Office of Substance Abuse Prevention

ANNUAL STATE MEETINGAugust 9, 2011

Frank G. Magourilos, SCPSNew Mexico Prevention Networkwww.NMPreventionNetwork.org

PreventionWorks@msn.com

Prevention in the 21st Century

SAMHSA…has identified eight Strategic Initiatives to focus its limited resources on areas of urgency and opportunity.

In addition, three issues cut across all of the Initiatives: behavioral health disparities, health reform, and workforce development.

The Strategic Initiatives

1. Prevention of Substance Abuse and Mental Illness

2. Trauma and Justice

3. Military Families

4. Recovery Support

5. Health Reform

6. Health Information Technology

7. Data, Outcomes, and Quality

8. Public Awareness and Support

Strategic Initiative #1

Prevention of Substance Abuse and Mental Illness—Creating communities where individuals, families, schools, faith-based organizations, and workplaces take action to promote emotional health and reduce the likelihood of mental illness, substance abuse including tobacco, and suicide. This Initiative will include an emphasis on the Nation’s high-risk youth, youth in Tribal communities, and military families.

Why the Emphasis on Mental Health?

The Initiatives are data driven and grounded in a public health foundation as they respond to the toll that substance abuse, poor emotional health, and mental illnesses take.

Like physical illnesses, mental and substance use disorders cost money and lives if they are not prevented, are left untreated, or are poorly managed. Their presence exacerbates the cost of treating co-morbid physical diseases and results in some of the highest disability burdens in the world for individuals, families, businesses, and governments.

Why the Emphasis on Mental Health?

The annual total estimated societal cost of substance abuse in the United States is $510.8 billion.

By 2020, behavioral health disorders will surpass all physical diseases as a major cause of disability worldwide.

In 2008, an estimated 9.8 million adults aged 18 and older in the United States had a serious mental illness. Two million youth aged 12 to 17 had a major depressive episode during the past year.

In 2009, an estimated 23.5 million Americans aged 12 and older needed treatment for substance use.

Half of all lifetime cases of mental and substance use disorders begin by age 14 and three-fourths by age 24.

What Does All This Mean For Us?

As Prevention Professionals it will give us an opportunity to expand our influence and reach.

Mental Health is traditionally recognized as a component of Treatment; SAMHSA’s new direction bridges the fields of Prevention & Treatment.

Problem Id & Referral (CSAP SIX), is that bridge.

Riverside County California Problem Id & Referral Example:

Providing Prevention Services to Individuals is a new concept to most Substance Abuse Programs!

In 2006 the County of Riverside decided to provide Individual Prevention Services (IPS) Problem Id & Referral at their 7 Health Clinics as a way of costs savings. This made a lot of sense for an entry point of those seeking Substance Abuse help.

Operational Challenge - Staff

Initially, 4 certified Substance Abuse Counselors (Behavioral Health Specialist III) that were currently working at various clinics were assigned to serve as Prevention Specialists (PS) in the IPS Program.

Selected based on their interest in program and on their merit as personable and successful SA counselors.

These individuals underwent approximately 40 hours of specialized training in the Problem Id & Referral intervention model

Separating Prevention Screening fromTreatment Assessment

Screening – the process used to determine if education can reverse behavior.

Assessment – the process used to determine a diagnosis for treatment.

Selecting an Evidence-Based Intervention CSAP Strategies of Problem Identification &

Referral and Education provide the foundation of the intervention.

Needed a tool that was not disease focused – needed to be able to quickly identify individual’s strengths and internal and external resources.

Brief Risk Reduction Interview & Intervention Model (BRRIIM) was utilized.

BRRIIM Goals and Objectives

Increase access to prevention by filling the “gap”

between prevention and treatment services. Serve individuals of any age who are AT RISK of

abusing alcohol/drugs. Implement a problem identification tool to rapidly

assess an individual’s risk level. Provide evidence based prevention practices aimed

at stemming the progression to substance abuse. Engage the individual’s personal motivation to make

positive health choices.

