Reducing perceived barriers to scaling up overdose education and naloxone distribution and medications for opioid use disorder in the United States in the HEALing (Helping End Addiction Long-Term®) communities study.

BACKGROUND: Scaling up overdose education and naloxone distribution (OEND) and medications for opioid use disorder (MOUD) is needed to reduce opioid overdose deaths, but barriers are pervasive. This study examines whether the Communities That HEAL (CTH) intervention reduced perceived barriers to expanding OEND and MOUD in healthcare/behavioral health, criminal-legal, and other/non-traditional venues. METHODS: The HEALing (Helping End Addiction Long-Term®) Communities Study is a parallel, wait-list, cluster randomized trial testing the CTH intervention in 67 communities in the United States. Surveys administered to coalition members and key stakeholders measured the magnitude of perceived barriers to scaling up OEND and MOUD in November 2019-January 2020, May-June 2021, and May-June 2022. Multilevel linear mixed models compared Wave 1 (intervention) and Wave 2 (wait-list control) respondents. Interactions by rural/urban status and research site were tested. RESULTS: Wave 1 respondents reported significantly greater reductions in mean scores for three outcomes: perceived barriers to scaling up OEND in Healthcare/Behavioral Health Venues (-0.26, 95% confidence interval, CI: -0.48, -0.05, p = 0.015), OEND in Other/Non-traditional Venues (-0.53, 95% CI: - 0.84, -0.22, p = 0.001) and MOUD in Other/Non-traditional Venues (-0.34, 95% CI: -0.62, -0.05, p = 0.020). There were significant interactions by research site for perceived barriers to scaling up OEND and MOUD in Criminal-Legal Venues. There were no significant interactions by rural/urban status. DISCUSSION: The CTH Intervention reduced perceived barriers to scaling up OEND and MOUD in certain venues, with no difference in effectiveness between rural and urban communities. More research is needed to understand facilitators and barriers in different venues.

The Development of Social Determinants of Health Outcome Measures: The Role of Multisector Partnerships and Community Validation.

PURPOSE: To develop a set of social determinants of health (SDOH) measurements. PROBLEM: Despite burgeoning interest in addressing both SDOH and health-related social needs, the evidence on what works is limited due in part to the lack of standardized measures for evaluation. METHODS: In 2020, the Centers for Disease Control and Prevention (CDC) National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) identified 5 SDOH domains related to chronic disease for future programmatic work. These included built environment, community connections to clinical care, tobacco-free policies, social connectedness, and food and nutrition security. Subsequently, NCCDPHP launched an effort to develop a set of SDOH measures for evaluating funded programs in these domains. The approach involved a literature scan and a rating process based on 5 criteria relevant to NCCDPHP's SDOH priorities. A complementary community review by 13 multisector community partnerships (MCPs) applied a real-world public health practice lens to measure development. MCPs' ratings were analyzed to create summary scores for each measure, and open-ended feedback was synthesized using rapid qualitative analysis. RESULTS: The internal workgroup identified 59 measures from the initial 200 measures. Feedback from the MCPs identified issues of relevancy and burden of measures. Their high scores narrowed the 59 measures to 22 covering all 5 domains. In response, CDC is honing the original measures review criteria to include community perspectives. CONCLUSION: Public health measures development is often an academic pursuit. Engaging MCPs lends real-world credibility to the development of common SDOH measures.

Using the Prevention Impacts Simulation Model to Estimate Long-Term Impacts of Multisector Community Partnerships' Efforts to Address Social Determinants of Health.

Public health plays a key role in addressing social determinants of health (SDOH) through multisector community partnerships (MCPs), which contribute to community changes that promote healthy living; however, little is known about the longer-term impact of MCP-driven interventions. We used the Prevention Impacts Simulation Model (PRISM) in a rapid evaluation to better understand the implementation and potential impact of MCPs' SDOH initiatives. Results suggest that, if sustained, initiatives implemented by the 27 included MCPs may prevent 880 premature deaths and avert $125.7 million in medical costs over 20 years. As a validated model that estimates impact by using available implementation data, PRISM is a useful tool for evaluating SDOH initiatives.

Integrating the Consolidated Framework for Implementation Research (CFIR) into a Culturally Responsive Evaluation (CRE) Approach to Conduct Mixed-Method Evaluations of Diabetes Prevention and Management Programs Reaching Underresourced Populations and Communities.

