Substance Abuse Prevention and Mental Health Promotion
Q: Most of these data are HYS or NSDUH.  Are these questions not asked on the BRFSS?  What data do we get from BRFSS that is applicable to this assessment? 
A:   Adverse Child Experience data is from BRFSS. We looked at data, across a variety of surveys that gave us the most pertinent information. 

Q: Will there be any data presented on FAE/FAS? 
A:  We do have data on FAS.  We also have programs like PCAP and Safe Babies/Safe Moms. There is a center in SAMHSA that focuses on effects of Fetal Alcohol Syndrome and have brochures available. As far as we know, SAMHSA does not have a formal line of funding. CASAT at the University of Nevada Reno put in a grant to do conference focusing on this.  Pregnant and Parenting Women is a SAMHSA and Washington State priority population.  

Q: What’s your plan for suicide prevention? 
A: In the past, the State had an aggressive plan but this was reduced as budgets were cut.  There is no specific plan at this time but we have been meeting with our State Policy Consortium where suicide prevention is addressed as a priority.  We have talked with OSPI, DOH, and other agencies about coordination of information.  Scott Waller is our lead in DBHR.  He can be reached at Scott.Waller@dshs.wa.gov. 

Q: Will dollars for suicide prevention be required in the application for MH services. 
A:  It is not required.

Q: The 2008 Healthy Youth Survey included questions related to problematic gambling. Is it possible to address gambling as a co-occurring issue under this block grant? 
A: SAMHSA is very clear on what programs and services can be funded either with the Substance Abuse Prevention and Treatment Block Grant or the Community Mental Health Block Grant. Unfortunately, gambling treatment services cannot be supported.  We can, however, incorporate gambling prevention messages as part of the prevention strategies.

Q: Although we do not have data that shows an increase in use and risk related to I-502 and Liquor Privatization, at the treatment level we are already seeing increases in adverse consequences.  Is there any way we can be sure this is addressed? 
A: We continue to look at trends. There is a grant from Robert Wood Johnson that focuses on impacts of that initiative.  We will also be contracting with the Washington State Institute for Public Policy to evaluate the impacts of Initiative 502.
  
COMMENT: I would like to comment that our numbers show that we have an increased number of parenting and pregnant women using opiates.  

Q: I certainly agree with the last polling question but I'm concerned about how we are going to add focused, effective prevention for the 18-24 year olds with the limited funding that exists.
A:  We recognize the challenge and there is a spike in problem use with young adults.  Efforts in environmental strategies may be the most effective. Coalitions and tribal partners are looking at all strategies.  We are working with colleagues at WSU to use Washington Screening, Brief Intervention, and Referral to Treatment (WASBIRT) on college campuses statewide.

Q: are there opportunities to become involved with the state level suicide planning? 
A:  Contact Scott Waller at Scott.Waller@dshs.wa.gov to get involved.

Q: Drug and alcohol treatment centers for youth and young adults are few and far between. Is there any movement to increase these centers? Sadly youth have the right to NOT participate, yet parents are concerned as to how to help a young person with substance and mental health risks. 
A:  Youth are a priority and most counties have the ability to have youth assessed and treated.  As we take reductions, the services for youth are protected (the funding remains untouched).  If you have any questions please contact either a treatment manager or Michael Langer at Michael.Langer@dshs.wa.gov. 

Q: What kind of tracking will we have available on the mental health side (related to I-502), especially related to increase in psychotic episodes and earlier first break schizophrenia, etc. 
A: We are trying to identify specific areas to add to Core GIS to investigate.  We will be looking at claims data across systems and look for correlations.

COMMENT: In addition, we are seeing an increase in challenges with managing anxiety and PTSD symptoms related to increase marijuana use.

Q: What kinds of preventative measures are being taken to educate the youth in all the high schools about substance abuse
A: Prevention funding is limited.  DBHR is investing in the highest need communities in each County, including paying for at least 1.0 FTE Prevention/Interventionist in the schools within the highest need communities (52 total statewide).  We hope all schools are continuing to provide evidence-based prevention curriculum, however this is doubtful as a significant amount of funding was lost with the elimination of the Federal Safe and Drug Free Schools and Communities funding, and the reduction of the state tobacco settlement funds dedicated to prevention services. 

