The

Substance Abuse and Mental Health Services Substance Abuse and Mental Health Services

Administration (SAMHSA)

Dennis O. Romero, MA

Regional Administrator

Region II (NJ, NY, PR, U.S. VI)

The Veterans Mental Health Coalition

of NYC

Touro College Graduate School of SW

December 14, 2012

U.S. Dept. of Health and Human

Services

• The U.S. Department of Health and Human

Services (DHHS)

� The largest grant-making agency in the Federal

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� The largest grant-making agency in the Federal

government.

� 60,000-plus grants per year.

� 11 Operational Divisions

Substance Abuse and Mental Health Services

Administration

• One of the eleven grant making agencies of DHHS

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SAMHSA

• SAMHSA’s FFY 2012 budget is approximately

$ 3.4 billion

• SAMHSA has approximately 600 employees.

Behavioral Health: A National Priority

• SAMHSA’s Mission:

Reduce the impact of

substance abuse and

Behavioral health is essential to health

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substance abuse and

mental illness on

America’s communities Treatment is effective

Prevention works

People recover

Department of Health and Human ServicesDepartment of Health and Human ServicesDepartment of Health and Human ServicesDepartment of Health and Human Services

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Behavioral Health Fast Facts

• Almost 18.5 percent of service members returning from Iraq or Afghanistan have PTSD or depression, and 19.5 percent report experiencing a TBI during deployment.

• In 2008, 47 percent of all current DoD services personnel were binge drinkers.

• Nearly 50 percent of service members who need treatment for mental health conditions seek it, but only slightly more than half who receive treatment receive adequate care.

• From 2005 to 2009, more than 1,100 members of the Armed Forces took their own lives, an average of 1 suicide every 36 hours. The CDC estimates that veterans account for approximately 20 percent of the deaths from suicide in America.

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approximately 20 percent of the deaths from suicide in America.• In 2010, the Army’s suicide rate among active-duty soldiers dropped slightly (162 in 2009;

156 in 2010), but the number of suicides in the National Guard and Reserve increased by 55 percent (80 in 2009; 145 in 2010).

• Mental and substance use disorders caused more hospitalizations among U.S. troops in 2009 than any other cause.

• According to HUD and VA, nearly 76,000 veterans were homeless on a given night in 2009. Some 136,000 veterans spent at least one night in a shelter during that year.

• Cumulative lengths of deployments are associated with more emotional difficulties among military children and mental health diagnoses among U.S. Army wives.

• Children of deployed military personnel have more school-, family-, and peer-related emotional difficulties, compared with national samples.

SAMHSA’S Strategic InitiativesSAMHSA’S Strategic InitiativesSAMHSA’S Strategic InitiativesSAMHSA’S Strategic Initiatives

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1. Prevention

2. Trauma and Justice

3. Military Families

4. Recovery Support

5. Health Reform

6. Health Information Technology

7. Data, Outcomes & Quality

8. Public Awareness & Support

Background/History of SAMHSA’s

Military Families Strategic Initiative

• Started in 2005 as a result of grantee/provider agencies noticing an increase of military/veteran populations in seeking community-based services and requesting guidance from SAMHSA

• SAMHSA participated in the DoD Mental Health Task Force in 2005

• Developed voluntary internal workgroup to establish goals and activities

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activities

• Established linkages and contacts at both leadership and programmatic levels at DoD, VA and Military Component Commands

• SAMHSA served on the DoD Task Force on the Prevention of Suicide by Members of the Armed Forces in 2009

• Co-Chaired a psychological health workgroup for PSD-9/Interagency Policy Council representing HHS producing the President’s Report “Strengthening Our Military Families”

• Officially designated a SAMHSA strategic priority in 2010

Strategic Initiative #3 Military FamiliesStrategic Initiative #3 Military FamiliesStrategic Initiative #3 Military FamiliesStrategic Initiative #3 Military Families

Goals

• Goal 3.1: Improve military families’ access to community-based behavioral health care through coordination among SAMHSA, TRICARE®, U.S. Department of Defense, and Veterans Health Administration services.

• Goal 3.2: Improve the quality of behavioral health-focused

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• Goal 3.2: Improve the quality of behavioral health-focused prevention, treatment, and recovery support services by helping providers respond to the needs within the military family culture.

• Goal 3.3: Promote the behavioral health of military families with programs and evidence-based practices that support their resilience and emotional health and prevent suicide.

• Goal 3.4: Develop an effective and seamless behavioral health service system for military families through coordination of policies and resources across Federal, national, State, Territorial, Tribal, and local organizations.

Partnerships and Relationships

• Department of Veterans Affairs (VA)– Interagency Agreement supporting the Veterans Crisis Line through the National

Suicide Prevention Lifeline and coordinating VA/SAMHSA suicide prevention initiatives

• Department of Defense (DoD)– Two MOUs with National Guard Bureau – General support; host NGB Liaison at

SAMHSA.

