Seasons Greetings...

from the T-ACT team.

Positive Psychology

This does not specifically related to substance abuse treatment, however I thought some might find it useful....

This link takes you to Dr. Martin Seligman's Authentic Happiness website at the University of Pennsylvania. The site contains some potentially useful surveys that address character strengths and emotional happiness. If you have been looking for a way to measure "persistence" or "optimism" or other positive traits to help your clients, these may be useful tools.

Select Committee on Children & Youth Hearings

The Select Committee on Children & Youth will be holding hearings the next two days related to children's mental health and child welfare:

On Tuesday, December 12, 2006 from 1:30-3:30 p.m. the SJR 799 Mental Health Subcommittee will meet to hear testimony from experts on barriers to providing mental health care for children.

On Wednesday, December 13, 2006 from 9:30 a.m.-noon, the full Select Committee on Children and Youth will meet to continue hearing testimony on child welfare indicators. The committee will also hear from the Comptrollers Office of Research and Education Accountability concerning several reports issued during the past year. Video streaming for the December 13th meeting can be accessed at: www.legislature.state.tn.us/joint/JVideo.html or
www.legislature.state.tn.us/joint/Committees/jschedule.htm.

Both meetings will be held in 12 Legislative Plaza, Nashville, Tennessee.

Please feel free to contact the office of the Select Committee on Children and Youth with any questions you may have.

Debbie Gazzaway
Legislative Aide
Select Committee on Children and Youth
3rd Floor, James K. Polk Bldg.
Nashville, TN 37243
#615-741-6239
#615-741-5471 (fax)
debbie.gazzaway@legislature.state.tn.us

This may be of interest to those concerned about co-occurring disorders or who suspect the barriers to mental health treatment may overlap with those to substance use treatment. Also, you may wish to inquire about having a similar hearing focused on substance use.

Magellan Newsletters

Posted at the archive is a recent issue of Magellan's member newsletter. (The two copies are identical except that one is sent to Premier enrollees and uses Premier's contact information and the other is for TBH enrollees.)

The first article covers co-occurring disorders. The second talks about youth suicide; the third, coping with loss. Given that youth with substance disorders may have histories of suicidal ideation or attempts or possible loss of significant people in their lives, all the articles have relevance.

State Co-occurring Disorders Page

TDMHDD's Office of Special Populations and Minority Services has a co-occurring disorders home page. On that page, you can find training materials on co-occurring disorders, a treatment resource directory, and other links.

Among those other links is one to the Dual Recovery Anonymous webpage, which has a listing of meeting locations. In fact, Alcoholics Anoynmous has contact information for local AA organizations. Some of those local organizations include searchable meetings, including the ability to subset by age (adolescent and youth programs). Narcotics Anonymous has contact information for regional offices to call to find local meetings. I will add these links to the right-hand side of the blog.

NIDA Newsletter

This link takes you to the current issue of NIDA Notes, a newsletter published by the National Institute on Drug Abuse. Among the interesting articles: one describing a lottery-reward system used to encourage clients to submit clean urine samples.

I'm also adding NIDA and NIAAA to the links on the right-hand side of the page.

Experiences of Rural Families

This 2004 report, sponsored by the Casey Foundation and authored in part by TCCY, discusses results of focus groups and interviews with rural families from Kentucky, Tennessee, and Alabama. While it does not focus specifically on substance abuse services, many of the problems faced by rural families will affect the capacity to effect change in the substance abuse treatment system in those areas. A link will also be kept on the archive page.

Prevention Conference, April 2006

PRIDE Youth Programs is hosting its 30th anniversary World Drug Prevention Conference in Charleston, WV, April 11-14, 2007. For more information, follow the links or call 800-668-9277 or email peggy(AT)prideyouthprograms.org.

Government Benefits Site

The federal government maintains a website with information about federal programs for which individuals may qualify: www.govbenefits.gov. You can search by state, too. This is Tennessee's page.

