STRATEGIC PREVENTION ENHANCEMENT PLAN

Transcription

1 STRATEGIC PREVENTION ENHANCEMENT PLAN New Hampshire State Fiscal Years New Hampshire Bureau of Drug & Alcohol Services Prevention Task Force NH Governor s Commission on Alcohol & Drug Abuse Prevention, Intervention, and Treatment July 31, 2012

2 New Hampshire State Fiscal Years July 31, 2012 Strategic Prevention Enhancement Plan The New Hampshire Bureau of Drug and Alcohol Services has developed this five-year strategic prevention enhancement plan to strengthen the infrastructure and support the key stakeholders, regional networks and community-level efforts that are in service to the prevention and reduction of alcohol and drug abuse in New Hampshire. The plan reflects year-long efforts at the community, regional and state levels to use data and key stakeholder and community participation to set goals and objectives; prioritize evidence-based programs, practices, and policies; coordinate activities; determine key data indicators and evaluation plans to measure outcomes; and plan for the sustainability of systems and activities. The following stakeholder groups and their role and function in the planning process are acknowledged for their participation and contributions: Governor s Commission on Alcohol and Drug Abuse Prevention, Intervention and Treatment NH Attorney General s Office NH Department of Safety NH Court System NH Liquor Commission NH Department of Corrections NH Department of Education NH Department of Health and Human Services House Representation (2) State Senate Representation (2) Public and Provider Representation (6) Governor s Commission s Prevention Task Force NH Bureau of Behavioral Health NH Board of Medicine NH Bureau of Drug and Alcohol Services NH Division of Liquor Enforcement NH Drug Free Communities NH NO Fetal Alcohol Spectrum Disorders NH Regional Network System NH Youth Advisory Council National Alliance on Mental Illness (NAMI-NH) NH Center for Excellence NH Alcohol and Other Drug Services NH Department of Education Providers Association New Hampshire Charitable Foundation Substance Abuse Portfolio 1

3 New Hampshire State Fiscal Years July 31, 2012 State Epidemiological Outcome Workgroup NH Bureau of Drug and Alcohol Services NH Bureau of Behavioral Health NH Department of Safety NH Department of Education National Alliance on Mental Illness (NAMI-NH) Peter Antal Consulting University of New Hampshire (UNH) UNH Institute on Disabilities Regional Network System and its Coordinators and Leadership Teams Capital Area Region Network Greater Manchester Regional Network Greater Nashua Regional Network Lower Grafton County Regional Network Greater Rockingham County Regional Network Monadnock Regional Network Lakes Region-Mt. Washington Regional Network North Country Regional Network Southeastern Regional Network Sullivan County Regional Network New Hampshire Center for Excellence JBS International NH Expert Panel Community Health Institute/JSI Research and Training Institute Pacific Institute on Research and Evaluation 2

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5 I. INTRODUCTION The New Hampshire Bureau of Drug and Alcohol Services (BDAS) and its key stakeholders have developed the following strategic prevention enhancement plan to strengthen the infrastructure and support BDAS and its contractors to provide support at the state, regional and community level in service to the prevention and reduction of alcohol and drug abuse in New Hampshire. The plan reflects year-long efforts to use data and key stakeholder and community participation to set goals and objectives; prioritize evidence-based programs, practices, and policies; coordinate activities; determine key data indicators and evaluation plans to measure outcomes; and plan for the sustainability of infrastructures and activities. There are several critical features of the state s prevention infrastructure that plays an important and distinct role in the substance abuse prevention system in New Hampshire. Each feature supports the mission of BDAS, New Hampshire s Single State Authority for substance abuse. The Governor s Commission on Alcohol and Drug Abuse Prevention, Intervention and Treatment (the Commission) The Commission was established in 2000 by legislation seeking to cultivate state leadership, effective strategies, enhanced coordination, increased resources, and visibility to lessen the harmful impact of alcohol and drug abuse on individuals, families, communities, and state systems. The Commission s membership includes the highest levels of state government, substance abuse service providers, lawmakers, and citizens and meets bi-monthly to meet its statutory obligations. These obligations and responsibilities include overseeing disbursements from the state s alcohol sales to substance abuse providers; coordinating state agency prevention, treatment and recovery initiatives; on-going strategic planning; and the monitoring substance abuse trends and service outcomes in the state. The New Hampshire Center for Excellence (the Center) The Center is a key infrastructure vital to ensuring data-driven practice; to support effective implementation and quality improvement; to facilitate the ongoing work of the State Epidemiological Outcome Workgroup (SEOW); to facilitate the evidence-based practice work group, referred to as the Expert Panel; to conduct state and regional evaluation; and to provide responsive technical assistance to a wide range of data, professional development and strategic planning needs. Currently, the Center s funding from the state only covers a.9 FTE (full-time equivalent) position to manage the functions noted above for the entire state, which includes the ten RNs and a myriad of community and state agency stakeholders and partners. The Center will need to expand its capacity in order to provide the services above to PFS II sub-recipients. The NH Training Institute on Addictive Disorders (TIAD) The TIAD is currently slated to receive funds from NH s Strategic Prevention Enhancement grant to build the capacity to offer online trainings for prevention. With this technological capacity established, PFS II sub-recipients can tap the TIAD to develop training curricula or to provide existing training to new providers in the evidence-based practices they will be implementing with PFS II funds, centralizing training to reduce PFS II training costs for sub-recipients.\ 4

