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Strategic Plan

Introduction

The Community Overdose Action Team (COAT) is pleased to present the 2023 Montgomery County Drug Overdose Prevention strategic plan. This planned approach provides a guide for achieving the goals and objectives identified in the priority areas.

The strategic planning process included input from coalition members and community stakeholders and was facilitated by the Center for Public Health Practice at Ohio State University. This process included a series of planning sessions that occurred over a one-month period. The work plans that were developed serve as tools to steer the direction of the coalitions in achieving their missions.

Strategic priorities and goals

Community Overdose Action Team

  • Harm Reduction – Increase capacity of harm reduction programming to provide overdose prevention and engage clients in support services.
  • Response – Coordinate Quick Response Team efforts and ensure there is an emergency plan for a significant cluster of overdoses.
  • Education & Information – Raise public awareness and knowledge of the dangers of substance misuse and abuse.
  • Prescription – Support healthcare providers with education about the nature of addiction and knowledge of community resources to ensure patients have the comprehensive services they need for recovery.
  • Treatment & Recovery – expand access to treatment and community support program.
  • Criminal Justice – expand access to and use of treatment and community support programs for those involved in the criminal justice system.
  • Drug Supply Control* – decrease the supply of illicit and illegal substances available for misuse and abuse.

* Does not have a work plan due to the sensitive nature of branch activities.

About Us

The United States continues to experience the deadliest public health crisis in history, as unintentional drug overdose deaths continue to rise. During 2022, there were more than 110,000 overdose deaths in the United States, up from 72,000 in 2017. In addition to fatal and non-fatal opioid overdoses, the epidemic also contributes to a wide range of devastating community consequences.

Montgomery County, Ohio has been devastated by the drug crisis and the overwhelming impact it has had on the community. Our community became the face of the opioid epidemic in national media, with the state’s highest age-adjusted overdose death rate from 2012 to 2017. In response, our community mobilized to address this crisis, creating the Community Overdose Action Team (COAT) to align goals and objectives across sectors, to engage our communities, and to strategically approach prevention and treatment to affect the most change. And these efforts, in part, have succeeded in making that change. Montgomery County now ranks 12th in the state in the age-adjusted death rate, with a nearly 50% decrease in the rate, from 106.6 in 2017 to 57.4 in 2022. Yet, we recognize that one life lost is one too many, and the COAT remains committed to halting the crisis. The Community Overdose Action Team (COAT) is an interdisciplinary team seeking to reduce the number of people dying from drug overdoses and drug abuse. The team seeks to enhance current services, looks for gaps in existing services and explores more effective ways to combat drug overdoses. The COAT operates under a Collective Impact Model – an innovative and structured approach to making collaboration work across various sectors to achieve significant and lasting social change. The following priority areas are addressed through the COAT: drug supply control, harm reduction, response, education & information, prescription, treatment & recovery, and criminal justice.

It is this collaborative work of our community partners and citizens that has led to great success in Montgomery County. However, there is still a great amount of work to be done and our collaborative, unified response must continue.

Our Process

The Center for Public Health Practice at the Ohio State University (CPHP) provided overall guidance and support using a seven-phase planning approach. The process began in December 2022 and concluded in June 2023; our planning team met virtually a total of two times, with several branch meetings that focused on developing the work plans. A summary of activities related to the first five phases of our process follows.

December 2022 – January 2023 - Phase 1 - Plan to Plan: A strategic planning team, comprised of a variety of coalition members, was asked to participate in the development of the strategic plan. With guidance from CPHP, an outline and timeframe of activities was developed to guide the agency through the process of forming a strategic plan. Planning included a recorded webinar explaining the process of strategic planning for all coalition members to set the stage for the planning process.

February 2023 - Phase 2 – Develop Guiding Principles: Since the coalition had recently approved its mission statement to guide the strategic planning process it was determined that an update was not needed. An online survey was distributed to coalition members in February 2023 to gather input to assure that those statements were still appropriate. The survey also gathered input on the vision and values of each coalition.

February 2023- Phase 3 – Assess the Situation: An online SOAR survey to assess strengths, opportunities, aspirations and results, and challenges was distributed via online survey to all coalition members. An additional question concerning health equity was also included in the survey.

February – March 2023 - Phase 4 – Priority Selection: The COAT chose to focus this strategic planning process on their branch areas of: harm reduction, response, education and information, prescription, treatment and recovery, and criminal justice. These preselected priorities had predetermined goals associated with them.

