needs assessment for substance abuse prevention and mental ... 2013... · 5% 10% 15% 20% 25% 30%...
TRANSCRIPT
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Needs Assessment for
Substance Abuse Prevention
and Mental Health Promotion
Prepared for Combined Block Grant
Discussions
January 2013
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Agenda
• Introduction: 10 minutes – Michael Langer
• Data Presentation: 30 minutes – Alice Huber
• Q/A and Discussion: 30 minutes – Michael Langer
• Closing: 5 minutes – Michael Langer
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
New Defined Purposes of BG
States will use the BG … for prevention, treatment, recovery
supports and other services to supplement … Medicaid,
Medicare and private insurance. …. Four purposes:• Fund … treatment and support services for those without
insurance or for those with intermittent coverage.
• Fund … treatment and support services not covered by Medicaid
… for low income individuals and that demonstrate success in
improving outcomes and/or supporting recovery.
• Fund primary prevention - universal, selective and indicated
prevention activities and services….
• Collect performance and outcome data to determine the ongoing
effectiveness of behavioral health promotion, treatment and
recovery support services and plan the implementation of new
services on a nationwide basis.
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Changes
• Combined application.
• Spending to align with Statewide Needs Assessment and Block Grant purpose.
• Emphasis on strategic planning and accountability.
• Planning moves from a Federal to State Fiscal Year. Two-year plans.
• Requested/Mandatory sections.
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Timeline
Jan 4 Notice of Application
Jan 22 Public Comment on Needs Assessment
Feb 12 Roundtable #1 with Tribes
Feb 20 BHAC meeting
Feb 22 Public Comment on Plan
Feb 26 Roundtable #2 with Tribes
Mar 5 Consultation with Tribes
Mar 8 DSHS Review
Apr 1 Application Deadline
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Questions?
• Questions on overall Block Grant changes?
• Questions on timeline?
Please ‘raise your hand’ if you have a
question you would like to ask. You can
also type into the question box if you
prefer.
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Review of
Needs Assessment for
Substance Abuse Prevention and
Mental Health Promotion
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Recent Data Workgroup Process
• Prevention Redesign Initiative (PRI) and State Prevention Enhancement (SPE)
• SPE and SEOW workgroup partners:– State agencies, state associations, universities,
stakeholders, BHAC
• Initial criteria identified and data gathered
• Reviewed and refined data– Indicators/data from partners
– Patterns of use
– Consideration of Age Groups, Race/Ethnicitydisparities; Socio-Economic Status (SES)
• Agreement on priorities
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Needs Assessment Matrix
Alcohol Tobacco Marijuana Meth-
amphetamine
Prescription
Drugs
Rates
Trends
Economic
Impacts
Social
Impacts
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Rates
• Rates of self-reported substance use – HYS
– NSDUH
– BRFSS
• Rates data give us information about how common or how uncommon the use of a particular substance. For example:– Is methamphetamine a large problem in
Washington State?
Note: survey details are included at the end of the presentation
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Rates: By Youth Age Groups
Source: Healthy Youth Survey 2010/2008
*2008 rates. Data not available for 6 graders.
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
6th Grade 8th Grade 10th Grade 12th Grade
Pe
rce
nt
of
Stu
de
nts
2010 Rates
Youth substance use (in past 30 days)
Alcohol
Marijuana
Cigarette Smoking
Pain Killer (Non-
medical use)
Meth*
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Rates: By Adult Age Groups
Source: National Survey on Drug Use and Health
61% 60%
17%
6%
42%
26%
8%
3%
0%
10%
20%
30%
40%
50%
60%
70%
18-25 26+
Pe
rce
nt
of
Po
pu
lati
on
2008-2009 Substance use during past 30 days
Alcohol
Marijuana
Tobacco
Other illicit
drugs
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Alcohol Rates:
By Adult Age Group
Source: Behavioral Risk Factors Surveillance System (BRFSS), 2010
0%
10%
20%
30%
40%
50%
60%
70%
80%
18 to 20 21 to 24 25 to 34 35 to 44 45 to 54 55 to 64 65 or older
Had alcohol in past 30 days by age group
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Marijuana Rates:
By Adult Age Group
Source: Behavioral Risk Factors Surveillance System (BRFSS), 2010.
