication/5529147_Implementation_Matters_A_Review_of_Research_on_the_Influence_of_Implementation_on_Program_Outcomes_and_the_Factors_Affecting_Implementation</ref>

= Promising Practices =

SAFE Solutions is an ever-growing platform.  Currently limited information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Sources =

Activate Your Community

2025-01-29T23:06:47Z

Mlabrie21: Mlabrie21 moved page Activate Your Community to Build Capacity

#REDIRECT [[Build Capacity]]

Build Capacity

2025-01-29T23:06:47Z

Mlabrie21: Mlabrie21 moved page Activate Your Community to Build Capacity

= Introductory Paragraph =

There are many barriers that prevent and limit the efforts of communities to address drug misuse and substance use disorder (SUD), but one particular challenge that many communities face is the ability to elevate their initiative above other competing priorities. The key to building local power is to mobilize the community by bringing together a variety of allies to take collective action. From a systems science perspective, a coalition which identifies the optimal levers of change will have the highest return on investment from it's efforts. In a community, these most powerful levers are people. Identifying champions who can publicly support the coalition’s mission can help to build and foster strategic partnerships, generate buy-in, and increase commitment to bolster support.

= Key Information =

'''Coalition-Building Principles'''

Coalitions form to meet a variety of objectives, such as building and strengthening programs, reaching a diverse audience with a wide range of needs, or developing legislative or regulatory efforts, or a combination of these driving purposes. Whatever the original motivation, communities of all sizes should consider the following principles when activating their community:

*Create alliances and strategic partnerships which build political will and generate support from a broad range of stakeholders
*Use local data trends to drive strategy development and decision-making
*Focus on measurable outcomes at both the individual and population scale
*Engage individuals with lived experience or those directly impacted by substance use disorder in decision-making roles
*Keep equity at the center of all efforts
*Empower citizens by increasing public awareness and community engagement opportunities
*Build relationships with federal, state, and locally elected leaders, and keep them regularly informed of coalition efforts
*Evaluate local and state policies to achieve impact at scale

'''Starting the Coalition'''

It is important to note that any community organizing, mobilizing, or strategy to build buy-in should be implemented with regularity. It should not be a single event or effort. Each coalition will determine for itself what works best for them, but all coalitions will benefit from evaluating what has worked in the past in their community. Additional considerations during initial planning include questions of leadership, frequency of meetings, who else should be included, the need for some type of by-laws or governance document, and the roles of participants. Since staffing changes over time, coalition leaders should track lessons learned during the life of the coalition to help maintain institutional knowledge. It is not unlikely that a standing coalition might experience "mission creep" - a tendency to slowly drift away from the organizing purpose of the group. So, is important to consistently evaluate the coalition structure, membership, and goals.

'''Expanding the Coalition'''

Anyone in the community can be a leader or a champion. Drug misuse and SUD affects a substantial number of residents in all communities. Having a wide variety of stakeholders and allies embedded within the community can help to advance policies, programs, and systems that can work together and improve local response. When appropriate, engaging new community partners will leverage efforts and boost support within the community. These individuals could be key champions or partners along the way, but might not necessarily participate in the coalition. When identifying champions or strategic alliances, communities should consider their most powerful levers for change. Who in the community can unlock opportunity and accelerate change? What is the backbone of the community? Is it the local hospital system, community college, or a specific business or company? Even if some individuals or organizations have conflicting viewpoints, it is useful to approach them and open a door for conversation. Sometimes non-traditional partners are only “non-traditional” because we label them as such. Some examples of community champions might include those below, but also refer to the SAFE wiki "Strengthen Your Community Coalition" for a more comprehensive list of potential community partners. <ref>https://www.yoursafesolutions.us/wiki/Strengthening_Your_Community_Coalition</ref>

*'''Elected Officials and Local Health Leaders.''' Locally elected leaders and health officials can play a key role in leading efforts to improve the response to the SUD epidemic. Mayors, County Executives, County Managers, Commissioners, and the local health leaders they appoint, can be powerful allies in raising public awareness about the extent of the problem and the availability of resources. They can provide information on specific strategies that can help save lives. In many instances, elected officials and local health officials might already be part of some type of community task force or other group charged with coordinating and improving local response to the epidemic. However, in the absence of such an effort, elected and health leaders can and should be engaged in raising awareness about the issue and solutions while also increasing support within the community. Elected leaders, and especially legislators, play an important role in the creation of budgets and ultimately decide on how local revenues are allocated to different programs, so it is critical they are aware of the scope of these issues in their communities and what is being done in response. In most cases, they have political allies and are regularly invited to speak at community events or participate in meetings with diverse audiences where they can help to relay the coalition message. Although locally elected leaders are important champions, it’s also critical for a coalition to work alongside its state partners to help align efforts for maximum impact, inform policy, support funding, and make recommendations on the scalability of programs that are working on-the-ground to avoid duplication or manage expectations that might not be feasible or sustainable at the local level. Civic engagement is a necessary component of effective prevention to change attitudes and norms around substance use. Collaboration among local government officials is a key to success.

*'''Individuals with Lived Experience.''' Communities should engage individuals with lived experience in decision-making roles - meaning those who have had first-hand involvement with substance use disorder and those who are friends or family members of those directly impacted. Individuals with lived experience bring knowledge, understanding, and experience which is not learned through formal education. To be most effective, it is imperative that communities honor and reflect the voices of those most impacted in their programs and systems, and if possible, find ways to offer fair compensation for their time.

*'''Youth and Young Adults. '''Authentically engaging youth to inform response efforts provides multiple benefits. It not only helps communities identify creative solutions, but it also helps to build momentum across this particular population. When youth are engaged in their community, they build resiliency skills, leadership skills, and feel a sense of purpose and belonging. While many communities are bringing together subject matter experts from all areas to address substance use, many find that their messaging falls flat to the adolescent population and that parents are still challenged to find a way to communicate with their teens. Including youth helps to design effective messaging to the teen demographic, highlights gaps only seen by youth, and increases the overall effectiveness of system-building efforts. Youth bring energy and passion that can help increase action. Examples of youth engagement models include Dover’s Youth 2 Youth <ref>http://dovery2y.org/wp-content/uploads/YEP-model-visual.pdf</ref> and Manchester’s Makin’ It Happen. <ref>https://makinithappen.org</ref>

'''Messaging the Coalition'''

Coalition messaging can be used to drum up new interest. It helps to keep a consistent focus on progress that has been made and to use a message of hope in order to sustain engagement. Coalitions have the greatest impact when they can demonstrate the intersection of substance use disorder with other community priorities. Drug misuse and SUD have consequences for all residents of local communities, and the current epidemic increases costs related to public health, public safety, criminal justice, treatment services, and many more. Locally elected leaders are typically motivated by the economic impacts to improve local response, but a far greater price comes from the fatalities caused by the epidemic and related overdoses and the loved ones who must face the pain of those lost. This reality motivates many others to join efforts to combat the epidemic within their communities. Although many coalition leaders work in prevention, harm reduction, treatment, recovery support services, and other efforts that save lives and help those in need find recovery, it may be necessary to tailor messaging to suit a wide variety of audiences in a manner that speaks to the receiver’s particular interest.

There are many options to conduct outreach to the community and to decision makers. Outreach strategies can include a broad public awareness campaign or something more focused that asks community members to become involved in specific programs. Communities have employed numerous campaign strategies to provide education and awareness and to move people to action. It is recommended that a coalition adopt a comprehensive communications plan to help enhance each of the strategies identified and contained in their action plan. These might include the following tactics:

*Creating public service TV and print ads
*Developing signage for public facilities (like hospitals, malls, billboards, etc.)
*Offering extended outreach within schools, faith-based communities, or other existing community groups by speaking at a local youth sports game or holding a local prayer day
*Door-to-door canvassing
*Grassroots letters of support or an open letter
*Proposal of a public declaration or resolution for a board to recognize or pass
*A community town hall event or local speaker series
*Effective storytelling
*Standardized talking points for the coalition and strategic community partners
*Press releases
*Attendance at speaking engagements and conferences

The phrase “A rising tide lifts all boats” certainly applies when working together to change your community. There are many national observations associated with substance use disorder, treatment, and recovery. Most of them provide free resources such as toolkits, banners, fliers, and posters. Joining with others who are making a difference connects the coalition to these national efforts and helps to maintain momentum throughout the calendar year:

*January: Every January, National Drug and Alcohol Facts Week <ref>https://teens.drugabuse.gov/national-drug-alcohol-facts-week</ref>focuses on connecting teens, scientists, and other experts at community and school events to discuss how drugs affect the brain, body, and behaviors .
*May/October: The DEA’s National Take Back Day <ref>https://takebackday.dea.gov/</ref>happens twice a year — once in May and again in October. Americans can clean out their medicine cabinets and turn in — safely and anonymously — unused prescription drugs. The DEA also offers a year-round locator<ref>https://apps2.deadiversion.usdoj.gov/pubdispsearch/spring/main;jsessionid=2ySEC8mcKX0PTaLvWQbbdbt0gogLg_1M6nCxqCaX.web1?execution=e1s1</ref> for where unused prescriptions can be turned in.
*May: National Prevention Week <ref>https://www.samhsa.gov/prevention-week</ref>is an annual health observance in May focused on increasing public awareness of, and action around, mental health and/or substance use disorders.
*September: Every September is recognized as National Drug Addiction Recovery Month.<ref>https://www.samhsa.gov/recovery-month</ref>
*October: Red Ribbon Week <ref>https://www.redribbon.org/</ref>is the last week of October and mobilizes communities to educate youth and encourage drug prevention activities.

Using local data is particularly effective in moving community members to take action, because people are more likely to help their own communities. There is a lot of publicly available which can help increase awareness of local conditions. Many state and local communities have created data "dashboards," typically hosted and maintained by the state and local health departments. Topics covered may include:

*Prescription Monitoring Program
*Naloxone availability or use
*Drug-related hospital visits
*Crime statistics
*Treatment statistics
*Viral Hepatitis statistics
*Neonatal Abstinence Syndrome (NAS) statistics

For more information on using data to advance coalition-building, please see the SAFE wiki "Improve Data Analysis and Reporting." <ref>https://www.yoursafesolutions.us/wiki/Improve_Data_Sharing,_Analysis,_and_Monitoring</ref>

= Impactful Federal, State, and Local Policies =

'''Johns Hopkins School of Public Health.''' Funds from the opioid industry are being delivered to states and local governments as a result of litigation brought against companies for their role in the opioid epidemic. Various decision makers will need to determine the best use of these funds, and the following five principles have been delineated to guide policies around allocation of this funding stream: <ref>https://opioidprinciples.jhsph.edu/wp-content/uploads/2022/02/Opioid-Principles-Doc.pdf</ref>

* '''Spend money to save lives.''' Given the economic downturn, many states and localities will be tempted to use the dollars to fill holes in their budgets rather than expand needed programs. Jurisdictions should use the funds to supplement rather than replace existing spending.

* '''Use evidence to guide spending.''' At this point in the overdose epidemic, researchers and clinicians have built a substantial body of evidence demonstrating what works and what does not. States and localities should use this information to make funding decisions.

* '''Invest in youth prevention.''' States and localities should support children, youth, and families by making long-term investments in effective programs and strategies for community change.

* '''Focus on racial equity.''' States and localities should direct significant funds to communities affected by years of discriminatory policies and now experiencing substantial increases in overdoses.

* '''Develop a fair and transparent process for deciding where to spend the funding.''' This process should be guided by public health leaders with the active engagement of people and families with lived experience, clinicians, as well as other key groups.

= Available Tools and Resources =

'''The Centers for Disease Control and Prevention''' offers "Gateway to Health Communication & Social Marketing Practice" to promote social marketing as a useful method to change social norms. It provides tools and templates which communities can use to develop communication and social marketing campaigns and programs. This resource provides tips on analyzing audience, choosing appropriate tools, and evaluating the success of messages and campaigns. <ref>https://www.cdc.gov/healthcommunication/</ref>

'''SAMHSA''' has published "Engaging Community Coalitions to Decrease Opioid Overdose Deaths Practice Guide 2023." The guide includes tools and real-world examples that can be used to build and strengthen community coalitions that work to reduce opioid overdose deaths.
<ref>https://www.samhsa.gov/resource/ebp/engaging-community-coalitions-decrease-opioid-overdose-deaths-practice-guide-2023?utm_source=SAMHSA&utm_campaign=fd106b9728-EMAIL_CAMPAIGN_2024_07_03_02_33_COPY_01&utm_medium=email&utm_term=0_-a534a40a43-%5BLIST_EMAIL_ID%5D</ref>

'''SAFE Project''' has four tools and resources which are particularly useful in community activation, and staff are available to support each of the following:

*'''The #NoShame Pledge''' is a virtual campaign and nationwide movement that combats stigma, because there is no shame in getting help for mental health and substance use. SAFE Project has created a campaign toolkit for communities who want to replicate the campaign locally and use it as a community mobilizing tool to drum up political will and raise awareness about local efforts to combat stigma. The toolkit includes graphics, social media messages, and a sample press release. By using the pledge as a catalyst, communities can identify new stakeholders who can be activated and drive social impact. For example, communities have challenged their commission boards, football teams, business owners, police departments, and others to take the pledge. <ref>https://www.safeproject.us/takethepledge/</ref>

*'''Be SAFE.''' This campaign spreads awareness nationally to educate Americans on all issues in the substance use epidemic. The graphics target malls, public billboards, medical facility waiting areas, elevators, cafeterias, and other areas. <ref>https://www.safeproject.us/be-safe/</ref>

* '''SAFE Choices''' is SAFE Project's programming that fosters resiliency in youth development through collaborative and diversified approaches to substance use prevention, intervention, treatment, and recovery. It takes aim at the transformation of attitudes, beliefs, and behaviors that empower SAFE Choices in all stages of youth development. <ref>https://www.safeproject.us/safe-choices-program/</ref>

* '''The Naloxone Awareness Project.''' Forty-eight states have some rules to expand access to naloxone for residents so they do not need a doctor’s prescription to carry it. Communities that have significantly expanded knowledge and access around naloxone, sometimes known as Narcan®, have seen reduced numbers of opioid-related deaths. The Naloxone Awareness Project is a program designed for volunteers to visit pharmacies and talk to friends to increase awareness about naloxone access in their state and community. SAFE Project can provide free digital training and documents. <ref>https://www.safeproject.us/naloxone-awareness-project/volunteer-information/</ref>

'''The National Association of Counties and the National League of Cities''' have published a joint report titled "Prescription for Action: Local Leadership in Ending the Opioid Crisis." This model for local government leaders to establish or enhance their system-building efforts provides guidance on how cities and counties can strengthen collaboration with each other and with state, federal, private, and nonprofit partners. The report shows successful practices from cities and counties and provides recommendations for coalitions to work with state and federal officials and nonprofit organizations. <ref> https://www.nlc.org/resource/opioids/ </ref>

'''Penn State''' provides an online "engagement toolbox" which includes coalition resources which range from facilitation skills to goal-setting and evaluation procedures. <ref>https://aese.psu.edu/research/centers/cecd/engagement-toolbox</ref>

= Promising Practices =

All across the country, communities are leading efforts to advance innovative and research-backed programs and policies to make an impact on the addiction epidemic. One of the most effective steps that communities can take is to connect with other community leaders from across the country to learn about their initiatives and challenges they’ve experienced while sharing innovations and best practice solutions. Although what works well in one community might not work well in another, there are many lessons to be learned that communities can replicate successfully in their own localities.

= Sources =

Improve Data Sharing, Analysis, and Monitoring

2025-01-29T23:06:31Z

Mlabrie21: Mlabrie21 moved page Improve Data Sharing, Analysis, and Monitoring to Collect and Share Data

#REDIRECT [[Collect and Share Data]]

Collect and Share Data

2025-01-29T23:06:31Z

Mlabrie21: Mlabrie21 moved page Improve Data Sharing, Analysis, and Monitoring to Collect and Share Data

= Introductory Paragraph =

Data collection, analysis, and reporting are critical components to strengthening a community’s response to drug misuse and substance use disorder (SUD). By sharing and regularly monitoring data, communities can build credibility, raise awareness and political will, share knowledge, identify more effective interventions and strategies, guide decision making, and allow for better budgeting and allocation of funds. For a community coalition to be successful, it needs to understand how the community perceives a number of elements of substance use, as well as what resources are already at work across the many stakeholders in the community.

Systems-building is a complex process. The role of data in this process can be understood using a chemistry metaphor. Data are the atoms, and in proper combination, they form molecules of information. In complex systems, these molecules interact in a variety of ways. So, having the right amount of data and converting that data into information is essential for the optimal functioning of a balanced system. When the system is out of balance, as we see in the SUD crisis, then it is essential to identify the right data and to convert that data to information for use within the community.

= Key Information =

Assessment is the first of five phases in SAMHSA's Strategic Prevention Framework (SPF). The collection of data from multiple sectors is vital to inform the ''assessment, planning, implementation, and evaluation'' steps in the SPF approach. The first step of assessment is based upon up-to-date and accurate data to support the diagnosis of what is currently happening at the most local scale of community. The planning phase uses the information derived from that assessment data to prioritize optimal implementation strategies. Planning data also fosters coalition capacity-building by using a data-driven approach to reaching agreement about the most effective strategies to implement. The evaluation phase not only uses data to measure outcomes, it also provides a method for communicating success, backed by data, to the community. This creates a new baseline for the coalition to revise its strategies and begin the SPF cycle again -- more effectively.

Assessment of community resources links to the assessment of community needs. The gap between needs and resources creates a clear foundation for next action steps. The collection, distribution, and rapid analysis of data is critically important to developing a strategy to address areas within a community which are being severely impacted by SUD. This typically goes far beyond just tracking overdose deaths and non-fatal overdoses. It is important to know precisely where they are occurring in order to know where more resources need to be deployed. Data are commonly simplified or ''aggregated'' into broad geographic regions such as the city or by population characteristics such as race and ethnicity. Using more specific census data requires going to a ''disaggregated level'' which can help to identify disparities and to inform policies and practices for specific populations at the zip code, census tract, or even neighborhood level. Such data collection efforts foster healthy equity and can help to more effectively direct appropriate services to targeted areas within the community where they are most needed. This will also help community partners in better addressing the crisis in their specific neighborhoods.

Some examples of disaggregate data include: age, sex, average household income, veteran status, marital status, education, citizenship, disability status, primary language spoken at home, and employment status.

'''Where to Start and Key Questions to Consider'''

Drug misuse and SUD are complex problems requiring a comprehensive set of solutions. Building a sufficient data set to support real solutions can often be challenging, so communities should expect to be met with some level of resistance. Many agencies who hold important sources of data are often not accustomed to working with others and sharing their data. Although questions of confidentiality may pose a barrier to data-sharing, many communities have successfully worked to establish trusting relationships between agencies. One key to this success has been having clearly identified leadership to coordinate and gather needed data and to regularly summarize and report on findings. These leaders are often individuals in the public health sector, who have the experience and expertise necessary to collect, analyze, and present data in a way that is clear and easy to understand. Once leadership of the data effort is determined, discussions can take place between agencies to determine data sources, willingness and ability to share data, and any restrictions which may exist. In most cases, all parties want to help save lives and improve their community, and any issues can be worked out with little difficulty.

In some cases, there may not already be a community-wide data collaboration effort in place. The following questions may serve to guide the coalition in launching commitment to such a process:

*What data sources are currently available?
*How are they being used?
*Does the coalition have the partners to provide the necessary data?
*How can the coalition expand the data set to help focus resources where they are most needed, and when they are most needed?
*What can be done in a short amount of time, at reasonable expense, to better collect, analyze, and make use of data related to the SUD epidemic in the region?
*How can the coalition better serve areas of the community that have been underserved?
*What partnerships can help make this happen effectively?
*What drugs are residents using? What are the trends? What are youth substance use rates?
*How many who need medication-assisted treatment (MAT) are receiving it? Does this include the criminal justice system?
*Are recovery support services - including housing, job training, coaching, and education available, and do they meet the needs of the community?
*For those involved in the criminal justice system, is there a history or presence of substance use problems?

It also may help to start with the exploration of data on the most severe harms - including fatal and non-fatal overdoses. Knowing the numbers is important to understand the scope of the problem, but to guide response, more detailed data is usually required. For example:

*Where are the geographic regions of where overdoses are occurring?
*What are the demographics of those areas?
*What type of substance, or combination, is involved?
*How often are such data collecting and analyzed?
*For non-fatal overdoses, how many go to a hospital or community health center?
*How many non-fatal overdoses are revived with naloxone? Who administers Naloxone - first responders or others?
*Are there clusters of overdoses occurring in specific areas and neighborhoods?
*What is currently being done? Are overdose prevention services being offered in areas with high overdose rates?
*What are the local opioid prescribing practices?
*Are people experiencing overdose being connected to services? How is this being done, and by whom?
*Are area treatment and other support services at capacity? Are there wait times or wait lists to get in?

'''Other Potential Data Sources'''

Asking any combination of all of the questions above typically leads to new questions which require additional data in order to identify gaps in services and the implementation of strategies to fill such gaps. Before collecting any new data, it is useful to scan existing sources, such as public records or a needs assessment which may have already been conducted that includes some SUD considerations. Common '''local data sources''' include:

*Local and State Health Departments (number of overdoses, locations, demographics)
*Fire/EMS Services (portion of overdoses, connection to services, Naloxone administration)
*Police and Public Safety Departments (number of overdoses, drug seizures, drug-related crime, diversion, and MAT in correctional facilities)
*Medical Examiner/Coroner's Reports (cause of death from overdose, type of substance(s) involved)
*911 Calls (calls related to suspected overdose)
*Local Hospitals and Community Health Organizations (number of non-fatal overdoses, connection to services, naloxone administration)
*Local Harm Reduction Service Providers (Naloxone and needle distribution, connection to services)
*Treatment Providers (treatment capacity and availability, wait times, MAT providers)
*Pharmacies (records on Naloxone distribution to indicate awareness and/or increased use)
*Prescription Drug Monitoring Program (PDMP) (identify high risk prescribers)
*Recovery Support Services (amount and adequacy of peers, availability of housing, access to job training, tracking data on clients remaining in recovery)

To help put community data into a bigger context, it helps to compare local data to other communities with a similar makeup at the state and even national levels. Some '''national data sources''' include:

*Centers for Disease Control (CDC) <ref>https://www.cdc.gov/</ref>
*Substance Abuse and Mental Health Services Administration (SAMSHA) <ref>https://www.samhsa.gov/</ref>
*National Survey on Drug Use and Health <ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>
*Robert Wood Johnson County Rankings and Roadmaps <ref>https://www.countyhealthrankings.org/</ref>
*U.S. Census Bureau American Community Survey (ACS)<ref>https://www.census.gov/programs-surveys/acs</ref>

'''Telling the Story Behind the Data'''

In addition to measurable, or quantitative data, a community coalition can use ''qualitative data'' to make the issues more personal and relatable. Capturing qualitative data to describe the story behind the numbers can be done through community surveys, listening sessions, public forums, interviews, observations, case studies, or focus groups. Such a deeper examination may identify trends in drug use, types of drugs, and community perception of the problem. This may lead to a better understanding of the root causes of the problem which might not be as immediately apparent using only quantitative data ''about the problem.'' This targeted examination can include questions about accessibility, affordability, availability, and the cultural relevance of programs and policies. Honoring the perspectives and voices of those most impacted by the coalition’s decisions helps to increase the engagement of individuals directly being served. Understanding their challenges and barriers creates a foundation for including some of them in the formal decision-making of the coalition. If possible, these community members should be provided compensation for their time.

Another benefit to using qualitative data, is that the process can be used to balance how much coalition time is dedicated to data and to know when they have collected enough quantitative data. The qualitative data help to have a true understanding of what i occurring in their communities and to be able to tell that story in a way that is compelling. quantitive data back up the story. While data should be at the forefront of the coalition’s decision-making, it is important to move from assessment to the action phase of implementation.

= Impactful Federal, State, and Local Policies =

'''Federal.''' SAMHSA promotes a data-driven approach in order to ensure that evidence-based practices are deployed and the optimal outcomes can be known to be achieved. It is important for communities to understand the federal and state legal framework since some data might contain protected health information -- because they are measured. The US Bureau of Justice Assistance has worked with the Justice Center of the Council of State Governments to create a guide about best practices for sharing data across behavioral health and criminal justice systems. <ref>https://bja.ojp.gov/sites/g/files/xyckuh186/files/Publications/CSG_CJMH_Info_Sharing.pdf</ref>

'''Communities''' often have to break down existing data silos so that various public, private, and community partners can engage and collaborate effectively. When agencies are ready to share data, some type of data sharing agreement is usually required. Parties will need to know that confidential or other sensitive data will not be disclosed publicly or beyond a limited number of participants. While the creation of such documents is often done by legal counsel in order to address privacy issues and compliance with laws and regulations, there are many existing examples which can be modified to meet the requirements of most agencies.

= Available Tools and Resources =

* '''SAMHSA''' provides online access to national substance use and mental health data and a variety of tools for performing analysis and presentation for communities to utilize. It has also has compiled extensive information on SPF. Two starting points for accessing decades of experience on the role of data processes within SPF can be found in "A guide to SAMHSA’s Strategic Prevention Framework" <ref> https://www.samhsa.gov/sites/default/files/20190620-samhsa-strategic-prevention-framework-guide.pdf </ref> and "Selecting Best-fit Programs and Practices: Guidance for Substance Misuse Prevention Practitioners." <ref>https://www.samhsa.gov/sites/default/files/ebp_prevention_guidance_document_241.pdf</ref>

* '''SAFE Project''' provides the "Community Playbook" which is a framework for communities to organize, evaluate, and create the level of change needed to impact the substance use epidemic. <ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/</ref> It includes tools such as the SAFE Community Pulse Survey and SAFE Community Resources Exercise which are designed specifically to provide the insight a coalition needs to focus and prioritize its work. The Pulse Survey examines community perceptions of the opioid and substance use crisis through a short survey. It is not meant to be a scientific analysis of attitudes and perceptions, but rather to provide a snapshot of how the community as a whole perceives the issues a coalition will be tackling. This is also a tool to let the broader community know about the coalition’s focus and to engage with other community members. Not everyone will agree on the best approaches; the climate survey allows the community to “speak for itself.” The SAFE Community Resources Exercise helps coalition members understand the resources that their fellow members bring to the table as well as to educate the coalition about the depth and breadth of other services that are offered in the community.

*'''Johns Hopkins Bloomberg School of Public Health''' has created a database of suggested indicators for monitoring opioid settlement funds. This tool is especially useful for linking the assessment process within SPF to the evaluation phase following Implementation. Opioid Settlement Principles Resource and Indicators (OSPRI) aims to help local government leaders find tangible impact indicators to evaluate community objectives funded by opioid settlement dollars. <ref> https://opioidprinciples.jhsph.edu/ospri/#using-the-indicators%22</ref>

* '''Harvard Institute for Excellence in Government''' – Includes case studies on data-driven approaches.<ref>https://scholar.harvard.edu/files/janewiseman/files/data_driven_approaches_to_fighting_the_opioid_crisis_jane_wiseman_april_2019.pdf</ref>

* '''The Monitoring the Future Study''' <ref>http://monitoringthefuture.org/</ref> from the University of Michigan is an ongoing study that provides communities with data necessary to frame the issue related to the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Each year, a total of approximately 50,000 8th, 10th, and 12th grade students are surveyed (12th graders since 1975, and 8th and 10th graders since 1991).

= Promising Practices =

Most coalitions choose to make public at least some of the data they collect. A data report raises awareness about the problem, the impacts it is having within the community, and often comparing the community to state or national conditions. This can be done through a dashboard or other regularly updated reports made available by the local government or a local task force. Dashboards often include information about opioid overdoses and other substance use concerns. These dashboards not only helps build public awareness and transparency, but also helps coalitions to support their identified strategies and to report back to their communities on progress over time. Most states and localities who have developed dashboards have greatly expanded available information to include information on other programs and efforts which provide additional opportunities for community members to take action. Three examples of dashboard follow:

* Cincinnati Overdose Response <ref>https://insights.cincinnati-oh.gov/stories/s/Heroin-Overdose-Responses/dm3s-ep3u/</ref>

* New Hampshire Drug Monitoring Initiative <ref>https://www.dhhs.nh.gov/programs-services/health-care/substance-misuse-data-page</ref>

* New Jersey Overdose Data Dashboard <ref>https://www.state.nj.us/health/populationhealth/opioid/</ref>

= Sources =

System Building

2025-01-24T19:08:31Z

Mlabrie21: Created page with "While not part of the traditional Institute of Medicine's (IOM) Continuum of Care model, systems building strategies allow community leaders to build big picture vision, address underlying values, and change the source of conditions. This may include strategies that support your broader work, such as building public awareness and momentum around your movement, broadening and engaging your coalition, supporting advocacy efforts, applying data performance approaches, and l..."

While not part of the traditional Institute of Medicine's (IOM) Continuum of Care model, systems building strategies allow community leaders to build big picture vision, address underlying values, and change the source of conditions. This may include strategies that support your broader work, such as building public awareness and momentum around your movement, broadening and engaging your coalition, supporting advocacy efforts, applying data performance approaches, and leading policy change.

The themes addressed below are tightly linked to issues addressed across the full spectrum of the IOM Continuum of Care, and the reader is strongly encouraged to read the overview articles in each of the other five SAFE Solutions menus (prevention, early intervention, treatment, harm reduction, and recovery).

Three clusters of system-building articles are outlined. The first menu, "Principles of Systems Thinking," addresses the methodology of system building and creates a foundation for all of the other articles. The second menu details each of the five phases of SAMHSA's Strategic Prevention Framework (SPF). The last menu addresses themes introduced in the articles on systems thinking principles as they apply across the Continuum of Care and throughout the SPF phases.

Principles of Systems Thinking include:
*"[[Systems Change Science]]" explains the methodology of systems thinking and change generally and its importance in addressing fundamental root causes to improve outcomes, rather than symptoms of a problem.
*"[[Apply a Multi-Sectoral Approach]]" covers the breadth of agencies and stakeholders to engage in the kind of community-wide systems change initiative needed to end the substance use crisis.

Solutions which focus on the SPF include:
*"[[Collect and Share Data]]" covers the first of the five SPF phases, assessment, and the need to collect, share, and monitor data at the local level in order to implement a data-driven approach.
*"[[Build Capacity]]" addresses the second SPF phase and provides methods for new and mature coalitions to deploy to improve community impact.
*"[[Plan, Implement & Evaluate]]" addresses the last three phases of SPF and highlights the way in which the three are interrelated.

The third menu, "Cross Cutting Strategies," are strategies that should be applied across the entire Continuum of Care and includes:
*"[[Apply a Health Equity Lens]]" addresses how determinants and conditions by which people are born are impacted by substance use and how to apply a health equity lens in all approaches, so that all people have access to high-quality health. This article is under development for release in 2025.
*"[[Intersectionality and Addressing Disparities]]" addresses the enhancement of protective factors linked to substance use prevention and approaches in other intersecting areas like domestic violence, gun violence, suicide, and a variety of others. It specifically addresses disparities and unequal distribution across various groups of people impacted by substance use and highlights key needs. This is an article under development for release in 2025.
*"[[Mobilize Community Champions]]" focuses on applying motivational interviewing at the community scale and building champions outside of a coalition. This is an article under development for release in 2025.
*"[[Advocate for Policy Change]]" addresses various strategies and levels of engagement for changing policy at the local, state, and federal levels.
*"[[Understand Funding and Identify Your Resources]]" highlights various funding sources and strategies for funding and sustaining community efforts. This is an article under development for release in 2025.
*"[[Build Awareness and Education]]" focuses on communications tactics for educating the general public and elevating your community efforts. This is an article under development for release in 2025.
*"[[Reduce Stigma]]" defines the various types of stigma and examines strategies for stigma reduction in the prevention, treatment, and recovery domains.

