Multilevel Leadership

2 Leadership illustration

The SPACECAT tool explains multilevel leadership as the people and process that make up leadership at all levels that interact and collaborate to impact the program. Leadership drives efforts to address the intersection of suicide, overdose, and ACEs. Leadership that is inclusive and comprehensive in its reach generates greater buy-in, more resources, and helps to expand rather than duplicate efforts. Local health departments (LHDs) are uniquely positioned in the community to act as leaders, as well as identify and grow formal and informal leaders. These leaders can expand the reach and impact of intersection initiatives by engaging multiple sectors and levels of public health system.

Look at the results of Q11 in your completed SPACECAT to identify opportunities to strengthen multilevel leadership.

LHDs and the community are highly interconnected with multiple decision-makers, stakeholders, and processes. The concept of a single leader who makes top-down decisions in isolation will not fit initiatives to address suicide, overdose, and ACEs as this intersection spans multiple sectors, and disciplines. Consider leadership structures that promote internal and external collaboration. If possible, establish a network of leaders inclusive of LHD staff and community members who are champions of intersectional initiatives to address suicide, overdose, and ACEs.

Identify formal and informal leaders[1]:

  • At all levels within the LHD beyond staff currently in leadership positions. LHD direct service staff, outreach staff, communications staff can all be champions of goals to increase capacity at the intersection of suicide, overdose, and ACEs. Talk with different teams in the LHD about the SPACECAT to see who might be willing to serve as a champion for your efforts, lending their specific skillset, network, or expertise. A bottom-up approach to leadership can help generate internal buy-in.
  • Among partners both existing and potential. Spread the word among current and potential partners about the efforts your LHD is making to address this intersection. Reach out to local or regional organizations that are involved in suicide, overdose, or ACEs prevention work to identify who is currently leading those efforts and discuss potential partnerships. See the Networked Partnerships section for additional information and resources.
  • Among community members with lived experience. Community members who are or have been directly impacted by suicide, overdose, or ACEs—people with lived experience—can be leaders and champions of efforts to prevent these issues. People with lived experience can be powerful advocates for change and can provide invaluable input into program development, however, their voices are often undervalued. Engaging or recruiting people with lived experience must be done appropriately and equitably. Consult the following resources for best practices on how to do so:
  1. Engaging People with Lived Experience Toolkit
  2. Engaging People with Lived Experience: A Toolkit for Organizations
  • Among other sectors, such as private agencies, academic institutions, and faith-based organizations.

Develop and encourage local champions:

Champions are individuals within an organization or community that bring energy, enthusiasm, persistence, problem-solving skills, and consistency in their efforts to garner support and move an idea, approach, or program forward.[2] The champion believes that the change is one that can benefit the community and is driven by hope and passion.

Anyone can be a champion. Sometimes champions emerge as individuals who already have some expertise in the topical area, recognition in the community, or professional contacts to move ideas forward, but this expertise not a requirement. Within an organization, champions can be from any level; in fact, having champions from multiple levels, if possible, often works well.[3]


[1] Centers for Disease Control and Prevention. Adverse childhood experiences, overdose, and suicide webpage. Retrieved July 11, 2022, from https://www.cdc.gov/injury/pri...

[2] Howell, J.M., Shea, C.M. & Higgins, C.A. (2005). Champions of product innovations: defining, developing, and validating a measure of champion behavior. Journal of Business Venturing, 20: 641-661.

[3] Warrick, D. D. (2009). Developing organization change champions. OD practitioner, 41(1), 14-19.

