THREE-YEAR STRATEGIC PLAN FOR SUBSTANCE USE DISORDER PREVENTION, TREATMENT AND RECOVERY SERVICES Fiscal Years

THREE-YEAR STRATEGIC PLAN FOR SUBSTANCE USE DISORDER PREVENTION, TREATMENT AND RECOVERY SERVICES Fiscal Years 2015-2017 Submitted for August 1, 2014 Lakeshore Regional Partners 376 Apple Ave Muskegon, MI 49442-3466

1. NARRATIVE ONE SUD Problems Impacting the Community Prevention Section Note Planned prevention services are documented in a manner which reflects the state of regional integration of SUD services (pursuant to PA 500 of 2012) as of the date of the submission of this plan. It is expected that future planning will be more wholistic and cohesive as experience is gained within the newly organized Region 3 PIHP. As a result, this plan is separated at some points into prevention services planned for (a) Allegan, Muskegon, Ottawa, Mason, Oceana, (b) Kent, and (c) Lake counties. Prevention Priority Focus Area 1: To Reduce Underage Drinking (Allegan, Lake, Mason, Muskegon, Oceana and Ottawa Counties) Prevention providers in Region 3 PIHP continue to coordinate efforts to address alcohol misuse and abuse through the Reducing Ottawa Area Drunk Driving (ROADD) coalition, the Allegan Substance Abuse Prevention (ASAP) Coalition, the Coalition for a Drug Free Muskegon (CDFM) and the Oceana County the Oceana Prevention Partnership for Change (TOPPC). These coalitions continue to partner with Liquor Licensees, law enforcement, community organizations, agencies, and schools. Coalition members are key in that they contribute by assisting the coalitions in accomplishing their goals and objectives. Local law enforcement agencies play a significant role by conducting the necessary enforcement activities and sharing resources toward coalition efforts. Early in fiscal year 2012, town hall meetings were held in Allegan, Ottawa, and Muskegon counties with unprecedented attendance rates. We believe that this increase in community interest is due to the raised awareness caused by the talk sooner media campaign encouraging parents to talk to their youth underage drinking. Although funding for talk sooner ended with the SPF/SIG grant local coalitions have continued to grow the campaign and distribute messaging and recently launched a mobile app. All counties continue to work with retailers in an effort to reduce alcohol sales to minors. Compliance checks continue in most counties with funding from either the Drug Free Community Support Grants or law enforcement funding. TIPS trainers are still available in each county to provide low cost training for alcohol retailer staff. All counties in the Region 3 PIHP have lower rates than the state for both current and lifetime alcohol use and have a lower percentage of youth who first used alcohol before the age of 13. County First use before the age of 13 Lifetime Use Current Use Allegan 10.5% 26.0% 13.8% Lake 19.7% 46.5% 19.0% Muskegon 13.3% 28.3% 13.75% Mason* 13.7% n/a n/a Oceana 14.4% 43.5% 17.0% Ottawa 11.2% 33.4% 18.9% Michigan 14.0% 60.2% 28.3% Source: MIPHY 2013-14, Youth Assessment Survey 2013-14 Ottawa County, 2013 YRBS *Mason County did not participate in MIPHY 2011-14. Page 1

Prevention Priority Focus Area 1: To Reduce Underage Drinking (Kent County) - Youth alcohol use continues to be a significant problem in Kent County, echoing trends at the national level. Eleven percent of Kent County high school students have tried alcohol before age 13 (2013/14 Michigan Profile for Healthy Youth (MiPHY)), and 43% of Kent County high school students report having tried at least one alcoholic drink (2013/14 MiPHY). The average age of onset for Kent County youth is age 14, with 21% having past 30-day use. The earlier the onset of drug use, the higher the likelihood of addiction (Young, 2002) as well as community ramifications. In fact, underage drug use is a contributing factor to academic failure, unwanted sexual contact, unplanned sexual encounters, the onset of mental illness and criminal activity (Califano, 2002). The opportunity to prevent youth alcohol use is as timely and significant as the problems associated with youth use. Network180 in partnership with the Kent County Prevention Coalition is committed to developing and implementing community-wide interventions designed to deter youth alcohol use. While it is impossible to shield teens completely from the negative influences that surround them, when protective factors in a teen s life outweigh risk factors, a teen is less likely to use drugs. The inverse is also true; teens with more risk than protective factors are at significantly greater risk for substance use. Underage drug use is not just a matter of personal choice. Holding youth solely responsible for underage substance use is akin to blaming fish for dying in a polluted stream. Community-wide prevention approaches or environmental strategies are better suited to decrease `stream pollution - the societal norms, family, community and health factors, policies and laws that shape the teen surroundings and living conditions. SHORT-TERM OUTCOMES Magnify community acknowledgement and celebration of youth making positive choices Enhance youth refusal and decision making skills Increase youth perception of consequence and harm from alcohol use INTERMEDIATE OUTCOMES Increase advocacy to impact community norms and availability [Ex: retail availability, social availability, etc.] Expand adoption of community standards Increase media literacy among youth LONG-TERM OUTCOMES Youth use of alcohol is reduced Age of onset of alcohol use is increased Adult/parental disapproval of youth alcohol use is increased Page 2

