Academy Community

SAMHSA is allocating $50 million to Tribal Opioid Response Grants. This money will go to tribes and tribal organizations to fund prevention, treatment and recovery activities in response to the opioid crisis. By increasing community access to culturally appropriate #EBPs, including #MAT, grants will reduce unmet treatment needs and opioid overdose-related deaths. This effort is in line with U.S. Department of Health and Human Services (DHHS) five-point Opioid Strategy. Do you know what the five-point areas are? https://www.samhsa.gov/newsroom/press-announcements/201806210500

Deadline approaches for NASHP’s State #SUD Policy Institute: Leveraging Federally Qualified Health Centers (FQHCs). The institute will support up to five state teams to develop innovative strategies to increase access to and quality of #SUD treatment, recovery and prevention for Medicaid beneficiaries. Apply by Tuesday, July 31, 2018. Check the website for fast facts and further information: https://nashp.org/apply-today-nashps-state-sud-policy-institute-supports...

Sustaining Healthcare Across Integrated Primary Care Efforts (SHAPE) has practice, policy and research implications. SHAPE demonstrated that integrated primary care practices utilizing alternative and flexible non-fee for service payment models decreased net cost and increased access to behavioral health services. As a practitioner or clinician, what are some practice level mechanisms that facilitate cost savings? Comment below and check out the full article:  https://www.ncbi.nlm.nih.gov/pubmed/term=Cost+savings+associated+with+a...

The Health Resources and Services Administration (HRSA) is seeking a contractor to provide enhanced training and technical assistance (T/TA) to HRSA-supported Health Centers. T/TA in #EBP and treatment approaches for primary care providers and interdisciplinary care coordination teams will help to advance the primary care integration of behavioral health and substance abuse services. See the solicitation here: https://www.fbo.gov/indexs=opportunity&mode=form&id=3c20aec86b7b4d5c007...

SAMHSA announced a $930 million funding opportunity that aims to combat the opioid crisis by increasing access to treatments that work and ultimately reducing opioid-related overdose deaths. Of the total funds, 15% will be set aside specifically to provide extra funds for states/territories that have been hit the hardest by the opioid epidemic.
Where does your state/territory fit in to the prevention, treatment, and recovery response to the opioid crisis, and how could this funding opportunity be useful for those efforts?
https://www.hhs.gov/about/news/2018/06/15/samhsa-announces-930-million-f...

Maternal depression screening can be claimed as a service for the child in well-child exams. Despite evidence that maternal depression is common (1 in 9 women experience it before, during or after pregnancy, CDC, 2018) and can negatively affect the development of young children, it is often undiagnosed and untreated. Medicaid policies vary by state and can include physician reimbursement for depression screening during well-child visits. Are you familiar with screening tools used to identify maternal depression? Find more information here: https://healthychild.nashp.org/resource-center/maternal-depression/

In primary care, as many as 2 in 3 adolescents with depression are not identified or treated appropriately. Guidelines to assist primary care clinicians in the identification and initial management of depressed adolescents may be a first step in providing whole person health care in primary care settings. Optimal diagnostic procedures should combine the use of parent and self-report depression-specific screening tools, followed by a more comprehensive clinical interview. How does adequate training in depression screening and treatment help to further the mission and delivery of comprehensive health care? Comment below, and see the full article at: http://pediatrics.aappublications.org/content/pediatrics/120/5/e1299.ful....

Additionally, check out the GLAD-PC toolkit (www.gladpc.org).

We can make health whole. makehealthwhole.org is Eugene S. Farley, Jr. Health Policy Center’s platform that highlights and progresses the journey of whole person health through a transformative series of issue briefs and other evidence, stories and advantages of integrating of mental, physical and social health needs. How could you use this resource in your work? Tell us about it and comment below.

Integrated primary care can increase access to addiction treatment for individuals with substance use disorders (SUDs). In many parts of the country, particularly in rural America, people must travel long distances to seek addiction treatment. Government leaders, clinicians, and medical educators have increasingly recognized that integration of addiction treatment into primary care settings is a practical and realistic access point to help those with SUDs. Read the article to learn more about models of action, incentives for primary care, and open door clinics: http://www.commonwealthfund.org/publications/newsletters/transforming-ca...

Fragmentation of care is a barrier to delivering adequate mental and behavioral health services. This, along with absent or inadequate insurance coverage and lack of access to specialty care, according to the NEJM Catalyst Insights Council Survey on Care Redesign: Integrating Mental and Behavioral Health into Care Delivery. Learn about examples of successful whole-person health care delivery systems and more: https://catalyst.nejm.org/time-treat-mental-and-behavioral-health-equal-...

