Stories of Success and Tools to Help You Get There
Innovative Funding Model Facilitates Prevention Collaboration in Massachusetts
To address increasing rates of opioid drug misuse and related poisoning deaths, Massachusetts instituted a unique “cluster funding” model that requires sub-recipient communities to collaborate with a broad range of stakeholders.
In January 2013, the Massachusetts Department of Public Health’s Bureau of Substance Abuse Services, a Partnerships for Success II grant recipient, created the Massachusetts Opioid Abuse Prevention Collaborative (MOAPC) sub-recipient grant program—an innovative approach to stemming the state’s growing rates of unintentional opioid-related deaths. Under this program, high-capacity municipalities are expected to collaborate with two to four other neighboring municipalities, and to bring a wide range of stakeholders, representing multiple community sectors, to the prevention table. This collaborative approach facilitates the sharing of resources and allows communities that are newer to the prevention arena to learn from more seasoned communities. It also extends the reach of limited prevention dollars and enables municipalities to more effectively tackle a problem that extends beyond community borders.
Collaboration is woven throughout MOAPC’s application, funding, and reporting requirements, specifying how communities are expected to collaborate, and with whom. Steps have also been taken to confirm that these partnerships are not just in name only. For example, lead municipalities are required to establish memorandums of understanding (MOUs) with their partnering communities, and to report on the level and quality of these partnerships in quarterly reports. In making these collaboration requirements explicit, the state helps to ensure that the voices of multiple stakeholders are heard, and that the constellation of partners needed to implement environmental change strategies are engaged from the outset. According to Scott Formica, Massachusetts’ cross-site evaluator, it also “forced people to go beyond their comfort areas and do what’s needed to launch a comprehensive prevention effort.”
The state gave priority to MOAPC applicants who had the highest fatal and non-fatal opioid overdose episodes that could demonstrate capacity and readiness to both lead this effort and mentor other municipalities. Applicants needed to describe how their cluster would build on existing collaborations, provide documentation that neighboring municipalities were willing to commit to an active partnership, and explain how they were currently using available resources to reduce opioid overdoses. By targeting communities with high capacity, the state was able to capitalize on lessons learned from previous grant initiatives. Nearly all MOAPC communities were former recipients of SPF SIG* funds, which enabled them to hit the ground running and focus their efforts on mentoring their partner communities.
Developing clear and consensus-based answers to questions like “Who is in charge?” and “Who has the authority to do what?” was a critical starting point for successful functioning, and many clusters devoted significant time to these issues, early on. For example, one cluster held a retreat that focused exclusively on the design and function of their internal structure. Their decisions were developed into an “operational agreement” that outlined the policies and procedures of collaborative membership. Since executing this agreement, partnership participation has increased and members consistently adhere to the commitments they made to each other.
As their grant programs launched, clusters received ongoing support from a statewide technical assistance provider—the Massachusetts Technical Assistance Partnership for Prevention (MassTAPP). The presence of a centralized TA provider helped to ensure that funded sites all had access to the same resources and services, and ultimately “spoke the same prevention language.” Working as a team, MassTAPP providers were able to track common challenges that communities were experiencing and quickly deploy the resources necessary to address those challenges. The TA center also served as a centralized facilitator of best practices dissemination and cross-cluster collaboration, leading to the development of valuable “learning communities” both regionally and across the state. Members of these learning communities are actively engaging their peers to address topics and challenges of shared interest.
Modeled on the state’s earlier SPF SIG, clusters were required to firmly ground their work in SAMHSA’s Strategic Prevention Framework (SPF), a five-step, data-driven planning process that relies on the involvement of multiple stakeholders. This framework provided communities with a clear model for how to do their work, underscored by the expectation that community members be involved in all phases of prevention planning. According to Alejandro Rivera, a MassTAPP technical assistance provider, “The SPF provided clear parameters for how communities should work together, while also providing the flexibility for each cluster to find their own data and then set their own paths.” Most importantly, the SPF emphasized the importance of dedicating significant time to the assessment and planning process before jumping to the selection of intervention strategies. In fact, the presentation of strategies was specifically forbidden from inclusion in replies to the funder’s request for responses. Instead of thinking about what was going to happen, MOAPC grantees were required to focused on how.
MOAPC funded municipalities, not coalitions. This approach helped to offset variations in capacity, reach across individual coalitions, and enabled political leaders to use their influence to access the data and resources necessary for a successful and sustainable initiative. “We had coalitions that were very high capacity and could do this work, but we knew many of them did not have the relationships with the range of players—emergency services, treatment facilities, hospitals—needed to tackle this issue,” says Formica. “Sending money through the mayor's office would help strengthen these relationships, and the mayors could use some of this power to open doors.”
Although clusters are still in the early stages of their funding, initial successes are already evident. Formica praises the comprehensive and partnership-focused approach clusters are taking in their work, “The communities have successfully completed the early steps of the SPF, and developed sophisticated strategic plans and strong logic models. These required solid collaboration.”
These early successes have also influenced the state’s decisions regarding future prevention funding. The state will be using the model to address underage drinking and the MOAPC was recently expanded to include five additional communities; the new MOAPC cohort has already reached out to the first cohort for guidance and mentorship. This cross-cohort collaboration continues to be proactively fostered by MassTAPP.
Broader, population-level successes are also being documented. For example, in one site, both awareness of, and attitudes toward, opioid abuse and overdose have begun to change. According to Rivera, “the city is much more prepared . . . Police officers now carry life-saving doses of Naloxone (Narcan)† and a large community group has formed to provide support to parents and families impacted by this serious problem. There has been a shift in the stigma associated with opioid use. The language being used to describe it is no longer synonymous with “junkies” and hopelessness; instead the language being used in this and other MOAPC communities represents hope and recovery.”
*SPF SIG stands for Strategic Prevention Framework State Incentive Grants—infrastructure grants provided to States and federally recognized tribes and tribal organizations to implement SAMHSA's Strategic Prevention Framework.
† Naloxone (Narcan) is a fast-acting medication that reverses the potentially life-threatening effects of opioids in the body.