Prevention Priority Focus Area 2a: Early Initiation of ATOD Use Partnership for Success specific; Allegan, Lake, Muskegon and Ottawa Counties This SAMHSA funded grant program is designed to help states and U.S. territories reduce state-wide substance abuse rates by addressing gaps in their current prevention services and increasing their ability to reach out to specific populations or geographic areas with serious, emerging substance abuse problems. In the State of Michigan various indicators were identified and vetted in the selection of high need Partnership for Success Communities. Based on epidemiological data 10 Michigan high need communities were selected. Schools continue to play a key role in providing educational opportunities for youth to reduce the risk of youth initiating early ATOD use. Local coalitions continue to provide guidance for prevention priorities and opportunities for youth serving organizations to work together toward common goals. Youth leadership committees plan social marketing campaigns and sponsor positive youth activities. Community volunteers and school professionals receive training and then provide education to youth in school settings. Advisory councils guide program improvement and development. Libraries, schools, YMCA, and community agencies provide space for prevention services to take place. Local universities provide staffing and volunteer support to prevention activities. All counties in the Region 3 PIHP have a lower rate of youth reporting first use of alcohol, marijuana, and or tobacco before the age of 13 than the state. County First use of alcohol before the age of 13 First use of Marijuana before the age of 13 First use of cigarette before the age of 13 Allegan ** 10.5% 5.2% 6.3% Kent ** 3.2% 5.3% 5.7% Lake 19.7% 13.9% 14.3% Mason* 13.7% n/a n/a Muskegon 13.3% 7.1% 8.5% Oceana 14.4% 6.4% 8.1% Ottawa 11.2% 5.2% 9.9% Michigan 14.0% 18.2% 17.9% Source: MIPHY 2013-14, Youth Assessment Survey 2013-14-Ottawa County, 2013 YRBS *Mason County did not participate in MIPHY 2011-14 years; ** Non-Partnership for Success Community Prevention Priority Focus Area 2b: To Reduce Youth Marijuana Use (Kent County) Marijuana use is becoming increasingly popular among Kent County youth. The average age of first use of marijuana is 13.9 years (2013/14 MiPHY). In fact, local youth are using marijuana at a rate higher than their peers across the state. Nearly 28% of 12- to 17-year-olds indicated marijuana use in a recent county-wide survey (2013/14 MiPHY). What s more, the percentages of use increases with age, as 1.4% of 7th graders, 20.2% of 9th graders and 37.0% of 11th graders reported using marijuana in the past month (2013/14 MiPHY). Page 3

Equally unsettling is a more lax attitude among youth about marijuana use than in past years. This is likely fueled by recent policy changes, widespread medical marijuana advertising and new channels of access and social acceptance (i.e., a grandparent having legal access to marijuana as part of palliative treatment). Fewer teens are reporting that marijuana use can cause them harm, though there is growing concern from experts over the short-term and long-term effects of marijuana use, from memory loss and addiction to cancer. The magnitude of the issue is perhaps best represented through a shift in Minor in Possession (MIP) referrals at one Kent County counseling program. Reports since the MIP law was enacted in 2009 show that minors referred to the program for possession of marijuana cases have surpassed alcohol cases. With youth marijuana use and attitudes greatly changing, the Kent County Prevention Coalition seeks to prevent a gradually more permissive attitude among youth, which can offset the accepting use behaviors that often accompany these lax attitudes. SHORT-TERM OUTCOMES Increase youth perception of consequence and harm from marijuana use Enhance youth refusal and decision making skills Increased advocacy to increase awareness of the impact of the Medical Marijuana law on youth use INTERMEDIATE OUTCOMES Youth perception of harm from marijuana use is increased Expand adoption of community standards Increase advocacy to impact community norms and availability [Ex: parental disapproval, target populations, counter marijuana messaging, youth-music, Medical Marijuana Law, etc.] LONG-TERM OUTCOMES Reduce medical marijuana marketing Youth use of marijuana is reduced Age of onset of marijuana use is increased Page 4

Prevention Priority Focus Area 3: Reduce prescription and over-the-counter drug abuse/misuse including Opiates. (All Counties) Prescription drugs are the second most abused category of drugs after marijuana. Prescription drug abuse and misuse is the second most common cause of injury and death in the United States due to poisoning and overdosing. Prescription drug abuse is a rapidly increasing problem among youth ages 12-17. Research indicates one third of youth ages12 and older abuse prescription medication (National Survey on Drug Use and Health (NSDUH). Most often prescription drugs originate from legitimate sources, yet some of these sources actually facilitate and help to create drug addiction. Many people are not aware of the harm and damages that occur from misuse and abuse of prescription and OTC drug. Issues influencing prescription drug abuse include easy access, environmental influences, demographics such as age and race, and inexperience and uneducated doctors in the area of addiction science. The substance abuse prevention coalitions in the Region 3 PIHP have developed strategic plans in relation to prescription drug misuse prevention. Local drug drop-offs have been occurring throughout the region for a few years and has allowed the communities to document the need for permanent disposal locations. Each county in the Region 3 PIHP has established permanent drug drop off boxes within local law enforcement agencies. Coalitions work to raise awareness of this resource and the importance of disposing of medications properly. Prescription drug abuse prevention has provided an opportunity to strengthen relationships with law enforcement, the medical community, and environmental health professionals. Prevention professionals continue to integrate of prescription drug misuse into existing educational programming being provided to youth. The Region 3 PIHP is pleased to have data available for each county in the region regarding the scope of the prescription drug misuse issue. The availability of this data will allow monitoring of community outcomes for prevention initiatives. County Percentage of Students Who Took an Rx Med Such as Ritalin or Adderall w/o Rx in Past 30 Days Percentage of Students Who Took an Rx Med Such as OxyContin or Vicodin w/o Rx in Past 30 Days Allegan 6.3% 6.9% Kent 5.7% 5.7% Lake 6.3% 7.1% Mason* 5.7% 7.0% Muskegon 5.3% 6.3% Oceana 4.7% 5.5% Ottawa 4.2% 4.0% Michigan n/a n/a Source: MIPHY 2013-14, Youth Assessment Survey 2013-14 Ottawa County,