Q: Any anticipated changes to the minimum 20% prevention funding under the new block grant? 
A: Prevention is still a priority and 20% of the Substance Abuse Prevention and Treatment Block Grant is dedicated to prevention, according to SAMHSA rules.  We currently use 25% towards prevention programs.  SAMHSA is talking about prevention as the #1 priority, but it all depends on Health Care Reform. We are in a holding pattern until we see how Health Care Reform the Washington Way is implemented.

COMMENT: Evidence Based Practices are mobile in our community but traditional mental health services require individuals and families to go to an office and that can create barriers to treatment individuals and families. 

COMMENT: I do believe you are on the right track with mental health promotion, I'm just curious as to why funding cannot be used for suicide prevention in the PRI communities. (Please correct me if I have misunderstood your earlier response)

Q: Are PRI communities adding suicide prevention to their strategic plans?
A: Block Grant funds are tied to each center. We cannot combine funds.  We know that to the degree that we can use MHBG we will do that.

Q: Law enforcement agencies seem to record data differently on suicide attempts - are they a part of the state task forces?
A: State Patrol is on the larger group.  We will have to get with you on whether they are part of the task force.  Our EPI workgroup is working on data mostly form DOH, WASPIC, Healthy Youth Survey, but not sure about BRFSS.  More information can be found at the Athena Website http://www.theathenaforum.org/ 

Q: Our state has a very high level of veterans and related military suicides - are those included?
A: Understand they would be if in Washington State.

COMMENT: Thanks for the clarification. I do hope there is less research and more youth providing the solutions/

Q: The EBP are not tested in our populations, Tribes and Urbans, and normally the practices have not been developed using culturally appropriate practices. Your response seems to indicate that culture will not be considered, only the EBP that historically have not worked in the Native American communities as well as other cultures 
A: As DBHR, we have a commitment to EBP and encourage opportunities for Promising Practices. We want communities to look at EBP or promising approaches as applicable for areas.

COMMENT: We shifted clubhouse services to block grant funding to replace lost (b)(3) Medicaid funding and would hate to lose that valuable resource

Chemical Dependency Treatment
Q: Is there any plan to more intentionally incorporate harm reduction strategies into the spectrum of treatment options? 
A:  Harm reduction models are being discussed more nationally.

Q: Our agency is concerned that the emphasis on EBPs will become burdensome to administer, document, monitor, audit, & demonstrate adherence to fidelity standards.  The cost of utilizing many EBPs, especially those that are not in the public domain, can be cost prohibitive from a training & utilization perspective for many providers.  PACT is able to use EBPs based on a different funding model and smaller caseload size and do so effectively.  But this is not financially realistic for other community based health services.  We currently use a blend of many EBP and Evolving Practices & have been able to innovate by having the flexibility to develop an integrated program that serves the needs of our COD clients.  If this is one of the commitments for SAMHSA Block Grant funds, can we be sure there is enough flexibility to allow for innovation & combining of practices to allow for individually tailored services & new practice design & that funding is attached to implementation? We need a large/flexible tool box.  
A: We encourage and support flexibility to use an EBP or promising approach that best meets the needs of the community.

COMMENT: I am concerned that you have said that there are beds for people across the state and we also know that people need to immediately access services, when they are ready. We know that does not happen. You have said "we want to maintain that continuum".

COMMENT: People who have insurance - Medicaid & Medicare included do NOT qualify for the Insurance Exchange. People who have NO insurance will not qualify for Medicaid Expansion.

Q: How can we provide any level of real input without seeing the proposal? Will you do an Environmental Impact Assessment to analyze the impact upon the social system?
A: There is not plan at this time to do an Environmental Impact assessment. 

Q: Please address the fact that the Expansion will not be available to people with ANY type of health insurance
A: We are not sure yet how it will affect our clients.

