From 100-Day Challenge to Systems Change: An Unlikely Journey for Opioid Stakeholders in Palm Beach County
President and Founding Board Member,
Rapid Results Institute
Patrick McNamara, President and CEO, Palm Health Foundation
Palm Beach County, Florida became an epicenter for the nation’s deadly opioid crisis, with the number of opioid-related deaths hitting epidemic proportions in 2016. An upward trend in deaths continued, with nearly 600 fatal overdoses recorded in 2017. In response, Southeast Florida Behavioral Health Network partnered with Palm Health Foundation, Hanley Foundation, and the Town of Palm Beach United Way in the winter of 2018, to bring the Rapid Results Institute (RRI) to Palm Beach County to help spur urgent systems change. RRI has emerged as a pioneer in embedding “100-Day Challenges” within community change efforts that have yielded breakthrough results in more than 20 countries. Through the convening power of the philanthropic partners, RRI brought together community stakeholders, including service providers, police departments, and hospitals, to design a coordinated response. Many of the organizations had previously participated in various task forces and other efforts to respond to the emerging crisis, yet this convening was different in a few important ways:
- The collaborative effort was framed in the context of a 100-day challenge, with the aim of making significant progress on one or more critical indicators of success related to the crisis.
- The convening set the stage for launching a cross-organizational team of ‘front-liners’ who were more familiar with the issues and constraints. These frontline staff became the 100-day team that took ownership for defining the goals and implementing solutions.
- The 100-day team had full agency to decide and act, with the organizational leaders providing support and air cover.
The 100-day team eventually landed on a goal of creating a unified and coordinated system of care to serve at least 125 persons in 100 days at 15 participating treatment centers and 25 Florida Association of Recovery Residences (FARR) - Certified Residences, with proper support and recovery navigators. The process of arriving at this goal was far from straightforward; in fact, the team began as two separate teams and merged into one a few weeks into the process. While the effort was tough on everyone involved, the results achieved by the 100-day team exceeded expectations:
- A total of 135 people were served within the new safety net recovery system of care linked to treatment and housing.
- Eleven FARR-Certified Residencies began using navigation services and receiving rent subsidy for individuals who could not previously access services due to lack of insurance or financial resources.
- A centralized database of scholarship beds and treatment was established to help expand the capacity of treatment and residential beds.
- A 211 Helpline was established as a central call center connecting those in crisis to the newly established system of care.
- Fourteen recovery navigators were enrolled in the Recovery Outcomes Institute Program, where navigators mentor, monitor, and measure an individual’s development of recovery.
- The county’s first respite facility was established to help alleviate waitlists for detox and crisis support. The 14-bed respite facility provides 24/7 medical assessment and a stable housing environment for those who agree to medication assisted treatment after being discharged from the hospital.
- The Delray Beach and Jupiter Police departments were early adopters of facilitation to treatment and spearheaded education of other jurisdictions to reduce stigma around opioid use disorder.
- Peer engagement services were expanded, and the groundwork was laid to establish an Emergency Department peer specialist program that will connect opioid use disorder patients to a peer specialist who can connect the patient to needed resources before hospital discharge.
Beyond achieving these results, it was remarkable to see the level of innovation and collaboration that was unleashed during the 100 days. The community of stakeholders came together to address this issue in ways we had not experienced before. While the 100-day challenge was completed in mid-June 2018, the organizations involved are continuing to collaborate and build out their coordinated response system to the crisis.
By January 2019, the Palm Beach Post reported that the death rate from overdoses in 2018 had plummeted by 41 percent. While attributing causality after the fact in complex systems change is tricky, there is little doubt that the combined efforts of the State Attorney’s office, the heroic work of first-responders and peer specialists, and the new safety net system of recovery helped disrupt the deadly dynamics of the opioid crisis.
The unique challenge process also highlighted the roles health philanthropy can play in supporting systems change. First, health philanthropy can exercise adaptive leadership in times of crisis. This entails “accepting responsibility to create conditions that enable others to achieve shared purpose in the face of uncertainty” (Ganz 2010). Given the fact that addiction issues are heavily stigmatized, often fraught with competing agendas, and can present a fair amount of uncertainty, philanthropy has generally been reluctant to get involved. We learned that, particularly in times of crisis, philanthropy can play a vital leadership role in helping to create conditions for systems change. While funders and local authorities helped to convene organizational leaders to participate in the 100-day challenge, they were also asked to adopt certain principles during the challenge process, including: ceding power and control to members of the 100-day team who were mostly frontline staff; giving full autonomy to the team to set goals and develop solutions; and encouraging leaders to act as mentors during the experimentation and implementation phase. Additionally, leaders from philanthropic organizations and local authorities were asked to model this ‘power reversal’ by refraining from exercising their own power without the input of the teams.
We often emphasize specific outcomes when identifying practices that can be replicated or scaled yet ignore core factors, such as how these practices emerge and why they gain traction in a local system. Drawing from FSG’s “The Water of Systems Change” report, transforming a system entails diving below the surface to change the mental models, relationships, and power dynamics that hold a problem in place (Kania et. al. 2018). The focus on an ambitious goal and the urgency of the 100-day timeframe helped nudge system actors towards new behaviors characterized by intense collaboration and rapid experimentation. The community will undoubtedly encounter setbacks on its path to tackling this complex issue, but the 100-day challenge opened a door towards a new way of collaborating and sparked innovation at an unprecedented pace.
Ganz, Marshall. Leading Change: Leadership, Organization, and Social Movements. Excerpted from Handbook of Leadership Theory and Practice: A Harvard Business School Centennial Colloquium. Boston: Harvard Business Press. 2010.
Kania, John; Kramer, Mark; Senge, Peter. The Water of Systems Change. FSG. June 2018.