Strengthening Your Community Coalition
Systems-building is a complex task. Extensive work has been done in systems research in the physical and biological sciences, but less in the social sciences, especially focused on social systems associated with SUD. The classic introduction to the field is provided by Peter Senge.  A summary of work in changing social systems can be found in the work of David Stroh.  Creating a community coalition is one of the most effective ways to solve complex systems-level problems and is at the core of creating 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. 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 of what it takes to build and strengthen an effective coalition based on the experiences of communities across the country.
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. Without a unified strategy and a focus on broader common community goals (rather than singular programmatic goals), communities addressing a crisis as large as the addiction epidemic will not be poised for success. 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. By bringing together and working with a broad range of stakeholders, communities, both large and small, can develop solutions that work for all of those touched by the opioid and addiction crisis. Many local communities have 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 that 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 individuals at the table - these are suggestions based on the types of partners that are most often brought together. Keep in mind, it’s 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 equally include individuals who are trusted in the community and have connections to people and neighborhoods who can support grassroots efforts? If you do not include all of these partners in the coalition, consider engaging them to build momentum and activate your community.
- Locally elected officials
- State/local drug prevention office
- Public safety officers/officials
- First responders to include EMS and Fire
- Health department
- School administration or school board
- Criminal judges and court professionals
- 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
- School district leadership
- School principals
- Parent Teacher Associations (PTA) and other youth serving organizations
- Colleges, universities, institutions of higher education, community colleges, and trade or technical schools
- 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
- Chamber of Commerce
- Union leaders
- Local philanthropic organizations
- Primary care physicians
- Nurse practitioners
- Emergency room doctors and staff administration
- Dental professionals
- Community behavioral healthcare providers
- Health plans and insurance providers
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 your coalition progresses, you will likely find that the needs of the coalition will change over time. Most often, 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; or,
- 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 your desired partners to the table is not always easy. Keep in mind that while there are a number of ways to contact these groups, in-person and direct contact is always preferable. You may have to overcome several types of resistance. Some organizations are not naturally inclined to work with others. For example, the harm reduction and law enforcement communities are not always natural allies in some communities. However, when these two groups come together and see the problem through each other’s lenses, some very powerful work can be done. 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). You may have to expend considerable effort to convince these groups that reversing the epidemic is in the entire community’s interest 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 includes:
- Honoring the Work that has Been Done. Everyone fighting this epidemic is doing their best and should always be recognized for their efforts.
- 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 discuss how greater collaboration will benefit the efforts of all involved.
Organization, Structure, and Coalition Meetings. Each coalition will determine for itself what works best for them; however, some initial guidelines based on experience of what has worked in your community in the past may be helpful. 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 are just some of the questions that typically arise during planning. As a coalition leader, it might also be helpful to track lessons learned over time to help maintain institutional knowledge as staffing changes over time. 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. Consistent evaluation of the coalition members, structure, and goals is an important function of any coalition leader.
Initial Actions of the Coalition. Hold your first meeting. Don’t worry if you have as few as five community leaders or as many as twenty. The important thing is that you have found people who are willing to work together to thoughtfully and comprehensively address the particular problem in your community. 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 your stakeholders, focus on defining the common problem you are looking to solve. A goal of your first meeting should be to establish a meeting rhythm in which the coalition frequently gathers to review progress, update your plan, and share success stories.
Evaluate the State of Your Community. For your community coalition to be successful, it will need to understand how the community perceives a number of elements of addiction, as well as what resources are already at work across the many stakeholders sets within your community. One way to evaluate perception and resources is through the SAFE Community Pulse Survey and SAFE Community Resources Exercise. These tools are designed specifically to provide you with the insight your coalition needs to focus and prioritize your work. These tools can be found in SAFE Project’s Community Playbook – a framework for communities to organize, evaluate, and create change in their community to impact the addiction epidemic. Once you have completed both evaluations, it’s time to take a step back and look at what the data and research are telling you. Is there a correlation between what the community survey tells you and the gaps that you have identified in your resource exercise? Data is a critical foundation to action. The improved collection, distribution, and rapid analysis of data is critically important to the development of a strategy to address areas within a community that are being severely impacted by SUD. This typically goes far beyond just tracking overdose deaths and non-fatal overdoses. It is important to know where they are occurring in order to know where more resources need to be deployed. 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? Use local data disaggregated by population characteristics like race, ethnicity, immigration status, language, and household levels of income to identify disparities in outcomes and inform policies and practices for specific populations, neighborhoods, and zip codes. Stronger data collection efforts and centering efforts around healthy equity 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 neighborhoods. How can the coalition better serve areas of the community that have been underserved? What partnerships can help make this happen effectively? Both qualitative and quantitative data can help your community coalition to narrow down a set of goals to tackle. Ultimately, the approaches should address broad systemic and policy changes. Strategies should increase awareness, build education, enhance skills, build capacity, and improve access or fill gaps. For more information about setting S.M.A.R.T. goals, please refer back to SAFE Project's Community Playbook. 
