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Leadership Briefing Outline.ppt


									Mental Health and Substance Abuse Division
         Substance Abuse Briefing

                  Joe Vesowate
        Assistant Commissioner for Mental Health
             and Substance Abuse Services
                                                  Economic Impact of
                                                Substance Abuse in Texas

                                 Estimated Economic Costs of Substance Abuse, 2007
                                        by Cost Category (Total: $33.4 Billion)


                                     27%                                                           Work Lost

                                                      Premature Death

„Other‟ includes estimated costs of treatment services, prevention services, medical care, motor vehicle crashes, social welfare administration,
                fire destruction, and special disease groups (FAS, drug-exposed infants, AIDS, Hepatitis B/C, and tuberculosis).

                                                   Source: Decision Support Unit, MH & SA, DSHS.

                                                                Page 2
               Consequences of Substance Abuse:
            Number of Fatalities in Motor Vehicle Crashes
                       Texas vs. Nation, 2006

50,000                                                             4,000
         Total Fatalities: 42,642                                                 Total Fatalities: 3,475

40,000                               Alcohol-                                                                  Alcohol-
                  17,602             Related                                                  1,677            Related
30,000           ( 41% )             Fatalities                                            ( 48% )             Fatalities



   -                                                                  -
                    U.S.                                                                      Texas

           Source: Fatality Analysis Reporting System, National Highway Traffic Safety Administration, 2006.

                                                  Page 3
        Consequences of Substance Abuse:
        Number of Alcohol- and Drug-Related Deaths
                   in Texas, 2002-2004

2,500                                                           2002




          Chronic Liver               Suicide               Homicide

                    Source: Texas Vital Statistics, DSHS.

                                 Page 4
                     Substance Abuse Treatment Need
                     Met in Texas, Adjusted for Poverty

Percent of need met in Texas for DSHS-funded substance abuse treatment in
                SFY2007, adjusting for poverty (200% FPL)

                                 Texas Population
                                     (age 12+)

                                    Estimated Number                            SFY2007
                                      with Chemical                         Number Served in
                                       Dependency                             DSHS-Funded
                                        1,825,591                           Substance Abuse
                                                                           Treatment Programs
                                         Who Are                         (including NorthSTAR)
                                         Also Poor                                63,929

                         Source: Decision Support Unit, MH & SA, DSHS.

                                         Page 5
      Prevalence of Co-Occurring Substance
      Use Disorders Among Clients Served in
                  Mental Health

Number Served in DSHS-Funded Community Mental Health
                 (including NorthSTAR)


                           Substance Use

              Source: Decision Support Unit, MH & SA, DSHS.

                              Page 6
                                 Total Funding for
                             Substance Abuse Services

               Both state and federal funds are represented




                2005 (Expended) 2006 (Expended) 2007 (Expended) 2008 (Budgeted)

                 Source: 1. Fiscal Year 2008-2009 Legislative Appropriations Request, May 30, 2007, DSHS.
                         2. Fiscal Year 2008 Operating Budget Submitted to the Governor‟s Office of Budget,
                           Planning & Policy and the Legislative Budget Board, Nov. 29, 2007, DSHS.

                                                 Page 7
                           General Revenue Funds
                               Appropriated to
                          Substance Abuse Services


                                                       $22,951,583 $22,924,163 $22,924,163


                   2005       2006       2007       2008                                         2009
                (Expended) (Expended) (Expended) (Budgeted)                                   (Budgeted)

              Source: 1. Fiscal Year 2008-2009 Legislative Appropriations Request, May 30, 2007, DSHS.
                      2. Fiscal Year 2008 Operating Budget Submitted to the Governor‟s Office of Budget,
                        Planning & Policy and the Legislative Budget Board, Nov. 29, 2007, DSHS.

                                              Page 8
                         System Improvement
                    Initiatives and Collaborations

• Drug Demand Reduction Advisory Committee (DDRAC)
• Clinical Management for Behavioral Health Services
• Texas Recovery Initiative (TRI)
• Access to Recovery (ATR)
• Drug Courts & Family Courts
• Rural Border Initiative (RBI)
• SBIRT: Screening, Brief Intervention, Referral, and
  Treatment (InSight Program)
• Money Follows the Person (MFP)

                             Page 9
                Drug Demand Reduction Advisory
                      Committee (DDRAC)

• 77th Texas Legislature (2001) - SB 558

• Mandate: To develop a comprehensive statewide
  strategy and legislative recommendations to reduce
  drug demand in Texas

