Jurisdiction Level Vulnerability Assessment Toolkit

The second step was to compile data and calculate indicators, if needed. Data used in assessments varied from state to state, but a number of sources were fairly common and included: American Community Survey (ACS), Behavioral Risk Factor Survey (BRFSS), hospital discharge data, National Electronic Disease Surveillance System (NEDSS), Prescription and Drug Monitoring Programs (PDMP), US Census, USDA Food Security Survey, and vital records.

Analysts in some states then visually explored data using geospatial software to identify patterns across the jurisdiction and qualitatively identify areas with overlapping risk factors. This was done to gain a better understanding of the data such as data completeness, extent of ‘zero’ values, distribution, and preliminary geographic variability. The Data Collection and Exploration section describes software (Microsoft Power BI and R) that can be used for data exploration and visualization, the advantages and disadvantages of each, and includes example maps for select indicators.

The third step was to develop the assessment, detailed in the Assessment Approaches section of the toolkit. There were three primary analytic approaches applied:

Composite Index Score. The Composite Index Score (CIS) approach is based on the Social Vulnerability Index (SVI) by the Geospatial Research, Analysis, and Services Program (GRASP). For JVAs, indicators appropriate to opioid-related vulnerability were used rather than the natural disaster and response related indicators used in the SVI. A nationwide example, including an Excel template, based on publicly available data on socio-demographics, crime, prescriptions, and mortality is available to demonstrate how to calculate the CIS. This example serves as a template for jurisdictions to perform a CIS analysis.

Statistical Modeling. Statistical modeling was used to identify the specific factors associated with the outcome(s) of interest for a specific jurisdiction. Using this approach, analysts could calculate an estimated rate of the outcome of interest and better understand the key factors affecting that community. The Statistical Modeling section goes through appropriate types of models, variable selection, transformations, correlation matrices, factor analysis and presentation of model outputs.

Spatial Epidemiology. Spatial epidemiology addresses the place component of the epidemiologic triad – person, place, and time – by using multiple layers of georeferenced data to achieve a more granular understanding of the phenomenon of interest within a community or other defined geographic area. Several jurisdictions used spatial epidemiologic approaches to assess their vulnerability, often displaying their results using choropleth maps. The Spatial Epidemiology section provides examples of choropleth mapping options as well as additional methods used by states such as drive time analyses.

After conducting assessments, jurisdictions examined higher vulnerability areas further to identify what services and resources are available in those areas to mitigate these risks. These gap identification efforts typically involved engaging local stakeholders, such as county programs and providers to analyze findings, identify services and resources, and provide feedback. For example, it was found that some counties were providing rapid testing services or syringe services programs outside of their catchment areas to fill existing gaps in the other counties. Alternatively, jurisdictions created lists of community-based programs and providers of treatment services and compared the locations of those to the identified highly vulnerable communities to see where pockets of need still exist. The Identifying Prevention Gaps section provides specific details and examples of how states carried out this step of the project.

The fifth step was to develop plans to address the identified gaps in services. This activity also centered around stakeholder engagement. Often, models of services that worked well in one area of the state were leveraged to help plan for other areas where a community was experiencing a gap in service. For example, new developments in treatment and harm reduction, and increasing awareness and providing education around medications for opioid use disorder were activities included in plans to address gaps in services. The Addressing Prevention Gaps and Intervention Considerations section describes how states leveraged vulnerability assessment findings to shape interventions and address prevention gaps.

Throughout the process, jurisdictions used a variety of strategies to engage and communicate with stakeholders about the assessments and to disseminate the findings of the assessment. Frequently, existing stakeholder groups and public health partners were engaged early in the assessment process to discuss the goals of the project, potential indicators, and data sources. Health departments found that leveraging existing relationships and coordinating with partners already implementing prevention strategies to address opioid use and associated bloodborne infections was most effective in securing buy-in and participation in the assessment. Results were communicated using the health department website, newsletters, community meetings, webinars, and state legislative briefings. In the final stages of the assessments, stakeholders reviewed the draft plan to address intervention gaps and provided feedback prior to finalization and implementation. Information on the asset-based approach of stakeholder engagement and communication guidance are available in the Collaboration, Communication, and Dissemination Strategies section of the toolkit.