Building the Adolescent Substance Use Disorder Treatment Continuum California Mental Health Advocates for Children and Youth Annual Conference May 18th, 2017 Pacific Grove, CA

Presenters Steve Hornberger, Director Social Policy Institute School of Social Work San Diego State University Dave Neilsen, Senior Mental Health Policy Advocate California Alliance of Child and Family Services

Three Questions Generally, in my community when someone hears a family has an alcohol or drug problem they believe… Working with a family in need of alcohol or drug treatment is challenging because… I have been successful working with a youth or family receiving drug treatment when I …

Unmet Prevalence In 2014, 17.0 million people aged 12 or older needed treatment for an alcohol problem. Of those, only 1.3 million (2.5%) received any treatment. In 2014, 7.1 million people aged 12 or older needed treatment for an illicit drug problem Of those, only 1 million (14.6%) received any treatment

Why are we here today In 2005, federal, state and local government spending as a result of substance abuse and addiction was a least $467.7 billion or 10.7 % of their combined $4.4 trillion budget. For each dollar of the $467.7 billion spent, 95.6 cents went to shoveling up the wreckage and only 1.9 cents on prevention and treatment, 0.4 cents on research, 1.4 cents on taxation or regulation and 0.7 cents on interdiction.

Impact ½ of all children (35.6 million) live in a household where a parent or other adults use tobacco, drink heavily or use illicit drugs. 13% of children under 12 live in a household where a parent or other adults use illicit drugs. 1 in 4 children under the age of 18 has a family member who abuses alcohol or has alcoholism.

Some CA BH Facts 1 Our Youth Believe: About 6 in 10 (59.9%) 12- to 17-year-olds in California in 2013- 2014 perceived no great risk from drinking five or more drinks once or twice a week. About 8 in 10 (79.9%) 12- to 17-year-olds in California in 2013-2014 perceived no great risk from smoking marijuana once a month About 1 in 3 (33.0%) 12- to 17-year-olds in California in 2013- 2014 perceived no great risk from smoking one or more packs of cigarettes a day

Some CA BH Facts 2 Usage: Among 12- to 17-year-olds in California, the mean age of first marijuana use was 13.8 years, and the mean age of first cigarette use was 13.2 years.   about 195,000 youths (6.2% of all youths) per year in 2010-2014 reported using cigarettes within the prior month   About 702,000 youth (14.2%) report binge alcohol use within the prior month about 353,000 youths (11.2% of all youths) per year in 2010-2014 reported using illicit drugs within the prior month  

Some CA BH Facts 3 Treatment: among persons aged 12 or older with illicit drug dependence or abuse, about 110,000 persons (11.7%) per year in 2010-2014 received treatment for their illicit drug use within the year among persons aged 12 or older with alcohol dependence or abuse, about 159,000 persons (7.2%) per year in 2010-2014 received treatment for their alcohol use within the year about 876,000 persons aged 12 or older (2.7% of all persons in this age group) per year in 2010-2014 were dependent on or abused illicit drugs within the year  

Some CA BH Facts 4 Mental health: about 355,000 youths (11.5% of all youths) per year in 2010-2014 had at least one Major Depressive Episode within the year prior to being surveyed about 89,000 youths with MDE (30.5% of all youths with MDE) per year in 2010-2014 received treatment for their In 2014, 240, 646 children and adolescents received services from the CA county mental health system 72% of youths reported improved functioning from treatment received through the public mental health system

BH Continuum of Care Multiple public and private agencies have roles and responsibilities!

BH Continuum of Care Promotion Prevention What do we have What’s needed Who needs to be involved Prevention

BH Continuum of Care Treatment Recovery What do we have What’s needed Who needs to be involved Recovery

RECOVERY

SAMHSA’s new working definition A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential Health: overcoming or managing one’s disease(s) as well as living in a physically and emotionally healthy way; Home: a stable and safe place to live; Purpose: meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; Community: relationships and social networks that provide support, friendship, love, and hope.

