National Strategies for Local Solutions LCDR Michael R. Muni, MPA, MPH National Heroin Task Force Education and Community Awareness Committee s Staff Lead Substance Abuse Mental Health Services Administration U.S. Public Health Service Commissioned Corps McKimmon Conference & Training Center, Raleigh, NC
United States Public Health Service Commissioned Corps USPHS CC
U S Department of Health & Human Services (HHS) Substance Abuse Mental Health Services Administration (SAMHSA) Center for Substance Abuse Prevention (CSAP)
SAMHSA Organizational Chart Office of the Administrator Administrator (Acting) Kana Enomoto, M.A. Office of Communications. Office of Behavioral Health Equity. Office of Policy, Planning, and Innovation. Office of Financial Resources Office of Management, Technology, and Operations. Center for Substance Abuse Prevention Center for Mental Health Services Center for Substance Abuse Treatment Center for Behavioral Health Statistics and Quality.. 5
SAMHSA s Direction Mission: To reduce the impact of substance abuse and mental illness on America s communities. Roles: Voice and Leadership Funding-Service Capacity Development Information and Communications Regulation and Standard Setting Improve Practice 6
SAMHSA s Vision SAMHSA provides leadership and devotes its resources including programs, policies, information and data, contracts and grants to help the United States act on the knowledge that: Behavioral health is essential to health. Prevention works. Treatment is effective. People recover. 7
The Role of Prevention 8 To create communities in which people have a quality life: Supportive workplaces, schools, and communities Drug-free and crime-free neighborhoods Positive connections with friends and family 8
SAMHSA s Strategic Initiatives Workforce Development Prevention of Substance Abuse and Mental Illness Health Information Technology Trauma and Justice Health Care and Health Systems Integration 9 Recovery Support
SAMHSA s Strategic Initiative #1: Prevention of Substance Abuse and Mental Illness Top Priorities Prevent substance abuse and improve well-being in states, territories, tribes Establish prevention of underage drinking as a priority issue for states, territories, tribal entities, colleges and universities, and communities. Increase public knowledge of the warning signs for suicide and actions to take in response. Surgeon General s National Strategy on Suicide Prevention Reduce prescription drug misuse and abuse.
Objectives National Heroin Task Force Initiative National Level Strategy Building Community Level Initiative Identified Blueprint for your Local Solution Slide 11
Logic Model Behavior and Related Problems Risk and Protective Factors Interventions Short Term Outcomes Long Term Outcomes Slide 12
About 24 million Americans age 12 or older starting nonmedical pain reliever use since 2002. Rate of past year use is 4.6 percent, but there is geographic variation: 3.6 percent in North Dakota 5.8 percent in Arkansas Of 10 states with highest combined 2011, 2012 use rates: 4 are in the South region, 3 are in the West region Of the 10 States with lowest rates: 4 are in the Midwest region 4 are in the Northeast region
Prescription Drug Abuse Affects Everyone Prescription medications are among the top substances abused by 12th graders in the past year. In 2011, more than 4,500 young people per day abused a prescription drug for the first time. All ages are affected. Older Americans 2009: approximately 1 U.S. infant born per hour with signs of drug withdrawal. 55 to 94 percent of neonates exposed to opioids in utero experience withdrawal.
National Prescription Drug Abuse Prevention Strategy Prescriber and consumer education/awareness. More than half, 54 percent, of people 12 and older using prescription pain relievers non-medically got them from a friend or relative for free. Estimated 1 out of every 5 patients with non-cancer pain or pain related diagnosis are prescribed opioids.
