HEALing Communities Study

2 Years of HEALing Work in Cayuga County

By Monika Salvage, The Citizen, February 2022

HEALing Communities “Study” is perhaps a misleading name for a project that has had a tangible and life-saving impact in our county. The research part revolves around testing out a community-driven framework to reduce opioid overdose deaths. It’s about learning how community stakeholders work together to come up with countywide strategies to identify and address existing service gaps and improve access to treatment. The practical part that shows if this approach can be successful is the actual implementation of these strategies in a coordinated and collaborative manner with tangible outcomes. To illustrate the impact HEALing has had in Cayuga County, I’d like to describe some of our initiatives over the past two years, how we have supported community agencies in the process, and potentially contributing to the 24% decrease in overdose fatalities in 2021.

The HEALing team that was funded by the grant combines expertise in substance use disorder, project management, communications, peer work, community outreach, how to navigate local services, data analysis, health research, and facilitating organizational change. In collaboration with community partners, the team collected and analyzed near-real-time overdose data, which helped us identify susceptible populations, geographic areas of need, and any potentially concerning trends in a timely manner. It also allowed us to facilitate the implementation of targeted programs to ensure access to care where and when it is needed. This infrastructure did not exist before the grant.

Another focus of the HEALing team was to support our community partners to facilitate a successful implementation of targeted interventions, especially around improved access to medications for opioid use disorder. This required a sustained effort to educate critical providers in our substance use system, such as outpatient providers, the hospital, the mental health clinic, recovery peers, and others on the role they can have in expanding access to their clients. The team’s effort included stigma education for staff, training for prescribers, bringing in experts from different fields to discuss best practices, and ultimately assisting with developing procedures to further integrate these services. 

Grant funding was also available to support the start-up of these new initiatives. The local steering committee approved the allocation of these community impact dollars and the team drafted the scope of services for agreements with involved agencies and assisted them during implementation. Since 2020, almost $600,000 has been distributed to support new intervention services and more funds have been allocated for 2022. 

    The HEALing grant money supports Nick’s Ride 4 Friends to expand peer support services. Funding was provided to hire additional peers to work with clients in jail or treatment court, for post-overdose outreach and linkage to treatment, for peer training and certifications, and for an additional car to be able to transport clients to treatment facilities and other services. In addition to financial support, the HEALing team worked closely with the organization's leadership and peers on policies and procedures and documenting their work through data collection.

    Barriers to timely treatment were an identified gap, especially access to medications for opioid use disorder and treatment beds in outpatient facilities. HEALing money funded an on-call prescriber that peers could link their clients to so medication treatment could start that same day. The first prescription was also covered to remove insurance barriers. This is a critical resource as there is a small window of opportunity when individuals are ready to seek help and medication treatment is an evidence-based practice to treat opioid use disorder. Wait times of a week or more are often a barrier to successful linkage. In the last 16 months, 98 individuals were linked to same-day medication initiation. 

    Once medication treatment is initiated, connection to ongoing care is important. Referrals are being made to outpatient clinics and now also to the community mental health clinic, which has started integrating substance use with mental health services a year ago. Since then, 25 opioid use disorder patients have received medication treatment at the clinic and stayed in treatment an average of 5 months. Grant funding was utilized for staffing and training to support integrated mental health and substance use/medication treatment.

    Grant funding was crucial in supporting individuals who are seeking outpatient treatment but have to wait for a spot. A treatment bed would be secured and in the meantime, the client could be set up with temporary accommodation, food, and basic needs items if necessary until the spot becomes available.

    The Unity House’s Grace House recovery and supportive living programs received funding for additional peer support and computers that assist residents with school work and job searches. 

    To expand the local workforce in the substance use field, funding was made available for qualifying community members to become Credentialed Alcoholism and Substance Abuse Counselors. HEALing is currently sponsoring five individuals who attend this year-long certification course at Cayuga Community College.

