MassCALL2 Strategic Plan
City of Lynn
MassCALL2 Strategic Plan
City of Lynn
November 2008
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MassCALL2 Strategic Plan
City of Lynn
OVERVIEW
Lynn is a low income, blue collar, aging factory city (population 91,922, based on the 2008
MassCHIP health status indicators report). Lynn has been a historical destination for
immigrants, with a growing population of diverse linguistic and cultural groups, including 18.4%
Hispanic/Latino, 10.5% Black, and 6.4% Southeast Asian. Nearly 23% of the city’s population
is foreign born and more than one third are non-English speaking. The per capita income in
Lynn is $17,492 and 16.5% of the population (more than twice the state average) live below the
poverty level. These demographics, combined with high rates of crime, gang involvement,
increasing unemployment, lack of health insurance, and inadequate or unaffordable housing
contribute to the fragmentation and social isolation that increases the risk of substance abuse.
The target population for this initiative includes individuals with a history of opiate use and
abuse at risk for overdose. Fatal and non-fatal overdose victims in Lynn have been primarily
male (62%) and white (83%) with the highest percentage being between the ages of 25 and 44
years old (57%). Demographic information (based on client data from participating substance
abuse providers) indicate that 59% of the target population is male and 41% female, 35% report
homelessness, 70% are white, 15% are Hispanic/Latino, 9.5% are African American, and less
than 2% are Southeast Asian. Further, 11% are under the age of 21 years, 31% between the ages
of 21 to 30, 26% between the ages of 31 and 40, and 24% are 41 years and older.
The intervening variables selected for prioritization by this initiative are: a) Low healthcare
provider knowledge/skills which was mentioned by all key stakeholders interviewed and
considered sufficient data to prioritize this issue; b) lack of post overdose care, an area that was
also mentioned by multiple key stakeholders; c) delays and barriers to seeking emergency or
medical attention, supported by both quantitative data (community profile data indicating higher
numbers of overdoses than reflected by police and emergency room data) and qualitative data
(frequent mention by key stakeholders, past user surveys expressing reluctance to call 911);
d) previous non-fatal overdoses (based on qualitative data on numbers of users who had
previously experienced overdoses); and e) changes in tolerance. Although there was no specific
data available to support the impact of changes in tolerance, the team identified reduced
tolerance following periods of abstinence as a significant risk factor and recommended collecting
data on this issue during the implementation phase.
The strategies selected for implementation include a) training a range of providers in opioid risk
management strategies and the screening and assessment of OD risk for purposes of referral, to
address low healthcare provider knowledge for recognizing opiate abuse, diversion, and
overdose risk; b) training emergency room and medical treatment staff, and first responders to
promote access to follow up services and advocacy after an overdose to encourage initiation of
treatment involvement to address lack of post overdose care; c) working with law enforcement to
reduce user/bystander fear of contacting police or other emergency services when an overdose
occurs to address delays/barriers to seeking emergency and/or medical services; d) provision of
information and training to users on the risk factors for overdose, overdose prevention, and
overdose management to address the variables of previous non-fatal overdoses; and e) providing
education/training to users on risk factors for overdose, overdose prevention, and overdose
management following periods of abstinence.
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The implementation plan will involve identifying training facilitators, as well as the specific
target audiences for education and training, the development of curriculums for training sessions
provided to prescribing physicians and educational group sessions on overdose prevention
provided to users, and developing a pre- and post-training/education evaluation tool to assess
changes in knowledge stemming from the training sessions. After the first year of
implementation, this initiative will utilize collected data to further assess and refine the
curriculums used and the target audiences. The implementation plan will also involve working
closely with the local police, involving them in efforts to receive and provide training and
education to the target audiences to reduce barriers to calling the police in overdose situations.
The City of Lynn is working closely with a local evaluator to create an evaluation plan, collect
and analyze data, and assess outcomes. Through this process, the Lynn initiative will also
participate in the Massachusetts State and CSAP Cross-Site Evaluations and provide any
progress reports as required.
STEP 1. COMMUNITY ASSESSMENT
1.1 Local Assessment Data on Opioid Overdoses
Members of the strategic planning team included representatives from three community based
substance abuse treatment providers (Project COPE, CAB Health and Recovery Services, and
Habit OPCO), the City’s Health Department, the medical provider community (North Shore
Medical Center and the Lynn Community Health Center), the North Shore Medical Center’s
Family Resource Center (support services for parents of substance abusers), a State Legislator’s
office, the local police (although only at the outset), a pharmacist, and a parent. The team
members participating in the needs assessment met in a series of 4 meetings held in July, August,
and September identifying sources of data on the number/rate of unintentional fatal and nonfatal
opioid overdoses, including the local police, first responders, hospital emergency rooms, death
records from City Hall, in addition to community profile data available from the state. Team
members accessed this data and provided it to the committee within an agreed upon timeline.
The sources of data on opioid overdoses in the community were as follows:
 Death certificates for any opioid related death in Lynn from 2006-May 2008
 Lynn police data on opioid related overdoses and fatalities from 2003-August 2008
 Lynn Fire Department data on Emergency Medical Services for overdoses from 10/01/07
to 9/17/08
 Hospital data from North Shore Medical Center on discharge codes for opioid related
poisonings from July 2004 to August 2008
 State supplied data on fatal and non-fatal poisonings for 2003-2006
The quantitative data was analyzed and categorized to update the State supplied community
profile for Lynn with 2007 and 2008 data, especially for numbers of fatal and non-fatal
poisonings.
Opioid-related fatal poisonings: The table below displays state, Lynn death certificate and
police1 reports of fatal poisonings from opioids from 2003 through August 2008. After a sharp
Police numbers are consistently lower than state or municipal data because police do not encounter all poisonings.
Police data are included however, in to confirm trends derived from the other data sources.
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increase in 2005, fatal poisonings have declined in 2006 and 2007. This trend should continue,
barring a large upsurge in the last quarter.
Opioid-related non-fatal poisonings: The table below presents State supplied, hospital
(NSMC) and police supplied data. State data are Lynn residents only, while hospital and police
data contain some non-Lynn residents. All three data sources confirm decreased poisonings
from 2005-2006, with hospital data thereafter leveling and police numbers continuing to decline.
It was noted that the data maintained by the state indicate higher numbers of fatal and non-fatal
overdoses than the local police and emergency room data. As the police data only reflect
overdoses that involved the police, these local numbers are seen as an underestimate of actual
incidents. Similarly, emergency department data only reflect overdose victims who received
medical attention at local hospitals, representing another underestimate of incidence that does not
include individuals who refused medical treatment or transport to a hospital. Available local
data do not provide a true number of non-fatal overdoses as they do not include those that are
unreported.
To address these data gaps, this initiative will continue to survey active users to monitor the
numbers of individuals who continue to be resistant to calling 911 in the event of an overdose.
Every three to four months, outreach staff from CAB Health and Recovery Services will conduct
face to face surveys with a minimum of 50 individuals per survey episode to assess changes in
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willingness to call emergency services. CAB staff will be designated to conduct these surveys as
they have ready access to the target population through ongoing outreach activities. If the trend
of avoiding making 911 calls decreases as a result of the implementation plan, it is anticipated
that there will be less of a discrepancy between community profile data on overdoses and those
resulting in police and/or emergency room involvement.
In addition, recognizing that there are multiple data sources on overdose occurrences (including
the police department, EMS responders, and emergency rooms, data will continue to be collected
on a monthly basis from all three sources and combined to obtain a more accurate estimate of the
number of fatal and non-fatal overdoses that are occurring in the community. Comparisons will
also be made between the three data sources to determine the presence of spikes and dips in rates
of overdoses from one month to the next. Particular attention will be paid to tracking individuals
with repeat incidences of overdoses over the course of a year, thereby identifying individuals at
greatest risk for overdose due to a previous overdose.
