Surgeon General’s Report on Alcohol, Drugs, and Health

by Bridget Murphy

There are so many noteworthy aspects to the “first ever” Surgeon General’s Report on Alcohol, Drugs, and Health. For example, it is grounded in the best evidence available to date and it examines issues of neurobiology, prevention, treatment, recovery, and health care systems. It also has educational and promotional materials such as fact sheets and social media ideas and resources. If you have not reviewed it – now is the time. It’s my understanding that additional fact sheets are forthcoming including one on criminal/juvenile justice populations. As such, keep visiting the website for updates and let’s keep talking about this report and its importance to individuals, families, and communities impacted by substance misuse and/or disorders.

I want to take a moment to discuss the chapter on prevention. The efforts we make each day with youth and families to provide education; supports, Asian Girl 600 x 190 SGR Digital Ad (a)and services are likely preventing further consequences of substance use and involvement with juvenile/criminal justice systems. The Surgeon General’s report indicates that the “vast majority of people who misuse substances in the United States do not have a substance use disorder” (p. 3-4). This suggests that prevention efforts to educate and intervene about the potential harmful effects of substance misuse while offering healthy behavioral options might be sufficient for the majority of people. This is not to suggest that treatment options should be ignored; but rather, taking the time to respond to a young person’s needs using a continuum of services and supports is likely to be most effective.

The Surgeon General’s report discusses three prevention interventions – universal, selective, and indicated. I would like to suggest that these prevention interventions are directly aligned with Reclaiming Futures 6-step model.

  • Universal prevention strategies are designed for the entire population. Step 1.0 in the Reclaiming Futures model is screening. The goal of screening is to screen all youth involved with juvenile justice to help identify young people who may have substance use concern(s).
  • Selective prevention strategies are aimed at those who may have substance use and/or mental health concerns. The goal of step 1.5 (Reclaiming Futures’ brief intervention) and 2.0 (initial assessment) are to intervene and assess young people who show substance use concerns based on the screening results.
  • Indicated prevention strategies are for those involved with substance use at levels that suggest treatment is necessary. Using results from the screening, brief intervention, assessment and interaction with the young person, the goals of steps 3.0 – 6.0 are to coordinate services and work to assist the young person in initiating, engaging in, and transitioning from services.

Reclaiming Futures 6-step model is based on population and public health approaches and best practices in the prevention and treatment domains for both substance use and mental health concerns among young people involved in juvenile justice.

The Surgeon General’s prevention chapter discusses types of prevention, developmentally appropriate interventions, and cost benefits. Moreover, we must not forget the National Research Council’s (2013) publication Reforming Juvenile Justice A Developmental Approach and the entire chapter focused on prevention. Taken together, these two seminal reports communicate the importance of intervening at the appropriate time with the appropriate intervention, using evidence-supported tools and interventions while adhering to implementation fidelity. These reports detail the evidence that shows using these approaches improves health and wellness of young people, decrease crime/delinquency, and offer costs benefits.

Authors Note: Reclaiming Futures will be releasing an update to its 6-step model that adds step 1.5 for our brief intervention. Stay tuned for more information.

 

Bridget Murphy

About

Ms. Bridget Murphy understands behavioral health issues from personal, familial, and professional education and experiences. She joined the Reclaiming Futures National Program Office (NPO) as the Program and Policy Analyst and supports Reclaiming Futures sites by translating research into practice through training and technical assistance. She has more than two decades experience in the behavioral health field. Ms. Murphy has worked as a provider, project director/principal investigator, evaluator, consultant, and federal contractor. She has a particular interest in improving access to and quality of behavioral health services and its workforce through evidence-based practices, participant protections, peer and family recovery supports, integrated care, and participatory evaluation methods. Ms. Murphy has a master’s degree in education.

 

H.R.6 – 21st Century Cures Act

by Bridget Murphy

Acknowledged as the final signed legislation for President Obama’s Administration, the 21st CeBridgetntury Cures Act is important for behavioral health and juvenile justice. The key components of this Act include provisions for:

In addition to the jurisdiction and community level supports, the Act provides structural changes to the way the government oversees and funds behavioral health. The 21st Century Cures Act includes developing a committee for federal agencies such as the Substance Abuse and Mental Health Services Administration, Department of Justice to work together on behavioral health issues; it designates a new position – Assistance Secretary for Mental Health and Substance Use, and designates an advisory board for analyzing treatments and services.

