Understand Funding and Identify Your Resources

Introductory Paragraph

This article focuses on ways that coalitions can increase their funding base. It also addresses various components of sustaining funding, because communities and funders need assurance that the coalition is working toward long-term outcomes that are built on a reliable foundation that will continue independently of single-source financing.

One key strategy is to diversify approaches to funding, so this article covers public, private, and philanthropic sources. In addition, within the public, or governmental funding stream, a key strategy is to balance state and local sources with federal, and if appropriate, tribal funding sources.

Key Information

The Funding Landscape

There are a variety of funding streams that can be blended and braided, including:

• Public funding or grants, which includes federal, state, and local funding streams,
• Private sources include contributions from corporate resources and in-kind support or fee-for-service options. Traditional approaches to fundraising can be supplemented with social impact bonds also known as pay-for-success financing
• Philanthropic agencies — at both national and local levels,
• Other one-time payments, such as opioid settlement dollars.

Understanding the funding landscape of the substance use crisis is essential, but complex. Taking the long view, on the positive side, major impacts have been achieved as a result of focused funding initiatives. For example, prevention efforts generated by the tobacco settlement dollars resulted in dramatic decreases in adolescent smoking over a ten-year span. However, public health gains in this domain dissolved rapidly after the advent of e-cigarettes. There is a great deal of optimism about the potential use of opioid settlement funds to have a similar degree of impact, but optimal allocation of funding requires an awareness of sustainability strategies. It takes a committed intention to offset the flux in the history of funding which has been directed at substance use prevention, harm reduction, treatment, and recovery. For example, there is long-term oscillation associated with particular substances, shifting priorities from one substance to another, rather than addressing all forms of substance use. Likewise, there is variability in focus between reducing supply, which typically falls to law enforcement, and reducing demand, which involves public health and social services. Prevention funding has witnessed a dynamic which started with reaching individuals (“just say no”) to changing social norms (nicotine free-free public spaces). Taking recent advances in harm reduction strategies within such a broad perspective ensures that optimal strategies are deployed across changing political climates at national and local scales.

Sustainability

While human capital is the lifeblood of the coalition, financial capital is vital to initiate and sustain long-term collaborative efforts. Unfortunately, both human and financial capital are too frequently overlooked in the week-to-week stream of coalition activities. The energy and wisdom of coalition members and agency relationships are often only recognized when they are gone. Likewise, focus on financial resources is typically considered as a grant cycle approaches closure. A sustainability strategy brings home that creating significant community change is a long-term process. Despite short-term successes, long-term results can take years. Persistent collaboration and working toward a common vision are essential to sustain long-term community efforts.

Crafting a sustainability plan with specific objectives brings ongoing support to the coalition vision by its members, funders, and the community at large. It is useful to build a vision as part of a grant or a project, but more useful to plan from the start how that vision will be sustained after the grant is over. Sustainability planning should happen as soon as the vision, mission, and objectives are established. Since sustainability is a process and not just a one-time venture, each phase of every project should have sustainability considerations. This will help the coalition to:

• Make time to recognize problems and to allocate funding, staffing, and resources for best solutions.
• Structure approaches and objectives that will continue to grow and achieve the desired impact in the community.
• Have more efficient and effective efforts to maintain support.
• Avoid interruptions in progress if funding is declined.

Coalition Actions

Effective strategies to increase and sustain funding are closely tied to building robust partnerships (See “Mobilize Community Champions” wiki). One example can be seen in developing ties with experts in local universities, who may be adept in obtaining grant funding. Likewise, other agencies working on distinct but related issues, such as suicide prevention and gun violence or domestic violence prevention. While agencies working in these areas have different risk factor reduction strategies, their methods to enhance protective factors are similar (See SAFE Solution article titled, “Address Risk & Protective Factors for Individuals, Families, and Communities.) This both fosters increased collaboration and provides opportunities to share funding streams. (See “Apply a Multi-Sectoral Approach.”)

