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Aligning Concepts, Practice and Contexts to Promote Long-term Recovery: An Action Plan. “Recovery Oriented Systems of Care: SAMHSA/CSAT’s Public Health Approach to Substance Use Problems & Disorders”. May 2, 2008 Philadelphia, PA. H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director

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slide1

Aligning Concepts, Practice and Contexts to Promote Long-term Recovery: An Action Plan

“Recovery Oriented Systems of Care: SAMHSA/CSAT’s Public Health Approach to Substance Use Problems & Disorders”

May 2, 2008

Philadelphia, PA

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM

Director

Center for Substance Abuse Treatment

Substance Abuse Mental Health Services Administration

U.S. Department of Health & Human Services

slide2
President George W. Bush

“…To build a future of quality health care, we must trust patients and doctors to make medical decisions and empower them with better information and better options.”

2008 State of the Union

terry l cline phd administrator substance abuse and mental health services administration
Terry L. Cline, PhDAdministratorSubstance Abuse and Mental Health Services Administration

“At SAMHSA, our mission includes helping prevention and treatment counselors, clinics, and health care providers develop ways to change their service systems to increase positive outcomes for their clients.”

September 2007

an introduction to the substance abuse and mental health services administration samhsa
An Introduction to the Substance Abuse and Mental Health Services Administration (SAMHSA)

One of the eleven grant making agencies of the U.S. Department of Health and Human Services, with a budget of approximately 3 billion dollars.

SAMHSA’s Mission:

To build resilience and facilitate recovery for people with or at risk for substance abuse and mental illness.

Website: http://www.SAMHSA.gov

samhsa s role in fighting substance misuse and abuse
SAMHSA’s Role in Fighting Substance Misuse and Abuse
  • SAMHSA works to ensure that science, rather than ideology or anecdote, forms the foundation for the Nation’s addiction treatment system.
  • SAMHSA serves health professionals and the public by disseminating scientifically sound, clinically relevant information on best practices in the treatment of addictive disorders and by working to enhance public acceptance of that treatment.
the samhsa matrix
The SAMHSA Matrix

SAMHSA’s Matrix provides a graphic representation of the collaboration needed to promote holistic, integrated approaches that advance the health and well-being of individuals, families, and communities.

samhsa centers
SAMHSA Centers

Center for Mental Health Services Mission:

To ensure access and availability of quality mental health services to improve the lives of all adults and children in this Nation.

Center for Substance Abuse Prevention Mission:

To decrease substance use and abuse by bringing effective substance abuse prevention to every community.

Center for Substance Abuse Treatment Mission:

To improve the health of the nation by bringing effective alcohol and drug treatment to every community.

samhsa programs support a comprehensive approach to public health

Law

Enforcement

Public

Health

Substance

Abuse

Prevention

Substance

Abuse

Treatment

Mental

Health

SAMHSA Programs Support a Comprehensive Approach to Public Health
we face multiple challenges
We Face Multiple Challenges
  • Reaching those in need of services
  • Providing adequate resources
  • Developing culturally-appropriate, evidence-based interventions
  • Building and sustaining a qualified workforce
  • Integrating substance use disorder services into the public health paradigm
greater burden on public sector
Greater Burden on Public Sector

Private

Private

Public

Public

1986 All SA = $9.3B

Public = $4.6 B

Private = $4.6 B

2003 All SA = $20.7 B

Public = $16.0 B

Private = $4.7 B

Source: Health Affairs, July-August 2007

a public health imperative substance misuse can
A Public Health ImperativeSubstance Misuse can:
  • Lead to:
  • Worsened medical conditions (e.g. diabetes, hypertension) and
  • Worsened brain disorders (e.g. depression, psychosis, anxiety & sleep disorders)
  • Unintentional injuries & violence
  • Result in:
  • Dependence, which may require multiple treatment services
  • Low birth weight, premature deliveries, and developmental disorders, child abuse & neglect
a public health imperative substance misuse can12
A Public Health ImperativeSubstance Misuse can:
  • Contribute to or be associated with :
  • Homelessness
  • Criminal justice involvement
  • The effect and abuse of prescribed medications
  • Unemployment
  • Gambling
  • Bankruptcy
  • Legal Issues (e.g. DUI, DWI, domestic violence)
  • Dropping out of school
a public health imperative substance misuse can13
A Public Health ImperativeSubstance Misuse can:
  • Induce or facilitate:
  • Medical diseases (e.g. Stroke, dementia, hypertension, cancers)
  • Acquiring Infectious diseases & infections (e.g. HIV, Hepatitis C)
  • Suicide attempts or tendencies
past month alcohol use 2006
Past Month Alcohol Use - 2006

