Opioid Settlements in Rural North Carolina: Core Principles for Equitable Engagement

By Sabrina McGee, Partnership Manager, Rural Prosperity & Investment

This guide for public engagement draws from MDC’s experiences across rural North Carolina counties as they worked alongside community members to make decisions about Opioid Settlement funding. This funding offered an exciting opportunity for communities that often receive fewer resources to plan for longer-term investments into community needs. While these lessons were learned in the context of this single funding stream, the practices outlined here offer insight that can be utilized by any organization, agency, institution, or government seeking to move from basic participation to meaningful partnership with the communities they serve.

To view our full resource guide on how to get involved with the opioid settlement in your community, click HERE.

Public health policy and funding decisions present a unique challenge. Here, leaders with significant decision-making power must address complex community needs that no single area of expertise can fully capture. Even the most skilled administrator or experienced policy expert cannot match the deep understanding that comes from lived expertise. The core principles outlined- inclusive leadership, diverse representation, clear communication, transparency, and sustained relationships- apply to any program design or policy decision.

While public engagement opportunities can catalyze positive change, they also highlight existing power dynamics between decision-makers and community leaders. Those controlling resources hold significant power to shape both processes and outcomes. Acknowledging these power differentials is essential for moving beyond surface-level engagement toward authentic partnership.

When decisions affect entire communities, they impact a wide variety of people with diverse experiences, all in interconnected ways. We look to decision-makers to recognize the gaps in their own knowledge and use their power to create processes that allow community members to fill those gaps. This guide demonstrates how moving toward true partnership does just that, integrating community expertise into the process to create more effective solutions. Through meaningful engagement, decision-makers access critical information about local needs, existing resources, and potential solutions that might otherwise remain hidden.

The engagement approaches in this guide lay the groundwork for deeper community partnership and more equitable decision-making. By integrating the essential wisdom that comes from lived experience into existing structures, decision-makers can build the trust and relationships necessary for lasting change. When we combine specialized knowledge with community wisdom, we create solutions that are not only more effective but more sustainable, because they reflect the true needs and aspirations of the people they aim to serve. In a world of increasing complexity, this kind of partnership is essential for creating the communities where we hope to live, work, worship, and play for years to come.

Building Strong Communities Through Meaningful Partnership

In North Carolina’s rural counties, we’ve witnessed the power of robust community engagement. When local governments partnered meaningfully with their communities to allocate opioid settlement funds, they made more informed decisions, built lasting trust, and developed action plans with real community buy-in.

To review case study overviews of the three counties used as examples in this resource, click HERE.

Through the successes and lessons learned across these counties, five core principles emerged as essential for genuine, equitable engagement:

Inclusive Process Leadership

Great community engagement begins with trusted local organizations at the helm. The Twin Counties Partnership for Healthier Communities, a community-based coalition, started meeting about the Opioid Settlement funding in 2021, before either Edgecombe or Nash had made any decisions. Before and during the planning and implementation processes, leaders in both counties joined and collaborated with the community organizations that attended regularly. This partnership created natural bridges between decision-makers and community members, ensuring that conversations started from a foundation of mutual understanding. 

The inclusion of the community leaders that are already working on these issues matters because it addresses inherent power dynamics while creating channels for stronger decision-making. When trusted organizations help lead the process, they bridge the gap between institutional authority and community wisdom, acknowledging that power differences exist while building pathways for more effective collaboration. When leaders are working across siloes, it can serve as an opportunity to build capacity in both directions – government or institutional leadership learns about the informal networks that make communities strong, and community leadership increases understanding of formal systems. Then, both sides of the process can better serve as interpreters, bridge-builders, and champions for genuine dialogue and better decisions. The relationships built through this process often result in creative collaborations that help all partners achieve their goals more successfully, while thoughtfully addressing historical power imbalances that could otherwise limit community engagement. 