Services Analysis

Today concluded the first meeting related to a technical assistance project that GOCCC initiated through SAMHSA, as described at the last PAB meeting. One component of the grant is to build capacities around data sharing and identification of funding mechanisms through the public system. As part of that, Barabara and Nancy joined SAMHSA's consultant, Doreen Cavanaugh, in meetings with representatives from the child serving agencies to discuss each department's needs, interests, and capacities in this regard. A full summary will be posted soon.

As part of that meeting, we mentioned that the report by Northrup & Heflinger (2000) that described the then-current system would be made available. That report is posted on our archives at t-act.info. Additional materials will be posted as I receive electronic copies.

Project Advisory Board Evalautions

If you left early or otherwise forgot to turn in your meeting evaluations, please fax them to Robert at 615-322-1141 or Barbara and Nancy at 615-741-5719.

We will make the meeting materials available online in the next several days and include information about possible follow up items, so check back often.

Materials from "State of the Child" Posted

Presentations and other materials from T-ACT's track at the TVC State of the Child conference have been posted and are available for download.

The host site is a little bare bones right now, but for now it is functional. In the future, materials for the PAB will be posted here.

Additional Information Added to Blog

If you look down the column to your right, I have added links to some resources that were mentioned during the conference, including:

• Tennessee Redline, a service of the TAADAS clearinghouse that provides information about substance abuse providers around the state 24/7. If you wish to be listed, here is the form to submit.
  
• Tennessee 2-1-1, a service of the United Way that exists online and by phone, by dialing 2-1-1, to obtain information about human services available in the state, including substance abuse and mental health treatment.
  
• SAMHSA's facility locator service, providing information on providers in Tennessee and nationwide.
  
• Association of Recovery Schools which provides information on recovery environments supported through schools.

TVC State of the Child Info Coming

Thank you to those who attended TVC's State of the Child Conference this week. Information from T-ACT's co-occurring disorders track will be posted over the weekend. (Working out hosting issues to store the presentations.)

In the meantime, please feel free to read through the site and archives for information related to the project and adolescent substance use treatment.

Changing Practice Patterns

This is a link to a blog maintained by economists at George Mason University in which one of the owners discusses his preference for more routinized medical practice.

I post it not because I (dis)agree with the author's opinion or those of people who commented. Rather I post it because:

• it provides an example of a topic that has relevance to substance abuse and the culture of evidence-based practice and best practices, and
  
  
• it provides an example of a post-and-comment model that I would like to see used in the T-ACT blog, that is, an opinion or knowledge about something relevant to the project is posted and members of the group post comments that enhance that knowledge through concurrence, disagreement, or whatever (so long as it is respectful and not given to political or ad hominem attacks).

If you are new to the blogging experience, follow the links within the author's posting and see what connections or new ideas it generates for you.

In the meantime, later this week I will post some information related to the experience at the Tennessee Voices for Children State of the Child Conference and associated meetings involving T-ACT staff and advisory board members.

Race for Recovery

Community High School is hosting its 7^th Annual Shelby Bottoms Boogie for Recovery Run & Walk. The event features 5k and 15k courses and is sponsored by Nashville Striders, City Paper, and 104.5 The Zone.

The race entry fee is $20. The race begins at 7:30 a.m. Saturday 9/30/2006 at Shelby Park.

Adolescent SA Grant Awarded for Tennessee

Centerstone has been awarded a grant to provide treatment for adolescents with substance use and/or co-occurring disorders.

Tennessee Centerstone Community Mental Health Centers, Inc., Nashville -- $300,000 in first-year funding will support implementation of the Adolescent Community Reinforcement Approach and Assertive Continuing Care models under Project SELF (Students Experiencing Life Free), a culturally sensitive, community-based treatment program serving a total of 144 adolescents, ages 12-18, with substance use disorders and/or co-occurring mental disorders, and their families. Project SELF will collaborate closely with the local school system, juvenile courts, and the recently funded SAMHSA/CMHS system of care grant (serving children, adolescents, and young adults, ages birth to 21 years) in the area.