Strengthening Your Community Coalition

2025-01-24T18:56:40Z

Mlabrie21: Mlabrie21 moved page Strengthening Your Community Coalition to Apply a Multi-Sectoral Approach

#REDIRECT [[Apply a Multi-Sectoral Approach]]

Apply a Multi-Sectoral Approach

2025-01-24T18:56:40Z

Mlabrie21: Mlabrie21 moved page Strengthening Your Community Coalition to Apply a Multi-Sectoral Approach

= Introductory Paragraph =

Creating a community coalition is one of the most effective ways to solve complex systems-level problems. Applying a multi-sectoral approach to coalition-building is at the core of generating a local movement. A coalition is simply a group of individuals and organizations with a common interest who agree to see the problem through each other’s eyes and work together toward a common goal. The more sectors, such as law enforcement, health departments, and school systems, are involved, the more "eyes are on the ball" -- and the more that effective communication skills are required. A coalition concentrates a community’s focus on a particular problem, creates alliances among those who might not normally work together, and keeps the community’s approach consistent. This page provides an overview on how to use a multi-sectoral approach, based on the experiences of communities across the country.

= Key Information =

'''Why Start A Coalition?''' The substance use disorder epidemic (SUD) is a complex problem requiring a highly coordinated and cooperative response from communities. The increase in non-fatal and fatal overdoses in recent years has caused many communities to realize that individual organizations cannot afford to work in silos. Communities addressing a crisis as large as the addiction epidemic will be poised for success if they have a unified strategy and a focus on broader common community goals, rather than on singular programmatic goals. There is clear understanding that partners across sectors must align and work together to develop and implement effective strategies to improve their collective response to the SUD epidemic. Communities, both large and small, can develop solutions that work for all of those touched by the opioid and addiction crisis, by bringing together and working with a broad range of stakeholders. Many local communities have successfully assembled coalitions to improve their response to the SUD epidemic. There is no one-size-fits-all set of practices for creating an effective coalition. The suggestions that follow are based on the experiences of many communities and are meant to serve as a guide for those looking to form a new coalition or expand and improve upon one that already exists.

'''Who Can Start A Coalition?'''
Anyone can. Coalitions and task forces are often started by locally elected leaders, public health departments, public safety agencies, community organizations, or even passionate individuals engaged in the fight to save lives and reduce harm created by drug misuse and SUD. Typically, coalitions are formed as a response to increased rates of overdose and overdose deaths. Regardless of who takes the initiative, it is important to be inclusive and identify stakeholders whose ultimate goals align. Get started by looking around the community and determining if there are similar existing efforts in which to get involved or add value. It’s important not to duplicate efforts. Is there a mechanism or coalition body already taking a comprehensive approach to addiction that can be leveraged?

'''Potential Partners and Their Roles.'''
There are many potential partners who can be invited to join the coalition and improve the community response to SUD. The following list is not intended to be all-inclusive, and it is not a requirement to have all of these agencies at the table. These are suggestions based on the types of partners which are most often brought together. It is important to establish a team of optimal size and with sufficient authority to plan and implement ideas and strategies effectively and efficiently. Does the team include leaders with the perceived power and authority in the community to make decisions and drive the implementation of new strategies? Does it include individuals who are trusted in the community and have connections to people and neighborhoods who can support grassroots efforts? Any or all of the following partners in the coalition can engage the broad community to build momentum:

'''Government/Public Sector:'''

*Locally elected officials
*State/local drug prevention office
*Public safety officers/officials
*First responders, including EMS and Fire Departments
*Health department
*School administration or school board
*Criminal judges and court professionals

'''Law Enforcement:'''

*Police and/or sheriff
*High Intensity Drug Trafficking Area (HIDTA) office
*Drug Enforcement Agency (agency in charge)
*School Resource Officers (SRO's)
*Criminal judges, court professionals, and correction officers

'''Education Leaders:'''

*School district leadership
*School principals
*Teachers
*Parent Teacher Associations (PTA) and other youth-serving organizations
*Colleges, universities, institutions of higher education, community colleges, and trade or technical schools

'''Community Leaders:'''

*Lions Club, Rotary, Elks, veteran’s groups
*YMCA, 4H, Boys & Girls Clubs
*Family support groups and recovery allies
*Youth and young adults including youth sports programs
*Faith community
*Housing providers

'''Business Leaders:'''

*Chamber of Commerce
*Employers
*Union leaders
*Local philanthropic organizations

'''Medical Community:'''

*Primary care physicians
*Nurse practitioners
*Emergency room doctors and staff administration
*Dental professionals
*Community behavioral healthcare providers
*Pharmacists
*Providers of health plans and insurance

'''Treatment and Recovery:'''

*Treatment professionals
*Substance use disorder counselors
*Harm reduction organizations
*Recovery support organizations

'''Community Members with Lived Experience:'''

*Persons in recovery and active substance users
*Family and friends of those in active use or recovery
*Families of those lost to overdose

As the coalition progresses, the needs of the coalition will change over time. Usually, the composition of the coalition will change as well. There are many examples where organizations may need to expand services or take on new roles to address the SUD epidemic, especially in underserved areas of the community. This might include:

*Police working with peer recovery specialists/coaches in cases of overdose
*Community organizations taking on prevention/education/training roles
*Hospitals coordinating with area treatment providers to help overdose patients

Do new roles need to be taken on by government agencies and/or community groups? If so, who and what new roles would be helpful? Who should the coalition include to create new or expanded partnerships in the region? Ideally, what role(s) would they take on?

'''Initial Outreach.''' Getting the desired partners to the table is not always easy. Although there are a number of ways to contact these groups, in-person and direct contact is always preferable. Several types of resistance may need to be addressed. Some organizations are not naturally inclined to work with other agencies. For example, the harm reduction and law enforcement communities are not always natural allies in some communities. However, some very powerful work can be done when these two groups do come together and see the problem through each other’s lenses. Some organizations might not want to get involved because of their own perception of capacity (this is more work for me) or stigma (this is not my problem). It may be necessary to expend considerable effort to convince these groups that it is in the entire community’s interest to reverse the epidemic and that everyone has a contribution to make.

It is important to build trust from the outset. Some common advice heard from those who have been through the process of bringing together a coalition include:

*'''Honor the Work that has Been Done.''' Everyone fighting this epidemic is doing their best and should always be recognized for their efforts.
*'''Initiate.''' It does not matter how many community leaders attend first meeting. It could be five or as many as twenty. The important thing is to find people who are willing to work together to thoughtfully and comprehensively address a specific problem. Although the topic that brings all of the stakeholders together is difficult, it is the coalition leader’s job to bring energy and optimism to the movement. Because solutions might look different to each of the stakeholders, defining the common problem precisely is essential. A primary initiation goal should be to agree upon a meeting rhythm in which the coalition frequently gathers to review progress, update its plan, and share success stories.
*'''No Judgement.''' The rise of the current epidemic has been created by a series of events outside of any local jurisdiction. It is not the fault of local governments and community leaders fighting the epidemic.
*'''Common Goals'''. As part of initial discussions, it is important to talk about what all partners typically have in common - the desire to save lives and reduce suffering. While partners will vary in the approaches they use, and which they may feel are more effective, all involved want to see the same end result. It is important to focus on what the partners share in terms of outcomes they want to see and to allocate time to discuss how greater collaboration will benefit the efforts of all involved.

= Impactful Federal, State, and Local Policies =

'''The Drug-Free Communities (DFC) Program''' is a nationwide, collaborative effort led by the White House Office of National Drug Control Policy (ONDCP) and CDC in which hundreds of local coalitions have participated. Funding provides up to $125,000 per year for five years to local community coalitions to prevent and reduce youth substance use. <ref>https://www.whitehouse.gov/ondcp/grant-programs/dfc/</ref> Applicants are required to prove they are working towards multi-sectoral collaboration in the submission of letters of intent documenting the commitment of various types of agencies during the implementation of the grant. The coalition work must use evidence-based frameworks and address the unique community challenges surrounding substance use and overdoses. Annual data has shown a marked decrease in youth substance use. <ref>https://www.cdc.gov/drugoverdose/featured-topics/drug-free-communities.html</ref>

= Available Tools and Resources =

'''SAMHSA''' promotes implementation of a systems approach in the advancement of recovery-oriented systems of care (ROSC). <ref>Substance Abuse and Mental Health Services Administration. (2010). Recovery-oriented system of care (ROSC) resource guide. Rockville, MD: U.S. Department of Health and Human Services. </ref> It has published "Engaging community coalitions to decrease opioid overdose deaths: Practice Guide 2023." <ref>https://www.samhsa.gov/resource/ebp/engaging-community-coalitions-decrease-opioid-overdose-deaths-practice-guide-2023</ref>

'''Faith communities''' can support strategies to address substance misuse and support recovery in their community. Churches, synagogues, mosques, and other faith groups can be a valuable bridge to the community. The U.S. Department of Health and Human Services has a dedicated Center for Faith and Opportunity Initiatives with an accessible online toolkit containing ideas to help engage your spiritual community, educate and build community capacity, and respond to the opioid health crisis. <ref>https://www.hhs.gov/about/agencies/iea/partnerships/opioid-toolkit/index.html</ref> Other resources include:
* The Opioid Epidemic Practical Toolkit: Helping Faith and Community Leaders Bring Hope and Healing to Our Communities.<ref>https://www.hhs.gov/about/agencies/iea/partnerships/opioid-toolkit/index.html</ref>
*One Body Collaboratives <ref>http://www.onebodycollaboratives.org/</ref>
*Meet the Need, a software package which can help engage and equip churches to participate in their communities. <ref>https://meettheneed.org/</ref>

'''Harm-reduction organizations''' are nonprofit groups that advocate for public access to Naloxone, needle exchanges, and in some cases safe-use zones. They promote Good Samaritan laws protecting users from arrest if they call 911 to save a friend. In many communities, harm-reduction and law enforcement are polarized. Law enforcement personnel are often perceived as thinking only about arresting and jailing people for the illegal possession of drugs, while harm reduction organizations are perceived as focused on the complete legalization of all drugs. While each group certainly applies a different approach, both of these perceptions are false. Ensuring that law enforcement and harm-reduction organizations are coordinating and collaborating is absolutely essential in the fight to end the opioid fatality epidemic. Harm-reduction coalitions have been essential in convincing law enforcement agencies to enact pre-arrest diversion programs. These programs provide low-level users the opportunity to seek treatment in lieu of facing charges or arrest. Law enforcement also must be at the table when harm-reduction organizations are planning new initiatives or programs.
* The Law Enforcement Action Partnership has compiled harm-reduction strategies supported by law enforcement professionals. Its list is useful in starting the conversation between these two communities, which are both focused on saving lives.<ref>https://cdn.americanprogress.org/content/uploads/2019/01/10055812/DaytonOpioids-fig9-693.png</ref>

= Promising Practices =

'''National Efforts:''' There are many national coalitions and organizations that provide useful information and resources for local coalitions. These national groups are widely varied and numerous. Therefore, it is important to research these organizations so local coalitions can verify that their goals and priorities are aligned with any national organization they choose to become involved with. A few examples follow, but there are many more at the national and even regional level.

* '''Community Anti-Drug Coalitions of America (CADCA)''' CADCA is the premier membership-based non-profit organization representing adult and youth coalition leaders throughout the United States and internationally - all working to make their communities safe, healthy, and drug-free. CADCA's model for community change represents a comprehensive, evidence-based, multi-sector approach to reduce underage and binge drinking, tobacco, illicit drugs, and the abuse of medicines.

* '''Coalition to Optimize the Management of Pain Associated with Surgery (COMPAS)''' Mission: To educate all those involved in pain management decisions about acute pain management strategies that minimize the need for opioids. COMPAS also provides education on how to implement multimodal analgesic strategies and how to measure success for patients and hospitals alike.

* '''Fed Up! Coalition to End the Opioid Epidemic''' A grassroots coalition seeking action from the federal government to bring this public health crisis to an end. Fed Up’s mission is to use united voices in a call for immediate, comprehensive and sustained federal action to end the opioid addiction epidemic. <ref>https://feduprally.org/</ref>

'''An Exemplary State Effort:'''

'''New Jersey''' There are nearly 400 Municipal Alliances in New Jersey -- all organized to provide substance use prevention education services.
Each alliance focuses on its community’s particular needs and may include: <ref>https://www.sussex.nj.us/cn/webpage.cfm?TID=7&TPID=6596</ref>
*parenting workshops to enhance parent’s ability to assist their children to live a healthy and drug free lifestyle,
*peer leadership programs to train students to develop leadership skills and goal oriented behaviors and to be role models and helpers to other students,
*drug awareness events that offer families and community members drug-free activities while providing information about substance abuse and community-wide prevention programs, and
*collaboration with the Division of Senior Services to provide education on potential consequences of medicinal interactions with other medicines, over-the-counter drugs, or alcohol.

'''An Exemplary Local Effort:'''

* '''Dayton, Maryland -- Community Overdose Action Team (COAT)''' Dayton provides an example of a highly structured coalition. Their organizational chart details this structure and summarizes the role of each component within the COAT. <ref>https://cdn.americanprogress.org/content/uploads/2019/01/10055812/DaytonOpioids-fig9-693.png</ref> Other local coalitions might not be as complex or highly structured, but this example helps to provide ideas of what could be considered.

= Sources =

Shift from Punishment to Treatment Approach

2025-01-24T18:40:20Z

Mlabrie21: Mlabrie21 moved page Shift from Punishment to Treatment Approach to Shift from Punishment to Treatment in the Criminal Justice System

#REDIRECT [[Shift from Punishment to Treatment in the Criminal Justice System]]

Shift from Punishment to Treatment in the Criminal Justice System

2025-01-24T18:40:20Z

Mlabrie21: Mlabrie21 moved page Shift from Punishment to Treatment Approach to Shift from Punishment to Treatment in the Criminal Justice System

= Introductory Paragraph =

A significant number of inmates suffer from substance use disorder, a mental health disorder, or a combination of the two. When proper treatment is made during incarceration there is a decrease in inmate misconduct. When treatment is followed through to post-release, there is documented lower risk for relapse and recidivism.

The United States has the highest incarceration rate in the world. <ref>https://medicalxpress.com/news/2021-02-incarceration-strongly-linked-premature-death.html</ref> There is substantial evidence that shows how detrimental it is to overcrowd jails and prisons and to turn a blind eye to the revolving door effect that happens when individuals are incarcerated without adequate support to change behaviors. Although evidence shows that substance use disorder is a treatable disease of the brain, many people never receive treatment. As a result too many end up involved in the criminal justice system from illegal drug-seeking behavior. Recent data shows a significant correlation between criminal justice involvement and substance use. This highlights the importance of identifying a different approach to the problem and the need to shift from a punishment to a treatment approach.

More than half of the prison population in the United States, about 65%, is estimated to have an active substance use disorder. <ref>https://nida.nih.gov/publications/drugfacts/criminal-justice</ref> About 20% who did not fully meet the criteria for a substance use disorder were under the influence of substances at the time of their arrest. <ref>https://nida.nih.gov/publications/drugfacts/criminal-justice</ref> Many of the individuals in prison who need treatment are not receiving it. Thus, they have a high risk of reoffending once released. Treatment has impacts that can last for decades -- on an individual’s quality of life, reduced likelihood of recidivism, and future relapse. Failure to provide adequate and high-quality substance use treatment is not only detrimental to the individuals who are incarcerated but also has negative implications for their families, society, and the economy.

It should be a priority to offer treatment to individuals within the criminal justice system who have a substance use disorder. The National Institute on Drug Abuse has increased its efforts to find solutions. It supports social workers, counselors, and others who work within the court system to provide services to individuals involved in the criminal justice system due to drug use. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref> This helps both to decrease substance use and to reduce crime. There are evidence-based strategies that play a role in transforming traditional punishment-based approaches which may be used within the criminal justice system. Moving from a punishment to treatment approach improves both public health and public safety while decreasing rates of future incarceration. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/#R16</ref>

= Key Information =

The Substance Abuse and Mental Health Services Administration (SAMHSA) identified eight principles to assist community-based behavioral health providers and criminal justice professionals to collaborate most effectively. <ref>https://store.samhsa.gov/product/Principles-of-Community-based-Behavioral-Health-Services-for-Justice-involved-Individuals-A-Research-based-Guide/SMA19-5097</ref> These principles provide a strong foundation for understanding re-entry programs, evidence-based practices, the risk of recidivism, pre-arrest and diversion programs, and medication assisted therapy:

* Community providers are knowledgeable about the criminal justice system. This includes the sequence of events, terminology, and processes of the criminal justice system, as well as the practices of criminal justice professionals.
* Community providers collaborate with criminal justice professionals to improve public health, public safety, and individual behavioral health outcomes.
* Evidence-based and promising programs and practices in behavioral health treatment services are used to provide high quality clinical care for justice-involved individuals.
* Community providers understand and address criminogenic risk and need factors as part of a comprehensive treatment plan for justice-involved individuals.
* Integrated physical and behavioral health care is part of a comprehensive treatment plan for justice-involved individuals.
* Services and workplaces are trauma-informed to support the health and safety of both justice-involved individuals and community providers.
* Case management for justice-involved individuals incorporates treatment, social services, and social supports that address prior and current involvement with the criminal justice system and reduce the likelihood of recidivism .
* Community providers recognize and address issues that may contribute to disparities in both behavioral health care and the criminal justice system.

Ongoing research has suggested that substance use can be associated with poorer outcomes among individuals who have been incarcerated, including those under supervision in the community. A study by Pew Trusts study shows that more imprisonment does not reduce drug related issues. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2018/03/more-imprisonment-does-not-reduce-state-drug-problems?hd&utm_campaign=2018-03-14+PNN&utm_medium=email&utm_source=Pew</ref> This study reinforces a large body of research that casts doubt on the theory that tough prison terms deter drug misuse, distribution, and other drug-law violations. The evidence strongly suggests that policymakers should pursue alternative strategies which the research shows work better. There have been two major avenues that have proven successful in shifting a from a punishment to treatment approach. The first is through by-passing incarceration with therapeutic alternatives. The second is through increasing treatment options inside jails and prisons.

'''By-passing Incarceration'''

Community-based behavioral health providers play a key role in ensuring that every individual they serve has the treatment, support, skills, and opportunity for recovery they need in order to live productively with dignity and respect. People who simply need access to quality community-based care may be arrested instead. In many communities, people with behavioral health disorders cannot access adequate community-based services and find themselves channeled into the justice system. This may happen when a person is arrested for behaviors related to their untreated mental illness or when a law enforcement officer believes that a person could benefit from healthcare services that are provided in the jail. Arrest and even brief incarceration can destabilize an individual’s life in many ways, including housing, health care, employment, and disruptions in family life and social connections. Once in the criminal justice system, individuals with mental and substance use disorders stay in jails longer, have an increased risk for self-harm, and receive more frequent punitive responses to infractions. Due to funding and staffing limitations, many people with mental illnesses do not receive the services that they need, and their conditions often worsen inside jail settings. For individuals already receiving medications and treatment in the community, these services may be interrupted during incarceration, creating lapses in treatment and difficulties in resuming treatment upon reentry to the community. Without continuous coordinated care throughout and following incarceration, these individuals are at risk for re-incarceration. Programs to improve outcomes of those in recovery within the criminal justice system includes community-based diversion programs, drug/treatment courts, treatment while incarcerated, and re-entry resources and services. For more detailed information on re-entry, please see the SAFE wiki titled "Improve Reentry After Incarceration." <ref>https://www.yoursafesolutions.us/wiki/Improve_Reentry_After_Incarceration</ref>

'''Increasing Treatment Options'''

Treatment services for people within the criminal justice system, give society an opportunity to better the lives of the individuals and to improve public health and safety. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref> Without treatment, individuals are more likely to commit crimes at a higher rate once released from prison when compared to those who are not using substances. <ref>https://drugfree.org/drug-and-alcohol-news/choosing-substance-abuse-treatment-over-prison-could-save-billions-study/</ref> The provision of drug treatment inside the prisons and jails while the offenders are incarcerated has shown promise. Since the 1990’s researchers have discovered highly effective interventions that can be implemented while offenders are incarcerated and after they are released. <ref>https://www.apa.org/research/action/aftercare</ref> A critical component of this approach is adequate pre-release and post-release counseling and support. This reduces detrimental impacts of individuals returning to a stressful home-life or environments with negative peer influences. Lack of access to treatment upon release increases the likelihood of relapse. The risk of overdose is amplified due to the changes in an individual’s tolerance after being incarcerated, leading to a higher probability of death. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref> Common treatments include the following proven evidence-based approaches: <ref>https://nida.nih.gov/publications/drugfacts/treatment-approaches-drug-addiction</ref>

*behavioral counseling
*medication assisted treatment (MAT)
*evaluation and treatment for co-occurring mental health issues such as depression and anxiety
*long-term follow-up to prevent relapse

Well-designed prison treatment programs reduce relapse, criminality, inmate misconduct and recidivism. They also increase levels of education, mend relationships, boost employment opportunities upon release and improve overall health. Cost-benefit analysis indicates that residential prison treatment is cost-effective if prisoners continue treatment after their release. There are immediate and long-term fiscal benefits. In a direct and immediate cost comparison, the cost of treatment pales in comparison to the cost of incarceration. In a longer-term vantage point, when prisoners overcome drug use, it reduces the economic burden of recidivism. <ref>https://doi.org/10.1007/s11920-013-0414-z</ref> In general, the criminal justice system supports treatment during incarceration by offering inmates with substance use problems a mix of psychotherapy sessions, religious ministry meetings, and 12-step programs, such as Alcoholics Anonymous. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

'''Medication-Assisted Treatment (MAT)''' can be utilized for drug-dependent individuals within the criminal justice populations. Currently, within the criminal justice system, MAT is used primarily for pregnant women to detoxify and is minimally used for reentry. There are ongoing studies surrounding MAT, as well as efforts to expand the use of MAT within the current correctional infrastructure. Efforts to expand MAT include training, education, reducing stigma, and increasing funding. Expansion of MAT within community correctional settings will also require increased collaboration with community providers in order to enhance the appropriate pharmacotherapy for individuals under community correction supervision. Concerns of correctional facilities surrounding MAT have included liability, staffing, regulation, and funding. More information can be found at the SAFE wiki article titled, "Expand the Use of MAT/MAR in Correctional Facilities." <ref>https://www.yoursafesolutions.us/wiki/Expand_the_Use_of_MAT/MAR_in_Correctional_Facilities</ref>

'''The federal prison system''' utilizes four primary types of programs to assist inmates in overcoming a substance use disorder:

*'''The Residential Drug Abuse Program (RDAP)''' is the most intensive program that the Federal Bureau of Prisons will provide and is normally nine months in length. Inmates in this program live in their own separate community from the rest of the population. Inmates take part in daily half-day programming and a half-day of work, school, or vocational activities. Research has shown that inmates that take part in RDAP are significantly less likely to recidivate and relapse to drug use compared to those inmates who do not take part in RDAP. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''Nonresidential Drug Abuse Treatment.''' This involves a 12-week cognitive behavioral therapy (CBT) program that is organized in group sessions that address criminal lifestyles while increasing skills in the areas of rational thinking, communication, and institution-to-community adjustment. Inmates that are enrolled in this program normally have short sentences, do not meet the Residential Drug Abuse Program, are waiting to be enrolled in RDAP, are in transition back into the community, or have a positive urinalysis test <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''Drug Abuse Education''' entails a series of classes that educate inmates on substance use disorder and the effects it has on your body and mind. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''Community Treatment Services (CTS)''' provides continued care to inmates who have been released and put into Residential Reentry Centers or on Home Confinement. Evidence shows that the period after being released is the most vulnerable time for inmates to relapse back to drug use or criminal activity. So, continued treatment after release is vital to the success of the offender completing their treatment. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

= Relevant Research =

*'''This article''' reviews therapeutic alternatives to incarceration, such as judicial oversight in drug courts, and documents their effectiveness in transitioning offenders back into the community where they can address their illness and live productive lives. Research has shown the positive impact community-based drug treatment has on criminal behavior and may result in 1.8 times better outcomes in reducing drug use and the chances of reoffending. Drug courts that combined judicial supervision and treatment in place of incarceration had half the rearrests rates than those who did not participate in said programs. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref>

*'''SAMHSA''' has published Treatment Improvement Protocol (TIP) titled, "Substance Abuse Treatment: For Adults in the Criminal Justice System." In addressing the need for trauma-informed care, the report distinguishes between historic trauma as root cause of criminality and trauma associated with incarceration. The panel that made the report, reached consensus on the recommendation that in-prison treatment address both the trauma of the incarceration itself and the prison culture that conflicts with treatment goals. Since prisons can be violent, harsh, and psychologically damaging, incarcerated people live in an environment that is both depersonalizing and dehumanizing. When added to the social stigma associated with incarceration, this may result in a sense of hopelessness and powerlessness, as well as deeply internalized shame and guilt -- highlighting the need to concurrently treat for both substance use and mental health. <ref>https://www.ncbi.nlm.nih.gov/books/NBK572935/</ref>

*'''NIDA''' has published a research-based guide titled "Principles of Drug Abuse Treatment for Criminal Justice Populations." <ref>https://www.txwp.uscourts.gov/wp-content/uploads/2017/05/Recommended-Reading-Drug-Abuse-Treatment-for-Criminal-Justice-Populations.pdf</ref> NIDA reports that over 80% of prisoners who would benefit from treatment while incarcerated do not receive it -- despite the overwhelming evidence that drug treatment is more effective than incarceration. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref>

*'''GAO Report on Overcrowding of Jails and Prisons.''' One of the major barriers to treatment and recovery support during incarceration is the availability of effective treatment. Overcrowding is a leading factor as to why inmates with drug dependency problems are not enrolled in these programs. This report indicates that over 50,000 inmates were on waiting lists to enter drug treatment programs. In addition to overcrowding, staff shortages and limited resources are part of the enrollment issues in drug treatment programs. <ref>https://www.alec.org/article/drug-treatment-programs-of-the-federal-bureau-of-prisons-exist-but-need-more-availability/</ref>

*'''The National Drug Intelligence Center (NDIC)''' estimated the cost of illicit drug use to society was $193 billion. <ref>https://www.drugabuse.gov/publications/drugfacts/criminal-justice</ref> This is in addition to the $249 billion, estimated by the Office of the Surgeon General, in costs associated with alcohol misuse. <ref>https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/index.html</ref> The NDIC estimated the cost to treat drug use at $14 billion -- including healthcare costs, hospitalizations, and government specialty treatment.

*'''This article''' is titled "Treating Drug Abuse and Addiction in the Criminal Justice System: Improving Public Health and Safety." It summarizes relevant findings in neuroscience and evidence-based principles of addiction treatment that could help improve public heath and reduce criminal behavior. The authors report that individuals who participated in prison-based drug treatment programs paired with community programs after release were 7 times more likely to continue to abstain from substances and 3 times less likely to re-offend when compared to those who did not receive treatment. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref>

*'''This article''' documents the benefits of treatment for the incarcerated in terms of both increased recovery rates and decreased recidivism. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2681083/</ref>

= Impactful Federal, State, and Local Policies =

*'''The Residential Substance Use Disorder Treatment Act''' of 2021 expanded access to substance use treatment in jails and prisons within the United States. This bill also expanded access to treatment within the communities after offenders were released. This was a step in the right direction for providing treatment in place of incarceration. One major advance was the government’s acknowledgment of how important it is to stop the "revolving door" pattern associated with substance use and incarceration through the use of treatment and medication. <ref>https://www.whitehouse.senate.gov/news/release/-cornyn-whitehouse-introduce-bill-to-fight-substance-use-in-jails-and-prisons-support-inmates-upon-release</ref>

*'''Medicaid''' now allows those leaving incarceration to have Medicaid coverage, expanding their access to treatment options upon release from jail or prison. <ref>https://www.ncbi.nlm.nih.gov/books/NBK541389/ </ref>

*'''The Adult Drug Court Grant Program''' is managed by the Department of Justice. It provides financial assistance to states, local courts and government, and federally recognized Indian tribal governments to integrate substance abuse treatment, drug testing, incentives, and sanctions in judicially supervised settings with the intent to reduce recidivism and substance use among offenders. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/overview</ref>

*'''Many states''' are revising their drug penalties and focusing on prevention, treatment, and recovery to integrate evidenced-based practices for treatment. For example:
**'''Connecticut''' enacted sentencing and drug-free zoning reform based on two models promoted by the American Legislative Exchange Council (ALEC). In its 2021 Report, ALEC has a policy section titled "Criminal Justice Reform" which references ALEC resolutions, supporting drug free zones and a minimum age of 10 for delinquency adjudication. <ref>https://alec.org/wp-content/uploads/2022/05/2021-Annual-Report_V10_WEB.pdf</ref>
**'''Oregon''' passed a groundbreaking drug law in 2020 which was reversed in 2024. The 2020 legislation, “Measure 110,” decriminalized the possession of small amounts of illegal substances and expanded funding and access to substance use treatment. Previously, access to treatment for substance use treatment was a common result of being arrested or coming into contact with the criminal justice system, having detrimental impacts on an individual’s life and ability to hold employment. Measure 110 offered another pathway by treating possession like a traffic ticket and opening the door to treatment instead of incarceration. <ref>https://www.npr.org/2021/06/18/1007022652/oregons-pioneering-drug-decriminalization-experiment-is-now-facing-the-hard-test</ref> During its four years of implementation, Measure 110 used tax revenue from savings from reduced arrests and incarceration. One downside to this new approach was the impact it had on the medical community, stressing resources to handle and increase in overdose patients. One critique raised in the campaign to reverse Measure 110 was that it was poorly implemented, normalizing and amplifying a crisis of drug use by a growing unhoused population. In the wake of 110, there has been a change in the way some law enforcement agencies address substance use possession. Likewise, there has been increased support for alternatives to incarceration, such as diversion programs. However, this is highly variable from county to county.

