Activate Your Community

Introductory Paragraph

There are many barriers that prevent and limit the efforts of communities to address drug misuse and substance use disorder (SUD), but one particular challenge that many communities face is the ability to elevate their initiative above other competing priorities. The key to building local power is to mobilize the community by bringing together a variety of allies to take collective action. From a systems science perspective, a coalition which identifies the optimal levers of change will have the highest return on investment from it's efforts. In a community, these most powerful levers are people. Identifying champions who can publicly support the coalition’s mission can help to build and foster strategic partnerships, generate buy-in, and increase commitment to bolster support.

Key Information

Coalition-Building Principles

Coalitions form to meet a variety of objectives, such as building and strengthening programs, reaching a diverse audience with a wide range of needs, or developing legislative or regulatory efforts, or a combination of these driving purposes. Whatever the original motivation, communities of all sizes should consider the following principles when activating their community:

• Create alliances and strategic partnerships which build political will and generate support from a broad range of stakeholders
• Use local data trends to drive strategy development and decision-making
• Focus on measurable outcomes at both the individual and population scale
• Engage individuals with lived experience or those directly impacted by substance use disorder in decision-making roles
• Keep equity at the center of all efforts
• Empower citizens by increasing public awareness and community engagement opportunities
• Build relationships with federal, state, and locally elected leaders, and keep them regularly informed of coalition efforts
• Evaluate local and state policies to achieve impact at scale

Starting the Coalition

It is important to note that any community organizing, mobilizing, or strategy to build buy-in should be implemented with regularity. It should not be a single event or effort. Each coalition will determine for itself what works best for them, but all coalitions will benefit from evaluating what has worked in the past in their community. Additional considerations during initial planning include questions of leadership, frequency of meetings, who else should be included, the need for some type of by-laws or governance document, and the roles of participants. Since staffing changes over time, coalition leaders should track lessons learned during the life of the coalition to help maintain institutional knowledge. It is not unlikely that a standing coalition might experience "mission creep" - a tendency to slowly drift away from the organizing purpose of the group. So, is important to consistently evaluate the coalition structure, membership, and goals.

Expanding the Coalition

Anyone in the community can be a leader or a champion. Drug misuse and SUD affects a substantial number of residents in all communities. Having a wide variety of stakeholders and allies embedded within the community can help to advance policies, programs, and systems that can work together and improve local response. When appropriate, engaging new community partners will leverage efforts and boost support within the community. These individuals could be key champions or partners along the way, but might not necessarily participate in the coalition. When identifying champions or strategic alliances, communities should consider their most powerful levers for change. Who in the community can unlock opportunity and accelerate change? What is the backbone of the community? Is it the local hospital system, community college, or a specific business or company? Even if some individuals or organizations have conflicting viewpoints, it is useful to approach them and open a door for conversation. Sometimes non-traditional partners are only “non-traditional” because we label them as such. Some examples of community champions might include those below, but also refer to the SAFE wiki "Strengthen Your Community Coalition" for a more comprehensive list of potential community partners.

• Elected Officials and Local Health Leaders. Locally elected leaders and health officials can play a key role in leading efforts to improve the response to the SUD epidemic. Mayors, County Executives, County Managers, Commissioners, and the local health leaders they appoint, can be powerful allies in raising public awareness about the extent of the problem and the availability of resources. They can provide information on specific strategies that can help save lives. In many instances, elected officials and local health officials might already be part of some type of community task force or other group charged with coordinating and improving local response to the epidemic. However, in the absence of such an effort, elected and health leaders can and should be engaged in raising awareness about the issue and solutions while also increasing support within the community. Elected leaders, and especially legislators, play an important role in the creation of budgets and ultimately decide on how local revenues are allocated to different programs, so it is critical they are aware of the scope of these issues in their communities and what is being done in response. In most cases, they have political allies and are regularly invited to speak at community events or participate in meetings with diverse audiences where they can help to relay the coalition message. Although locally elected leaders are important champions, it’s also critical for a coalition to work alongside its state partners to help align efforts for maximum impact, inform policy, support funding, and make recommendations on the scalability of programs that are working on-the-ground to avoid duplication or manage expectations that might not be feasible or sustainable at the local level. Civic engagement is a necessary component of effective prevention to change attitudes and norms around substance use. Collaboration among local government officials is a key to success.

