Flo A. Stein, MPH
NC PIC Project Manager
Deputy Director
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
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November NC PIC Meeting Review

November 7 Practice Improvement Collaborative Meeting on Early Identification and Treatment of First-Episode Psychosis

On November 7, 2014, the North Carolina Practice Improvement Collaborative sponsored a conference on Early Identification and Treatment of First Episode Psychosis (FEP), with three leading experts in the field. Robert Heinssen, Ph.D., Scientific Executive and Director of the Division of Services and Intervention Research at the National Institute of Mental Health (NIMH), is widely recognized as a scientific leader in the areas of prodromal schizophrenia research, first episode psychosis, and neuroscience approaches for improving assessment and remediation of cognitive deficits in schizophrenia. In his presentation, Recovery After an Initial Schizophrenia Episode (RAISE) and the North American Prodrome Longitudinal Study (NAPLS), he made the case for early intervention, stating that it led to rapid remission of positive symptoms; lower rates of psychiatric re-hospitalization; decreased substance use; improved social and vocational functioning; and increased quality of life. He discussed the RAISE clinical trial and its implications for individuals and their families in North Carolina and elsewhere and introduced the Coordinated Specialty Care (CSC) model.

Cathy Abshire, Acting Director of the Center of Mental Health Services, Division of State and Community Systems Development, Substance Abuse and Mental Health Services Administration (SAMHA) is responsible for implementation of the State Mental Health Block Grant (MHBG), which provides comprehensive community mental health services. Ms. Abshire provided an Overview of SAMHSA/CMHS Block Grant and 5% FEP Set-aside. SAMHSA and NIMH have been collaborating to develop resources and technical assistance promoting the usefulness of the CSC model in improving functioning for individuals with FEP illnesses. The OASIS (Outreach and Support Intervention Services) program was specifically named as one of the CSC models that SAMHSA endorses.

Diana Perkins, MD, Professor of Psychiatry at the University of North Carolina School of Medicine and Medical Director of the UNC OASIS program. OASIS is an innovative clinical program aimed at enhancing recovery from a first psychotic episode, or preventing psychosis in persons with high risk symptoms. Dr. Perkins presented on the Early Intervention in Psychosis: Why and How and discussed the causes and course of schizophrenia and evidence-based interventions to address different aspects of the disease. OASIS staff will provide technical assistance, coaching, and mentoring to Alliance Behavioral Healthcare LME/MCO, Coastal Care LME/MCO, and the provider agencies that they select.

A four-person panel—Cathy Abshire; Dr. Perkins; James McCracken, MSW, LCSW, Program Coordinator, UNC OASIS; and Elizabeth Zeman, family member—presented on the Implications for North Carolina. They presented two cases, which illustrated the benefits of early identification and treatment. Ms. Zeman discussed the impact of the disease on her son and family.

Presentations from the Meeting:

Recovery After an Initial Schizophrenia Episode (RAISE) and the North American Prodrome Longitudinal Study (NAPLS)
Presented by: Robert Heinssen, Ph.D.
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Evidence-Based Treatments for First Episode Psychosis:Components of Coordinated Specialty Care

Overview of SAMHSA/CMHS Block Grant and 5% FEP Set-aside
Presented by: Cathy Abshire
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Early Intervention in Psychosis: Why and How
Presented by: Diana Perkins, MD
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The videotapes of the conference will be uploaded by the end of the month.

November I/DD PIC Meeting Review

November 17 Meeting of the Intellectual and Developmental Disabilities

Practice Improvement Collaborative (I/DD PIC)

On November 17, the I/DD PIC met to discuss different models used for working with individuals with intellectual and developmental disabilities. Joan Beasley, Ph.D., Research Associate Professor, University of New Hampshire Institute on Disability, presented on the START (Systemic, Therapeutic, Assessment, Resources and Treatment) model. She started with an overview of core START elements, including a schematic diagram of team components. North Carolina has been implementing the program statewide since 2009. She outlined what NC START currently provides and suggested what it could add.

Don Kincaid, Ed.D., Louis de la Parte Florida Mental Health Institute, Department of Child and Family Studies, University of South Florida, discussed Coaching for System Change. He reviewed the coaching literature and provided a model for identifying and training integrated academic and behavior coaching skills. Dr. Kincaid used Florida’s PBIS:MTSS (Positive Behavioral Interventions and Supports: Multi-Tiered System of Supports) as an example of a coaching model. Three tiers of academic and behavior systems were identified, where academics and behavioral instruction and interventions are integrated across a continuum of supports, utilizing a 4-step problem-solving process. All students are taught the core curriculum for academics and behavior, and those students not responding effectively to the core are provided with supplemental supports (Tier 2) and/or intensive supports (Tier 3), based on their need. Coaching domains include problem-solving facilitation skills, content knowledge, leadership support, and professional development.

Presentations from the Meeting:

What We Have Learned About Coaching And Systems Change
Presented by: Don Kincaid, Ed.D. University of South Florida
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START Systemic, Therapeutic, Assessment, Resources and Treatment
Presented by: Joan B. Beasley, Ph.D. Research Associate Professor Director, Center for START Services Institute on Disability University of New Hampshire
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The videotapes of the conference will be uploaded soon.

New Resources on Trauma-informed Care & Prevention Interventions

Trauma Informed Care: Perspectives and Resources

Supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Technical Assistance Center on Children’s Mental Health at Georgetown University and JBS International, Inc. collaborated to develop a resource tool that would support state and local decision makers, administrators, system of care coordinators, providers, parents, and youth and family advocates to become more trauma informed.

