Counties turn to universities, hard data to gauge opioid settlement impact

Key Takeaways

Because opioid settlement funds can often be paid out over roughly 18 years, most counties have time to test what works, measure it and change course. The catch, panelists said Thursday during the Opioid Settlement Summit, a pre-conference workshop at NACo’s Annual Conference, is that the measuring itself — formal evaluation — is often the hardest and most neglected piece of that cycle.

Evaluation is the final step that restarts the loop, and frequently the most complicated one, said Amy Dolinky, director of opioid services for the Michigan Association of Counties, who moderated a session on evaluating the impact of settlement investments. She pointed to two counties that have wired data collection into their programs rather than bolting it on afterward.

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For Jason Berry, director of planning and community engagement in Monroe County, Mich., evaluation started with a question some counties might skip: What is the community trying to accomplish? The county of roughly 150,000 partnered with Michigan State University on a community needs assessment and Wayne State University to analyze the results, mapping gaps in services and barriers to treatment through focus groups, surveys and interviews with residents in recovery and their families.

The data gave Berry standing with county leadership. “My ideas, I didn’t believe were good enough,” he said. “I wanted to bring hard data.” When state grant funding ran out, Monroe County used settlement dollars to keep the Wayne State analyst on staff to help providers build quarterly reports and benchmark similar services against one another.

Settlement money should supplement existing services, never supplant them, Berry stressed, and should go directly to programs and the people affected. “While we can’t change the past, we can look forward and make a difference,” he said. He credited that approach with a sharp drop in overdose deaths since the programs began — a decline he attributed largely to peer recovery coaches who help people navigate insurance, medication and housing.

In Mecklenburg County, N.C., Opioid Settlement Program Manager Marcus Boyd described a similar evolution. Providers initially reported whatever metrics mattered most to them, making programs impossible to compare. The county shifted to the North Carolina Measures Model — strategy-specific process, quality and outcome measures that let treatment, housing and employment programs be benchmarked while still tracking custom metrics. The University of North Carolina at Charlotte serves as its formal evaluator, tying front-end assessments to outcomes ahead of a fall request for proposals.

The numbers are moving in the right direction, Boyd said: fewer overdose events and more people entering care. But he was candid about the gaps — a jail-based medication program served just 54 people this year, too few for the county’s size, prompting a contract review. Mecklenburg pairs its quantitative measures with private community surveys and resident feedback. “Sometimes the data doesn’t tell the full story,” Boyd said.

Asked what single practice every local government should adopt regardless of budget, Berry urged counties to start with people, not money: stand up a task force at little cost, then call local colleges. “There are departments and professors that live for this kind of stuff,” he said, noting university extension offices and community mental health agencies can often help protect sensitive data.

Boyd’s prescription was simpler — core metrics and a willingness to listen. “You have to listen to the community,” he said, not only people in recovery, but the families and children affected alongside them.