Horizon Public Health, Minnesota
September 26, 2018
Horizon Public Health, Minnesota
September 26, 2018
The opioid epidemic has spread rapidly and uncontrollably through our country and our community. Research consistently links Adverse Childhood Experiences and Adverse Community Environments, the Pair of Aces, with opioid use and abuse. Ending this threat requires a coordinated, community-wide effort between non-traditional partners to address the immediate crisis as well as the root causes.
Recognizing the rising number of opioid prescriptions being written as well as the total opioid pill count being prescribed for patients by local clinic providers, the Chief Medical Officer (CMO) of a local clinic/hospital system reached out to a neighboring community that had experienced significant success in reducing opioid prescriptions and total pill counts through the implementation of a number of provider-based and community-level interventions. With a desire to replicate this effort in the health care system’s service area, the CMO partnered with Horizon Public Health to secure a state grant to educate providers, change provider prescribing practices, increase public knowledge and awareness and ultimately build community resilience in order to end the growing opioid abuse problem in our community. Engaging non-traditional partners in looking not only at the immediate opioid crisis, but also the underlying causes has been challenging. With some of the critical partners seeing only their traditional enforcement and emergency response roles, increasing their understanding of the Pair of ACEs has taken them far out of their comfort zone. Finding those rare “champions” has been instrumental in keeping those partners sufficiently involved to begin to understand the connection between ACEs and many social ills, including opioid abuse.
During the past year, Horizon Public Health, a 5-county local health department, brought together a broad sector of community representatives as the Community Partnership Team (CPT) to guide the Community Health Assessment process. After gathering and analyzing data and actively seeking community input through key informant interviews and focus groups, the 2 priority issues identified were Adverse Childhood Experiences (ACEs) and Drug Use. With those focus areas, the CPT again worked with community partners to begin the process of developing the Community Health Improvement Plan (CHIP). Simultaneous with the CHIP development, the community-wide initiative to address the opioid crisis in one Horizon community emerged. While the early focus of the local health care system was initially targeted at educating providers and changing opioid prescriber practices, the CMO has also become actively supportive of seeking community interventions aimed at reducing ACEs, a common root cause of the opioid epidemic. Three subcommittees have been formed to address: 1. Increasing public education and awareness of ACEs 2. Expanding resources to better respond to the impact of ACEs 3. Building community resilience Using this multi-pronged approach, the community anticipates having an immediate impact on the opioid crisis and a long term impact on ACEs.
The health care system’s focus on educating providers and patients, tracking opioid prescriptions and pill counts, and providing some public education has resulted in impressive reductions in the number of opioid pills being provided to patients along with a reduction in the morphine equivalents being prescribed. At the same time, the number of controlled substance care plans have increased significantly. Between 35 and 40 community partners participate in the bi-monthly Opioid Abuse Prevention Task Force meetings and provide updates about their respective organization’s efforts to respond to the opioid crisis. At the same time, the efforts to address ACEs as the root cause of opioid abuse have taken off. The Public Education and Awareness Subcommittee has identified those groups that have previously been educated about ACEs as well as the priority groups to be trained in the near future. Training opportunities and participation are being tracked. The Impact and Response Subcommittee is gathering information about existing resources and tools for responding to ACEs as well as identifying gaps in tools available to entire systems, such as the school system. The Building Community Resilience Subcommittee is identifying key partners and exploring broad community-wide approaches to building resilience.
Bringing community partners together around a well-recognized and prominent community health issue can result in profound changes in organizational practices and community norms. The “peer pressure” between sometimes competitive community providers is a strong incentive for each partner to contribute to the collective goal. Finding those “champions” within an organization, particularly a well-respected local physician whose perspective extends beyond the walls of the health care system, is an effective means of jump-starting a community-wide effort. By combining the influence of that champion with Public Health’s broad preventive approach and efforts to address the root causes, or social determinants of health, community partners can see both the immediate results in terms of a reduction in opioid pills prescribed as well as the anticipated long term impact that will result from addressing the underlying causes of drug abuse as well as other social ills of the community. In addition, it’s been a positive lesson learned that the increasing public discussion and concern about the impact of ACEs and Adverse Community Environments (the Pair of ACEs) has provided the forum for educating community partners and the public about the Social Determinants of Health, by simply using new terminology.