Any Use: 51% (125 million)

Binge Use: 23% (57 million)

Heavy Use: 7% (17 million)

(Current, Binge, and Heavy Use estimates are similar to those in 2002, 2003, 2004, and 2005)

Source: NSDUH 2006

slide15

Drug Use Among the General Population – 2006

Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use & Health, 2005 & 2006

slide16

Illicit Drug Dependence or Abuse in Past Year among Persons Aged 12 or Older: Percentages,

Source: Annual Averages Based on 2005-2006 NSDUHs

slide17

Non-Medical use of Pain Relievers in Past Year among Persons aged 12 or Older: Percentages

Source: Annual Averages Based on 2005-2006 NSDUHs

slide18

Alcohol Dependence or Abuse in Past Year among Persons Aged 12 or Older: Percentages

Source: Annual Averages Based on 2005-2006 NSDUHs

slide19

Past Year Perceived Need for and Effort Made to Receive Treatment among Persons Aged 12+ Needing But Not Receiving Specialty Treatment for Illicit Drug or Alcohol Use: 2006

Felt They Needed Treatment and Did Not Make an Effort

(625,000)

Did Not Feel They Needed Treatment(20,114,000)

95.5%

1.5%

Felt They Needed Treatment and Did Make an Effort

(314,000)

The Challenge

21.1 Million Needing But Not Receiving Treatment for Illicit Drug or Alcohol Use

identifying treating substance abuse
Identifying & Treating Substance Abuse

Substance abuse is often observed, but ignored or excused, before the client is identified as needing treatment.

Drug Courts

Alcohol Treatment

Public

Health

Treatment

Strategies

SBIRT

HIV/AIDS

Employer/

Co-Workers

Family

Friends

Adolescent Treatment

Women &

Children Services

SAPT Block Grant

the recovery process
The Recovery Process

Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life.

Source: CSAT National Summit on Recovery, 2005

recovery oriented systems of care a paradigm shift
Recovery-Oriented Systems of Care: A Paradigm Shift

Recovery-Oriented Systems of Care shift the question from “How do we get the client into treatment?” to “How do we support the process of recovery within the person’s environment?”

slide24

Person’s Entry into treatment

Discharge

A Traditional Course of Treatment for a Substance Use Disorder

Severe

Symptoms

Remission

Resource: Tom Kirk, Ph.D

slide25

A Traditional Service Response

Severe

Remission

Acute symptoms

Discontinuous treatment

Crisis management

Resource: Tom Kirk, Ph.D

slide26

Continuous treatment response

A Recovery-Oriented Response

Severe

Remission

Promote Self Care, Rehabilitation

Resource: Tom Kirk, Ph.D

slide27

Recovery Zone

Helping People Move Into A Recovery Zone

Severe

Symptoms

Improved client outcomes

Remission

Time

Resource: Tom Kirk, Ph.D

benefits of moving into a recovery zone
Benefits of Moving into a Recovery Zone
  • Most clients undergo 3 to 4 episodes of care before reaching a stable state of abstinence ¹
  • Chronic care approaches, including self-management, family supports, and integrated services, improve recovery outcomes 2
  • Integrated and collaborative care has been shown to optimize recovery outcomes and improve cost-effectiveness 3

¹Dennis, Scott & Funk, 2003

2 Lorig et al, 2001; Jason, Davis, Ferrari, & Bishop; 2001; Weisner et al, 2001; Friedmann et al, 2001

3Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001)

recovery oriented systems of care approach
Recovery-Oriented Systems of Care Approach
  • In the recovery-oriented systems of care approach, the treatment agency is viewed as one of many resources needed for a client’s successful integration into the community.
  • No one source of support is more dominant than another.
  • Various supports need to work in harmony with the client’s direction, so that all possible supports are working for and with the person in recovery.

