1. California Behavioral Health Directors Association Children’s System of Care Subcommittee July 21, 2016
Department of Health Care Services
Office of Women, Perinatal, and Youth Services
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2. Primary Prevention
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3. What is Substance Abuse Primary Prevention?
SAPT definition: “Primary prevention includes activities directed at individuals who do not require treatment for substance abuse. Such activities may include education, counseling, and other activities designed to reduce the risk of substance abuse by individuals. Note that under the SAPT Block Grant statute, early intervention activities are not included as part of primary prevention.”
Contract definition: “Public Health Services Act Section : each State/Territory shall develop and implement a comprehensive prevention program which includes a broad array of prevention strategies directed at individuals not identified to be in need of treatment.”

4. Five Steps of Strategic Prevention Framework (SPF)
Assessment
Profile population needs, resources, readiness to address needs and gaps
Capacity
Mobilize and/or build capacity to address needs
Planning
Develop a comprehensive Strategic Plan
Implementation
Implement evidence-based prevention programs and activities
Evaluation
Monitor, evaluate, sustain, and improve or replace those that fail
Also keep in mind that Sustainability and Cultural Competence should be considered at every stage of the SPF.
SAMHSA requires us to use the SPF. This framework is much like USDOE Principles of Effectiveness and mental health’s PEI planning requirements in that it requires data informed decision making. Your program decisions should be strategic and make sense; you should work with partners and build the capacity of your community to take action; your programs must have research behind it, and you should work to be able to demonstrate that you’ve made a difference.
CalOMS Pv is a web-based prevention data collection application designed around the Strategic Prevention Framework

5. Institute of Medicine Addresses the entire population.
1994—Institute of Medicine full continuum of care model for mental health
2000—CSAP adopts language
2003—CSAP mandates use by states
Primary prevention’s focus is on the universal, selective, and indicated populations.
Universal Prevention :
Addresses the entire population.
Aim is to prevent/delay use of ATOD. Deter onset through a variety of broad level approaches
Selective Prevention :
Addresses needs of subsets of population considered at risk by virtue of their membership in a particular subgroup.
Targets the entire subgroup regardless of the degree of risk in the group.
Indicated Prevention :
Focuses on individuals who are exhibiting early signs or consequences of AOD use or problem behavior associated with substance use.