= Available Tools and Resources =

'''SAFE Project:'''
*'''Treatment and Family Support Locator''' is a resource created with the University of Maryland which is designed to allow users seeking substance use/mental health treatment to search the SAMHSA Treatment Locator database using more specific criteria to help find the best options available.<ref>https://safelocator.org/en/search</ref>
*'''SAFE Connections.''' This SAFE Project subprogram of the SAFE Choices portfolio provides an opportunity to impact youth recidivism and redirect young lives toward reaching their full potential.<ref>https://www.safeproject.us/safe-choices/connections/</ref>
*See the wiki titled "Expand Law Enforcement Assisted Diversion and Deflection Programs" for more detailed information on diversion and deflection programs that aim to redirect individuals away from the justice system, particularly those with behavioral health needs, to reduce recidivism, address personal needs, and optimize justice system resources.<ref>https://www.yoursafesolutions.us/wiki/Expand_Law_Enforcement_Assisted_Diversion_and_Deflection_Programs#Available_Tools_and_Resources</ref>

'''The US Department of Justice''' has published "Criminal Conduct & Substance Abuse Treatment: Strategies for Self-Improvement and Change Pathways to Responsible Living." <ref>https://www.ojp.gov/ncjrs/virtual-library/abstracts/criminal-conduct-substance-abuse-treatment-strategies-self</ref>

'''BJA''' manages the Residential Substance Abuse Treatment Program (RSAT) which offers training and technical assistance to county and states <ref>https://www.rsat-tta.com/</ref> BJA runs the Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP) which hosts a website which offers peer-to-peer learning opportunities, profiles of COSSUP sites across the nation, information on demonstration projects, and access to technical assistance. <ref>https://www.cossapresources.org/</ref> COSSUP has published "Guidelines for Managing Substance Withdrawal in Jails: A Tool for Local Government Officials, Jail Administrators, Correctional Officers, and Health Care Professionals." <ref>https://www.cossup.org/Content/Documents/JailResources/Guidelines_for_Managing_Substance_Withdrawal_in_Jails_6-6-23_508.pdf</ref>

'''The American Academy of Addiction Psychiatry''' Published "Cultivating Law and Medicine Partnerships to Support Justice-Involved Individuals With Substance Use Disorders – Digital Guide." <ref>https://www.aaap.org/law-and-medicine/guide/</ref>

'''The National Institute of Corrections''' provides training for correctional professionals. One of these is Residential Substance Abuse Training (RSAT). <ref> https://nicic.gov/training</ref>

'''The Opioid Response Network''' provides "Community Supervision and MOUD Toolkit," a free online learning series to help probation officers and treatment providers enhance client recovery during supervision. <ref>https://resources.opioidresponsenetwork.org/Education/CommunitySupervisionandMOUDToolkit.aspx</ref>

= Promising Practices =

'''Massachusetts.''' This video titled "Reforming Criminal Justice to Help Inmates Live a Life of Dignity, not Dependency" highlights a positive case study associated with fostering musical talent in a Worcester prison. <ref>https://alec.org/article/video-reforming-criminal-justice-to-help-inmates-live-a-life-of-dignity-not-dependency/</ref>

'''New York.''' An innovative triage approach called Buffalo Opioid Court, reduced the risk of overdose deaths and substance use by providing funding for court staff and treatment programs such as substance use counseling and medical interventions. The court staff has the ability to deploy a Rapid Integration Team that connects individuals with immediate treatment, assessment, and access to a licensed professional counselor. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/promising-practices</ref>

= Sources =

Treatment

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Mlabrie21:

Treatment services for individuals with a substance use disorder diagnosis include assessment, the development of a treatment plan, implementation of the treatment plan, evaluation, case management, extended care, and monitoring. Programs vary in length and intensity, and they may include approaches like medical stabilization/detox, counseling and behavioral healthcare, and rehabilitation services. In treatment, the ASAM Criteria (American Society Of Addiction Medicine) is the most widely used and comprehensive set of standards for placement, continuation of services, and determining levels of care for individuals seeking treatment for substance use disorder. Level of care recommendations and treatment plans are developed based on multidimensional patient assessments that consider the patient’s medical, psychological, and social needs to help determine what services are a best fit to meet individual and/or patient needs. Additionally, when utilizing ASAM criteria, these guideline assessments take into account an individual's strengths, needs, resources, and recovery capital. Levels of care/continuum of care include:

https://www.yoursafesolutions.us/misc/asam-dimension-changes-800w.jpg

''(Figure 1 ASAM American Society Of Addiction Medicine, 2024) ''

In SAFE Solutions, treatment themes, which are addressed below, are tightly linked to issues addressed across the full spectrum of the Institute of Medicine's (IOM) Continuum of Care, and the reader is strongly encouraged to read each of the other five overview articles. Two clusters of treatment articles are provided. The first menu, Focus on Effective Treatment, addresses general treatment themes. The second menu details considerations on Medicated Assisted Treatment (MAT)/Medicated Assisted Recovery (MAR).

*"[[Support and Advance Effective Treatment]]" addresses the major types of treatment options and provides an introduction to the framework within which new treatment services are developing.
*"[[Improve Links to Treatment for People who Experience Non-Lethal Overdoses or Naloxone Revivals]]" covers a specific harm reduction strategy which treatment providers should prioritize.
*"[[The Role of Treatment Providers in Promoting Early Intervention, Harm Reduction, And Recovery]]" addresses the unique opportunity that treatment providers have in advancing efforts across the continuum of care.
*"[[Enhance Collaboration of Providers Using a Family-Centered Approach]]" spells out the synergistic benefits of service provision to families through collaborative efforts. It also details the mechanics of a family-centered approach.
*"[[Expand and Enhance Speciality Courts]]" describes the variety of specialty courts, including drug courts. It provides the historical context within which the implementation of these courts has increased and it documents their individual and social benefits.
*"[[Shift from Punishment to Treatment in the Criminal Justice System]]" outlines the need to address the correlation between recidivism and substance use disorder by amplifying treatment options available to the judicial system.
*"[[Expand Perinatal Treatment and Support for People with SUDs]]" is focused on the community role in norm change around pregnancy and substance use. It provides the context for the following article.
*"[[Improve Care for Babies Born Drug Dependent]]" covers treatment options for FAS and NAS.

Articles which focus on MAT/MAR include:

*"[[Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR)]]" provides a detailed coverage of the MAT/MAR process, medication choices involved, and the community context within which MAT/MAR must be promoted.
*"[[Accelerate the Development of New MAT/MAR Approaches]]" covers the need for innovation in the MAT/MAR field and an FDA program designed to foster treatment approaches.
*"[[Expand DNA Testing to Improve Precision MAT/MAR Therapies]]" highlights the benefits of Precision/Personalized Medicine and its emergent status.
*"[[Expand the Use of MAT/MAR in Correctional Facilities]]" bridges to the focus of the the use and challenges of MAT/MAR within criminal justice settings.
*"[[Expand Access to MAT/MAR for Pregnant People]]" supplements a cluster of MAT/MAR articles within SAFE Solution's menu on Treatment by providing information specifically relevant for the role of MAT/MAR during and after pregnancy.

Enhance Collaboration Among Medical, Behavioral Health, and Social Services Providers

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Mlabrie21: Mlabrie21 moved page Enhance Collaboration Among Medical, Behavioral Health, and Social Services Providers to Enhance Collaboration of Providers Using a Family-Centered Approach

#REDIRECT [[Enhance Collaboration of Providers Using a Family-Centered Approach]]

Enhance Collaboration of Providers Using a Family-Centered Approach

2025-01-24T18:37:37Z

Mlabrie21: Mlabrie21 moved page Enhance Collaboration Among Medical, Behavioral Health, and Social Services Providers to Enhance Collaboration of Providers Using a Family-Centered Approach

=Introductory Paragraph=

Many families have complex needs which challenges the capacity of social service providers within the child welfare system. This points to a need to integrate care among medical, behavioral health, and social service providers. For instance, children affected by trauma and prenatal substance exposure often require interventions and treatment, in addition to substance use and mental health treatment provided to parents. Emphasis on treatment interventions and supports which focus only on children or parents separately, often result in fragmented and uncoordinated care. Collaborative practice provides a wider realm of resources to address the needs of families than is traditionally available through one system. Collaborative practice between the dependency court, child welfare, substance use treatment, and other services systems offers a multitude of practical strategies and solutions to improve outcomes for child welfare in families affected by substance use disorders.

Collaborative policies and practices provide access to family-centered interventions. These address the multiple needs of families and positively influence five core outcomes, or the 5Rs, for families in the child welfare system impacted by substance use disorders: <ref>https://ncsacw.samhsa.gov/files/Forum_Brief_FINAL_092314_reduced_508.pdf</ref>

*Recovery: parental recovery from substance use disorders
*Remain at home: more children remain in the care of parents
*Reunification: increased number and timeliness of parent-child reunification
*Recidivism: decreased incidence of repeat maltreatment
*Re-entry: decrease in number of children re-entering out-of-home care

= Key Information =

When a parent has a substance use disorder the entire family is impacted. A multi-team and community approach best serves families impacted by substance use disorders. This includes professionals building collaborative relationships and working together across agencies and resources to improve outcomes for families. Models of collaborative intervention vary widely in approach. They include innovative strategies such as: <ref>https://ncsacw.samhsa.gov/files/Forum_Brief_FINAL_092314_reduced_508.pdf</ref>

*Wraparound services
*Development of collaborative structures
*Improved cross-system communication protocols
*Collaborative case management and planning
*Co-location of substance abuse specialists in child welfare offices or dependency courts
*Cross-agency training of staff
*Family drug courts

'''The Family-Centered Approach'''

The National Center of Substance Abuse and Child Welfare (NCSACW) promotes a family-centered approach. This assesses the needs and well-being of family members and addresses the family in recovery as a whole system. The family-centered approach provides supportive services such as parenting programs, resources surrounding child development, and therapeutic clinical services. <ref>https://ncsacw.acf.hhs.gov/topics/family-centered-approach.aspx</ref> SAMHSA identified the following principles of the family-centered approach within a treatment context, all of which translate directly to fostering collaboration among systems and agencies with harm reduction as well: <ref>https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf</ref>
*Family-centered treatment is comprehensive. Family-centered treatment includes clinical treatment, clinical support, and community support services addressing substance use, mental health, physical health, and developmental, as well as social, economic, and environmental needs for women and their families.
*Women define their families. Family is inclusive of the supportive network of relatives and others whom the woman identifies as part of her family. Treatment can focus on healthy attachment and relationships between parents and children and on women’s relationships with others. Family-centered treatment helps a family function as a unit.
*Treatment is based on the unique needs and resources of individual families. The goals, interventions, type, length, frequency, location, and method of services vary depending on the strengths and needs of the family members.
*Families are dynamic, and thus treatment must be dynamic. Treatment must be able to address evolving and changing family engagement. Everyone may not participate at the same time, stay the same length of time, or have the same motivations.
*Conflict is inevitable, but resolvable. Multiple crises are the norm, not the exception. Families must juggle conflicting needs and priorities and balance the needs of members.
*Meeting complex family needs requires coordination across systems. Most families with substance use disorders participate in multiple service delivery systems (e.g., child welfare, health, criminal justice, education). Coordination and collaboration prevents conflicting objectives and provides optimal support for family members.
*Substance use disorders are chronic, but treatable. The treatment process is not an event but rather a gradual process that moves individuals and families toward lasting recovery. Treatment includes a broad continuum of programs and strategies designed to address dependence, ameliorate adverse consequences associated with substance use, return bio-psycho-social functioning and reduce/eliminate substance use. Behavioral therapies, motivational enhancements, pharmacological interventions, and case management are common elements of treatment.
*Services must be gender responsive and specific and culturally competent. Services must be grounded in and use the knowledge and skills that fit the background of individuals and families. Gender-responsive services recognize the unique characteristics of initiation of use, effects of use, histories of trauma, co-occurring mental health and physical disorders, and other treatment issues including the primacy, importance, and continuity of relationships. Culturally competent services are embedded in the language, values, and experiences of a client’s culture.
*Family-centered treatment requires an array of staff professionals as well as an environment of mutual respect and shared training. Organizational cultures that encourage learning, a team approach, and consultation are necessary for diverse staff members to work together.
*Safety comes first. Maintaining a safe environment for all family members, in all client families, is essential. Programs must have policies for addressing inappropriate behavior in children, youth, and adults and protecting confidentiality. Maintaining trauma-informed and trauma-sensitive services and treatment milieu is of paramount importance.
*Treatment must support creation of healthy family systems. Healthy family systems include structure, appropriate roles, and good communication that allow the family to function as a unit while concurrently supporting the needs of each individual member.

= Relevant Research =

*SAMHSA provides a summary of data from NSDUH (National Surveys on Drug Use and Health) through the Center for Behavior Health Statistics and Quality. This report titled, "Children Living with Parents Who Have a Substance Use Disorder," indicates that about 1 in 8 children (8.7 million) aged 17 or younger lived in households with at least one parent who had a substance use disorder in the past year. <ref>https://www.samhsa.gov/data/sites/default/files/report_3223/ShortReport-3223.html</ref> It documents how the entire family is impacted by substance use disorder.

*SAMHSA has also published a report titled "Family-Centered Treatment for Women With Substance Use Disorder." This report includes an extensive bibliography of relevant research on the topic. <ref>https://www.samhsa.gov/sites/default/files/family_treatment_paper508v.pdf</ref>

= Impactful Federal, State, and Local Policies =

In 1997, the Adoption and Safe Families Act (ASFA) was enacted to address child welfare cases which lingered in the court system while parents cycled in and out of treatment. The legislation created a mandate to find effective responses to substance use and maltreatment within families. Five national reports followed addressing the co-occurring issues of parental substance abuse and child abuse and neglect. <ref>https://ncsacw.samhsa.gov/files/Forum_Brief_FINAL_092314_reduced_508.pdf</ref> These reports are:
*Responding to Alcohol and Other Drug Problems in Child Welfare: Weaving Together Practice and Policy (Child Welfare League of America, 1998)
*Foster Care: Agencies Face Challenges Securing Stable Homes for Children of Substance Users (U.S. General Accounting Office, September 1998)
*No Safe Haven: Children of Substance-Abusing Parents (The National Center on Addiction and Substance Abuse at Columbia University, 1999)
*Healing the Whole Family: A Look at Family Care Programs (Children’s Defense Fund, 1998)
*Blending Perspectives and Building Common Ground: A Report to Congress on Substance Abuse and Child Protection (Dept. of Health and Human Services, 1999). This report includes research as well as sources and information surrounding federal, state and local policy and funding. <ref>https://aspe.hhs.gov/reports/blending-perspectives-building-common-ground</ref>

'''SAMHSA''' manages Substance Abuse Prevention and Treatment Block Grant program which promotes a socioecological approach integrating individual, family, and community domains. <ref>https://www.samhsa.gov/grants/block-grants/sabg</ref> SAMHSA has published two documents that are useful resources for policy and funding considerations:
*"Funding Family-Centered Treatment for Women." <ref>https://www.samhsa.gov/sites/default/files/final_funding_paper_508v.pdf</ref>
*"State-Level Policy Advocacy for Children Affected by Parental Substance Use." <ref>https://www.samhsa.gov/find-help/national-helpline</ref>

'''Medicaid''' has benefits which are directed to alcohol and substance use. These include the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) to cover both prevention and treatment services for children and adolescents younger than age 21. <ref>https://www.nashp.org/medical-necessity/</ref>

= Available Tools & Resources=

'''The Children’s Bureau''' is an agency within the Administration for Children and Families within the U.S. Department of Health and Human Services. It provides a fact sheet titled "Major Federal Legislation Concerned With Child Protection, Child Welfare, and Adoption." <ref>https://www.childwelfare.gov/pubPDFs/majorfedlegis.pdf</ref>

'''The Treatment Court Institute''' is one of the divisions of AllRise, formerly known as the National Association of Drug Court Professionals. It has published "Transitioning to a Family-Centered Approach: Best Practices and Lessons Learned from Three Adult Courts." This includes case studies of adult drug courts which included a family-centered approach to treatment and recovery. <ref>https://www.ndci.org/wp-content/uploads/2016/05/Transitioning-to-a-Family-Centered-Approach.pdf</ref>

'''The Primary Care Collaborative (PCC)''' offers a webinar titled "Assessing the Practice with Patients and Families - Opportunities to Improve Patient and Family-Centered Care''' <ref>https://www.pcpcc.org/webinar/pcpcc-san-webinar-assessing-practice-patients-and-families-opportunities-improve-patient-and</ref>

'''NCSACW''' provides web-based training resources to help professionals increase their knowledge and skills to work with families affected by substance use disorders. <ref>https://ncsacw.acf.hhs.gov/training/default.aspx</ref> They offer a variety of tools, including:
*The Building Collaborative Capacity Series" gives strategies to states and communities to create cross-systems collaborative teams, communication protocols, and innovative practices. These strategies aim to improve screening, assessment, and engagement to best serve families affected by substance use disorders and child welfare service involvement. <ref>https://ncsacw.acf.hhs.gov/collaborative/building-capacity.aspx</ref>
*"Understanding Substance Use Disorder - A Resource Guide for Professionals" provides a fundamental understanding of the substance use treatment and recovery process. It is a technical assistance tool designed to equip professionals who refer parents to substance use treatment. It includes a list of questions which child welfare or court staff can ask treatment providers to begin establishing a collaborative relationship with their treatment agency. Professionals using this tool will be able to make informed referral decisions for services which are a good fit to meet the needs of parents and their families. <ref>https://ncsacw.acf.hhs.gov/files/understanding-treatment-508.pdf</ref>
*"Disrupting Stigma: How Understanding, Empathy, and Connection Can Improve Outcomes for Families Affected by Substance Use Disorders." <ref>https://ncsacw.acf.hhs.gov/files/disrupting-stigma-brief.pdf</ref>
*A Webinar titled "Implementation of Family-Centered Practice in Substance Use Disorder Treatment." <ref>https://www.youtube.com/watch?v=BM5mB1Pi0BY</ref>

= Promising Practices =

SAFE Solutions is an ever-growing platform. Currently, limited information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

= Sources =
</div>
[[Category:SAFE-Prescriptions and Medical Response]]

Increase Access to Syringe Exchange Programs

2025-01-24T18:28:29Z

Mlabrie21: Mlabrie21 moved page Increase Access to Syringe Exchange Programs to Increase Access to Syringe Services Programs

#REDIRECT [[Increase Access to Syringe Services Programs]]

Increase Access to Syringe Services Programs

2025-01-24T18:28:29Z

Mlabrie21: Mlabrie21 moved page Increase Access to Syringe Exchange Programs to Increase Access to Syringe Services Programs

=Introductory Paragraph=

Needle exchange programs (NEPs) distribute sanitized needles in exchange for contaminated or used needles. NEPs reduce the spread of blood-borne diseases like HIV and Hepatitis C. According to the CDC, syringe services programs (SSPs) are community-based prevention programs that can provide a range of services, including linkage to substance use disorder treatment; access to sterile syringes and injection equipment; and vaccination, testing, and referral to care and treatment for infectious diseases. <ref>https://www.cdc.gov/ssp/index.html</ref> NEPs and SSPs promote harm reduction to help protect the community by providing exchange programs and sterile supplies which help prevent the spread of infectious disease.

= Key Information =

Needle exchange programs have decades of evidence behind them - but not public support. <ref>https://opioidaction.org/2018/06/vox-a-new-study-shows-stigma-is-hurting-our-response-to-the-opioid-epidemic/</ref> Many organizations have endorsed needle exchange including NIH (National Institute of Health), CDC (Center for Disease Control), the American Bar Association, the American Medical Association, the American Psychological Association, and the World Health Organization. The NIH estimates that in the United States, between fifteen and twenty percent of injection drug users have HIV and at least seventy percent have Hepatitis C.<ref>https://aasldpubs.onlinelibrary.wiley.com/doi/abs/10.1002/hep.1840360703 </ref> As such, sharing needles has become the most common mode of HIV transmission among injection drug users. In addition, used syringes and needles are a potential biohazard. Harm reduction services such as the provision of sterile needles and syringes can effectively prevent Hepatitis C and HIV transmission among people who inject drugs, provided they are accessible and delivered at the required scale. Needle exchange programs help educate and inform injection drug users regarding injection practices, safety steps, non-sharing behavior, and other risk reduction methods. The CDC promotes SSPs and states that they "reduce HIV and HCV infections and are an effective component of comprehensive community-based prevention and intervention programs that provide additional services." <ref>https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html</ref>

There are currently several different models for syringe exchanges that have different advantages and limitations. The models include:

*'''Primary and Secondary Needle and Syringe Programs''' are fixed sites which are typically located in areas with high levels of injecting drug use. They can be found in community centers, pharmacies, or specialized voluntary counseling and testing centers. Those who attend will be able to receive clean paraphernalia and safely dispose of used paraphernalia. <ref>https://www.avert.org/professionals/hiv-programming/prevention/needle-syringe-programmes</ref>

*'''Mobile or On-Call Service''' operate from a van or bus with clean needles which are distributed. Larger mobile programs typically provide testing and other healthcare services and operate along regular routes at fixed times, often at night when increased use occurs. Mobile services can also be smaller and choose to target specific populations. Mobile programs are more accessible to injection drug users and face less opposition from a community. <ref>https://www.avert.org/professionals/hiv-programming/prevention/needle-syringe-programmes</ref>

*'''Dispensing Machine Distribution.''' Australia and countries in Europe have adopted a newer strategy and have begun to use syringe vending machines. They use non-currency tokens which are distributed by outreach workers to injection drug users in return for harm reduction packs. Australia’s machines include needles, syringes, alcohol swabs, cotton, wool, sterile water, and spoons. Others sometimes contain educational materials. Typically, these machines act in conjunction with fixed sites which provide needles and syringes 24 hours a day, 7 days a week. A clinical trial found that this strategy can be highly effective for reaching populations who are most marginalized or otherwise hard to reach. <ref>https://www.avert.org/professionals/hiv-programming/prevention/needle-syringe-programmes</ref>

*'''Peer Service Distribution Networks.''' This is a strategy in which clients of needle exchanges provide services to their peers, distributing needles, syringes, and associated injection equipment. These clients are trained to assist peers to access exchangers, to distribute information about safer drug use and safer sex, and to facilitate referrals to other health services. This model, in addition to disseminating safer practices and helping make needle exchange programs reach a larger population, may have the psychological impact of making interventions more effective. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241304/</ref>

*'''Prison-Based Facilities''' are still a newly developing practice, only used in 3 of 24 UN countries that have needle exchange programs for the public. <ref>http://blogs.biomedcentral.com/on-health/wp-content/uploads/sites/8/2016/10/Prison-based-needle-and-syringe-programmes-PNSP-final.pdf</ref> They meet a high need because prison populations have more cases of Hepatitis C and HIV than the average population. <ref>http://blogs.biomedcentral.com/on-health/wp-content/uploads/sites/8/2016/10/Prison-based-needle-and-syringe-programmes-PNSP-final.pdf</ref>

= Relevant Research =

*'''Three Studies Documenting Positive Results.''' A review of needle exchange done by the office of the Surgeon General and the assistant secretary for health found that needle exchange did not cause an increase in drug injection, but rather typically led to a decrease in injection rates when these programs were used.<ref>http://www.csdp.org/research/surgeongennex.pdf</ref> Another study sought to answer the question "is the number of needles distributed from needle exchange programs proportionate to the number of needles returned to needle exchange programs?" It was found that in the United States the return rate was on average over 90% (~315,000 needles distributed and ~283,000 needles returned). <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419716/</ref> The National Research Council report on the topic states: “The need for and value of targeted education and behavior modification efforts directed at injection drug users at risk of HIV transmission have been clearly demonstrated in programs that do not include needle exchange.” <ref>https://www.ncbi.nlm.nih.gov/books/NBK232350/</ref>

*'''Two Cost-Benefit Analyses.''' Needle exchanges have been projected to be a cost-effective prevention practice. An analysis of the cost-effectiveness of a New York City needle syringe exchange estimated that the program would result in a baseline one year savings to the government of $1,300 to $3,000 per client. <ref>Belani, H.K. and P.A. Muennig, Cost-effectiveness of needle and syringe exchange for the prevention of HIV in New York City. Journal of HIV/AIDS & Social Services, 2008. 7(3): p. 229-240.</ref> Another analysis estimated that increasing access to clean syringes through an additional annual U.S. investment of $10 million would lead to a decrease of 194 HIV infections per year and a lifetime treatment cost savings of $75.8 million which would be a return on investment of $7.58 for every $1 spent. <ref>Nguyen, T.Q., et al., Syringe exchange in the United States: a national level economic evaluation of hypothetical increases in investment. AIDS and Behavior, 2014. 18(11): p. 2144-2155.</ref>

*'''Meta-Analysis on Community Impact.''' This literature review found that supplying injecting drug users with clean or sanitized needles does not lead to more "dirty" needles in a community. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC419716/</ref>

= Impactful Federal, State, and Local Policies =

* '''The Consolidated Appropriations Act, 2016''' restricted the use of federal funds for programs distributing sterile needles or syringes for HHS programs. However, HHS also provides a guidance document that outlines how federal funds may be used for other aspects of SSPs based on evidence of a demonstrated need, in consultation with CDC. <ref>https://www.congress.gov/114/bills/hr2029/BILLS-114hr2029enr.pdf</ref>

* Currently each state has their own laws surrounding syringe exchange programs.

* '''A Comprehensive Guide to Syringe Services Programs and Syringe Possession Laws'''<ref>https://pdaps.org/datasets/syringe-services-programs-laws</ref> delineates how syringe possession polices impact ease of access to sterile syringes for injection drug users.

=Available Tools & Resources=

*'''SAFE Project:'''
**'''"Have A Safety Plan"''' is a SAFE Project resource that instructs drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
**See the wiki titled "The Linkage Between Syringe Use and Infectious Disease" for more detailed information on drug use and the concern for those with an SUD catching or spreading infectious diseases.<ref>https://www.yoursafesolutions.us/wiki/The_Linkage_Between_Syringe_Use_and_Infectious_Disease/</ref>

*'''The World Health Organization''' has published a "Guide to Starting and Managing Needle and Syringe Programs." <ref>https://www.unodc.org/documents/hiv-aids/NSP-GUIDE-WHO-UNODC.pdf</ref>

*'''CDC''' provides a fact sheet on harm reduction to promote prevention of transmission of infectious disease, including blood-borne infections. <ref>https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html</ref> They have published a document titled "Syringe Services Programs: A Technical Package of Effective Strategies and Approaches for Planning, Design, and Implementation." <ref>https://www.cdc.gov/ssp/docs/SSP-Technical-Package.pdf</ref> They have also provided guidance to state, local, tribal, and territorial health departments to determine if they have adequately demonstrated need for SSPs according to federal law. <ref>https://www.cdc.gov/ssp/determination-of-need-for-ssp.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fhiv%2Frisk%2Fssps.html</ref>

*'''SAMHSA''' provides specific guidance for Minority HIV/AIDS Initiative (MAI) Programs that are implementing SSPs. <ref>https://www.samhsa.gov/sites/default/files/grants/ssp-guidance-for-hiv-grants.pdf</ref>

*'''The National Association of County Health Officials (NACCHO).''' In collaboration with the CDC and in partnership with the University of Washington, NACCHO provides funding and technical assistance to local health departments and community-based SSPs. <ref>https://www.naccho.org/blog/articles/funding-opportunity-building-capacity-for-harm-reduction-monitoring-evaluation</ref>

*'''The North American Syringe Exchange Network''' provides a directory of locations for SSPs. <ref>https://www.nasen.org</ref>

*'''The Comer Family Foundation''' provides harm reduction grants for free sterile syringes. <ref>https://www.comerfamilyfoundation.org/syringe-service-program</ref> It has also published "A Guide to Establishing Syringe Services Programs in Rural, At-Risk Areas." <ref>https://www.comerfamilyfoundation.org/img/A-Guide-to-Establishing-Syringe-Services-Programs-in-Rural-At-Risk-Areas.pdf</ref>

*'''The Syringe Access Fund''' awards grants in two categories: 1) SSPs providing direct services, and 2) harm reduction organizations at the local, state and federal levels conducting community education and mobilization activities focused on legalizing or SSPs and other health interventions for people who use drugs. <ref>https://aidsunited.org/new-funding-opportunity-syringe-access-fund/</ref>

= Promising Practices =

*'''Miami, Florida.''' In three years of operation, Miami's pilot program pulled more than a quarter million used needles out of circulation. By handing out Narcan at the needle exchange, it has helped prevent more than a thousand overdoses. The program also offers clients testing for HIV and Hepatitis C and connects people to medical care and rehabilitation services. <ref>https://www.npr.org/sections/health-shots/2019/06/27/725462715/key-florida-republicans-now-say-yes-to-clean-needles-for-drug-users</ref>

*'''Philadelphia, Pennsylvania.''' A case study found that Prevention Point, a needle exchange located in Philadelphia helped prevent 10,000 people from contracting HIV over 10 Years. The researchers from George Washington University estimate that the total lifetime taxpayer savings from this needle exchange averting 10,000 cases of HIV saved them $1.8 billion. <ref>https://www.phillymag.com/news/2019/10/31/prevention-point-syringe-exchange-study/</ref>

*'''Scott County, Indiana.''' Before Scott County set up its syringe exchange program in 2015, this rural county was seeing 10-20 new HIV cases every week. Almost immediately, the number of new cases was slowed to 1-2 a month.

= Sources =

----
</div>
[[Category:SAFE-Full Spectrum Prevention]]

Harm Reduction

2025-01-24T18:27:53Z

Mlabrie21:

Increase Access to Overdose Reversal Medications

2025-01-24T18:27:19Z

Mlabrie21: Mlabrie21 moved page Increase Access to Overdose Reversal Medications to Increase Access to Naloxone

#REDIRECT [[Increase Access to Naloxone]]

Increase Access to Naloxone

2025-01-24T18:27:19Z

Mlabrie21: Mlabrie21 moved page Increase Access to Overdose Reversal Medications to Increase Access to Naloxone

= Introductory Paragraph=

Naloxone (Narcan) has the potential to be very beneficial in communities with a high opioid problem. Increasing community awareness about the power of Narcan to reverse overdose is a benefit unlike any other. Narcan is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain and prevents breathing and heart rates to slow down to fatal levels. It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help. <ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.</ref> Narcan allows victims of substance use to be more likely to survive an overdose when first responders are rightly prepared. Many states are working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation.

Narcan can either be injected or be administered in a nasal spray. In 2023, The US Food and Drug Administration made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. <ref>https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray</ref> It can be easily administered with little or no formal training. Although the drug could potentially save more lives if it were more widely distributed, bystanders often do not summon medical assistance due to fear of possible legal prosecution. Narcan only works on opioids, and does not harm an individual in the case of a non-opioid overdose. So, if there is any question as to what a person took, use Narcan.

= Key Information =

Opioid overdose education and Naloxone distribution programs increase knowledge on how to effectively respond when someone is experiencing an overdose. Participation in the Naloxone distribution programs is linked to a reduction in overdose deaths and an increase in confidence when responding to overdose. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref> Research documents that communities which have programs aimed at training bystanders to respond to opioid overdoses have experienced a more rapid reduction in opioid overdose death rates than communities without these programs. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

Those who are close to opioid users have greater knowledge about overdose and how to respond appropriately after they have completed training in Naloxone administration compared to peers who learn via an information booklet. Current and former opioid users who complete overdose response training are as adept as medical experts in the identification of an overdose and are equally able to tell when Naloxone is appropriate. Opioid users who participate in only a brief 5-minute training or who have learned about Naloxone administration through social networks are able to respond appropriately to an overdose.

