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Young people face challenges as they approach adulthood and independence, but those who have mental health issues and economic hardship encounter additional obstacles. To support these youth and their families, SAMHSA developed Systems of Care grants, under the Children’s Mental Health Initiative, which use a wraparound approach to develop community-based interventions to work in tandem with treatment services. This approach includes other supportive people – such as family members, caregivers, teachers, mentors, and coaches – as part of the care team. The services they provide may include case management, vocational training, evidence-based therapeutic services, respite services, crisis intervention, family and peer support, and life skill development (including tutoring, or financial planning). Coordination of a wide array of services has been shown to enhance recovery outcomes.
Building on the wraparound approach, System of Care grantees are incorporating a model called The Open Table. This model taps into the resources of faith communities to address the barriers that keep people from achieving employment, a livable wage, and life stability – issues that many young adults and families, including those supported by the Systems of Care grant program, often face.
SAMHSA embraced The Open Table model in an effort to expand public-private partnerships and engage faith organizations in delivering services to the larger community. This team approach provides mentorship, support, and friendship, while providing coordinated care – similar to the wraparound approach in Systems of Care.
To date, the System of Care grantees that have integrated this model include the Chatauqua Tapestry Expansion Initiative, Saginaw Max System of Care, Wraparound Orange, Bringing Systems of Care to Scale, and HELPing BC-SCORES. Project directors for these programs have reported life-changing experiences for all participants because of the relationships and natural supports that develop over time.
“Having service come through a faith community, as a coordinated network, is incredibly helpful. The volunteers care deeply about helping,” says Gary Blau, Chief, Child, Adolescent and Family Branch at SAMHSA’s Center for Mental Health Services. “Systems of Care grantees immediately saw this model as a natural extension of their work and as a powerful tool to provide continued support.”Systems of Care Values and Principles
The Open Table model began in 2006 when founder Jon Katov realized that people living in poverty needed more than clothing or food to change their situation – they needed relationships. Over the course of a year, volunteers meet on a weekly basis to work with a person (called a “brother” or “sister”) seeking support to change. The program educates and trains the volunteers, who can be anyone in a faith- or community-based organization. The group of volunteers then forms a “Table,” guided by a “life plan” that outlines goals specific to a brother or sister.
Volunteers contribute $10 per month to support the program and they have “homework” that helps the brother or sister with socialization, life skills, or other needs. Assignments might include providing a cooking lesson, teaching bookkeeping basics, finding affordable health insurance, or fixing a bike found at a yard sale so that it can be used for transportation to work. Together, the Table tackles each obstacle to improve functioning and economic stability.
Through the trust forged between Table members, doors open to allow exploration of paths to employment, housing, health care, and education and training.
“Because of the Table, brothers and sisters have their own individual support networks, and subsequently access to many other connections to address housing or other needs,” says Rachel Ludwig, LCSW, Project Director for the Chautauqua Tapestry Expansion Initiative. Ms. Ludwig currently sits on a Table herself. “I have felt friendships mature as our group of relative strangers – our Table – develops into a family that is resilient and loyal,” she says.
Systems of Care grantees support the faith community and their Tables by providing facilitation, coordination, funding, and referrals to behavioral health professionals that might be helpful to the person receiving services.
SAMHSA also works with faith and community-based initiatives to support several programs in mental health services, substance abuse prevention, and addiction treatment at the national, state, and local levels. The Community Substance Abuse Prevention Partnership Program includes more than 800 faith-based community partners among its grantees, and grant program funds are available through the states to faith-based organizations that engage people with or at risk for mental health and substance use disorders. Because of the success with The Open Table model, SAMHSA is also exploring its use with Center for Substance Abuse Treatment grantees.
Video clips courtesy of The Open Table and Cinematographer Brian Simmermacher.Resources
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Jails and prisons house significantly greater proportions of individuals with mental, substance use, and co-occurring disorders than are found in the general public. Upon release from jail or prison, many people with mental or substance use disorders lack access to services and, too often, fall into a recurring, costly cycle of involvement with the justice system.
Experts in the justice, behavioral health, and public policy fields agree that by providing behavioral health support services to these people in transition they can increase their chances of returning to healthy and productive lives in the community.
To support this goal, SAMHSA recently released Guidelines for Successful Transition of People with Mental or Substance Use Disorders from Jail and Prison: Implementation Guide. The guide provides behavioral health, correctional, and community stakeholders with approaches for effectively transitioning people with mental or substance use disorders from institutional correctional settings into the community. The guide also promotes the Assess, Plan, Identify, and Coordinate (APIC) approach to identifying various successful evidence-based strategies that work across jurisdictional systems, and describes 10 guidelines. These include –
These APIC approaches have been successfully implemented in communities throughout the nation such as Allegheny County, PA.; Franklin County, MA; Gwinnett County, GA.; Hampden County, MA; Hancock Count, OH; Montgomery County, MD.; and Pima County, AZ. It has also been adopted on a statewide basis in Hawaii, North Carolina, and New York.