I am optimistic this Act will help coordinate funding and improve behavioral health policy, improve practice to identify individuals in need of services, increase equitable access to evidence-based services and supports, reduce stigma associated with accessing services by celebrating those in recovery, and expand the availability of community-based treatment throughout the United States.

2017 is guaranteed to bring many changes. I hope this Act will offer the field the leadership, coordination, funding, and research that will help us continue to improve the work we do in partnership with youth, families, and communities.

Bridget Murphy

About

Ms. Bridget Murphy understands behavioral health issues from personal, familial, and professional education and experiences. She joined the Reclaiming Futures National Program Office (NPO) as the Program and Policy Analyst and supports Reclaiming Futures sites by translating research into practice through training and technical assistance. She has more than two decades experience in the behavioral health field. Ms. Murphy has worked as a provider, project director/principal investigator, evaluator, consultant, and federal contractor. She has a particular interest in improving access to and quality of behavioral health services and its workforce through evidence-based practices, participant protections, peer and family recovery supports, integrated care, and participatory evaluation methods. Ms. Murphy has a master’s degree in education.

 

News from the National Executive Director, November 2016

by Evan Elkin

Reclaiming Futures National Executive Director Evan ElkinIn this month’s Reclaiming Futures newsletter, we draw your attention to a new report issued by US Surgeon General Vivek Murthy on November 17, 2016.  The report is significant because it marks the first time a United States Surgeon General has taken such a clear and strong position that substance use and addiction should be viewed first and foremost as a public health issue.  This is a position many advocates and organizations, like Reclaiming Futures, have taken for many years because we know firsthand the collateral consequences of continuing to view substance use and addiction as a moral failing and as a matter for the criminal justice system, and not the public health system and/or through a racially biased lens.

We know from our own work and national evaluation results that partnering with juvenile justice systems across the country to adopt a public health lens and replacing punitive responses with science-based, humanistic, and community-driven treatment alternatives, attending to issues of equity in access to care and justice, not only leads to better health outcomes for youth, but reduces recidivism and saves significant taxpayer dollars that could be reinvested in community-based treatment alternatives.

The Surgeon General’s report is encouraging and the potential policy and national public health implications of the Surgeon General’s position are enormous, but only if there continues to be high level government support and investment in continued reforms to the way we view and respond to substance use and mental health treatment needs in this country.

Evan Elkin

About

Evan Elkin is the executive director of Reclaiming Futures.

 

News from the National Executive Director, August 2016

by Evan Elkin

Reclaiming Futures National Executive Director Evan ElkinIn the current Reclaiming Futures newsletter we focus our attention on Screening Brief Intervention and Referral to Treatment (SBIRT). SBIRT is a public health-oriented framework revolutionizing the way we think about behavioral health and substance use screening and prevention. Buoyed by strong evidence from the adult research literature, there has been a surge in national interest in translating the successes of the adult SBIRT model for youth populations.

The process of developing an SBIRT framework for youth is in its very early stages and the interest in the approach is currently outpacing the presence of either a body of research evidence and a set of best practices to guide the field. However, with a significant strategic investment by the Conrad N. Hilton Foundation (CNHF), the field is making strides. Among other elements of a multi-pronged strategy, CNHF is supporting the field to develop and pilot innovative approaches to youth SBIRT, to look at workforce training, and to explore appropriate settings for implementation. The result has been to challenge a number of youth-serving systems like schools and juvenile justice systems to view their work with youth through a public health lens.

Reclaiming Futures is a grantee of CNHF and has been tasked with developing a new adaptation of SBIRT for juvenile justice system involved youth populations. See a recent blog post by Reclaiming Futures Program and Policy Analyst Bridget Murphy for an update on our SBIRT pilot. Reclaiming Futures has also just embarked on a project to collaborate with a number of tribal communities, beginning with the Yurok Tribal Community of Northern California, to develop a cultural adaptation of our SBIRT approach for tribal youth. We look forward to reporting on the progress of that work in an upcoming newsletter.

