Evaluating Change in Representation and Coordination in Collaborative Governance Over Time: A Study of Environmental Justice Councils.

Collaborative governance involves convening of government and non-government actors in policy formulation and implementation. Motivating collaborative governance is the expectation that engagement of diverse arrays of stakeholders in the public policy process allows policymakers and administrators to draw on the expertise, resources, and perspectives of these stakeholders to develop more contextually appropriate and effective policies. Since collaborative governance is fundamentally premised on the representation of diverse stakeholders in collaborative processes, assessing the extent to which representation is actualized is paramount. This paper adds to recent scholarship that examines representation dynamics in collaborative governance arrangements, focusing specifically on: (i) how diverse stakeholders included in collaborative governance arrangements are descriptively and substantively represented; (ii) how substantively represented stakeholders are coordinating on informational and relationship building activities; (iii) how representation and coordination dynamics change over time; and (iv) the extent to which representation and coordination dynamics are indicative of collaboration life cycle stage. Additionally, in responding to this latter aim, the paper presents a novel approach for measuring life cycle stages. The paper reports on a comparative case study of environmental justice councils, which are collaborative governance arrangements convened by states to assist in the design and implementation of policies aimed at reducing environmental harms within low income and minority populated communities.

Predictors of seeking emergency medical help during overdose events in a provincial naloxone distribution programme: a retrospective analysis.

OBJECTIVES: This study sought to identify factors that may be associated with help-seeking by witnesses during overdoses where naloxone is administered. SETTING: Overdose events occurred in and were reported from the five regional health authorities across British Columbia, Canada. Naloxone administration forms completed following overdose events were submitted to the British Columbia Take Home Naloxone programme. PARTICIPANTS: All 182 reported naloxone administration events, reported by adult men and women and occurring between 31 August 2012 and 31 March 2015, were considered for inclusion in the analysis. Of these, 18 were excluded: 10 events which were reported by the person who overdosed, and 8 events for which completed forms did not indicate whether or not emergency medical help was sought. PRIMARY AND SECONDARY OUTCOME MEASURES: Seeking emergency medical help (calling 911), as reported by participants, was the sole outcome measure of this analysis. RESULTS: Medical help was sought (emergency services-911 called) in 89 (54.3%) of 164 overdoses where naloxone was administered. The majority of administration events occurred in private residences (50.6%) and on the street (23.4%), where reported rates of calling 911 were 27.5% and 81.1%, respectively. Overdoses occurring on the street (compared to private residence) were significantly associated with higher odds of calling 911 in multivariate analysis (OR=10.68; 95% CI 2.83 to 51.87; p<0.01), after adjusting for other variables. CONCLUSIONS: Overdoses occurring on the street were associated with higher odds of seeking emergency medical help by responders. Further research is needed to determine if sex and stimulant use by the person who overdosed are associated with seeking emergency medical help. The results of this study will inform interventions within the British Columbia Take Home Naloxone programme and other jurisdictions to encourage seeking emergency medical help.

Qualitative assessment of take-home naloxone program participant and law enforcement interactions in British Columbia.

BACKGROUND: The British Columbia take-home naloxone (BCTHN) program has been in operation since 2012 and has resulted in the successful reversal of over 581 opioid overdoses. The study aims to explore BCTHN program participant perspectives about the program, barriers to participants contacting emergency services (calling "911") during an overdose, and perspectives of law enforcement officials on naloxone administration by police officers. METHODS: Two focus groups and four individual interviews were conducted with BCTHN program participants; interviews with two law enforcement officials were also conducted. Qualitative analysis of all transcripts was performed. RESULTS: Positive themes about the BCTHN program from participants included easy to understand training, correcting misperceptions in the community, and positive interactions with emergency services. Potential barriers to contacting emergency services during an overdose include concerns about being arrested for outstanding warrants or for other illegal activities (such as drug possession) and confiscation of kits. Law enforcement officials noted that warrants were complex situational issues, kits would normally not be confiscated, and admitted arrests for drug possession or other activities may not serve the public good in an overdose situation. Law enforcement officials were concerned about legal liability and jurisdictional/authorization issues if naloxone administration privileges were expanded to police. CONCLUSIONS: Program participants and law enforcement officials expressed differing perspectives about warrants, kit confiscation, and arrests. Facilitating communication between BCTHN program participants and other stakeholders may address some of the confusion and remove potential barriers to further improving program outcomes. Naloxone administration by law enforcement would require policies to address jurisdiction/authorization and liability issues.