0%
10%
20%
30%
40%
50%
60%
70%
80%
18-24 25 to 34 35 to 44 45 to 54 55 to 64 65 or older
Used marijuana in past 30 days, by adult age group
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Alcohol Rates: By Income Group
45.80%
54.90%
69.92%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Alcohol use
Pe
rce
nt
of
Po
pu
lati
on
Used alcohol during past 30 days
Less than $25,000
$25,000 to $50,000
$50,000 or more
Source: Behavioral Risk Factors Surveillance System (BRFSS)
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Trends
Trends data give us information about
the changes in substance use, over
time. For example:
– Is the rate of alcohol use going up or
going down?
– Is the rate of prescription drug abuse
increasing or decreasing?
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Alcohol Trends:
By Youth Age Groups
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
2004 2006 2008 2010
Pe
rce
nt
of
Stu
de
nts
Had alcohol during past 30 days (Youth)
6th Grade
8th Grade
10th Grade
12th Grade
2004 2006 2008 2010
6th Grade 4%+/-1 4%+/-1 4%+/-1 4%+/-0
8th Grade 18%+/-2 15%+/-2 16%+/-2 14%+/-1
10th Grade 33%+/-2 33%+/-2 32%+/-2 28%+/-2
12th Grade 43%+/-2 42%+/-2 41%+/-3 40%+/-2
Source: Healthy Youth Survey
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Alcohol Trends:
By Adult Age Group
Source: National Survey on Drug Use and Health
0%
10%
20%
30%
40%
50%
60%
70%
80%
2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009
Pe
rce
nt
of
Po
pu
lati
on
Had alcohol in the past month (Adults)
18-25
26+
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Marijuana Trends:
By Youth Age Groups
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
2004 2006 2008 2010
Pe
rce
nt
of
Stu
de
nts
Used marijuana during past 30 days (Youth)
6th Grade
8th Grade
10th Grade
12th Grade
2004 2006 2008 2010
6th Grade 1.7%+/-0.4 1.5%+/-0.4 1.2%+/-0.3 1.6%+/-0.4
8th Grade 9.2%+/-1.2 7.0%+/-1.2 8.3%+/-1.1 9.5%+/-1.1
10th Grade 17.1%+/-1.4 18.3%+/-1.4 19.1%+/-1.2 20.0%+/-1.8
12th Grade 19.5%+/-2.2 21.6%+/-2.0 23.4%+/-2.3 26.3%+/-2.0
Source: Healthy Youth Survey
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Marijuana Trends:
By Adult Age Group
Source: National Survey on Drug Use and Health
0%
10%
20%
30%
40%
50%
60%
70%
80%
2002-2003 2003-2004 2004-2005 2005-2006 2006-2007 2007-2008 2008-2009
Pe
rce
nt
of
Po
pu
lati
on
Used marijuana in the past month (Adults)
18-25
26+
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Mental Health Indicators
• Serious mental illness
• Serious psychological distress
• Major depressive episodes and
symptoms of depression
• Suicidal ideation
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Mental Illness Rates:
by Adult Age Group
0%
10%
20%
30%
40%
50%
60%
70%
80%
18-25 26+
Mental illness in past year, by adult Age Group
Any Mental
Illness
Serious
Mental Illness
Source: National Survey on Drug Use and Health, 2008/2009
Notes: Any mental illness is defined as having a diagnosable mental, behavioral, or emotional disorder, other
than a substance use disorder, that met the criteria found in DSM-IV. Serious mental illness is defined as
having a diagnosable mental, behavioral, or emotional disorder that resulted in functional impairment.
