FAQ for opioid abatement grant applicants

The following information was compiled based on questions Healthy Minds has received from applicants and is intended to help applicants as they build their proposals. Grant application details and resources, including an application checklist, a budget template, a webinar, additional FAQ documents about the technical aspects of the grant application, and guidance from Healthy Minds, are available at: www.oag.ok.gov/opioid-abatement-board

How much justification is needed for each item of the funding request?

Applicants are asked to demonstrate the local need for settlement funds and strong evidence of future success through utilization of evidence-based practices. Applicants are encouraged to apply best practices that have been shown to improve local problems related to the opioid crisis. Healthy Minds has developed a guidance document and is providing a learning series on sound approaches to the prevention and treatment of opioid-related problems at the local level. The rubric that will be used to score grant applications can be found in the Office of the Attorney General (OAG) webinar slides.

We’ve just started our planning. Can we propose to do more planning?

The grant application requires applicants to identify how you assessed the needs in your political subdivision to identify and deploy your proposed approach. The expectation is that applicants undertake an effort to use data and other information such as discussion with qualified community partner organizations to understand your local needs and design an approach that will likely produce a positive outcome in a timely way. Therefore, it’s important to demonstrate in your proposal what actions you have taken to do this. There will be a continued need for funded subdivisions to continue to meet and evaluate needs throughout the duration of the program. This monitoring of your work helps ensure you are realizing the desired result, allows you to make necessary adjustments, and improves coordination with related efforts and partners. It is ultimately up to the Opioid Abatement Board what degree of additional planning political subdivisions will be allowed to undertake after the award.

What strategies apply to county law enforcement?

Opioid abatement strategies can be used for pre-arrest diversion from the criminal justice system to treatment for substance use with activities like youth offender screening and assessment and sobering centers that provide an alternative to jail for individuals who are intoxicated. Additionally, there are many programs for individuals who are currently in custody and individuals who have been released, such as using medications for opioid use disorder (MOUD) during and after custody, providing case management services, and providing medication and naloxone. Funds cannot be used for interdiction (patrol, investigation, and arrest activities), but can be used for strategies directly tied to abatement efforts.

What strategies apply to school nurses?

It’s important to understand the role school nurses play in your district and what types of duties they are best positioned to provide. School nurses may play a critical role in behavioral health or other interdisciplinary teams, support crisis response, conduct screenings, and manage care coordination. An example of a strategy that includes identifying and intervening with students who require additional supports is Screening, Brief Intervention, and Referral to Treatment (SBIRT), which is a public health approach that provides opportunities for early intervention for substance use, can be used in school settings using screening tools appropriate for school-age students (e.g., CRAFFT 2.1 and CRAFFT 2.1+N).‍

• ‍Massachusetts SBIRT in Schools provides training and implementation resources.

Additionally, school administrators may authorize school employees, including nurses, to receive training to recognize the signs of an opioid overdose and administer an opioid antagonist (such as naloxone). School nurses are authorized to administer opioid antagonists to students or others at a school site or school-sponsored event exhibiting signs of an opioid overdose. The National Association of School Nurses has a Naloxone Education for School Nurses Toolkit.‍

What curriculum is available for schools and what strategies apply to school counselors?

There are many evidence-based substance use prevention programs available for different grade levels and populations of focus with differing approaches. Some programs are curriculum-based, and others are designed as classroom-level approaches that rely on training of school staff. Examples of prevention programs that can be delivered in school-based settings are:

• Botvin Lifeskills Training Program, which builds youth social resistance skills, self-confidence, and coping mechanisms: Botvin Middle School (Grades 6–8)
• The Good Behavior Game helps youth build self-regulation skills.
• Guiding Good Choices teaches parents and caregivers to learn specific actions that promote healthy development and reduce risky behavior in teen years.
• The Strengthening Families Program helps parents and youth to develop skills together to increase protective factors and reduce risk factors to prevent substance use.
• Motivational Enhancement Therapy, Cognitive Behavioral Therapy, and Adolescent Community Reinforcement Approach have all been tested in schools and are best practices for treating substance use disorder.

What are best practices for Career Technology Center schools?

