Treatment for Substance Use Disorders Nevada Stephanie Woodard
Treatment for Substance Use Disorders Nevada Stephanie Woodard, Psy. D. Licensed Clinical Psychologist Bureau of Behavioral Health Wellness and Prevention Nevada Division of Public and Behavioral Health Department of Health and Human Services 1
Overview § Overview of available options for screening, treatment, and recovery § Funding for screening, treatment, and recovery § Public Health policy considerations Department of Health and Human Services 2
National Governor’s Association Policy Academy on Prescription Drug Abuse Prevention Screening and Treatment § Identify and make recommendations of standardized screening tools that can be utilized across disciplines. Require SBIRT/ early intervention screenings with developmental milestones and key intervention points. § Develop and enhance referral processes between screening sources and treatment centers. Department of Health and Human Services 3
Continuum of Care: Screening § Range of settings, provided by a range of providers, and focused across populations. § Behavioral health integrated into healthcare settings can provide non-pharmacological treatments for chronic pain and brief interventions for those at risk of misuse and high-risk use of substances. Department of Health and Human Services 4
Screening, Brief Intervention, and Referral to Treatment § SBIRT as a public health intervention. § Screening is universal. § Goal is to identify individual level of risk and intervene with the most appropriate response, not to look for addiction. § Stratifies risk, encourages early intervention, matches stage of change. § Evidence-Based Practice for Alcohol Use, Emerging Practice for Opioid Use. Department of Health and Human Services 5
Screening, Brief Intervention, and Referral to Treatment: Challenges § Lack of clear guidelines for screening and brief intervention. § Fear of alienating patients. § Concern that there is not enough time to screen and intervene. § Limited or lack of reimbursement for screening and brief interventions. § Lack of knowledge about referral sources. Department of Health and Human Services 6
Screening, Brief Intervention, and Referral to Treatment: Opportunities § SBIRT has been identified as one of the Governor’s Priorities. § Scale up training and support for implementation to practice. § Expand opportunities for integrated healthcare practices. § Investigate and disseminate re-imbursement information. § Implement programs (i. e. Hav. Bed) for coordinated referrals. § Establish care coordination standards across payers. § Consider addition of NCQA measures to support data collection for evaluation. Department of Health and Human Services 7
Screening, Brief Intervention, and Referral to Treatment: Quality Measures TOPIC MEASURE STATUS Screening Alcohol Screening and Brief Intervention Under Development Access to Care Initiation and Engagement in AOD Services In HEDIS Utilization Identification of AOD Services In HEDIS Department of Health and Human Services 8
National Governor’s Association Policy Academy on Prescription Drug Abuse Prevention Screening and Treatment § Identify funding for treatment. Department of Health and Human Services 9
Provider Type 17 expenditure trend Pre & Post ACA implementation SAPTA Billing data FY 2011 -2015 16000000 14000000 $15 016 645, 00 $14 776 470, 00 $15 065 030, 50 $12 985 882, 50 12000000 10000000 $8 948 383, 20 8000000 6000000 4000000 2000000 0 Pre-ACA Implimentation Department of Health and Human Services Post-ACA 10
Provider Type 17 expenditure trend Pre & Post ACA implementation DHCFP Billing Data FY 2011 -2015 16000000 14000000 $14 001 590, 03 12000000 10000000 8000000 6000000 $8 206 346, 32 $6 990 058, 44 $6 256 528, 50 $6 358 700, 58 4000000 2000000 0 Pre-ACA Implimentation Department of Health and Human Services Post-ACA 11
Admissions by Health Insurance 7 000 Treatment Episode Data Set (TEDS) 2013 -2015 6 000 5 000 4 000 3 000 2 000 1 000 0 2013 Private Insurance 2014 BC/BS Medicare Medicaid 2015 HMO Other Department of Health and Human Services None Unknown 12
Admissions by Primary Substance 3 500 Treatment Episode Data Set (TEDS) 2013 -2015 3 000 2 500 2 000 1 500 1 000 500 0 2013 Alcohol Heroin 2014 Other Opiates and synthetics 2015 Marijuana/hashish Department of Health and Human Services Methamphetamine 13
Admissions by Referral Source 6 000 Treatment Episode Data Set (TEDS) 2013 -2015 5 000 4 000 3 000 2 000 1 000 0 2013 2014 2015 Individual SUD Provider Health Care Provider School Employer Community Referral Court/Criminal Justice Referral Department of Health and Human Services 14
Number of Previous Treatment Episode Data Set 2013 -2015 10 000 9 000 8 000 7 000 6 000 5 000 4 000 3 000 2 000 1 000 0 2013 2014 0 1 to 4 2015 5+ Department of Health and Human Services 15