“Reentry assistance provides justice and behavioral health agencies the opportunity to identify and address barriers that prevent people with mental and substance use disorders from integrating and thriving in communities,” said Captain David Morrissettee, Ph.D., LCSW, with the U.S. Public Health Service in SAMHSA’s Center for Mental Health Services. “The guidelines help providers give people the best opportunity to overcome these barriers and stay connected to community supports.”Related Articles
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As a part of its comprehensive strategy to address the opioid use crisis and overdose epidemic in the United States, SAMHSA launched a new interactive tool for consumers. Decisions in Recovery: Treatment for Opioid Use Disorder supports people with opioid use disorder in making informed decisions about their care and treatment choices.
The online tool and accompanying handbook were developed to help people with opioid use disorder learn about medication-assisted treatment (MAT), explore and compare treatment options, and discuss treatment preferences with their healthcare provider.
Prescription opioids, such as hydrocodone, oxycodone, and fentanyl, and the illegal opioid, heroin, reduce the perception of pain. Repeated use can result in opioid overdose, dependence, and addiction. In 2015, nearly 2.4 million Americans had an opioid use disorder. MAT can successfully treat opioid use disorder, and for some people struggling with addiction, can help sustain recovery.
Individuals can use the interactive tools to review medications approved by the U.S. Food and Drug Administration for use in the treatment of opioid use disorder, identify their personal goals, develop a recovery plan, and watch videos of people who struggled with opioid use disorder and are now succeeding in their recovery journey.
“These resources will be helpful for anyone wanting to explore recovery from opioids,” said Keris Myrick, Director of Consumer Affairs at SAMHSA’s Center for Mental Health Services. “The tools can be used by individuals, family members, and treatment providers. Together with many other resources, SAMHSA offers a suite of materials available to help people achieve recovery.”
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When a severe storm is on the horizon, communities focus on safety and emergency response. However, communities must also prepare for and respond to the impact and aftermath of severe weather on behavioral health. SAMHSA has dedicated resources through the SAMHSA Disaster Technical Assistance Center (DTAC) to support communities that would help prepare for, respond to, and deliver effective mental health and substance use responses to disasters.Mental Health Impacts – Before, During, and After the Event
Severe weather can affect mental health before, during, and after the event. The toll and trauma that stems from disasters can contribute to stress and anxiety, acute stress reaction, and ability to self-regulate – and for some, posttraumatic stress disorder.
The anticipation of storms can create anxiety or a kind of pre-traumatic stress. With many channels of communication, people are exposed frequently to severe weather warnings – even if they are not at risk – which can increase anxiety. This heightened state of alert is most prevalent in regions that experience disasters often, such as coastal communities vulnerable to hurricanes, towns on fault lines where earthquakes are likely, Tornado Alley, and dry regions prone to fires.
During the event, severe weather can cause injury and disability that may affect mental health. Food shortages, water-borne illnesses, and other infectious diseases may also arise, which can affect the behavioral health of people who manage their health issues, or the health of someone they care for.
The overwhelming consequence of rebuilding in the wake of a disastrous storm can result in stress and sleeplessness, where some may misuse substances, such as alcohol or drugs, to lessen the stress and anxiety, relax, or help with sleep. Grief and depression stemming from the loss of life, home, or employment can take time to recover from. And those displaced from their homes and neighborhoods may experience economic stressors and social effects like the disconnection from neighborhood and community – a disruption from the familiar and routine that helps to stabilize daily life.Disaster Mental Health Tips
While familiar routines are central to stability, storms can disrupt normal everyday experiences. They also affect the availability of services that could result in disruptions in counseling or other provider appointments, and access to psychotropic and other medications. Service providers, clinics, and pharmacies can experience power failures, obstructed streets, and building damage – sometimes for prolonged periods of time as communities rebuild. Further exacerbating the situation, there may be an increase on the demand for support services due to injury and trauma resulting from the storm – complicating both delivery and access to critical services.Planning for Resilience
SAMHSA DTAC offers resources to help communities plan and prepare for thoughtful approaches that consider behavioral health preparations and responses to severe storms and other disasters. This includes online education and training resources, webinars and podcasts on an array of topics, and tip sheets for first responders, community leaders, and disaster survivors. In addition, SAMHSA’s Crisis Counseling Assistance and Training program offers direct, face-to-face psychoeducational outreach and resources. Crisis Counseling is considered strength-based and includes understanding that most disaster survivors are naturally resilient. Crisis Counseling provides support, education, and linkage to needed community resources, to better support survivors in their recovery from disaster.
Using these resources, individuals can learn about disaster-related mental health concerns and substance use, and better cope with disasters. On the SAMHSA DTAC site, first responders will find helpful information on self-care, compassion fatigue, and how to prevent burnout. Resources also provide insight into the planning that behavioral health providers and communities should consider to sustain behavioral health and resilience.