Other grantees and program details are listed in the SAMHSA press release.

Consequences of Early-Onset Alcohol Dependence.

Board member Andy Finch forwards a link to an article on the consequences of early-onset alcoholism (before age 25) relative to late-onset alcoholism (after age 30). The article uses data from the NIAAA's National Epidemiologic Study of Alcohol Related Conditions (NESARC) and its Alcohol Use Disorder and Associated Disabilities Interview (DSM-IV version), a national probability sample of the U.S. in 2001-2002.

Among the consequences reported, those with early onset:

• were less likely to have sought treatment,
• had greater odds of multiple dependence episodes and episodes of greater than one year, and
• had more dependence symptoms.

More can be found in the article itself. Please feel free to discuss the implications of this research for treatment, intervention, or anything else related to adolescent substance abuse treatment and coordination in the comments.

Teen and Parent Attitudes to Substance Use

Nancy forwarded a link to the results of a recent survey of teens (ages 12-17) and parents on attitudes to substance use, availability of drugs, and risk factors for abuse. The file contains copies of the survey itself and responses.

The authors note that the survey under-represents 12-year-olds, which the analysts corrected for, and over-represents youth from two-parent families, which they did not. You may determine other strengths or limitations for yourself.

Departmental Liaisons

At the last PAB meeting in July, the GOCCC staff mentioned that it is having regular meetings with departmental liaisons. Listed below are the departmental liaisons:

• Bureau of Alcohol & Drug Abuse Services: Ira Lacy


• Bureau of TennCare: Michael Myszka


• Dept of Children's Services: Gwen Harris and Tammy Rohane-Henderson


• Dept of Education: Rita Tompkins


• Dept of Health, Office of Minority Health: Robbie Jackman and Cynthia Allen
  
• Dept of Human Services: Finney Clarkson


• Dept of Mental Health & Developmental Disabilities: Ken Horvath

Visit the blog to receive periodic updates on activities being undertaken by these groups.

And as a reminder, these are your T-ACT staff members' contact information:

• Barbara Frey, 615-741-9428


• Nancy Reed, 615-741-5714

RWJF Call for Proposals

The Robert Wood Johnson Foundation has announced the 11^th round of funding in its Substance Abuse Policy Research Program (SAPRP), which targets on tobacco, alcohol, and other drugs. From its announcement:

The primary focus of SAPRP grants for this round of funding in the areas of alcohol and other drugs will be to reduce the harmful effects of substance use disorders and addictions by improving the quality of care for the millions of Americans who need treatment. To help achieve this objective, SAPRP will make grants of under $100,000 and larger grants of between $100,000 and $400,000.

The primary focus of SAPRP grants for this round of funding in tobacco will be in three primary areas: (1)policies targeted at preventing or reducing tobacco use and exposure (e.g., comprehensive clean indoor air policies, tobacco tax increases, reduced co-pays for tobacco treatment); (2) health care system strategies that seek to increase consumer demand for and use of proven cessation products/services; and, (3) tracking and evaluating the tobacco control policy gains achieved over the past decade. As a guiding principle, at least two-thirds of all SAPRP’s tobacco-related grantmaking will be focused on these objectives and will be limited to grants of under $100,000 only.

Anyone interested in applying is encouraged to contact Nancy or Barbara at GOCCC.

DOH/BADAS Breakout Group

The DOH/BADAS breakout group identified the following barriers, with the first four listed in rank order.

• Lack of standardized tools among funding sources (repetition): The group noted issues of repetition, length of assessment(s), and service expectations as barriers. A potential solution the group listed was a coordinated system of care.
  
  
• ASAM criteria assumes "continuum of care" exists: Such a continuum does not exist, according to the group.
  
  
• Lack of funding: [no details]
  
  
• Resources available: There is a need for knowledge of available resources in terms of training issues and time constraints with respect to increasingly extensive tools. The group noted a potential role for public health nurses. [I combined this with another entry.]
  
