10/10/2019

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Policy into Practice: Using Nurse-led Collaborative

Groups to Develop Substance Use Treatment Initiatives

Tanya R. Sorrell, PhD, PMHNP-BCMary Weber, PhD, PMHNP-BC, FAANP, FAAN

Paul Cook, PhDClaudia R. Amura, PhD, MPH

Disclosure Information

No disclosures to note

Presentation Objectives

• Review 2 nurse-led advocacy groups state and local level

• Discuss methods to develop groups designed to educate, advocate, and advise legislative policy decisions

• Develop "Next-Steps" plans specific to your local/state areas

• Outline facilitators and barriers to successful policy care provisions that facilitate improved outcomes

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Colorado Opioid Epidemic:

Overview

• Colorado ranks 12th in nonmedical use of opioids • 25% of Coloradans use non-prescription pain medications• ~ 20,000 D.U. prescription drugs seized annually• Only 36% of Coloradans wanting treatment can access it • Alarming rise in opioid-related deaths

Nursing Collaborative Potential

• Nurses serve as leaders in the healthcare field and with the community in general as the purveyors of health education and advocacy.

• Nurses have a unique opportunity to provide policy guidance as the US addresses the current Opioid and Substance Use Crisis.

Project #1

• Project 1- a statewide initiative to increase the number of Advanced Practice Nurse Practitioners providing MAT services to rural/frontier counties in Colorado

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Policy Overview: Collective Impact

• Enables a group to address a major challenge by developing an integrated plan of interventions that fundamentally changes population-level outcomes in a community.

• Allow solving big complex challenges (e.g., youth unemployment, low graduation rates, poverty) or make substantial societal shifts (e.g., more sustainable food systems)

2013• CO Substance Use Task Force

• Naloxone Kits

2012• CO Plan to Reduce Prescription Drug Abuse

• Prescribing Provider Education

2013• CU- College of Nursing

• SBIRT Education in schools, hospitals, and clinics

Initial Policy Work: Silo’d Sections

• Social problems and solutions have multiple interacting factors

• Alignment with government, non-profit, philanthropic and corporate sectors as partners

• Coordinated actions and sharing lessons learned• Work toward the same goal and measure the same

things

What is Collective Impact?

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TrustTrust

Turf

LooseTight

Compete Co-exist Communicate Cooperate Coordinate Collaborate Integrate

Competition for clients, resources, partners, public attention.

No systematic connection between agencies.

Inter-agency information sharing (e.g. networking).

As needed, often informal, interaction, on discrete activities or projects.

Organizations systematically

adjust and align work with each other for greater outcomes.

Longer term interaction based on shared mission, goals; shared decision-makers and resources.

Fully integrated programs, planning, funding.

The collaboration spectrum

Colorado Consortium for

Prescription Drug Abuse Prevention

Collective Impact: 2014 Partners

OpioidOpioidResponseResponse

CollegeCollege of of NursingNursing

School of School of PharmacyPharmacy

Community Community leadersleaders

Public/Public/

ClientsClients

LegislatureLegislature

Law Law EnforcementEnforcement

Public Public HealthHealth

College of College of MedicineMedicine

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Mobilizing Policy= Patient- Provider-Academia- Legislature ACTION!

Medication Assisted Treatment

Benefits:• Reduction in drug-

related overdose deaths• Reduction in disease &

violent crimes• Improved treatment

outcomes

MAT providers 2014

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CO OD rates in 2014

Pilot MAT Bill

SATR, Consortium and CON

-Draft Bill

Review with

stakeholders across the state

Review with Committee Members in Legislature

Develop Bill

Testify and Educate

Legislature

Pilot MATBill!

Pilot MAT Program: Resource Allocation and Goals

SB17-074 Resource Allocation

• $500,000 per year for 2 years, $123,000 per organization per year

• Continued funding based on review of CO legislature expenditure programming

Goal #1: Increase the number of MAT-trained NPs/PAs in 2 rural counties

Goal Two: Increase access to MAT and other therapies for individuals with OUD

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# o

f M

AT

Pro

vid

ers

Availa

ble

in

Com

munity

Agency

0123456789

PA

NP

MD

Pilot MAT Program:

Results for SB17-074

Site 1 (Pueblo)Methadone & Suboxone MAT

Site 2 (Pueblo)Suboxone MAT

Site 3 (Routt) Suboxone & Vivitrol MAT

Goal 1: Goal 1: Increase # new providers in underserved areasIncrease # new providers in underserved areas

89

100

298284

60

219

98

46

0

50

100

150

200

250

300

350

400

Site 1 (Pueblo) Site 2 (Pueblo) Site 3 (Routt)

2017

2018

2019 (Q1-Q2)

#M

AT

Patients

Seen

(Cum

ula

tive for

Year)

Methadone & Suboxone MAT Suboxone MAT Suboxone & Vivitrol MAT

Pilot MAT Program:

Results for SB17-074

Goal Goal 2: Increase # patients2: Increase # patients

Pilot MAT Program:

Client’s FeedbackYou have been so supportive and patient with us that we want to share some anecdotal comments about our program:” (agency)

“Got my life back, my children back, and my dignity back. I could not have

done with it without the MARC.”

“Suboxone has literally saved my life. I didn’t think I was going to live at the rate I was going. I am clean and I am sober and feel like I have a second lease on life.”

