Colerain Township Community Health Coordinator

Hamilton County Public Health (HCPH) serves 45 jurisdictions in Hamilton County, Ohio with a wide range of services and a staff of 132 that include Environmental Health Specialists, plumbers, health educators, physicians, nurses, counselors, epidemiologists and more. Hamilton County is located in southwest Ohio, with a population of 817,473 and contains the city of Cincinnati. The residents are 67.6% white, 26.6% black or African American, 3.6% Hispanic or Latino and 2.9% Asian. The median household income is $57,212. Colerain Township is located in the northwest portion of Hamilton County, has a population of around 60,000 residents and is the largest township by population in Hamilton County.

Like the rest of Hamilton County, Colerain Township has largely impacted by the addiction crisis. In 2019 Colerain Township residents accounted for 219 EMS dispatches for overdoses and 241 emergency department visits for overdoses by residents. In 2019, Colerain residents also accounted for 34 deaths from overdoses. While Colerain Township does have a large population, they lack some of the social service and treatment options that exist in the urban parts of Hamilton County. Colerain Township only has one outpatient addiction treatment facility and no inpatient facilities. Colerain residents also lack direct access to many harm reduction services such as a syringe services program.

In 2015 Colerain Township launched the nations first Quick Response Team (QRT) in response to the increasing number of overdoses. Since that time, Colerain has continued to be proactive in their outreach and partnership development in bringing support and resources to their residents.

In 2020, HCPH approached Colerain Township with an idea for a pilot program to better respond to the public health needs of the addiction crisis and to decrease the number of fatal and non-fatal overdoses among residents. This partnership would place a full time HCPH employee in Colerain Township whose primary goal would be engaging with residents to identify their needs and provide a connection to resources and services. While the focus would be on addiction and recovery support, the staff member would have the ability to provide a wide array of support services and linkage to care.

By embedding a staff person in the Colerain Township administration, they are able to act as an essential resource to all township employees including Fire/EMS, police, code enforcement, maintenance, and others. Navigating resources can be a confusing process for those in need and the front-line employees in Colerain do not always have the expertise to provide referrals and information to residents. The Colerain Community Health Coordinator (CHC) is a bridge between the township residents and the services and supports available in Hamilton County. Providing better access to services and resources allows staff to address the many factors that play a role in a person's ability to seek treatment and maintain their recovery.

This program includes many strategies such as the continuation and enhancement of the Colerain QRT, a community member needs referral system for first responders to send direct referrals to the CHC, engagement with established community service organizations, partnership with Northwest Local School District on a first-time offense diversion program, and outreach to local businesses to provide substance use disorder (SUD) resources and education.

Since the launch of the Colerain CHC program in 2020, Colerain Township has seen a 40.78% decrease in resident emergency department visits for overdoses and a 33.33% decrease in EMS dispatches for overdoses. The referral system for first responders now averages 30 referrals per month. Through the partnership with Northwest Local School District, over 100 individual intervention sessions have been held with students with a first-time drug offense.

The decrease in overdoses bring benefits to the community that reach far beyond the direct lives saved. From a public safety standpoint, Colerain police and EMS can more readily respond to other emergencies in the township with fewer overdose calls coming in. There is also a cost savings associated with fewer EMS runs allowing for funds to be re-allocated as needed. With fewer overdose calls, there are less transports to local emergency departments which also helps to lower the burden on hospitals near Colerain Township.

The success of this program is owed to the partnerships and engagement of township employees and residents. By working with Colerain Township to place this position, HCPH was able to obtain quick buy-in from Colerain Township Fire/EMS and Police as well as other township employees. Colerain is a unique community and residents have a lot of pride for their community. This position has been able to build on the trusting reputation of both Colerain Township and HCPH when engaging with residents, businesses, and community organizations. Teams from different departments of the township have been involved at various stages of the development of this program. By working with these teams to develop the various strategies, HCPH and Colerain were able to build out programs that had more buy-in and were set up for success from the beginning.