• Individuals with Lived Experience. Communities should engage individuals with lived experience in decision-making roles - meaning those who have had first-hand involvement with substance use disorder and those who are friends or family members of those directly impacted. Individuals with lived experience bring knowledge, understanding, and experience which is not learned through formal education. To be most effective, it is imperative that communities honor and reflect the voices of those most impacted in their programs and systems, and if possible, find ways to offer fair compensation for their time.

• Youth and Young Adults. Authentically engaging youth to inform response efforts provides multiple benefits. It not only helps communities identify creative solutions, but it also helps to build momentum across this particular population. When youth are engaged in their community, they build resiliency skills, leadership skills, and feel a sense of purpose and belonging. While many communities are bringing together subject matter experts from all areas to address substance use, many find that their messaging falls flat to the adolescent population and that parents are still challenged to find a way to communicate with their teens. Including youth helps to design effective messaging to the teen demographic, highlights gaps only seen by youth, and increases the overall effectiveness of system-building efforts. Youth bring energy and passion that can help increase action. Examples of youth engagement models include Dover’s Youth 2 Youth and Manchester’s Makin’ It Happen.

Messaging the Coalition

Coalition messaging can be used to drum up new interest. It helps to keep a consistent focus on progress that has been made and to use a message of hope in order to sustain engagement. Coalitions have the greatest impact when they can demonstrate the intersection of substance use disorder with other community priorities. Drug misuse and SUD have consequences for all residents of local communities, and the current epidemic increases costs related to public health, public safety, criminal justice, treatment services, and many more. Locally elected leaders are typically motivated by the economic impacts to improve local response, but a far greater price comes from the fatalities caused by the epidemic and related overdoses and the loved ones who must face the pain of those lost. This reality motivates many others to join efforts to combat the epidemic within their communities. Although many coalition leaders work in prevention, harm reduction, treatment, recovery support services, and other efforts that save lives and help those in need find recovery, it may be necessary to tailor messaging to suit a wide variety of audiences in a manner that speaks to the receiver’s particular interest.

There are many options to conduct outreach to the community and to decision makers. Outreach strategies can include a broad public awareness campaign or something more focused that asks community members to become involved in specific programs. Communities have employed numerous campaign strategies to provide education and awareness and to move people to action. It is recommended that a coalition adopt a comprehensive communications plan to help enhance each of the strategies identified and contained in their action plan. These might include the following tactics:

• Creating public service TV and print ads
• Developing signage for public facilities (like hospitals, malls, billboards, etc.)
• Offering extended outreach within schools, faith-based communities, or other existing community groups by speaking at a local youth sports game or holding a local prayer day
• Door-to-door canvassing
• Grassroots letters of support or an open letter
• Proposal of a public declaration or resolution for a board to recognize or pass
• A community town hall event or local speaker series
• Effective storytelling
• Standardized talking points for the coalition and strategic community partners
• Press releases
• Attendance at speaking engagements and conferences

The phrase “A rising tide lifts all boats” certainly applies when working together to change your community. There are many national observations associated with substance use disorder, treatment, and recovery. Most of them provide free resources such as toolkits, banners, fliers, and posters. Joining with others who are making a difference connects the coalition to these national efforts and helps to maintain momentum throughout the calendar year:

• January: Every January, National Drug and Alcohol Facts Week focuses on connecting teens, scientists, and other experts at community and school events to discuss how drugs affect the brain, body, and behaviors .
• May/October: The DEA’s National Take Back Day happens twice a year — once in May and again in October. Americans can clean out their medicine cabinets and turn in — safely and anonymously — unused prescription drugs. The DEA also offers a year-round locator for where unused prescriptions can be turned in.
• May: National Prevention Week is an annual health observance in May focused on increasing public awareness of, and action around, mental health and/or substance use disorders.
• September: Every September is recognized as National Drug Addiction Recovery Month.
• October: Red Ribbon Week is the last week of October and mobilizes communities to educate youth and encourage drug prevention activities.