*Mason County - Data from NMSAS 2011-12 SHORT-TERM OUTCOMES Increase youth and community perception of consequence and harm from prescription misuse Increased advocacy to increase awareness of the impact of prescription misuse and abuse INTERMEDIATE OUTCOMES Increase in the number of Scheduled drugs appropriately disposed Increased use of the MAPS and decrease in unmonitored prescriptions Increase advocacy to impact community norms and availability LONG-TERM OUTCOMES Increased perception of the harm/risk of using prescription drugs not as prescribed Youth use of prescription misuse is reduced Page 1

Prevention Priority Focus Area 4: Reduce Youth Tobacco Use (YATT) (Allegan, Mason, Muskegon, Oceana, and Ottawa counties) How do Youth Access To Tobacco Planning Activities Complement Recovery Oriented System of Care/Prevention Prepared Communities Goals and Outcomes? Lakeshore efforts to address youth access to tobacco are developed and conducted in partnership with the substance abuse prevention coalitions in each county. These coalitions are the basis for prevention prepared communities and allow DYTURs to integrate our efforts into the comprehensive strategic plans developed for each county by these coalitions. By reducing youth access to tobacco we work to create healthy communities supportive of recovery and promoting health and wellness. How Did Analysis of Local Synar Data From Last Year Impact the Development of the Compliance Check and Vendor Education Plans for This Fiscal Year? Synar results were consistently poor in the Region 3 PIHP prior to 2006 indicating a need for the region to increase efforts to improve YTA compliance. Since 2005 the region has been implementing the No Cigs for our Kids campaign comprised of increased enforcement compliance checks, vendor education visits, efforts to raise awareness of the issue and increase retailer perception of enforcement and significant penalties. The Region 3 PIHP has dramatically decreased the number of retailers that sell tobacco to minors. In 2009 the Lakeshore Synar rate was 81% which achieved the minimum standard but was low enough for us to realize the need to enhance our efforts and to revitalize campaign visibility. During Synar conducted in July of 2009 there were five failed compliance checks. In 2010, our enhanced non-synar efforts led to a more successful Synar rate of 93%. In 2011 our Synar compliance rate was 86% indicating that a continuous targeted effort is required to sustain compliance rates that exceed 90% which is the LCC targeted compliance rate goal. Targeted geographic areas will continue to be determined through conducting non-synar compliance checks. At the beginning of the campaign (2005) the entire area was assessed to determine hot spots where retailers are most likely to sell to youth. As the campaign has expanded to additional areas, baseline compliance checks are conducted in new target areas to determine the need for efforts and to establish baseline rates for evaluation purposes. Each retailer in a newly targeted area receives a vendor education visit prior to the start of compliance checks. In addition, Vendor education is conducted with all retailers that receive a non-compliant check throughout the year and also with any retailer that requests a vendor education. Problem retailers are also identified by law enforcement, youth, and community members and are targeted for vendor education visits. Analysis of Synar results has not been very informative for planning efforts due to the small sample size. The region finds that conducting non-synar compliance checks throughout the year and targeting retailers that prove to be non-compliant is a more informative method of identifying retailers in need of vendor education visits. Page 2

Briefly Describe Other Planned Tobacco Initiative/Activities The counties of Allegan, Ottawa and Muskegon are using a targeted campaign to increase YTA compliance. Each county has identified hot spot communities within their county and is targeting efforts in these communities. This effort consists of law enforcement compliance checks with randomly selected retailers, each quarter throughout the entire year (excluding the Synar month February), vendor education for non-compliant retailers and for those requesting services, and earned media coverage of YTA issues and compliance check results. This effort has also included the local law enforcement agencies and prosecuting attorneys, as a signatory or cc, on all correspondence with retailers in order to increase the perception by retailers that this issue is well monitored and actively enforced. In addition corporate headquarters for all chain retailers are notified of compliance check results on a quarterly basis. Copies of every citation written are sent to the MLCC for all retailers with a noncompliant compliance check in which the retailer holds a liquor license. The purpose of this effort is to decrease the number/percentage of retailers that are willing to sell tobacco to minors. The target population is retailers that sell tobacco and the clerks that work there. The geographic area covers the Region 3 PIHP but focuses on targeted communities within each county. DYTURs participate on the tobacco coalitions in counties where there are active tobacco coalitions and keep the coalitions informed of Synar related efforts and ways that coalition members can contribute to the efforts. This effort will be explored to be expanded into Kent, Lake, Mason and Oceana Counties if funding, staff time and community readiness is present. Youth Access to Tobacco (YATT) 2015 Kent County How do Youth Access To Tobacco Planning Activities Complement Recovery Oriented System of Care/Prevention Prepared Communities Goals and Outcomes? Michigan s ROSC Implementation Plan includes the goal: To enhance our collective ability to support the health, wellness, and resilience of all individuals by developing preventionprepared communities (PPC). The objectives under this goal are the following: 1. Developing systems that promote continuing prevention services, which enhance individual, family and community health, and 2. Reducing the development of substance use disorders among those at high risk by providing early intervention services to individuals and families with an increased risk of developing substance use challenges and disorders. This plan complements the above goal by the following: Working collaboratively with other prevention providers in the shared responsibility of educating our youth, families and communities on the harm of tobacco use Page 3

