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July 2010
ANNAPOLIS COALITION UPDATES
Recovery into Practice Webinar Attracts Hundreds
Annapolis Coalition Executive Director John Morris and Board member Sue Bergeson participated in a webinar in June for the Recovery to Practice initiative, a SAMHSA-funded project that seeks to accelerate the adoption of recovery-based principles and content in the curricula of training programs. Sue and John discussed involving consumers and families in curriculum development, as well as consumers and family members as workforce leaders. The organization reported that there were 700 participants logged on to the Internet, and nearly 990 listening through the audio connections to the presentation. In fact, their carrier (Verizon) reported that the webinar had one of the highest attendance records it had ever recorded! You can still download the slides form the webinar on the Recovery to Practice website.
Morris Honored with Howery Award
Annapolis Coalition Executive Director John Morris, M.S.W., has been named recipient of the 2010 Victor I. Howery Memorial Award (Howery Award). Awarded annually, the Howery Award is bestowed on an individual who has made significant contributions to the rural mental health field. The Howery Award was presented at the annual conference of the National Association for Rural Mental Health (NARMH) in Denver on June 3, 2010. The full release can be accessed here.
In Search of Behavioral Health Pacesetters
The review process is in full swing for the 2010 Behavioral Health Pacesetter Award. Presented by The Annapolis Coalition in partnership with The Hitachi Foundation, the award will give national recognition to organizations that have fostered workforce practices that strengthen behavioral health businesses, enhance conditions for its lowest wage workers, and improve client outcomes.
Fifty-one award applications were received, and the review process to winnow that number down to a select few awardees is underway. Employers were encouraged to nominate their own practices and programs, but nominations came from a wide range of sources. Four review panels have been established by the Coalition and they will assess the applications by the end of the month using a carefully defined process.
Applicants were asked to tell their story – to outline the details of their program, to explain the importance to their organization and to describe the positive benefits for the business, for their unlicensed employees and for their clients, their families and the communities in which they live.
"Thanks to the Hitachi Foundation grant, we can identify best practices and really work to make the business case for investing in training and development—especially for direct service workers,” said Annapolis Coalition Executive Director John Morris.
The goal of the Behavioral Health Pacesetter Award is to promote the dissemination and replication of best workforce practices that promote "Better Jobs, Better Services, and Better Business.” The winner is expected to be announced in late 2010 or early 2011.
VIEWS FROM THE BOARD: CAN TECHNOLOGY HELP FILL THE VOID FOR THE UNDER-SERVED?
Eliminating disparities in care: Can technology help fill the void?
By D.J. Ida, Ph.D.
Improving the current workforce to eliminate the disparities in quality care for under-served populations has been a major concern of mine for years. One possible solution for closing the gap is the use of technology. The most common concern I hear over and over is the serious lack of trained providers who are capable of meeting the needs of our most vulnerable individuals, particularly those who are isolated due to cultural and language barriers. This is not to say that very competent providers do not exist ~ there just aren’t enough of them, and those who are there are at risk of burn out. Increasing the number of providers from ethnically diverse communities is one approach but that in and of itself will not guarantee the quality of training, nor does it insure that all communities will receive services of any kind. A person may live in the heart of Los Angeles but fail to receive services because the nearest provider who speaks the appropriate language and is familiar with the particular problem may live in another country or state.
The vast majority of community-based organizations that serve our communities are on survival mode. They desperately need to increase recruitment and training efforts but cannot access funding because they lack the "critical mass” to warrant the necessary resources to make training for a few providers cost effective.
One of my greatest frustrations has been the lack of funding for workforce development. Report after report talks about the importance of access for eliminating disparities, yet there is precious little for our communities to access. The recent surge of interest in technology holds promise by providing a means for ongoing training, supervision and implementation of services. In February 2009, the American Recovery and Reinvestment Act (ARRA) provided $19 billion for use of health information technology in the delivery of healthcare services but I was dismayed to see that once again the funding focused on physical health with little to no dollars being dedicated to mental health or behavioral health.
If there is an upside to this issue, it may force the integration of primary health with behavioral health and move towards a more public health model. My concern is that behavioral health will not receive the attention it deserves and needs. This would be unfortunate for I have seen firsthand how a small organization like the Khmer Health Advocates, Inc. in West Hartford, Connecticut, has successfully used technology to address trauma-informed services that looks at the health and mental health needs of Cambodian refugees. They have been able to use technology with a community that has a high percentage of individuals who are not literate in any language because of the mass killings of the educated class by Pol Pot in Cambodia. Much can be learned from their work. I join fellow members of the Annapolis Coalition in our collective push for increased resources to insure the inclusion of behavioral health, cultural competency and use of technology in the ongoing healthcare reform discussions.
