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Possible Future Directions

At the close of the event, workshop participants considered how the ideas presented might be carried forward. This chapter reviews reports from small-group discussions held during the workshop on developing plans for future family-focused interventions. Two groups shared highlights from their discussions, centering around seven key questions.

DEVELOPING PLANS FOR FUTURE FAMILY-FOCUSED INTERVENTIONS

Leslie Walker-Harding, University of Washington, explained the process for the small-group discussions on how to take the conversations from this workshop forward. Small-group participants were asked to consider the following questions:

1. How do we obtain funding and support for planning, implementing, and sustaining these interventions?
2. How do we leverage and support the full workforce?
3. How do we ensure sustainability of an intervention?
4. What pragmatic factors are necessary to ensure an intervention will be successful in a particular setting?
5. What stakeholders need to be part of implementing an intervention within a health care setting?
6. What are effective strategies for engaging parents and families?
7. How do we reach families that do not come to primary health care settings?

Group 1 Report

Ken Shatzkes, Foundation for Opioid Response Efforts, shared some salient points of conversation from his group, which began its conversation by discussing how to leverage and support the entire child-serving healthcare workforce, noting people working across the healthcare spectrum, including pediatricians, nurses, and social workers, among others. The group suggested using the community health worker model to help address the workforce shortage. He called for creating professional pathways for community health workers and peer support providers.

The second question they focused on is how to ensure sustainability of an intervention. This is difficult, he acknowledged, and requires the buy-in of a range of stakeholders from the initial stages of intervention implementation. He suggested including people who can support sustainability—including funders—from the beginning of the project. Involving these stakeholders at the outset can support a study design better suited to improving long-term outcomes. Shatzkes also said having an advocate of the program on the ground can help encourage additional funding when the initial trial phase of an intervention ends.

Regarding pragmatic factors for an effective intervention, this group discussed cost, burden, meeting the perceived need, and cultural competency. Overall, Shatzkes said, the group discussed the necessity of being realistic about what can be accomplished with the resources available in a community. He noted that religious leaders are often trusted resources for families in need. Other stakeholders, including health system leaders, as well as payers such as Medicaid, are also important and will need to be involved at the start of project implementation.

The next discussion centered on identifying effective strategies for engaging parents and families in prevention interventions. Shatzkes reiterated the idea of meeting families where they are, including consideration of their concerns outside of the intervention’s target. For example, he said, families concerned about putting food on the table or juggling multiple jobs and appointments will not be able to participate fully in the intervention unless these needs are also addressed. Examples of ways to support families include providing child care and food at the intervention site. Having a meal ready for the family so they can focus on the intervention itself can support the family’s progress. Finally, he noted the importance of using non-stigmatizing language, welcoming families, and building trust. Shatzkes suggested that one way to accomplish this would be to invite parents who have already gone through the process to share their experience. To reach families that do not typically come to primary care settings, he said the group thought it was crucial to understand why those families are not coming—understanding the problem is the first step to engaging with the families, he commented.

Lastly, the group discussed how to obtain funding and support for planning, implementing, and sustaining these types of interventions. Shatzkes reiterated the importance of including funders from the beginning, so they have all the information they need to support future phases and programs. Pamela A. Matson, Johns Hopkins University School of Medicine, added that each state could have someone in charge of leveraging the money from opioid settlements and coordinating with other people and agencies in the state, including primary health care providers.

Group 2 Report

Nataki MacMurray, Office of National Drug Control Policy, reported that her group began their discussion by highlighting the importance of understanding the core components of interventions that are effective at preventing adolescent substance use. This way, regardless of the intervention, those core components can be built into its infrastructure. She said that while people in the field are eager for a new system, they have been unable to build it because of uncertainty about funding from year to year. She suggested that underpinning sustainability efforts with these core components can help support the creation of a more effective prevention system.

Vinu Ilakkuvan, PoP Health, shared the group’s thoughts about a hypothetical toolkit that could support prevention interventions. For example, the toolkit could demonstrate how to make an intervention modular so that different primary care offices with different levels of capacity can use pieces of the intervention. She suggested the toolkit could also provide guidance for setting up referral systems, building community connections, and providing statewide technical assistance. Such a toolkit would need to provide guidance for stakeholders with different access to resources, she said. Karen Scott, president of Foundation for Opioid Response Efforts, added they also talked about what pieces would be useful and necessary for communicating with policy makers and decision makers at different levels. In addition to providers, she added, there would need to be materials for state policy officials or a Medicaid agency director.

CLOSING COMMENTS

This workshop made the case for family-focused interventions for preventing adolescent substance use, considered barriers to and opportunities for implementing these interventions, and highlighted potential next steps for moving the work forward, said Walker-Harding. She advocated for continuing work to advance the efforts discussed at the workshop. She suggested people should work to identify the right interventions for the