Public Substance Use Disorder Treatment for Youth in California Department of Health Care Services Substance Use Disorders Statewide Conference
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1 Public Substance Use Disorder Treatment for Youth in California Department of Health Care Services Substance Use Disorders Statewide Conference August 23, 2017 Molly Brassil, MSW, Director of Behavioral Health Integration
2 Report Overview Background / Introduction Medicaid Coverage of Substance Use Disorder (SUD) Treatment State-Only Medi-Cal Minor Consent Program Financing Public Resources and Promising Practices Conclusion Note: Citations for data in this presentation are available in the CHCF Report. 2
3 Inconsistencies in Defining Youth In this presentation, and in the report, we use the term youth generally to mean children and adolescents below age 21. However, definitions for child / youth / adolescent differ among programs. Resource Diagnostic and Statistical Manual of Mental Disorders The American Society of Addiction Medicine Criteria Definition No minimum age limitation for SUD diagnoses. Prevalence estimates for youth generally include ages Defines adolescence in its glossary as ages The American Academy of Pediatrics Defines adolescence as ages 11 to 21. Early and Periodic Screening, Diagnostic and Treatment Benefit covers individuals under age 21. 3
4 Impact of Substance Use in the United States In 2013, over twenty-one million Americans ages twelve and older (8% of the population) were classified as having an SUD within the course of the previous year. $ More than $700 billion in annual costs nationally are caused by abuse of illicit drugs, tobacco, and alcohol. These costs are related to crime, lost work productivity, and health care. According to the Centers for Disease Control and Prevention, drug overdose deaths and opioid-involved deaths continue to increase in the United States, with more than half a million people dying from drug overdoses from 2000 to
5 Impact of Substance Use on Youth Brain development occurs throughout adolescence, making youth particularly vulnerable to SUDs. Early use of drugs increases an individual s chance of developing addiction and can impact memory, motivation, learning, judgement, and behavior control. 90% of Americans who meet the clinical criteria for an SUD began smoking, drinking, or using other drugs, before the age of eighteen. The earlier substance use begins, the more likely that it will continue into adulthood. Image source: 5
6 California Prevalence and Incidence *Source: California Healthy Kids Survey, 15 th Biennial Statewide Survey Roughly 11% of all youth ages twelve to seventeen in California (347,000 individuals) reported using illicit drugs. Over 15% (779,000 individuals) of youth between ages twelve to twenty reported binge alcohol use within the month prior to being surveyed. 8% of youth under age eighteen have SUD treatment needs (similar to the statewide prevalence estimate for adults with SUD). Current-use rates among 11 th graders were 29% for alcohol, 18% for binge drinking, and 20% for marijuana. Any drug use stood at 22%, and any AOD use at 35%, roughly 3x higher than in 7 th grade.* 6
7 Medi-Cal Coverage for SUD Youth Services Screening (Health Plans) SBIRT CRAFFT Treatment Services (County) Drug Medi-Cal & Drug Medi-Cal Pilot Program (waiver) Pharmacy and Detox (State) DHCS Fee-for-Service 7
8 Other Programs State-Only Medi-Cal Minor Consent: Eligible minors who wish to receive confidential care, including SUD services, may do so under the Medi-Cal Minor Consent Program (must be at least twelve years old). Substance Abuse Prevention and Treatment (SAPT) Block Grant Funding: Pays for local prevention and treatment programs, for activities not reimbursable by Medicaid. 8
9 Funding Streams State General Funds Federal Financial Participation 2011 Realignment SAPT Block Grant Local Funds
10 Best Practices for Treating Youth with SUD Employment Family and Community Supportive Services SUD Treatment Assessment Substance Use Monitoring Recovery Support Programs Criminal Justice / Child Welfare Adapted from Youth with SUDs Evidence- Based Treatment Mental Health Continuing Clinical and Care Case Management Education HIV/AIDS services Medical 10
11 Key Themes and Best Practices Patient Centered Care Screen / Address Co-Occurring Disorders Treatment should be age-appropriate, as well as developmentally, culturally, and gender-appropriate. Patient should be engaged in decision-making when possible. Integrate other needs into treatment beyond the drug use, such as medical, social, and psychological factors. Use an integrated care treatment approach that addresses co-occurring SUD and mental health disorders, as well as primary care services. Family Involvement Support from family members and community resources (e.g., school counselors, parents, peers) during treatment can support recovery. 11
12 Key Themes and Best Practices Evidence Based Practices Ongoing Support Motivational enhancement therapy with or without cognitive behavioral therapy, and family-based treatments have demonstrated effectiveness for youth with SUDs. Residential treatment can also support youth in moving to an outpatient setting Continuing care should be available within two weeks of leaving treatment in a variety of settings. 12
13 Considerations for Improving Access to Effective Treatment for Youth in California System Complexity. The complex nature of the Medi-Cal program and the unique role of counties in administering components of the program can make accessing covered services challenging for youth and their families. Limited Provider Network / Workforce Challenges. Access to services is often limited by a lack of available providers in the region, particularly residential treatment providers equipped to effectively serve youth. Access is especially limited in rural areas of the state. Few providers have received focused training for youth treatment. Specialized Care Needs. Treatment should be age-appropriate, with developmentally, culturally, and gender-appropriate care. Adaptations of adult SUD models geared at addressing youth often fall short. 13
14 Contact Our Behavioral Health Team Don Kingdon, PhD, Principal, Behavioral Health Integration Molly Brassil, MSW, Director, Behavioral Health Integration 14
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