National Governor’s Association Policy Academy on Prescription Drug Abuse Prevention Screening and Treatment § Identify the capacity of treatment program in the community to treat persons with prescription drug problems. Develop a plan to address identified shortages and gaps. § Investigate the need for more funding of Medication. Assisted Treatment. Department of Health and Human Services 16
State of Nevada SAPTA Providers Overview Certified 76 Funded 18 Total Number of Locations 116 Level 0. 5 Early Intervention 7 Level 1 Outpatient 41 Level 2. 1 Intensive Outpatient 31 Level 2. 5 Partial Hospitalization 2 Residential 16 Transitional 4 Women's Services 3 Adolescent Services 27 Department of Health and Human Services 17
MAT PROVIDERS Adelson Clinic Center for Behavioral Health - LV Desert Treatment Clinic Eastern Treatment Clinic Life Change Center Northern Nevada Locations 2 Southern Nevada Locations 9 Rural Locations 3 Mission Treatment Centers, Inc. Nevada Treatment Center New Beginnings Counseling Center Department of Health and Human Services 18
CAPACITY DATA The information in this report is specific to the Substance Abuse Prevention and Treatment Agencies certified and funded treatment providers ADULT & ADOLESCENT SERVICES Comprehensive Evaluation* Level 0. 5: Early Intervention Level 1: Outpatient Services Level 2. 1: Intensive Outpatient Services Level 2. 5: Partial Hospitalization Services Level 3. 1: CM Low-I Residential Services Level 3. 2 -WM: CM Residential WM Level 3. 5: CM Med-I Residential Services Level 3. 7: MM High-I Inpatient Services Level 3. 7 -WM: MM Inpatient WM Opioid Treatment Services Transitional Housing* Drug Court Service* Civil Protective Custody/Withdrawal Management* WOMENS SERVICES Max Capacity Current Client Count 3272 486 703 99 150 90 0 0 3985 1392 892 226 468 173 210 71 0 0 196 82 102 36 195 60 15 215 118 82 32 0 0 20 12 0 0 330 190 300 3 139 79 31 10 1024 464 336 89 178 46 38 0
WAITLIST DATA Level of Care Outpatient Intensive Outpatient # of Clients on Waitlist 26 3 Average Time on Waitlist 57 40 Primary Drug of Choice 115 34 1 -Incarcerated Waiting for Bed 9 -Waiting for jail/parole release date 6 -Waiting for counselor/program availability 4 -Scheduled for Assessment 6 -Other 1 - Woman with Dep Children 8 -IV Drug Users 16 -Criminal Justice Involvement 11 -Co-occurring Issues 1 -Alcohol 1 -Amphetamines 1 -Opiates 1 -Waiting for counselor/program availability 1 -Does not want a referral 1 -Waiting for jail/parole release date 71 -Unknown 22 -Incarcerated Waiting for Bed 12 -Waiting for bed 6 -Waiting for jail/parole release date 4 -Waiting on transportation 3 -Non IV Drug Users 1 -Ciminal Justice Involved 4 -Cannot be located 1 -Senior Citizen 3 -Criminal Justice Involved 4 -Homeless 2 -Co-occurring Issues 34 -Heroin 18 -Alcohol 7 -Unknown 4 -Marijuana 3 -Opiates 2 -Benzodiazapienes 2 -Crack/Cocaine 4 -Unknown Transitional Housing 4 30 Population Identifiers 8 - Alcohol 10 -Amphetamine 1 -Cocaine 1 -Herion 2 -Opiates 4 -Unknown 46 -Amphetamines Residential Reasons for Being on Waitlist 1 -Pregnanct IV Drug User (Incarcerated) 27 - IV Drug User 96 -Criminal Justice Involved 90 -Incarcerated (Jail) 1 -Incarcerated (Prison) 7 -Cooccuring 4 -Homeless 2 -Veteran
The Vision for a Good and Modern System Grounded in a public health model and addresses: § the determinants of health § system and service coordination § health promotion, prevention, screening and early intervention, treatment, resilience and recovery support § promotes social integration and optimal health and productivity Description of a Good and Modern Addictions and Mental Health Service System. (Draft – April 18, 2011. ) [PDF version. ] Retrieved July 9, 2013 from http: //www. samhsa. gov/Healthreform/docs/Addiction. MHSystem. Brief. pdf.
Public Health Policy § Increase awareness of benefits for treatment § Expand funding for residential and transitional living § Collaborate with criminal justice/juvenile justice to build systems of care § Create a data surveillance system to drive intervention opportunities § Implement best-practices for MAT, including SAMHSA’s Guidelines for Opioid Treatment Programs Department of Health and Human Services 22
Public Health Policy § Increase BH integration into Health Care Settings § Incentivize utilization of SBIRT targeting risk § Provide interventions for individuals at-risk § Implement healthcare data systems to enhance quality and performance § Increase access to MAT and expand services to include counseling and wrap-around services § Embed opportunities for OEND throughout health systems Department of Health and Human Services 23
Contact Information Stephanie Woodard, Psy. D. Nevada Division of Public and Behavioral Health 775 -684 -2211 swoodard@health. nv. gov
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