Building Safe, Healthy, and Drug Free Communities

Kareemah Abdullah, ICPS, CPS

Director National Coalition Institute

Vice President Training Operations

Community Anti-Drug Coalitions of America (CADCA)

Integrating Primary and Behavioral Health Care Through the Lens of Prevention

New Orleans, Louisiana

July 13, 2016

Integrating Prevention Activities: The Role of Community Coalitions

2

Today’s Presentation

• Overview CADCA

• Explain Coalition Prevention Approach

• Establish Position on Integrating Prevention Activities

• Explore Roles of Community Coalitions

• Discuss Models and Activities for Appropriate Integration

Building Safe, Healthy, and Drug Free Communities

Who isCommunity Anti-Drug Coalitions of America?

(CADCA)

Video

4

About CADCA

• Founded in 1992 as a recommendation from the President’s Drug Advisory Council.

• Today, CADCA supports a comprehensive, data-driven approach to prevent the use of illicit drugs, underage drinking, youth tobacco use, and the abuse of medicines.

• CADCA represents more than 5,000 community coalitions nationally and in 29 countries globally.

Mission: To strengthen the capacity of community coalitions to create and maintain safe, healthy and drug-free communities globally.

5

CADCA’s Core Services

• Public Policy and Advocacy

• Training and Technical Assistance and Outreach

• Research, Evaluation and Dissemination

• International Programs

• Youth Programs – National Youth Leadership Initiative (NYLI)

• CADCA’s National Leadership Forum (February)

• CADCA’s Mid-Year Training Institute (July)

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CADCA’s Public Policy Impact

Since FY 1994, CADCA has been responsible for the restoration of cuts and/or funding increases for

substance abuse prevention totalingover $2.79 billion.

CADCA’s

Public Policy

Expertise

CADCA’s

Network

Policies, Funding

& Laws That

Benefit

Prevention and

Treatment

+

=

8/2/2016

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CADCA’s Institute

The National Coalition Institute was established by Congress in 2001 by the Drug Free Communities (DFC)

Support Act.

The Institute is “a vehicle for coalition-specific substance abuse prevention, policy development and a center for coalition training, technical assistance, evaluation, research and capacity building.”

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The Congressional Mandate

The Drug Free Communities Support Act charges the Institute to fulfillthese three goals:

1. Provide education, training and technical assistance for coalition leaders and community teams with emphasis on the development of coalitions serving economically disadvantaged areas;

2. Develop and disseminate evaluation tools, mechanisms and measures to better assess and document coalition performance measures and outcomes; and

3. Bridge the gap between research and practice by translating knowledge from research into practical information.

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The Drug-Free Communities Support Program

• CADCA was the driving force behind the passage of the DFC program, and continues to play a key role in its successful reauthorization and growth.

• The US has invested a total of $1.16 billion in the DFC program since its inception in 1998.

• Approximately 2,000 community anti-drug coalitions have been funded.

• CADCA’s Coalition Institute is the primary training and technical assistance provider for the program.

The White House Office of Drug Control Policy (ONDCP)

CADCA’s Seven Strategies for Community Change

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Institute Training

and Technical

Assistance

Enhanced

Coalition

Capacity

Coalitions

Pursuing

Comprehensive

StrategiesCreated

Community

Changes

The Institute’s

Framework for Community Change

Improved Population Level Outcomes

Coalitions

Implementing

Essential

Processes

CADCA’s National Coalition Academy

8/2/2016

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Proven Effective Model

• ‘CADCA’s training and support model is effective’

• ‘Coalitions that receive training and support from CADCA are more effective . . .’ - Michigan State University Study, 2014

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National Evaluation on Institute Impact

1. Overall Capacity

2. Use of Comprehensive Strategies

3. Use of Environmental Strategies

4. Student perception of parental disapproval for using:

a. marijuana

b. tobacco

30 Day Use of Marijuana

Sign

ific

ant

Incr

ease

sSign

ificant D

ecreasesSummary of Findings –

Longitudinal Evaluation of the Impact of CADCA’s Institute's Training & TA On Coalition Effectiveness; Dr. Pennie Foster-Fishman, Ph.D. Michigan State University, February 7, 2015

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• Protection of Primary Prevention

• Increase Prevention Funding

• Educate Impact of Marijuana Legalization

• Mobilize Policy Makers Build Sustainable Coalitions

Research into Practice

Priorities

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UNIVERSAL PREVENTION MUST

CONTINUE TO BE DIFFERENTIATED…

NOT INTEGRATED IF IT IS TOSURVIVE6

CADCA’s POSITION

8/2/2016

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COALITIONS :“TURN KEY” SOLUTION FOR

