prompt.tennessee.edu

Innovative Education to Combat Opioid Misuse in Tennessee

PROMPT TN (Preventing Opioid Misuse through Partnerships and Training in Tennessee) stands as a proactive response to the opioid crisis, initially envisioned as a series of in-person training sessions. However, with the challenges posed by the COVID-19 pandemic, we swiftly pivoted to digital solutions, creating a comprehensive online platform complemented by live social media streaming. This approach has enabled us to host virtual webinars, manage scheduling, and execute effective promotion strategies, ensuring our vital message reaches a broad audience.

Leadership in Digital Learning and Community Engagement

Adaptive Project Leadership

Spearheaded the transition from in-person to virtual training, overseeing the development of a dedicated site for webinar hosting, scheduling, and promotion.

Implemented strategic decisions to adapt content delivery to online formats, ensuring uninterrupted access to training.

Creative and Technical Excellence

Directed the art of branding, design, and content creation, developing a cohesive and engaging online presence that effectively communicates the urgency and importance of the opioid crisis.

Managed a dynamic creative team, guiding the design and execution of e-learning modules and webinar presentations.

Engagement and Outreach

Hosted live social media streams, broadening the reach of our message and facilitating real-time interaction with our audience.

Led the branding and marketing efforts, crafting a powerful narrative that resonates with individuals and communities alike.

Educational Impact

Our online training sessions are meticulously designed to dissect the causes and consequences of the opioid epidemic, with a particular focus on Tennessee. Through short, accessible segments, we aim to equip community workers and the general public with the knowledge needed to contribute to local solutions.

The trainings are free and accessible to all, with options to attend live webinars or view recordings at a later time, ensuring flexibility and inclusiveness.

The PROMPT TN project embodies our commitment to leveraging digital platforms and social media to educate and engage communities in the fight against opioid misuse. Through innovative e-learning modules, compelling webinar presentations, and strategic online outreach, my team and I have created a resource that not only informs but also empowers individuals across Tennessee to take part in meaningful conversations and actions toward local solutions.

Relevance

Support needs for those with substance use disorder (SUD) and their families have increased in Tennessee, which has the third highest per capita rate of opioid prescribing in the country at 81.4 prescriptions for every 100 people. Effects of the opioid epidemic have persisted with onslaught of the COVID-19 pandemic. Opioid overdoses, which were on the rise prior to COVID-19, increased 22% from 2019-2020. While Tennesseans struggled with pandemic protocols and social isolation, over a 12-month period from April 2020 – 2021, drug overdose deaths increased 50%, the fifth highest increase in the U.S. More than 75% of overdose deaths were attributable to opioids. Worsening of the opioid crisis and resulting societal burden amplifies calls for increased involvement of Extension in addressing this crisis. Increased educator capacity is needed to adequately support families and communities struggling to deal with SUD and subsequent outcomes.

Response

Recognizing the need to address the opioid crisis and bolster capacity for engagement, the University of Tennessee Extension sought and received funding through USDA’s Rural Health and Safety Education competitive grants program for PROMPT. PROMPT is an acronym for Preventing Rural Opioid Misuse through Partnerships and Training. In partnership with the state Department of Health and East Tennessee State University’s Addiction Science Center, the initiative aims to increase capacity to address the opioid epidemic for both health educators and county Extension educators.

PROMPT TN activities included conducting an e-Delphi study to increase understanding of training and resource needs at the county level; a survey of Extension educators to determine existing opioid knowledge, attitudes toward opioid misuse, and existing resources to address the opioid epidemic locally, and a webinar series for Extension educators, health educators, and community members to increase understanding of opioids and addiction, increase awareness of stigma, and increase capacity for local work. We also implemented Communities That Care (CTC), an evidence-based prevention system, in rural Greene County.

e-Delphi Results: Panelists identified substance misuse stigma among community members, inadequate resources such as funding restrictions, lack of local services, and limited knowledge and skills of Extension and health educators as challenges. Opportunities included collaboration and partnerships with schools, faith-based organizations, mental health agencies, and other local organizations such as anti-drug and prevention coalitions. Up-to-date curriculum, funding, clear guidance on what educators can do and what should be referred to outside agencies and professionals, connections with partner organizations, and a pathway to reach schools with educational programs rated highest in importance. Strategies to address stigma of opioid addiction was ranked as the most important training need.  

