Rides Over Mountains, LLC Public Health evaluation consulting ridesovermountains

1. Gaps in Substance Abuse and Alcohol Services: Community Planning and Evaluation Brenda F. Seals, PhD, MPH, MA, 1 Spero Manson, PhD, 2 Perry Ahsogeak, BHS3 1Rides Over Mountains Consulting, 2Centers for American Indian and Alaska Native Health, University of Colorado Denver, 3Behavioral Health, Fairbanks Native Association Background and Purpose Sample Gaps Recommendations • Prevention or “early” services • “. . . Needs services . . . in trouble but . . . [not] abusing yet.” • “ . . . In MH they cover severe but not serious . . . Missing the opportunity to address problems when they are small • Access to Care • People need to access services without it being so challenging. . . .” • “There are a lot of people who don’t know what is available.” • 57 agencies selected from a resource guide. • 25 agencies excluded: • Part of an included organization • Reported not serving relevant populations • Not an independent agency (e.g. AAA) • Two agencies declined participation • Final sample of 32 agencies • Include a wider range of agencies for SAA prevention programs. • Coordinate between SAA and court services to reward sobriety • Decrease social stigma and improve community SAA sympathy • Expand Mental Health services, facilities and trained professionals • SAA funders need to coordinate to better reach gap populations.. • Substance abuse and alcoholism (SAA) continue to thwart existing servicesand few prevention services exist. • Communities and families continue to suffer from substance use and abuse. • The burden of cost for SAA is large and growing. • The goal of this project was to facilitate community planning efforts by identifying opportunities for filling gaps and improving coordination of care. Fairbanks Skyline • Providers gaps • “Need patient navigators or case managers to help people get to the system . . .” • “People who can officially diagnose problems, . . .” • “Needs to be MA level training for supervising and providing . . . direct services. • More facilities/beds/services to meet service demand and eliminate wait lists • “If we doubled what we have now we still wouldn’t have enough.” • Outreach • In-patient treatment, especially for those with multiple problems • Detox for youth, homeless, mentally ill: • “[in] these long cold winters, . . .homeless people need . . . shelter . . .” • Fairbanks in Winter • Follow-up care“What happens afterwards? Relapses are possible for anyone . . . There has to be more than [existing services].” • Individual therapy for low/no cost • Housing, especially with those newly out of treatment, women and those who have multiple problems (e.g. mental health concerns, domestic violence and SAA) • “When you just come out of services . . . from mental health . . . , there is a little housing available . . .” • Quality health and mental health care services • “There is nothing worse than sending someone where they get crappy treatment . . .” • Culturally sensitive and neutral services • “If you send a real, native urban AK kid that hasn’t been connected to the culture then they don’t do as well . . .” Conclusions Organizations/Participants • The wide range of services, issues and special populations identified underline the complexity of offering a “wrap around” approach. However, substantial cost savings could be achieved if such services targeted those at risk for initiation and relapse with a priority for youth and young adults and special needs populations. • Meeting Health 2020 goals for SAA services and populations requires community planning with coalitions like those in Fairbanks. Expanding services in the challenges of the 2013 economy will require coordination and new partnerships and data-driven decision-making. • FairbanksMemorialHospital Contact Information Methods • Rides Over Mountains, LLC • Public Health evaluation consulting • www.ridesovermountains.com • bseals@ridesovermountains.com • Acknowledgements: This project was funded, in part, by the Alaska State Department of Health • Thanks to the Fairbanks Prevention Coalition. • Coalition Members: Bernard Gatewood, Adrian Kohrt, Carol Davila, Jennifer Luke, Glenn Brady, Kelli Boyles, Monica Skewes, Montean Jackson, Pete Lewis, Susanna Marchuk, Inna Rivkin, Marjorie Risner, Sarah Twaddle, Chris Santos, Doug Welborn, Alana Malloy, Amber Terrill, Chris Howe, Ryan Cunningham, Angie Wenger, Twyla Cruger, Felicia Cooper, Shawna Nayduch, Octavia Harris, Willy Blackburn • Especially appreciated are the participants for their time, careful considerations and commitment to improving alcohol and substance abuse services. • Thanks also to Amy Bollaert, Coalition Coordinator, and Carol Thiel, Design and Layout. • Pictures courtesy of en.wikipedia.org • Fairbanks Prevention Coalition (FCP) partners with the Centers for AIAN Health, UCD to identify service gaps • Direct and indirect Substance Abuse and Alcohol (SAA) agencies identified in The Fairbanks Resource Guide • Participants received letters and telephone calls. • Calls of 30-70 minutes (avg.= 52 min.) Special Needs Populations Stigma • Children, foster and homeless: “Parental consent requirement for treatment needs to be waived . . .especially if it is outpatient“ • Youth, especially truants, run-aways and homeless • Mentoring, youth voluntary Substance Abuse services • Safe housing especially for homeless, runaways and criminal justice involved youth • Recreation that is fun and safe and substance abuse free. • Mentally Ill, violent, difficult to handle and multiple problems • Those ineligible for services, many middle income families “Those with jobs but . . . [no] insurance and aren’t eligible for low income services” • Young adults, elderly, parents (childcare while in SAA), homeless;History of victimization/violence/witnessing; Those in the military and vets, with a history of SAA or trauma • “[a] lot of denial around [SAA] and a lot of stigma so people who need services are afraid to address their problem . . .” • “. . . need to educate the community on [SAA] being a coping mechanism for people who are suffering . . . trauma . . . [and MH] . . .” • “The way we drink is a very powerful idea. . . ‘partying’.” • “. . . more compassion awareness. What a person does when they see an inebriate walking down the street. What is going on in people’s minds? We all can do something..” Fairbanks City Hall