community meeting to inform the strategic plan update · - teen birth rate - uninsured adults -...

December 9, 2014

Community Meeting to Inform the Strategic Plan Update

WELCOME & INTRODUCTIONS

2

Agenda

3

Welcome & Introductions

Data Presentation

Breakout Session – Group Review & Prioritization

Breakout Session – Identifying Potential Strategies

Wrap-Up & Closing

Meeting Goals

4

Disseminate data on substance use and related issues

to stakeholders

Gather community input on identifying and

prioritizing key issues to be

included in the Strategic Plan

Update

Provide the opportunity to begin thinking

about strategies to address the

identified priorities

Meeting Agreements & Norms

5

To build our ability to work together, we…

• Agree to participate

• Learn from other’s questions and comments

• Focus on interests, not positions

• Try to see the whole picture

• Be open to the possibilities

To show respect and courtesy, we agree

to…

• Have one person speak at a time

• Focus on one process

• Express disagreement with ideas, not people

• Keep our comments short

• Use the parking lot

• Turn off electronics

To promote understanding, we

agree to…

• Use inquiry more than advocacy

• Ask for clarifications versus assuming

• Uncover underlying assumptions

Kristen Law

Leigh Steffy

DATA PRESENTATION

6

Setting the Stage

Getting Grounded in Local Data

County Health Rankings: Marin Ranks High In Most Indicators

Marin County ranked in the top 5% in: - Premature death rate - Adults self reported health -Mentally unhealthy days - Adult obesity - Teen birth rate - Uninsured adults - Primary care physicians per capita - High school graduation - Unemployment - Children in poverty - Physical activity - Violent crime rate High food environment index -Low rate of preventable hospital stays -Low violent crime rate

Ranked in the top 10% in: -Low percent of adults reporting fair or poor health

-Low average number of mentally unhealthy days

-High access to exercise opportunities

-High dentists per capita

-High mental health providers per capita

-High percent with some college

Ranked in the top 25% in: -Low number of physically unhealthy days - Adults without social/emotional support - Low percent driving alone to work

Ranked in the top 15% in: -Low percent of adults who smoke - Low percent of children in single-parent households - Low average daily air pollution

Marin County ranked in the bottom 50% in: - 1Excessive Drinking

-2Drug poisoning mortality rate

1 Data collected from Behavioral Risk Factor Surveillance System 2006-2012 (2005-2010 for social support indicator) and may vary from other local sources used in county health reports and factsheets. 2 Drug poisoning deaths was an additional measure and did not contribute to the overall county health rankings.

Marin vs Marin

• Healthiest county in California

• Healthiest county for young people in America

• High income inequality

• Alcohol consumption, particularly binge drinking across the age span, is in the top 5%

The Three Cs

Source: Christin Borbely, PHD

• Consumption

• Contributing Factors

• Consequences

CONTRIBUTING FACTORS Perceived Harm Access and Availability Access to Services Mental Health Risk and Protective Factors

0

10

20

30

40

50

60

Great Moderate Slight None

Pe

rce

nt

Most Marin Youth are Aware That Binge Drinking* is Harmful

7th

9th

11th

Non Trad

*Five or more drinks in one sitting.

Source: California Healthy Kids Survey (2013-14)

0

10

20

30

40

50

60

70

Great Moderate Slight None

Marin Youth’s Perception about the Harm of Smoking Marijuana* is More Variable

7th

9th

11th

Non Trad

*Smoking Marijuana once or twice a week.


Most Marin Youth Say that Marijuana and Alcohol are Easy to Access

0

10

20

30

40

50

60

70

80

90

Easy

Perceived Difficulty to Obtain Marijuana

7th

9th

11th

0

10

20

30

40

50

60

70

80

90

Easy

Perceived Difficulty to Obtain Alcohol

7th

9th

11th


0

5

10

15

20

25

Pe

rce

nt


11th Graders In Marin Access Alcohol and Drugs from Parties and Friend’s Houses

0

5

10

15

20

25

30

35

40

Very Likely Likely Not Likely Don't know

Likelihood of Finding Help at School to Reduce Substance Use

7th

9th

11th

Non Trad

More than half of Marin 7th, 9th, 11th and NT students don’t know if help is available or think help is not likely available at school


Access to Substance Use Treatment and Recovery Support Services County Funded Service Capacity for FY 2014/15

