A New Era in Prevention: Challenges and Opportunities Tonia F. Gray, M.P.H. Senior Public Health Advisor 12th Annual Substance Use Disorder Conference Lansing, MI September 12, 2011

 Behavioral health is essential for health  Prevention works  Treatment is effective  People recover from mental and substance use disorders SAMHSA’s Key Messages

Role of Prevention in Substance Abuse and Mental Health Disorders  Behavioral health is essential for health  Addiction as a complex and chronic disease  Recovery as a process rather than an event  Ongoing contact and support to complement treatment  Natural supports such as friends, peers, and family  Assets, strengths, skills, and resources Prevent substance use relapse Boost emotional stability  Assets, strengths, skills, and resources  Collaborative community-based strategies  Evidence-based, multi-component prevention programs  Data-driven systems

Assessing Public Knowledge and Attitudes: What Americans Believe 66 percent believe treatment and support can help people with mental illness lead normal lives 20 percent feel persons with mental illness are dangerous to others Two thirds believe addiction can be prevented 75 percent believe recovery from addiction is possible 20 percent say they would think less of a friend/relative if they discovered that person is in recovery from an addiction 30 percent say they would think less of a person with a current addiction

Health Reform State Budget Declines Federal Domestic Spending EMERGING SCIENCE Drivers of Change

Health Reform  More people will have insurance coverage.  Theme: prevent diseases, promote wellness  Integrated care: new thinking—recovery, wellness, role of peers, response to whole health needs  New opportunities for behavioral health: Parity: Mental Health Parity and Addiction Equality Act and within Affordable Care Act Tribal Law and Order Act National Action Alliance for Suicide Prevention  Medicare and Medicaid changes

Beginning in 2014: 32 Million More Americans Eligible to be Covered 4-6 mil

Challenges—State Leadership 90–95 percent will have the opportunity to be covered by Medicaid or through insurance exchanges.

Federal Domestic Spending  Focusing on the Strategic Initiatives  Revised Approach to Grant-Making  Implementing a Theory of Change  Prevention Funding for 2012: Substance Abuse-State Prevention Grant ($395 million). Mental Health-State Prevention Grant ($90 million). Behavioral Health-Tribal Prevention Grant ($50 million). Prevention-Prepared Communities ($23 million).

Staying Focused During Change

SAMHSA’S Theory of Change INNOVATION Proof of concept Services Research Practice-based Evidence TRANSLATION Implementation Science Demonstration Programs Curriculum Development Policy Development Financing Models and Strategies DISSEMINATION Technical Assistance Policy Academies Practice Registries Social Media Publications Graduate Education IMPLEMENTATION Capacity Building Infrastructure Development Policy Change Workforce Development Systems Improvement WIDESCALE ADOPTION Medicaid SAMHSA Block Grants Medicare Private Insurance DOD/VA/DOL/DOJ/ED ACF/CDC/HRSA/IHS SURVEILLANCE EVALUATION

SAMHSA’S Strategic Initiatives 1. Prevention 2. Trauma and Justice 3. Military Families 4. Recovery Support 5. Health Reform 6. Health Information Technology 7. Data, Outcomes & Quality 8. Public Awareness & Support

Strategic Initiative 1: Prevention of Substance Abuse and Mental Illness Goal 1.1 With primary prevention as the focus, build emotional health, prevent or delay onset of, and mitigate symptoms and complications from substance abuse and mental illness. Goal 1.2 Prevent or reduce consequences of underage drinking and adult problem drinking. Goal 1.3 Prevent suicides and attempted suicides among populations at high risk, especially military families, LGBTQ youth, and American Indians and Alaska Natives. Goal 1.4 Reduce prescription drug misuse and abuse.

Work Ahead—SAMHSA  Revised Block Grant application and reporting; analysis of expenditures  Implementation of Tribal Law and Order Act—Office of Indian Alcohol and Substance Abuse  Establishment of health homes/ACOs with TA to States  Health insurance exchanges—Policies and operations  Essential benefits for exchange and benchmark plans  Training and tracking of MHPAEA and Medicaid parity  Decisions and implementation of prevention funds  Regulations—Home- and community-based services  Evidence of good and modern services: Benefit decisions, practice protocols, research agenda

Current Federal Partners Administration for Children and Families (ACF) Administration on Aging (AoA) Centers for Disease Control and Prevention (CDC) Centers for Medicare and Medicaid Services (CMS) Food and Drug Administration (FDA) Health Resources and Services Administration (HRSA) Indian Health Service (IHS) National Institutes of Health (NIH) Office of Minority Health Office of National Drug Control Policy (ONDCP) Office of the Surgeon General (OSG) Department of Education (ED) Department of Defense (DOD) Department of Interior (DOI) Department of Justice (DOJ)

New Roles—State SA and MH Leadership  Take key role in design and execution of health reform.  Be more strategic in purchasing services.  Design and collaborate in planning health information systems (HIT/EHRs).  Form or enhance strategic partnerships.  Think beyond traditional Block Grant populations.  Get people covered—enrollment processes.  Be more accountable for improving experience. of care and overall health of populations served.  Focus on recovery services—help people get and stay well.

We’ve Been Here Before  Risk and protective factors—Commonalities between mental health and substance abuse.  Chronic disease indicators—Substance use represents a spectrum of conditions and risk factors as well as social context.  Links with physical health care providers— Prevent problems related to mental illnesses and substance use.

SAMHSA PRINCIPLES PEOPLE Stay focused on the goal PARTNERSHIP Cannot do it alone PERFORMANCE Make a measurable difference