Stigma has become increasingly recognized as a major population health concern. How can we stop the stigma train? Stigma is social. According to Daniel Goldberg, (of the University of Colorado’s Center for Bioethics and Humanities) “there is ample evidence of the commonality with which health care providers, public health officials and policymakers channel and intensify stigma against the least well-off.” The foundations of stigma are firmly rooted in social structures. Even before a person seeks health services, they are already more likely to have experienced stigma in multiple social domains. Learn how religious beliefs, evolutionary perspectives, chronic pain disability, and the opioid epidemic are all tied to social and health stigma. Daniel Goldberg’s Introduction on Stigma & Health: http://journals.sagepub.com/doi/abs/10.1177/1073110517750581?journalCode....

From 1999-2015, the opioid death rates in rural areas have quadrupled among 18-25-year olds and tripled for females. Differences in socioeconomic factors contribute to drug overdoses and, among other unintentional injuries, are 50% higher in rural versus urban areas. Learn more about the opioid epidemic:          https://blogs.cdc.gov/publichealthmatters/2017/11/opioids/. What specific practices can help prevent the rise of drug overdoses in rural America?

Adolescent Substance Use Screening Tools: Brief Screener for Alcohol, Tobacco and other Drugs (BSTAD) and Screening to Brief Intervention (S2BI). Have you heard of them? Take the screener as a patient or clinician to see summary and implications of score and suggested clinician action. Additional tools for high risk patients, and FAQs about these tools also found here: https://www.drugabuse.gov/adolescent-substance-use-screening-tools

What is value-based payment and how will it address the opioid addiction crisis? Value-based payment models are emerging as a broader and more sustainable strategy to successfully implement a cascade treatment of care framework that is effective in addressing the opioid epidemic. Value-based payment models include provider accountability through incentives, quality measures, performance reports and quality improvement plans. Consequentially, this treatment model aims to provide better individual, community and population health outcomes and reduce health care costs.

Take a look at evidence of cost-effectiveness of value-based payment systems used in state Medicaid agencies and accountable care organizations (ACOs): https://www.healthaffairs.org/action/showDoPubSecure?doi=10.1377%2Fhblog...

Is your state Medicaid agency pursuing an 1115(a) demonstration? The Centers for Medicare & Medicaid Services (CMS) announced a new direction to address opioid use disorder (OUD) and substance use disorders (SUDs) crises. Despite the effectiveness of evidence-based treatment for OUD and SUDs, only about one in five people who currently need treatment actually receive it. The CMS announced a revised policy direction to more progressively support patients struggling with OUD and SUDs with an intention to create a more robust continuum of care. The new initiative demonstrates action to improve access to high quality treatment opportunities through specific goals and milestones to be addressed in state applications for section 1115(a) demonstrations. Check them out at: https://www.medicaid.gov/federal-policy-guidance/downloads/smd17003.pdf

A must read - Behavioral Health Integration in Pediatric Primary Care: Considerations and opportunities for Policymakers, Planners, and Providers is a report that focuses exclusively on mental health and developmental disorders in children. It explores the prevalence of childhood behavioral health problems; describes the need for, barriers to, and models of behavioral health integration in pediatrics; and offers policy and implementation considerations for policymakers, planners, and providers. The estimation is that only 15-25% of children with psychiatric disorders receive specialty care. Read the full report here: https://www.milbank.org/wpcontent/uploads/2017/03/MMF_BHI_REPORT_FINAL.pdf (PDF - 326.44 KB)

Have you seen the first-ever Surgeon General’s Report on Alcohol, Drugs, and Health? The report presents what is known about substance misuse as well as suggestions for action among key stakeholders, including individuals and families, educators, health care professionals, health care systems, researchers, and more. https://addiction.surgeongeneral.gov

Join me in welcoming our new members of the National Integration Academy Council (NIAC):

James Berry, DO
Mark Duncan, MD
Andrea Hayes, RN, MPH
Noah Nesin, MD

The NIAC members represent diverse areas of content expertise, experience, and approach to integrating behavioral health and primary care, and advise the Academy on strategic initiatives. Learn more about our experts here: https://integrationacademy.ahrq.gov/about-us/academy-team/niac-bios

A 10 year view of integrated healthcare from Intermountain. http://www.healthcareitnews.com/news/intermountain-healthcare-study-show...

Integration is one way to truly combat mental health stigma; however, we should not lose sight of the need to address prevention, too: http://healthaffairs.org/blog/2016/06/30/no-room-for-prevention-the-unin...