Service Contracted Providers

Annual Capacity

Adult Residential Substance Use Treatment Men, Women, Women with Children 1

91 Clients (29.4 Beds)

Community Based Adult Outpatient Substance Use Treatment

General Population, Adult Drug Court, Justice-Involved, Women/Perinatal, Safety Net, Spanish Speaking (starts in January)

2 241 Clients

In Custody Adult Engagement/Outpatient Substance Use Treatment

1 416 Clients

Outreach and Engagement Program Co-Occurring Mental Health and Substance Use 1 40 Clients

Narcotic Replacement Therapy Methadone

1 163 Clients

Adult Residential Detox

1 1,275 Clients

(14 Beds)

Adolescent Outpatient Substance Use Treatment Outpatient Drug Free, Intensive Outpatient, Juvenile Drug Court 2 92 Clients

*Additional services are available for adults eligible for AB 109 and SB 678-funded services, including Sober Living, Thinking for a Change and Recovery Coach/Care Manager services

0

5

10

15

20

25

30

35

40

45

Yes

Chronic Sadness or Hopeless Feelings in the Past 12 Months

7th

9th

11th

Non Trad

One in four high school students reported feeling chronic sadness and hopeless feelings in the past year


0

10

20

30

40

50

60

70

High Medium Low

School Connectedness

7th

9th

11th

Non Trad


0

10

20

30

40

50

60

70

High Medium Low

Academic Motivation

7th

9th

11th

Non Trad


CONSUMPTION Prevalence of Adult Alcohol, Tobacco and Other Drug Use

Prevalence of Youth Alcohol, Tobacco and Other Drug Use

0

5

10

15

20

25

30

35

40

18 + 21 - 64 65 +

Percent of Marin Adults Reporting Binge Drinking in the Past Year

Source: California Health Interview Survey (2011-12)

Substance Use Treatment Admissions (FY 2013/14)

Treatment Modality Unduplicated Clients Admitted

Number of Admissions

Adolescent: Outpatient Treatment 73 74

Adult: Outpatient Treatment 132 137

Adult: Residential Treatment 109 113

Adult: Narcotic Replacement Therapy 62 62

Adult: Residential Detoxification 604 968

TOTAL 980 1,360

0

50

100

150

200

250

300

350

Treatment Detox

Age of Clients Admitted

Under 18

18-25

26-35

36-45

46-55

56-65

65+

Source: Marin WITS

71.5 74.2

28.5 25.8

0%10%20%30%40%50%60%70%80%90%

100%

Treatment Detox

Gender of Clients Admitted

Female

Male

Source: ITWS

0

20

40

60

80

100

120

140

160

180

200

Alcohol Marijuana Meth Crack Opiates Heroin Other

Nu

mb

er

of

Ad

mis

sio

ns

Primary Substance Use by Age Marin Adult Treatment Admissions

(July 2013 – June 2014)

70+

60-69

50-59

40-49

30-39

20-29

Heroin and Prescription Opiates are used more heavily by individuals that are 20 to 29 years old

Source: Marin WITS

0

10

20

30

40

50

60

70

80

90

100

5-9 10-12 13-14 15-16 17-18 19-24 25-29 30-35 36-40 41+

Age of First Use – Marin Adult Treatment Admissions (July 2013 – June 2014)

Age of First Use Other

Age of First Use Heroin

Age of First Use Opiates

Age of First Use Crack

Age of First Use Meth

Age of First Use Marijuana

Age of First Use Alcohol

Source: Marin WITS

Prevalence of Co-Occurring Substance Use and Mental Health Issues

• Approximately 10 million people in the US meet criteria for co-occurring mental health and substance use disorders in any given year

• In 2013, national data indicates that 3.2% of adults had a co-occurring mental illness and substance use disorder and 1.4% of adolescents had a co-occurring major depressive episode and substance use disorder

• Applied to Marin, this would translate to approximately 6,200 adults and 400 adolescents

Source: National Survey on Drug Use and Health (2013)

0

10

20

30

40

50

60

Percent of Adults Reporting a Co-Occurring Disorder at Treatment

Admission

FY 2011/12 FY2012/13 FY 2013/14

Source: ITWS

0

5

10

15

20

25

30

35

40

45

50

Age of Onset (14 yrsold or less)

Used 3 days ormore in last 30 days

Have binged in thelast 30 days

Marin County Youth are Drinking Too Early, Too Often and Too Much

7th grade

9th grade

11th grade

Non Traditional

By 11th grade, 65% of youth have consumed alcohol. Almost 50% have consumed 4 or more times.


