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Latest SAMHSA News Highlights Work of GAINS Center: Turning Point – Criminal Justice to Behavioral Health

For individuals entering the criminal justice system, the experience of incarceration can lead to disconnection from supportive relationships, weakened self-esteem, and additional trauma and violence. Those with behavioral health conditions have a particularly difficult time in jail and prison – not only do these environments impede recovery, they can make life even more challenging after release. Many justice systems, including police, corrections, and courts work closely with behavioral health agencies to screen for mental or substance use disorders and refer individuals who need help to treatment and support.

SAMHSA has been supporting jail diversion programs – criminal justice system-based screening, assessment, referral to treatment, and diversion efforts – for individuals, including veterans, who enter the system, in part, because of mental or substance use conditions. Jail diversion programs are set up to be a "positive pipeline" to connect the person with behavioral health supports, while offering the chance to reduce or avoid jail time in exchange for a commitment to pursue wellness and recovery.

While some communities have a well-established court-to-provider diversion system, others are just starting to explore what might be established in their community. SAMHSA has two new resources that can help.

For additional information read the full SAMHSA News article.

Note. Adapted from "Turning Point: Criminal Justice to Behavioral Health," by Substance Abuse and Mental Health Services Administration, 2016, SAMHSA News.

GAINS Center Facilitates Trauma-Informed Train-the-Trainer Event in King County, WA

SAMHSA's GAINS Center Senior Project Associate Lisa Callahan and Project Associate Ashley Krider recently traveled to Seattle, WA, to facilitate a How Being Trauma-Informed Improves Criminal Justice System Responses Train-the-Trainer event. The two-day event, held June 23-24, 2016, was organized to train a select group of individuals from throughout King County, WA, on how to deliver the training and equip them with the skills and resources necessary to be effective trainers. The objectives of the train-the-trainer event were to:

Patty Noble-Desy, Recidivism Reduction and Reentry Senior Manager at the Office of the King County Executive, submitted an application for the train-the-trainer event in response to the national solicitation that the GAINS Center released in October 2015. The group was one of six selected to receive the training from a field of 58 applicants.

23 trainees participated in the event including representatives from the King County Sheriff's Office, King County Behavioral Health and Recovery Division, King County Drug Court, King County Department of Adult and Juvenile Probation, King County Department of Public Defense, King County Executive's Office, Seattle Police Department, Seattle Municipal Courts Probation, Washington Department of Corrections, and several local behavioral health treatment provider organizations.

To learn more about opportunities for trauma training through the GAINS Center please visit our website.

SMVF TA Center Presents: Critical Partners and Next Steps for Expanding Diversion Opportunities and Implementing Veterans Treatment Courts

On Wednesday July 27, 2016, from 2:00-3:00 PM EDT, the Service Members, Veterans, and their Families (SMVF) Technical Assistance (TA) Center will host a virtual learning event that will provide information for moving forward in the implementation of best practices for expanding veterans treatment courts. Veterans treatment courts, a component of the Sequential Intercept Model, give service members, veterans, and their families (SMVF) the opportunity to not only address their behavioral health needs but avoid the negative and compounding impacts of incarceration. As many states and communities are working towards implementing and expanding their veterans treatment courts, there are essential partnerships, tools, and resources to consider that can help simplify the process.

Evidence shows that SMVF respond favorably to this best-practice model and that it offers a means of ensuring that service members and veterans meet their obligations and get the help they deserve. Typically, there are several key players that must collaborate to effectively implement and adopt this approach. This webinar will feature opportunities for discussion and guidance from both a national justice subject matter expert and a SMVF justice peer outreach worker. The webinar will feature lessons learned from their work with states that have successfully implemented this model.

Objectives

Moderator
Michelle Cleary, M.A. | Senior Project Associate, SAMHSA's SMVF TA Center, Policy Research Associates, Inc.

Presenters
Dan Abreu, M.S., C.R.C., L.M.H.C. | Senior Project Associate, Policy Research Associates, Inc.

Michael D. Little, C.P.S. | Forensic Peer Specialist Coordinator, Criminal Justice Trauma-Informed Trainer, Mental Health First Aid Instructor, Wrap Facilitator, Philadelphia Department of Behavioral Health

Target Audience
Policymakers and SMVF service providers from state, territory, and tribal systems, workforce development and training staff, providers, mental health and addiction peers, military family coalitions, and advocates.