Impactful Federal, State, and Local Policies
To our knowledge, there are no existing regulations or policies on coalitions, but as you consider who to reach out to in order to create or expand a coalition, below are some key lessons learned by communities that have gone through - and continue to go through - this process:
The Contribution of Peer Support Networks. Peer Support Specialists and Recovery Coaches can play a vital role across numerous initiatives. Working together with police, health services, treatment providers, and recovery support networks, Peer Support Specialists and Recovery Coaches often provide an initial link to care for someone seeking help after an overdose or just wanting help. In many instances, they continue to work with people for longer periods of time - helping them find and get through treatment, as well as to provide support in meeting needs to maintain recovery. How are peers being utilized in the area? Is there room to expand current efforts and add more peer support through additional training and funding? If more peer specialists/coaches could be added in the region, who is needed to help make that a reality?
Harm Reduction Saves Lives and Provides a Linkage to Care. The distribution and training of how to use naloxone continues to be an effective way to reverse opioid overdose and save lives. Other programs, like needle/syringe exchanges, reduce the risk of infection and prevent the spread of other diseases. Resistance to these programs is reduced when they are paired with providing information about treatment options and other available support in the community. What training on naloxone administration is available in the area? How is this service being marketed to ensure organizations across the health system know it is available? What are the most effective ways to expand distribution of naloxone and add other harm reduction measures? Are there ways to improve linkages to care? What can the coalition do to reach more people, especially in areas with the highest rates of overdose, to expand harm reduction efforts?
The Criminal Justice System Plays a Key Role. It is generally recognized that a person suffering from SUD can be helped to a far greater degree through various diversion and treatment programs that can lead to a life in recovery, as opposed to long-term incarceration. Socially and economically, this is tremendously beneficial to society. What options are there for those in the criminal justice system in terms of diversion, drug court, treatment while incarcerated, and treatment/support services for those leaving incarceration? Are there areas that need to be added or improved? Given what programs currently exist, what improvements could be made within the state and local criminal justice systems in terms of additional or expanded programs to help those with SUD find treatment - either through diversion programs or treatment for those incarcerated? Are key figures who are part of the system willing to participate in a coalition?
Increasing Recovery Supports are Critical to Long-term Success. Housing, education, childcare, job training, and job placement assistance are just some of the recovery support services needed to help people in early recovery. Without these supports, many with limited means and/or a criminal record can become frustrated and hopeless - increasing their chances of relapse. Communities with strong supports for people newer to recovery have seen positive results. What types of recovery support services exist in the region? Who are the key organizations working on one or more recovery supports? Are area employers engaged? What about area workforce development entities? Who can help expand these efforts as part of the coalition?
Available Tools and Resources
Leaders of faith communities can support strategies to address substance misuse and support recovery in their community. Please see the Opioid Epidemic Practical Toolkit: Helping Faith and Community Leaders Bring Hope and Healing to Our Communities. Programs like One Body Collaboratives and software like Meet the Need can help engage and equip churches to participate in their communities. 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.
Harm-reduction organizations are nonprofit groups that advocate for public access to naloxone, Good Samaritan laws protecting users from arrest if they call 911 to save a friend, needle exchanges, and in some cases safe-use zones. In many communities, harm-reduction and law enforcement seem to be polar opposites. Law enforcement personnel are 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 in your community 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 a great way to start the conversation between these two communities, both focused on saving lives.
National Efforts. There are many national coalitions and organizations that can 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.
- SAMHSA Implementation of a systems approach can be seen in the advancement of recovery-oriented systems of care (ROSC). 
- 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. 
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.  Other local coalitions might not be as complex or highly structured, but this example helps to provide ideas of what could be considered.
- Senge, P. (1990). The fifth discipline. New York: Doubleday.
- Stroh, D. (2015). Systems thinking for social change. White River Junction: Chelsea Green Publishing.
- 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.