With planning, thoughtful response, and support in the aftermath of severe weather, communities are better able to endure the storms, remain connected to their communities, and know how to address behavioral health concerns that might arise.SAMHSA’s Disaster Resources
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This week, Director of National Drug Control Policy Michael Botticelli will depart after two years of service as the leader of the Obama Administration’s drug policy efforts. We sat down with him to hear his ideas about his work, the relationship between ONDCP and SAMHSA, and where the field of recovery is headed.
What are some of the things you think have changed about the idea of recovery during your career?
The most significant change in how people view recovery is that it has truly become a movement. In the early days, the tradition of anonymity in 12-step programs kept many people from talking about being in recovery. So there wasn’t a visible and vocal recovery movement that you could see other than the fellowship that people in 12-step programs had with each other.
When I started as the Director of the Bureau of Substance Abuse Services at the Massachusetts Department of Public Health, I was fairly open about my recovery. Some people counseled me not to be public about it at the time. But since then, especially over the past five years, it’s really taken off as a movement. Today’s young people who are in recovery are more transparent, open and honest about who they are. There has been a growing scientific acknowledgment of the role recovery plays, and now we see recovery coaches and recovery community organizations. So I think we’re seeing it both as a service movement as well as an advocacy movement.
What are your most significant achievements at the Office of National Drug Control Policy?
Through the course of the Obama administration, we have really changed the conversation and reframed how we approach issues of substance use and addiction. While we still have some ways to go, there is general consensus across political stripes, with public health and public safety, that this is a health issue. While law enforcement and our justice system have a role to play, substance use and addiction need to be dealt with as a health issue. That is a legacy this administration leaves for those who follow.
I think we’re at the point where most of us understand that people with addiction need treatment—they need health interventions, and that arrest and incarceration will do little or nothing to change the trajectory of people with substance use disorder.
Is there a moment that reflects that understanding?
Certainly watching the President sign the 21st Century Cures Act was a huge moment for not only us at ONDCP, but all of us in the field. I was sitting next to [SAMHSA Deputy Assistant Secretary for Mental Health and Substance Use] Kana Enomoto as it was signed, and many other people in the field were a part of that signing ceremony. Prevention and treatment of opioid addiction is a top priority for the administration, and we backed that up with a huge investment.
How has your relationship with SAMHSA helped advance drug control policy?
SAMHSA has played a huge role in in our execution and implementation of a public health-based national drug control strategy. SAMHSA is probably our premier partner, if you will, in terms of moving from policy to implementation on a practical basis. Our strategy has focused on public health responses like monitoring, prevention, early intervention, treatment and recovery support, and increasing access to medication-assisted treatment. I’d be hard-pressed to think of a single health-focused strategy item we have that SAMHSA has not played a significant role in accomplishing. So it was very important to me personally that when I came in as Deputy Director of National Drug Control Policy and then as Director, that we had a strong ongoing partnership SAMHSA leadership.
What are some of the significant accomplishments on which you’ve collaborated with SAMHSA?
This is recent so it’s top of mind maybe. The 21st Century Cures Act obviously gave us a substantial infusion of dollars. SAMHSA did a tremendous amount of work to get the money out as soon as possible. The funding opportunity was announced the day after the legislation was signed. We worked closely with them in terms of the structure of the application.
The funding is one example, but if you look over the past four years, I could think of probably 20 examples in our response to the opioid epidemic that SAMHSA helped orchestrate. Recovery Month is another good example. SAMHSA has for a long time been the organizer of Recovery Month nationally and helped coordinate local events. Without SAMHSA, I don’t think we would have as strong of a recovery movement.
What do you see coming next in the field of recovery?
A couple things. I think we’ve come a long way, whether it’s health systems or Medicaid or state and community providers really understanding the role that peers in recovery play in the service delivery structure. And not just in treatment programs. We now have peer recovery coaches reimbursed by Medicaid and other payers, and we have seen peers as parts of service teams and emergency departments and primary care settings. So from the service standpoint, we have come a long way, but we are still understanding the role of peers in our service delivery system.
Another change I would like to see is this: It should not happen by accident that people in recovery are in policymaking roles at the federal, state and local levels. We should strive to make sure we have people in recovery in those roles. They have an understanding that no one else can bring to the table. I would like to see continued advocacy for recovery.
What advice do you have for others who are in recovery?
Part of what is important is for anyone who is in recovery and does advocacy, to be grounded and secure in their own recovery before venturing out in other, more public ways. Sometimes I’ve worried when I’ve seen people who are very early in recovery playing a public and prominent role. I’m not saying they shouldn’t talk about it at all, but early recovery is stressful enough. Then again, even at this level, it’s important for me to put my recovery above a job or political environment. Recovery is the greatest treasure we have.
What would you say to the family and friends who are close to someone in recovery?
You can’t underestimate the support of friends and family. Substance use disorders don’t affect just one person. It’s important for the people around someone who is in recovery to understand the fundamentals of what addiction is, and what it means to be in recovery. Sometimes people think they’re being supportive, but they may not be. It also a good idea for those loved ones to have some support themselves so they can not only take care of themselves but offer support for a loved one who is in early recovery.
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