Warren W. Hewitt, Jr. DrPH, M.S. Center for Substance Abuse Treatment

2. SYNCing Government Agencies with NHAS and VHAP Warren W. Hewitt, Jr. DrPH, M.S. Center for Substance Abuse Treatment Substance Abuse Mental Health Services Administration U.S. Department of Health & Human Services SYNChronicity Sheraton Crystal City Arlington, Virginia April 20, 2012

3. SAMHSA Implementation of NHAS and VHAP

4. SAMHSA Implementation of NHAS and VHAP • Minority AIDS Initiative Targeted Capacity Expansion HIV grants • Building community capacity to treat behavioral health disorders (substance abuse and co-occurring disorders) racial and ethnic minorities at high risk of or living with HIV/AIDS. • Tertiary care for behavioral health disorders • Secondary prevention of HIV • Rapid HIV Testing of all entering behavioral health treatment.

5. SAMHSA Implementation of NHAS and VHAP • Case-managed referral to ART for those who test positive, • Test, Concurrent Treatment (Behavioral Health and ART), and Sustain Recovery. • Integrated Behavioral Health Network Cooperative Agreements • In FY 2011, SAMHSA awarded cooperative agreements totally $42.6 million over three years to 11 MSAs highly impacted by HIV/AIDS.

6. Integrated Behavioral Health Primary Care Networks • MAI –TCE: Integrated Behavioral Health/Primary Care Network (IBHPCN) Cooperative Agreements. • IBHPCNs were funded to ensure that individuals who were at high risk for or had a mental and/or substance use disorder who are also at high risk for or are living with HIV/AIDS received appropriate services in integrated behavioral health and primary care settings. • Test, Concurrent Treatment (Behavioral Health and ART), and Sustain Recovery.

7. Integrated Behavioral Health Primary Care Networks A total of 11 cooperative agreements were made to the following jurisdictions: • New York, New York • Philadelphia, Pennsylvania • Baltimore, Maryland • Washington, D.C. • San Juan, Puerto Rico • Miami, Florida • Atlanta, Georgia • Chicago, Illinois • Dallas, Texas • Los Angeles, California • San Francisco, California

8. SAMHSA Implementation of NHAS and VHAP • Addiction Technology Transfer Center - Creating lasting behavioral health care system change by translating, disseminating and promoting the adoption and implementation of effective and culturally sensitive clinical practices. • Central East ATTC – Workshop The Role of OTP Healthcare Providers in the Prevention and Treatment of Hepatitis C in OTP patients (October 2011); • Pacific Southwest ATTC - Training at the STD/HIV Update for Clinicians Serving Diverse Populations at the Phoenix Indian Medical Center (August 2012)

9. SAMHSA Implementation of NHAS and VHAP • Pacific Southwest ATTC - Cross-Collaborative Training with a focus on interventions to improve health care services related to HIV infection. • Pacific Southwest ATTC - Making Connections: Preventing HIV, Hepatitis, and Tuberculosis Among Substance-Using Populations (June 2012); • Pacific Southwest ATTC - Training Series on Treatment of TB, STDs, HIV, Hepatitis C and Substance Abuse on the Border (2011-2012) • Pacific Southwest ATTC - Training on HIV in 2011: Current Trends and Best Practices;

10. SAMHSA Implementation of NHAS and VHAP • Central East ATTC- “Trainer’s Guide For the Community-Based Outreach Model to Prevent HIV and Hepatitis Among Drug Users.” • Central East ATTC- Keeping It Real Conference---Street-Level Intervention Strategies for Addiction, HIV/AIDS, and Hepatitis • Mid-Atlantic ATTC - What’s New Update STD, HIV, TB, Hepatitis, Family Planning and Addictions (February, 2012).

