State Planning Efforts to Prevent Substance Abuse In Older Adults

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State Planning Efforts to Prevent Substance Abuse
In Older Adults

• 2007 IHS/SAMHSA/National Behavioral Health
  Conference

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Session Objectives

• This presentation will focus on
• The Older Americans Technical Assistance Center
  used the Strengths Weakness and Other Threats
  (SWOT) Assessment with five states.
• CSAP utilizes the Substance Abuse Prevention
  Framework with health and social service provides
  to incorporate substance abuse and mental health
  prevention programs into their state planning
  efforts.
• The Center supports the identification of
  evidence-based practices.
• The Get Connected Toolkit is being used to train
  health and social service providers.

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Substance Abuse Prevention Framework
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The Demographic Imperative

• 13 percent of U.S. population age 65 expected
  to increase up to 20 percentby 2030
• 83 million Baby Boomers (born from 1946-1964)
  in U.S. Census 2000
• 78 million baby boomers began to turn 65 in
  January 2006

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Population Age Structure1965
Baby Boom
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Population Age Structure 1995
Baby Boom
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Population Age Structure 2025
Baby Boom
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Impact on Social Systems

• Baby Boomers retirement
• Enormous pressure on retirement systems, health
  care facilities, and other services
• Major implications for substance abuse and mental
  health prevention and treatment

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Substance Abuse Among Older Adults I

• Most common addictions
• Nicotine 1822 percent
• Alcohol 218 percent
• Psychoactive Prescription Drugs 24 percent
• Other illegal drugs (marijuana, cocaine,
  narcotics)gt1 percent

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Substance Abuse Among Older Adults II

• An estimated one in five older Americans (19)
  may be affected by combined difficulties with
  alcohol and medication misuse.
• In the DASIS Report of Treatment Admissions for
  2001 Native Americans had a 3 admission rate
  for alcohol and drugs for persons over the age of
  55. (SAMHSA)

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Depression and Anxiety

• One in five older adults has a significant mental
  disorder
• Primary psychiatric illness 16 percent
• Dementia complicated by psychiatric symptoms 3
  percent
• Depression affects 3-7 percent
• Anxiety affects 11 percent
• Frequent comorbidity among anxiety,
  depression,and physical illness.

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National Initiatives

• 2002 Presidents New Freedom Commissionon Mental
  Health
• Prevention of substance abuse and mental health
  disorders identified as a national priority
• 2005 White House Conferenceon Aging Top 10
  Resolutions
• 8 Improve Recognition, Assessment, and
  Treatment of Mental Illness and Depression Among
  Older Americans

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SAMHSA Initiative

• Overarching goal
• To create sustainable changes in the field of
  geriatrics around substance abuse and mental
  health so that these issues are recognized and
  planned for

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Center Priorities

• Funded by the Center for Substance Abuse
  Prevention (CSAP)
• Provide technical assistance with respect to the
  prevention and early intervention of
• Substance abuse
• Medication misuse and abuse
• Dissemination and implementation of
  evidence-based and promising practices

• Mental health disorders
• Co-occurring disorders

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Center Resources

• Quarterly electronic eCommunication
• Professional articles
• Highlights of successful older adult programs and
  practices
• Most current older adult behavioral health
  information
• Evidence-Based Practices for Preventing
  Substance Abuse and Mental Health Problems in
  Older Adults
• Website

http//www.samhsa.gov/OlderAdultsTAC
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Key Activities and Partnerships

• Activities
• Assist states in developing plans around
  substance abuseand mental health
• Provide training and technical assistance to
  states, communities, and health and social
  service providers
• Partnerships
• Administration on Aging
• National Council on the Aging

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State Planning and Training

• Washington State Co-Occurring Disorders
  Conference Changing Systems Changing Lives,
  September 2005
• Partnership with AoA
• SAMHSA Older Americans TAC conducted a state
  pilot test with Washington and Oregon
• Half-day state planning focusing on geriatric
  substance abuse prevention and intervention and
  mental health promotion
• Washington and Oregon State teams attended with
  personnel from mental health, substance abuse and
  aging

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SWOT

• Strengths, Weaknesses, Opportunities, and Threats
• Culmination of SWOT interviews with key
  informants, including both service planners and
  service providers
• Integrated reports were developed
• Served as basis of pilot test training

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Pilot Test Results I

• Key participants from the Washington team now
  meet regularly for planning.
• Aging and Disability Services Administration
  (ADSA)
• Division of Alcohol and Substance Abuse (DASA)
• Washington Institute (representing mental health)
• Other agencies and organizations are included in
  meetings as needed.