Addiction and Chronic Care Compliance Relapse Rate Addiction/Chronic Illness Rate (%) (%) Alcohol 30-50 50 Opioid 30-50 40 Cocaine 30-50 45 Nicotine 30-50 70 Insulin Dependent Diabetes Medication <50 30-50 Diet and Foot Care <50 30-50 Hypertension Medication <30 50-60 Diet <30 50-60 Asthma Medication <30 60-80

Recovery Oriented Systems of Care Recovery-Oriented Systems of Care shifts the question from How do we get the youth into treatment? to How do we support the process of recovery within the youth’s life and environment?

Recovery and Resilience Oriented System of Care

A Game Changer? In November of 2016, the California voters approved Proposition 64, the Adult Use of Marijuana Act, and have set in motion a number of possible state and community level changes in the continuum of behavioral health interventions

What are the Basics of Prop 64? From a high altitude vantage point, Prop 64 moves California into the world of reduced criminality related to the use of marijuana, and seeks to monitor and control the recreational use through local controls and decision making about the distribution and taxation of this substance.

State Level Activities Numerous funding designations for state departments, to include law enforcement, research, environmental, public health and social impacts of previous criminal justice involvements. IMPORTANT to the CMHACY attendees, it will also create a very comprehensive menu of local options that can be targeted towards youth and the range of substance use concerns

The ‘Prop 64’ Augmented BH Continuum of Care Promotion and Prevention – “ the program shall emphasize accurate education, effective prevention, early intervention…..” Outreach, Risk Surveys, Education on risks and early signs of problematic use, and substance use disorders Student Assistance Programs Grants for Outreach / Education for Homeless and Out of School Youth Peer Run Anti-Stigma Campaigns

Augmented BH Continuum of Care Treatment – Recovery “and timely treatment services for youth, their families and caregivers” Access and Linkage Evidence based Youth Focused substance use disorder services and supports Access to “two generation” approach for Tx Construction of community-based treatment facilities AND, to do this work, focus upon immediate Work Force Needs

ACTIONABLE ITEMS and CLOSING THOUGHTS

The Goal A community where all members of a family affected by alcohol and other drugs know there are knowledgeable and caring others who: understand what they are experiencing, care about them and are available, can help them find emotional and physical safety, can support their healing, health and wellness.

What you can do personally Take good care of yourself, family, friends and colleagues Learn about addiction and recovery, advocate for system collaboration and become a change agent Define and monitor outcomes at four levels, the status quo is not good enough Be bold, imagine a community where people live better lives, where children are safe, healthy, happy and educated, where people achieve their aspirations Provide hope

What we can do together Raise awareness, Find allies, Take action to end: Silence Stigma Disparities Promote the many roads to recovery

What can we do personally and together on Prop 64? Find your community leaders within city/county government, behavioral health and education. Sign up for all task forces, community stakeholder meetings. Understand the purpose of each meeting, contribute! Study the data, and local impacts if known. Be prepared Follow the legislative clean ups, and visit your state level representatives. Tell them your ideas!

Proposed Shared Vision A community where all are safe, healthy and well, where each has a sense of belonging, purpose and opportunities to achieve their aspirations.

Web Resources Al-Anon and Alateen www.al-anon.alateen.org Faces and Voices of Recovery www.facesandvoicesofrecovery.org Federation of Families for Children’s Mental Health www.ffcmh.org Join Together www.jointogether.org National Association for Children of Alcoholics (NACoA) www.nacoa.org National Center on Substance Abuse and Child Welfare (NCSACW) www.ncsacw.samhsa.gov

Web Resources 2 National Center on Addiction and Substance Abuse at Columbia (CASA) www.casacolumbia.org National Clearinghouse for Alcohol and Drug Information (NCADI) www.ncadi.samhsa.gov National Institute on Alcohol Abuse and Alcoholism (NIAAA) www.niaaa.nih.gov National Institute on Drug Abuse (NIDA) www.nida.nih.org Substance Abuse and Mental Health Services Administration (SAMHSA) www.samhsa.gov