• Membership mandated by statute – 16 State
  Agencies, 5 At-Large

• Must report on their work at the start of each
  legislative session

                          Page 10
                 Drug Demand Reduction Advisory
                  Committee (DDRAC), continued

• January 2007 initiatives included:
   • Expanding the systemic use of evidenced-based practices to
     all substance abuse intervention and treatment services
     purchased with state dollars
   • Revise the state Medicaid plan to include reimbursement for
     Screening and Brief Intervention in emergency, primary care,
     and women’s health care settings provided a cost analysis
     conducted by HHSC and determines the services to be cost
   • Remove the exclusion clause for medical expenses from the
     Uniform Individual Accident and Sickness Policy Provision
     Law (UPPL)
   • Authorize the use of sobriety checkpoints as an optional tool
     for law enforcement
                              Page 11
                   Clinical Management for
              Behavioral Health Services (CMBHS)

• Web-based clinical record keeping system
  for state-contracted community mental health and
  substance abuse service providers

• Combines electronic health recordkeeping
  requirements for treatment providers in a single

• Beta testing currently underway at seven treatment
  contractor provider locations

• High interest at federal and state level

                          Page 12
                 Texas Recovery Initiative (TRI)

• Partnership between DSHS and the substance abuse
  treatment and recovery communities

• Identifies opportunities and methods for improving
  the quality and effectiveness of services provided to
  the adult population

• Concept is to link evidence-based and recovery-
  oriented addiction treatment protocols together to
  enhance recovery and reduce relapse

                          Page 13
                          Access to Recovery (ATR)

•   Texas was one of 14 states to receive funding in 2004 through this new
    federal substance abuse treatment initiative
     • Funded at $7.3M/year for three years
     • Focused on the expansion of access to treatment services through
       drug courts in thirteen counties
•   Second ATR grant awarded in 2007
     • $4.5M/year for three years
     • Allows the continued expansion of treatment services through drug
     • Expands the geographic reach of the program (from 13 to 18
       counties) and extends services to clients with methamphetamine
       dependency or addiction
     • Jointly implemented by the Governor’s Criminal Justice Division
       and DSHS
                                    Page 14
                     Drug Courts and Family Courts

• 2007 legislation created a dedicated revenue source for drug
    • $50 court fee on certain intoxication and drug offense
    • The state receives 40% of this fee
• 2007 legislation expands the definition of drug courts to allow
  other types of problem-solving courts to be established
    • DWI courts, juvenile drug courts, re-entry drug courts and
      family dependency drug courts
    • County population threshold lowered to 200,000
• Expanding the number and types of drug and family courts
  should produce a significant cost saving for Texas

                               Page 15
                       Rural Border Initiative (RBI)

• Provides substance abuse services in high-need underserved
  areas in remote rural areas along the Texas-Mexico border,
  including Colonias
   • Culturally and linguistically competent substance abuse prevention
     and intervention services are provided
   • Trained community members are utilized as volunteers and
     mentors to enhance community involvement in addressing
     substance abuse issues

• Program has significantly increased the use of Community
  Health Workers (Promotores)
• Created alliances among the HHSC Colonias Initiative, DSHS’
  Office of Border Health, and Texas A&M University's Colonias
                                Page 16
                      SBIRT: Screening, Brief Intervention,
                            Referral, and Treatment
                               (InSight Program)
•   Five-year, $17.5 million Targeted Capacity Expansion Grant funded by the
    federal Center for Substance Abuse Treatment to expand treatment capacity
     •   Final year of funding
•   7 grant recipients across the nation are testing models in a health care setting
     •   Focus on stopping the initiation of alcohol, tobacco and other drug use
     •   Intervening early with nondependent users to stop inappropriate use
     •   Improving treatment delivery to achieve significant and sustained recovery
         for those who are dependent on alcohol, tobacco and other drugs
     •   Creates a bridge between the general medical system and the substance
         use disorders service system
•   Located in eight Harris County Hospital District locations, four community clinics
    and three school-based clinics
•   Project utilizes general healthcare staff and a specially trained multidisciplinary
    SBIRT team to screen and serve over 44,000 patients

                                         Page 17
                                SBIRT: Screening, Brief Intervention,
                                      Referral, and Treatment
                                   (InSight Program), continued
                          Examples of cost benefits of SBIRT Program

14                                                                             140
                                                 2003                                                              Untreated
12                                               2004                          120
                                                                               100                                 Group

