To achieve the collaborative, multi-faceted approach so crucial to tackling the opioid crisis in North Carolina, the School of Government is pairing faculty specialists with teams from ten communities across the state over a two-year period. These teams were selected through a competitive, application-based process.

Each participating community is engaging in five peer-learning forums being conducted across the state and coordinated by the School. In these sessions, participants are investigating and developing inter-departmental, intergovernmental, and intersectoral efforts for responding to the opioid crisis in their local communities; learning from the successes and challenges of other jurisdictions; and receiving hands-on coaching and technical support from School faculty. In addition to this direct faculty input, the School is producing a publication and a web resource containing model policies and practices to help guide local governments unable to take part in the forums. This multi-pronged effort is in line with other successful efforts to address this public health crisis. For example, the Governing Institute, in its booklet, Confronting a Crisis: A Practical Guide for Policy Makers to Mitigate the Opioid Epidemic, which was created with information, feedback, and support from the Blue Cross Blue Shield Association of America, recommends establishing cross-agency partnerships and convening community stakeholder groups on a regular basis.1

Each community team is completing exercises designed to bring members together and to start the process of identifying critical opioid-related issues in their community. These exercises provide baseline information to School instructors to better shape the trajectory of the program.

Between forums, each community team meets, identifies policy responses, and takes actions to implement those responses. A community project manager helps convene the team, manages the project, and tracks progress. Community teams have access to community implementation funds to help them move from talk to action. School of Government faculty leads coaching check-ins with each team, providing technical assistance to help the team work through specific issues. The coaching process has the additional benefit of helping School faculty identify critical issues and refine the creation of the online resource.


Engaging in Community-Based Work

In addition to participating in the forums, each community team meets monthly over the course of the program to develop and implement a cogent strategy that (1) leverages existing assets and activities and (2) increases the effectiveness of the local government response to the opioid crisis. Community-based work is supported by a community project manager and technical assistance from the School of Government.

As part of the program, each community team has hired a community project manager. The School of Government provided each team $10,000 to assist with hiring or funding of the position. 

The community project manager is called upon to handle a variety of roles, including facilitator, communication coordinator, liaison to the School, and record keeper.


Collective Impact: The Crucial Program Component

The opioid crisis is complicated. Its potential impacts are broad and far-reaching, it has no single root cause, and it is not confined by geographic boundaries or socio-economic classes. To succeed, any attempts to mitigate the damages inflicted by this scourge cannot be made in isolation. Instead, they must be guided by the principle of collective impact, which has been defined as “the commitment of a group of important actors from different sectors to a common agenda for solving a specific social problem.”2

There are five elements necessary to achieve collective impact.3 The first requires that participants working toward a specific goal share a common agenda for change. They do not have to begin their collaboration with a shared understanding of the solution(s) needed to achieve their goal, but they should come into the process knowing that a joint effort is necessary to be successful. Second, to evaluate whether goals are achieved, shared measures must be developed to track progress. Each participant in the collective action will undertake different efforts to reach the shared goals. Third, while each actor’s role is different, their activities should be mutually reinforcing—that is, coordinated with the activities of other participants and aligned with the common agenda and pre-established measures of success. Fourth, throughout the process, continuous communication is essential to building trust and motivating participants. Finally, to keep the process moving forward, there must be a backbone organization, described as “a separate organization dedicated to coordinating the various dimensions and collaborators involved in the initiative.”4 The backbone organization provides expertise, planning, and coordination to keep the participants on task and offers advice and support during the initiative.


The common agenda element of collective impact is the easiest one to achieve. Many collaborative efforts begin with a common agenda but, unfortunately, most do not have the other four key elements for success in place and, therefore, most fall short of their goals. This will not happen with the School of Government’s opioid mitigation program. The School will serve as the backbone organization for participants, ensuring that all of the elements of collective impact are achieved, “distinguish[ing] this work from other types of collaborative efforts.”5

To this end, faculty from the School is

  1. guiding participants’ visions and strategies;
  2. supporting the aligned activities of the community teams and ensure that they are consistent with the shared agenda (i.e., are mutually reinforcing);
  3. working with the teams to establish shared measurement practices;
  4. building up public goodwill for the project;
  5. advancing policy developed in collaboration with participants;
  6. mobilizing funding to achieve established goals; and
  7. keeping the lines of communications open and flowing among all participants.


Forums and Resources

Throughout the Opioid Response Project, the School of Government offers assistance to ensure that participating communities engage in data-driven decision-making, which employs careful and rigorous analysis to inform policy choices. With the School’s help, each community is tailoring its work to the local demographic and geographic parameters of the problem, examining the reach of the opioid challenge and the effectiveness of current responsive efforts. 

Five forums are featured throughout the project, with each community team attending all five sessions. Each of these forums includes a general session, topical breakouts, and collaborative discussions. Issues that have arisen for multiple teams during the time period between forums will receive special attention. The forums promote iterative progress, as participating teams seek to accomplish goals in advance of the next forum and obtain new information and strategies in the current session. Outside experts are brought in to participate in the forums as necessary.

The first forum was held at the School of Government, where community team members began to develop strategic implementation plans based on a needs assessment. Faculty from the School of Government facilitated the process of developing the strategic plans and providing expertise on best practices, leadership, collaboration, and the legal implications of policy proposals suggested by the teams.

The most recent forum was held in Winston-Salem, where community team members learned more about setting strategic short-term and long-term goals. Faculty from the School of Government led breakout sessions helping members better understand how to navigate confidentiality, how to assess mental models to unify partners in problem-solving, and why taking time to celebrate smaller wins is important to long-term success. Two additional forums are being planned, to be held at different locations across the state. 

The fifth and final forum will be held over a two-day period. Day one will be open to the public, allowing non-participating communities to learn about the program and to determine how strategies developed by participants could be pursued in their own regions. To accomplish this, faculty from the School of Government explains the program and members of the community teams discusses their experiences through interactive panels. Day two is open only to community teams and is designed to provide guidance to the community networks created through the program process, so as to sustain program efforts into the future.

Based on research being conducted by the School on best practices around the country, efforts currently underway in North Carolina, and the scope of the problem; input from the participating communities throughout the scope of the project (and perhaps even beyond); and the content of forum discussions; School faculty members are creating a draft resource for local governments responding to the opioid crisis. Intended as a guide for communities wishing to implement strategic initiatives similar to those initiated during the program forums, the resource is being updated as the participating teams encounter and ultimately overcome challenges in their efforts to mitigate the damages caused by opioid use in their communities. This draft will be published as a web resource and will be made widely available to communities not participating in the program.

Ultimately, School faculty will finalize the online resource, incorporating the topics and solutions brought up and developed during the program coaching sessions and forums, as well as any points of interest raised and addressed after the technical end of the program. A hard-copy version will also be produced.





1. The booklet is downloadable, for free, on the Governing Institute’s website:


2. See John Kania and Mark Kramer, “Collective Impact,” Stanford Social Innovation Review (Winter 2011), available online at

3. Ibid.

4. Collaboration for Impact, “The Backbone Organisation,” available online at the-backbone-organisation/.

5. See Shiloh Turner, Kathy Merchant, John Kania, and Ellen Martin, “Understanding the Value of Backbone Organizations in Collective Impact: Part 2,” Stanford Social Innovation Review (July 18, 2012), available online at understanding_the_value_of_backbone_organizations_in_collective_impact_2.