





































Authors 
ROBIN P. NEWHOUSE 
Distinguished Professor, Indi-
ana University

Dean, Indiana University 
School of Nursing 

Deputy Chair, University Clini-
cal Affairs Cabinet

FAITH KIRKHAM HAWKINS 
Assistant Vice Chancellor for 
Research, UC San Diego

NOTE: Faith Kirkham Hawkins 
was IU associate vice pres-
ident for research develop-
ment and strategic initiatives 
2017-2019. 

abstract 
In 2017, significant increases in 
opioid overdoses and the crippling 
effect of substance use on the health 
of Hoosiers heightened a sense 
of urgency to address this major 
health crisis. Indiana University 
(IU) initiated a Grand Challenge: 
Responding to the Addictions 
Crisis (AGC) through a $50 million 
investment in intramural research 
and projects to address addictions 
in Indiana in synergy with state 
and health system partners. The 
announcement resulted in immedi-
ate response from the community 
via email and calls with request for 
engagement from the people of In-
diana, groups, organizations and 
policy makers.  The challenge was: 
How can a public university part-
ner with communities to advance 

our understanding of a complex 
problem like addiction while de-
veloping strategies to address that 
problem? To organize quickly, ini-
tial contacts were categorized into 
an AGC Community Engagement 
Framework with five potential 
levels of engagement - curiosity, in-
terest, advocacy, project partners, 
and initiative partners. To guide 
our team’s responsiveness, each 
level was mapped to specific AGC 
goals, mechanisms of engagement, 
and engagement owners. The 
engagement framework developed 
has high utility for universities and 
other public institutions who seek 
to engage the broad community in 
public health responses. 

KEYWORDS: Engagement; 
Health; Addictions; Community; 
Partnerships 

Indiana University’s 
Community Engagement 
Framework for a Public 
Health Priority
Responding to the addictions crisis 

ROBIN P. NEWHOUSE AND FAITH KIRKHAM HAWKINS

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introduction  
In 2017, Indiana reached its highest age-adjust-
ed drug overdose death rate at 29.4 per 100,000 
people, significantly higher than the national rate 
and the 2016 Indiana rate. As the opioid epidemic 
ravaged the nation, the stark reality that Ameri-
cans are more likely to die from accidental opioid 
overdoses than from car crashes riveted commu-
nities (National Safety Council, 2019). Indiana 
University (IU) responded to this crisis by launch-
ing one of the nation's largest and most compre-
hensive state-based responses to the opioid addic-
tion crisis — and the largest led by a university. As 
one of IU’s three Grand Challenges, the response 
to the addictions crisis is rooted in the univer-
sity’s commitment to rigorous interdisciplinary 
research with public impact, an expression of the 
university’s responsibility to serving the public.  

President Michael A. McRobbie, announced the 
Grand Challenge in October 2017 alongside Indi-
ana Gov. Eric J. Holcomb, IU Health CEO Dennis 
Murphy and lead investigator Robin Newhouse.  
The Addictions Grand Challenge (AGC) funds 
projects led by teams of IU faculty, many working 
alongside community members, business, non-
profit and government partners (Indiana Univer-
sity, 2019a).  The AGC focuses its work on five 
areas of IU’s greatest capacity: data infrastructure 
and analysis; training and education; policy and 
policy analysis; basic, applied and translational 
research; and community and workforce de-
velopment. All projects focus on at least one of 
three goals: reduce deaths from opioid overdose, 
ease the burden of substance use on Hoosier 
communities and reduce exposure to unplanned 
substances for babies before birth (including 
medication-assisted treatment for mothers when 
indicated) (Indiana University, 2019b).   

A Steering Committee (SC) chaired by the lead 
investigator includes research leaders and faculty 
from each research-intensive campus [Blooming-

ton (IUB) and Indiana University Purdue Univer-
sity Indianapolis (IUPUI)]. The SC is responsible 
for the AGC five-year strategy, goal attainment 
and evaluation. Prior to the IU AGC commit-
ment, the SC assessed IU’s capacity to respond to 
the addictions crises, developed a five-year plan 
to fund proposals aligned with three primary 
goals, and continue to advise the AGC strategy 
and monitor evaluation outcomes.  A Scientific 
Leadership Team (SLT) was appointed. The team 
included one faculty from each research-intensive 
campus [Bloomington and Indiana University 
Purdue University Indianapolis (IUPUI)] and one 
representative of the five IU Regional campuses. 
They advise on the science and priorities, invited 
proposals, act as a resource in their area of exper-
tise, conduct scientific review of proposals and 
recommend proposals to be funded.   