Further, templates will be created for treatment providers submitting data on consumption
patterns in order to ensure that the information being collected and the variables considered is
consistent between agencies.
During the needs assessment process, questions arose regarding why data on fatal overdoses
from death certificates showed a more significant decline in fatal overdoses as compared to other
data sources. It was learned that not all deaths stemming from overdoses are reflected in death
certificates as the fatality is often attributed to medical causes and are not modified and defined
as a fatal overdose until reviewed by a medical examiner. This trend impacted the long term
usefulness of this data source.
Questions were also raised about data on fatal and non-fatal overdoses from vital records as
overdoses do not always occur in the town in which the individual lives. The team was uncertain
as to whether strategies that work in Lynn could help Lynn residents at risk, but not necessarily
individuals from other communities who just buy or use in Lynn. Overdose deaths tend to be
connected to the town/city in which an individual lives but non-fatal overdoses are attributed to
the town/city in which the overdose occurs. The team discussed consideration of intervening in
surrounding communities to catch individuals who use/overdose in Lynn, but determined it
would be most effective to focus on Lynn and who is in the community at any given time.
Assessing Local Intervening Variables
Members of the strategic planning team outlined above were also involved in collecting data to
assess local intervening variables. The team met in a series of 4 meetings held in July, August,
and September. The first step in this process involved reviewing each of the intervening
variables listed in the guidance document and identifying whether there were sources of local
data that supported these variables, what these sources were, and who had access to these
sources, and assigning team members to collect this data. The ability of the coalition to access
certain data was a significant factor in selecting which intervening variables to prioritize during
the assessment process. In addition, the planning team believed it would be most effective to
prioritize those intervening variables on which it could collect and maintain data on an ongoing
basis. Once the data sources were identified, the final decision regarding whether to prioritize
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specific intervening variables was based on group consensus. The majority of the members of the
strategic planning team represented the substance abuse provider network and the medical
community. Representatives from outpatient, intensive outpatient, residential, and methadone
and Suboxone services provided ready access to data on consumption patterns, treatment
involvement and compliance, chronicity of use, and the presence of co-occurring disorders, by
demographics. Local service providers who were part of the planning team were involved in
ongoing street outreach activities and had access to qualitative data on user resistance to calling
for emergency assistance in an overdose situation and were tracking individuals in treatment who
had previously overdosed. Team members were asked to provide data available from their own
agencies and identified providers with whom they had a working relationship in order to obtain
outside provider data. The specific intervening variables on which the team planned to collect
data included active IV drug users living with HIV/AIDS (from HIV service providers), barriers
to contacting emergency medical services (from first responders and from active users surveyed
through focus groups), co-morbid substance abuse and mental health issues (from hospital
discharge data, local substance abuse and mental health providers, and private practitioners in
Lynn), concomitant use of opiates and other drugs, individuals who use only opiates, and
individuals with long term histories of IV drug use (from local substance abuse providers,
including methadone and Suboxone programs), drug users who dropped out of treatment
(discharge data from local substance abuse treatment programs), and fluctuations in purity levels
(from the Lynn Police Department).
A variety of quantitative data was gathered by the community of Lynn to ascertain consumption
patterns and intervening variables found in the MASSCALL2 logic model:
 Project COPE Residential and Outpatient summary data for FY 06 – FY 08. The data
from 2008 (100 residential clients; 700 outpatient clients) was further analyzed and
classified to indicate: (i) which consumption patterns applied to each client (e.g.,
injection drug use, opiates plus other drugs) and (ii) whether either or both of the
intervening variables of dual diagnosis and / or homelessness applied to each client.
 CAB Health and Recovery Services client data (101 clients) from 2008 analyzed and
classified to indicate: (i) consumption patterns; intervening variables (e.g., homeless,
previous overdose) and (iii) cause of overdose, witness to overdose and action taken.
 Habit OPCO client data reported at admission from 7/1/2007 to present which indicated,
for 290 unique clients, the primary drug of misuse and, for 137 unique clients, the
secondary drug of misuse.
The quantitative data was analyzed and categorized to:
 Identify quantitatively any particular consumption patterns related to overdoses or deaths
(e.g., those due to mixing opioids with other drugs);
 Identify quantitatively particular intervening variables (e.g., number of injection drug
users who were also homeless) related to consumption patterns.
In addition, team members conducted 27 key stakeholder interviews representing diverse
community sectors. The following data summary includes the impressions of key stakeholders
about which patterns are most prevalent in Lynn and summarizes quantitative data that validate
these impressions. The summary includes lists of “intervening variables” most often mentioned
by key stakeholders in face-to-face interviews and also summarizes some corroborating
quantitative data.
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Consumption patterns
Each key stakeholder interview was coded for which consumption patterns were mentioned. The
table below displays the percentage of the twenty-seven (27) key stakeholders who mentioned
each consumption pattern at least once during the course of their interview.2
% of key stakeholders who mentioned each consumption pattern
Quantitative data validating impressions of key stakeholders:
 Concerning injection drug use: 97% of CAB clients, 67% of Habit OPCO clients and
61% of COPE Residential clients are injection drug users. Forty two percent of COPE
Outpatient clients are injection drug users, an increase of 10% from the previous year.
 Concerning opioids with other drugs: 71% of COPE Residential clients, 35% of Habit
OPCO clients and 36% of CAB clients use opiates with other drugs.
 In addition, of 52 CAB clients reporting a previous overdose, 31 (60%) attributed the
overdose to “mixing”.
 Concerning opioids with benzodiazepines: 11% of Habit OPCO clients reported
benzodiazepines as a secondary drug of misuse at admission.
2 It should be noted that this is not the same as the number of times a consumption pattern was mentioned, which would
overweigh the interviews of more talkative key stakeholders (for example, prescription drug misuse being mentioned
many times by the same key stakeholder).
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Intervening variables
Each key stakeholder interview was also coded for which intervening variables were
mentioned. The table below displays the percentage of the twenty-seven (27) key stakeholders
who mentioned each intervening variable at least once during the course of their interview.3
% of key stakeholders who mentioned each intervening variable
Quantitative data validating impressions of key stakeholders:
 Concerning limited access to care / lack of post overdose care: In 2008 47% of
residential clients at COPE with a history of opiate use were homeless and 51% of clients
at CAB were homeless.
 Concerning delays / barriers to seeking emergency /medical attention: 30% of clients at
CAB who witnessed an overdose did not call 9-1-1.
 Concerning previous non-fatal overdoses: 52% of CAB clients reported personally
having experienced a previous overdose
 Concerning co-morbid SA and MH: nearly 70% of COPE residential clients for the past 3
years had dual diagnoses, as well as 20-30% of outpatients
One notable data gap pertained to the number of individuals in treatment, accessed through
outreach, or presenting in emergency room settings who had previously experienced an
3 It should be noted that this is not the same as the number of times an intervening was mentioned, which would
overweigh the interviews of more talkative key stakeholders (for example, fluctuations in purity being mentioned many
times by the same key stakeholder).
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overdose. This information is not routinely collected by most of the treatment providers
surveyed during the needs assessment process. To address this gap, providers involved with the
implementation team will continue to collect and track this data from their agencies. The team
will also begin tracking information on whether individuals sought emergency services when an
overdose occurred in order to be able to monitor changes in barriers in accessing services. In
addition, it was not possible to obtain data on the intervening variables from sources other than
the providers who were members of the needs assessment team. To address this gap, the
implementation team will focus on cultivating relationships with providers participating in the
training provided through this initiative in an effort to access this data from additional sources.
