STEP 1: Assessment

Step 1

Assessment is a critical first step in prevention planning. Assessment allows you to pinpoint the nature of the problem in a particular community, which populations are affected, and what intervening variables are in play. Without it, you risk selecting strategies that do not address the true contributing factors.

Systematically gathering and analyzing local data related to opioid misuse will help you do the following:

  • Identify the nature and extent of the opioid misuse problem in different community populations, including those defined by age, gender, race/ethnicity, or other demographic characteristics
  • Identify the geographic areas where the problem is greatest
  • Define one or more target populations
  • Identify intervening variables (factors linked to opioid misuse in your community)
  • Determine your community’s perception of the problem
  • Determine your community or organization’s readiness to address the problem and what additional resources may be needed

These data will also serve as a baseline for program monitoring and evaluation. Assessment comprises six primary tasks:

STEP 1: Assessment comprises the following primary tasks:

TASK 1: Collect Data to Determine Needs

Consumption and Consequence Data

These local data help you define the needs of your community specific to opioid misuse.

Consumption data describe opioid misuse in terms of the frequency or amount used; these data help you see the usage patterns in your community. For example:

  • Number of youth ages 12–17 reporting current (within the past 30 days) misuse of prescription opioids
  • Number of adults ages 18 and older reporting use of heroin in the past year
  • Number of prescriptions for opioid pain relievers in a given year

The consequences of opioid misuse include physical and mental health conditions, increased health care use, and increased risk of overdose and death. Consequence data can help you better understand the problem in your community. For example:

  • ED visits involving the use of heroin or prescription opioids
  • Opioid-related hospital discharges
  • Deaths from opioid overdose
  • Opioid-related arrests

Quantitative and Qualitative Data

Both quantitative and qualitative data are useful to the assessment process.

Quantitative data are usually reported numerically—often as counts or percentages. In addition to self-reported survey data, quantitative data can be mined from archival data sources, such as police reports, census data, and death certificate data. Quantitative data can measure the extent of opioid misuse, and provide insights into how different factors (such as intervening variables) relate to each other.

  • Example: The percentage of teens who reported using heroin during the last 30 days

Qualitative data may help you gain a deeper understanding of the opioid misuse problem in your community and give you insight into the beliefs, attitudes, and values of various stakeholders. These data are usually reported in words. Sources of qualitative data include stories, key stakeholder interviews, case studies, testimonials, and focus groups.

  • Example: Findings from focus groups with individuals who misuse opioids suggesting that these people are disconnected from formal health and social service support systems

Consider Existing Data

Before launching your data collection effort, take stock of information that may have already been collected in your state or community. For example:

  • Data collected through national or state surveys, such as the National Survey on Drug Use and Health or the Massachusetts Youth Health Survey and the Massachusetts Youth Risk Behavior Survey
  • Interviews and/or focus groups with active users, health care providers, etc.
  • Records from public meetings or forums
  • Public health statistics—self-reported survey data, death certificates indicating an opioid overdose as the cause of death, etc.
  • Law enforcement data, such as opioid-related drug arrests or drug trafficking
  • Department of Justice data, such as outcomes of criminal cases related to opioid misuse
  • Public safety data—data from the fire department on emergency medical services for opioid overdose, etc.
  • Hospital data, such as discharge codes for opioid-related poisonings

Since local data are not as readily available as national or state data, you’ll likely need to supplement these sources by collecting data from your local target area. To standardize data collection and allow for comparisons across different areas, do your best to use the same questions and wording as used in the national and state survey.

TASK 2: Identify intervening variables

Intervening variables are factors that have been identified through research as helping to explain substance abuse—in this case, opioid misuse. They include risk factors that have been shown by research to predict opioid misuse, and protective factors that exert a positive influence or buffer against the negative influence of risks. These risk and protective factors can be found at different levels, such as individual, peer, family, and community.

Findings from a literature review of risk and protective factors for the nonmedical use of opioids, conducted by the Center for the Application of Prevention Technologies (CAPT) under a contract with SAMHSA, are summarized in Table 3 (CAPT, 2012b).

An annotated bibliography addressing risk and protective factors for unintentional fatal and nonfatal opioid overdose—originally designed for Massachusetts Collaborative for Action, Leadership, and Learning (MassCALL2) grantees and updated by the Northeast CAPT— is available here.

Risk and protective factors can be measured using both quantitative and qualitative data. After identifying and prioritizing the risk and protective factors in your community, you will select prevention strategies for addressing them, which is described in Step 3 of the SPF.

TASK 3: Assess readiness and resources

Once you have determined what intervening variables to address, your next step is to determine which strategies may be most feasible to implement. To do this, you must assess your community’s readiness to address the opioid misuse problem and the existing resources that may be dedicated to this purpose.

A community readiness assessment will help you determine how willing and prepared your community is to support a substance abuse prevention initiative.

Note: Be sure that your readiness assessment reflects principles of cultural competence by involving representatives from across sectors in planning and data collection and by collecting information in ways that are appropriate and respectful.

A community resource assessment will help you identify potential resource gaps, build support for prevention activities, and ensure a realistic match between identified needs and available resources.

