STEP 3: Strategic Planning

Step 3

Strategic planning is pivotal to prevention success. It brings together all of your data collection and capacity-planning work to create an overall vision of what your group is attempting to do and how it will evaluate the results of its efforts. Strategic planning increases the effectiveness of your prevention efforts by focusing energy, ensuring that staff and other stakeholders are working toward the same goals, and providing the means for assessing and adjusting programmatic direction as needed.

Use the information obtained via your needs assessment to develop a strategic plan for addressing opioid misuse in your community.

Strategic planning comprises eight primary tasks:

STEP 3: Strategic Planning comprises the following primary tasks:

TASK 1: Prioritize intervening variables

Intervening variables are those factors identified in the literature as helping to explain opioid misuse in a particular community. They include both risk and protective factors.

When prioritizing intervening variables, it is important to look at opioid misuse in a comprehensive way and to consider the potential consequences of addressing one risk or protective factor versus another.

  • Example: There is some evidence that reducing access to prescription opioids without reducing the demand for these drugs could increase the use of heroin.

For each intervening variable you consider, think about the potential for unintended consequences and how you might anticipate and address these issues.

You might also consider the time lapse, or the amount of time between opioid misuse and its consequences. A short time lapse may make it easier for you to show a relationship between your activities and improved outcomes.

Communities often use two criteria in particular—importance and changeability—to decide which intervening variables to address. You may want to select intervening variables that are high in both.

Importance

Importance refers to the extent to which various intervening variables impact the problem in question. When examining the data you’ve collected, ask yourself how important a particular factor is in addressing opioid misuse in your community. If the answer is “very important,” then this factor should be considered high in importance; if the answer is “not that important,” then it should be considered low in importance.

  • Example: The problem is youth misuse of prescription opioids, and the data show that youth are more likely to obtain these drugs from peers (social access) than from parents (via unlocked medicine cabinets in their homes). Therefore, social access is high in importance, whereas access through parents is low.

When weighing the importance of intervening variables, consider the following:

  • Does the intervening variable impact other behavioral health issues?
  • Example: Poor parental monitoring is a risk factor for both opioid misuse and other risky behaviors, such as alcohol use and early sexual activity. Therefore, focusing on this risk factor will likely impact more than one issue, so it can be considered high in importance.
  • Do the intervening variables directly impact the specific developmental stage of those experiencing the problem?
  • Example: If the identified problem is the misuse of opioids among 18–25 year olds, the risk factor of parental monitoring is less important than it would be for 12–17 year olds.

Changeability

Changeability refers to how easy it may be to change the intervening variable. Consider the following:

  • Whether the community has the capacity—the readiness and resources—to change a particular intervening variable
  • Whether a suitable evidence-based intervention exists
  • Whether change can be brought about in a reasonable time frame (i.e., changing some intervening variables may take too long to be a practical solution)

For each intervening variable, consider whether your community has ample resources and sufficient readiness to address the variable, if a suitable evidence-based intervention exists, and if change can occur within a reasonable time frame. If the answer to all three questions is yes, then the factor is high in changeability. If the answer is no (there are not adequate resources, there is no suitable intervention, and/or the community is not ready to address the intervening variable), the factor is low in changeability.

TASK 2: Evidence-Based Interventions

Evidence-based interventions refers to prevention activities or strategies that evaluation research has shown to be effective. Some of these activities help individuals develop the intentions and skills to act in a healthy manner, while others focus on creating an environment that supports healthy behavior.

To address opioid misuse in your community, select strategies that have been shown to be effective, are a good fit for your community, and are likely to promote sustained change.

Evidence of Effectiveness

Few studies have examined the effectiveness of interventions focused specifically on opioid misuse. As a result, traditional guidance about strategy selection (e.g., selecting interventions from Federal registries of evidence-based interventions) may be difficult to follow.