Training first responders to administer Naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in Naloxone administration and overdose training report having increased knowledge and confidence in dealing with opioid overdose emergencies after the program is finished. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

'''Personal Impact of Overdose'''
Survival of an overdose has lasting physical, psychological, and personal health implications for the individual that increase in likelihood and severity of each overdose. These include<ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma18-4742.pdf</ref>:
*Opioid-Induced Respiratory Depression (OIRD) - most dangerous health consequence; acute respiratory compromise, dizziness, confusion, and ineptness.
* Brain injury - hypoxia-related brain injuries, complications caused by the OIRD
* Hypoxia injuries can contribute to:
* short-term memory loss,
* changes in cognitive and physical functioning,
* increased risk of stroke, mental disorientation,
* loss of bodily movement or lower-extremity paralysis,
*gait changes,
*incontinence,
*slow reaction time,
*reduced motor skills,
* kidney failure,
*cardiac complications,
*neurological consequences and seizures,
* nerve damage,
*fluid buildup in lungs and pneumonia, and
*temporary motor paralysis
*Increased risk of comorbid mental illness
*Interruptions in education or career goals
*Family and relationship conflicts

'''The Dangers of Dual Use'''

The extent of fatalities associated with opioids is well-documented. However, it is less understood that opioid overdoses are seldom due to opioid use alone. The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid an opioid overdose is not taking opioids. It is also critical to increase awareness of the need to avoid knowingly mixing opioids with other drugs. Some safety precautions are listed below:

*Don't use alone
*Limit the amount of drugs you have available
*Stick to less lethal combinations of drugs
*Use smaller amounts of each drug
*Use the least impairing drug first
*When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
*When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
*Make sure someone knows what drug combinations you have taken
*Have a plan in place in case something goes wrong
*Have Narcan on hand

= Relevant Research =

* '''This Massachusetts study''' found that cities which have Naloxone distribution programs have lower overdose death rates than those without a program. <ref>http://www.bmj.com/content/346/bmj.f174</ref>

*'''A University of Washington study''' evaluated the initial results of the state’s Good Samaritan policy. Drug users who were aware of the law were found to be 88 percent more likely to call 911 in the event of an overdose than before the policy took effect.<ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> <ref>http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf</ref>

*'''This article''' was published in the Annals of Emergency Medicine and is directed to physicians in Emergency Departments. It highlights successes that have been achieved in recent years and calls for specific patient-centered action by emergency physicians. <ref>https://www.annemergmed.com/article/S0196-0644(19)30606-7/fulltext</ref>

= Impactful Federal, State, and Local Policies =

In 2015, the White House announced a treatment-based initiative. The $2.5 million budget was allocated to a program that engaged law enforcement officers and public health professionals to collect data on the movement of heroin along the East coast and to train first responders on when it is adequate to administer Naloxone. <ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> Various federal organizations have come together to encourage good faith prescription of Naloxone to ordinary citizens. They also encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

State laws make it difficult for citizens to obtain prescriptions for ''injection'' Narcan, due to policies on third-party prescriptions and on prescriptions via standing orders. The third party-prescription law prohibits the prescription of drugs to someone other than the person who will receive them, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician. There are a variety of cases in which the complexity of Naloxone policies are advancing:

*The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone without a prescription in case of emergencies. <ref>https://nabp.pharmacy/news/news-releases/california-pharmacists-may-now-dispense-naloxone-without-prescription/</ref>

* In 2006, New Mexico passed a Good Samaritan Law that granted limited immunity from prosecution on simple possession charges for people who dialed 911 to report a drug overdose. Within ten years, 28 states in addition to the District of Columbia had passed similar laws to overcome hesitation to seek treatment or to call medical assistance, as a result of fear of incarceration or other forms of punishment

* In 2023, in Minnesota, a Good Samaritan law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removed a potential barrier --fear of arrest -- that sometimes leads to help not being called and lives being lost to overdose. <ref>https://www.revisor.mn.gov/statutes/cite/604A.01</ref>

*The National Conference of State Legislatures has many examples of policy efforts that have been attempted or passed, including Drug Overdose Immunity and Good Samaritan Laws. <ref>http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx</ref> <ref>http://www.ncsl.org/research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx</ref>

= Available Tools and Resources =

* '''SAMHSA''' provides an overdose prevention and response toolkit. <ref>https://store.samhsa.gov/sites/default/files/overdose-prevention-response-kit-pep23-03-00-001.pdf</ref>

*'''SAFE Project:'''
**'''"Have A Safety Plan"''' is a SAFE Project resource that instructors drug users on how to create a safety plan to prevent overdoses.<ref>https://www.safeproject.us/safety-plan/</ref>
**'''"Keep the Seats Filled: Learn How to Save a Life with Naloxone and Take the #NoShame Pledge"''' is a SAFE Project resource that explores what Naloxone is, where it can be purchased, how to use it, the signs of an overdose, and information on the #NoShame Pledge.<ref>https://www.safeproject.us/life/</ref>
**'''SAFE Project Online Courses''' are SAFE Project original online trainings that focus on harm reduction techniques such as: Narcan administration and navigating Fentanyl use safely. <ref>https://safeproject-s-school-262f.thinkific.com/</ref>
**'''SAFE Workplaces''' provides employers and employees, alike, with the tools and resources necessary to address issues of behavioral health and achieve emotional wellbeing in the workplace.<ref>https://www.safeproject.us/workplaces/</ref>
**See the wiki titled "Expand Harm Reduction Practices" for more detailed information on what harm reduction is and how substance use treatment/support programs can integrate its practices into their services. <ref>https://www.yoursafesolutions.us/wiki/Expand_Harm_Reduction_Practices</ref>
**See the wiki titled "Improve Links to Treatment for People who Experience Non-Lethal overdoses or Naloxone Revivals" for more detailed information on ways to improve linkage to services for those who have experienced a non-lethal overdose or have survived a Naloxone revival. <ref>https://www.yoursafesolutions.us/wiki/Improve_Links_to_Treatment_for_People_who_Experience_Non-Lethal_Overdoses_or_Naloxone_Revivals</ref>

*'''CDC''' provides a website titled "Reverse Overdose to Prevent Death." This has information on Naloxone and Good Samaritan laws. <ref>https://www.cdc.gov/opioids/overdoseprevention/reverse-od.html</ref>

*'''The Bureau of Justice Assistance (BJA)''' maintains an online toolkit featuring resources and information on Naloxone, including a section on liability and risk for law enforcement officers and their employers. <ref>https://bjatta.bja.ojp.gov/tools/naloxone/Liability-and-Risk</ref>

*'''The National Association of Drug Diversion Investigators, Inc. (NADDI)''' provides a resource titled "Overdose and Prevention Strategies" which has every state's strategy in an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This allows communities to identify the most effective strategies for them to implement. <ref>https://www.overdosepreventionstrategies.org/</ref>

= Promising Practices =

*'''Aetna.''' Nearly 35% people who are prescribed Narcan don’t pick it up because they can’t afford the co-pay.<ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref> Having insurers eliminate the co-pay is one strategy to help address that. Aetna was the first national payer to waive copays for Narcan for its fully insured commercial members. This improved access by eliminating potential financial barriers to the lifesaving drug. <ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref>

*'''Connecticut.''' Several communities have made it mandatory for first responders to receive overdose training. <ref>https://www.newstimes.com/local/article/More-responders-using-wonder-drug-Narcan-to-5925616.php</ref>

*'''New York.''' The Drug Policy Alliance printed 1 million cards and posters that explained the Good Samaritan Law and offered basic instructions on how to initially respond to an overdose and worked with various agencies to help distribute these materials to vulnerable populations.

*'''North Carolina.''' The NC Harm Reduction Coalition has given out 52,000 Naloxone kits since 2013 through their statewide grassroots network that includes syringe exchange and Naloxone distribution, with more than 8,700 overdose reversals reported. <ref>https://www.usatoday.com/story/opinion/2017/12/01/opioid-commission-almost-got-right-their-naloxone-recommendation-megan-mclemore-corey-davis-column/899812001/</ref>

*'''The Police Executive Research Forum''' provides case examples of law enforcement Naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), and Camden County, Montgomery County, and Hagerstown (MD). They include descriptions of training, funding, administration, and support. <ref>https://cops.usdoj.gov/RIC/Publications/cops-p356-pub.pdf</ref>

= <br/> Sources =
</div>
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Treatment and Recovery]]

Expand Law Enforcement Assisted Diversion and Deflection Programs

2025-01-24T18:24:02Z

Mlabrie21: Mlabrie21 moved page Expand Law Enforcement Assisted Diversion and Deflection Programs to Expand Law Enforcement and First Responder Assisted Diversion

#REDIRECT [[Expand Law Enforcement and First Responder Assisted Diversion]]

Expand Law Enforcement and First Responder Assisted Diversion

2025-01-24T18:24:02Z

Mlabrie21: Mlabrie21 moved page Expand Law Enforcement Assisted Diversion and Deflection Programs to Expand Law Enforcement and First Responder Assisted Diversion

= Introductory Paragraph =

Diversion and deflection programs seek to re-direct or channel people away from the justice system. This practice is based on the theory that processing individuals through the justice system may do more harm than good or may not be an appropriate response for someone with behavioral health needs. In addition to law enforcement officers, other first responders, such as emergency medical technicians and firefighters, are on the front lines of the illicit substance use epidemic. They frequently respond to drug overdoses and calls for services involving individuals with substance use and co-occurring disorders. As a result, across the country, a variety of diversion services have emerged -- led by law enforcement agencies, fire departments, and emergency medical services (EMS). These first-responder programs represent a pivotal opportunity to redirect individuals with SUDs, mental health disorders, and co-occurring disorders away from jails or emergency departments and toward community-based treatment for substance use, mental health services, recovery support, housing, and social services.<ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ_Pathways_to_Diversion_Self-Referral.pdf</ref>

While the exact number of diversion and deflection programs in the United States is currently unknown, their growth has become accelerated by research showing that they can impact recidivism and help individuals avoid the consequences of having a criminal record. Over the past few decades, much of the innovation in deflection and diversion has focused on individuals whose interactions with the justice system are driven by behavioral health needs. The outcomes sought by diverting or deflecting individuals are generally three-fold:
*Reduce crime by connecting individuals with resources and services that decrease the likelihood of future offenses.
*Assist individuals according to their self-identified needs and provide support and opportunities to change the behaviors that brought them to the attention of the justice system.
*Reduce utilization of limited justice system resources by reducing re-arrest, recidivism, and future justice system expenditures.

= Key Information =

'''Deflection & Diversion Programs'''

Two approaches used by first responders are deflection and pre-arrest diversion programs. It is important to note, these are complementary practices within a systems approach at the intersection of first responders, behavioral health service providers, recovery support, and community. These collaborative interventions connect public safety and public health systems to create community-based pathways to treatment and services for people who have SUD, mental health disorders, or co-occurring disorders. These multidisciplinary programs are forging partnership between first responders and treatment providers, peers, and recovery personnel, and they are succeeding in reducing overdoses by connecting individuals to community-based treatment.

Deflection and pre-arrest diversion program are related, but distinct. Deflection is the practice by which law enforcement ''or other first responders,'' such as fire and EMS, connect individuals to community-based treatment and/or services when arrest would not have been necessary or permitted. This is done in lieu of inaction when issues of substance use, mental health, and/or other needs are present. Deflection is performed without fear by the individual that if they do not “accept the deflection” they will subsequently be arrested.

Pre-arrest diversion is the practice by which ''law enforcement officers'' connect individuals who otherwise would have been eligible for criminal charges to community-based treatment and/or services, ''in lieu of arrest.'' This diverts them from the justice system into the community. Some pre-arrest diversion programs have policies that mandate holding charges in abeyance until treatment or other requirements, such as restitution or community service, are completed, at which time the charges are dropped. Although pre-arrest diversion is facilitated by justice system stakeholders (usually police and sheriffs), clients are diverted to community-based services. Pre-arrest diversion programs should not be confused with ''prosecutorial diversion'', which occurs after individuals have already been arrested and become involved in the justice system. In contrast, pre-arrest diversion occurs before the filing of charges.

Pre-arrest diversion programs are designed to reduce the number of persons who are arrested and placed in jail because of a mental health problem, these programs shift responsibility for rehabilitation from the criminal justice system to the mental health system.<ref>http://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=73&title=The-Police,-Treatment-and-Community-Collaborative-(PTACC)</ref> Early diversion programs provide an alternative to arrest for individuals with substance use and/or mental health disorders, as well as for low-risk offenders. They allow these individuals to avoid the collateral consequences that result from arrest and contact with the criminal justice system. The movement for early diversion is data-driven and is grounded in the belief that public safety and public health approaches must work in tandem to support vulnerable individuals with substance use disorder and/or mental illness. Instead of shifting responsibility or cost from one system actor to another, this collaborative approach creates additional tools and supports for those on the front line. It provides appropriate treatment for eligible individuals. It opens up community opportunities for systemic change by leadership looking for creative solutions to complex problems. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2018/07/PTACC_visual.pdf</ref> Thus, these programs serve the best interest of the individuals involved, the community, and taxpayers. A variety of case studies provide documentation of the following beneficial outcomes of pre-arrest diversion and deflection programs: <ref name="SAFE Pre-Arrest Diversion Guide">https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>

*Break the costly cycle of justice system involvement for eligible individuals.
*Increase cross-sector collaboration to create new pathways to community-based behavioral health services.
*Enhance relations between community members and law enforcement.
*Decrease crime, incarceration, and recidivism rates.
*Lessen the burden on justice systems.
*Improve public health and safety.
*Reduce the burden on individuals who commit non-violent, low-level offenses.
*Ensure equal access to pre-arrest diversion regardless of race, income, or geography; and
*Save taxpayer dollars

'''The Five Pathways to Treatment Model.'''

In 2014, Treatment Alternatives for Safe Communities (TASC) and Center for Health and Justice (CHJ) developed the first iteration of the Five Pathways to Treatment. This offered different methods for deflection that first responders could use, at the point of contact, to move someone from the justice system to community-based treatment. Each pathway has unique characteristics that make it appropriate to address particular problems such as SUD, mental health disorder, homelessness, and other issues. Identifying and naming these pathways created a common language for practitioners to use in the new, emerging field of deflection. For each pathway listed below, the targeted population or circumstance appropriate for the pathway is elaborated. <ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ-TASC_Nation_Survey_Report.pdf</ref> <ref>https://www.cossapresources.org/Content/Documents/Articles/CHJ_Pathways_to_Diversion_Self-Referral.pdf</ref>

*''Self-Referral:'' Drug–involved individuals are encouraged to initiate the engagement with law enforcement without fear of arrest, and an immediate treatment referral is made.
*''Active Outreach:'' Participants are identified by law enforcement, but are engaged primarily by an outreach team, often with a clinician and/or a peer with lived experience, who actively contacts them and motivates them to engage in treatment. Individuals with SUDs are the targeted population.
*''Naloxone Plus:'' A first responder and program partner (often a clinician or peer with lived experience) conducts outreach specifically to individuals who have experienced an overdose recently to engage them in and provide linkages to treatment. Individuals with opioid use disorder are the targeted population.
*''First-Responder/Officer Prevention:'' During routine activities such as patrol or response to a service call, a first responder conducts engagement and provides treatment referrals. If a law enforcement officer is the first responder, no charges are filed or arrests made. The targeted population are persons in crisis, or with non-crisis mental health disorders and SUDs, or in situations involving homelessness or sex work.
*''Officer Intervention:'' (applicable only for law enforcement) During routine activities such as patrol or response to a service call, a law enforcement officer engages an individual and provides treatment referrals or issues noncriminal citations for that individual to report to a program. Charges are held until treatment and/or a social service plan is successfully completed. The targeted population are persons in crisis, or with non-crisis mental health disorders and SUDs, or in situations involving homelessness or sex work.

'''The Sequential Intercept Model (SIM) <ref>https://www.samhsa.gov/criminal-juvenile-justice/sim-overview</ref>'''

SIM helps communities identify resources and gaps in services at each of six "interception points." The SIM mapping process brings together leaders and different agencies and systems to work together to identify local strategies and action plans to divert people with mental and substance use disorders away from the justice system into treatment. The six SIM intercepts are described below:

*'''Community Services.''' This involves opportunities to divert people into local crisis care services. Resources are available without requiring people in crisis to call 911, but sometimes 911 and law enforcement are the only resources available. The emphasis is on connecting people with treatment or services instead of arresting or charging them with a crime.
*'''Law Enforcement.''' At this point, diversion is performed by law enforcement and other emergency service providers who respond to people with mental and substance use disorders. It allows people to be diverted to treatment instead of being arrested or booked into jail.
*'''Initial Court Hearings/Initial Detention.''' This involves diversion to community-based treatment by jail clinicians, social workers, or court officials during jail intake, booking, or an initial hearing.
*'''Jails/Courts.''' This interception involves diversion to community-based services through jail or court processes and programs after a person has been booked into jail. It includes services that prevent the worsening of a person’s illness during their stay in jail or prison.
*'''Reentry''' supports reentry back into the community after jail or prison to reduce further justice involvement. It includes reentry coordinators, peer support staff, or community in-reach to link people with proper mental health and substance use treatment services.
*'''Community Corrections.''' This involves community-based criminal justice supervision with added supports for people with mental and substance use disorders to prevent violations or offenses that may result in another jail or prison stay.

= Relevant Research =

'''Collaborative Research Report.''' This survey was performed by the Treatment Alternatives for Safe Communities, The University of Chicago, and the US Justice Department. It is titled "Report of the National Survey to Assess Law Enforcement-Led Diversion and First Responder Deflection Programs in Response to the Opioid Crisis." It provides a comprehensive overview of the field and its role in responding to the opioid crisis, as well as how deflection/first responder deflection offers alternatives to law enforcement and first responders in their work. <ref>https://www.cossup.org/Content/Documents/Articles/CHJ-TASC_Nation_Survey_Report.pdf</ref>

'''The Police Treatment And Community Collaborative (PTACC)''' published a research report on the benefits of diversion programs. Key findings indicate that despite the lack of large-scale and multi-site evaluation efforts, there are important trends emerging from early research on pre-arrest diversion initiatives across the US. Here are some key results drawn from empirical research on a variety of programs. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2020/06/PTACC_Key_Research_FINAL.pdf</ref>
*Pre-Arrest Diversion represents the first intercept with the criminal justice system, making it a prime opportunity to redirect adults with mental health conditions and substance use disorders from jails and to connect them with community-based service providers.
*The majority of adults booked into local jails require mental health services and treatment for SUDs, which are typically not provided in local facilities.
*Behavioral health conditions are associated with repeat criminal justice contact, and SUDs are the strongest predictor of jail readmission.
*Pre-arrest diversion programs assess and address behavioral health needs associated with continual involvement in the criminal justice system.
*Preliminary results indicate participants who fully engage in pre-arrest diversion programs tend to have low rates of recidivism for extended periods of time.

= Impactful Federal, State, and Local Policies =

Communities are subject to state laws and regulations that directly impact their ability to institute pre-arrest diversion and other crisis response strategies. Often, strategies are locally designed and implemented and do not operate in a legal or political vacuum. Laws that grant local officials noncriminal responses to crises can propel diversion efforts or provide alternative, supplemental crisis responses. Laws that require criminal responses or otherwise circumscribe when and how non-law enforcement responders are able to intervene can impede them. Current statewide barriers exist in pre-arrest diversion and crisis response strategies.

'''The Office of National Drug Control Policy''' funded a study that provides a model for states to use to generate legislation authorizing diversion. When the template is followed and enacted by a state, it allows law enforcement officers to divert some individuals with substance use disorders or mental health conditions away from arrest and prosecution to treatment and other supportive services. This helps states legislate collaborative programs between law enforcement, treatment providers, and community organizations to support individuals to access treatment and services and avoid justice involvement. <ref> https://www.opioidlibrary.org/wp-content/uploads/2019/08/Model-Deflection-Act-FINAL-7.1.2019.pdf</ref>

'''Illinois Senate Bill 3023''' is one example of legislation on deflection. The 2018 Community-Law Enforcement Partnership for Deflection and Substance Use Disorder Treatment Act authorizes and encourages local law enforcement leaders to partner with treatment and community members on programs that deflect individuals who have overdosed or who have substance use problems away from the justice system and into treatment services. <ref>https://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=84&title=SB-3023-Community-Law-Enforcement-Partnership-for-Deflection-and-Treatment#:~:text=Illinois%20Senate%20Bill%203023%2C%20signed,that%20%E2%80%9Cdeflect%E2%80%9D%20individuals%20who%20have</ref>

'''The R Street Report.''' This policies report reviews all fifty states relating to pre-arrest diversion and crisis response including legal status and legislative actions. <ref>https://www.rstreet.org/wp-content/uploads/2019/10/Final-187.pdf</ref> Policies relating to pre-arrest diversion and crisis response include:
*Emergency Mental Health Hold laws authorize certain first responders to take an individual experiencing a mental health crisis into a form of civil custody in order for them to be evaluated by appropriate mental health or medical personnel.
*Protective Custody. These procedures operate as the substance use analog to emergency mental health holds by authorizing first responders to place an individual experiencing an acute substance use episode in temporary civil custody.
*Citation Authority statutes permit or require law enforcement officers to issue a citation to individuals alleged to have committed certain specified offenses, instead of detaining them or placing them under arrest.
*Good Samaritan laws offer immunity from arrest, criminal charges, prosecution or conviction for limited, drug-related offenses as an incentive for individuals to call for assistance for someone experiencing a suspected overdose.
*Ambulance Transport laws and regulations can influence where emergency medical services may take an individual experiencing a crisis, potentially by requiring transport to a hospital emergency department or otherwise discouraging the use of alternative destinations.

= Available Tools and Resources =

'''SAMHSA''' provides a guidebook titled, "Crisis Intervention Team (CIT) Methods for Using Data to Inform Practice: A Step-by-Step Guide. <ref>https://www.opioidlibrary.org/document/crisis-intervention-team-cit-methods-for-using-data-to-inform-practice-a-step-by-step-guide/</ref>

'''SAFE Project:'''
*'''"Law Enforcement Pre-Arrest Diversion Resource Guide"''' was created in collaboration with PTACC. It is a downloadable resource designed to help law enforcement agencies create pre-arrest diversion programs for individuals with substance use disorder. The guide describes pre-arrest diversion, defines two types of pre-arrest diversion programs, includes background information and research, and provides case studies of PTACC's five pathways. <ref>https://www.safeproject.us/law-enforcement-pre-arrest-diversion/</ref> The guide can be downloaded. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf </ref>
*'''Integrated-Forensic Peer Recovery Specialist (I-FPRS) Training.''' This SAFE Project program is a comprehensive set of curriculums designed for Peer Recovery Specialists, organizations, and groups working with justice-involved individuals who experience substance use disorders. This training equips participants to navigate the intersection of behavioral health and the criminal justice system. <ref>https://www.safeproject.us/ifprs-training/</ref>
*'''SAFE Connections.''' This subprogram of the SAFE Choices portfolio provides an opportunity to impact youth recidivism and redirect young lives toward reaching their full potential.<ref>https://www.safeproject.us/safe-choices/connections/</ref>
*See the wiki titled "Shift from Punishment to Treatment Approach" for more detailed information on using evidence-based practices for treating those in the criminal justice system with substance use issues. <ref>https://www.yoursafesolutions.us/wiki/Shift_from_Punishment_to_Treatment_Approach/</ref>
*See the wiki titled "Improve Links to Treatment for People who Experience Non-Lethal overdoses or Naloxone Revivals" for more detailed information on ways to improve linkage to services for those who have experienced a non-lethal overdose or have survived a Naloxone revival. <ref>https://www.yoursafesolutions.us/wiki/Improve_Links_to_Treatment_for_People_who_Experience_Non-Lethal_Overdoses_or_Naloxone_Revivals</ref>

'''The U.S. Department of Justice''' Bureau of Justice Assistance (BJA) manages the Comprehensive Opioid, Stimulant & Substance Use Program (COSSUP). Its Law Enforcement/First Responder Diversion and Referral Mentoring Initiative provides communities interested in starting diversion and/or referral programs with the opportunity to learn from established or innovative programs that have shown success in meeting the treatment needs of individuals with a substance use disorder, and in some cases may have experienced an overdose. <ref>https://www.cossapresources.org/Learning/PeerToPeer/Diversion</ref>

'''Advanced Recovery Systems University''' provides an online library of webinars specific to mental health and substance use within the first responder community. <ref>https://arsuniversity.thinkific.com/collections?category=ba5e2b</ref>

'''The Center for Prison Reform''' published "Jail Diversion Programs in America." <ref>https://centerforprisonreform.org/wp-content/uploads/2015/09/Jail-Diversion-Programs-in-America.pdf</ref>

'''Crisis Intervention Team International''' published "A Best Practice Guide for Transforming Community Responses to Mental Health Crises." <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/10/CIT-guide-desktop-printing-2019_08_16-1.pdf</ref>

'''Law Enforcement Assisted Diversion (LEAD)''' is a community-based diversion approach with the goals of improving public safety and reducing unnecessary justice system involvement of people who participate in the program. The site includes a video, tools and resources. <ref>https://www.leadbureau.org/</ref>

'''The National League of Cities''' offers "Working Across Systems for Better Results: City Efforts to address Mental Health, Substance Use and Homelessness Through Emergency Response and Crisis Stabilization" highlighting case studies in cities in Kansas, Texas, and West Virginia. <ref>https://www.opioidlibrary.org/wp-content/uploads/2020/01/YEF_MentalHealth_IssueBrief2_Final.pdf</ref>

'''The Police Assisted Addiction and Recovery Initiative (PAARI)''' helps police departments create non-arrest pathways to substance use disorder treatment and recovery like the ANGEL program in Gloucester, Massachusetts. PAARI works with over 400 police departments in 32 states and helps communities customize their programs to their circumstances. Offered services include technical assistance, policy templates and tools, seed grants, and connections to experts with established programs. <ref>https://paariusa.org/</ref>

'''The Police Treatment And Community Collaborative (PTACC)''' is an alliance of practitioners in law enforcement, behavioral health, advocacy, research, and public policy. <ref>https://ptaccollaborative.org/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref> It provides a webinar titled "Starting Your Pre-Arrest Diversion (PAD) Effort: Law Enforcement, Behavioral Health, and Community Together" which gives information on pre-arrest diversion models. <ref>https://ptaccollaborative.org/webinars/</ref> The PTACC mission is to strategically widen community behavioral health and social service options available through law enforcement diversion. The purpose of the Collaborative is to provide vision, leadership, advocacy, and education to facilitate the practice of pre-arrest diversion across the United States. Their focus is to educate law enforcement and communities on pre-diversion for those who have committed nonviolent misdemeanors. This helps people to be moved away from the criminal justice system and toward appropriate treatment or services which can support these individuals, helping them avoid falling into the revolving door of the criminal justice system. "PTACC is the national voice of the deflection and pre-arrest diversion field." <ref>https://ptaccollaborative.org/about/</ref> PTACC recognizes that there are multiple models of pre-arrest diversion. It has adopted the TASC model, described above, as its "Pathways to Community" because using one or more of them creates pathways to treatment or social services. <ref>http://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=73&title=The-Police,-Treatment-and-Community-Collaborative-(PTACC)</ref> PTACC endorses each of the five pathways and encourages communities to explore the approaches which best meet their needs. PTACC encourages availability of as many pathways as possible to maximize diversion opportunities and connection to treatment, recovery support, and community services.
<ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2018/07/PTACC_visual.pdf</ref> PTACC is organized into eight strategic areas, each having their own working groups and associated websites: <ref>https://ptaccollaborative.org/strategy-areas/</ref>
*Children and Families
*Community, Diversity, and Equity
*International Deflection and Diversion
*Policy and Legislation
*Public Safety
*Research
*Stigma Reduction
*Treatment, Housing, and Recovery

= Promising Practices =

'''Alabama -- The Mercy Project.''' Walker County had the fifth-highest per capita rate of overdoses in the United States and the highest overdose rate of any county in the state. As a result, Sheriff Nick Smith wanted to create a program to help people struggling with SUD and to reduce the recidivism rate resulting from substance use. Interested participants fill out an application and then receive consultation. People are ineligible for program entry if they are facing drug charges or have outstanding warrants. The consultation allows a potential participant to turn in any drugs or drug paraphernalia without the threat of arrest. Although the individual must still enter the justice system, drug court is an option. If the person is accepted into the program, consultation determines individual treatment needs. <ref>https://walkercountysheriff.com/mercy-project.html</ref>

'''Arizona.''' The Arizona Angel Initiative is a community-based, police-assisted program. Police departments work in partnership with community-based treatment providers and the Governor's Office of Youth, Faith and Family. This program is modeled after a similar program in Gloucester, Massachusetts. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/07/AZ_AngelInitiativeReport_2018.pdf</ref>

'''Florida.''' The Pre-Arrest Diversion/Adult Civil Citation (PAD/ACC) is a model pre-arrest diversion program. The Leon County/Tallahassee program holds offenders accountable for their crime, but instead of being arrested and prosecuted by the traditional criminal justice system, the person receives civil sanctions, such as community service. Following referral by law enforcement, one essential element of the program is the use of evidence-based behavioral health intervention services to reduce the likelihood of future criminal activity. PAD/ACC also works to avoid an arrest record for those who successfully complete the program. The decision to arrest or refer for behavioral health assessment and intervention services is best made by the law enforcement officer who is on the scene and understands the nature of the offense at the time it occurred. Since its inception, the program has had over 1300 participants. The Civil Citation model has grown throughout the State of Florida. Today the Civil Citation Network (CCN) assists communities in implementation of the model. <ref>https://university.pretrial.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=514d95d4-413d-7a4f-f2e2-7fa588a297c2&forceDialog=0</ref>

'''Georgia.''' The Adult Felony Drug Court Program in Clayton County is an 18-to-24-month program that gives nonviolent drug offenders with a substance use disorder the chance to avoid incarceration. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/promising-practices</ref>

'''Illinois -- A Way Out.''' In Lake County, an Illinois Law Enforcement Assisted Diversion (LEAD) pilot program was designed to fast-track users to substance use programs and services. This program is available 24 hours a day, 7 days a week, at participating police departments across Lake County. It ensures that no criminal charges will be sought for those who may be in possession of narcotics or paraphernalia, if assistance is sought out by the prospective program participant. “A Way Out” is a program developed by the Lake County Opioid Initiative to create additional treatment access points, reduce crime, reduce substance-related harms, re-frame the role law enforcement plays in community safety, and unite the community. For too long, substance use has been stigmatized and dealt with as a criminal issue. Substance use is a public health problem that needs to be addressed as such. Lake County Opioid Initiative is committed to developing innovative ways to create positive change regarding substance use and mental health. <ref>https://awayoutlc.org/</ref>

'''Illinois -- Safe Passage.''' People who realize they need help can go to one of the participating law enforcement agencies in Lee and Whiteside Counties without fear of being arrested. If they ask for help with their substance use and turn in their drugs, they will be placed in a treatment facility, usually within 24 hours. Once initial paperwork is completed, persons will be paired with a volunteer who will guide them through the process. Safe Passage partners with treatment centers throughout Illinois and the Midwest. <ref>https://www.dixongov.com/departments/police-department/inside-the-dixon-police-dept/safe-passage.html</ref>

'''Maryland -- Safe Stations''' is an innovative new program in Anne Arundel County. It shifts barriers to treatment for those community members who are ready to recover from substance use disorder. Persons seeking treatment can visit any police or fire station across the county, day or night, to dispose of any paraphernalia and find assistance gaining access to care. <ref>https://www.annapolis.gov/1325/Safe-Stations</ref>

'''Maryland -- Stop, Triage, Engage, Educate and Rehabilitate (STEER)''' in Montgomery County is a pre-booking law enforcement and drug treatment and recovery linkage program that aims to provide rapid identification, deflection, and access to treatment for drug-involved individuals as an alternative to conventional arrest. Individuals are assigned a care coordinator who focuses on rapid treatment access, retention, motivation, engagement, and completion and conducts a full clinical assessment and referral. Police officers use a screening tool to decide whether a person is a candidate for this deflection. The risk assessment may be used by a police officer who is responding to a call for service or in an on-view situation. Charges can be held in abeyance while the person is seeking services. STEER operates around the core value proposition of deflection, namely ensuring the “correct” movement of citizens either into the criminal justice system or away from it. As a result of moving people towards the human services system, STEER exemplifies the following outcomes: <ref>https://opioid-resource-connector.org/index.php/program-model/stop-triage-engage-educate-and-rehabilitate-steer</ref>
* reducing crime
* rebuilding community relations
* reducing drug use
* restoring the lives of citizens

'''Massachusetts -- Arlington Opiate Outreach Initiative.''' This community-based strategy has two major components. First is the proactive outreach to known substance users. This involves a clinician at the police department reaching out to the known population of persons with substance use disorders to support them in developing a plan to ensure their survival, to provide access to services, and to facilitate the long-term process of recovery. The second component is the Arlington Community Training & Support (Arlington ACTS) which involves a series of community-based meetings. These are co-facilitated by the police department’s clinician and a community substance use intervention expert and are aimed at creating a supportive non-judgmental environment for substance users and their families. <ref>https://cops.usdoj.gov/RIC/Publications/cops-p356-pub.pdf</ref>

'''Massachusetts -- Plymouth County Outreach (PCO)''' was developed through the Public Safety, Community Coalition, and the Faith Based Subcommittees of the Plymouth County Drug Abuse Task Force. Since its inception, PCO has fostered innovative law enforcement collaboration with faith-based coalitions, the District Attorney’s Office, The Sheriff’s Department, all 27 police departments, 5 major hospitals, the Division of Children and Families, recovery coaches, District Court Probation, and the Police Assisted Addiction and Recovery Initiative (PAARI). The two main aspects of the program are overdose follow-up and community drop-in centers. Within 12-24 hours of an overdose, an outreach team consisting of plainclothes officers, a licensed clinician, and/or a recovery coach will conduct a home visit of the overdose survivor. The intent of the outreach effort is to provide resources and support to those with substance use disorders and/or their families with the hope of getting people into treatment and connecting family/friends with existing resources in the county. Drop-in centers are held each week in various sites across Plymouth County. These centers host a growing number of health care providers who help with treatment options and train and distribute Narcan for free. <ref>https://otf.plymouthda.com/project-outreach/</ref>

'''Minnesota.''' The Yellow Line Project in Blue Earth County provides a collaboration between law enforcement, human services, and care providers to improve coordination and access to treatment for individuals with substance use or mental health conditions, instead of in incarceration. <ref>https://www.yellowlineproject.com/operational-toolkit</ref>

'''New Hampshire.''' The Safe Station Program offers help to anyone with substance use disorder at any Manchester Fire Department. The firefighters will arrange for or provide a medical assessment within their scope of training. If there is cause for concern that there is something else medically wrong with the patient, transportation to an appropriate level medical facility will be provided. Each individual seeking assistance will be required to drop any needles and/or paraphernalia into a collection bin located at each fire station prior to speaking with coaches or seeking treatment. <ref>https://manchesterinklink.com/as-safe-station-ends-those-in-need-of-addiction-treatment-and-recovery-services-directed-to-call-2-1-1/</ref>

'''New Jersey.''' In Ocean County, the Blue Heroin Addiction Recovery and Treatment (HART) is New Jersey's first program allowing substance users to seek help from authorities without risk of prosecution. <ref>https://www.staffordnj.gov/DocumentCenter/View/943/BLUE-HART-program-brochure?bidId=</ref>

'''New York.''' Hope Not Handcuffs is an initiative started by Families Against Narcotics (FAN). It aims to bring law enforcement and community organizations together in an effort to find viable treatment options for individuals seeking help to reduce dependency with heroin, prescription drugs, and alcohol. A person struggling with any substance use can come to a participating police agency and ask for help. They will be greeted with support, compassion, and respect. If accepted into the program, the individual will be guided through a brief intake process to ensure proper treatment placement. <ref>https://www.familiesagainstnarcotics.org/hopenothandcuffs-ny</ref>

'''North Carolina.''' The HOPE Initiative in Nashville was the first pre-arrest diversion program in North Carolina. Its purpose is to assist those individuals with substance use disorder find treatment options, get into treatment, and begin recovery. While other programs were centered on opioids, the HOPE Initiative was willing to accept any substance use disorder. Partnerships were established with the local district attorney’s office, the Eastpointe Local Management Entity, UNC Nash Hospital, Coastal Plain Hospital (Detox facility), Police Assisted Addiction and Recovery Initiative (PAARI), and many others. The program allows individuals to come to the Nashville Police Department to start their recovery process by turning over any drugs and/or paraphernalia without fear of charges. The first organization in the HOPE Initiative served 320 clients in 2 years. The program is funded through donations, grants, and fundraisers. <ref> https://www.townofnashville.com/home/showpublisheddocument/129/636527353948700000</ref>

'''Ohio -- Drug Abuse Response Team (DART).''' Developed by the Lucas County Sheriff’s Office, DART has been credited with diverting more than a thousand people from the criminal-justice system in Toledo and into treatment during its first 4 years. 70% of participants successfully entered detox and treatment programs. The Ohio legislature has since approved a pilot grant program to assist other Ohio counties in implementing the DART program. 39 programs received grant funding for 21-month-long pilots. The Lucas County DART program has over 20 officers from several area law enforcement agencies, including Toledo PD, the Sheriff’s Department, and the Division of Children and Families. Each officer works with parents with substance use disorder whose children have been put in foster care, in order for parents to get access to treatment, so that the family can be reunited.