Source: Addiction Messenger, November 2007, Vol. 10 Issue 11, published by the Northwest Frontier ATTC.

slide31

ROSC support person-centered and self-directed approaches to care that build on the personal responsibility, strengths, and resilience of individuals, families and communities to achieve health, wellness, and recovery from alcohol and drug problems.

Recovery

V

Individual

Family

Community

Wellness

Health

slide32

ROSC offer a comprehensive menu of services and supports that can be combined and readily adjusted to meet the individual’s needs and chosen pathways to recovery.

Recovery

Services & Supports

Family/Child Care

Alcohol/Drug Services

Vocational

Education

Housing/

Transportation

Individual

Family

Community

PTSD &Mental Health

Physical Health Care

Spiritual

HIV Services

Financial

VSO & Peer Support

Health

Wellness

Legal

Case Mgt

rosc encompass and coordinates the operations of multiple systems
ROSC encompass and coordinates the operations of multiple systems…

Recovery

Systems of Care

Addiction

Services System

Child Welfare

and Family

Services

Social

Services

Services & Supports

Mental Health

System

Family/Child Care

Alcohol/Drug Treatment

Housing

System

Vocational

Individual

Family

Community

Primary Care

System

Educational

PTSD & Mental Health

Housing/

Transportation

Health Care

Faith Community

HIV Services

Vocational

Services

Spiritual

Indian Health

Services

Financial

VSO & Peer Support

Legal

Case Mgt

Health Insurance

Criminal Justice

System

Wellness

Health

DoD & Veterans Affairs

providing responsive outcomes driven approaches to care
…providing responsive, outcomes-driven approaches to care.

Recovery

Abstinence

Evidence-Based Practice

Systems of Care

Addiction

Services System

Child Welfare

and Family

Services

Employment

Menu of Services

Cost Effectiveness

Social

Services

Family/Child Care

Alcohol/Drug Treatment

Mental Health

System

Vocational

Individual

Family

Community

Housing

Authority

Educational

PTSD &Mental Health

Reduced

Crime

Housing/

Transportation

Health Care

Primary Care

System

Perception

Of Care

HIV Services

Faith Community

Spiritual

Vocational Services

Indian Health

Services

Financial

VSO & Peer Support

Safe & Drug-free

Housing

Legal

Case Mgt

Retention

Health Insurance

Criminal Justice

System

Health

Wellness

DoD & Veterans Affairs

Access/Capacity

Social Connectedness

slide35
ROSC require an ongoing process of systems improvement that incorporates the experiences of those in recovery and their family members.

Recovery

Abstinence

Evidence-Based Practice

Systems of Care

Addiction

Services System

Child Welfare

and Family

Services

Employment

Services & Supports

Family/Child Care

Alcohol/Drug Treatment

Mental Health

System

Social

Services

Vocational

Cost Effectiveness

Individual

Family

Community

Educational

PTSD & Mental Health

Reduced

Crime

Housing/

Transportation

Primary Care

System

Housing

Authority

Health Care

Perception

Of Care

Spiritual

HIV Services

Vocational Services

Indian Health

Services

Financial

VSO & Peer Support

Legal

Case Mgt

Safe & Drug-free

Housing

Retention

Health Insurance

Criminal Justice

System

Health

Wellness

DoD & Veterans Affairs

Access/Capacity

Social Connectedness

Ongoing Systems Improvement

recovery oriented systems of care
Recovery-Oriented Systems of Care
  • Support person-centered and self-directed approaches to care that build on the strengths and resilience of individuals, families and communities to take responsibility for their sustained health, wellness, and recovery from alcohol and drug problems.
  • Offer a comprehensive menu of services and supports that can be combined and readily adjusted to meet the individual’s needs and chosen pathway to recovery.
slide37