Assessing Community Readiness and Resources
The strategic planning team used the content of key stakeholder interviews to assess readiness
and resources. In August, a representative from the Northeast Center of Healthy Communities
provided training on conducting key stakeholder interviews, reviewing the questions to be asked
and the procedures for asking these questions to ensure uniformity. The group then generated a
list of individuals to participate in the key stakeholder interviews and assigned interviews and a
timeline for completion to each team member. The list of potential interviewees generated was
purposely large to ensure the completion of an adequate number of interviews. The selection
process included consideration of persons who could offer insight and interest in reducing opioid
poisonings in Lynn and identifying individuals from different segments of the community,
including the treatment provider network, social service agencies, police, first responders,
parents, active users, the business community, pharmacists, government officials, and
community members. The objective was to collect data from individuals invested in addressing
the issue of opiate overdoses, as well as those who did not have the same level of investment, as
a means of assessing community readiness. Each interviewee was sent an introductory letter
outlining the purpose of the interview and received follow up contact to schedule an
appointment. One hour interviews were conducted on a face-to-face basis, consisting of a series
of specific questions that were asked in sequence, with suggested probes also specified. By
standardizing the interview, a higher level of constancy was gained among the different
interviewers and greater similarity amongst participating municipalities. The team member
conducting the interview documented content through note taking. These notes were then
submitted to the team leader who compiled the content of each interview into an excel
spreadsheet, question by question. The interviewees were representatives of local agencies or
organizations who could provide accurate information as well as personal interpretation of the
opioid overdose situation confronting the Lynn community.
Twenty-seven (27) key stakeholders participated in the Lynn key stakeholder interviews,
representing nine different community sectors. The figure below shows the relative size of each
sector representation.
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Coding of key stakeholder interview data: Key stakeholder interviews were coded for any
mention of particular consumption patterns or themes about particular intervening variables. The
first twelve interviews were independently rated by two different evaluators to establish interrater reliability. High inter-rater reliability was found for the coding of consumption patterns
(95% agreement) and adequate reliability for the coding of intervening variables (80%
agreement). Discrepant ratings were discussed among the two raters, consensus reached and
conventions agreed upon. Only one evaluator then rated the remaining interviews.
With respect to the results of the readiness assessment, of the 27 key stakeholders interviewed,
23 (85%) indicated that either they or their agency were ready and open to addressing the
occurrence of opiate overdoses in the community and 21 (78%) indicated that either they
personally or their agency were already taking some steps to address the issue. Only 13 (48%)
believed, however, that the community at large was ready to address the issue of opiate
overdoses. Most individuals interviewed indicated that while service providers in the
community were ready and willing to deal with the issue of opiate overdoses, members of the
community at large were not, commenting that many in the community do not see overdoses as
an issue of priority (unless they are personally effected) and that efforts to address and reduce
overdoses have not been well organized to date. Some interviewees were able to cite efforts that
had been made, including the implementation of education on harm reduction with active users,
educational activities conducted through outreach, services focusing on relapse prevention, and
training users and bystanders on overdose management and overdose reversal.
During this process, several resources were identified to address the problem of opiate overdoses
in the community, including:
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







Existing data collection efforts from substance abuse providers on many intervening
variables, including concomitant use of opiates and other drugs, consumption patterns, IV
drug use, history of past overdoses, and barriers to seeking emergency services
Existing staff and protocols within some agencies that focus on overdose risk as part of
the client assessment and treatment planning process
Hospital and medical provider representatives committed to training their staff on
overdose risk and management
Existing efforts to teach harm reduction strategies in outreach venues and services
focusing on relapse prevention
An existing pilot program through CAB Health and Recovery Services to train users and
bystanders on opiate overdose reversal through the use of Narcan
Existing efforts to provide training on overdose management and reversal to active users
An annual overdose vigil held in the community geared toward increasing public
awareness of the problem
Willingness on the part of the media to provide coverage on this issue
During this process, several gaps were also identified that have impeded the reduction of opiate
overdoses in the community, including:
 Existing efforts are not well coordinated in that not all members of the provider
community are aware of them or know how to access them
 Lack of awareness among many prescribing providers on opiate addiction, medication
diversion, and overdose risk factors
 Attitudes and public perceptions that reduce interest in the overdose issue as victims are
seen as having brought it on to themselves
 Inadequate availability of post overdose care; overdose victims are frequently sent home
after the medical crisis passes without encouragement to become involved in follow up
treatment. There are also insufficient numbers of treatment beds to which individuals at
risk for overdose can be referred.
 Service providers are understaffed and do not have the resources to ensure proper training
of their staff to comprehensively address overdose prevention
 Service providers lack the proper tools for screening for overdose risk and preventing
overdoses
Cultural Responsiveness during the Assessment Process
The coalition recognized the importance of obtaining data that is reflective of the diversity of the
community and the target population The strategic planning team did not reach its stated
objective of establishing cultural diversity within the team (based on race/language), but did
discuss actively recruiting individuals representing these diverse groups. To meet this objective,
the working group will establish and implement an outreach plan that will include meeting with
representatives from agencies (such as faith based and social service agencies) that serve specific
diverse populations (including diverse linguistic and ethnic groups such as Latinos and African
Americans, active users, individuals in recovery, homeless individuals, and individuals at risk
for/living with HIV/AIDS and conducting focus groups with specific populations to obtain their
input on the unique factors that contribute to overdose risk. These outreach activities and focus
groups will also be conducted in the first three months of implementation and used to recruit
individuals to participate in planning activities and to provide consultation and support to the
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implementation process to ensure that it is inclusive of diverse segments of the at-risk
community.
The strategic planning team did solicit data from diverse sectors of the community, each with its
own perceptions, needs and priorities, including the social service, business, political, police,
medical, and community member sectors. The team recognized the importance of obtaining
input from these diverse segments of Lynn. As part of the needs assessment process, the
coalition also did ensure collecting data and input from individuals representing both the active
and recovering community, including conducting key stakeholder interviews with individuals in
recovery from opiate use, staff working directly with the active and recovering population, as
well as surveying active users regarding their concerns about calling emergency services in the
event of an overdose. Further, raw treatment data collected from Project COPE and CAB Health
and Recovery Services was broken down by age, gender, race, and socioeconomic status (as
indicated by rates of homelessness) to identify trends with respect to the intervening variables.
All of the service providers involved in this initiative provide treatment services to opiate users
from diverse cultural and linguistic groups, including African Americans and Hispanics/Latinos
and intend to collect data that is reflective of cultural differences in consumption patterns,
overdose risk, service needs, and responsiveness to services. To ensure that the data collected is
culturally inclusive, team members will maintain and analyze data based on demographics and
use representatives of these diverse cultural groups to assist with interpretation of the data to
identify cultural factors that contribute to any specific trends. This process will involve
providing information and training on cultural inclusion in regularly scheduled team meetings
and inviting representatives from diverse cultural segments to attend scheduled meetings and
participate in these training sessions. The implementation team will also solicit input from other
communities in Massachusetts with similar demographics to enhance its capacity to understand
and respond to cultural issues as they pertain to substance abuse and overdose risk.
Sustainability during the Assessment Process: Members of the team that supplied data from
their treatment services will continue to track the same data on consumption patterns and the
intervening variables of concomitant use of opiates and other drugs, IV drug use, chronicity of
IV drug use, homelessness, and co-occurring disorders on an ongoing basis. This data will be
organized by gender, age, and ethnicity. Maintaining this data collection will allow the coalition
to monitor changes on an ongoing basis. The North Shore Medical Center will continue to track
discharge data on patients seen in the emergency room due to an overdose as well as begin
tracking the number of patients referred for post overdose care. In addition, the team will
continue to track police and EMT data on 911 calls for overdoses.