March – June 2023 - Phase 5 – Write the Plan: During two half-day virtual sessions facilitated by CPHP in March 2023, the writing team met and worked to develop work plans which included objectives, strategies and action steps to address the priority areas for the coalitions. The group conducted a multi-step gap analysis to identify what gaps existed in the community that needed to be filled to achieve the goals. The results of this analysis influenced the development of objectives and strategies. The COAT chose to write three-year objectives and strategies.

Phase 6 – Plan Implementation: The Strategic Planning team, along with coalition leadership, will implement the strategies outlined in the work plan to reach the goals and objectives of the strategic plan.

Phase 7 – Plan Monitoring and Evaluation: To ensure progress is being made toward the strategic priorities, the plan will be monitored by the COAT during monthly or bi-monthly meetings. A progress report will be developed to update the community.

Contributing Organizations

The following agencies had representatives involved in the development of this plan:

  • Public Health – Dayton & Montgomery County
  • Montgomery County Alcohol, Drug Addiction & Mental Health Services
  • Montgomery County Commissioners
  • Dayton Police Department
  • Samaritan Behavioral Health
  • Montgomery County Sheriff’s Office
  • Greater Dayton Area Hospital Association
  • Ascend Innovations
  • Montgomery County Common Pleas Court and Probation
  • Law Office of the Montgomery County Public Defender
  • State of Ohio Board of Pharmacy
  • Montgomery County Office of Emergency Management
  • Montgomery County Criminal Justice Council
  • City of Dayton Fire Department
  • Dayton Recovers
  • MonDay Community Correctional Institution
  • Dayton Municipal Court Probation Department
  • Montgomery County Coroner’s Office
  • Greater Miami Valley EMS Council
  • Woodhaven Behavioral Health
  • Goodwill Easterseals
  • Montgomery County Prevention Coalition Leadership
  • Montgomery County Drug Free Coalition Leadership
  • Whole Truth Ministries
  • Brave Technology Co-Op
  • House of Restoration
  • Good Shepherd Ministries
  • Kettering Health Network
  • Premier Health Network
  • OneFifteen
  • Families of Addicts
  • DeCoach Rehabilitation
  • Joshua Recovery Ministries
  • Recovery Alliance of Montgomery County Ohio (RAMCO)

Environmental Scan

As part of our overall strategic planning process, the coalition conducted a Strengths, Opportunities, Aspirations, Results and Challenges (SOAR/C) analysis, assessing strengths, opportunities, aspirations, results and challenges. During February 2023, electronic surveys were distributed to all members of the COAT. The results were reviewed by coalition leadership and presented to the strategic plan writing team at the first in-person meeting. General themes generated with the survey are found in the table below

As part of our overall strategic planning process, the coalition conducted a Strengths, Opportunities, Aspirations, Results and Challenges(SOAR/C) analysis, assessing strengths, opportunities, aspirations, results and challenges. During February 2023, electronic surveys were distributed to all members of the COAT. The results were reviewed by coalition leadership and presented to the strategic plan writing team at the first in-person meeting. General themes generated with the survey are found in the table below