'''Ohio -- Hamilton County Heroin Task Force''' partnered with law enforcement, fire departments and social workers to create the Quick Response Team (QRT). It follows up with overdose victims and offers them substance use treatment. The goal is to have a first responder follow up with overdose victims within the “recovery window” (72 hours after an overdose reversal) and to provide a warm hand-off to treatment options. Teams work to find overdose survivors using a database maintained by the Greater Cincinnati Fusion Center, a public safety data-collecting agency. Teams also use “predictive analysis” to track drug activity to target potential overdoses with the help of University of Cincinnati’s Institute of Crime Science. QRT has since been launched as a national model. <ref>https://www.cossapresources.org/Content/Documents/Diversion_Library/HCTF_Hamilton_County_OH_Program_Policy_508.pdf</ref>

''' Tennessee.''' The Crisis Intervention Team (CIT) program is a community partnership working with mental health consumers and family members. The CIT is made up of volunteer officers from each Uniform Patrol Precinct. Officers are part of a specialized team which can respond to a crisis at any time, and they will work with the community to resolve each situation in a manner that shows concern for the citizen’s well-being. CIT officers are called upon to respond to crisis calls that present those officers, face-to-face, with complex issues relating to mental illness. CIT officers also perform their regular duty assignment as patrol officers. The Memphis Police Department has 268 CIT officers who participate in specialized training under the instructional supervision of mental health providers, family advocates, and mental health consumer groups. After the training, CIT officers can, with confidence, offer a more humane and calm approach. These officers maintain a 24/7 coverage. <ref>https://www.memphistn.gov/government/police-department/crisis-intervention-team/</ref>

'''Washington.''' Law Enforcement Assisted Diversion (LEAD) is a pre-booking diversion program developed in King County to address low-level drug and prostitution crimes in Seattle and King County. The program allows law enforcement officers to redirect low-level offenders engaged in drug or prostitution activity to community-based services, instead of jail and prosecution. By diverting eligible individuals to services, LEAD is committed to improving public safety and public order and to reducing the criminal behavior of people who participate in the program. The King County LEAD program has evolved to a national model with a support organization, the LEAD National Support Bureau, which assists departments in establishing LEAD programs. <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx</ref>

= Sources =

Expand Motivational Interviewing for Pregnant People

2025-01-24T18:21:23Z

Mlabrie21: Mlabrie21 moved page Expand Motivational Interviewing for Pregnant People to Expand Motivational Interviewing

#REDIRECT [[Expand Motivational Interviewing]]

Expand Motivational Interviewing

2025-01-24T18:21:23Z

Mlabrie21: Mlabrie21 moved page Expand Motivational Interviewing for Pregnant People to Expand Motivational Interviewing

=Introductory Paragraph =

Motivational Interviewing (MI) is an evidence-based practice that is effective in helping people make decisions to stop negative behaviors and start positive ones. MI is a therapeutic tool intended for use in conjunction with other forms of therapy or treatment. MI is an intervention which is significant across the continuum of care. Since it is designed to inspire change in clients who may otherwise feel reluctant to change, MI supports incremental choices toward recovery. It also holds particular relevance to the harm reduction community, because it is designed to "meet people where they are at."

= Key Information =

MI was founded by Dr. William Miller and Dr. Stephen Rollnick. <ref>https://www.stephenrollnick.com/about-motivational-interviewing/</ref> It is a collaboration approach which is based on an interview process between the provider and the patient. MI patients are empowered to create their own goals, as opposed to goals imposed by a therapist, such as complete abstinence. <ref>https://www.addictioncenter.com/treatment/motivational-interviewing/</ref> When individuals in recovery feel as though they are in control of their own recovery, they take ownership of their success and move forward with their own goals. This encourages patient autonomy. When a patient feels responsible for their actions and is confident in their recovery, they are more likely to stay sober and to not relapse after treatment.

Motivational interviewing does not focus on the underlying causes of substance use disorder, such as past traumas or mental illnesses. It is intended to be used in addition to other forms of therapy, such as cognitive behavioral therapy. Although MI pulls from various therapeutic styles and theories, such as humanistic therapy, cognitive dissonance theory, therapeutic relationship building, and positive psychology, it is most effective when used in conjunction with one of these forms of treatment. MI is also an effective part of an inpatient treatment regimen, before seeking other recovery options.

Miller and Rollnick formulated four client-centered processes to help patients identify their goals and begin to work towards them. They are as follows: <ref>https://www.stephenrollnick.com/about-motivational-interviewing/</ref>
*Engaging – Getting to know the client and establishing a trusting and respectful alliance.
*Focusing – Coming to a shared idea about the main focus of a client’s recovery.
*Evoking – Bringing out the client’s own arguments for change.
*Planning – The client is willing and able to envision change and how they will manifest it.

= Relevant Research =

'''This article''' documents the results of MI training for obstetric healthcare professionals working with obese pregnant people. Participants made more interventions towards the principles of motivational interviewing and asked fewer closed and more open questions than they had before the training. <ref>https://obgyn.onlinelibrary.wiley.com/doi/10.1111/aogs.12401</ref>

= Impactful Federal, State, and Local Policies =

SAMHSA identifies MI as as a model of change and indicates that it aligns to the five "stages for change:" <ref>https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-02-02-014.pdf</ref>
*Precontemplation — Individuals currently using substances are not thinking of making a change now or in the future.
*Contemplation — Individuals currently using substances are aware that they need to make a change.
*Preparation — Individuals currently using substances begin weighing the pros and cons of making a change and preparing for how to deal with urges and triggers.
*Action — Individuals currently using substances decide to change their behavior and successfully attempt to do so.
*Maintenance — Individuals who changed their substance use behaviors are engaged in efforts to continue doing so over the long term.

= Available Tools and Resources=

*'''SAMHSA''' has published a guide titled "Using Motivational Interviewing in Substance Use Treatment." <ref>https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-02-02-014.pdf</ref> One of the Addiction Technology Centers (ATTC) in the SAMHSA Network focuses on family-centered behavioral health of pregnant and postpartum people. It includes three videos on MI in an integrated care setting -- for nurse practitioners, counselors, and social workers. <ref>https://attcppwtools.org/PPWProgram/Videos.aspx#MI</ref>

*'''The Founders of MI''' provide a website that offers an instructional overview of the four MI processes, online trainings, and free resources. <ref>https://psychwire.com/motivational-interviewing/resources</ref>

*'''University of Arizona''' has a website dedicated to information on pregnant and post-partum people with SUDs. It includes a one-hour video training titled "Essentials of Motivational Interviewing." <ref>https://phoenixmed.arizona.edu/ppw-sud/trainings</ref>

*'''The National Harm Reduction Coalition''' has published "Pregnancy and Substance Use: A Harm Reduction Toolkit" that includes information on MI.<ref>https://harmreduction.org/issues/pregnancy-and-substance-use-a-harm-reduction-toolkit/</ref>

= Promising Practices =

'''The Motivational Interviewing Network of Trainers (MINT)''' is an international organization of MI trainers. Trainers in MINT come to the non-profit from diverse backgrounds and apply MI in a variety of settings. Their central interest is to improve the quality and effectiveness of counseling and consultations with clients about behavior change. MINT was started in 1997 by a small group of trainers who were trained by Miller and Rollnick. The organization has since grown to represent 35 countries and more than 20 different languages. <ref>https://motivationalinterviewing.org/</ref>

'''Clinical Health Coach® Training''' provides online training through the Iowa Chronic Care Consortium (ICCC), a non-profit that specializes in population health consulting, training, and organization planning. Their mission is to build capacity with other organizations to deliver effective and personalized strategies for health improvement and chronic care. Clinical Health Coach Training Online is a flexible, 26-hour, self-paced, six to twelve week experience. It engages participants in an online learning platform for various topics, including MI. <ref>https://clinicalhealthcoach.com/</ref>

'''An MI App.''' Steven Ondersma, Ph.D., at Michigan State University has a primary research interest in computer-delivered assessment and motivational interventions for substance use and other risk factors among pregnant and postpartum people. He developed an MI app that runs on tablets and smart phones that uses a 3-D animated guide to walk patients through an intervention specific to their responses. The guide asks questions such as “what do you like about opioid use, why do you use opioids, and what do they do for you?” The guide then reflects their answers. At the end of the session, if the patient indicates a need for change, the guide in the app can help them develop a plan to change, send tailored text messages after they leave the doctor’s office, and suggest treatment options in their area. This type of intervention has shown success in some communities and is currently being tested to address opioids. This intervention could be very successful for four reasons:
*Using an electronic based system to ask these difficult questions could remove stigma from the situation.
*Most people will have access to a mobile device.
*It automates follow-up.
*It does not require additional MI training for doctors and decreases their time for screening. <ref>https://www.addictioncenter.com/treatment/motivational-interviewing/</ref>

= Sources<br/>   =
</div>
[[Category:SAFE-Full Spectrum Prevention]]

Expand Prescription Drug Take-Back and Disposal Programs

2025-01-24T18:18:30Z

Mlabrie21: Mlabrie21 moved page Expand Prescription Drug Take-Back and Disposal Programs to Expand Safe Storage and Prescription Drug Take-Back and Disposal Programs

#REDIRECT [[Expand Safe Storage and Prescription Drug Take-Back and Disposal Programs]]

Expand Safe Storage and Prescription Drug Take-Back and Disposal Programs

2025-01-24T18:18:30Z

Mlabrie21: Mlabrie21 moved page Expand Prescription Drug Take-Back and Disposal Programs to Expand Safe Storage and Prescription Drug Take-Back and Disposal Programs

= Introductory Paragraph =

Prescription drug take-back and disposal programs enhance safety, protect the environment, and decrease opportunities for drug diversion:
* Safety is is increased by limiting the risk of accidental exposure, such as childhood poisoning. <ref>http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm</ref>
* Environmental benefits are linked to a decrease in flushing. Proper disposal ensures that medications do not get into drinking water and watersheds. <ref>http://www.takebackyourmeds.org/what-you-can-do/medicine-disposal-myths-and-facts/</ref>
* Reducing drug diversion limits the ability of people to misuse these medications or give them to others who may misuse them. Prescription drugs involved in overdoses are almost all originally prescribed by physicians but are used by individuals other than the patient prescribed the drugs. A majority of abused prescription drugs are obtained from family and friends, including from the home medicine cabinet. <ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref> SAMHSA’s National Survey on Drug Use and Health found that over 70 percent of people who used prescription pain relievers non-medically got them from friends or relatives, while approximately 5 percent got them from a drug dealer or from the Internet. Nearly 80 percent of heroin users reported using prescription opioids prior to heroin. <ref>Muhuri PK, Gfroerer JC, Davies MC; Substance Abuse and Mental Health Services Administration. Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Review. Published August 2013.</ref>

Most opioid abuse prevention strategies address proper disposal, and this is a step in the right direction. However, communities have significant opportunities to expand and enhance these efforts to reach more people. This article focuses on practical ways to make improvements to existing efforts and to add new options for communities.

= Key Information =

The worst disposal strategy is to throw drugs in the garbage, because they can accidentally be taken by kids or pets. The best options are detailed below, all of which can implementated in conjunction with each other:

*'''Increasing the Number of Drug Drop-Boxes in your Community.''' This is considered the best disposal option. So, it is important for communities to increase the number of drop boxes that are available and to promote awareness of them as a disposal option. In multiple cities and communities, drop boxes have resulted in increased safety and reduced the risk of opioid addiction. Boxes are often located in close proximity to law enforcement agencies, so the drugs are secure. Many pharmacies are now providing drop boxes as well.

*'''Education Campaigns''' - An information campaign enables a variety of sectors in the community to collaborate. For example, an awareness campaign could engage law enforcement in drug take-backs. When law enforcement hosts drop-off locations, it promotes the overall campaign. Health department staff could disseminate information. Schools could provide an avenue for reaching parents and informing them about the location of take-back events. Pharmacies and the businesses could be engaged in sponsoring the campaign. A few models of national campaigns are provided in the “Promising Practices” section below. Families are generally more receptive to tips for medication safety than they might be for information about other forms of prevention. Although statistics can be used in an education campaign, it may be more effective to provide basic ideas which can get people thinking about their own practices in a new way. For example, most people have not considered that it makes sense to keep a medication log or an inventory of all their medication types and amounts. Updating their inventory every six to twelve months keeps medication safety in their awareness. <ref>http://www.youthconnectionscoalition.org/content/wp-content/uploads/2015/04/safe_storage.pdf</ref> Likewise, people are ready to recall that the medicine cabinet in a bathroom is often not the best place to store prescriptions, since they should be stored in a cool, dry place. Humidity, heat, and the change in temperatures in the bathroom can alter the potency of some medications, and some storage devices can help protect medications from humidity, even if they are stored in bathrooms. <ref>http://www.youthconnectionscoalition.org/content/reduce-rx-abuse-2/the-proper-storage-of-prescription-drugs/</ref> This is a good lead-in to building a desire to obtain a lock-box. While community efforts should target everyone, there are three special populations which typically yield the highest return on educational investment:
**'''Senior Citizens''' -- Senior citizens have a disproportionate number of medications in their homes. Helping seniors understand how to properly dispose of medications can make a big difference in the success of your program.
**'''Nursing Homes.''' One study estimated the nation’s nursing homes discard anywhere from $73 million to $378 million worth of drugs a year. Some are incinerated, but many are flushed. <ref>https://www.nbcnews.com/health/health-news/got-old-medicine-don-t-flush-it-flna1c9478735</ref> Nursing homes could be provided with information and tools (or services) for more appropriate disposal options which are better for the environment and which minimize the likelihood of diversion of these medications.
**'''Hospice Programs and Funeral Homes''' can help family members understand how to properly handle the medications they inherit when a loved one passes away. <ref>https://www.dea.gov/press-releases/2017/05/08/dea-brings-record-amount-unused-prescription-drugs-national-prescription</ref> Funeral homes may distribute brochures to remind people to make sure that any prescription drugs which were being taken by a loved one are properly disposed. People in the late stages of life may have been getting prescription opioids to deal with pain, so hospice and funeral homes should be provided with disposal options.

*'''Proper Disposal''' — In addition to take-backs and promotion of drop-off locations, there are medication neutralization kits that are available. These provide an appealing way to engage people to take action in a one-off event that increases their readiness to take more routine medication safety actions. The U.S. Food & Drug Administration (FDA) provides guidance on the safest ways of disposing of medications at home. <ref>https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know</ref> Some experts strongly recommend against flushing medications down the toilet. <ref>Minnesota Pollution Control Agency https://www.pca.state.mn.us/featured/dont-flush-medicines-down-drain</ref> However, the FDA recommends that certain drugs be flushed immediately, such as Fentanyl patches, Oxycontin, and Percocet, and publishes a full list of pharmaceuticals that are safe to flush. <ref>http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm#Flush_List</ref> While flushing is the last resort, flushing unused medications which are on the "flush list" is better than keeping them around. There are three optimal categories of in-home disposal — deactivation powders that are poured into prescription bottles, deactivation pouches into which prescriptions can be poured, and medication mail-back envelopes. Example of vendors which provide each of these are listed in the “Available Tools and Resources” section below. All three approaches have the benefit of being a low-cost solution to disposal. Powder packets offer a level of simplicity in distribution, because they can be easily attached to prescriptions by the pharmacist. All three in-home disposal approaches are useful as give-aways in campaigns to increase awareness of medication safety. All three methods support the environment and decrease the possibility of accidental exposure or intentional misuse.

*'''Safe Storage''' of prescription drugs within the home has been prioritized as a key strategy by many organizations and coalitions. <ref>https://end-overdose-epidemic.org/task-force-recommendations/</ref> It is essential that people who have prescription medications in their homes store them safely. If prescription drugs are safely stored, misuse can be stopped earlier, because people who have not yet developed a dependence on opioids usually do not go directly to illegal opioids like heroin or Fentanyl. Increasing awareness about the importance of safe storage often goes hand-in-hand with providing members of the community free or affordable storage options. A variety of vendors associated with both safe storage and disposal products are listed in the “Available Tools and Resources” section below. Failure to securely store prescription drugs contributes to the opioid epidemic and other health hazards in several ways:
**Access to prescription drugs can lead to initial experimentation, especially by teens.
**Easy access to unsecured opioids or other prescription drugs contributes to theft by people who sell them or give them away. This can occur with family, relatives, friends or from homes which they enter for other reasons such as work, open houses, or breaking and entering. Stealing prescription drugs, which is much easier when they are commonly available in unlocked medicine cabinets, is often a step toward more destructive misuse.
**Children who access unsecured drugs sometimes take them, thinking they are candy.

It should be noted that the rise of synthetic Fentanyl on the street has led to conflicting viewpoints on disposal programs within the harm reduction community. It is safer for people to use prescribed opioids from a pharmacy, even if they have been prescribed for someone else. While not advocating stealing someone prescriptions, it is common knowledge that it is safer. This is a fine line, since prescription drugs are regulated and the illicit supply is not, and a person who regularly uses drugs is safer using drugs from a regulated supply over an unregulated supply. For someone who is in active use, destroying their safe supply - even though well intentioned - may put them at a higher risk of overdose if the result is that they turn to an unregulated (illicit) source instead. See SAFE Solutions article titled "Expand Drug Testing Options," for more information on Fentanyl, especially within the context of Fentanyl testing strips (FTS). <ref>https://www.yoursafesolutions.us/wiki/Expand_Drug_Testing_Options</ref>

= Relevant Research =

'''This report''' highlights survey results that reveal the disconnect between parent knowledge and behavior regarding safe storage of medicine.<ref>https://www.safekids.org/node/25758</ref>

'''The Product Stewardship Institute''' documents successful cases of Extended Producer Responsibility (EPR). <ref>https://productstewardship.us/4-reasons-why-epr-is-the-best-solution-for-safe-drug-disposal/</ref> EPR, also known as product stewardship, describes a system where the life cycle costs of a product become part of the cost of manufacturing. EPR is a proven method to sustainably fund the recycling or disposal of a variety of products that have disposal concerns, such as paint and fluorescent lights. The following two cases show promise for a change in responsibility for pharmaceutical disposal:
* In France, the pharmaceutical EPR collects on average over 16,000 tons per year, at a cost of just $0.0022 per box. "In a recent survey, 77% of French residents claimed to have disposed of unwanted medication via these take-back sites, while 70% said they always dispose of pharmaceuticals in this way."
* In British Columbia the pharmaceutical industry has been funding the entire cost of their drug take-back program since 2004.

'''Staggering Statistics'''

* Only 2 in 10 who have dangerous medications—such as opioid pain pills, stimulants used to treat ADHD, and sedatives—lock them up. <ref> https://www.jhsph.edu/news/news-releases/2017/majority-of-opioid-medications-not-safely-stored-in-home-with-children-survey-finds.html</ref>

* A recent study of adults living in households with children found that prescription opioids were stored in a locked or latched place in only 32.6% of households with young children and 11.7% with older children. <ref> https://pediatrics.aappublications.org/content/139/3/e20162161</ref>

* More than 1,600 teens begin abusing prescription drugs each day. <ref>https://www.ridgefieldrecovery.com/drugs/prescription-drugs/related/commonly-abused-prescription-drugs/</ref>

* 1 in every 4 teens in America say they have misused or abused a prescription drug at least once. <ref> https://drugfree.org/newsroom/news-item/national-study-teen-misuse-and-abuse-of-prescription-drugs-up-33-percent-since-2008-stimulants-contributing-to-sustained-rx-epidemic/</ref>

* 60,000 kids under the age of 5 accidentally ingest these dangerous drugs every year and wind up in emergency rooms. <ref>http://www.consumerreports.org/drugs/best-ways-to-protect-kids-accidental-drug-poisoning-/</ref>

* 12-17 year olds abuse prescription drugs more than ecstasy, heroin, crack/cocaine and methamphetamines combined.

* In one study, only 8.6% of the respondents reported locking up their opioid medication and only 20.9% reported using a latched location. <ref>Kennedy-Hendricks A, et al. “Medication sharing, storage and disposal practices for opioid medications among US adults.” JAMA Intern Med 2016; 176:1027-29.</ref>

* The National Drug Intelligence Center notes that older people are especially vulnerable to theft of prescription drugs. They also indicate that over half of teens, ages 12 and up, obtained prescription drugs from a friend or family member "for free." <ref>https://www.nnw.org/publication/medication-theft-protecting-our-most-vulnerable-neighbors</ref>

= Impactful Federal, State, and Local Policies =

* '''Federal.''' According to the Government Accountability Office, only 2.5 percent of eligible organizations are participating in take-backs. <ref>https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/</ref> The primary barrier is financial, because it costs money to maintain secure prescription drop-off container, to train staff to follow the relevant regulations, and to destroy the returned medication. A potential policy solution is to mandate opioid manufacturers to subsidize drop-off location operations and to pay patients for their returned bottles of pills.

* '''State Legislation Requiring Disposal Kits be Given with Prescriptions.''' In 2018 Kentucky passed a bill that amended KRS 218A.170 -- requiring "a practitioner or a pharmacist to sell or distribute a nontoxic composition, which permanently captures the controlled substance, for the sequestration or deactivation and disposal of unused, unwanted, or expired controlled substances anytime a controlled substance is sold or distributed." Kentucky was the first state to pass such a bill. <ref>https://legiscan.com/KY/bill/SB6/2018</ref>

* '''Local Drug Take-Back Programs.''' San Francisco and several West Coast counties have issued legislation which require drug companies to fund drug take-back programs. <ref>[https://www.washingtonpost.com/news/wonk/wp/2017/12/05/one-idea-for-preventing-leftover-opioids-from-fueling-opioid-abuse/</ref> At least a dozen other local governments around the country are considering similar legislation. <ref>http://www.productstewardship.us/</ref>

= Available Tools and Resources =

'''SAFE Project:'''
*'''"At-Home Drug Disposal"''' is a SAFE Project written article that discusses the importance of proper disposal for opioid/prescription medications at home and how to do so safely.<ref>https://www.safeproject.us/disposal/</ref>
*See the wiki titled "Activate Your Community" for more detailed information on overcoming barriers to addressing drug misuse and building strategic partnerships for effective local initiatives.<ref>https://www.yoursafesolutions.us/wiki/Activate_Your_Community</ref>
*See the wiki titled "Reduce Criminal Diversion of Prescription Drugs" for more detailed information on the illegal distribution and misuse of prescription drugs, encompassing activities like selling medications, doctor shopping, and theft or forgery of prescriptions.<ref>https://www.yoursafesolutions.us/wiki/Reduce_Criminal_Diversion_of_Prescription_Drugs</ref>

'''DEA National Prescription Drug Take-Back Day Initiative'''

This Initiative addresses a crucial public safety and public health issue by providing an opportunity for Americans to prevent drug addiction and overdose deaths. Since September 2010, the DEA has been promoting two national take-back days each year in April and October. An ongoing inventory of success cases is documented at the DEA website. <ref>https://www.dea.gov/takebackday</ref> Nationally, hundreds of tons are collected on each take-back day, and thousands of tons of prescription drugs have been collected. To support local Rx Take-Back Days, the DEA provides a toolkit featuring promotional materials for associated partners. <ref>https://www.dea.gov/content/partnership-toolbox</ref> DEA also has variety of on-line resources and ideas on how to implement a local take-back day.

'''State Level Drug Take-Back Programs'''

A sample of exemplary state efforts are referenced below:

*Arkansas <ref>https://www.artakeback.org</ref>
*Georgia <ref>http://stoprxabuseinga.org/</ref>
*Indiana <ref>http://www.in.gov/bitterpill/</ref>
*Oregon <ref> http://www.oregon.gov/oha/ph/HealthyEnvironments/DrinkingWater/SourceWater/Pages/takeback.aspx </ref>
*Pennsylvania <ref>http://www.ddap.pa.gov/Prevention/Pages/Drug_Take_Back.aspx#.V07YY_krLcs</ref>
*Washington <ref>http://www.takebackyourmeds.org/</ref>

'''Medication Disposal Locators'''

The National Association of Drug Diversion Investigators (NADDI) provides an online resource to find locations of drop boxes, to buy boxes, apply for grants, and other information about drop boxes. <ref>http://www.rxdrugdropbox.org/</ref> The DEA disposal locator matches zip code to registered collectors which will pass unused medicine on to the DEA to disposed. <ref>https://apps.deadiversion.usdoj.gov/pubdispsearch/spring/main?execution=e1s1</ref> Additional drug disposal locators are listed below:

*American Medicine Chest Challenge <ref>http://www.americanmedicinechest.com/</ref>
*Dispose My Meds <ref>http://disposemymeds.org/</ref>
*National Association of Boards of Pharmacy <ref>https://nabp.pharmacy/initiatives/awarxe/drug-disposal-locator/</ref>
*Rx Drop Box <ref>http://rxdrugdropbox.org/</ref>

'''The Product Stewardship Institute''' provides detailed guidance for expanding and improving a pharmacy-based collection program.<ref>https://productstewardship.us/wp-content/uploads/2022/11/160920_PSI_Pharmacy_Guide_vS.pdf</ref>

'''In-Home Disposal Products'''

* '''Deterra Drug Disposal System.''' Verde Technologies offers a product which deactivates prescription drugs. Each patented pouch contains a water-soluble inner pod containing activated carbon. Once the pharmaceuticals are placed in the pouch, warm water is then added, which dissolves the inner pod releasing the activated carbon. The warm water also dissolves prescription pills, patches, and liquids, allowing them to be absorbed by the carbon, rendering them inert and non-retrievable. <ref>https://deterrasystem.com/company/</ref>
* '''DisposeRx''' is a powdered blend of solidifying materials that provides a solution for the safe disposal of unwanted or expired prescription drugs. Prescription drugs can be rendered safe for disposal (and impossible to misuse) by adding water and powder from the packet directly into the pill bottle and shaking the bottle. <ref>https://www.disposerx.com/products/drug-disposal-packets/</ref>
* '''Stericycle''' has a program "Prescription Drug Seal & Send Pouches" which provides an option for unused prescription drugs to be mailed to Stericycle in an unmarked mailing pouch. The pills are then incinerated. <ref>https://www.stericycle.com/en-us/solutions/specialty-services/consumer-take-back-solutions</ref>

Here is a small sample of products which can either be distributed or advertised by community coalitions for families to purchase. Some of these are low-cost items, useful as give-ways at community events. Some of the items could have logos of local business sponsors or coalition branding added:
* '''IKeyp''' provides a safe that offers storage for personal items that need to be securely stored yet regularly accessed. It is linked to an app on a smart phone. <ref>https://www.ikeyp.com/</ref>
* '''Pack4U''' equips pharmacies with single-dose packaging. Using blister packs instead of having an entire bottle filled with prescription pills has been shown to help prevent accident poisonings in children. <ref>http://www.livescience.com/58351-kids-opioids-ingestion.html</ref>
*'''Safer Lock''' provides 4-digit combination lock boxes and locking caps. <ref>https://rxguardian.com/</ref>
* '''TimerCaps''' have a built-in LCD stopwatch timer which displays how long it has been since the cap was last replaced. Timer caps come in different sizes, and they can replace an existing medicine bottle cap (or you can get a cap and bottle combination). TimerCaps are easy to use and don't require a change in patient behavior. They are also useful to track the timing since the last dosage -- reducing accidental overdoses and emergency room visits. <ref>https://www.timercap.com/</ref>

= Promising Practices =

Many communities have engaged in education and awareness efforts to increase prescription drug disposal and safe storage. There is potential to reach significantly more people by reaching a more diverse group of cross-sector partners in a campaign. The CDC promotes two different national campaigns: <ref>https://www.cdc.gov/medicationsafety/campaign_initiatives.html</ref>
* '''The PROTECT Initiative''' is an innovative collaboration led by CDC. PROTECT unites public health agencies, private sector companies, professional organizations, consumer/patient advocates, and academic experts to keep children safe from unintended medication overdoses. <ref>https://www.cdc.gov/medicationsafety/protect/protect_initiative.html</ref>
* '''Up and Away Campaign.''' "Put your medicines up and away and out of sight." This campaign is designed to remind families about the importance of safe medicine storage. <ref>https://www.cdc.gov/medicationsafety/protect/campaign.html</ref>

There are numerous examples of successful campaigns:
*'''Colorado.''' The Consortium for Prescription Drug Abuse Prevention has developed a successful program for reaching people age 65+ <ref>https://corxconsortium.org/about/</ref>
*'''Minnesota.''' The Mallinckrodt pharmaceutical company donated 30,000 disposal pouch systems to be distributed. <ref>http://www.startribune.com/30-000-opioid-deactivation-pouches-being-distributed-in-state/394659601/</ref>
*'''New Jersey.''' The Inspira Health Network distributes the Deterra® pouch throughout their network. <ref>http://www.njtvonline.org/news/video/inspira-health-network-battles-opioid-crisis-proper-drug-disposal/ Case Study]</ref>
*'''Pennsylvania''' has a goal of distributing Deterra® Drug Deactivation and Disposal pouches alongside 10% of all opioid prescriptions. In 2017, Attorney General Shapiro unveiled a plan to distribute 300,000 drug disposal pouches in 12 counties. <ref>https://www.pennlive.com/news/2017/07/drug_deactivation_and_disposal.html</ref>
*'''Rhode Island''' has a partnership between the South Kingstown Partnership for Prevention and Rebels Inspiring Positive Lifestyles. Their medication safety campaign held community awareness events and garnered local news publicity for their cause and was able to raise funds to send youth leaders to CADCA training. <ref>https://www.cadca.org/resources/coalitions-action-south-kingstown-partnership-prevention-launches-med-safety-campaign</ref>
*'''Walmart''' provides DisposeRx powder packets with its pharmacy prescriptions. <ref>https://www.aarp.org/health/drugs-supplements/info-2018/walmart-dispose-painkillers-fd.html</ref>

= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Sources</span></span></span></span></span></span> =

----

Prevention

2025-01-24T18:11:42Z

Mlabrie21:

One of [https://www.safeproject.us SAFE Project]'s goals is to support communities in breaking down silos by fostering greater collaboration between the numerous fields of work engaged in addressing the impacts of overdose and substance use. If you have not already, please read more about the importance of integration across the Continuum of Care and prioritizing outcomes in community work before [https://www.yoursafesolutions.us/about-safe-solutions/ delving into this overview].

