Substance Abuse Prevention and Mental Health Promotion
Like all health conditions, mental health and substance use disorders cost money and lives if they are not prevented and treated. The health and safety impacts on children, adults and communties is enormous. In their Strategic Plan, the U.S. Substance Abuse and Mental Health Services Administration estimates that by 2020 behavioral health disorders will surpass all physical diseases as a major cause of disability worldwide.
We all pay the price for youth substance abuse. Washington residents paid more than $1.4 billion in 2010 for problems and costs associated with underage drinking. The cost is also high in other ways. Children and teens who use alcohol and other drugs are more likely to drop out of school, be seriously or fatally injured, and have thoughts of suicide.
DBHR's prevention and intervention goals are to delay and prevent the misuse of alcohol, tobacco and other drugs; reduce the negative consequences of drug misuse; and prevent and reduce alcohol and other drug dependency. The services we fund are data-driven, prioritized based on our state's Substance Abuse Prevention and Mental Health Promotion Strategic Plan, and delivered in collaboration with counties, tribes, statewide organizations and other state agencies.
These investments have cut underage drinking in half, reduced other unhealthy behaviors, increased academic success for students, and saved public costs. Our long-term vision is that proven prevention practices will be adequately funded in every Washington community.
DBHR funds, manages and/or coordinates the following services with resources from the federal Substance Abuse and Mental Health Services Administration, and the federal Office of Juvenile Justice and Delinquency Prevention.
The Screening, Brief Intervention, and Referral to Treatment (SBIRT) Primary Care Integration project is a universal, evidence-based practice used to identify, reduce, and prevent problematic use, abuse, and dependence on alcohol and illicit drugs.
The current funding will integrate SBIRT into primary care settings. Services are provided to adults receiving primary care in selected community health clinics in King, Whitman, Cowlitz and Clallam Counties. We anticipate over 96,000 adults will be screened and served over the life of the grant, which will reduce substance abuse and related injuries, and decrease health care use and costs for chronic conditions such as depression and anxiety.
The primary components of services are:
Screening - a healthcare professional assesses a patient for risky substance use behaviors using standard screening tools;
Brief Intervention - a healthcare professional engages a patient showing risky substance use behaviors in a short conversation, providing feedback and advice; and
Referral to Treatment - a healthcare professional provides a referral to brief therapy or additional treatment to patients who screen in need of additional services.
The grant allows Washington to build upon our successes with the SBIRT grant in 2003 by expanding and further integrating behavioral health care services.
As part of our mission to transform lives, the state Department of Social and Health Services/Division of Behavioral Health and Recovery (DBHR), worked with our partners to redesign state funding and leverage limited resources for prevention in targeted, high-need communities.
DBHR invests in prevention planning and practices that lead to the best possible outcomes. We support prevention coalitions to provide school and community-based prevention services through our publicly-funded Community Prevention and Wellness Initiative (CPWI). The goal of this initiative is to support proven strategies and sustainable funding that will have long-term, positive impacts on families and communities. CPWI programs are implemented through active partnerships with county governments, Educational Service Districts, local school districts, and the Office of the Superintendent of Public Instruction. Services are available in 52 communities, located in all 39 counties and nine educational service districts.
Read more in the CPWI Brochure
DBHR contracts with the Office of the Superintendent of Public Instruction (OSPI) to administer the Washington State Prevention/Early Intervention Program. The program places intervention specialists in local schools to serve those students at risk of using alcohol, tobacco, and other drugs, as well as those students who have initiated substance use. Students who are chemically dependent are referred to community-based treatment centers.
Local programs: Program funds are distributed to the nine Educational Service Districts (ESDs) that serve the state. Funding amounts are based on two criteria: (a) Community Prevention and Wellness Initiative (CPWI) guidelines from Washington’s Division of Behavioral Health and Recovery (DBHR), and (b) a formula that accounts for both student enrollment and estimated need for services in each region.
Activities and services provided: Universal prevention activities typically target classrooms or the entire school. Examples include supervising peer leadership clubs; providing information to students, staff, and families; and coordinating with community coalitions.Direct intervention services involve identifying students who are:
at risk of initiating substance use or antisocial behavior; coping with the substance use of significant others;
using alcohol, tobacco, or other drugs; or developing a dependence on alcohol or other drugs.
An array of counseling, peer support groups, social skills training, and individual and family interventions are employed to address the needs of each student. When the severity of use requires services that cannot be provided in the school setting, students are referred to community based services such as substance abuse treatment.
