CMHS Older Adult Initiatives & Updates

1. CMHS Older Adult Initiatives & Updates Betsy McDonel Herr, Ph.D. Community Support Program Branch, Division of Services and Systems Improvement Substance Abuse and Mental Health Services Administration NASMHPD Older Adults Division Meeting September 26, 2005 Baltimore, MD betsy.mcdonelherr@samhsa.hhs.gov 240-276-1911

2. http://www.samhsa.gov/Matrix/matrix_older.aspx

3. TCE Program Targeted Capacity Expansion Program for Older Adults Rounds 1 and 2 Older Adult EBP Toolkit NREPP National Registry of Effective Programs and Practices Four Initiatives

4. 9 provider sites identified, implemented EBPs for older adults (65+) Each site conducted local evaluation of implementation success & outcomes Program Included a Technical Assistance Center, PARC TCE Program I - Purpose

5. Positive Aging Resource Center (PARC) Helped sites implement & evaluate EBPs Provide limited TA to field through website & CE courses Collected, analyzed cross-site GPRA data TCE I - TA Center - PARC

6. www.positiveaging.org PARC website Site detail available educational and CME material resource links outcome findings from projects posted on website for GPRA data TCE I - Program Description

7. Sites diverse in starting points and levels of sophistication about EBPs Difficulty identifying EBPs Lack of buy-in for EBP & Fidelity concept Concerns about future sustainability beyond grant TCE I - Program Challenges

8. Can’t find funding for all or part of EBP Too ambitious, too many EBPs EBP choice was poor fit, not well vetted with stakeholders or matched to population needs EBP and TCE program goals not well communicated from top to front line Cultural diversity & competence issues TCE I - Program Challenges

9. Sites have been presenting findings from local evaluations at national conferences ASA/NCOA & AAGP PARC presented initial findings from GPRA data at ASA in March 2005 Local evaluations essential to helping program managers course-correct TCE 1 - Preliminary Outcomes

10. Data aggregated over all sites Over 1000 seniors served to date 61% 75 and over 3/4 remain in service at 6 and 12 months improvement in depressed mood, managing daily responsibilities, living independently, overall health status, life satisfaction lowered use of emergency services for health complaints TCE 1 - Preliminary Outcomes GPRA data

11. Seniors reported moretrust in service providers affiliated with greater # of agencies in community More trust in providers with higher rate of referrals to a range of community services as compared to providing all services in house TCE I - GPRA Outcomes

12. New program just announced FY05 Mix of funds for direct services, infrastructure support Each site conducts local evaluation of implementation success & outcomes Funds services for persons 60+ Emphasis-- Evidence Based Practices TCE Program II - Purpose

13. Screening Workforce Development (Training, Credentialing) Evidence Based Practice Adoption Integrated Treatment, Service Linking Consumer & Family involvement Obtaining technical assistance Outreach,engagement, case-finding Improve access for racial/ethnic minorities, rural Needs assessment MIS/Medical Records Enhancement TCE Program II - Infrastructure Support

14. Strategic planning, consensus building Quality improvement activities Financing coordination of funding streams Leadership development Partnership development Community Outreach, Dissemination Social marketing Public education/Health literacy Sustainability planning TCE Program II - Infrastructure Support

15. $4.4 million for 11 awards, 3 years Grants Awarded September 23, 2005 Texas (2), Colorado (1), Arizona (2), Virginia (1), Hawaii (1), New York (1), Ohio (1), Massachusetts (1), Tennessee (1) Press release available www.samhsa.gov. TCE II - Awards

16. Older Adult Practice Implementation Resource Kit • New contract with Abt Associates for FY 2005 • Identify key promising and evidence-based mental health practices for older adults • Provide materials to help providers successfully choose and adopt promising and evidence-based practices

17. Older Adult Track in NREPP • National Registry of Evidence-based Programs and Practices • New contract for FY 2005 • Reviews & scores programs to identify promising, effective and model programs • Funds set aside to review MH programs for older adults • Prevention & Treatment

18. Older Adult Track in NREPP • www.modelprograms.samhsa.gov • Kevin Hennessy leading the project • kevin.hennessy@samhsa.hhs.gov • Rigorous, well-developed and field-tested methodology for reviewing programs • www.nationalregistry.samhsa.gov in September 2005

19. The NREPP Review Process SAMHSA Model Program Developer Initiation Upon receiving evaluation materials, NREPP contacts developer to: 1) Confirm receipt; 2) Verify completeness of materials; 3) Request additional data when available. Identification Identify programs through: 1) Published scientific literature; 2) Final grant reports; 3) Other organizations’ lists of exemplary programs; 4) Submissions from field. Contact Developers Send program developer: 1) SAMHSA solicitation letter; 2) NREPP rating criteria. Review Initiation Determine priority of review (expedited etc). Effective (4.0 or >) Triage Triage program based on evaluation rigor. Review Assign and distribute program to NREPP reviewers. Achieve Consensus Confirm scores with reviewers as to status of program. Assign Status Once review is complete, based on compiled scores, program categorized as: Promising (3.33 to 3.99) Insufficient Current Support (3.32 or <)

20. SAMHSA Model Program NREPP Review Summary: August 2004 1,124 submitted 1,039 reviewed 63 Promising 52 Effective 57 Model

21. Vision for NREPP Expansion • NREPP becomes leading national resource for practical, contemporary and reliable information on scientifically-proven treatment and prevention service • Wide range of stakeholders has good working knowledge of, and/or direct experience with NREPP

22. NREPP Expansion in Progress • Older Americans TAC providing field with technical assistance with NREPP applications • Delivery of TA through existing Center-supported contracts or directly by Model Program developers • NREPP is “necessary but not sufficient” for ensuring greater use of evidence-based interventions – TA, training, and other components such as toolkits are essential • NREPP is referenced in our RFAs and standing mechanisms as a place to identify practices • Currently there is a commentary period by field; Federal Register notice

23. “Branding” NREPP • SAMHSA becomes known as the place to: • Identify effective, evidence-based programs • Be linked with implementation assistance • Be linked with development assistance to build a program’s evidence-base • Promote movement up the “evidence ladder” – from Insufficient Evidence to Promising to Effective

24. Pulling it All Together • Program Activities reviewed in SAMHSA’s Older Adult Matrix Workgroup to: • Assess progress • Highlight gaps where growth in evidence base is needed or additional tools and technical assistance needed • Coordinate and communicate about activities