Organizational Function, Structure and Action Teams

Name

Tuolumne County Opioid Safety Coalition (TCOSC).

Vision

A safe and healthy community for the residents and visitors in Tuolumne County, free of the behavioral, medical, social and economic harms associated with addiction to improperly prescribed or illicitly obtained substances including opioid drugs.

Mission

Design and carry out evidence-based activities which will enable our county to implement interventions and education to achieve results based on the following four strategic objectives, which were established in 2017 by the California Opioid Safety Network and the California Department of Public Health (CDPH):

 

 

Background

Establish a TCOSC Steering Committee to help expand the membership and strengthen the coordination and the conduct of monitoring and evaluation activities among existing members of the TCOSC which includes the Tuolumne County Public Health, Behavioral Health, and Social Services Departments; Amador-Tuolumne Community Action Agency (ATCAA); YES Partnership; Adventist Health Sonora; Tuolumne Me-Wuk Indian Health Center (TMWIHC); Tuolumne County Medical Society; Legal Services and Law Enforcement agencies; and other community-based and faith-based partners, in order to successfully and sustainably carry out initiatives to ensure that Tuolumne County is a safe and healthy place to live, work and visit.

Organization

The TCOSC will consist of a Steering Committee and three Action Teams. The Steering Committee and each of the three Action Teams will meet independently on a monthly basis or as needed at the discretion of the leadership of each group. At annual meetings of all TCOSC member organizations, each member organization will have one vote to be used every two years in electing the Chair and Co-Chair of the Steering Committee and the leaders and deputy leaders of the three Action Teams who will serve for a 2-year term.

Responsibilities and Function of the TCOSC Steering Committee

On a quarterly basis, the TCOSC Steering Committee will:

• Meet with the leaders of TCOSC member organizations to discuss progress and constraints of the Action Teams, and make policy decisions regarding the purpose, function, strategies, priorities, activities, and methods for measuring and continuously improving the performance, quality and results of the work of the Action Teams.
• Establish operating procedures of the TCOSC, including membership composition, term of service, and selection of membership and leadership for the Steering Committee and Action Teams.
• Appoint new TCOSC member organizations upon recommendations from the Steering Committee.• Promote collaboration and coordination among TCOSC member organizations across all sectors of the community.
• Review and provide recommended modifications and support as appropriate for grant applications and other proposals by TCOSC Action Teams and member organizations.

Steering Committee and Data Sub-committee

The Steering Committee will consist of a Chair and a Co-Chair (elected as described above), and six additional members who will be appointed by the three Action Team leaders (two appointees by each Action Team leader). The Steering Committee provides guidance, support, and coordination between Action Teams, monitors progress, and serves as the public voice for the TCOSC. The Steering Committee and Action Team leaders will draw upon volunteers from TCOSC member organizations to appoint a 4-member Data Sub-committee which will help the Action Teams obtain, analyze, interpret, and use secondary data (and primary data, if resources are available) to best monitor and act upon the situation and trends in opioid use and adverse effects of opioids in Tuolumne County by tracking indicators that include: changes in community behaviors, providers’ prescribing practices, pharmacists’ dispensing practices, and opioid-associated morbidity and mortality.Action Teams – each organization which is a member of the TCOSC will designate the names of one or two representatives and an alternate for each Action Team on which the member organization has an interest in serving.

The functions and activities of these three teams are intended to be coordinated, cooperative and/or collaborative in design and implementation:

 

Prevention Action Team: PREVENTING OPIOID USE DISORDERS (OUDs) due to prescribed or illicitly obtained opioid drugs. 

• Community-Based Prevention – this Action Team includes representatives from member organizations with a focus on educating the community about prescription drugs by raising awareness about the dangers and addictions associated with misuse. They also promote safe storage and disposal of unused medications.
• Proper Prescription & Dispensing Practices – this Action Team also includes representatives from member organizations with a focus on balancing the benefits of medicines with the harm of over-prescribing and the potential for abuse and addiction. The Action Team develops mechanisms to reduce the amount of opiate drugs prescribed in Tuolumne County by primary care and emergency department physicians and promote safe in-home storage and disposal of unused, unwanted, and expired medications.