Click here to register prior to the event: https://praincevents.webex.com/praincevents/onstage/g.php?MTID=eccce40520f2f023913b3edfafad217a3

If you have any questions about your registration, please contact Lisa Guerin at 518-439-7415 ext. 5242 or by e-mail at lguerin@prainc.com.

HHS Announces New Actions to Combat Opioid Epidemic

On July 6, 2016, U.S. Health and Human Services (HHS) Secretary Sylvia M. Burwell announced several new actions the department is taking to combat the nation's opioid epidemic.

The actions include expanding access to buprenorphine, a medication to treat opioid use disorder, a proposal to eliminate any potential financial incentive for doctors to prescribe opioids based on patient experience survey questions, and a requirement for Indian Health Service prescribers and pharmacists to check state Prescription Drug Monitoring Program (PDMP) databases before prescribing or dispensing opioids for pain. In addition, the department is launching more than a dozen new scientific studies on opioid misuse and pain treatment and soliciting feedback to improve and expand prescriber education and training programs.

"The opioid epidemic is one of the most pressing public health issues in the United States. More Americans now die from drug overdoses than car crashes, and these overdoses have hit families from every walk of life and across our entire nation," said Secretary Burwell . "At HHS, we are helping to lead the nationwide effort to address the opioid epidemic by taking a targeted approach focused on prevention, treatment, and intervention. These actions build on this approach. However, if we truly want to turn the tide on this epidemic, Congress should approve the President's $1.1 billion budget request for this work."

The actions announced today build on the HHS Opioid Initiative, which was launched in March 2015 and is focused on three key priorities: 1) improving opioid prescribing practices; 2) expanding access to medication-assisted treatment (MAT) for opioid use disorder; and 3) increasing the use of naloxone to reverse opioid overdoses. They also build on the National Pain Strategy, the federal government's first coordinated plan to reduce the burden of chronic pain in the U.S.

Actions that are part of the recent announcement include the:

Buprenorphine Final Rule

Expanding access to MAT is one of the three foundational priorities of the HHS Opioid Initiative, and buprenorphine is one of the drugs frequently used for MAT. The rule finalized today by the Substance Abuse and Mental Health Services Administration (SAMHSA) allows practitioners who have had a waiver to prescribe buprenorphine for up to 100 patients for a year or more, to now obtain a waiver to treat up to 275 patients. Practitioners are eligible to obtain the waiver if they have additional credentialing in addiction medicine or addiction psychiatry from a specialty medical board and/or professional society, or practice in a qualified setting as described in the rule.

HCAHPS Proposal

Many clinicians report feeling pressure to overprescribe opioids because scores on the HCAHPS survey pain management questions are tied to Medicare payments to hospitals. But those payments currently have a very limited connection to the pain management questions on the HCAHPS survey. In order to mitigate even the perception that there is financial pressure to overprescribe opioids, the Centers for Medicare and Medicaid Services (CMS) is proposing to remove the HCAHPS survey pain management questions from the hospital payment scoring calculation. This means that hospitals would continue to use the questions to survey patients about their in-patient pain management experience, but these questions would not affect the level of payment hospitals receive.

IHS PDMP Policy

While many Indian Health Service (IHS) clinicians already utilize PDMP databases, IHS will now require its opioid prescribers and pharmacists to check their state PDMP database prior to prescribing or dispensing any opioid for more than seven days. The new policy is effective immediately for more than 1,200 IHS clinicians working in IHS federally operated facilities who are authorized to prescribe opioids. Checking a PDMP database before prescribing an opioid helps to improve appropriate pain management care, identify patients who may have an opioid misuse problem, and prevent diversion of drugs. This policy builds on IHS efforts to reduce the health consequences associated with opioid use disorder. As a part of this work, IHS announced that it would train hundreds of Bureau of Indian Affairs law enforcement officers on how to use naloxone, and provide them with the life-saving, opioid overdose-reversing drug.

New Research Priorities

Research on opioids conducted and funded by HHS helps the department better track and understand the epidemic, support the development of new pain and addiction treatments, identify evidence-based clinical practices to advance pain management, reduce opioid misuse and overdose, and improve opioid use disorder treatment – all areas of research that are critical to our national response to the opioid epidemic. HHS will launch more than a dozen new scientific studies on opioid misuse and pain treatment to help fill knowledge gaps and further improve our ability to fight this epidemic. As part of this announcement, the department released a report and inventory on the opioid misuse and pain treatment research being conducted or funded by its agencies in order to provide policy-makers, researchers, and other stakeholders with the full scope of HHS activities in this area. The report will also help these stakeholders and external funders of research avoid unnecessarily duplicating research that is currently underway. For more information, download the HHS infographic on the department's research priorities.