COMMENT: My “no” response was based strictly upon not have available beds and treatment for people when they need it.

Q: I believe that your youth target age is way too old - by 14 kids are on their way. The folks in my life began using at 10 and 11 and that was 25-years ago
A: There was some discussion at BHAC.  They had the same sentiment. In a future BHAC meeting we will be reviewing what systems are currently in place. 
Q: Is there funding for COD for adults and adolescents? The measure of Completion does not allow for the efforts of programs with those individuals suffering from COD disorders. Will the Recovery Support services also include COD Recovery Support? Many of the individuals coming out of treatment end up losing their ADATSA funding and thus their Medicaid funding for their psychotropics. This then creates a dilemma at health clinics such as NATIVE Health here in Spokane. 
A: Psychotropic medication is covered by Medicaid.

Q: Will Promising Practices be allowable or only the listed EBP? I would hope that especially for Tribes and Urban Indians that there would be allowance for cultural differences in planning purposes. 
A: We want communities to look at EBP or promising approaches as applicable for areas.

Q: The fee for CDP versus the LICSW, etc. seems quite unfair. My LICSW renewal is 142 and my CDP renewal is $230
A: Fees are set by DOH. 

Q: What programs will be able to access the funding for the 18-24 year olds? 
A: There is no new funding for this population.  This is more an interest that providers are trained up to take on more clients from this age group.

Q: With healthcare expansion, will those individuals involved with the ADATSA programs also be enrolled in health homes? 
A: Clients currently on ADATSA, low income, or no insurance will move to Medicaid.

Q: The voucher system does not allow for those Native individuals with COD who are not always able to complete the requirements of the ATR system. Many end up relapsing and then later entering into services elsewhere. Is there a way that ATR could provide some funding for individuals who are not able to complete all of the requirements of the ATR programs? 
A: Please email John directly at John.Taylor@dshs.wa.gov.

Q: When Block Grant funding is able to be directed more toward recovery support, we should remember to have discussions about using a "voucher" system to ensure individual choice.  Can a voucher system be used with Block Grant funding?
A: The voucher system is not available for block grant funding however, SAMHSA is looking at that possibility.

Mental Health
Q: What is the deadline for RSN's to submit their application? 
A: RSNs’ plans will be based on the State’s Block Grant State Plan. RSNs will likely have April and a good part of May to prepare for the contract starting July 1, 2013.  

Q: It sounds like our (RSN) plans will be based on the plan DBHR submits. 
A:  Yes

Q: Why do the feds list such general priority populations for MH, but such specific ones (and very detailed populations) for CD? Or are these state level decisions and if so why such a disparity between the two fields? 
A: These are Federal determinations, based on input from Congress and the Field.  The State must agree to focus on these populations as a condition of funding.

Q: Do you plan to include bi-racial in the disparities
A: As you know, there is not a specific “bi-racial” category in the CIS database.  There is a category of “other” in the RSN data field.  However, we have learned that there is inconsistency with how RSNs and providers are using “other”.  Some are using this category to indicate “multi-racial”, some are using it to record only specific sub-populations (i.e., Filipino or Russian), and some are using it to indicate “unknown”.  Until we get this resolved, we cannot report out what “other” means.  We can bring the issue back to our PIWG (performance indicator workgroup) for more discussion.

Q: Do the disparity reports include services provided by tribes that are not funded by RSNs? 
A: No.

Q: We have noticed problems with providers updating residential status information so that what is initially entered is never updated
A: We have also noted that the “Periodics” data is not being updated as frequently as we would expect.  We will continue to work with RSNs and Providers on this.

Q: Was the employment data captured before or after the termination of B3 funding?
 A: Before.  The data in the disparities report come from 2010 data.

Q: Do we have any stats on why these consumers have become homeless? 
A: We do not currently collect any information on why consumers become homeless.

Q: Is the employment data correlated to the funding or the inputs for employment support for this population? Where do we stand next to other states? A: We look significantly worse than the national average on both the housing and employment statistics.  The National Outcome Measures (NOMS) data specifically identify these demographics and outcomes for consumers served by State Mental Health agencies.