Clinical Action Team: MANAGING and TREATING OUD through MAT and evidence based treatment interventions. 

• Intervention, Treatment & Recovery – this Action Team focuses on increasing capacity for and implementation of age-appropriate integrated treatment services with access to healthcare, Naloxone, X-waiver-qualified medically assisted treatment options, non-pharmaceutical alternative options, and ongoing Behavioral Health, Mental Health, and Social Services support for those in recovery.

Harm Reduction Action Team: AVERTING or REDUCING OUD-related HARM due to prescribed or illicitly obtained opioid drugs. 

• Naloxone - This Action Team encourages the distribution and use of Naloxone, a drug used to reverse opioid overdose. Activities such as the distribution to high-risk individuals and training in its use as well as providing supplies of Naloxone to settings where fatal or near-fatal events have occurred or where they might occur. Pharmacists will be encouraged to distribute naloxone along with certain opioid prescriptions.
• Law Enforcement, Emergency Medical Services, and Public Health – this Action Team also addresses the complex medico-legal and enforcement challenges related to emergency medical services for fatal or near-fatal overdoses, drug diversion, and the use of legally prescribed drugs for unintended or unlawful purposes. The team will strengthen or establish coordinated protocols to efficiently identify the sources of improperly prescribed and illegally obtained drugs; strengthen or establish effective mechanisms to identify associated prescribers and illegal suppliers; reduce the availability of opioids for abuse and misuse; and ensure the availability, accessibility, and acceptability of Naloxone for use by high-risk individuals and EMS/first responders as well as facilities for safely disposing of opioids and syringes. The team will explore other Harm Reduction and Syringe Services options as implemented in “peer” counties.

Other Strategies

• Obtain commitments for leadership and participation in one or more of the Action Teams by representatives of TCOSC member organizations.
• Provide community education and resources about safe prescribing of opiates, as well as their safe use and disposal.
• Provide support and training opportunities for physicians, physician assistants, nurse practitioners, and pharmacists on safe prescribing of opioids and other medications prescribed in conjunction with opioids.
• Facilitate X-Waiver Training to increase prescribing of Buprenorphine plus Naloxone as appropriate for pain management in Tuolumne County and the surrounding area.
• Provide increasing access and use of Naloxone, including training and distribution for overdose prevention.
• Expand and strengthen community resources for treatment referrals and accessibility of integrated medical, mental, and behavioral treatments to community members.
• Strengthen community resources for safe and effective management of both acute and chronic pain, including non-pharmaceutical methods.
• Consider the implementation of a pilot Harm Reduction and Syringe Disposal Program to reduce the risk of transmission of blood-borne infectious diseases and increase access and use of referral services for persons who inject drugs.

Fiscal Agency

Tuolumne County Public Health Department (TCPHD)

Staff

The TCOSC will be supported by two paid staff members: the Coalition Coordinator and the Coalition Assistant. An AmeriCorps VISTA Volunteer provides assistance to many of the Opioid Safety Coalition Steering Committees in many California counties, including the TCOSC at the present time.

Coalition Coordinator (.5 FTE)
The Coalition Coordinator will coordinate the regular activities of the TCOSC including: provide staff support to the Steering Committee and Action Teams, maintain records of all Coalition activities, assist in the preparation of all grant funded progress and budget reports, assist in monitoring, evaluating, and continuously improving the performance, quality and results of the Action Teams, and other duties as assigned by the TCOSC Steering Committee.

Coalition Assistant (.25 FTE)
The Coalition Assistant will work with the Coalition Coordinator to support the regular activities of the TCOSC including: schedule all Steering Committee and Action Team meetings, record minutes from Steering Committee, Action Team and general TCOSC meetings, maintain records of all TCOSC members, and other duties as assigned by the TCOSC Steering Committee and the Coalition Coordinator.

Sustainability & Reporting

The TCOSC Steering Committee will develop a three-year Sustainability Plan to sustain the work of the Coalition, and the plan will be updated as needed. A draft of the TCOSC Organizational Function, Structure, and Sustainability Plan will be presented to the Tuolumne County Board of Supervisors for their review and comments at a public meeting of the Board to which community opinion leaders and stakeholders will be invited.