Ron Bialek, MPP, President, Public Health Foundation.
First, the good news. Substantial federal, state, and local resources are being allocated for planning and implementing responses to the opioid crisis. For example, there are new and redirected federal funds available through the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, Health Resources and Services Administration, Department of Education, Department of Justice, National Institutes of Health, and the list goes on. The bad news, however, is that these resources are in silos and have diverse and often disconnected requirements, resulting in funding driving local and state strategies.
Strategies and actions to respond to the opioid crisis require working across sectors, and tailoring to address local conditions such as culture, language, poverty, housing, education, historical trauma, and more. Developing siloed strategies to meet funding source requirements, rather than designing cross-cutting strategies that address local conditions and needs, is not a recipe for success.
How can states and localities reverse this situation so that effective strategies are developed and actions taken that result in reducing opioid-related mortality and morbidity, address the root causes that have been contributing to this crisis, and impact overall substance misuse and abuse? The Public Health Foundation (PHF) recommend the following approach:
- Convene multiple stakeholders and identify primary, secondary, and tertiary prevention strategies.
- Determine specific short-term and longer-term actions to be taken.
- Explore the multitude of federal, state, and local government funding sources and requirements to determine how each specific funding stream may fit with the identified actions.
- Identify gaps in funding to address identified actions.
- Explore less traditional funding sources to help fill in the gaps (e.g., local businesses, philanthropic organizations, hospital community benefit implementation strategies, Medicaid waivers, community development financial institutions)
- Align funding to the local strategies and actions.
- Develop metrics and tracking strategies to assure compliance with the various funding sources.
By no means is the above approach simple. But, this approach will result in the locally-developed strategies driving action, rather than the funding determining what actions will be taken locally. This also will result in a greater likelihood of truly impacting the opioid crisis, both short- and long-term.
The PHF Population Health Driver Diagram framework is an excellent place to start. This framework results in developing strategies and actions across sectors that are feasible and impactful. When initiating discussions with your community or state coalition, it may be useful to review the opioid-related driver diagrams drafted by individuals from hospitals and local health departments and by state health officials. These draft driver diagrams can provide your coalition with ideas about what you may want to include in your locally developed driver diagram. Once the driver diagram is completed, the next step is to identify and align funding sources. Depending on where you are located, there are likely to be different approaches to identifying the various funding sources and requirements. A good place to start may be at the state level because many of the federal funding sources go directly to state agencies. If there is a statewide task force, it is possible that information about federal and state funding sources and requirements may be available through that body. However, identifying and aligning funding sources will likely require considerable digging.
Seeking outside assistance also may be helpful. For instance, PHF assists communities in establishing coalitions, developing population health driver diagrams that identify the drivers of change and specific actions that can be taken locally, and identifying funding sources to help implement short- and longer-term actions. If you are interested in seeking assistance from PHF, the best place to start is a discussion about your local conditions and needs. Contact Ron Bialek, [email protected], 202-218-4420 to begin your discussion and explore ways that PHF may be able to meet your community’s unique needs.