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/