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Title: H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM


1
Aligning Concepts, Practice and Contexts to
Promote Long-term Recovery An Action Plan
Recovery Oriented Systems of Care SAMHSA/CSATs
Public Health Approach to Substance Use Problems
Disorders
May 2, 2008 Philadelphia, PA
H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM
Director Center for Substance Abuse
Treatment Substance Abuse Mental Health Services
Administration U.S. Department of Health Human
Services
2
To build a future of quality health care, we
must trust patients and doctors to make medical
decisions and empower them with better
information and better options .
2008 State of the Union
  • President George W. Bush

3
Terry L. Cline, PhD Administrator Substance Abuse
and Mental Health Services Administration
At SAMHSA, our mission includes helping
prevention and treatment counselors, clinics, and
health care providers develop ways to change
their service systems to increase positive
outcomes for their clients.
September 2007
4
An Introduction to the Substance Abuse and
Mental Health Services Administration (SAMHSA)
  • One of the eleven grant making agencies of the
    U.S. Department of Health and Human Services,
    with a budget of approximately 3 billion
    dollars.
  • SAMHSAs Mission
  • To build resilience and facilitate recovery for
    people with or at risk for substance abuse and
    mental illness.
  • Website http//www.SAMHSA.gov

5
SAMHSAs Role in Fighting Substance Misuse and
Abuse
  • SAMHSA works to ensure that science, rather than
    ideology or anecdote, forms the foundation for
    the Nations addiction treatment system.
  • SAMHSA serves health professionals and the public
    by disseminating scientifically sound, clinically
    relevant information on best practices in the
    treatment of addictive disorders and by working
    to enhance public acceptance of that treatment.

6
The SAMHSA Matrix
SAMHSAs Matrix provides a graphic representation
of the collaboration needed to promote holistic,
integrated approaches that advance the health and
well-being of individuals, families, and
communities.
7
SAMHSA Centers
  • Center for Mental Health Services Mission
  • To ensure access and availability of quality
    mental health services to improve the lives of
    all adults and children in this Nation.
  • Center for Substance Abuse Prevention Mission
  • To decrease substance use and abuse by bringing
    effective substance abuse prevention to every
    community.
  • Center for Substance Abuse Treatment Mission
  • To improve the health of the nation by bringing
    effective alcohol and drug treatment to every
    community.

8
SAMHSA Programs Support a Comprehensive Approach
to Public Health
9
We Face Multiple Challenges
  • Reaching those in need of services
  • Providing adequate resources
  • Developing culturally-appropriate, evidence-based
    interventions
  • Building and sustaining a qualified workforce
  • Integrating substance use disorder services into
    the public health paradigm

10
Greater Burden on Public Sector
Private
Private
Public
Public
1986 All SA 9.3B Public 4.6 B Private
4.6 B
2003 All SA 20.7 B Public 16.0 B Private
4.7 B
Source Health Affairs, July-August 2007
11
A Public Health Imperative Substance Misuse can
  • Lead to
  • Worsened medical conditions (e.g. diabetes,
    hypertension) and
  • Worsened brain disorders (e.g. depression,
    psychosis, anxiety sleep disorders)
  • Unintentional injuries violence
  • Result in
  • Dependence, which may require multiple treatment
    services
  • Low birth weight, premature deliveries, and
    developmental disorders, child abuse neglect

12
A Public Health Imperative Substance Misuse can
  • Contribute to or be associated with
  • Homelessness
  • Criminal justice involvement
  • The effect and abuse of prescribed medications
  • Unemployment
  • Gambling
  • Bankruptcy
  • Legal Issues (e.g. DUI, DWI, domestic violence)
  • Dropping out of school

13
A Public Health Imperative Substance Misuse can
  • Induce or facilitate
  • Medical diseases (e.g. Stroke, dementia,
    hypertension, cancers)
  • Acquiring Infectious diseases infections (e.g.
    HIV, Hepatitis C)
  • Suicide attempts or tendencies

