Reclaiming Futures Expansion

RWJF is expanding its Reclaiming Futures program for teens in the justices sytem with substance abuse problems. From the news release at CADCA:

The RWJF board approved $6.5 million to support the 10 pilot sites for two more years and to help additional new sites implement the Reclaiming Futures model over the next four years. The expanded effort also will create a national resource center to provide data, case studies and other information to even more communities seeking to improve drug and alcohol services for justice-involved youth.

...

The Reclaiming Futures model combines system reform, treatment improvement and community engagement to help teens in the justice system get off drugs and alcohol. Teens who enter the justice system with serious drug and alcohol problems rarely receive treatment, even though research shows that young people who use drugs and alcohol are more likely to end up in trouble with the law, behave violently, or drop out of school.

Key elements of the Reclaiming Futures model include screening and assessing teens for drug and alcohol problems; assembling a team to develop a personal care plan; training drug and alcohol treatment providers in evidence-based practices that work with teens; providing family support; and involving community members as mentors and role models to provide the support teens need.

Beginning in 2002, 10 communities helped create and test the Reclaiming Futures model: Anchorage, Alaska.; Santa Cruz, Calif.; Chicago, Ill.; four counties in Southeastern Kentucky; Marquette, Mich.; the state of New Hampshire; the Sovereign Tribal Nation of Sicangu Lakota in Rosebud, South Dakota; Dayton, Ohio; Portland, Ore.; and Seattle, Wash.

NIDA's Science of Addiction

NIDA has published a consumer publication titled, "Drugs, Brains, and Behavior: The Science of Addiction."

The report is part of a larger media effort to reduce stigma and increase understanding of addictive disorders, including an HBO documentary, "Addiction," scheduled to air on HBO at 9:00 ET 15 March 2007. The documentary is funded by RWJF, NIDA, and NIAAA.

Note: For those attending JMATE in April, the documentary will be screened on the first day of the conference.

COCE Monthly Review

SAMHSA's Co-Occurring Center for Excellence (COCE) has released its current issue of COD Research and Resources Monthly Review (v2,n2).

Consumer-Driven Health Purchasing

From State Health Watch (v14,n1)...HSR: Health Servies Research is publishing a special issue (February 2007 - Vol. 42 Issue 1,pt2, pp.353-586--the link may only connect for individual or institutional subscribers) devoted to the Cash & Counseling Medicaid demonstration program. The demonstration started in FL, NJ, and AR, and it has since expanded to 12 other states.

Targeted primarily at long-term care (i.e., nursing facilities) and home and community based services (HCBS) available through Medicaid, the program awards funds to Medicaid recipients to be used to purchase personal care or assistive services, instead of relying upon direct funding to home care agencies. Briefly, the program led to somewhat increased program costs because consumers randomly assigned to the demonstration connected themselves to more support services and these additional services identified greater health care needs than had been addressed, whereas individuals in the usual care condition were less likely to receive care at all. The demonstration also helped individuals in areas with a labor shortage to obtain support services more easily than those in usual care.

HCBS is a Medicaid funding option in other states that may allow substitution of outpatient services for residential substance abuse treatment or enhancement of residential treatment with community support services. What opportunities might there be for adolescents and their families to use this model? What capacity is there for Tennessee to implement such a model? What are the costs and benefits of such a change?

Update: For those interested in obtaining copies of the HSR articles, email me and I will try to connect you to them.

Telehealth Audioconference

I just received an email announcing this audioconference on telehealth:

With health care costs rising—especially for patients in isolated areas or with chronic conditions—telehealth presents itself as an opportunity for patients, practitioners, and payers to reduce health care costs and improve quality. But many are not convinced, despite the possible benefits. Join us on March 15 at 1:00 pm ET as our panel of distinguished speakers will explore the challenge and opportunities in health technology, including reimbursement, regulatory concerns, and the actual nuts-and-bolts of providing care.

Attend this audio conference and explore:

• Benefits and services offered by telehealth networks
  
• What effect telehealth has on outcomes
  
• Cost and reimbursement issues of telehealth
  
• Legal and regulatory issues inherent in the offering of telehealth services

Don't miss this important educational opportunity—register today for this audio conference. All registered attendees will receive an email the day before the audio conference with instructions on how to access this event, and the special access website that contains an agenda and the speaker presentations.

Rural Telehealth

From State Health Watch (v14,n1)....The Roanoke Chowan Community Health Center (N.C.) received $360,000 to implement a telehealth intervention over the next three years. WebVMC's (Virtual Medical Care) RemoteNurse provides a method for doctors to monitor patients' vital signs and other risk factors related to obesity, cardiovascular disease, and diabetes. The RemoteNurse device has been installed in senior centers, churches, middle schools, and some patients' homes. There is no direct cost to the patient. Details on RemoteNurse are available at www.webvmc.com.

Are folks aware of similar telehealth interventions for substance abuse (or mental health) treatment, either generally or in Tennessee? Are there ways to apply a similar tool for adolescent substance abuse care? Could it be used in schools or jails as a means to monitor medication compliance and/or complications? Could it be used to monitor abstinence, directly or indirectly?

Satisfied Addicts Underestimate Their Cravings

A forthcoming article in the Journal of Health Economics, summarized here, describes a study in which heroin addicts were asked to rate how much money they would accept in lieu of a next dose. Addicts who had just received a dose severely underestimated their cravings relative to addicts who were asked the question before receiving the dose. Researchers suggest the inability to estimate their future cravings could play a role in the decision to use addictive drugs in the first place.