Each sustainability tactic the coalition chooses will require members, staff, or other volunteers with skills or interests related to the identified need. Some examples include activity implementation, grant writing, marketing, event planning, and establishing a donor or membership base. Asking the kinds of questions listed below will help clarify what is needed to build a sustainability strategy:

• Is sustainability being considered “up front” and integrated with tracking performance over time? Data demonstrating success and a trend of success justify the sustainability of the funding for that program. See SAFE Solutions article, titled “Plan, Implement, and Evaluate.”
• What goals have been successfully achieved?
• What new goals are emerging?
• Do we have a broad range of support across all partner systems (health, legal, social, etc.)
• Can we connect our local initiatives back to state-level efforts and link to broader activities?
• Does our initiative have enough staffing or volunteer support to consistently drive its efforts?
• Can our budget cover existing costs? Can we pursue new funding opportunities? Have we explored innovative solutions?
• Have we communicated our successes to our partners and the public?
• Do we incorporate the voice of people most impacted by our decisions?
• Do we focus on the specific needs of individuals and families in our community?

“Small and Fast” Funding Wins

While large grants get a lot of attention, there are a number of ways that coalitions can gain traction in the funding arena by taking on quick and easy projects that work from small-dollar expenditures:

• Supplement local health department funding for use on addressing overdose. This could include basic education, marketing, and printing costs, or it could enhance overdose data collection to understand the local severity of the crisis in real time.
• Purchase low-cost Naloxone. Remedy Alliance is a nonprofit with the cheapest price for intramuscular Naloxone, which is much more affordable than intranasal.
• Purchase test strips. Fentanyl test strips are particularly useful for stimulant users who might not have a tolerance for opioids. Xylazine test strips can help people avoid this contaminant, which can cause extreme sedation and skin wounds.
• Purchase wound care supplies for people who use drugs. Supplies to treat Xylazine wounds include soap and sterile water, petroleum jelly, gauze pads, and gauze wrap.
• Campaign to combat increasing overdose rates amongst stimulant users. Provide educational materials and training specifically for stimulant users about the risks of opioids and how to access Naloxone.
• Provide transportation vouchers so people can get to treatment, job interviews, and other appointments.
• Flexible funds for care navigators, especially for reentry, peer, recovery programs. These could include bus passes, cellphones, etc.
• Wifi for those who don't have access to it so they can take advantage of tele-health appointments.
• A more ambitious project might support or create a local syringe service program, to offer an “on-ramp to care” for people who don't currently interface with the medical system.
• Similar in scope, fundraising could be directed to help people stay on medication-assisted treatment, as they transition out of local jails.

Relevant Research

• The O’Neill Institute for National and Global Health Law at the Georgetown University Law Center has published a research report on methods to transform government budgets to incentivize investment in a coordinated, targeted, and outcomes-driven approach to SUD. One chapter in this report is titled “Aligning Funding for SUD Across the Government Agencies to Meet a Cohesive Set of Outcomes.”

• The Center for Health Care Strategies offers an online “Principles-in-Action” series funded by the Pew Charitable Trusts with support from Bloomberg Philanthropies. It addresses financing strategies for state investments in SUD along three evidence-based SUD interventions: peer supports, medications for opioid use treatment, and harm reduction services.

Impactful Federal, State, and Local Policies

A variety of federal agencies have legislative mandates to provide services associated with prevention and treatment of substance use. Although SUD funding is typically prioritized on a bi-partisan basis, these funds can be impacted by presidential and congressional priorities and decisions. Election cycles in both the executive and legislative branches can influence funding streams. In addition to political variability, one source of confusion in developing funding strategies at the state and local level is the number of federal departments in which funds are housed. The major focus on policy and associated SUD grant funding can be found in three agencies. The Department of Health and Human Services (HHS) includes the Centers for Medicare and Medicaid Services, CDC, FDA, HRSA, NIH, and SAMHSA. Medicaid expansion which has been adopted in 39 states and Washington DC provides access to additional services for low-income populations, and this has a positive impact on SUD services. The Department of Justice and the Department of Housing and Urban Development are also key agencies in implementing policy and grants linked to the various HHS missions.

