Health Reform: Is Your Community Ready for 2014? Frances M. Harding, Director SAMHSA’s Center for Substance Abuse Prevention 2011 School for Prevention Leadership Washington, DC October 20, 2011

Role of Prevention in Substance Use 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  Evidence-based, multi-component prevention programs

Selected National Prevention Strategy Actions Communities can: Develop comprehensive prevention systems. Establish linkages. Conduct education, outreach, and training. Health care systems, insurers, and clinicians can: ID and screen patients for excessive drinking. ID, track, and prevent inappropriate patterns of prescribing. Develop and adopt evidence-based guidelines for prescribing opiates.

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

National Prevention Strategy Priorities Tobacco Free Living Preventing Drug Abuse and Excessive Alcohol Use Healthy Eating Active Living Mental and Emotional Well- being Reproductive and Sexual Health Injury and Violence Free Living Source: National Vital Statistics Report, CDC,

Health Reform: A Defining Moment for Prevention Emerging opportunities, growing complexity: Multiple client pathways—primary care, behavioral health, schools, jails/prisons, child welfare Service coverage issues—third-party payment and Block Grant funding Behavioral health integration in health homes Incentives for mutual integration of behavioral health and primary health care activities Definition of prevention services and service models Dissemination of evidence-based practices Behavioral workforce training and support

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

New Roles—Community Leadership  Ensure your community’s voice is heard in the design and execution of health reform.  Develop or enhance strategic partnerships with non- traditional partners for prevention.  Work with States to serve more than traditional Block Grant populations.  Focus on recovery support—help people get and stay well.

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

Collaboration is the key!