Diverse Stakeholder Representation

Effective engagement means hearing all voices—from healthcare workers and justice system representatives to educators and individuals with lived experience with addiction and recovery. Beaufort County demonstrated their commitment to capturing broad perspectives by hosting two rounds of public engagement meetings. When they realized their initial series had mostly drawn the usual perspectives, they launched a second round of focused outreach to fill the gaps in their understanding and targeted their efforts toward hard-to-reach populations that they hoped to serve. 

Diverse representation is essential because complex community challenges affect different groups in different ways. Without intentional effort to include varied perspectives, solutions may overlook critical needs or miss valuable opportunities. Sometimes, diverse representation in engagement processes will mean building genuine relationships before they are needed. Creating ongoing connections with groups who may be hesitant to engage with processes that they have often been excluded from takes resource investment, time, and trust-building. 

Committing to capturing input from a variety of perspectives might look like ensuring language access, transportation, or bringing the conversation to places where people already gather. When communities see that there is extra effort made to include them consistently, they build trust and are more likely to become ongoing partners. 

Accessible & Multi-Channel Communication

Information must flow freely and in multiple directions, not just at the start but throughout the entire engagement process. Nash County exemplified this through a thoughtful mix of engagement methods: community-wide meetings for broad discussion, smaller group sessions for deeper dialogue, one-on-one relationship building, paper handouts for those without digital access, and online surveys for convenient participation. They recognized that different community members have different needs and preferences for engagement, and met people where they were. 

There is no one-size-fits-all approach to reaching community members. Some people prefer face-to-face conversations, while others need written materials to process information. By diversifying communication channels and maintaining them over time, organizations ensure that important information reaches everyone, not just those who are easy to reach. This might include everything from text message updates and social media posts to radio announcements and door-to-door outreach. Consistent presence creates multiple opportunities for community members to see and celebrate progress, offer additional information, or identify information gaps that might otherwise go unfilled. 

Regular, multi-channel communication helps build momentum by showing how today’s conversations lead to tomorrow’s impact. When community members can see how their input influences decisions, they are more likely to stay engaged and bring others into the process over time – and this builds up their trust in those with the most power to make decisions. This develops a sustainable relationship and ongoing dialogue that creates checkpoints where the community can help course-correct and ensure that there’s always an open door for the right voices to be heard at the right time.  

Transparent Decision-Making 

Trust grows from transparency. Communities need clear information about available resources, constraints, and how their input shapes decisions – even when the decisions made might not be in perfect alignment with what community members hope for. Edgecombe County’s Community Paramedic Program showcased this value by consistently participating in existing coalition meetings and sharing transparent updates, especially regarding setbacks. When stakeholders fully understood the barriers, they were more satisfied with the progress made. And the Community Paramedic Program found that many partners had relevant resources or tools that helped address challenges. 

Transparent decision-making is crucial because it helps maintain community trust even when difficult choices must be made. Like a doctor explaining both the benefits and risks of a treatment plan, leaders who share the full picture of decision-making—including constraints and trade-offs—help communities become informed partners rather than anxious spectators. By clearly explaining the decision-making process and how community input will or will not be used, leaders can maintain credibility even when the final decision isn’t what everyone hoped for. This might include regular updates on budgets or challenges, clear explanations of legal requirements, or public dashboards tracking progress toward goals. 

When community collaborators understand not just what was decided but why and how, they develop a deeper understanding of systemic navigation and become stronger thought partners for future decisions. Even when decisions need to shift for reasons beyond anyone’s control, maintaining open communication prevents misunderstandings and builds trust. While no one welcomes disappointing news, community representatives are far more likely to remain engaged partners when they’re treated as respected collaborators who deserve to understand the full story. 

Trust-Building Through Sustained Engagement & Accountability 

Real engagement isn’t a one-time event—it’s an ongoing commitment. Nash County’s new Assistant County Manager showed her commitment to sustained engagement by intentionally following up with requests received during community conversations, visiting community leaders in their offices and homes, and convening groups to confront barriers even after initial decisions were made – showing that the County was a partner, not just a gatekeeper. This continual flow of information kept partner organizations asking questions, offering support, and identifying new needs and opportunities in the community. 

