nh drug and alcohol services community-baseddata-driven

NH DRUG AND ALCOHOL NH DRUG AND ALCOHOL SERVICESSERVICES

Community-basedCommunity-based

Data-drivenData-driven

The System

NH Regional Networks

The Structure: Treating CommunitiesThe Structure: Treating Communities

REGIONAL NETWORKSREGIONAL NETWORKS Convene community stakeholdersConvene community stakeholders Facilitate needs assessments, capacity development, and planningFacilitate needs assessments, capacity development, and planning Leverage resourcesLeverage resources Lead/support environmental activities (policy, media, targeted communications, Lead/support environmental activities (policy, media, targeted communications,

information dissemination, outreach/awareness)information dissemination, outreach/awareness)

PREVENTION AND INTERVENTION PROVIDERSPREVENTION AND INTERVENTION PROVIDERS Deliver evidence-based programs to selective and indicated populationsDeliver evidence-based programs to selective and indicated populations Collect Process (PIERS) and Intermediate (CORE MEASURE) dataCollect Process (PIERS) and Intermediate (CORE MEASURE) data Focus on selective (high risk) and indicated populationsFocus on selective (high risk) and indicated populations Serve youth, parents, elders, and communitiesServe youth, parents, elders, and communities

TECHNICAL ASSISTANCE, TRAINING AND WORKFORCE DEVELOPMENTTECHNICAL ASSISTANCE, TRAINING AND WORKFORCE DEVELOPMENT NH Center for Excellence (Evidence-Based Practice, Data, Systems Change, Learning NH Center for Excellence (Evidence-Based Practice, Data, Systems Change, Learning

Teams)Teams) NH Training Institute on Addictive Disorders (core competency and general NH Training Institute on Addictive Disorders (core competency and general

professional development)professional development) Prevention Certification BoardPrevention Certification Board

CLEARINGHOUSE AND LENDING LIBRARYCLEARINGHOUSE AND LENDING LIBRARY Materials, curricula, information disseminationMaterials, curricula, information dissemination Coordinated media and marketingCoordinated media and marketing Two web sites: Two web sites: www.drugfreenh.orgwww.drugfreenh.org www.nhcenterforexcellence.orgwww.nhcenterforexcellence.org

Prevention & Early InterventionPrevention & Early Intervention

http://www.drugfreenh.org/

http://www.nhcenterforexcellence.org/

Resources leveragedResources leveraged Stakeholders engagedStakeholders engaged Evidence-Based Services offeredEvidence-Based Services offered Intervening variables affected (e.g. perception of Intervening variables affected (e.g. perception of

risk, perception of wrongness, knowledge of risk, perception of wrongness, knowledge of biological nature of addiction, intention not to biological nature of addiction, intention not to use)use)

= Population level behavior change= Population level behavior change

How do we know How do we know preventionprevention is is working?working?

Centralized population level indicator Centralized population level indicator datadata

Arrest data including liquor law violations and DWIArrest data including liquor law violations and DWI BRFSS BRFSS Hospital discharge dataHospital discharge data Retailer complianceRetailer compliance Youth Risk Behavior SurveyYouth Risk Behavior Survey

Provider and Network level dataProvider and Network level data Core Measure Survey (Universal, Selected, Core Measure Survey (Universal, Selected,

Indicated)Indicated) PIERS (Capacity and Process)PIERS (Capacity and Process) Partnership Tool (Network)Partnership Tool (Network)

Prevention Data SystemPrevention Data System

How do we know prevention is working?How do we know prevention is working?

ResourcesResources: : Funds and human resources Funds and human resources raisedraised

StakeholdersStakeholders:: Who and how many are engagedWho and how many are engagedEvidence-Based ServicesEvidence-Based Services::

Based on Contributing Factors Based on Contributing Factors Based on Target PopulationBased on Target PopulationFidelity to model! Fidelity to model! ““Saturation” – how many servedSaturation” – how many served

Intervening variable ChangeIntervening variable Change::Knowledge Knowledge

-of harm-of harm-of strategies to avoid use-of strategies to avoid use-of biology of addiction, etc-of biology of addiction, etc

AttitudeAttitude (Perceived risk, perceived (Perceived risk, perceived wrongness, perceived self-wrongness, perceived self-efficacy, intentionality)efficacy, intentionality)