Diabetes is a significant population health threat. Evidence-based interventions, such as the Centers for Disease Control and Prevention's National Diabetes Prevention Program and diabetes self-management education and support programs, can help prevent, delay, or manage the disease. However, participation is suboptimal, especially among populations who are at an increased risk of developing diabetes. Evaluations of programs reaching populations who are medically underserved or people with lower incomes can help elucidate how best to tailor evidence-based interventions, but it is also important for evaluations to account for cultural and contextual factors. Culturally responsive evaluation (CRE) is a framework for centering an evaluation in the culture of the programs being evaluated. We integrated CRE with implementation and outcome constructs from the Adapted Consolidated Framework for Implementation Research (CFIR) to ensure that the evaluation produced useful evidence for putting evidence-based diabetes interventions to use in real-world settings, reaching populations who are at an increased risk of developing diabetes. The paper provides an overview of how we integrated CRE and CFIR approaches to conduct mixed-methods evaluations of evidence-based diabetes interventions.

Health Departments' Role in Addressing Social Determinants of Health in Collaboration With Multisector Community Partnerships.

Multisector community partnerships (MCPs) are key component of the public health strategy for addressing social determinants of health (SDOH) and promoting health equity. Governmental public health agencies are often members or leaders of MCPs, but few studies have examined the role of health departments in supporting MCPs' SDOH initiatives. We engaged 42 established MCPs in a rapid retrospective evaluation to better understand how MCPs' SDOH initiatives contribute to community changes that promote healthy living and improved health outcomes. As part of this work, we gained insights into how health departments support MCPs' SDOH initiatives, as well as opportunities for enhanced collaboration. Results indicate that health departments can support MCPs' SDOH initiatives through the provision of funding and technical assistance, data sharing, and connecting community organizations with shared missions, for example. Findings can be used to inform the development of funding opportunities and technical assistance for MCPs and health department partners.

Evaluating Comprehensive State Tobacco Prevention and Control Programs Using an Outcome Indicator Framework.

The outcome indicator framework helps tobacco prevention and control programs (TCPs) plan and implement theory-driven evaluations of their efforts to reduce and prevent tobacco use. Tobacco use is the single-most preventable cause of morbidity and mortality in the United States. The implementation of public health best practices by comprehensive state TCPs has been shown to prevent the initiation of tobacco use, reduce tobacco use prevalence, and decrease tobacco-related health care expenditures. Achieving and sustaining program goals require TCPs to evaluate the effectiveness and impact of their programs. To guide evaluation efforts by TCPs, the Centers for Disease Control and Prevention's Office on Smoking and Health developed an outcome indicator framework that includes a high-level logic model and evidence-based outcome indicators for each tobacco prevention and control goal area. In this article, we describe how TCPs and other community organizations can use the outcome indicator framework in their evaluation efforts. We also discuss how the framework is used at the national level to unify tobacco prevention and control efforts across varying state contexts, identify promising practices, and expand the public health evidence base.

Transition Home Plus Program Reduces Medicaid Spending and Health Care Use for High-Risk Infants Admitted to the Neonatal Intensive Care Unit for 5 or More Days.

OBJECTIVE: To evaluate the effects of a transition home intervention on total Medicaid spending, emergency department visits, and unplanned readmissions for preterm infants born at ≤366/7 weeks gestation and high-risk full-term infants. STUDY DESIGN: The Transition Home Plus (THP) program incorporated enhanced support services before and after discharge from the neonatal intensive care unit (NICU) provided by social workers and family resource specialists (trained peers) working with the medical team from October 2012 to October 2014. Rhode Island Medicaid claims data were used to study the 321 infants cared for in the NICU for ≥5 days, who were enrolled in the THP program. THP infants were compared with a historical comparison group of 365 high-risk infants born and admitted to the same NICU in 2011 before the full launch of the THP program. Intervention and comparison group outcomes were compared in the eight 3-month quarters after the infant's birth. Propensity score weights were applied in regression models to balance demographic characteristics between groups. RESULTS: Infants in the intervention group had significantly lower total Medicaid spending, fewer emergency department visits, and fewer readmissions than the comparison group. Medicaid spending savings for the intervention group were $4591 per infant per quarter in our study period. CONCLUSIONS: Transition home support services for high-risk infants provided both in the NICU and for 90 days after discharge by social workers and family resource specialists working with the medical team can reduce Medicaid spending and health care use.