6 The New Hampshire Charitable Foundation (NHCF) The NHCF is currently in a unique and powerful public-private partnership with BDAS and has stated publicly that it intends to direct the majority of its substance use portfolio, one of the largest private foundation portfolios in the nation specifically dedicated to addressing alcohol and drug abuse, to meet some of the resource needs of the state s Regional Network System (RNS) for prevention. Their planned commitment is to match state existing funds in the amount of approximately $1M per year for ten years to support the RNS. As such, NHCF is playing a critical role by serving as a leveraged funding stream for the RNS and communities. The NHCF also uses regular data reports from the RNS to cultivate existing and new donors considering charitable gifts for community substance abuse prevention, growing its substance use portfolio even more. In addition to these state resources, NH s prevention system benefits from the technical assistance from the Northeast Center for Applied Prevention Technology (CAPT), the New England School of Addiction Studies, and other federal and regional resources. II. IDENTIFICATION OF NEED The needs identified for the prevention system over the next five years from State Fiscal Year (SFY) 2013 to 2017 were determined by three inter-related planning processes that correspond with three fundamental components of the prevention system : state level, regional or community level, and the core elements of the system infrastructure that support prevention work at each level. State Level At the state level, the Governor s Commission on Alcohol and Drug Abuse Prevention, Intervention and Treatment (the Commission) initiated its own 12-month planning process that is tapping the knowledge and expertise of a wide range of stakeholders at the state and community level, also utilizing the five sector approach. The Commission, thus far in its planning process, has spearheaded the following assessment and planning activities in service to a five-year strategic plan that will incorporate this plan and will be more comprehensive in its attention to state agency collaboration, coordination, and leadership for prevention, as well as intervention, treatment and recovery support. - SEOW recommendations 1 - Fifteen one-on-one interviews with Commission members and key staff - An electronic survey of community-level stakeholders (N=188) - Day-long strategic planning summit held June 22, 2012 (165 attendees) 1 5

7 Community Level At the community level, the fundamental structure for addressing substance abuse problems and related consequences is the state s development of a regional prevention network, established through NH s participation in SAMHSA s Strategic Prevention Framework Cohort I program (SPF I) 2. Through this federal funding, technical assistance, and evidence-based community planning process, the state established and is continuing to fund ten geographically determined regions in the state, providing a full-time network coordinator, evaluation support, and technical assistance for the five steps of SPF: Assessment, Capacity building, Planning, Implementation and Evaluation (ACPIE). This new infrastructure, known as the Regional Network System (RNS) for substance abuse prevention is now stabilized and sustained with Substance Abuse Prevention and Treatment (SAPT) Block Grant. In direct relation to the planning effort put forth in this strategic prevention enhancement effort is the state s Regional Network System for substance abuse prevention that reaches all communities in the state engaged in a 12-month strategic planning processes articulated by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). This planning process involves the first three stages of a five-step approach to data-driven practice: Assessment, Capacity-building, Planning, Implementation and Evaluation. Each region engaged community members from five core and several ancillary sectors of the community, supporting SAMHSA s recommendations that prevention be integrated with other community-level safety and health systems. The five core sectors of this approach are Education (including schools, colleges and universities), Business (including employers, insurers, and business associations), Safety (including law enforcement and the justice and corrections systems), Health (including primary care and mental health), and Government (including local, county, and state governing bodies). These sectors have been articulated as institutions within communities and the state that are significantly impacted by the misuse of alcohol and other drugs and that have infrastructures and resources that can be leveraged to influence behavior and perception change relative to the misuse of alcohol and other drugs. Below is a summary of the number of stakeholders by region who attended forums and planning meetings to complete the community-level planning process. REGIONS Number of People Engaged Capital Area Region Network 125 Greater Manchester Regional Network 72 Greater Nashua Regional Network 39 Greater Rockingham County Regional Network 291 6

8 Lakes Region-Mt. Washington Regional Network 782 Lower Grafton County Regional Network 210 Monadnock Regional Network 458 North Country Regional Network 177 Southeastern Regional Network 266 Sullivan County Regional Network 87 Total Engaged in RNS Planning 2,507* *Total may include duplicates This community-level planning process is detailed in each region s strategic prevention plan, completed in June Please refer to Attachment A: Capital Region Strategic Plan to view one of the ten regional plans. All plans are accessible via the web for further review. 3 Infrastructure Supports System infrastructure needs were identified through the Strategic Prevention Enhancement (SPE) assessment process conducted between December 1, 2011, and February 15, The assessment process included structured discussions held with six key stakeholder groups that comprise a majority of the existing system s infrastructure and was designed to identify system infrastructure needs. Additionally, a survey of community level providers and stakeholders collected 47 responses relative to infrastructure needs. These needs informed four plans for short-term systems improvements that are referred to within this document and enclosed as Attachment B: NH SPE Mini Plans. System infrastructure needs were also identified during a day-long health system assessment forum held March 27, 2012, with a companion survey of assessment categories not covered during the day-long forum. Findings from the Health System Assessment, conducted by JBS International, have been incorporated into this five-year plan and are referenced throughout this document. The full report of the assessment is included as Attachment C: NH Health Assessment III. SUMMARY OF NEEDS Within the pages that follow are the needs identified by and for the three components of the state s prevention system. State Level The Governor s Commission state level needs assessment articulated in Section II resulted in the determination of prevention needs relative to specific substances and populations presented on the following page. They are currently under review by the Commission, with recommendation sources noted: 3 7

