Practice Title: Stop Reinventing the Wheel: Helping Local Health Departments Address the Opioid Overdose Crisis

Department: New York City Department of Health and Mental Hygiene
Size: Large (Population of 500,000+ people)
State: New York

Summary of Practice: 

The New York City Department of Health and Mental Hygiene (NYC DOHMH) is one of the world's largest public health agencies, serving over 8 million New Yorkers. NYC DOHMH's Bureau of Alcohol and Drug Use Prevention, Care and Treatment (BADUPCT) works to reduce morbidity and mortality related to alcohol and substance use among New Yorkers through contracting and oversight of prevention, treatment, harm reduction, and recovery and support services; policy analysis and development; epidemiology, surveillance, and evaluation; development and dissemination of treatment and management guidelines; harm reduction initiatives; public and provider outreach and education; and community involvement and interagency collaboration. Within BADUPCT is the Center for Disease Control Technical Assistance (CDC-TA) team that supports local health departments (LHDs) across the country to implement successful programs and strategies to tackle the opioid overdose crisis in their communities. Based on evidence-based initiatives developed by BADUPCT, the CDC-TA team adapts this programming to fit the unique needs of the partner LHDs and their respective communities. The CDC-TA team collaborates closely with the National Association for County and City Health Officials (NACCHO), the funding partner, to support the partner sites in meeting their grant-funded deliverables and objectives.

The CDC-TA team provides the partner LHDs with information and assistance for a suite of evidence-based programs including, hospital-based non-fatal overdose response (Relay), prescription drug monitoring programs (PDMP), syndromic and mortality surveillance, medications for opioid use disorder (MOUD), anti-stigma and media campaigns, and rapid assessment and community engagement using BADUPCT's Rapid Assessment and Response (RAR) model. The TA is delivered through various modes, including individual calls, all-site calls, and an immersive summit hosted in NYC in March 2020.

Partner LHDs adapted at least one evidence-based strategy or program developed by NYC DOHMH, collaborated, and shared experiences with other partner sites to build a peer-to-peer network of health departments doing substance use work. Through introspection, they also identified and evaluated their existing practices so that the CDC-TA team could provide program-specific support. Additionally, all sites examined stigma within their communities with the help of an anti-stigma subject matter expert. Each site conducted surveys to assess the stigma of a population or demographic of interest within their community. Depending on specific site restraints (capacity, funding, political will, etc.), the CDC-TA team recommended that sites develop a media campaign, per the survey results, to address knowledge, attitude, and beliefs within their community. In addition to addressing stigma, these campaigns would help address health inequities within the LHDs communities by promoting access to harm reduction and treatment services. 

With the onset of the COVID-19 pandemic, in-person site visits were put on hold indefinitely. To account for this, the CDC-TA team has been developing an online learning series that covers the entire suite of BADUPCT technical assistance programming. Overall, with the community partner's help, the CDC-TA team created seven asynchronous learning modules that will be freely available online through NACCHO University— not limited to the partner LHDs included in this specific CDC-TA project. The modules will allow health departments across the country to access and learn from NYC DOHMH programming, broadening the TA project's reach and ability to disseminate successful strategies to tackle the opioid overdose crisis while reducing health inequities.

Simultaneously, a comprehensive evaluation is being conducted by a professional consulting firm, Joslyn Levy & Associates. This evaluation aims to understand how well the CDC-TA project addressed the six sites' needs and how well these sites integrated the CDC-TA into their ongoing interventions or used the CDC-TA as a starting point for implementing new interventions to address the opioid crisis in their communities. 

This practice was successful, in part, because of the community partnerships, stakeholder buy-in, and the ability to translate the already existing evidence-based NYC DOHMH substance use programs to fit the specific needs of the various communities. Additionally, due to the impact COVID-19 had on the LHDs' capacity to continue this programming, the flexibility and adaptability of the partner sites and the CDC-TA team was imperative. Lastly, the practice built peer-to-peer networks between the partner sites that can be sustained over time.

Supporting LHDs to develop and enhance their capacity to launch programs based on the DOHMH's existing portfolio of opioid prevention and response initiatives will help reduce the burden of unintentional opioid overdose deaths nationally. Additionally, with the creation of the free online learning series, health departments across the country, not initially included in the TA program, will have access to this evidence-based substance use programming, allowing for a more far-reaching, sustained impact.

NYC DOHMH website: https://www1.nyc.gov/site/doh/index.page