The Ohio town introduced a simple, but groundbreaking approach to tackle the opioid crisis.
The Ohio town introduced a simple, but groundbreaking approach to tackle the opioid crisis. Geoff Milz, Township Administrator, and Will Mueller, Assistant Chief Administrative Services talk about their award winning, low-tech, high-impact Quick Response Team model, as well as Colerain's budget friendly approach to innovation through projects large and small. Read more...
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Featured government: Colerain Township, OH
Episode guests: Geoff Milz, Colerain Township Administrator, and Will Mueller, Assistant Chief Administrative Services.
Visit govlaunch.com for more stories and examples of local government innovation.
Lindsay (00:05): Welcome to the Govlaunch Podcast. Govlaunch is the Wiki for local government innovation and on this podcast we’re sharing the stories of local government innovators and their efforts to build smarter governments. I’m Lindsay Pica-Alfano, co-founder of Govlaunch and your host.
In this episode, Jess from our team sits down with Geoff Milz and Will Mueller of Colerain Township, Ohio. Their team has taken a simple, yet effective approach to serving their most vulnerable community members and their work in response to the opioid crisis has earned them international recognition. The model relies on relationship building — not technology — is being replicated across other local governments large and small.
Colerain is the second largest township in Ohio with about 60,000 residents spanning 43 square miles. With such a large geography, serving, let alone reaching some of their more rural residents can be a challenge.
I’ll turn to Jess and the team in Colerain Township to talk about their work in response to the opioid crisis. We’ll also hear about some other interesting projects and useful insights for anyone looking to innovate in a more cost effective and human-centered way.
Jess: I'm Jess from Govlaunch, and I'm here with Geoff Milz and Will Mueller from Colerain Township, Ohio. Geoff and Will tell us about your rules.
Geoff (01:25):
Hi Jess, just my name is Geoff Milz. I'm the township administrator here in Colerain township. The township administrator's job is different every day, but that's the chief administrative officer for the township.
Will: Hey Jess. My name is Will Mueller and assistant fire chief of administrative services for the Colerain township fire department. In that role, I oversee our human resources division, our emergency medical services, operations, our training division and our community risk reduction division, which encompasses code enforcement, public education and outreach.
Jess (01:55): I'm really excited to hear more about this project or this initiative. You've launched a quick response team in Colerain to help address opioid abuse in your township and help get these folks back on track. Tell us a little bit more about this project.
Will (02:11): Well in July of 2015, we launched what you'd mentioned as the quick response team, which was our community's response to our opiate epidemic. In 2014, we saw a stark increase in opiate overdose responses for our emergency medical services agency, which prompted us to act. And so in an attempt to become a little bit more educated about what the scope of the epidemic was, we learned several things about addiction that helped us with this implementation of this particular program. And so what this quick response team is, it’s a team of three individuals that encompasses law enforcement, firefighter paramedic, and a peer support specialist. And that team of three has several goals, which are multi-pronged in nature. Um, the first goal is to bring recovery resources to the doorstep of someone who has overdose and is suffering with addiction. Um, our goal is to meet them where they are.
Will (03:13): We don't expect them to leave their circumstances, leave their family and come to a strange place that is very institutional in nature, which is very uncomfortable. And so we want to meet them where they are. And lastly, we want to remove barriers to treatment and to recovery. And some of those barriers include stigma. They include pre existing, untreated medical conditions, transportation to and from treatment, and lack of ID and Medicaid services, which is a huge barrier. So our quick response team, like I said, encompasses a multipronged approach that addresses that barrier removal and that warm handoff to recovery resources.
Jess (03:57): That's great. I think that coming to the people and building that in-person connection is, is so powerful. And, you know, it seems maybe a little obvious that that would be a key to success in hindsight, but how did you get to that concept?