Results (3-YEARS)

Total Interviews – 1970 individuals

Prevention Service Agreements –

793 (40.2%)

Referrals for diagnostic assessment

1177 (59.8%)

Impact - Fiscal

Average cost of 16-week Riverside County outpatient treatment program = $4,800

Average cost of IPS program, based on times reported in previous slide = $1,011

Average savings per individual that goes through IPS program = $3,789

Total cost savings to Riverside County over three years = $3,004,677 (793 IPS agreements x $3,789)

Impact - Participants

Follow-up Interviews with Participants

95% indicated they would seek prevention services through IPS again if needed

95% indicated they would recommend IPS services to others

Evaluation

In February 2010, the Riverside County Individual Prevention Services Program was the recipient of one of this year’s Service to Science Awards after being nominated by the State of California Department of Alcohol and Drug Programs.

External Evaluator- is in place and outcomes are pending…

LOCAL DWI PROGRAMS

Problem Id & Referral Access Points:

Alcohol Screening;

Treatment side only

Teen Courts

Some Prevention Specialists

LOCAL DWI PROGRAMS

Process:

Standardized Process (ADE)

Only Treatment!

LOCAL DWI PROGRAMS

Gaps: Bridge—Integration—Active

Collaboration of all/between DWI Local Program Components

State assessment-Inventory of what each program is doing in this area

Cross-training; Prevention & Treatment Professionals

Is this the end of Environmental Strategies?

Looking at SAMHSA’s Mental Health Priorities, we might think that the prevention direct services approach is about to take over and replace other CSAP strategies, and especially Environmental approaches?...not so fast…

Prevention research over the past decades has overwhelmingly shown us that a comprehensive “Systems” approach is the vehicle to population level changes.

Problem Id & Referral is the most immediate bridge to our closest neighbors, Treatment, thus, SAMHSA’s intention.

NATIONAL PREVENTION STRATEGY

“This strategy is a critical component of the

Affordable Care Act.”

The National Prevention Council comprises 17 heads of departments, agencies, and offices across the Federal government. The Council provides the leadership necessary to engage not only the federal government but a diverse array of stakeholders, from state and local policy makers, to business leaders, to individuals, their families and communities, to champion the policies and programs needed to ensure the health of Americans prospers.

National Prevention Council Members & Agencies

Surgeon General Regina M. Benjamin, Council Chair

• Secretary Kathleen Sebelius, Department of Health and Human Services• Secretary Tom Vilsack, Department of Agriculture• Secretary Arne Duncan, Department of Education• Chairman Jon Leibowitz, Federal Trade Commission• Secretary Ray LaHood, Department of Transportation• Secretary Hilda L. Solis, Department of Labor• Secretary Janet A. Napolitano, Department of Homeland Security• Administrator Lisa P. Jackson, Environmental Protection Agency• Director R. Gil Kerlikowske, Office of National Drug Control Policy• Director Melody Barnes, Domestic Policy Council• Assistant Secretary-Indian Affairs Larry Echo Hawk, Department of the Interior• Acting Chief Robert Velasco II, Corporation for National & Community Service• Secretary Robert M. Gates, Department of Defense• Secretary Shaun Donovan, Department of Housing and Urban Development• Attorney General Eric H. Holder, Jr., Department of Justice• Secretary Eric K. Shinseki, Department of Veterans Affairs• Director Jacob J. Lew, Office of Management and Budget

National Prevention StrategyAmerica’s Plan for Better Health and Wellness

REFERENCES

http://www.samhsa.gov/About/strategy.aspx http://www.samhsa.gov/prevention/ http://www.samhsa.gov/militaryFamilies/ http://www.samhsa.gov/publicAwareness/ http://www.samhsa.gov/dataOutcomes/ http://www.healthcare.gov/center/councils/np

hpphc/strategy/report.pdf http://www.healthypeople.gov/2020/