= = Population level behavior changePopulation level behavior change

State $1,117,200

28%

Federal $978,318

25%

Leveraged (all sources) $1,893,322

47%

Stakeholders Engaged Stakeholders Engaged SFY 2010 FundingSFY 2010 Funding

Stakeholders Engaged: 3,031Stakeholders Engaged: 3,031

Evidence-Based Practices “Saturation”Evidence-Based Practices “Saturation”

Direct Services

2721

8678

30

20

40

60

80

100

Spec

ialize

d Tra

inin

g

Indi

vidua

lized

Ser

vices

Guide

d Disc

ussio

n Gro

ups

Empo

werm

ent/L

eade

rship

T...

Educa

tiona

l Pro

gram

s

# of

Pro

gram

s Fu

nde

d


Indirect (Environmental) Activities

30

111

82

139

0

25

50

75

100

125

150

Targ

eted

Com

mun

icatio

ns

Polic

y Cha

nge

Med

ia C

ampa

ign

Info

Dissem

inat

ion

# of

inte

rven

tion

s


#s Being Served by Category

3924

24611176301

8831

0

2,000

4,000

6,000

8,000

10,000

Research has proven that perception of risk and Research has proven that perception of risk and wrongness correlate strongly with likelihood of use.wrongness correlate strongly with likelihood of use.

BUT IS THEBUT IS THE PROGRAMMING DRIVING THE CHANGE?PROGRAMMING DRIVING THE CHANGE?

Showing the correlation between the two is good, but Showing the correlation between the two is good, but being able to show that evidence-based practice is being able to show that evidence-based practice is changing the intervening variables builds that case.changing the intervening variables builds that case.

Effect on Intervening VariablesEffect on Intervening Variables

2009 YRBS Perception of Risk2009 YRBS Perception of Risk

Past 30 Day Use by Student Perception of Risk

55.25%

45.99%

54.13%

44.00%

32.40%

16.04% 15.47%

10.55%

0%

10%

20%

30%

40%

50%

60%

Alcohol Binge Alcohol Marijuana Cigarettes

Substance

Per

centa

ge o

f Stu

den

ts W

ho

Hav

e U

sed in t

he

Pas

t 30

Day

s

Student Perception: No Risk to Slight Risk Student Perception: Moderate to Great Risk

Parent Perception of Parent Perception of Wrongness: MarijuanaWrongness: Marijuana

Marijuana Use in Past Marijuana Use in Past 30 Days30 Days

With the assistance and endorsement of the NH Expert Panel, With the assistance and endorsement of the NH Expert Panel, the Northeast CAPT Regional Expert Team, and community the Northeast CAPT Regional Expert Team, and community level evaluators, NH developed a level evaluators, NH developed a CORE MEASURECORE MEASURE survey survey administered in all age appropriate program level group administered in all age appropriate program level group prevention to gauge impact of funded programming on prevention to gauge impact of funded programming on intervening variables.intervening variables.

In other words, the CORE MEASURE instrument will inform In other words, the CORE MEASURE instrument will inform BDAS if funded programming, supported by fidelity audits BDAS if funded programming, supported by fidelity audits and technical assistance, is producing change in the and technical assistance, is producing change in the intervening variables that research says will change intervening variables that research says will change behavior at the population level?behavior at the population level?


Knowledge: Alcohol or drug use can be more Knowledge: Alcohol or drug use can be more harmful for adolescents because the brain is harmful for adolescents because the brain is

still developing.still developing.

Source: Youth Pre/Post Core Measure SurveySource: Youth Pre/Post Core Measure Survey

93.7%

80.8%

100% 100%

0%

20%

40%

60%

80%

100%

120%

Universal Selective

Pre-test Agree or Strongly Agree Post-test Agree or Strongly Agree

Knowledge: People can inherit a higher Knowledge: People can inherit a higher risk for alcohol and drug problemsrisk for alcohol and drug problems

77.9%84.6%

92.8%100.0%

0%

20%

40%

60%

80%

100%

120%

Universal Selective

Pre-test Agree or Strongly Agree Post-test Agree or Strongly Agree


Perception of wrongness: How wrong do you Perception of wrongness: How wrong do you think it is for someone your age to drink think it is for someone your age to drink

beer, wine, or hard liquor?beer, wine, or hard liquor?