Recovery-Oriented Systems of Care

  • Encompass and coordinate the operations of multiple systems, providing responsive, outcomes-driven approaches to care
  • Require an ongoing process of systems improvement that incorporates the experiences of those in recovery and their family members
elements of recovery oriented systems of care
Elements of Recovery-Oriented Systems of Care
  • Person-Centered:
  • Individualized & Comprehensive Services
  • Responsive to Culture & Personal Belief Systems
  • Community-based
  • Commitment to Peer Services
  • Involvement of Family and other Allies
  • Ongoing Monitoring & Outreach
elements of recovery oriented systems of care39
Elements of Recovery-Oriented Systems of Care
  • Cost Effective:
  • Outcomes Oriented
  • Integrated Services, resulting in Non-Duplication of Services
  • Competency-based
  • Effective use of Collaboration & Partnerships
  • Systems-wide Education and Training
  • Continuity of Care
  • Research-based
  • Flexible Funding
alcohol drug related emergency department ed visits
Alcohol & Drug Related Emergency Department (ED) Visits
  • In 2005 there were an estimated 394,224 ED visits that involved alcohol in combination with another drug.
  • Alcohol was most frequently combined with one or more of the following: cocaine, marijuana, and heroin

SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2005 (04/2006 update).

slide42

36,007

Heroin

5,694

Methadone

5,085

Hydrocodone*

5,066

Oxycodone*

225

Opiate Reports in Emergency Department Visits Related to Drug Misuse/Abuse

Buprenorphine*

* Includes single- and multi-ingredient products

Unweighted reports from 243-445 U.S. hospitals

Source: U.S. SAMHSA; DAWN Live! Oct 2, 2007

traditional substance abuse intervention
Traditional Substance Abuse Intervention

5% Alcoholics

20% At-Risk Drinkers

35% Low Risk Drinkers

40% Abstainers

  • Little attention has been given to the large group of individuals who use alcohol and other drugs but are not, or not yet, dependent .

Adapted from Babor,T,F., Higgins-Biddle,J.C., (2001), Brief Intervention for Hazardous and Harmful Drinking: A manual for use in primary care . p 33. WHO/MSD/MSB/01.6b World Health

screening brief intervention referral to treatment sbirt
Screening, Brief Intervention & Referral to Treatment (SBIRT)
  • Embeds screening, brief intervention & treatment of substance abuse problems within primary care settings such as emergency centers, community health care clinics, and trauma centers.
  • Identifies patients who don’t perceive a need for treatment,
  • Provides them with a solid strategy to reduce or eliminate substance abuse, and
  • Moves them into appropriate services.
sbirt takes advantage of the teachable moment
SBIRT Takes Advantage of the “Teachable Moment”

“Teachable Moment” is the moment of educational opportunity – a time at which a person is likely to be particularly disposed to learn something or particularly responsive to being taught or made aware of something.

Source: MSN Encarta Online Dictionary, Retrieved 3/25/08 from http://encarta.msn.com

top five substances reported by sbirt clients
Top Five Substances Reported by SBIRT Clients

Source: Services Accountability Improvement System (SAIS)

csat sbirt initiative
CSAT SBIRT Initiative
  • Increases access to clinically appropriate care for nondependent as well as dependent persons.
  • Links generalist and specialist treatment systems.
  • Combines intervention and treatment toward a consistent continuum of care.

4. Builds a coalition between health care services and alcohol and drug treatment services.

sbirt enhances state substance abuse treatment service systems by
SBIRT enhances State substance abuse treatment service systems by:

Expanding the State’s continuum of care to include SBIRT in general medical and other community settings