Evan Elkin

About

Evan Elkin is the executive director of Reclaiming Futures.

 

Year 2 Update! Reclaiming Futures’ Version of Screening, Brief Intervention, and Referral to Treatment (SBIRT)

by Bridget Murphy

As many of you know, Reclaiming Futures was awarded a Conrad N. Hilton Foundation grant in September 2014. The purpose of this grant is to develop, pilot test, evaluate, and disseminate a new version of SBIRT for youth at risk for deeper involvement with the juvenile justice system. As a first step, Reclaiming Futures issued a request for proposals and awarded five sites to help us in the endeavor. The sites selected, through a competitive process, were:

  • Chittenden County, Vermont
  • King County, Washington
  • Mecklenburg County, North Carolina
  • Nassau County, New York
  • Washington County, OregonMap of Reclaiming Futures sites, now including NW Ohio

Subsequently, in April 2016, using local resources, four sites in Ohio joined our SBIRT initiative. These sites include:

  • Hocking County
  • Lucas County
  • Montgomery County
  • Northwest Ohio – Three County Collaboration (Williams, Henry, and Defiance Counties)

We are wrapping up the second year of the Hilton funding and have some exciting updates. Before I share our collective accomplishments and upcoming directions, let me provide a little information about SBIRT and Reclaiming Futures’ version of SBIRT.

As you may know, SBIRT is a population health approach designed to offer universal screening to help identify individuals in need of behavioral health supports, services, and/or treatment (substance use or mental health). Historically, SBIRT has been implemented in primary care settings and is used to detect unhealthy alcohol or other drug use and to intervene in order to prevent further problems or severity. Our project is unique as we are working in juvenile justice settings. The goal is to combine public health and justice approaches to identify, intervene, and refer youth who are in the pre-adjudication phase to prevent further penetration in the justice system. There is another Hilton funded project working in juvenile justice being led by the National Center on Mental Health and Juvenile Justice (NCMHJJ). Together, Reclaiming Futures and NCMHJJ will be able to offer important implementation considerations about SBIRT in juvenile justice settings.

Reclaiming Futures executive director Evan Elkin and his colleagues developed our four-session brief intervention. It is strength-based and uses Motivational Interviewing as a way to engage youth and families. The intervention allows the youth to examine how behavioral health concerns might be influencing their goals. It also encourages parents/caregivers to create empathetic environments by remembering their own experiences as a youth and learning about adolescent development. In addition, it reminds project staff to take time to gain insight about the context of a family’s situation prior to making justice, treatment, or community decisions. While we are still early in implementation, we are optimistic about the promising benefits to families – as the SBIRT coordinator at one of the pilot sites said:

“I can’t fully express the beauty and joy that are these sessions. The rapport that is built through the activities in the parent session that dovetails so gracefully into the parent/youth session is profound. Every time I have a session I benefit from the experience of a deeper and sometimes in that moment unearthed, if only for a short time, bond between a parent and their teen. It is an honor every time to witness parents with their children in those moments. The activities allow me to be a trusted bystander while the family interacts. It is seriously awesome.”

–Katherine Wiley, Washington County, Oregon

We have some other notable accomplishments since beginning implementation:

  • Through a competitive process, we hired an external evaluator to conduct a cross-site process and outcome study – Impact Justice is leading it. This included designing research protocols, training project staff on participant protections, and obtaining Portland State University Institutional Review Board and National Institutes of Health, Certificate of Confidentiality approvals
  • Developed and implemented a screening tool and feedback report that combines strength-based questions with the Global Appraisal of Individual Needs – Short Screener
  • Engaged sites to provided us with invaluable feedback for refining the intervention and implementation process
  • As of the end of June, 2016, we have:
    • Enrolled 36 youth into the evaluation and they are in some phase of the project (intervention; follow up)
    • Trained 165 providers. Providers are defined as individuals who are implementing or supervising the implementation of SBIRT
    • Distributed SBIRT related materials to 403 people (PowerPoint slide deck; manual)
    • Completed 44 monthly implementation calls
    • Hosted SBIRT-specific monthly Learning Collaborative calls. Rates of staff attendance vary by site, but, on average, staff have participated in 89% of the calls
    • Disseminated Reclaiming Futures version of SBIRT through formal activities (e.g., presentation); we have reached approximately 435 people

Futures Directions:

We recently held a Training of Trainers (ToT) event to increase our capacity for training with current sites and for sustainability purposes. We continue to expand by seeking other partners in schools and juvenile justice settings. For example, recently in collaboration with the Center for Court Innovation, we have begun working on a Tribal version of SBIRT. The evaluators will be conducting on-site visits with the Hilton funded grants to examine the process of implementation.