A Socio-Ecological Model (SEM) for Respond-
ing to Addictions was adapted to addictions 
to inform the AGC’s strategy recognizing that 

F I G U R E  1 :  A  S O C I O E C O L O G I C A L  M O D E L  F O R  
R E S P O N S E  T O  A D D I C T I O N
Adapted from McLeroy KR, Bibeau D, Steckler A, Glanz K. 
(1988). An ecological perspection on health  promotion 
programs. Health Education Quarterly. 15. 351-77

Individual 

Biological, 
genetic, 

psychological 

Interpersonal 
Family, friends, 
social networks 

Organizational

Organizations, social 
institutions

Community

County, town, 
neighborhood

Society and Public Policy

National, state, and local 
laws and regulations 

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change is shaped by multiple levels of influence 
that must be considered if population level 
health benefits of AGC interventions were to be 
achieved (Figure 1).  The ecological perspective 
introduced by McLeroy, Bibeau, Steckler and 
Glanz (1988) frames determinates of change 
or outcomes as intrapersonal, interpersonal 
and institutional, community and public policy. 
Over the past three decades SEM models have 
provided a framework for health improvements 
(National Cancer Institute, 2005) and specific 
diseases alike (Pearson, 2011). As a result, AGC 
projects needed to align with interventions and 
outcomes that affect each level and engage with 
community members and partners.  

From the beginning of the planning process, a 
range of potential partners aligned with research 
priorities were identified – including governent 
agencies, nonprofit and community groups, 
and private sector companies. Many of our first 
project teams funded in January 2018 (Phase 1 
funding) could initiate studies quickly, as they 
drew on existing partnerships outside the uni-
versity to shape their research and intended 
impacts. Phase 2 projects were funded in October 
2018, after open addiction related discussion 
groups, scoping sessions, and the opportunity to 
participate in an Ideas Lab1 intended to cre-
ate proposals and teams able to respond to the 
request for proposals. An undergirding tenet of 
Phase 2 required engagement with community 
partners. The basic principle was to create teams 
that include relationships enhancing and inform-
ing the design; methods and outcomes used for 
the studies; as well as supplementing expertise 
on research teams. Engagement was based on 
the 1999 Kellogg Commission on the Future of 
State and Land-Grant Universities characterized 
by “a commitment to sharing and reciprocity … 
partnerships, two-way streets defined by mutual 
respect among the partners for what each brings 

to the table,” (Kellogg Commission on the Future 
of State and Land-Grant Universities, 1999). This 
reciprocal engagement with community part-
ners is both a practical and ethical imperative for 
initiatives like the Addictions Grand Challenge. In 
practical terms, university efforts to address crit-
ical problems facing society will work only to the 
degree that they address community priorities, 
draw on community capacities, and respond to 
community challenges. Any “solution” a univer-
sity develops to critical social problems like the 
addictions epidemic must be implemented by 
those with boots on the ground – often ground 
that is geographically or culturally distant from 
universities. The ethical imperative for universi-
ties – particularly for public universities like In-
diana University – is equally critical. Universities 
are members of the larger community, and have 
an ethical responsibility to contribute directly to 
community. To be good citizens, universities must 
expand efforts to focus research toward critical 
social problems, while continuing to engage in 
fundamental research focused on expanding the 
boundaries of knowledge.  

The Kellogg Commission identified seven charac-
teristics of an engaged institution (Table 1) that 
resonate with the AGC efforts, providing not only 
important principles, but also an ethical frame-
work and imperative for healthy partnerships 
to address common public health goals (Kellogg 

In practical terms, 
university efforts to address 

critical problems facing society 
will work only to the degree that they 

address community priorities, draw 
on community capacities, and respond 
to community challenges. 

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Commission on the Future of State and Land-
Grant Universities, 1999). Applying these charac-
teristics to our engagement plan offers a helpful 
evaluation framework: listening carefully to 
partners; engaging in dynamic exchange of infor-
mation; and promoting a shared understanding 
in order to assess, enhance, and amplify mutual 
efforts. Questions aligned with each characteristic 
can guide both short and long-term evaluation 
efforts.

announcement and community 
response 
In the week after the AGC announcement, the 
team was inundated with emails from more than 
100 community members, organizations and 
business owners asking how they could become 
involved with the initiative.  Two facts were clear 
in the initial response: 1) the AGC resonated with 
Hoosiers’ experiences and needs, and 2) the vari-
ety of responses required an undergirding com-
mitment to engagement with all levels of influence 
in our socio-ecological model. The immediate 
focus was to develop strategies to address the 
community requests for engagement and part-
nership. The challenge presented was: How can 
a public university partner with communities to 
advance our understanding of a complex prob-

lem like addiction while developing strategies to 
address that problem?  