37.5%

30.7%

64.3%

75.0%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Universal Selective

Pre-test Wrong or Very Wrong Post-test Wrong or Very Wrong

Skills: How likely are you to make a personal Skills: How likely are you to make a personal commitment not to use alcohol or other commitment not to use alcohol or other

drugs?drugs?Selective Population

53.9%

83.4%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Pre Post

L ikely and Very L ikely


Refusal Skills: I plan on using my skills and Refusal Skills: I plan on using my skills and knowledge to refuse alcohol, tobacco & other knowledge to refuse alcohol, tobacco & other

drugs.drugs.


Selective Population

57.70%

100%

0%

20%

40%

60%

80%

100%

120%

Pre Post

Agree or Strongly Agree

Refusal Skills: I know ways to avoid Refusal Skills: I know ways to avoid situations that could lead to drinking or situations that could lead to drinking or

drug use.drug use.


Selective Population

61.5%

100.0%

0%

20%

40%

60%

80%

100%

120%

Pre Post

Probably and Definitely Yes

Data provide a means to monitor Data provide a means to monitor local trends and prevalencelocal trends and prevalence Alcohol on the declineAlcohol on the decline Marijuana steadyMarijuana steady Perception of Risk re Marijuana on declinePerception of Risk re Marijuana on decline Prescription Drug Use: 1 in 5 initiated Prescription Drug Use: 1 in 5 initiated

use; use;

1 in 10 regularly use1 in 10 regularly use


Are We Making a Difference?Are We Making a Difference?

Impact: Past 30 Day Use of AlcoholImpact: Past 30 Day Use of Alcohol

Past 30 Day Use: Alcohol (at least one drink on one or more days)

37.65%

43.91%44.25%47.16%49.43%

0%

10%

20%

30%

40%

50%

60%

2001 2003 2005 2007 2009

NH vs. US Past 30 Day Alcohol UseNH vs. US Past 30 Day Alcohol Use(NH Local Sample YRBS)(NH Local Sample YRBS)

49.43%

37.65%

43.91%44.25%

47.16%47.10%44.90%

43.30%44.70%

41.80%

20%

25%

30%

35%

40%

45%

50%

55%

2001 2003 2005 2007 2009

NH US

Substance Use Trends 2001-2009Substance Use Trends 2001-2009Local Sample YRBSLocal Sample YRBS

20%

25%

30%

35%

40%

45%

50%

55%

2001 2003 2005 2007 2009

Alcohol Binge Alcohol Marijuana Tobacco

SPF Funding Received

SPF Funding out to

Communities

SPF Funding

Ends

NH Age of Onset NH Age of Onset Local Sample YRBS Grades 9-12Local Sample YRBS Grades 9-12

12.9

4 13.2

2

13.3

0 13.5

9

12.4

4 12.6

5

13.1

13.0

3 13.3

513.5

5

13.6

3

13.7

7

13.7

6 14.0

2

13.0

0

11.5

12.0

12.5

13.0

13.5

14.0

14.5

2001 2003 2005 2007 2009

Year

Age

Alcohol NH Tobacco NH Marijuana NH

Age of Onset: Alcohol (by Region)Age of Onset: Alcohol (by Region)

11.5

12.0

12.5

13.0

13.5

14.0

2001 2003 2005 2007 2009

A

B

C

D

E

F

G

H

I

J

ALL Regions

Region

What is the value of these outcomes?What is the value of these outcomes?

The longer we delay initiation, the less likely NH’s children The longer we delay initiation, the less likely NH’s children are to ever become dependent on alcohol or other drugsare to ever become dependent on alcohol or other drugs

Applying the percent reductions in underage drinking Applying the percent reductions in underage drinking among high school aged youth from 2001 to 2009 to the among high school aged youth from 2001 to 2009 to the number of 15-19 year olds living in New Hampshire, the number of 15-19 year olds living in New Hampshire, the long-term impact translates to 5,190 NH youth not initiating long-term impact translates to 5,190 NH youth not initiating

regular alcohol useregular alcohol use[1][1]..