STEP 2: CAPACITY BUILDING
Strengths and Areas of Growth: The strategic planning/implementation team has representation
from the medical and substance abuse provider communities and pharmacists, supporting access
to the target population of prescribing physicians, dentists, and pharmacists to be trained through
this initiative, as well as the target population of individuals at risk for overdose (including active
users and individuals in recovery, and individuals being released from jail). Further, members of
the implementation team have expertise in the areas of overdose prevention and are available to
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work on curriculum development and the facilitation of training/education sessions. In addition,
the completion of 27 key stakeholder interviews indicates a sizeable pool of individuals
representing diverse sectors of the community who have a vested interest in supporting this
initiative and addressing the overdose problem in the community.
Capacity building included the identification of the individuals/providers that should be
represented on the strategic planning team. The Lynn CTC coalition was fortunate to have a preexisting overdose subcommittee whose members had met during the previous year to address
concerns about opiate overdoses. This group re-convened at the onset of the strategic planning
process and identified additional individuals to be included in the process. The result of this
process was the establishment of a team that was knowledgeable about, and committed to, the
issue of overdose prevention, and afforded access to the range of target populations identified by
this process, including both the provider network and the active and recovering community.
One notable area still in need of development, however, is that of establishing a consistent police
presence in the implementation process. Police representation was available at the initial
strategic planning meeting and the department has been willing to provide overdose data as
needed. However, the planning team was not able to maintain a consistent level of involvement
and participation and recognizes the need to reach out to the police department to establish a
working relationship that will be mutually beneficial. A second area in need of growth and
development for purposes of capacity building is the identification of a physician or physicians
who will assist the implementation team in championing this initiative within the community.
The planning team recognized that its efforts at education and training would be enhanced by the
involvement of a well-known and respected member of Lynn’s medical community who would
participate in providing training and publicly promote efforts to reduce fatal and non-fatal
overdoses.
Plan for Addressing Areas of Growth: It is important for the implementation team to be sensitive
to the challenges with which the police must deal, particularly with respect to the public
perception of officers, the role of the police within the community, and the difficulties inherent
in coping with the consequences of drug use and addiction, including overdoses. The police
department is aware of public perceptions and feelings of mistrust toward the department in
overdose situations and that there is a lack of understanding of the interest of the police in
reducing the incidence of overdoses. To enhance and support police involvement in this
initiative, representatives of the implementation team will meet with the Chief of Police and
provide a copy of the complete strategic plan document for review. Mark Kennard, Executive
Director of Project COPE who has a longstanding relationship with the Chief will initiate this
process and ensure the opportunity to respond to any questions or concerns raised. The objective
of this plan will be to request a commitment from the Chief to provide a representative from the
department who will work with the implementation team in coordinating training for police
personnel on overdose risk management as well as assisting with curriculum development and/or
co-facilitation of trainings to providers. This process will be initiated in January (or upon final
approval of the strategic plan by the State), with an intention to complete the process of
recruitment of a representative of the police department by April 2009. The measure of success
of this plan will be the commitment of a police representative to the implementation team and the
establishment of a consistent presence of the police department.
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The second area in need of growth and development involves identifying one or more
representatives of the medical community to champion this initiative. The team recognizes that
information and training on overdose prevention needs to be promoted and provided by a
physician or physicians that are known in the community and to whom their peers would more
likely respond. While the implementation team will have the capacity to offer continuing
education units to physicians that participate in the trainings as an incentive, the goal of this
process is to ensure that participating providers benefit from the training and recognize opiate
abuse, medication diversion, and overdose risk factors as serious public health concerns. To
enhance and support physician representation within this initiative, members of the team
representing the medical provider community (North Shore Medical Center and Lynn
Community Health Center) will assume a lead role in identifying and recruiting an individual to
assume this responsibility. This individual or individuals will assist with curriculum selection
and development and the co-facilitation of trainings provided to the medical community. The
process of identification and recruitment will also be initiated in January with an intention to
complete the process in February 2009, in time to select a curriculum and begin planning the
training sessions. The measure of success of this plan will be the commitment of a medical
representative promoting and supporting the implementation team’s efforts. To sustain capacity
building efforts, physicians identified as champions of this initiative will be asked to join the
implementation team to assist in identifying additional strategies for provider trainings. The plan
will also include conducting post training interviews with participating physicians/practitioners
to assess their willingness to be engaged in ongoing training efforts, to share what they have
learned with their peers, or to become a part of the implementation team.
In addition to these areas, as part of its planning process, the committee surveyed its members to
identify and discuss potential areas in need of development, including knowledge and/or skills in
the areas of data collection, the needs of the target population, and cultural inclusiveness. The
team will schedule two to three trainings per year to be facilitated by staff from the Northeast
Center for Healthy Communities to enhance and maintain the implementation team’s skill set
and capacity to sustain the initiative. Team members will also participate in trainings on the
Strategic Prevention Framework to enhance understanding and use of this model for all members
and any meetings and trainings scheduled for MassCALL2 grantees across the state. This
training involvement will include participation in the upcoming training on Opiate Overdose
Prevention Basics.
Cultural Competence and Sustainability: The implementation team’s emphasis on continuously
identifying who else to include in this process has been geared toward achieving cultural
competency, by ensuring that the participants either represent or fully understand the impact of
the diversity of the culture of the community, including hard to reach cultural and linguistic
groups and active and recovering opiate users. In addition, through capacity building, the team is
seeking to ensure that this initiative is attentive to the needs, concerns, and priorities of the
varying sectors represented by key stakeholders. As noted earlier, this capacity building will be
accomplished by conducting focus groups and recruiting individuals from the diverse cultural
segments of the community and including these individuals in ongoing planning and
implementation activities and data collection. This approach also supports sustainability as the
team continues to recruit a broad base of providers that are committed to the issue at hand and
who have the expertise and ongoing access to the target population and will maintain consistent
14
MassCALL2 Strategic Plan
City of Lynn
surveillance data on the target population across all treatment agencies involved, as well as
hospital discharge, police intervention, EMT, and death certificate data. The coalition will work
with the NCHC to access training on cultural competency to ensure that participants not familiar
with this process or with specific cultural variances develop a sensitivity to the unique cultural
factors that must be considered in the plan’s implementation.
STEP 3: STRATEGIC PLANNING
The strategic planning team met six times between July and late October. As noted earlier,
members of the strategic planning team included representatives from three community based
substance abuse treatment providers (Project COPE, CAB Health and Recovery Services, and
Habit OPCO), the police department, the City’s Health Department, the medical provider
community (North Shore Medical Center and Lynn Community Health Center), the North Shore
Medical Center’s Family Resource Center (support services for parents of substance abusers, a
State Legislator’s office, the local police, a pharmacist, and a parent. The initial meeting focused
on providing the team with an overview of the function and requirements of the MassCALL2
funding and an overview of the needs assessment process. Each of the intervening variables
outlined in the guidance document was reviewed and team members worked together to identify
potential sources of the data necessary to support each intervening variable and reached a
consensus on which variables to address. The team opted to prioritize those variables on which
it had the capacity to obtain data. In subsequent meetings, team members were trained on how to
conduct key stakeholder interviews, potential key stakeholders to be interviewed were identified
and assigned, and team members discussed progress with collecting data and resolving barriers
to obtaining data. Two meetings were devoted to reviewing all of the data that had been
collected from substance abuse treatment providers, the local police, the local hospital, EMTs,
death records, and key stakeholder interviews, discussing the data analysis compiled by the local
evaluator, identifying which intervening variables to prioritize (based on data trends), and
selecting strategies to incorporate into the strategic plan framework. This process involved
reviewing which variables received the most data support, considering several factors including
the number of sources that identified a certain intervening variable, the reliability and validity of
the available data, how long it might take to change the selected variable, whether there were
other efforts already in place addressing this variable, and the coalition’s capacity and level of
readiness in the community to address the issue. In prioritizing the variables, consideration was
also given to whether the collected data reflected what the team members believed was occurring
in Lynn and whether it would be necessary to use other data collection methods to obtain more
information such as user surveys, more key stakeholder interviews, and focus groups. The
intervening variables identified by each of the key stakeholders were reviewed and, based on the
level of support for the issue, the group selected low healthcare provider knowledge, lack of post
overdose care, barriers to seeking emergency/medical attention, previous non-fatal overdoses,
and changes in tolerance as the priority areas to be addressed. The team recognized that it was
choosing to address a large number of intervening variables and extensively discussed its ability
to address each of these variables. The target populations included emergency department staff,
community based providers, PCPs, pharmacists, hospital medical staff, first responders, and
prescribing physicians, including dentists and, among the user population, overdose victims
presenting in emergency rooms or treated by first responders, individuals in outpatient treatment
settings (including those in methadone maintenance and Suboxone programs), those completing
15
MassCALL2 Strategic Plan
City of Lynn
detox, and individuals being released from jail. Any recommendations made not to prioritize a
particular variable were not a reflection of its importance but, rather, a reflection of the
coalition’s capacity to address it and the availability of data to justify addressing it within the
strategic plan. The group determined data gaps and created a plan for addressing them as the
plan is implemented.