Educating systems (e.g. government and schools) on the harm of tobacco use and promoting tobacco free policies supports prevention prepared communities and helps deliver a consistent no tobacco use message throughout the community Promotion of Michigan s Quitline supports the reduction of substance use disorders in individuals that actually follow through with the referral Vendor education of owners, managers, and/or clerks promotes individual and community health by limiting access to underage consumers Compliance checks are a method of identifying problems areas, problem vendor types, and individual problem vendors so solutions can be explored and implemented. This support prevention prepared communities Collaborative initiatives such as the Community Transformation Grant initiative can be the backbone of the development of a comprehensive tobacco free community plan with ownership of the plan held by many How Did Analysis of Local Synar Data From Last Year Impact the Development of the Compliance Check and Vendor Education Plans for This Fiscal Year? The 2014 Synar rate for Kent County was almost 27%. This is much higher than in previous years. In part this is due to the timetable for Synar compliance checks, which were done before there was adequate time for vendor education to be completed. With the change in Michigan s law regarding smoking in restaurants and bars, Kent County has very few that still sell tobacco (1%). These types of establishments are not a planned focus for vendor education or compliance checks in 2014. We did have 5 Synar checks in grocery stores this past year and all passed. While we will do a few checks and vendor education, this is not a primary focus for 2014. All eight of the establishments that failed the Synar compliance check in 2013 were either a convenience store or gas stations. The majority of the focus for 2014 in the area of vendor education and compliance checks will be with this type of establishment. Additionally any vendor that failed a Synar check (or non Synar check) will be targeted for vendor education and/or another compliance check in the remainder of the year of the check or in the following year. Briefly Describe Other Planned Tobacco Initiative/Activities Other work in regards to tobacco has been focused on 24/7 tobacco free comprehensive school policy. There are 5 identified public school districts without a comprehensive tobacco free school policy. We will focus vendor education and non Synar tobacco compliance checks on vendors in or near these school districts: Page 4

Cedar Springs Public Schools East Grand Rapids Public Schools Grandville Public Schools Kelloggsville Public Schools Kent City Public Schools In collaboration with the Asian Center and the Grand Rapids Urban League, Cherry Street Health Services will continue to support the City of Grand Rapids becoming tobacco free in all of its parks and beaches. This is work that has been going on for over a year and they will continue to educate the community and city commission on the merits of tobacco free environments. Michigan s Quitline number will continue to be promoted with clients and patients throughout Cherry Street Health Services. Youth involved in Cherry Street s Minor In Possession program that self-identify as tobacco users, will be provided with Michigan s Quitline number. This number will also be promoted with public school districts as a resource for them to refer students or staff to when they find they have violated the school s tobacco use/possession policy. The Quitline will also be promoted with the Kent County Prevention Coalition. Support will continue to be provided by Cherry Street Health Services staff to the Community Transformation Grant initiative lead by Spectrum Health. One of three capacity planning areas focuses on tobacco. As a regional collaborative Kent County will also implement the No Cigs for our Kids a campaign comprised of increased enforcement compliance checks, vendor education visits, efforts to raise awareness of the issue and increase retailer perception of enforcement and significant penalties. Describe Anticipated Hurdles and Plans to Overcome Them Not having vendor education packet available to do this activity as planned o Request packets be available at beginning of the fiscal year Youth availability matching gender/race/culture of youth with timeline for specific neighborhoods or vendors o Reach out to collaborative partners, staff at Cherry Street Health Services, and Kent County Prevention Coalition to help with recruitment of a variety of youth Working with tobacco vendors who have English as a second language and they aren t familiar with the Youth Tobacco Act. It is hard for them to comprehend the law and its explanation. Request law be available in a variety of languages (e.g. locally it appears SE Asian, Indian, and Pakistan are counties of origin) Page 5

Youth Access to Tobacco (YATT) 2015 Lake County How do Youth Access To Tobacco Planning Activities Complement Recovery Oriented System of Care/Prevention Prepared Communities Goals and Outcomes? Community and individual health and wellness are desired outcomes of the Recovery Oriented System of Care (ROSC) theoretical model. Research has shown that the prevention of youth tobacco use and addiction is a key factor in the development and maintenance of both healthy individuals and communities. To achieve these shared outcomes the development of a prevention prepared community - prepared to promote health and offer the resources to enhance healthy outcomes - is paramount. As research indicates that individuals who refrain from tobacco use have healthier outcomes than their counterparts who use tobacco, it follows that a prevention-prepared community by definition has supports in place to keep youth from initiating unhealthy addictive behaviors including those that minimize youth tobacco use. The environmental activities and processes that have been formulated in conjunction with likeminded community partners and citizens and are contained in Northern Michigan Substance Abuse Services plan are based on practices proven to reduce youth access to tobacco. Limiting access and availability in a community have been shown to reduce the percentages of youth who initiate and become addicted to tobacco. With research also indicating that those addicted to tobacco are at increased risk for not only a myriad of physical health problems and premature death but also for other addictive behavior, limiting youth access to tobacco will promote a healthy non-use community norm, reduce the percentage of youth who use tobacco and become addicted, and contribute to the improvement of the health and wellness of the community. How Did Analysis of Local Synar Data From Last Year Impact the Development of the Compliance Check and Vendor Education Plans for This Fiscal Year? The 2014 Synar rate specific to Lake County was 20.7%. The most current significant emerging trend via the combined counties of NMSAS is that two well-known chain discount stores, known as dollar stores and classified in type as other, have initiated the sale of tobacco. Sales by Family Dollar came first followed by competitor Dollar General. The number of other retail outlets increased from 130 mid-year FY 2012 to 200 in FY 2013. There are numerous discount stores in Region 3 PIHP and as such the trend of declining numbers of regional tobacco retailers that has been experienced since the advent of new state and federal laws of FY 2010 has slowed. The decreasing number of bars and restaurants where vending machines were being eliminated is being offset by the addition of the discount stores as retailers. As there is little compliance check history regarding these chain stores as yet, it has not been determined if their management policy includes vigilant procedures relative to Youth Tobacco Act compliance. In addition and in accordance with a trend of several years, gas stations and convenience stores types have grown in percentage relative to other types of retailers. Gas stations and convenient store by percentage have been the least compliant types of retailers historically. Over the years there has been a gradual reduction in the restaurant and bar/lounge types of retailers and operational cigarette vending machines due to the laws introduced in FY 2010. The reduction of these types as well as a higher rate of business closures have contributed to the challenge of Page 6