9 PRIMARY BEHAVIORS AND IMPACTS Behavior Source* Focus Populations Primary Impacts Alcohol abuse, including binge drinking Non-medical use of prescription drugs Marijuana Synthetic marijuana and similar products CS GCI SEOW SSA CS GCI GCA SEOW SSA SSA CS SEOW CS GCI Youth; young adults; college students; individuals reentering from corrections, co-occurring disordered Youth, young adults, parents, college students, adults, individuals re-entering from corrections, co-occurring disordered Youth, young adults, parents Youth, young adults, parents, adults Impaired driving, addiction, domestic violence, workforce productivity/employment, fractured families, homelessness, high-risk children Crime (theft, assault, robbery, etc.), impaired driving, addiction, violence Educational attainment; workforce productivity/ employment; need more data Need data Other Illicit Drugs SEOW Youth and adults Crime; need more data * ONDCP 2012 National Drug Control Strategy, U.S. Office of National Drug Control Policy, April 2012 GCI Governor s Commission Interviews, May 2012 GCA Governor s Commission Annual Report, December 2011 CS Community Level Survey, May 2012 SSA Single State Authority: NH Bureau of Drug and Alcohol Services (Prevention Health System Assessment (JBS), March-April, 2012 OR Substance Abuse and Mental Health Block Grant NH Application, 2012) SEOW NH State Epidemiological Outcome Workgroup, data indicator selection, Spring 2012 Community Level The needs assessments conducted by the Regional Network System (RNS) during State Fiscal Year (SFY) 2012 serve as the state s community-level needs assessments. A wide range of community members from the five core sectors and other ancillary sectors such as faith-based organizations participated in the 2012 regional assessments to identify local problems, local risk factors, and local contributing factors. These assessments and planning activities produced the prioritization of the following substance use behaviors, populations, and risk factors by the RNS: Substance Use Behavior Alcohol use and misuse # of 10 Regions Addressing Focus Populations year olds year olds Marijuana use year olds year olds Prescription drug misuse year olds year olds Primary Risk Factors addressed (# of 10 regions addressing) Access (7), Perception of risk of harm (8), Perception of wrongness (3), Perception of parental disapproval (3), Monitoring and communication (1), Community norms (2), Perception of peer use (2) Access (3), Perception of risk of harm (9), Perception of wrongness (3), Perception of parental disapproval (2), Community norms (2), Perception of peer use (1) Access (10), Perception of risk of harm (9), Perception of wrongness (3), Community norms (1) 8

10 Infrastructure Supports The following infrastructure needs were identified by the SPE assessment process and the JBS Health System Assessment and were prioritized by the SPE Policy Consortium to support service coordination: - Improved understanding and awareness of all components of and inter-relationships across the system for substance abuse prevention and treatment; - Increased capacity for early intervention through enhanced communication and coordination of efforts across sectors; and - Improved communication, coordination and integration of efforts between prevention and treatment providers IV. GOALS AND OBJECTIVES Goals and objectives serve to ensure that strategies and activities selected for implementation will meet the needs identified during the assessment phase of a planning effort. The following goals and objectives are under review, in the case of the Commission s state level planning, or have been established and approved in the case of the community level (RNS) and infrastructure support domains. State Level As discussed earlier, the Commission is in the middle of a year-long strategic planning process that has identified a range of prevention needs provided in Section III. Based on these needs, the Commission has established as its overarching goal for substance abuse prevention to reduce the percentage of individuals who misuse alcohol or other drugs. The Commission s planning process will select the specific problem substance use behaviors and target populations from the identified needs to refine this goal and determine specific objectives for its December 31, 2012, comprehensive, five-year plan for prevention, intervention, treatment and recovery, relying heavily on this report for the prevention portion of the plan. Community Level Based on the problems and needs identified by the multiple assessment and planning activities conducted in NH communities, the following goals and objectives were developed by a majority of Regional Networks: GOAL 1 Decrease alcohol misuse by youth between the ages of 9 and 17 GOAL 2 Decrease marijuana use by youth between the ages of 9 and 17 GOAL 3 Decrease non-medical prescription drug use among youth and young adults between the ages of 14 and 25 These goals above serve as the core goals of the RNS as a whole, although an individual region may or may not include all goals listed above in their region-specific strategic plan. Infrastructure Supports For the purposes of this plan, BDAS will rely on the service coordination goals and objectives prioritized during the SPE assessment, with the addition of the recommendations of the NH Health System Assessment relative to vision, leadership and increased integration of prevention, treatment and recovery. These goals and objectives 9

