Strengthening Your Community Coalition

 

 

Summary

The substance misuse and SUD epidemic is a complex problem requiring a highly coordinated and cooperative response from communities.  The increase in non-fatal and fatal overdoses in recent years has caused many communities to realize that individual organizations cannot afford to work in silos.  Without a unified strategy and a focus on common goals, communities addressing a crisis as large as the addiction epidemic will not be poised for success. There is a clear understanding that local government, community partners of all types, and the private sector must align and work together to develop and implement effective strategies to improve their collective response to the SUD epidemic across the continuum of care.  By bringing together and working with a broad range of stakeholders, communities large and small can develop solutions that work for all those touched by the opioid and addiction crisis.  

Creating a community coalition is one of the most effective ways to solve complex problems and it is at the core of creating a local movement.  A coalition is simply a group of individuals and organizations with a common interest, who agree to see the problem through each other’s eyes and work together toward a common goal.  A coalition concentrates a community’s focus on a particular problem, creates alliances among those who might not normally work together, and keeps the community’s approach consistent. 

This page provides an overview of what it takes to build and strengthen an effective coalition based on the experiences of communities across the country.

 

 

Building Your Coalition

Many local communities have assembled coalitions to improve response to the SUD epidemic.  There is no one-size-fits-all set of practices for creating an effective coalition.  The suggestions that follow are based on the experiences of many communities, and are meant to serve as a guide for those looking to form a new coalition or expand and improve one that already exists.  One important aspect when looking to create a coalition is to realize that, historically, substance use disorder has been seem by many as a moral failing and not a disease.  

As Mayor Nan Whaley from Dayton, Ohio puts it, "When we began our work in Dayton, there was no blueprint for treating a substance misuse epidemic because the United States has never treated addiction as it treats other chronic illnesses."  

Dayton and other communities who have found success have embraced the fact that SUD is a chronic health illness, not a choice.  This outlook, in turn, has informed a new set of strategies that includes compassion and meeting those suffering from SUD where they are at the moment.  

 

 

Getting Started

Who can start a coalition to address SUD?  Anyone can.  Existing Coalitions and Task Forces are often created by local elected leaders, public health departments, public safety agencies, community organizations, or even passionate individuals engaged in the fight to save lives and reduce harm created by drug misuse and SUD.  Typically coalitions are formed as a response to higher rates of overdose and overdose deaths.  Regardless of who takes the initiative, it is important to be inclusive and identify members whose ultimate goals align.  Without a collaborative effort of many, varied partners it is difficult to create and implement the types of comprehensive strategies needed to achieve success.

 

Potential Partners and Their Roles

There are many potential partners that can be invited as part of a coalition to improve response to SUD.  The following list is not intended to be all inclusive, and it is not required to have partners representing all groups.  These are suggestions based on the types of partners most often brought together.  Highlighted categories contain links to what roles they might play within the Coalition.

 

1. Local Health Departments
2. Hospitals
3. Pharmacists
4. Primary Care Physicians
5. Pain Specialists or Pain Centers
6. Nurses
7. Health Plans and Insurance Companies
8. Local Law Enforcement
9. Corrections
10. Treatment Providers
11. Faith Communities  (See examples of how to engage below) 
12. Persons with lived experience, including those in recovery and still using substances
13. Local Harm Reduction Organizations
14. Education Leaders
15. Business Leaders
16. Recovery Support Organizations
17. Family Support Groups and Recovery Allies

 

 

Lessons Learned and Related Questions

As you consider who to reach out to in order to create or expand a coalition, we have provided below some lessoned learned by communities that have gone through - and continue to go through - this process.  As you proceed you will likely find that the needs of the coalition, as expressed by the members, will change over time.  Most often the composition of the coalition will change as well.  The lessons are followed by questions that should be asked when considering potential partners to include.

 

Data is a Critical Foundation to Action  

The improved collection, distribution, and rapid analysis of data is critically important to the development of a strategy to address areas within a community that are being severely impacted by SUD.  This typically goes far beyond just tracking overdose deaths and non-fatal overdose.  It is important to know where they are occurring to know where more resources need to be deployed.   What data sources are available? How are they being used? Does the coalition have the partners needed to provide necessary data?  How can the coalition expand the data set to help focus resources where they are most needed, and when they are most needed?  What can be done in a short amount of time, at reasonable expense, to better collect, analyze, and make use of data related to the SUD epidemic in the region?