– MOU with Defense Centers of Excellence

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– MOU with Defense Centers of Excellence

– MOU with Marine Corps providing on-site SAMHSA liaison at Camp Pendleton to support suicide prevention efforts

– DoD Reserve Affairs funded SAMHSA’s 2011 Policy Academy

– Dialogue with TRICARE Management Activity (TMA)

• Health Resources and Services Administration (HRSA)– Interagency Agreement to conduct training at Area Health Education Centers

(AHEC); SAMHSA provided $500,000 in funding

• Sharing and coordinating efforts with Behavioral Health Professional Organizations to develop curricula to better support this population

• Partner with The Alliance of Military and Veteran Family

Behavioral Health Providers

Service Members, Veterans, and

their Families (SMVF) Policy their Families (SMVF) Policy

Academies

Service Members, Veterans and Their Families

(SMVF) Behavioral Health Policy Academies*

• SMVF Behavioral Health Policy Academies represent an opportunity to strengthen prevention and treatment systems for service members, veterans, and their families within States, Territories, and Tribes through the provision of technical assistance and the promotion of ongoing interagency collaboration at the State and local levels.

• Each State/Territory’s 10-member interagency team develops a practical

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• Each State/Territory’s 10-member interagency team develops a practical and sustainable strategic action plan that is unique to its needs and includes goals, policies, time frames, resources, and input from key constituencies.

• Conducted three SMVF Behavioral Health Policy Academies.

• 23 States, Washington, D.C., and 2 Territories completed the SMVF Behavioral Health Policy Academy.

• SAMHSA provides follow-up technical assistance to States and Territories to enhance their behavioral health care systems for service members, veterans, and their families.

*Supports goals in President’s report Strengthening Our Military Families

SMVF Policy Academies*

• Partnerships

– DoD, National Guard Bureau, VA, The National Council, NASMHPD, NASADAD

• Goal

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• Goal

– For States and Territories to strengthen behavioral health systems for service members, veterans, and their families.

• Mechanism

– State/Territory establishes a long-term, 10-member interagency team, endorsed by the Governor. *Supports goals in President’s report Strengthening Our Military Families

States Completed SMVF Behavioral

Health Policy Academies15

OR

WA

ID

MT

WY

ND

SD

NE

MNWI

OH

NY

ME

MI

IA

VTNH

NJPA

CTMA

RI

MI

Policy Academy Graduates

2008 2010 2011

TX

NMARAZ

UTNV

CACO

LA

PR

VI

KS

AL GA

NEIN

MO

ILOH

KY

TNSC

NC

VA

AK

WV

MS

HI

DEMD

OK

FL

DC

GU

American

Samoa

TRICARE Work

• Working with TRICARE to expand behavioral health provider capacity

– Developed a TRICARE credentialing resource packet for behavioral health practitioners interested in becoming

certified to receive TRICARE reimbursement.

– Partnered with TRIWEST and Community Partnership of Southern Arizona (CPSA), in AZ to provide TA to

behavioral health providers to become credentialed.

• Consulting on the redefinition of behavioral health benefits

– Recommend to modernize 32CFR199, which regulates TRICARE to bring the behavioral health benefit in line

with standards of care throughout the Nation, especially with regard to evidenced based treatments for chemical

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with standards of care throughout the Nation, especially with regard to evidenced based treatments for chemical

dependency and recovery outcomes.

• Developing demonstration project opportunities

– Developed a proposal for a TRICARE demonstration project designed to test the cost effectiveness of expansion

of TRICARE for some community-based behavioral health services and eligibility of providers.

– The proposal was presented to TRICARE Management Activity but was not approved.

– Proposed similar pilot to be conducted in West Virginia to address the behavioral health needs of members of the

military, veterans and their families who live in rural areas (currently under consideration).

• Including behavioral health providers in TRICARE

– In dialogue with TRICARE Management Activity about the possibility of extending TRICARE “Corporate

Status” to behavioral health agencies (e.g., community mental health centers and substance abuse agencies).

– TRIWEST suggested a regulatory change to include behavioral health treatment facilities as “Institutional

Providers.”

Examples of Work with VA

• Ongoing collaboration to ensure that VA and SAMHSA’s suicide prevention

initiatives are coordinated

– VA adopted SAMHSA’s Treatment Improvement Protocol, Addressing Suicidal Thoughts

and Behaviors in Substance Abuse Treatment and created a complementary training video,

used by VA and community providers.

– SAMHSA assisted VA in updating its suicide prevention gatekeeper training (Operation

S.A.V.E) for communities

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S.A.V.E) for communities

– SAMHSA participated in group to develop DoD/VA joint Clinical Practice Guidelines to

prevent suicide

• SAMHSA collaborates to help VA meet the requirements of the Family

Caregivers Act, enhancing linkages between VA and community providers

and increasing their referral sources.

• VA has begun working with SAMHSA’s Regional Administrators to ensure

strong linkages between VISNs and State mental health and substance abuse

systems.

SAMHSA’s Current Activities

• Continue TRICARE credentialing and behavioral health provider

network development.

• Support Military Culture Training for behavioral health providers.