Will (04:14): Sure. Well, as we were becoming educated about the scope of the problem in Colerain and learned a lot about what addiction is and in terms of it being a disease, we learned that in Colerain that there were two prevalent causes that was bringing the epidemic to our backyard. One of them being the availability of the opiates themselves, as well as the lack of connection to recovery resources. We learned that people who were suffering from addiction, families who had loved ones suffering from addiction had a real hard time reaching out to recovery resources. It wasn't as simple as calling an 800 number and getting help on the line and being able to get in that day. That's what society thinks. That's what culture is telling us. We would learn that that was not the case at all. So we wanted to develop and implement a program that was addressing the issue at its root cause. With those being identified as the root causes, we wanted to make sure that we developed a program that involved both harm reduction and supply reduction.
It's a supply reduction addressing the prevalence and the availability of the opiates themselves, and then the harm reduction, which was the recovery resources. So that's why the team of three individuals. So the idea of developing relationships came from us using public safety as part of this multi pronged approach and part of this team, we knew that if public safety was a key to this program, we would find success. These individuals, both police and fire and EMS were the ones who were responding to the 911 calls anyway. Those individuals knew those, say the fire and EMS individuals and law enforcement individuals knew that people that were overdosing, they knew him by name. They knew where they lived. They knew where they hung out, they know who they hung around. So using that team to kind of infiltrate and break down some of those barriers, really made a lot of sense to us.
Will (06:22): We also know that there was a certain underlying tone of trust associated with the public safety divisions as well. Our law enforcement agency has a strong history of community policing. And so they're very well known in the community and they're a very trusted entity in the community. And when we talk about developing relationships, which we believe is the key ingredient to our program, there has to be trust involved. So using public safety as part of that trust factor was a no brainer. So when people ask, how are you so successful in getting people connected to treatment? We say, because our goal is to develop relationships, and we have a backbone and a foundation for providing that trust in our public safety entities.
Jess (07:07): That's great. And you mentioned, you know, your success, which this program has been incredibly successful, both in your community and beyond. Can you tell us a little bit about what that looks like and how you measure success?
Will (07:19): Absolutely. When we first started the program, we had no idea what to expect in terms of being successful and reaching individuals because our program is somewhat reactive as well as proactive. It's reactive in the sense that we are responding to somebody after they've already overdosed. So it's proactive in the sense that we want to get them connected, to recover resources and leave them Narcan so that we can prevent another overdose and possibly death from occurring before we can get them to help us need. So we really had no idea how to judge, because there was no model before us, as this was the first model in the nation to address opioids in this fashion, that no model would go from them. We had no statistical data to support what we believe was going to be successful. So we were really going into this blind, but what we were told by addiction experts in our area that runs several agencies, that if we got 10% of the individuals that we reached into treatment, that we would be doing exceptionally well.
So with that being said, we entered this whole program thinking that let's shoot for 10%, because that's what we were hoping for and so what we quickly found was that we were going to blow the 10% success rate out of the water. So what we've come to find since our implementation on July 15th of 2015, we have conducted 550 follow ups, just a little over actually, but that 550 is that nice round number. So 550 follow ups, those are investigations that we conducted since that date in 2015. Of the 550, we have been successful at making face to face contact with 375 of those individuals. Now more importantly, out of 375 individuals that we've made that face to face communications with we've engaged 270 in treatment. That number is huge. That represents 72% of the individuals that we come face to face with are successful in engaging in the treatment.
Now what a performance metric is hard to determine is how many of those successfully completed treatment. That's just a number that we're just not able to get ahold of. These individuals, we know that recidivism is part of recovery, especially when you're dealing with opiates and especially when you're dealing with chemical components such as Fentanyl. And so we know that relapse is just part of the process. It's difficult to tell often how many times people relapsed. It's difficult to track individuals who go from one treatment facility to the next. It's difficult to determine when somebody exits treatment and signs out, when do they reenter or do they reenter at all? So that's really one, that's a moving target. That's really difficult for us to put our finger on. So it's not a controllable factor that we can track. However, we do know that out of those 375, we were able to develop a relationship with 270 of those individuals and engage them in treatment. And so we know that the relationship piece is working. We know that the trust is there and we know that the barrier removal is there because those numbers are just unprecedented from similar type programs and from hospital systems that are even trying to get their own patients into recovery. So the 10% number quickly was revised as a goal.