Using local data is particularly effective in moving community members to take action, because people are more likely to help their own communities. There is a lot of publicly available which can help increase awareness of local conditions. Many state and local communities have created data "dashboards," typically hosted and maintained by the state and local health departments. Topics covered may include:

• Prescription Monitoring Program
• Naloxone availability or use
• Drug-related hospital visits
• Crime statistics
• Treatment statistics
• Viral Hepatitis statistics
• Neonatal Abstinence Syndrome (NAS) statistics

For more information on using data to advance coalition-building, please see the SAFE wiki "Improve Data Analysis and Reporting."

Impactful Federal, State, and Local Policies

Johns Hopkins School of Public Health. Funds from the opioid industry are being delivered to states and local governments as a result of litigation brought against companies for their role in the opioid epidemic. Various decision makers will need to determine the best use of these funds, and the following five principles have been delineated to guide policies around allocation of this funding stream:

• Spend money to save lives. Given the economic downturn, many states and localities will be tempted to use the dollars to fill holes in their budgets rather than expand needed programs. Jurisdictions should use the funds to supplement rather than replace existing spending.

• Use evidence to guide spending. At this point in the overdose epidemic, researchers and clinicians have built a substantial body of evidence demonstrating what works and what does not. States and localities should use this information to make funding decisions.

• Invest in youth prevention. States and localities should support children, youth, and families by making long-term investments in effective programs and strategies for community change.

• Focus on racial equity. States and localities should direct significant funds to communities affected by years of discriminatory policies and now experiencing substantial increases in overdoses.

• Develop a fair and transparent process for deciding where to spend the funding. This process should be guided by public health leaders with the active engagement of people and families with lived experience, clinicians, as well as other key groups.

Available Tools and Resources

The Centers for Disease Control and Prevention offers "Gateway to Health Communication & Social Marketing Practice" to promote social marketing as a useful method to change social norms. It provides tools and templates which communities can use to develop communication and social marketing campaigns and programs. This resource provides tips on analyzing audience, choosing appropriate tools, and evaluating the success of messages and campaigns.

SAFE Project has four tools and resources which are particularly useful in community activation, and staff are available to support each of the following:

• The #NoShame Pledge is a virtual campaign and nationwide movement that combats stigma, because there is no shame in getting help for mental health and substance use. SAFE Project has created a campaign toolkit for communities who want to replicate the campaign locally and use it as a community mobilizing tool to drum up political will and raise awareness about local efforts to combat stigma. The toolkit includes graphics, social media messages, and a sample press release. By using the pledge as a catalyst, communities can identify new stakeholders who can be activated and drive social impact. For example, communities have challenged their commission boards, football teams, business owners, police departments, and others to take the pledge.

• Be SAFE. This campaign spreads awareness nationally to educate Americans on all issues in the substance use epidemic. The graphics target malls, public billboards, medical facility waiting areas, elevators, cafeterias, and other areas.

• SAFE Choices is SAFE Project's programming that fosters resiliency in youth development through collaborative and diversified approaches to substance use prevention, intervention, treatment, and recovery. It takes aim at the transformation of attitudes, beliefs, and behaviors that empower SAFE Choices in all stages of youth development.

• The Naloxone Awareness Project. Forty-eight states have some rules to expand access to naloxone for residents so they do not need a doctor’s prescription to carry it. Communities that have significantly expanded knowledge and access around naloxone, sometimes known as Narcan®, have seen reduced numbers of opioid-related deaths. The Naloxone Awareness Project is a program designed for volunteers to visit pharmacies and talk to friends to increase awareness about naloxone access in their state and community. SAFE Project can provide free digital training and documents.

The National Association of Counties and the National League of Cities have published a joint report titled "Prescription for Action: Local Leadership in Ending the Opioid Crisis." This model for local government leaders to establish or enhance their system-building efforts provides guidance on how cities and counties can strengthen collaboration with each other and with state, federal, private, and nonprofit partners. The report shows successful practices from cities and counties and provides recommendations for coalitions to work with state and federal officials and nonprofit organizations.

Penn State provides an online "engagement toolbox" which includes coalition resources which range from facilitation skills to goal-setting and evaluation procedures.

Promising Practices

All across the country, communities are leading efforts to advance innovative and research-backed programs and policies to make an impact on the addiction epidemic. One of the most effective steps that communities can take is to connect with other community leaders from across the country to learn about their initiatives and challenges they’ve experienced while sharing innovations and best practice solutions. Although what works well in one community might not work well in another, there are many lessons to be learned that communities can replicate successfully in their own localities.