If you would like more information, please feel free to contact us.

Bridget Murphy

About

Ms. Bridget Murphy understands behavioral health issues from personal, familial, and professional education and experiences. She joined the Reclaiming Futures National Program Office (NPO) as the Program and Policy Analyst and supports Reclaiming Futures sites by translating research into practice through training and technical assistance. She has more than two decades experience in the behavioral health field. Ms. Murphy has worked as a provider, project director/principal investigator, evaluator, consultant, and federal contractor. She has a particular interest in improving access to and quality of behavioral health services and its workforce through evidence-based practices, participant protections, peer and family recovery supports, integrated care, and participatory evaluation methods. Ms. Murphy has a master’s degree in education.

 

“Read All About It” – Research Findings Published!

by Bridget Murphy

BridgetReasons why I am proud to write this blog post…

Reason 1: My former colleagues (and friends) at The University of Arizona, Southwest Institute for Research on Women (UA SIROW) (UA SIROW) have been leading the efforts on the national evaluation of Juvenile Drug Courts and Juvenile Drug Courts blended with Reclaiming Futures (JDC/RF).  UA SIROW collaborated with Chestnut Health Systems and Carnevale Associates, LLC to implement a comprehensive evaluation that included data from Juvenile Drug Courts, Juvenile Drugs Courts blended with Reclaiming Futures, and non-justice related intensive adolescent outpatient programs. The purpose was to examine processes, outcomes, and costs.

Reason 2: A collection of five research reports and two commentaries are published in a guest issue of the Drug Court Review – a project of the National Drug Court Institute.

Reason 3: A logic model was developed for the blended juvenile drug courts and Reclaiming Futures, which includes problem statement(s), sub-problems, goals, objectives, key activities, and output measures (Greene, et. al., p. 31). With proper credit to the authors, this could be adapted and used in other jurisdictions implementing Juvenile Drug Courts and Reclaiming Futures.

Reason 4: The collection of research articles highlights some key points:

  • A historical look at the implementation and evaluations of Juvenile Drug Courts and Reclaiming Futures (Dennis, et. al., p. 6)
  • Youth enrolled in JDC/RF are younger, male, and nonwhite, in comparison to the general population of youth who met criteria for JDC (Baumer et. al., p. 60)
  • Reductions in substance use and delinquency/crime were evidenced over time.
  • Seven program characteristics were found to positively impact substance use and crime/delinquency changes over time including (Korchmaros, et. al. p. 80):
    • Having a defined target population and eligibility criteria
    • Imposing sanctions to modify non compliance
    • Conducting random and observed drug testing
    • Coordinating with the school system
    • Providing gender-appropriate treatment
    • Employing policies and procedures responsive to cultural differences
    • Training personnel to be culturally competent
  • Eight feasible recommendations for engaging the community to improve health and well-being of youth and families are discussed (Greene, et. al, p. 150)

Reason 5: While Reclaiming Futures has had previously published peer reviewed journal articles and reports (RF_Bibliography 07.06.16), this is the first to examine youth characteristics, effective program characteristics, and youth changes over time as it relates to the blended approach of Juvenile Drug Courts and Reclaiming Futures. As Tyson (2016, p. 163) indicates these studies do not conclusively support this approach as the only way to work with youth involved in the juvenile justice system, but they offer the important information about the “why, who, and how” for supporting and improving the practice of juvenile justice services and supports.

