Policy Practice: Engaging Coalitions to Understand Opioid Policy Landscape to Impact Social Justice and Health Equity in HCS Communities in Ohio

Background and Purpose: Policy practice is a crux of social work practice. The focal point of person-in-environment in social work practice lends a unique perspective into policy barriers that broader approaches to policy analysis, such as surveillance or statistical inference, could miss. Policy information that impacts the populations that are most at risk is often discovered through engagement by frontline professionals or people with lived experience. Furthermore, expanding this idea to collations with diverse professionals to identify policy issues from a multidisciplinary perspective allows a broader approach for social workers to engage in policy advocacy and intervention to achieve social justice through a health equity lens.

Methods: The NIDA-funded HEALing Communities Study (HCS), a wait-listed, community-level, randomized clinical trial, implemented the Communities That HEAL (CTH) intervention. The CTH model uses a three pillar approach using community engagement to implement evidence based practices (EBPs) to reduce opioid overdose deaths through a data driven approach. Policy data collection was completed as part of the HCS implementation in 19 rural and urban communities across two waves of implementation in Ohio. Community engaged research staff were trained to complete policy data collection as it was identified through their local opiate coalition, key stakeholders, or EBP implementation service venues. Community engaged staff were encouraged ask throughout implementation if there were any policy issues to report and informed coalitions about purpose of the policy data collection. Policy information that was identified as a policy barrier, facilitator, or misunderstanding related to the implementation of the CTH and the information recorded based on the community level context.

Results: 84 separate policy entries were created throughout the study with Wave 1 = 37 and Wave 2 = 47. Descriptive information of the policies were created to share with state partners responsible for statewide oversight of policies and services related to opioid use disorder. Policies were sorted related to federal, state and local levels. Findings were examined to determine health equity and social justice differential impact of policies in high-risk OUD populations across urban and rural communities. Policy barriers examples include Good Samaritan Laws, MOUD access in drug courts, and jurisdiction issues with naloxone distribution. Facilitators include naloxone hubs, adding naloxone distribution to CPR Training, and state legislation to purchase Fentanyl test strips

Conclusions: This approach offered the ability to address policy barriers in real time, engage with state and local partners to address systemic barriers within the 19 counties that implemented the CTH. Trainings, technical assistance and community level supports were implemented in real time to resolve barriers. State partners worked with the research team to address specific policy barriers such as naloxone distribution and use of Naloxboxes. Guidance was provided to communities related to policy barriers such as naloxone distribution with Good Samaritan Laws and MOUD access. Community level facilitators such as naloxone hubs were implemented in several counties to support stainability. Using a policy practice approach to collect policy barriers and facilitators at a direct practice level can allow for real time interventions.