The field of prevention emphasizes factors that contribute to one's overall health and wellbeing, aiming to promote health development and prevent problems before they occur. It is a multidisciplinary field developing strategies that prevent or reduce occurance, severity, or negative outcomes of disease, substance use, violence, injury, and mental illness. Prevention strategies can be addressed at various levels - individual, family, and community.

The prevention strategies on this platform are streamlined and organized into four primary clusters. Prevention strategies mirror the economics of supply and demand. The last two clusters are explicitly focused on the role of the medical system and law enforcement in disrupting the supply. The second cluster of articles is more oriented to the demand side of the equation — changing individual perceptions on drug use, peer relationships, family norms, and the role of the school system.

=The Field of Prevention Science=
The first cluster is focused on the field of prevention science. It includes the following strategies:
*"[[Address Risk & Protective Factors for Individuals, Families, and Communities]]" provides examples of the two functions of prevention science — reducing risk factors and enhancing protective factors. It also covers the Socio-Ecological Model, Strategic Prevention Framework (SPF), and the National Prevention Strategy.
*"[[Expand Positive Recreation Opportunities]]" contextualizes prevention science within the behavioral health work on health and wellbeing.
*"[[Integrate Substance Use Prevention & Mental Health Services]]" unpacks co-occurring mental health and substance use disorders. The current partitioning of behavioral health care misses the interaction between substance use medication (and self-medication) related to stress management and depression.
*"[[Become a Trauma-Informed Community]]" addresses definitions of trauma and its root causes, such as Adverse Childhood Experiences (ACES). It also links to social determinants of health and it scales to the services that a trauma-informed community needs to offer and how systems, such as the school system, can be more proactive in building community resilience.

=Focus on Youth and Families=
The second set of strategies takes a deeper look at the four domains of the socio-ecological ecosystem of prevention — individual, youth, peers, family, and schools. It is important to note that an intentional balance is needed between efforts in all four of these domains and the broader policy domain in which these are embedded. Early prevention strategies over-emphasized education, placing the onus of burden on the individual ("Just Say No"). Current prevention strategies are shifting emphasis to include more environmental strategies. It includes the following strategies:
*"[[Increase Awareness of SUD Impacts on a Fetus]]" addresses Fetal Alcohol Syndrome (FAS) and Neonatal Abstinence Syndrome (NAS).
*"[[Prevent First Time Use Through Education]]" covers the effectiveness of different types of prevention education and addresses the need to move away from fear-based tactics and toward an increased emphasis on trauma and stress management.
*"[[Expand and Improve Support for Youth Outreach and Leadership]]" addresses the linkage between providing basic information and changing perception of harm by creating positive behavioral choices at the earliest age possible. It also addresses opportunities for youth leadership to offset peer pressure.
*"[[Empower Parents]]" highlights the magnitude of influence which parents have in youth perceptions and behavior. It addresses their role in engagement with the school system and the need for parents to support both prevention and recovery.
*"[[Expand School-Based Prevention Programs]]" points out the power of the school system within prevention strategies. Schools are a primary point of contact to youth and have proven success in public health initiatives associated with safety and disease prevention.

=Focus on Medical & Pharmaceutical Systems=
The third set of strategies address the role of the medical and pharmaceutical community in reducing the supply of drugs and includes articles on patient education, medical training, chronic pain management alternatives, and Prescription Drug Monitoring Programs (PDMPs). These strategies are as follows:
*"[[Increase Access to Contraception]]" addresses the high rate of unintended pregnancies associated with substance use and public health consensus around the need to increase access to contraceptive choices. In particular, this article details the benefits of long-acting reversible contraception (LARC) methods.
*"[[Reduce Over-Prescription of Prescription Drugs]]" documents the two-fold benefit of reducing both the number of excess pills, which could reach illicit circulation, and the number of people who are at risk as a result of receiving prescriptions.
*"[[Educate Patients on the Risks of Prescription and Non-Prescription Drugs]]" lists specific educational topics doctors can promote and risk factors for physicians to keep in mind when prescribing opioids. It also addresses procedures for screening and referral.
*"[[Improve Professional Training on Opioids and Alternative Pain Management Approaches]]" highlights a range of topics, which are gaps in current medical training. These include an awareness of chronic pain management and alternatives, risk factors for opioid dependency, dosage options, and patient communication skills that could lead to lower prescription use.
*"[[Expand and Enhance Chronic Pain Prevention and Management]]" documents the large number of Americans who have chronic pain and the dilemma which the medical community faces in reducing pain without increasing opioid use disorder. It shares methods to concurrently decrease prescription rates and increase alternatives for chronic pain management.
*"[[Expand and Enhance Prescription Drug Monitoring Programs (PDMPs)]]" outlines the benefits and challenges of PDMPs and provides a review of successful initiatives and funding sources.

=Focus on Disrupting the Supply=
The final prevention cluster is focused on strategies to disrupt supply. The sequence of strategies begins with law enforcement, expands to collaboration between law enforcement and medical professionals, and closes with community-wide participation in coalition campaigns. It includes the following:
*"[[Disrupt the Supply of Illegal Drugs]]" identifies the collaboration that needs to occur between law enforcement in local jurisdictions and federal agencies, and within the international arena. It identifies historical reactivity and inconsistencies in supply disruption and points to developments reflective of more effective strategies.
*"[[Reduce Criminal Diversion of Prescription Drugs]]" covers the illegal distribution or use of prescription drugs. This strategy addresses the intersection of guidance from law enforcement and best practices within the medical community in detecting criminal diversion.
*"[[Expand Safe Storage and Prescription Drug Take-Back and Disposal Programs]]" broadens participation in drug diversion strategies and builds upon strategies for law enforcement and medical professionals to include local businesses, citizens, and members of coalitions engaged in education campaigns. This strategy focuses (a) take-backs and drop boxes which involve law enforcement, (b) safe storage, which involves doctors and pharmacists, and (c ) disposal options, which involve coalition outreach to nursing homes, hospices, funeral homes, and the community at-large.

Increase Awareness of Risks of SUD on the Baby

2025-01-24T18:08:32Z

Mlabrie21: Mlabrie21 moved page Increase Awareness of Risks of SUD on the Baby to Increase Awareness of SUD Impacts on a Fetus

#REDIRECT [[Increase Awareness of SUD Impacts on a Fetus]]

Increase Awareness of SUD Impacts on a Fetus

2025-01-24T18:08:32Z

Mlabrie21: Mlabrie21 moved page Increase Awareness of Risks of SUD on the Baby to Increase Awareness of SUD Impacts on a Fetus

=Introductory Paragraph=

Substance use during pregnancy can affect both the user and their babies. This article covers the risks to the baby which are associated with two substance -- alcohol and opioids.

=Key Information=

'''Fetal Alcohol Syndrome'''

Alcohol use during pregnancy can lead to what is known as Fetal Alcohol Syndrome (FAS), characterized by low birth weight, cognitive deficits, increased risk of birth defects, and behavioral problems later in life. Impacts on the fetus are vast and vary by the specific substance. Consuming alcohol, however minor the amount, increases the baby’s risk of FAS, preterm birth, teratogenicity, neuro-developmental disorders, miscarriage, and stillbirth. FAS impacts the baby’s physical growth and appearance, along with its emotional, behavioral, and cognitive health. Exposure to illicit drugs may have the following consequences: <ref>https://www.fountainhillsrecovery.com/blog/pregnancy-and-addiction/</ref>

* low birth weight and growth restriction
* preterm birth
* miscarriage
* stillbirth
* sudden infant death syndrome
* exaggerated startles and diminished crying response
* neonatal withdrawal or abstinence symptoms
* transient central and automatic nervous system symptoms
* congenital heart malformations
* abnormal physical developments

'''Neonatal Abstinence Syndrome (NAS)'''

Pregnant people may use opioids as prescribed, may misuse prescription opioids, may use illicit opioids such as heroin, or may use opioids (opioid agonists and/or antagonists) as part of medication-assisted treatment for opioid use disorder. Regardless of the reason, people who use opioids during pregnancy should be aware of the possible risks during pregnancy and potential treatment options for opioid use disorder.

Opioid use in women aged 15–44 years has increased at a similar rate to the dramatic increase in opioid use in the United States. During 2008–2012, about 1 in 3 reproductive-aged women filled an opioid prescription each year. <ref>https://www.cdc.gov/pregnancy/opioids/basics.html</ref> As such, opioid use during pregnancy is not uncommon. There have been significant increases in opioid use disorder during pregnancy. For example, the number of people with opioid use disorder at labor and delivery more than quadrupled from 1999 to 2014. Opioid exposure during pregnancy has been linked to negative health effects for both mothers and their babies. These include maternal death, stillbirth, and NAS. Birth outcomes for infants exposed to opioids during pregnancy include an increased likelihood to:

*Be born preterm (born before 37 weeks of pregnancy)
*Have poor fetal growth
*Have longer hospital stays after birth
*Be re-hospitalized within 30 days of being born
*Possible birth defects

The effects of prenatal opioid exposure on children over time are largely unknown. However, using opioids as prescribed or for treatment of opioid use disorder during pregnancy may be necessary and may outweigh the risks. Opioid use and medication assisted treatment for opioid use disorder during pregnancy can lead to NAS which is a group of conditions occurring when newborns withdraw from certain substances including opioids which they were exposed to before birth. Withdrawal caused by opioids during the first 28 days of life is sometimes also called neonatal opioid withdrawal syndrome (NOWS). Withdrawal symptoms in newborns usually occur 48–72 hours after birth. Drug withdrawal symptoms may include:

*Tremors (trembling)
*Irritability, including excessive or high-pitched crying
*Sleep problems
*Hyperactive reflexes
*Seizures
*Yawning, stuffy nose, or sneezing
*Poor feeding and sucking
*Vomiting
*Loose stools and dehydration
*Increased sweating

The symptoms a newborn might experience and their severity depend on different factors. These include the type and amount of exposure before birth, the last time a substance was used, whether the baby is born full-term or premature, and if the newborn was exposed to more than one substance before birth.

=Relevant Research=

*'''Opioid Use and Opioid Use Disorder in Pregnancy.''' This report provides an extensive literature review and includes recommendations and conclusions from the American College of Obstetricians and Gynecologists. <ref>https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref>

*'''Longer-Term Developmental Outcomes.''' There is limited information about longer-term outcomes of children exposed to opioids prenatally, including those with or without NAS. Not all babies exposed to opioids during pregnancy experience signs of NAS, but they may still have longer-term outcomes which are not obvious at birth. Results from a recent study suggest that children with NAS were more likely to have a developmental delay or speech or language impairment in early childhood, compared with children without NAS. It is not clear if these impacts are due to opioids specifically, other substance exposures, or other environmental influences. Findings about long-term outcomes of children exposed to opioids during pregnancy are inconsistent. More research is needed to better understand the spectrum of possible outcomes related to opioid exposure during pregnancy.

*'''This article''' titled "Narcotic Addiction, Pregnancy, and the Newborn," provides a 19-year overview of cases at one hospital. Although it is dated (1978), it potentially provides a baseline for comparison to conditions five decades ago. <ref>https://jamanetwork.com/journals/jamapediatrics/article-abstract/507913</ref>

*'''This study''' showed that real-time ultrasound feedback focused on the potential effects of smoking on the fetus may be an effective treatment adjunct to improve smoking outcomes.<ref>https://www.researchgate.net/publication/26317678_Ultrasound_feedback_and_motivational_interviewing_targeting_smoking_cessation_in_the_second_and_third_trimesters_of_pregnancy</ref> This could be adapted and used to treat people with other types of SUDs as well.

=Impactful Federal, State, and Local Policies=

*'''Medicaid.''' Numerous Medicaid authorities, including the state plan, waivers, and other demonstration programs, can be used to provide SUD treatment and recovery support services to pregnant people with SUD as well as specialized services for infants with NAS. <ref>https://www.medicaid.gov/federal-policy-guidance/downloads/cib060818.pdf</ref>

*'''West Virginia''' has a state plan amendment on NAS services that provides for an all-inclusive prospective bundled payment based on the daily treatment of Medicaid beneficiaries. <ref>http://www.wvlegislature.gov/Bill_Status/bills_text.cfm?billdoc=SB288%20INTR.htm&yr=2020&sesstype=RS&i=288</ref>

=Available Tools and Resources=

*'''SAMHSA''' has published comprehensive clinical guidance for optimal care for pregnant and parenting people with opioid use disorder and their infants. <ref>"Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants." at https://store.samhsa.gov/product/Clinical-Guidance-for-Treating-Pregnant-and-Parenting-Women-With-Opioid-Use-Disorder-and-Their-Infants/SMA18-5054</ref>

*'''SAFE Project:'''
**'''"Addiction and Mental Health Resources for Women."''' This SAFE Project guide includes a variety of resources specifically providing support during pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>
**See the wiki titled "Improve Care for Babies Born Drug Dependent" for more information on babies who are born with Neonatal Abstinence Syndrome and how they can better receive compassionate treatment/care.<ref>https://www.yoursafesolutions.us/wiki/Improve_Care_for_Babies_Born_Drug_Dependent/</ref>

*'''The American College of Obstetricians and Gynecologists (ACOG)''' has published a report titled, "Opioid Use and Opioid Use Disorder in Pregnancy." This provides recommendations and clinical guidance. <ref> https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref> They also provide a FAQ sheet on "Opioid Use Disorder and Pregnancy" that identifies the most effective treatment for opioid use disorder during pregnancy to be opioid replacement medication, which includes medication-assisted treatment such as Methadone and Buprenorphine. The FAQ sheet also covers ways that behavioral therapy and counseling can assist with providing support and tools for ongoing recovery.<ref>https://www.acog.org/womens-health/faqs/opioid-use-disorder-and-pregnancy</ref>

*'''The University of Baltimore''' has published "Supporting Mothers and Infants Impacted by Perinatal Opioid Use: A Cross-Sector Assessment." This collaborative assessment resulted from a community-level intervention initiative that was funded by the Center for Drug Policy and Enforcement. The report provides information on process, lessons learned, and resources that may help others engaged in similar projects and collaboratives. <ref>https://www.texaschildrens.org/sites/default/files/uploads/documents/Perinatal%20Opioid%20Report%20Final_%20march%202019.pdf</ref>

=Promising Practices=

'''Baptist Health System.''' The Baptist Medical Center in San Antonio is a nationally recognized Center of Excellence for NAS Care. <ref> https://www.baptisthealthsystem.com</ref>

'''Maternal Opioid Misuse (MOM) Model''' is promoted through the Center for Medicare and Medicaid Innovations. The primary goals are to: <ref>https://innovation.cms.gov/innovation-models/maternal-opioid-misuse-model</ref>
*improve quality of care and reduce costs for pregnant and postpartum people with OUD as well as their infants
*expand access, service-delivery capacity, and infrastructure based on state-specific needs
*create sustainable coverage and payment strategies which support ongoing coordination and integration of care

= Sources =

Prevention

2025-01-24T18:06:47Z

Mlabrie21:

One of [https://www.safeproject.us SAFE Project]'s goals is to support communities in breaking down silos by fostering greater collaboration between the numerous fields of work engaged in addressing the impacts of overdose and substance use. If you have not already, please read more about the importance of integration across the Continuum of Care and prioritizing outcomes in community work before [https://www.yoursafesolutions.us/about-safe-solutions/ delving into this overview].

The field of prevention emphasizes factors that contribute to one's overall health and wellbeing, aiming to promote health development and prevent problems before they occur. It is a multidisciplinary field developing strategies that prevent or reduce occurance, severity, or negative outcomes of disease, substance use, violence, injury, and mental illness. Prevention strategies can be addressed at various levels - individual, family, and community.

The prevention strategies on this platform are streamlined and organized into four primary clusters. Prevention strategies mirror the economics of supply and demand. The last two clusters are explicitly focused on the role of the medical system and law enforcement in disrupting the supply. The second cluster of articles is more oriented to the demand side of the equation — changing individual perceptions on drug use, peer relationships, family norms, and the role of the school system.

=The Field of Prevention Science=
The first cluster is focused on the field of prevention science. It includes the following strategies:
*"[[Address Risk & Protective Factors for Individuals, Families, and Communities]]" provides examples of the two functions of prevention science — reducing risk factors and enhancing protective factors. It also covers the Socio-Ecological Model, Strategic Prevention Framework (SPF), and the National Prevention Strategy.
*"[[Expand Positive Recreation Opportunities]]" contextualizes prevention science within the behavioral health work on health and wellbeing.
*"[[Integrate Substance Use Prevention & Mental Health Services]]" unpacks co-occurring mental health and substance use disorders. The current partitioning of behavioral health care misses the interaction between substance use medication (and self-medication) related to stress management and depression.
*"[[Become a Trauma-Informed Community]]" addresses definitions of trauma and its root causes, such as Adverse Childhood Experiences (ACES). It also links to social determinants of health and it scales to the services that a trauma-informed community needs to offer and how systems, such as the school system, can be more proactive in building community resilience.

=Focus on Youth and Families=
The second set of strategies takes a deeper look at the four domains of the socio-ecological ecosystem of prevention — individual, youth, peers, family, and schools. It is important to note that an intentional balance is needed between efforts in all four of these domains and the broader policy domain in which these are embedded. Early prevention strategies over-emphasized education, placing the onus of burden on the individual ("Just Say No"). Current prevention strategies are shifting emphasis to include more environmental strategies. It includes the following strategies:
*"[[Increase Awareness of Risks of SUD on the Baby]]" addresses Fetal Alcohol Syndrome (FAS) and Neonatal Abstinence Syndrome (NAS).
*"[[Prevent First Time Use Through Education]]" covers the effectiveness of different types of prevention education and addresses the need to move away from fear-based tactics and toward an increased emphasis on trauma and stress management.
*"[[Expand and Improve Support for Youth Outreach and Leadership]]" addresses the linkage between providing basic information and changing perception of harm by creating positive behavioral choices at the earliest age possible. It also addresses opportunities for youth leadership to offset peer pressure.
*"[[Empower Parents]]" highlights the magnitude of influence which parents have in youth perceptions and behavior. It addresses their role in engagement with the school system and the need for parents to support both prevention and recovery.
*"[[Expand School-Based Prevention Programs]]" points out the power of the school system within prevention strategies. Schools are a primary point of contact to youth and have proven success in public health initiatives associated with safety and disease prevention.

=Focus on Medical & Pharmaceutical Systems=
The third set of strategies address the role of the medical and pharmaceutical community in reducing the supply of drugs and includes articles on patient education, medical training, chronic pain management alternatives, and Prescription Drug Monitoring Programs (PDMPs). These strategies are as follows:
*"[[Increase Access to Contraception]]" addresses the high rate of unintended pregnancies associated with substance use and public health consensus around the need to increase access to contraceptive choices. In particular, this article details the benefits of long-acting reversible contraception (LARC) methods.
*"[[Reduce Over-Prescription of Prescription Drugs]]" documents the two-fold benefit of reducing both the number of excess pills, which could reach illicit circulation, and the number of people who are at risk as a result of receiving prescriptions.
*"[[Educate Patients on the Risks of Prescription and Non-Prescription Drugs]]" lists specific educational topics doctors can promote and risk factors for physicians to keep in mind when prescribing opioids. It also addresses procedures for screening and referral.
*"[[Improve Professional Training on Opioids and Alternative Pain Management Approaches]]" highlights a range of topics, which are gaps in current medical training. These include an awareness of chronic pain management and alternatives, risk factors for opioid dependency, dosage options, and patient communication skills that could lead to lower prescription use.
*"[[Expand and Enhance Chronic Pain Prevention and Management]]" documents the large number of Americans who have chronic pain and the dilemma which the medical community faces in reducing pain without increasing opioid use disorder. It shares methods to concurrently decrease prescription rates and increase alternatives for chronic pain management.
*"[[Expand and Enhance Prescription Drug Monitoring Programs (PDMPs)]]" outlines the benefits and challenges of PDMPs and provides a review of successful initiatives and funding sources.

=Focus on Disrupting the Supply=
The final prevention cluster is focused on strategies to disrupt supply. The sequence of strategies begins with law enforcement, expands to collaboration between law enforcement and medical professionals, and closes with community-wide participation in coalition campaigns. It includes the following:
*"[[Disrupt the Supply of Illegal Drugs]]" identifies the collaboration that needs to occur between law enforcement in local jurisdictions and federal agencies, and within the international arena. It identifies historical reactivity and inconsistencies in supply disruption and points to developments reflective of more effective strategies.
*"[[Reduce Criminal Diversion of Prescription Drugs]]" covers the illegal distribution or use of prescription drugs. This strategy addresses the intersection of guidance from law enforcement and best practices within the medical community in detecting criminal diversion.
*"[[Expand Safe Storage and Prescription Drug Take-Back and Disposal Programs]]" broadens participation in drug diversion strategies and builds upon strategies for law enforcement and medical professionals to include local businesses, citizens, and members of coalitions engaged in education campaigns. This strategy focuses (a) take-backs and drop boxes which involve law enforcement, (b) safe storage, which involves doctors and pharmacists, and (c ) disposal options, which involve coalition outreach to nursing homes, hospices, funeral homes, and the community at-large.

Expand and Strengthen Recovery Schools and Collegiate Recovery Programs

2024-09-25T17:59:03Z

Mlabrie21: Mlabrie21 moved page Expand and Strengthen Recovery Schools and Collegiate Recovery Programs to Strengthen Collegiate Recovery Programs

#REDIRECT [[Strengthen Collegiate Recovery Programs]]

Strengthen Collegiate Recovery Programs

2024-09-25T17:59:03Z

Mlabrie21: Mlabrie21 moved page Expand and Strengthen Recovery Schools and Collegiate Recovery Programs to Strengthen Collegiate Recovery Programs

= Introductory Paragraph =

Collegiate Recovery is an emerging and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, and researchers learning more about recovery every day. Although the first collegiate recovery program started in the 1970s, the field as a whole is still young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by substance use can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first Alcohol and Drug Counselor. This led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are four general types, or levels, of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery, either from substance use or behavioral health disorders. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identify as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities commonly offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings which indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal substance use legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance use and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. <ref>https://collegiaterecovery.org/</ref> ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. It also offers "The Best Practices Guide" which is intended to help start planning processes. Since every campus has its own unique culture, this document is not a step-by-step how-to guide, but rather something every school can adapt in its own way to meet the needs of their students. <ref>https://collegiaterecovery.org/wp-content/uploads/2021/08/Collegiate-Recovery-Best-Practice-Guide.pdf</ref>

*'''American College Health Association (ACHA)''' publishes the National College Health Assessment annually. It indicates that 2.2% of all college students identify as being in recovery. <ref>https://www.acha.org/documents/ncha/NCHA-III_FALL_2022_REFERENCE_GROUP_DATA_REPORT.pdf</ref>

*'''SAFE Project.''' SAFE Campuses is one of the six lines of operation at SAFE Project. It aspires to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs, advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery and collects meaningful metrics which contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page. <ref>https://www.safeproject.us/census/</ref> The following are examples of available resources:
**"Recovery Allyship Training." This slide deck provides a strong focus on stigma reduction and understanding recovery inclusion. This training can be implemented on any campus, and our team is willing to collaborate on “Training of Trainers” and co-branding these resources. <ref>https://www.canva.com/design/DAFQ0qNAhto/QpTNSLfudJs5rXOf-A-kOg/view?utm_content=DAFQ0qNAhto&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>
**"Supporting Harm Reduction: This webinar is part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series. Community harm reduction experts, MJ Jorgensen and Brandi Drtina, share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools. <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>
**"Support Not Stigma." This slideshow was presented by the SAFE Campuses team at the 2023 NASPA Annual Meeting. The session covered the history of recovery ally trainings around the country, provided a content preview, shared the impact of these sessions, and gave implementation resources and strategies. <ref>https://www.canva.com/design/DAFdMYgYX1I/cWIHQhyaXJqdFbyk8oSBVQ/view</ref>
**"Where Are the Students?" A slideshow summarizing the tensions, barriers, and approaches related to student engagement with collegiate recovery initiatives. <ref>https://www.canva.com/design/DAFCUn0slNE/SEiSodRZ-kJJRXiqWk7zhw/view</ref>
** "Making the Case: Fostering Buy-in for Recovery Support." This slideshow summarizes approaches to collegiate recovery advocacy among professionals and potential partners. <ref>https://www.canva.com/design/DAFCUnEqJUA/2coDbLD5LNwF-SngErzuew/view?utm_content=DAFCUnEqJUA&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>
**Tools Over Fear: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis." In this slideshow, delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>
**"Substance Use Disorder, Collegiate Recovery, & Student Accommodations." This slideshow, presented as part of the 2021 ARHE Fall Webinar Series, overviewed the relationship between disability law, substance use disorder, recovery, and student accommodations. <ref>https://www.canva.com/design/DAEsFbVT9sk/-l7kCdukKVWPrXr2fXq4PA/view?utm_content=DAEsFbVT9sk&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink#1</ref>

*'''Inside Higher Ed (IHE)''' published "Students Are Learning to Stop Opioid Overdoses." This article shares a number of perspectives from colleges and universities making the overdose-reversal drug Naloxone widely available to counter the the rise of Fentanyl and other opiates. <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs." <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''Florida State University''' The All-Recovery Meeting holds a ”Self-Healers Book Club” based on a curriculum from the book "How To Do The Work" by Dr. Nicole LePera, a clinical psychologist. The text offers readers the support and tools that will allow them to break free from destructive behaviors to reclaim and recreate their lives. Nothing short of a paradigm shift, this is a celebration of empowerment that will change the way we approach mental wellness and self-care. <ref>https://drive.google.com/file/d/1uGHfCUm0Lgn6MW-N4H83AGZr6Mf3_I88/view</ref> The FSU Center for Health Advocacy & Wellness created Recovery Bingo, an activity used to build community in the CRC/P and as an outreach activity with student orgs across campus. <ref>Cryderman, Jacob. J, Thompson, Zabe., Shore, C.D., Gundrum, G., Gomez, M., (2023, March 8th – 10th). Alcohol and Other Drugs Bingo: Gamifying Health Education [Presentation – Breakout Session]. 2023 Southern College Health Association Annual Meeting in Greenville, North Carolina, United States of America. retrieved at https://drive.google.com/file/d/1srLJKBqlshPADuOHBu2Rw1WLDmFKlmEx/view</ref>

*'''Mississippi State University'''provides the "Collegiate Recovery Community Replication Model." Since collegiate recovery programs are incredibly diverse, this provides context for how large southern campuses have established their programs. The model offers comprehensive support services for recovering students by embracing a wellness approach. Choosing to focus on recovery enhancement as the best way to prevent recurrence of use equips the CRC to enhance a student's recovery.<ref>https://drive.google.com/file/d/1ifTnN6Ffd0ZkXaCpvMwP3I4TPpN44mT2/view</ref>

*'''Texas Tech''' is one of the pioneers in the collegiate recovery field and is a model for what many CRCs and CRPs can look like. Texas Tech created the "Collegiate Recovery Communities Curriculum" for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''UC Berkeley.''' University Health Services (UHS) at the Health Promotion Department offers the Party Safe Toolkit." PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. It strives to engage, educate and motivate stakeholders to:
**Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices
**Recognize and respect that many chose not to use alcohol and other drugs
**Ask all users and social/retail providers to do so in mindful and low-risk ways
**Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''UC Davis Health''' published "Can fentanyl be absorbed through your skin?“ in which a toxicology expert dispels myths around fentanyl exposure. <ref>https://health.ucdavis.edu/news/headlines/can-fentanyl-be-absorbed-through-your-skin/2022/10</ref>

= Promising Practices =

*'''North Carolina.''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

* '''West Virginia.''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Recovery

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Mlabrie21:

The Substance Abuse and Mental Health Services Administration (SAMHSA) states, "Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential." This definition is widely applicable since it does not mention the cessation of substance use. For many individuals in recovery, the term is not built solely on the alcohol, tobacco, and other drugs' (ATOD) termination of use. This is where harm reduction strategies or medicated assisted recovery can intersect. Recovery is a complete change in thought, behaviors, identity, and for some, a change in social circles. It is crucial for non-recovery individuals to understand that this shift can be transformative. Individuals who have experienced this transformation will tend to incorporate their recovery pathway into their identity. Moreover, that recovery path consistently changes — it is an evolutionary journey.

One of [https://www.safeproject.us/ SAFE Project]'s goals is to support communities in breaking down silos by fostering greater collaboration between the numerous fields of work engaged in addressing the impacts of overdose and substance use. If you have not already, please read more about the importance of integration across the Institute of Medicine's (IOM) Continuum of Care and prioritizing outcomes in community work before [https://www.yoursafesolutions.us/about-safe-solutions/ delving into this overview], as well as the overview articles in each of the other five menus on this platform. Likewise, users who have a particular interest in the criminal justice system are encouraged to read the article on recovery within the SAFE Solutions Treatment menu titled, "Improve Recovery Support for People in the Criminal Justice System."

The first of two recovery menus is "Recovery Science." It is organized to provide detailed consideration along each of four domains within the socio-ecological model — individuals, families, peers, and community.

