Mental Health and Substance Abuse Services

1. Mental Health and Substance Abuse Services Joe Vesowate Assistant Commissioner

2. Organizational Structure

3. Division Summary • Substance Abuse Prevention, Intervention, and Treatment Services • Inpatient Psychiatric Services • Community-Based Mental Health Services • Projects for Assistance in Transition from Homelessness (PATH) • NorthSTAR – Community-Based Mental Health, Substance Abuse and Co-Occurring Services • South Texas Health Care System • Texas Center for Infectious Disease (TCID)

4. Substance Abuse Prevention and Early Intervention Services • Primary Prevention • HIV Early Intervention and Outreach • Outreach, Screening, Assessment and Referral Services (OSAR) • Tobacco Prevention and Control • Pregnant and Post-partum Intervention for Women (PPI)

5. PREVENTION OUTCOMESOutcomes Positive among Youth in DSHS-Funded Substance Abuse Prevention Over Time Percent of Youth Completing SA Prevention Number of Schools Participating in SA Prevention Source: DSHS Behavioral Health Integrated Provider System (BHIPS).

6. PREVENTION OUTCOMESPercentage of Texas Youth Who Used Substances in the Past Month Decreasing Over Time Source: Texas School Survey of Substance Use, DSHS.

7. Substance Abuse Treatment Services • Detoxification • Intensive and Supportive Residential (adult and youth) • Outpatient (adult and youth) • Opioid Replacement Therapy • Co-Occurring Psychiatric and Substance Abuse Disorders (COPSD) Services • Specialized Female Services

8. TREAMTMENT OUTCOMESClinical Outcomes Positive among Adults Completing DSHS-Funded Substance Abuse Treatment Over Time Source: DSHS Behavioral Health Integrated Provider System (BHIPS).

9. TREATMENT OUTCOMESClinical Outcomes Positive among Youth Completing DSHS-Funded Substance Abuse Treatment Over Time Source: DSHS Behavioral Health Integrated Provider System (BHIPS).

10. Current and Emerging Challenges • Increase in methamphetamine use • Emergence of “Cheese” Heroin usage by youth • Changing trends in use patterns • Cost pressures on treatment providers • Workforce development • Availability of specialized services • Ensuring a continuum of care and appropriate use of clinical information

11. DRUG USE TRENDSCocaine and Alcohol Decreasing, while Marijuana, Methamphetamines, and Opioids Increasing as Primary Substances for Which Adults Seek DSHS-Funded Substance Abuse Treatment Source: DSHS Behavioral Health Integrated Provider System (BHIPS).

12. DRUG USE TRENDSAlcohol Decreasing while Marijuana Increasing as Primary Substances for Which Youth Seek DSHS-Funded Substance Abuse Treatment Source: DSHS Behavioral Health Integrated Provider System (BHIPS).

13. Partnerships and Stakeholder Engagement • Texas Education Agency (TEA) • Education Service Centers (ESC) - expanding role of School Health Specialist to include MH promotion and substance abuse prevention efforts • Legislative direction to implement tobacco education program in schools • Drug Demand Reduction Advisory Committee (DDRAC)

14. Partnerships and Stakeholder Engagement (cont’d.) • Rural Border Initiative (RBI) • Provides substance abuse services in Health & Human Service Regions 8, 10, and 11, covering 15 counties (including Colonias) • Creates and expands service linkages along a continuum of substance abuse prevention, intervention, and treatment, while at the same time strengthening individuals, families and communities through mobilization and empowerment. • Utilizes trained community members as volunteers and mentors, and have significantly increased the use of Community Health Workers (Promotores), trained outreach workers from the target population. • Created alliances with HHSC’s Colonias Initiative, DSHS’ Office of Border Health, and Texas A&M University (TAMU) Colonias Projects (CHUDs).

15. System Improvement • Clinical Management Behavioral Health System (CMBHS) • Access to Recovery (ATR) • Screening, Brief Intervention, Referral, and Treatment (SBIRT) • Crisis Counseling Program Initiatives • Substance Abuse Services Performance Improvement • Actively seeking new funding opportunities

16. Clinical Management Behavioral Health System (CMBHS) • Integrated clinical management tool for Substance Abuse and Mental Health service providers • Capture demographic, service and clinical data for Substance Abuse and Mental Health clients • Track service utilization and client progress • Facilitate State and Federal reporting requirements

17. Access to Recovery(ATR) • Federal SAMHSA Grant awarded 2004 • $22.8 million for three years • Federal target 8,928 clients; served 15,000 • Voucher issued to client rather than contract with provider • 30 participating drug courts in 13 counties • Second ATR Meth Grant awarded 2007 • $13.5 million for three years • Federal target 6,038 clients • Focus on methamphetamine use • Partnership with Governor’s Office/Criminal Justice Division

18. Screening, Brief Intervention and Treatment (SBIRT) • Federal initiative designed to integrate screening, brief intervention, and referral treatment services for substance abuse problems into routine delivery of medical care • Creates bridge between general medical system and the substance use disorders delivery system

19. Crisis Counseling Program Initiatives • Ensuring comprehensive disaster response and recovery plan by integrating substance abuse into State’s Disaster Behavioral Health Plan • Collaborating with substance abuse OSAR centers to ensure that substance abuse services remain consistent during and after a disaster • Providing easier access to community resources that will significantly enhance delivery of crisis counseling services following disasters

20. Substance Abuse Services Performance Improvement • The Texas Recovery Initiative (TRI) • Partnership between DSHS and the substance abuse treatment and recovery communities • Identify opportunities and methods for improving the quality and effectiveness of services provided to adult population • Process will consist of a series of community meetings, creation of a task force and the presentation of a set of summary findings for service improvement and recommendations