Overdose Data to Action (OD2A) at IDOH
Through The Centers for Disease Control and Prevention (CDC) Overdose Data to Action grant in 2019, the Indiana Department of Health (IDOH) Division of Trauma and Injury Prevention was funded to implement 10 strategies to address surveillance and prevention of Substance Use Disorder and drug overdoses. IDOH used this funding to leverage comprehensive, high-quality data to inform prevention strategies across the state. In August 2023, IDOH was awarded once more as a part of a five-year cooperative agreement from CDC called Overdose Data to Action in States. The goals of this program are to:
- Address the evolving epidemiology of the drug overdose crisis.
- Close identified gaps in prevention activities.
- Apply lessons learned from the previous OD2A funding opportunity.
- Reflect the differing roles and spheres of influence state and local health departments and their partners have.
CDC has developed a framework to achieve these goals, the Overdose Data to Action Framework this framework and more information about the Overdose Data to Action program can be found here.
IN CAREs ECHO Program
Funded by the OD2A grant in 2019, IDOH collaborated with the Indiana University of Indianapolis (IUI) to develop the Indiana Communities Advancing Recovery Efforts (IN CAREs) Enhancing Community Healthcare Outcomes (ECHO).The ECHO model is an innovative framework that uses videoconferencing technology to increase the knowledge, skills, and performance of community stakeholders, particularly those located in rural and underserved areas. The IN CAREs ECHO connects a group of faculty experts (referred to as the “Hub”) who have experience in reducing overdose (OD) deaths with a set of community-based teams (referred to as “Spokes”) made up of leaders within each community. The Spoke teams are committed to working together to implement strategies and coordinate efforts to reduce substance misuse, reduce morbidity and mortality associated with substance use disorder (SUD), and increase linkage to care for those with SUD.The ECHO model requires Spoke teams to participate, virtually, in monthly, 90-minute sessions throughout their contract period. A session will consist of a short, expert-led lecture (didactic) presentation to improve content knowledge and share evidence-based best practices, followed by one community case presentation with clarifying questions and recommendations. As part of the community case presentation, Teams will identify and share stories that illustrate progress, successes, and challenges associated with their efforts. Each participating Spoke will be encouraged to have post-ECHO action meetings to ensure that participants are applying the knowledge learned in the virtual ECHO sessions to implement changes in their communities.
- Clinician/Health System Engagement and Health IT/PDMP Enhancement
- IDOH partners with the Indiana Professional Licensing Agency (IPLA), the state agency that houses the state’s Prescription Drug Monitoring Program (PDMP) to maintain bidirectional connection for the exchange of PDMP data with other state systems
- IDOH will educate clinicians on opioid prescribing as described in the 2022 CDC Clinical Practice Guideline for Prescribing Opioids.
- IUPUI ECHO Center educates and supports health professionals to implement evidence-based pain management practices focusing on SUD prevention, screening, diagnosis, treatment, and linkage to care. ECHO is a web-based educational framework that builds communities of practice among multidisciplinary health professionals using case-based learning and peer knowledge sharing. It will build clinical capacity among established and new providers to offer SUD services. It will encourage providers to achieve patient-centered care aligned with the 2022 Guidelines. An interdisciplinary team of local experts, including peer navigators, will use their understanding of community needs and challenges to design a curriculum that addresses these complexities, and includes an audience of Indiana health providers that meet regularly to collaborate and discuss care for patients living with chronic pain and SUD. The curriculum includes co-managing pain and SUD, screening and treatment, health and stigma, linkage to and retention in care for SUD, and peer navigation. IDOH will partner with Marion County Public Health Department to create and disseminate relevant resources on various platforms.
- Public Safety Partnerships/Interventions
- Law enforcement/justice system employee
- Northeastern University (NU) will expand Safety and Health Integration in Enforcement of Laws on Drugs (SHIELD) Training Initiative deployment curriculum for Indiana Law Enforcement (LE) by leveraging existing relationships between behavioral health professionals and local LE; using an enhanced train-the-trainer model; and further adapt the material for continuing and new sectors.
- Department of Trauma and Injury Prevention (DTIP)
- Under the Department of Trauma and Injury Prevention (DTIP) Overdose Response Plan (ORP) program, participating counties funded through the IN CAREs ECHO program will monitor Overdose (OD) Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) data, strengthen partnerships with stakeholders, develop an ORP using a template provided by IDOH in partnership with the Division of Emergency Preparedness and simulate virtual plans. Locally driven ORPs will address issues plaguing communities, including targeted education, naloxone trainings, and improved mass communication for fatality reviews. Law Enforcement (LE) will provide reports to inform Suicide/Overdose Fatality Review (SOFR) and identify gaps in justice involvement where linkage to care may be necessary. Implementing ORPs encourages Emergency Department (ED) doctors to prescribe buprenorphine, refer to outpatient Medically Assisted Treatment (MAT) and other treatment options, establish reporting mechanisms, and establish/maintain insurance coverage for patients.