Additional information can be found at
:
American Recovery and Reinvestment Act: http://www.recovery.gov/Pages/home.aspx
Dept of HHS Health Information Technology: http://healthit.hhs.gov/portal/server.pt
Broadband USA: http://www.broadbandusa.gov/
Washington Health Information Collaborative: http://www.wahealthinfocollaborative.org/
National Telecommunication & Information Admin: http://www.ntia.doc.gov/broadbandgrants/
D.J. Ida, Ph.D. serves as Executive Director of the National Asian American Pacific Islander Mental Health Association and was a contributing author for the subcommittee report on Eliminating Disparities for the President’s New Freedom Commission on Mental Health, served on the National Advisory Council for the US DHHS SAMHSA’s Center for Mental Health Services and the Board for Mental Health America. Dr. Ida helped develop the first national training curricula for use with Asian American, Native Hawaiians and Pacific Islanders consumers and the subsequent curricula for children as well as a training program for mental health interpreters.
IN THE NEWS: AN UPDATE ON THE NATIONAL 2010 DRUG CONTROL STRATEGY
Getting Inside the 2010 National Drug Control Strategy
by Michael T. Flaherty, Ph.D.
On Tuesday, May 12, the White House Office of National Drug Control Policy (ONDCP) released its long-awaited 2010 National Drug Control Strategy ("Strategy”). We are told that the key word to summarize this new Strategy is "balance” as we move in a "new direction,” stated President Obama in his letter to Congress that accompanied the Strategy. The President’s opening line to Congress: "I am committed to restoring balance in our efforts to combat the drug problems that plague our communities.” ONDCP Director R. Gil Kerlikowske followed this with his Preface to the Strategy describing the new Strategy as "unique” in its "balanced approach of evidence-based prevention, treatment, and enforcement” to address our nation’s serious drug problem.
Calling it "balanced” asks readers to see more than the typical 80% or more of ONDCP funding dedicated to drug interdiction (law enforcement)—we are to see at least the intent to prioritize the reduction of drug demand, if not the dollars. Before describing the specifics of the Strategy, I will begin with some context.
Today in America there are believed to be 68 million individuals who use alcohol or drugs in harmful ways and would benefit from intervention; 28 million who if diagnosed would qualify for a substance dependence treatment; and only 2.3 million individuals who actually are in treatment. That is, only 8.2% of those who need treatment are getting it and only 3.3% whose problematic use is being addressed. Moreover, substance use specialty care desperately needs an expanded and skilled workforce, as many clinics lack MD’s (44% have none); 75% have no psychologists or social workers on staff, and on average, clinics have an annual 50% turnover rate in staff.[1] The treatment gap is huge, the workforce strained and experts predict a 30% growth in demand for service over the next two years with the implementation of healthcare reform and parity. In short, by addressing demand for drugs more fully within our national border, we might substantially shrink the drug market and reduce the need for interdiction so we can move toward "balance.”
The Strategy has seven immediate key objectives and a series of goals to be attained by 2015, with promised funding increases to support these efforts over the ensuing years.
Key Strategy Objectives:
Strengthen Efforts to Prevent Drug Use in Our Communities
Preventing drug use before it begins is a cost effective, common sense way to build safe and healthy communities. Instead of a system in which communities must adapt to the ways and conveniences of federal and state agencies, it is vital for our federal and state agencies and departments to adapt and remain sensitive to the needs of local communities. This objective represents a new focus on community-led prevention.
Seek Early Intervention Opportunities in Health Care
Only a fraction of the money spent on health-related drug use costs is spent on identifying and intervening early in emerging cases of problematic drug use or treating those with the disease of addiction. Research has clearly established that brief screening and intervention by a primary care provider helps halt both problematic use and the trajectory of addiction. The Strategy calls for increasing screening and early intervention for substance use in all healthcare settings and expanding prescription drug monitoring programs.
