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 Betsy McDonel Herr is the CMHS lead program officer for Older Adult programs. She also serves as the lead contact on Primary Care issues and initiatives. Betsy McDonel Herr is the CMHS lead program officer for Older Adult programs. She also serves as the lead contact on Primary Care issues and initiatives.

2. Brochures can be e-mailed as PDF. Note we update continually & there are new versions every 6 months or so. Purpose of the matrix group is to coordinate and integrate older adult initiatives across SAMHSA, consistent with the stated recommendations of the President’s NFC report (2003) to reduce barriers within and between bureaucracies to better meet the NFC goals. NFC reports and executive summaries available on resource table as are SAMHSA priority matrix brochures.Brochures can be e-mailed as PDF. Note we update continually & there are new versions every 6 months or so. Purpose of the matrix group is to coordinate and integrate older adult initiatives across SAMHSA, consistent with the stated recommendations of the President’s NFC report (2003) to reduce barriers within and between bureaucracies to better meet the NFC goals. NFC reports and executive summaries available on resource table as are SAMHSA priority matrix brochures.

3. Four Initiatives 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 Describe and update 4 initiatives in CMHS to improve MH services for older adults. Note McDonel Herr, English and Brown (2003) article that describes most of our aging initiatives in the last decade, and describes the last decade’s attempts to synthesize and translate evidence base to the field. Products and learnings from these initiatives will be pertinent to the proposed EBP initiative to be discussed in tomorrow’s planning meeting.Describe and update 4 initiatives in CMHS to improve MH services for older adults. Note McDonel Herr, English and Brown (2003) article that describes most of our aging initiatives in the last decade, and describes the last decade’s attempts to synthesize and translate evidence base to the field. Products and learnings from these initiatives will be pertinent to the proposed EBP initiative to be discussed in tomorrow’s planning meeting.

4. TCE Program I - Purpose 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 Note that this 3-year program started in 2002. The competition for this program was intense with over 100 applications for the site grants. Evidence of great interest and need for help with Older Adult EBPs.Note that this 3-year program started in 2002. The competition for this program was intense with over 100 applications for the site grants. Evidence of great interest and need for help with Older Adult EBPs.

5. TCE I - TA Center - PARC 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 Website is www.positiveaging.org Dr. Sue Levkoff, Director of the PARC, will provide much greater detail on the PARC’s activities in her talk. The was great need for a TA center to help the sites with the challenges of implementing EBPs. Site descriptions available at websiteWebsite is www.positiveaging.org Dr. Sue Levkoff, Director of the PARC, will provide much greater detail on the PARC’s activities in her talk. The was great need for a TA center to help the sites with the challenges of implementing EBPs. Site descriptions available at website

6. TCE I - Program Description www.positiveaging.org PARC website Site detail available educational and CME material resource links outcome findings from projects posted on website for GPRA data Website is www.positiveaging.org Dr. Sue Levkoff, Director of the PARC, will provide much greater detail on the PARC’s activities in her talk. The was great need for a TA center to help the sites with the challenges of implementing EBPs. Site descriptions available at websiteWebsite is www.positiveaging.org Dr. Sue Levkoff, Director of the PARC, will provide much greater detail on the PARC’s activities in her talk. The was great need for a TA center to help the sites with the challenges of implementing EBPs. Site descriptions available at website

7. TCE I - Program Challenges 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 Quick overview of some of the challenges of the TCE sites in meeting their goals of identifying, implementing and evaluating EBPs. The challenges described here are are broadly stated to give the big picture. These are areas of difficulty straight from the real-world laboratory and need to be considered in the development of a major national EBP initiative. Some sites pretty much wanted funding for usual care--and supported what they were doing with some citations. Some sites inspired by an EBP but not adhering closely to a model or manual or protocol. Some implementing a a very rigorous protocol, but having trouble getting buy in for complete adoption of all elements.Quick overview of some of the challenges of the TCE sites in meeting their goals of identifying, implementing and evaluating EBPs. The challenges described here are are broadly stated to give the big picture. These are areas of difficulty straight from the real-world laboratory and need to be considered in the development of a major national EBP initiative. Some sites pretty much wanted funding for usual care--and supported what they were doing with some citations. Some sites inspired by an EBP but not adhering closely to a model or manual or protocol. Some implementing a a very rigorous protocol, but having trouble getting buy in for complete adoption of all elements.

