The Principles for the Use of Funds From the Opioid Litigation are nationally recognized guidance for states, counties and cities receiving money from the lawsuits against entities that contributed to the opioid epidemic. These planning Principles, coordinated by faculty at the Johns Hopkins Bloomberg School of Public Health, can help jurisdictions create a foundation for effective spending of the monies to save lives from overdose.

The Principles encourage communities to use settlement funds to supplement existing opioid abatement work (Principle 1) and invest in effective, evidence-based interventions (Principle 2). Conducting a local needs assessment is an important early step in determining how to disburse these limited resources for maximum impact.

What is a needs assessment?

A needs assessment is a systematic process for identifying a community’s health needs and assets. In the context of opioid settlement planning, a needs assessment is used to identify the areas in which interventions can save the most lives.

Needs assessments rely on local data. Both quantitative data (e.g., number of overdose events, number of individuals receiving treatment, and length of waitlists for care) and qualitative data (e.g., community-identified priorities) help tell the story of a community’s opioid challenges and current methods for navigating them. Needs assessments use this data to identify discrepancies between a community’s needs and its system capacity that warrant further investigation and investment.

Who conducts a needs assessment?

In many counties, needs assessments are entirely administered by the local health department, though it may also contract with other organizations to conduct all or part of the assessment (e.g., schools of public health, non-profit organizations).

When should a needs assessment be conducted?

The Substance Abuse and Mental Health Services Administration suggests conducting a needs assessment every three years. As we have seen during the COVID-19 pandemic and with the introduction of synthetic opioids like fentanyl into the drug supply, the substance use landscape in the United States can change quickly. Periodic needs assessments help counties tailor their opioid response strategies to their population’s evolving needs.

Why is a needs assessment important for planning opioid settlement spending?

Opioid settlement funds are arriving after years of county-led opioid response efforts. A needs assessment can help counties invest this new funding strategically to expand the reach of currently funded solutions and close gaps in services, either where needs are not being met or where new needs arise. These funds will be disbursed annually over many years depending on the settlement terms. A needs assessment is a powerful tool counties can use to ensure settlement funds create a sustainable, long-term reduction in opioid misuse and overall substance use disorder.

Many jurisdictions already possess sufficient resources and data to conduct a needs assessment. This guide will serve as a quick reference to aid counties in conducting such an assessment to assist in investing their opioid litigation funds.

Steps for conducting a needs assessment

1. Define the scope

Prior to launching a needs assessment, define the learning objectives and subject to be studied. By focusing the needs assessment on areas that settlement funds can support (i.e., eligible uses per settlement and state-specific guidelines), jurisdictions can streamline planning and implementation. To accomplish this:

a. Specify the issue

Define the scope of the problem within the community—the needs assessment may look only at opioid use or at substance use more broadly. Understanding the changing nature of opioid and substance use in the community can help localities invest in programs that address polysubstance use, which contributes heavily to overdose-related death.

b. Locate geographic boundaries

Determining the appropriate geographic area clarifies the needs of the community and the services that are available to community members. For example, a treatment facility that is widely used by community members might be located in an adjacent county. Understanding such patterns in service use will help a community more accurately address gaps within and between service systems.

c. Identify populations of focus

No community is homogeneous and the needs of different subsets of a community may vary significantly. Jurisdictions should determine which subgroups should be studied as part of the needs assessment. This could include breakdowns by age, race, ethnicity, income, and sexual orientation.

In 2020, the Sacramento County, Calif. Board of Supervisors approved a resolution to ensure that the county consistently collected, analyzed, and reported data to measure progress towards eliminating racial disparities. In 2022, Sacramento County conducted a needs assessment using a health equity lens to identify geographic areas that have the greatest concentration of poor health outcomes and prioritize the health needs of each of these areas. The 2022 Community Health Needs Assessment describes the data sources and methodology used for this effort and examples for reporting and discussing data on racial inequities. Visit NACo’s diversity, equity, and inclusion resources for additional examples.

d. Assess mechanisms for interventions

A needs assessment can identify community strengths and gauge a county’s readiness to implement other solutions. It can explore:

  • Currently available resources across the continuum of care, including:
    • Prevention projects/programs
    • Harm reduction resources
    • Treatment options
    • Recovery supports
  • Evidence of effectiveness of currently-funded interventions
  • Existing funding sources, and
  • Opportunities to address service gaps and other key challenges facing the community.

2. Assign who will conduct the needs assessment

County health departments may be well-positioned to conduct the needs assessment based on existing staff capacity or staff hired with settlement funds. The selected staff members should have quantitative and qualitative data collection and analysis skills.

There are many effective ways to structure the administration of a needs assessment. County health departments may decide to contract out all or part of the needs assessment. The assessment can be led by either a state or a region. In the case of a regional needs assessment, counties may consider pooling resources. Local foundations or academic institutions (e.g., schools of public health) can also assist with the needs assessment.

