Collaborative Problem Solving and Coordinated Interventions: Filling service gaps and improving overdose prevention
It can be challenging to move from data to action, or from a better shared understanding to better implementation of evidence-based interventions. This module outlines simple collaborative processes to identify gaps in programs and services and prioritize areas in need of improvement, expansion, or intervention.
Action Steps Throughout the evolving overdose crisis, a number of strategies and interventions have emerged through innovation and scientific study. In 2018 CDC published Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States, in which the authors describe and provide examples of several evidence-based interventions.
Across all of the identified strategies, four critical needs are evident:
These four critical areas can serve as an organizing framework to help a PHAST assess multi-sector strengths and opportunities for improved overdose prevention.
Collectively reviewing evidence-based strategies, then working together to identify existing community interventions and discussing jursidictional capacity to prevent overdoses can be an effective approach to gaining a shared undertanding of national and local evidence-based interventions.
As PHAST partners discuss the list of evidence-based strategies, develop a list of existing programs and policies in your community that align with those strategies and that directly or indirectly address the four critical needs listed in the previous action step.
Use the Inventory of Evidence-based Interventions to track interventions currently implemented by partners in the community that align with each area of critical need.
Once your PHAST has reviewed evidence-based interventions for preventing opioid overdose, partners may then focus their discussion on the extent to which local needs, gaps, and challenges are effectively addressed through existing interventions in your jurisdiction.
For this action step, consider:
By the end of this discussion, the PHAST should have a list of existing interventions that can be expanded or improved upon and new evidence-based interventions that can be implemented to address local gaps, needs, and challenges.
Use the Inventory of Evidence-based Interventions to track how existing programs are or are not addressing local gaps, needs, and barriers.
Throughout the implementation process, the PHAST will encounter barriers, factors that hinder change, and facilitators, factors that motivate change. A key step in implementation is identifying what those barriers and facilitators are. Identifying barriers and facilitators will enable people involved in your programs to overcome barriers by picking the right supports, and to leverage facilitators in your implementation plan.
To begin this process, determine who is experiencing the obstacle and what type of obstacle it is – is it a policy issue, a program-related issue, or a perception (e.g., a value or belief)? Then determine who controls those policies or programs, or who holds those perceptions. Now you know the focus of your intervention.
Once your PHAST has identified what needs to change, the next step is to consider:
Barriers to making each of the changes. These might relate to the design of a program (i.e., who is involved, how it works) or to how people engage with the program (i.e., the capability, opportunity, and motivation of the people delivering, attending, or involved in the program.)
Facilitators to making each of these changes. What policies or practices may support this change? What factors may encourage behavior change?
Use the Inventory of Evidence-based Interventions to track limitations/barriers and facilitators to existing interventions.
Depending on how many evidence-based interventions you have selected to improve, expand, or implement, you may need to prioritize which to address first.
With your PHAST, develop a set of prioritization criteria (e.g., ease of implementation, importance, urgency, or target population.)
Taking a few moments, even 10 – 15 minutes of discussion time, to get on the same page about how you are prioritizing will ensure a common understanding of how you will collectively tackle this step.
After your PHAST has examined barriers and facilitators, PHAST partners may begin discussing and recommending solutions that specifically address each barrier.
Barriers might indicate that changes are needed to service design (i.e., how the actual program is coordinated/delivered, how information is shared), or related to engagement with the program (e.g., more knowledge and skills are needed, attitudes and stigma need to be overcome, certain restrictions need to be lifted through policy).
Depending on the type of barrier, solutions would involve making changes to the intervention itself or identifying and developing supports like education and training.
For each prioritized intervention, PHASTs are encouraged to develop a detailed plan that documents recommendations and design changes chosen by the PHAST. Implementation plans will typically include the following elements:
As part of the intervention plan, partners may also consider discussing performance measures that will help the team monitor and track progress over time. Following the implementation plan helps to ensure that PHASTs stay on track and complete each action step in a timely manner.
See an example implementation plan.