Literature reviews and best practice summaries may help you identify strategies that have been evaluated and that may be a good fit for your community. For example:

  • This literature review summarizing the evidence in support of various strategies and interventions for addressing the nonmedical use of opioid drugs31 was developed by the Northeast CAPT under a contract with SAMHSA.
  • Best practices from MassCALL2 grantees regarding strategies for reducing unintentional fatal and nonfatal opioid overdoses are summarized here.

These and other resources (e.g., other literature reviews, published studies, unpublished evaluation findings) may help you identify the strategies with the greatest potential to affect the intervening variables you identified as a priority.

For each strategy you consider:

  • Review the research evidence that describes how the strategy is related to your selected intervening variable(s)
  • Based on this evidence, present a rationale describing how the strategy addresses the intervening variable(s)

Conceptual Fit

To determine conceptual fit, consider the following:

  • How relevant is this strategy to your community?
  • Has the strategy been tested with the identified target population? If not, how can it be applied to the target population?
  • Is the strategy logically connected to your intervening variable(s) and desired outcomes? How will implementing this strategy in your local community help you achieve your anticipated outcomes?

Practical Fit

Is your community currently able to effectively implement the selected strategy, given its readiness, population, and general local circumstances? Consider the following:

  • Resources—cost, staffing, access to target population, etc.
  • Organizational or coalition climate—how the strategy fits with existing prevention or reduction efforts, willingness on everyone’s part to accept new programs, buy-in from key leaders, etc.
  • Community climate—the community’s attitude toward the strategy, buy-in from key leaders, etc.
  • Sustainability of the strategy—community ownership, renewable financial support, community champions, etc.

Potential Impact

Consider the comprehensiveness and potential for long-term impact of each strategy:

  • Strategies that are more narrow in focus (e.g., educating parents or health care providers) may be easier to implement
  • Strategies aimed at changing policies, systems, and environments (e.g., prescription drug monitoring programs, system-wide changes in how EDs treat opioid overdose) may be more likely to promote sustained improvement in outcomes
TASK 3: Establish Outcomes for Each Strategy

To establish measurable outcomes for each selected strategy, identify the intervening variable(s) being addressed, note the strategy you’ve chosen, and list the anticipated short-term, intermediate, and long-term outcomes.

For example:

  • Intervening variables: Poor parental monitoring and supervision of children, lack of clear parental disapproval of substance use
  • Strategy: Communication campaign aimed at reaching 90 percent of parents of eighth grade students with information on the importance of communicating the harms of opioid misuse to their children
  • Outcomes:
  • Short-term: Parents of eighth grade students believe that opioid misuse is harmful
  • Intermediate: Parents of eighth-graders clearly communicate disapproval of opioid misuse to their children
  • Long-term: Decreased rates of opioid misuse among eighth grade youth
  •  A short-term outcome is a change in the target group who received your strategy
  •   An intermediate outcome is a change in the intervening variable
  •   A long-term outcome is the ultimate impact of the strategy on the issue identified in your problem statement

 

 

TASK 4: Identify Resources Needed for Implementation

Specify all resources needed to implement each selected strategy and to measure the related outcomes. Consider the following:

  • Human resources—staffing, partnerships, volunteers, coalition membership, etc.
  • Skills—data collection and analysis, prevention, intervention, etc.
  • Fiscal resources—both monetary and in-kind
  • Material resources—space, equipment, etc.

Also consider the existing resource gaps that will limit your ability to effectively implement your selected strategy or strategies. How will (or can) you address these gaps?

TASK 5: Develop a Logic Model

A logic model is a chart that describes how your effort or initiative is supposed to work and why your intervention is a good solution to the problem you’ve identified. Effective logic models depict the activities that will bring about change and the results you expect to see in your community. A logic model keeps program planners moving in the same direction by providing a common language and point of reference.

Logic models may be used for various purposes and can feature different elements.

  • Example: Logic models used in evaluation often list inputs, activities, outputs, and outcomes.

