RAISING the BARRAISING the BAR: : Developing community Developing community

capacity to address capacity to address substance abuse substance abuse

in rural Tennessee countiesin rural Tennessee countiesKris Harper BowersKris Harper Bowers

Substance Abuse Projects CoordinatorSubstance Abuse Projects CoordinatorEast Tennessee State University East Tennessee State University

Office of Rural and Community Health and Office of Rural and Community Health and Community PartnershipsCommunity Partnerships

Tackling Substance Abuse in Rural Tennessee Appalachian Counties

Why?Where?How?Who?

What happened?

The ARC/ETSU Connection• ARC has had a commitment to health policy issues since the 1960’s

with precedent for cross border health demonstration projects– Appalachian Health Policy Advisory Council (2000)– Health research papers– Coalition on Appalachian Substance Abuse Policy– 2008 Annual Conference of Governors– Partnership with SAMHSA and ORHP for meeting 8/19/08

• Funding for substance abuse– 2006 ETSU conference– Challenge Grants to Communities – NORC research into substance abuse prevalence 2008– Competitive Substance Abuse Grant Competition Rounds I & II– TN Flex-E Grant

Partners

• Appalachian Regional Commission• Tennessee Department of Economic and

Community Development– Development Districts

• 8 Tennessee Counties and their Communities• East Tennessee State University’s Office of

Rural and Community Health and Community Partnerships

Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2006,

2007, and 2008 NSDUHs

Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2010). Substate estimates from the 2006-2008 National Surveys on Drug Use and Health. Rockville, MD. Web only report is available at: http://oas.samhsa.gov/substate2k10/toc.cfm

General Objectives*

Goal

Reduce negative aspects of substance abuse in these counties by

– participatory leadership development – targeted skills enhancement– strategic planning– financial encouragement through challenge grants

Specific objectives

• Encourage economic change in counties adversely affected by substance abuse issues

• Promote community involvement in substance abuse prevention activities

• Create effective, better-informed community response to drug use

County Profile Assessments

Meet with local development

districts

Invitational meeting with 8 county teams; establish an

advisory group

Phase 1 – Local stakeholder meetings

Phase 2 – Multi-county team development and

capacity building activities

Phase 3 - Challenge grants to address

priorities

Evaluation of outcomes and

process

Flow of Program Activities

Challenge Grants• Teams/coalitions submit requests for small

grants of up to $5000 for completion of one strategy from their community plan

• Teams would provide cash or in-kind matching• Evaluation

– Project– Economic impact

Local Communities

• Identify key stakeholders from health, government, judiciary, law enforcement, mental health, education, media, youth, faith, addiction community, etc.

• Hold meeting of stakeholders (2 delegates to grant advisory committee)

• Assess community needs• Create strategic community plan• Implement plan

Community Readiness Assessment• Community Key Leader Survey

– Awareness – Concern– Action across community levels

• Strategic Prevention Framework– Assessment– Capacity– Planning– Implementation– Evaluation

Using the Health Belief Model to Explore Community Using the Health Belief Model to Explore Community Action in Substance Abuse IssuesAction in Substance Abuse Issues

Personal characteristics

and knowledge of substance abuse

Perceived threat from substance

abuse

Perceived susceptibility

and seriousness of substance

abuse

Benefits versus barriers to changing

community’s substance abuse

Cues that promote community action

Likelihood of commitment

to community action

Definition of Substance

Abuse

Stakeholders Coalitions

Community Action

Community Perceptions Modifying Factors Likelihood of Action

Strategic Planning• Based on Strategic Prevention Framework

– Assess prevention needs based on epidemiological data,

– Build prevention capacity, – Develop a strategic plan,– Implement effective community prevention

programs, policies and practices, and – Evaluate efforts for outcomes.

Modified Strategic Framework

• Define Common Beliefs – What do we believe?• Identify Problems – Where are we? • Goals - Where do we want to go? • Strategies – What can we do to get there? • Outcomes – How do we know we’re getting

there?– Impacts – Long term effects from actions– The Logic Model

Eight Counties• Rural• Tennessee• Appalachian• Distressed

– Unemployment– Poverty level– Per capita income

Fewer resources ∴ Drug problems are greater

Clay County•Established Drug Hot Line with sheriff’s office – student initiative

•Drug prevention puppet show

•Town hall debate with local officials

•Established community coalition

Cocke County•ArtScape intergenerational arts day for at-risk youth

•Increased participation in coalition

•Successful grant application for policy change in county

Fentress County

•Increased community sector involvement

•Youth camp for at-risk youth

•Town Hall meetings• •Reorganization

Hancock County

•New coalition members

•Pool party parent/child “teach-in”

•Strategic planning chili supper

•Fall Festival community needs assessment

•Lock boxes and drug security information distributed •Yard signs, news articles, media presence

Johnson County

•Youth involvement in leadership and planning community events

•Health Rocks curriculum coalition staff training

Scott County

•School prevention curriculum and supplies •Media awareness

•Newspaper•Outdoor advertising campaign•Direct mail

Grundy County•Leadership model for CAMP program for 15 at-risk youth with many community sectors involved

•100% negative drug screens at 6 months

•Provided information at Health Fair, Take-Back event, community events, and in local media

•Coalition evolution

Pickett County•Coalition established

•Office - equipment, officers, regular meetings, etc.

•Leadership training for officers

•Tabletop display created for fairs and community events

•Visibility: brochure, T-shirts, website

•Senior Center drug disposal speaker from hospital

•Additional funding from local sources

Next?

• Economic Impacts Study Report• Coalition Training – December 13-14, 2010• Increased Coalition activities

Economic Impacts

Personal and cultural

• Lives lost due to accidental overdose.• Increased medical expenses for drug related

accidents• People are afraid to come down town with children.

• Youth don’t see better options when they see the

negative impacts around them.• Limited opportunities for drug treatment in rural

areas. • Not completing treatment because of

transportation and getting and maintaining employment.

Community • Increased crime, which increases court costs,

police expenses, jail expenses, insurance costs, and destruction of property.

• People travel out of town to spend money because of drugs and illegal activity in town.

• People, especially young people, leave to get jobs . Or they sell drugs to make money.

• There is much looking the other way in local government agencies.

Commercial • Business owners identified revenue loss due to

substance use by employees as well as poor performance.

• High rate of substance use adversely affects decisions of businesses to move to the community.

• Loss of hours due to substance abuse at home and on the job results in unanticipated time off.

• Lost jobs and decreased production due to absent workers.

Contact

Kristine Harper BowersSubstance Abuse Projects Coordinator

ETSU Office of Rural and Community Health and Community Partnerships

PO Box 70412Johnson City, TN 37614

423-439-7156423-439-7720 fax

Bowersk@etsu.edu  

www.etsu.edu/kellogg/Substance%20Abuse.asp