 8                                                                               80

 6                                                                               60


 2                                                                               20

 0                                                                                 0
     Total Hospital Costs for Harris                                                   FY 2005 Average Monthly
           County, in Millions                                                         Emergency Room Costs,
                                                                                              in Dollars

        Source: “Lowering the Cost of Medicaid Treatment by Providing Drug and Alcohol Treatment” by Matthew Gever, January 2007

                                                               Page 18
                     Money Follows the Person (MFP)

•   $2.8 million from CMS to implement a $3.7 million Behavioral
    Health Pilot Project in Bexar County as part of the larger statewide
•   Pilot implements Spring 2008, operates through 2011
•   Help individuals with mental health or substance abuse disorders
    leave nursing facilities and return to their communities
•   Participants will receive community-based long term care services
    and service coordination through STAR+PLUS Medicaid managed
    care program
•   Successful pilot could result in the behavioral health demonstration
    services being added to home and community-based waiver

                                  Page 19
                       Prevention in Texas

• Prevention activities improve the lives of Texans by
  discouraging substance use before it results in costly
  and life-threatening consequences

• DSHS funds approximately 200 school and
  community based programs to prevent the use and
  consequences of alcohol, tobacco and other drugs

• These programs utilize evidence-based curricula that
  are proven to be effective prevention strategies

                          Page 20
               Substance Abuse Prevention

• Prevention Resource Centers
• Strategic Prevention Framework (SPF)
• Methamphetamine Awareness
• Pregnant Post Partum Intervention (PPI)
• Partnership for Family Recovery
• Request for Proposals (RFP) in FY ‘08
                     Page 21
                 Prevention Resource Centers

• 11 regional Prevention
  Resource Centers funded by

• Provide communities with
  prevention information,
  resources and expertise

• Participate in community events
  including those at K-12 schools

                        Page 22
               Strategic Prevention Framework (SPF)
                Strategic Prevention Framework State Incentive Grant

• Promoting a substance abuse prevention systems change
  led by the state, driven by the needs of local communities
• Texas Epidemiological Workgroup: Develop the state’s
  capacity to share common data elements across agencies
  and to assess prevention needs in Texas
• Seven high-risk counties selected to participate based on
  the severity of alcohol-related motor vehicle fatalities
• Focus on underage drinking & college-age binge drinking

                              Page 23
                 Methamphetamine Awareness

• Texas Meth Watch – Retailer education

• Texas Meth Alert – Information for teens,
  parents, educators

• Drug Free Bunny – Methamphetamine-specific
  stickers and posters

   • Award-winning campaign has

     garnered national attention

                         Page 24
              Pregnant Postpartum Intervention (PPI)

• Provides intervention for pregnant and postpartum
  women at risk for substance abuse

• Offers on-site, gender specific, community-based
  outreach, intervention, motivational counseling, case
  management, treatment referral and support

• Pregnant and postpartum teens and adults who are
  at risk of substance abuse/dependency or who have
  family members with substance abuse problems

                         Page 25
                 Partnership for Family Recovery

• Seeks to reduce the number of children in out-of-home
  placements, shorten time in care, and increase the
  number of children successfully reunited with families
• Serves children and families who are involved with the
  judicial and Child Protective Services (CPS) systems due
  to substance use/abuse or mental health disorders
• Collaborators: DSHS, Office of Court Administration
  (OCA), Department of Family & Protective Services
  (DFPS), the Court Improvement Project (CIP) and Texas
  Court Appointed Special Advocates for Children (TX

                           Page 26
                  Request for Proposals (RFP) in FY ‘08

• Solicited February 2008 from public, for-profit, and
  non-profit organizations

• Funding for planning, implementing, and evaluating
  evidence-based curriculum and other related
  prevention and intervention strategies designed to
  address behavioral health needs

• Total received: 482
   • Intervention      78
   • Prevention       404

                            Page 27

• Integrated behavioral health project
   • Blends funding (Medicaid, mental health and substance abuse
     block grant funds, state general revenue) from HHSC and DSHS

• Services are for Medicaid-eligible and other
  individuals meeting eligibility criteria for community
  mental health or substance abuse services

• Serves residents of Collin, Dallas, Ellis, Hunt,
  Kaufman, Navarro and Rockwall counties

                              Page 28
• Keys to success
  •   Partnerships with state agencies
  •   Community-based relationships
  •   Recovery support services
  •   Leveraging federal and state funds
  •   Leadership

                         Page 29

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