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

2. 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

3. 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 …

4. 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

5. 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.

6. 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.

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

8. 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 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 reported using illicit drugs within the prior month  

9. 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 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 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 were dependent on or abused illicit drugs within the year  

10. Some CA BH Facts 4 Mental health:
about 355,000 youths (11.5% of all youths) per year in 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 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

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

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

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

14. RECOVERY

15. 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.

16. Addiction and Chronic Care
Compliance Relapse Rate
Addiction/Chronic Illness Rate (%) (%)
Alcohol
Opioid
Cocaine
Nicotine
Insulin Dependent Diabetes
Medication <
Diet and Foot Care <
Hypertension
Medication <
Diet <
Asthma
Medication <

17. 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?

18. Recovery and Resilience Oriented System of Care

19. 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

20. 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.

21. 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

22. 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

23. 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

24. ACTIONABLE ITEMS and CLOSING THOUGHTS

25. 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.

26. 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

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

28. 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!

29. 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.

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

31. Web Resources 2
National Center on Addiction and Substance Abuse at Columbia (CASA)
National Clearinghouse for Alcohol and Drug Information (NCADI)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
National Institute on Drug Abuse (NIDA)
Substance Abuse and Mental Health Services Administration (SAMHSA)

32. Additional Resources
What is Substance Abuse Treatment: A Booklet for Families
SAMHSA Recovery and Recovery Supports
SAMHSA Prevention Resources
NIDA Preventing Drug Abuse Among Children and Adolescents

33. Center for Integrative Health Solutions
Additional Resources
Center for Integrative Health Solutions
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: pdf •
Information on pharmacotherapy for youth with SUD may be found at: •

34. Additional Resources
Information regarding coverage of Peer Supports may be found at:
Information regarding Caregiver to Caregiver Support may be found at:
Joint CMCS and SAMHSA Informational Bulletin: Coverage of Behavioral Health Services for Youth with Substance Use Disorders may be found at

35. Additional Resources 1
NW ATTC Addiction Messenger 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)

36. 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)

37. Additional Resources 3
The Institute for Health Improvement
Institute for Patient and Family Centered Care
Child Welfare Information Gateway  
National Juvenile Justice Network
“An Advocates Guide to Meaningful Family Partnerships”
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?

38. Additional Resources 4 PCORI Engagement Rubric
IHI High Impact Leadership
 2015 Behavioral Health Barometer CA
 Motivational Interviewing with Adolescents

39. CONTACT INFORMATION
Steve Hornberger, MSW dave neilsen, MSW