Relationships Between Theoretically Derived Short-Term Outcomes and Support for Policy Among the Public and Decision-Makers.

PURPOSE AND OBJECTIVES: Policy change is a lengthy and complex process. Thus, it is important to articulate hypothesized causal pathways between advocacy activities and policy change outcomes and to identify and monitor early indicators of progress toward policy change. INTERVENTION APPROACH: The Kansas Health Foundation supports grantee efforts to address the public health effects of obesity through evidence-based policy, systems, and environmental change interventions. To build support for policy, systems, and environmental changes in schools, workplaces, and health care and retail settings, grantees mobilize communities, educate government policy makers, and advocate with organizational decision makers. EVALUATION METHODS: To understand whether early outcomes from obesity-prevention advocacy efforts predict interim outcomes related to eventual policy change, we conducted surveys of the general public and of opinion leaders in Kansas, which were designed to measure components of Kansas Health Foundation's theory of change. We then used structural equation modeling to test the theory of change's underlying relationships by using support for obesity prevention policies as the outcome. RESULTS: Our findings supported the hypothesized model: perceptions of obesity as a serious community problem influence beliefs about causes of the problem. Beliefs about causes predict beliefs about who is responsible for the solution to the problem, which in turn predicts support for obesity prevention policies. IMPLICATIONS FOR PUBLIC HEALTH: Evaluators of advocacy for policy change interventions can use this approach to monitor proximal changes in public and opinion leader beliefs related to eventual policy change and to determine whether efforts are likely to be successful or need to be adapted or abandoned.

Using a Theory of Change to Guide Grant Monitoring and Grantmaking.

Charitable foundations play a significant role in advancing public health, funding billions of dollars in health grants each year. Evaluation is an important accountability tool for foundations and helps ensure that philanthropic investments contribute to the broader public health evidence base. While commitment to evaluation has increased among foundations over the past few decades, effective use of evaluation findings remains challenging. To facilitate use of evaluation findings among philanthropic organizations, evaluators can incorporate the foundation's theory of change-an illustration of the presumed causal pathways between a program's activities and its intended outcomes-into user-friendly products that summarize evaluation findings and recommendations. Using examples from the evaluation of the Kansas Health Foundation's Healthy Living Focus Area, we present a mapping technique that can be applied to assess and graphically depict alignment between program theory and program reality, refine the theory of change, and inform grantmaking.

Public and Opinion Leader Willingness to Fund Obesity-Focused Policies in Kansas.

Obesity increases the risk for leading causes of death, including cardiovascular disease and some cancers. Midwestern and southern states have the highest obesity rates-in Kansas, one in every three adults is obese. We compared the willingness of Kansas adults and opinion leaders to pay more in taxes to fund obesity prevention policies. In 2014, we asked a representative sample of 2,203 Kansas adults (response rate 15.7%) and 912 opinion leaders (response rate 55%) drawn from elected office and other sectors, including business and health, whether they would pay an additional $50 in annual taxes to support five policies that improve access to healthy foods and opportunities for physical activity. We used adjusted Wald tests to compare public and opinion leaders' responses, and regression analysis to assess whether differences in respondents' gender, age, location (urban/rural), race/ethnicity, and political stance affected results. Adjusting for demographic differences, Kansas adults were more willing than opinion leaders to pay $50 in taxes for each of the five policy interventions. This study demonstrates a willingness among residents of a fiscally conservative state to pay increased taxes for policies that could reduce population obesity rates. Health professionals, including nurses, can use these findings to educate policy makers in Kansas and geopolitically similar states about widespread public support for obesity prevention policies. Public health and other nurses could also apply our methods to assess support for obesity prevention policies in their jurisdictions.

Measuring public health practice and outcomes in chronic disease: a call for coordination.

A strategic opportunity exists to coordinate public health systems and services researchers' efforts to develop local health department service delivery measures and the efforts of divisions within the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) to establish outcome indicators for public health practice in chronic disease. Several sets of outcome indicators developed by divisions within NCCDPHP and intended for use by state programs can be tailored to assess outcomes of interventions within smaller geographic areas or intervention settings. Coordination of measurement efforts could potentially allow information to flow from the local to the state to the federal level, enhancing program planning, accountability, and even subsequent funding for public health practice.

Cost-Effectiveness of Social Determinants of Health Interventions: Evaluating Multisector Community Partnerships' Efforts.

