Coalition for Healthy Tomorrows

Washington County
Substance Abuse Prevention
Strategic Plan

June 2007

 Introduction

The Coalition for Healthy Tomorrows (CHT) began as a local, but international organization in 1996 when citizens from Lubec, Maine (USA) and Campobello Island, New Brunswick (Canada) came together to address local health issues. This group became the Downeast Healthy Tomorrows (DHT), which continues by that name as the coalition supporting tobacco cessation, nutrition, and physical activity healthy choice issues. The Coalition for Healthy Tomorrows was an outgrowth of the DHT whose goals focused on substance abuse prevention, intervention and treatment. CHT will take advantage of the state’s public health infrastructure development to reintegrate with DHT in the new Community Comprehensive Health Coalition serving coastal Washington County south and west of Wesley and east along the coast to Lubec. CHT partners who lent significant support to this planning activity include HealthWays, Weed & Seed, Neighbors Against Drug Abuse (NADA), the  Women’s Health Resource Library (WHRL), the EdGE Program (Maine Seacoast Mission), the Pleasant Point Housing Authority, the Community Caring Collaborative, the Washington County Drug Action Team, Downeast Healthy Tomorrows, St Croix Valley Healthy Communities, the Washington County Alcohol Abuse Reduction Collaborative, Drug-Free Communities Support Program, and the University of Maine at Machias. Other contributors included the Washington County Commissioners, the Washington County Council of Governments, Residents Against Drugs, the Downeast Community Hospital, the Harrington Family Health Center, Eastport Health Care, Discovery House, and the Rapid Response Trauma Network. This plan is intended to carry forward the work of CHT and its partners as active members of the new state public health infrastructure.
Washington County is treasured by its residents for its beautiful rural environment that includes stunning rocky coastlines, extensive blueberry barrens, and vast preserves of fir and spruce. However, the endemic poverty, poor economic environment, and low educational achievement in this rural and geographically isolated region of Downeast Maine contribute to a social climate characterized by under-employment, low wages, dysfunctional families, and low aspirations for the future. These are predominant risk factors that promote high rates of substance abuse in the area. Our strategic planning group first convened last September to collaboratively develop new strategies to reduce alcohol, tobacco, and illicit drug (ATID) use among county residents. Enclosed herein is documentation of our work and findings.

Vision
All Washington County residents – from infants to elders – receive the public health support they need to achieve healthy, substance-free, productive and financially viable lives while respecting cultural and community differences.

Description of Geographic Areas Covered in the Strategic Plan and Collaborating Partners

The Healthy Maine Partnership current coverage areas will be adopted for the new infrastructure. Two CCHC / HMP areas will divide along the formal hospital coverage areas defined for Calais Regional Hospital and the Down East Community Hospital and continue to the Washington County border. 

Partners invited to collaborate include the 21st Century Learning Centers / After School program, Alcoholics Anonymous, the American Lung Association, Big Brothers Big Sisters, the Boys & Girls Club, the Calais City Government, the Calais Police Department, Calais Regional Hospital, Calais Weed & Seed, chambers of commerce, the Coalition for Healthy Tomorrows, the Cobscook Community Learning Center, the Community Caring Coalition, Discovery House, Downeast Aids Network, Downeast Community Hospital, Downeast Health Services, Downeast Healthy Tomorrows, Downeast Hospice, Drug Court, Eastport Health Center, EdGE, faith-based leaders, Families First, Family Planning, Hancock County Breastfeeding Coalition, Harrington Family Health Center, Husson College, Greenland Point, HealthWays, Indian Township Health Center, the Lighthouse Corporation, Local Health Officers, Local Public Health Nurses, Lubec Cares, Maine Center for Disease Control,  Maine Department of Health and Human Services, Maine Office of Substance Abuse, Maine Seacoast Mission, Maine Wabanaki Program, Maine Youth Voices, the Margaret Chase Smith Policy Center, Moosabec Area Drug Awareness Group, Narcotics Anonymous, Neighbors Against Drug Abuse, Next Step, Pleasant Point Indian Health Center, Princeton Health Center, private practitioners, private schools, Protea, the Rapid Response Trauma Network, the Red Cross, Residents Against Drugs, St. Croix Valley Healthy Communities, the Salvation Army, Scouts (BSA, GSA), Sipayik Housing Authority, Sunrise County Economic Council, the University of Maine at Machias, Washington County Alcohol Abuse Reduction Collaborative (MSAD 14, 19, 37, SU 102, 103, 104, 106, 107 and Washington Academy), the Unobskey School, the Washington County Ambulance Authority, the Washington County Asthma Council, Washington County Commissioners, Washington County Community College,  Washington County Council of Governments, Washington County Drug Action Team, Washington County Drug-Free Communities, Washington County Emergency Management Agency, Washington County Psychotherapy Associates, Washington County Sheriff’s Department, Washington County Substance Abuse Continuum of Care Advisory Board, Washington Hancock Community Agency, the Women’s Health Resource Library, WIC (Women, Infants, and Children), the Women’s Program, and Youth Leaders Encouraging A Difference. 