During the strategic planning sessions, the team identified basic goals and outcomes with the
help of a logic model. The intermediate goals and outcomes include successfully accessing and
providing training to the members of the target populations (medical providers, dentists,
pharmacists, emergency room personnel, and first responders, as well as active opiate users and
those in recovery at risk for overdose), offering four trainings to the provider community
annually (reaching a minimum of 48 providers per year) and incorporating opioid risk
management training into existing treatment services and incarcerated individuals to reach a
minimum of 500 to 600 users and individuals in recovery annually. A process evaluation will be
used to determine whether this initiative reached the intended targets in significant numbers and
with the interventions intended. The trainings provided will be intended to increase knowledge
and awareness of overdose risk factors and significantly increase perceived skills in preventing
overdoses which will be assessed through pre- and post-training surveys. The long term goals
and outcomes are decreased fatal and non-fatal opiate overdoses.
Once the priorities to be addressed by this initiative were established and the target population
and goals and objectives identified, the team reviewed the list of potential strategies and made a
preliminary selection of seven strategies that best fit the prioritized intervening variables. The
next step in this process included extensive discussion of the selected strategies, taking into
account political will and community readiness (how ready is the community to respond to this
strategy and what barriers need to be considered), the meaningfulness of the strategy (does the
use of this strategy reflect what is going on in Lynn), capacity to effectively use the selected
strategy, whether other efforts are already in place to implement this type of strategy, and
feasibility (can this strategy be realistically implemented and have an impact within the time
frame of the initiative). The team members ranked the selected strategies according to these
variables and the ensuing discussions led to a narrowing of the list of selected strategies to five:
 To address the intervening variables of low healthcare provider knowledge for
recognizing opiate abuse, diversion, and overdose risk, the plan proposes to train a range
of providers in opioid risk management strategies and the screening and assessment of
OD risk for purposes of referral, including emergency department staff, community
based providers, PCPs, pharmacists, first responders, and prescribing physicians,
including dentists
 To further address the issues of low healthcare provider knowledge, as well as lack of
post overdose care, the second strategy will involve providing training to emergency
department, medical treatment staff, and first responders to promote access to follow up
services and advocacy after an overdose to encourage initiation of treatment involvement
 To address delays/barriers to seeking emergency and/or medical services, the plan
proposes to use the strategy of working with law enforcement to address user/bystander
fear of contacting police or other emergency services when an overdose occurs
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MassCALL2 Strategic Plan
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

To address the variables of previous non-fatal overdoses, the strategic plan will include
the provision of information and training to users on the risk factors for overdose,
overdose prevention, and overdose management
To address the intervening variable of changes in tolerance, the strategy of providing
education/training to users on risk factors for overdose, overdose prevention, and
overdose management following periods of abstinence will be used. Individuals targeted
by this strategy would include individuals in outpatient treatment settings (including
those in methadone maintenance programs and Suboxone programs), those completing
detox, inpatient, or residential program, and individuals being released from jail
The selection of the first strategy of training providers in opioid risk management and screening
and assessment of overdose risk was based on the universal identification of low healthcare
provider knowledge and skills as an area in need of attention. The logical approach to
addressing these needs was to provide training and education on overdose risk and how to
recognize and respond to it. Researchers have cited the importance of addressing the abuse and
diversion of prescription opiates and establishing a coordinated effort by key stakeholders and
practitioners to enhance opioid risk management practices (Katz et al, 2007). The approach of
providing professionals with training and education on risk management was incorporated into a
strategic plan to prevent heroin overdoses in New South Wales, Australia in 2000 (NSW Health,
2000). In addition, researchers have studied behavioral predictors of overdose and recommend
using emergency room physicians to screen for these behaviors and provide information on
overdose prevention, particularly to individuals presenting with a non-fatal overdose or other
indicators of chronic substance abuse (Coffin et al., 2007). One study indicated that a majority
of individuals who died of an overdose had prior contact with either a primary doctor, emergency
department, psychiatrist, and/or substance abuse treatment program within one year prior to their
death (Jones, et al., 2002), supporting the fact that there are opportunities for providing education
on overdose prevention and screening for risk factors, particularly if providers are properly
trained. Researchers have been working on the development of appropriate screening tools to
assess risk of opioid misuse (Adams et al., 2004) and found that the use of screening tools to
assess risk for misuse among individuals on prescription pain medications is a useful process for
facilitating intervention to reduce risk factors. Further, the training of emergency department
personnel in brief interventions has been shown to improve their knowledge base and willingness
to screen and provide intervention to individuals presenting with alcohol related issues
(D’Onofrio, 2004). Therefore, it is reasonable to believe that the application of this type of
training on screening and intervention would assist providers in working with individuals
presenting with histories of chronic substance abuse, including opioid misuse and/or an
overdose. Providing prescribing and treating physicians and similar direct care providers with an
understanding of the nature of opiate abuse, diversion of prescription medications, and
recognition of the risk factors for overdose and how to respond to them will increase the
likelihood that this issue will be discussed between a provider and individual patient and that the
latter, in turn, will have the opportunity to better understand the potential risk for overdose and
how to prevent its occurrence. The use of this strategy fits within the available resources of the
coalition as the key members of the implementation team are members of the provider
community, have expertise in the areas of opiate abuse and overdose risk, and have access to
other members of the provider community who would benefit from training in this area. In
addition, representatives of the medical provider network that participated in the strategic
17
MassCALL2 Strategic Plan
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planning process recognized the lack of training and awareness of the consequences of opiate
addiction, particularly sensitivity to, and knowledge about, overdose risk factors among their
own medical staff and identified a need to provide access to ongoing education in this area. The
coalition recognizes that it will not reach every member of the medical community through the
trainings that are to be provided and, therefore, in order to reach a broader audience, will create
written materials on overdose risk factors and how to respond to them and will distribute them
throughout the medical community, including other hospital and clinic based physicians, private
practitioners, and dentists that do not attend the training.
