First Steps and Second Chances

By Loreen Nichols

Multnomah County Health Department administers two programs that demonstrate how innovative health care delivery models can be applied to urgent public health problems.

Haven Wheelock was co-ordinating a syringe exchange in Portland, Oregon, when a terrified participant ran into her office. Someone had overdosed on heroin. Wheelock grabbed her naloxone kit and ran three blocks to where a man was blue and unresponsive in the February chill. She performed rescue breathing and injected naloxone into the man’s shoulder. By the time the ambulance arrived, the man was alert and asking, “What happened?”

Opiate overdose is a major public health problem in Oregon. Between 2000 and 2011, prescription opiate overdose deaths increased more than 400 percent, while heroin overdose deaths increased 42 percent. Since 2009, the Multnomah County Health Department has led efforts to reduce overdose deaths through surveillance, harm reduction, and policy advocacy. Currently, we are providing funding and technical assistance to organizations like Outside In, the nonprofit where Wheelock works.

“Overdoses are terrifying,” Wheelock says. “People don’t want to die, and they don’t want their friends to die. With naloxone, I know I’m doing everything I can to help.”

Naloxone is a safe, widely used medication that can reverse an opiate overdose. Historically, Oregon law allowed only physicians and emergency medical personnel to administer naloxone. The new legislation allows public health departments and community organizations to distribute naloxone to lay people and train them to use it in opiate overdose situations. Since July 2013, more than 600 people have been trained to administer naloxone. This training has resulted in the reversal of approximately 200 overdoses.

Compared to the year before the naloxone legislation was passed, there has been a 44 percent decrease in heroin deaths.

Multnomah County plans to distribute more naloxone through our own needle exchange sites and increase capacity for naloxone distribution at homeless shelters, substance abuse treatment centers, and correctional facilities.

We will also be working with community partners to identify culturally specific ways to engage communities of color in overdose prevention and align this work with efforts to address substance abuse and addictions treatment in communities of color.

More people are getting a second chance through these life-saving efforts. As health system transformation expands access to mental health and addictions services, we are hopeful that more pathways for opiate treatment will open up for those seeking help.

Community partner Wheelock said those conversations have already begun.

“Since we started the naloxone program, more clients are talking to me about their habits, treatment options, and HIV prevention,” Wheelock said. “It’s opened doors that I didn’t expect.”

Partnering to Promote Healthy Birth

African American women in Multnomah County are more than twice as likely to deliver a baby with low birth weight, and almost twice as likely to have their babies die in the first year of life, than non-Hispanic white women. The Healthy Birth Initiative Program is changing these alarming statistics.  

The program works to improve birth outcomes and the health of mothers and fathers in the African American community. It is a partnership between our health department, program participants, health and social service providers, and the community. The program uses a family-centered approach that engages mothers, fathers, and other caretakers in supporting a child’s development. The Healthy Birth Initiative is directed by a client-governed Community Action Network of medical and social service providers and community members.

The program is seeing success. Participants have demonstrated lower rates of infant mortality and low birth weight and higher rates of early prenatal care compared to those not enrolled in the program.

Shaqulia Roach attests that the program has made a big difference in her life.  After her firstborn son died during an asthma attack at age 17 months, the Portland mother found support and education through the program. She attended Healthy Birth Initiative classes about asthma that prepared her to manage the health of her three surviving sons.

“I didn’t know anything about asthma, other than about inhalers. But now I know all the triggers,” she said. When she was pregnant, program staff helped her reach doctor’s appointments. She also attended classes on nutrition, domestic violence—“anything they offered.”

“It is great to be around other African American women my age. The whole group helps me cope,” Roach said. “When I get depressed or stressed out, I know all the girls’ numbers and can call them.”

This innovative care model brings a high degree of trust and community connection to the health system transformation table. “We are excited about linking the experiences of our clients to the design of new policies and practices in the larger health care system,” says Rachael Banks, Program Director for the Healthy Birth Initiative.

The Healthy Birth Initiative currently has an agreement with Health Share of Oregon—an Accountable Care Organization that includes all the major health care systems and three public health departments in the Portland area—to collaborate on improving services. The agreement includes cultural competence training and enrollment data-sharing to reach out to pregnant women earlier and get them into appropriate care.

An Asset in Health System Transformation

As we move more deeply into the uncharted terrain of health system transformation, local public health departments can be valuable assets. At Multnomah County Health Department, we have acted as leader, convener, and coordinator on a number of long-standing and emerging public health issues. We do this in partnership with the communities we serve. As one of the moms from the Healthy Birth Initiative Program said, “This program develops leadership skills and supports us to network. This is unique. When I started in this program I was afraid to talk in front of people. Now I’m running for Community Action Network Chair because I think it will help me continue to grow.”

Author

Loreen Nichols is Director of Community Health Services at Multnomah County Health Department in Portland, Oregon.