Module I: Introduction. 2 Purposes Provide an overview and rationale for the program. Introduce the curriculum developed for the programs. Identify.

Module I:

Introduction

2

Purposes Provide an overview and rationale for the

program. Introduce the curriculum developed for

the programs. Identify the accomplishments of the first

five years of the initiative.

3

Learning ObjectivesHealth Care Professionals will be

able to: Discuss the program rationale. Identify the relevant goals and objectives

of Healthy People 2010.

4

Learning Objectives (continued)

Define the role of health care professionals in meeting the challenge of substance use disorders.

List the basic substance use related competencies germane to all health care professionals.

5

Learning Objectives (continued)

Discuss the recommendations of the Strategic Planning Document of the HRSA-AMERSA-CSAT/SAMHSA Interdisciplinary Program to improve Health Professional Education in Substance Abuse.

Discuss the organization and accomplishments of the Faculty Fellowship component of the program.

Discuss a model of the process of cultural competence.

Identify evolving trends in prevention and treatment of substance use disorders.

6

Outline of Syllabus Module 1: Introduction Module 2: Overview of Substance Use

Disorders Module 3: Screening and Assessment Module 4: Intervention and Referral Module 5: Motivational Interviewing Module 6: Prescription Drug Abuse

7

Outline of Syllabus (continued)

Module 7: Identifying and Assisting

Children of Substance Abusing Parents Module 8: Substance Abuse and the Elderly Module 9: Community-Based Substance Abuse

Prevention Module 10: Population Health and Substance Abuse Module 11: Curriculum and Evaluation

8

Program Overview and Rationale

HRSA-AMERSA-SAMHSA/CSAT

Interdisciplinary Program in Substance Abuse Education

9

Substance Use Disorders 119 million (50.1%) American aged 12 or

older use alcohol. 54 million (22.6%) binge drink 16.1 million (16.8%) drink heavily.

NSDUH, 2004.

10

Substance Abuse Disorders 19.5 million (8.2%) use illicit drugs 70.8 million (29.8%) use tobacco

NSDUH, 2004

Overall drug and tobacco use among teens has declined but inhalant and vicodin use has increased.

MTF, 2004

11

Healthy People (HP) 2000 Goals: Reached

Increase in average age of first marijuana use

Decline in cocaine use

12

Alcohol-related crashes Average age of first cigarette Alcohol use - ages 12 to 20 Tobacco use - ages 12 to 17

HP 2000 Goals: Some Progress

13

Average age of first alcohol use Marijuana use - ages 12 to 25 Heavy drinking - high school students Heavy drinking - college students

HP 2000 Goals: No Progress

14

Drug-related emergency room visits Drug-related deaths, especially

among African Americans and Hispanic Americans

HP 2000 Goals: Regression

15

Healthy People 2010

Reduce substance abuse to protect health, safety and quality of life for all, especially children (25 objectives related to this goal).

Reduce illness, disability, and death related to tobacco use and exposure to secondhand smoke (21 objectives related to this goal).

Other goals relate indirectly.

16

Healthy People 2010 -Indirect Goals/Objectives

Access to Quality Health Services1-3 Counseling about health behaviors.1-7 Core competencies in health provider training.

Educational and Community-Based Programs7-2 School health education.7-3 Health-risk behavior information for college and university students. 7-5 Worksite health promotion programs.7-6 Older adult participation in employer-sponsored health promotion activities.

17

Healthy People 2010 -Indirect Goals/Objectives (continued)

Educational and Community-Based Programs (continued)

7-7 Patient and family education.

7-10 Community health promotion programs.

7-11 Cultural appropriate community health promotion programs.

HIV prevention

13-8 HIV counseling and education for persons in substance abuse treatment.

18

Healthy People 2010 -Indirect Goals/Objectives (continued)

Injury and Violence Prevention

15-15 Deaths from motor vehicle crashes

15-32 Homicides

15-34 Physical assault by intimate partners

15-35 Rape or attempted rape

Maternal, Infant, and Child Health16-17 Prenatal substance exposure

16-18 Fetal alcohol syndrome.

19

Healthy People 2010 -Indirect Goals/Objectives (continued)

Mental Health and Mental Disorders18-10 Treatment for co-occurring disorders.

Occupational Safety and Health20-9 Worksite stress reduction programs.

Public Health Infrastructure23-8 Competencies for public health workers.23-17 Prevention research.

Sexually Transmitted Diseases25-11 Responsible adolescent sexual behavior.

