From 2013 to
2017, Ohio had a drug overdose mortality rate of 47.6
deaths per 100,000 people aged 15-64; in comparison, the
national rate was 25.1, according to Drug Overdose Deaths
in the United States. In addition, poverty, coupled
with the scarcity of facilities that treat opioid use
disorder (OUD) and the lack of providers with
medication-assisted treatment waivers, are barriers to
receiving OUD care in this region.
Matthew Courser, PhD, Senior Research Scientist with the
Pacific Institute for
Research and Evaluation (PIRE), helps communities in
Ohio work with data and build capacity to address public
health issues. “At the state and community
level, we had prevention, treatment, and recovery pretty
much siloed,” Courser said.
“Communities really weren't able to collaborate
across the continuum of care.”
Courser added that, while communities he had worked with
had collected some data, a key gap was that strategic
planning around OUD was not data-driven.
However, Raffle noted that the communities with the
greatest needs for funds often don't have the capacity to
apply for these federal funds: “When you have a
community who is basically just trying to stay afloat
with all the issues that they have, the idea of writing a
grant application – which could be a lot of time
investment for something that might happen – is
In addition, rural communities that receive grants might
not know how to complete tasks like invoices or budget
revisions. “You're working with rural
communities, and you have that capacity issue,”
Raffle said. “It's not that the communities
don't want to do it or they're not ready to do it. It's
that they don't have that experience.”
We wanted to ensure that Ohio's rural and Appalachian
communities had access to those dollars.
“We wanted to ensure that Ohio's rural and
Appalachian communities had access to those
dollars,” Raffle said.
A Unique Grant Application
Ohio University (OU) and PIRE have worked together for
about ten years now, providing training, technical
assistance, and leadership development to local
communities. When the HRSA Federal Office of Rural Health
Policy (FORHP) Rural
Communities Opioid Response Program (RCORP) planning
grant application period opened in 2018, the two
organizations decided to apply. While it's designed for
rural communities, RCORP allows urban organizations to be
the lead applicants as long as they partner with rural
organizations and all services funded through the grant
are directed solely to benefit rural communities.
In order to maximize their reach, OU and PIRE chose to
apply separately, each planning to serve two counties if
awarded, because they determined that $200,000 wasn't
enough money to serve all five counties in their
collective service area. In their applications, they
wrote about their plans to collaborate with each other
and serve Ashtabula, Fairfield, Sandusky, Seneca, and
Washington counties if the grants were both funded. Some
of the costs – like website hosting and development or
renting a meeting space – became duplicative, so OU and
PIRE could serve five counties across the awards instead
of two counties each.
Kiley Diop, Public Health Analyst at FORHP and project
officer for the Ohio University grant, said,
“Those applications were reviewed
independently, and then, by each of their own merits, the
applications were awarded.”
Both organizations were each awarded a $200,000 grant, so
the two grantees signed a shared-services agreement to
define their complementary collaboration.
“[The collaboration] is a way to enhance value
of federal investments as a way to increase impact
without requiring an additional outlay of federal
resources,” Courser said.
Creating a Consortium
When the grants were braided together through the
shared-services agreement, the five communities called
their initiative the Communities of Practice for Rural
Communities Opioid Response Program (CoP-RCORP). One
requirement of the grant was to form a consortium. Using
the hub-and-spoke model, CoP-RCORP has a master
consortium (OU, PIRE, and project directors from each
county) and each county has a consortium that brings
together community partners like county boards and health
departments. The Washington County Consortium, for
example, consists of law enforcement, healthcare and
behavioral health providers, schools, local health
departments, drug courts, and municipal courts.
Courser explained that developing a local consortium led
counties to form partnerships with organizations that
they might not have partnered with otherwise and improve
their reach across the full continuum of care. He said,
“It's something that's going to give them a
lasting benefit beyond any sort of HRSA
The counties have a weekly technical assistance call with
either OU or PIRE and a monthly videoconference with the
master consortium members. Shae Sprigg, Local Public
Health Emergency Preparedness Coordinator at Washington
County Health Department, said that these calls are very
helpful, since consortium members can share struggles and
hear what other members have done in similar situations.
How OU and PIRE Support the Five
Through the RCORP grant, Ohio University and the
Pacific Institute for Research and Evaluation provide
the following services to the master consortium
Training and leadership development
Technical assistance and evaluation
Financial resources to support the counties'
Website where the counties post meeting notes,
workplans, and other resources
“They have more experience in getting there and
getting set up and they've been extremely helpful in
sharing,” Sprigg said, adding that the
Washington County Consortium is newer than some of the
[The other consortium members] have more experience in
getting there and getting set up and they've been
extremely helpful in sharing.