DEALING WITH YOUTH ATODISSUES

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COALITIONS ARE PERFECTLY ENGINEERED FOR

COLLABORATION

COOPERATION

COORDINATION

THEREFORE…

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Examples of Universal Prevention Bridging/Collaborating/Interfacing

with the Health Care System

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Community Benefit for Non-Profit Hospitals

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What is Community Benefit

1. Legal requirement for non-profit hospitals to invest in the health and health care of their communities in exchange for their tax-exempt status

2. Overseen by the Internal Revenue Service

3. Historically, community benefit mostly funded charity care or uncompensated care

4. New accountability as part of the Affordable Care Act

-Community Health Needs Assessment (CHNA) every 3 years

-Implementation Strategy

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(CHNA) Requirements

• ACA requires that the CHNA “take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge or expertise in public health.”

• ACA requires CHNA to be widely available

• IRS requires engagement of public health

• North Carolina has a unique process that “marries” public health agencies and hospitals in syncing the CHA and CHNA assessments and cycles*

*Healthcare and State Health Agency Collaboration Around Community Health Needs Assessment. North Carolina Public Health Hospital Collaborative. 2013

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CHNA, Implementation Strategy, and Reporting

• CHNA must provide a prioritized description of community health needs identified and the process for prioritizing such needs

– Must be available on website

• Implementation strategy

– Describes how needs identified in CHNA will be met

– Describes why some needs may not be addressed

– Must be approved by the governing board

– Must be attached to IRS Form 990 (Schedule H)

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Implementation Strategy Explicitly includes the following:

Community Building Activities:

• Physical improvements and housing

• Economic development

• Community support

• Leadership development and training for community members

• Coalition building

• Community health improvement advocacy

• Workforce development

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• These assessments and strategies create an important opportunity to improve the health of communities by ensuring that hospitals have the information to provide community benefits that meet the needs of their communities.

• They also provide an opportunity to improve coordination of hospital community benefits with other efforts to improve community health.

*Healthcare and State Health Agency Collaboration Around Community Health Needs Assessment. North Carolina Public Health Hospital Collaborative. 2013

Community Health Needs Assessments/Implementation Strategies

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Opportunity for Universal Prevention

• Substance use, when included in a CHNA, is usually rated as a high need

• Community benefit dollars can NOT be spent on services a hospital would ordinarily provide or be reimbursed

• Hospitals and their community benefit programs are looking for experts and help with defining problems and “turn-key” solutions on how to address them (e.g. opportunity to package a coalitions expertise, knowledge and functions as a “turn-key” option to solve a community issue identified and ranked in a hospital’s CHNA)

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Community Benefit Models and Coalitions

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MODEL 1

THE HOSPITAL IS THE LEAD AGENCY FOR DFC GRANT AND COALITION

1. REVERE CARES (MASSACHUSETTS GENERAL, MA): GRADUATED DFC GRANTEE (1999-2008)

2. CRAWFORD ABUSE RESISTANCE EFFORT (CRAWFORD/GRANT COUNTY HOSPITALS, WI): GRADUATED DFC GRANTEE (1999-2008)

3. COALITION FOR A DRUG FREE MUSKEGON (MERCY HEALTH, MI): DFC GRANTEE (2005-PRESENT)

4. CHELSEA (MASSACHUSETTS GENERAL, MA): DFC GRANTEE (2009-PRESENT)

5. CHARLESTOWN SUBSTANCE ABUSE COALITON (MASSACHUSETTS GENERAL, MA): DFC GRANTEE

(2012-PRESENT)

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HOSPITAL IS THE LEAD AGENCY

• ATOD METRICS/ISSUES ARE INCLUDED IN THE COMMUNITY HEALTH NEEDS ASSESMENT EVERY 3 YEARS AND RANKED IN THE TOP TIER

• ATOD ACTIVITIES ARE INCLUDED IN THE HOSPITAL’S COMMUNITY BENEFIT IMPLEMENTATION PLANS

(COALITIONS AND COMMUNITY BUILDING COUNT AS ALLOWABLE USE OF COMMUNITY BENEFIT FUNDS)