keeping the regional retailer list current particularly in rural, remote areas with seasonal businesses. Abrupt closures and discontinued retailer tobacco sales status are not often publicized. As it is not that uncommon for businesses such as bars/lounges to have unlisted numbers the list of eligible retailers is constantly evolving. DYTURs have known for the past several years now that gas stations and convenience stores have been the least compliant types of retailers. With an increase in this representative percentage coupled with more compliant types of retailers discontinuing sales beginning in FY 2010 a lower regional rate of compliance of 78.5% was not surprisingly evidenced in FY 2010. The original number of random compliance check sample for completion was not only downsized as there were more ineligibles that occurred during the sample draw period, but also gas stations and convenience stores were dominant in the remaining draw. The improved FY 2011 compliance rate of 86% was thought to be due in part to a more stable list and more targeted retailer education efforts by DYTURs. In January of FY 2013 the new chain discount store retailers selling tobacco (Family Dollar) were also targeted for retail education by DYTURs. Concentrated retailer education activity commenced in January and ended just prior to the FY 2014 Synar Compliance Check. As winter 2013 Synar compliance checks yielded an improved 86.5% compliance rate, the implication was that the strategies employed in the plan, enhanced targeting and the increased emphasis on keeping the list current as possible, appeared to have positive impact and that the plan was sound. These past strategies, using data pooled across years to target sites for educational visits and the solicitation of local policy support by law enforcement will be utilized by DYTURs in FY 2015. Briefly Describe Other Planned Tobacco Initiative/Activities DYTURs will: 1. Collect information on citations 2. Plan regular collaborative meetings with local groups/individuals, 3. Meet with prosecutors to educate, inform and garner support letters, 4. Meet with area law enforcement to inform and garner support in activities, 5. Plan and conduct non-synar compliance checks (on not less than 10% of retailers) using trend data to target sites and enlisting law enforcement for checks when possible, 6. Provide retailer education (20% of region) targeting the specific areas identified through regional and local trend data and the results of non-synar checks, 7. Plan collaborative meetings with local school liaison officers, and FDA compliance check officers and Health Department personnel monitoring signage, to lend support for their activities, 8. Participate in local health events in support of YTA goals (e.g., World No Tobacco Day), 9. Participate regional planning and in regional and statewide YTA/DYTUR related meetings/event and SPF planning processes when applicable, and 10. Promote the YTA/DYTUR activities through the use of local media in conjunction/collaboration with other community partners. Page 7

Describe Anticipated Hurdles and Plans to Overcome Them Anticipated hurdles include: 1. Current tight budgets for law enforcement will result in law enforcement staff time being allocated to high priority tasks and little or no time will be available for non- Synar compliance and retailer education activity. Plan to offset - DYTURs plan to engage commitment for cited compliance checks earlier in the fiscal year and collaborate with the FDA grant compliance check and monitoring activity planned locally. 2. Community partner agencies continue to be impacted by budget cuts and as a result staff and community volunteers are stretched to cover even more areas which will decrease their time available to collaborate on YTA initiatives. Plan to offset - DYTURs will continue to investigate options including the use of technology currently available for more efficient collaborative activity. 3. Chain discount stores, with numerous sites across the region have initiated tobacco sales. Likely additional like chains will initiate sales. Stores have management and staff inexperienced at selling restricted substances that require identification checks at the point of sale. Targeting them for retailer education in addition to other sites given resources will be onerous. Plan to offset DYTURs plan to engage chains in planning multiple store participation in group training. 4. State budgetary restrictions/guidelines have contributed to limited availability of standardized statewide printed materials for retailer education particularly on an as needed basis throughout the year, state budget for statewide DYTUR training opportunities doesn t include travel reimbursement and training is limited. Plan to offset - DYTURs are planning to augment printed material supplies if there are shortfalls with local materials and to attend state and regional meetings through electronic technology when possible. Page 8

YATT SERVICES PLANNING CHART AND NARRATIVE Allegan, Mason, Muskegon, Oceana, and Ottawa Counties Fiscal Year 2015 Planned Activities Vendor Education Non Synar Compliance Checks # Law Enforcement Checks 500 # by Civilian 350 80 # by Other 0 0 TOTALS: 350 580 Activity Will Occur: October-December X X January-March April-June X X July-September X X Targeting Criteria: Geographic Area X Allegan, Lake, Mason, Oceana, Ottawa and Muskegon Counties X Allegan, Lake, Mason, Oceana, Ottawa and Muskegon Counties Random Sample 25% 10% Previous Failed Checks X X Sales Complaint Rec d X X By Vendor Type # % # % Grocery Stores 115 11.5% 115 11.5% Convenience Stores 400 40.2% 400 40.2% Gas Stations 300 30.1% 300 30.1% Restaurants 35.35% 35.35% Bars/Lounges 20.20% 20.20% Other 125 13% 125 13% Comments Except Synar months Each county will pick a targeted Hot Spot in Fall 2014 Pharmacy, Golf Course, Marinas, Bowling Centers, Amusement Centers Page 9

