Community Outreach and Collaboration

The opioid crisis spans many different areas of care and response. It affects EDs, ORs, neonatal ICUs, police, fire, EMT, family practice, behavioral health, dental, Federally Qualified Health Centers (FQHCs), pharmacies, schools, libraries, homeless shelters and most of all, families.

Hospitals and health systems across the United States have begun to realize the effect of the opioid crisis and its immensity. Although great strides are taking place in organizations to reduce opioid prescriptions and help with treatments of opioid addiction, they are learning that they cannot do it alone. We all need to collaborate and work with each other, and at times with some untraditional partners, to be successful in stemming the tide against the crisis.

Reaching out to the communities we serve. building relationships and collaborating with other entities and organizations are vital to success. There can be many different reasons or objectives for collaborating with other entities and organizations spanning regions or within local areas. There are many resources at the national, state and local levels available to help fight the opioid crisis. Single entities and organizations will have a much larger impact in their communities by leveraging and working with other resources in their area.

In some instances, though, resources or programs just don’t exist. To fill the gap, people may need to look outside the box and join forces to create frameworks or programs. In order to do that they need to locate and align themselves with people and organizations they may not have had contact with before.

Some examples of collaboration and community outreach include working with FQHCs to design or leverage an existing Suboxone treatment plan. Hospitals can reach out to local health services to place resources strategically in the most effective areas. There are opportunities to work with police departments on strategies dealing with overdoses and treatment options, or with school systems to proactively educate children and parents about the dangers of opioids and prescriptions. Working with pain management practitioners within local and regional areas may help identify new standards and alternative treatments.

This chapter will look at different types of collaborations among different organizations and entities. Where possible, we will highlight the role of IT in facilitating these collaborative endeavors.

• Lily’s Place Neonatal Abstinence Syndrome Center in West Virginia.
• The Emerald Jenny Foundation
• PROACT
• North Sonoma County Opiate Harm Reduction Task Force

In October of 2014, Sara Muncy and Rhonda Edmunds, two nurses in the Cabell Huntington Hospital in West Virginia, joined forces with volunteer Mary Calhoun-Brown to address the increasing number of babies born with drug exposure. The state has the highest rate of neonatal abstinence syndrome (NAS) in the nation, with 33 NAS births per 1,000 babies, according to Stephen Patrick, MD, a physician and professor of pediatrics at Vanderbilt University.

NAS babies have much different responses and requirements for their recovery and wellbeing. Edmunds and Muncy visited Pediatric Interim Care Center in Kent, Wash., and learned techniques that would provide better therapeutic care to the drug-exposed babies at the hospital. When they returned, they implemented a comprehensive program directed specifically at treating the NAS babies within their system.

Lily’s Place, located in Huntington, is the first neonatal abstinence syndrome center to open in the U.S. Lily’s Place provides a continuum of care to any NAS baby born in West Virginia, from medical services to social work. This holistic approach means they can care for infants going through the withdrawal processes while simultaneously helping families deal with the special circumstances that surround having a NAS baby. The center has specially trained nurses, social workers and patient care assistants. Doctors from Valley Health oversee the medical treatment of the babies, and volunteers ranging from college students to grandparents’ rock babies, do laundry, clean and perform odd jobs around the building.

CHIME members interviewed Lily’s Place management for this chapter. Below are their answers to our questions:

Q: Can you describe the governance and membership of the collaboration? (e.g., participants, oversight, subgroups, responsibilities, etc.)?  

(Membership includes) the West Virginia Department of Health and Human Resources, the West Virginia State Legislature and the West Virginia Legislature Women’s Caucus. We had to break through a lot of traditional structures, rules and bureaucratic regulations because no place like this existed the way we felt would be best for babies.

Q: Did you have challenges gaining buy-in from all of the stakeholders? If so, how did you overcome those challenges? 

We did have challenges from hospitals, West Virginia Department of Health and Human Resources and Medicaid, all thinking we could not provide safe care for babies outside the hospital. There was concern how to license us. … behavior health, nursing care facility or create a separate license. Each came with hurdles and hoops and extended our time of opening a facility for years. – we overcame by education and many meetings to finally get buy-in from all parties.