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REVERE CARES

CADCA’S 2009 COALITION OF THE YEAR AWARD WINNER FOR REDUCING BINGE

DRINKING AMONG TEENS BY 39% OVER 8 YEARS

8/2/2016

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COALITION FOR A DRUG-FREE MUSKEGON

CADCA’S 2014 COALITION OF

THE YEAR AWARD

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HOSPITAL IS THE LEAD AGENCY

COMMUNITY BENEFIT IMPLEMENTATION PLANS SUSTAINED COALITION EFFORTS AFTER 10 YEARS OF

DFC FUNDING: REVERE CARES AND CRAWFORD COALITIONS

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MODEL 2

THE NON-PROFIT HOSPITAL USES THE COALITION’S DATA

AS PART OF THE REQUIRED COMMUNITY HEALTH NEEDS ASSESMENT (CHNA)

WORKING THROUGH THE COMMUNITY’S LEAD PUBLIC HEALTH AGENCY

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ALLIES FOR SUBSTANCE ABUSE PREVENTION (ASAP) ANDERSON COUNTY, TENNESSEE

• COALITION PARTICIPATED, THROUGH THEIR LOCAL PUBLIC HEALTH AGENCY, IN TWO NONPROFIT HOSPITAL CHNA’S

• METHODIST MEDICAL CENTER (THE SURGEON AT THE MEDICAL CENTER WAS ON ASAP BOARD OF DIRECTORS)

• RIDGEVIEW BEHAVIORAL CENTER (HOSPITAL STAFF WERE FOUNDING MEMBERS OF THE COALITION AND CONTINUE TO BE ACTIVE)

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ASAP DATA USED IN CHNA FOR BOTH HOSPITALS

1. HEALTH STATISTICS

–PREVALENCE OF YOUTH USE

–PREVALENCE OF NEONATAL ABSTINENCE SYNDROME

2. SOCIAL SERVICE LEADER FOCUS GROUPS

–COALITION MEMBERS PARTICIPATED IN FOCUS GROUP DISCUSSIONS

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KEY FINDINGS BASED ON ASAP DATA- CHNA (RIDGEVIEW HOSPITAL)

• SUBSTANCE ABUSE RANKED #1 OUT OF 5 AS THE TOP HEALTH CONCERN IN ANDERSON COUNTY

1. SUBSTANCE ABUSE (INCLUDING PRESCRIPTION DRUG ABUSE)2. OBESITY

3. MENTAL HEALTH

4. DIABETES

5. ASTHMA

• THE ASAP COALITION HAS NOT ASKED THIS HOSPITAL FOR ANY FUNDING UNDER THE COMMUNITY BENEFIT

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KEY FINDINGS BASED ON ASAP DATA- CHNA (METHODIST MEDICAL CENTER)

RISKY BEHAVIOR RANKING

1.DRUG ABUSE (82%)

2.ALCOHOL ABUSE (55%)

3.TOBACCO USE (31%)

• THE ASAP COALITION HAS NOT ASKED THIS HOSPITAL FOR ANY FUNDING UNDER THE COMMUNITY BENEFIT

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ALLIES FOR SUBSTANCE ABUSE PREVENTION OF ANDERSON COUNTY

CADCA 2014 MILESTONES AWARD WINNER

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MODEL 3

THE HOSPITAL FUNDS THE WORK OF THE COALITION THROUGH

COMMUNITY BENEFIT PLAN

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FRANKLIN COUNTY COMMUNTIES THAT CARE

FRANKLIN COUNTY COMMUNTIES THAT CARE:

GRADUATED DFC GRANTEE

(2002-2012)

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HOW FRANKLIN COUNTY COALITION GOT INVOLVED WITH BAYSTATE FRANKLIN MEDICAL CENTER

• BUILT STRONG RELATIONSHIPS WITH THE HOSPITAL DURING YEAR 1 OF DFC

• HAD A HOSPITAL REPRESENTATIVE ON THE COALITION’S COORDINATING COUNCIL

• PROVIDED COALITION DATA TO THE HOSPITAL FOR THE CHNA OVER TIME

• TEEN HEALTH SURVEY DATA

• KEY INFORMANT INTERVIEW AND FOCUS GROUP DATA

• COMMUNITY NEEDS AND RESOURCES ASSESSMENT DATA

• ARCHIVAL DATA COLLECTED BY THE COALITION

• PRIORITY RISK AND PROTECTIVE FACTORS FOR THE COALITION’S WORK IN THE REGION

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HOW FRANKLIN COUNTY MADE THE CASE TO HOSPITALS TO FUND THEIR COALITION

