About the OCRH
The Opioid Coalition Resource Hub (OCRH) was created to help community coalitions and states more effectively respond to our nations sweeping opioid epidemic. No community or state has solved this crisis, so it is a "moon shot" that requires a blend of rapid learning, use of research, and unprecedented collaboration along wit continuous innovation and pro-active problem-solving to accelerate progress. In spite of many years working to address substance abuse in general and the various stages of the opioid crisis, communities and their local coalitions are still struggling to make significant progress.
Some people working to address the crisis are still looking for a silver-bullet fix, the one program or effort that will solve this issue. The OCRH is based on the thinking that there is no silver-bullet intervention that will solve this crisis, but rather that a robust, multi-faceted strategy is needed to simultaneously address as many factors as practical and use as many available resources as can be harnessed to implement that strategy. Beginning in late 2015, a team of consultants at InsightFormation, Inc., who work on advanced practices in community strategy implementation began to review the growing number of "comprehensive" recommendations that were coming out from groups like the Governor's Council on Alcoholism and Drug Abuse, the U.S. Surgeon General's report, numerous strategic recommendations from states or large prescription drug abuse task forces, the DEA, SAMHSA, medical associations, the National Governor's Association, law enforcement groups, and other respected sources of information. Some reports were hundreds of pages long, and many had some similar recommendations but most had a variety of recommendations that were not included in other reports. Many recommendations were worded differently but essentially pointed in the same direction. Some were more high-level and others were focused on specific groups like pain professionals or local health departments. We initially started by developing a consolidated list of strategy recommendations and attempted to organize them in broad categories and then decided to develop a master "strategy map" template so states or coalitions that were working on a strategy would not have to expend precious time and resources repeating the exhausting task of trying to create a comprehensive framework.
In early 2016, we realized that just having a strategy map would be helpful, but communities would either be stuck without a means to make progress on all the important objectives or they would spend their resources in re-creating the means for trying to advance various strategies. So, we decided to share the strategy map as a free, open source tool that would continue to be refined, and we decided to being building out a free, open-source knowledge repository structured around the strategy map. Since the top priority audience for these resources were state and community coalitions, we launched this as the Opioid Coalition Resource Hub. We chose to use a wiki platform and try to adopt practices (like using footnotes to link to the source of information as often as possible) to enable people to apply good judgement in how they rely on the information in the OCRH.
The OCRH is a carefully-structured and continuously growing compilation of evidence-based strategies, innovative ideas, and lessons learned, and tools to help support understanding and implementation of plans to achieve positive change. When implemented in parallel and as a coordinated effort, these strategies can help communities make faster and more successful progress in achieving the important outcomes we hope to see: less people dying of overdoses, more people in successful recovery, and vibrant communities with hope.
The OCRH is continually evolving as new tools, products, and ideas are developed and as new research emerges and communities gain experience attempting the various strategies. New information--including ideas and research or links to communities working on similar approaches--is added nearly every day. Communities do not have to wait for rigorous evidence-based practices to start taking action in their community. Many of the strategies that communities are using or may attempt to use may never be part of a rigorous research study because the problems and potential solutions are evolving so quickly and the factors are so complex that doing research is very difficult and expensive. Have you ever tried to get research funding for a new innovation that will likely evolve repeatedly as those attempting to use it learn and make adjustments?
As the OCRH matures, each strategy page will equip communities with ideas to take immediate action, tools, lessons learned, options for creatively engaging under-utilized partners, and suggestions of ways to practically measure progress. The more organizations, coalitions, universities and other stakeholders use this an add information to it, the faster communities can learn and implement the most effective interventions in the most efficient ways. In 2018, we hope to have more and more pages adopted by individuals who care about the topic and who can identify an independent expert to periodically review and add comments to each significant page.
Are the Strategies and Ideas in the OCRH Evidence-Based?
The OCRH has been influenced by a variety of national, state and local strategic plans including, but not limited to: SAMHSA, CADCA, CDC, President's Commission. In many ways, the strategy map framework is a robust and comprehensive Theory of Change to solve a problem that has never been solved (the opioid epidemic). So, it is technically impossible to have a comprehensive strategy map or theory of change that has been demonstrated to solve the problem we are facing. When NASA began plans to put a man on the moon and bring him back safely, they did not rely on only using evidence-based techniques but instead systematically broke the big challenge into many smaller challenges and brought the best combination of science, innovation and pro-active risk management to develop a strategy and them implement that strategy. We believe a similar mindset is appropriate here. (The opioid crisis is much harder to solve due to the complexity when compared to the Apollo mission, which was a big complicated engineering problem, but without as many constantly changing complexity of the opioid crisis.) There are some great management lessons from the Apollo program in this presentation.
We want to see the OCRH grow as a dynamic platform that dramatically accelerates the learning of what is possible, what is being tried, what is working, how can interventions be improved, and what data is being collected for accelerated research. We are adding (and "crowd-sourcing" ideas for measures and hope that the most sensible measures will be highlighted and that many coalitions or regions would start measuring things in the same way to enhance data collection and subsequent research on the strategies that are being attempted.
As much as we hope to bring visibility to interventions and innovations that work, we want to bring visibility to things that don't work and then determine if adjustments or "assists" could improve their success or if the evidence indicates that the idea should be abandoned.
Why Strategy Maps?
There are several reasons for using the Strategy Map format as opposed to logic models or driver diagrams to structure a strategy for an issues such as the opioid crisis. Strategy maps are a well-established tool for strategy implementation with over 20 years of success. They are therefore both a well-established evidence-based approach for improving the implementation of complex strategies (something very much needed for addressing the opioid crisis) and also a valuable innovation in that this proven technique and the rich body of knowledge of how to use it has not been used much in public health and for helping communities address the opioid crisis.