  
• Lanaguage: This covered both issues of serving the hearing impaired--which the group described the system as "inadequate, cost-prohibitive" and lacking in resources to serve--and serving Latino and other immigrant communities. Immigration also raised issues about a client's legal status in the U.S.
  
  
• Medication issues: "destabilization."
  
  
• Urban-rural: "Need to look at rural v. urban assessment tool."
  

Editors note: If anyone from this group has details of the discussion on these items, please email robert.c.saunders [at] vanderbilt.edu, and I will flesh out these items.

Education Breakout Group

The Education breakout group listed the following items as barriers that were in their control to do something about (in order listed):

• Training linked to local priorities
  
  
• Dispelling myths re: liability issues
  
  
• Lack of supportive policy re: intervention
  
  
• Info re: availability and criteria [for SA services?]
  

The following were items listed as beyond the control of the group (in order listed):

• NCLB [No Child Left Behind]
  
  
• IDEA [Individuals with Disabilities Education Act]
  

Spanning both lists was:

• Resources

Editors note: If anyone from this group has details of the discussion on these items, please email robert.c.saunders [at] vanderbilt.edu, and I will flesh out these items.

DCS Breakout Group

The DCS breakout group noted that it served two different populations of youth: the dependent/neglected and children in court. The group listed the following items as barriers, with the first four ranked in order of importance.

• Minority Providers, Resource Coordination & Community Partnerships: The system lacks sufficient numbers of both. Recruitment of minority providers and licensure issues are among the problems faced ["We need startup cost to get the person to train the person, licensure."].
  
  
• Co-occurring services: The system (providers?) lacks training in co-occurring problems ["issue is payor sources"] and difficulties with youth who have conduct disorders specifically, but mental health problems generally.
  
  
• Transitional living/services: Youth need these supports because of issues around homelessness, unemployability, and their addiction/MH issues. [Could not interpret: "Adult DOC"--Dept of Corrections?].
  
  
• Funding sources: [no notes listed]
  
  
• JJ youth-No standard screening across courts: [no notes listed]
  
  
• Time constraints: [no notes listed]
  

Editors note: If anyone from this group has details of the discussion on these items, please email robert.c.saunders [at] vanderbilt.edu, and I will flesh out these items.

Juvenile Justice Breakout Group

The JJ group identified and rank ordered the following system barriers:

1. Lack of a system of care and system integration, including cross-department communications regarding youths' services, history and current needs: these limit the capacity of the system to refer/place youth in a timely manner.
   
   
2. Loss of TennCare eligibility among youth placed in "hardware" secure settings: The difficulty is that when youth leave the secure setting, TennCare re-enrollment lags as much as six-weeks, so the courts cannot direct youth, who often have their first screening/assessment/treatment experience in the secure setting, to treatment to capitalize on any momentum.
   
   
3. (In)accessible/(In)effective service: specifically the lack of available providers, available time among those providers who will take the clients, and scheduling/timelienss issues. The BHO's standard for non-urgent care scheduling is within 2 weeks, but this may be too slow for this population.
   
   
4. Cultural competence: This was sometimes an issue, not just with ethnicity but also by urban/rural status, gender, and language. There was an expression of greater need for younger and more diverse treatment providers, and often youth succumb to cultural barriers to using services through the traditional system. However, having someone that "looks like" the client was not strictly enough.
   
   
5. Transportation: A particular problem among the working poor who do not qualify for TennCare. Whatever accessibility issues there are with TennCare's transportation system, youth in TennCare at least have access to those services when provided, which is not the case for non-enrollees.

We brainstormed some about possible solutions for item #2. Part of the root of the problem is that beginning in January, the group understood it to be the case that TennCare let lapse an agreement with DCS regarding suspension of enrollment during incarceration, which previously allowed youth to have their TennCare coverage reinstated upon exit from the facility. One aspect of action would be to identify somebody at TennCare to work with on possible reinstatement of this option.