Geoff (11:00): Chief, What I think is so special about this program is that this innovation is rooted in compassion, right? And that is such a simple thing to have, but, obviously, you know, it didn't always dawn on folks to go back to that basic foundational principle of let's care about these people. And that's something that you and former police chief turned township administrator, Dan Malloy, who was also one of the foundational partners in this really brought to the forefront was we're going to start a model that is based on caring about people and wow, look what happens when you care about people, you can really make a difference. And you don't need great amounts of technology. All you need is, is a program that is based on caring, compassion. That's pretty cool.
Will: Absolutely. And there's another reason to use public safety as a vehicle to connect individuals with recovery resources. Law enforcement, personnel, fire, and EMS personnel, they get into this because we want to help people. And so when we take that traditional role of assisting people and we put it into this non-emergency capacity, that is thinking outside the box, that is innovation in a nontechnical perspective. So you're absolutely right. And I would also be remiss to say is that also as a result of that compassion and empathy, we have people who walk into the police department looking for recovery resources.
We have people approaching our fire stations because they've heard about our program and they're looking for help. And I mentioned those statistics before, but I'd be remiss to say that has also resulted in a near 52% reduction in overdose responses over the last year and a half for our EMS agency. And what that 52% reduction means in overdose responses is not just a reduction in number of times, our personnel are being called to go out the door, it means that there's a 52% reduction in the potential for death as a result of an overdose. There's a 52% reduction in the potential of exposure to hepatitis C and HIV, which we are experiencing a rise in. So that means a lot more than just 52%.
Jess: It's so incredible. And, and now Colerain has been serving essentially as a model for other communities to implement similar approaches. What has that looked like? Where, where else are they taking this approach?
Will (13:33): Very quickly on, as we started to gain the success that we did with our quick response team, um, the news traveled pretty quickly here, uh, various media outlets. And so we started to get calls from multiple agencies throughout the country wondering on what our program looked like, how we implemented that, and could we help them develop a training program for their agency so that they can copy the model. Our model's been as, as far as we know, has been replicated in eight states outside of the state of Ohio. We have been replicated in Kentucky, Indiana, West, Virginia, Tennessee, North and South Carolina, Texas, and Delaware. As far as Ohio is concerned, we know to date that we have functioning QRTs up and running in approximately 60 of our 88 counties.
Jess: Wow. So given sort of the, uh, the pickup of this, if there's a community out there that would be interested in implementing a QRT approach, uh, in their own town or city, what advice do you have for them?
Will (14:45): I would advise them to call Goeff Milz.
Geoff: Stop it!
{laughter}
Will: Sorry, we needed a little reprieve. We were getting so intense. So there is several pieces of advice that we give when we do train and invitation for other agencies. However, some of the most important advice, lies with this, don't be afraid to fail, and that's the message to leaders. Don't be afraid to wait for somebody else and their success to be the tip of the spear for the drive and for the innovation that you want to create in your agency. There is no shame and wanting and needing to redesign programs because we missed the mark on some of them. There have been some marks that we have missed in this program. And we've only learned from them and they've only become better from that. I think culture and society tell us a little bit different about failure from a leadership perspective and simply put here those failures and those redos and there's remakes of our program have only made us become stronger as a result. So number one, don't be afraid to fail.
The second one is don't be afraid to lead your agency outside of what their traditional roles are. We are in an age where a multidisciplinary approach to healthcare is becoming more and more prevalent. And this program is a model for a multidisciplinary approach. We are taking three different disciplines that have never worked before together. The silos, they need to be destroyed. They need to be erased. And so that's, um, and we need to not be afraid to look at things a little bit and not be afraid about changing the job description just a little bit to benefit the overall health, wellness and safety of our communities.