Q: Given our general unemployment rate during the recession compared to other states, do we still look bad? 
A:  Our data look dreadfully worse.

Q: Are there any data looking at MH issues specifically with kids involved in the foster care system? Is that a survey item on the HYS? A:  There is not a question on the Healthy Youth Survey (HYS) regarding foster care.  There are some Research and Data Analysis (RDA) reports about children in the foster care system.  Here is the link to the location on their website for those reports:  http://publications.rda.dshs.wa.gov/category/4/online/order-by-date/show-20/

Q: It would be useful to have either funds available or technical assistance in getting promising practices researched. That's the weak link in making new practices available. A: There is a requirement that DSHS and HCA submit a report to the Legislature, identifying the EBPs currently used for Children with Mental Health issues.  The first report is due the end of June 2013.  A survey has been sent out to all publically-funded providers requesting information, including the use of EBPs.  An implementation/plan report is due to the Legislature by the end of December 2013.  

COMMENT: Evidence based practices are valuable, but so are new and innovative things that aren't funded in other ways and haven't been thoroughly researched. 

COMMENT: King County has employment as a recovery measure and provides an incentive payment for reaching targets. 

Q: Has anyone factored in the effect of having more services? When I used to work with youth, runaways would migrate here because we had services.
A: I believe the question is whether or not individuals move to one county or another, because there are different services available.  It is possible, or even likely, that this happens. But, we do not have a way of figuring that out with our existing data collection.  It would need to be a local survey.

COMMENT: The statewide one night homeless count shows that King county is the highest in the state. 

COMMENT: This isn't a question just clarification King uses some their 1/10th of 1% sales tax on employment services. 

Q: Is the increase in homelessness due to the fact they may have lost their income while in the hospital?
A:  That is not what our data show.  There are two important research reports regarding housing/ homelessness.  

The Housing Status of Individuals Discharged from Behavioral Health Treatment Facilities:  http://publications.rda.dshs.wa.gov/1460/ Identifying Homeless and Unstably Housed DSHS Clients in Multiple Services Systems:  http://publications.rda.dshs.wa.gov/1457/

Q: The DD system tracks aging caregivers who are caring for their sons and daughters that are eligible but not receiving services.  Does the mental health system track these numbers, maybe for those who are caring for sons and daughters receiving mental health services.[ 
A: At this time, we do not track that.  We will look into the feasibility of doing this.  It may not be possible given how we have our data collected.

COMMENT: RSNs may be addressing issues such as housing and employment with other funding sources and want to use block grant money for things that can't be funded another way.  It would be unfortunate to have to abandon valuable programs if they don't meet the stated criteria.

COMMENT: I would hope we could build a provider system for employment supports that is specific to individuals with mental health needs even though there are lessons to be learned from others that have been providing these services for many years.  I think there are too many generalists and while that may save dollars in the short run it may not serve the population with mental health needs.

COMMENT: The last youth I referred had multiple suicide attempts over years and was at risk for losing her housing. It took 5 months for her to receive RSN services. We need enough money for timely services before we squeeze money elsewhere. 

Q: Is it still the assumption that programs funded by MHBG should only be funded for a maximum of four years? If so, how would housing and employment services be sustained? 
A:  There is no limitation or benchmark for the use of Block Grant funds.

COMMENT: We are already using local tax dollars for employment so would prefer to use block grant funds for other services not approved for use by our sales tax plan. 

Q: How will data from Tribes be integrated in the Block Grant Needs Assessment - rates of suicides for youth is very high.
A:  We recognize that there are high risks of both Substance Abuse and Mental Illness in some tribes.  We are happy to continue working with Tribes about their issues.  However, it should be noted: tribes own their data and retain control over how those data are reported

COMMENT: Suggest that we use blended funding for these proposed employments and housing efforts, such as Medicaid, federal block grant and private foundation dollars. 
Q: I think it is also important to focus on outreach services for adults, not just older adults and youth. .  We can't help people get housing or employment if we can't engage them in office based programs. 
A:  We would agree that it is important for adults --- the data and information presented today that this is a broader and more significant issue for the youth and older adults.  In all case, the treatment (and access to support services) must be individualized.