Prescriber Training RFI

HHS is actively working to stem the overprescribing of opioids in a number of ways, including by providing prescribers with access to the tools and education they need to make informed decisions. In particular, HHS has developed a number of activities that support opioid prescriber education. This request for information seeks comment on current HHS prescriber education and training programs and proposals that would augment ongoing HHS activities.

For more information on other actions HHS has taken to address the opioid epidemic, download the department's new Opioid Epidemic fact sheet.

Families USA Issue Brief and 50 State Map of Medicaid Suspension Policies for Incarcerated People

As enrollment assisters seek new populations to enroll in health coverage, people involved in the criminal justice system offer great potential for successful outreach. Working with this population can help both the individual gaining coverage and the community as a whole.

This issue brief (PDF) describes the outreach and enrollment strategies that enrollment assisters can use when working with the justice-involved population. The issue brief shares examples of how enrollment assisters in Kentucky and Virginia are using partnerships and coalitions to inform the justice-involved population about available health coverage options.

Who is the "justice-involved population?"

The "justice-involved population" refers to people recently or currently incarcerated or under court supervision. This includes individuals who are on parole or probation, serving short terms in county or state jails, and serving longer sentences in state or federal prisons.

Three reasons enrollment efforts should focus on the justice-involved population

The issue brief explains just a few of the reasons why enrollment assisters should consider including this population in their outreach efforts:

People who are in prison are generally not eligible for Medicaid. But making sure they can get health care when they are released is smart policy.

States can adopt a policy to suspend—rather than terminate—a person's Medicaid coverage while he or she is incarcerated. The map below shows which states suspend and which states terminate Medicaid for people entering jail or prison.

Suspending Medicaid makes it easier for a person leaving the criminal justice system to regain health coverage. This ensures quicker access to mental health services, prescribed medicines, and other needed care. It also helps the economy, improves the health of local communities, and reduces the chance of people returning to prison.

Note. Adapted from "Health Insurance for People Involved in the Justice System: Outreach and Enrollment Strategies," by Elizabeth Hagan and Jessica Kendall, 2016, Families USA.

Note. Adapted from "Medicaid Suspension Policies for Incarcerated People: 50 State Map," by Elizabeth Hagan, 2016, Families USA.

Sequential Intercept Mapping in Lewis and Clark County, Montana

Policy Research Associates Inc. (PRA), the operator of SAMHSA's GAINS Center, conducted a Sequential Intercept Mapping (SIM) Workshop June 28-29, 2016, in Helena, MT. The focus of the one-day and a half workshop was the area of Lewis and Clark County, MT. PRA Senior Project Associate Dan Abreu and Senior Consultant Patricia Griffin led the workshop. 35 people participated including representatives from the Lewis and Clark County Sheriff's Office, Helena Police Department, Lewis and Clark County Health Department, Helena Indian Alliance, Helena Public Schools, Lewis and Clark County Attorney's Office, Office of the Public Defender, First Judicial District Treatment Court, Lewis and Clark County Detention Center, probation and parole, local behavioral health treatment provider organizations, and persons with lived experience receiving local mental and substance use disorder treatment services.

The primary objectives for the workshop were:

Following the mapping portion of the workshop, the participating group generated a list priorities and began developing an action plan to implement those priorities. Some of the priorities that the group identified included: developing a countywide information sharing system for criminal justice and behavioral health agencies, expanding affordable and safe housing options, and replacing or improving the local detention center.

The GAINS Center will provide a map of the criminal justice system in the county, as well as a report that includes findings and recommendations. The GAINS Center will continue to work with the community in the future to prevent justice involved individuals from entering the criminal justice system and/or minimize penetration into the criminal justice system.

The GAINS Center's Website Has Moved to SAMHSA.gov

As a reminder, the GAINS Center's website has been moved, and is now being hosted along with the new SAMHSA.gov. The GAINS Center's website has also been redesigned, and will be updated and improved over time.

Please take a moment to check out the GAINS Center's new website. The URL or web address has changed, but fortunately anyone attempting to navigate to the old web address will be automatically redirected to the new web address (http://www.samhsa.gov/gains-center).

Many of the resources that were previously available through the GAINS Center's old website are in the process of being added to the new website, and may not be available at this time. If you are looking for something in particular and are unable to locate it, please contact Matthew Robbins at mrobbins@prainc.com.