11 are presented in the following pages and frame the implementation strategy for infrastructure supports later in plan. Goal: Increase understanding and awareness of all components of and inter-relationships across the system for substance abuse prevention and treatment Objective: Improve surveillance of existing resources for prevention and treatment across all state and local systems Objective: Improve communication procedures to better inform system providers and sector partners on the components of and developments within the prevention and treatment systems. Goal: Improve capacity for early intervention through enhanced communication and coordination of efforts across sectors Objective: Engage the health service delivery sector to identify potential strategies for greater integration of efforts including improved screening, intervention and referral practices Objective: Increase outreach efforts to other sectors involved in prevention to improve communication, coordination and resource awareness Goal: Improve communication, coordination and integration of efforts between prevention and treatment providers Objective: Initiate greater cross-representation of prevention and treatment providers in system planning efforts and initiatives to engage other sectors in improving screening, intervention and referral practices Goal: Improve leadership, capacity, and outcome-focused processes within prevention system Objective: Establish and communicate clear vision, mission, and value statements developed and embraced by system members Objective: Increase knowledge, skills, abilities and organization of system members to solve complex alcohol and other drug (AOD) problems and consequences Objective: Ensure effective, outcome-focused processes to prevent and reduce the burden and harm caused to individuals, families, and communities by AOD use and abuse. V. SERVICE COORDINATION Improvement of service coordination to support more effective prevention activities is inherent in New Hampshire s transformed and transforming substance abuse services system. State Level At the state level, the Governor s Commission on Alcohol and Drug Abuse Prevention, Intervention and Treatment has a diverse membership that lends itself to service coordination. Established by legislation in 2000, the Commission is required to be comprised of the Commissioners of Education, Safety, Health and Human Services, and Corrections; the Attorney General s Office; the Administrative Justice of the Courts; two members of the House and Senate, one from each political party; four providers; and two public seats. Furthermore, the Commission is in favor of and is currently working toward legislation to expand its membership to include a seat from primary care and the business sector to diversify and coordinate action even more. The Commission is taking these steps in part to complement BDAS five-sector approach to integrated leadership, resources, and services. The Commission s membership structure and responsibility to improve service coordination has led to several initiatives that have leveraged coordination and integration, including the Access to Recovery project that is establishing innovative coordination between the Department of Corrections, BDAS, and a traditional and non- 10

12 traditional network of treatment and recovery support providers. Another significant achievement of the Commission, as a result of its diverse membership, is the assessment, capacity development and planning work it led to develop a state- and community-based strategy to address the state s prescription drug epidemic. 4 In relation to the Commission s work in support of resiliency- and recovery-oriented systems of care, state contracts with treatment providers now require for SFY 2012 that providers develop after-care plans for individuals leaving treatment that include the identification of and initial contact with a primary care physician and promoting service coordination with primary care. Additionally, in one of the most significant policy developments resulting from and inherent in the leadership, collaboration and coordination of the Commission is the release of a Request For Proposals (RFP) from the NH Division of Public Health Services that listed for the first time in its core service requirements for community health center funding universal screening for alcohol and drug use disorders and appropriate response. These examples of significant and powerful shifts in policy and leadership are supporting service coordination to a significant degree. As mentioned earlier, the Commission is in the midst of its strategic planning process for all services. This planning has involved key processes designed to articulate and improve service coordination across multiple systems, including primary health care. During the Commission s State Strategy Summit for over 165 state and community stakeholders, the five core sectors spent the majority of the day in sector-based workgroups to review recommendations for service coordination and to prioritize these objectives. These service coordination goals and objectives are under review by the Commission for their December 2012 publication of the state s five-year plan for alcohol and other drug services and efforts. Community Level Service coordination at the regional and community level is inherent in the networks engagement of five core community sectors, including primary care and behavioral health. All regions have within their contractual scope of service the on-going engagement of new and existing community partners, the facilitation of coordinated and collaborative activities, and a shared mission and leadership structure to ensure the networks integration with existing systems and community infrastructures. With coordination as a function of the network system, the RNS evaluation requires annual participation in the Partner Tool 5, an evidence-based assessment, evaluation and quality improvement instrument that measures the connectivity and synergistic outputs of the RNS, with the purpose of collecting, analyzing and interpreting data to improve collaboration within community networks. Infrastructure Supports Coordination within the prevention infrastructure is the result of several key structures: 1) the BDAS State Team meetings; 2) the Commission s Prevention Task Force; 3) the RNS monthly meetings; 4) estudio; 5) the Center s web site for prevention professionals; and 5) bi-monthly newsletters from the Center. BDAS hosts monthly State Team meetings to bring together the various infrastructure systems to review technical assistance (TA) needs in the prevention system, to monitor training and TA delivery and evaluation

