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RAISING the BAR

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					       RAISING the BAR:
Developing community capacity to
     address substance abuse
   in rural Tennessee counties

           Kris Harper Bowers
     Substance Abuse Projects Coordinator
         East Tennessee State University
   Office of Rural and Community Health and
            Community 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*
This project expects to contribute to


                                               and will
   preserve job opportunities that exist in the Appalachian
   region by promoting a stable and drug free work force.

                                    by providing needed
   confidence, leadership, and resources to concerned
   stakeholders in each participating county.


* from ARC Strategic Plan for Appalachia, 2005–2010
                    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
     Flow of Program Activities
County Profile      Meet with local   Invitational meeting with 8
 Assessments         development      county teams; establish an
                       districts             advisory group


                                            Phase 1 – Local
                                         stakeholder meetings



                                        Phase 2 – Multi-county
                 Evaluation of          team development and
                 outcomes and              capacity building
                    process                   activities


                                          Phase 3 - Challenge
                                           grants to address
                                               priorities
             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
         Action in Substance Abuse Issues
Community Perceptions         Modifying Factors          Likelihood of Action


                                     Personal
                                                          Benefits versus
                                  characteristics
                                                        barriers to changing
                                 and knowledge of
                                                            community’s
                                 substance abuse
                                                         substance abuse




Definition of    Perceived           Perceived          Likelihood of
 Substance      susceptibility      threat from         commitment       Community
   Abuse             and            substance          to community        Action
                seriousness            abuse               action
                of substance
                    abuse

Stakeholders     Coalitions        Cues that promote
                                   community 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 Bowers
          Substance Abuse Projects Coordinator
ETSU Office of Rural and Community Health and Community
                        Partnerships
                      PO Box 70412
                 Johnson City, TN 37614
                      423-439-7156
                     423-439-7720 fax
                   Bowersk@etsu.edu

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

				
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