Q: Did your effort have a charter, vision or mission that you could share with us?

At Lily’s Place, our mission is to provide medical care to infants suffering from neonatal abstinence syndrome and offer non-judgmental support, education and counseling services to families and caregivers.

“Many mothers need long-term care and counseling to balance the harm of trauma and drug addiction,” said Executive Director Rebecca Crowder in an interview with the West Virginia Executive. “The services provided by Lily’s place do not end when infants graduate from our program.”

Providing for the babies means providing support and education for their parents – or, in certain cases, their foster parents, adoptive parents, grandparents, or other family members. Custody decisions are made by West Virginia’s child protective services. Crowder said one of her goals for the future is to expand the center’s support services to include full-time recovery coaches and substance abuse counselors. Eventually, she said, she’d like Lily’s Place to house an intensive outpatient program for mothers who want recovery but are afraid of losing their children.

Support for Lily’s place comes from the communities, schools, businesses and other organizations throughout the tri-state region. Even the building itself was a gift from the community – and “nothing short of a miracle,” Edmunds said.

While there are no plans for expansion into other counties in the Mountain State, others have contacted Crowder about replicating the Lily’s Place model. A guide is available for a fee at https://www.lilysplace.org/replication-plan. More information about Lily’s Place is available at www.lilysplace.org.

“As a parent, I would tend to focus on the behavior.” So, begins an interview Bill Ayars did with Smart Business, talking about his approach for dealing with daughter Jennifer Emerald Ayars’ addiction struggles. Jennifer lost her life after an overdose in 2016 at the age of 28. Her father then realized that he never fully understood that addiction was a disease.

In memory of Jennifer, he and his family founded a non-profit to help others find resources that might be suitable for their situation. The Emerald Jenny Foundation is a 501(c)(3) free searchable database for rehabilitation and treatment facilities, healthcare providers, counselors and other organizations in Ohio dealing with drug and alcohol addiction.

They started by researching treatment providers in Northeast Ohio and contacting them in January of 2017 to verify information to provide on the website. The website went live on May 14 – Jennifer’s birthday – with 14 counties in Northeast Ohio. In July, they decided to expand, following the research and verification process used earlier with contacts throughout the state. In October of 2017 the entire state was covered, and by January of 2018 the Ohio Department of Mental Health had replaced its online addiction locator with the Emerald Jenny Foundation website.

Emeraldjennyfoundation.org offers an easy and efficient process to search for treatment facilities. Searches can be refined to include criteria such as age, gender and more. Visitors can view facility profile pages with contact information. The foundation collaborated with their website developer, who helped them to launch the website in a short time, build out statewide content and develop a social media strategy.

CHIME members talked with Director of Operations Susan Tary for this chapter. Below are her answers to our questions:

Q.: What is the most important factor in successfully collaborating with multiple organizations?

First, ​dedication to the mission. We all felt this was an extremely important cause. We were keenly aware of the fact that people were dying every day. Every number was a person to us. We wanted to relieve some of the suffering that Ohio families were experiencing. We still feel that same desire to alleviate at least the problem of not knowing where to begin the search for help. Second, communication; we began by keeping each other in touch with our progress, and that continues to be how we operate. 

Q.: Please describe IT’s role in the collaboration or any tools or products that were used to help with the collaboration.

We worked very closely with the website developer, having regular meetings to ensure everything went as planned and on schedule. Fortunately, the website developer took our mission as THEIR mission. They did some research on their own, becoming knowledgeable about the crisis and they pushed as hard as we did in getting the website up and running on time (an amazing four months after we began), as well as expanding it when we decided to cover the entire state, and helping us define our social media strategy.  