  • community health centers
  • nursing homes
  • schools and student assistance programs
  • occupational health clinics
  • hospitals, emergency departments.
sbirt enhances state substance abuse treatment service systems by49
SBIRT enhances State substance abuse treatment service systems by:
  • Changing how substance abuse is managed in primary care settings
  • Treating substance abuse issues at the lowest level of acuity, before clients are diagnosed with substance use disorders
sbirt core clinical components
SBIRT: Core Clinical Components
  • Screening: Very brief screening that identifies substance related problems
  • Brief Intervention: Raises awareness of risks and motivation of client toward acknowledgement of problem
  • Brief Treatment: Cognitive behavioral work with clients who acknowledge risks and are seeking help
  • Referral: Referral of those with more serious addictions
sbirt screening
SBIRT: Screening
  • Quick method to identify individuals who may be at risk for developing alcohol and substance abuse problems
  • Includes screening plus immediate feedback
    • serves as an intervention and
    • is tailored to the level of either illness or risk
  • Screening is performed using a brief questionnaire about the context, frequency, and amount of alcohol or other drugs used by an individual
sbirt brief intervention
SBIRT: Brief Intervention
  • Healthcare provider uses the results of a screening questionnaire that indicates a moderate alcohol or drug problem to motivate an individual to begin to do something about his/her substance use behavior
    • Typically 1-3 sessions, not more than 5 sessions
    • One or more follow-up care management contacts with patients either in brief face-to-face counseling or by telephone
  • Low-cost, effective treatment alternative for alcohol and other drug problems
components of brief interventions
Components of Brief Interventions
  • Give feedback about screening results, impairment and risks, while clarifying the findings
  • Inform the patient about hazardous consumption limits and offer advice about change
  • Assess the patient's readiness to change
  • Negotiate goals and strategies for change
  • Arrange for follow-up treatment
sbirt brief treatment
SBIRT: Brief Treatment
  • Based on moderate to high risk screening scores
  • Involves motivational discussion and client empowerment
  • Similar to brief intervention, but more comprehensive
  • Includes assessment, education, problem solving, and building a supportive social environment
  • Examples include:
    • Brief cognitive-behavioral therapy
    • Brief psychodynamic therapy
    • Brief family therapy
sbirt referral to treatment
SBIRT: Referral to Treatment
  • Healthcare provider -- using the results of a screening questionnaire that indicates alcohol or drug dependence -- refers an individual to a specialized treatment setting
  • Proactive process facilitates access to specialty treatment for individuals requiring more extensive resources than can be provided in a primary care setting
  • This integral component of SBIRT ensures access to the appropriate level of care for all who are screened
coding for sbi reimbursement february 2008
Coding for SBI ReimbursementFebruary 2008

Reimbursement for screening & brief intervention is available through commercial insurance CPT codes, Medicare G codes and Medicaid HCPCS codes

  • HCPCS Codes (Medicaid)

- H0049: Alcohol &/or Drug Screening ($24)

- H0050: Brief Intervention:15 mins. ($48)

  • CMS G-Codes (Medicare)

- G0396: 15-30 mins ($29.42)

- G0397: > 30 mins ($57.69)

  • CPT Codes (Commercial Health Plans)

- 99408: 15-30 mins ($33.41)

- 99409: > 30 mins ($65.51)

sbirt current grantees colleges
SBIRT Current Grantees & Colleges

Massachusetts

Connecticut

Delaware

College/University Grants

State Grants

sbirt patients served
SBIRT– Patients Served

625,937 patients have been seen through the SBIRT process:

  • 16.2% received brief intervention
  • 3.1% received brief treatment
  • 3.6% were referred to treatment
sbirt outcomes
SBIRT Outcomes
  • Since FY 2004, there has been a 152.6% increase in the number of clients reporting abstinence 6 months after intake.

Source: Random sample collected at baseline & 6 months post intake, as of 3/24/08.

Results are from SBIRT early implementation and reflect a more severely involved substance abuse population.

alcohol to intoxication illegal drug use sbirt outcomes
Alcohol to Intoxication & Illegal Drug Use – SBIRT Outcomes

The data below represent follow-up from the SBIRT programs as of 3/24/08. Sample selection was random and collected at intake and 6 months post intake.

Important to note: Results are from SBIRT early implementation and reflect a more severely involved substance abuse population.

access to recovery atr
Access to Recovery (ATR)
  • ATR is a Presidential Initiative designed to promote client choice through
    • the expansion of treatment capacity,
    • the implementation of a voucher system, which allows most grantees to choose their target populations and geographic area(s) of coverage, and
    • the inclusion of non-traditional substance abuse treatment providers, such as faith- and community based organizations
access to recovery atr63
Access to Recovery (ATR)
  • The recovery-oriented approach contributes to the effective application of the ATR program.
    • Recovery support services in conjunction with clinical treatment help to establish a more continuous treatment response.
  • The recovery-oriented model ultimately means that the program focuses on reducing the acute and severe relapses that substance abusing clients often experience.
more choices for clients
More Choices for Clients
  • ATR has helped mobilize community networks and build collaborative partnerships that result in more choices and more services for clients with substance abuse issues.
  • Faith-based organizations have expanded the concept of choice by offering faith-based options to clients who may have a more spiritual approach to their recovery
more flexibility
More Flexibility
  • Empowers clients to directly participate in their own recovery by offering them choices about where and from whom they receive treatment.
  • Levels the playing field so that smaller and newer providers can improve their ability to compete for Federal funds and address the issues of their communities.
helps build networks
Helps Build Networks
  • ATR provides a platform to develop linkages with other federal agencies/programs which can help to leverage ATR funds or serve as a source of referrals/services:
    • Drug courts may be sources of referrals into the program
    • DOJ-DOL program—Prisoner Reentry Program
    • HUD—Housing services (direct housing services such as rent payments are not permissible under ATR)
atr electronic voucher system
ATR Electronic Voucher System
  • Significantly reduces paperwork and creates administrative efficiencies;
  • Streamlines the referral process for clients;
  • Improves data collection on client outcomes to track the impact of the program on clients;
  • Increases accountability by tracking clients through the system, and tracks ATR dollars to manage program funds and monitor for fraud, waste, or abuse;
  • Links various providers together through an electronic database.
examples of services that can be paid for using atr vouchers
Employment coaching

