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Ionia County Substance Abuse Initiative

State: MI Type: Promising Practice Year: 2020

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Ionia County Health Department
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Ionia County Substance Abuse Initiative

Ionia County is located in Southwest Michigan and has an estimated population of 64,000. It is primarily rural, and the major economic drivers are the agriculture industry and State Corrections. Ninety-two percent of the population is white, and 10% lives below the federal poverty line. The public health issue addressed by this practice is substance abuse/substance use disorders. The goal of the practice is twofold - to facilitate substance abuse services in Ionia County and thereby reduce the prevalence of substance abuse. The first objective was to form both an Advisory Board and a Workgroup made up of local stakeholders that would assist the Health Department with decision-making and implementation and with approval of funding and initiatives. The second objective was to hold regular meetings of both groups to generate ideas for services and begin to implement those services. The practice was implemented by Advisory Board members being appointed by the County Board of Commissioners (one for each of seven Commissioner Districts). The Workgroup was facilitated by making invitations to area stakeholders. The Advisory Board and Workgroup have now been in operation for 10 years. The result has been the creation of a Substance Abuse treatment and prevention program at the Health Department that has overseen and helped to implement multiple major programs over those 10 years. These programs include youth education in local schools, a treatment program in the local jail, a mobile educational unit for local parents, prescription drug drop boxes, and a syringe services program, among others. We believe that the success of this practice is the result of the interaction of multiple stakeholder groups and the broad array of stakeholders involved, which has helped to generate ideas, local support, and funding for the various programs. Also critical to success has been the the fact that the County Board is an integral part of the process through appointment of Advisory Board members. The public health impact has been to vastly increase the number of services available to local citizens and to generally raise awareness regarding substance abuse and substance use disorders.

Website: https://ioniacounty.org/health/icsai/

The ICSAI is responsive to the epidemic of substance abuse currently facing both our community and most communities across the country. It is a community-based response to a community-wide problem, with the Health Department playing the lead role.

Community initiatives are not a new idea in public health. However, we believe that the ICSAI is innovative in two ways that improve upon existing models. First, the ICSAI Advisory Board members are appointed by the County Board of Commissioners - one per Commissoner District. This gives the Board of Commissioners more tangible buy-in and helps to keep them engaged in the activities of the Initiative. It also makes certain that different geographic, and effectively different socioeconomic, segments of the County are represented. The other innovative aspect of the ICSAI is its two-pronged approach. The Advisory Board is appointed and provides oversight of and consent for various programs and projects. It also reviews and approves budgets and grant applications. The Workgroup takes ideas and funding and puts them into practice and to use, respectively. It also helps to generate ideas for new programs. Being made up of volunteers, the Workgroup is more suited to this "boots on the ground" mentality. This division of labor not only directs specific tasks to where they can best be completed, it also helps break new programs into smaller, more manageable pieces.

The goal of the practice is twofold - to facilitate substance abuse services in Ionia County and thereby reduce the prevalence of substance abuse. The first objective was to form both an Advisory Board and a Workgroup made up of local stakeholders that would assist the Health Department with decision-making and implementation and with approval of funding and initiatives. The second objective was to hold regular meetings of both groups to generate ideas for services and begin to implement those services. The practice was implemented by Advisory Board members being appointed by the County Board of Commissioners (one for each of seven Commissioner Districts). The Workgroup was facilitated by making invitations to area stakeholders. The Advisory Board and Workgroup have now been in operation for 10 years. The initial timeframe for implementation was one year, and the initial goal of the ICSAI was to provide a treatment framework for low-income citizens in need of services. The original Advisory Board was involved in this process, which resulted in the creation of a subcontracting system wherein local providers subcontracted with the Health Department to provide substance use disorder treatment services to the Medicaid community. The Health Department held the primary contract with a regional Prepaid Inpatient Health Plan, and handled most administrative duties associated with the contract and patient treatment. The assumption of these responsibilities by the Health Department allowed area providers to operate and provide treatment at Medcaid rates, which until that time had been prohibitive.  It also gave the Health Department an opportunity to refer clients to services more easily. Over the past ten years, the services provided and supported by the ICSAI have morphed considerably. As the makeup of the Advisory Board and Workgroup changed, and as the needs of the community changed, services and programs have changed accordingly. ICSAI programs and services are now primarily prevention-based rather than treatment-based, with the exception of a recent treatment program in the Ionia County Jail. The process typically works as follows: the Health Department sits on both the Workgroup and Advisory Board as a nonvoting member. A member of either group identifies a problem, a need for a particular service, or a funding opportunity. If a solution to a given problem is not readily apparent, ideas are brainstormed at the Workgroup level and options are presented to the Advisory Board by the Health Department. Once the Advisory Board approves a particular plan of action, the Health Department will begin applications for funding. Funding is primarily sought from State behavioral health dollars, although other sources of funding have been pursued and obtained at times. The workgroup may assist with the application, and will assist with implementation of the program/service as needed. This interaction between the Advisory Board and Workgroup with the Health Department as the go-between creates a process in which collaboration among the groups and individual stakeholders is automatic. Start-up costs were minimal and consisted of Health Department staff time to attend the necessary informational and stakeholder meetings. Since that time outside funding has fueled the ICSAI.