Mental Health Promotion Project
The purpose of the Mental Health Promotion Project (MHPP) is to provide federally recognized tribes with Mental Health Block Grant funds for mental health promotion proejcts in their communities. Mental health promotion works at three levels: strengthening individuals, strengthening communities, and reducing structural barriers to mental health.
Structural barriers to mental health can be reduced through actions to reduce discrimination and inequalities and to promote access to education, meaningful employment, housing, health services, and support to those who are vulnerable.
Mental Health Promotion Projects must provide a plan using one or more of the MHPP strategies/programs listed on SAMHSA's website: include a budget, use no more than 8% of the budget for administrative or indirect costs; and adhere to all other requirements of the Intergovernmental Agreement.
Substance Abuse Prevention
Of the 29 Federally Recognized Tribes in Washington State, 23 currently contract with DSHS/DBHR to provide substance abuse prevention services in their communities. Tribes enter agreements with the state to provide prevention programming that:
Recognizes the government-to-government relationship between the tribes and the U.S. Government.
Honors tribes' inherent right to design and operate culturally-relevant and appropriate programs on behalf of the population served.
Increases the quality and efficiency of state and tribal benefits and services to Washington State native people and other eligible clients served by tribes.
Simplifies the contracting process to allow increased direct services to all clients.
Supports tribal dedication of funding resources for needs.
Simplifies reporting responsibilities for services included in the Tribal Plan.
Tribes receive technical assistance from DSHS/DBHR and the DSHS Office of Indian Policy to support their ability to access and use federal substance abuse block grant funds.
For more information, contact Julie.Bartlett@dshs.wa.gov.
Current efforts in mental health promotion and suicide prevention
In 2012, the State Prevention Enhancement Consortium (SPE Consortium) prioritized suicide and mental health promotion based on data that demonstrates a nexus with substance abuse and mental health problems and other youth-focused problems, such as low academic achievement and youth violence.
Also in 2012, Michael Compton, Ph.D., and Dr. Ruth Shim, two of the country's leading mental health promotion experts, worked with DBHR staff to increase their ability to plan for and implement mental health promotion efforts. Their presentation, called Mental Health Promotion, deals with the following subject areas: What is Mental Health Promotion?, Bridging the Gap (between Prevention and Mental Health), and Mobilizing Toward Action.
A Suicide and Mental Health Workgroup was formed to examine suicide prevention and mental health issues. The workgroup includes the Department of Health's youth suicide prevention program, statewide youth suicide service providers, tribal representatives, the Office of the Superintendent of Public Instruction, Department of Early Learning, Healthcare Authority, and Department of Social and Health Services. Since its inception, the workgroup has:
Arranged for community capacity-building resources for the Wenatchee valley to address a two-year spike in suicides
Met with the DSHS Secretary and DSHS Office of Indian Policy to discuss suicides among American Indians and Alaska Natives
Helped develop a powerful video portrait of a successful community mobilization in White Swan that has helped reduce suicides there; and
Organized a first-ever statewide suicide prevention awareness effort in Spring 2013.
The workgroup submitted an application for federal Garrett Lee Smith suicide prevention funding. The grant proposal was not accepted for funding, but it would have focused on counties and communities with high 5-year overall suicides and high youth suicides. The project would use evidence-based practices, develop effective referral networks from school-based student assistance specialists and other helping professionals (including law enforcement, fire departments, emergency room staff, and ambulance crews), and would increase the effectiveness of work by primary healthcare and behavioral healthcare providers in communities around suicide prevention.
Other efforts include:
Organizing Mental Health First Aid trainings in support of implementation of HB 1336 and participated on HB1336 workgroup advising OSPI - the agency named as lead in the bill - on implementation of training and other requirements.
Participating in review of proposals for contractor to develop model suicide prevention and post-vention curricula as part of HB 1336 implementation.
20 tribes submitted applications to participate in the Washington State Tribal Mental Health Promotion Project and all were allocated grants for $14,700 for SFY14. Of those, 8 tribes selected evidence based programs that specifically target suicide. The project is designed to bring funding to the tribes to focus on a specific issue related to mental health.
For more information contact Scott.Waller@dshs.wa.gov.
The purpose of the College Coalition for Substance Abuse Prevention (CCSAP) is to promote substance abuse prevention programming and awareness activities in all Washington State institutions of higher learning.
CCSAP sponsors a statewide college wellness conference each year for students, staff, and faculty. Additionally, CCSAP supports educational webinars that bring the latest research about substance abuse, mental health and student life, and supports multiple colleges and universities in providing students with online self-assessments for substance abuse.