Reason 6: Policy recommendations are summarized about the research findings (Kagan & Ostlie, 2016, p. 155). The authors recommend targeting youth with high substance use severity and delinquency/crime as these youth seem most responsive to this approach and model. It is recommended to identify youth through universal screening and assessments. Furthermore, it is recommended that juvenile justice jurisdictions ensure that the implementation of the seven program characteristics found to reduce substance use and crime/delinquency.

For these reasons, I am thrilled to help disseminate this work. Of course, maintaining a critical eye on any type of research is important. All studies have limitations, but scholars that discuss these limitations and leave the reader with additional questions to consider helps build the foundation for improved policy, practice, and subsequent studies. We encourage the Reclaiming Futures community to read and share these articles and discuss how policy and practice improvements might be made based on the research findings.

 

Bridget Murphy

About

Ms. Bridget Murphy understands behavioral health issues from personal, familial, and professional education and experiences. She joined the Reclaiming Futures National Program Office (NPO) as the Program and Policy Analyst and supports Reclaiming Futures sites by translating research into practice through training and technical assistance. She has more than two decades experience in the behavioral health field. Ms. Murphy has worked as a provider, project director/principal investigator, evaluator, consultant, and federal contractor. She has a particular interest in improving access to and quality of behavioral health services and its workforce through evidence-based practices, participant protections, peer and family recovery supports, integrated care, and participatory evaluation methods. Ms. Murphy has a master’s degree in education.

 

Talking About Addiction

by Kate Knappett

On June 1, 2016, our Reclaiming Futures national executive director Evan Elkin spoke at Red Emma’s in Baltimore for Open Society Institute-Baltimore’s second event in their “Talking About Addiction” series. Elkin was accompanied on the panel by Dr. Hoover Adger from Johns Hopkins Children’s Center and by Carin Callan Miller, who founded Save Our Children Peer Family Support. The conversation was moderated by Scott Nolen, director of OSI-Baltimore’s Drug Addiction Treatment Program. A full room of community members joined them for the evening, including families affected by adolescent addiction.

Youth, Addiction and the Juvenile Justice System

Whereas the first “Talking About Addiction” event explored alternative law enforcement approaches to addiction, this event focused on youth, addiction, and the juvenile justice system. Despite public acknowledgment of the failures of the “War on Drugs,” and an increased understanding of addiction as a public health issue rather than a criminal justice issue, OSI-Baltimore recognizes that research and policy around adolescent addiction are slow to reach the mainstream. Indeed, during the discussion, some attendees expressed frustration with how long addiction treatment reform is taking; OSI moderator Nolen suggested reassurance that the addiction paradigm is finally shifting.

The conversation was reported on by the Juvenile Justice Information Exchange and OSI-Baltimore and includes these takeaways:

  • Inequitable healthcare makes for inadequate healthcare infrastructures
  • Race plays a significant role in adolescent substance use treatment
  • The stigma surrounding addiction is an obstacle for treatment
  • Teens need access to substance use treatment in their communities, rather than the system
  • Youth treatment should consider the whole family and not take a punitive approach

If you missed the discussion, but would like to know more, you can listen to this WEAA Marc Steiner Show podcast which includes an hour-long talk with Elkin and Nolen recorded on the morning of the event.

Kate Knappett

About Kate Knappett

Kate Knappett is a member of the Reclaiming Futures National Program Office.

 

Youth Justice News Roundup

by Kate Knappett

We round up the latest news on youth justice reform and national public health.

  • OSI-Baltimore hosts their second “Talking About Addiction” event. Open Society Institute-Baltimore hosted the second event in their “Talking About Addiction” series on Wednesday. The discussion was focused on youth justice and addiction; the panel of speakers included Evan Elkin (Reclaiming Futures), as well as Dr. Hoover Adger (Johns Hopkins Children’s Center) and Carin Callan Miller (Save Our Children). [Open Society Institute-Baltimore]
  • For new events, webinars, jobs, and grants visit the Reclaiming Futures Opportunity Board.
Kate Knappett

About Kate Knappett

Kate Knappett is a member of the Reclaiming Futures National Program Office.