6. Youth Treatment FY 2013-14 SAPT BG Adolescent SUD treatment services
About $7.3 million in FY
Decreased over the last 2 FY to $6.85 million
Concerns
Decreasing funds
Sustainability of services
Outcome of this meeting and workgroup
Input and continued collaboration
Development of a system of care for youth and
Better serve California’s adolescent population
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7. Substance Use Disorders Services for Youth
Funding sources
Substance Abuse Prevention and Treatment Block Grant (SAPT BG)
Youth Treatment Allocation
SAPT Discretionary
Drug Medi-Cal
Residential
Intensive Outpatient Treatment
Outpatient Drug Free
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8. Youth Treatment Fundamental principle Holistic continuum of care
Promotion of wellness
Prevention of substance use disorders
Move through the entire continuum
Relationships between promotion, prevention, treatment, and recovery support
State-County Contract
2015 Youth Services Policy Manual
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9. Primary Prevention by Age FY 2013-14
CalOMS Pv by age for FY
Peak ages 12 to 14
Onset of adolescence
Around 37%
Between ages 5-11
Less than half (14%)
Note: Counties are only required to report services in CalOMS Pv that are funded with SAPT BG dollars; services provided with other funds are not reflected.
*CalOMS Pv Data retrieved 7/3/15, FY 2014/15 data represents a six month time period from 7/1/14 to 12/31/14
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10. Age of First Use for Youth in SUD Treatment FY 2013-14
Unique client counts collected by CalOMS Tx
Individual counted only once during a given time period FY
14,946 adolescent clients
24% were age 13
19% were age 12 and 14.
Elevated numbers at age 10 and younger
Drug use at younger age
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11. Age of Youth in SUD Treatment FY 2013-14
In contrast to the previous slide,
Adolescents in Tx
Peak age – 17
Around 30% of total adolescents in Tx
Trend
Increased numbers in Tx at the end of adolescence
Age 15 – 21 %
Age 16 – 28%
Age 17 – 30%
Possible reasons for increased numbers at the end of adolescence
Accessibility of educational material at an older age
Physical, experienced awareness that comes with maturity and physical development
Considerations
Begin Pv at younger age and deliver more rigorous Pv programs
Pv programs prior to peak age
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12. Primary Prevention by Race/Ethnicity FY 2013-14
CalOMS Pv by race/ethnicity FY
Hispanic – 39%
White Not Hispanic – 30%
African American – 11%
Asian /Asian American – 10%
Multi-ethnic – not Hispanic 7%
Other – Not Hispanic 2%
Hawaiian/Pacific Islander – 2%
American Indian or Alaska Native – 1%
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13. Youth Treatment by Race/Ethnicity FY 2013-14
This graph shows percentages of adolescents who received treatment services by race/ethnicity.
Hispanics – 67%
White-not Hispanic – 14%
Black-not Hispanic – 12%
All other race/ethnicity groups are significantly less and constitute fewer than 10% of the total adolescent treatment population.
Does not reflect propensity to substance use
i.e., Not a race issue
May be due to cultural beliefs
Example: Asians
Deal within own community
Take care of their own
Other Tx practices
The next slide presents a situation that is problematic and perhaps can lead to further discussions today as well.
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14. Keyword Analysis of County Strategic Prevention Plans FY 2013-14
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15. Primary Drug Reported at Admission FY 2013-14
In FY , marijuana is the highest-used substance
77 percent
Second is alcohol – 15 percent
Aligns with national statistics
According to SAMHSA, marijuana is the most common-used illicit drug in the United States
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16. Number of Adolescents Served in SUD Treatment by County FY 2013-14
500+ adolescents admitted to Tx:
Fresno*
Los Angeles*
Riverside
Sacramento
San Diego*
Santa Barbara
Santa Clara
Tulare
Counties with over 500 adolescents admitted to treatment in FY
Top three: Fresno, Los Angeles, and San Diego.
(If asked: CalOMS Tx FY : an adolescent is counted once in each county but the same individual may be counted twice if treatment services were sought in two different counties)
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17. Referral Source for Youth Clients in SUD Treatment FY 2013/14
School and educational sources – 28 percent
Criminal justice referrals – 27 percent
Problematic
Diagnoses by a non-licensed person in the field
Criminal justice referrals
Uncertified person (judge, probation office, etc.)
Sentencing became the focus of treatment
Not actual time necessary for Tx and recovery
Necessity to develop an infrastructure
Individualized, holistic treatment service
Access to a healthy lifestyle for California’s adolescents with SUDs
Note: If necessary or if asked, percentages have been rounded up and therefore may not equal 100%.
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18. Treatment Provider Service Type FY 2013-14
83% Outpatient
<1% Outpatient NTP
13% Intensive Outpatient
<1% Residential Detox
1% Residential Short Term
4% Residential Long Term
Majority of youth clients seen in Outpatient:
83 % Outpatient
Followed by:
13 % Intensive Outpatient
4 % Residential Long Term
Less significant numbers in:
1 % Residential Short Term
< 1% of clients seen in Outpatient NTP
< 1 % OP NTP Detoxification
< 1 % Residential Detox
Note: FY CalOMS Tx Data (Clients served aged 17 or younger; non-fixed dataset). Due to rounding, percentages may not equal 100%
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19. Median Income Levels in 2014*
Fresno
Household: $43,335
Rank 45
Los Angeles
Household: $55,686
Rank 24
San Diego
Household: $66,034
Rank 15
*County Health Rankings & Roadmaps
Top three counties with over 500 adolescents in treatment
Year of data used was 2014 income data listed on website for 2016, from The California County Health Rankings & Roadmaps
58 counties
Fresno ranked 45,
Higher rank number means the lower the income level
Household median level – $43,335
Los Angeles ranked 24
Household median level – $55,686
San Diego ranked 15
Household median level – $66,034
Range in California (Min-Max): $35, ,800
Overall in California: $61,900
Unemployment rate (U.S. Department of Labor, Bureau of Labor Statistics)
San Diego
Total population – Approximately 3.2 million, which ranked second in the state
Less than 6% unemployment rate
Higher numbers of adolescents admitted to SUD Tx
Fresno
11% unemployment rate
Illustrates that adolescents with SUDs cannot be categorized as those in lower income or high unemployment rate areas.
*Has no barriers – socioeconomic
Identification of adolescents with SUDs cannot be limited to one demographic
For example, we cannot limit to race/ethnicity or low income areas
Moreover, even within those demographics, determining root causes for SUD use are complex and varied (e.g., cultural beliefs, San Diego, etc.)
Note / if asked: Los Angeles had a 7.3% unemployment rate.
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20. For more information contact: Denise Galvez, Chief Policy and Prevention Branch SUD Program, Policy and Fiscal Division Department of Healthcare Services
Summary of Information
Challenges to delivering SUD services across the continuum to adolescents:
Culturally and linguistically diverse population
Diverse socioeconomic situations
Diverse sub-populations
LGBTQI
Residency status
Homeless
Single parent homes, etc.
How can we best serve our adolescents
State, counties, and local providers collaborate to simultaneously provide:
Increase program capacity
Sustain adolescent SUD treatment services
Ensure data is meaningful and accurate
Ensure all adolescent SUD treatment facilities provide effective, developmentally, culturally, and linguistically appropriate care
Ask for questions
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