12-step groups

Recovery coaching

Spiritual support

Child Care

Housing Support

Literacy Training

Traditional Healing Practices, e.g.:

Sweat lodge

Sundance ceremony

Burning sage

Beading

Other

Examples of Services That Can be Paid for Using ATR Vouchers
contributions of faith and community based organizations fbcos
Contributions of Faith- and Community-based Organizations (FBCOs)
  • FBCOs have expanded the concept of choice by offering faith-based options to clients who may have a more spiritual approach to their recovery.
  • In many cases clients consider them trustworthy sources that were located within the client’s community and who were unaffiliated with any formal state or federal structure.
  • FBCOs are particularly effective for engaging and retaining clients who had been incarcerated or had criminal records.
contributions of faith and community based organizations fbcos70
Contributions of Faith- and Community-based Organizations (FBCOs)
  • FBCOs infused the treatment networks with recovery support services such as transportation, child care, scriptural study groups, faith-based counseling, and peer-to-peer support.
  • The inclusion of recovery support services has enhanced treatment outcomes and has helped clients to remain motivated and engaged in their treatment.
  • FBCOs can counter the “spiritual malaise” the results from guilt and shame for how addiction has affected loved ones and can, consequently, can hinder recovery.
slide71

Benefits of Faith- and Community-based Treatment Programs

  • 79% of Americans believe that spiritual faith can help people recovery from disease.
  • 63% think that physicians should talk to patients about spiritual faith.

Source: Sloan, R. P., Bagiella, E., Powell, T. (1999) Religion, spirituality, and medicine. Lancet, 353(9153), 664-667, cited in CASA study: So Help Me God: Substance Abuse, Religion and Spirituality, 2001

slide72

ATR Evidences of Success

  • More than 206,000 individuals with substance abuse problems have received treatment and/or recovery support services through the first round of ATR grants awarded in August 2004.
  • 1,233 Faith-based providers account for 23% of all recovery support providers and 31% of all Clinical Treatment providers with voucher redemptions.

Source: SAMHSA data reported by ATR 2004 grantees through the Services Accountability Improvement System (SAIS). 12/31/07

atr evidences of success
ATR Evidences of Success
  • 74.3% of clients who reported using substances at intake into ATR were abstinent from substance abuse at discharge.
    • This exceeds the success rate of most national programs.

Source: SAMHSA data reported by ATR 2004 grantees through the Services Accountability Improvement System (SAIS). 12/31/07

treatment drug courts
Treatment Drug Courts
  • Treatment Drug Courts combine the sanctioning power of courts with effective treatment programs
  • Currently, there are 25 Family & Juvenile Drug Court grantees in the following states:
  • Alabama
  • California
  • Florida
  • Kentucky
  • Massachusetts
  • Michigan
  • Missouri
  • Montana
  • Ohio
  • Oregon
  • Pennsylvania
  • Rhode Island
  • Texas
  • Wyoming
samhsa s commitment to treatment drug courts
SAMHSA’s Commitment to Treatment Drug Courts
  • Family & Juvenile Drug Court grants allocate funds to be used by treatment providers and the courts for:
    • the provision of alcohol & drug treatment,
    • Wrap-around services supporting substance abuse treatment,
    • Case management, and
    • Program coordination.
treatment drug courts evidences of success
Treatment Drug Courts Evidences of Success
  • A total of 8,363 clients were served from FY 2003 to FY 2006.
  • Of the clients served in FY 2007:
  • 1,152 clients were discharged from the program
  • 57.1% of those discharged graduated/completed the program
  • Nearly three-quarters stayed in the program for more than 121 days.