National Strategy
Building Capacity
Committees - Education & Community Awareness - Law Enforcement Responses - Coordinated Community Responses - Treatment and Recovery Support
Recommendations - 3 Principles public safety and public health authorities must integrate and harmonize their response to the misuse of prescription opioid medications and use of heroin policies regarding heroin use and misuse of prescription opioid medications must be grounded in a scientific understanding that substance use disorder is a chronic brain disease that can be prevented and treated treatment and recovery services and support must be accessible, affordable, and highlighted
Moving Forward - Evidence-based prevention programs - Prescription drug monitoring - Prescription drug take-back events - Medication-assisted treatment - Overdose reversal drug naloxone 1.1 Billion dollars in new funding proposed in the President s budget to address the prescription opioid abuse and Heroin use epidemic
Establish the community s initiative (Use SPF to assess the greatest need) The National Heroin Task Force s initiative on a national level can be the Behavioral Health and Public Safety Integrated organizational blueprint for a local solution that plans the work and then allows the community to work the plan
First steps (lay the foundation) - Make it known that an effort is underway to mobilize the community - Determine what others are doing to combat the need and maintain an active recruitment process to secure the participation of dedicated, action-oriented people - Identify the target and the desired measurable outcomes - Be realistic and keep the focus narrow - Once you have become a force to reckon with expand your scope to include multiple threats
Organize the group effectively (clear structure) - Design an organizational structure that allows for representative and community-wide membership - Make the structure simple and flexible - Basic elements of an effective structure - Steering Committee (10-12 key individuals) - Working Group(s) (up to 50 workers) - Task Forces (small group specialisits) NHTF -4 committees can be mirror local approach
Educate the community about their local drug use prevalence (identify the threat) National crisis - an unprecedented surge in the illicit use of prescription opioid medications and heroin. In 2014, 1.9 million people had a prescription opioid use disorder and nearly 600,000 had a heroin use disorder. National data on overdose deaths are startling- in 2014, there were more than 27,000 overdose deaths involving prescription opioid medications and/or heroin. That is equivalent to an average of one death every 20 minutes. Also use local data to support the prevalence in the community
Provide local leaders with a big picture view of the threat (map out the issue) - Study and carefully document the problem, then share this assessment with all sectors of the community - Base your assessment on solid evidence, not hunches or assumptions. Use local data to paint the picture - Seek the involvement of local law enforcement. They are an important part of your team, as they often have access to data systems and technical support for comprehensive threat assessments Hone in on specific points grounded in data that will draw local leaders to the table
Identify the right people for the job (build capacity through existing resources) - Put together a workgroup of dedicated individuals willing to volunteer their time and energy - Seek the participation of action-oriented people from various sectors of the community 1) Treatment 7) Prevention 2) Law Enforcement 8) Schools 3) Coalitions 9) Local Government 4) Public Health 10) Businesses 5) Youth 11) Parents 6) Parents 12) Faith Community
Design and carry out the action plan (evidence-based environmental strategies) - Bring all participants together for a strategy development session - At the meeting, arrange for presentations about the impact of drug use from the perspectives of prevention, intervention, treatment, and criminal justice - Review the current National Drug Control Strategy and relevant municipal documents or statewide strategies - Present the finding of your local threat assessment - Develop plans that clearly delineate who will do what
Keep the initiative moving forward (stay connected) - Evaluate your progress: Have the action plans worked as intended. - Recruit other dedicated individuals into the effort, keeping in mind the constructive partnerships require close interaction - Communication - Time management - Conflict resolution - Planning and involvement - Collaborative decision-making
Ensure the initiative s success (long-term sustainable strategies) - Watch the data for signs of new or emerging trends in local activity - Provide data updates and progress reports - Make sure all partners adhere to the strategies collaboratively developed - Always seek new information and other views
Prevention Strategies Universal Prevention Prevent new cases Selective Prevention Reduce Overdose Risk Indicated Prevention Prevent Overdose Deaths Substance Abuse Block Grants & Discretionary Grants -Family & friends training -Provider training -Community awareness -Media/Campaign Protective factors -Remain in MMT -Age and HIV sero-positivity -Offer range of treatments -Investigate poly-substance use -Offer training Policy -Prescription Drug Monitoring Programs (PDMPs) -Availability of Naloxone Supply -Outreach efforts and harm reduction training Relapse Prevention -Long-term treatment strategies -Short-term treatment strategies Gaps -Potential benefits and harms of short-term therapies -Overprescribing of opioid prescriptions associated with overdose deaths and heroin use -Targeting vulnerable Slide groups 30
Spirit Science Action Assessment Evaluation Did it work? What do we need to do differently? What do we know about our community and its substance abuse problems? Sustainability & Cultural Competence What skills/resources do we need and who needs to be at the table? Capacity Building Implementation How do we track our plan? Are there barriers in carrying out our plan? Given the problem, what are we going to do? Strategic Planning
Spirit -Opportunity -Comfortable -Goals -Growth -Dream - Enemy - Failure - Focus - Drive Slide 32
National Strategies for Local Solutions LCDR Michael R. Muni, MPA, MPH -National Heroin Task Force, Education and Community Awareness Committee s Staff Lead -CSAP s Lead on Military Service Members, Veterans, and Their Families -Drug Free Communities Project Officer (FL, NC, & SC) 240-276-2559 Michael.muni@samhsa.hhs.gov Slide 33