march

For years, the country’s opioid crisis has quietly escalated. From 1999 to 2012, deaths from common opioid medications increased by 400 percent. Additionally, accidental drug overdose is currently the leading cause of injury-related death in the country for people between the ages of 35 and 54.

North Carolina is no exception. In 2014, more people in North Carolina died from drug overdoses than car accidents.

Some blame decades of overprescribing opioids for the epidemic. Others blame law enforcement for not controlling the influx of cheap heroin. But according to community health advocate Anne Thomas, the “blame game” isn’t helpful. “Everyone is part of the problem. And everyone is part of the solution.”

Anne Thomas
Consultant for Chronic Pain Initiative and Project Lazarus

Anne Thomas is the current Chair of the Foundation’s Board of Directors and a consultant for the Chronic Pain Initiative and Project Lazarus. She supports communities in over 30 North Carolina counties who are building capacity to address the opioid epidemic and manage chronic pain effectively.

“Communities are best poised to solve their community health problems because they know their resources, they know their own culture,” said Thomas. “They know what things are possible, where there’s support, and where there’s resistance.”

The Chronic Pain Initiative and Project Lazarus is a two-year project funded by the Kate B. Reynolds Charitable Trust. The Foundation partners with the NC Office of Rural Health and Community Care of North Carolina to administer this statewide collaborative around opioid prescription management.

Project Lazarus is based on a successful model developed in Wilkes County aimed at preventing overdoses and meeting the needs of those living with chronic pain. The model includes the use of toolkits for clinical and community training. The toolkits are a range of guidelines for community action, education and for assessing pain and prescribing medication safely.

Thomas’s work is with community engagement. She provides technical assistance to help communities create and maintain local coalitions. She assists them with developing locally identified needs and locally tailored drug overdose prevention programs and connects them with state and national resources. This work includes identifying stakeholders who need to be at the table, leveraging resources or providing educational materials to boost awareness. “Many times they have the resources right there in their community, it’s just helping them explore and navigate them,” said Thomas.

One of the premises of the project is that change is possible with community engagement. Thomas says this means engaging with traditional and nontraditional partners. “We try to bring everyone together and engage the entire community,” said Thomas. Many coalitions are made up of parents, school systems, law enforcement, public health, businesses, churches, pharmacists and the medical community.

Thomas said that regional alliances can have a big impact. A cluster of seven counties in the northeastern part of the state have a coalition called the Albemarle Region Project Lazarus Coalition. The coalition includes Currituck, Camden, Pasquotank, Perquimans, Gates, Chowan and Bertie counties. Because of their shared resources, the alliance distributed effective messaging around safe opioid medication use and disposal.

They also organized drop boxes for unused prescription medication and purchased two incinerators for disposing them. They organized training in naloxone—a drug that reverses opioid overdoses—for emergency first responders. The alliance has partnerships with the school system to train school resource officers and school staff in providing prevention education. They work with community colleges to provide addiction education in the health curriculum as well as with law enforcement and the public health department.

“Rural communities have scarce resources,” said Thomas. “So creating economies of scale and scope by sharing resources and getting more people at the table is really effective.”

Thomas says communities can accomplish a lot by setting goals, assigning roles and developing strategy. “People don’t want to come to the table to just talk about something,” she said. “They’d rather be doing something. And when the doing starts to happen, people get involved.”

To learn more about the Chronic Pain Initiative and the Project Lazarus model, visit:
https://www.communitycarenc.org/population-management/chronic-pain-project/

For more information on North Carolina’s opioid epidemic, read “Policy for the Use of Opiates for the Treatment of Pain”.

Erin Hultgren, a Bernstein Fellow and Program Manager at Gaston Family Health Services (GFHS) is currently assisting with a behavioral health initiative that will improve and expand the delivery of substance abuse services and Medication-Assisted Treatment (MAT) to underserved populations with opioid use disorders. This initiative is funded by the Health Resources & Services Administration (HRSA) through their recent Substance Abuse Service Expansion, which awarded a total of $94 million in funding to health centers across the United States. GFHS was one of seven centers in North Carolina and one of 271 centers across 45 states to be awarded.