INTRODUCTION: The purpose of this analysis was to rapidly evaluate the potential costs, cost-effectiveness, and long-term effects of efforts by multisector community partnerships (MCPs) to improve chronic disease outcomes and advance health equity by addressing social determinants of health (SDOH). METHODS: In 2022, the evaluators partnered with 13 MCPs to collect data on start-up and ongoing costs for implementing SDOH interventions and on intervention reach and timing. In 2023, the team used the Prevention Impacts Simulation Model (PRISM) to estimate the longer-term impact of MCPs' efforts over 5-, 10-, and 20-year periods. The team also analyzed costs and cumulative 10- and 20-year cost-effectiveness of the MCPs' SDOH interventions. RESULTS: Over 20 years, SDOH interventions implemented by the 13 MCPs can potentially prevent 970 premature deaths and avert $105 million in medical costs and $408 million in productivity losses. The 20-year cumulative results show potential net costs of $38 300 per quality-adjusted life-year gained from the health care sector perspective and indicate potentially reduced costs and improved health outcomes from the societal perspective. CONCLUSIONS: These findings can help inform and provide support for future investments in SDOH interventions. With a better understanding of costs needed to start up and implement SDOH interventions, funders and MCPs can prepare for the resources required to do this work. Findings also suggest promising long-term impacts and potential cost-effectiveness for most MCP-implemented SDOH interventions.

Effects of the Communities that Heal (CTH) intervention on perceived opioid-related community stigma in the HEALing Communities Study: results of a multi-site, community-level, cluster-randomized trial.

Background: Community stigma against people with opioid use disorder (OUD) and intervention stigma (e.g., toward naloxone) exacerbate the opioid overdose crisis. We examined the effects of the Communities that HEAL (CTH) intervention on perceived opioid-related community stigma by stakeholders in the HEALing Communities Study (HCS). Methods: We collected three surveys from community coalition members in 66 communities across four states participating in HCS. Communities were randomized into Intervention (Wave 1) or Wait-list Control (Wave 2) arms. We conducted multilevel linear mixed models to compare changes in primary outcomes of community stigma toward people treated for OUD, naloxone, and medication for opioid use disorder (MOUD) by arm from time 1 (before the start of the intervention) to time 3 (end of the intervention period in the Intervention arm). Findings: Intervention stakeholders reported a larger decrease in perceived community stigma toward people treated for OUD (adjusted mean change (AMC) -3.20 [95% C.I. -4.43, -1.98]) and toward MOUD (AMC -0.33 [95% C.I. -0.56, -0.09]) than stakeholders in Wait-list Control communities (AMC -0.18 [95% C.I. -1.38, 1.02], p = 0.0007 and AMC 0.11 [95% C.I. -0.09, 0.31], p = 0.0066). The relationship between intervention status and change in stigma toward MOUD was moderated by rural-urban status (urban AMC -0.59 [95% CI, -0.87, -0.32], rural AMC not sig.) and state. The difference in stigma toward naloxone between Intervention and Wait-list Control stakeholders was not statistically significant (p = 0.18). Interpretation: The CTH intervention decreased stakeholder perceptions of community stigma toward people treated for OUD and stigma toward MOUD. Implementing the CTH intervention in other communities could decrease OUD stigma across diverse settings nationally. Funding: US National Institute on Drug Abuse.

Effect of the Communities that HEAL intervention on receipt of behavioral therapies for opioid use disorder: A cluster randomized wait-list controlled trial.

BACKGROUND: The U.S. opioid overdose crisis persists. Outpatient behavioral health services (BHS) are essential components of a comprehensive response to opioid use disorder and overdose fatalities. The Helping to End Addiction Long-Term® (HEALing) Communities Study developed the Communities That HEAL (CTH) intervention to reduce opioid overdose deaths in 67 communities in Kentucky, Ohio, New York, and Massachusetts through the implementation of evidence-based practices (EBPs), including BHS. This paper compares the rate of individuals receiving outpatient BHS in Wave 1 intervention communities (n = 34) to waitlisted Wave 2 communities (n = 33). METHODS: Medicaid data included individuals ≥18 years of age receiving any of five BHS categories: intensive outpatient, outpatient, case management, peer support, and case management or peer support. Negative binomial regression models estimated the rate of receiving each BHS for Wave 1 and Wave 2. Effect modification analyses evaluated changes in the effect of the CTH intervention between Wave 1 and Wave 2 by research site, rurality, age, sex, and race/ethnicity. RESULTS: No significant differences were detected between intervention and waitlisted communities in the rate of individuals receiving any of the five BHS categories. None of the interaction effects used to test the effect modification were significant. CONCLUSIONS: Several factors should be considered when interpreting results-no significant intervention effects were observed through Medicaid claims data, the best available data source but limited in terms of capturing individuals reached by the intervention. Also, the 12-month evaluation window may have been too brief to see improved outcomes considering the time required to stand-up BHS. TRIAL REGISTRATION: Clinical Trials.gov http://www. CLINICALTRIALS: gov: Identifier: NCT04111939.