COMMUNITY BENEFITS ADVISORY COMMITTEE VALUED:

• THE EVIDENCE-BASED PRACTICES

• DATA-DRIVEN DECISION-MAKING

• ENVIORNMENTAL STRATEGIES

• COLLECTIVE IMPACT OF THE COALTION

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FRANKLIN COUNTY COMMUNITIES THAT CARE

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FRANKLIN COUNTY COMMUNITIES THAT CARE

CADCA 2007 COALITION OF EXCELLENCE AWARD

The Franklin County Communities That Care Coalition, Greenfield, MA, won “Coalition as a Whole” category, which recognizes coalitions that achieved targeted population-level outcomes through the use of comprehensive communitywide strategies.

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FRANKLIN COUNTY COALITION WAS FUNDED UNDER THE COMMUNITY BENEFIT IN 2015 FOR THE FOLLOWING ACTIVITIES:

• COALITION (BACKBONE) SUPPORT

• UPDATING COMMUNITY ACTION PLAN

• FUND TEEN HEALTH SURVEY AND OTHER DATA COLLECTION AND ANALYSIS

• SUPPORT IMPLEMENTATION OF LIFESKILLS CURRICULUM IN SCHOOLS

• PROVIDE PARENT EDUCATION MINI GRANTS

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LESSONS LEARNED

1. USE COALITION’S HEALTH SECTOR CONTACTS TO GET IN THE DOOR OF THE PUBLIC HEALTH AGENCY AND THE HOSPITALS

2. GET COALITION’S ATOD DATA INCLUDED IN THE CHNA’S OF THEIR LOCAL NONPROFIT HOSPITALS

3. ONCE ATOD ISSUES ARE INCLUDED IN THE CHNA, THEY RISE TO THE TOP OF IDENTIFIED COMMUNITY ISSUES

4. USE HOSPITAL CONTATCS TO SHARE VALUE OF MULTI-SECTOR, DATA DRIVEN ENVIORNMENTAL STRATEGIES

5. USE HOSPITAL CONTACTS TO DEMONSTRATE POPULATION LEVEL OUTCOMES DUE TO COALITION STRATEGY IMPLEMENTATION AND USE TO GET FUNDING UNDER THE COMMUNITY BENEFIT PLAN

6. PACKAGE ENTIRE COALITION SPF PROCESS, DATA, STRATEGIES, EVALUATION, ETC. INTO A “TURN-KEY” APPROACH TO SOLVE A HOSPITAL/COMMUNITY PROBLEM

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Other Examples of Collaboration

Coalitions collaborating with the local heath department to engage all physicians in Westchester County, New York in proper

prescribing practices for youth

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Westchester County, New York

• Westchester Coalition for Drug and Alcohol Free Youth, a group whose members represent 30 local anti-drug coalitions throughout Westchester County worked with the county executive and head of their local health department to fax a “Dear Colleague” letter to all physicians in the county regarding youth prescription drug use and abuse.

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The Westchester “Dear Colleague” letter reminded all physicians to:

• Educate teen patients and their parents/guardians about the dangers of overdose and addiction, and the risks of storing narcotic medications at home

• Provide brochures in their offices with information about adolescent Rx use and abuse and about the county’s Medication Take-Back Program

• Consider non-narcotic options for pain medication rather than the narcotics such as OxyContin and Vicodin

• Consider prescribing fewer pain pills to decrease the likelihood that they will be given to a friend, sold, or used after they are no longer medically necessary

• When writing a prescription, counsel your patients not to leave leftover prescription medications at home (police station lock boxes)

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Drug Free Muskegon County, Michigan

• Coalition convened community focus group on sources of Rx diversion and shared results with the hospital

• Hospital changed prescribing practices based on this information

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Allies for Substance Abuse Prevention of Anderson County, Tennessee

The East Tennessee Children's Hospital (ETCH) reached out to the Allies for Substance Abuse Prevention coalition

looking for help in organizing their efforts around Neonatal Abstinence Syndrome (NAS). The coalition

worked with ETCH to create a problem analysis, a logic model and media/educational campaign around NAS.

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Allies for Substance Abuse Prevention of Anderson County, Tennessee

• The hospital had a tremendous increase in prevalence and re-admission as babies sent home on maintenance methadone were being readmitted to the ER with withdrawal symptoms because the parents were using the baby's methadone.

• Through an analysis process, the hospital changed the way it treated NAS babies from using methadone to using morphine.