Source: SAMHSA Services Accountability Improvement System (SAIS) 2006

treatment drug courts evidences of success78
Treatment Drug CourtsEvidences of Success

Source: SAMHSA Services Accountability Improvement System (SAIS) March 3, 2008

slide79

Injection Drug Use & HIV/AIDS

  • According to CDC data on U.S. adolescents and adults
  • – in 2006:
  • Approximately 13% of the reported new AIDS cases were related to injection drug use.
  • 19% of males and 32% of females living with AIDS were exposed through injection drug use.
  • Almost one-third (27.8%) of AIDS deaths were adolescents and adults infected through injection drugs.

Source: CDC. HIV/AIDS Surveillance Report, 2006. Vol. 18. Atlanta: US Department of Health and Human Services, CDC; 2008.

the hiv aids challenge
The HIV/AIDS Challenge

Number of HIV Infected in the U.S. at end of 2003:

1,039,000 to 1,185,000

Number unaware of their HIV infection (U.S.) at end of 2003:

252,000 to 312,000 (24% - 27%)

Source: Glynn M, et al. Estimated HIV prevalence in the United States at the end of 2003. National HIV Prevention Conference; June 12–15, 2005; Atlanta. Abstract T1-B1101.

csat minority aids initiative
CSAT - Minority AIDS Initiative
  • Minority AIDS grants are awarded to community-based organizations with two or more years of experience in the delivery of substance abuse treatment and related HIV/AIDS services.
  • Programs target African American, Latino/Hispanic and other racial or ethnic communities highly affected by substance abuse and HIV/AIDS.
  • HIV Outreach grants served 22,760 clients
  • TCE/HIV grants served 18,158 clients
  • As a whole, the HIV Portfolio served a combined 40,918 clients
slide82

AK

WA

NH

VT

MT

ME

ND

MN

OR

ID

SD

WI

NY

WY

MI

MA

IA

PA

NV

NE

OH

RI

IL

IN

CT

UT

WV

NJ

CO

VA

CA

KS

MO

DE

KY

MD

NC

DC

TN

AZ

NM

AR

SC

OK

AL

GA

MS

TX

LA

Puerto Rico

FL

HI

Virgin Islands

2007 CSAT TCE/HIV Grantees

States with 2007 Grantees

tce hiv and hiv outreach changes in risk behaviors
TCE/HIV and HIV OutreachChanges in Risk Behaviors

Source: SAIS data FY 2004 through 3/21/08

residential treatment for pregnant and postpartum women ppw
Residential Treatment for Pregnant and Postpartum Women (PPW)
  • PPW is a gender and culturally specific residential treatment program for pregnant and postpartum women.
  • Providing comprehensive services to women during pregnancy significantly improves the lives of women, children, and their families.
  • These services are also important after birth, since the effects of alcohol and drug use continue to have negative consequences for women, their children, and the entire family.
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Residential Treatment for Pregnant and Postpartum Women (PPW)
  • Target is traditionally underserved populations -- especially racial and ethnic minority women, as an important subpopulation
    • Low-income women, age 18 and over, who are pregnant, postpartum (the period after childbirth up to 12 months), and their minor children, age 17 and under, who have limited access to quality health services are the target population for the PPW program.
pregnant postpartum parenting program
Pregnant, Postpartum & Parenting Program

Residential Treatment for Pregnant and Postpartum Women and Residential Treatment for Women and their Children  program served 2,067 women from FY 2004 through the present.

1.3%

15.9%

12.1%

1.0%

7.9%

0.7%

2.3%

27% of women also considered themselves Hispanic, in addition to race reported.