13 outcomes, and to reduce redundancy and increase efficiency and efficacy. The State Team meeting includes the Center, the NH National Guard s Counter Drug Task Force, and the NHCF. The Commission s Prevention Task Force is a critical component of service coordination relative to infrastructure supports in that the task force serves as the nexus between the collective system s goals and the TA needed to meet those goals. The Task Force includes representation from a wide range of providers and stakeholder groups and includes the NH Alcohol and Other Drug Service Providers Association. For example, most recently the task force initiated an ad hoc work group to review and recommend model school alcohol and drug policy components and engaged the Center to conduct assessments and strategies to carry out such work. The RNS coordinators participate in monthly meetings with BDAS and the Center to share activities and resources and to discuss common TA needs, outcomes, challenges and successes. The RNS meetings provide the opportunity for quality improvement and often include guest presenters from other infrastructures, such as the NHCF, the National Guard Counter Drug Task Force, and the state s media work group. Additionally, the RNS is represented on a number of inter-related task forces such as a National Guard task force to support military families, a fetal alcohol syndrome prevention task force, and the state s suicide prevention task force. At monthly RNS meetings, coordinators share updates from each coordinator serving on these state task forces, further supporting service coordination. Another means by which prevention services are coordinated is estudio, a web-based peer sharing platform that allows prevention professionals to share tools, documents, locally developed media, and other resources through a secure login on The web platform also allows for blog-type informal conversations to take place between RNS members to support service and activity coordination. Over the last several years, RNS collaboration and coordination has increased efficiency through shared speaker fees, peer-topeer TA, shared media message development, and other collaborations. Finally, the alcohol and drug prevention and treatment system s newsletter produced by the Center is disseminated bi-monthly and includes resources, training information, articles, field highlights and recognitions. VI. STRATEGIC PREVENTION ENHANCEMENT POLICY CONSORTIUM The SPE Policy Consortium, a function filled by the Prevention Task Force of the Governor s Commission, has been the key decision-making body for prevention planning and has engaged in the following activities in service to this function: SPE Activity Time Frame Accepted role and responsibility of SPE Policy Consortium December 2, 2011 Communicated to key stakeholders the goal of SPE and what would be requested of them Promoted SPE assessment activities (enlisted related sub-groups to participate in focus groups; helped disseminate community survey) December 2-16, 2011 December 2, 2011-January 6, 2012 Reviewed and provided edits and improvements to SPE mini plans February 3-17, 2012 Approved final SPE mini plans March 2, 2012 Presented SPE mini plans to full Commission April 27, 2012 Helped disseminate SPE mini plans to stakeholder groups April-May

14 Prioritized a prevention policy to take the lead on in the current year (Model School Policy) March 2, 2012 ongoing Approved five year SPE Plan July 27, 2012 VII. SELECTING & IMPLEMENTING EVIDENCE-BASED STRATEGIES State Level The Commission, in its on-going strategic planning development, is considering the following preventionspecific evidence-based strategies reviewed and prioritized at the June 22, 2012, State Strategy Summit. Commission Prevention Strategies Reviewed June 22, 2012 Recommended Strategy Source ONDC P GCI GCA CS SSA Increase adoption of and reimbursement for SBIRT codes x x x x Work place screening and referrals to services for alcohol and drug problems if identified Increased training in effective prevention for general audiences Support mentoring for at-risk youth x x Support work place prevention education programs Implement widespread, effective media campaign, including the use of stories and state and societal costs Increase public education to counter prescription drug marketing Expand leadership within Legislature to champion the issue and continuously improve policies supporting individuals & communities harmed by alcohol & other drug problems Foster more financial or other resource investment by communities, including health care, local and county government, law enforcement, schools, colleges, and businesses, for alcohol and drug abuse prevention, intervention, treatment referral and recovery support x x x x x Increase funding for alcohol and other drug efforts x x x Institute a Prescription Drug Monitoring Program x x x x x Promoted model AOD Policies in NH schools and colleges, particularly to increase early identification and intervention Promote expanded screening for substance use in all health care settings Increase support for prescription drug return/take back/disposal programs Sustain and expand support for Community Mobilization for prevention x x x x x x x x x x x These strategies above are at a much broader level than those at the regional level and, when prioritized, will be a means by which the Commission supports a state-level environment that enhances community-based prevention such as through a state public education campaign, state agency policy, the sustained and expanded x x x x x 13

15 commitment of state resources to substance abuse prevention, and the furtherance of the community mobilization that is at the heart of the RNS and its sustainable infrastructure. Community Level As discussed throughout this document, the Commission is relying on BDAS and its Regional Network System (RNS) to develop, prioritize, implement and evaluate goals, objectives, and strategies for prevention services at the community level to incorporate into its broader five-year alcohol and other drug abuse plan that will be complemented by the prevention supports noted. Therefore, the selection process and implementation plan for evidence-based strategies in service to the state s prevention needs is embedded in the ACPIE process conducted by the RNS over the last 12 months and articulated in each region s strategic plan. The evidencebased strategies included in each plan are based on local qualitative and quantitative data, including one-on-one interviews, focus groups, contributing factor discussions, and strategic planning meetings. The following table presents the most prominent strategies selected by communities through the RNS ACPIE process that comprise the state s prevention delivery system. The strategies listed were selected by at least 50% of regions and are either federally endorsed on the National Registry of Evidence-based Programs and Practices (NREPP) as an effective prevention strategy; are research-based meaning the strategy has been formally evaluated with positive outcomes but is not on a registry; or are theory-based, meaning that although evaluation results are not in evidence, the design of program is based on sound prevention theory. 14