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Allies for Substance Abuse Prevention of Anderson County, Tennessee

• In addition, the hospital has been a powerful partner with ASAP in a regional effort to prevent NAS and helped launch a media campaign and education effort to prevent NAS diagnoses, which have been identified as an epidemic in East TN.

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COALITIONS MUST SYSTEMATICALLY MARKET OUTCOMES TO HEALTHCARE PROVIDERS AND

HEALTHCARE SYSTEMS AS WELL AS TO DECISION MAKERS AND FUNDERS AT ALL

LEVELS

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In this DFC community, past 30 day non-medical use of prescription drugs decreased at a rate of 88.9% among 10th

graders; 83.3% among 12th graders.

9

12

3 31 2

0

5

10

15

10th Grade 12th Grade

Carter County Drug Task ForceGrayson, KY

Past 30 day Non-Medical Use of Prescription Drugs Among 10th and

12th Graders

2004 2010 2012

Carter County Drug Task Force

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• Partnered with local law enforcement to implement take back events and increase DUI/drug suppression checks;

• Provided funding for law enforcement agencies to receive drug suppression training;

• Implemented a social norms media campaign;

• Provided education to parents, teachers, youth and healthcare professionals; and

• Convened a key leader community forum to educate elected officials about the growing prescription drug problem

Strategies Implemented To Achieve Reductions

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Chairmen Roger’s Statement on DFC

“I am also pleased that this bill funds the Drug Free Communities program at $95 million, roughly $10 million above the request, so that we can increase access to successful community-based prevention and treatment initiatives. As we’ve seen an uptick in the abuse of heroin around the country, these initiatives are perhaps more important than any time in the recent past.”

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Past 30-day use of marijuana among high school seniors decreased at a rate of 39.7%, from 18.4% in 2003 to 11.1% in

2012.

Healthy Communities Initiative CoalitionWisner, Nebraska

Senator Mike Johanns, Ranking Republican on the Financial Services Senate Appropriations

Subcommittee

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COALITIONS ARE A “TURN KEY” SOLUTION FOR DEALING WITH YOUTH ATOD ISSUES

8/2/2016

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SBIRT

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What is SBIRT?

Screening, Brief Intervention, Referral to Treatment

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SEVERE

intensive

purposive

experimental

Substance Use Patterns Among Adolescents

Major

SUD

Risk Factors?

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Research has shown that adolescence is a period of profound brain maturation.

Maturation process occurs from

back to front and is not complete

until age 24

Major processes of the brain that

are maturing during adolescence

Substance use interrupts this

process Show poor judgment Act impulsively Make irrational decisions

D2: Main

reasons for

using are to

get pleasure

or dull pain

pain

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Other Risk Factors for Adolescent SUDs?

Family

School

DeviantPeers

SUD RiskBehavior

Indiv FactorsPersonalityValues, Beliefs

Low Parental MonitoringLow AffectionHigh Conflict

Low School InvolvementPoor Academic Performance

-

-+

+

Neighborhood

Access/Availability; Norms

-

-

Attitudes

Confidence

Motivation

What do all these factors

ultimately affect?

Building Safe, Healthy, and Drug Free Communities

Support for SBIRT with Adolescents

Behavior

change

Awareness/Attitude

s of problem

Motivation

Self-

Efficacy

Screening

Reduce or Stop use

Seek treatment

Brief

Intervention

Include

Referral to

Treatment,

as needed

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Major Change in SUD Field supporting importance of Early Interventions for Adolescents

• Adolescents have extensive substance use heterogeneity that fall along a behavioral continuum of risk

Severe

Intensive

Purposive

Experimental

Severity Rating:

6 +: Severe 4-5: Moderate 2-3 : Mild

DSM-IV

DSM-5

Substance Use Disorder

Abuse Dependence

Diagnostic Criteria

Failure to fulfill obligations X -- X

Hazardous use X -- X

Substance-related legal problems X -- --

Social/interpersonal substance-related problems X -- X

Tolerance -- X X

Withdrawal -- X X

Persistent desire/unsuccessful efforts to cut down -- X X

Using more or over for longer than was intended -- X X

Neglect of important activities -- X X

Great deal of time spent in substance activities -- X X

Psychological/Physical use-related problems -- X X

Craving -- -- X

Diagnostic Threshold

1+

criteria

3+

Criteria

Mild: 2-3

Moderate: 4-5

Severe: >5

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Developmentally Responsive System for Adolescents

No Use Abstinence

Severe Risk Use

Experimental Use

Low Risk Use

Moderate Risk Use

Binge Use

Traditional Treatment

Outreach, Screening and Early Intervention Services

SUD Risk Trajectory

Detox

Residential Outpatient

Case Management

Recovery Support

SBIRT

*At any one point, use might reach levels that warrant Referral to Treatment

Primary Prevention Services

Risk Reduction Education

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How can Coalitions develop plans for implementing SBIRT Practice?

