1. NH DRUG AND ALCOHOL SERVICES Community-basedData-driven

2. The System

3. NH Regional Networks

4. The Structure: Treating Communities

6. REGIONAL NETWORKS REGIONAL NETWORKS Convene community stakeholders Convene community stakeholders Facilitate needs assessments, capacity development, and planning Facilitate needs assessments, capacity development, and planning Leverage resources Leverage resources Lead/support environmental activities (policy, media, targeted communications, information dissemination, outreach/awareness) Lead/support environmental activities (policy, media, targeted communications, information dissemination, outreach/awareness) PREVENTION AND INTERVENTION PROVIDERS PREVENTION AND INTERVENTION PROVIDERS Deliver evidence-based programs to selective and indicated populations Deliver evidence-based programs to selective and indicated populations Collect Process (PIERS) and Intermediate (CORE MEASURE) data Collect Process (PIERS) and Intermediate (CORE MEASURE) data Focus on selective (high risk) and indicated populations Focus on selective (high risk) and indicated populations Serve youth, parents, elders, and communities Serve youth, parents, elders, and communities TECHNICAL ASSISTANCE, TRAINING AND WORKFORCE DEVELOPMENT TECHNICAL ASSISTANCE, TRAINING AND WORKFORCE DEVELOPMENT NH Center for Excellence (Evidence-Based Practice, Data, Systems Change, Learning Teams) NH Center for Excellence (Evidence-Based Practice, Data, Systems Change, Learning Teams) NH Training Institute on Addictive Disorders (core competency and general professional development) NH Training Institute on Addictive Disorders (core competency and general professional development) Prevention Certification Board Prevention Certification Board CLEARINGHOUSE AND LENDING LIBRARY CLEARINGHOUSE AND LENDING LIBRARY Materials, curricula, information dissemination Materials, curricula, information dissemination Coordinated media and marketing Coordinated media and marketing Two web sites: www.drugfreenh.org Two web sites: www.drugfreenh.orgwww.drugfreenh.org www.nhcenterforexcellence.org www.nhcenterforexcellence.orgwww.nhcenterforexcellence.org Prevention & Early Intervention

7. Resources leveraged Resources leveraged Stakeholders engaged Stakeholders engaged Evidence-Based Services offered Evidence-Based Services offered Intervening variables affected (e.g. perception of risk, perception of wrongness, knowledge of biological nature of addiction, intention not to use) Intervening variables affected (e.g. perception of risk, perception of wrongness, knowledge of biological nature of addiction, intention not to use) = Population level behavior change How do we know prevention is working?

8. Centralized population level indicator data Centralized population level indicator data Arrest data including liquor law violations and DWI Arrest data including liquor law violations and DWI BRFSS BRFSS Hospital discharge data Hospital discharge data Retailer compliance Retailer compliance Youth Risk Behavior Survey Youth Risk Behavior Survey Provider and Network level data Provider and Network level data Core Measure Survey (Universal, Selected, Indicated) Core Measure Survey (Universal, Selected, Indicated) PIERS (Capacity and Process) PIERS (Capacity and Process) Partnership Tool (Network) Partnership Tool (Network) Prevention Data System

9. How do we know prevention is working? Resources: Funds and human resources raised Stakeholders: Who and how many are engaged Evidence-Based Services: Based on Contributing Factors Based on Target Population Fidelity to model! “Saturation” – how many served Intervening variable Change: Knowledge -of harm -of strategies to avoid use -of biology of addiction, etc Attitude (Perceived risk, perceived wrongness, perceived self- efficacy, intentionality) = Population level behavior change

10. Stakeholders Engaged SFY 2010 Funding Stakeholders Engaged: 3,031

11. Evidence-Based Practices “Saturation”

14. Research has proven that perception of risk and wrongness correlate strongly with likelihood of use. BUT IS THE PROGRAMMING DRIVING THE CHANGE? Showing the correlation between the two is good, but being able to show that evidence-based practice is changing the intervening variables builds that case. Effect on Intervening Variables

15. 2009 YRBS Perception of Risk

16. Parent Perception of Wrongness: Marijuana Marijuana Use in Past 30 Days

17. With the assistance and endorsement of the NH Expert Panel, the Northeast CAPT Regional Expert Team, and community level evaluators, NH developed a CORE MEASURE survey administered in all age appropriate program level group prevention to gauge impact of funded programming on intervening variables. In other words, the CORE MEASURE instrument will inform BDAS if funded programming, supported by fidelity audits and technical assistance, is producing change in the intervening variables that research says will change behavior at the population level? Prevention Data System

18. Knowledge: Alcohol or drug use can be more harmful for adolescents because the brain is still developing. Source: Youth Pre/Post Core Measure Survey

19. Knowledge: People can inherit a higher risk for alcohol and drug problems Source: Youth Pre/Post Core Measure Survey

20. Perception of wrongness: How wrong do you think it is for someone your age to drink beer, wine, or hard liquor? Source: Youth Pre/Post Core Measure Survey