    When state aid cuts were announced in 2020 that would affect local treatment and recovery agencies, the steering committee allocated funds for CHAD, Unity House, and Nick’s Ride 4 Friends to bridge that gap so substance use services weren’t impacted. 

    During the early shutdown due to COVID-19 and beyond, 25 prepaid phones and phone cards were purchased and distributed to homeless individuals so they could stay in contact with their support system and treatment team.

    Distributing the opioid-overdose reversing nasal spray Narcan during the pandemic became a lifeline for people struggling with opioid use disorder and their friends and families. HEALing funds paid for shipping costs and print material for the Narcan mailing program, material for Narcan in-person training events, and wall-mounted red boxes that are placed in public places for quick access to Narcan. The Narcan nasal spray itself we receive at no cost from the State Department of Health through Cayuga County Mental Health’s opioid overdose prevention program. That also allowed us to distribute Narcan to the Auburn Fire Department to support the new initiative of leaving Narcan behind at the scene of an overdose. This expanded Narcan distribution program was spearheaded by the HEALing team and over 1,300 Narcan kits have been given out that way. With this increase in Narcan availability, data shows that in 2021 overdose witnesses administered Narcan as many times as first responders, potentially contributing to the 24% decrease in overdose fatalities.

    The county jail started voluntary Narcan training for inmates in 2020 and HEALing money was used to purchase equipment to facilitate group training. The jail has since trained 299 inmates who receive a free Narcan kit upon their release, which is critical as they are at high risk for overdose and death after incarceration.

    Several counties participating in the HEALing study collaborated to organize an online training series for pharmacists to discuss their role in fighting the opioid epidemic. Grant funds were used to facilitate this conference and make it available as continuing education credits.

    Initiatives were supported by public information campaigns on stigma, access to medication treatment, and Narcan distribution. The HEALing team involved local people in recovery and local businesses in the execution of these campaigns that utilized social media, billboards, print material, bus ads, TV and newspaper outlets.

About the Study

Cayuga County is participating in the HEALing Communities Research Study with the goal of reducing opioid deaths by 40% over three years. Cayuga County is one of 67 communities in four states that were selected to take part in this ground-breaking national study.

Columbia University in New York City is leading the research effort among the 16 participating communities in New York State where 3,224 people died in 2017 of overdoses involving opioids. Communities that experience many opioid overdose deaths were chosen, with a focus on rural communities, to test evidence-based practices and reduce the stigma of opioid use disorder and treatment.

Communities were randomly assigned into two groups that will receive intervention services at different times to be able to compare their impact. Cayuga County was assigned to start its intervention phase in 2019 while the second group will start intervention in 2021. Regardless of the random assignment, all participating communities are at the leading edge of this life-saving national initiative and stand to benefit from its outcomes.

We are excited to be part of this large-scale effort to find answers together and compare notes on outcomes,” said Raymond Bizzari, County Mental Health Commissioner, “We are ready to get to work with our community partners and get even more evidence-based opioid treatment to people in Cayuga County.

Cayuga County is fortunate to have many community and grassroots organizations working closely with the County Mental Health Department to educate the community and combat opioid deaths,” said Elane Daly, Chair of the County Health & Human Services Committee, “I am happy to be part of the steering committee for this important initiative that will bring more resources to our communities.

Most of us know someone who has been affected by this terrible epidemic and we all want to learn what works to fight it,” said Monika Salvage, Project Director for HEALing Communities Study, “I can’t wait to start work with our local organizations and study partners around the country to find the most effective ways to reduce opioid deaths.

Part of the National Institute of Health’s HEAL (Helping to End Addiction Long-term) Initiative, the HEALing Communities Study is funded by the National Institute on Drug Abuse along with the Substance Abuse and Mental Health Services Administration. HEAL is a large effort to find scientific solutions to stop opioid overdoses. For more information on the study and its participants, visit the HEALing Communities Study project page.