This innovative partnership is aimed at working with residents of Colerain Township to better address their needs around addiction and recovery support. Like many communities in Ohio and around the country, Hamilton County and Colerain Township have been heavily impacted by the addiction crisis. Colerain Township has a population of around 60,000 residents and in 2020 residents accounted for 206 EMS dispatches for overdoses, 129 emergency department visits for overdoses, and 34 fatal overdoses. Past efforts to address overdoses in Colerain Township include the establishment of the nations first post-overdose follow-up team, the Colerain Quick Response Team (QRT). HCPH has partnered with Colerain Township to operate their QRT since mid-2020. Other efforts in Colerain Township include participation in the Safe Stations program where residents can approach any Colerain Township Fire Department and ask for assistance for a substance use disorder.

This program is for township residents, with the primary focus of providing addiction and recovery resources including but not limited to; harm reduction supplies and services, linkage to healthcare and treatment services, connection to social services such as housing or food assistance, and others. Colerain is about 15 miles northwest of downtown Cincinnati. Many of the social services in the county are located closer to downtown in more urban areas of the county. Colerain only has one outpatient addiction treatment program and does not have a homeless shelter. The services that are available to residents are often provided through community and religious organizations. Even with the limited number of resources available, as compared to nearby communities, residents do not want to leave Colerain to access support and services. This places many residents at a disadvantage when attempting to navigate the system of available resources while staying in their community.

Having a dedicated HCPH staff person embedded in Colerain Township has allowed for this person to become an expert on services and support in Colerain. Township employees and residents can come to this person to help connect them with services they need. Including township staff and community organizations in the design process of this program allowed for better planning on how residents would access this person and what resources are available to them.

This position appears to be a first of its kind in the field of public health. While similar positions exist, most are not operated as closely with the local jurisdiction as the Colerain Community Health Coordinator (CHC). This person is truly a member of both HCPH and Colerain Township, which places them in a unique and beneficial position of being able to utilize the resources and relationships of both organizations.

Similar programs in other jurisdictions have sought to provide direct services to community members in an attempt to fill gaps in their support systems by creating new programs or providing direct services. By working with established organizations and services, HCPH and Colerain Township have been able to better utilize funding to reach more residents. Rather than creating new services that may be duplicative, the CHC is able to spend more time connecting residents to established organizations and services versus providing those services directly. Not only is this a cost and time savings for the position, but it also allows for strong relationship building with organizations that have a proven track record and trust within the community they serve.

The core of the program is the direct referral system, which allows low barrier access for township residents. Any resident that interacts with a township employee, school district staff, or partner organization can be referred to the CHC for a brief assessment and connection to services. Having this central referral source in the community is what makes this program innovative and impactful.

The primary goal for this program is to reduce the number of fatal and non-fatal overdoses in Colerain Township. This goal was achieved through several strategies, with the primary being the central referral system.  

Planning for the Community Health Coordinator (CHC) position began in 2020. The idea was for a pilot program to bring a subject matter expert to a jurisdiction in Hamilton County. This subject matter expert could act as a central referral source for substance use disorder (SUD) and recovery services while also participating in any related community health programs. Colerain Township was selected due to their history of supporting innovative programs to support their residents and their strong existing relationship with HCPH. Several planning meetings occurred between Colerain Township and HCPH to design the logistics of this position including work location, system access at both HCPH and Colerain, and reporting structure.

The CHC is responsible for many programs in Colerain Township including both new programs as a part of this pilot and some established programs.

Starting with the more established programs, the CHC began participating in the Colerain Township Quick Response Team. Each week the CHC, along with a police officer and medic drive around the township knocking on doors of residents that experienced an overdose. The goal of this program is to make a connection and provide any needed services identified by the team. The QRT program is a natural fit for the goals of the CHC position and HCPH has been partnering with Colerain Township to run QRT since mid-2020.

The first new project established was a referral system for first responders in Colerain Township to be able to directly refer residents they interact with to the CHC. Using the existing medical record system, Colerain Fire and EMS were able to build in an easy to navigate referral system for medics to send referral information. Medics simply check a box and select a from a dropdown list of services needed. When this action is performed, the CHC gets a notification that a referral has been sent. They are then able to check the notes from the medics allowing them to better assess what services are needed for the resident. The CHC then reaches out to the resident, initially by phone if available, followed by an in-person visit to better assess their needs and connect them with services. Should additional follow-up be needed, the CHC will continue to work with the resident to establish care with other needed services or an ongoing case manager from a partner organization.

