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

NC Data Comparable to National Data on the 2013 NSDUH

Recently, the US Substance Abuse and Mental Health Services Administration (SAMHSA) issued a report based on the results of the 2013 National Survey on Drug Use and Health.

While they reported on national statistics related to mental illness in their press release, individual state data are also available for mental and substance use disorders.

In the survey, serious mental illness (SMI) is defined as mental illness that resulted in serious functional impairment, which substantially interfered with or limited one or more major life activities. A sample of findings follows:

A sample of findings: NC
Percent of adults served through the Mental Health Block Grant (MHBG) who meet the Federal definitions for SMI 67.9% 68.0%
Percent of children served through the MHBG who meet the Federal definitions for serious emotional disturbance (SED) 65.9% 71.5%
Percent of adults served through MHBG who had a co-occurring mental health (MH) and substance use disorder (SUD) 26.8% 21.2%
Percent of children served through the MHBG who had a co-occurring MH and SUD 3.7% 5.2%
Percent of adults served through the MHBG who met the Federal definitions of SMI who also have a SUD diagnosis 21.4% 21.7%
Percent of children served through the MHBG who met the Federal definitions of SED who also have a SUD diagnosis 3.1% 5.8%
Percent of adults reporting improved social connectedness from services 75.8% 69.5%
Percent of children reporting improved social connectedness from services 93.2% 85.1%
Percent of adults reporting improved functioning from services 76.2% 70.0%
Percent of children reporting improved functioning from services 67.0% 69.3%
*Data downloaded from pages 10 and 21


NC DHHS Crisis Solutions Initiative and Mental Health First Aid

DHHS is committed to implementing Mental Health First Aid (MHFA) as part of Governor McCrory’s NC Center for Safer Schools and the NC Division of Mental Health, Developmental Disabilities and Substance Abuse Services’ Crisis Solutions Initiative. MHFA is a public education program that introduces participants to risk factors and warning signs of mental illnesses, builds understanding of their impact, and overviews common supports. MHFA uses role-playing and simulations to demonstrate how to offer initial help in a mental health crisis and connect persons to the appropriate professional, peer, social, and self-help care. MHFA is included on the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices (NREPP).

Currently there are 6,500 North Carolinians trained as First Aiders. However, that only equates to less than 0.1% of the population. NC DHHS is pleased to announce plans to add 120 new instructors by May 1, 2015. In partnership with the National Council for Behavioral Health, four more Training of Trainer events will be held.

January 26-30, 2015 – Guilford Technical Community College, Greensboro, NC – ADULT

February 23-27, 2015 – Martin Community College, Williamston, NC – ADULT

March 9-13, 2015 – Martin Community College, Williamston, NC – YOUTH

April 27-May 1, 2015 – Guilford Technical Community College, Greensboro, NC – YOUTH

This initiative will result in an additional 32,000 North Carolinians becoming equipped to interact with a person experiencing a behavioral health crisis and to connect the person with help.

For this initiative, DHHS is particularly interested in recruiting potential trainers from the faith communities and the NC Justice Academy. If you, or someone you know, is interested in becoming a MHFA Trainer in North Carolina, please see the attached application for information regarding dates, locations and the application process.

To further support statewide dissemination of MHFA, DHHS will also be providing coordination of statewide instructional support and assistance for new instructors in purchasing training manuals.

North Carolina Mental Health First Aid Program Instructor Certification Application Packet

More information about Crisis Solutions North Carolina.

More information about MHFA.

For questions regarding NC’s Mental Health First Aid initiatives, contact tbohley@email.unc.edu.






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.

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

Early Intervention in Psychosis: Why and How
Presented by: Diana Perkins, MD

If you missed the meeting, you can view the video here:

Part 1 – Welcome, Background, and Robert Heinssen, PhD Presentation

Part 2 – Cathy Abshire Presentation

Part 3 – Diana Perkins, MD Presentation

Part 4 – Panel Discussion

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

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

Video of Dr. Beasley’s Presentation – Enter Password: Start1 (please be aware that this video make take a few minutes to load)

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.


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.