Quality Improvement to Address the Opioid Epidemic in Missouri

1. Quality Improvement to Address the Opioid Epidemic in Missouri Butler County Health Department

2. Goal To create a program offering structured technical assistance for quality improvement for local public health agencies and partnering stakeholder agencies through collaboration with a team at Johns Hopkins Bloomberg School of Public Health.

3. Objective To implement technical assistance on the topic of quality improvement in implementing projects to address the opioid epidemic in Region E

4. Counties Involved • Ripley • Scott • Stoddard • Wayne • Perry • St. Francis • Ste. Genevieve • Ozark • St. Louis • Bollinger • Butler • Cape Girardeau • Dunklin • Iron • Madison • Mississippi • New Madrid • Pemiscot

5. Workshops • Kickoff – (PLAN) • Interim – (PLAN) • Workshop 2 – (PLAN) • Interim – (DO) • Workshop 3 – (CHECK) • Workshop 4 – (ACT)

6. Naloxone Distribution Partner with the MO-HOPE project with the goal of reducing opioid related deaths by providing access to prevention, public awareness, overdose education, and naloxone to individuals at risk of experiencing or witnessing an overdose. AIM: Increase the percentage of first responders who are trained to administer Naloxone from 0-50% by January 2019, by providing training and education to qualified personnel and community members.

7. Naloxone Distribution

8. Naloxone Distribution Projects biggest successes: • In all of the communities at the table someone has a training set up or has been trained. • 9 of 13 communities showed up for a training at New Madrid and provided continuing education hours

9. Naloxone Distribution Issues that must be addressed/corrected • Trainers availability to train • Finding times for first responders to come • Communication between community partners i.e. “politics” of certain areas

10. Naloxone Distribution Next steps: • Keep doing what we are doing.- Reaching out to community members, training new staff, etc • Follow up with organizations that have not been trained yet • Contact each other when we are having a training to share our trainings so more people can get trained

11. Prescription Drug Monitoring Program Implement GIS mapping to analyze patterns of medical and nonmedical opioid misuse utilizing MO’s Prescription Drug Monitoring Program. Goals to include: identification of doctor shopping and decreased controlled substance availability by prescription AIM: By January 1, 2019, Butler, Reynolds, and Ozark County Health Departments will partner with Prescription Drug Monitoring Program to implement geospatial analysis regionally to identify and decrease controlled substances being prescribed by 50%.

12. Prescription Drug Monitoring Program

13. Prescription Drug Monitoring Program Project’s biggest successes • Health Literacy Media has agreed to help develop strategic media messaging increasing awareness and education. • St. Louis County is developing a regional report • MFH CQI LPHA’s have all passed county ordinances partnering with St. Louis County PDMP • All regional and non-regional MFH CQI LPHA’s have passed county-wide ordinances enacting PDMP.

14. Prescription Drug Monitoring Program Issues that must be addressed/corrected • Verbal pushback from staff internally and partnering organizations about PDMP information • Lack of knowledge surrounding PDMP

15. Prescription Drug Monitoring Program Next Steps: • Disseminate reports to partnering organizations with an executive summary • Develop awareness campaign about what PDMP is • Implement strategic media messaging, educating community members about PDMP findings. • The PDMP team will also be presenting about the PDMP to providers and pharmacists in the coming months, as was requested through initiatives with CDC.

16. Overdose Fatality Collaborative Primary goal is to reduce incidence of overdose deaths in the community; a comprehensive review of overdose and non-fatal overdose data, generates recommendations to identify opportunities reducing opioid related deaths and overdoses as well as raising community awareness. AIM: Expand current cause of deaths, including all substance abuse deaths as identified by coroner, ages 18 years and older, for data/statistics in Butler County by January 31, 2019.

17. Overdose Fatality Collaborative

18. Overdose Fatality Collaborative Project’s biggest successes • Creation of the OFC • Identified a legislator to serve as champion and sponsor for OFC s in Missouri General Assembly • Established an OFC model that is replicable for other jurisdictions • Secured funding for GIS software and training to geo map overdose incidents

19. Overdose Fatality Collaborative • Issues that must be addressed/corrected • Engaging new Prosecuting Attorney • Need to create a formal report process • Create a format for community partners to share non-PHI data

20. Overdose Fatality Collaborative • Next Steps • Branch out to surrounding counties

21. Safe Syringe Access / Harm Reduction Exchange of needle, while providing rapid HIV testing anonymously, however, other health services, such as rapid testing for Hepatitis C, STDs, pregnancy tests, and immunizations will be available AIM: Implement a Safe Syringe Access Program by January 1, 2019 to reduce the rate of HCV and HIV co-infections by 50%.

22. Safe Syringe Access / Harm Reduction

23. Safe Syringe Access / Harm Reduction Project’s biggest successes • Paring with smart moves smart choices program • County wide Narcan training

24. Safe Syringe Access / Harm Reduction Project changes needed • The change of syringe access

25. Safe Syringe Access / Harm Reduction Next Steps • Distribute harm reduction packets • Safe Syringe cleaning • Fentanyl testing strips to help decrease overdoses • Still approaching everything from a harm reduction stand point. BCHD will be a guest speaker along side a highway patrol officer and a person who has been in recovery discussing harm reduction and Narcan use.

26. SBIRT / IPV Screening Tool Create an opioid screening tool attachment for the Electronic Health Records system, specially assessing / screening women of child bearing years and male family planning clientele for opioid misuse. AIM: By January 2019, increase # of LPHA’s from 0% to 100% utilizing an electronic screening tool assessing substance use/abuse and intimate partner violence by screening all adult clients seeking family planning, pregnancy testing, and/or STD/HIV services.

27. SBIRT / IPV Screening Tool

28. SBIRT / IPV Screening Tool Project’s biggest successes • All counties are live on EHR • Increased cooperation and communication between counties

29. SBIRT / IPV Screening Tool Issues that must be addressed/corrected • At this time nursing staff has to go to a separate report in order to screen client. • Automatic population of questions vs. having to go to a separate report. • Generate a score based on client’s response to questions.

30. SBIRT / IPV Screening Tool Next Steps: • Meet with other counties to streamline with all seven counties that are using the template. • Work with Patagonia on re-vamping the SBIRT/IPV templates.

31. Smart Moves Smart Choices Partner with Smart Moves Smart Choices, a national awareness program designed to inform parents, teens, and educators about the risk of middle school and teen prescription drug abuse and misuse and to empower them to address this serious problem AIM: By March 29, 2019, 20% of school aged children will participate in awareness of prescription medication abuse and safety program.

32. Smart Moves Smart Choices

33. Smart Moves Smart Choices Project’s biggest successes • Pre and Post Test Scores; Pre Test and Post Test increase in scores • The students were very receptive • The Feedback provided by the student

34. Smart Moves Smart Choices Issues that must be addressed/corrected • Funding Issues • Changing the length of curriculum

35. Smart Moves Smart Choices Next Steps • Implementation in more Counties • Schools to take on program

36. Where are we going

37. Contact Emily Goodin Community Planner Butler County Health Department 573-785-8478 Emily.goodin@lpha.mo.gov