Potential partners for conducting a needs assessment

  • Community-based organizations
  • Charitable foundations
  • Public hospitals
  • Social service agencies
  • State departments of health
  • Colleges or universities
  • Private health systems
  • Civic and volunteer groups
  • Private research firms

3. Choose the data

A needs assessment weaves together different types of information to compare the scope of the problem with existing solutions to inform recommendations. Much of this data is already available and key partners can help track down missing data. This information can come from:

a. Quantitative assessments

Quantitative information can demonstrate the magnitude of the issue being studied, and whether outcomes are improving or deteriorating. Potential sources of data include:

  • Health care systems (e.g., number of visits to emergency rooms for nonfatal overdoses)
  • Treatment records (e.g., number of individuals receiving or awaiting treatment and support services)
  • Medical examiner reports (e.g., specific substances present at the time of a fatal overdose)
  • State or national surveys on drug use

It is often helpful to contextualize this information by comparing the quantitative outcomes from one county to those of the region, state, or even country.

b. Qualitative assessments

Qualitative information can fill any gaps in the local “story” or landscape, and answer the “why” and “how” questions that quantitative data cannot. These data can be collected through short community surveys, listening sessions, or key informant interviews. In seeking community input, it is important to include individuals who represent the larger community, who might include:

  • People with lived experience (e.g., people who were previously or are currently in treatment for drug use, people who use drugs, and family of people who use drugs)
  • Community members who represent the diversity of the local community (e.g., selected based on their age, race, income, and/or geography)
  • Service providers (e.g., treatment providers, harm reduction practitioners, and other social service providers)
  • County agency leaders (e.g., public health directors and law enforcement leaders)
  • Local elected officials (e.g., county executives, commissioners, or supervisors).

4. Put the needs assessment to use

Once the needs assessment has been conducted, communities should determine which evidence-based interventions they will fund to fill any gaps the needs assessment has identified. This information can be used to inform procurement decisions or targeted requests for proposals from community-based providers.

As decision makers review the needs assessment, they should identify the most appropriate source to fund the identified areas of need. For example, localities may have more flexibility to fund capital projects or harm reduction programs with resources from opioid settlements than they do with other funds. This information is also useful in planning for the long-term effectiveness and continuity of these programs.

Counties should consider making the findings of the needs assessment public so the community can see the decision-making process. This transparency can be achieved by posting the report on a website and highlighting the findings in a press release and/or through public meetings (Principle 5). 

Jurisdictions can also use the needs assessment process to examine possible barriers to program success (Principle 2). This could include insufficient or inconsistent funding, provider availability, bias, or local policies or regulations that
block program implementation.

County Examples

Cambria County, Pennsylvania

Between 2018 and 2020, Cambria County conducted a comprehensive needs assessment focused on substance use prevention. The needs assessment was led by the Cambria County Drug and Alcohol Program (the single county authority for drug and alcohol services) in partnership with several community organizations. The assessment team used a process developed by the state and a local university to gather administrative data and qualitative data from community members. ACCESS THE REPORT.

Howard County, Maryland

The Howard County Health Department conducts biennial health assessment surveys modeled after the CDC’s Behavioral Risk Factor Surveillance System. The county uses this data to develop strategic plans that model the years ahead and annual reports that communicate existing programs and services to the community. The 2018 and 2019 annual reports detailed the county’s opioid response efforts, including stakeholder engagement, evidenced-based prevention strategies, harm reduction, public education and behavioral health courts. ACCESS THE REPORTS.

La Porte County, Indiana

In 2016, the Healthcare Foundation of La Porte (HFL) received a grant from the state to conduct a community needs assessment specific to opioid use. HFL partnered with the Center for Health Policy at Indiana University to conduct the assessment, which sought to measure the current state of opioid misuse in the county, measure the community’s capacity to respond and identify gaps in services. Through survey and interview data analysis, the team developed a strategic framework to reduce opioid misuse in the county. ACCESS THE REPORT.

Lyon County, Nevada

In 2022, Lyon County developed an “Opioid Use and Misuse Community Needs Assessment.” The assessment was informed the CDC’s Behavioral Risk Factor Surveillance System, data collected by the county’s Mobile Outreach Safety Team and information shared during the Lyon County Human Services 2019 Opioid Summit. The report details low-, mid- and high-level priorities for addressing the opioid crisis and promoting continuity of care and expanded services. ACCESS THE REPORT.

Maricopa County, Arizona

Maricopa County conducts a community health needs assessment every three years, developing this assessment into a Community Health Improvement Plan (CHIP). Data for the assessment is gathered through multiple sources, including community health status reports, community surveys, focus groups, key informant interviews, local public health system assessments and Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis. The three priority areas identified in the 2020-2023 report were access to care, access to healthy food and early childhood development. ACCESS THE REPORT.

Wake County, North Carolina

Wake County conducts a community health needs assessment every three years. The 2019 assessment was co-chaired by a member of the Board of Commissioners and the president of a local nonprofit health system and completed by over 100 agency and community partners. The needs assessment identified five county-wide priorities: transportation options and transit; employment; access to care; mental health/substance use disorders; and housing and homelessness. After releasing the report, the needs assessment team held a series of action planning meetings with residents and community organizations to determine how to address these priorities. ACCESS THE REPORT.