14
Past Month Alcohol Use - 2006
  • Any Use 51 (125 million)
  • Binge Use 23 (57 million)
  • Heavy Use 7 (17 million)

(Current, Binge, and Heavy Use estimates are
similar to those in 2002, 2003, 2004, and 2005)
Source NSDUH 2006
15
Drug Use Among the General Population 2006
Source SAMHSA, Office of Applied Studies,
National Survey on Drug Use Health, 2005 2006
16
Illicit Drug Dependence or Abuse in Past Year
among Persons Aged 12 or Older Percentages,
Percentages of Persons Percentages of Persons
3.11-4.25
2.92-3.10
2.82-2.91
2.57-2.81
2.10-2.56
Source Annual Averages Based on 2005-2006 NSDUHs
17
Non-Medical use of Pain Relievers in Past Year
among Persons aged 12 or Older Percentages
Percentages of Persons Percentages of Persons
5.66-6.72
5.31-5.65
4.83-5.30
4.40-4.82
3.85-4.39
Source Annual Averages Based on 2005-2006 NSDUHs
18
Alcohol Dependence or Abuse in Past Year among
Persons Aged 12 or Older Percentages
Percentages of Persons Percentages of Persons
8.78-10.81
8.15-8.77
7.52-8.14
6.81-7.51
6.30-6.80
Source Annual Averages Based on 2005-2006 NSDUHs
19
Past Year Perceived Need for and Effort Made to
Receive Treatment among Persons Aged 12 Needing
But Not Receiving Specialty Treatment for Illicit
Drug or Alcohol Use 2006
The Challenge
21.1 Million Needing But Not Receiving Treatment
for Illicit Drug or Alcohol Use
20
Identifying Treating Substance Abuse
Substance abuse is often observed, but ignored or
excused, before the client is identified as
needing treatment.
Drug Courts
Alcohol Treatment
Public Health Treatment Strategies
SBIRT
HIV/AIDS
Employer/ Co-Workers
Family
Friends
Adolescent Treatment
Women Children Services
SAPT Block Grant
21
Shifting our Paradigm to Recovery-Oriented
Systems of Care
21
22
The Recovery Process
  • Recovery from alcohol and drug problems is a
    process of change through which an individual
    achieves abstinence and improved health,
    wellness, and quality of life.

Source CSAT National Summit on Recovery, 2005
23
Recovery-Oriented Systems of Care A Paradigm
Shift
  • Recovery-Oriented Systems of Care shift the
    question from How do we get the client into
    treatment? to How do we support the process of
    recovery within the persons environment?

24
A Traditional Course of Treatment for a
Substance Use Disorder
Severe
Symptoms
Remission
Resource Tom Kirk, Ph.D
25
A Traditional Service Response
Severe
Remission
Acute symptoms Discontinuous treatment Crisis
management
Resource Tom Kirk, Ph.D
26
A Recovery-Oriented Response
Severe
Remission
Promote Self Care, Rehabilitation
Resource Tom Kirk, Ph.D
27
Helping People Move Into A Recovery Zone
Severe
Symptoms
Improved client outcomes
Remission
Time
Resource Tom Kirk, Ph.D
28
Benefits of Moving into a Recovery Zone
  • Most clients undergo 3 to 4 episodes of care
    before reaching a stable state of abstinence ¹
  • Chronic care approaches, including
    self-management, family supports, and integrated
    services, improve recovery outcomes 2
  • Integrated and collaborative care has been shown
    to optimize recovery outcomes and improve
    cost-effectiveness 3

¹ Dennis, Scott Funk, 2003 2 Lorig et al, 2001
Jason, Davis, Ferrari, Bishop 2001 Weisner et
al, 2001 Friedmann et al, 2001 3 Smith, Meyers,
Miller, 2001 Humphreys Moos, 2001)
29
Defining Recovery-Oriented Systems of Care
29
30
Recovery-Oriented Systems of Care Approach
  • In the recovery-oriented systems of care
    approach, the treatment agency is viewed as one
    of many resources needed for a clients
    successful integration into the community.
  • No one source of support is more dominant than
    another.
  • Various supports need to work in harmony with the
    clients direction, so that all possible supports
    are working for and with the person in recovery.