For similar reasons, the second strategy of providing training to emergency department, medical
treatment staff, and first responders to promote access to follow up services and advocacy after
an overdose to encourage initiation of treatment involvement was selected to address lack of post
overdose care. The data collected as part of Lynn’s needs assessment indicated that a significant
number of overdose victims treated in emergency room settings or by first responders are sent
home once the medical crisis passes without a follow up plan. This trend places the individual at
risk for another overdose as they are left to continue the same patterns of behavior that
contributed to their overdose. Education of providers on available services and strategies for
encouraging overdose victims to become involved in treatment is seen as a crucial step in
preventing repeat overdoses as is follow up to ensure the promotion of linkages to treatment
services. While researchers have acknowledged time constraints in emergency room contacts
that can make intervention difficult, studies have shown that patients with substance abuse
disorders receiving brief interventions at the time of an emergency room visit were more likely
to follow through with an initial follow up treatment visit (D’Onofrio, 2004). One example of
this approach is Project ASSERT, a program developed to increase access to substance abuse
services for patients presenting in the emergency room with health problems related to their
substance use (Bernstein et al, 1997). With this model, use of interventions to promote treatment
involvement resulted in increased follow through with treatment services and positive outcomes
with respect to substance use. Pollini et al (2005) sought to assess what factors contribute to a
decision to seek or not seek treatment following an overdose. It was determined from this study
that the IDUs surveyed who spoke with someone about drug treatment after their overdose were
more likely to enroll in follow up treatment, supporting the approach of providing interventions
in lieu of missing opportunities to promote treatment involvement. As with the first strategy,
providing emergency room/hospital personnel and first responders with information about
available resources and with an understanding of how to conduct brief interventions will increase
the likelihood that an overdose victim may become involved in follow up treatment. Again, in
order to reach a broader audience, the coalition will generate and distribute written materials on
strategies for engaging overdose victims in treatment services to emergency personnel and first
responders that do not participate in the trainings to ensure they have access to the same
information. The use of this strategy fits within the available resources of the coalition as the
key members of the implementation team are members of the provider community, have
expertise in the areas of treatment resources and brief interventions, and have access to other
members of the provider community who would benefit from training in this area. In addition,
representatives of the medical provider network that participated in the strategic planning process
recognized the lack of training and awareness of these types of interventions among their own
medical staff and identified a need to provide access to ongoing education in this area.
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MassCALL2 Strategic Plan
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The third strategy of working with law enforcement to address user/bystander fear of contacting
police or other emergency services when an overdose occurs was selected as significant numbers
of users have reported a reluctance to call 911 when witnessing an overdose due to fear of the
police response. The objectives of this strategy are to support the police in understanding the
impact of this variable and work toward changing perceptions and attitudes on both sides of the
issue, creating more positive experiences with police personnel in overdose situations and
reducing unwillingness to call for emergency assistance. Numerous studies have cited fear of
police response as a reason for not calling 911 in an overdose situation (Tracy et al, 2005;
Pollini et al., 2006; Davidson et al., 2002). Many of these studies concluded that efforts should
be made to reduce the need for police involvement in an effort to increase witness response.
However, Lynn is seeking to enhance the connection with the police and first responders to
increase the likelihood that 911 calls will be made and to educate users (with police support)
about the steps that can be taken to reduce fear of seeking emergency assistance when an
overdose occurs. This process would entail working closely with the police to identify areas in
which they would benefit from additional training and support, as well as areas in which they
could participate in providing training to the target population. Consideration will also be given
to assessing the feasibility of creating a Good Samaritan policy within the community to reduce
fear of emergency intervention. This strategy is possible to implement as coalition members
have an ongoing relationship with the Chief of Police and the police department does have a
vested interest in addressing the issue of overdose prevention.
The fourth strategy of providing information and training to users on the risk factors for
overdose, overdose prevention, and overdose management to address the variables of previous
non-fatal overdoses was selected due to concerns about the increased risk of repeat overdoses
among individuals with previous overdoses (Coffin et al., 2007). The strategy seeks to educate
users in treatment that demonstrate patterns of behavior that place them at risk for overdose
(such as mixing opiates with other drugs and using after a period of abstinence), users
encountered through outreach activity, and those presenting in emergency room settings with an
overdose. Many overdose victims in Lynn are young adults who do not demonstrate an
understanding of the potential consequences for repeat overdoses and are prone to minimizing
their own personal risk factors. Research has identified a number of risk factors for heroin
overdose, including previous overdoses, using after a period of abstinence, concomitant use of
opiates, alcohol, and benzodiazepenes (or other central nervous system depressants), perceptions
of limited susceptibility to overdose, chronicity of use, and intravenous use of opiates (McGregor
et al., 1998). The conductors of this research discuss the need for providing education to users
on the risk factors for opiate overdose and the use of interventions to change behaviors to prevent
experiencing an overdose. Providing educational information through outreach activities and in
group sessions to individuals in treatment provide users with the tools and strategies needed to
change specific behaviors and reduce the risk of overdose. The use of this strategy fits within the
available resources of the coalition as the key members of the implementation team are members
of the provider community and are currently conducting outreach activities and providing
treatment services to individuals in a variety of settings, including traditional and intensive
outpatient treatment, residential programs, and detoxes, as well as methadone and Suboxone
services. Therefore, the implementation team has expertise in the areas of educating about
overdose risk, and access to members of the target population in need of education in this area.
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MassCALL2 Strategic Plan
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The fifth strategy of providing education/training to users on risk factors for overdose, overdose
prevention, and overdose management following periods of abstinence was selected to address
the intervening variable of changes in tolerance. Users are at greater risk of overdose following
a period of abstinence due to decreased tolerance, including after leaving substance abuse
treatment and after release from incarceration (Sporen, 1999). Similarly, Gossop et al. (1996)
conducted a study of factors contributing to overdose among heroin users, one of which was the
use of heroin following a period of abstinence and recommended the provision of educational
services to educate individuals about risk factors for overdose, including the impact of a loss of
tolerance. McGregor et al (1998) studied risk factors for overdose in heroin users (over half of
whom had previously experienced at least one overdose) and also noted reports of overdose
following periods of abstinence. The use of harm reduction based treatment, such as methadone
maintenance, has been studied to assess its effectiveness in reducing fatal overdoses, the results
of which have indicated lower rates of mortality by overdose compared to individuals who did
not remain in such treatment. The treatment services provided included receipt of methadone as
well as medical support and counseling (Langendium et al., 2001). This study supports the use
of intervention to opiate users in treatment that will reduce the risk of overdose after leaving
treatment. Seaman et al (1998) conducted a study of increased risk for fatal overdoses within the
first two weeks following release from prison and discovered a higher rate of deaths from
overdose during this period of time compared to subsequent periods. These researchers also
recommended the provision of education and information on risk factors for overdose following
release. Providing educational information in sessions in treatment settings (outpatient,
residential, detox) and in prison settings will provide users with the tools and strategies needed to
change specific behaviors and reduce the risk of overdose. As clients are preparing for discharge
from treatment, aftercare planning generally focuses on becoming engaged in follow up
treatment services such as continued outpatient services and self-help programs and on the use of
strategies for relapse prevention. Clients are provided with information on available treatment
resources and referrals to these services are facilitated. The intent of this initiative is to add
training on overdose prevention which has not historically been incorporated into aftercare
planning. Therefore, the use of this strategy will serve to augment services rather than duplicate
them as it will add a new component to the treatment and discharge planning process. The use of
this strategy fits within the available resources of the coalition as the key members of the
implementation team are members of the provider community currently providing treatment to
individuals in a variety of settings, including traditional and intensive outpatient treatment,
residential programs, and detoxes, as well as methadone and Suboxone services and have access
to inmates within Middleton jail. Therefore, the implementation team has both expertise in the
areas of educating about overdose risk, and access to members of the target population who are
in need of education in this area.
The process of educating active users and individuals in recovery about risk factors for overdose
and overdose prevention and management will also involve the creation of informational flyers
that will be routinely distributed in treatment settings and correctional settings and through
outreach activities in order to provide as many individuals as possible access to this information
as well as serve as a reminder to individuals that do participate in training sessions.