While the police referral system is not built into the documentation system, the process is just as simple. Officers complete a simple form that lets the CHC know the general need that was identified along with the police report number. From this information, the CHC can pull the police report and see more details about the individual, the nature of their interaction with the police, and what services may be needed. Follow-up is the same as it is for Fire/EMS referrals.

The CHC also works with Northwest Local School District to run a first-time drug offense diversion program. District staff also can refer students and family members to the CHC for services similar to Colerain Township staff. The goal of the diversion program is to provide a brief intervention and educational resources to students and their parents around drug use and treatment options. Students who participate in this program are able to avoid extended suspension or expulsion for a first-time drug offense at school. This program is an important part of the overall CHC program as it helps connect at-risk students with needed resources as well establish stronger relationships between community members and the CHC.

The last strategy for this program is engaging Colerain Township businesses to provide addiction and recovery services to their employees. Through another program at HCPH, Recovery Friendly Hamilton County, the CHC can connect businesses to a wide range of support services including trainings, resource posters, and recovery friendly workplace policies. The CHC has worked with Colerain Township chamber of commerce to ensure that these resources are available to any interested business.

HCPH and Colerain Township staff compiled a list of organizations that provide services in Colerain Township. The CHC worked with staff at both organizations to help build strong ties with community organizations. As a part of this effort, the CHC attends meetings held by community organizations and groups. These strong community relationships have helped the success of the program and helped to create a two-way network of support with the CHC referring residents to services that meet their needs and organizations referring people to the CHC when client needs go beyond their scope.

As was the plan from the initial design, the CHC has become the community wide expert on services and resources in Colerain Township. Part of the evolution of this program is that community groups that are looking to offer additional services, or new organizations that are moving into the Colerain community will reach out to the CHC for advice and support on what and where services are needed. This provides additional benefits to the community as it helps to prevent too much overlap in services and more evenly spreads out the community response to resident's needs.

The cost of running this program is focused almost entirely on staffing. Since the CHC is not providing direct services and instead working with established groups, there is no need for a financial commitment beyond the staffing of the CHC position. The buy-in among the partner community organizations has helped to create a network of support for the position including ample access to resources beyond what HCPH and Colerain Township Administration provide without adding additional financial requirements. The annual costs of the program include $85,000.00 for salary and fringe benefits and approximately $1,000.00 for harm reduction supplies, bringing the annual program cost to $86,000.00.

To evaluate the effectiveness of this program, HCPH worked with Colerain Township to collect data from several sources. This includes the number of fatal and non-fatal overdoses occurring in Colerain Township, the number of referrals sent by first responders including the type of referral, connections to services made from referrals, school intervention referrals and meetings held, number of Quick Response Team (QRT) contacts made, and quantity of harm reduction supplies (naloxone, fentanyl test strips, etc.) distributed.

The primary data source for overdose surveillance is from HCPH's epidemiology team which collects data from local healthcare systems EMS agencies, the Hamilton County Coroner's Office, and the Ohio Department of Health related to overdose calls and emergency department visits. This data is broken down into EMS dispatch and patients' residences ZIP codes and filtered for Colerain Township. Data for referrals is pulled from 2 sources. The first is be pulled as a report from the Colerain Fire and EMS record system. The second are police referrals that are sent directly to the CHC. as Connections made, school meetings held, QRT contacts, and harm reduction supplies are recorded by the CHC as they occur.

The primary performance measures for the program are the number of referrals from first responders and the percentage of those that are follow-up on and connected to services. The benchmark for each of those was 200 referrals from first responders with a goal of connecting with 60% of referrals and at least 60% of those being connected to services.

In 2021 the CHC received 352 referrals from first responders. Of these referrals, 86% were Colerain residents and eligible for the referral program. Of those that were eligible, the CHC was able to successfully connect with 60%. Of those connected with, the CHC was able to successfully connect 61% to a service or resource.  Of the referrals received, 24% were for addiction services and 19% were for medical services, 16% were for mental health services (other than SUD), 15% were for senior services, and 11% were for basic social service needs. The remaining were for services such as environmental concerns, veterans' services, and domestic violence services. These referrals and resulting connections to services and treatment may not have happened without this program in place. The impact of the direct interactions from the CHC help to build community trust leading to more effective connections to care.

