Non Technical Summary
Drug poisoning deaths remain the leading cause of injury death in Utah, with about 11 deaths per week of which 8 were due to opioids and potentially preventable through the use of Naloxone, the overdose prevention medication. To address this issue and reduce overdose deaths, we are proposing to develop, implement and evaluate the TriCounty Overdose Prevention Program (TOPP) which is designed to address the high rates of opioid overdose deaths observed in our three rural target counties including Duchesne, Uintah and Daggett. Within these counties, we will develop overdose prevention and harm reduction trainings designed for high-risk populations including high-risk occupational groups (construction, mining, manufacturing and service industry employees), and high-risk minority groups including Native American and Hispanic. The trainings will be culturally and linguistically appropriate for our Native American and Hispanic populations and designed to provide participants with the skills to respond to opioid overdoses using Naloxone and save lives. Furthermore, our trainings will provide businesses and participants with overdose prevention kits, which include Naloxone, increasing ability to respond to overdoses at work and home. In addition, our trainings will increase awareness of available prevention, treatment, and recovery services available in the region with the goal to increase the number of people accessing these life-saving services. The overall program goal will be to decrease overdose deaths by 10% by the end of the three year program. We will evaluate several outcomes through use of pre, post, and 3-month follow up surveys and widely disseminate our findings.

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
903	6099	3020	100%

Knowledge Area
903 - Communication, Education, and Information Delivery;

Subject Of Investigation
6099 - People and communities, general/other;

Field Of Science
3020 - Education;

Goals / Objectives
Objectives, Activities, Outcomes and TimelineAlignment of Objectives with Federal Goals: Our objectives address Goal 5 of USDA's Strategic Plan for FY 2022-2026 "Expand Opportunities for Economic Development and Improve Quality of Life in Rural and Tribal Communities". Our proposed program will focus on improving quality of life among our selected rural and Tribal populations through the implementation of an innovative overdose prevention program designed specifically for high-risk populations including Native Americans, Hispanics and high-risk occupations. We will follow USDA's priorities for improving the quality of life in rural and Tribal Communities by ensuring that we (1) Build Trust by working with underserved Tribal and Hispanic Communities, and (2) Reduce Barriers to Access by designing our program to be culturally and linguistically appropriate and available in in-person and online formats (USDA, 2022).In addition, our program aligns with Congressional guidance that Rural Health and Safety Education programs may focus on the prevention and/or reduction of opioid and other substance misuse. This aligns with the recommendation to focus programming on individual and family health education that implement programs to prevent or reduce opioid and substance misuse and abuse. Specifically, our program aligns with the US Department of Health & Human Services Overdose Prevention Strategy, specifically by widening access to opioid overdose reversal treatments such as naloxone/Narcan (Haffajee, RL, Sherry, TB, Dubenitz, JM, White, JO, Schwartz, D, et al., 2021).Objectives, Activities, and EvaluationObjective 1: Develop and disseminate the TOPP curriculum among high-risk occupation employees by the end of Year One, with a minimum of 10 trainings offered and 100 employees trained per year.Activity 1: The Co-Program Directors will develop the TOPP curriculum and assessment surveys designed specifically for our high-risk occupation groups.Activity 2: Program Coordinators will recruit local high-risk occupation businesses to enroll in the training, with a goal of hosting at least 10 trainings with total of 100 employees per year. Evaluation: We will track the number of high-risk employees that are trained in each county. During the trainings we will collect a pre-and-post survey to assess knowledge, attitude, and self-efficacy related to administering Naloxone to prevent an overdose. Then we will collect a follow-up survey at 3-months to assess changes in attitude, self-efficacy, and use of Naloxone.Objective 2: Increase access to Naloxone among high-risk occupation employees by distributing naloxone to over 100 employees and overdose prevention kits to over 25 businesses by the end of Year 2.Activity 1: Program Coordinators will distribute a naloxone kit to all Employees completing our training and an overdose prevention kit to all businesses. This will increase the ability to respond to opioid overdose at work and in personal lives.Evaluation: We will track the number of overdose prevention kits distributed to businesses and employees that completed training.Objective 3: Update and finalize our culturally centered overdose prevention and harm reduction training designed specifically for our Native American population to ensure it is culturally and linguistically appropriate and meeting current needs by the End of Year 2.Activity 1: The Program Directors and Tribal Program Coordinator will collaborate with key Tribal partners, including the Ute Tribe Health Board, to review training materials and provide feedback which will be used to modify all materials to be culturally and appropriate since the Ute Tribe does not have a written language.Activity 2: The Tribal Program Coordinator will conduct outreach to enroll Native American groups in the training program. Once enrolled, we will conduct on-site and online trainings with a goal of training at least 5 groups and 50 people per year, starting in Year 2.Activity 3: Tribal Program Coordinator will distribute a naloxone kit to all people completing the culturally centered training the increasing ability to respond to opioid overdose.Evaluation: The finalized culturally centered Native American focused training curriculum will be the key outcome for this objective. We will also track the number of Native Americans that complete the training in each county. Due to respect for data sovereignty and limitations to obtain Tribal IRB approval, we will not collect any surveys among trainings completed on Tribal lands.Objective 4: Develop and disseminate a culturally and linguistically appropriate overdose prevention and harm reduction training for the Hispanic Population in our target counties with a goal of training 25 people by the End of Year 3.Activity 1: The Program Directors and Hispanic Program Coordinator will collaborate with key community partners to modify existing training materials to be culturally and linguistically appropriate for our target population.Activity 2: The Hispanic Program Coordinator will work with professional translation services to have all curriculum materials translated in Spanish. Once translated, we will pilot test the Spanish curriculum with community partners to identify any other areas needing modification.Activity 3: The Hispanic Program Coordinator will conduct outreach to enroll high-risk Hispanic groups in the training program. Once enrolled, we will conduct on-site and online trainings with a goal of training at least 3 groups and 25 people by the end of year 3.Activity 4: The Hispanic Program Coordinator will distribute a naloxone kit to all people completing the Hispanic focused training increasing ability to respond to opioid overdose.Evaluation: The finalized Hispanic Focused training curriculum will be the key outcome for this objective. We will track the number of Hispanic people that complete the training in each county. We will also collect a pre-post survey to assess knowledge, attitude, and self-efficacy related to administering Naloxone to prevent an overdose.Objective 5: Host an annual substance use prevention, treatment, and recovery conference for the general population to improve knowledge, attitude, skills and abilities to address substance use and reduce stigma in the community.Activity 1: The Program Directors and Program Coordinators will plan and host an annual conference in the target counties. Each year will have a focus on one of our target populations. Year 1 will focus on high-risk occupational groups, Year 2- Native Americans, and Year 3-Hispanics. We will recruit experts to provide the educational sessions and have time for community input and cultural activities.Evaluation: We will track the number of participants and basic demographics. In addition, we will collect conference evaluation surveys to assess knowledge, attitude, skills and abilities to address substance use and levels of stigma in the community.

