Earlier this month while campaigning in New Hampshire, Hillary Rodham Clinton announced a strategy calling on states and communities to develop plans that would prevent substance use and abuse, offer treatment, and train healthcare providers. As I read her reflections on why she felt such a strategy was necessary, I realized that here at FSG we’ve worked with several clients on addressing substance use disorders and we’ve learned a lot from their experiences.
Here are 5 ideas to help states and communities develop plans for addressing substance use disorders. But don’t stop reading if you are focusing efforts on a different issue; these lessons can be applied to most any systemic social and environmental challenge.
1) Remember that everything is connected
It is impossible to make much progress on intractable health, social and environmental problems without engaging the variety of stakeholders impacted by that problem. For instance, family members, medical professionals, educators, law enforcement, business owners, pastors, service providers, community members, and the systems they represent all feel the impact of widespread substance use and abuse. But it’s not enough to assign specific goals to these individual stakeholder groups and have them go get results on their own. Change happens when a broad set of people with diverging perspectives gather around a table to share information and data, learn from each other, and build trust. That is when you see behaviors adjusting, action aligning, and outcomes shifting. And it’s hard work.
Community members in Staten Island, a community which struggled with the highest proportion of youth binge drinking and use of prescription pain relievers without a prescription among NYC boroughs, understand the importance of connections. They formed the Tackling Youth Substance Abuse Initiative (TYSA), a cross-sector coalition to help the teens in their community. In 2014 TYSA reported its focus was to “shift cultural attitudes around substance abuse and dispel the ‘not my child’ mentality that has plagued our community.” They arrived at this focus after much discussion about their overarching strategy and common agenda.
ACTION IDEA: Gather a broad and diverse set of committed players on a regular basis to set a common agenda and align action across those actors.
2) Accept that experts may have limited experience
Please think beyond traditional experts as you develop your plans and include the voice of individuals who are coping with substance use disorders or are in recovery. They will know best what help they need, so engage them as active participants in your work in order to redesign a system that makes sense. For thoughts on how to do this, check out IDEO’s Human Centered Design Toolkit.
To take another idea from TYSA, given their focus on building community awareness on the issue of substance use, they have a “Share Your Story” form on their website as a way to collect stories from those with lived experience. While the ultimate purpose is not to co-create strategy, the gathering of these stories helps to “dispel the stigma and provide hope” which is a key component of TYSA’s goals.
ACTION IDEA: Engage those who have first-hand experience.
3) Make sure you have access to data to measure progress
Despite how inundated we feel by data, it sometimes can be hard to come by in the social sector. And if you do have access to data, it may be incomplete, inaccurate, or not quite what you need. Keep this in mind as you set your goals: you should avoid setting goals without thinking about how you will measure your progress toward those goals.
Bill Pitkin, Director of Domestic Programs at the Conrad N. Hilton Foundation reflected on this challenge for their substance use prevention work in a recent interview with FSG:
“With system-wide goals, you absolutely need the data to measure progress. We have been able to improve data collection systems for some of our priority areas, but for substance use in particular grantees are often collecting new data they have not previously gathered. Incorporating new data collection into existing health or social service agencies requires dedicated planning and resources at the outset. Changing and strengthening data collection systems to gather the information grantees need to demonstrate success is a work in progress.”
ACTION IDEA: Specify quantitative goals only if you have the baseline data to back it up and the means to track progress. If your data isn’t where it needs to be, then focus on how you will audit and improve (if necessary) existing data systems.
4) Allow room to experiment
Small pilots allow you to test different approaches to understand what works best in your community. The Robert Wood Johnson Foundation (RWJF) spent $700 million over 25 years to reduce the harm caused by alcohol and other drugs with tremendous impact in many areas. But what’s one of the missed opportunities a retrospective of the work identified? More pilots. From the retrospective: “RWJF could have piloted innovative program-level strategies at a smaller scale to allow for learning and refinement and to use resources more effectively.” It’s hard not to go all-in immediately when you want results, but prototyping strategies will ultimately get you further.
ACTION IDEA: Set the expectation that experimentation through small-scale pilots is the first step toward systemic change.
5) Don’t forget the research and learning
A complex problem requires multiple approaches, but in the flurry to get to results, it’s easy to forget the importance of research and learning to uncover the evidence-based approaches that actually get results. The Conrad N. Hilton Foundation has prioritized youth substance use prevention and has a multi-pronged strategy targeting training on and access to screening and early intervention practices. But they did not stop there. The Foundation also places a priority on “conducting research and advance learning to improve screening and early intervention practices” and is funding several studies, including a study by the University of Minnesota’s Center for Adolescent Substance Abuse Research and Kaiser Permanente Division of Research focused on an SBIRT model for primary care and school settings that is tailored to adolescents and involves parents.
ACTION IDEA: Make the case for funding new research or tapping into existing research to inform the various approaches you will take in your community.
What other action ideas and advice do you have for social change initiatives?