11. SAMHSA Implementation of NHAS and VHAP • SAMHSA Hepatitis A and B (TWINRIX) Vaccination Initiative • The initiative seeks the prevention of hepatitis B virus (HBV) and hepatitis A virus (HAV) infections by vaccination of individuals at risk because of substance abuse/dependency; • The population covered will be persons receiving prevention or treatment services from • SAMHSA’s regulated Opioid Treatment Programs (OTPs), • physicians approved to use buprenorphine, and • SAMHSA current grantees under the Minority AIDS Initiative • Continuing viral hepatitis education for OTPs.

12. SAMHSA Implementation of NHAS and VHAP • Rapid HIV Testing Incorporated into SAMHSA Grant Announcements: • Joint Adult Drug Court Solicitation to Enhance Services, Coordination, and Treatment FY 2012 Competitive Grant Announcement; • Offender Reentry Program; • Grants to Expand Substance Abuse Treatment Capacity for Juvenile Treatment Drug Courts; • Grants to Expand Substance Abuse Treatment Capacity for Adult Drug Courts;

13. SAMHSA Implementation of NHAS and VHAP • Rapid HIV Testing Incorporated into SAMHSA Grant Announcements: • Grants to Develop and Expand Behavioral Health Treatment Court Collaboratives; • Services Grant Program for Residential Treatment for Pregnant and Postpartum Women; and • Cooperative Agreements to Benefit Homeless Individuals.

14. SAMHSA Implementation of NHAS and VHAP The main objective of this Treatment Improvement Protocol (TIP) is to improve care for clients with SUDs by increasing knowledge of viral hepatitis among staff in behavioral health programs.

15. SAMHSA Collaboration with Federal Partners

16. Engagement of Federal Partners to Implement NHAS and VHAP • Enhanced Comprehensive HIV Prevention Planning (ECHPP) Implementation. • Core Indicators working group. • NHAS Implementation. • African American Inventory. • Interagency Coordination, e.g., SAMHSA IBHNs and CDC ECHPP Cooperative Agreements.

17. SAMHSA Strategies to Implement NHAS and VHAP

18. SAMHSA’s Strategic Initiatives • Prevention of Substance Abuse and Mental Illness • Trauma and Justice • Military Families • Recovery Support • Health Reform • Health Information Technology • Data, Outcomes, and Quality • Public Awareness and Support

19. SAMHSA Strategies to Implement NHAS and VHAP • Strategic Initiative 1: Prevention of Substance Abuse and Mental Illness Disorders • Prevention can reduce the burden of disease (DALYS) and the impact that behavioral health disorders have among those with other co-occurring diseases including HIV/AIDS and viral hepatitis. • Prevention of behavioral health disorders is vital element in the strategy to address HIV and viral hepatitis.

20. SAMHSA Strategies to Implement NHAS and VHAP • Strategic Initiative2: Trauma and Justice • Trauma and violence are ubiquitous among those with mental illness and co-occurring substance abuse disorders. • Many of those at risk or living with HIV or viral hepatitis are affected by trauma and violence and suffer from Acute Stress Disorder, Post Traumatic Stress Disorder and Major Depression. • Addressing the pervasive and harmful effects of violence and trauma is important to those who have behavioral health disorders and are at risk for or living with HIV and viral hepatitis.

21. SAMHSA Strategies to Implement NHAS and VHAP • Recovery Support • Effective treatment and recovery are secondary HIV; • People with a mental or substance abuse disorder can recover; and • Sustaining recovery among those with a mental or substance abuse disorder is associated with reduce risk of relapse, and greater adherence to psychotropic and ART medications.

22. Syncing Locally

23. Syncing Locally • Community engagement all segments of the affected community; • Listen and learn, don’t be prescriptive; • Involve those in recovery; • Keep it Real and Relevant

24. Responding to Change

25. Responding to Change • Change is inevitable. • The HIV/AIDS pandemic has been in a state of change from the initial cases in Los Angeles and New York. Why should things be any different? • HIV/AIDS and viral hepatitis have taught us to be fluid, flexible and resilient. • These strategies will no doubt change the context and conversation, and we will do what we have always done adapt and change.

26. Thank you. warren.hewitt@samhsa.hhs.gov