16 Strategy Evidence-Base # of Regions Implementing Strategy (of 10) Target Substance(s) Alcohol Marijuana Rx Drugs Primary Risk and Protective Factors Addressed Community Mobilizing for Change on Alcohol; Communities That Care; Community-based proc. Evidence-Based Prevention Curriculum (e.g. Project Alert) Parental Monitoring/ Family Education Initiatives (e.g. Guiding Good Choices) NREPP Research-Based NREPP Research- Based NREPP Research- Based 10 X X X Low community readiness and lack of capacity to address substance use 8 X X X Low Perception of Risk and Wrongness 7 X X X Lack of Parental Monitoring and Communication, Family Cohesion Life of an Athlete Theory-Based 7 X X X Low Perception of Risk and Wrongness, Community Norms Favorable Towards use Youth Leadership Initiatives Research-Based 7 X X X Low Perception of Risk and Wrongness, Community Norms, Ease of Access Permanent Prescription Theory-Based 6 X Ease of Access Drug Disposal Locations Community Assessment Research-Based 5 X X X Insufficient Substance Use Data Screening, Brief Intervention and Referral to Treatment (SBIRT) Research-Based 5 X X X Low Perception of Risk and Wrongness Infrastructure Supports These confirmed evidence-based strategies from the RNS and anticipated evidence-based strategies from the Commission are congruous with BDAS logic model for prevention services that incorporates the common risk and protective factors identified by the RNS ACPIE process (See Attachment D: BDAS Regional Network Logic Model). As stated previously, support for these efforts is inherent in the operations of the Commission and the RNS. Additionally, the completion of the implementation of the SPE recommendations over the next five years, described later in this plan, will ensure infrastructure support for the state s prevention system. The state s evidence-based workgroup, the New Hampshire Expert Panel, which has been meeting bi-monthly or more often since January 2010, has overseen and endorsed the regional planning process and its selection process. Previous to the RNS, one of the core functions of this group was to review the evidence base of 15

17 prevention strategies being considered for funding by the state and to determine the strength of the evidence base. With this second round of strategic planning, the Expert Panel will review fidelity assurances and monitoring systems established for the RNS and endorse the evaluation strategies under development for each regional network to ensure that implemented strategies will be able to produce evidence of their effectiveness in New Hampshire communities over time. VIII. RESOURCE ALLOCATION The prevention needs of New Hampshire communities are identified by communities themselves through the assessment, capacity and planning activities of the RNS. Ultimately, therefore, it is the communities themselves within the RNS organizational frame that allocates leveraged local, state, federal and private resources as well as the resources of the network membership according to their prioritized needs, geographies, and populations of focus. The SPE Policy Consortium endorses this approach and has been supportive of BDAS design and community-based resource allocation strategy. Below is a table showing an aggregate of the resources secured and needed to fully implement RNS Strategic Plans during the three year period of SFY Region THREE-YEAR BUDGETS SFY Funds Secured Funds Needed Total Cost North Country $676,431* $557,745* $1,234,176* Lower Grafton $96,975 $575,704 $672,679 Lakes RegionMount Washington Valley $1,372,500 $592,100 $1,964,600 Capital Area $487,500 $1,039,410 $1,526,910 Southeastern $1,010,100 $1,371,800 $2,381,900 Monadnock $521,600 $976,877 $1,498,477 Greater Manchester $93,765* $1,252,590* $1,370,655* Greater Nashua $515,832* $669,822* $1,185,654* Greater Rockingham $671,229 $1,003,500 $1,674,729 Sullivan Data pending Data pending Data pending *Estimated figures based on year one budget provided by this region IX. IMPLEMENTATION PLAN This section refers to the prevention infrastructure being enhanced and sustained by the NH Bureau of Drug and Alcohol Services to support the community-based organizations with whom it contracts and the state agencies with whom it partners. Strategic Prevention Enhancement efforts serve as the important intersection between state support and community level action. 16