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Pilot Test Results II

• 2006, WA State Legislature allocated dollars to
  expand Access to Treatment for aged, blind and
  disabled
• Training is taking place across systems mental
  health,aging, and substance abuse
• DASA is turning increased attention to these
  issues historically not a priority
• Trainings include
• Engaging Older Adults in Treatment
• Understanding and Screening Geriatric
  SubstanceAbuse Disorders
• Motivational Interviewing

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Pilot Test Results III

• Group Enhancement Modelfor Older Adults
• Older Adult Chemical Dependency Counselor
  outsourced to local Area Agency on Aging (AAA) in
  Pierce County, WA
• Works directly with AAA case managers
• Home-based treatment
• RFP to model the program in other counties

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Pilot Test Results IV

• DASA Co-Occurring Disorders introduced an Aging
  Trackin 2005
• LIFESPAN
• Co-Occurring Disorders Among Older Adults Academy
• Aging, mental health, and substance abuse service
  providers

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Washington State Training

• SAMHSA Older Americans TAC conducted training in
  February and March 2006
• Trained over 150 clinicians, paraprofessionals,an
  d administrators from mental health, substance
  abuse,and aging fields in Seattle and Spokane
• Two-pronged training approach addressing health
  literacy and behavioral health resources

• Increasing Provider Comfort Levels Working
  withOlder Adults
• Get Connected! Toolkit

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Increasing Provider Comfort LevelsWorking With
Older Adults I

• Modes of Training
• Lecture
• Experiential
• Interactive

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Increasing Provider Comfort LevelsWorking With
Older Adults II

• Learning Objectives
• Increase awareness of the daily physical, mental,
  and emotional challenges faced by some older
  adults.
• Review U.S. functional literacy rates and its
  impact on older adult health literacy and health
  outcomes.
• Examine topics that are sensitive to many older
  adults and present obstacles for healthcare
  providers.

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Increasing Provider Comfort LevelsWorking With
Older Adults III

• Discuss and engage in activities designed to
  remove provider obstacles and promote positive
  interactions with older adults.
• Increase provider comfort levels in working with
  older adults.

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Get Connected! Toolkit

• Get Connected! Toolkit LinkingOlder Adults with
  Medication, Alcohol,and Mental Health Resources
• Partnership with the National CouncilOn the
  Aging and SAMHSA
• Targeted to organizations that provideservices
  to older adults
• Provides materials necessaryfor training staff
  who workwith older adults

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CT, MD OH State Training March

• SAMHSA Mental Health Transformation State
  Incentive Grants (MHT-SIG)
• 7 states awarded MHT SIG in 2005
• CSAP is partnering with the Center for Mental
  Health Services (CMHS) to enhance technical
  assistance efforts
• Ohio has also received a CMHS Targeted Capacity
  Expansion Grant
• CT, MD OH State Training
• Over 20 SWOT calls were conducted with over 50
  individuals during February
• State training was held in Baltimore, MD on March
  7-8, 2006

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Common Strengths

• Promotion of evidence-based practices
• Aids in maintaining funding levels
• Brings together clinicians, policymakers, and
  academia
• Increased collaboration between mental health and
  substance abuse
• Historical silos
• Collaborative spirit at local and state levels
• Creative use of Medicaid dollars to provide
  community-based services whenever possible

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Common Gaps

• Lack of planning for demographic shift
• Providers are not trained or comfortable with
  older adult population
• Lack of training opportunities for providers
• Primary care physicians are hesitant to address
  mental health and substance abuse issues with
  patients
• Older adults are not a priority
• Resources are often directed towards children
  (preventive care)
• Lack of qualified geriatrics professionals
  entering the workforce

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Common Opportunities

• MHT SIG specifically addressesthe lifespan and
  collaborationwith other state agencies
• Increasing communication
• Ombudsman program
• Consumer advocacy and grassroots efforts
• Community-level programs
• National push to increase community-based
  services and home-based long-term care

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Future State Training

• SAMHSA Older Americans TAC will conduct state
  trainings over the next 4 years
• MHT SIG focus for FY2006
• Assist states and territories in developing plans
• Continued collaboration with the National
  Registry for Evidence-Based Programs and
  Practices (NREPP)
• Share NREPP programs with communities across the
  Nation

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Continued Partnerships

• Continue to partner with AoA to
• Identify and disseminate evidence-based programs
• Work with staff around the development of
  substance abuse and mental health state plans for
  older adults

Additional Partnerships

• State/territory-level aging, mental health, and
  substance abuse agencies
• SAMHSA Technical Assistance Centers
• Addiction Technology Transfer Center Network
  (ATTC)

• National Council on the Aging
• Centers for the Application of Prevention
  Technologies (CAPTS)
• Professional Associations

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Questions?

• Older Americans Substance Abuse and Mental
  HealthTechnical Assistance Center
• 1-888-281-8010
• OlderAmericansTAC_at_westat.com
• http//www.samhsa.gov/OlderAdultsTAC

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