In 2022, after 2 years of the Colerain CHC position, reported overdoses and overdose deaths have decreased in Colerain Township. Prior to the start of this program overdoses had been increasing in Colerain Township. Between 2018 and 2020 Colerain saw an increase in emergency department visits of 41%. In 2020, Colerain had 129 resident emergency department visits for overdoses and 206 EMS dispatches. As of December 16, 2022 Colerain had 102 resident emergency department visits and 122 EMS dispatches representing a decrease of 33.33% and 40.78% respectively. This is significant as Colerain's decrease in ED visits is outpacing Hamilton County as whole, which saw a 29.80% decrease in ED visits for overdoses and a 32.45% decrease in EMS dispatches in the same period. While this data does not represent a full year since figures were pulled with 2 weeks remaining in December of 2022, it still represents a significant decrease in the number of reported overdoses in Colerain Township.

Overdose death data has a potential 3-month reporting delay, so data was compared for January through September for both 2021 and 2022. In 2021 between January and September, Colerain Township had 20 deaths. In the same months in 2022, there was only 13 overdose deaths representing a 35% decrease between 2021 and 2022 which is significant since this decrease in overdose deaths is outpacing Hamilton County as a whole which saw a 22% decrease in overdose deaths in the same time period.

Public safety and public health have the goal of saving and improving the lives of the communities they serve. The decrease in fatal and non-fatal overdoses is an important accomplishment in helping to meet these goals. Beyond the lives saved, the results seen in Colerain Township allow for increased public safety. Officers responding to fewer overdose calls can spend more time patrolling and may have a faster response time to other emergencies. EMS units that are responding to fewer overdose calls and making fewer hospital runs are more readily available for other calls. Fewer overdose calls also provide for a financial savings as crews are on the road less and using fewer supplies like naloxone, IVs, and oxygen masks.

As the initial data was reviewed, it was found that there was a larger need for senior services than originally predicted. To better understand and meet these needs, the CHC worked closely with 2 elder services organizations to provide direct referrals.

 Another lesson learned by the team was that more needed to be done earlier in the process to engage with law enforcement. The majority of the referrals from first responders have come directly from fire/EMS. In order to better engage with the police department and increase the number of referrals being sent, the CHC started working directly from the police department on a weekly basis. This was done to help increase engagement with the police officers and to build a trusting relationship with them. Police referrals have increased as the program has progressed and as a result of this increased engagement effort. Starting this increased engagement with the police department earlier could have helped to create more buy-in from officers sooner in the process.

One of the original goals of the Community Health Coordinator (CHC) position was to prove the value that it was adding to the community. The position itself was originally funded through a grant HCPH received as part of a larger overdose prevention effort. While the grant funding is scheduled to end in late 2023, the intention was to prove the value the position added, and gain buy in from leaders in Colerain Township to fund the position permanently. HCPH has had ongoing discussions with Colerain Township on the future of the CHC position, and there is interest from Township officials to include funding in their staffing budget to continue the work once the original grant has ended.

While the decrease in overdoses and overdose deaths cannot be solely attributed to the CHC program, the work being done has a positive impact on the lives of those that interact with the staff member. The connections made and supplies provided to residents has certainly had an impact on the number of overdoses in Colerain Township.

The primary lesson learned is that obtaining buy-in from law enforcement is a challenge and needed more focus earlier in the process. Various factors like the global pandemic, staffing shortages, and changes in public perception of law enforcement acted as barriers for the HCPH team to effectively engage with law enforcement early in the program. As the program evolved, the CHC was able to find a champion in the police department to help spread the word about the program and obtain more buy-in from officers.

The cost benefit for this program is difficult to fully recognize due to the nature of the work being performed. The number of overdoses prevented, and number lives saved are invaluable. More measurable items like reduction in calls for overdoses and social service needs provide a benefit to public safety by keeping police officers patrolling and EMS available for other calls.