YATT SERVICES PLANNING CHART AND NARRATIVE KENT Fiscal Year 2015 Planned Activities Vendor Education Non Synar Compliance Checks Comments # Law Enforcement 0 25 Checks # by Civilian 200 200 # by Other 0 0 TOTALS: 200 225 Activity Will Occur: October-December X X If vendor ed. packets can be ready in time January-March X X April-June X X July --- --- August-September X X Targeting Criteria: Geographic Area Grandville, Cedar Springs, East Grand Rapids, Kent City, Kelloggsville ZIP Code (list) 49418, 49319, 49506, 49330, 49548 Grandville, Cedar Springs, East Grand Rapids, Kent City, Kelloggsville 49418, 49319, 49506, 49330, 49548 Random Sample (%) 50% 50% Previous Failed X X Checks Sales Complaint Rec d X X By Vendor Type # % Targets # % Target Grocery Stores 51 12 5 51 12 5 Convenience Stores 148 33 85 148 33 100 Gas Stations 171 39 100 171 39 100 Restaurants 5 1 0 5 1 0 Bars/Lounges 1 0 0 1 0 0 Other 66 15 10 66 15 20 Page 10

YATT SERVICES PLANNING CHART AND NARRATIVE LAKE Fiscal Year 2015 Planned Vendor Non Synar Activities Education Compliance Checks Comments # Law Enforcement Checks 24 Dependent upon officer availability # by Civilian 215 83 # by Other TOTALS: 215 107 Activity Will Occur: October-December January-March April-June X X Time frame could change in response to formal Synar check dates July August-September Targeting Criteria: Geographic Area Baldwin, Branch, Chase, Idlewild, Irons, Luther Baldwin, Branch, Chase, Idlewild, Irons, Luther ZIP Code (list) Random Sample (%) 20% 10% Previous Failed X X Checks Sales Complaint X X Rec d By Vendor Type # % Targets # % Target NMSAS Regional totals; county specific TBD Grocery Stores 181 17% 36 181 18% 18 Convenience Stores 358 33% 72 358 36% 36 Gas Stations 288 27% 58 288 29% 29 Restaurants 37 3% 7 37 4% 4 Bars/Lounges 9 1% 2 9 1% 1 Other 200 19% 40 200 20% 20 Department/ Variety/ Discount, SkiResorts, Pharmacies, Golf Courses, Marinas, Bowling Alleys, Amusement Centers Page 11

Kent County Narrative Kent County has a population of 602,622 (2010 U.S. Census), and stands as the fourth largest county in the state of Michigan. Grand Rapids is Kent County s largest city and, with a population of 188,040 (2010 US Census), is the second largest city in the state of Michigan. Data from the 2010 US Census indicate that Kent County s population is becoming increasingly diverse with 76% of the population identified as white, non-hispanic, 9.7% as Hispanic/Latino, 9.7% as African American, 2.3% as Asian, and 0.5% of individuals identified as American Indian/Alaskan Native. African Americans and Hispanics continue to be more concentrated in the City of Grand Rapids. In 2010, 67% of African Americans and 50% of Hispanics in the county lived within the city limits, compared to 25.2% of their white counterparts. Similar to most communities in Michigan, the most substantial change in Kent County over the past decade has been economic. According to the 2000 US Census, 8.9% of Kent County s population lived below the poverty level in 1999. In 2010, the percentage of Kent County residents living in poverty increased to 16.4%, with 24% of children under the age of 18 living in poverty (2010 American Community Survey). The poverty situation in the city of Grand Rapids was even worse, with 30% of all people and 43.7% of children under the age of 18 living in poverty. According to a Brookings Institution study featured in the January 26, 2010 edition of the Grand Rapids Press, Grand Rapids experienced the greatest increase in city and suburban poverty rates among the nation s 95 largest metropolitan areas between 2000 and 2008. It is upon this foundation that network180 looks to build a healthier environment to prevent underage alcohol, tobacco, and marijuana use among Kent County youth, who local surveys suggest are using alcohol, tobacco and other drugs at a higher rate, and are beginning to use alcohol at a younger age, than youth nationally and in the state of Michigan. The majority of resources will be used to increase youth knowledge of the risks and consequences of alcohol, tobacco, and other drug use. This three-year plan fosters peerto-peer positive social norming, uses educational teaching aids that appeal to the digital native culture of the current generation, and implements community-focused strategies that impact the environment where youth learn, play, and gather. Kent County is a unique mix of urban, suburban, and rural communities within close proximity, therefore, cultural competence is interwoven in every aspect of the work. Network180 is very intentional about engagement of urban, suburban, and rural youth. The proposed activities outlined will reach several thousand 6th-12th grade students living in Kent County. Network180 has made the commitment to work with community stakeholders in developing focused interventions; communications and other supports related to culturally sensitive prevention services. The plan will implement strategies that provide information, enhance skills, and provide support, change consequences, and impact policy (via change of knowledge, attitude, and behaviors). The goal of Prevention is to reduce social burdens by applying a public health approach - having a collective impact on communities. For every $1 spent in Prevention equals a $10 savings to our Society. Engaging an entire village to relieve a local condition is very applicable to the current public health model for addressing underage substance use and adult substance misuse in Kent County. The ripple effect of systemic public health issues like substance abuse and its byproducts on individuals, families, local institutions, and Page 12