Project Methods
Approach DescriptionOur review has identified a key need to develop and implement opioid overdose prevention and harm reduction trainings among high-risk occupation groups including goods production and service industry. This will include trainings that are culturally centered to meet the needs of Native American and Hispanic workers in these industries as well. To expand access and use of Naloxone, we are proposing to develop and implement the TOPP designed specifically for high-risk occupation groups in the region.TOPP will provide in-person and online trainings specifically designed for these occupational groups. The curriculum will educate the participants on key overdose prevention and harm reduction information including: biology of opioids, occupational risks for substance use, signs and symptoms of opioid overdose, administration of naloxone, steps to responding to overdose at home or work, good Samaritan laws, harm reduction, effective treatment options, self-care, insurance options and referral information to key services related to substance use. Participants who complete the training will have the option to receive a naloxone kit (depending on availability) to take home, which will improve their ability to effectively respond to opioid overdose emergencies. In addition, all participating businesses will be provided with an overdose prevention kit to keep at the workplace as part of their first-aid kit, increasing the ability to respond to overdoses at the workplace.To ensure that we are providing an effective training to our underserved high-risk minority groups, we will also modify the trainings to be culturally and linguistically appropriate for the Native American and Hispanic populations. This will include delivery of educational programming facilitated by Native American and Hispanic Program Coordinators with input from the local Indigenous and Hispanic communities. We will use materials developed through the USU TROI and the Mountain Plains ATTC and will modify materials to address cultural norms related to substance use, treatment, recovery and other key aspects. In addition, we will provide materials in Spanish for non-English speaking participants. Lastly, we will utilize the expertise and pervious experience from the USU Tribal and Rural Opioid Initiative (TROI) Resource Center which has developed several training programs for the rural and indigenous communities throughout Utah, including culturally centered naloxone trainings.