The CCSAP meets bimonthly and provides mini-grants and technical support to colleges and universities. Learn more about CCSAP and substance abuse among college and university students.
For more information about CCSAP, email Scott.Waller@dshs.wa.gov.
DBHR develops and distributes prevention information, publications and advertising messages and works with news media to increase public awareness and education about the harmful consequences of substance abuse. Our messages promote healthy attitudes and behaviors, and connect individuals and families with prevention and intervention resources. We also partner with state and local agencies to educate families and communities about preventing alcohol and other drug use, and maintain a website for parents and prevention groups with news and resources: www.StartTalkingNow.org.
Through our state alliance program with the Partnership for a Drug-Free America, effective drug prevention messages are delivered to major media outlets in Washington every six months.
The following are helpful resources for planning and delivering communication strategies:
- Centers for Disease Control and Prevention: Gateway to Health Communications and Social Marketing Practices.
For more information about DBHR's communications/health promotion program, contact Deb.Schnellman@dshs.wa.gov.
Originally funded by Congress in 1997 with the understanding that local problems need local solutions, the federal Drug Free Communities Support Program (DFC) is a cornerstone of the Office of National Drug Control Policy's (ONDCPs) national drug control strategy.
The competitive funding provides support for community coalitions that focus on comprehensive strategies and environmental change to prevent and reduce youth substance use. Applicants who meet the criteria to apply may request up to $125,00 in funding for each year of a five-year cycle. Grantees may apply for a second round of competitive funding for years 6-10. DFC grants this year will generate about $4 million for substance abuse prevention initiatives in Washington State, in addition to the required minimum 100% local match funding.
The ONDCP is responsible for the program and partners with the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Prevention, who administers and manages DFC. Washington State currently has 33 DFC grantees.
DBHR services are planned and delivered using a research-based planning framework and model to reduce risk factors and increase protective factors to help teens stay healthy and succeed in school.
To ensure publicly-funded services are effective, DBHR collaborates with the Oregon Health Authority to maintain a list of programs and strategies deemed to be evidence-based. The Evidence-Based Practice (EBP) list is available at www.theathenaforum.org and includes a searchable database. The programs on the EBP list meet the following criteria:
1. They are shown in at least two studies to produce intended results;
2. They include 'substance abuse prevention' as an area of interest; and
3. They come from at least one of the following primary sources:
The Substance Abuse and Mental Health Services Administration's National Registry for Evidence-Based Programs and Practices (NREPP); or
The State of Oregon's list of EBPs; or
The Pacific Institute for Research and Evaluation's Scientific Evidence for Developing a Logic Model on Underage Drinking: A Reference Guide for Community Environmental Prevention.
DBHR and the Oregon Health Authority have established an annual submission and review process for additional programs to be considered for the Excellence in Prevention (EIP) EBP list. Both agencies will conduct a collaborative, biannual review of programs that have been removed from the NREPP website. Program removal from the EIP database will result upon agreement by both state agencies, and the prevention field will be notified about updates to the list.
For evidence-based prevention programs, the Washington State Institute for Public Policy Report, Benefits and Costs of Prevention and Early Intervention Programs for Youth, shows that prevention programs will save Washington State tax payers over $40 million from reductions in juvenile crime, substance abuse, mental health disorders, teen pregnancies, school failure, violence and injuries.
For more information about EPBs, contact Julia.Greeson@dshs.wa.gov.
Initiative 502 (I-502) established a system, overseen by the Washington State Liquor Control Board, to license, regulate, and tax the production, processing and wholesale retail sales of marijuana. It creates a dedicated marijuana fund, consisting of excise taxes, license fees, penalties, and forfeitures, and specifies the disbursement of this money for a variety of health, education, and research purposes, with the remainder distributed to the state general fund. The state Department of Health is the lead agency for implementing marijuana education campaigns. Educational materials are available at www.LearnAboutMarijuanaWA.org.
The Washington State Department of Social and Health Services (DSHS), Division of Behavioral Health and Recovery (DBHR) as the Single State Authority for substance abuse and mental health, is well positioned to meet the requirements and intent of I-502 as it pertains to DSHS. DBHR has demonstrated a reduction in the prevalence of alcohol abuse and risk, and an increase in protective factors associated with youth substance abuse, while improving coordinated service delivery across multiple agencies. DBHR also provides services to assess and treat patients with co-occurring mental health and substance use disorders.