The additional grant money will enable GFHS to expand behavioral health and substance abuse services to serve its patient panel as well as extending services to both pregnant women and people living with HIV/AIDS and opioid addiction. Through its history of collaborative work with the Gaston County Health Department (GCHD), GFHS will work with GCHD and other community partners to identify pregnant and parenting women and HIV+/AIDS patients who need a more integrated approach to their opioid addiction including primary care, behavioral health, MAT and counseling services. Identification is only the first step. The ultimate goal of GFHS is to not only identify these patients, but also provide them with the integrated care they need to achieve and sustain recovery.

Additionally, GFHS will enhance their existing integrated model by:

Increasing the number of patients screened.
Connecting identified patients to treatment.
Hiring additional behavioral health providers to connect patients with access to MAT treatment.
Providing training and education for providers on best practices for opiate prescription.
Working with patients and community members on the availability and use of opioid antagonists.

As the HIV program manager for GFHS, Erin’s primary role in this initiative is to increase screening and education regarding the availability of testing and treatment for patients with or at risk of HIV/AIDS and Hepatitis C, both associated with opioid use disorders. Erin will work with behavioral health staff to update risk assessments to include questions regarding sexual health, HIV and Hepatitis C risk. Since integration and coordination of services is key to success, Erin will coordinate services between GFHS and health departments in the area to ensure patient’s have access to HIV testing and clinical services regardless of ability to pay. Although she’s new to the work of opioid addiction, she believes that an integrated care approach is the best way to provide support for these substance abuse issues.

“As we move forward, I think collaboration and communicating between partners will be our largest challenge and biggest asset,” she says. “Education will be critical – educating primary care providers, working with ERs, changing protocols, etc. Opioid addiction has far-reaching consequences and it will take all players at the table to conquer this public health crisis.”

For more information about Gaston Family Health services and their unique integrated care approach, visit http://gfhs.info.

Just this month, Monica Harrison joined the team as Technical Assistant for the Center of Excellence for Integrated Care. With years of experience and a great deal of passion, she will provide tools, techniques, training and technical assistance to organizations and healthcare professionals that will help them implement best practices for integrated care. We asked Monica a few questions to get to know her better.

Q. Where are you from and how did you end up in North Carolina?
I was born in New Orleans, LA. However, I’ll say I’m from everywhere, as I am what they call a “military brat.” Both of my parents were in the army and we moved to Fayetteville (Ft. Bragg), NC in 1991. I decided to attend college at the University of North Carolina at Greensboro for my Bachelor’s Degree in Human Development and Family Studies, and then attended NC A&T for my Master’s Degree in Social Work.

Q. What drew you to the Foundation?
Talk about the universe smiling down on me. I was eager to learn all I could about integration and making sure my agency participated in continuing our integration efforts in the most concise and evidence-based way possible. I’ve been on this endeavor since 2010. When I met the Center of Excellence staff in 2011, I thought, “wow it would be great to have had a blueprint to build off of and follow.” I’ve kept pushing forward ever since and have hoped I would have the opportunity to help others in their journey. Now I get to do just that.

Q. What type of organizations have you worked for in the past?
Believe it or not my first career was as an educator/teacher so, I hold a Birth Through Kindergarten Teaching License. Since then, I’ve held multiple positions with the Guilford County Head Start/Early Head Start program (teacher, education specialist, professional development coordinator, consultant). I’ve worked for Wake Forest Outpatient Dialysis Centers as a Nephrology Social Worker and Social Worker Manager in which I traveled to facilities in different parts of North Carolina as a part of an interdisciplinary team. I’ve worked for Win-Win Resolutions where we focused on character education, mentoring, bullying and conflict resolutions for the school system as well as juvenile justice led family programs. I’ve been the clinical lead for a residential home (group home) conducting clinical groups, and I’ve also worked at a pediatric primary care office to consult with other pediatric offices to work on integrative efforts. Lastly, I transitioned to working in a Federally Qualified Health Center as a part of and manager of their integrative endeavors.

Q. What are you excited for in this position?
I am excited to get the opportunity to spread my love and joy of integration and to be able to assist others to be successful in their integration efforts.