Source Addiction Messenger, November 2007, Vol.
10 Issue 11, published by the Northwest Frontier
ATTC.
31
ROSC support person-centered and self-directed
approaches to care that build on the personal
responsibility, strengths, and resilience of
individuals, families and communities to achieve
health, wellness, and recovery from alcohol and
drug problems.
Recovery
V
Individual Family Community
Wellness
Health
32
ROSC offer a comprehensive menu of services and
supports that can be combined and readily
adjusted to meet the individuals needs and
chosen pathways to recovery.
Recovery
Services Supports
Family/ Child Care
Alcohol/Drug Services
Vocational
Education
Individual Family Community
Housing/ Transportation
PTSD Mental Health
Physical Health Care
Spiritual
HIV Services
Financial
VSO Peer Support
Health
Wellness
Legal
Case Mgt
33
ROSC encompass and coordinates the operations of
multiple systems
Recovery
Systems of Care
Addiction Services System
Child Welfare and Family Services
Mental Health System
Social Services
Services Supports
Family/ Child Care
Alcohol/Drug Treatment
Vocational
Housing System
Individual Family Community
Primary Care System
Educational
PTSD Mental Health
Housing/ Transportation
Health Care
Faith Community
Vocational Services
HIV Services
Spiritual
Indian Health Services
Financial
VSO Peer Support
Legal
Case Mgt
Health Insurance
Criminal Justice System
Health
Wellness
DoD Veterans Affairs
34
providing responsive, outcomes-driven approaches
to care.
Recovery
Abstinence
Evidence-Based Practice
Systems of Care
Addiction Services System
Child Welfare and Family Services
Employment
Menu of Services
Social Services
Cost Effectiveness
Family/ Child Care
Alcohol/Drug Treatment
Mental Health System
Vocational
Individual Family Community
PTSD Mental Health
Educational
Housing Authority
Reduced Crime
Housing/ Transportation
Health Care
Primary Care System
Perception Of Care
HIV Services
Spiritual
Faith Community
Vocational Services
Financial
VSO Peer Support
Indian Health Services
Safe Drug-free Housing
Legal
Case Mgt
Retention
Health Insurance
Criminal Justice System
Health
Wellness
DoD Veterans Affairs
Access/Capacity
Social Connectedness
35
ROSC require an ongoing process of systems
improvement that incorporates the experiences of
those in recovery and their family members.
Recovery
Abstinence
Evidence-Based Practice
Systems of Care
Addiction Services System
Child Welfare and Family Services
Employment
Services Supports
Family/ Child Care
Alcohol/Drug Treatment
Mental Health System
Social Services
Vocational
Cost Effectiveness
Individual Family Community
Educational
PTSD Mental Health
Reduced Crime
Housing/ Transportation
Primary Care System
Housing Authority
Health Care
Spiritual
Perception Of Care
HIV Services
Vocational Services
Financial
VSO Peer Support
Indian Health Services
Legal
Case Mgt
Safe Drug-free Housing
Retention
Health Insurance
Criminal Justice System
Health
Wellness
DoD Veterans Affairs
Access/Capacity
Social Connectedness
Ongoing Systems Improvement
36
Recovery-Oriented Systems of Care
  • Support person-centered and self-directed
    approaches to care that build on the strengths
    and resilience of individuals, families and
    communities to take responsibility for their
    sustained health, wellness, and recovery from
    alcohol and drug problems.
  • Offer a comprehensive menu of services and
    supports that can be combined and readily
    adjusted to meet the individuals needs and
    chosen pathway to recovery.

37
Recovery-Oriented Systems of Care
  • Encompass and coordinate the operations of
    multiple systems, providing responsive,
    outcomes-driven approaches to care
  • Require an ongoing process of systems improvement
    that incorporates the experiences of those in
    recovery and their family members

38
Elements of Recovery-Oriented Systems of Care
  • Person-Centered
  • Individualized Comprehensive Services
  • Responsive to Culture Personal Belief Systems
  • Community-based
  • Commitment to Peer Services
  • Involvement of Family and other Allies
  • Ongoing Monitoring Outreach

39
Elements of Recovery-Oriented Systems of Care
  • Cost Effective
  • Outcomes Oriented
  • Integrated Services, resulting in Non-Duplication
    of Services
  • Competency-based
  • Effective use of Collaboration Partnerships
  • Systems-wide Education and Training
  • Continuity of Care
  • Research-based
  • Flexible Funding

40
How do we sell treatment to those who need it?
40
41
Alcohol Drug Related Emergency Department (ED)
Visits
  • In 2005 there were an estimated 394,224 ED visits
    that involved alcohol in combination with another
    drug.
  • Alcohol was most frequently combined with one or
    more of the following cocaine, marijuana, and
    heroin

SOURCE Office of Applied Studies, SAMHSA, Drug
Abuse Warning Network, 2005 (04/2006 update).
42
Opiate Reports in Emergency Department Visits
Related to Drug Misuse/Abuse
Buprenorphine
Includes single- and multi-ingredient products
Unweighted reports from 243-445 U.S. hospitals
Source U.S. SAMHSA DAWN Live! Oct 2, 2007
43
Traditional Substance Abuse Intervention
  • Little attention has been given to the large
    group of individuals who use alcohol and other
    drugs but are not, or not yet, dependent .