Strengths Opportunities
  • A Full-time project manager
  • Idea Mining
  • Diversity
  • Passion
  • Collaboration
  • Communication
  • People in recovery being involved
  • Data collection, use the data to drive the strategic action plan
  • Sharing of data and information
  • Access to up-to-date data collection, analysis, interpretation, and surveillance
  • Collective mission to reduce stigma and provide resources
  • Education of the community at large of our mission, vision, and objectives for buy-in.
  • Breaking Silos instead of building them
  • Harm Reduction
  • Information Sharing
  • Community Education
  • Collaborative and Co Design-Informed Approaches
  • Expand peer support/link connect peer supporters with other institutions (hospitals, Tx centers)
  • Better collaboration among the subcommittees. Annual meeting with backbone and all committees.
  • Ensure we have lived experience represented at all branches
  • Funding to promote broad based education to healthcare professionals: Break the Stigmas!
  • To create a new paradigm
  • To create real equity and not superficial equity
  • To challenge big industry dictating best practices
  • To focus and develop and enlarge the recovery end of the continuum
  • Creating Access
  • Recognition of the effects of trauma, ACES, grief on substance use disorder creates the opportunity to work more upstream
Aspirations/Results Results
  • Aspiration: Improve and increase access to harm reduction information, safer use supplies, services, and multiple pathways/modalities of treatment and recovery
  • Aspiration: Better public knowledge about harm reduction services and resource through sharing of information, doing outreach, and building supports - especially about overdose detection and preparedness
  • Aspiration: Reduce stigma and criminalization of substance use. To create a drug free, substance free community where all youth and adults can thrive. A system where insurance or lack of insurance is not prohibitive to quality services for substance use and mental health
  • Aspiration: communication, collective work, and quality monitoring/control among Tx community
  • Aspiration: List of all treatment places and what types of treatments they offer
  • Results: Reduce overdose fatalities and increase the chances that someone will be empowered to make decisions about their life that support their health and are a good fit for them
  • Results: Less stigma, more familiarity with local resources, better signal boosting of information, more overdose fatalities averted, better preservation of health for PWUD while in active use, more sustainable treatment and recovery experiences
  • Results: Law enforcement not responding to overdoses, not prosecuting charges associated with overdose, education for medical providers in ERs, more job opportunities/friendly employers for people in recovery to create an equitable environment where anyone seeking help for substance use disorder knows how to access and obtain quality services.
  • Results: Fewer shady Tx places, more rapid access to the appropriate Tx space for everyone, eliminate competition among Tx centers, find best matches for care not just what your insurance will cover
Internal Weaknesses/Challenges External Challenges
  • Policies being dictated by external forces at times
  • Providers still pitted against one another for dollars
  • New opportunities being forced into existing structures as opposed to what’s needed
  • Burnout - When we are under-resourced on our teams and have burnout looming constantly, we end up with high turnover of staff and low performance all around. This directly impacts the people we are trying to help and the work we do.
  • Workforce - Staffing shortages, burnout, position hopping among front line staff and leadership, issues with recruitment, lack of funding for needed positions, lack of diverse workforce
  • Competing (and sometimes self-serving) goals among stakeholders
  • Recruit new and active committee members
  • Funding for programs, peers, etc. [worries that some of the most important stakeholder perspectives are coming from the stakeholders with the most precarious support in terms of funding & workload]
  • Siloed communications keep information locked up and unable to be useful and actionable. When we have open communication and information, we have a better shot at doing our best work.
  • Having been so reactive to the problem vs really getting proactive and creative to try to get in front of issues (look upstream!)
  • Helping Peers build boundaries to prevent burnout and relapse.
  • Adequate pay and workloads are often untenable
  • Politics/competition between entities instead of working together
  • Lack of housing and shelter services
  • The funding issues is basically an extension of stigma
  • Educating the stakeholders and public of our mission and vision as a whole.
  • Funding: The funding sources are not congruent or non-existent. To try and maneuver through Medicaid and all the different grants creates inefficiency and roadblocks to the work needed.
  • Not enough funding for peers and a lack of training for businesses that are using peers
  • Institutional Support (financial support but also support for one’s time to participate in COAT-type activities)
  • Inconsistent and limited funding
  • Lack of education on SUD within the medical community at large, which drives stigma with people who could have an impactful change
  • Unfriendly political climate - more punitive, threats to DEI framework
  • Adequate pay and workloads are often untenable
  • Some populations not being included
  • Lack of Psychiatric services with growing mental health needs in the community
  • Poverty, housing
  • Social determinants of health
  • Siloed communications between different sectors/committees/working groups etc. leads to a deficit of knowledge, erases opportunities, and limits the scope and reach of our work.
  • Stigma
  • Restrictions on payments with Medicaid and Medicare
  • Unethical persons/agencies causing harm vs help

Our Strategic Priorities

This section lists our strategic priorities, key measures, goals, and objectives. More detailed action plans are included in Appendix A.

Goal: Expand access to treatment and community support programs

Objectives

  • 1.1: By, June 2026, develop and implement Recovery Housing standards for Montgomery County
  • 1.2: By June 2026, develop a 5-year treatment protocol for Montgomery County
  • 1.3: By, June 2026 Increase by 20% access to acute treatment placement, engagement and management
  • 1.4: By June 2026, establish a process to identify gaps, track and update changes, and disseminate up to date information on services for mental health care, trauma-related care and addiction care.
  • 1.5: By August 2024, create a toolkit to assist stakeholders in advocating for increased funding for more mental health services for people in primary residential programs with a dual diagnosis - policy concern/reimbursement.

Goal: Expand access to and use of treatment and community support programs for those involved in the criminal justice system

Objectives

  • 2.1: By January 2025, increase active participation and diversity of direct criminal justice providers by at least 5 providers from 3 different jurisdictions.
  • 2.2: By July 2026, provide up to 4 relevant training and support opportunities per year to direct service providers in the criminal justice system with priority issues being administration of MAT and other emerging needs.
  • 2.3: By July 2026, develop a program to offer everyone exiting a correctional facility in Montgomery County Naloxone upon release.
  • 2.4: By July 2026, we will utilize social media platforms of branch participants to promote branch objectives and accomplishments.