In the context of the SPF, a logic model generally includes the following categories:

  • Local problem statement (related to consumption or consequences)
  • Intervening variable(s)
  • Strategies (evidenced-based, with measurable outputs)
  • Target group
  • Expected outcomes (short-term, intermediate, and long-term)

Using the information you gathered in Steps 1 and 2, develop a community-level logic model that links local problems, related intervening variables, evidence-based strategies, and anticipated outcomes. A Sample Logic Model and Logic Model Worksheet  are provided as resources.

TASK 6: Develop an Action Plan

An action plan is the sequence of steps that must be taken for a strategy to succeed. It details:

  • Your chosen strategy
  • Steps you will take to implement this strategy
  • Who is responsible
  • The timeline for completion
  • How you will measure success

Your action plan should be comprehensive, logical, and data-driven; it should include your community-level logic model, plans for addressing identified resource and readiness gaps, and how you have addressed (and will continue to address) issues of cultural competence and sustainability.

Keep in mind that good planning requires a group process. Whether decisions are made within a formal coalition or among a more informal group of partners, they cannot represent the thoughts and ideas of just one person; they must reflect input of individuals from across community sectors and cultures.

An Action Plan Template is provided as a resource.

Things to consider when developing an action plan

  • Have a clear objective
  • Start with what you will do now
  • Clearly define the steps you will take
  • Identify the end point for each step
  • Arrange the steps in logical, chronological order, and include the date by which you will start each step
  • Think about the types of problems you might encounter at each step and how you will address them
  • Review your progress

 

TASK 7: Develop and Evaluation Plan

Ongoing monitoring and evaluation are essential to determine if you’ve achieved your desired outcomes and to assess the effectiveness and impact of your intervention and the quality of service delivery.

It is a common misperception that evaluation starts only at the end of a project. Although conducting the evaluation is Step 5 of the SPF, planning how you will collect baseline information and track outcomes over time should be part of your strategic plan.

In addition, since your evaluation will ultimately affect the sustainability of your intervention, you should have a plan for securing and maintaining the commitment of all the partners involved—community members, agencies, etc. Fostering these relationships makes it more likely that these folks will continue to provide political support, cooperation, volunteers, and other resources on a long-term, ongoing basis.

Finally, your evaluation plan should monitor how well your group is functioning and identify areas for improvement.

TASK 8: Incorporate Cultural Competence

Cultural competence should be visibly interwoven throughout your intervention. Increasing your group’s cultural competence means being open to modifying your planning and thinking processes to reflect the preferences of your target population(s).

For example:

  • Some American Indian and Alaska Native communities prefer planning processes that are circular, such as using a Mind Map to brainstorm rather than a linear list or table.
  • Faith-based organizations may believe that action-oriented plans should be tempered by other forms of spiritual guidance about the best way to move forward.
  • Some folks may not be familiar with logic models. You may need to conduct several training sessions to get everyone to the same baseline of understanding. Ideally, you will not start work on a logic model until all coalition members understand and are comfortable with the process.

Listening to and incorporating different viewpoints promotes fruitful discourse and consensus building. This will also help you develop a plan that is culturally competent and shows respect for participants’ values, and is therefore more likely to succeed.32

Your plan to increase your group’s cultural competence should include the following:

  • Measurable goals and objectives with concrete timelines
  • Example: Contact 30 different community organizations within six months, with the ultimate goal of recruiting 12 new partners
  • Strategies to involving representatives from all sectors of the community in your prevention efforts
  • Example: If the aim of your logic model is to reduce the use of heroin among young adults, outline the steps your group will take to include young adults from diverse backgrounds as full participants in your efforts, rather than solely as the target of your activities
  • Who is responsible for the proposed action steps
  • What potential resources needed

It’s important to review the cultural competence plan on a regular basis.

Note: Your cultural competence planning process may identify several areas of discord among members of your organization or coalition. This is actually a good opportunity to address these differences early on, thereby preventing them from resurfacing later and derailing your work.