DBHR is responsible for developing a plan to implement Section 28 of I-502, which includes the following components:
Washington State Healthy Youth Survey and Young Adult Survey
DBHR is required under I-502 to design and administer the Washington State Healthy Youth Survey (HYS), analyze the collected data, and produce reports. The information from the HYS can be used to identify trends in substance abuse over time. The goals for the HYS include identifying youth attitudes and risk behaviors and their consequences, and risk and protective factors for school, community, family, and peer-individual. DBHR is allowed under I-502 to expand to a young adult survey. DBHR will administer the HYS and, as funds allow, conduct a young adult survey utilizing social media to survey populations who are 18-25 years of age.
Washington State Institute for Public Policy (WSIPP)
DBHR is required under I-502 to contract with WSIPP to conduct the cost-benefit evaluation and produce reports to the legislature by September 1, 2015, with subsequent reports in 2017, 2022, and 2032. DBHR will work directly with WSIPP in evaluating prevention and intervention program impacts on marijuana-related maladaptive use, abuse and dependence.
Preventing and Reducing Substance Abuse
I-502 instructs DBHR to implement and maintain programs and practices aimed at preventing or reducing maladaptive substance use, substance-use disorders, and substance dependence. These programs and practices will be evidence-based (85%) with the remaining 15% being research-based or a promising practice. DBHR-funded services will be delivered through Community Prevention and Wellness Initiative (CPWI) coalitions, as well as Tribes and Educational Services Districts (ESDs). DBHR will direct a portion of dedicated marijuana funds to support youth residential treatment providers (through direct contracts), outpatient providers (through County contracts) and Tribes.
For more information contact Scott McCarty at firstname.lastname@example.org.
PREP is a federally funded teen pregnancy prevention program mandated by the 2010 Affordable Care Act. Through this grant, states implement evidence-based teen pregnancy prevention programs in an effort to decrease disproportionate teen pregnancies and sexually transmitted infections among high risk youth populations. In Washington State, organizations implementing PREP include institutional education facilities, local detention centers, juvenile rehabilitation facilities, local community organizations serving specific youth populations, local health departments, middle school & high schools, and a youth chemical dependency treatment facility. Implementation sites receive a one-time stipend for implementation start-up.
In Washington State, the Department of Health (DOH) is the PREP grantee. DOH contracts with Cardea Services, an organization that provides curriculum training, technical assistance, and data collection. DOH also contracts with the Department of Social and Health Services (DSHS) and the Office of Superintendent of Public Instruction (OSPI) to incorporate PREP within social and health service programs and the school system.
Research shows that kids who begin drinking before the age of 15 are four times more likely to develop alcohol dependence than those who wait until age 21. Each additional year of delaying alcohol use reduces the risk of alcohol dependence by 14 percent.
Because underage drinking is a leading cause of injury and death among teens, and their primary drug of choice, it is our highest prevention priority. More youth under the age of 21 die from alcohol-related injuries in the U.S. than from the use of tobacco and illicit drugs combined. An average of 1,400 college students die each year due to alcohol abuse. Underage drinking is also a huge cost to our state's citizens. The Pacific Institute for Research and Evaluation estimated this cost at $1.4 billion in 2010.
DBHR has secured grants from the federal Office of Juvenile Justice and Delinquency Prevention since 1998 to fund strategies to reduce underage drinking. Our efforts are focused in two ways:
Washington State Coalition to Reduce Underage Drinking
Working with state agency partners, we formed the Washington State Coalition to Reduce Underage Drinking (RUaD) to provide state-level leadership to reduce underage drinking by leveraging resources and strengthening communities in Washington. Membership draws from over two dozen state agencies and statewide organizations. There are two sub-committees, called Impact Teams, which focus on communications and policies.
In 2013 RUaD began addressing marijuana prevention for youth. The coalition is undergoing a renaming process to better reflect its broadened focus. Some of the outcomes and deliverables for RUaD include:
Creating, maintaining and promoting the www.StartTalkingNow.org website for parents, caregivers, educators, and other adult influencers.
Prioritizing resources that support youth influencers such as parents, caregivers, coaches, faith leaders, educators and other youth.
Awarding Let's Draw the Line mini-grants each spring to coalitions and community groups for projects to support community norms, policies and enforcement efforts that help to prevent underage drinking.
Other actions as defined by RUaD's Communications or Policy Impact Team(s) and authorized by the larger coalition.
Enforcing Underage Drinking Laws Discretionary Grant
The grant has a community-level and a state-level component. Most of the efforts and funding addresses the community-level component. Coalitions in four pilot communities implement a comprehensive mix of underage drinking prevention strategies, with a major focus on working with their local and county law enforcement agencies. Enforcement activities supported by this project include compliance checks, high visibility party patrols, and source investigations. Communities also conduct activities for making schools safer, policy development and raising community awareness of enforcement efforts through media messaging. The community-level component ends March 31, 2014. The state-level component ends September 30, 2014.