Goal: Raise public awareness and knowledge of the dangers of substance misuse and abuse.

Objectives

  • 3.1: By Dec 2023, create a one-pager COAT Overview.
  • 3.2: By Dec 2024, promote the “Ask for Alternatives” campaign to three prioritized targeted audiences.
  • 3.3: By April 2024, execute a 3-month public education campaign to promote One Pill Can Kill.
  • 3.4: By June 2024, create an education plan to reach 50 medical providers.
  • 3.5: By June 2024, promote the social media toolkit to 10 partner agencies.

Goal: Support healthcare providers with education about the nature of addiction and knowledge of community resources to ensure patients have the comprehensive services they need for recovery.

Objectives

  • 4.1: By Oct 2023, increase diversity in meetings by including additional members from each of the following groups: DEA, a peer with lived experience with Rx opioids, a dentist, a social worker (LPC), an EMT, an addiction medicine fellow, Equitas, and a nurse practitioner or physician assistant.
  • 4.2: By Nov 2023, double active participation in monthly meetings.
  • 4.3: By Dec 2023, develop and distribute a digital outreach (email) to support providers through changes to medical licensure requirements (e.g., new education requirements and removal of DATA-X waiver).
  • 4.4: By March 2024, create and share a patient focused resource that can be used in waiting rooms to promote patient-clinician discussion of addiction.
  • 4.5: By Dec 2024, develop and implement a plan to educate providers on 1) the nature of addiction and the recovery experience 2) best practices for interacting with those with SUD, such as trauma informed care and motivational interviewing and 3) available referral resources (MAT, counselling, peers).
  • 4.6: By Dec 2024, 20 local pharmacies are using the locking pill medication bottles/Safe Rx.
  • 4.7: By June 2024, promote ongoing takeback locations and drug disposal programs.

Goal: Increase capacity of harm reduction programming to provide overdose prevention and engage clients in support services.

Objectives

  • 5.1: By June 2024, build an updated and easily available resource guide for harm reduction organizations that contains local resources.
  • 5.2: By October 2024, build an overdose preparedness plan framework that can be utilized by multiple stakeholders in the community as needed for prevention purposes
  • 5.3: By June 2024, build and deploy an education campaign around safer substance use.
  • 5.4: By Jan 2026, build and deploy a public messaging campaign around the “face of harm reduction.

Goal: Coordinate Quick Response Team (QRT) efforts and ensure there is an emergency plan for a significant cluster of overdoses.

Objectives

  • 6.1: By June 2026, increase the percentage of emergency response agencies within Montgomery County with OD Surge Alert/ODMap by at least 15%.
  • 6.2: By June 2026, recruit additional LE/EMS/Fire representation onto COAT Response and other branches for comprehensive inclusion of relevant stakeholders.
  • 6.3: By January 2026, establish evening and weekend coverage for Dayton Police Department GROW team(s).
  • 6.4: By January 2026, establish a peer network where existing GROW programs can share effective tools and initiatives in dealing with drug use and persons struggling with addiction and their families in their communities.
  • 6.5: January 2025, develop best practices guidance document based on standard algorithms/operating procedures/processes for both Front Door Project and Crisis Stabilization Unit
  • 6.6: By January 2026, disseminate finalized best practices document to all law enforcement/Fire/EMS agencies in Montgomery County

Goal: Decrease the supply of illicit and illegal substances available for misuse and abuse

This priority was not included in the strategic planning process due to the actions of this branch of COAT. The COAT backbone support does not instruct the task forces on what work they should be doing. Drugs seized by law enforcement provide a snapshot of drugs present in the community. Montgomery County has three task forces working to remove unwanted drugs from our streets:

  • Miami Valley Bulk Smuggling Task Force - includes eight (8) agencies that conduct criminal investigations utilizing their investigative authority to protect the citizens of the Miami Valley by disrupting and dismantling international drug trafficking organizations.
  • Regional Agencies Narcotics and Gun Enforcement (R.A.N.G.E) Task Force - includes fourteen (14) law enforcement agencies in Montgomery County and works to combat drug abuse and trafficking.
  • Dayton Police Department Narcotics Bureau. In 2019, they re-emphasized their commitment to parcel interdiction, which resulted in major seizures of both methamphetamine and illegal proceeds.