Impact of the Communities That HEAL Intervention on Buprenorphine-Waivered Practitioners and Buprenorphine Prescribing: A Prespecified Secondary Analysis of the HCS Randomized Clinical Trial.

Importance: Buprenorphine significantly reduces opioid-related overdose mortality. From 2002 to 2022, the Drug Addiction Treatment Act of 2000 (DATA 2000) required qualified practitioners to receive a waiver from the Drug Enforcement Agency to prescribe buprenorphine for treatment of opioid use disorder. During this period, waiver uptake among practitioners was modest; subsequent changes need to be examined. Objective: To determine whether the Communities That HEAL (CTH) intervention increased the rate of practitioners with DATA 2000 waivers and buprenorphine prescribing. Design, Setting, and Participants: This prespecified secondary analysis of the HEALing Communities Study, a multisite, 2-arm, parallel, community-level, cluster randomized, open, wait-list-controlled comparison clinical trial was designed to assess the effectiveness of the CTH intervention and was conducted between January 1, 2020, to December 31, 2023, in 67 communities in Kentucky, Massachusetts, New York, and Ohio, accounting for approximately 8.2 million adults. The participants in this trial were communities consisting of counties (n = 48) and municipalities (n = 19). Trial arm randomization was conducted using a covariate constrained randomization procedure stratified by state. Each state was balanced by community characteristics including urban/rural classification, fatal opioid overdose rate, and community population. Thirty-four communities were randomized to the intervention and 33 to wait-list control arms. Data analysis was conducted between March 20 and September 29, 2023, with a focus on the comparison period from July 1, 2021, to June 30, 2022. Intervention: Waiver trainings and other educational trainings were offered or supported by the HEALing Communities Study research sites in each state to help build practitioner capacity. Main Outcomes and Measures: The rate of practitioners with a DATA 2000 waiver (overall, and stratified by 30-, 100-, and 275-patient limits) per 100 000 adult residents aged 18 years or older during July 1, 2021, to June 30, 2022, were compared between the intervention and wait-list control communities. The rate of buprenorphine prescribing among those waivered practitioners was also compared between the intervention and wait-list control communities. Intention-to-treat and per-protocol analyses were performed. Results: A total of 8 166 963 individuals aged 18 years or older were residents of the 67 communities studied. There was no evidence of an effect of the CTH intervention on the adjusted rate of practitioners with a DATA 2000 waiver (adjusted relative rate [ARR], 1.04; 95% CI, 0.94-1.14) or the adjusted rate of practitioners with a DATA 2000 waiver who actively prescribed buprenorphine (ARR, 0.97; 95% CI, 0.86-1.10). Conclusions and Relevance: In this randomized clinical trial, the CTH intervention was not associated with increases in the rate of practitioners with a DATA 2000 waiver or buprenorphine prescribing among those waivered practitioners. Supporting practitioners to prescribe buprenorphine remains a critical yet challenging step in the continuum of care to treat opioid use disorder. Trial Registration: ClinicalTrials.gov Identifier: NCT04111939.

Key insights on multisector community partnerships from real-world efforts to address social determinants of health.

PURPOSE: To better understand and inform how multisector community partnerships (MCPs) perform meaningful work to prevent chronic disease and advance health equity by addressing social determinants of health (SDOH). METHODS: We conducted a rapid retrospective evaluation of SDOH initiatives implemented within the past three years by 42 established MCPs across the United States. The mixed methods evaluation included document review and coding of available outcomes data, virtual discussions, and Prevention Impacts Simulation Model (PRISM) analysis. RESULTS: All 42 MCPs built community capacity for addressing SDOH through new or strengthened data systems, leveraged resources, or engaged residents, for example. Most MCPs (N = 38, 90%) reported contributions to community changes that promote healthy living. More than half of the MCPs (N = 22) reported health outcomes data for their SDOH initiatives, including improved health behaviors and clinical outcomes. Based on reach data provided by 27 MCPs, PRISM analysis results suggest that sustained initiatives could save over $633 million in productivity and medical costs cumulatively through 20 years. CONCLUSIONS: With sufficient technical assistance and funding resources, MCPs are a key component of the public health strategy to address SDOH.