The tool includes video interviews, issue briefs, key resources, and weblinks that will be updated monthly to keep up with new developments in the field. It also includes an 8-module resource tool that addresses topics such as:

  • Understanding the impact of trauma
  • Trauma-informed child-serving systems
  • Creating trauma-informed provider organizations
  • Evidence-based treatments addressing trauma
  • Youth and family perspectives on trauma-informed care

Concept of Trauma and Guidance for a Trauma-informed Approach

The Substance Abuse and Mental Health Services Administration (SAMHSA) supports the National Center for Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC), which provides training, technical assistance, and resources to behavioral health provider agencies and state agencies. It recently released the Concept of Trauma and Guidance for a Trauma-informed Approach, which provides a framework to assist agencies and systems in developing a trauma-informed approach.

A free copy can be downloaded here.

Washington State Institute for Public Policy (WSIPP)

Since its establishment by the Washington State legislature in 1983, the Washington State Institute for Public Policy (WSIPP) has been implementing non-partisan research that has implications for public policy. While the WSIPP responds directly to their legislature, their reports have relevance to the NC Practice Improvement Collaborative, in that they not only identify prevention interventions, but they also provide policy implications, including cost-benefit analyses. All four reports can be downloaded from their website:

For additional information, contact Catherine Nicolai at catherine.nicolai@wsipp.wa.gov or 360/586-2769.

 

New Online Course on Military Culture for Health Care Professionals

Center for Deployment Psychology (CDP) Releases New Online Course

North Carolina is the home to nearly 800,000 veterans, over 125,000 military members who have served in Iraq and/or Afghanistan, and over 155,000 military children. While veterans are eligible for health and behavioral health services from the US Department of Veterans Affairs (VA), only 51% of Gulf II veterans have enrolled for VA services. The remaining 49% as well as military spouses and children have sought their care from public and private health care facilities. Due to this significant sector of military-connected individuals, it is critical for health and behavioral health care professionals to be competent in military culture.

Last month, the CDP, in collaboration with the US Department of Defense, the US Department of Veteran Affairs, and the Substance Abuse and Mental Health Services Administration, launched the first of four modules in an online course, Military Culture: Core Competencies for Health Care Professionals. The course as a whole will offer a total of eight Continuing Education credits, although each module may also be taken individually. All four modules are anticipated to be available in February 2014.

Module 1: Self-Assessment and Introduction to Military Ethos

Module 2: Military Organization and Roles

Module 3: Stressors and Resources

Module 4: Treatment, Resources, and Tools

Click here to read more about each module and take the course.

Free continuing education credits are available for physicians, nurses, psychologists, social workers, counselors, and marriage and family therapists. For more information, click here.

Students in health career preparatory programs are also advised to take the course. In a recent visit to Duke University, Secretary of Veterans Affairs Bob McDonald met with medical students to promote the VA as an ideal place of employment. The VA is facing an estimated shortage of 28,000 physicians, nurses, other healthcare providers, and administrative staff.

Transitioning Youth with Special Needs

Every developmental age comes with its own challenges. For individuals experiencing mental illness and/or substance use disorders or individuals with intellectual and/or developmental disabilities, these challenges may be greater during the transition to adulthood as services and supports change or become difficult to access.

In 2009, ta North Carolina Institute of Medicine Task Force Transitions for People with Developmental Disabilities issued a report, Successful Transitions for People with Developmental Disabilities outlining the challenges and issuing a set of recommendations. While this report specifically addressed transitions for individuals with developmental disabilities, many of the barriers and solutions are similar.

To provide an idea of how many individuals may be affected in North Carolina, a quick look at the statistics is helpful. About 23.2% or 2,284,750 individuals were under the age of 18 in 2013 . Using recent data, the following statistics can be estimated for the State:

  • • 456,950 teens with a serious mental disorder between the ages of 13-18 (The National Alliance on Mental Illness used an estimate received from the National Institute of Mental Health in 2013 that 20% of adolescents between the ages of 13-18 experience serious mental disorders in a given year – source
  • • 91,390 adolescents needed but did not receive treatment for alcohol use (In 2011, the US Department of Health and Human Services used an estimate from the NC Youth Risk Behavior Survey that 4% of teens needed but did not receive treatment for alcohol use from 1991 to 2011 – source
  • • 91,390 adolescents needed but did not receive treatment for illicit drug use (In 2011, the US Department of Health and Human Services used an estimate from the NC Youth Risk Behavior Survey that 4% of teens needed but did not receive treatment for illicit drug use from 1991 to 2011 – source
  • • 316,895 children between the ages of 3 and 17 with any developmental disability between the years 1997 and 2008 (The US Centers for Disease Control and Prevention estimated that 13.87% of children between the ages of 3 and 17 experience a developmental disability based on data between the years 1997 and 2008 – source

Both the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control and Prevention (CDC) have promoted the value of early identification and early intervention. SAMHSA discussed the importance of early identification and early intervention of youth experiencing mental illness and/or substance use disorders in a recent issue of The CBHSQ Report. The CDC has also developed resources to encourage early identification and early intervention of developmental disabilities – CDC’s “Learn the Signs. Act Early.” Program, Developmental Disabilities Increasing in US, and Developmental Disabilities Research.

 

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.