Ohio Deflection Association: History

Colerain's then-public safety director, Daniel P. MeloyPDF — who had previously served as the township's police chief and, later, as the township's administratorPDF — oversaw the development of its pilot Community Outreach Team program, in collaboration with the community's assistant fire chief Will Mueller (also an adjunct instructor of Fire Science at the University of CincinnatiPDF), and the Greater Cincinnati Addiction Services Council, CEO (Ret.) Nan Franks and social worker Shana Merrick. See also: other Cincinnati-area communitiesPDF.

Concurrently and independently of the Colerain program, Lucas County, Ohio, developed its similar DART model, which it also first deployed in 2014.

Impetus

Meloy and other Colerain officials saw the need to develop more innovative, person-centered approaches to reduce the rising number of narcotic overdoses in their community, which had been particularly hard hit by the mid-2000s opioid epidemic.

At the time of the Community Outreach Team pilot program's development, Colerain Township had approximately 60,000 residents, usually covered by just 33 fire/EMS personnel and six police department patrol officers at any given time.

In 2015, the year Colerain's Community Outreach Teams were first deployed, the township reported 167 emergency response runs to overdose victims, comprising 2.2% of the community's total emergency response volume for that year.

Organization

In the original Colerain model, a special-tactics-trained police officer, a specially trained firefighter-medic, and an addiction counselor from the community were partnered to form a single Community Outreach Team.

The community's initial Community Outreach Team emergency responder candidate pool included six firefighter paramedics with previous experience as military, SWAT, or Hostage Rescue Team tactical medics (TACMEDs), and five police officers with special tactics training through military service, SWAT, or narcotics squads.

The chosen firefighters and paramedics received additional self-defense, chemical irritant deployment, and de-escalation training. Special tactics training was deemed necessary, in township officials' estimation, due to the often-volatile circumstances on scene during narcotics-related responses.

Licensed substance use counselors were provided to the Community Outreach Team program through a partnership with the Addiction Services Council of Greater Cincinnati.

The Community Outreach Team program included a “360 Solution” component, under which all Colerain patrol officers were equipped with nasal-delivery naloxone (Narcan) provided by the Ohio Department of Public Health and the Hamilton County Department of Public Health. Additionally, the police department canvassed the community several times door to door, delivering brochures about the township's response to the opioid epidemic.

They were also trained to identify barriers to treatment, to assist individuals and their families in preparing to remove or overcome those barriers, to move toward a firm commitment to action, and to engage the family and enlist its help.

Outreach and engagement were directed to build trust, maintain discretion and confidentiality, protect the individual's right to choose their own care, and comply with all state and federal (HIPAA) regulations on patient privacy.

Efficacy

From January through June 2015 — the six months immediately preceding the unit's first deployment — Colerain's first responders made 96 overdose-related emergency runs, 19 of which involved associated cardiac arrests. In the six months following deployment, the township made 71 overdose-related runs, 7 of which involved cardiac arrests.

Although those initial indications were insufficient to prove the pilot program's effectiveness, they were encouraging. A subsequent year-over-year analysis lent support to the hypothesis that the Community Outreach Team program could effectively reduce overdoses in the community.

From January through June 2016, the township made 67 overdose-related emergency runs, just 6 of which involved cardiac arrests — just over a 30% reduction from the same period the preceding year.

Nearby Middletown, Ohio's Community Outreach Team arguably did not succeed in reducing overdose rates or overdose-related deathsPDF in its first year of operation. According to then-fire chief Paul Lolli, in 2016 — the year its Community Outreach Team was implemented — the city's emergency response agencies made 532 overdose-related runs (5.7% of total response volume) with 74 deaths recorded. From January 1 to June 17, 2017, the city's agencies had already made 577 opioid overdose responses (12.4% of EMS run volume to that point) with 51 recorded deaths.

It is possible, though, that temporary spikes in the available supply of illicit opiates, or sudden shifts in opiate quality, could artificially depress Community Outreach Team/DART success rates. Success rates might be more readily quantified over longer data-gathering periods. For example, in 2017 Lucas County Sheriff John Tharp stated that the county's DART program had achieved a similar success rate in its first three years, with 74% of contacted individuals either entering detox or connecting with other treatment programs. See Three million in grants for DART and Community Outreach Team teamsPDF.

