The Waterbury Health Department (WHD) vision is to establish a healthier community by addressing the social determinants to achieve health equity.
Our mission is to “Promote Healthier Families, Healthier Neighborhoods, and a Healthier Community.”
Waterbury is the 5th largest city in Connecticut with a current population estimated at 107,568 per the most recent U.S. Census estimates. Since 1999, Waterbury has been listed among the most distressed municipalities by the CT Department of Economic & Community Development.
“No one and no worksite is safe from the possibility of encountering opioid overdose, and therefore preparedness is of the utmost importance.”
—Adam Rinko, Director of Emergency Management, Waterbury Fire Department
WATERBURY'S OPIOID CRISIS
• Connecticut residents are more likely to die from unintentional drug overdose than a motor vehicle accident;
• Many of these deaths are linked to overdose of prescription opioid painkillers
• In 2018, the New Haven County age-adjusted rate for opioid-induced mortality is 28.7 per 100,000 population, compared to the Connecticut opioid-induced mortality rate of 27.5 per 100,000 population and the national rate of 14.6.
What this measures: The annual percent change estimates in rates of all opioid overdoses per 10,000 ED visits for the most recent month of data.
Why this matters: Between February 2019 and February 2020, Connecticut experienced a significant increase in ED visits for suspected opioid overdose.
Source: CDC’s Drug Overdose Surveillance and Epidemiology (DOSE) System: Annual Trends in Emergency Department Visits for Suspected All Opioid Overdose, January 2018 to February 2020
There was a 12.9% increase in unintentional drug overdose deaths as of November 2020 in Connecticut, when compared to the same time frame of January to November of 2019. November 2020 numbers may increase as there are 59 cases pending waiting for toxicology confirmation. The chart at left represents the monthly count of confirmed drug overdose deaths.
*U.S. data is only available through 2016.
Fentanyl-involved overdose deaths increased significantly in 2019 to 82%, compared to the previous years of 2015 to 2018. As of December 2020 (December data not shown as there are 182 pending cases), the average percentage of fentanyl-involved deaths was 85.4%. The chart above represents the percentage of fentanyl-involved deaths by month.
Mayor Neil M. O'Leary has consistently provided strong leadership in response to the opioid crisis. The Connecticut Opioid Response Initiative, or CORe grant, allowed Mayor Neil M. O'Leary to establish The Mayor’s Opioid Task Force two years prior to the governor’s CORe strategic plan. The CORe grant allocated funding to support Mayor Neil M. O'Leary launch of an Opioid Task Force which included close collaboration between Waterbury Health, Fire, and Police Departments. A major component of CORe was the initial development of a pamphlet for overdose survivors and their loved ones that provided connection to care resources- agency names and telephone contact information. This is sometimes known as a “Cold Hand Off” where the OD survivor must initiate access to care on their own, oftentimes leaving an emergency room still at risk. Waterbury knew that this was just the start. With the CT Overdose Data to Action (OD2A) grant, Waterbury “brought the pamphlet to life” by developing a Warm Hand Off Program- one in which a trained Overdose Response Technician meets overdose survivors in real time, to encourage referral to treatment for substance use, and other connections to care, that help reduce risk and improve outcomes for persons affected by opioids. The services provided under OD2A build upon the groundwork laid by the CORe grant, enhancing prevention, intervention, treatment, and recovery efforts engagement with the ultimate goal of decreasing overdoses and overdose-related deaths in our city.
COLLABORATION WITH STRATEGIC PARTNERS
The City of Waterbury, Department of Public Health coordinates the Greater Waterbury Area Opioid Abuse Prevention Workgroup. The strategic partners that participate in this monthly meeting are concerned prevention, treatment and healthcare professionals, law enforcement officers, local officials, people in recovery from opioid use disorders, family members and others who endeavor to reduce the harmful effects of opioid misuse, abuse and overdose in our region.
The purpose of this workgroup is to identify and develop resources in our area to prevent & address opioid misuse, addiction, treatment, stigma, and recovery needs of all people in our communities.