Q. What do you like to do for fun?
Well if not running around crazy to my children’s sporting events (I have five boys who all play a different sport, some of which travel constantly – and yes I am the loudest yelling mom on the team) then you will find me out with my husband trying out a new or favorite restaurant – we are “foodies.”

Joanne Rinker describes her mission succinctly: “The work that I do is focused on helping health departments identify and implement evidence-based interventions in their county to improve the health of the people in their population.”

The Bernstein Fellow is convinced that local health departments can play a valuable role in implementing Affordable Care Communities (ACC).

“I have this passion for my health department population,” Joanne said. “I want the health department to have a seat at the table in an Accountable Care Community. I know that they provide services that other organizations and providers in their community are not offering. Instead of duplicating services, which is more expensive and requires additional FTE hours, ACCs need to bring the local health department to the table to allow them to provide the service, and in turn reimburse them financially for the cost savings.”

Joanne, who will complete the Bernstein Fellow program later this year, has insight and perspective born of experience and education. The native New Yorker attended West Virginia University, where she completed both her bachelor’s and master’s degrees. She came to North Carolina after graduation to begin working with diabetes self-management education programs. Joanne became a Certified Diabetes Educator (CDE) and worked for multiple education recognition programs for diabetes patients around the state.

In 2006, Joanne joined the N.C. Division of Public Health where she, along with Laura Edwards, started a state-administered program that helped local health departments throughout North Carolina gain ADA recognition for their diabetes education programs. While Joanne was the coordinator, it was the largest ADA accredited site in the United States.

In the summer of 2013 Joanne received the opportunity to join The Center for Healthy North Carolina as its Director for Training and Technical Assistance. Her role is whole-health focused rather than diabetes-specific, and focuses on helping health departments select and implement evidence-based interventions in their communities.

Joanne’s vast experience and established relationships with administrators and communities in most of the 100 counties across North Carolina have enabled her to better provide support and training to communities and local staff around the state.

Joanne’s Bernstein Fellows project very much supports improving community coalitions’ access to evidence-based interventions and showing how those projects can benefit an ACC. She worked to conduct a large-scale survey with active and inactive Healthy Carolinians partnerships throughout the state to find out how the partnerships wanted to receive technical assistance, and what technical assistance they needed. She then worked with the Care Share Health Alliance to develop and execute webinars to provide the necessary training and assistance.

Some of the most requested webinar topics included Collaboration and Coalition Building, Meeting Facilitation with Community Members, Evidenced-based Intervention 101, Evidence-Based Selection and Evaluation 101. The audience for each webinar consists of a range of public health professionals, including health directors, public health nurses and health educators.

The webinars have already seen great success. Attendance has reached as high as 100 participants. Although they officially wrap up in August, Joanne and her team have so many ideas for additional content to cover and audiences to reach that they have planned another 6-month series. The series will continue August 2015 until March 2016. In the meantime, the team is conducting a follow-up survey to determine if any of the partnerships have been able to build capacity because of the technical assistance provided by the webinars.

Joanne was part of a recent Bernstein Fellows educational event focused on ACCs. The speakers demonstrated the benefit to communities across the country and discussed why focusing on building ACCs is timely. Joanne and the other fellows agreed that it was very energizing to learn how ACCs can be so beneficial and why health professionals should make a point to be a part of the process.

“It was good to hear that there are functioning, successful ACC’s around the country,” she said. “We learned that there is a time when the ACC may lose money in the initial startup, but many have shown that they then see themselves gaining money and being able to pay back any start-up funds needed to get organized and fully functional. This will cost money but, in the long-term, the goal is for it to be cost-effective.”

Joanne speaks highly of the Bernstein Fellows program in general, and says it has been an incredibly valuable experience for her over the past two years.

“Not only are we learning, but we are also developing relationships with professionals who have the same end goal in mind,” she said. “The Bernstein Fellowship is such an amazing way to honor Jim Bernstein! I have been honored to be part of this. I know how important his work was, and still is, and I hope that myself and the other fellows can make a meaningful contribution to rural public health in North Carolina!”

Communities Respond to the Rising Opioid Crisis