Adapted from Babor,T,F., Higgins-Biddle,J.C.,
(2001), Brief Intervention for Hazardous and
Harmful Drinking A manual for use in primary
care . p 33. WHO/MSD/MSB/01.6b World Health
44
Screening, Brief Intervention Referral to
Treatment (SBIRT)
  • Embeds screening, brief intervention treatment
    of substance abuse problems within primary care
    settings such as emergency centers, community
    health care clinics, and trauma centers.
  • Identifies patients who dont perceive a need for
    treatment,
  • Provides them with a solid strategy to reduce or
    eliminate substance abuse, and
  • Moves them into appropriate services.

45
SBIRT Takes Advantage of the Teachable Moment
  • Teachable Moment is the moment of educational
    opportunity a time at which a person is likely
    to be particularly disposed to learn something or
    particularly responsive to being taught or made
    aware of something.

Source MSN Encarta Online Dictionary, Retrieved
3/25/08 from http//encarta.msn.com
46
Top Five Substances Reported by SBIRT Clients
Source Services Accountability Improvement
System (SAIS)
47
CSAT SBIRT Initiative
  • Increases access to clinically appropriate care
    for nondependent as well as dependent persons.
  • Links generalist and specialist treatment
    systems.
  • Combines intervention and treatment toward a
    consistent continuum of care.
  • 4. Builds a coalition between health care
    services and alcohol and drug treatment services.

48
SBIRT enhances State substance abuse treatment
service systems by
  • Expanding the States continuum of care to
    include SBIRT in general medical and other
    community settings
  • community health centers
  • nursing homes
  • schools and student assistance programs
  • occupational health clinics
  • hospitals, emergency departments.

49
SBIRT enhances State substance abuse treatment
service systems by
  • Changing how substance abuse is managed in
    primary care settings
  • Treating substance abuse issues at the lowest
    level of acuity, before clients are diagnosed
    with substance use disorders

50
SBIRT Core Clinical Components
  • Screening Very brief screening that identifies
    substance related problems
  • Brief Intervention Raises awareness of risks and
    motivation of client toward acknowledgement of
    problem
  • Brief Treatment Cognitive behavioral work with
    clients who acknowledge risks and are seeking
    help
  • Referral Referral of those with more serious
    addictions

51
SBIRT Screening
  • Quick method to identify individuals who may be
    at risk for developing alcohol and substance
    abuse problems
  • Includes screening plus immediate feedback
  • serves as an intervention and
  • is tailored to the level of either illness or
    risk
  • Screening is performed using a brief
    questionnaire about the context, frequency, and
    amount of alcohol or other drugs used by an
    individual

52
SBIRT Brief Intervention
  • Healthcare provider uses the results of a
    screening questionnaire that indicates a moderate
    alcohol or drug problem to motivate an individual
    to begin to do something about his/her substance
    use behavior
  • Typically 1-3 sessions, not more than 5 sessions
  • One or more follow-up care management contacts
    with patients either in brief face-to-face
    counseling or by telephone
  • Low-cost, effective treatment alternative for
    alcohol and other drug problems

53
Components of Brief Interventions
  • Give feedback about screening results, impairment
    and risks, while clarifying the findings
  • Inform the patient about hazardous consumption
    limits and offer advice about change
  • Assess the patient's readiness to change
  • Negotiate goals and strategies for change
  • Arrange for follow-up treatment

54
SBIRT Brief Treatment
  • Based on moderate to high risk screening scores
  • Involves motivational discussion and client
    empowerment
  • Similar to brief intervention, but more
    comprehensive
  • Includes assessment, education, problem solving,
    and building a supportive social environment
  • Examples include
  • Brief cognitive-behavioral therapy
  • Brief psychodynamic therapy
  • Brief family therapy

55
SBIRT Referral to Treatment
  • Healthcare provider -- using the results of a
    screening questionnaire that indicates alcohol or
    drug dependence -- refers an individual to a
    specialized treatment setting
  • Proactive process facilitates access to specialty
    treatment for individuals requiring more
    extensive resources than can be provided in a
    primary care setting
  • This integral component of SBIRT ensures access
    to the appropriate level of care for all who are
    screened