Description of Planning Team and Process (including data and information used)

The following listed participants attended the number of meetings identified in the chart below. All but one session was facilitated by a contracted professional facilitator, Deb Burwell. We followed the work plan submitted in the original application, with minor delays due to inclement weather. 

Participant	Number 
of 
meetings	
Rick Tanney (Washington County Drug-Free Communities Support Program / Washington County Council of Governments)	11	
David Archer (Downeast Healthy Maine Partnership)	9	
Barbara Drisko (Washington County Drug Action Team)	7	
Eleody Libby (Downeast Healthy Maine Partnership)	8	
Gail Wahl (Calais Weed & Seed)	7	
Wendy Harrington (Maine Seacoast Mission EdGE)	8	
Carol Carew (HealthWays)	6	
Don Hallcom (HealthWays Community Services)	7	
Amanda Adams (Neighbors Against Drug Abuse)	5	
Billie Jo Ham (St. Croix Valley Healthy Communities Healthy Maine Partnership)	6	
Brian Altvater (Sipayik Housing Authority)	3	
Alison Ouellette (Maine Seacoast Mission – The EdGE Program)	2	
Cindy Look (Public Health Nurse)	2	
Jane Weil (Community Caring Collaborative)	2	
Linda Pagels (Washington County Commissioners)	2	
Marjorie Withers (Community Caring Collaborative)	2	
Mike Doran (Washington County Alcohol Abuse and Reduction)	2	
Sunshine Lambert (Women's Health Resource Library)	2	
Ann Acheson (Margaret Chase Smith Policy Center)	1	
Aslan Howard (Maine Seacoast Mission - The EdGE Program)	1	
Charlie Harrington (Maine Seacoast Mission – The EdGE Program)	1	
Dee Howard (Maine Seacoast Mission - The EdGE Program)	1	
Erica Famous (HealthWays Resource and Evaluation)	1	
Glen Avery (HealthWays) 	1	
Heather Henry  (St. Croix Valley Healthy Communities Healthy Maine Partnership)	1	
Helen Adams (Neighbors Against Drug Abuse)	1	
Jane Brissette (Downeast Community Hospital)	1	
Jayna Smith (Discovery House)	1	
Jennifer (Oakes) Pitts (Lubec Consolidated School / Machias School Union 102)	1	
Joan Crockett (Harrington Family Health)	1	
Katie Evans (Eastport Health Care)	1	
Kristy Sprague (University of Maine at Machias)	1	
Larry Saunders (Discovery House)	1	
Nichole Greaves (Rapid Response Trauma Network)	1	
Paul Stuart  (St. Croix Valley Healthy Communities Healthy Maine Partnership)	1	
Paula Lumbert  (St. Croix Valley Healthy Communities Healthy Maine Partnership)	1	

Most meetings were held simultaneously at the Career Center in Machias and the NADA conference room at 479 Main Street in Calais, with videoconferencing connections. Sessions held at the Clipper Lounge on campus at the University of Maine at Machias were intended for the general public; the community was invited to attend to hear about project progress and to give their feedback. The other sessions were intended for a core planning group, and the attendance numbers were good indicators of who had been active in that group.