Jess (16:57): Changing gears a little, I know there are a number of interesting projects underway in Colerain. Geoff, I'm really interested in, in what you mentioned, this approach where you can do so much without leaning on technology. Last time we talked, you mentioned a clever way that you're all, uh, testing the benefit of a traffic barrier. Can you share a little bit more about that?
Geoff (17:20): Yeah, you bet. So I think anybody in local government who is listening can agree that everybody cannot stand speeders. Speeders are just the bane of everyone's existence in, in, uh, in our neighborhoods. And so, you know, in Colerain township, just like in many other communities, um, we get calls from our residents saying, you know, you've got to do something about speeders and, and a lot of times, we revert to what we know first and that is speed bumps. Well, there's a lot of reasons why speed bumps may not be the optimal solution to the speeding problem. So in one neighborhood in our community, we decided to just test an idea that hadn't been tested around our area. And that's the use of a what's called a chicane. Chicane is something, if you, if you visualize, sort of three offsetting islands, um, that, uh, change the roadway, um, from a, you know, sort of a two lane road into sort of an S curve whereby just one car can get through. We had seen this in Seattle for example, but, you know, Colerain Township certainly is not Seattle and would it work? We didn't know.
And instead of spending, you know, hundreds of thousands of dollars putting in a chicane someplace and then realizing that either A), it didn't work or B) the neighborhood just couldn't stand it. We decided to do this test and really this is sort of indicative of how we look at innovation, right? The idea is to use these cheaper, faster, quicker tests, and then iterate on those ideas until we get it right. So what we did in this instance was, uh, we went out and purchased, uh, some sort of erosion control, uh, hay bales and we created three islands and we put up signage, um, and, uh, and we effectively change the way that this road, this road, uh, functions.
But before we did that, we got data and that's the other really critical piece to our approach to innovation and Colerain is that we really want it to be data-driven. I mean, I know that's a buzz phrase these days, but this is how we sort of operationalize it. We put out speed cameras and signs, and we're able to get traffic information as in how many cars are going down this, this portion of the road and how fast they're going. We did that for about three weeks. Then we installed this cheap chicane. And we kept the speed signs there. We've collected data to see if it worked. That was our first goal is that this thing should slow people down and sure enough, it slowed people down. And we had the data to prove it and then, and so, okay, so it worked, but, but then the next question is, you know, is this going to really, you know, uh, infuriate all the residents that have to drive through this every day on their way to and from the grocery store at work and all that stuff, we went, and we knocked on all the doors on the street and said, Hey, how do you like it?
Geoff (20:17): And of course, 50% said, we like it. 50% said, get it out of here. But ultimately the community group that represents the neighborhoods stepped up and said, no, we really, really like this, and we want it to go forward. So, um, for about $250, we were able to test this, this sort of, uh, infrastructure intervention. Right now it's in design and hopefully next year it'll be in construction. We're really excited about it. It'll be the first, uh, chicane on a local road here certainly in Hamilton County, I don't know, I don't know about the rest of Ohio, but it was fun also.
Jess (20:52): Yeah, I think that's brilliant. I mean, I think the concept of testing and piloting is something that we're seeing among these really innovative governments, we see it a lot in technology, but I love how you guys have brought it into the physical world and done it at such a low cost. And then of course, getting the community buyin and just making sure that there's communication with all stakeholders, we know is, is incredibly important with all projects. Are there any other projects that you'd like to share, um, you know, maybe others for those looking to innovate on a smaller budget?
Geoff (21:23): Well, you know, one of the things that I think, um, is key to the success of, of, you know, a midsize place like Colerain township with 60,000 people is crowdsourcing innovation, right? One of the things that we did was we created a, what we call it, a tactical urbanism mini grant program where residents and neighborhoods could come to us with our ideas for how they could improve their neighborhood, right? We don't have all the answers. That's one of, one of the critical things about our sort of governing philosophy is that we do this in partnership with our neighborhoods, you know, we work for them. And so, you know, if they have a great idea about how to improve their neighborhood, look, let's make that happen. So we set up set aside $5,000 in our annual budget of right now, we're at about $40 million in all funds.
