1. Preventing Substance Use and Mental Health Disorders Examining Shared Risk and Protective Factors Sandra Del Sesto, M.Ed, CPSS

2. Learning Objectives  Define shared risk and protective factors  List 3 reasons for addressing shared risk and protective factors  List at least 3 strategies for overcoming common barriers to collaboration around shared factors

3. Review: Risk and Protective Factors  Risk factor: a characteristic at the biological, psychological, family, community, or cultural level that precedes and is associated with a higher likelihood of problem outcomes  Protective factor: a characteristic associated with a lower likelihood of problem outcomes or that reduces the negative impact of a risk factor on problem outcomes 3 Source: National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities (O’Connell, M.E., Boat, T., & Warner, K. E., Eds.) Washington, D.C: National Academies Press.

4. Shared Factors  Early predictors that relate to and/or influence the occurrence of both substance abuse and mental health disorders  Focus on factors across life-span  Socio-ecological Framework 4 Handout 1: Shared Risk and Protective Factors

5. Examples of Shared Risk Factors 5 Socio- Ecological Level Shared Risk FactorsData Sources SocietyPrejudice/discrimination Lack of cultural identify Community surveys CommunityChronic community stress Problems/difficulties in school Uniform Crime Reports School records National Survey of Children’s Health (NSCH) RelationshipParental substance use Child abuse/maltreatment (ACEs handout) National Survey on Drug Use and Health (NSDUH) Monitoring the Future (MTF) IndividualIllness/poor physical health Poor social/problem solving skills Behavioral Risk Factor Surveillance System ( NSDUH, MTF

6. Examples of Shared Protective Factors 6 Socio- Ecological Level Shared Protective FactorsData Sources SocietyCultureSurveys CommunityAvailability of or opportunities for social activities (clubs, school or community sports) NSCH, Youth Risk Behavior Survey RelationshipParental support and bonding Access to mentors NSCH NSCH, YRBS IndividualReligiosity/spirituality Stable housing NSCH, NSDUH U.S. Census

7. Example of a Shared Risk Factor: Family Disruption 7 7 Family Disruption Heavy Alcohol Use Depression Shared Risk Factor Substance Abuse ProblemMental Disorder States/Tribes/Jurisdictions Epidemiology Focus

8. Example: Influence of a Factor Across the Lifespan 8 Social Support Suicide Attempts in Adolescence Substance Abuse in Young Adulthood Mental Illness in Older Adulthood

9. Example of Shared Consequences: Substance Use, Depression and Suicide 9 Other Risk Behaviors (Alcohol-Related Consequences) Depression Substance Use Suicide- Related Behavior 3

10. 10 Shared Factors, Shared Interventions Shared R/P Factors Mental Health (MH) Disorders Substance Use (SA) Disorders Shared Interventions Risk/Protective Factors

11. Shared Risk/Protective Factors: Examples from the Community

12. Considerations and Caveats  The relationship between factors and outcomes may be mediated by other factors  Mental disorders are risk factors for substance abuse and vice versa 12

13. Considerations and Caveats (cont.)  Risk factors and protective factors tend to cluster  Risk factors and protective factors can have a cumulative effect ACEs Family Dysfun ction NeglectAbuse 13

14. Getting Ready to Collaborate

15. No awareness Professionalization Denial Vague Awareness PreplanningPreparationInitiationStabilization Confirmation/Expansion Adaptation of Stages of Community Readiness,Tri- Ethnic Center for Prevention Research, Colorado State University Readiness to Engage in Collaboration

16. Poll: What is your community’s current stage of readiness to work together to address shared factors? a ) No awareness/denial b) Vague awareness c) Pre-planning d) Preparation e) Initiation

17. Strategies to Increase Readiness to Collaborate No Awareness Raise awareness of the connection between substance abuse and other behavioral disorders Denia l Raise awareness that substance abuse prevention and other behavior health providers can collaborate Vague Awareness Increase motivation to take action to increase collaboration 17

18. Strategies to Increase Readiness to Collaborate Pre-Planning Detail possible efforts or actions that promote collaboration Preparation Create an action plan for collaboration and commit to moving forward Implementation Implementing an approach to collaborate 18

19. Planning: Examples of Successful Behavioral Health Collaborations 19

20. Strategies for Overcoming Common Barriers to Collaboration 20

21. Final Poll: Over the next several months, I will… a)Learn more about the connection between substance abuse prevention and other behavioral health issues in my community b)Determine what is already happening in my community regarding substance abuse prevention and other behavioral health issues c)Reach out to a new partner d)Educate the community on both issues e)Learn about best prevention practices

22. 22