Integrate Treatment for Substance Use Disorders into Health Care and Expand Support for Recovery
For millions of Americans, substance use progresses to a point where brief interventions are not sufficient to promote recovery. Addiction treatment can be a critical—even lifesaving—resource in such situations, but only if it is readily available and of high quality. Among other measures, the Strategy calls for expanding addiction treatment in community health centers and the Indian Health Service.
Break the Cycle of Drug Use, Crime, Delinquency and Incarceration
Actions described in the Strategy include supporting law enforcement efforts to reduce drug availability, promoting alternatives to incarceration, and mandating treatment and court monitoring for chronic drug-using offenders.
Disrupt Domestic Drug Trafficking and Production
This objective is the interdiction side of the strategy. Drug trafficking organizations move large quantities of illicit drugs into the U.S. These same groups, at times working through street and prison gangs, work within criminal networks that return the illicit proceeds of the drug trade – along with an array of weapons – across our borders. The Strategy lays out federal support for law enforcement drug task forces, assisting tribal authorities in combating drug trafficking, and interdicting the southbound flow of currency and weapons.
Strengthen International Partnerships
The U.S. is one of the world’s most lucrative markets for illegal drugs. The Strategy includes conducting joint counterdrug law enforcement operations with international partners, promoting alternative livelihoods for coca and opium farmers, and targeting the illicit finances of drug trafficking organizations.
Improve Information Systems for Analysis, Assessment and Local Management
Science should help inform policy and rigorously evaluate its effects. This is possible only with near real-time information on drug use patterns, associated problems, and the results of previously implemented policies. The Strategy seeks to enhance current data systems and assess the availability, price and purity of illicit drugs on the street so that what it is known when our programs have a measurable impact on drug markets.
These seven objectives are followed by two National Drug Control Strategy Goals to be attained by 2015:
Goal 1: Curtail illicit drug consumption in America
a.) Decrease the 30-day prevalence of drug use among 12-17 year olds by 15%
b.) Decrease the lifetime prevalence of eighth-graders who have used drugs, alcohol or tobacco by 15%
c.) Decrease the 30-day prevalence of drug use among young adults aged 18-25 by 10%
d.) Reduce the number of chronic drug users by 15%
Goal 2: Improve the public health and safety of the American people by reducing the consequences of drug abuse
a.) Reduce drug-induced deaths by 15%
b.) Reduce drug-related morbidity by 15%
c.) Reduce the prevalence of drugged driving by 10%
In total, the Strategy does bring some $151 million new funds to reducing demand—about a tenth of the need, by my estimation—toward accomplishing these lofty objectives and goals. Additionally, with the advent and refocus of healthcare reform and parity, the ONDCP Strategy for demand reduction could be greatly enhanced. This is truly a new direction for national drug control and it is more complex than just interdiction versus demand. It is both as necessary and complimentary parts needing top priority to be more balanced to truly address the full scope of the problem.
For the full Strategy, go to www.WhiteHouseDrugPolicy.gov.
Michael T. Flaherty, Ph.D. is a clinical psychologist and Executive Director of the Institute for Research, Education and Training in the Addictions (IRETA), located in Pittsburgh, Pa. He is also a Board Member and substance use liaison for the Annapolis Coalition. He can be reached at flahertym@ireta.org.
IN THE LITERATURE: CPS ROLES AND ACTIVITIES
Certified Peer Specialist Roles and Activities: Results From a National Survey
Mark S. Salzer, Ph.D.; Edward Schwenk, B.A., C.P.S.; Eugene Brusilovskiy, B.A.
Objective: In 2001 Georgia became the first state to allow services provided by certified peer specialists (CPSs) to be reimbursed by Medicaid. Six other states have since followed Georgia’s lead, with many others in the process of doing so. This study examined where CPSs work and what they do. Methods: CPSs (N=291) from 28 states completed an online survey.
Results: CPSs primarily did their work within the agency rather than in the community and worked most often with individuals rather than groups. CPSs frequently provided peer support and focus on self-determination, health and wellness, hope, communication with providers, illness management, and stigma. They spent the least amount of time supporting people’s family, parenting, dating, or spiritual relationships.
Conclusions: CPS work settings and modalities varied greatly, although a core set of activities was identified. Implications for developing and refining CPS roles in the system are discussed, along with suggestions for additional training and supervision. (Psychiatric Services 61:520–523, 2010)
Abstract reprinted with permission from Psychiatric Services, May 2010 (Copyright 2010). American Psychiatric Association. Full article available for subscribers at ps.psychiatryonline.org.
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