Another issue the group thought it could address was the inability of the juvenile courts staff to access information on TennCare enrollment status and who a youth's primary care provider is as well as initiate the process of re-enrollment (if suspension proves impossible to regain). Magellan indicated that this information is known and sharable among its providers, but it could not share access out directly to the courts. However, they indicated that some treatment providers have a liaison with DHS at their facility who is able to make determinations there. This suggested two avenues for action: (a) could the courts connect with these DHS liaisons to obtain the information they need (since it would be sharing across governmental bodies); and, (b) could the courts have their own DHS liaison who could help plan for the reintroduction of youth to the community and possibly accelerate the re-enrollment process. Another option was that certain groups (e.g., TennCare Partners Advocacy Line) have at times (and may still) had access to real time TennCare enrollment information: connecting the courts to such groups might resolve this problem.

Finally, we talked about ways to share information between the BHO/providers and the juvenile courts about placement availabilities. Magellan has this responsibility already, and the courts will track down a coordinator. However, often the courts will independently contact facilities, too. One idea considered was a reporting system between the BHO/providers and the juvenile courts, perhaps starting with residential programs (or some other group that would be managable), to update them as to the number of slots available at area providers. This would also help the courts, which struggle to know which facilities and programs to contact and which accept clients, particularly those with behavioral issues in addition to A&D treatment problems. At a very basic level, an up to date "cheat sheet" of key treatment/coordination contacts was considered helpful by the courts.

The group talked about continuing this discussion online in the comments to this blog. Robert will follow up with Nancy/Barbara regarding who might be contacted at TennCare and DHS regarding the enrollment issues. Robert will look into what groups have or might have real time access and connect them to the courts. Magellan indicated it would review what would be possible to provide in terms of "open spaces" and a roster of providers/contacts.

Update: The JJ Breakout Group was combined with the TennCare/BHO breakout group.

More Links on Screening and Assessment

Here is a link to another site, Project Cork, hosted by Dartmouth Medical School and funded through the Kroc foundation, with information about substance screening and assessment tools.

Chestnut Health Systems has information about the different flavors of its GAIN screening and assessment tools.

Training Opportunity

TAMHO is sponsoring a Tennessee Conference on Alcohol Tobacco & Other Drug Use Prevention. The program will be at Montgomery Bell State Park August 13-15, 2006.

The site has details on the program, cost, and continuing education information. Additional details may be obtained from Jackie Crumley (jcrumley [at] tamho.org 615-244-2220 ext. 15) or Teresa Fuqua (tfuqua [at] tamho.org 615-244-2220 ext. 14).

Evidence-based Practices & Instruments Database

As part of our literature review of evidence-based practices in adolescent treatment, we found a couple of searchable databases maintained at the Alcohol and Drug Abuse Institute at the University of Washington.

• Evidence-based treatment
• Screening & assessment instruments

If you find other useful tools or tips on evidence-based treatment, feel free to post a comment to this entry.

Screening & Assessment Survey

Click on the following to link to take the T-ACT Project Advisory Board Screening & Assessment Survey. The survey should take about 10 minutes.

Under Construction

As you may be able to tell, the blog is very much a skeleton at this point and is still under construction. The Vanderbilt evaluation team's weblog (or blog) for T-ACT is designed to provide:

1. information to T-ACT Project Advisory Board members about the project,
   
2. a forum for members to discuss or provide information about particular issues, and
   
3. a resource for information related to the project or substance abuse services and adolescents.

This is also a test to see whether this new technology can be helpful in providing a communications hub for projects like this. Our hope is that it eventually will serve as an electronic community bulletin board where members may post their own announcements or questions directly to spark discussion among members and speed dissemination of information.

Also, the list of links is far from complete. If you would like to suggest a site for us to link to, please feel free to make the suggestion in a comment to this post. Or, you may email Robert Saunders at Robert.C.Saunders [ AT ] Vanderbilt.Edu.

We hope this proves useful and beneficial for members.

Welcome!

Welcome to the Blog for the Tennessee Adolescent Coordination of Treatment project. This blog is a forum for project advisory board members to brainstorm about issues in the coordination of adolescent substance abuse treatment services.