56
Coding for SBI Reimbursement February 2008
  • Reimbursement for screening brief intervention
    is available through commercial insurance CPT
    codes, Medicare G codes and Medicaid HCPCS codes
  • HCPCS Codes (Medicaid)
  • - H0049 Alcohol /or Drug Screening (24)
  • - H0050 Brief Intervention15 mins. (48)
  • CMS G-Codes (Medicare)
  • - G0396 15-30 mins (29.42)
  • - G0397 gt 30 mins (57.69)
  • CPT Codes (Commercial Health Plans)
  • - 99408 15-30 mins (33.41)
  • - 99409 gt 30 mins (65.51)

57
SBIRT Current Grantees Colleges
Massachusetts
Connecticut
Delaware
College/University Grants
State Grants
58
SBIRT Patients Served
  • 625,937 patients have been seen through the SBIRT
    process
  • 16.2 received brief intervention
  • 3.1 received brief treatment
  • 3.6 were referred to treatment

59
SBIRT Outcomes
  • Since FY 2004, there has been a 152.6 increase
    in the number of clients reporting abstinence 6
    months after intake.

Source Random sample collected at baseline 6
months post intake, as of 3/24/08. Results are
from SBIRT early implementation and reflect a
more severely involved substance abuse population.
60
Alcohol to Intoxication Illegal Drug Use
SBIRT Outcomes
The data below represent follow-up from the SBIRT
programs as of 3/24/08. Sample selection was
random and collected at intake and 6 months post
intake.
Measure Intake Follow-up Change Rate
Alcohol to intoxication (5 drinks) 51.7 32.2 - 37.7
Use of any illegal drugs 37.1 18.6 - 49.9
Important to note Results are from SBIRT early
implementation and reflect a more severely
involved substance abuse population.
61
Access to Recovery A Recovery-Oriented Systems
of Care Model
61
62
Access to Recovery (ATR)
  • ATR is a Presidential Initiative designed to
    promote client choice through
  • the expansion of treatment capacity,
  • the implementation of a voucher system, which
    allows most grantees to choose their target
    populations and geographic area(s) of coverage,
    and
  • the inclusion of non-traditional substance abuse
    treatment providers, such as faith- and community
    based organizations

63
Access to Recovery (ATR)
  • The recovery-oriented approach contributes to the
    effective application of the ATR program.
  • Recovery support services in conjunction with
    clinical treatment help to establish a more
    continuous treatment response.
  • The recovery-oriented model ultimately means that
    the program focuses on reducing the acute and
    severe relapses that substance abusing clients
    often experience.

64
More Choices for Clients
  • ATR has helped mobilize community networks and
    build collaborative partnerships that result in
    more choices and more services for clients with
    substance abuse issues.
  • Faith-based organizations have expanded the
    concept of choice by offering faith-based options
    to clients who may have a more spiritual approach
    to their recovery

65
More Flexibility
  • Empowers clients to directly participate in their
    own recovery by offering them choices about where
    and from whom they receive treatment.
  • Levels the playing field so that smaller and
    newer providers can improve their ability to
    compete for Federal funds and address the issues
    of their communities.

66
Helps Build Networks
  • ATR provides a platform to develop linkages with
    other federal agencies/programs which can help to
    leverage ATR funds or serve as a source of
    referrals/services
  • Drug courts may be sources of referrals into the
    program
  • DOJ-DOL programPrisoner Reentry Program
  • HUDHousing services (direct housing services
    such as rent payments are not permissible under
    ATR)

67
ATR Electronic Voucher System
  • Significantly reduces paperwork and creates
    administrative efficiencies
  • Streamlines the referral process for clients
  • Improves data collection on client outcomes to
    track the impact of the program on clients
  • Increases accountability by tracking clients
    through the system, and tracks ATR dollars to
    manage program funds and monitor for fraud,
    waste, or abuse
  • Links various providers together through an
    electronic database.