Because Career Technology Center schools serve students of many ages across varied programs of study, programs should be carefully selected based on the population to be served. For instance, Career Tech schools can benefit from many of the school-based prevention and intervention programs discussed above, including training employees to recognize and respond to an opioid overdose. Career Technology schools may also consider integrating opioid overdose training into health care programs offered to students. Additionally, Career Tech schools can disseminate prevention messages and create pathways to refer students who may be at risk for substance use disorder to community supports. For students in recovery from substance use disorder, Career Tech schools can adopt the federal Substance Abuse and Mental Health Services Administration’s (SAMHSA) four dimensions of recovery and provide services such as peer support and mutual benefit groups for students in recovery from substance use disorder. They can also partner with community organizations to help connect students to recovery-oriented services such as supported employment and recovery housing.

How do we know what strategies or services are considered evidence-based or evidence-informed?

An evidence-based practice or program has been well-researched and has proven effective. The Healthy Minds Guidance Document includes a list of evidence-based and best practices for opioid abatement in Oklahoma. The list was informed by federal evidence-based practice clearinghouses, academic research literature, and high-impact strategies from the National Association of Counties Opioids Solution Center. You can also search databases of evidence-based practices and review additional resources, such as the following:

• The Athena Forum — A substance use prevention resource library with a searchable database of evidence-based prevention strategies
• SAMHSA’s 2023 Prevention Resources for Health Communities
• SAMHSA’s Evidence-Based Practices Resource Center

We have high needs and aren’t sure which program to fund. How do we decide?

We recommend engaging community stakeholders in a planning and assessment process. A review of local data and input from stakeholders will help you understand needs, find gaps in services and funding, and determine priorities. The assessment can identify which program(s) your community has the most readiness to implement and partnerships that are already in place. In some cases, services in your community may be in place but lack the sufficient scale needed to achieve an impact. You may find that needed programs could be better sustained in your community by investing in training of trainers or other capacity-building activities to increase the sustainability of the service long-term.

Questions you may ask your local planning group to help with program selection may include:

• What types of substance use or related services do we have today in our community and whom do they serve?
• Do we have prevention, early intervention, treatment, and recovery services?
• Do the services we have reach everyone who needs them (why or why not)?
• Are the services we have well-coordinated and easily accessible?
• Are the organizations in our community that provide these services using up-to-date, evidence-based practices?
• What programs and services lack viable funding streams or are otherwise non-compensable (or under-resourced) through other sources?
  

Why is the Board interested in knowing about other sources of funding for our project and if the opioid abatement grant will be the last resort funding for our project?

Many treatment services are reimbursable through Medicaid or private insurance, and some may be funded through other grant programs. It is recommended to use the opioid abatement grant to fund services that cannot be paid for through other means. Coordinate with partners to examine startup costs and other costs that are not reimbursable or may require a period of time to get started and sustain, as well as to identify what funding is required — for example, someone’s time to deliver a service is covered with billable hours, but the curriculum or training itself is not compensable. This planning and coordination of resources will help communities use this grant program to appropriately braid with other resources, fill an unfunded gap, and prepare to sustain projects after grant funding ends.

Why is it recommended to create a governance council or advisory committee?

Advisory committees or councils are a sound practice for planning and monitoring funding projects. They can coordinate assessment, planning, implementation, and evaluation activities. These partnerships can be formalized with Memorandums of Agreement (MOAs) or charters that define the group’s commitment and roles. Your advisory committee can help determine who will be involved with implementing your program — who will serve as the primary lead or champion; who will be trained to deliver the program or services; and who will be responsible for collecting and reporting data to evaluate the program’s progress and outcomes. Additionally, engagement of local stakeholders—people who represent different organizations and different types of expertise — is important for public health planning purposes.

For example, you might convene people who represent public health agencies, local Certified Community Behavioral Health Centers (CCBHCs), first responders, prevention specialists, employers, and individuals who have been impacted by the opioid crisis. You might also engage state or local experts who’ve successfully implemented opioid abatement strategies. Seeking input and sharing decision-making processes with community members will help build support and buy-in for your effort.

We are struggling to find data for our community. Where can we access the information required for the application?

Healthy Minds is currently working to compile data for the Opioid Abatement Board to assist with the completion of Question 13 in the grant application. At this time, not all of these data are readily available for communities. However, you can find opioid overdose deaths by county here and opioid prescription dispensing by county here, which can help inform you about the scope of the problem in your area. Consider additional accessible sources of data that can help define how your area is affected by the opioid crisis, and meet with engaged community partners to gauge the needs in your community.
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