Community selected strategies to reduce opioid-related overdose deaths in the HEALing (Helping to End Addiction Long-term SM) communities study.

The Helping End Addictions Long Term (HEALing) Communities Study (HCS) seeks to significantly reduce overdose deaths in 67 highly impacted communities in Kentucky (KY), Massachusetts (MA), New York (NY), and Ohio (OH) by implementing evidence-based practices (EBPs) to reduce overdose deaths. The Opioid-overdose Reduction Continuum of Care Approach (ORCCA) organizes EBP strategies under three menus: Overdose Education and Naloxone Distribution (OEND), Medication Treatment for Opioid Use Disorder (MOUD), and Safer Prescribing and Dispensing Practices (SPDP). The ORCCA sets requirements for strategy selection but allows flexibility to address community needs. This paper describes and compiles strategy selection and examines two hypotheses: 1) OEND selections will differ significantly between communities with higher versus lower opioid-involved overdose deaths; 2) MOUD selections will differ significantly between urban versus rural settings. METHODS: Wave 1 communities (n = 33) provided data on EBP strategy selections. Selections were recorded as a combination of EBP menu, sector (behavioral health, criminal justice, and healthcare), and venue (e.g., jail, drug court, etc.); target medication(s) were recorded for MOUD strategies. Strategy counts and proportions were calculated overall and by site (KY, MA, NY, OH), setting (rural/urban), and opioid-involved overdose deaths (high/low). RESULTS: Strategy selection exceeded ORCCA requirements across all 33 communities, with OEND strategies accounting for more (40.8%) than MOUD (35.1%), or SPDP (24.1%) strategies. Site-adjusted differences were not significant for either hypothesis related to OEND or MOUD strategy selection. CONCLUSIONS: HCS communities selected strategies from the ORCCA menu well beyond minimum requirements using a flexible approach to address unique needs.

Protocol for community-driven selection of strategies to implement evidence-based practices to reduce opioid overdoses in the HEALing Communities Study: a trial to evaluate a community-engaged intervention in Kentucky, Massachusetts, New York and Ohio.

INTRODUCTION: Opioid-involved overdose deaths continue to surge in many communities, despite numerous evidence-based practices (EBPs) that exist to prevent them. The HEALing Communities Study (HCS) was launched to develop and test an intervention (ie, Communities That HEAL (CTH)) that supports communities in expanding uptake of EBPs to reduce opioid-involved overdose deaths. This paper describes a protocol for a process foundational to the CTH intervention through which community coalitions select strategies to implement EBPs locally. METHODS AND ANALYSIS: The CTH is being implemented in 67 communities (randomised to receive the intervention) in four states in partnership with coalitions (one per community). Coalitions must select at least five strategies, including one to implement each of the following EBPs: (a) overdose education and naloxone distribution; expanded (b) access to medications for opioid use disorder (MOUD), (c) linkage to MOUD, (d) retention in MOUD and (e) safer opioid prescribing/dispensing. Facilitated by decision aid tools, the community action planning process includes (1) data-driven goal setting, (2) discussion and prioritisation of EBP strategies, (3) selection of EBP strategies and (4) identification of next steps. Following review of epidemiologic data and information on existing local services, coalitions set goals and discuss, score and/or rank EBP strategies based on feasibility, appropriateness within the community context and potential impact on reducing opioid-involved overdose deaths with a focus on three key sectors (healthcare, behavioural health and criminal justice) and high-risk/vulnerable populations. Coalitions then select EBP strategies through consensus or majority vote and, subsequently, suggest or choose agencies with which to partner for implementation. ETHICS AND DISSEMINATION: The HCS protocol was approved by a central Institutional Review Board (Advarra). Results of the action planning process will be disseminated in academic conferences and peer-reviewed journals, online and print media, and in meetings with community stakeholders. TRIAL REGISTRATION NUMBER: NCT04111939.