Baseline Survey – Opioid Knowledge and Attitudes: 196 Extension agents and 40 other county Extension employees completed the survey. Employees represented all regions of the state, were primarily White (91%) and most (70%) had a master’s degree or higher. Respondents were asked to identify from a list of eleven drugs those classified as opioids; 15% correctly identified all 8 opioids. Eighty percent correctly identified Narcan or naloxone drugs reversing an opioid overdose. Responses to attitude questions indicated that most respondents (79%) believed opioid addiction is treatable, drug addiction should be treated as an illness (75%), and incarcerated people should have access to drug treatment (88%). Related to medical responses, 50% believed doctors write prescriptions for pain medications before properly assessing patients; 59% believed pharmaceutical companies do not adequately explain risks of addiction for their drugs.  

Few respondents felt they had adequate resources to address the opioid issue in their county. Only 4% indicated having the tools, 10% having enough knowledge, and 37% feeling comfortable about the issue. Almost half (49%) felt that they had adequate partnerships. On a personal level, almost all (98%) responded that they would feel comfortable intervening with youth who were talking about misusing prescription medications and 73% were comfortable talking with someone in recovery.  

Webinars: A webinar series reached 194 people through Zoom and 4,004 through Facebook live streams. The website saw 42,370 users and 137,788 page views from January – September 2021. Post-webinar evaluations showed knowledge gain for key training content (5-point scale: 1=strongly disagree; 5=strongly agree). Combined ratings by topic: A Practical Guide to Understanding Opioid Data – 4.02; Unpacking TN Adolescent Substance Misuse Data – 4.12; A Guide to Addressing Substance Misuse in Your Community – 3.73; Addiction and the Brain – 4.51; Understanding Stigma, Treatment, and Recovery – 4.6; and Words Matter: How We Talk about Substance Use and Addiction – 4.13. 

Communities That Care: Results from a youth survey (n=765) in the targeted county indicated depression, low commitment to school, exposure to adult anti-social behavior, and alcohol and e-cigarettes as highest priority issues. Evidence based programs/strategies will be selected and implemented in 2022.  

Results

Extension personnel surveys increased understanding of educator’s knowledge, attitudes, and capacity to address the opioid epidemic. Additionally, an e-Delphi study identified opportunities and challenges in addressing substance misuse, resource needs, training preferences, and topics for professional development. These data sources, together with expert feedback from an advisory committee, informed content for a 6-session webinar series offered in 2021 in partnership with East Tennessee State University Addiction Science Center.

Webinars reached 194 people through live Zoom sessions and 4,000+ through Facebook live streams. Recordings were posted to the project website (prompt.tennessee.edu) which saw 42,370 users and 137,788 page views from January – September 2021. Webinar evaluations indicated participants increased knowledge and shifted attitudes. One rural county is piloting the Communities That Care (CTC) model. Results from a youth survey (n=765) in the targeted county indicated depression, low commitment to school, exposure to adult anti-social behavior, and alcohol and e-cigarettes as highest priority issues. Evidence based programs/strategies will be selected and implemented in 2022.  

Publicly available PROMPT TN webinars offer on-demand resources for research-based information addressing SUD. Capacity-building training provided community-level leaders access to information, increased knowledge of opioid misuse and stigma, and led to greater interest and engagement of Extension and health educators in addressing the opioid epidemic. Despite stalls due to COVID-19, new county-level collaborations have been forged to address prevention. The CTC pilot provides a blueprint for replication, enabling expansion of this model and implementation of prevention strategies in additional counties in future years.  

Public Value Statement

When Extension educators and community members increase knowledge and understanding of the opioid epidemic, attitudes change and stigma toward those with substance use disorders (SUD) is reduced. Decreased stigma and increased knowledge boost confidence and willingness to address local issues and readiness to work with those impacted by SUD. Increased capacity of educators and community members supports local substance misuse prevention efforts and invigorates collective action to address the opioid epidemic, thus providing greater support for those with SUD and their families and reducing short- and long-term negative outcomes and societal costs.