Throughout the evolving overdose crisis, a number of strategies and interventions have emerged through innovation and scientific study. In 2018 CDC published Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States, in which the authors describe and provide examples of several evidence-based interventions.
Across all of the identified strategies, four critical needs are evident:
These four critical areas can serve as an organizing framework to help a PHAST assess multi-sector strengths and opportunities for improved overdose prevention.
Collectively reviewing evidence-based strategies, then working together to identify existing community interventions and discussing jursidictional capacity to prevent overdoses can be an effective approach to gaining a shared undertanding of national and local evidence-based interventions.
As PHAST partners discuss the list of evidence-based strategies, develop a list of existing programs and policies in your community that align with those strategies and that directly or indirectly address the four critical needs listed in the previous action step.
Use the Inventory of Evidence-based Interventions to track interventions currently implemented by partners in the community that align with each area of critical need.
Once your PHAST has reviewed evidence-based interventions for preventing opioid overdose, partners may then focus their discussion on the extent to which local needs, gaps, and challenges are effectively addressed through existing interventions in your jurisdiction.
For this action step, consider:
By the end of this discussion, the PHAST should have a list of existing interventions that can be expanded or improved upon and new evidence-based interventions that can be implemented to address local gaps, needs, and challenges.
Use the Inventory of Evidence-based Interventions to track how existing programs are or are not addressing local gaps, needs, and barriers.
Throughout the implementation process, the PHAST will encounter barriers, factors that hinder change, and facilitators, factors that motivate change. A key step in implementation is identifying what those barriers and facilitators are. Identifying barriers and facilitators will enable people involved in your programs to overcome barriers by picking the right supports, and to leverage facilitators in your implementation plan.
To begin this process, determine who is experiencing the obstacle and what type of obstacle it is – is it a policy issue, a program-related issue, or a perception (e.g., a value or belief)? Then determine who controls those policies or programs, or who holds those perceptions. Now you know the focus of your intervention.
Once your PHAST has identified what needs to change, the next step is to consider:
Barriers to making each of the changes. These might relate to the design of a program (i.e., who is involved, how it works) or to how people engage with the program (i.e., the capability, opportunity, and motivation of the people delivering, attending, or involved in the program.)
Facilitators to making each of these changes. What policies or practices may support this change? What factors may encourage behavior change?
Use the Inventory of Evidence-based Interventions to track limitations/barriers and facilitators to existing interventions.
Depending on how many evidence-based interventions you have selected to improve, expand, or implement, you may need to prioritize which to address first.
With your PHAST, develop a set of prioritization criteria (e.g., ease of implementation, importance, urgency, or target population.)
Taking a few moments, even 10 – 15 minutes of discussion time, to get on the same page about how you are prioritizing will ensure a common understanding of how you will collectively tackle this step.
After your PHAST has examined barriers and facilitators, PHAST partners may begin discussing and recommending solutions that specifically address each barrier.
Barriers might indicate that changes are needed to service design (i.e., how the actual program is coordinated/delivered, how information is shared), or related to engagement with the program (e.g., more knowledge and skills are needed, attitudes and stigma need to be overcome, certain restrictions need to be lifted through policy).
Depending on the type of barrier, solutions would involve making changes to the intervention itself or identifying and developing supports like education and training.
For each prioritized intervention, PHASTs are encouraged to develop a detailed plan that documents recommendations and design changes chosen by the PHAST. Implementation plans will typically include the following elements:
As part of the intervention plan, partners may also consider discussing performance measures that will help the team monitor and track progress over time. Following the implementation plan helps to ensure that PHASTs stay on track and complete each action step in a timely manner.
See an example implementation plan.
Appendix C5: Inventory of Evidence-Based Interventions Template
Appendix D2: Example #1 of Local Promising Practices
Appendix D2: Example #2 of Local Promising Practices
Appendix D3: Example of Implementation Plan
CDC’s Evidence-Based Strategies for Preventing Opioid Overdose: What’s Working in the United States
