Tom Williams, MD Chief Medical Officer Director of the Division of Public Health Nebraska Department of Health and Human Services

Tom Williams, MD Chief Medical Officer Director of the Division of Public Health Nebraska Department of Health and Human Services

Helping People Live Better Lives Background DHHS dynamic agency Helping people live better and healthier lives in diverse and broad ways A focus on prevention

In 2015, drugs and medications prescription drugs, illicit drugs, and over-thecounter medications were the underlying cause of death for 91% of all poisoning deaths. Of all drug overdose deaths, 67% were unintentional. (Source: Nebraska Vital Records) In 2015, Nebraska s drug overdose age-adjusted death rate was 8.0 per 100,000 up from 3.6 per 100,000 people in 2004. The U.S. age-adjusted drug overdose death rate per 100,000 people was 16.3 in 2015 and 9.3 in 2004. (Source: National Vital Statistics System) 13th lowest state in rate (4.18) of non-medical use of prescription painkillers (2010-2011). (Source: National Survey on Drug Use and Health)

9 8 7 6 5 4 Drug overdose Opioid related 3 2 1 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Prescription Drug Overdose Prevention Business Plan Priority Federal Funding Awarded to DHHS Department of Justice Harold Rogers Grant $250,000 per year 2 year grant (2015-2017) CDC Prescription Drug Overdose Prevention for States Grant $771,249 per year 4 year grant (2015-2019)

1. Enhance and maximize Nebraska s PDMP 2. Develop and encourage statewide uptake of pain management guidelines 3. Conduct needs assessment and educate on expanded access to naloxone

Purpose Prevent the misuse of controlled substances Allow prescribers and dispensers to monitor the care and treatment of patients to ensure prescription drugs are used for medical appropriate purposes Enhancements No patient opt out Allow prescribers, dispensers, and designees to access the PDMP January 1, 2017 All dispensed controlled substances reported daily January 1, 2018 All dispensed prescriptions reported daily

Purpose - to promote consistent, safe, and effective pain management standards Internal DHHS group Utilizing Oregon template and CDC Guidelines as resources External stakeholder engagement (Fall 2016 Summer 2017) Collaborative effort with DHHS divisions and stakeholders Share Guidance Document with professional Boards for input/advice Distribution of Pain Management Guidance Document (Fall 2017) Education on Guidance Document will be provided www.dhhs.ne.gov/pdmp

Purpose - to decrease rate of drug overdose deaths, specifically opioid and heroin deaths Project Outcomes: Successfully identify barriers and gaps to accessing naloxone for first responders, law enforcement, physicians, pharmacists and community members Provide comprehensive education to increase awareness about naloxone How to access and how to use Priority Activities Year 1 Completed statewide needs assessment - March 2017 Develop education for EMS, Prescribers, and Dispensers based on results

Routinely monitoring use of prescription medications by Nebraska Medicaid clients. Medication assisted treatment developing training for clinicians. Partner with our state Attorney General s Office to host first-ever Nebraska Opioid Summit. Partner in statewide public information campaign for preventing opioid misuse.

PDMP System Enhancement Jan. 1, 2018 Nebraska first state to require collection of all dispensed prescriptions Develop and disseminate media awareness campaign for naloxone Continued focus on quality of mortality data through increased toxicology testing

Public Health s partnership to address Mental Health DPH contributes to mental health/substance abuse population health efforts primarily in prevention and early intervention: Infant Mental Health Community Health Worker training to screen, linking people to care Trauma Informed Care initiatives Local Health Departments: Community Health Improvement Plans School Health initiatives Partnering with Division of Children & Family Services to address the Comprehensive Addiction and Rehabilitation Act DBH, DPH and 4 local health departments = 6 month cohort received TA from ASTHO in 2016 Mental Health First Aid National Council for Behavioral Health conference Added additional local health departments in 2017 cohort 12

Mental Health First Aid 8-hour course that gives people the skills to help someone who is developing a mental health problem or experiencing a mental health crisis Not aimed at mental health professionals, but geared to provide basic information for anyone In addition to the basic course, curriculums also available on military/veterans and youth DBH and DPH sponsoring training statewide Partnered with Nebraska Association of Local Health Directors to organize trainings 6 local health departments involved, offering trainings in their area One day training for EMS providers Continued trainings and project evaluation ongoing 13

Promotes health and well-being of Nebraskans 2017 2021 Plan with 5 Co-Launch Partners Collective Impact model: Collaborative, community driven 5 Priorities: Obesity Depression & Suicide Health Equity Health System Integration Utilization & Access

Obesity Prevention/Control Response in Nebraska Obesity continues to be a major issues in the state. Approaches to increase physical activity, healthy eating and breastfeeding. Interrelated with health care systems intervention and community and clinical linkages DHHS Chronic Disease Prevention and Control Program Funding: Two major CDC Initiatives: Public Health Actions for Prevention and Control emphasis on policy, systems and environmental change approaches (1305 and 1422 Grants) Other responses: State Health Improvement Planning (SHIP) prioritization Local Public Health Departments Community Health Improvement Process and Community Health Needs Assessment prioritization PHHS Block Grant supporting worksite health initiatives 16

Early Childhood Initiatives Breastfeeding- Obesity prevention in the first year of life: Increasing access to professional and peer support through a Community Breastfeeding Initiative Worksite-based initiatives support new mothers Nebraska NAP SACC- Impacting young children from ages 0-5 in child care settings across the state: Nutrition and Physical Activity Self-Assessment for Child Care Impact providers and children through training and technical assistance Child Nutrition Infant Feeding & Breastfeeding Infant & Child Physical Activity Outdoor Play & Learning Screen Time 17

School-Based Initiatives Whole School, Whole Community Whole Child Model: Approaching schools through a Coordinated School Health Initiative led by the Nebraska Department of Education Emphasis increasing physical activity and healthy eating in schools and districts statewide through: USDA School Wellness Policy Smarter Lunchrooms and Smarter Snack Initiatives Nebraska Physical Education Standards Comprehensive School Physical Activity Program 18

Adult-Based Initiatives Worksite Health Promotion Initiatives: Worksite Wellness 101 & 201 Training Healthy Beverage Guide Walk It Toolkit Active Commuting Toolkit Lactation Support Toolkit Healthy Community Design Initiatives: Choose Healthy Here Nebraska Walkable Communities Initiatives 19

Tom Williams, MD dhhs.ne.gov