Flo A. Stein, MPH
NC PIC Project Manager
Chief, Community Policy Management
Division of MH/DD/SAS

EBP Quick Links
MH#1: Trauma-Focused Cognitive Behavioral Therapy (TF-CBT)
Mental Health Bulletin #1 - Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) was developed to treat post-traumatic stress and related emotional and behavioral problems in children and adolescents.
MH#2: Integrated Dual Disorders Treatment (IDDT)
Mental Health Bulletin #2 - Integrated Dual Disorders Treatment (IDDT) requires that mental health and substance abuse treatment be delivered concurrently by a team of cross-trained clinicians within the same program.
MH#3: Wellness Management and Recovery (WMR)
Mental Health Bulletin #3 - The National Institute of Mental Health estimates that approximately 6% of the U.S. population has severe mental illness (SMI). For North Carolina, that percentage translates to approximately 200,000 people who suffer from severe psychiatric disorders.
MH#4: Family Psychoeducation
Mental Health Bulletin #4 - Persons with severe mental illness (SMI) often rely on family members for the majority of their needed support, and it is estimated that 35-60% of adults with SMI live with family members.
SA#1: Contingency Management (CM)
Substance Abuse Bulletin #1 - Contingency management (CM) is a motivational incentive intervention in which clients with substance use disorders receive small rewards for attending treatment, taking prescribed medication, providing negative urine samples, or complying with other defined treatment-related goals.
SA#2: Strengthening Families Program (SFP)
Substance Abuse Bulletin #2 - The Strengthening Families Program (SFP) is a parenting and family strengthening program for high risk families. It combines science-based (1) parenting-skill training, (2) child life-skill building, and (3) family lifeskill education into a program that improves the child's social/life skills and family functioning and protects the children from the long-term risks of drug abuse.
SA#3: Seeking Safety
Substance Abuse Bulletin #3 - Post-Traumatic Stress Disorder (PTSD) is an anxiety disorder that may result from exposure and sometimes multiple exposures to highly traumatic events such as child abuse, accidents, violent personal assaults, military combat, or natural or human caused disasters.
SA#4: Matrix Intensive Outpatient Treatment
Substance Abuse Bulletin #4 - Matrix was developed in the 1980s by researchers at the University of Southern California and clinicians at the Matrix Institute on Addictions who found that clients addicted to stimulants were challenging the existing treatment system.
SA#5: The Seven Challenges
Substance Abuse Bulletin #5 - The Seven Challenges program was developed in the early 1990s by Dr. Robert Schwebel who recognized the lack of age appropriate substance abuse treatment models for adolescents.
Developing Effective, High-Quality Community Mental Health and Substance Abuse Services: A Guide for Local Management Entities
by Beth Melcher, Ph.D. This manual seeks to clarify and provide guidance to LMEs on how to successfully engage in the service development role. It promotes the implementation of evidence-based and best practice services and supports.
National Registry of Evidence-based Programs and Practices
NREPP is a searchable database of interventions for the prevention and treatment of mental and substance use disorders. SAMHSA has developed this resource to help people, agencies, and organizations implement programs and practices in their communities.

PIC Application
Download


Binge Drinking among Women and High School Girls

In the January 11, 2013 issue of the Morbidity and Mortality Weekly Report, Kanny and her colleagues reported that one in eight women and one in five high school girls engaged in binge drinking in the US.  Binge drinking was most prevalent among women aged 18–24 years (24.2%) and 25–34 years (19.9%), and among those from households with annual incomes of ≥$75,000 (16.0%). Among high school girls, the prevalence of current alcohol use was 37.9%, the prevalence of binge drinking was 19.8%, and the prevalence of binge drinking among girls who reported current alcohol use was 54.6%.

Binge drinking is a risk factor in deaths due to excessive alcohol use (1) , unintentional injuries, violence, liver disease, hypertension, cardiovascular disease, stroke, cancers, reduced cognitive function, and alcohol dependence.  It may also increase the risk for acquiring HIV/AIDS and other sexually transmitted diseases, unintended pregnancy, miscarriage, and low birth weight.  If a women binge drinks during pregnancy, the fetus may be exposed to high blood alcohol concentrations, thus increasing the risk for sudden infant death syndrome, fetal alcohol spectrum disorder, and attention deficit/hyperactivity disorder.

In 2011, the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services was awarded a SBIRT (screening, brief intervention, and referral to treatment) grant from the US Substance Abuse and Mental Health Services Administration. The purpose of SBIRT is to identify individuals with potential substance use disorders in a primary care setting and to implement an appropriate intervention. Widespread implementation of SBIRT would potentially decrease the prevalence of binge drinking among women and high school girls.