Processes Used to Interpret Information and Make Decisions

Project staff and expert participants, such as Healthy Maine Partnership directors and New England Institute for Addiction Studies trained members, provide data and planning guidance based on publicly available sources, such as the Maine Youth Drug and Alcohol Use Survey, agency and coalition collected data, and the county summary provided by Hornby and Zeller. The data are examined in light of current OSA guidance, SAMHSA’s Communities That Care program, and recent trends in prevention work. We avoid ambiguity about whether we are planning for programs or for infrastructure by focusing on infrastructure needs first. The new HMP RFP is invaluable in clarifying these needs. Decisions are made by modified consensus, that is, by vote only if a consensus decision is not clear.
Prioritization of Goals and Objectives

I. Infrastructure/Capacity Priorities:
Goal #1: Create a governing body representing all of Washington County responsible for planning, organizing, directing, communicating and evaluating.
	Goal #2: Establish a coordinated infrastructure that will promote healthy and productive lifestyles throughout Washington County. 
	Goal #3: Build capacity to address unmet needs. 

II. Substance Abuse Priorities:
	Goal #4: Reduce Underage Drinking
	Goal #5: Reduce High Risk Drinking in 18-25 year olds
	Goal #6: Reduce Prescription Drug Abuse
	Goal #7: Reduce Marijuana Abuse
Activities to Reach Each Goal
Goal #1: Create a governing body representing all of Washington County responsible for planning, organizing, directing, communicating and evaluating.
•	Define criteria for choosing governing board members, keeping prevention’s place in the new public health infrastructure in mind. 
•	Current planning participants are an interim Board with the authority to establish the governing body, its rules and mandates.
•	Define by-laws 
•	Work group asks for input on how to emphasize that within the governing structure we need an advocate who goes to Augusta to be a voice of the county
•	Recruit representative on the two-county council to represent this coalition
•	Recruit representatives who are not linked to agencies for example, families
•	Create expectations of the governing body spelled out in MOUs

Goal #2: Establish a coordinated infrastructure that will promote healthy and productive lifestyles throughout Washington County.
•	It is the board’s function to create this infrastructure by hiring staff to do it
•	Coordinate efforts to establish Comprehensive Community Health Coalition infrastructure and staffing
•	Additional functions include: conducting needs assessments, maintaining an agreement with a fiscal agency, grant and resource coordination, outreach, communications, maintain a history of public health efforts in the county 

Goal #3: Build the capacity to address unmet needs.
•	Assess community heath needs, especially related to substance abuse, and develop assessment strategies to maintain both historical and up-to-date current information on county and more local health needs and indicators
•	Assess capacity of existing resources and integrate them into the overall public health service effort
•	Establish participant commitment to address identified priorities by creating funding-dependent Memoranda Of Understanding
•	Develop funding sources
•	Monitor effectiveness of all programs and develop improvement strategies
•	Develop evaluation capacity and tools
•	Create plan for continuous quality improvement by creating a shared data system for Washington County agencies, organizations and collaborations
•	Maintain demographic, economic and epidemiological data for county, HMP coverage area, and minor civil divisions
•	Maintain up-to-date survey results from the Maine Youth Drug and Alcohol Use Survey) MYDAUS and Behavioral Risk Factor Surveillance System (BRFSS) BRFSS, and other state, federal and private institution sources. 
•	Create a centralized accessible online data collection repository. 