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Serious Psychological Distress
Rates: by Adult Age Group
0%
10%
20%
30%
40%
50%
60%
70%
80%
18-24 25 to 34 35 to 44 45 to 54 55 to 64 65 or older
Past month Serious Psychological Distress, by Adult Age Group
Source: Behavioral Risk Factors Surveillance System (BRFSS), 2010. SPD is defined as a score>= 13 on
Kessler-6 distress scale.
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Major Depressive Episode Rates:
by Age Group
0%
10%
20%
30%
40%
50%
60%
70%
80%
12-17 18-25 26+
Had at least one major depressive episode in the past
year, by age group
Source: National Survey on Drug Use and Health, 2008/2009
Note: Major depressive episode is defined as in DSM-IV, which specifies a period of at least 2 weeks when
a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a
majority of specified depression symptoms.
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Depressive Symptom Rates:
by Youth Age Group
0%
10%
20%
30%
40%
50%
60%
70%
80%
Had depressive feelings
Pe
rce
nt
of
Stu
de
nts
Had symptoms of depression during past 12 months, by
youth age group
8th Grade
10th Grade
12th Grade
Source: Washington Healthy Youth Survey, 2010
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Suicidal Ideation Rates:
by Adult Age Group
0%
10%
20%
30%
40%
50%
60%
70%
80%
18-25 26+
Had serious thoughts of suicide in past year, by adult age
group
Source: National Survey on Drug Use and Health, 2008/2009
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Suicidal Ideation Rates:
by Youth Age Group
0%
10%
20%
30%
40%
50%
60%
70%
80%
Seriously considered Suicide
Pe
rce
nt
of
Stu
de
nts
Seriously considered suicide in past 12 months, by youth
age group
8th Grade
10th Grade
12th Grade
Source: Washington Healthy Youth Survey, 2010
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Social and Economic Impacts
• Economic costs are varied:
– Treatment, medical consequences, lost
earnings, accidents, criminal justice
• Broad social impacts
– School-related consequences
– Drinking and driving
– Substance use during pregnancy
– Adverse Childhood Experiences
– Deaths
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Economic Impacts:
National Estimates
Source: Surgeon General’s Report, 2004; ONDCP, 2004; Harwood, 2000, quoted in NIDA (2008). Addition
Science: From Molecules to Managed Care. http://www.drugabuse.gov/publications/addiction-science
Note: Economic costs include specialty treatment, medical consequences, lost earnings, and other costs
such as accidents and criminal justice.
$185 $181
$158
$0
$20
$40
$60
$80
$100
$120
$140
$160
$180
$200
Bil
lio
n D
oll
ars
Estimated Annual Economic Cost to Society: United States
Alcohol
Illegal Drugs
Tobacco
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
School Related Consequences
Alcohol Marijuana Pain Killer* Tobacco
Depressive Feelings 2.3 2.0 3.1 2.3
Drunk or high at school 12.6 24.7 22.3 14.0
Riding with driver who had alcohol 6.0 4.8 7.3 4.9
Skipping school 3.5 4.1 5.0 4.1
Correlation between substance use and negative consequences
(Odds Ratio)
Source: 2010 HYS.
* Used pain killers to get high
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Drug Only
Alcohol Only
Both Alcohol & Drug
0.00
0.25
0.50
0.75
1.00
16-17 18-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81+Fat
al C
rash
es/1
0,00
0 Li
cens
ed D
river
s
Driver Age Group
Drug Impaired Only
Alcohol Impaired Only
Fatal Crashes
Data source: Fatality Analysis Reporting System (FARS) (1/12/2011)
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Serious Injury Crashes
Alcohol Ohly
Both Alcohol and Drugs or
Medication Drugs Only
0.0
0.5
1.0
1.5
2.0
16-17 18-20 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81+Ser
ious
Inju
ry C
rash
es/1
0,00
0 Li
cens
ed D
river
s
Driver Age Group
Alcohol Impaired OnlyBoth Alcohol and Drug/MedicationDrug Impaired OnlyMedication Only
Data source: WSDOT (12/15/2010)
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Substance Use During Pregnancy
Source: Behavioral Risk Factors Surveillance System (BRFSS), 2010
17%
4%
10%
0%
10%
20%
30%
40%
50%
60%
70%
Substance Use Druing Pregnacy
Percentage of Pregnant Women who Reported Substance Use
Alcohol
Marijuana
Cigarettes
35
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Alcohol Use During Pregnancy
Source: Pregnancy Risk Assessment Monitoring System (PRAMS). Alcohol Use Before and During Pregnancy.