Our collective work is making a difference. Since 1998, underage drinking and binge drinking have been reduced by half. The 2012 Healthy Youth Survey showed that more youth are talking with their parents about alcohol and 11,000 fewer youth used alcohol compared to 2010. Students report an increased commitment to school, local ordinances have been passed to reduce youth access and exposure to alcohol, and there is more prevention collaboration among schools, law enforcement, government agencies, health professionals, and community groups that serve youth.
While these are very positive outcomes, there is much more prevention work to be done. One in four (28%) 10th graders reported drinking in the past month in the last Healthy Youth Survey. That's more than double the percentage of 10th graders who smoke cigarettes.
For more information about reducing underage drinking, contact Ray.Horodowicz@dshs.wa.gov.
Service to Science is a national initiative to better evaluate innovative programs and practices that aim to prevent substance abuse and related mental and behavioral health problems, or the underlying factors associated with increased risk.
Operated by SAMHSA's Center for the Application of Prevention Technologies (CAPT), Service to Science assists local program developers, implementers, and evaluators in applying more rigorous evaluation methods to their work. Ultimately, the initiative supports state prevention efforts by increasing the number of local programs that meet evidence-based standards.
The long-range goals include supporting innovative local interventions seeking to demonstrate and document evidence of effectiveness, and increasing the number and array of evidence-based interventions from which states and communities can select to address substance abuse.
In order to participate in Service to Science, programs must be nominated by their state's Alcohol and Drug Agency (Single State Agency) or National Prevention Network representative. Each year during June through July, DBHR staff seek nominations from the prevention field, review applications, interview applicants and submit final nominations for the initiative to the CAPT staff.
For more information visithttp://store.samhsa.gov/shin/content/SMA11-4629/01-FullDocument.pdf or contact Stephanie.Atherton@dshs.wa.gov.
Resources for Prevention Professionals
The Athena Forum website is created for prevention professionals to develop, update and sustain their substance abuse prevention work.
You can find general information about substance abuse prevention on this site or get specific documents and tools, such as sample agendas and surveys. You can also access prevention discussions and online training opportunities.
The Washington State Healthy Youth Survey (HYS) is administered in schools statewide every two years to collect data from students about their alcohol and other drug use, and other behaviors that impact their health, safety and success. This data is analyzed and used to track trends and prioritize prevention resources. The 2012 HYS data show that:
More than 115,000 students ages 12-17 use alcohol regularly.
Nearly one in five 12th graders (19%) said they have been drunk or high at school.
About one in five students rode in a car with a driver who had been drinking.
Marijuana use among 10th graders (19%) and 12th graders (27%) is almost double the percentage who smoke cigarettes.
Over 100,000 students (12-17 year olds) seriously considered suicide in the past year (about one in every six students).
The good news is that prevention programs are helping youth make healthy choices and encouraging parents to support these choices:
From 2010 to 2012, 11,000 fewer youth in Washington drank alcohol.
Since 1998, drinking among 8th and 10th graders has dropped by half, and use among 6th graders has dropped from 14% to 2.5%.
More students report that their parents talk with them about the risks of using alcohol and other drugs.
While these results are very promising, there is much more work to be done. The need for prevention programs is also identified through Risk and Protection Profiles for Washington communities, developed by the DSHS Division of Research and Data Analysis.
The Spring Youth Forum is the follow-up conference to the Prevention Summit. The Forum provides youth prevention teams the opportunity to learn from others while showcasing their own education and planning skills. Youth teams share successes and lessons learned from projects commenced during or following previous Prevention Summits or other youth trainings.
The Prevention Summit and the Spring Youth Forum work in tandem to create momentum and help to encourage, reward and support youth-led prevention in local Washington communities.
For more information, visit the Spring Youth Forum website or contact Ivon.Urquilla@dshs.wa.gov.
In collaboration with other state agencies and prevention organizations, DBHR supports an annual State Prevention Summit. The goal is to provide an enriching and culturally competent training and networking opportunity for youth, volunteers and professionals working toward the prevention of substance abuse, violence and other destructive behaviors, mental health promotion as well as integrating such prevention efforts with primary health care.
High quality workshops, forums, and hands-on learning opportunities meet a variety of needs, including professional development for prevention professionals. A youth track to support and engage youth volunteers in prevention initiatives is also provided.