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 upon one that already exists.  One important aspect when looking to create a coalition is to realize that, historically, substance use disorder has been seen 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."  [1]

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.  Coalitions and task forces are often started 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 stakeholders whose ultimate goals align.  Get started by looking around the community and determining if there are similar existing efforts in which to get involved or add value.  It’s important not to duplicate efforts.  Is there a mechanism or coalition body already taking a comprehensive approach to addiction that can be leveraged?  

Potential Partners and Their Roles

There are many potential partners that can be invited to join the coalition and improve the community response to SUD.  The following list is not intended to be all inclusive and it is not a requirement to have all of these individuals at the table.  These are suggestions based on the types of partners that are most often brought together.  Highlighted categories contain links to what roles they might play within the coalition.  Keep in mind it’s important to establish a team of optimal size and with sufficient authority to plan and implement ideas and strategies effectively and efficiently.  Does the team include leaders with the authority to make decisions and drive the implementation of new strategies?

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 Elected Officials
9. Local Law Enforcement
10. Corrections
11. Treatment Providers
12. Faith Based Communities
13. Persons with lived experience, including those in recovery and still using substances
14. Local Harm Reduction Organizations
15. Education Leaders
16. Business Leaders
17. Recovery Support Organizations
18. Family Support Groups and Recovery Allies
19. Local Philanthropic Organizations

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.

Public Health and Public Safety

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]

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 during planning. 

Working through these and other issues requires patience and cooperation.  Many involved with this effort will be passionate and have strong opinions that others may disagree with.  Differences will arise.  How they are resolved is what matters.  It is important to have procedures that allow people to be heard and for a respectful debate to take place.  This is balanced with the need to make decisions and mover forward.  Either the group or designated leadership needs to be assertive, end debate, and make a decision by vote or executive decision.  Leaders need to remind all involved that all involved want the same thing - to save lives and reduce suffering.

Initial Outreach

Getting your desired partners to the table is not always easy.  Keep in mind that while there are a number of ways to contact these groups, in-person and direct contact is always best.  You may have to overcome resistance of several types.  Organizers of local coalitions to improve response to drug misuse and SUD have often found that some potential partners are suspicious or even defensive.  Some organizations are not naturally inclined to work with others.  For example, the harm reduction and law enforcement communities are not always natural allies.  However, we have found that where these two groups come together and see the problem through each other’s lenses, some very powerful work can be done.  Some organizations might not want to get involved because of their own perception of capacity (this is more work for me) or stigma (this is not my problem).  You may have to expend considerable effort to convince these groups that reversing the epidemic is in the entire community’s interest and that everyone has a contribution to make.

It is important 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 the partners share in terms of outcomes they want to see and discuss how greater collaboration will benefit the efforts of all involved. 

Initial Actions

Hold your first meeting.  Don’t worry if you have as few as five community leaders or as many as 20.  The important thing is, you have found people who are willing to work together to thoughtfully and comprehensively address the particular problem in your community.  Although the topic that brings all of the stakeholders together is difficult, it is the coalition leader’s job to bring energy and optimism to the movement.  Because solutions might look different to each of your stakeholders, focus on defining the common problem you are looking to solve.  A goal of your first meeting should be to establish a meeting rhythm in which the coalition frequently gathers to review progress, update your plan, and share success stories.   

Evaluate the State of Your Community

For your community coalition to be successful, it will need to understand how the community perceives a number of elements of addiction, as well as what resources are already at work across the many stakeholder sets within your community.  One way to evaluate perception and resources is through the SAFE Community Pulse Survey and SAFE Community Resources Exercise.  These tools are designed specifically to provide you with the insight your coalition needs to focus and prioritize your work.  These tools can be found in SAFE Project’s Community Playbook – a framework for communities to organization, evaluate, and create change in their community to impact the addiction epidemic.  

Once you have completed both evaluations, it’s time to take a step back and look at what the data and research are telling you.  Is there a correlation between what the community survey tells you and the gaps that you have identified in your resource exercise?  

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 lessons 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 which potential partners to include.  As a coalition leader, it might also be helpful to track lessons learned over time to help maintain institutional knowledge as staffing changes over time.

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 in order to know where more resources need to be deployed.  What data sources are currently available?  How are they being used?  Does the coalition have the partners to provide the 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?  Use local data disaggregated by population characteristics like race, ethnicity, immigration status, language, and household levels of income to identify disparities in outcomes and inform policies and practice for specific populations, neighborhoods, and zip codes.

Prevention Efforts Reduce First Time Use and Support other Coalition Stakeholders

Prevention efforts that focus on educating the community - especially youth and young adults - about the risks of drug use are an important component of an effective community coalition.  Prevention organizations have experience with messaging and building awareness campaigns that educate the community about the impacts of drug use on individuals and families.  This knowledge and experience is often helpful in developing strategies to reach specific populations and the community at large.  Prevention reaches into many other areas along the continuum of care, and they often help provide information on linkages to care, treatment options, and recovery supports. 

Harm Reduction Saves Lives and Should Provide a Linkage to Care  

The distribution and training of how to use naloxone continues to be an effective way to reverse opioid overdose and save lives.  Other programs, like needle/syringe exchanges, 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 training on naloxone administration is 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 naloxone 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 naloxone, 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?  

The Contribution of Peer Support Networks 

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, Peer Support Specialists and Recovery 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, as well as 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 issue of major concern in most communities, and often, multiple strategies are necessary.  Stronger data collection efforts can help to more effectively direct the appropriate services to targeted areas within the community where they are most needed.  This will also help community partners in better addressing the crisis in their neighborhoods.  How can the coalition better serve areas of the community that have been underserved?  What partnerships can help make this happen effectively?  

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

Although there is growing understanding that SUD is a disease, there is still a stigma present that often prevents individuals and families from seeking help.  Stigma can also impact the type and quality of care provided by clinicians.  Stigma can be reduced through public awareness campaigns and education efforts.  If these are taking place in the community - how can these be expanded?  What organizations in the community can help this effort as part of the coalition? 

SAFE Project’s #NoShame Pledge – This virtual campaign helps to combat negative perception and offers support to others when seeking treatment or speaking up about mental health and substance use disorders.

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 can lead to a life in recovery, as opposed to long-term incarceration.  Socially and economically, 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?  What about area workforce development entities?  Who can help expand these efforts as part of the coalition?

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.

Local Coalition Examples and Resources

Once you have completed both evaluations, it’s time to take a step back and look at what the data and research are telling you.  Is there a correlation between what the community survey tells you and the gaps that you have identified in your resource exercise? 

Dayton Ohio - Community Overdose Action Team (COAT)

Dayton provides an example of a highly structured coalition.  The chart below details this structure and summarizes the role of each component within the COAT.  Other local coalitions might not bas complex or highly structured, but this example helps to provide ideas of what could be considered. 

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

SUBJECT MATTER EXPERT: [fill out table below]

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