Overdose Data to Action Stories

Building meaningful partnerships in Baltimore County, MD

The Baltimore County Department of Health is one of 40 health departments funded under the OD2A: LOCAL cooperative agreement. Bina Ali, PhD, MPH, a senior evaluator at the Pacific Institute for Research and Evaluation, has worked with the Baltimore County Department of Health since 2020. After seeing her presentation during CDC's site visit in July 2024, we spoke to Dr. Ali about how Baltimore County uses the comprehensive community needs assessment results to build solid and meaningful partnerships in the first year of this five-year cooperative agreement.

CDC: What went into conducting the community needs assessment for Baltimore County?

Bina Ali: Our needs assessment was informed by the overdose prevention literature and CDC's resources, including the OD2A Framework, the Framework for Evaluation in Public Health, and the principles for health equity. We used multiple data sources and methods to make our needs assessment as comprehensive as possible, including:

• Reviewing Baltimore County fatal and nonfatal drug overdose surveillance data to identify populations at the highest risk for overdose and to determine where certain prevention activities and services would be needed most.
• Conducting in-depth interviews with certified peer recovery specialists to identify system-level challenges to peer recovery specialist work in the county.
• Surveying EMS staff to assess their overall awareness, attitudes, and self-efficacy regarding drug overdose prevention and practices and identify training needs.
• Interviewing friends and family of people who have died from drug overdose to explore gaps in Baltimore County's overdose response and identify system- and program-level recommendations and service needs from the loved ones' perspectives.
• Surveying members of the county's Drug Overdose Lethality Review Team to understand their processes, factors that affect those processes, and areas for improving their processes.
• Discussions with the Baltimore County Overdose Prevention Team members to explore partners' perspectives on ways to advance system-level recommendations.
• Assessing the needs of clinical staff to gain insights into providers' awareness and use of services and supports in the county and to inform the development of a learning collaborative.

CDC: What surprised you about conducting the community needs assessment?

Bina Ali: Engaging partners during a needs assessment is challenging in public health work. However, in Baltimore County, we found that many local partners were excited to participate and contribute to the county's prevention efforts when approached. Through this community needs assessment, we brought essential partners and meaningfully involved them from the beginning. Such engagement of partners, especially the buy-in from our harm reduction services organization partners, led to collecting data from hard-to-reach populations, including people who use drugs and experience inequities.

Participants in the needs assessment were genuinely interested in participating in the data-to-action process. Some community members had specific recommendations for improving systems and felt welcome to make them. They said, "Here are different ways we want the county to help us." Hearing about ways to address inequities directly from the folks experiencing gaps and challenges in the system was an unexpected bonus from conducting the community needs assessment.

CDC: How has it been sharing findings back with everyone whose work and lived/living experiences informed the assessment?

Bina Ali: Since completing the assessment, our team has been disseminating the results tailored to different audiences. In addition to sharing formal reports with executive summaries with the OD2A program staff, we have also created infographics and given oral presentations with slides for specific audiences. When deciding how to share the findings, we consider our audiences. We also collaborate with the OD2A program staff to determine the best ways to engage the appropriate partners.

Sharing the findings with community partners is an essential part of the data-to-action process, but contextualizing the assessment's findings has also been essential for making informed decisions and taking action. The process has led to increased collaboration and deepened partnerships.

CDC: What are some examples of Baltimore County's actions because of the needs assessment? How are partners using the data for action?

Bina Ali: Based on the literature and discussions with our partners, we identified implications for our findings. I'll share a few examples. Findings from the interviews with the county peer recovery specialists identified the need to create a directory of trained peer recovery specialists, extend the hours of staff providing harm reduction services in the county, and confirm the need for naloxone vending machines. Findings from the EMS survey identified the need to educate EMS staff on the roles and responsibilities of peer recovery specialists and to form a quick response team. All these actions were taken and are already making a difference. The community partners are also using the needs assessment data to help better understand disparities and engage in discussions around improving access to services. They use this info for people who use drugs across the county systems and inform their organizational efforts.

Year one program progress is setting the stage for future success

In year one of the cooperative agreement, Baltimore County built a strong foundation for working together. Strengthened partnerships and collective work are critical to making a difference in a local area—systems-level effort is required and must engage all relevant parts of the system. After just one year, partners have seen the value of engaging all sectors and how much that contributes to making a difference.

In closing, Bina shared, "The county leaders, program staff, and partners are engaged, passionate, and care about the work. Despite their busy schedules, they make the time to talk about evaluation findings and dig deep to reduce silos and make sure everyone is working together toward the shared goal of preventing drug overdoses. I'm honored to work alongside such a dedicated team of public health professionals."