The strategic planning team carefully considered the feasibility of implementing this plan,
recognizing that it was geared toward providing a significant number of training sessions and
20
MassCALL2 Strategic Plan
City of Lynn
reaching a large number of high risk individuals.. It was determined that the implementation
team had the necessary resources to fulfill this plan based on the following: 1) Two agencies
(North Shore Medical Center and the Lynn Community Health Center) were active members of
the strategic planning committee and have access to the medical personnel to whom training will
be provided, potential trainers, space for conducting training, and the capacity to provide CMEs
for participating physicians. They also have the capacity to assist the implementation team with
scheduling and coordinating the training sessions, including through NSMC’s Grand Rounds;
2) Members of the strategic planning team have prior experience and expertise in the areas of
overdose awareness and prevention and have the capacity to oversee the provision of training to
consumers and providers; and 3) The implementation team includes three substance abuse
treatment providers, all of whom provide specific services to opiate users (Project COPE, CAB
Health and Recovery Services, and Habit OPCO) and one of which provides street outreach to
high risk individuals and have ready access to the target population. These 3 agencies serve well
in excess of 500 opiate abusing clients on an annual basis.
The selected strategies are culturally appropriate in that the education and training recommended
can be delivered in more than one language, if necessary, and in a variety of settings to ensure
that it is readily available to all segments of the target population, within environments in which
they are most comfortable or can best be reached. Participation in these kinds of educational
opportunities are generally more effective when brought to the recipient, rather than requiring the
recipient to seek it out and the provision of training will be provided in multiple venues,
including through street outreach, within treatment settings, and within the jail. Distinct
educational opportunities will be made available to both the community of active opiate users,
and those currently in recovery, both of whom represent diverse service needs. The strategic
plan is also considering the needs of other members of its target population, specifically
physicians and other prescribing providers, by tailoring trainings to meet their schedule demands,
delivering them within their venue, and provide CME credits to increase incentive to attend.
The selected strategies have a high potential for sustainability. The implementation plan will
include both the selection of appropriate curriculums and materials to be used for education and
training as well as the assessment, revision, and refinement of these materials and the training
approach in general. This process will also involve identifying which curriculum approach and
materials best meet the needs of the diverse populations that are on the receiving end of the
training and education. Completion of this process will enhance the sustainability of the
strategies of educating both active users and individuals in recovery in different treatment
settings, and through outreach contacts. Community based substance abuse treatment providers
as well as medical providers that begin using these curriculum materials and incorporating
routine training and education on overdose risk factors and prevention strategies into their
programs will be in a better position to maintain an ongoing focus on overdose prevention.
In addition, the team will designate members who will be responsible for establishing a
sustainability plan. It is recognized that the team will need to focus on post-funding
sustainability from the outset. On a quarterly basis, team members designated to ensure
sustainability will facilitate discussion of a) what aspects of the implementation plan are working
as anticipated, what steps need to be taken to maintain its effectiveness, and who will be
responsible for enacting these steps, and b) what aspects of the implementation plan are not
21
MassCALL2 Strategic Plan
City of Lynn
working as anticipated and what steps need to be taken to improve effectiveness? Sustainability
will be linked to the evaluation process as the team regularly reviews its process objectives and
measures and its capacity to effectively implement this initiative. Sustainability will also require
a public relations effort by the committee as it establishes champions of the activities in which is
engaged, including physicians and other substance abuse treatment providers, who will conitnue
to promote the spread of information about overdose risk and the need for risk management after
the period of funding has ended.
STEP 4: IMPLEMENTATION
Strategy 1:
Train a range of providers in opioid risk management strategies and the
screening and assessment of OD risk for purposes of referral, including emergency department
staff, community based providers, PCPs, pharmacists, first responders, and prescribing
physicians, including dentists
Action Steps
Who is
Timeline
Measure of
Responsible
Success
Identify specific physician groups to
target for each training session
Identify trainers and physician(s) with
whom to co-facilitate trainings
Plan training, including selecting a
curriculum, and promote to providers
Wendy Kent
(Project COPE),
Lori Berry
(LCHC), Lori Long
and Marguerite
Roberts (NSMC),
Gary Langis and
Mary Wheeler
(CAB), MaryAnn
O’Connor (Health
Department), Ted
Ball (Crown Drug),
Larry O’Toole
(Habit OPCO),
Paul Florin
(Evaluator)
February 2009
A list of providers to
target for training will be
generated
February 2009
All trainers will be
identified
March 2009
Training dates will be
established and training
to be provided at NSMC
Grand Rounds will be on
the schedule; a
curriculum outline for the
training will be generated
and materials for
distribution created
CMEs will be available
for all trained physicians
Arrange for the receipt of CME’s for
trained physicians
April 2009
Develop pre- and post-training evaluation
tool
April 2009
A training evaluation tool
will be ready for use at
the first training
Provide 4 1-hour trainings per year,
starting in April 2009, for a minimum of
12 providers attending per training
Starting
April/May
2009
A minimum of 48
providers will attend
training on
Use the first year of implementation as a
pilot year to refine the target audience and
curriculum
April 2010
The implementation team
will make necessary
revisions to the
curriculum and refine the
providers and venues in
which training will be
provided
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MassCALL2 Strategic Plan
City of Lynn
Strategy 2: Provide training to emergency department, medical treatment staff, and first
responders to promote access to follow up services and advocacy after an overdose to encourage
initiation of treatment involvement
Action Steps
Who is
Responsible
Timeline
Measure of
Success
Identify specific physician groups to
target for each training session
Wendy Kent
(Project COPE),
Lori Berry
(LCHC), Lori Long
and Marguerite
Roberts (NSMC),
Gary Langis and
Mary Wheeler
(CAB), MaryAnn
O’Connor (Health
Department), Ted
Ball (Crown Drug),
Larry O’Toole
(Habit OPCO),
Paul Florin
(Evaluator)
February 2009
A list of providers to
target for training will be
generated
February 2009
All trainers will be
identified
March 2009
Training dates will be
established and training
to be provided at NSMC
Grand Rounds will be on
the schedule; a
curriculum outline for the
training will be generated
and materials for
distribution created
Arrange for the receipt of CME’s for
trained physicians
April 2009
CMEs will be available
for all trained physicians
Develop pre- and post-training evaluation
tool
April 2009
A training evaluation tool
will be ready for use at
the first training
Provide 4 1-hour trainings per year,
starting in April 2009, for a minimum of
12 providers attending per training
Starting
April/May
2009
A minimum of 48
providers will attend
training on
Use the first year of implementation as a
pilot year to refine the target audience and
curriculum
April 2010
The implementation team
will make necessary
revisions to the
curriculum and refine the
providers and venues in
which training will be
provided
Identify trainers and physician(s) with
whom to co-facilitate trainings
Plan training, including selecting a
curriculum, and promote to providers
23
MassCALL2 Strategic Plan
City of Lynn
Strategy 3: Working with law enforcement to address user/bystander fear of contacting police
or other emergency services when an overdose occurs
Action Steps
Hold follow up meeting with Police
Chief (Key Stakeholder) and provide
copy of strategic plan
Who is
Responsible
Mark Kennard
(Project COPE),
Wendy Kent
(Project COPE)
Hold additional follow up meetings to
discuss potential for commitment of a
representative from the police
department for the implementation
team
Timeline
January 2009
Measure of
Success
Meeting takes place
January –
April, 2009
Discussion occurs and
departmental concerns
and questions are
addressed; commitment
for police
representation is
obtained
February
2009
Focus groups
conducted and data
provide more clarity of
factors contributing to
fears of contacting
emergency services
Conduct focus group(s) to collect
more data on this issue
Wendy Kent
(Project COPE),
Gary Langis and
Mary Wheeler
(CAB)
Research and assess the feasibility of
Good Samaritan policies in the
community
Mark Kennard,
FebruaryWendy Kent
April, 2009
(COPE), Gary
Langis, Mary
Wheeler (CAB),
MaryAnn
O’Connor (Health
Dept.), Lynn
Police
Representative
An informed decision