PROACT, or the Provider Response Organization for Addiction Care and Treatment, is a community collaborative established in Huntington, W. Va., to fill gaps in care for people with substance abuse disorder (SUD). PROACT partnered in 2009 with Valley Health to offer medication-assisted treatment to the region. Over the decade, numerous complementary programs (including Lily’s Place, detailed earlier) formed to address aspects of the opioid crisis. Realizing the need for a comprehensive approach, healthcare organizations collaborated to address SUD’s clinical, behavioral and spiritual issues. Cabell Huntington Hospital, Marshall Health and St. Mary’s Medical Center became PROACT’s founding partners in April 2018 and Thomas Health System and Valley Health came on board after that.

PROACT offers the following services to treat substance use disorder and help individuals achieve long-term recovery:

• Clinical assessments
• Medication-assisted treatment
• Peer recovery supports
• Individual and group therapy
• Career placement and career readiness training
• Spiritual care
• On-site pharmacy

Today Proact serves as a centralized resource for SUD treatment, recovery, therapy, education, research and support. PROACT unveiled its first facility in Huntington in October 2018 in a renovated CVS Pharmacy. Its reach includes the Charleston-Huntington region and other parts of the state using telemedicine capabilities. It is seen as a model that can be adapted to meet the needs of other communities.

CHIME members interviewed PROACT Director Michael Haney for this chapter. Below are his answers to our questions:

Q.: When did you start your engagement with collaborating with other agencies, organizations or departments?

The different partners involved in PROACT began discussing the project in 2017. Marshall Health, Cabell Huntington Hospital and St. Mary’s Medical Center were the initial partners and they formed the original board and filed for incorporation in February 2018. Valley Health and Thomas Health were involved in discussions shortly thereafter but were not made official members of the PROACT Board until just prior to the opening of the Huntington PROACT location.

Q: Please describe IT’s role in the collaboration or any tools or products that were used to help with the collaboration?

IT played an incredibly important role in the creation of PROACT and continues to play one today. One of the more challenging parts of this collaboration has been the integration of two separate clinics into one site. PROACT is occupied by both Marshall Health and Valley Health, existing side-by-side, sharing staff and resources. That said, however, both entities maintain separate electronic health records that don’t interface with each other, necessitating scanning in order to incorporate documents from one service into the records of the other. Also, as PROACT exists off-site from their respective servers housing both EHRs, communicating with the servers has been an issue. 

The original concept of PROACT called for the majority of the billing to be done through Valley Health and so it was their equipment that we decided to utilize. Unfortunately, after installation problems became apparent as Valley utilizes a “thin client” system, which makes it difficult to interact with Marshall systems as we essentially use an app to communicate with another app in order to gain access to Marshall’s EHR. It also causes a restriction to even such simple resources as Microsoft Office. IT has played an important role in helping us navigate these issues as electronic communication is the norm now rather than a luxury.

Q.: Did you have challenges gaining buy-in from all of the stakeholders? If so, how did you overcome those challenges?

The really incredible thing about this process was how cooperative and excited all the stakeholders were from the beginning. The only challenges have come from simply defining the scope of work for each of the partners involved and how the partnership would be structured.

In June 2018, Terry Leach, health policy and innovation consultant with the American Association of University Women, started to reach out to organizations in northern Sonoma County to build a North Sonoma County Harm Reduction Task Force. The initial request went to the Healdsburg Police Department, Healdsburg School District, Public Health Department and local providers Dave Anderson, MD, and Walter Maack, MD.

The objective of the collation was to raise awareness of the opioid crisis in Northern Sonoma County and prevent opioid drug overdose deaths. As the collation started to take shape, Walter Maack and his wife Bretta emerged as the face of the cause. In 2017, the Maacks tragically lost their son Morgan, 37, to an accidental heroin overdose.

The task force started meeting to go over the basic tenets of a successful advocacy program. Members needed to come together and focus on the initiatives and plan of action. In order to succeed, each area needed to designate a champion. These champions could then go back to their respective organizations and lead a subcommittee to address the issues and objectives of the Harm Reduction Coalition.

Local statistics were provided by the police department and local health agencies. Although the   crisis had not truly taken a foothold in the area, there were signs of growing problems. The local police had reported that overdoses were on the rise and that it would be prudent if the officers started to carry Narcan to treat overdosed individuals if the police were the first to arrive on the scene.