– Internal: Operation Immersion, grantee webinars

– Best Practices: Center for Deployment Psychology, The National Council for

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– Best Practices: Center for Deployment Psychology, The National Council for

Community Behavioral Healthcare, Citizen Soldier Support Program. Being

released June/July 2012: VA modules.

• Define and collect demographic data re “military families” consistent

with HHS.

• Focus on military families across the SAMHSA portfolio, especially in

the areas of Prevention, Trauma & Justice (see slides 10&11).

• Support other commitments of psychological health chapter of the

President’s Report “Strengthening Our Military Families.”

Military FamiliesA Sampling of SAMHSA Accomplishments

• 22 out of the 30 current Access to Recovery (ATR) grantees have designated National

Guard, Reserves, Active Duty, Veterans and their families as a priority population.

(Treatment vouchers for substance abuse treatment and recovery support services)

• Military Cultural Competence: Train ATR grantees (webinars and Tennessee’s Operation

Immersion). Operation Immersion has spread to at least 6 other States.

• * Host quarterly meetings with professional behavioral health organizations. Each

Organization provides updates, which includes work with Joining Forces, GiveAnHour,

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Organization provides updates, which includes work with Joining Forces, GiveAnHour,

scholarships for students with military background, and Congressional briefings.

• * Provide training to Area Health Education Centers (AHEC) staff through a SAMHSA-

HRSA IAA to conduct train-the-trainer workshops to identify and better understand

Veterans behavioral health issues and resources.

• Created website to map community providers for National Guard members and others

through a search of databases from SAMHSA’s substance abuse and mental health

providers list and HRSA’s provider list. This site is available to the public through

www.communityproviders.samhsa.gov.

• * In fiscal year 2011, 51.3% of SAMHSA funded discretionary grants will prioritize

services to military personnel, their families, and/or veterans.

*Supports goals in President’s report Strengthening Our Military Families

Military FamiliesA Sampling of SAMHSA Accomplishments cont.

• * SAMHSA member of Military/Veteran Task Force of National Action

Alliance for Suicide Prevention is leading pilot project to engage faith-

based communities in supporting and preventing suicide among Military

Families, in partnership with National Guard Chaplains in five states (AZ,

MO, MN, OR, VA).

• SAMHSA is proposing appropriate demographic identification questions to

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• SAMHSA is proposing appropriate demographic identification questions to

add to the 2015 National Survey on Drug Use and Health to collect data on

military families.

• OMB has approved changes to three data systems used by SAMHSA

grantees to support data collection for the military/veteran population.

• SAMHSA is focused on hiring vets and is ready to support any assistance

needed for accommodations. SAMHSA uses multiple methods to recruit

veterans like DCjobs.com which is reviewed by 20+ veteran organizations.

• SAMHSA participates in the Joining Forces Round Tables.

*Supports goals in President’s report Strengthening Military Families

Current and Future Work

• * Sponsor Service Member, Veteran, and Their Families Behavioral Health Policy Academy and follow-up TA/support for States/Territories that have not yet attended, based on $3.5 million one-time appropriation to SAMHSA in FY 2012.

• Military Culture TA summit scheduled for late summer 2012– Best practices, support for implementation of strategic plans

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– Best practices, support for implementation of strategic plans

• Pursue a TRICARE Demonstration Program and regulatory changes to increase access to behavioral health services.

– Explore integrated approaches to behavioral health services for Reserve and National Guard in rural areas through proposal of pilot in West Virginia with TRICARE, National Council, and VA

– Explore rule changes needed to expand access to services by including behavioral health organizations as institutional or corporate providers through TRICARE

*Supports goals in President’s report Strengthening Military Families

Resources

• SAMHSA’s Service Members, Veterans and their Families TA Center (SMVF TA)– Provides TA to state level entities for improving the BH needs of Military/Veterans, and

families

– www.samhsa.gov/militaryfamilies

• Community Provider Treatment Locator Website for National Guard and others– www.communityproviders.samhsa.gov

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• Access to Recovery (30 States/Tribes) most have identified a priority to serve Military/Veteran and families

– Voucher program for SA Treatment and recovery support services

• Jail Diversion for Military/Veteran population– Jail Diversion programs from arrest to re-entry in 13 States (CO, CT, GA,FL, IL, MA, NM,

NC, OH, PA, RI, TX and VT)

– http://gains.prainc.com/grant_programs/jdtr.asp

• National Child Traumatic Stress Network– Resource center focused on Child Trauma and Military/Veterans, and families

– http://www.nctsn.org/resources/topics/military-children-and-families

For More Information

Dennis O. Romero, MARegional Administrator

Region II (NJ, NY, PR, VI))

Substance Abuse and Mental Health Services Administration (SAMHSA)

U.S. Department of Health and Human Services (HHS) U.S. Department of Health and Human Services (HHS)

26 Federal Plaza, Suite 3337

New York, New York 10278

Phone: 212-264-8097

Fax: 212-264-2673

E-mail: dennis.romero@samhsa.hhs.gov

Website: www.samhsa.gov / 1-877-726-4727

Behavioral Health is Essential To Health • Prevention Works

Treatment is Effective • People Recover