The solution was clear. A framework and process 
were needed to ensure responsiveness to our com-
munity and handle inquiries in a way that we can 
enable partners to come together, collaborate, and 
focus on multiple attributes of the problem in an 
integrated manner.  

approach to developing the 
agc community engagement 
framework 
In reviewing the variety of inquiries received, it 
was clear that a single form of response would 
not suffice. To address the interest generated 
by the announcement effectively, a framework 

Responsiveness: Are we listening to communities, 
and to diverse members of varied communities? 

Respect for partners: Do we respect the expertise, 
experience, and skills that our partners bring to the 
process of identifying and responding to the addictions 
crisis? 

Academic neutrality: How can the university 
ensure that policy and practical recommendations are 
based firmly in evidence-based research? 

Accessibility: How can we make our work receptive 
to, and accessible to, all the constituencies within the 
state? 

Integration: Does our framework facilitate the 
integration of scholarship, teaching, and service?  

Coordination: Are we facilitating coordination across 
units and disciplines within the university, and with varied 
partners outside the university? 

Resource partnerships: What are the various ways 
in which we are resourcing our work – both financially and 
intellectually?  

Adapted from Kellogg Commission on the Future of State 
and Land-Grant Universities (1999, p.12). 

To be good citizens, uni-
versities must expand efforts 

to focus research toward critical 
social problems, while continuing 

to engage in fundamental research 
focused on expanding the boundaries of 
knowledge. 

TA B L E  1 :   K E L LO G G  C O M M I S S I O N  S E V E N  CHARACTERISTICS OF AN ENGAGED INSTITUTION 

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identifying five distinct levels of engagement was 
developed, with specific goals for each level and 
mechanisms for engaging. Our priorities were 
to respond to community queries, link potential 
project partners to researchers or teams engaged 
in related work, and dialog with businesses to 
understand their interest while connecting them 
to the best-aligned partner either within or outside 
the university.  

The five levels of engagement with the IU AGC 
range from curiosity to initiative partners (see 
Table 2).  Examples of queries from our communi-
ty are included in Table 3. Curiosity (e.g. How will 
this work?) requests information without higher 

levels of connection, requiring communication 
through multiple media. Interest (How can I con-
nect?) requests a higher level of linkage to resourc-
es, requiring various strategies of communication 
– extending from email to in-person invitations 
(e.g. public interest sessions such as scoping re-
views or discussion groups). With Advocacy, (How 
can I advance this work?) requests went beyond 
interest toward action to help disseminate, for 
example, tools or information.  Project partners 
actively engaged with research teams to write 
research proposals or serve as community adviso-
ry boards for specific projects. Initiative partners 
(How can we synergize our efforts?) actively en-

TA B L E  2 :   A D D I C T I O N S  G R A N D  C H A L L E N G E  C O M M U N I T Y E N G AG E M E N T F R A M E WO R K 

Engagement 
Level

Engagement 
Goals

Engagement 
Mechanisms

Engagement 
Outcome 

Engagement 
Responsibility 

Curiosity Keep the curious 
informed about our 

work

Earned media, paid 
media, social media

Be informed at a 
basic level

Communications

Interest Build on interest to 
create connections, 

link to resources

As above, + 
newsletter, websites, 

public interest 
sessions

Be informed at 
a moderate level 

about the crisis and 
IU’s response

Communications

Advocate Use connections 
to disseminate 

information, connect 
with communities

As above, + 
dissemination 
and education 

tools, occasional 
partnerships on 

outreach

Be asked for 
input, assistance 

in spreading 
information

Director of 
Operations

Project Partners Enhance our activity 
through partnership 

with community 
members, agencies

As above, + link to 
specific projects and 
faculty; membership 

on Community 
Stakeholders’ Board

Help develop 
solutions through 

partnership with IU, 
inform, advocate for 

our work

VPR office, SC, 
SLT  Director of 

Operations 

Corporate Relations

Initiative Partners Coordinate across 
multiple levels 

and stakeholders; 
maximize impact 

across sectors

As above, + 
Coordinating 

Committee and 
External Advisory 

Board

Help deliver services 
and solutions to 

reduce addiction in 
Indiana

VPR, PI

Notes: VPR: IU Vice President of Research, PI: AGC Lead Investigator, SLT: AGC Scientific Leadership Team, SC: AGC Steering 
Committee | Source: Authors 