Reference:
Kanny D, Liu Y, Brewer RD, Eke PI, Cox SN, Cheal NE, Green Y.  Vital signs:  binge drinking among women and high school girls—United States, 2011.  MMWR, 2013:62(1);9-13.

(1) Excessive alcohol use was defined as binge drinking (four or more drinks per occasion), heavy drinking (more than one drink per day on average), any alcohol consumption by pregnant women, and any alcohol consumption by youth under the age of 21.

FACT SHEET – Impact of Substance Abuse among NC Adolescent Girls Aged 12-17
Free Webinar Series for Civilian Providers

From the War Zone to the Home Front:  Free Webinar Series for Civilian Providers

With support from the Red Sox Foundation, Massachusetts General Hospital, and the National Center for PTSD, the Home Base Program offers free training on military-connected topics of interest to civilian providers.  In 2012, this collaboration resulted in an excellent 14-part series of live, interactive, online trainings for community primary care and mental health providers. Providers have the option of taking the course at their own pace; the PowerPoint slides may also be downloaded. One hour of CEUs is available for each week’s session, and a certificate can be downloaded. This course is available by clicking here.

Courses from 2012 include:

Introductory Sessions (Lecture 1 -4)

1.   The Challenges of Coming Home After War: What Providers Need to Know – Series Overview by Matthew Friedman, M.D., Ph.D., and Naomi Simon, M.D., M.Sc.
2.   Reintegration Issues from the Veterans Perspective: Overcoming the Stigma of Seeking Help by Margaret Harvey, Psy.D., Roger A. Knight IV, and Nicholas Dutter
3.   When One Family Member Serves, the Entire Family Serves by Kathy Clair-Hayes, LICSW, M.S.W., M.A. and Patricia Lester, M.D.
4.   Recognizing PTSD and Co-Morbidities by Terence M. Keane, Ph.D.

Family & Child Content (Lecture 5 -8)

1.   Keeping Military Families Emotionally Strong: Couples Therapy for PTSD by Steffany Fredman, Ph.D.
2.   Challenges Facing Other Family Members When a Veteran Has PTSD by Bonnie Ohye, Ph.D. and Daniel Maher, LICSW
3.   Supporting Resiliency in Military Connected Children: The PACT Model by Paula Rauch, M.D.
4.   Impact of Combat-Related Injury, Illness and Death on Military Children and Families by Stephen Cozza, M.D.

Veteran Content (Lecture 9 -14)

1.   Clinical Practice Guidelines and Resources for PTSD Treatment by Matthew Friedman, M.D., Ph.D.
2.   Traumatic Brain Injury by Ross Zafonte, D.O.
3.   Prolonged Exposure and Virtual Reality Therapy for PTSD by Barbara Rothbaum, Ph.D. and Stefan Schmertz, Ph.D.
4.   Military Sexual Trauma by Amy Street, Ph.D.
5.   Psychopharmacology of PTSD by Rebecca Brendel, M.D. and Bruce Capehart, M.D.
6.   Cognitive Processing Therapy for PTSD by Kathleen Chard, Ph.D.

In 2013, the National Center for PTSD, the Massachusetts General Hospital, and the Red Sox Foundation again collaborated and developed an additional nine-session online course for the Home Base Program.  The curriculum includes the following courses:

• Challenges of Treating Co-Morbid PTSD and TBI by Rebecca Weintraub Brendel, MD, JD and Ross D. Zafonte, DO
• Recognizing Suicide Risk in Returning Veterans by Lisa Brenner, PhD, ABPP
• Military Culture and the Challenges of Coming Home by BG (Ret) Jack Hammond and Roger A. Knight IV
• Sleep Issues in Returning Veterans by Bruce P. Capehart, MD
• Substance Abuse by Andrew J. Saxon, MD
• Aggression and Domestic Violence by Casey Taft, Ph.D.
• Managing Grief and Loss in Returning Veterans and Families by Naomi M. Simon, MD, MSc
• Pain Issues in Returning Veterans by Carri-Ann Gibson, MD, DAAPM
• PTSD Diagnosis and DSM-5 by Matthew J. Friedman, MD, Ph.D.
The National Network to Eliminate Disparitiesin Behavioral Health

With support from the US Substance Abuse and Mental Health Services Administration (SAMHSA), in partnership with the National Alliance of Multi-ethnic Behavioral Health Associations (NAMBHA), the National Network to Eliminate Disparities (NNED) in Behavioral Health was established to address disparities in behavioral healthcare.  “The NNED works with network members to:

Coordinate the sharing of community-based knowledge and training of cultural, indigenous, and community-based best practices;

Foster new collaborative partnerships to grow and spread ‘pockets of excellence’;

Leverage resources through partnering and collaborative initiatives;

Research and design new practices and adapt existing practices; and

Collectively advance political will.”