http://www.doh.wa.gov/cfh/assessment/docs/datareport/alcusepreg.pdf
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Adverse Childhood Experiences
Respondents’ Current Substance Use
Source: Behavioral Risk Factors Surveillance System (BRFSS), 2010
0%
10%
20%
30%
40%
50%
60%
70%
80%
Alcohol Binge Drinking Cigarettes Marijuana Pain killer (non-
medical)
Family Alcohol Use:Did you live with anyone who was a problem drinker/alcoholic
Yes
No
Exposed to
Family
Alcohol Use
37
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Adverse Childhood Experiences
Respondents’ Current Substance Use
Source: Behavioral Risk Factors Surveillance System (BRFSS), 2010
0%
10%
20%
30%
40%
50%
60%
70%
80%
Alcohol Binge Drinking Cigarettes Marijuana Pain killer (non-
medical)
Family Drug UseDid you live with anyone who used illegal street drugs or who abused
prescription medications
Yes
No
Exposed to
Family Drug
Use
38
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Adverse Childhood Experiences
0%
10%
20%
30%
40%
50%
60%
70%
80%
Alcohol Binge Drinking Cigarettes Marijuana Pain killer (non-
medical)
Family Mental Illness:Did you live with anyone who was depressed, mentally ill, or suicidal?
Yes
No
Exposed to
Family Mental
Illness
Respondents’ Current Substance Use
Source: Behavioral Risk Factors Surveillance System (BRFSS), 2010
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Washington State Department of Social & Health Services
OneDepartment
Vision
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Core set of Values
Alcohol or Drug Related Deaths
Source: Department of Health, Center for Health Statistics, Death Certificate Data File
40
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Washington State Department of Social & Health Services
OneDepartment
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Prescription Opioid Involved
Deaths
Source: Comprehensive Hospital Abstract Reporting System (CHARS)
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Conclusions from SA Prevention/
MH Promotion Needs Assessment
• Mental Health Needs: Less info available– Depression and anxiety both important
• Substance Use Prevalence: – Alcohol (youth: 1st, adults: 1st)
– Marijuana (youth: 2nd, adults: 3rd)
– Tobacco (youth: 3rd, adults: 2nd)
• Impacts: – Economic costs: alcohol highest
– Deaths: alcohol worse than illicit drugs
– Traffic injuries and fatalities: alcohol highest
– For pregnant women: alcohol use highest
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Washington State Department of Social & Health Services
OneDepartment
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Core set of Values
POLL
How well do these data align with your
community’s data?
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Proposed Substance Abuse Prevention
Priorities based on Needs Assessment
• Underage drinking remains the top
prevention priority for youth and adults.
• Marijuana ranked second due to high
prevalence among youth.
• Tobacco ranked third due to high
prevalence among adults.
• Substance use prevention must focus on
both youth and young adults.
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Proposed Mental Health Promotion
Priorities based on Needs Assessment
• Depression is the top priority.
• Suicide prevention, particularly is
essential.
• Mental health promotion should be
focused on youth and young adults.
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
POLL
How much do you agree with the stated
priorities for substance abuse
prevention and mental health
promotion?
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Discussion/Questions
47
Please ‘raise your hand’ if you would
like to make a comment or have a
question you would like to ask.
You can also type into the question box
if you prefer.
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Thank you!
• Thank you for participating in today’s
meeting.
• These presentations will be posted to the
DBHR website following today’s webinar.
• Following this webinar, you will receive an
email which includes a link to a survey
where you can submit additional comments.