8. TCE I - Program Challenges 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 States went into a funding crisis at beginning of program, one had to withdraw and reorganize with its partners because the funding crisis did not allow them to begin a new program when old ones were being cut. Some sites too ambitious citing too many new EBPs to implement, and couldn’t do a large amount of what had been proposed &had to scale back.States went into a funding crisis at beginning of program, one had to withdraw and reorganize with its partners because the funding crisis did not allow them to begin a new program when old ones were being cut. Some sites too ambitious citing too many new EBPs to implement, and couldn’t do a large amount of what had been proposed &had to scale back.

9. TCE 1 - Preliminary Outcomes 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

10. TCE 1 - Preliminary Outcomes GPRA data 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 GPRA is Government Performance and Results Act, simple program accountability data that we have leveraged and used in a way to track changes for clients across time. Original intent of GPRA wasn’t necessarily to perform such longitudinal analyses, but rather cross-sectional snapshots of the program.GPRA is Government Performance and Results Act, simple program accountability data that we have leveraged and used in a way to track changes for clients across time. Original intent of GPRA wasn’t necessarily to perform such longitudinal analyses, but rather cross-sectional snapshots of the program.

11. TCE I - GPRA Outcomes Seniors reported more trust 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

12. TCE Program II - Purpose 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 for Older Adult Mental Health provides funds for services providers to identify and implement evidence-based mental health practices for older adults 60 years and above. Infrastructure activities include: Screening Increase/Train Providers Evidence Based Practice Adoption Integrated Treatment Consumer involvement Technical assistance Outreach,engagement, case-finding Improve access for racial/ethnic minorities, persons in rural settings Service Linking Needs assessment Strategic planning Quality improvement activities Cross-training Consensus building Sustainable financing Leadership development Partnership development Community Outreach Social marketing Public education/Health literacy Dissemination Consumer/Family/Advocacy Group Participation EvaluationTCE Program for Older Adult Mental Health provides funds for services providers to identify and implement evidence-based mental health practices for older adults 60 years and above. Infrastructure activities include: Screening Increase/Train Providers Evidence Based Practice Adoption Integrated Treatment Consumer involvement Technical assistance Outreach,engagement, case-finding Improve access for racial/ethnic minorities, persons in rural settings Service Linking Needs assessment Strategic planning Quality improvement activities Cross-training Consensus building Sustainable financing Leadership development Partnership development Community Outreach Social marketing Public education/Health literacy Dissemination Consumer/Family/Advocacy Group Participation Evaluation

13. TCE Program II - Infrastructure Support 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 for Older Adult Mental Health provides funds for services providers to identify and implement evidence-based mental health practices for older adults 60 years and above. Infrastructure activities include: Screening Increase/Train Providers Evidence Based Practice Adoption Integrated Treatment Consumer involvement Technical assistance Outreach,engagement, case-finding Improve access for racial/ethnic minorities, persons in rural settings Service Linking Needs assessment Strategic planning Quality improvement activities Cross-training Consensus building Sustainable financing Leadership development Partnership development Community Outreach Social marketing Public education/Health literacy Dissemination Consumer/Family/Advocacy Group Participation EvaluationTCE Program for Older Adult Mental Health provides funds for services providers to identify and implement evidence-based mental health practices for older adults 60 years and above. Infrastructure activities include: Screening Increase/Train Providers Evidence Based Practice Adoption Integrated Treatment Consumer involvement Technical assistance Outreach,engagement, case-finding Improve access for racial/ethnic minorities, persons in rural settings Service Linking Needs assessment Strategic planning Quality improvement activities Cross-training Consensus building Sustainable financing Leadership development Partnership development Community Outreach Social marketing Public education/Health literacy Dissemination Consumer/Family/Advocacy Group Participation Evaluation