Membership is free to agencies and organizations that address mental health and substance abuse disparities.

NNED offers opportunities to expand knowledge and leadership around evidence-supported and culturally appropriate clinical and consumer practices through the provision of discussion forums; forum calls or webinars; a platform to share innovative, culturally appropriate interventions through reports, programming, toolboxes, and other materials; communities of practice on specific evidence-based and promising practices; learning clusters; online resources; funding opportunities; and a calendar of events.  A sample of news coverage includes the following:

Series on Mental Health in Black Community Seeks to Remove Stigma • Apr 05, 2013

New Factsheet: HIV Among American Indians and Alaska Natives • Apr 04, 2013

Latino Youth Look to Help Address Complexity of Mental Health and Substance Abuse Issues • Apr 03, 2013

Increased Risk of Alcohol and Drug Use among Children from Deployed Military Families • Apr 02, 2013

Need for and Receipt of Substance Use Treatment among Blacks • Apr 01, 2013

School Health Centers Enhance Access to Mental Health Services for African-American & Hispanic Boys • Mar 31, 2013

Communities Using New Spin on Tradition to Help At-Risk Yup’ik Youth • Mar 29, 2013

For more information, click here.
Improving Access to Children’s Mental Health Care

In 2011, researchers at the Center for Health and Health Care in Schools undertook a study to examine children’s mental health services in schools across the US, with the intent of identifying systematic challenges to access and highlighting effective school-based programs.  Eleven states were identified to participate in the study, including North Carolina.  Forty-seven individuals were interviewed about school mental health.

Key findings included the following:

1. The critical challenge to strengthening children’s mental health programs is funding, a result of the low priority assigned to these services.  Often this comes as a result of the stigma associated with mental health.

2. Services for seriously emotionally disturbed children and adolescents remain the primary focus of effort and funding by state governments.

3. The complexity of child mental health service delivery systems and funding streams hampers integration and expansion of services.

4. Court actions have varying impacts on children’s access to mental health services.

5. State action expanding insurance coverage for low-income children and families can lead directly to increased service access.

6. While legislative and judicial actions to improve children’s mental health care have been encouraged by community and family advocates, professional associations and clinical providers have also pressed for change.

7. While most states have prioritized services to support seriously emotionally disabled children, at least one state has implemented a comprehensive approach that links prevention and early intervention services to deep-end care.

8. Locally-controlled school policies and priorities may complicate implementation of state-funded, school-located child mental and behavioral health programs.

9. While underfunding has limited the capacity of child mental health services across the nation, additional promising practices can be found in a number of states.”  One of the examples was related to classroom-based social-emotional learning and positive behavioral instructional supports, which are promoted in North Carolina schools.

North Carolina was also singled out as having “demonstrated the power of partnerships between mental health professionals and physical health providers.”

Although the researchers lamented the underdeveloped state of children’s mental health services, particularly for low-income children, they noted that policymakers, school administrators, and mental health professionals recognize the value of not only integrating primary medical and behavioral health care but also of integrating children’s mental health services and K-12 schools.  They also found broad support for improving services and encouraged states to conduct its own self assessment and determine what is likely to make a difference in moving forward.

Click here for a copy of the full report.

The citation is as follows:

Behrens D, Lear JG, Price OA.  Improving access to children’s mental health care:  Lessons from a study of eleven states.  Washington, DC:  George Washington University Center for Health and Health Care in Schools, March 2013.

 
Comparison of Treatment Foster Care Models

During the past six months, members representing the Mental Health PIC and the Substance Abuse PIC and staff from the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, the Division of Medical Assistance, and the Division of Social Services reviewed four models of care, specifically identified for use in treatment foster care services, that are currently  being implemented by providers throughout the State.  This evaluation process was undertaken to inform both policy and practice in an effort to support evidence-based practices, programs, and policies that would ensure that individuals receive the services and supports needed to enhance their overall quality of life.

In the matrix below, four models—Together Facing the Challenge, the Teaching Family Model, Pressley Ridge Treatment Foster Care, and Multidimensional Treatment Foster Care—are summarized along dimensions such as ratings provided by national registries, target population served, CALOCUS and ASAM levels of care addressed, training, required staff, evaluation, and fidelity assessment.

Comparison of Treatment Foster Care Models
PAGE 1 of 612345...6
Funded wholly or in part by the federal Substance Abuse Prevention and Treatment Block Grant Fund (CFDA #93.959) as a project of the NC Division of Mental Health, Developmental Disabilities & Substance Abuse Services.