“My family trusts me again enough to where I can live with them again. My children are happy to have their mommy again.”

“I have a new job, my own apartment, and was able to grieve the loss of my pregnancy appropriately without using drugs, and focus on my two children. And lead a healthy life, like normal people do.”

Today both patient and patient’s mother said, “We don’t know what we would have done if you were not available to see me today. We had called several other places and no one is accepting new patients until mid February. You saved his life and our family.”

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MAT Program:

Future Goals

• Ongoing advocacy and legislative support for increasing NP prescribing numbers• Increase Loan Repayment Program numbers• Link to recent 2018 MAT waivered- CRNAs, CNM, CNS,

• Increasing Naloxone kit availability- “Take Naloxone Home”-August 1, 2019

• July, 2019- SB(19)-01 Expanded MAT Program to 13 rural counties• $2.5 million/yr for 2 years 2019-2021• CON leading clinical administration

Can Collective Impact Happen?

But on a Smaller Scale?

You can, too!

Project #2

• A county-wide project to increase Treatment on Demand access to substance use treatment to those in need

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Denver Coalition for Collective Impact

• In 2016, DPHE funded 1 employee for development of Syringe Access programs

• DCCI formed in 2017 to coordinate efforts

Denver Collaborative Collective Impact

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A Typical Collective Impact

Journey

Stage I: LaunchCreating the Team

Stage II: Building our Collective Impact Framework Identifying Themes

Stage III: Refining our Collective Impact Framework

Identifying Strategies

Stage IV: ConnectingSharing With Key Partners

Stage V: Action PlanningMoving on Strategies

Stage VI: ImplementationSupporting Community Action Through

Collective Impact

Create your team

Identify Themes

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Identify Strategies

Key Partners

Move on Strategies

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Action Implementation

© 2012 FSG35

The 5 Phases of Collective Impact

Source: FSG

www.fsg.org35

© 2012 FSG36

Next Steps for your Plan- Make contacts with your community Health

Departments- see where they land in your plan- Make contacts with your local and state

legislators- inform them of your Impact planning

- Assess the needs of your community- Decide goals and outcomes of your group- Get to work!

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DCCI- Impact areas to dateTreatment on Demand- Access survey to develop call line- Safe-injection site

- Policy and State approval → National policy

Lived Experience- Peer Support development- State bill for reimbursement

Data- Methamphetamine OD and treatment options

Judicial - Jail services- MAT, LEAD

Financing!Methods that Collective Impact groups use to finance changes

• Legislative funding• Focus on return on investment- $7 for each $1 spent• Potential funds from Opioid recovery suits, drug companies• Taxes from cigarettes, other substances for funding

• Also helps garner support for taxes• Go-fund-me and other collective fund agencies• Grants, programs, donors- private/public

• Will to action• Tug the Emotional Heartstrings• Lived Experience/Testimony

• Focus on results, and long-term community improvements• Medical, Jail, Social services costs

Facilitators - Barriers- Much political movement with current pharmacy settlements

pending- Development now can prepare you for directed

treatments/programs for this funding

- Continued stigma of substance use- Provide educational packets and testimony to officials- Health fairs and community outreach in substance use- Bio-behavioral knowledge on addiction pathways

- “Just say NO” to diabetes- Use stages of change learning to ‘normalize’ addiction

experience- diabetes, weight loss, exercise, smoking- Financial priorities- focus on ROI, budget vs outcomes

- Small pilots that can move decision making

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Outcomes and Measures

Goal settings starts at the start of the group- What areas you want to address- What objective, measureable goals- SMART

- Number of clients seen, MAT providers trained- % decrease in opioid/benzo combinations, % PDMP look-ups

- Review periodically and adapt

References

• Colorado Health Institute (2018). "Death by Drugs: Colorado Reaches a Record High for Overdose Fatalities. Again."https://www.coloradohealthinstitute.org/research/death-drugs.

• C. D. P. H. E. (2018). "Good To Know- Colorado: Substance Use Prevention." from http://goodtoknowcolorado.com/before-you-use/marijuana-101.

• Collective Impact Forum (2019).”What is Collective Impact?” Retrieved from https://www.collectiveimpactforum.org/what-collective-impact

• Community Tool Box (2019). “Collective Impact Tools” Retrieved from

https://ctb.ku.edu/en/table-of-contents/overview/models-for-community-health-and-development/collective-impact/main

• Frank, J. (2017). "Colorado’s opioid epidemic explained in 10 graphics."https://www.denverpost.com/2017/11/06/colorado-opioid-epidemic-explained-10-graphics/

• Korthuis, P. T., et al. (2017). "Primary care–based models for the treatment of opioid use disorder: a scoping review." 166(4): 268-278.

• LaBelle, C. T., et al. (2016). "Office-based opioid treatment with buprenorphine (OBOT-B): statewide implementation of the Massachusetts collaborative care model in community health centers." Journal of substance abuse treatment 60: 6-13.

• Mendelson, B. (2014). Drug Abuse Patterns and Trends in Colorado and the Denver/Boulder Metropolitan Area. National Institute on Drug Abuse.

• Post, W. (2016). Survey: Colorado stands out for consuming drugs, alcohol. Denver Post. Denver. https://www.denverpost.com/2016/05/23/colorado-first-in-drugs-survey/