 

News from the National Executive Director, May 2016

by Evan Elkin

America is facing a heroin and opiate crisis. Heroin is increasingly popular – a report by the federal Substance Abuse and Mental Health Administration indicates that first-time heroin users doubled between 2006 and 2013 and data from the National Institute on Drug Abuse opiates imageindicate that deadly heroin overdoses increased sixfold in the years between 2001 and 2014. More than ever before, this crisis is addressed as a public health issue more than as a public safety or criminal justice issue. This shift has sparked much public debate about why this is the case. Have we finally reached a tipping point as a society in our views of addiction as a health concern? Have irresponsible pain management prescription practices contributed to opening our eyes to one of the epidemic’s root causes? Some argue that race is a critical part of the story and feel that the shifting demographic – with an apparent increase in the proportion of white heroin and opiate users – is what has changed the perception of heroin abuse and finally mobilized policy makers. In this month’s Reclaiming Futures newsletter, we focused our attention on the issues surrounding the opiate crisis and featured a new blog post by Reclaiming Futures Program and Policy Analyst Bridget Murphy.

Evan Elkin

About

Evan Elkin is the executive director of Reclaiming Futures.

 

Opiates: A National Discussion

by Bridget Murphy

On March 29, 2016 President Barack Obama communicated support for addressing the opiate and heroin crisis in the United States. Joined by physicians and individuals in recovery on a panel at the National Rx Drug Abuse and Heroin Summit in Atlanta, GA, President Obama announced several private and public sector supports including access to treatment, medical coverage and physician training, enforcement to combat distribution, and a number of other services. At the same time, the Centers for Medicare & Medicaid Services finalized “a rule to strengthen access to mental health and substance use disorder treatment.

These services and supports are specific to opiates and heroin and thisPAGE 2-COUNSELOR is good news for the juvenile justice and substance use disorders fields. Why….? Let me explain.

Although the majority of adolescents present to treatment for alcohol or cannabis problems and disorders, intervening early may prevent the onset of heroin and non-prescription use of pain relievers. Adolescent use of opiates has not significantly changed in recent years; however, for transitional aged youth it has. According to the 2014 National Survey on Drug Use and Health found that as compared to the 2009 rates, past year heroin use among 18 to 25 year olds has significantly increased (0.5 vs. 0.8). Additionally, the Center for Disease Control (CDC) reported a 14% increase in opioid overdoses in one year. Providing the necessary services and supports to adolescents and their families involved with the juvenile justice system, including education of heroin and opiate addiction, has the potential to change these significant increases in use and deaths.

Why else is this good news? If you listen to conversation about this issue – it has a very different tone and message. It elevates opiate and heroin addiction and recovery as a public health versus a criminal issue. Having a national discussion about addiction and recovery in which youth and families are not criminalized for substance use disorders, but rather, offered prevention, support, treatment, and recovery is an important shift and one that is likely to improve health and related outcomes.

It has been argued that shifting demographics and increased use and overdose rates among suburban white youth has been a catalyst for the policy and practices changes. While that is a valid observation, there are a number of factors influencing these changes including our better understanding of addiction,  increased identification of individuals in need through screening, brief intervention, and referral to treatment (SBIRT), effective medications and behavioral treatments, increased availability and simplicity of Narcan to reverse overdose, improved community responses, and better training and practices for law enforcement. Yet, we must continue to be vigilant in reducing public health disparities in access to effective treatment and supports. We need to ensure and advocate for fair distribution of resources to all communities affected by heroin and opiates. And, we should use this opportunity to change the paradigm that criminalizes individuals struggling with substance use problems and disorders by increasing the availability of culturally and linguistically responsive evidence-based prevention, treatment, and recovery supports for youth and families.

Bridget Murphy

About

Ms. Bridget Murphy understands behavioral health issues from personal, familial, and professional education and experiences. She joined the Reclaiming Futures National Program Office (NPO) as the Program and Policy Analyst and supports Reclaiming Futures sites by translating research into practice through training and technical assistance. She has more than two decades experience in the behavioral health field. Ms. Murphy has worked as a provider, project director/principal investigator, evaluator, consultant, and federal contractor. She has a particular interest in improving access to and quality of behavioral health services and its workforce through evidence-based practices, participant protections, peer and family recovery supports, integrated care, and participatory evaluation methods. Ms. Murphy has a master’s degree in education.