People in a circle


How community funding hubs can help combat the opioid epidemic

Insights to action

The financial infrastructure of a hub could allow community organizations to collaborate more effectively in their fight against the opioid epidemic, and scale evidence-based interventions tailored to their own community’s needs.

How the opioid crisis impacts communities

A blog post by Melissa Majerol and Anne de Biasi

The photo sent shockwaves through social media. In the front seat of a car, a man and woman are slumped over, passed out in the middle of the day from an apparent opioid overdose. In the back seat, a young boy looks on.

When the city of East Liverpool, Ohio posted this photo on social media in 2016, it sparked a national conversation about how the epidemic is impacting families and communities.

In 2015, an average of 91 people a day died from an opioid overdose, an increase of 13 percent from the previous year. Nearly 1.3 million inpatient hospital stays and emergency rooms visits were attributed to opioids in 2014. Police departments have had to train their officers to properly respond to the growing number of cases involving opioids. And the epidemic is creating a crisis in the foster care system, where children sometimes land in cases where parents or guardians have died, are taken into custody, or are deemed unable to care for them.

Circle of houses

An ecosystem approach

The opioid crisis can impact an entire community’s ecosystem. One way to respond is with an ecosystem approach, which leverages available resources, expertise, and support across multiple institutions, and builds on the existing strengths within a community. Collaboration across hospitals, social services, law enforcement, schools, and community groups can be an effective way to fight the opioid epidemic as community-wide efforts have shown to be an effective strategy for reducing substance misuse.

Case in point:

In the rural Franklin County and North Quabbin region of Massachusetts, the Communities that Care coalition model was adopted more than a decade ago with the goal of building community capacity to implement evidence-based approaches to improving youth health and well-being. The coalition engages partners from across many sectors of the community, including local government, schools, social services, law enforcement, businesses, and faith-based organizations all dedicated to supporting positive youth development and using evidence-based approaches to prevent risky behaviors such as substance misuse.

The Franklin County model appears to be working. Since the coalition’s work began 15 years ago, the region has seen dramatic reductions in youth substance use and a substantial reduction in the number of risk factors per youth in the community. A recent independent review of the program found compelling evidence that the coalition’s efforts undoubtedly contributed to these reductions. Between 2003 and 2017, the region has seen a 54 percent reduction in alcohol use, a 63 percent reduction in binge drinking, and a 33 percent reduction in marijuana use.1 And from 2014 to 2017, the region had a reduction in the number of 12th graders who used prescription drugs overall and opioids specifically.2

The Communities that Care model appears to make economic sense, too. Research shows that for every dollar invested, Communities that Care returns $5.30 by preventing youth tobacco use and delinquency. The effort in Franklin County and the North Quabbin has created population-level change in a community of roughly 100,000 people with a budget of less than $300,000 per year—that’s less than $3 per person.

Despite its success, the Massachusetts program faces a problem that can be common among community-based initiatives: sustainable funding. The coalition is currently funded by a local non-profit hospital that provides them with community benefit funds, but for much of its existence, the staff that supported the basic functions of the coalition was financed through time-limited grants, which meant some activities had to be postponed until the coalition could shore up additional grant funding. Under a best-case scenario, funding gaps can put stress on a program and temporarily postpone non-essential activities. Under a worst-case scenario, it can threaten a program’s effectiveness and long-term viability.


Building the funding infrastructure

“Braiding” resources from various philanthropies, government agencies, and community groups can be an important component to maintaining cross-sector community health initiatives to fight the opioid crisis. But braiding without a funding infrastructure can lead to operational challenges, as evidenced by those faced by the Communities that Care Coalition in Massachusetts.

Other barriers that community-based health initiatives often face include:
  • Lack of sustainable funding mechanisms for health improvement efforts.
  • Funding processes that often fragment the distribution of resources, discourage the coordination of funds, and limit the ability to jointly address common risks and protective factors.
  • Siloed agencies and institutions, with different funding requirements and often incompatible data collection and information systems.
  • The so-called “wrong pocket problem.” Though investments in one sector can affect outcomes and generate cost savings in another, individual sectors generally consider only their own investments and benefits. For example, a drug treatment program might lower costs for local police and hospitals, but the local police might simply weigh its own investments and savings when deciding whether to support such an initiative.
  • Distinct cultures, values, and vocabularies across the various sectors that affect health, and a general lack of experience working together.

One approach to addressing this challenge is the Healthy Communities Funding Hub, a model developed by the non-profit The Trust for America’s Health (TFAH). The hub could be an existing entity like a hospital, criminal justice department, social services agency or an entirely new entity, and could provide fiduciary oversight and management of the multiple funding sources.

A hub could be used to:

Identify and leverage funding resources that are not typically coordinated.

  • Prioritize spending on evidence-based interventions to drive accountability to the target community.
  • Serve as a trusted fiscal intermediary between various sectors.

The financial infrastructure of a hub could allow community organizations to collaborate more effectively in their fight against the opioid epidemic, and scale evidence-based interventions tailored to their own community’s needs. Scenes like the one that played out in Ohio in 2016 bluntly illustrate how the opioid epidemic can directly impact users, law enforcement, and the child welfare system. But the devastation often reaches far deeper, into nearly every part of a community. New tools, like a Healthy Community Funding Hub, can help communities fight back.

1 Franklin County/North Quabbin Teen Health Survey 2003-2017
2 ibid

To learn more, read our latest piece on Strategies for stemming the opioid epidemic.

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