The study used a small sample of adults, but the results are consistent with somewhat similar research on teens:

Prior research has not addressed this issue directly. There is some research showing that young cigarette smokers significantly underestimate their own risk of becoming addicted (Slovic, 2001). For example, one study found that only 15% of high school students who smoked less than one cigarette per day predicted they might be smoking in 5 years when in fact 43% were still smoking 5 years later (Johnston et al., 1993). And, among high-school seniors who smoke, 56% predicted that they would not be smoking 5 years later, but only 30% had in fact quit at that point (Department of Health and Humans Services; cited in Gruber, 2001). However, there are many reasons why smokers may mispredict their own future behavior other than that they underestimated the impact of drug craving.

SA Prevention Info

CSAP sponsors five regional centers for the application of prevention technologies across the U.S. They include some information on evidence-based prevention activities and other information about prevention programs and resources.

ISATE Reports

The University of Memphis conducts a variety of data collection activities on behalf of BADAS and reports on individuals who use bureau funded services through its Institute for Substance Abuse Treatment Evaluation (ISATE). [Ed.: ISATE is the new name for the center that may be more familiar to some as Tennessee Outcomes for Alcohol and Drug Services (TOADS).] A listing of reports is available here.

Substance Abuse and Child Welfare

SAMHSA is partnering with the Agency for Children, Youth, and Families (ACYF) to sponsor a National Center on Substance Abuse and Child Welfare (NCSACW). The mission:

"to improve systems and practice for families with substance use disorders who are involved in the child welfare and family judicial systems by assisting local, State and tribal agencies."

The site contains a variety of useful information about substance abuse and issues related to child maltreatment, interface between the substance abuse and child welfare systems, and technical assistance for those interested.

TCCY's Children's Advocacy Days

TCCY's Children's Advocacy Days '07 will be hosted 13-14 March 2007 in Nashville at Memorial Auditorium. The goal of CAD:

Many children born during 2007 should graduate from high school in 2025. Therefore, the theme of Children’s Advocacy Days 2007 is “Class of 2025: Looking Forward to a New Future.” Tennessee Children’s Advocacy Days 2007 will provide a forum for those working with, and on behalf of, children and families across the state to gain new information that will facilitate their efforts to improve the health and well-being of children and families in their communities. The conference, through key speakers and networking, is intended to:

• Promote greater knowledge and understanding of current issues confronting children and their families in Tennessee.
  
• Provide an opportunity for participants to become more effective advocates for children both in the public policy arena and in their communities.
  
• Provide an opportunity for participants to interact with Tennessee legislators on critical children’s issues.
  
• Provide an opportunity to hear perspectives on children’s issues and financing children’s services.

Click here for more info.

Vanderbilt Meth Forum

Vanderbilt University will be hosting a forum, "Meth Rescue: Meth’s Effects on Children, Families and the Foster Care System," on 24-27 Apr. 2007. The program is intended to help educate members of the media about methamphetamine abuse, treatment, and policy issues. Speakers include PAB members Michelle Crowley and Craig Anne Heflinger. View the Vanderbilt news release here.

Update: The conference is in April, not February as previously posted.

Cultural Competence & Disparities

This report by the National Initiative for Children's Healthcare Quality (NICHQ) includes some information about how to incorporate cultural competence into a health care organization. One of the premises of the report is that health disparities reflect quality disparities, so efforts to build cultural competence into an organization's quality improvement activities may reduce disparities.

PAB Annual Survey

In December 2005, the evaluation team circulated a two-page survey that asked about PAB members' priorities concerning coordination of treatment and what they perceived as the strengths they could contribute and barriers to coordination. We would like for you to complete this again for the current project year so that we may see how these ratings have changed over time. You may download the survey here (pdf) (or in Word format here), and you may fax it anonymously to Barbara and Nancy at 615-741-5719 or Robert at 615-322-1141. Please complete these before 2/14/2007 so that the results may be included in the projects semi-annual report to SAMHSA, which is due 3/1/2007. You may also email or mail the completed survey if you desire. Note: New board members should complete the survey, even if they did not complete the first survey in December 2005/January 2006.

Also, as part of the 1-on-1 interviews for the first year evaluation, I distributed copies of a longer survey, the Assessing Local Service Systems instrument. I did not include results of this in the preliminary evaluation results because so few responded. In the event you misplaced this instrument, you may download the form here and submit it by fax to Robert at 615-322-1141 or by mail to:

Robert Saunders
Box 90 GPC
Vanderbilt University
Nashville, TN 37203

Please complete these before 2/21/2007 so that the results may be included in the final first year evaluation report.

NIATx Training

NIATx is sponsoring a training session 23-25 April 2007 in San Antonio. The title of the training is, "Improving Access and Engagement in Addiction and Behavioral Health Treatment."

For those of you who do not know about NIATx, it stands for Network for the Improvement of Addiction Treatment. The organization was started by a group of human factors engineers who apply the principles of process measurement and design from the industrial world to the treatment of addiction disorders. Among their particular research interests are how to decrease wait times, improve retention in treatment, and reduce no shows. They focus intently on the day-to-day administrative and clinical processes of care and how those contribute to such problems and how they may be overcome.

T-ACT Glossary

A copy of the project glossary is available for download here. I have included a link to it on the righthand side, too.