communities far exceeds the capacity and resources of any single effort or entity to resolve alone. According to the 2010 National Prevention Strategy, chronic diseases and conditions account for 7 out 10 deaths in the United States and 75% of medical care expenditures, most of which are PREVENTABLE. National public health trends are shifting from a focus on disease treatment to one of prevention! Not only does prevention work, but collaborative problem solving and community coalition building are proven vehicles for preventing and reducing the onset of substance use disorders. Our goal as the Region 3 PIHP is to create communities where individuals, families, schools, faith-based communities, and workplaces take action to promote health and wellness in our community. Last year through our prevention provider network we served nearly 70,000 individuals; this does not include the estimated reach via social marketing, movie trailer premiere, cable channel, and YouTube. Prevention services draws on the strength of our community. Our strength in prevention coordination is community mobilization, relationships, and strategic planning. Our charge is to educate, equip and empower change. As the guardrail for Kent County we are pursuing a relentless commitment to outcomes that change lives and improve the health and wellness of all who call Kent County home. Our village-like framework has changed community conditions, norms, systems and policies in Kent County and beyond in landmark ways. Kent County knows PREVENTION WORKS! Network180 has focused tremendous efforts towards increasing our understanding of substance abuse prevention. In our efforts to align ourselves with the States Strategic Prevention Framework the organization dedicated additional resources towards the development of a county-wide substance abuse prevention plan. Our planning process and service delivery system shows evidence of community involvement and achievement towards the identified National Outcomes Measures. The intention is to build infrastructure in order to increase the complexity and availability of data collection and utilization in local substance abuse planning and evaluation. Network180 used the Strategic Prevention Framework as its planning model; the concept is a data driven and outcome based decision-making process that will enhance the capacity of substance abuse prevention in Kent County. This capacity building approach has resulted in the development of a core county coalition (CSPPC); where providers and other community partners / stakeholders across Kent County define, integrate data and outcomes as a natural part of their planning and evaluation processes. The Strategic Prevention Framework planning process focuses its efforts on needs, services, and resources to substance abuse prevention, treatment and advocacy in Kent County. Network180 and our coalition of partners utilize local data to assess the needs of populations at highest risk for substance use, misuse and abuse. Network180 in partnership with its community coalition address prioritized needs through the implementation of evidence-based strategies and preferred practices. The outcome is to strengthen a seamless system of prevention services for Kent County, anchored by a long-term strategic plan that will guide providers to: address targeted needs and gaps, build community capacity, integrate data and research, connect state, regional, county and community networks and reduce substance use, misuse and abuse among youth and adults. The key elements of the Strategic Prevention Page 13

Framework: Needs/Resources Assessment, Capacity Building, Planning, Implementation and Evaluation. The result of this infrastructure development is Community Transformation. The significant effects of this planning process is the braiding of funding streams, the reduction in duplication of services and strengthening of the community s ability to address its issues. This public health model is the connection among people, neighborhoods, interventions and desired changes in behaviors. Kent County s plan will promote healthy development and encourage wise and responsible decisions regarding alcohol and other drug use among youth and adults in our community. Our energy will focus on reducing or eliminating risk factors and enhancing and creating the many conditions that can protect and support individuals living in Kent County. The assessment of the problems and consequences of substance use in Kent County is outlined in the Kent County Substance Abuse Prevention Plan 2012-2015; the 2013 Community Report (provided upon request), and on the Prevention Logic Model and Other Details for Prevention Services form. Kent County - Process for Data Prioritization (Outline) ROUND 1: 1. Review data and decide on which goal area to prioritize (the data). 2. Have a brief discussion about how CEC (Community Epidemiology Committee) members should think about and weigh each construct (i.e., conceptual piece of the framework puzzle). a. For RISK and PROTECTIVE FACTORS, basis for prioritization might be any combination of: i. How actionable (i.e., likely to be able to inform or change local prevention strategy) would data about this area be? ii. How different or special do we suspect Kent County might be compared to the national picture or other local communities on this factor? (i.e., do we think that having more data about this area will make us much smarter about local prevention than we would be by following what the national research literature suggests? iii. How likely is data in this area to be useful as a baseline against which can gauge current/future progress? iv. Any other criteria you determine! b. For USAGE and CONSEQUENCES/BURDENS factors, basis for prioritization might be any combination of: i. How much could information on this construct inform network180 about the extent or seriousness of the problem, where the problem is happening, and to whom? ii. Any other criteria you determine! 3. Each CEC member look through the Construct Priorities Matrix sections for the chosen goal area and rate each construct according to how hot or cold - it is given the priorities decided upon. Note: each area is completed separately - RISK / Page 14