Block grants are issued in areas of general need like public health, housing, and other social services. Each state is awarded the federal grant and is given flexibility to decide on specific implementation strategies. States determine eligibility for the grants they manage, setting their own guidelines on their service expectations. State offices determine how to distribute these funds between various statewide initiatives and how much funding is allocated to specific counties. Below are some examples of block grants:

• The Community Development Block Grant (CDBG) is administered by the Department of Housing and Urban Development (HUD) and awards funds for community development projects.
• The Community Mental Health Block Grant (MHBG) is administered by the Substance Abuse and Mental Health Services Administration to improve mental health services.
• The Social Services Block Grant (SSBG) is administered by the Office of Community Services and provides funding for programs and services that increase self-sufficiency, decrease dependency, and protect people from abuse and neglect.
• The Substance Abuse Prevention and Treatment Block Grant (SAPTBG) is administered in partnership between HHS and SAMHSA and awards funding to update, improve, and expand SUD services. States are required to set aside 20% of their SAPTBG funding for prevention services. There is an effort underway to allocate a comparable 10% exclusively for recovery services.
• Temporary Assistance for Needy Families (TANF) is administered through the Department of Health and Human Services and provides assistance to families with children in financial need.
• The Indian Housing Block Grant is administered by HUD and helps low-income Native Americans living in a tribe or on a reservation find and maintain suitable housing.

To support a local level understanding of policy concerns, the National Association of Counties (NACo) has published “The Principles Quick Guide to Removing Policy Barriers.” It summarizes the role of policy barriers in implementing best practices and provides steps to perform a policy review to overcome barriers. The information on the NACo website is based upon “The Principles for the Use of Funds from the Opioid Litigation” developed by the Johns Hopkins Bloomberg School of Public Health.

Available Tools and Resources

Grants.gov is a one-stop shop on federal funding opportunities for organizations which support the development and management of government-funded programs and projects. The website includes a useful search engine.

The National Academy for State Health Policy has generated a report and infographic which summarizes the major sources of SUD funding for states.

There are numerous resources associated with the opioid settlement:

• The Opioid Settlement Tracker provides a status report on settlements reached between U.S. state and local governments and the major pharmaceutical opioid manufacturers, marketers, distributors, and retailers.
• The National Tracker also includes a searchable index on non-opioid remediation use reports.
• The Tribal Opioid Settlement website provides information and a tracker on suits brought by American Indian Tribal Nations against companies involved in manufacturing and selling opioids in the United States.
• The Appalachia Opioid Remediation (AOR) database catalogues information about how the 13 states of Appalachia are managing and spending funds received from litigation settlements with opioid manufacturers, distributors, and retailers.
• The National Association of Counties (NACo) offers the Opioid Solutions Center to help counties maximize the impact of the opioid settlement funding stream. It provides custom planning, implementation and peer learning resources.
• Vital Strategies provides opioid settlement guides to demystify how each state will receive and allocate opioid settlement funds. Their goal is to empower on-the-ground community advocates to effectively understand and engage with their states and localities on the opioid settlement planning and spending processes.
• National Association of County and City Health Officials (NACCHO) partnered with Community Education Group (CEG) in a 3-part webinar series on opioid settlements. The webinars provide information on how to leverage funds to support evidence-based strategies to reduce harms associated with opioid use and are summarized in a “How-To” Guidebook.
• The Legal Action Center, with funding from NACCHO, has published “Equity Considerations for Local Health Departments on Opioid Settlement Funds.”
• The Margolis Institute for Health Policy at Duke University has published "Pathways to Progress on sustainability.” This resource includes numerous links to related resources to support and supplement use of opioid settlement funds.

Promising Practices

• Colorado and North Carolina. A webinar titled, “Promising Practices for Collaboration on State and Local Opioid Settlement Spending, was sponsored by the National Academy for State Health Policy and the National Association of Counties. It highlights how state and county officials are working together to maximize the impact of settlement resources and includes best practices for settlement administration, coordinating spending at the state and local levels, and promoting transparency of settlement spending.

• New York. Allegany County has published their strategic plan to align with potential state and federal funding opportunities with evidence-based and best-practice prevention, intervention and treatment programs and services.

• North Carolina. The Campus & Community Coalition (CCC) was launched through a collaborative funding agreement between the University of NC, the Town of Chapel Hill, the Orange County Health Department, and the Orange County Board of the Alcohol Beverage Commission.

• Wisconsin. Milwaukee County collaborated with the Wisconsin state legislature to decriminalize fentanyl test strips which enabled ti to begin distribution of testing strips through its Division of Behavioral Health Services.