Additional Resources What is Substance Abuse Treatment: A Booklet for Families http://store.samhsa.gov/shin/content/SMA14-4126/SMA14-4126.pdf SAMHSA Recovery and Recovery Supports http://www.samhsa.gov/recovery SAMHSA Prevention Resources http://www.samhsa.gov/prevention NIDA Preventing Drug Abuse Among Children and Adolescents https://www.drugabuse.gov/publications/preventing-drug-abuse-among-children-adolescents/acknowledgments

Center for Integrative Health Solutions Additional Resources Center for Integrative Health Solutions http://www.integration.samhsa.gov/clinical-practice/sbirt RESOURCES CMS policy guidance and information bulletins related to the provision of SUD services provided to youth can be accessed using the following links: Information regarding Early Identification and Screening for Youth with SUD may be found at: http://www.medicaid.gov/federal-policy-guidance/downloads/CIB-03- 27-2013.pdf • Information on pharmacotherapy for youth with SUD may be found at: http://www.medicaid.gov/Federal-Policy-Guidance/downloads/CIB-07-11-2014.pdf •

Additional Resources Information regarding coverage of Peer Supports may be found at: http://www.medicaid.gov/Federal-Policy-Guidance/downloads/SMD081507A.pdf Information regarding Caregiver to Caregiver Support may be found at: http://www.medicaid.gov/federal-policy-guidance/downloads/CIB-05-07-2013.pdf Joint CMCS and SAMHSA Informational Bulletin: Coverage of Behavioral Health Services for Youth with Substance Use Disorders may be found at https://www.medicaid.gov/federal-policy-guidance/downloads/cib-01-26-2015.pdf

Additional Resources 1 NW ATTC Addiction Messenger http://www.attcnetwork.org/ series Series 16 (2004) on Recovery, Series 17 (2005) on Family Treatment, Series 29 (2008) Family Participation in Addiction Treatment SE ATTC and Florida Certification Board, Engaging Family Members Into Adolescent Drug Treatment (2008) http://www.scattc.org/pdf_upload/Engaging_Families_Adolescent_Drug_Tx_FinalWEB.pdf

Additional Resources 2 Generational Patterns of Resistance and Recovery Among Families with Histories of Alcohol and Other Drug Problems: What We Need to Know (2008) Addiction recovery: Its definition and conceptual boundaries (2007) http://www.williamwhitepapers.com/

Additional Resources 3 The Institute for Health Improvement www.ihi.org http://www.ihi.org/NR/rdonlyres/C810CCBB-2DEB-4678-994A-57D9B703F98D/0/PartneringwithPatientsandFamiliesRecommendationsApr08.pdf Institute for Patient and Family Centered Care www.ipfcc.org http://www.ipfcc.org/pdf/CoreConcepts.pdf Child Welfare Information Gateway http://www.childwelfare.gov/pubs/f_fam_engagement/   National Juvenile Justice Network www.njjn.org “An Advocates Guide to Meaningful Family Partnerships” http://njjn.org/media/resources/public/resource_1665.pdf I think we should trauma resources and MH resources.. We seem to be hitting JJ and Child Welfare but what about Schools? Given that we find our children in all these child serving places we should give some resources that get them connected to those agencies or fileds. …. What do you all think?

Additional Resources 4 PCORI Engagement Rubric http://www.pcori.org/assets/2014/02/PCORI-Patient-and-Family-Engagement-Rubric.pdf IHI High Impact Leadership http://www.ihi.org/resources/Pages/IHIWhitePapers/HighImpactLeadership.aspx  2015 Behavioral Health Barometer CA http://www.samhsa.gov/data/sites/default/files/2015_California_BHBarometer.pdf  Motivational Interviewing with Adolescents http://doczine.com/474033.html#/Motivational_Interviewing_Strategies_to_Facilitate_Adolescent_.../

CONTACT INFORMATION Steve Hornberger, MSW shornberger@mail.sdsu.edu dave neilsen, MSW dneilsen@cacfs.org