PROTECTIVE factors first, discussion than rating of USAGE / CONSEQUENCES/BURDENS, etc. 4. Going down the list of constructs, each group member shares his/her rating arriving at an aggregate total for each area. ROUND 1A 1. Identify and discuss the summary ratings; confirming: a. Does everyone agree that the constructs prioritized make sense? b. Were there any areas where members had very different ideas about the priority? Discuss as needed so everyone s voice is heard and the CEC builds a shared understanding of priorities. c. Are there too many top priorities? If so, can the group identify 3-5 in each area that are worth the most? Put a star next to these! ROUND 2 1. Focus on identified top priorities first, look through the master data framework and identify the measures that look to be the most useful for assessing those constructs 2. Discuss as a group For the data that looks most useful, identify which of those data elements are available now, and which will require special access or new collection. The idea isn t to necessarily weed out those that require more work, but just to know what they are. Treatment Section a. Demographic profile of the population of the Region 3 PIHP Population Distribution Allegan Kent Lake Mason Muskegon Oceana Ottawa Population 112,531 621,700 11,386 28,605 171,008 26,245 272,701 Percent of Total 9.04% 49.96% 0.92% 2.23% 13.74% 2.11% 21.91% (n=1,244,176) Source: US Census Bureau, 2013 Population Estimates Median Household Income $ Persons per Household Homeownership Rate Persons below poverty level Source: US Census Bureau Socioeconomic Characteristics Allegan Kent Lake Mason Muskegon Oceana Ottawa 51,030 51,030 30,390 40,957 48,843 39,667 55,760 2.62 2.60 2.71 2.28 2.54 2.65 2.71 82.3% 70.2% 82.1% 74.3% 74.7% 83.2% 78.9% 13.1% 15.6% 24.1% 16.9% 19.5% 20.6% 10.5% Page 15

Race Allegan Kent Lake Mason Muskegon Oceana Ottawa White 95.5% 83.7% 87.3% 95.9% 81.5% 96.1% 93.3% Af-Am 1.4% 10.3% 9.2% 0.8% 14.3% 0.6% 1.7% AmerInd 0.7% 0.7% 0.9% 1.1% 0.9% 1.4% 0.6% Asian 0.7% 2.5% 0.2% 0.5% 0.6% 0.4% 2.8% Hawaiian 0% 0.1% 0.0% 0.0% 0.0% 0.1% 0.0% 2+Races 1.7% 2.7% 2.5% 1.7% 2.7% 1.5% 1.7% Hispanic 6.9% 9.9% 2.4% 4.1% 5.1% 14.2% 9.0% Source: US Census Bureau Language Other Than English Spoken at Home Allegan Kent Lake Mason Muskegon Oceana Ottawa 5.9% 11.5% 2.2% 4.7% 4.2% 11.8% 9.6% Source: US Census Bureau Gender Allegan Kent Lake Mason Muskegon Oceana Ottawa Female 50.2% 50.9% 49.0% 50.5% 50.7% 49.9% 50.9% Male 49.8% 49.1% 51.0% 49.5% 49.3% 50.1% 49.1% Source: US Census Bureau Age Allegan Kent Lake Mason Muskegon Oceana Ottawa <18 25.4% 25.7% 16.9% 21.0% 24.3% 24.5% 25.4% 65+ 14.2% 11.6% 25.5% 20.2% 14.4% 18.0% 12.5% Source: US Census Bureau Adult Literacy Allegan Kent Lake Mason Muskegon Oceana Ottawa % Lacking 8% 8% 11% 7% 8% 10% 7% Basic Skills Source: Inst. of Educ. Sciences (http://nces.ed.gov/naal/estimates/stateestimates.aspx) b. Population of Focus The population of focus for treatment services includes all persons who have a diagnosable substance use disorder and who are covered by one or more of the several public funding streams managed by the Region 3 PIHP. The relationship of the population of focus to the overall population in the PIHP catchment area is that they will be drawn from the same population in varying amounts based on the prevalence of use for various addictive substances in the region. Page 16

c. Description of Current System As noted in prior submissions, the Region 3 PIHP is an integration of part or all of three prior Coordinating Agency regions. Network180 served Kent County; three of the four counties served by the Lakeshore Coordinating Council of Grand Haven will be coming into the Region 3 PIHP (Allegan, Ottawa and Muskegon); and three of the thirty counties served by Northern Michigan Substance Abuse Services of Gaylord are coming into the Region 3 PIHP. Accordingly, there are at present three somewhat different methods used to operate the publicly managed SUD system. These must now must be brought together into a new configuration by October 1, 2014. Until September 30, 2014, the three existing CA s will manage these systems as they do now, assuring for uninterrupted access to care and delivery of services as required by their respective contracts with DCH. They will (and are) supporting a transition plan that will result in the ability of the Region 3 PIHP to manage this responsibility starting October 1, 2014 for Allegan, Kent, Lake, Mason, Muskegon, Oceana and Ottawa counties. Consistent with the requirements of PA 500 of 2012, providers currently serving residents of the seven identified counties will continue to hold contracts through the Region 3 PIHP or its members. The region s plans for SUD service delivery involves the delegation of treatment and recovery support services to each of the Community Mental Health Service Programs (CMHSPs). Prevention services will be provided directly by the Region 3 PIHP. As such, the full array of evidence-based prevention, treatment and recovery support services that are available today will be available as of October 1, 2014 and throughout the three-year period covered by this strategic plan. This does not, however, mean that ongoing development will not occur. To the contrary, new and exciting evidence is continuing to accumulate on the use of novel technologies and emerging best practice medications in the treatment of substance use disorders. We intend to leverage those new interventions as quickly as possible following their affirmation as responsible practices. In addition, for those clients who have coverage through Healthy Michigan Plan funding, we expect to leverage the array of newly available services as soon as details are made available in the 10/1/2014 update to the Michigan Medicaid Manual which we are led to understand will be the official initial opportunity to make use of these new (to persons with SUD) benefits. Gaps and barriers will not be fully known until after the system is initiated in its reorganized form on October 1, however we anticipate that gaps may exist in the area of having an adequate capacity for evidence-based opioid treatment services. We anticipate having to deal with the need deal with issues related to the distance between persons in need of treatment services and their preferred treatment or recovery support services providers (a geographic issue of access to services). Page 17