When people hear the word resources, they might think of staff, financial support, and a sound organizational structure. However, substance abuse prevention resources may also include the following:

  • Community efforts to address substance abuse
  • Community awareness of those efforts
  • Specialized knowledge of prevention research, theory, and practice
  • Practical experience working with particular populations
  • Knowledge of the ways that local politics and policies help or hinder prevention efforts

It is important to focus your assessment on relevant resources (i.e., resources related to your priority problem). A well-planned and focused assessment will produce far more valuable information than one that casts too wide a net. At the same time, keep in mind that useful and accessible resources may also be found outside the substance abuse prevention system, among the many organizations in your community that promote public health.

TASK 4: Analyze the data

By identifying the types (e.g., use of heroin, misuse of prescription opioids) and the extent of opioid misuse, and the populations and areas most affected, you can better understand the actual problem in your community.

Examine your quantitative data to see if specific groups of people or other factors stand out. For example:

  • Are most heroin users young men?
  • What proportion of overdoses in the community are nonfatal versus fatal?
  • What specific substances are being used when overdoses occur?

Look for trends in your data that may suggest factors that influence opioid misuse and/or intervening variables.

Example: Say there was a sharp rise in opiate overdoses in the past year.

  • What happened or what changed that may explain this?
  • Did your community see an influx of an at-risk population?
  • Was there an increase in heroin purity levels?
  • Did any critical services accessed by the target population shut down or experience budget cuts?

Examine local data in relation to state data to determine if there may be something unique or unusual about the community associated with opioid misuse or its intervening variables.

  • Is there something different about the problem in your community?
  • Does the difference point to an intervening variable that may be important, or perhaps to a strategy to consider later in the process?

To increase confidence in the process of qualitative data analysis, it is best to have two or more people do the analysis independently:

  • Read and reread the materials
  • Identify the different themes that emerge for each question
  • Have coders compare their themes
  • If the themes differ, have coders reconcile their views and reach consensus
  • Record and report comments for each theme
  • Count the number of respondents who mentioned each theme (which is a primary indicator of its importance to participants)

Compare the quantitative data with the qualitative data to see if they reinforce one another or raise new questions.

  • Example: If the police chief tells you that the number of opioid overdoses has been unchanged for the past five years or more, but state and/or local hospital, ED, and death data show that overdoses have increased, what is the source of the discrepancy?

Analyzing the data you collect during the assessment process will help you answer the question, “Why is opioid misuse happening here?” This can help you select strategies that get to the unique root causes of opioid misuse in your community.

TASK 5: Develop Your Problem Statement

Developing a clear problem statement will help you focus on where to build capacity and how to measure outcomes and plan for sustainability. Interventions without a clearly articulated problem statement may lose steam over time, or not know whether they have made a difference. Communities should use their data about consumption, consequences, readiness, and resources to frame their problem statement in specific terms.

A good problem statement will meet each of the following criteria:

  • Identify one issue or problem at a time
  • Avoid blame
    • Example: “Young people do not have enough positive activities” is better than “The kids here have nothing to do and are troublemakers”
  • Avoid naming specific solutions
    • Example: “Young people in our neighborhood are getting into trouble during after-school hours” is better than “We don’t have a youth center”
  • Identify outcomes that are specific enough to be measurable
  • Reflect community concerns as heard during the assessment process

When you develop your problem statement, be sure to describe what actually exists that is problematic, rather than what is lacking. Defining a problem simply as a “lack” of something will narrow your planning focus and direct energy and resources to strategies that are not likely to be sufficient on their own, while other important factors are missed.

  • Example: “Hospital staff lack training on how to address opioid overdoses”

This statement assumes that addressing this lack by offering training alone will solve the problem. In reality, there may be many factors—such as lack of awareness among prescribing providers regarding opioid overdose risk factors, and inadequate availability of post-overdose care—that also contribute to the problem.

  • Better examples:
    • Too many local high school students (2.6 percent) are currently using opiate-based prescription drugs that were not prescribed for them.
    • Too many young adults (ages 18–25) in our town have died from an opioid overdose (20 over the past three years).

These problem statements are clear and specific, identifying just one issue at a time.

Keeping the focus on the priority behaviors, consequences, and/or underlying intervening variables at this stage in the planning process will help you select a comprehensive array of strategies that will be more effective in addressing the problems you have identified.

Some communities find that they need to develop more than one problem statement. For example, you may need to develop a problem statement that addresses an issue related to consumption (use) and one that addresses an issue related to consequences (e.g., overdoses, deaths).

TASK 6: Assess Your Cultural Competence

Determine how your group is currently functioning in regard to cultural competence. The following questions can help you assess your group’s strengths and weaknesses in this area:27

  • Does your community assessment include information about the major cultural groups in your community?
  • Do members of diverse group(s) assist in the analysis and interpretation of your data?
  • Does your organization or coalition engage all sectors of the community in community-wide prevention efforts?
  • Are all groups adequately represented or “at the table”?
  • Do your organizational plans incorporate cultural competence concepts?

When collecting qualitative data, it is likewise important to use methods that are culturally competent and appropriate. Consider:

  • Will any of your interview or focus group questions be perceived as too personal or inappropriate?
  • Have you considered (and then addressed) any translation needs?
  • Do the interviewers or group facilitators reflect the composition of the group being interviewed?