[1][1] http://factfinder.census.gov/servlet/DTTable http://factfinder.census.gov/servlet/DTTable

TREATMENT SERVICES TREATMENT SERVICES InpatientInpatient Outpatient/Intensive OutpatientOutpatient/Intensive Outpatient Care Coordination (ATR)Care Coordination (ATR)

RECOVERY SUPPORT SERVICES RECOVERY SUPPORT SERVICES Training and supervision of Recovery Support WorkersTraining and supervision of Recovery Support Workers Resource and Referral for those in recovery to receive and/or Resource and Referral for those in recovery to receive and/or

provide recovery supportsprovide recovery supports

Methadone clinics- regulatory only Methadone clinics- regulatory only

Alcohol and Other Drug Licensure and Credentialing Alcohol and Other Drug Licensure and Credentialing

NH Training Institute on Addictive DisordersNH Training Institute on Addictive Disorders

Crisis line Crisis line

Treatment & RecoveryTreatment & Recovery

Electronic Health Records/WITSElectronic Health Records/WITS Client Event Data System (CEDS) Client Event Data System (CEDS) GPRA (ATR)GPRA (ATR)

Data Driven Practice:Data Driven Practice:

National Outcome Measure: EmploymentNational Outcome Measure: Employment

Other Treatment Outcomes in NHOther Treatment Outcomes in NH

Changes from Treatment Intake to Post-Treatment Follow-Up (All Follow-Ups Combined)

55

71

52

31

25

80

89

72

6

24

0 20 40 60 80 100

Percent Abstinent in PastMonth

Percent L ivingIndependently

Percent Working, Student,or Homemaker

Percent Arrested in Prior 6Months

Percent Visiting an ER inPrior 6 Months

Intake Follow-Up

West, Alan N. “Substance Abuse Treatment Outcomes From Telephone Follow-Up Interviews in SFY 2006” Division of Public Health Services, July 13, 2006

Post Treatment AbstinencePost Treatment Abstinence

Maintained or Sustained Abstinence

6 month follow-up

12 month follow-up

18 month follow-up

83% 79% 75%

West, Alan N. “Substance Abuse Treatment Outcomes From Telephone Follow-Up Interviews in SFY 2006” Division of Public Health Services, July 13, 2006

Ever Used Prescription Ever Used Prescription DrugsDrugs

Past 30 Day Use of Past 30 Day Use of Prescription DrugsPrescription Drugs

Percentage of students who have taken a prescription drug (such as OxyContin, Percocet, Vicodin, Adderall, Ritalin or Xanax) without a doctor’s prescription one or more times during their life by Regional Network.

% Ever Used - Prescription

2009 Youth Risk Behavior Survey (YRBS)

17.6 – 17.918.0 – 18.318.4 – 18.919.3 – 20.720.8 22.3

2009 Local Sample YRBS n=30,274

Vermont

Maine

Canada

Massachusetts

Systems ChangeSystems Change

With the SPF SIG having transformed prevention delivery With the SPF SIG having transformed prevention delivery (community –based and data-driven);(community –based and data-driven);

With Access To Recovery ensuring care coordination, recovery With Access To Recovery ensuring care coordination, recovery supports and client-driven care;supports and client-driven care;

With evidence-based practice in prevention and treatment the With evidence-based practice in prevention and treatment the standard;standard;

With web-based data systems for both prevention (PIERS), With web-based data systems for both prevention (PIERS), treatment (WITS), and population level indicators treatment (WITS), and population level indicators (nhcenterforexcellence.org)…(nhcenterforexcellence.org)…

The prevention and treatment delivery system is being The prevention and treatment delivery system is being significantly upgraded, and improved outcomes significantly upgraded, and improved outcomes areare and and will bewill be demonstrable. demonstrable.

THANK YOUTHANK YOUQuestions?Questions?

The NH Center for Excellence is an initiative of the NH Department of Health and Human Services’ Bureau of Drug and Alcohol Services and is funded in part by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA); the NH Governor’s Commission on Alcohol and Other Drug Prevention, Intervention and Treatment; and the New Hampshire Charitable Foundation.

Lisa Mure, MEd, CPS

Project Director, NH Center for Excellence

Community Health Institute, Bow NH

[email protected] 603-573-3300

mailto:[email protected]

nh drug and alcohol services community-baseddata-driven

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