What should be considered?

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Some Thoughts:

• Identify appropriate settings to disseminate SBIRT

• Recognize benefits and challenges of utilizing technology

with the SBIRT process

• Develop a advocacy plan for SBIRT and its implementation

• Understand and identify reimbursement sources for SBIRT

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1. Identify Appropriate Settings

• Most widely used models that can work to initiate SBIRT: Hospitals, EDs, trauma centers, primary care offices, and community health centers

• Other settings that have been used to implement SBIRT services:Selected SAMHSA SBIRT Grantee Service Settings

•Federally qualified health center•Public health department office

•High school-based clinic•Planned Parenthood office

•Specialty health clinic (e.g., women, adolescents)•Senior nutrition program

•Senior center•HIV and sexually transmitted diseases clinic

•Tribal clinic•College/university settings - student union kiosk; athletic

department; counseling center, health clinic

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2. Leverage Technology

• Research supports the use of technology for delivering BIs (equivalent to brief in-person interventions).

• Several advantages:

– Convenience - Accessibility

– Privacy/anonymity

– Reduces stigma

– Engaging

– Culturally relevant (for who?)

8/2/2016

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TechnologySocial Medial TextingVideo GamesRaves – Music FestsSports

Technology based interventions

– using mobile apps, texting,

social media websites and

other tools, computer

simulations, e-gaming

simulation, music recovery (i-

tunes and other audios)

Adolescents! What are they

into?

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3. Develop implementation plan

• After identifying Setting and Delivery…

• Who will perform SBIRT? [partner with sites that have staff who can implement SBIRT]

• When will SBIRT occur in various settings/workflows?

• What measures will be used?

• What steps will be taken when a high severity positive screening occurs – the RT process is well thought out and developed (beyond an “added

AND”)

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4. Develop an Advocacy Plan for SBIRT

How to get Buy-in and Adoption of SBIRT – Champions – 2 important elements:

1. Discuss need and effectiveness

• Besides Data Facts: According to the 2012 National Survey on Drug Use and Health, 23% of Americans aged 12 or older reported binge drinking in the last 30 days or 94% of illicit drug users have never sought treatment, show illustration

2. Discuss reimbursement opportunities

• This has been reinforced by 2 Presentations from CADCA

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Know the Basics

• Medicare pays for medically reasonable and necessary SBIRT services when furnished in physicians’ offices and outpatient hospitals – reimbursement codes

• Health care suppliers eligible to provide SBIRT services:

–Physician–Physician Assistant (PA)–Nurse Practitioner (NP)–Clinical Nurse Specialist (CNS)–Clinical Psychologist–Clinical Social Worker (CSW)–Certified Nurse Midwife

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CONCLUSION

WE NEED TO MAKE THE CASE TO HEALTH CARE PROVIDERS AND THE HEALTH CARE SYSTEM THAT

ATOD PREVENTION WORKS:

1. IT CAN REDUCE POPULATION LEVEL RATES OF ATOD USE

2. IT CAN REDUCE DOWNSTREAM CONSEQUENCES AND HEALTH CARE COSTS

3. IT CAN IDENTIFY AND SOLVE POPULATION LEVEL CHNA IDENTIFIED HEALTH PROBLEMS

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BUT

UNIVERSAL PREVENTION MUST CONTINUE TO BE DIFFERENTIATED– NOT INTEGRATED

IF IT IS TO SURVIVE

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AND

WE CAN CONTINUE TO DEVELOP APPROPRIATE OPPORTUNITIES TO INTERFACE, BRIDGE AND

COLLABORATE WITH THE HEALTH CARE SYSTEM

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Community as Product

‘Community as a brand idea’

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It takes a village to build a brand-idea

So collaboration is the rule, not the exception

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And in the realm of coalition work, where change

and complexity are constants...

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THINK AT THE

INTERSECTION!

8/2/2016

82

You can' tExplain

t o A Tu rt l e aGiraffe Decision

- B is ho p T. D . Ja k e s