•	Identify primary factors to address and develop strategies to address them

Goal #4: Underage Drinking
Primary strategy: policy changes at three levels – law enforcement, school and city/municipal level
•	NADA will use OSA’s Comprehensive Underage Drinking Strategies
•	Continue the party patrol/hot line in Calais
•	Expand policies and practices to the entire county
•	NADA also got the City Council to make policy changes around drinking at the International Festival (this is also collaboration)
•	Implement OSA’s model school policy

Secondary Strategies: 
Retail Access: 
•	Community Trials implemented in 9 towns in the county
•	Will use Card Me when it comes out from OSA

Parental Monitoring 
•	Implement social marketing campaign (i.e. OSA’s Parent Monitoring Campaign)
•	Build on social marketing by adding in information on brain research

Goal #5: High Risk Drinking (18-25 – these are youth in transition)
Primary strategy: policy changes at three levels – law enforcement, school and city/municipal level
•	Border crossing checks (into Canada where the legal age is lower)
•	Work with municipalities on serving alcohol at public events 
•	Implement work place policies
•	Build on DHT’s workplace wellness work with businesses
•	Collaborate with the Washington County -- One Community initiative, which has identified developing a sober workforce as a top priority 
•	Locate county-wide business champion
•	Present on high risk drinking at pre-existing forums to reach businesses (such as the annual business conference)

Secondary Strategies: 
Education: 
•	Engage young adults at the University in high risk drinking prevention
•	HealthWays Research and Evaluation will check to see how web based tools are being used such as E-Chug
•	Create a pamphlet on the risks of binge drinking
•	Research possible connection with concerns about obesity 

Price/promotions: 
•	Participate with the Maine Alcohol Impact Coalition in trying to raise the cost of each drink (proceeds for law enforcement, after school programs and other prevention activities)
•	Assess to see what, if any, price promotions are occurring in the County

Goal #6: Prescription Drug Abuse
Primary strategy: improve effectiveness of law enforcement
•	Encourage collaboration between wardens, sheriffs, and local law enforcement

Access: 
•	Educate on and implement a drug take-back initiative pilot 
•	Collaborate on the drug take-back initiative with the public safety department 
•	Public health nurses will work with elders to identify expired drugs
•	NADA to conduct a conference on prescription drug issues 

Policy change:
•	Work with pharmacies and prescribers in monitoring 

Education and communications: 
•	NADA conference to focus on new research on brains and also look at how people become addicted

Goal #7: Marijuana Abuse
•	Conduct research on marijuana use in the county
•	Collaborate with school health coordinators and law enforcement to determine the best approach to prevent marijuana use.

Workplan / Action Plan

Underage Drinking
Primary Strategy: policy change at three levels – law enforcement, school and city/municipal level
Objective: improve effectiveness of law enforcement
Activity/Task & Target  Audience	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Expand use of OSA’s Comprehensive Underage Drinking Strategies from Calais to entire county

Target audience: 
Law enforcement staff
	Find champion to kick off this effort by talking with sheriff and state police (Calais police chief just had a health crisis, so unavailable)

Develop county-wide strategy building on what Calais has learned

Explore how to  work on border issues (legal age is younger in Canada)	Fall 2007	Leads: Gail Wahl with
Weed and Seed/ and both CCHC’s

	Washington County Drug Action Team, municipal police, wardens, Coast Guard, college security at UMM and WCCC	

Objective: improve effectiveness of school policies
Activity/Task & Target  Audience	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Expand use of best practices in school policies (use OSA work out in 2008)

Target audiences: 
School administrators
School boards
Parents	Ask all schools in county to share a copy of their current policies

Build on work of U.S. Department of Education evidence based curriculum Class Action using community trials intervention 

Look for ways to sustain these activities	Underway now through 2008	Lead Washington County Alcohol Abuse Reduction Collaborative	School Health Coordinators
School staff	

Objective: improve effectiveness of municipal policies
Activity/Task & Target  Audience	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Raise awareness regarding youth access to alcohol at public events

Build on success of NADA getting Calais City Council to make policy changes re: drinking at International Festival

Target audience: 
Municipal officials
The Public	Determine what municipalities are currently doing