Harm Reduction Saves Lives and Should Provide a Linkage to Care  

The distribution and training of how to use Narcan continues to be an effective way to reverse opioid overdose and save lives.  Other programs like needle/syringe exchange reduce the risk of infection and prevent the spread of other diseases.  Resistance to these programs is reduced when they are paired with providing information about treatment options and other available support in the community.   What trainings on Narcan administration are available in the area? How is this service being marketed to ensure organizations across the health system know it is available? What are the most effective ways to expand distribution of Narcan and add other harm reduction measures?  Are there ways to improve linkages to care?   What can the coalition do to reach more people, especially in areas with the highest rates of overdose, to expand harm reduction efforts?

 

Agencies and Community Organizations May Need to Take on new Roles

There are many examples where organizations need to expand services and take on new roles to address the SUD epidemic - especially in underserved areas of the community. This might include:       

- Police working with peer recovery specialists/coaches in cases of overdose.

 - Community organizations taking on prevention/education/training roles.

 - Hospitals coordinating with area treatment providers to help overdose patients  

Do new roles need to be taken on by government agencies and/or community groups?  If so who and what new roles would be helpful?   Who should the coalition include to create new or expanded partnerships in the region?  Ideally what role(s) would they take on?

Family Members and Related Support Groups Can be Powerful Partners  

Some communities have strong, well organized family support groups that provide volunteers to help carry out the work of the coalition.  Many such groups help raise awareness, reduce stigma, educate and train on the use of Narcan, and advocate for needed policy changes.   Is there an effective family group in the area?  Would greater coordination and involvement with the coalition be beneficial?  

Peer Support Networks have multiple Areas where they Contribute.  

Peer Support Specialists and Recovery Coaches can play a vital role across numerous initiatives.  Working together with police, health services, treatment providers, and recovery support networks, Specialists and Coaches often provide an initial link to care for someone seeking help after an overdose or just wanting help.  In many instances they continue to work with people for longer periods of time - helping them find and get through treatment, and get what they need to help them maintain recovery.   How are peers being utilized in the area?  Is there room to expand current efforts and add more peer support through additional training and funding?   If more peer specialist/coaches could be added in the region, who is needed to help make that a reality?   

Finding Ways to Serve Underserved Areas  

This is an issues of major concern in most communities.  Multiple strategies are needed -  several which have been mentioned above.  Data collection leads to accurate focusing, services can then be focused and community partners can be utilized and trained to better address the crisis in their neighborhoods.  Efforts also typically include more targeted education/prevention efforts.   How can the coalition better serve areas of the City that have been underserved?  What partnerships can help make this happen?  

SUD must be seen as a Disease, not a Crime or Moral Failing  

Though the understanding of SUD and the fact that it is a disease has increased in recent years, there is still a stigma present that often prevents individuals and families from seeking help.  This stigma is reduced through education efforts at schools, PSAs, and a wide variety of other programs.   Efforts on this front are taking place - how can these be expanded?  What organizations in the community can help this effort as part of the coalition?  

The Criminal Justice System Plays a Key Role  

It is generally recognized that a person suffering from SUD can be helped to a far greater degree through various diversion and treatment programs that often lead to a life in recovery as opposed to long-term incarceration.  This is tremendously beneficial to society.   What options are there for those in the criminal justice system in terms of diversion, drug court, treatment while incarcerated, and treatment/support services for those leaving incarceration?  Are there areas that need to be added or improved?   Given what programs currently exist, what improvements could be made within the state and local criminal justice systems in terms of additional or expanded programs to help those with SUD find treatment - either through diversion programs or treatment for those incarcerated?  Are key figures who are part of the system willing to participate in a coalition?

Increasing Recovery Supports are Critical to Long-term Success  

Housing, education, child care, job training and job placement assistance are just some of the recovery support services needed to help people in early recovery.  Without these supports, many with limited means and/or a criminal record can become frustrated and hopeless - increasing their chances of relapse.  Communities with strong supports for people newer to recovery have seen positive results.   What types of recovery support services exist in the region?  Who are the key organizations working on one or more recovery supports?  Are area employers engaged?  Area workforce development entities?  Who can help expand these efforts as part of the coalition?

 

 

Organization, Structure, and Meetings

This is another area where each coalition will determine for itself what works best for them.  However some guidelines based on experience may be helpful.  Questions of leadership, frequency of meetings, who else should be included, the need for some type of by-laws or governance document, and the roles of participants are just some of the questions that typically arise.  Working through these and other issues requires patience and cooperation.