14. TCE Program II - Infrastructure Support 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 for Older Adult Mental Health provides funds for services providers to identify and implement evidence-based mental health practices for older adults 60 years and above. Infrastructure activities include: Screening Increase/Train Providers Evidence Based Practice Adoption Integrated Treatment Consumer involvement Technical assistance Outreach,engagement, case-finding Improve access for racial/ethnic minorities, persons in rural settings Service Linking Needs assessment Strategic planning Quality improvement activities Cross-training Consensus building Sustainable financing Leadership development Partnership development Community Outreach Social marketing Public education/Health literacy Dissemination Consumer/Family/Advocacy Group Participation EvaluationTCE Program for Older Adult Mental Health provides funds for services providers to identify and implement evidence-based mental health practices for older adults 60 years and above. Infrastructure activities include: Screening Increase/Train Providers Evidence Based Practice Adoption Integrated Treatment Consumer involvement Technical assistance Outreach,engagement, case-finding Improve access for racial/ethnic minorities, persons in rural settings Service Linking Needs assessment Strategic planning Quality improvement activities Cross-training Consensus building Sustainable financing Leadership development Partnership development Community Outreach Social marketing Public education/Health literacy Dissemination Consumer/Family/Advocacy Group Participation Evaluation

15. TCE II - Awards $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.

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 Project should take about 2 years to complete, although there have been some preliminary planning activities, the formal start date for this Older Adult Kit is in the summer of 2005. Contract to Abt Associates. This follows a similar project just completed and disseminated for six other Implementation resource kits in the areas of 1) Assertive Community Treatment, 2) Integrated Treatment for Dual MH and SA disorders, 3) Illness Self-Management, 4) Family Psychoeducation 5) Medication Algorithms, 6) Project should take about 2 years to complete, although there have been some preliminary planning activities, the formal start date for this Older Adult Kit is in the summer of 2005. Contract to Abt Associates. This follows a similar project just completed and disseminated for six other Implementation resource kits in the areas of 1) Assertive Community Treatment, 2) Integrated Treatment for Dual MH and SA disorders, 3) Illness Self-Management, 4) Family Psychoeducation 5) Medication Algorithms, 6)

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 RFP was let in 2004, contract to Manila. Project is an extension of previous NREPP which focused on substance abuse prevention programs. Began in 1998 within SAMHSA’s CSAP under Dr. Paul Brounstein as a system for identifying & promoting interventions that are: Well implemented , thoroughly evaluated, and that produce consistent positive and replicable results. Identified programs able to assist in dissemination and training efforts. RFP was let in 2004, contract to Manila. Project is an extension of previous NREPP which focused on substance abuse prevention programs. Began in 1998 within SAMHSA’s CSAP under Dr. Paul Brounstein as a system for identifying & promoting interventions that are: Well implemented , thoroughly evaluated, and that produce consistent positive and replicable results. Identified programs able to assist in dissemination and training efforts.

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 PowerPoint available from me or Kevin Hennessy explaining “what is NREPP.” PowerPoint available from me or Kevin Hennessy explaining “what is NREPP.”

20. NREPP Review Summary: August 2004

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 In FY2004 NREPP began reviewing programs in mental health promotion and prevention, treatment, and substance abuse treatment. NREPP expanded to include community coalitions, and examined revisions to review criteria.In FY2004 NREPP began reviewing programs in mental health promotion and prevention, treatment, and substance abuse treatment. NREPP expanded to include community coalitions, and examined revisions to review criteria.

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