Spring Highlights 2023

Although there may be differences in scope and nature, no county in the State of Nevada has escaped the negative impacts of opioid addiction, over-prescribing, inappropriate use of legally prescribed opioids, or illegal use of prescribed or illicit forms of opioids.

The State of Nevada and various counties have entered into lawsuits against the manufacturers and distributors of opioid medications. Nevada Senate Bill 390 (SB 390) set forth various requirements and expectations for counties in Nevada who wish to utilize funding from statewide opioid settlement dollars to mitigate damages from the opioid epidemic.

Impact and Douglas County worked together to create their Opioids Needs Assessment in accordance with SB 390 by following these steps:

1. Impact met with Douglas County's Opioid Needs Assessment Stakeholder Group to create a plan for collecting qualitative and quantitative data for the assessment that aligned with recommendations in SB 390. This preparation included creating a list of agreed-upon questions for focus groups and individual interviews.

2. Impact reviewed relevant quantitative data and created hand-outs for use with focus groups and individual interviews.

3. Impact facilitated focus groups and interviews with representatives from various sectors of the community, including: law enforcement, substance misuse treatment providers, persons/families impacted by opioid misuse, persons in recovery, prevention coalitions, social services, and health care providers. Extra effort was made to include representatives from these sectors who were public-facing, but not necessarily in a decision-making role (e.g., employees rather than agency heads, etc.).

4. Once the qualitative data had been collected and analyzed, Impact met with the Douglas County's Opioid Needs Assessment Stakeholder Group to review findings and craft a set of priorities.

5. Finally, Impact worked with Brook Addie, Douglas County's Assistant Director of Community Services, to write the Needs Assessment. The resulting Needs Assessment was reviewed by the Douglas County Opioid Needs Assessment Stakeholder Group and was approved by the Douglas County Commissioners on April 6, 2023.

This Needs Assessment will serve two purposes. First, it will allow Douglas County to be eligible to apply for opioid settlement dollars through the State of Nevada and, second, it will help Douglas County align their efforts to mitigate the harms caused by opioids in ways that meet the expressed needs of the community.

Assessment

"Being aware of challenges doesn't make them sting less, but once you see them, you can assess the best way to handle them."

Mellody Hobson

The process described above is fairly typical of a needs assessment regardless of the topic being addressed. Impact typically follows a "Studying Up" theoretical framework (Nader, 1972) and its successor "Up, Down, and Sideways: Anthropologists Trace the Pathways of Power" (Stryker and Gonzales, 2014). These theories recommend anthropologists study "up," starting from the perspective of the recipients of a program or those who are on the front lines of a situation, and then moving up and around and ending with the study of the processes and policies in place. In the case of Douglas County's Opioid Needs Assessment, we talked to parents who have lost children to overdose, people in recovery, law enforcement officers, treatment providers and others who see the impacts of the opioid crisis every day. Once we had a good idea of what folks believed was needed, we turned our gaze "up" from that perspective, and "around" our potential recipients, to ask what structures are in place and what Douglas County might be able to do to address the gaps.

Evaluation

"One of the great mistakes is to judge policies and programs by their intentions rather than their results."

Milton Friedman

Similarly, when completing an evaluation, Impact starts with the people impacted by a program. If Douglas County wanted to evaluate whether their approach to the opioid crisis is working, we would begin by looking at current use and consequence (ODs, ER encounters, etc.) data. This is a measure of "outcomes." Impact would then examine how well the plan was implemented. This is known as a "process" evaluation. In other words, did they do what they said they were going to do (process) and did their efforts have the effect they were expecting (outcomes).

In both instances, assessment and evaluation, Impact strives for a mixed methods approach that includes both qualitative and quantitative data.

In the most perfect situations, organizations complete needs assessments, create evaluation plans, implement evidence-based policies, programs, and practices, and then complete an evaluation report. In the real world, however, this almost never happens in such a linear fashion. That's OK, Impact can jump in and improve program performance at any stop along the way.

If you are interested in finding out how Impact can help your organization meet its goals, contact Margo at margo.impactevaluation@gmail.com or

call (775) 397-0785.