Proliferation

The Colerain Community Outreach Team'sPDF initial successes garnered close attention from officials in surrounding communities, many of whom expressed interest in adopting the model. Within the Community Outreach Team's first two years of operation, communities in North Carolina, southern and northern Ohio, Texas, and West Virginia contacted Colerain to inquire about its program.

By June 2016PDF, Ross County, Ohio, and its seat, Chillicothe, had launched their joint, multi-agency Post-Overdose Response Team (PORT) based on Colerain's Community Outreach Team. See PORT visits 14 sites seeking answers to overdose surgePDF.

In August 2016PDF, Butler County's Oxford, Ohio, had loosely formed a Community Outreach Team. By September 2016PDF, another Cincinnati suburb, Norwood, had developed and deployed a Colerain-model Community Outreach Team.

In January 2017, the Funders' Response to the Heroin Epidemic — a Greater Cincinnati-based private funding collaboration operated by InterAct for Change, a nonprofit subsidiary of Interact for Health — awarded Colerain Township and Clermont County, Ohio, $100,000 grantsPDF to support their Community Outreach Team operational and development efforts. Both grants were to be paid over three years.

By March 8, 2017, two other Tristate communities — Lawrenceburg, Indiana, and Kenton County, Kentucky — had developed and launched their versions of the Community Outreach Team program. In contrast to the Colerain model, Kenton County's Community Outreach Team — developed by Kenton County Police Department chief Spike JonesPDF and Independence (Ky.) Fire District chief Scott BreezePDF — was operated by part-time staffers who are not responsible for non-Community Outreach Team duties.

Middletown, OhioPDF implemented its Community Outreach Team program in 2016; the city's fire chief reported that 92% of individuals contacted by the unit had been able to enter treatment, although he acknowledged the program had not recorded the results experienced by those who entered treatment.

In June 2017PDF, citing opiate addiction as his community's number one public safety issue, Boone County, Ky., Judge-Executive Gary Moore announced the county's launch of its own Colerain-inspired overdose response team.

By July 2017, several other Ohio communities — including Colerain-neighboring Greene Township, the cities of Cincinnati, Cleveland, Hamilton, Mansfield, Oxford, and Troy, and Logan and Richland counties — had developed and implemented Community Outreach Team programs.

Summit County developed its Community Outreach Team in partnership with the nonprofit drug education and prevention organization Cover2 Resources, with significant advisory support from Colerain Township's Meloy. The county deployed Community Outreach Team units in Akron, Barberton, Coventry, Cuyahoga Falls, Green, Hudson, Munroe Falls, Norton, Stow, and Tallmadge under partnership agreements with those communities. Indianapolis, Indiana, and Raleigh, North Carolina, had also deployed Community Outreach Team units as of July 2017.

In June 2017, Butler County Mental Health and Addiction Recovery Services received a $660,000 federal grant, funded by the 21st Century Cures Act, to develop a mobile overdose response program. Also in June 2017, Ohio Governor John Kasich signed a state budget allotting $3 million in grant funding to help Ohio communities develop their own Community Outreach Team or DART programs, administered by the Ohio Attorney General's Office.

In September 2017PDF, Ohio Attorney General Mike DeWine announced Community Outreach Team/DART development grants to 40 Ohio law enforcement agencies and their partner organizations. Hancock County received $87,500 and had an operational Community Outreach Team by year's end; Ottawa and Wood counties also received funding. The Mahoning County Sheriff's Office was awarded $150,000 for a county-wide Community Outreach Team program. The Newton Falls Police Department in Trumbull County and the East Liverpool Police Department in Columbiana County each received $50,000. Tuscarawas County's sheriff's department was awarded $83,500 to start a county-wide, multi-agency program, operational in mid-October 2017.

In December 2017PDF, Meloy retired from his role as Colerain Township CEO/Administrator to become a consultant building public safety and community collaboration efforts through training and education, helping other communities start their own deflection programs.