Identify what resources and model policies are available to offer municipalities

Engage youth so they can speak about the reality of access to alcohol in their local areas

Take pictures at  summer events like Milbridge Days and Cherryfield Days to document this issue

Meet with Western  Washington County selectmen 	Summer 2007

September 2007	Lead: Washington County Alcohol Abuse Reduction staff

Assisted by: 
St Croix Valley Healthy Communities (HMP), WHRL, Maine Seacoast Mission,
and municipal governments

Downeast Healthy Tomorrows

WCDAT	Council of Governments

Washington County One Community

Lubec Cares

The EdGE Program

Maine Youth Voices

Youth Advocacy Programs 

Objective: Reduce access/availability of alcohol
Activity/Task & Target  Audience	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Utilize Community Trials

Utilize Card Me Program when available

Target Audience: 
Retailers
The public 	
Institute Card Me program	Ongoing

Begin January 2008	WCAAR and CCHC’s 	Schools

Chambers of Commerce as link to retailers
Washington County Economic Development Council 
North and south HMPs	

Objective: Improve quality and frequency of parental monitoring practices
Activity/Task & Target  Audience	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Institute OSA Find Out More, Do More Campaign 

Target Audience: 
Parents
The public 

	Social marketing campaign and community discussions
Show films
Work with WABI-TV to do story

Put info out at public events

Have Health Centers share info with patients	September 2009	Leads: CCHC’s

Assist: School Health Coordinators

EdGE

Health Centers: 
WHRL
HealthWays

	After school programs including The EdGE (through meetings with parents)

Schools – have health fair on parent night, half-time at basketball games

Health Centers	

High Risk Drinking – 18-25 (youth in transition)
Primary Strategy: policy change at four levels – law enforcement, school and city/municipal level (many activities from underage drinking will apply to this area)
Objective: improve effectiveness of law enforcement and school policies
Activity/Task & Target  Audience	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Work with institutions of higher education to develop and implement effective policies 

Target audience:
UMM and WCCC Administration and staff	Ask both institutions for policies on drinking and ask how they enforce them

Research best practices on campus policies

	Fall 2007	Lead: CCHC

UMM / CLL 
	Staff at both institutions
	
Work with jails to see what policies they have in working with 18-25

Target audience: 
18 – 25 year old youth 	Explore whether there is a difference in how jails work with underage drinking vs. 18-25

Research how Passamaquoddy are providing treatment in jail	Have info on this by fall of 2007	Lead: WCDAT	Sipayik Housing Authority 

County sheriff 	

Objective: Increase knowledge of repercussions of binge drinking (social, health)
Activity/Task & Target  Audience	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Work with employers to increase knowledge of repercussions of binge drinking

Target audience: 
Employers of 18-25 year olds	Work with Geoff Miller (OSA) to talk about how best to work with employers

Identify a large company who could become a champion

Explore collaboration with business forums (annual county business conference)

Look at overlap with public events like Lobster Boat Races 	Have information about what we can offer employers by Fall 2007	Lead: Weed & Seed

WHRL will contact Marine Resources
	Cheryl Mahar who does drug testing with businesses
Washington County Drug Action Team 
Washington County One Community
Sunrise County Economic Development Council 
Marine Resources
Lobsterman’s Association 
Construction Industry	
Work with campuses at University of Maine at Machias and Washington County Community College 

Target audience: students and educational institutions and their staff	Continue work with Alex,  UMM counselor, and Student Life staff on social norming campaign using E-Chug, Virtual Bar and peer counselors

Explore working with Alex on doing more education during student orientation 

Fitness Center at UMM offer alternative events to drinking

Look into possibilities of students doing action research on health risks

Work with staff on what to do when see students hung over

Explore having college Peer Educators talk with high school students (many attend UMM)

Explore creating a forum for students modeled after the UMM  Wellness Work Place for employees	Fall 2007	Lead: CCHC
CLL at UMM
WCDAT / UMM	UMM Student Life and counselor
UMM Fitness Center 	

