ES 2. Investigate, diagnose, and address health hazards and root causes

Core Function: Assessment

Why This Is Important

Health departments cannot change a substance misuse problem directly. Instead, they must work through the factors that are known to be related to the problem (e.g., ease of access to substances, need to develop social and emotional skills, norms supportive of use). An opioid prevention program or practice is only effective if it is a good match for both the problem and its associated factors. To ensure this match, all planning efforts should be informed by a thorough understanding of local data.

What’s Involved

  • Identify the factors that both contribute to and protect against the opioid misuse problems in your community, including “upstream” factors like the social determinants of health.[3]
  • Assess and build, as needed, your capacity to address identified these factors.
  • Analyze the data and draw conclusions with the input from community members.

Key Considerations

  • Examine the root causes of substance misuse and associated problems. Individual and family-level factors can play an important role in whether someone develops an OUD. But it is also important to consider the constellation of factors present in our culture and society that also play a role, such as racism, violence, and limited access to education, job opportunities, and health care. Health departments need to understand the root causes of substance misuse and its associated problems, including the role that racial inequities play.
  • Think beyond risk. All too often, communities focus exclusively on the negative factors that contribute to local substance misuse problems, overlooking the wealth of supports present in every community that protect against misuse. Focusing solely on risk can lead to victim-blaming, sweeping generalizations, and the perpetuation of myths, stereotypes, and assumptions about particular groups or populations.
  • Assess readiness (and if you don’t have it, build it). Communities need both human and structural resources to establish and maintain a prevention infrastructure capable of responding to local opioid problems and their consequences. It also needs people who have the motivation and willingness—that is, the readiness—to address these problems. Initiatives that are not well-supported are unlikely to succeed. Readiness is particularly important for initiatives focused on the needs of people who use drugs—a population that experiences high levels of stigma and is routinely dismissed.
  • Involve community members in data analysis. Just like data collection, data analysis is best done in collaboration with others. This includes community members with direct experience working with data and those with a strong understanding of the people behind the data. Engaging partners in this process will ensure that you correctly interpret the data you have collected.
  • Include the voices of people with lived experience. Don’t just get listen to those community members with the loudest voices or who are in positions of power. Also, consider how you are weighing the value of different voices and examine biases that may be influencing how you ‘hear’ different perspectives.

[3] According to the World Health Organization, social determinants of health are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems that shape the conditions of daily life.

Get Started!

  • Connect with local agencies and coalitions that provide substance use-related services. Find out what they do and explore ways to align your work with theirs. Identify local champions who can help you build support for your opioid prevention and treatment initiatives. This will help you avoid duplication of effort and maximize existing resources.
  • Review surveillance data, such as drug arrest and emergency room data, to detect causes and consequences of opioid misuse at the local level. These data can also help you identify specific sub-populations that may be at greater risk for opioid misuse and/or neighborhood clusters of overdoses produced by particularly lethal synthetic opioids.
  • Partner with organizations within the community that address “upstream” factors, such as food pantries and local housing authorities. Root causes might also be something to explore with groups focusing on equity and social determinants (e.g., anti-racism groups, social service agencies supporting certain populations, economic development organizations). These organizations can help you understand how these factors may be impacting local opioid misuse.
  • Make an asset map that catalogues key services, benefits, and resources in the community. Community assets might include schools, parks, community centers, hospitals or community clinics, existing prevention agencies, treatment centers, churches or other religious institutions, and other community organizations. Community assets can also include informal supports such as volunteers.

Assessment in Action: Data Capacity-building in Dedham

Over the past five years, the Dedham Organization for Substance Awareness (DOSA) has focused its efforts on building the capacity of its coalition members to use data. One of the first steps they took was to engage staff and coalition members in an interactive “data dive” dialogue process.

  • Working in small groups, members began by naming their assumptions about substance use in their community, and their expectations about what the data would reveal.
  • The groups then examined and interpreted local data sets—a parent survey, two student surveys, and compliance check data, as well as data on fatal and non-fatal overdoses in the community. They explored questions such as “What patterns do you see?,” “Which groups seem most at risk?,” and “What surprises you?,” and created charts and other visuals to communicate their findings with one another.
  • The groups shared their observations, discussed the implications of what they learned, and decided collectively which problems were most pressing.

In a follow-up meeting, members used these priorities as the foundation for their logic model—a visual roadmap that linked problems to goals and defined the strategies the coalition would use to reach them.