After forming a consortium, the counties completed a
needs assessment. Courser said the assessment challenged
what consortium members knew about OUD in their
communities. “We had a couple communities tell
us that they actually came away from the process knowing
a lot more about their community than they otherwise
would have,” he said.
The consortium members recently finalized sustainability
plans and focused on workforce development. Courser said
they're also building a data system at the state level.
Accomplishments and Recognition
In 2019, Diop,
Courser, and Raffle, along with other FORHP staff and an
RCORP grantee from Michigan, gave a presentation at the
National Rural Health Association (NRHA) Annual Rural
Health Conference in Atlanta. FORHP presented its opioid
funding programs and highlighted the work of
collaborative grantees like CoP-RCORP.
“The partnership that OU and PIRE have together
was one of the first examples that came to mind to
highlight at the conference,” Diop said.
“It's a really innovative approach of being
able to serve more communities.”
Diop also praised the CoP-RCORP website (no longer
available online), in which the counties list webinars,
memoranda of understanding, and master consortium meeting
notes, among other documents. “They are
incredibly transparent to the communities on everything
that is going on,” she said.
The partnership that OU and PIRE have together was one of
the first examples that came to mind to highlight at the
conference. It's a really innovative approach of being
able to serve more communities.
The planning grant has taught Sprigg that “we
have more need for data than what we realized, and we
don't have access to data that we really need in order to
do this work.” For example, the Washington
County Consortium currently doesn't collect data on how
many times emergency medical services have administered
Narcan for an opioid overdose or how many people come to
the emergency department for an overdose. Thanks to this
grant, the county's working on improving its data
When the opportunity came up to apply for the
RCORP implementation grant, Courser and Raffle asked
the five consortium members if they wanted to continue to
work collaboratively. All five members wanted to continue
the consortium model, saying that they like learning from
and supporting one another, sharing resources like an
evaluator or fiscal agent, and splitting the costs of
training or hiring a media company for a stigma reduction
campaign. Raffle is interested to see how many
shared-services agreements continue after the
OU and PIRE individually applied for the implementation
grant and were awarded $1 million each, so they're
working with FORHP to formalize complementary
collaboration on this grant; then they'll put the
blueprint they developed through their planning grant
into action. The implementation workplan includes
prevention, treatment, recovery, and sustainability
activities across the five-county service area.
Challenges and Lessons Learned
OU and PIRE selected the five counties after interviewing
seven. The interview process allowed the organizations to
make sure the partnerships were “a mutually
good fit,” Raffle said.
Raffle added that it can be a difficult conversation to
ask communities to sign on to a project like this not
knowing if they'll be funded. For example, if OU had been
funded instead of PIRE, then only the two counties that
OU included in its grant application would have received
funding, and vice versa. The fifth county would only
receive funding if both OU and PIRE were funded.
The consortium members have had videoconferencing
meetings but met face-to-face last June. Courser called
that meeting “transformative” and
recommended that other consortia meet in person sooner in
the planning process.
Consortium members told Raffle that they preferred
“homework assignments” to connect
with other members. While they can call their peers at
any time for advice, they preferred being asked to
schedule a call and discuss, for example, their workforce
development plan and keep a record of their conversation.
In addition, Sprigg said that stigma is still an issue in
her county. “Everyone's touched by this one way
or another. It might be a niece or a nephew or a
greatgrandchild or a brother or sister, but it's crazy
that there is still such stigma around something that is
so commonly spread, even in these rural
communities,” she said.
Sprigg visits organizations like harm reduction programs
and pharmacies to learn how they're combating the opioid
crisis and how her organization can better promote their
work. In addition, the Washington County behavioral
health board travels to other counties to see what
they're doing well (for example, in harm reduction and
opioid overdose response) and to bring those ideas home.
Another challenge is that local entities may have
different business practices than larger organizations
like OU, Raffle said. She added it takes patience and
sometimes creating a template to help communities
Trust is a key component of a consortium like this.
“Over time we've built a significant amount of
trust, both with the folks who work together within local
consortium organizations and between the consortium
organizations themselves,” Courser said.
Raffle said that larger organizations, like research
universities or technical assistance programs, need to
look at communities as equals, “not doing stuff
to communities or for communities but
Allee Mead is a web writer for the Rural Health Information Hub. She has written on important rural issues, including maternal mortality and farmers' mental health, and has presented nationally on RHIhub's opioid resources. Originally from rural North Dakota, she has a master's degree in English. Full Biography