Q: Will there be a format to submit our application? 
A: This has not been determined at this time.  We will let you know.

Q: What can tribes do when their county RSN has been unwilling to collaborate with them or include them in this application process?
A: -- Please call David Reed at 360.725.1457

COMMENT: Your approach to tribes is problematic for tribes that have uncooperative RSN's in their reservations.

Q: What kind of financial analysis has been to assess the feasibility of the proposed measures that include percentages such as 50% of agencies providing Permanent Supported Housing?  Including service payment and workforce development?  Can that analysis of feasibility be shared? 
A: No feasibility study has been done at this time.

COMMENT: We currently use a majority of our FBG funds for housing efforts.  It may be difficult for us to demonstrate an "increase". Going forward, I think maintaining our ability to serve the same number of individuals with housing, with similar outcomes could also be seen as a success.   

Q: With housing being considered as a priority, how are you taking into account PATH funding?
Path funding is limited and the services are focused on outreach and engagement of individuals with mental illness or co-occurring disorders who are literally homeless.  One of the federal outcomes for this program are to measure the number of individuals that become engaged with mental health services.  The annual Point in Time count revealed 20,346 homeless persons in 2011 in Washington State.  In that same year PATH teams had contact with 5,136 individuals.  PATH and FBG funds can work together but can not be used as match.  Addressing the vast housing needs of WA citizens will need a multi-pronged and multi-system effort. PATH will play one small role in that effort.
 
Q: We currently fund tribes for services that are not covered with other funds and so we use block grant funds. What category would that fall under in this new plan.
A: It depends on what you are purchasing.

COMMENT: I would encourage you to review baseline assessments for all measures that include percentage targets.  We want forward momentum and likely success, not unfeasible targets.

Q: I am unclear how the measures work with the grant process.  For example, if the % increases for Permanent Supported Housing, which would definitely be the right direction, would that, be success even if the 50% number is not hit?  What is the baseline?  What is the planned investment?  Is the 50% number feasible?
A: --This indicator was focused on measuring the number of mental health agencies providing evidence based permanent supportive housing. The second year target is to increase the number of mental health agencies providing EBP PSH is by 50%—

PowerPoint Availability
Q: Will we be getting a copy of this presentation after the webinars or should we be taking notes? 
A: We will be posting this presentation online on the DBHR website following today's www.dshs.wa.gov/dbhr/stakeholders.shtml 

Q: When is the round table for tribal partners?
A:  The next roundtable is February 26, 2013.

Q: Will both the audio & power points be saved online? 
A: Only the power point presentation will be available.

Q: Is there a way to post the BH Outcomes and Needs Assessment findings? 
A: This information is available on the DBHR website. www.dshs.wa.gov/dbhr/stakeholders.shtml

Q: Can you tell me when a draft of these plans will be available for the public to review? I have only been able to locate the blank form from SAMHSA. I do not know how things have worked for SA but know that historically the MH FBG is not available until midnight on the due date.
A: The Washington State Block Grant State Plan will be available after the Department Secretary has opportunity to review and approve the document.

Q: I am a bit confused ... did I misunderstand you to say that a draft would be posted PRIOR to going to the Secretary and SAMHSA?
A: We will post this draft following today's presentation.  We will post the final draft after reviewed by the secretary.

Q: Sorry I am not quite catching on: by "this draft" do you mean the actual draft of the plans - at this stage and as they develop to allow for public comment PRIOR to it going to the Secretary to sign and then uploaded to the SAMHSA site on April 1st?
A: Sorry about that more specifically, we will post today's presentation by Monday on DBHR website.  We will post the final application after the secretary's review and approval.  If you have additional comments following today's webinar, you may submit them to aaron.starks@dshs.wa.gov .

COMMENT: Really professional and good job responding to questions!