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Engagement 
Level

Engagement 
Goals

Engagement 
Mechanisms

Engagement 
Outcome 

Engagement 
Responsibility 

Curiosity Keep the curious 
informed about our 

work

Earned media, paid 
media, social media

Be informed at a 
basic level

Communications

Interest Build on interest to 
create connections, 

link to resources

As above, + 
newsletter, websites, 

public interest 
sessions

Be informed at 
a moderate level 

about the crisis and 
IU’s response

Communications

Advocate Use connections 
to disseminate 

information, connect 
with communities

As above, + 
dissemination 
and education 

tools, occasional 
partnerships on 

outreach

Be asked for 
input, assistance 

in spreading 
information

Director of 
Operations

Project Partners Enhance our activity 
through partnership 

with community 
members, agencies

As above, + link to 
specific projects and 
faculty; membership 

on Community 
Stakeholders’ Board

Help develop 
solutions through 

partnership with IU, 
inform, advocate for 

our work

VPR office, SC, 
SLT  Director of 

Operations 

Corporate Relations

Initiative Partners Coordinate across 
multiple levels 

and stakeholders; 
maximize impact 

across sectors

As above, + 
Coordinating 

Committee and 
External Advisory 

Board

Help deliver services 
and solutions to 

reduce addiction in 
Indiana

VPR, PI

gaged with the AGC leaders (e.g. AGC Community 
Advisory Board).  Each level was mapped to the 
best area of responsibility and person that could 
respond in a timely manner and have the ability to 
link the community member to the right investi-
gator, team, leader or organizational affiliate. 

discussion 

IU’s AGC Community Engagement Framework 
provided an effective approach responding to our 
community’s interests. Our team was able to reply 
quickly to each level of query linking the intent of 
the contact to AGC specific goals, potential mech-
anisms of engagement, and engagement own-
ers.  The experience also taught us a number of 
lessons. First, IU’s AGC Community Engagement 
Framework applied principles of engagement to 
create a rapid organizational response to a public 
health crisis. Second, the experience of respond-
ing to our community enabled priority setting for 
communication strategies. Third, we began to 
approach our AGC scientific Phase II formative 
efforts differently, incorporating our community 
into discussion groups, scoping reviews and pro-
posal development events.   

There were also lessons learned in developing and 
using IU’s AGC Community Engagement Frame-
work for application to communication strategies. 
For example, the first two levels of engagement 
indicate curiosity and interest from the pub-
lic.  Curiosity and interest informed discussions 
resulting in planned actions to keep information 
flowing in response to public interest. The need 
for information led to a strategic communications 
plan that includes a website dedicated to the AGC, 
paid media (advertisements in publications and 
social media) and use of multiple social media 
strategies. The dedicated AGC website provides 
resources for the community, both looking for 
opioid/substance use information and seeking a 
partner on research projects. As engagement with 
the community grew, there were opportunities to 
provide resources and information on the topic 
of the AGC and other substance use/addictions 
related topics via public panels, training and our 
website.  Because of lessons learned about the 
engagement processes and need for informa-
tion among stakeholders, community members, 

TABLE 3: EXAMPLES 2017 COMMUNICATION FROM 
COMMUNITY FOR EACH LEVEL OF ENGAGEMENT  

Curiosity 
“We were curious if there were funding 
opportunities….” or “How will you involve 
families who have lost someone to 
addiction?” 
How is this going to work? 
(Student group response) 

Interest
“Would like to….explore possibilities, in 
using XXX to relieve pain” 
How can I get involved? 
(Scoping sessions, discussion groups ) 

Advocate
“Please take the time to investigate the XXX 
program” 
How can I help to advance your work? 
(Families who have lost someone to 
addiction) 

Project Partner
“…would love to provide any assistance I 
can as you implement this initiative…. “ 
“We are implementing a….system-wide 
project to standardize and improve the care 
and treatment, of medical patients who also 
have substance abuse problems…would like 
your input.” 
How can I work with you to move XX 
forward? (Project advisory board or 
participant in ideas lab) 

Initiative Partner
Would like to “discuss options with the 
addictions work aligned …. noted the 
number of projects at XX already underway 
that could be a basis for future work… and 
goal setting.” 
How can we synergize our efforts? (AGC 
Community Advisory Board) 

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research teams and IU in general, the position of 
Assistant Director of Research Communications 
was created for the AGC. 