21. Skills: How likely are you to make a personal commitment not to use alcohol or other drugs? Source: Youth Pre/Post Core Measure Survey

22. Refusal Skills: I plan on using my skills and knowledge to refuse alcohol, tobacco & other drugs. Source: Youth Pre/Post Core Measure Survey

23. Refusal Skills: I know ways to avoid situations that could lead to drinking or drug use. Source: Youth Pre/Post Core Measure Survey

24. Data provide a means to monitor local trends and prevalence Alcohol on the decline Alcohol on the decline Marijuana steady Marijuana steady Perception of Risk re Marijuana on decline Perception of Risk re Marijuana on decline Prescription Drug Use: 1 in 5 initiated use; Prescription Drug Use: 1 in 5 initiated use; 1 in 10 regularly use 1 in 10 regularly use Prevention Data System

25. Are We Making a Difference?

26. Impact: Past 30 Day Use of Alcohol

27. NH vs. US Past 30 Day Alcohol Use (NH Local Sample YRBS)

28. Substance Use Trends 2001-2009 Local Sample YRBS SPF Funding Received SPF Funding out to Communities SPF Funding Ends

29. NH Age of Onset Local Sample YRBS Grades 9-12

30. Age of Onset: Alcohol (by Region) Region

31. What is the value of these outcomes? The longer we delay initiation, the less likely NH’s children are to ever become dependent on alcohol or other drugs The longer we delay initiation, the less likely NH’s children are to ever become dependent on alcohol or other drugs Applying the percent reductions in underage drinking among high school aged youth from 2001 to 2009 to the number of 15-19 year olds living in New Hampshire, the long-term impact translates to 5,190 NH youth not initiating regular alcohol use[1]. Applying the percent reductions in underage drinking among high school aged youth from 2001 to 2009 to the number of 15-19 year olds living in New Hampshire, the long-term impact translates to 5,190 NH youth not initiating regular alcohol use[1].[1] [1] http://factfinder.census.gov/servlet/DTTable [1]

32. TREATMENT SERVICES TREATMENT SERVICES Inpatient Inpatient Outpatient/Intensive Outpatient Outpatient/Intensive Outpatient Care Coordination (ATR) Care Coordination (ATR) RECOVERY SUPPORT SERVICES RECOVERY SUPPORT SERVICES Training and supervision of Recovery Support Workers Training and supervision of Recovery Support Workers Resource and Referral for those in recovery to receive and/or provide recovery supports Resource and Referral for those in recovery to receive and/or provide recovery supports Methadone clinics- regulatory only Methadone clinics- regulatory only Alcohol and Other Drug Licensure and Credentialing Alcohol and Other Drug Licensure and Credentialing NH Training Institute on Addictive Disorders NH Training Institute on Addictive Disorders Crisis line Crisis line Treatment & Recovery

33. Electronic Health Records/WITS Electronic Health Records/WITS Client Event Data System (CEDS) Client Event Data System (CEDS) GPRA (ATR) GPRA (ATR) Data Driven Practice:

34. National Outcome Measure: Employment

35. Other Treatment Outcomes in NH West, Alan N. “Substance Abuse Treatment Outcomes From Telephone Follow-Up Interviews in SFY 2006” Division of Public Health Services, July 13, 2006

36. Post Treatment Abstinence Maintained or Sustained Abstinence 6 month follow-up 12 month follow-up 18 month follow-up 83%79%75% West, Alan N. “Substance Abuse Treatment Outcomes From Telephone Follow-Up Interviews in SFY 2006” Division of Public Health Services, July 13, 2006

37. Ever Used Prescription Drugs Past 30 Day Use of Prescription Drugs Percentage of students who have taken a prescription drug (such as OxyContin, Percocet, Vicodin, Adderall, Ritalin or Xanax) without a doctor’s prescription one or more times during their life by Regional Network. % Ever Used - Prescription 2009 Youth Risk Behavior Survey (YRBS) 17.6 – 17.9 18.0 – 18.3 18.4 – 18.9 19.3 – 20.7 20.8 22.3 2009 Local Sample YRBS n=30,274 Vermont Maine Canada Massachusetts

38. Systems Change With the SPF SIG having transformed prevention delivery (community –based and data-driven); With Access To Recovery ensuring care coordination, recovery supports and client-driven care; With evidence-based practice in prevention and treatment the standard; With web-based data systems for both prevention (PIERS), treatment (WITS), and population level indicators (nhcenterforexcellence.org)… The prevention and treatment delivery system is being significantly upgraded, and improved outcomes are and will be demonstrable.

39. THANK YOU Questions? The NH Center for Excellence is an initiative of the NH Department of Health and Human Services’ Bureau of Drug and Alcohol Services and is funded in part by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA); the NH Governor’s Commission on Alcohol and Other Drug Prevention, Intervention and Treatment; and the New Hampshire Charitable Foundation. Lisa Mure, MEd, CPS Project Director, NH Center for Excellence Community Health Institute, Bow NH Lmure@jsi.comLmure@jsi.com 603-573-3300