* The first article, "[[The Recovery Ecosystem]]," defines recovery within the context of its social dimensions and provides an introduction to recovery capital as a protective factor.
* "[[Increase Support for Individuals in Recovery]]" unpacks complementary tools useful for recovery at the personal scale to include motivational interviewing, progress tracking, and quality of life tools.
* "[[Expand Community Support for Impacted Families]]" provides a variety of resources for family recovery and support.
* "[[Strengthen Peer Recovery Support Services and Programs]]" defines the role of peer support specialists and addresses the institutional contexts in which peer support can be delivered.
* "[[Create Recovery-Ready Communities]]" outlines the responsibility of communities in recovery and details steps which communities can take to be recovery-ready. It also describes recovery oriented systems of care (ROSC).

Articles in the second group of the menu, "Community Systems of Recovery," address four different systems in which people in recovery might engage throughout their life. These range from high schools and college campuses to the workplace, and the housing system.

* "[[Expand Recovery High Schools]]" highlights the needs of young adults in recovery, a population that is often overlooked and under-served.
* "[[Strengthen Collegiate Recovery Programs]]" provides examples from a suite of successful collegiate recovery initiatives.
* "[[Improve Education, Job Training, and Employment for People in Recovery]]" outlines the importance of employment as a protective factor in recovery and identifies a series of successful cases.
* "[[Improve Recovery Housing]]" showcases the different certification levels in recovery housing and also offers best practices.

Improve Tracking of Recovery Progress

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#REDIRECT [[Increase Support for Individuals in Recovery]]

Increase Support for Individuals in Recovery

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Mlabrie21: Mlabrie21 moved page Improve Tracking of Recovery Progress to Increase Support for Individuals in Recovery

=Introductory paragraph=

This article focuses on the role of the individual in the socio-ecological model's continuum of individual-family-peer-community. It addresses clinical or therapeutical topics, such as progress tracking and motivational interviewing. Likewise, it introduces concerns around quality of life, as experienced at a personal scale.

=Key Information=

Recovery Science is a relatively new field. The application of its principles at the ''individual scale'' can be seen as mirroring the history of prevention science. In its early development, the prevention community placed the burden of responsibility of SUD on the individual, with a simplistic “Just say no” approach. As it matured as a field, prevention science began to balance individual roles with more environmental strategies, such as access, social norms, and media advertising. Recovery science has its flagship success at the interpersonal scale, as reflected in peer support, and it is beginning to become more effective in addressing environmental concerns, such as stigma reduction and social determinants of health, as well as in providing more effective support at the individual scale.

Both disciplines have a challenge in balancing the role of ''quantitive'' measures with the ''qualitative'' components of their fields — people. This struggle can be seen in prevention science which has a two-pronged approach to both reduce risk factors and increase protective factors, but which leans to the more readily measured component of risk factor reduction. In recovery science, the single most widely used metrics are the binary score based upon abstinence and the duration of an abstinence-based sobriety. However, the advent of harm reduction and the growing acceptance of multiple pathways makes quantification of outcomes more problematic. Even more challenging is the qualitative side of the equation in recovery science which can be seen as a parallel to protective factors in prevention science. How does one measure self-esteem or resilience?

The complexity of working on both the quantifiable aspects of risk factor reduction and the intangible, but essential qualities of recovery can be seen in the need to concurrently deploy all three of the complementary approaches detailed below.
* Progress tracking aligns to the quantitive risk factor domain.
* Quality-of-life tools address the more subjective elements in the implementation of recovery science.
* Motivational interviewing can be seen as a blending of the two approaches.

'''Progress Tracking'''

Tracking progress in behavioral health recovery is essential because it allows us to gauge how far we’ve come, what we’ve become stronger in, what we’ve learned so far, what we can and should zero in on next, and how we can help others with the tools that we’ve learned. Progress tracking is a tool that has been used by mental health practitioners that, “measures, monitors, and provides feedback,” to allow for real-time treatment responses and adjustments to be made. <ref>https://cpa.ca/docs/File/Task_Forces/Treatment%20Progress%20and%20Outcome%20Monitoring%20Task%20Force%20Report_Final.pdf</ref> The success of progress monitoring in mental health, especially when a specific illness is targeted, is well-documented and shown to be a beneficial tool that allows efficient, treatment-paced monitoring and evaluation of the treatment efficacy. <ref>https://vista-research-group.com/why-progress-monitoring-improves-addiction-treatment-outcomes</ref> While there isn’t a significant amount of literature on its use in substance-use treatment, the few studies done on its use with SUDs have shown similar rates of positive patient outcomes. <ref>https://vista-research-group.com/why-progress-monitoring-improves-addiction-treatment-outcomes</ref> It allows both the therapists and the client to monitor and adjust treatment in the interim, rather than waiting to view results at the end, ensuring that treatment is patient-focused and individualized. With documented results in mental health treatment and promising outcomes for substance use. Improving and implementing recovery tracking should be a key component of treatment in a population with relapse risk as high as 85% within the first year. <ref>https://drugabuse.com/addiction/relapse/</ref>

Much of SUD progress tracking has revolved solely around treatment attendance and urine testing. Since metrics are compared to group data, this often fails to address individual progress outcomes beyond the scope of continued drug use. Goodman, McKay, and DePhilippis (2013) report in their study that, while progress monitoring should be standard practice, only about 37% of therapists use any form of tracking. Further, they report that there is evidence of frequent inaccuracies in tracking and unrecognized deterioration of treatment. <ref>https://psycnet.apa.org/record/2013-28458-002</ref> The importance of effective progress tracking for patients with SUDs lies in the ability to recognize ineffective aspects of the treatment and to adjust accordingly during active treatment. This ensures that the patient is receiving care that is matched to their situation. The use of scales in progress tracking allows the practitioner to maintain focus on both the individual and the symptoms. This aligns with the NASW ethical principles of commitment to the client, their autonomy, and treatment competency. <ref>https://psycnet.apa.org/record/2013-28458-002</ref> <ref>https://www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English </ref> Substance Use Disorder is a recognized mental health disorder and has a high rate of comorbidity with other mental illnesses, especially with anxiety, PTSD, depression, panic disorder, and bipolar disorder <ref>https://nida.nih.gov/sites/default/files/1155-common-comorbidities-with-substance-use-disorders.pdf</ref> For successful progress monitoring to occur, clinicians must recognize and address comorbidity.

'''Quality of Life.'''

The term “quality of life” within recovery science parallels protective factors within prevention science. Any tools which enhance quality of life (QoL), either at the individual or inter-personal level (family and peers), actively build recovery capital. Aspects within the umbrella of QoL include physical and material well-being, such as health and employment and housing. Likewise mental well-being includes educational opportunities. However, most of the emphasis in QoL is in the emotional and relational realms. For example, fostering self-determination includes autonomy, personal control, choice, goals, and values. Enhancing interpersonal relations and social inclusion involves increasing interaction and community participation, finding new relationships and support, and creating new roles within community. <ref>Morisse, F., Vandemaele, E., Claes, C., Claes, L., & Vandevelde, S. (2013). Quality of life in persons with intellectual disabilities and mental health problems: An explorative study. Scientific World Journal, 2013 - 1</ref>

'''Motivational Interviewing (MI).'''

MI is a method for implementing behavioral change that has been used for over 40 years. As a person-centered approach, it has proven success in meeting individuals "where they are at" and helping them to advance to their chosen goals. For more information on MI, its network of trainers, and various tools, such as the MI app, see the SAFE Solutions article on MI <ref>https://www.yoursafesolutions.us/wiki/Expand_Motivational_Interviewing_for_Pregnant_People</ref>

=Relevant Research=

*'''The Canadian Psychological Association''' published a report titled “Outcomes and Progress Monitoring in Psychotherapy.” <ref>https://cpa.ca/docs/File/Task_Forces/Treatment%20Progress%20and%20Outcome%20Monitoring%20Task%20Force%20Report_Final.pdf </ref> This report provides a framework for progress modeling that includes relevant research on its success and background, an evaluation of gaps between research and implementation, and recommendations for clinical implementation, maintenance, and training.

*'''Vista Research Group''' provides a website with links to a variety of current research findings. Gaps: They conclude that there is very little clinical research, especially randomized control trials in regard to progress monitoring for use with SUD, despite promising results and documented success with use in other mental illness treatments. Clinicians struggle to find inexpensive, user-friendly, real-time feedback tools, making progress monitoring a challenge. <ref>https://vista-research-group.com/why-progress-monitoring-improves-addiction-treatment-outcomes</ref>

*'''A meta-analysis.''' This article provides a review of findings associated with progress tracking in SUD. It compares several studies addressing traditional urine/attendance tracking against adaptive intervention including therapy treatments along with urine/attendance requirements. It is a comprehensive review showing the significance of including treatment and progress monitoring outside traditional parameters in relation to positive patient outcomes. <ref>https://psycnet.apa.org/record/2013-28458-002</ref>

*'''A Preliminary Study of the Effects of Individual Patient-Level Feedback in Outpatient Substance Abuse Treatment Programs.''' This is a unique study done on the effectiveness of patient-level feedback on treatment outcomes for SUD. It showed that patients who were “off track” in their progress and given the adapted Outcome Questionnaire (OQ-45) fared better than those who did not participate in the OQ-45. There was a marked decrease in drug use and promising improvement in mental health outcomes. A review of the OQ-45 allowed practitioners information to tailor treatment to the individual and provide any additional, unique support. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270209/</ref>

=Impactful Federal, State, and Local Policies=

'''SAMHSA''' has a comprehensive list of acts regarding mandated federal treatment guidelines that address evidence-based treatment and monitoring, disparities, and protected individuals. <ref>https://www.samhsa.gov/about-us/who-we-are/laws-regulations</ref>

'''Laws addressing progress tracking''' typically pertain to individuals who have a criminal history related to substance use. The U.S. Department of Justice notes that while drug testing can be mandated as a condition of bail, probation, and parole, its implementation and duration vary by jurisdiction. <ref>https://www.ojp.gov/sites/g/files/xyckuh241/files/archives/ncjrs/dtest.pdf </ref> While treatment may also be a condition of probation and parole, its requirements also vary by jurisdiction.

'''Promotion/Implementation of Progress Tracking.''' Current research and recommendations can be used by clinicians to lobby for available progress monitoring tools, conduction of further studies, and encouragement for the use of innovative tools that are cost-effective and user-friendly. Practices, whether private or public, should advocate for the use of (and ongoing training in) progress monitoring tools as an active component of treatment programs.

=Available Tools & Resources=

'''Partners for Change Outcomes Monitoring System (PCOMS)''' combines the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) in a collaborative effort on the part of the therapist and patient. <ref>https://onlinelibrary.wiley.com/doi/10.1002/jclp.20111</ref> The therapist and patient work together to create goals that are reviewed by the SRS and encourage a positive partnership. SAMHSA recognizes PCOMS as a significant tool for progress monitoring, and the Canadian Psychological Association notes that such union of the ORS and SRS has shown significant promise in tracking and treating SUD. It facilitates discussions of progress and relationship issues in the treatment, as well as the ability to alert the therapist to issues by “identifying off-track progress and alliance measures.” <ref>https://cpa.ca/docs/File/Task_Forces/Treatment%20Progress%20and%20Outcome%20Monitoring%20Task%20Force%20Report_Final.pdf</ref>

'''Modern handheld technologies''' support an autonomous form of tracking one’s progress in recovery. There are dozens of apps dedicated to assisting people in their recovery journey. They range in modality, from providing resources, motivation, peer connection, use and recovery tracking, and much more. ''Dual Diagnosis'' provides a list of top-rated apps that clinicians can review and suggest to their clients. <ref>https://dualdiagnosis.org/apps-for-addiction-recovery-and-mental-health/</ref> ''GoodRx'' has a comparable list. <ref>https://www.goodrx.com/conditions/substance-use-disorder/mobile-apps-for-managing-substance-use</ref> A small sample of these types of apps is provided below:

*'''Sobriety Clocks.''' These apps track the number of days in sobriety. They provide the ability to share clock data with people in a recovery support network. They also provide the capacity for an individual to message an accountability partner if they are feeling triggered to use.

*'''REC-CAP''' is shorthand for recovery capital which is conceptually linked to natural recovery, solution-focused recovery therapy, strengths-based case management, recovery management, resilience and protective factors, and the ideas of hardiness, wellness, and global health. The REC-CAP tool is appropriate for implementation in both clinical and peer settings, bridging the gap between a client’s exiting addiction treatment and assuming responsibility for self-directed recovery. The tool:
**Assesses an individual’s recovery strengths, barriers and unmet service needs
**Supports trained navigators to guide individuals in the execution of concrete recovery goals
**Delivers longitudinal measurement of recovery capital gains over quarterly intervals

*'''Cost Benefit Analysis (CBA).''' This app is distributed by SMART Recovery. <ref>http://www.smartrecovery.org/</ref> The CBA strategy helps many people recover from addiction and addictive behaviors, ranging from substance use to sexual addiction. The app makes performing a CBA convenient and easy. SMART Recovery recommends uncensored journaling about daily activities, thoughts, and ideas. This serves to identify recurring thought/behavioral patterns when reviewing entries dating back weeks, months, even years. This also fosters communication with people in an individual's recovery network, who may more rapidly recognize changes. The CBA tool serves to bring awareness to the consequences of potential actions by assessing four questions:
**What are the advantages of using/doing?
**What are the disadvantages of using/doing?
**What are the advantages of NOT using/doing?
**What are the disadvantages of NOT using/doing?

=Promising Practices=

*'''Progress Assessment.''' The PA is a tool created and tested by clinicians. It includes 5 items that assess the risk of relapse and 5 items that assess protective factors. <ref>https://www.sciencedirect.com/science/article/abs/pii/S0165178120305060?via%3Dihub</ref> Study results showed that cocaine use participants with high risk and low protective scores at baseline and the 3-month mark were at greater risk of relapse. The PA tool is short and easy to administer and allows for flexible and adaptive intervention to take place, addressing the ongoing and changing needs of the client. <ref>https://www.sciencedirect.com/science/article/abs/pii/S0165178120305060?via%3Dihub</ref>

*'''Treatment Progress Assessment-8 (TPA-8).''' This newly-developed instrument aims to monitor SUD symptoms and treatment progress. <ref>https://pubmed.ncbi.nlm.nih.gov/31870228/ </ref> Items that measure symptoms use DSM-V criteria, while items addressing treatment progress focus on self-efficacy, therapeutic alliance, emotion regulation, and hopefulness. TPA-8 fosters a collaborative partnership between the clinician and patient to create a treatment plan based on goals, autonomy, and hope, allowing for assessment and adjustment monthly. It shows promising results in retention and preventing relapse. <ref>https://pubmed.ncbi.nlm.nih.gov/31870228/</ref>

= <span style="background-color: #ffffff"><span style="background-color: #ffffff"><span style="background-color: #ffffff">Sources</span></span></span> =

 
</div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div></div>
[[Category:SAFE-Treatment and Recovery]]

Improve Community Recovery Supports

2024-09-25T17:55:06Z

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#REDIRECT [[The Recovery Ecosystem]]

The Recovery Ecosystem

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Mlabrie21: Mlabrie21 moved page Improve Community Recovery Supports to The Recovery Ecosystem

=Introductory Paragraph =

This article is the first in a series of articles designed to address the science of recovery. It covers the definitions and dimension of recovery, as outlined by SAMHSA. It also introduces the concept of recovery capital. The various scales at which recovery capital can be built matches the socio-ecological model detailed in the prevention science article titled "Address Risk & Protective Factors for Individuals, Families, and Communities." <ref>https://www.yoursafesolutions.us/wiki/Address_Risk_%26_Protective_Factors_for_Individuals,_Families,_and_Communities</ref> The recovery ecosystem is complex and requires intention to be applied at each scale (individual, family, social, and community). Aligning prevention science and recovery science in comparable multi-scale approaches will be a significant element in bridging prevention and recovery efforts and in advancing work that is coordinated across the full continuum of care.

= Key Information =

'''Definition and Dimensions of Recovery'''

SAMHSA defines recovery as "a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential." <ref>https://www.samhsa.gov/find-help/recovery</ref> The four major dimensions that SAMHSA has identified which support recovery include:

*Health — overcoming or managing one’s disease(s) or symptoms and making informed, healthy choices that support physical and emotional well-being.
*Home — having a stable and safe place to live.
*Purpose — conducting meaningful daily activities and having the independence, income, and resources to participate in society.
*Community — having relationships and social networks that provide support, friendship, love, and hope.

It is noteworthy that these four dimension span the socio-ecological model -- individual, family, social, and community.

'''Recovery Capital'''

Recovery Capital is a crucial component for sustained recovery. It has been defined as the quantity and quality of internal and external resources that one can bring to bear on the initiation and maintenance of recovery. <ref>Granfield, R., & Cloud, W. (1999). Coming clean: Overcoming Addiction without treatment. New York: New York University Press.</ref>
For too long, most of the aspects of recovery capital were either random or only reserved for individuals who had these resources readily available. Recovery capital is not dependent on socioeconomic status, and socioeconomic status is not
an accurate indicator of either high or low recovery capital. Since change in one's home or work environment may not be possible for everyone, many individuals return to family or community environments that are unsafe or recovery-hostile. Returning to a problematic home life or to a community which has a culture of alcohol and other drug use, can place stress on recovery capital. Faces & Voices of Recovery provides a breakdown of the scales of recovery capital and their role in sustaining recovery: <ref>https://facesandvoicesofrecovery.org/blog/2019/10/08/recovery-capital-its-role-in-sustaining-recovery/</ref>

*'''Personal.''' This includes an individual’s physical and human capital. Physical capital is the available resources to fulfill a person’s basic needs, like their health, healthcare, financial resources, clothing, food, transportation, and safe and habitable shelter. Human capital relates to a person’s abilities, skills, and knowledge, like problem-solving, education and credentials, self-esteem, the ability to navigate challenging situations and achieve goals, interpersonal skills, and a sense of meaning and purpose in life. See the SAFE Solutions article titled "Increase Support for Individuals in Recovery” for more information on building personal recovery capital. <ref>https://www.yoursafesolutions.us/wiki/Improve_Tracking_of_Recovery_Progress</ref>

*'''Family/social. '''These resources relate to intimate relationships with friends and family, relationships with people in recovery, and supportive partners. It also includes the availability of recovery-related social events. SAFE Solutions has two articles related to family/social recovery capital. The first, titled "Expand Community Support for Impacted Families" <ref>https://www.yoursafesolutions.us/wiki/Expand_Community_Support_for_Impacted_Families</ref> focuses on the family, and the second article titled "Strengthen Peer Recovery Support Services and Programs" addresses the role of peers in the broader social dimensions. <ref>https://www.yoursafesolutions.us/wiki/Strengthen_Peer_Recovery_Support_Services_and_Programs</ref>

*'''Community.''' This includes attitudes, policies, and resources specifically related to helping individuals resolve substance use disorders. Community resources can include recovery support institutions, such as recovery high schools, college recovery programs, recovery housing, and recovery ministries. Likewise, agencies and employers can bring resources to sustain recovery and early intervention programs, such as drug courts and employee assistance programs. See the SAFE Solutions article titled "Create Recovery-Ready Communities," for more detailed information on building recovery capital at the community scale. <ref>https://www.yoursafesolutions.us/wiki/Create_Recovery-Ready_Communities#Key_Information</ref>

=Relevant Research=

'''Nora's Blog''' on the Director's page of NIDA highlights recent advances in the science of drug use and addiction. For example, in evaluating the relationship between abstinence and relapse, it is noted that setbacks are regarded as a failure, leading to the perception that the client is starting all over, when in fact, a return to use may strengthen someone’s resolve to recover. <ref>https://nida.nih.gov/about-nida/noras-blog/2022/01/making-addiction-treatment-more-realistic-pragmatic-perfect-should-not-be-enemy-good</ref>

= Impactful Federal, State, and Local Policies =

'''Partners for Recovery''' published a report that provides information regarding the funding sources that support recovery support services throughout the continuum of care. The report includes an overview of federal, state, and private funding and highlights practices for obtaining funding. <ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/Financing-Recovery-Support-Services.pdf</ref>

'''Oregon''' passed a Drug and Addiction Treatment Act whose purpose is to make screening health assessment, treatment and recovery services for drug addiction available to all those who need and want access to those services; and to adopt a health approach to drug addiction by removing criminal penalties for low-level drug possession.<ref>https://www.oregon.gov/oha/hsd/amh/pages/measure110.aspx</ref>

=Available Tools and Resources=

* '''SAMHSA''' published "Recovery from Substance Use and Mental Health Problems Among Adults in the United States." This brief report presents self-reports of recovery among adults aged 18 and older in the United States who thought they had a problem with their use of drugs or alcohol and/or mental health. These findings provide a clearer characterization of the factors associated with recovery among adults and how future efforts can foster a whole-health approach to sustain recovery from mental health and substance use conditions. <ref>https://store.samhsa.gov/product/recovery-substance-use-and-mental-health-problems-among-adults-united-states/pep23-10-00?utm_source=SAMHSA&utm_campaign=3315782ffc-EMAIL_CAMPAIGN_2023_09_20_06_25&utm_medium=email&utm_term=0_-3315782ffc-%5BLIST_EMAIL_ID%5D</ref> SAMHSA also provides video trainings which promote recovery-oriented services and supports by highlighting new knowledge areas, hot topics, and cutting-edge programs, <ref>https://www.samhsa.gov/brss-tacs/video-trainings</ref> and it has a website titled "Recovery Resources for American Indian and Alaska Natives" with resources addressing recovery support within AIAN communities. <ref>https://www.samhsa.gov/tribal-affairs/recovery-resources-american-indian-alaska-natives?utm_source=SAMHSA&utm_campaign=24c288fca9-EMAIL_CAMPAIGN_2024_03_13_03_56&utm_medium=email&utm_term=0_-24c288fca9-%5BLIST_EMAIL_ID%5D</ref>

* '''Faces & Voices of Recovery (Faces & Voices)''' conducted the first nationwide survey of persons in recovery from alcohol and other drug problems. The purpose of this survey was to document the benefits of recovery. <ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/22Life-in-Recovery22-Report-on-the-Survey-Findings.pdf</ref>

* '''SAFE Project''' offers a suite of resources across the recovery ecosystem:
**'''Bridging Prevention and Recovery''' is a new evidence-based program designed to provide substance use disorder professionals with a step-by-step process to facilitate sustainable integration of these two approaches in communities that have traditionally been siloed. <ref>https://www.safeproject.us/bridging-prevention-recovery/</ref>
**'''Integrated-Forensic Peer Recovery Specialist (I-FPRS)''' uses a Training of Trainers model to equip participants to train Certified Peer Recovery Specialists and Supervisors to navigate the complexities associated with providing support to individuals who are justice-involved. <ref>https://www.safeproject.us/ifprs-training/</ref>
**"Recovery Supports for People in the Criminal Justice System" is a Safe Solutions article that provides information about strategies to support people in this population -- who have unique recovery needs. <ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Support_for_People_in_the_Criminal_Justice_System</ref> Substance use disorder and the justice system have a complex history. It is estimated that about one-half of state and federal prisoners misuse drugs or are addicted to drugs, but few typically receive treatment while incarcerated. <ref>https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-opioid-use-disorder-treated-in-criminal-justice-system</ref>
** "Improve Recovery Housing" is a Safe Solutions article which addresses the transfer from treatment to independent living. For some individuals, returning to their previous living environment can be unsafe or not conducive to their recovery. Sober living offers individuals a safe, peer-to-peer recovery-oriented home with structure, accountability, and support. Typically, there are household duties in sober living that need to be fulfilled including rent, chores, curfew, etc. <ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Housing</ref>
** "Improve Education, Job Training, and Employment for People in Recovery" focuses on vocational training. Substance use disorders could result in loss of job, job abandonment, or legal issues that may add additional barriers to obtaining employment. Vocational training can provide on-the-job training, remedial training, college training, and resume building. <ref>https://www.yoursafesolutions.us/wiki/Improve_Education,_Job_Training,_and_Employment_for_People_in_Recovery</ref>
**"Expand Collegiate Recovery Programs" provides information on how to help students balance recovery and higher education. <ref>https://www.yoursafesolutions.us/wiki/Expand_Recovery_Schools_and_Collegiate_Recovery_Programs</ref> This includes therapy, sober housing, and substance-free events. There is a related aSAFE Solutions article on recovery high schools. <ref>https://www.yoursafesolutions.us/wiki/Expand_Recovery_High_Schools</ref>
**"Expand Harm Reduction Practices" is a SAFE Solutions article focused on a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. <ref>https://www.yoursafesolutions.us/wiki/Expand_Harm_Reduction_Practices</ref> Harm Reduction is also a movement for social justice built on a belief in and respect for, the rights of people who use drugs. <ref>https://harmreduction.org/about-us/principles-of-harm-reduction/</ref>
**"Expand Access to Medication-Assisted Treatment" is an article focused on the role of MAT to provide a whole-patient approach to recovery. MAT is primarily used for addiction to opioids, such as prescription pain killers and heroin. MAT utilizes FDA-approved medications to help sustain recovery and prevent or reduce opioid overdose. <ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medication-Assisted_Treatment_(MAT)</ref>

=Promising Practices=

* '''Connecticut Community for Addiction Recovery (CCAR)''' supports all things recovery -- no matter what stage of recovery. The CCAR website helps people navigate the recovery community by providing support services and connections to people in recovery. They offer telephone recovery support, virtual support meetings on different recovery topics, peer recovery training, and a coffee lounge. They also have five recovery community centers throughout the state. <ref>https://ccar.us/</ref>

* '''The Hazelden Betty Ford Foundation''' has a series of virtual services. On-line outpatient addiction programs encompass addiction treatment, family services, community solutions, prevention and early intervention, recovery support, and mental health services. <ref>https://www.hazeldenbettyford.org/locations/online-care-support-services</ref>

*'''Oregon''' This case study highlights steps which advanced a "recovery-ready ecosystem" in the city of Eugene. <ref>https://www.opioidlibrary.org/wp-content/uploads/2019/08/Building-a-Recovery-Ready-Ecosystem-in-Oregon-Robert-Ashford1000.pdf</ref>

*'''Texas.''' Recovery Texas is a state-wide movement provides recovery support specialists, screenings for substance use and mental health, and digital recovery support such as meetings, meditation, and yoga. <ref>https://recoverytexas.org/</ref>

=Sources=

Recovery

2024-09-25T17:49:36Z

Mlabrie21: Creating page based on Tracy's submission for linking from main dashboard as introductory material

The Substance Abuse and Mental Health Services Administration (SAMHSA) states, "Recovery is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential." This definition is widely applicable since it does not mention the cessation of substance use. For many individuals in recovery, the term is not built solely on the alcohol, tobacco, and other drugs' (ATOD) termination of use. This is where harm reduction strategies or medicated assisted recovery can intersect. Recovery is a complete change in thought, behaviors, identity, and for some, a change in social circles. It is crucial for non-recovery individuals to understand that this shift can be transformative. Individuals who have experienced this transformation will tend to incorporate their recovery pathway into their identity. Moreover, that recovery path consistently changes — it is an evolutionary journey.

One of [https://www.safeproject.us/ SAFE Project]'s goals is to support communities in breaking down silos by fostering greater collaboration between the numerous fields of work engaged in addressing the impacts of overdose and substance use. If you have not already, please read more about the importance of integration across the Institute of Medicine's (IOM) Continuum of Care and prioritizing outcomes in community work before [https://www.yoursafesolutions.us/about-safe-solutions/ delving into this overview], as well as the overview articles in each of the other five menus on this platform. Likewise, users who have a particular interest in the criminal justice system are encouraged to read the article on recovery within the SAFE Solutions Treatment menu titled, "Improve Recovery Support for People in the Criminal Justice System."

The first of two recovery menus is "Recovery Science." It is organized to provide detailed consideration along each of four domains within the socio-ecological model — individuals, families, peers, and community.
The first article “The Recovery Ecosystem” defines recovery within the context of its social dimensions and provides an introduction to recovery capital as a protective factor.

* "[[Increase Support for Individuals in Recovery]]" unpacks complementary tools useful for recovery at the personal scale to include motivational interviewing, progress tracking, and quality of life tools.
* "[[Expand Community Support for Impacted Families]]" provides a variety of resources for family recovery and support.
* "[[Strengthen Peer Recovery Support Services and Programs]]" defines the role of peer support specialists and addresses the institutional contexts in which peer support can be delivered.
* "[[Create Recovery-Ready Communities]]" outlines the responsibility of communities in recovery and details steps which communities can take to be recovery-ready. It also describes recovery oriented systems of care (ROSC).

Articles in the second group of the menu, "Community Systems of Recovery," address four different systems in which people in recovery might engage throughout their life. These range from high schools and college campuses to the workplace, and the housing system.

* "[[Expand Recovery High Schools]]" highlights the needs of young adults in recovery, a population that is often overlooked and under-served.
* "[[Strengthen Collegiate Recovery Programs]]" provides examples from a suite of successful collegiate recovery initiatives.
* "[[Improve Education, Job Training, and Employment for People in Recovery]]" outlines the importance of employment as a protective factor in recovery and identifies a series of successful cases.
* "[[Improve Recovery Housing]]" showcases the different certification levels in recovery housing and also offers best practices.

Expand Recovery High Schools

2024-09-05T14:29:38Z

Mlabrie21: Creating blank page

Creating blank page

Treatment

2024-08-08T14:59:14Z

Mlabrie21: Adding in requested image

Treatment services for individuals with a substance use disorder diagnosis include assessment, the development of a treatment plan, implementation of the treatment plan, evaluation, case management, extended care, and monitoring. Programs vary in length and intensity, and they may include approaches like medical stabilization/detox, counseling and behavioral healthcare, and rehabilitation services. In treatment, the ASAM Criteria (American Society Of Addiction Medicine) is the most widely used and comprehensive set of standards for placement, continuation of services, and determining levels of care for individuals seeking treatment for substance use disorder. Level of care recommendations and treatment plans are developed based on multidimensional patient assessments that consider the patient’s medical, psychological, and social needs to help determine what services are a best fit to meet individual and/or patient needs. Additionally, when utilizing ASAM criteria, these guideline assessments take into account an individual's strengths, needs, resources, and recovery capital. Levels of care/continuum of care include:

https://www.yoursafesolutions.us/misc/asam-dimension-changes-800w.jpg

''(Figure 1 ASAM American Society Of Addiction Medicine, 2024) ''

In SAFE Solutions, treatment themes, which are addressed below, are tightly linked to issues addressed across the full spectrum of the Institute of Medicine's (IOM) Continuum of Care, and the reader is strongly encouraged to read each of the other five overview articles. Three clusters of treatment articles are provided.

The first menu, "[[Focus on Effective Treatment]]," addresses general treatment themes. The second menu details considerations on Medicated Assisted Treatment (MAT)/Medicated Assisted Recovery (MAR), and the last menu addresses treatment concerns linked to the criminal justice system.

*"[[Support and Advance Effective Treatment]]" addresses the major types of treatment options and provides an introduction to the framework within which new treatment services are developing.
*"[[Improve Links to Treatment for People who Experience Non-Lethal Overdoses or Naloxone Revivals]]" covers a specific harm reduction strategy which treatment providers should prioritize.
*"[[The Role of Treatment Providers in Promoting Early Intervention, Harm Reduction, And Recovery]]" addresses the unique opportunity that treatment providers have in advancing efforts across the continuum of care.

Articles which focus on MAT/MAR include:

*"[[Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR)]]" provides a detailed coverage of the MAT/MAR process, medication choices involved, and the community context within which MAT/MAR must be promoted.
*"[[Accelerate the Development of New MAT/MAR Approaches]]" covers the need for innovation in the MAT/MAR field and an FDA program designed to foster treatment approaches.
*"[[Expand DNA Testing to Improve Precision MAT/MAR Therapies]]" highlights the benefits of Precision/Personalized Medicine and its emergent status.
*"[[Expand the Use of MAT/MAR in Correctional Facilities]]" bridges to the focus of the next cluster of articles.