The survey will be open until Wednesday,
Jan. 30, 2013.
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Background Information and
Sources
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Acronyms (1)
• ACES – Adverse childhood experiences
• BG – Block Grant
• BHAC – Behavioral Health Advisory Council
• BRFSS – Behavioral Risk Factors Surveillance System
• CHARS – Comprehensive Hospital Abstract Reporting System
• DSHS – Department of Social and Health Services
• FARS – Fatality Analysis Reporting System
• HYS – Healthy Youth Survey
• NSDUH – National Survey on Drug Use and Health
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Acronyms (2)
• ONDCP – Office of National Drug Control Policy
• PRAMS – Pregnancy Risk Assessment Monitoring System
• PRI – Prevention Redesign Initiative
• RDA – Research and Data Analysis
• SEOW – State Epidemiological Outcomes Workgroup
• SES – Socio-Economic Status
• SPE – State Prevention Enhancement
• WSDOT – Washington State Department of Transportation
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Background Information
• Source information for surveys and data• BRFSS
• NSDUH
• HYS
• PRAMS
• FARS
• Estimating rates of serious
psychological distress, serious mental
illness, and depression
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Behavioral Risk Factors
Surveillance System (BRFSS)
• National and statewide annual
telephone survey
• Collects information on health
behaviors and preventive practices
• Respondents: adults 18 years and
older
• Sample size (2010): approximately
20,000 in Washington State
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
National Survey on Drug Use
and Health (NSDUH)
• Nationwide annual survey conducted through computerized interviews
• Collects data on the use of tobacco, alcohol, illicit drugs (including non-medical use of prescription drugs) and mental health Indicators
• Respondents: individuals 12 years and older
• Sample size: approximately 70,000 nationally
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Health Youth Survey (HYS)
• Statewide school survey conducted biannually
• Collects data on health risk behaviors that contribute to morbidity, mortality, and social problems among youth
• Respondents: students in the 6th, 8th, 10th and 12th grade
• Sample size (2012): approximately 210,000 students
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Pregnancy Risk Assessment
Monitoring System (PRAMS)
• National and statewide mail and telephone survey
• Collects data on new mothers’ behaviors and experiences before, during, and shortly after pregnancy
• Respondents: new mothers 2 to 6 months after delivering a baby
• Sample size: approximately 1,800 surveys mailed each year in Washington with about a 76% response rate
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Fatality Analysis Reporting
System (FARS)
• Nationwide census with data regarding fatal injuries suffered in motor vehicle traffic crashes
• Maintained by National Highway Traffic Safety Administration (NHTSA)
• Data available yearly from 1975
• Collects data on crashes involving a motor vehicle traveling on a traffic way customarily open to the public and result in the death of a person within 30 days of the crash
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Measuring Serious
Psychological Distress
• Measured by Kessler-6 distress scale in
BRFSS
• Serious psychological distress –
defined as a score of 13 or more on K-6
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Estimating Rates of Mental
Illness• Data collected in NSDUH
• Psychological distress measured by Kesseler-6 distress scale
• Functional impairment measured by the World Health Organization Disability Assessment Schedule (WHODAS) and the Sheehan Disability Scale (SDS)
• Conducted clinical interviews with a subsample to determine mental illnesses
• Rates of mental illness estimated using statistical models based on K-6, WHODAS/SDS, and parameters determined by the clinical interviews
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Estimating Rates of Depression
• Data collected in NSDUH
• Major depressive episode: defined as in DSM-IV - a period of at least 2 weeks when a person experienced a depressed mood or loss of interest or pleasure in daily activities and had a majority of specified depression symptoms
• Adult questions adapted from the National Comorbidity Survey Replication (NCS-R)
• Youth (12 to 17) questions adapted from the National Comorbidity Survey Adolescent (NCS-A)
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Washington State Department of Social & Health Services
OneDepartment
Vision
Mission
Core set of Values
Additional data
• Additional prevention needs
assessment data can be found at:
SPE Data Assessment Presentation -
March/April 2012
61