Sustained engagement matters because trust is built gradually through consistent interaction and demonstrated follow-through. One-off meetings or sporadic updates can actually damage trust if they’re not part of a longer-term relationship. A lack of follow up engagement might lead partners or community members to feel as if their time was wasted, or their input was not valued, even if it was. Sustained engagement is not just to continue to gather information, but also to take accountability for how decision-makers are using the feedback they’ve heard so far. This continuation of the discussion serves to strengthen bonds across community stakeholder groups and preserve partnerships that may be key in addressing challenges along the way. 

This ongoing engagement might take many forms: regular progress reports, community advisory committees, annual planning sessions, or informal check-ins with key stakeholders. Edgecombe County utilized creative methods to keep their networks in the loop, sharing statistics from program delivery, results from street drug testing initiatives, and continually showcasing success stories. The key is maintaining consistent, meaningful connection that shows community input and action remains valued even after initial decisions are made. 

In Practice: Making Engagement Work

The road to meaningful, equitable community engagement requires planning, intentionality, and consistency. Here’s how to turn these principles into action:

Start Early

1. Understand legal requirements, funding parameters, and decision-making deadlines – make sure you know what is up for discussion and what is not.
2. Identify existing community networks, leaders, and potential partners to help you build a process with inclusive leadership.
3. Research past engagement efforts and identify existing tools and resources – just like this guide demonstrates, others may have learned lessons you can incorporate into your process.
4. Build relationships with key stakeholders before you need them to show that you genuinely hope to include them.
5. Get clear internally about what aspects of decisions are flexible versus fixed and try to identify the boundaries you’ll communicate to stakeholders.

Create Structure for Input

1. Design multiple pathways for participation that fit different community needs to ensure diverse representation in your engagement. 
2. Be upfront about how community input will influence final decisions by explaining which elements are open for community direction and which are not.
3. Create clear timelines so people know when and how to engage and communicate those timelines consistently.
4. Demonstrate feedback systematically so nothing gets lost – not every piece of feedback will ultimately influence the final decision, but all feedback can be recorded and acknowledged.

Maintain Regular Communication

1. Share progress updates even when things move slowly.
2. Explain setbacks or delays honestly and promptly.
3. Celebrate small wins along the way to demonstrate momentum and remind yourself and partners that change is happening.
4. Circle back to show how input shaped decisions and think alongside partners about how they can continue to contribute to success.
5. Use multiple communication methods to reach different audiences and keep your work top of mind.

Track and Share Impact

1. Collect meaningful data about the process and its outcomes.
2. Share results in accessible, understandable formats with key messages emphasized.
3. Be transparent about what’s working and what isn’t – and remember that your partners may be a valuable part of identifying this.
4. Include community members redefining success metrics from the beginning and have shared expectations around what success will look like.
5. Use both data and storytelling to show change over time – some impacts will take more time than others, but you can still show progress.

Keep Learning and Adjusting

1. Regularly check in with community partners about the process and share your own reflections with them, as well.
2. Look for gaps in representation or participation so you can adapt your outreach methods to target missing voices in the future.
3. Be willing to change course when something is not working and apply these same strategies to plan adaptations or restructuring.
4. Create opportunities for new voices to join over time.
5. Document lessons learned so that future initiatives can build on your foundation to ven broader success, rather than having to start from scratch.

These steps are not one-time actions but part of an ongoing cycle. As you move through them, each round of engagement should build on previous experiences, deepen relationships, and strengthen the community’s capacity for meaningful partnership.

Conclusion

When decision-makers face complex policy and funding decisions, community engagement is a strategic necessity. No single person or organization holds all the answers to challenges facing communities like substance use and public health. The collective wisdom of community voices brings critical expertise about local needs, existing resources, and potential solutions that might otherwise go undiscovered. We hope these insights into critical principles for engagement help you, your communities, and the efforts you undertake together.