20240129-145439-74

In collaboration with the Institute for Intergovernmental Research and BJA, we convening COSSUP grantees in Milwaukee County, WI to discuss their programs and identify areas for collaboration.

Grantees
City of Milwaukee: 15PBJA-22-GG-04454-COAP
City of West Allis: 15PBJA-21-GG-04560-COAP
Milwaukee County: 2020-AR-BX-0103
West Allis Health Department: 2018-AR-BX-K106
Milwaukee County Housing Division: 2018-AR-BX-K117

Key themes identified across grant and other county initiatives
• Improve public health outcomes
o Fire/EMS as a “person-based tertiary prevention tool”
 Community paramedicine, nurse case manager
 Peer support
o Harm reduction/minimization through education and supply distribution
o Rapid drug testing: real-time; identify trends; upstream on street, not during postmortem toxicology screening
o Person centered
 Warm handoff
 What does the individual identify as a need?
o MOUD in the field (in WI all paramedics are authorized to do this)
o Community risk reduction
 West Allis project to overlap police, EMS, and emergency department data to identify unreported community violence and overdoses
• Build collaboration between public health and public safety
o “If you contribute to the work meaningfully, let’s partner”
o Deflection and pre-arrest diversion
 Post-overdose outreach
 EMPOWER for women and street-based sex trade
• Self-referral has seen more success than officer referrals or pre-arrest diversions
 Referrals post-crisis, at risk, crisis response
• Referrals from nontraditional sources, like city workers (like public works department); treatment providers to get help reengaging individuals, department of corrections, district attorney
o OD-Public Health and Safety Teams (PHAST)
o Overdose Fatality Review
 Next of kin engagement
o City’s current efforts include a diversion task force and community intervention task force
o Regular meetings
 Accountability through follow-up of identified action items
• CONVERSATION  ACTION
 Thoughtful agenda development: maximize time, include what the collaborative partners need
o Training: stigma education, trauma, harm reduction has a positive impact on partner buy-in and engagement
• Streamline processes
o Avoid duplication, redundancies
 What exists? What works? What do we want?
 Cost savings
o Standard/communication referral processes
 Where does the person live? Is another provider working with them?
o Understand roles, efforts, resources
o Share the workforce: like peers supporting multiple police departments
• Data and program evaluation
o Data collection as practice for relationship building
o What data sources already exist?
 Dispatch, Office of Emergency Management
 Medical/clinical: emergency, treatment
 Insurance/billing
 OD-PHAST
o Disseminate resources based on hotspot/geolocation
o Aggregate, individual
o Fatal and nonfatal
o Drug trends
o Qualitative and quantitative research
o Feedback loop to share successes (individuals’ stories) and identify areas for improvement
• Build trust and relationships with the community, stakeholders
o Outreach and engagement with vulnerable populations and underserved communities
o Communication and transparency
 If you make a promise, keep it; solve the problems the community brings to you- these are problems that the community trusts you with
o Equity, diversity, and inclusion
o Be aware of political roadblocks/the political environment: avoid the wrong place at the wrong time
o Build on existing social capital (fire department) and translate to post-overdose response efforts
 Fire department’s pediatric programming
 Familiar faces to fire/paramedics
• Widen the net
o Grief support to families and friends, address their resource/service needs
o Build off of existing programs, frameworks
o Respond to what the communities’ identified needs or desires are, and look for diversified funding opportunities
• Existing partners
o Milwaukee Police Department
o Milwaukee Fire Department
o West Allis Fire Department
o Dispatch
o EpiSurveillance
o Schools
o County and city public health
o NIST
o HIDTA
o Medical examiner
o Community coalitions
o Vital Strategies consulting work
o Johns Hopkins
o Justice system: treatment/speciality courts
o Hospitals
o Benedict Center

Wishlist
• Rapid communication to the community, centralized information sharing
o City website, WI SOAR
o Spike alerts
o Community education
o Recognize the different data needs, translation of results for different audiences (e.g., people who use drugs, law enforcement, medical professionals)
• Crime lab testing for more uncontrolled substance/types of substances
• Partnerships and champions: collectively engage and recruit needed partners, disengaged partners
o Build relationship and get support from the DA
o Get more champions, recognize the importance of politics
o Include more fire departments
o Continuum of services: connect programs and jurisdictions
• Research and evaluation
o Publish research/program evaluation reports, get recognition
• Build deflection infrastructure
o MOUs/data linkages
• Writing deflection into local and state legislation
o Standardize community paramedicine
o Make it billable

How to build sustainability
• Start planning for the future at day 1
• TA support, look to see what other initiatives are out there
• Marketing/communications strategies
o Branding/name, logo
o Media and press engagement
o Champions: local leaders (“credible messengers,” community members) and higher profile
o Get support from political leaders
• Funding and staffing
o Learn from others: how they have funded deflection program and how they layer/braid diverse funding sources (like settlement funding)
o Look to partnerships with universities
o Workforce: build in funding for staff to reflect promotions, salary increases, expanding your team
• Make deflection a standard of practice, not a unique program

Reflections/Challenges
 Why has the collaboration stayed beyond funding?
o Population served has a clear need for a comprehensive continuation of services and the deflection opportunities are a clear concept
o Challenges include bandwidth and needing
 More knowledge of available TTA
 Staffing (promotions, salary)
o Support those with lived experience
 Pay peers
 Providing training
o Consider the need for civilian staff versus sworn staff
 Program Evaluation & Research
o How do you define success?
o Translation of research is needed for a broader audience
o Gaps in the literature
 Feasibility/functionality for jurisdiction size/implementation; agency type
 Need to document efforts and outcomes; share more about what didn’t work: lessons learned
o The field is new, formal research is limited
 Funding
o Challenge to collaborate with potential partners during a limited application period for funding opportunities
o Partners are spread too thin to apply, commit to new/expanded partnerships
o Funding report requirement: report on failures
o What services are reimbursable? E.g., case management, peer support

Resource needs
 Toolkits
o Booklet “how to” by jurisdiction size
o Hospital framework
o How to scale deflection program examples up/down for your community
 Research and program evaluation guidance
 Podcasts: 10 minutes or less