14

10

5

25

20 20

48

42 41

59

52

43

0

10

20

30

40

50

60

70

2009 2011 2013

Pe

rce

nt

Trend in 30 Day Use

7th

9th

11th

Non Trad

6 4

1

15

11 10

33

28 29

53

38 36

0

10

20

30

40

50

60

70

2009 2011 2013

Pe

rce

nt

Trend in Binge Drinking, Last 30 Days

7th

9th

11th

Non Trad

Source: California Healthy Kids Survey (2009 – 2013)

0

10

20

30

40

50

60

Age of Onset (14 yrs old orless)

Used 3 days or more in last 30days

Marin Youth are Consuming Marijuana Too Early and Too Often

7th grade

9th grade

11th grade

Non Traditional


By 11th grade, 51% of youth have used marijuana. Almost 40% have used 4 or more times.

6 6 3

20 16 16

36 35 31

60

53 49

0

10

20

30

40

50

60

70

2009 2011 2013

Pe

rce

nt

Trend - Marijuana, Last 30 Days

7th

9th

11th

Non Trad

Source: California Healthy Kids Survey (2009 – 2013)


Marin Youth Have Used Prescriptions Medicine for Non-medical Purposes in the Last 30 Days

0

2

4

6

8

10

12

14

Yes

7th

9th

11th

Non Trad

By 11th grade, 16% of youth have used prescription painkillers, 7% have used 4 or more times.

4

12

0

2

4

6

8

10

12

14

2013-14

Cu

rre

nt

% C

iga

rett

e S

mo

kin

g.

Report Year

California Healthy Kids Survey in Marin

9th Graders

11th Graders

CONSEQUENCES Problems Related to Adult and Youth Substance Use

Percent of Arrests in Marin County in 2010 that were Drug Offenses

0%

10%

20%

30%

40%

50%

60%

Source: CA Attorney General

Most DUI Arrests Report Consuming Their Last Beverage at a Bar, Restaurant or in a Home

0

10

20

30

40

50

Source: Place of Last Drink Survey (2012-13) *1,246 POLD surveys collected in 2012-2013

Marin County Hospitalizations and Emergency Room

Visits for Alcohol and Drug Use

Year Number Of Hospitalizations

Number of Emergency Room Visits

2010 1,737 2,557

2011 1,837 2,651

2012 1,882 2,986

Total 5,456 8,194

Source: CDPH statistics non-fatal hospitalizations and emergency room visits for Marin County

Number of Adult Deaths in Which Alcohol and/or Other Drugs Were a Factor

Year Number of Deaths

2008 62

2009 58

2010 55

Total 175

Source: CDPH Vital Statistics Death Statistical Master and Multiple Cause of Death files

In FY12-13 42.25% of Adult PES Admissions also had a Substance Use Diagnosis

499

365 No

Yes

Source: Share Care

Marin Youth Report Experiencing Many Problems When Using Alcohol and Drugs

0

5

10

15

20

25

30

35

9th

11th

Non Trad


Marin Youth Report Experiences Related to Abuse/Dependency while Using Alcohol and Other Drugs

0

5

10

15

20

25

30

35

9th

11th

Non Trad


0

5

10

15

20

25

30

Yes

Ever Seriously Considered Attempting Suicide, Past 12 Months

9th

11th

Non Trad


0

5

10

15

20

25

30

Yes

Ever Attempted Suicide

7th

9th

11th

Non Trad

Marin Youth Reporting Considering or Attempting Suicide

Breakout Activity – Group Review &

Prioritization

1. Identify individual

Top 3 priorities

2. Share with group

3. Identify group’s Top

3 priorities

What is notable about this data?

What are key issues that are concerning with this data?

What connections are there across the various categories of data presented here?

Which priorities affect individuals and groups of greatest concern? Which priorities lead to higher risks?

Which priorities build on and extend work already happening in this area?

Which priorities are grounded in data?

Which priorities are both important and feasible to affect in the near-term

46

Activity Questions to Consider

Breakout Activity – Group Review &

Prioritization

1. Identify individual

Top 3 priorities

2. Share with group

3. Identify group’s Top

3 priorities

What is notable about this data?

What are key issues that are concerning with this data?

What connections are there across the various categories of data presented here?

Which priorities affect individuals and groups of greatest concern? Which priorities lead to higher risks?

Which priorities build on and extend work already happening in this area?

Which priorities are grounded in data?

Which priorities are both important and feasible to affect in the near-term

47

Activity Questions to Consider

Wrap-Up & Closing 48

community meeting to inform the strategic plan update · - teen birth rate - uninsured adults -...

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