So $5,000, small amount of money, and we made $500 mini grants available. So neighbors will come to us and say, you know, we want to, you know, um, we want to see if a bike lane would work in our community. And so right now there's a neighborhood that's, um, that's applying for a mini grant to, to see if, uh, if, if these bike lanes would work in their neighborhood. Um, and in that way, it's not just us as an organization, that's innovating, we're trying to create a culture in our neighborhoods and in the leadership in our neighborhoods to, to come up with ideas for solving some of the gnarly problems that, that, uh, every community has.
Jess (22:44): Yeah, that's great. And then you're kind of starting off with community buy in when the ideas are coming from them. So one fewer hurdle to clear, right?
Geoff (22:52): Absolutely. And the ownership of that idea is so important too. Kind of a process that has led to a decrease in finger pointing, right? It's gone or almost gone are the days when neighborhoods come and say, you, this is your problem township government, this is your problem. And more and more, we're starting to find that, uh, neighbors are coming to us, seeing us really as partners and saying, what can we do together as opposed to, you know, what can you do for me? It's what can we do together? And that change in culture and mentality within the organization of township government, but also within the community is huge. And I really think that that is going to be the ignition for that that's going to drive real change into the future in Colerain.
Jess (23:40): So last question for both of you, uh, what's something that excites you about the future of Colerain Township?
Will (23:46): Oh my gosh. What doesn't excite us here. We have some tremendous leadership across all of our departments and when you have a leadership team that works so well together, that comes together, so many things can be accomplished. We talked about multidisciplinary approaches to healthcare issues, but what has been developed here in Colerain has been a multi department approach to issues within the township. And this leadership group comes together collectively to say, Hey, how can we put our resources together? How can we put our different disciplines together to make this really work for us? We can bring so many resources to communities that, uh, the smaller communities within coloring, um, and could really assist them and empower them to step up and do great things. I know that's a very umbrella statement, but those things really excite me. They really charge me because they're things that have not been done before.
Geoff (24:47): Yeah. I think, chief Mueller you're spot on there and Jess, by training, I'm an urban planner and, uh, just, uh, because I've been doing that for a while, I get really excited about, uh, changes in the built environment and Colerain Township has a, just as many, many, many first ring suburbs do has a, you know, auto oriented retail corridor that was built up in the sixties that, you know, is showing its age and we have a regional mall here. Um, and so retail is changing and people's preferences are changing rapidly. And I get really excited about trying to envision the future for those kinds of places throughout the country. But we have this little microcosm here in Colerain Township where we're trying to figure out what's next for those retail oriented or those auto-oriented retail corridors, and what's next for regional malls there. How can we leverage the incredible real estate that we have here to provide better services and quality of life for our residents? Those things get me really excited too.
Jess (25:54): Yeah. I mean, you guys are doing such incredible work and I think it's really inspiring to see how much of it is based on community and compassion. And it's not all technology driven. It's not all high budget. It's really kind of keeping the focus on improving your community's quality of life. So thank you so much for coming and joining us today and for sharing all the exciting work you're doing and looking forward to seeing more innovation out of Colerain Township.
Geoff: Thanks, Jess.
Will: Yeah, thanks for having us.
Lindsay (26:30): Colerain Township's focus on low cost, high-impact projects shows that local governments can make significant progress without a lot of technology or a budget. The key is to not be afraid to try new things.
We've seen that local governments that aren't afraid to try things that may fail learn from these failures and try again, are able to have the greatest impact on their community in cases like we learned today, this philosophy can even save lives.
I'm Lindsay Pica-Alfano, and this podcast was produced by Govlaunch, the wiki for local government innovation. You can subscribe to hear more stories like this, wherever you get your podcasts. If you're a local government innovator, we hope you'll help us on our mission to build the largest free resource for local governments globally.
You can join to search and contribute to the wiki at govlaunch.com. Thanks for tuning in. We hope to see you next time on the Govlaunch podcast.