68
Examples of Services That Can be Paid for Using
ATR Vouchers
  • Employment coaching
  • 12-step groups
  • Recovery coaching
  • Spiritual support
  • Child Care
  • Housing Support
  • Literacy Training
  • Traditional Healing Practices, e.g.
  • Sweat lodge
  • Sundance ceremony
  • Burning sage
  • Beading
  • Other

69
Contributions of Faith- and Community-based
Organizations (FBCOs)
  • FBCOs have expanded the concept of choice by
    offering faith-based options to clients who may
    have a more spiritual approach to their recovery.
  • In many cases clients consider them trustworthy
    sources that were located within the clients
    community and who were unaffiliated with any
    formal state or federal structure.
  • FBCOs are particularly effective for engaging and
    retaining clients who had been incarcerated or
    had criminal records.

70
Contributions of Faith- and Community-based
Organizations (FBCOs)
  • FBCOs infused the treatment networks with
    recovery support services such as transportation,
    child care, scriptural study groups, faith-based
    counseling, and peer-to-peer support.
  • The inclusion of recovery support services has
    enhanced treatment outcomes and has helped
    clients to remain motivated and engaged in their
    treatment.
  • FBCOs can counter the spiritual malaise the
    results from guilt and shame for how addiction
    has affected loved ones and can, consequently,
    can hinder recovery.

71
Benefits of Faith- and Community-based Treatment
Programs
  • 79 of Americans believe that spiritual faith can
    help people recovery from disease.
  • 63 think that physicians should talk to patients
    about spiritual faith.

Source Sloan, R. P., Bagiella, E., Powell, T.
(1999) Religion, spirituality, and medicine.
Lancet, 353(9153), 664-667, cited in CASA study
So Help Me God Substance Abuse, Religion and
Spirituality, 2001
72
ATR Evidences of Success
  • More than 206,000 individuals with substance
    abuse problems have received treatment and/or
    recovery support services through the first round
    of ATR grants awarded in August 2004.
  • 1,233 Faith-based providers account for 23 of
    all recovery support providers and 31 of all
    Clinical Treatment providers with voucher
    redemptions.

Source SAMHSA data reported by ATR 2004 grantees
through the Services Accountability Improvement
System (SAIS). 12/31/07
73
ATR Evidences of Success
  • 74.3 of clients who reported using substances at
    intake into ATR were abstinent from substance
    abuse at discharge.
  • This exceeds the success rate of most national
    programs.

Behavior At Discharge
Clients involved with the criminal justice system at intake reported no involvement at discharge 87.8
Clients reporting lack of stable housing at intake reported being stably housed at discharge. 24.1
clients who were unemployed at intake reported being employed at discharge 32
clients who reported not being socially connected at intake were socially connected at discharge. 60.6
Source SAMHSA data reported by ATR 2004 grantees
through the Services Accountability Improvement
System (SAIS). 12/31/07
74
SAMHSA Programs Paths to Recovery
74
75
Treatment Drug Courts
  • Treatment Drug Courts combine the sanctioning
    power of courts with effective treatment programs
  • Currently, there are 25 Family Juvenile Drug
    Court grantees in the following states
  • Alabama
  • California
  • Florida
  • Kentucky
  • Massachusetts
  • Michigan
  • Missouri
  • Montana
  • Ohio
  • Oregon
  • Pennsylvania
  • Rhode Island
  • Texas
  • Wyoming

76
SAMHSAs Commitment to Treatment Drug Courts
  • Family Juvenile Drug Court grants allocate
    funds to be used by treatment providers and the
    courts for
  • the provision of alcohol drug treatment,
  • Wrap-around services supporting substance
    abuse treatment,
  • Case management, and
  • Program coordination.

77
Treatment Drug Courts Evidences of Success
  • A total of 8,363 clients were served from FY 2003
    to FY 2006.
  • Of the clients served in FY 2007
  • 1,152 clients were discharged from the program
  • 57.1 of those discharged graduated/completed
    the program
  • Nearly three-quarters stayed in the program for
    more than 121 days.

Source SAMHSA Services Accountability
Improvement System (SAIS) 2006
78
Treatment Drug Courts Evidences of Success
Behavior within past 30 days at Intake 6-Month Follow-up () Difference
Clients reporting being arrested 14.5 7.8 Decreased 46.2
Clients reporting being arrested for drug related offences 42.7 35 Decreased 18
Clients reporting spending time in jail/prison 22.5 14.1 Decreased 37.3
Clients reporting committing a crime 55.7 28.2 Decreased 49.4
Clients reporting awaiting charges, trial, or sentencing 17.9 12.2 Decreased 31.8
Clients reporting being on parole or probation 55.3 46.4 Decreased 16.1
Source SAMHSA Services Accountability
Improvement System (SAIS) March 3, 2008
79
Injection Drug Use HIV/AIDS
  • According to CDC data on U.S. adolescents and
    adults
  • in 2006
  • Approximately 13 of the reported new AIDS cases
    were related to injection drug use.
  • 19 of males and 32 of females living with AIDS
    were exposed through injection drug use.
  • Almost one-third (27.8) of AIDS deaths were
    adolescents and adults infected through injection
    drugs.