Strategic partners formalize these collaborative relationship with the city and health department via Memorandums of Understanding, which outline and describe the cooperative roles and responsibilities of each partner to communicate closely; to collect, analyze, and share non-HIPPA protected data; to promote safe storage and disposal of medications; to inform the public about the availability of and provide education about the evidence-base of harm reduction services; and to prioritize naloxone education and distribution among high-risk individuals and their loved ones.
Thank You To Our Partners
Warm Hand-Off Program
The Warm Hand Off Program is a public health & public safety partnership designed to ensure early, immediate, and repeated linkages to care and referrals to treatment for persons who have overdosed. Through collaborative efforts among law enforcement, medical providers, social workers, and prevention professionals, this team engages overdose survivors and their family or loved ones, to reduce risk of subsequent overdose and improve health outcomes. The team consists of Overdose Response Technicians, or ORTs. An ORT is someone with lived experience. They receive Recovery Coach Academy© training by CCAR and are practiced at the skills of motivational interviewing and engagement. The ORT’s job is to meet people where they are at- with unconditional positive regard. Through coaching they encourage and promote connections to care and treatment, education, and harm reduction practices that keep the overdose survivor alive and their community safe. Since August 2020, ORTs have helped 25% of overdose survivors successfully link to care and treatment resources.
Warm Hand-Off Program Evaluation
The University of Connecticut – Institute for Collaboration on Health, Intervention, and Policy (InCHIP) is conducting evaluation on the effectiveness of the Warm Hand-Off Program so that the City of Waterbury can contribute to the body of evidence on the efficacy of this approach, and serve as an innovator within the State. The project is anchored in its objective to fill gaps in service for case management by entering the survivor into the most appropriate evidence-based treatment program across a range of providers in the greater Waterbury area. The evaluation will use a mixed methods approach that examines quantitative data (numerical values of type and frequency) and qualitative data (stakeholder feedback via focus groups and interviews) to examine WHOP’s impact on treatment outcomes and identify areas of program strength, while monitoring any identified potential areas for continual improvement.
The Greater Waterbury Health Partnership
The Greater Waterbury Health Partnership aims to provide access to culturally sensitive, and evidence-based health information for the Greater Waterbury region, and to coordinate local healthcare services to improve overall community health. Supported by data, GWHP’s mission is rooted in community collaboration as a critical element to meet the needs of our diverse communities. As the region’s first health partnership of clinical and community providers, GWHP was founded by a group of non-profit community leaders in 2013 to collaboratively fund the region’s first Community Health Needs Assessment. Waterbury faces health challenges similar to other urban centers across the United States. By bringing multi-sector partners together to address these community challenges through a data-driven approach, there are opportunities to improve health outcomes.
The Community Care Team
The Community Care Team is a formalized clinical and community-based organization integration project. The CCT team is made up of over 40 social service and health care providers in the Greater Waterbury community who come together weekly to provide intensive case management and coordinate care for the highest utilizers of our hospital Emergency Departments and most vulnerable residents. The CCT uses the data platform, Unite Us, to efficiently and securely track and send referrals to Partners that are enrolled in the system. The unique care coordination database called Unite Us allows GWHP to track linkages and measure progress of patients with outcome indicators. The CCT works to link patients with the care they need and coordinate services for any social determinants of health or barriers they may be facing. CCT interventions tend to be long-term with the goal of helping communities of color that are housing challenged achieve stability and independence.
WHD delivers an integrated communications campaign including the use of CDC, CTDPH, and National Safety Council media campaigns and promotion of the NORA app. WPD partnered with the WHD to promote safe storage & safe disposal messaging. As a result, WPD tallied record Rx disposals in the WPD Rx drop box. The WHP, WFD, and WPD collaborate on numerous community outreach events such as on-site training events for workplaces and community groups. The WHD hosts monthly Narcan trainings to educate the public about opioids and how to respond if a loved one is experiencing an overdose. In addition, the WHD conducts QPR, or question, persuade, refer, training which is an evidence-based suicide awareness training.
Social media communication campaigns are catalogued under the hashtag #ODPreventionWaterburyCT. Local messaging is created weekly, including photos and videos to raise awareness, reduce stigma, promote naloxone training and preparedness, and to signal the emergency nature of the opioid crisis. In addition, the WHD has created PSA videos in collaboration with multiple municipal leaders and frontline staff to reduce stigma, create a welcoming environment, and educate the public on Naloxone, the NORA app, opioids and suicide, and much more.