More than half of those in U.S. prisons and jails meet the criteria for substance use disorders, so correctional institutions are looking for best practices which they can use to help handle the increased demand for substance use treatment, including diversion and drug courts, treatment while incarcerated, and reentry services. Articles which focus on criminal justice involvement include:

*"[[Shift from Punishment to Treatment Approach]]" advocates for the need to address the correlation between recidivism and substance use disorder by amplifying treatment options available to the judicial system.
*"[[Expand Law Enforcement Assisted Diversion and Deflection Programs]]" defines the difference between diversion and deflection approaches and provides examples of the benefits of both types of programs.
*"[[Expand First Response and Crisis Intervention Teams]]" supplements the previous article, which has a focus on law enforcement, with a focus on the role of other first responders, such as EMS, fire departments, and behavioral health outreach workers.
*"[[Expand and Enhance Speciality Courts]]" describes the variety of specialty courts which are often referred to as drug courts. It provides the historical context within which the implementation of these courts has increased, and it documents their individual and social benefits.
*"[[Expand Community Service Alternatives to Incarceration]]" delineates four major types of incarceration alternatives and outlines five benefits of these alternatives.
*"[[Improve Recovery Support for People in the Criminal Justice System]]" focuses on many of the themes covered in the set of SAFE Solutions articles on recovery, which are of particular relevance to the criminal justice system.
*"[[Improve Reentry After Incarceration]]" documents the challenges of returning to community and delineates a variety of resources aiming to support the recovery process.

Treatment

2024-08-07T19:49:20Z

Mlabrie21: Creating page based on Tracy's submission for linking from main dashboard as introductory material

Treatment services for individuals with a substance use disorder diagnosis include assessment, the development of a treatment plan, implementation of the treatment plan, evaluation, case management, extended care, and monitoring. Programs vary in length and intensity, and they may include approaches like medical stabilization/detox, counseling and behavioral healthcare, and rehabilitation services. In treatment, the ASAM Criteria (American Society Of Addiction Medicine) is the most widely used and comprehensive set of standards for placement, continuation of services, and determining levels of care for individuals seeking treatment for substance use disorder. Level of care recommendations and treatment plans are developed based on multidimensional patient assessments that consider the patient’s medical, psychological, and social needs to help determine what services are a best fit to meet individual and/or patient needs. Additionally, when utilizing ASAM criteria, these guideline assessments take into account an individual's strengths, needs, resources, and recovery capital. Levels of care/continuum of care include:

https://downloads.asam.org/sitefinity-production-blobs/images/default-source/criteria-new/dimension-changes.jpg

''(Figure 1 ASAM American Society Of Addiction Medicine, 2024) ''

In SAFE Solutions, treatment themes, which are addressed below, are tightly linked to issues addressed across the full spectrum of the Institute of Medicine's (IOM) Continuum of Care, and the reader is strongly encouraged to read each of the other five overview articles. Three clusters of treatment articles are provided.

The first menu, "[[Focus on Effective Treatment]]," addresses general treatment themes. The second menu details considerations on Medicated Assisted Treatment (MAT)/Medicated Assisted Recovery (MAR), and the last menu addresses treatment concerns linked to the criminal justice system.

*"[[Support and Advance Effective Treatment]]" addresses the major types of treatment options and provides an introduction to the framework within which new treatment services are developing.
*"[[Improve Links to Treatment for People who Experience Non-Lethal Overdoses or Naloxone Revivals]]" covers a specific harm reduction strategy which treatment providers should prioritize.
*"[[The Role of Treatment Providers in Promoting Early Intervention, Harm Reduction, And Recovery]]" addresses the unique opportunity that treatment providers have in advancing efforts across the continuum of care.

Articles which focus on MAT/MAR include:

*"[[Expand Access to Medicated Assisted Treatment/Recovery (MAT/MAR)]]" provides a detailed coverage of the MAT/MAR process, medication choices involved, and the community context within which MAT/MAR must be promoted.
*"[[Accelerate the Development of New MAT/MAR Approaches]]" covers the need for innovation in the MAT/MAR field and an FDA program designed to foster treatment approaches.
*"[[Expand DNA Testing to Improve Precision MAT/MAR Therapies]]" highlights the benefits of Precision/Personalized Medicine and its emergent status.
*"[[Expand the Use of MAT/MAR in Correctional Facilities]]" bridges to the focus of the next cluster of articles.

More than half of those in U.S. prisons and jails meet the criteria for substance use disorders, so correctional institutions are looking for best practices which they can use to help handle the increased demand for substance use treatment, including diversion and drug courts, treatment while incarcerated, and reentry services. Articles which focus on criminal justice involvement include:

*"[[Shift from Punishment to Treatment Approach]]" advocates for the need to address the correlation between recidivism and substance use disorder by amplifying treatment options available to the judicial system.
*"[[Expand Law Enforcement Assisted Diversion and Deflection Programs]]" defines the difference between diversion and deflection approaches and provides examples of the benefits of both types of programs.
*"[[Expand First Response and Crisis Intervention Teams]]" supplements the previous article, which has a focus on law enforcement, with a focus on the role of other first responders, such as EMS, fire departments, and behavioral health outreach workers.
*"[[Expand and Enhance Speciality Courts]]" describes the variety of specialty courts which are often referred to as drug courts. It provides the historical context within which the implementation of these courts has increased, and it documents their individual and social benefits.
*"[[Expand Community Service Alternatives to Incarceration]]" delineates four major types of incarceration alternatives and outlines five benefits of these alternatives.
*"[[Improve Recovery Support for People in the Criminal Justice System]]" focuses on many of the themes covered in the set of SAFE Solutions articles on recovery, which are of particular relevance to the criminal justice system.
*"[[Improve Reentry After Incarceration]]" documents the challenges of returning to community and delineates a variety of resources aiming to support the recovery process.

Harm Reduction

2024-07-17T17:24:25Z

Mlabrie21: Creating page based on Tracy's submission for linking from main dashboard as introductory material

Harm reduction is a strategy which minimizes the impacts of drug use and drug-related harms. Harm reduction supports interventions which are aimed at reducing negative effects without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery.

Harm reduction does not fall neatly within any single domain within the Institute of Medicine's (IOM) Continuum of Care, but rather supplements the prevention, treatment, and recovery strategies. Therefore, it is useful for anyone working within any of the IOM domains to be familiar with the harm reduction approach. Since it incorporates a number of innovations within the substance use disorder field, some of the strategies are controversial and have historically been met with community resistance. This makes it even more important for all behavioral health practitioners to be informed about the full spectrum of harm reduction strategies.

SAFE Solutions provides two clusters of harm reduction articles. The first addresses the major approaches to harm reduction and includes an article on the incarcerated population. The second set of articles details unique substance use issues associated with a second specific population — people who are pregnant or parents of newborns.

*The first article, "[[Expand Harm Reduction Practices]]," provides the definition and principles of harm reduction promoted by the National Harm Reduction Coalition. It introduces the four major approaches which are implemented in harm reduction.
*"[[Increase Access to Overdose Reversal Medications]]" covers the most common harm reduction strategy. While the use of naloxone in preventing death by overdose has been adopted by pharmacists, EMS, law enforcement, and even public libraries, it has also received significant resistance to its adoption.
*"[[Expand Drug Testing Options]]" covers another major strategy in harm reduction — the use of fentanyl testing strips (FTS). In addition to reducing the number of overdoses, the distribution of FTS provides opportunities for drug users to become aware of other treatment and recovery services.
*"[[The Linkage Between Syringe Use and Infectious Disease]]" is the first in a series of three articles associated with the complex topic of syringes. It provides a context for understanding the health risks associated with injecting drugs and the need to address the behavioral health issues of substance use within the arena of public health in curbing the spread of Hepatitis C, HIV, and AIDS.
*"[[Increase Access to Syringe Exchange Programs]]" details a variety of types of syringe service programs (SSPs) and documents the positive results and cost-benefits associated with SSPs.
*"[[Expand Number of Safe Injection Sites]]" makes a case for national adoption of a harm reduction practice which has been proven successful in a variety of international settings.
*"[[Adopt Harm Reduction Practices in Jails and Prisons]]" addresses concerns associated with one of two specific populations addressed by SAFE Solutions. While there are several articles under "Treatment" within "Focus on Criminal Justice," this article addresses unique concerns linked to harm reduction.

Articles which focus on the perinatal period include:
*"[[Minimize Substance Use During Pregnancy]]" addresses the broad spectrum of issues facing an increasingly prevalent population having high risks for both parent and child. It ranges from increased chance of unintended pregnancies associated with substance use disorder to statistics on use during pregnancy to challenges and barriers unique to the perinatal period. It includes emerging resources and promising practices.
*"[[Expand Perinatal Treatment and Support for People with SUDs]]" is the first in a cluster of three articles focused on the community role in norm change around pregnancy and substance use. It provides the context for the following two articles.
*"[[Reduce Stigma for Pregnant People with SUDs]]" delineates the need for norm change at the community scale and offers strategies and cases in which stigma reduction has been advanced.
*"[[Enhance Collaboration Among Medical, Behavioral Health, and Social Services Providers]]" spells out the synergistic benefits of service provision to families through collaborative efforts. It also details the mechanics of a family-centered approach.

The next three articles focus on the baby:
*"[[Increase Awareness of Risks of SUD on the Baby]]" addresses Fetal Alcohol Syndrome (FAS) and Neonatal Abstinence Syndrome (NAS).
*"[[Improve Care for Babies Born Drug Dependent]]" covers treatment options for NAS.
*"[[Improve Identification and Data Collection for NAS]]" details the benefits of system-level changes, such as universal screening and a national NAS data registry.

The last four articles address specific perinatal SUD considerations and methods to support people before, during, and after pregnancy:
*"[[Increase Access to Contraception]]" addresses the high rate of unintended pregnancies associated with substance use and public health consensus around the need to increase access to contraceptive choices. In particular, this article details the benefits of long-acting reversible contraception (LARC) methods.
*"[[Expand Motivational Interviewing for Pregnant People]]" describes a harm reduction approach which builds upon a desire to make positive changes during pregnancy by inspiring incremental steps to behavior change. As a positive psychology model, it is person-driven and empowering, which builds assets to address stigma and other challenges associated with substance use during pregnancy.
*"[[Expand Access to MAT/MAR for Pregnant People]]" supplements a cluster of MAT/MAR articles within SAFE Solution's menu on Treatment. It provides information specifically relevant for the role of MAT/MAR during and after pregnancy.
*"[[Improve Access to Recovery Coaches for Parents of Newborns]]" highlights the vulnerability of the postpartum period and the positive role which recovery coaches could play to support parents of newborns.

Increase Awareness of the Risks of SUD on the Baby

2024-07-17T17:24:13Z

Mlabrie21: Setting up redirect for potential mis-type

#REDIRECT [[Increase Awareness of Risks of SUD on the Baby]]

Improve Access to Recovery Coaches for Parents

2024-07-16T16:08:18Z

Mlabrie21: Mlabrie21 moved page Improve Access to Recovery Coaches for Parents to Improve Access to Recovery Coaches for Parents of Newborns: Changing title per Tracy request

#REDIRECT [[Improve Access to Recovery Coaches for Parents of Newborns]]

Improve Access to Recovery Coaches for Parents of Newborns

2024-07-16T16:08:18Z

Mlabrie21: Mlabrie21 moved page Improve Access to Recovery Coaches for Parents to Improve Access to Recovery Coaches for Parents of Newborns: Changing title per Tracy request

=Introductory Paragraph=

New motherhood is an incredibly stressful period of life for women. They must heal from the birth, adjust to the physical and mental demands of caring for a newborn, and make peace with their new lifestyle. There are a myriad of outside factors that influence this new phase, and new life hurdles are exacerbated for mothers with a substance use disorder who are trying to get to or maintain sobriety on top of having a new baby. During the first year after their baby is born, the relapse rate for new mothers is incredibly high at 80%. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4387084/</ref> Becoming sober and maintaining sobriety is no easy feat by itself, just as new motherhood is not. The combination of both circumstances is one which clinicians need to address with the utmost care, respect, and diligence. This critical time period can be profoundly improved by the addition of a recovery coach to the new mother's support team. SUDs are one of the main contributors to child removal and failed reunification of the child and parent, and the help of recovery coaches in reaching and maintaining sobriety has been shown to greatly impact the outcomes of parental-child cohabitation. <ref>https://ncpoep.org/guidance-document/treatment-matters/approaches-to-treatment/</ref> <ref>https://evidencebasedprograms.org/programs/recovery-coaches/</ref> The effectiveness of the lived experience and the training of the recovery coach cannot be understated in its value to comprehensive SUD treatment for new mothers. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>

=Key Information=

'''The Definition of a Recovery Coach.'''

''The NC Pregnancy and Opioid Exposure Project'' defines a recovery coach as a “paraprofessional who assists parents in obtaining needed benefits, coordinates child welfare and substance abuse treatment staff, and connects the family with treatment providers.” <ref>https://ncpoep.org/guidance-document/treatment-matters/approaches-to-treatment/</ref> While they are independent of these agencies, they will often be at home visits with agents from child welfare and substance abuse treatment programs. <ref>https://ncpoep.org/guidance-document/treatment-matters/approaches-to-treatment/</ref>

''The U.S. Department of Health and Human Services, Office of Planning, Research, and Evaluation (OPRE)'' describes recovery coaches who work in the child welfare system as those who work with parents who have had a child or are at risk of having a child removed from their care due to SUD. They, “increase access to and engagement in treatment and other services to support parents’ recovery, coordinate with child welfare agency staff, and ensure treatment and recovery progress is incorporated into plans to either maintain children with their families of origin or place them with other permanent families.” <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref>

The specific responsibilities of recovery coaches will vary from program to program. Some programs may require a bachelor’s degree. Many others employ peer recovery coaches who have lived experience, whether they have had success in SUD recovery and new parenting or have been directly involved with a loved one in that situation. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref> <ref>https://www.medstarhealth.org/-/media/project/mho/medstar/pdf/msh-ch-peer-recovery-coach-brochure_final.pdf</ref>

''SAMHSA'' has published ethical guidelines for peer-based recovery when the recovery coach is not a licensed clinician. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>
These guidelines provide a clear-cut picture of the competencies and responsibilities of a recovery coach and are intended to prevent any role confusion and potential unqualified treatment, because many programs presents overlapping duties between recovery coaches and other treatment players. According to these guidelines, employed peer recovery coaches are meant to provide emotional, informational, and instrumental support along with companionship in recovery. A recovery coach following these guidelines fulfills a mix of the following roles: <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>

*Outreach worker
*Motivator and cheerleader
**Offers a living example of hard work/recovery success
**Encourages & celebrates recovery milestones
**Encourages & models self-advocacy and self-sufficiency
*Ally & confidant - can be trusted, cares, and listens
*Truthteller - provides honest, constructive feedback on recovery progress
*Role model & mentor
*Planner
*Problem solver
*Resource broker
*Monitor
*Tour guide
*Advocate
*Educator
*Community organizer
*Lifestyle consultant/guide
*Friend

The SAMHSA guidelines note that a recovery coach is NOT a sponsor, therapist/counselor, nurse/physician, or a member of the clergy. Tasks that fall into the wheelhouse of these professions should not be permitted and always referred out by the recovery coach. <ref>https://www.naadac.org/assets/2416/whitew2007_the_pro-act_ethics_workgroup.pdf</ref>

Substance use disorder and postpartum depression are commonly identified as having comorbidity, regardless of which condition came first. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742364/</ref> It is important that the recovery coach not blur the lines in giving clinical advice regarding postpartum depression and maintain services that align to their training. However, the co-occurrence of the two conditions may indicate a greater need for the recovery coach, as they can alleviate some of the burdens of finding resources while providing social support which is critical for those with depression. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742364/</ref> <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518627/</ref>

'''Role of Recovery Coaches in the Postpartum Period.'''

Sobriety during pregnancy is an important goal, and about 85% of pregnant women with a substance use disorder are able to maintain abstinence from at least one substance while they are carrying their baby. <ref>https://www.recoveryanswers.org/research-post/stopping-starting-substance-use-pregnancy/</ref> However, the first year of postpartum is very dangerous for women who struggle with SUD. Mothers who have an SUD face challenges which may propel them towards relapses, such as food insecurities, legal troubles, the threat of infant removal, and domestic turmoil. Resources to aid the new mother in her recovery need to extend beyond birth and be tailored to the unique situations these mothers face with their addiction. Mothers with an SUD are a priority for substance treatment while pregnant, as the continued use can have a major impact on the fetus. However, many women, regardless of insurance status, see their treatment options dwindle postpartum, as the shift of medical attention goes from the mother to the infant. <ref>https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2018/08/14/for-addicted-women-the-year-after-childbirth-is-the-deadliest</ref>

Programs implementing recovery coaching have seen success with achieving and maintaining postpartum sobriety because the coach has unique, lived experience which they provide to help navigate these struggles. With so much stigma surrounding new mothers with an SUD, a primary goal of recovery coaching is to empower the mother without judgment. <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref> The coach’s lived experience can bring a sense of hope and trust to the new mother, upon seeing a peer who has gone through similar circumstances have success in maintaining sobriety. Because the recovery coach has had life experience coupled with paraprofessional training, they provide a unique and knowledgeable insight into the ins and outs of recovery and all the agencies and resources involved with recovery and child welfare.

Testimonials from mothers on the impact of their coach on their recovery document the importance of building a strong relationship with mutual understanding and unwavering support -- outside the stressors of therapies and agencies. <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref> Recovery coaches play an integral role in building esteem, giving support, and providing inter-agency resources. This helps to bolster the effects of treatment for new mothers and gives them the tools to work towards sobriety.

=Relevant Research=

There is not a lot of statistical research on the effectiveness of recovery coaches postpartum. One reason is that many mothers have access to these programs while pregnant, but lose it postpartum due to insurance restrictions. Thus, some of the information provided below is not specific to postpartum recovery coaching, but on the impact of recovery coaching on aiding SUD treatment. Research is needed on the effectiveness of recovery coaches during pregnancy and could provide a springboard for advocacy in postpartum treatment.

*An evidence-based review of an Illinois program found that parents with their baby removed from care who had access to a postpartum recovery coach had a 15% increase in parent-child reunification and a 14% increase in having foster-care cases closed. It is important to note that there was no evidence of adverse impact in the increased and quicker reunifications and case-closures. <ref>https://evidencebasedprograms.org/programs/recovery-coaches/</ref>

*This article highlights the high risk of relapse (28.3%) in the first three months postpartum, especially amongst those with comorbid mental illness. <ref>https://www.sciencedirect.com/science/article/pii/S0920996418304833</ref>

*The U.S. Department of Health and Human Services, Office of Planning, Research, and Evaluation (OPRE) made a comprehensive review of nine recovery coaching interventions. OPRE evaluated the replicability, success, and readiness of the programs and documents the strengths, weaknesses, and evidence-based practice implications of each model. <ref>https://www.acf.hhs.gov/sites/default/files/documents/opre/R3-recovery-coaching-march-2021.pdf</ref>

*This article provides a systematic review of peer recovery support services and recovery coaching. It highlights the potential of recovery coaching in SUD treatment. It recommends that more extensive research be done to empirically support the inclusion of recovery coaching and to provide a clear role definition. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6585590/</ref>

*This article evaluates an intervention delivered by peer recovery coaches in a medically underserved community in Baltimore City. <ref>https://psycnet.apa.org/record/2021-20460-001</ref>

*This article examines the cyclical effects of postpartum depression, both unrelated and related to substance use. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3742364/</ref>

=Impactful Federal, State, and Local Policies=

'''Federal.''' Recovery support services, including recovery coaches, were included in the Comprehensive Addiction Recovery Act (CARA), but not funded. There is not a federal definition of recovery services.

'''States.''' Implementation access requirements vary from state to state. <ref>https://www.safeproject.us/safe-takes/treatment-recovery/</ref>
*37 states provide coverage for some type of peer SUD support, but they all have various guidelines and restrictions.
*17 states discontinue Medicaid coverage 60 days postpartum. <ref>https://www.macpac.gov/wp-content/uploads/2019/07/Recovery-Support-Services-for-Medicaid-Beneficiaries-with-a-Substance-Use-Disorder.pdf</ref> Those people who do retain their coverage face challenges in navigating postpartum coverage changes, in finding new doctors to give them SUD treatment referrals, and in dealing with new and confusing paperwork.
*One state-level policy advance is reflected in Virginia, which provides a scholarship to help cover fees in becoming a Certified Peer Recovery Specialist. <ref>https://virginiapeerspecialistnetwork.org/getting-started/</ref>

=Available Tools and Resources=

'''SAMHSA''' provides a state-by-state directory of training and certification programs for peer recovery coaching. <ref>https://c4innovates.com/brsstacs/BRSS-TACS_State-by-State-Directory-of-Peer-Recovery-Coaching-Training-and-Certification-Programs_8_26_2020.pdf</ref> It was generated in 2018 by BRSS-TACS (Bringing Recovery Supports to Scale Technical Assistance Center Strategy).

'''SAFE Project''' has a dedicated website for Addiction and Mental Health Resources for Women that includes a number of support resources during and after pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>

'''The National Center on Substance Abuse and Child Welfare''' has published a guide, “The Use of Peers and Recovery Specialists in Child Welfare Settings.” This covers models, implementation, funding, qualifications/training, supervision, and much more. It is a good tool for those wishing to implement recovery coaches and peer support. <ref>https://ncsacw.acf.hhs.gov/files/peer19_brief.pdf</ref>

'''KFF''' formerly know as the Kaiser Family Foundation, provides a breakdown of postpartum Medicaid coverage state-by-state. It addresses gaps, disparities, and needs. Medicaid coverage greatly impacts new mothers with an SUD, who are more likely to need continuity of coverage to aid in their recovery. <ref>https://www.kff.org/womens-health-policy/issue-brief/expanding-postpartum-medicaid-coverage/</ref>

'''The Montgomery County Office of Mental Health''' has published its recovery coaching guidelines. It is a comprehensive guide on how to effectively implement recovery coaching in the community to address a wide array of vulnerable populations. <ref>https://www.montcopa.org/DocumentCenter/View/13037/Recovery-Coaching-Practice-Guidelines?bidId=</ref>

=Promising Practices=

'''California.''' The Sobriety Treatment and Recovery Teams (START) is an intensive child welfare program for families with substance use and child abuse or neglect. START is built on cross-system collaboration and integrated service delivery. It utilizes peer recovery coaches in long-term recovery in conjunction with families, treatment providers, and court systems to provide a “system-of-care and shared decision-making approach.” This program is both child welfare and SUD treatment centered and uses trauma-informed care to help maintain safety, reduce child-removal-of-care, achieve and maintain parental sobriety, improve parenting skills, and improve inter-agency collaboration. The site includes program goals, their logic model, components, delivery, training/manuals, implementation, and published research. <ref>https://www.cebc4cw.org/program/sobriety-treatment-and-recovery-teams/detailed</ref>

'''Georgia.''' The Certified Addiction Recovery Empowerment Specialist (CARES) program was developed by the Georgia Council on Substance Abuse. CARES provides training, examination, and continuing education to maintain a strengths-based approach in peer recovery support services that builds on client’s strengths. CARES has an emergency department that provides recovery coaches to those experiencing an overdose or other substance-related incident and in need of immediate aid. They also offer a warm line -- a call line to aid those are struggling and need to talk to someone but want to remain anonymous. <ref>Link: https://gasubstanceabuse.org/cares-program/</ref>

=Sources=

Increase Awareness of the Risks of Substance Use and Neonatal Abstinence Syndrome (NAS)

2024-07-16T16:06:18Z

Mlabrie21: Mlabrie21 moved page Increase Awareness of the Risks of Substance Use and Neonatal Abstinence Syndrome (NAS) to Increase Awareness of Risks of SUD on the Baby: Changing title per Tracy request

#REDIRECT [[Increase Awareness of Risks of SUD on the Baby]]

Increase Awareness of SUD Impacts on a Fetus

2024-07-16T16:06:18Z

=Introductory Paragraph=

Opioid use during pregnancy can affect women and their babies. Women may use opioids as prescribed, may misuse prescription opioids, may use illicit opioids such as heroin, or may use opioids (opioid agonists and/or antagonists) as part of medication-assisted treatment for opioid use disorder. Regardless of the reason, women who use opioids during pregnancy should be aware of the possible risks during pregnancy, as well as the potential treatment options for opioid use disorder.

=Key Information=

Opioid use in women aged 15–44 years has increased at a similar rate to the dramatic increase in opioid use in the United States. During 2008–2012, about 1 in 3 reproductive-aged women filled an opioid prescription each year. <ref>https://www.cdc.gov/pregnancy/opioids/basics.html</ref> As such, opioid use during pregnancy is not uncommon. There have been significant increases in opioid use disorder during pregnancy. For example, the number of women with opioid use disorder at labor and delivery more than quadrupled from 1999 to 2014. Opioid exposure during pregnancy has been linked to negative health effects for both mothers and their babies. These include maternal death, stillbirth, and neonatal abstinence syndrome. Birth outcomes for infants exposed to opioids during pregnancy include an increased likelihood to:

*Be born preterm (born before 37 weeks of pregnancy)
*Have poor fetal growth
*Have longer hospital stays after birth
*Be re-hospitalized within 30 days of being born
*Possible birth defects

The effects of prenatal opioid exposure on children over time are largely unknown. However, using opioids as prescribed or for treatment of opioid use disorder during pregnancy may be necessary and may outweigh the risks.

'''Neonatal Abstinence Syndrome'''

Opioid use and medication assisted treatment for opioid use disorder during pregnancy can lead to NAS which is a group of conditions occurring when newborns withdraw from certain substances including opioids which they were exposed to before birth. Withdrawal caused by opioids during the first 28 days of life is sometimes also called neonatal opioid withdrawal syndrome (NOWS). Withdrawal symptoms in newborns usually occur 48–72 hours after birth. Drug withdrawal symptoms may include:

*Tremors (trembling)
*Irritability, including excessive or high-pitched crying
*Sleep problems
*Hyperactive reflexes
*Seizures
*Yawning, stuffy nose, or sneezing
*Poor feeding and sucking
*Vomiting
*Loose stools and dehydration
*Increased sweating

The symptoms a newborn might experience and their severity depend on different factors. These include the type and amount of exposure before birth, the last time a substance was used, whether the baby is born full-term or premature, and if the newborn was exposed to more than one substance before birth.

=Relevant Research=

*'''Opioid Use and Opioid Use Disorder in Pregnancy.''' This report provides an extensive literature review and includes recommendations and conclusions from the American College of Obstetricians and Gynecologists. <ref>https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref>

*'''Longer-Term Developmental Outcomes.''' There is limited information about longer-term outcomes of children exposed to opioids prenatally, including those with or without NAS. Not all babies exposed to opioids during pregnancy experience signs of NAS, but they may still have longer-term outcomes which are not obvious at birth. Results from a recent study suggest that children with NAS were more likely to have a developmental delay or speech or language impairment in early childhood, compared with children without NAS. It is not clear if these impacts are due to opioids specifically, other substance exposures, or other environmental influences. Findings about long-term outcomes of children exposed to opioids during pregnancy are inconsistent. More research is needed to better understand the spectrum of possible outcomes related to opioid exposure during pregnancy.

*'''This article''' titled "Narcotic Addiction, Pregnancy, and the Newborn," provides a 19-year overview of cases at one hospital. Although it is dated (1978), it potentially provides a baseline for comparison to conditions five decades ago. <ref>https://jamanetwork.com/journals/jamapediatrics/article-abstract/507913</ref>

=Impactful Federal, State, and Local Policies=

*'''Medicaid.''' Numerous Medicaid authorities, including the state plan, waivers, and other demonstration programs, can be used to provide SUD treatment and recovery support services to pregnant women with SUD as well as specialized services for infants with NAS. <ref>https://www.medicaid.gov/federal-policy-guidance/downloads/cib060818.pdf</ref>

*'''West Virginia''' has a state plan amendment on NAS services that provides for an all-inclusive prospective bundled payment based on the daily treatment of Medicaid beneficiaries. <ref>http://www.wvlegislature.gov/Bill_Status/bills_text.cfm?billdoc=SB288%20INTR.htm&yr=2020&sesstype=RS&i=288</ref>

=Available Tools and Resources=

*'''SAMHSA''' has published comprehensive clinical guidance for optimal management of pregnant and parenting women with opioid use disorder and their infants. <ref>"Clinical Guidance for Treating Pregnant and Parenting Women With Opioid Use Disorder and Their Infants." at https://store.samhsa.gov/product/Clinical-Guidance-for-Treating-Pregnant-and-Parenting-Women-With-Opioid-Use-Disorder-and-Their-Infants/SMA18-5054</ref>

*'''SAFE Project''' has a dedicated online resource page titled, "Addiction and Mental Health Resources for Women." This includes a variety of resources specifically providing support during pregnancy. <ref>https://www.safeproject.us/resource/women/</ref>

*'''The American College of Obstetricians and Gynecologists (ACOG)''' has published a report titled, "Opioid Use and Opioid Use Disorder in Pregnancy." This provides recommendations and clinical guidance. <ref> https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/08/opioid-use-and-opioid-use-disorder-in-pregnancy</ref> They also provide a FAQ sheet on "Opioid Use Disorder and Pregnancy" that identifies the most effective treatment for opioid use disorder during pregnancy to be opioid replacement medication, which includes medication-assisted treatment such as Methadone and Buprenorphine. The FAQ sheet also covers ways that behavioral therapy and counseling can assist with providing support and tools for ongoing recovery.<ref>https://www.acog.org/womens-health/faqs/opioid-use-disorder-and-pregnancy</ref>

*'''The University of Baltimore''' has published "Supporting Mothers and Infants Impacted by Perinatal Opioid Use: A Cross-Sector Assessment." This collaborative assessment resulted from a community-level intervention initiative that was funded by the Center for Drug Policy and Enforcement. The report provides information on process, lessons learned, and resources that may help others engaged in similar projects and collaboratives. <ref>https://www.texaschildrens.org/sites/default/files/uploads/documents/Perinatal%20Opioid%20Report%20Final_%20march%202019.pdf</ref>

*'''The Council on Recovery''' operates the Center for Recovering Families, a program that guides people who are seeking help to lasting and fulfilling recovery. <ref>https://www.councilonrecovery.org/treatment-programs/</ref>

*'''The National Center on Substance Abuse and Child Welfare (NCSACW)''' is a technical assistance resource. <ref>https://www.cffutures.org/files/fdc/A-Planning-Guide_-Steps-to-Support-a-Comprehensive-Approach-to-Plans-of-Safe-Care-3.21.18-final.pdf</ref>

=Promising Practices=

'''Baptist Health System.''' The Baptist Medical Center in San Antonio is a nationally recognized Center of Excellence for NAS Care. <ref> https://www.baptisthealthsystem.com</ref>

'''Maternal Opioid Misuse (MOM) Model''' is promoted through the Center for Medicare and Medicaid Innovations. The primary goals are to: <ref>https://innovation.cms.gov/innovation-models/maternal-opioid-misuse-model</ref>
*improve quality of care and reduce costs for pregnant and postpartum women with OUD as well as their infants
*expand access, service-delivery capacity, and infrastructure based on state-specific needs
*create sustainable coverage and payment strategies which support ongoing coordination and integration of care

= Sources =

Improve Screening for Infectious Disease

2024-07-16T16:03:48Z

Mlabrie21: Mlabrie21 moved page Improve Screening for Infectious Disease to The Linkage Between Syringe Use and Infectious Disease: Changing title per Tracy request

#REDIRECT [[The Linkage Between Syringe Use and Infectious Disease]]