As the coalition was built and gained momentum, some additional organizations and entities started coming on board and implementing mitigation strategies. An example would be that local middle schools started talking about adding prevention curriculum. Local police departments initiated programs that would allow their patrol officers to administer Narcan on the scene to unconscious drug overdose victims.

Healdsburg City Police and Healdsburg District Hospital collaborated to provide fentanyl test strips in their lobbies to help addicts identify possible deadly fentanyl levels. Both organizations announced that the strips would be provided with no questions asked.

The committee struggled to locate physicians in the area who were willing to prescribe Suboxone to help patients to end their addictions. Through solicitations and networking, several providers and clinics were identified that would start prescribing Saboxone.

Leach proposed to establish and conduct a community-wide forum to raise awareness of the problem and identify resources available to the community. A date was selected in October of 2018 to have a community engagement and education session at a local community theater. Champions were asked to provide topics and materials that would support the event and educate the community about the ongoing crisis.

As a first outreach effort to the community, an article was published by the local Healdsburg Tribune to highlight the extent of the opioid crises and inform the community about the public event that was scheduled in October at the community theater.

The format of the event started to take shape. The event would have video introductions that would have the Maacks describe their loss and the impact the crisis has had on their lives. After the videos a panel consisting of the Maacks and Gary Pace, MD, a local provider, discussed the crisis and contributing factors that caused it. The session concluded with a community Q&A with members of the panel.

Demonstration tables were put together by Healdsburg District Hospital and Alliance Medical Center. Volunteers at the tables demonstrated how to use the fentanyl test strips and how to apply the Narcan spray in case of an overdose.

The event was well attended and many of the audience members were directly affected by the crisis. The community questions were emotional and raw. There were levels of frustration within the community on the factors that had brought them to this point in the crisis. Panel members engaged and shared their expertise and experiences. The question session ended with an emotional community member sharing that she had lost her son to the epidemic and pleading with audience members to do whatever they needed to do to prevent it from happening to their loved ones.

The North Sonoma County Harm Reduction Task Force is moving into 2019 with new goals and plans to hold more events and engage with more organizations to fight the epidemic. Some of the goals for this year are:

• Soliciting throughout the county to try and get more providers Medication Administration Certified (MAT) certified.
• Make an effort to pull in resources and contacts that can connect and communicate with the homeless communities.
• Help with Bright Heart Health to collect data from across multiple agencies.
• Reach out to the County Sheriff’s Office to try and provide information to the jail systems on treatment requirements.
• Coordinate another community event that might include more topics such as raising awareness, providing information about resources available to people addicted, more demonstrations on test strips and Narcan administration.

Lily’s Place

https://www.lilysplace.org/

https://www.circa.com/story/2018/07/20/nation/lilys-place-was-the-first

http://www.wvexecutive.com/lilys-place/

https://people.com/human-interest/lilys-place-west-virginia-clinic-nurses-newborns-opioid-withdrawal/

https://www.huntingtonquarterly.com/articles/issue96/nothing-short-of-a-miracle.php

Emerald Jenny Foundation

https://www.emeraldjennyfoundation.org/

https://www.cleveland.com/metro/2017/12/emerald_jenny_foundation_creat.html

https://www.crainscleveland.com/section/toc/weeks-issue-november-27-2017

PROACT

https://proactwv.com/

https://www.herald-dispatch.com/news/addiction-treatment-hub-coming-to-city/article_cd051bfe-0ef8-5909-9499-0526700b44b8.html

North Sonoma County Harm Reduction Coalition

http://www.sonomawest.com/cloverdale_reveille/news/confronting-the-opioid-epidemic-in-sonoma-county/article_9c91179c-cc03-11e8-8494-6fc031dac114.html

http://www.sonomawest.com/the_healdsburg_tribune/news/task-force-formed-to-battle-opioid-addiction/article_4d43c00c-bc60-11e8-8aae-fbf05c013061.html

http://mobile.raventheater.org/event.php?event_id=948