Consider ways to connect and collaborate regularly with the local leaders and champions of your efforts to prevent suicide, overdose, and ACEs. A network of leaders can take many forms with varying degrees of formality: an email thread, a quarterly networking meeting, or a more structured coalition are some options among many. The aim of a collaborative style of leadership is to convene local leaders around a shared mission to address suicide, overdose, and ACEs in the community, reduce siloed efforts, and increase impact.[1] Foster the leaders you’ve identified:

  • Find or offer trainings and educational opportunities about suicide, overdose, and ACEs to help internal and external leaders and champions to build a shared understanding of the issues and potential, evidenced-based solutions. See the Workforce Capacity section for more information. Consider well-established trainings in the areas of suicide, overdose, and ACEs that have train-the-trainer models, such as Question, Persuade, Refer (QPR), Adverse Childhood Experiences (ACE) Interface, and naloxone (Narcan) training. These models allow for community-led awareness that don’t require leaders to have a specific educational background.
  • Co-develop a shared mission for the network of leaders. Work together to decide what you’d like to accomplish and how each person’s skill set will contribute to that goal. Memorialize these ideas in a vision and/or mission statement (see Community Tool Box for guidance on this). Consider using the Quick Start Guide [link to guide] to help your network of leaders develop an action plan.
  • Set a communication schedule. Even if your network of leaders right now is two internal staff, agree upon a set schedule for communicating about ideas, plans, or needs. Will you email once per month? Will you meet quarterly with a set agenda? Are there any ways to stay connected between contacts (e.g., visual collaboration boards, newsletters, shared participation in community meetings)?


[1] Karl Umble, et al. (2005). The national public health leadership institute: Evaluation of a team-based approach to developing collaborative public health leaders. American Journal of Public Health 95(1), 641-644.

Suicide, overdose, and ACEs share overlapping risk and protective factors that are influenced by social determinants of health. For example, lack of access to education and limited job opportunities (social determinants of health) can lead to financial stress, which is a potential risk factor for suicide, overdose, and ACEs. Multiple sectors may touch issues related to education and employment; therefore, leadership efforts at the intersection of suicide, overdose, and ACEs must engage multiple sectors. Leaders should consider connections and partnerships with:

  • Academic institutions
  • Community-based organizations
  • Medicaid- serving organizations
  • Private organizations

Consider whether there are any coalitions that might allow leaders across sectors to come together to address the intersection of suicide, overdose, and ACEs. If no such coalitions exist, consider starting one. Coalitions can help communities develop a shared understanding of and approach to adversity, strengths, and opportunities. Developing a coalition involves:

  • Establishing a purpose
  • Recruiting the right people
  • Developing a successful structure
  • Developing activities and maintaining engagement[1]

The following resources provide some examples of coalitions and steps to follow for their development:

[1] California Mental Health Services Authority. (2019). Creating suicide prevention community coalitions: A practical guide. Retrieved July 19, 2022, from https://emmresourcecenter.org/...

LHD and community leaders can often expand their reach by engaging in initiatives that are occurring beyond their immediate neighborhoods. This allows leaders to learn more about what other counties and cities are doing, as well as understand priorities, efforts, and outcomes at the state level across agencies. In 2021, for example, National Governors Association published a paper highlighting goals, programs, and lessons learned from states that (1) had previously taken an approach to preventing and addressing ACEs and (2) were planning to implement a statewide approach. To learn more about what your state may be doing to address suicide, overdose, and/or ACEs, consider:

  • Reviewing state government websites for recently signed executive orders, commissions, or workgroups
  • Meeting with or learning more about non-profit organizations that operate across the state or region and their current funding streams and priorities
  • Learning more about recent statewide funding opportunities related to suicide, overdose, and ACEs, including what the objectives of the project were and who was awarded.
  • Securing Buy-in (Advancing Health Equity)— A framework from that provides several strategies to obtain buy-in from various sources including staff, patients, and the community.
  • Lessons Learned from Implementing Project Lazarus in North Carolina (University of North Carolina at Chapel Hill) — An evaluation report that reviews Project Lazarus, a local initiative developed to reduce harms associated with the opioid epidemic in North Carolina.
  • Engaging Leadership and Gaining Buy-In (Association of State and Territorial Health Officials)— A training presentation that provides perspectives on engaging leadership and gaining buy-in.
  • Prescription for Action: Local Leadership in Ending the Opioid Crisis (National Association of Counties & National League of Cities) –A joint report examining how cities and counties can strengthen collaboration among local, state, federal, private-sector, and non-profit partners, including recommendations and case examples of local practices.

This page is part of the SPACECAT Toolkit. It was last updated on September 22, 2022. To report broken links, please email ivp@naccho.org.

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