Partial List of Community Partners:

  • St. Patrick School (Portland, MI)
  • Portland (MI) Public Schools
  • Saranac (MI) Public Schools
  • Belding (MI) Public Schools
  • Local 3rd and 5th grade students and teachers
  • Belding Housing Commission
  • Ionia County Sheriff's Office
  • Lake Odessa (MI) Police Department
  • Local substance abuse treatment providers
  • Relief After Violent Encounter (Ionia/Montcalm Counties)
  • Eight-CAP
  • Michigan Works
  • My Community Dental Centers (Ionia Office)
  • Ionia County Intermediate School District
  • Ionia County Great Start Collaborative
  • Mid-State Health Network
  • Ionia County Board of Commissioners
  • Ionia County Administrator

This ICSAI had two primary objectives at the beginning of the initiative. The first objective was to form both an Advisory Board and a Workgroup made up of local stakeholders that would assist the Health Department with decision-making and implementation and with approval of funding and initiatives. The second objective was to hold regular meetings of both groups to generate ideas for services and begin to implement those services. These objectives were achieved within the first year of operation. Since that time, the following programs have been implemented (asterisk indicates currently active):

1) "Too Good for Drugs" educational programs in area 3rd and 5th grade classrooms*.

2) Health Department subcontracting program with area providers to facilitate treatment services for Medicaid population.

3) In-house treatment services at the Health Department.

4) Treatment program for Inmates at Ionia County Jail*.

5) Syringe Serices/Harm Reduction program*.

6) "Hidden in Plain Sight" educational trailer*.

7) Prescription drug take-back drop-boxes at area law enforcement*.

8) Teen Intervene - intervention counseling for at-risk teens*.

9) Tobacco and Alcohol Vendor Education*.

10) Education for alcohol servers at area restaurants and bars*.

10) Compliance checks at area tobacco vendors*.

The Health Department collects data on the various programs, where possible, and reports these back to the Workgroup, Advisory Board, and County Board of Commissioners. During FY 2017-2018, 4 Advisory Board and 7 Workgroup meetings were held. Over 800 students were reached through the "Too Good For Drugs" program and over 80 inmates received substance use disorder treatment services at the County Jail. Compliance checks were performed at 42% of the tobacco vendors in Ionia County. Six alcohol server educational sessions were held for area restaurants and bars. FY 2019-2020 was the first year of our "Hidden in Plain Sight" and Harm Reduction programs and data are not yet available. Moving forward we have engaged with local schools to begin participation in a Statewide survey program known as MiPHY. The MiPHY program surveys school-aged children to determine their exposure to and use of illegal substances. We recently obtained agreement from multiple local schools to allow their students to take the survey. In future years, we intend to track the progress and effectiveness of our school-based programs through this survey. We also intend to track the progress of the jail-based program through recidivism rates.

On a foundational, qualitative level, the continued existence of the ICSAI, the continued function of the Advisory Board and Workgroup, and the existence of the programs listed above are all evidence of resounding success. On a more quantitative level, we are currently moving beyond counts and percentages to look at trends of substance use over time.

The ICSAI itself is sustainable. Advisory Board and Workgroup members are not paid, and the two groups are made up of concerned and motivated community members. The Health Department provides staff time to help facilitate both groups, but the staff time provided is paid for with State Behavioral Health Dollars and is a small percentage of our annual budget.

As the ICSAI has grown and changed, we have learned that the makeup of the two groups is crucial for proper function. At times, the groups have had to self-police and "weed-out" members who do not participate regularly. We have also learned that the Advisory Board works best when populated with decision makers - for example a police chief versus a road officer or a superintendent versus a teacher. The Workgroup, on the other hand, works best when populated with professionals who are more "boots on the ground."

As mentioned earlier, the two groups are set up so that partner collaboration is an automatic part of group function. However, the Health Department plays a critical role as a facilitator. The Health Department is the only group that sits on both the Advisory Board and the Workgroup, and we have learned that it is essential for the Health Department to serve as a go-between. Communication between the Advisory Board and workgroup is necessary to keep programs and projects moving forward.

We have not performed a formal cost/benefit analysis. However, we feel comfortable saying that without the ICSAI none of the many programs enumerated in this application would exist. This was done at minimal cost to the Health Department.

There is sufficient stakeholder committment to sustain the practice. As mentioned above, when a particular stakeholder is not participating they are often phased out and replaced. In general, group members are committed to improving services and reducing substance abuse in the County. The County Board remains committed to the overall program because they see large results at small cost to the County. Advisory Board members must be reappointed every three years, and recruitment to the Workgroup is a constant endeavor.

NACCHO Publication (Connect, Exchange, Public Health Dispatch)