Transcript The Future of Prevention - MI-PTE

A New Era in Prevention:
Challenges and
Opportunities
Tonia F. Gray, M.P.H.
Senior Public Health Advisor
12th Annual Substance Use Disorder
Conference
Lansing, MI • September 12, 2011
SAMHSA’s Key Messages
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Behavioral health is essential for health
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Prevention works
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Treatment is effective
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People recover from mental and substance use
disorders
Role of Prevention in Substance Abuse
and Mental Health Disorders
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Behavioral health is essential for health
Addiction as a complex and chronic disease
Recovery as a process rather than an event
Ongoing contact and support to complement treatment
Natural supports such as friends, peers, and family
Assets, strengths, skills, and resources
Prevent substance use relapse
Boost emotional stability
Assets, strengths, skills, and resources
Collaborative community-based strategies
Evidence-based, multi-component prevention programs
Data-driven systems
Assessing Public Knowledge and
Attitudes: What Americans Believe
66 percent
believe
treatment and
support can
help people
with mental
illness lead
normal lives
20 percent feel
persons with
mental illness
are dangerous
to others
Two thirds
believe
addiction can
be prevented
75 percent
believe recovery
from addiction
is possible
20 percent say
they would
think less of a
friend/relative if
they discovered
that person is in
recovery from
an addiction
30 percent say
they would
think less of a
person with a
current
addiction
Drivers of Change
Federal
Domestic
Spending
EMERGING
SCIENCE
State
Budget
Declines
Health Reform
Health Reform
 More people will have insurance coverage.
 Theme: prevent diseases, promote wellness
 Integrated care: new thinking—recovery, wellness, role of
peers, response to whole health needs
 New opportunities for behavioral health:
• Parity: Mental Health Parity and Addiction Equality Act
and within Affordable Care Act
• Tribal Law and Order Act
• National Action Alliance for Suicide Prevention
 Medicare and Medicaid changes
Beginning in 2014: 32 Million More Americans
Eligible to be Covered
4-6
mil
Challenges—State Leadership
Individuals Served by SSAs
Individuals Served by MHAs
Insured
39%
Uninsured
39%
Uninsured
61%
Insured
61%
• 90–95 percent will have the opportunity to be covered
by Medicaid or through insurance exchanges.
Federal Domestic Spending
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Focusing on the Strategic Initiatives
Revised Approach to Grant-Making
Implementing a Theory of Change
Prevention Funding for 2012:
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Substance Abuse-State Prevention Grant ($395 million).
Mental Health-State Prevention Grant ($90 million).
Behavioral Health-Tribal Prevention Grant ($50 million).
Prevention-Prepared Communities ($23 million).
Staying Focused During Change
SAMHSA’S Theory of Change
EVALUATION
SURVEILLANCE
WIDESCALE ADOPTION
IMPLEMENTATION
Capacity Building
INNOVATION
Proof of concept
Services Research
Practice-based
Evidence
DISSEMINATION
Infrastructure
Development
Technical Assistance
Policy Change
Policy Academies
Workforce Development
TRANSLATION
Practice Registries
Systems Improvement
Implementation
Science
Social Media
Demonstration
Programs
Graduate Education
Curriculum
Development
Policy Development
Financing Models and
Strategies
Publications
Medicaid
SAMHSA Block Grants
Medicare
Private Insurance
DOD/VA/DOL/DOJ/ED
ACF/CDC/HRSA/IHS
SAMHSA’S Strategic Initiatives
1.
Prevention
2. Trauma
and Justice
3. Military
Families
4. Recovery
Support
5. Health
Reform
6. Health
Information
Technology
7. Data,
Outcomes
& Quality
8. Public
Awareness
& Support
Strategic Initiative 1: Prevention of
Substance Abuse and Mental Illness
Goal 1.1
With primary prevention as the focus, build emotional health, prevent or
delay onset of, and mitigate symptoms and complications from
substance abuse and mental illness.
Goal 1.2
Prevent or reduce consequences of underage drinking and adult problem
drinking.
Goal 1.3
Prevent suicides and attempted suicides among populations at high risk,
especially military families, LGBTQ youth, and American Indians and
Alaska Natives.
Goal 1.4
Reduce prescription drug misuse and abuse.
Work Ahead—SAMHSA
 Revised Block Grant application and reporting; analysis of
expenditures
 Implementation of Tribal Law and Order Act—Office of
Indian Alcohol and Substance Abuse
 Establishment of health homes/ACOs with TA to States
 Health insurance exchanges—Policies and operations
 Essential benefits for exchange and benchmark plans
 Training and tracking of MHPAEA and Medicaid parity
 Decisions and implementation of prevention funds
 Regulations—Home- and community-based services
 Evidence of good and modern services:
• Benefit decisions, practice protocols, research agenda
Current Federal Partners
• Administration for Children and
Families (ACF)
• Administration on Aging (AoA)
• Centers for Disease Control and
Prevention (CDC)
• Centers for Medicare and
Medicaid Services (CMS)
• Food and Drug Administration
(FDA)
• Health Resources and Services
Administration (HRSA)
• Indian Health Service (IHS)
• National Institutes of Health
(NIH)
• Office of Minority Health
• Office of National Drug Control
Policy (ONDCP)
• Office of the Surgeon General
(OSG)
• Department of Education (ED)
• Department of Defense (DOD)
• Department of Interior (DOI)
• Department of Justice (DOJ)
New Roles—State SA and MH Leadership
 Take key role in design and execution of health reform.
 Be more strategic in purchasing services.
 Design and collaborate in planning health information
systems (HIT/EHRs).
 Form or enhance strategic partnerships.
 Think beyond traditional Block Grant populations.
 Get people covered—enrollment processes.
 Be more accountable for improving experience.
of care and overall health of populations served.
 Focus on recovery services—help people get and stay
well.
We’ve Been Here Before
Risk and protective factors—Commonalities
between mental health and substance
abuse.
Chronic disease indicators—Substance use
represents a spectrum of conditions and risk
factors as well as social context.
Links with physical health care providers—
Prevent problems related to mental illnesses
and substance use.
SAMHSA PRINCIPLES
PEOPLE
Stay focused on the
goal
PARTNERSHIP
Cannot do it alone
www.samhsa.gov
PERFORMANCE
Make a measurable
difference