20

Workforce DeficienciesPrimary and secondary substance abuse

prevention is effectiveFew health care professionals engage

regularly in primary and secondary prevention

All of the U.S. is underserved with regard to substance abuse services

21

Needs

Routine screening, brief intervention, and referral

Identification and assistance for affected family members

Attention to substance use by elderly Health professional involvement in

community prevention efforts

22

Insufficient emphasis on substance abuse in education and training

Health professional workforce is deficient in basic competencies

Insufficient numbers of faculty able to teach and model these competencies

Barriers

23

Previous Faculty Development Programs (FDP’s)

NIAAA, NIDA, HRSA, CSAP

Effective for many participants Some ripple effects Short-lived; limited sites Federal effort not coordinated Little interdisciplinary synergy

24

Main Objectives

Produce a strategic plan for health professional education and training

Conduct a faculty devel. program for fellows from multiple disciplines

Build regional training and national electronic communication networks

25

Targeted Disciplines

Dentists Dieticians Nurses Nurse midwives Nurse practitioners Occup. therapists Pharmacists

Physical therapists Physicians Physician assistants Psychologists Public health

Social workers Speech path/audiologists

26

Strategic Planning Document

Magnitude of problem Effective ways to address problem Health care professionals’ involvement State of health professional education Trends in health care delivery Recommendations for all disciplines Discipline-specific recommendations

27

Strategic Planning Document(continued)

For all recommendations: Rationale Responsible parties Suggestions for implementation

28

Strategic Planning Staff Director of Strategic PlanningMary Haack, RN, PhD, Assoc. Prof.Rutgers University School of Nursing

Associate Director of Strategic PlanningHoover Adger, MD, Assoc. Prof.Johns Hopkins Univ. Medical School

Professional Editor –Linda Harteker, MA

29

Strategic Planning Advisory Committee

Addict. Psych. - Kathleen Brady, MD, PhD Allied Health - John Bonaguro, PhD Allopathic Med. - David Lewis, MD Dentistry - Arden Christen, DDS, MSD, MA Geriatrics - Kristen Barry, PhD Nursing - Madeline Naegle, RN, PhD Nurse Midwife - Pat Paluzzi, CNM, DrPH

30

Strategic Planning Advisory Committee(continued)

Nurse Pract. - Elias Vasquez, PhD, NNP Osteopathic Med. - Richard Butler, DO Pharmacy - Ernest Dole, PharmD Phys. Ass’t - C. Judd, PA-C; P.Morgan, PA-C Psychology – William Miller, PhD Public Health - Chris Ringwalt, MSW, DrPH Social Work - Lala Straussner, DSW

31

Project Goals for Health Care Professionals: Faculty Development

Improve and expand substance abuse curricula in health professional schools and

training programs in order to

Produce health professionals who will help the U.S. meet its Healthy People 2010 goals

on substance use/abuse

32

Clinic-based screening, assessment, intervention, and referral

Clinic-based identification and assistance of children and adolescents with affected parents

Community-based prevention

Primary Learning Objectives

33

Geriatric issues Population health Prescription Drug Abuse Pedagogy Curriculum design and evaluation Presentation/publication

Other Important Learning Areas

34

Role of Health Care ProfessionalsBasic competencies germane to all health care

professionals: Overview of substance use disorders Screening and assessment Intervention and referral Motivational interviewing* Identifying and assisting children of substance abusing

parents Recognizing and assisting elderly substance abusers Community-based substance abuse prevention* Recognizing population trends in substance use disorders.

* Level of competency varies by profession

35

Interfaculty Fellow Learning Groups (IFLG’s) Faculty apply as interdisciplinary faculty

learning groups 3 faculty fellows per IFLG with geographic

proximity Each IFLG has 3 disciplines Collaborative projects

36

Regional Structure - Cohort 1 & 2

Regional Director

MentorMentor

Fellow FellowFellow FellowFellow Fellow

37

FDP Learning Activities

AMERSA National Conference plus special FDP workshops

Spring regional meetings Annual mentor visits Learning contract Monthly contacts with mentors

38

FDP Learning Activities (continued)

Interdisciplinary clinical and educational projects

Interactions with IFLG FDP distance learning activities Present projects at meetings Publish peer-reviewed articles

39

Evaluation Team

Rebecca Henry, Ph.D.

Rich Brown, MD, MPH

Monina Lahoz, PhD

Marianne Marcus, RN, EdD

Jeff Morzinski, PhD

Gene Schoener, PhD

40

Evaluation Plan

Administrative, process, and outcome measures

Outcomes evaluation driven by objectives

41

Evaluation - Strategic Planning

Process Administration runs smoothly Meetings achieve aims

Outcome Reviewers rate document highly Document receives publicity Document stimulates change

42

Evaluation - Fellowship

Administrative Planning occurs on schedule Fellow & mentor recruiting succeeds re

numbers and diversity Fellow-Mentor contacts occur Mentor-Director contacts occurs Fellows exhibit consistent progress

43

Evaluation - Fellowship (continued)

Process - Fellows Application process Expectations - clear and appropriate Training events Mentor contacts Accessibility of guidance Overall experience

44

Evaluation - Fellowship (continued)

Process - Mentors Selection process Involvement with fellows Progress of fellows Support from project Compensation Overall experience

45

Evaluation - Fellowship (continued)

Process - Activities Participant satisfaction Best aspects; suggestions

Process - Infrastructure Awareness, use, suggestions Activities, income

46

Evaluation - Fellowship (continued)

Knowledge and Attitude Outcomes 30-item knowledge test SAAS treatment optimism Readiness to change clinical and field

practices

47

Evaluation - Fellowship (continued)

Competency Outcomes Self-efficacy and confidence OSCE stations Presentations Publications

48

Evaluation - Fellowship (continued)

Curricular Outcomes Teaching activities Trainee contacts - number, time Curricular presence

49

Evaluation - Fellowship (continued)

Distance Learning Programs Knowledge objectives Attitude objectives Competency objectives

50

Evaluation - Fellowship (continued)

Career Emphasis Outcomes Professional time allocations Professional organizations Professional activities

51

Fellowship Administration

Fellowship Director

Marianne T. Marcus, RN, EdD, Professor

UT-Houston School of Nursing Associate Director of Fellowship

Richard L. Brown, MD, MPH, Assoc. Prof.