Objective: Address availability through prices/promotions
Activity/Task & Target  Audience	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Support statewide efforts on promotions

Audience: retailers	Continue work with Maine Alcohol Collaboration on efforts to make legal changes

Promote Card Me Program 

Work with law enforcement on the number of promotional signs retailers can have	2008	Lead: CCHC
NADA	Maine Alcohol Collaboration 

OSA – Card Me

Sheriff, local police, state police 	

Prescription Drug Abuse
Objective: improve effectiveness of law enforcement
Activity/Task & Target  Audience	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Find out what law enforcement policies are 

Target Audience: 
Law enforcement	Do this work in concert with underage drinking efforts	Fall 2007	Weed & Seed	NADA
WCDAT

Objective: Reduce access/availability of prescription drugs
Activity/Task & Target  Audience	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Carry out Drug Turn In pilot in coordination with Calais law enforcement 

Target Audience: 
The public
Law enforcement
Pharmacies

Ensure that every pharmacy is signed up for the prescription monitoring program

Target Audience:
Pharmacies	Continue planning for Drug Take Back event 

Assess what learned 

Develop strategy to expand throughout the county (identify champions and collaborators)

Work with collaborators to develop strategy for full compliance	Fall 2007

Summer 2007	Lead: NADA and Weed and Seed

 	Calais Police Chief
Local pharmacies

Anne Perry, legislative sponsor of Prescription Monitoring Bill
Dave Peters – local pharmacist

Health Centers
Doctors
Emergency rooms
Hospitals

Objective: increase awareness of diverted prescription drugs 
Activity/Task & Target  Audience
	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Hold second conference for providers on prescription abuse

Target Audience: 
Pharmacies
Doctors
Policy makers
The public	NADA builds on success of first conference in planning second one 	October 2007	Lead: Weed & Seed, NADA 	Anne Perry
Doctors

Marijuana Abuse
Objective: conduct more research
Activity/Task & Target  Audience	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Continue gathering data to determine whether this is a significant problem

Target Audience: 
Prevention Planners	Work with law enforcement and school health coordinators to determine best strategy 	Spring 2008	Lead: Heather Henry
Assist: other school health coordinators 	YAP Coordinators
WCDAT
Discovery House	

Develop a Coalition Infrastructure 
Activity/Task & Target  Audience
	Action Steps	Timeframe	Who is responsible	With whom coordinate	
Create an engaged community-based coalition

Target Audience: 
Two CCHCs
Potential members of the coalitions	In the north – take the core group that they had six years ago and broaden it to reflect the ways that the work plan has changed

In the south Eleody is building momentum (buzz) and people are getting involved

Work on having the structure of the two – north and south – be as similar as possible to help them work together

Have a number of people who sit on both coalitions

Form the boards and develop by-laws so that are ready to go by September 2007

At the first meeting reflect on what we have learned from this planning process  and define the relationship with the fiscal agent and come up with a proposed operating policy	Summer 2007	Leads: CCHC 

Assist: neutral facilitator	Other Coalitions in state	

Sustainability 

The ongoing work of our group is influenced by the prevention organizations and programs currently operating in Washington County: Calais Weed & Seed, Neighbors Against Drug Abuse, Drug Free Communities Support Project, The Washington County Alcohol Abuse Reduction Collaborative, Community Caring Collaborative. Moosabec Cares, Lubec Cares, the Maine Youth Voices groups in the schools, and others.  One of our goals in developing this plan is to bring together the various groups to ensure greater coordination of services and programs and to avoid unnecessary duplication of services – while remembering that the sheer geographic area of Washington County often necessitates the provision of duplicative services in more than one area.

It is the work and financial resources of these various groups that will enable us to continue our planning work into the future.  In the near future, much of our work will be directed by the Comprehensive Community Health Coalition that oversees the two Healthy Maine Partnerships in Washington County.  As an impartial body, we anticipate that its involvement in our prevention work will only enhance and strengthen the work many of us have been committed to for many years.