Source CDC. HIV/AIDS Surveillance Report, 2006.
Vol. 18. Atlanta US Department of Health and
Human Services, CDC 2008.
80
The HIV/AIDS Challenge
  • Number of HIV Infected in the U.S. at end of
    2003
  • 1,039,000 to 1,185,000
  • Number unaware of their HIV infection (U.S.) at
    end of 2003
  • 252,000 to 312,000 (24 - 27)

Source Glynn M, et al. Estimated HIV prevalence
in the United States at the end of 2003. National
HIV Prevention Conference June 1215, 2005
Atlanta. Abstract T1-B1101.
81
CSAT - Minority AIDS Initiative
  • Minority AIDS grants are awarded to
    community-based organizations with two or more
    years of experience in the delivery of substance
    abuse treatment and related HIV/AIDS services.
  • Programs target African American, Latino/Hispanic
    and other racial or ethnic communities highly
    affected by substance abuse and HIV/AIDS.
  • HIV Outreach grants served 22,760 clients
  • TCE/HIV grants served 18,158 clients
  • As a whole, the HIV Portfolio served a combined
    40,918 clients

82
2007 CSAT TCE/HIV Grantees
States with 2007 Grantees
83
HIV/AIDS Outreach TCE/HIV Evidences of Success
National Outcome Measures (NOMs) at Intake 6-Month Follow-up () Difference
Clients reporting no substance use 31.9 56.1 Increased 75.9
Clients reporting being employed 25.0 37.6 Increased 50.7
Clients reporting being housed 33.5 39.8 Increased 18.8
Clients reporting no arrests 84.9 87.3 Increased 2.9
Clients reporting being socially connected 68.9 73.0 Increased 6.0
84
TCE/HIV and HIV Outreach Changes in Risk Behaviors
Risk Behavior at Intake 6-Month Follow-up () Difference
Clients reporting injection drug use 11.6 4.4 Decreased 62.3
Clients reporting having unprotected sex 68.9 61.7 Decreased 10.4
Clients reporting having unprotected sex with an HIV individual 5.2 4.6 Decreased 10.1
Clients reporting having unprotected sex with an IDU 8.9 5.8 Decreased 34.2
Clients reporting having unprotected sex with an individual high on some substance 33.6 20.8 Decreased 38.1
Source SAIS data FY 2004 through 3/21/08
85
Residential Treatment for Pregnant and Postpartum
Women (PPW)
  • PPW is a gender and culturally specific
    residential treatment program for pregnant and
    postpartum women.
  • Providing comprehensive services to women during
    pregnancy significantly improves the lives of
    women, children, and their families.
  • These services are also important after birth,
    since the effects of alcohol and drug use
    continue to have negative consequences for women,
    their children, and the entire family.

86
Residential Treatment for Pregnant and Postpartum
Women (PPW)
  • Target is traditionally underserved populations
    -- especially racial and ethnic minority women,
    as an important subpopulation
  • Low-income women, age 18 and over, who are
    pregnant, postpartum (the period after childbirth
    up to 12 months), and their minor children, age
    17 and under, who have limited access to quality
    health services are the target population for the
    PPW program.

87
Pregnant, Postpartum Parenting Program
Residential Treatment for Pregnant and Postpartum
Women and Residential Treatment for Women and
their Children  program served 2,067 women from
FY 2004 through the present.
1.3
15.9
12.1
1.0
7.9
0.7
2.3
27 of women also considered themselves Hispanic,
in addition to race reported.
58.8
Source SAMHSA data reported by grantees through
the Services Accountability Improvement System
(SAIS). 2/19/08
88
Substance Abuse Prevention and Treatment (SAPT)
Block Grant
  • The SAPT Block Grant distributes funds to 60
    eligible
  • States
  • Territories
  • The District of Columbia
  • The Red Lake Indian Tribe of Minnesota
  • 95 of appropriate funds are distributed to
    States through a formula prescribed by the
    authorizing legislation. (For information,
    contact the your Single State Authority)
  • The Goal To support and expand substance abuse
    prevention and treatment services, while
    providing maximum flexibility to the States.
  • In FY 2008 over 1.8 million admissions to
    treatment programs received public funding.