University of Wisconsin Medical School

52

Regional Directors

Toni Graham, RN, MSW, PhD, CWRU Theresa Madden, DDS, PhD, OHSU Marianne Marcus, RN, EdD, UT-Houston Gene Schoener, PhD, Wayne State Univ.

(website) Lala Straussner, DSW, New York Univ.

53

Syllabus

Designed and edited by Judie Pfeifer, MEd Borrowed from previous syllabi on

substance abuse Tailored for multidisciplinary use Updated with recent articles

54

Fellowship Advisory Committee

Addict. Psych. - John Chappel, MD Allied Health - John Bonaguro, PhD Allopathic Med. - Michael Fleming, MD,

MPH Dentistry - Karen Crews, DMD Geriatrics - Allison Moore, MD Nursing - Madeline Naegle, RN, PhD Nurse Midwife - Pat Palluzi, CNM, DrPH

55

Fellowship Advisory Committee (continued) Nurse Practitioner - Elias Vasquez, PhD,

NNP Ostoepathic Med. - Richard Butler, DO Pharmacy - Anthony Tommasello, PharmD Physician Ass’t - Janice Cooney, PA-C Psychology - Bruce Liese, PhD Public Health - Chris Ringwalt, MSW, DrPH Social Work - Lenore Kola, PhD

56

Administrative Group Project Director Richard L. Brown, MD, MPH

Project Manager Doreen MacLane-Baeder

Project Assistants Christine Benz, June Daws

57

Initial Project Officer Team

Dr. Ruth Kahn, Lead Dr. Mildred Brooks-McDow Dr. Marcia Starbecker Dr. Suzanne Cable Dr. Terri Spears

58

Accomplishments

Strategic Plan published 2002. Website now a valuable resource. Thirty-nine faculty fellows from 20

institutions trained.

59

Faculty Development: Project MAINSTREAM

Two cohorts: 39 fellows; 13 IFLGs10 physicians4 social workers11 nurses3 dentist2 physicians’ assistants2psychologists3 public health professionals2 pharmacists2 occupational therapists

60

Accomplishment - Curriculum

10,170 trainees reached by fellows. Based on clinical caseloads in generalist

settings approximately 126,275 patients could be reached by trainees daily.

66,995 hours of substance abuse content offered.

Each trained received 6.58 hours of instruction.

61

Evaluation Training experience evaluated positively. Mentoring rated positively. Interdisciplinary collaboration valued. Grants, manuscripts and evidence of

durable career change reported. New modules added based on fellow

feedback.

62

Website Development Valuable resource for Project

MAINSTREAM. Used by academics and organizations

outside of project. www.projectmainstream.net

63

HRSA-AMERSA-SAMHSA/CSAT Model Shows promise for improving services in

generalist health care settings. Strategic Plan and website are valuable

resources. Project MAINSTREAM results in

impressive outcomes.

64

Cultural Competence

Increased concern for cultural competence among all health care disciplines.

Impetus: concern for adequacy of services for members of ethnic minority groups.

Flexible changing process. Each person is unique within their culture.

65

Culture

“Sum total of a group’s lifeways, including material culture, world view, social organization, symbols, status, child raising, language, technology and citizenship.”

(Westermeyer, 1999) Acquired by experience. Transmitted from one generation to another.

66

Ethnicity

“...peoples from diverse cultural groups who share a common culture” (Westermeyer, 1999).

Characteristics: identity with a national origin, religious practice, language besides English, dress, diet, non-national holidays or ceremonials, family rituals, etc. (prescribed and proscribed substance use).

67

Subculture

Group within the culture with distinct characteristics but cannot exist independent of the group.

Subcultures and substance use: crack houses, opium dens, taverns, cocktail lounge.

68

A Culturally Competent Model of Care

Campina-Bacote, 1991

Cultural Knowledge (CK)

Cultural World Views,Theoretical and Conceptual

Framework

Cultural Skills (CS)Cultural Assessment Tools

Cultural Awareness (CA)Cultural Sensitivity,

Cultural Biases

Cultural Encounter (CE)Cultural Exposure,Cultural Practice

Cultural Competence (CC)

69

Diversity Within Culture Age Gender Level of acculturation Generation

• first generation• second generation

Sexual orientation Rural/Urban

70

Changing Frontiers in Prevention and Treatment

Faith-based settingsFamily drug courtsCriminal justice treatment initiativesComplementary and alternative

therapies

71

Summary

Overview and rationale Healthy People 2010 Role of health care professionals Accomplishments of HRSA-AMERSA-

SAMHSA/CSAT Program Cultural competence Changing frontiers