- IDOH/IUPUI ECHO Center/DOC/Step-Up, Inc.
- The Indiana Peer Education Program (INPEP) ECHO uses an evidence-based peer education model to mitigate substance use disorder (SUD) and connect to harm reduction program (HRP) services for incarcerated people. From 2018 to 2023, the program was implemented in eight Indiana Department of Correction (DOC) facilities. Over 200 peer health educators (PHE) have been trained, and more than 3,000 individuals have been educated. INPEP is implemented by a team from IDOH; IUPUI ECHO Center; DOC; and Step-Up, Inc., a re-entry focused non-profit. Supported by DOC, individuals apply and are selected to train as PHE through an intensive 40-hour training that includes naloxone administration, HRP, SUD, and professional skills. PHE host health education workshops and provide support to DOC residents. The ECHO team hosts monthly virtual sessions and monthly administrative site visits which include additional training, continuing health education, skill and knowledge development, and troubleshooting implementation challenges. Site visits also serve to encourage communication between PHE, wardens, unit managers, site liaisons, and Central Office leadership. After release from incarceration, PHE are connected to reentry support services and treatment as needed. PHE who are released may become a member of Outside Peer Education Program (OutPEP) to teach SUD topics in their community and hold workshops at various targeted locations.
- Overdose Response Strategy (ORS) Public Health Analyst
- IDOH DTIP collaborates with CDC Foundation’s Overdose Response Strategy to reduce fatal and non-fatal drug ODs by connecting public health and public safety agencies, sharing information, and supporting evidence-based interventions with support from a Public Health Analyst.
- Law enforcement/justice system employee
- Harm Reduction
- Certified Peer Recovery Coach (CPRC)/Syringe Service Programs (SSP)
- Increased equitable delivery and improved access to care/services (e.g., harm reduction services such as SSPs, treatment services, warm hand-off programs, post-overdose outreach, support services such as transportation assistance, and recovery services), especially among Persons Who Use Drugs (PWUD) as well as those previously underserved by overdose prevention programs and the healthcare system overall
- Increased linkages to care (e.g., use of navigators to link people to evidence-based treatment and promote access and link PWUD to harm reduction services) and engagement in care (e.g., peer support groups or linkages to community-based self-help groups, increasing access and retention to care through strengthened telehealth infrastructure and resources) across various settings including community, healthcare, and public safety settings
- Certified Peer Recovery Coach (CPRC)/Syringe Service Programs (SSP)
- Community-Based Linkage to Care
- Marion County Public Health Department (MCPHD)/Department of Trauma and Injury Prevention (DTIP)
- The MCPHD will collaborate with Indiana Department of Health (IDOH) to expand the Beyond Substance Podcast statewide. Monthly episodes will showcase key topics such as: Overdose (OD) prevention work within local communities and select sub-populations of Persons Who Use Drugs (PWUD), the 2022 Guidelines, treatment/Medications for Opioid Use Disorder (MOUD), Harm Reduction Programs (HRP), and linkage to care best practices, peer recovery, etc.
- Suicide/Overdose Fatality Review
- The Fatality Review and Prevention (FRP) division at IDOH coordinates and supports local Overdose Fatality Review (OFR) teams in the implementation of OD case review. The FRP has adopted the child fatality review model for OFR, engaged key local stakeholders in the process, and shared state-level data such as hospital records, toxicology analysis, Indiana's Prescription Drug Monitoring Program (INSPECT) data, and county-level hospital discharge information to identify trends. OFR enhances data and adds qualitative analysis of risk factors and circumstances for events where drugs or alcohol may have been a contributing factor. Based on the findings gathered through OFR case review, teams can identify areas requiring intervention and provide outreach and social service referrals to loved ones of those who suffered a fatal OD.
- IDOH and IN CAREs ECHO Spoke
- IDOH will partner with ECHO recipients to carry out the following campaigns: CDC Stop OD, CDC Rx Awareness, and DHMA Know the Facts. IDOH Community Outreach Coordinators will work with communities across the state to implement and disseminate toolkits and advertisement materials. IDOH will recommend ECHO communities to incorporate these campaigns in their awareness and marketing efforts.
- Marion County Public Health Department (MCPHD)/Department of Trauma and Injury Prevention (DTIP)