18 DOMAIN: Data Collection, Analysis and Reporting Recommendation Source: Strategic Prevention Enhancement assessment Health System Assessment Recommendations supported by these activities: Effective Process Improvement: Monitoring and Evaluation Goal # 1: Improve accessibility and utility of substance abuse-related health outcome information through a comprehensive web-based data system Strategy 1a: Coordinate with the NH Division of Public Health Services (DPHS) in the development and implementation of the Webbased Interactive System for Direction and Outcome Measures (WISDOM) to include risk, outcome, utilization and financial measures of substance abuse prevention efforts. -Complete a review of data specifications and initial topic/dashboard content for preventionrelated measures to be incorporated in WISDOM -Form a prevention data users group comprised of a diverse group of user types to inform the development and implementation work. -Provide access to BDAS maintained datasets to be included in the data warehouse accessed by WISDOM -WISDOM substance abuse module completed and live with initial prevention related topics/dashboards -AOD epi data accessed by state partners, regions and communities -WISDOM module and utilization monitored and provided quality improvement feedback -WISDOM generates regional and state level reports to track prevention goals and long-term outcomes -SEOW and regions use data to inform state and community dialogue and policy Responsibility Time Frame SEOW SPE Policy Work Group BDAS DPHS BDAS, Commission March 2012 Fall 2013 Spring 2013 Fall 2013 Fall Spring 2017 DPHS Fall Spring 2017 DPHS,BDAS Fall Spring 2017 SEOW, RNS Fall Spring 2017 Progress to Date Two State Epi Profiles completed (12/2011 and 4/2012) Presentation of epi data and recommendations to Governor s Commission (April 27, 2012) Presentation to State Strategy Summit (June 22, 2013) Data monitoring indicators for substance abuse selected and recommended to BDAS and WISDOM (May 2012) Goal #2: Enhance the comprehensiveness and relevance to a variety of stakeholders of the information available through a web-based health data system Strategy 2a: Coordinate with the NH Division of Public Health Services (DPHS) to implement interfaces to other datasets relevant to prevention efforts via their web-based WISDOM health data system -Develop interfaces between WISDOM and additional datasets relevant to prevention work including Uniform Crime Reports and mental health data Responsibility Time Frame BDAS, DPHS Spring 2013 Progress to Date BDAS directed $40,000 to DPHS to build substance abuse module (June 2012) BDAS prepared state and local sample YRBS data from 2011 administration for 17

19 -Complete process to incorporate YRBS, NSDUH, arrest data, hospital data, and other information into the data warehouse to be accessed by WISDOM -Wide range of data sets in WISDOM updated as new reporting years close Strategy 2b: Develop additional content to be included in WISDOM that is useful and relevant to multiple sectors and prevention partners Develop and load content that describes the nature and scope of the problem that is important to the core sectors: a) Include information describing social and financial costs; b) Include background research and model practice information linked to potential interventions Strategy 2c: Develop capacity to support input, analysis and reporting of regional, communityspecific datasets via WISDOM -Facilitate a regional level process to determine what data would be the most useful from the consumer s point of view (e.g., general public, prevention and treatment, policy, legislature) and what organizations (e.g. hospital, health center, mental health center, police dept. data) can commit to providing by region -Develop and implement a WISDOM module for data input by external, community-based agency users -RNS members and stakeholders access module for data entry and retrieval -Data module is used to inform regional performance management and quality improvement -Data module is used to inform state level prevention oversight BDAS, DPHS BDAS, DPHS Fall 2013 Spring 2014 and on-going Responsibility Time Frame Center for Excellence, NH Expert Panel Summer 2013 Responsibility Time Frame RNS, Center for Excellence BDAS,DPHS Summer 2013 Fall 2013 RNS Spring 2014 and on-going BDAS, RNS, Center for Excellence BDAS, Prevention Task Force Fall 2014 and on-going Fall 2014 and on-going WISDOM site (May-June 2012) Progress to Date Pacific Institute on Research and Evaluation (PIRE) submitted to Center for Excellence on model practice information for inclusion (June 2012) Progress to Date BDAS has consulted with DPHS and entered into a formal agreement to join WISDOM (May-June 2012) Goal # 3: Improve capabilities for measurement and reporting of prevention system capacity building outcomes. Strategy 3a: Develop improved methods, tools and consistent procedures for qualitative measurement of prevention system capacity building -Expand SEOW membership to include RNS coordinator representation to ensure that tools produced are practical and consistent on the ground -Research qualitative measurement methods employed in other states, settings Responsibility Time Frame BDAS August 2012 BDAS, SEOW Fall 2012 Progress to Date At the request of BDAS, the Center for Excellence subcontracted with a consultant to develop a qualitative data collection method, known as Appreciative Inquiry, to begin foundation of this strategy (Appreciative Inquiry methods and toolkit 18

20 -Select and implement an approach that balances precision with practicality and can be consistently applied over time -Include this activity in regional network contracts -Provide technical assistance and tools to support regional networks in qualitative data collection and utilization BDAS, SEOW Spring 2013 BDAS Spring 2013 BDAS, RNS, Center for Excellence Fall 2013 submitted to BDAS June 2012) -System collects, records and uses qualitative methods to track and improve capacity building -Qualitative data are used to inform regional performance management and quality improvement BDA, RNS, Center for Excellence BDAS, RNS, Center for Excellence Late fall and on-going Spring 2014 and on-going Goal # 4: Assure consistency, reliability and utility of prevention data collection tools, procedures and reporting over time Strategy 4a: Initiate a strategic planning process to determine the optimal statewide plan for useful, effective, and practical prevention data collection, analysis and reporting as part of state and regional evaluation -Form data committee, including SEOW and prevention data users group, to begin strategic planning process -Research prevention data plans, systems and methods employed in other Strategic Prevention Framework states -Contribute findings and recommendations to the overall statewide RNS evaluation process -Use findings and recommendations to inform regional performance management and quality improvement -Evaluation activities document use of data collection and procedures Responsibility Time Frame BDAS, SEOW, SPE Policy Work Group BDAS, Center for Excellence, NH Expert Panel Fall 2013 Spring 2013 BDAS Summer 2013 BDAS, RNS, Center for Excellence BDAS and/or selected contractor Fall 2014 and on-going Summer 2015 and on-going Progress to Date Center for Excellence is in receipt of ten regional plans and is currently developing evaluation design for each and for RNS as a whole (June-July 2012) DOMAIN: Coordination of Services Recommendation Source: Strategic Prevention Enhancement assessment Health System Assessment Recommendations supported by these activities: Effective Process Improvement Information, Communication and Marketing 19