It is important to note, that what we learned from 
our robust early AGC community response expe-
rience informed our approach to Phase II efforts. 
There was an increasing awareness and appreci-
ation for the importance of community engage-
ment needing to extend beyond just responding 
to inquiries. It became important to implement a 
processes in which those inside and outside the 
university could meaningfully contribute to the de-
velopment of future research efforts. We initiated 
across campus dialog and innovative partnership 
building strategies between community members 
facilitated by Knowinnovation (KI), an organiza-
tion dedicated to fostering interdisciplinary scien-
tific innovation. With the KI team, we first hosted 
“Scoping Sessions,” attended by more than 200 
university and community individuals. In these 
Scoping Sessions, participants were challenged to 
step outside their typical frames of reference and 
connect with others whose experience and exper-
tise might offer surprising avenues of inquiry and 
research. Numerous new collaborations resulted, 
ranging from short-term collaborations that in-
creased the degree to which community expertise 
and research priorities informed long-term im-
pact-focused research partnerships. and research-
ers through a research and team development 
process. After the scoping sessions,  a multi-day 
Ideas Lab was held bringing university research-
ers and community partners together to develop 
fully-formed draft research projects in response to 
the AGC Phase II request for proposals.   

Throughout the past two years more than 130 
community partnerships in 27 counties are 
actively engaged throughout the state. These 
partnerships have played a vital role in informing 
our research projects by partnering and providing 
researchers real-time information around ad-

dictions issues throughout the state. The role of 
engagement in a large university project focused 
on a major public health crisis is a natural exten-
sion in synchronizing many individual efforts into 
a common goal toward higher impact.   

conclusion  
Engaging with the community and community 
partners throughout Indiana became the founda-
tion of the AGC. Creating the AGC Community En-
gagement Framework guided connections between 
the community and IU faculty and teams to ad-
vance our understanding for how best to respond 
as a public health priority while simultaneously 
developing strategies to address that problem. 
Mapping engagement levels to specific AGC goals, 
mechanisms of engagement, and engagement 
owners resulted in a model and process with high 
utility for universities and other public institutions 
who seek to engage the broad community in public 
health responses. 

The expectation for community and stakeholder 
engagement in research has emerged quickly over 
the last decade to promote the conduct of rigorous 
relevant research informed by communities and 
people that will use the results of research. The 
Patient Centered Outcomes Research Institute 
(PCORI) has led the study and development of 
methods of patient and stakeholder engagement 
in all phases of comparative effectiveness research 

The role of engagement 
in a large university project 

focused on a major public health 
crisis is a natural extension in 

synchronizing many individual efforts 
into a common goal toward higher 
impact.    

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(Sheridan, et al., 2013). Effective en-
gagement methods are publicly avail-
able in a rubric to guide investigators 
submitting proposals to PCORI, with 
additional resources on the website 
(PCORI, 2019). Other major federal 
organizations including the U.S. Federal 
Drug Administration (FDA) [FDA, 2019] 
and funders have initiatives underway to 
promote patient and stakeholder engage-
ment, including the National Institutes 
of Health (NIH) [NIH: National Center 
for Advancing Translational Sciences, 
2019], Agency for Healthcare Research 
and Quality (AHRQ) [AHRQ, 2017], and 
Center for Medicare and Medicaid Ser-
vices (CMS) [CMS, 2019]. These efforts 
are working toward embedding engage-
ment into organizational policies and 
procedures broadly. IU’s AGC Commu-
nity Engagement Framework sought to 
organize response to our community rap-
idly and optimize community member’s 
expected level of engagement with IU to 
solve a mutually experienced community 
and state problem. 

Other universities and institutions of 
public education could use this model to 
involve and engage their community in 
research taking place at their institution 
and to create long-lasting partnerships 
that connect the university with those 
working on the frontline of public issues.  
We are certain that we could have done 
better to engage our community as we 
learned together. We are just as certain 
that a response to addictions can only 
be successful if we partner with people, 
organizations, and the state officials and 
engage with communities that share 
common goals.

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