Colorado’s Pueblo Triple Aim Corporation (PTAC) is an original IHI Triple Aim prototype community. Two PTAC representatives explain how the organization’s years of working in collaboration with multiple community stakeholders to tackle tough population health issues form the foundation of current efforts to address heroin addiction.
In Pueblo, Colorado, overdose deaths outnumber local homicide deaths. Law enforcement faces increased demands on their resources. Opioid protocol patients inundate emergency rooms and first responders daily. The local needle exchange program sees more patients than ever before.
Pueblo’s County Health Rankings help tell the story: of 60 counties, Pueblo County ranks 57th for health behaviors, 52nd for health outcomes, and 54th for social/economic factors and physical environment.
The most populous city in the county, and a former steel production center located near many rural towns, Pueblo faces many challenges. But we also have a history of successfully using a community-wide approach to address health issues.
PTAC was created in 2012 to act as the central community health strategist to address major population health issues, including obesity, teen/unintended pregnancy, smoking, emergency department use, and hospital readmissions. By convening stakeholders to collaborate on action planning and use data to drive decision making, PTAC is able to work with community agencies to change systems and ultimately reduce health inequities across the community.
Using Experience to Take on New Challenges
PTAC has learned from experience that tackling big population health concerns which develop over long periods of time requires system-level changes at both the local and state levels. Interventions must include coordination of services already available through multiple agencies as well as acquisition of new resources into the community.
Addressing major population health issues also requires a commitment from the community to work together in different ways, and a willingness to co-create solutions with people for whom the solutions are intended.
The approach to improving the heroin addiction issue in our community is no different. This epidemic has touched numerous lives and has a huge impact on so many systems, including law enforcement, addictions treatment, health care, social services, and education. With facilitation from PTAC, the local Heroin Task Force Steering Committee launched in December 2015 to bring all these groups together.
Reasons for Hope
With collaboration among dozens of disparate groups, no dedicated full-time staff, and a flurry of activity, coordination has become a much larger challenge than originally anticipated. Yet, we have never seen a more diverse group of community stakeholders mobilize so quickly. From the start, the community was ready to attack this issue on all fronts.
We also knew, however, that just taking action wasn’t enough. The stakeholders all agreed that true system-level change was the ultimate goal, so we were determined to put the proper framework in place from the beginning.
The Task Force has convened four community-wide forums that each attracted more than 100 people. This helped establish a large contingent of community leaders and community members. Our work together is led by five focus area groups representing the different systems within the community: Community Prevention Resources, Health Care Providers, Law Enforcement, Treatment Centers, and Community Members. Each group has identified objectives and activities by providing additional resources, new ways of thinking, and ultimately system-level change efforts.
The Task Force is creating a measurement strategy to ensure that progress made in each focus area translates to improved outcomes that create a healthier community in the long term. Data tracking includes overdose deaths, Narcan uses by first responders, and local needle exchange usage. In the coming months, focus area groups will identify process-level measures they will track as part of their action items. All of the Task Force’s efforts align and coordinate throughout the community, creating a collective impact-based approach that incorporates all necessary partners and increases the visibility of this issue as a major concern for the entire community.
One challenge the Heroin Task Force faced early on was how to include local health care providers in the framework and subsequent action plans. A group of local care providers has mobilized and crafted their own purpose statement and action plan, which focuses on approaching the heroin addiction problem differently than in the past. One area of immediate opportunity is the need to expand medication-assisted treatment options for patients. The provider group is formulating a plan to open an addiction specialist clinic in the community, which will include housing the local needle exchange program and providing other treatment resources. They are also considering establishing a triage center with caseworkers and behavioral health support for a law enforcement assisted diversion program.
Co-Creating Change with Community Members
A key element of a collective impact-based strategy is co-creating interventions with the people most affected by potential interventions. To create a safe space for people dealing with addiction and their family members to comfortably and candidly express concerns and ideas, the Task Force established a focus area group specifically for them, which has encouraged their participation. This group of community members is also welcome to attend all other community-wide forums, and they have provided excellent input and are genuinely interested in co-creating solutions.
Lessons Learned So Far
Heroin addiction is a community-wide issue that requires a community-wide response. Creating a framework to address the multiple systems within the community has enabled Pueblo to broadly define the issue, identify areas where interventions would be most helpful, and bring the community together. We’ve established a united front both locally and across the state.
We cannot stress enough the value of having a backbone support organization and/or person to help coordinate and convene current and future initiatives and community partners. Coordination of an effort this large is absolutely essential to ensure that activities become mutually reinforcing, maintain constant communication, identify a common agenda, and institute a measurement strategy.
This work takes patience. It took years for this crisis develop, so we can’t fix it overnight. Perseverance and dedication across the community are the catalysts for change.
Matt Guy is the former executive director of the Pueblo Triple Aim Corporation (PTAC). Lindsay Reeves is PTAC’s Community Engagement Director. They will share the PTAC improvement story during session C4: Community Solutions to Heroin Addiction Challenges at IHI's 18th Annual Summit on April 20-22, 2017, in Orlando, FL, USA.
You may also be interested in:
Pueblo County Triple Aim: Tips for Population Health Success
Addressing the Opioid Crisis in the United States