89
SAPT Block Grant Evidences of Success
Preliminary data collected for all SAPT Block
Grant programs indicate
  • 73.4 of clients reported alcohol abstinence at
    the time of discharge up 42.5 from time of
    admission.
  • 67.8 of clients reported drug abstinence at the
    time of discharge up 58.1 from time of
    admission.
  • 63.4 of clients reported having social support
    at the time of discharge up 44.3 from time of
    admission.

Source FY 2008 Uniform application for Substance
Abuse Prevention and Treatment (SAPT) Block Grant
Treatment Measures, 10/01/2007 (revised 12/02/07)
90
SAPT Block Grant Evidences of Success
SAPT Block Grant preliminary data contd
  • 40.8 of clients reported being employed at the
    time of discharge up 10.9 from time of
    admission.
  • 93.4 of the clients reported having housing at
    the time of discharge up 2.4 from time of
    admission.
  • 87.9 of clients reported no arrests at the time
    of discharge up 19.2 from time of admission.

Source FY 2008 Uniform application for Substance
Abuse Prevention and Treatment (SAPT) Block Grant
Treatment Measures, 10/01/2007 (revised 12/02/07)
91
Programs Focusing on Children Adolescents
  • Approximately 5 to 9 of children (aged 9-17)
    have a serious emotional disturbance
  • Many have a co-occurring substance abuse
    disorder.
  • 8.8 adolescents (aged 12 - 17) have met the
    criteria for dependence and/or abuse of illicit
    drugs or alcohol.
  • Adolescents who had experienced a past year major
    depressive episode were more than twice as likely
    to have used illicit drugs in the past month than
    their peers who had not (21.2 vs. 9.6).

92
Programs Focusing on Children Adolescents
  • SAMHSA treatment prevention programs that focus
    on the unique needs of children and adolescents
    include
  • Safe Schools/Healthy Students
  • Designed to prevent violence and substance abuse
    among our Nation's youth, schools, and
    communities.
  • Helping Americas Youth
  • Led by First Lady Laura Bush to benefit children
    and teenagers by encouraging action in three key
    areas family, school, and community.
  • StopAlcoholAbuse.gov
  • Comprehensive portal of Federal resources for
    information on underage drinking and ideas for
    combating this issue.

93
Programs Focusing on Children Adolescents
(contd)
  • Systems of Care
  • An approach to mental health services that
    recognizes the importance of family, school and
    community.
  • Too Smart to Start
  • An underage alcohol use prevention initiative for
    parents, caregivers, and their 9-to-13 year-old
    children.

94
Recovery Month September 2008
  • Goals
  • Support the administrations goal of reducing
    demand and promoting the message that recovery is
    possible
  • Generate momentum for hosting state and local
    community-based events
  • Enhance knowledge, Improve understanding, Promote
    support for addiction treatment
  • Publicize messages that
  • Reduce the stigma discrimination associated
    with addiction
  • Encourage those in need to get treatment
  • Support those who are already in recovery

95
Get involved in Recovery Month
  • Help bring hope and healing to others
  • Visit the Recovery Month Web site at
    www.recoverymonth.gov
  • Use the tools to spread the Recovery Month
    message
  • Toolkits, presentations, giveaways, public
    service announcements, and more
  • Join thousands of individuals and organizations
    by hosting a Recovery Month event in your
    community
  • Educate others about the effectiveness of
    treatment and the hope of recovery
  • For more information call 1-800-662-Help

96
SAMHSA/CSAT Information
  • SAMHSA web site www.samhsa.gov
  • CSAT web site http//csat.samhsa.gov/
  • ATR web site http//atr.samhsa.gov/
  • SBIRT web site http//sbirt.samhsa.gov/
  • Recovery Month web site http//www.recoverymonth.
    gov/
  • SHIN 1-800-729-6686 for publication ordering or
    information on funding opportunities
  • 1-800-487-4889 TDD line
  • 1-800-662-HELP SAMHSAs National Helpline
    (average of tx calls per mo.- 24,000)
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