58.8%

Source: SAMHSA data reported by grantees through the Services Accountability Improvement System (SAIS). 2/19/08

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Substance Abuse Prevention and Treatment (SAPT) Block Grant

  • The SAPT Block Grant distributes funds to 60 eligible:
    • States
    • Territories
    • The District of Columbia
    • The Red Lake Indian Tribe of Minnesota
  • 95% of appropriate funds are distributed to States through a formula prescribed by the authorizing legislation. (For information, contact the your Single State Authority)
  • The Goal: To support and expand substance abuse prevention and treatment services, while providing maximum flexibility to the States.
  • In FY 2008 over 1.8 million admissions to treatment programs received public funding.
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SAPT Block Grant Evidences of Success

Preliminary data collected for all SAPT Block Grant programs indicate:

  • 73.4% of clients reported alcohol abstinence at the time of discharge – up 42.5% from time of admission.
  • 67.8% of clients reported drug abstinence at the time of discharge – up 58.1% from time of admission.
  • 63.4% of clients reported having social support at the time of discharge – up 44.3% from time of admission.

Source: FY 2008 Uniform application for Substance Abuse Prevention and Treatment (SAPT) Block Grant Treatment Measures, 10/01/2007 (revised 12/02/07)

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SAPT Block Grant Evidences of Success

SAPT Block Grant preliminary data cont’d::

  • 40.8% of clients reported being employed at the time of discharge – up 10.9% from time of admission.
  • 93.4% of the clients reported having housing at the time of discharge – up 2.4% from time of admission.
  • 87.9% of clients reported no arrests at the time of discharge – up 19.2% from time of admission.

Source: FY 2008 Uniform application for Substance Abuse Prevention and Treatment (SAPT) Block Grant Treatment Measures, 10/01/2007 (revised 12/02/07)

programs focusing on children adolescents
Programs Focusing on Children & Adolescents
  • Approximately 5% to 9% of children (aged 9-17) have a serious emotional disturbance
    • Many have a co-occurring substance abuse disorder.
  • 8.8 % adolescents (aged 12 - 17) have met the criteria for dependence and/or abuse of illicit drugs or alcohol.
  • Adolescents who had experienced a past year major depressive episode were more than twice as likely to have used illicit drugs in the past monththan their peers who had not (21.2% vs. 9.6%).
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Programs Focusing on Children & Adolescents

SAMHSA treatment & prevention programs that focus on the unique needs of children and adolescents include:

  • Safe Schools/Healthy Students
    • Designed to prevent violence and substance abuse among our Nation's youth, schools, and communities.
  • Helping America’s Youth
    • Led by First Lady Laura Bush to benefit children and teenagers by encouraging action in three key areas: family, school, and community.
  • StopAlcoholAbuse.gov
    • Comprehensive portal of Federal resources for information on underage drinking and ideas for combating this issue.
programs focusing on children adolescents cont d
Programs Focusing on Children & Adolescents (cont’d)
  • Systems of Care
    • An approach to mental health services that recognizes the importance of family, school and community.
  • Too Smart to Start
    • An underage alcohol use prevention initiative for parents, caregivers, and their 9-to-13 year-old children.
recovery month september 2008
Recovery Month – September 2008

Goals:

  • Support the administration’s goal of reducing demand and promoting the message that recovery is possible
  • Generate momentum for hosting state and local community-based events
    • Enhance knowledge, Improve understanding, Promote support for addiction treatment
  • Publicize messages that:
    • Reduce the stigma & discrimination associated with addiction
    • Encourage those in need to get treatment
    • Support those who are already in recovery
get involved in recovery month
Get involved in Recovery Month

Help bring hope and healing to others

  • Visit the Recovery Month Web site at www.recoverymonth.gov
  • Use the tools to spread the Recovery Month message:
    • Toolkits, presentations, giveaways, public service announcements, and more
  • Join thousands of individuals and organizations by hosting a Recovery Month event in your community
  • Educate others about the effectiveness of treatment and the hope of recovery
  • For more information call 1-800-662-Help
samhsa csat information
SAMHSA/CSAT Information
  • SAMHSA web site: www.samhsa.gov
  • CSAT web site: http://csat.samhsa.gov/
  • ATR web site: http://atr.samhsa.gov/
  • SBIRT web site: http://sbirt.samhsa.gov/
  • Recovery Month web site:http://www.recoverymonth.gov/
  • SHIN 1-800-729-6686 for publication ordering or information on funding opportunities
    • 1-800-487-4889 – TDD line
  • 1-800-662-HELP – SAMHSA’s National Helpline (average # of tx calls per mo.- 24,000)