Jurisdiction Level Vulnerability Assessment Toolkit

Addressing Prevention Gaps and Intervention Considerations

Once prevention gaps were identified as a result of the assessments, jurisdictions leveraged the findings to address these gaps, and considered what interventions could best serve the vulnerable populations identified within their states. These considerations formed the basis of their intervention plans, which were shared and vetted with stakeholders before being finalized for implementation. In considering these interventions, states often engaged existing programs and services, looking at what had already been successful in the state or county, and leveraged those to address newly identified gaps through expansion to neighboring areas and providing shared services. For some interventions this was considered to be a scaling up of existing services, and for others it was viewed as implementing promising practices. Some specific interventions considered by states included medication-assisted treatment (MAT), syringe services programs (SSPs) or hub and spoke models of treatment [12]. In hub and spoke models, hubs are specialty opioid treatment program clinics that dispense medication and provide daily dosing and therapeutic services. Hubs, as opioid treatment programs, are the only settings at which methadone is offered for the management of opioid use disorder. Spokes are general medical settings providing office-based opioid treatment in which medications are prescribed and patients are seen weekly or monthly.

Many states consider these interventions to be one step that is part of a broader set of proactive efforts to avoid major outbreaks. Many states plan to replicate the assessment findings over time and to conduct further assessments of their population risks, including determining ways to tailor the findings and intervention responses to population subgroups.

Nebraska Vulnerability Assessment Project

Information provided by Felicia Quintana-Zinn

Nebraska’s Department of Health and Human Services (DHHS) sought to conduct a vulnerability assessment to both identify the high burden jurisdictions in the state, and to take a holistic approach to the entire state population. Nebraska has both rural and frontier areas, which despite having higher burdens of risk for opioid overdose and bloodborne disease transmission, lack the resources to address these risks. Public health jurisdictions had been expressing interest and the need for an assessment for several years, and collaborations and conversations that laid the groundwork for the assessment had begun more than two years ago.