Building the Coalition: Counties that have adopted the Project Lazarus Model of a community approach to overdose have largely followed the same general steps in establishing a community coalition. Naturally, every community is different and if there is an already existing coalition that will be adopting the model, the process will look slightly different. However, each of the following steps has a specific function that should occur in order to maintain the integrity and usefulness of the Project Lazarus Model.
Getting High Level Stakeholders On Board: The stakeholders may be the individuals who identified the issue in the first place. The fundamental point is to get the decision makers from the key sectors involved at the lead table from the initial onset. These are not the “worker bees,” but rather the ones who can assign resources, such as human resources, financial support, and intellectual or informational resources to the issue. Examples of the kinds of stakeholders who have been involved in other communities have included health directors, superintendents of schools, sheriffs or chiefs of police, directors of local substance abuse treatment facilities, mental health services administrators, hospital executives, and leaders in the medical field. Project Lazarus can help identify people in communities that should be involved at this stage. These stakeholders should come together and initiate action to guarantee support from county leaders in order for the efforts to be sustainable. If an already established coalition exists, but the support of the stakeholder does not, it is crucial to go back and engage with these key participants.
Bring Together the Larger Community: Once the stakeholders have committed to engage the support from each of the key sectors in the community, along with a preliminary base of public awareness on the issue, the first task is to plan and hold a community forum. The community forum is designed to share information with the broader community about the issues of prescription medication misuse, diversion, and overdose. Based on Project Lazarus experience, community forums are held approximately one month after the initial stakeholders’ presentation has taken place in order to build on initial community energy surrounding the issue. The forum serves two purposes: to raise awareness in the community that there is a problem, so community members are ready to engage as efforts are developed to address it, and to draw the attention of other dedicated people who want to become part of the on-going coalition.
The Steering Committee: The steering committee is a group of liaisons delegated from each sector along with the most active community representatives. This committee works closely with Project Lazarus in the establishment of the coalition and then propels and sustains the ongoing work of the coalition after Project Lazarus’s role diminishes. The stakeholders should designate one person from each sector to be involved and to ensure that the coalition has the organizational support to really engage members. At some point in this process, it is important that a Community Coalition Coordinator steps forward to work with the steering committee. It is important to have a designated person available for Project Lazarus to contact, as well as someone who will keep the process on track and gauge the effectiveness of their efforts.
Establish a Working Coalition: This is the group of people that will accomplish tasks. The forum will have hopefully identified community members such as parents, teens, people in recovery, pain patients, or advocates who would like to be involved, yet were not otherwise designated by the stakeholders. Together with the steering committee and Community Coalition Coordinator, these interested parties form the coalition.
Establish a Community Plan for Addressing Prescription Medication Overdose: Establishing a community plan generally happens through a series of workshops. Workshops begin by having coalition members divide into groups by sector, such as clinical care, public health, law enforcement, schools, faith community, general public, and local government, with at least one member of the steering committee in each group. Then, groups work through the primary goals and objectives for their sector. Overviews for each sector are available in the Community Toolkit Sector Factsheets. The groups then report back to the coalition for discussion, alignment, and collaboration with other sectors. Next, each sector identifies specific activities that would move them towards their revised goals and objectives. Input from the whole coalition allows for feedback and coordination of activities between sectors since many of them will overlap. At this point, the members of the steering committee work with the list of goals, objectives, and activities to figure out resources, responsible parties, and deadlines by which activities should occur. This is a multi-stage process that will initially occur in a series of meetings over 6-9 months.
Coalition leaders: Coalition leaders should have a strong understanding of what the nature of the issue is in the community and what the priorities should be to address the problem. There will be relatively high levels of energy and enthusiasm in each group. The key will be to figure out how to maintain and sustain the engagement and activity as the issue is addressed. A coalition and steering committee are needed for the long haul. While change varies from community to community, it can be anticipated that the first fruits of the coalition’s efforts will be seen in 1-2 years, although some changes such as ED policies may occur much more quickly. Finally, it is important to keep in mind the needs of coalition members who are not only professionally engaged with this topic, but who also may have personal connections. In building a community coalition, be prepared to support the members who are personally adversely affected, such as loved ones of people who are currently struggling or have overdosed. Specifically, resources about addiction treatment support for families of people who are currently using and grief support should be made available to coalition members. If there are no resources for these issues locally, direct individuals to internet-based resources, but know that development of local resources for support will need to be part of the action of the coalition.