The outreach workers encourage harm reduction practices by ensuring that individuals in the community have access to fentanyl testing strips, naloxone, STI & HIV/AIDS testing, education, and referral to counseling & case management, Syringe Service Program information, and safer sex materials. They utilize GIS mapping to determine high need areas which helps to establish where outreach services are necessary. Current staff are trained in Motivational Interviewing to help propel clients towards health efficacy.
ODMAP is a tool designed to facilitate real-time identification of suspected drug overdose spikes. ODMAP data can be used to deploy response plans to confirm and address increases in overdose incidents reported by first responders. Those who use ODMAP will be able to track overdoses specifically to identify trends and spikes to alert public health agencies so they can best deploy their resources and limit damaging effects of suspected narcotics by developing a plan to address the rise in overdoses in their jurisdiction.
ODMAP consists of two components- the data collection platform and a data dashboard. The data collection platform allows first responders to record information on fatal or non-fatal overdoses, naloxone administration, and the general location of the incident.
The data points in ODMAP are suspected overdose incidents and may not correspond to a confirmed overdose case. The data dashboard information is released to those who have a need and right to know the information in the performance of their criminal justice or public health functions.
OUR FUTURE PLANS
Waterbury’s Overdose Data to Action grant is a 3-year cooperative agreement between the Centers for Disease Control and the CT Department of Public Health, that began in September 2019 and focuses on the complex and changing nature of the drug overdose epidemic and highlights the need for an interdisciplinary, comprehensive, and cohesive public health approach. Funds awarded as part of this agreement will support city health departments in obtaining high quality, more comprehensive, and timelier data on overdose morbidity and mortality and using those data to inform prevention and response efforts.
The prevention component of this cooperative agreement will position recipients to strengthen prescription drug monitoring programs, improve state-local integration, establish linkages to care, and improve provider and health system support. And by piloting the Warm Hand Off to Care Program, Waterbury is using additional strategies that improve partnerships with public safety and first responders, empowers individuals to make safer choices, and provides opportunities for innovative prevention approaches. Waterbury’s goal is to fully staff this pilot to provide real-time overdose response 24 hours per day, 365 days per year, to connect persons at risk to care, decreasing subsequent overdose and death, and improve outcomes and recovery capital in the greater Waterbury area.
About the Data
Through Waterbury’s expanded strategic partnerships for data sharing and responsive service deployment, the Waterbury Health Department, Waterbury Fire Department, and Waterbury Police Department have partnered to create a weekly overdose report that demonstrates what is happening on the ground in this city. The report combines data gathered by WHD from the Epicenter Syndromic Surveillance system for related healthcare utilization, with local pre-hospital data compiled by WFD, including overdose-related calls to 9-1-1 dispatch and subsequent local ambulance transports. WFD pins the location to a GIS map to track overdose locations and identify high-need neighborhoods for outreach. WPD compiles all overdose-related reports for follow-up by Overdose Response Technicians. Together, Waterbury emergency responders and health partners are working together to utilize this important data to meet people where they are at- saving lives, building community capacity, and integrating care across the continuum of services.
Mortality data was queried from CDC WONDER based on the following combinations of ICD-10 codes:
• For opioid deaths — UCD codes: F11.0, X40-X44, X60-X64, X85, Y10-Y14; MCD codes: T40.0-T40.4, T40.6
• For fentanyl/synthetic opioid (excluding methadone) deaths — UCD codes: X40-X44, X60-X64, X85, Y10-Y14; MCD codes: T40.4
Opioid Prescription data is from the U.S. Opioid Prescribing Rate Maps.
Suspected overdoses in December 2020 by County is from the CT Statewide Opioid Reporting Directive (SWORD).
National drug-related deaths data is from amfAR.
Trends in Emergency Department Visits for Suspected All Opioid Overdose is from the CDC’s Drug Overdose Surveillance and Epidemiology (DOSE) System.
Monthly opioid and fentanyl overdose data was provided by CT DPH Opioids and Prescription Drug Overdose Prevention Program.
Opioid-related ED visits per 100,000 population and inpatient stays per 100,000 were queried from the Agency for Healthcare Research and Quality.