 

Initial Outreach

Getting your desired partners to the table is not always easy.  Organizers of local coalitions to improve response to drug misuse and SUD have often find that some potential partners are suspicious or even defensive.  As stated before, typically these efforts come together when overdose fatalities and other harms are on the rise - and have been for some time.  In addition, many of these partners have focused their efforts in their specific area of expertise an may not have experience collaborating with others.

It is thereforeimportant to build trust from the outset.  Some common advice heard from those who have been through the process of bringing together a coalition include:

     - Honoring the Work that has Been Done.  Everyone fighting this epidemic is doing their best, and should always be recognized for their efforts.

     - No Judgement.  The rise of the current epidemic has been created by a series of events outside of any local jurisdiction.  It is not the fault of local government and                       community leaders fighting the epidemic.

     - Common Goals.  As part of initial discussions it is important to talk about what all partners typically have in common - the desire to save lives and reduce suffering.  While          partners will vary in the approaches they use - and which they may feel are more effective, all involved want to see the same end result.  It is important to focus on what              partners share in terms of outcomes they want to see and discuss how greater collaboration will benefit the efforts of all involved. 

 

Governance and Structure

Dayton's Community Overdose Action Team

Dayton provides an example of a highly structured coalition.  The chart below details this structure, and summarizes the role each component within the COAT has.  Other local coalitions are not as complex or as highly structured - the goal here is to provide ideas on what could be considered.

https://cdn.americanprogress.org/content/uploads/2019/01/10055812/DaytonOpioids-fig9-693.png

   

Local Coalition Examples and Resources

The articles and resources below can be helpful to those seeking to create and improve locally focused coalitions whose primary purpose is to improve local response to the drug misuse and substance use disorder epidemic.  Resources also include those focused on working with different partner entities.

 

 

 

Building Effective Public Safety-Public Health Partnerships

Principles for Building Better Relationships
The Police Executive Research forum reports 5 principles for building better partnerships between law enforcement agencies, public health organizations, treatment providers, and other stakeholders from their April 2016 meeting. The five principles are:

1. Find common ground and work toward shared goals.
2. Respect and Learn from one another's positions and perspectives
3. Involve people from all levels within an organization
4. Be open to expanding your perspective and accepting new roles.
5. Maintain a community focus.^[1]

 

Working with Partners 

Faith-Based Communities

See Coalition Partner: Faith Communities for more details on how members and leaders of faith communities can support strategies to address opioid abuse and recovery in their community.  Opioid Epidemic Practical Toolkit: Helping Faith andCommunity Leaders Bring Hope and Healing to Our Communities may also be helpful.
Programs like One Body Collaboratives and software like Meet the Need can help engage and equip churches to participate in their communities.

 

National Coalitions

There are many national coalitions and organization that can provide useful information and resources for local coalitions.  These national groups are widely varied and numerous.  It is therefore important to research these organizations so local coalitions can verify that their goals and priorities are aligned with any national organization they choose to become involved with.  A few examples follow, but there are many more at the national and even regional level.

Fed Up! Coalition to End the Opioid Epidemic
Platform:

1. Take all measures necessary to ensure that opioids and other controlled drugs are prescribed more cautiously.
2. FDA must:
   1. Prohibit marketing of opioids for conditions where risks outweigh benefits
   2. Consult its advisory committees before approving any new opioids.
   3. Add an upper dose and a suggested duration of use on opioid labels.
   4. Designate naloxone an over-the-counter drug.
   5. Ensure that abuse-deterrent opioid formulations are NOT marketed as less addictive.
3. DEA must mandate prescriber education, free of pharmaceutical industry bias, for all DEA registrants who intend to prescribe more than a 3-day supply of opioids.
4. HHS, DEA, and Congress should immediately reduce barriers to buprenorphine treatment.
5. Congress must increase funding for evidence-based addiction treatment.
6. Congress must incentivize states to mandate prescriber use of Prescription Drug Monitoring Programs.

Coalition to Optimize the Management of Pain Associated with Surgery (COMPAS)
Mission: To educated all those involved in pain management decisions about acute pain management strategies that minimize the need for opioids.
COMPAS also will provide education on how to implement multimodal analgesic strategies and how to measure success for patients and hospitals alike.

Community Anti-Drug Coalitions of America (CADCA)
CADCA is the premier membership-based non-profit organization representing adult and youth coalition leaders throughout the United States and internationally - all working to make their communities safe, healthy, and drug-free. CADCA's model for community change represents a comprehensive, evidence-based, multi-sector approach to reduce underage and binge drinking, tobacco, illicit drugs and the abuse of medicines.
 

 

Tools & Resources

TR - Strengthen the Coalition to Reduce Opioid Abuse

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