will be made about the
feasibility of a Good
Samaritan Policy in
Lynn
Identify training needs of police
department in the area of overdose
risk factors and prevention
Police
Department
Representative
April/May
2009
The police department
will identify their
training and support
needs
Identify trainings on overdose
prevention and accessing emergency
services which police would facilitate
Police
Department
Representative
April/May
2009
The police department
will identify trainings
to facilitate
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MassCALL2 Strategic Plan
City of Lynn
Strategy 4: Provision of information and training to users on the risk factors for overdose,
overdose prevention, and overdose management
Action Steps
Identify specific client groups to target for
each training session, including clients
currently in outpatient, intensive
outpatient, detox, methadone and
Suboxone, and residential services
Who is
Responsible
Wendy Kent
(Project COPE),
Gary Langis and
Mary Wheeler
(CAB), Larry
O’Toole (Habit
OPCO)
Timeline
Measure of
Success
February 2009
A list of client groups at
participating agencies to
target for training will be
generated
Identify individuals to provide education
on overdose prevention
February 2009
All staff to provide
educational services will
be identified
Plan educational sessions, including
selecting a curriculum, and promote to
providers
March 2009
A schedule of when and
where educational
sessions will be held will
be generated; a
curriculum will be
selected and distributed to
providers facilitating
educational sessions
Develop pre- and post-education
evaluation tool
April 2009
An evaluation tool will be
ready for use at the first
sessions to measure
acquired knowledge
about overdose risk
factors
Incorporate curriculum into existing
group and individual sessions provided to
the target population at Project COPE,
CAB, and Habit OPCO
Starting
April/May
2009
A minimum of 500
clients will receive
education on overdose
risk factors per year
Use the first year of implementation as a
pilot year to refine the target audience and
curriculum
April 2010
The implementation team
will make necessary
revisions to the
curriculum and refine the
providers and venues in
which training will be
provided
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MassCALL2 Strategic Plan
City of Lynn
Strategy 5: Provide education/training to users on risk factors for overdose, overdose
prevention, and overdose management following periods of abstinence
Action Steps
Who is
Responsible
Timeline
Measure of
Success
Identify specific client groups to target for
each training session, including clients
currently in outpatient, intensive
outpatient, detox, methadone and
Suboxone, and residential services
Wendy Kent
(Project COPE),
Gary Langis/Mary
Wheeler (CAB),
Larry O’Toole
(Habit OPCO)
February 2009
A list of client groups at
participating agencies to
target for training will be
generated
Contact sheriff’s department and DOC to
obtain approval to distribute information
about overdose prevention to inmates and
facilitate educational groups on this topic
within the Middleton jail
February/March Approval to distribute
2009
materials and provide this
service will be obtained
Identify individuals to provide education
on overdose prevention in treatment
settings and at Middleton jail
February 2009
All staff to provide
educational services will
be identified
Plan educational sessions, including
selecting a curriculum, and promote to
providers
March 2009
A schedule of
educational sessions will
be created; a curriculum
will be selected and
distributed to providers
facilitating educational
sessions
Develop pre- and post-education
evaluation tool
April 2009
An evaluation tool will be
ready for use at the first
sessions to measure
acquired knowledge
about OD risk factors
Incorporate curriculum into existing
group and individual sessions provided to
the target population at Project COPE,
CAB, and Habit OPCO
A minimum of 500
Starting
April/May 2009 clients will receive
education on overdose
prevention per year
Provide regularly scheduled education
sessions to inmates at Middleton Jail
A minimum of 75
Starting
April/May 2009 inmates will receive
education on overdose
prevention per year
Use the first year of implementation as a
pilot year to refine the target audience and
curriculum
April 2010
26
The team will revise the
curriculum as necessary
and refine the providers
and venues in which
training will be provided
MassCALL2 Strategic Plan
City of Lynn
The implementation plan outlined above identifies the action steps to be taken during the first
year of implementation. The three year timeline for this initiative is as follows:
July to November 2008 Conduct community needs assessment and create strategic plan for
Lynn
January 2009: Reconvene implementation team following approval of strategic plan by DPH
February 2009: Conduct focus groups with members of active and recovering community to
obtain qualitative data on concerns about calling 911 in overdose situations; meet with Lynn
Police Chief to share this information and request police representation in this initiative; develop
outreach plan to enhance cultural inclusiveness
February to April 2009: – Identify trainers and recipients of training and develop curriculum
for provider trainings on overdose risk management and prevention and post overdose care;
arrange for receipt of CMEs; develop pre-post training evaluation tools; develop curriculum for
training to be provided in treatment settings to active users and members of the recovering
community and incarcerated individuals; implement outreach plan to enhance cultural
inclusiveness
April 2009 to January 2010 – Provide three trainings to physicians, dentists, first responders,
and pharmacists on overdose prevention and risk management and brief interventions to enhance
post overdose care; provide group and individual level interventions to users and individuals in
recovery in treatment settings and prison setting on overdose prevention and risk management;
administer pre/post training surveys; conduct focus groups to monitor attitudes about calling
911 in overdose situations; hold trainings for implementation team members on cultural
inclusiveness, sustainability, and data collection; conduct focus groups with members of active
and recovering community to obtain qualitative data on concerns about calling 911 in overdose
situations
January to February 2010: Evaluate effectiveness of trainings provided by reviewing pre-and
post training evaluation data and trends with respect to overdoses, consumption patterns, and
attitudes about calling 911 in overdose situations; revise curriculums and target population as
appropriate based on data outcomes; assess effectiveness of outreach plan designed to ensure
cultural inclusiveness
March 2010: Identify recipients of training and plan training schedule for the year to providers
and users/individuals in recovery; survey members of active and recovering community to obtain
updated data on concerns about calling 911
April to January 2011: Provide three trainings to physicians, dentists, first responders, and
pharmacists on overdose prevention and risk management and brief interventions to enhance post
overdose care, provide group and individual level interventions to users and individuals in
recovery in treatment settings and prison setting on overdose prevention and risk management;
administer pre/post training surveys; conduct additional surveys/focus groups on making 911
calls
27
MassCALL2 Strategic Plan
City of Lynn
February 2011: Evaluate effectiveness of trainings provided by reviewing pre-and post training
evaluation data and trends with respect to overdoses, consumption patterns, and attitudes about
calling 911 in overdose situations; revise curriculums and target population as appropriate based
on data outcomes; identify final group of providers to receive training on overdose risk and brief
interventions to support post overdose care; continue to provide group and individual level
training to active users and individuals in recovery in treatment and prison settings on overdose
prevention and risk management
February to April 2011: Provide one additional training on overdose prevention and risk
management for providers; continue to provide training sessions to users and individuals in
recovery at risk for overdose; survey users/recovering community on making 911 calls
April to June 2011: Review outcomes data; finalize sustainability plan
Through this initiative, the implementation team anticipates being able to provide education on
overdose prevention to a significant number of clients on an annual basis. These estimates were
determined to be achievable due to the large number of opiate using clients served by the
agencies participating, including Project COPE, CAB Health and Recovery Services, and Habit
OPCO. Habit OPCO alone does in excess of 400 to 450 clients on a daily basis and will be
easily accessed by the team members providing the educational sessions.
STEP 5: EVALUATION
The City of Lynn will participate in the Massachusetts State Cross-Site Evaluation and the
Center for Substance Abuse Prevention National Cross-Site Evaluation. The City will also
affirm that it will:
-
Complete the State/CSAP Community Level Instrument in January and June of
each funding year
Provide a written summary of the community’s progress in implementing the SPF
process and accomplishments to date in January and June of each funding year
Provide National Outcome Measure data in January and June of each funding year
28
MassCALL2 Strategic Plan
City of Lynn
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City of Lynn
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