21 Goal #1:Increase understanding and awareness of all components of and inter-relationships across the system for substance abuse prevention and treatment Strategy 1a: Improve surveillance of existing resources for prevention and treatment across all state and local systems -Improve procedures for gathering detailed information on funding intended for prevention and treatment activities at the state and community level -Develop a map of resources at the network level by source, purpose and implementing entity to provide a complete picture of status quo to inform effective strategic planning processes Strategy 1b: Improve communication procedures to better inform system providers and sector partners on the components of and developments within the prevention and treatment system -Develop an overall roadmap of how the system works at the state and regional levels to increase understanding, awareness and potential for effective engagement -Expand existing prevention newsletter to improve communication processes at the state level regarding new developments in the prevention and treatment system, model practices, agency/partner highlights, etc. via a new BDAS Updates section -Disseminate road map and quarterly or bimonthly newsletters to prevention and treatment field Responsibility Time Frame BDAS, contractor FEI BDAS, Center for Excellence November 2012 May 2012 Responsibility Time Frame BDAS, Commission, Center for Excellence BDAS, Center for Excellence BDAS December 2012 Summer 2013 and on-going Summer 2013 and on-going Progress to Date BDAS has contracted with new vendor (FEI) for surveillance of existing resources within RNS and community sectors through its WITS system (May 2012) Progress to Date Center for Excellence provided TA to RNS in resource mapping (Spring 2012) and has an existing newsletter for expansion (initiated in 2010) Goal # 2: Improve capacity for early intervention through enhanced communication and coordination of efforts across sectors Strategy 2a: Engage the health service delivery sector to identify potential strategies for greater integration of efforts including improved screening, intervention and referral practices -Convene a planning group comprised of representatives from the prevention and health care delivery communities to: a) Identify specific challenges to implementation of enhanced screening, intervention and referral in the clinical setting ; b) Share information describing health risks and outcomes including prescription drug misuse; c) Share information on referral resources and model practices -Initiate work with planning group to develop proactive strategies for addressing health reform including greater integration of clinical and Responsibility Time Frame BDAS, DPHS BDAS SFY Spring 2013 Progress to Date Progress to Date -Prevention Task Force added the NH Board of Medicine as a member (April 2012) -BDAS has amended its contract with its contractor for the NH Training Institute on Addictive Disorders to develop the capacity for webbased training (May 2012) -A new contract for the Center for Excellence includes a scope of service for the development of 20

22 prevention resources and activities -Promote similar activity within other community sectors -Track, monitor and inform state and regional performance management and quality improvement Strategy 2b: Enhance efforts to support local school districts in implementation of model policies and practices for substance abuse prevention and early intervention -Support and expand current work of Prevention Task Force to develop elements of model school policies -Sponsor local/regional workshops for school administration, boards, counselors and nurses on effective, low cost prevention and early intervention policies and practices -Track, monitor above to inform state and regional performance management and quality improvement BDAS, RNS BDAS using WITS system Fall 2013 and on-going Fall 2014 and on-going Responsibility Time Frame Prevention Task Force BDAS, RNS, Center for Excellence BDAS using WITS system April 2012 Spring 2013 Fall 2014 and on-going sector-based trainings, including trainings/ workforce education relative to the health sector such as enhanced screening, intervention and referral and prescription drug abuse (July 2012) - DPHS included evidencebased screening, intervention and referral to treatment for all adults as a required service of its community health center contractors effective January 1, 2013 (July 2012) Progress to Date -SPE Policy Consortium/Prevention Task Force initiated ad hoc model school policy work group to develop policy recommendations with schools that include early identification and referral (initiated March 2012; publication due early fall 2012). -This strategy is being reviewed and prioritized by the Commission s strategic planning process (April- September 2012) Strategy 2c: Increase outreach efforts to other sectors involved in prevention to improve communication, coordination and resource awareness -Work with justice and law enforcement personnel, including school resource officers and court diversion programs, to increase awareness of early intervention resources and to identify opportunities for improved identification and referral practices -Explore greater outreach and connections with faith community; offer basic training and resource information -Explore potential for Elder Wrap meetings and ServiceLink as potential points of collaboration, education and sharing of resources Responsibility Time Frame BDAS, Center for Excellence BDAS BDAS Spring 2013 Spring 2014 Spring Track, monitor above to inform state and BDAS using Fall 2014 and Progress to Date 21