1. RAISING the BAR : Developing community capacity to address substance abuse in rural Tennessee counties Kris Harper Bowers Substance Abuse Projects Coordinator East Tennessee State University Office of Rural and Community Health and Community Partnerships

2. Tackling Substance Abuse in Rural Tennessee Appalachian Counties Why? Where? How? Who? What happened?

3. The ARC/ETSU Connection ARC has had a commitment to health policy issues since the 1960’s with precedent for cross border health demonstration projects – Appalachian Health Policy Advisory Council (2000) – Health research papers – Coalition on Appalachian Substance Abuse Policy – 2008 Annual Conference of Governors – Partnership with SAMHSA and ORHP for meeting 8/19/08 Funding for substance abuse – 2006 ETSU conference – Challenge Grants to Communities – NORC research into substance abuse prevalence 2008 – Competitive Substance Abuse Grant Competition Rounds I & II – TN Flex-E Grant

4. Partners Appalachian Regional Commission Tennessee Department of Economic and Community Development – Development Districts 8 Tennessee Counties and their Communities East Tennessee State University’s Office of Rural and Community Health and Community Partnerships

6. Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2006, 2007, and 2008 NSDUHs Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2010). Substate estimates from the 2006- 2008 National Surveys on Drug Use and Health. Rockville, MD. Web only report is available at: http://oas.samhsa.gov/substate2k10/toc.cfm http://oas.samhsa.gov/substate2k10/toc.cfm

7. General Objectives*

8. Goal Reduce negative aspects of substance abuse in these counties by – participatory leadership development – targeted skills enhancement – strategic planning – financial encouragement through challenge grants

9. Specific objectives Encourage economic change in counties adversely affected by substance abuse issues Promote community involvement in substance abuse prevention activities Create effective, better-informed community response to drug use

10. County Profile Assessments Meet with local development districts Invitational meeting with 8 county teams; establish an advisory group Phase 1 – Local stakeholder meetings Phase 2 – Multi-county team development and capacity building activities Phase 3 - Challenge grants to address priorities Evaluation of outcomes and process Flow of Program Activities

11. Challenge Grants Teams/coalitions submit requests for small grants of up to $5000 for completion of one strategy from their community plan Teams would provide cash or in-kind matching Evaluation – Project – Economic impact

12. Local Communities Identify key stakeholders from health, government, judiciary, law enforcement, mental health, education, media, youth, faith, addiction community, etc. Hold meeting of stakeholders (2 delegates to grant advisory committee) Assess community needs Create strategic community plan Implement plan

13. Community Readiness Assessment Community Key Leader Survey – Awareness – Concern – Action across community levels Strategic Prevention Framework – Assessment – Capacity – Planning – Implementation – Evaluation

14. Using the Health Belief Model to Explore Community Action in Substance Abuse Issues Personal characteristics and knowledge of substance abuse Perceived threat from substance abuse Perceived susceptibility and seriousness of substance abuse Benefits versus barriers to changing community’s substance abuse Cues that promote community action Likelihood of commitment to community action Definition of Substance Abuse StakeholdersCoalitions Community Action Community Perceptions Modifying Factors Likelihood of Action

15. Strategic Planning Based on Strategic Prevention Framework – Assess prevention needs based on epidemiological data, – Build prevention capacity, – Develop a strategic plan, – Implement effective community prevention programs, policies and practices, and – Evaluate efforts for outcomes.

16. Modified Strategic Framework Define Common Beliefs – What do we believe? Identify Problems – Where are we? Goals - Where do we want to go? Strategies – What can we do to get there? Outcomes – How do we know we’re getting there? – Impacts – Long term effects from actions – The Logic Model

17. Eight Counties Rural Tennessee Appalachian Distressed – Unemployment – Poverty level – Per capita income Fewer resources ∴ Drug problems are greater

18. Clay County Established Drug Hot Line with sheriff’s office – student initiative Drug prevention puppet show Town hall debate with local officials Established community coalition

19. Cocke County ArtScape intergenerational arts day for at-risk youth Increased participation in coalition Successful grant application for policy change in county

20. Fentress County Increased community sector involvement Youth camp for at-risk youth Town Hall meetings Reorganization

21. Hancock County New coalition members Pool party parent/child “teach-in” Strategic planning chili supper Fall Festival community needs assessment Lock boxes and drug security information distributed Yard signs, news articles, media presence

22. Johnson County Youth involvement in leadership and planning community events Health Rocks curriculum coalition staff training

23. Scott County School prevention curriculum and supplies Media awareness Newspaper Outdoor advertising campaign Direct mail

24. Grundy County Leadership model for CAMP program for 15 at-risk youth with many community sectors involved 100% negative drug screens at 6 months Provided information at Health Fair, Take-Back event, community events, and in local media Coalition evolution

25. Pickett County Coalition established Office - equipment, officers, regular meetings, etc. Leadership training for officers Tabletop display created for fairs and community events Visibility: brochure, T-shirts, website Senior Center drug disposal speaker from hospital Additional funding from local sources

26. Next? Economic Impacts Study Report Coalition Training – December 13-14, 2010 Increased Coalition activities

27. Economic Impacts Personal and cultural Lives lost due to accidental overdose. Increased medical expenses for drug related accidents People are afraid to come down town with children. Youth don’t see better options when they see the negative impacts around them. Limited opportunities for drug treatment in rural areas. Not completing treatment because of transportation and getting and maintaining employment.

28. Community Increased crime, which increases court costs, police expenses, jail expenses, insurance costs, and destruction of property. People travel out of town to spend money because of drugs and illegal activity in town. People, especially young people, leave to get jobs. Or they sell drugs to make money. There is much looking the other way in local government agencies.

29. Commercial Business owners identified revenue loss due to substance use by employees as well as poor performance. High rate of substance use adversely affects decisions of businesses to move to the community. Loss of hours due to substance abuse at home and on the job results in unanticipated time off. Lost jobs and decreased production due to absent workers.

30. Contact Kristine Harper Bowers Substance Abuse Projects Coordinator ETSU Office of Rural and Community Health and Community Partnerships PO Box 70412 Johnson City, TN 37614 423-439-7156 423-439-7720 fax Bowersk@etsu.edu www.etsu.edu/kellogg/Substance%20Abuse.asp