Strength In Diversity - HBCU Center for Excellence

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STRENGTH IN DIVERSITY:
A WAY TO BETTER HEALTH
H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM
Director
Center for Substance Abuse Treatment
Substance Abuse Mental Health Services Administration
U.S. Department of Health & Human Services
Lonnie E. Mitchell Policy Academy
Atlanta, GA April 5, 2014
President Barack Obama
“In America, we share a
dream that lies at the heart of
our founding: that no matter
who you are, no matter what
you look like, no matter how
modest your beginnings or the
circumstances of your birth,
you can make it if you try. Yet,
for many and for much of our
Nation's history, that dream
has gone unfulfilled.”
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Diversity: Beauty and Strength
“It is time for parents to teach young
people early on that in diversity there is
beauty and there is strength. We should all
know that diversity makes for a rich
tapestry, and we must understand that all
threads of that tapestry are equal in value
no matter their color.”
– Maya Angelou
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April 2014 National Minority Health Month
 Prevention is Power: Taking
Action for Health Equity
emphasizes the critical role of
prevention in reducing health
disparities.
 It is a call to action, a charge for
all of us to unite towards a
common goal of improving the
health of our communities.
http://www.minorityhealth.hhs.gov/
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HBCUs: Leadership and Values
 White House Initiative on
HBCUs selected the
inaugural class of the
HBCU All-Stars.
 This All-Star class includes
75 undergraduate,
graduate, and professional
students enrolled at 62
historically Black schools,
who were selected from a
field of 445 students.
http://www.ed.gov/edblogs/whhbcu/
“Engaging with the next generation
of leaders who will graduate from
HBCUs and go on to make meaningful
contributions to society is crucial to
the success of our community, our
country and our global
competitiveness.” – George Cooper,
Executive Director of the White House
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Initiative on HBCUs
SAMHSA’s Office of Behavioral Health Equity
http://beta.samhsa.gov/about-us/who-we-are/offices-centers/obhe
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National Network to Eliminate Health
Disparities
A SAMHSA & National Alliance of
Multi-ethnic Behavioral Health
Associations Partnership
http://nned.net/8
Today’s Focus Areas for Tomorrow’s Leaders
Challenges, Trends, & Unmet Needs
Solutions
• Health Reform and the ACA
• Diversified Workforce
• SAMHSA Initiatives
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Challenges, Trends, & Unmet Needs
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Current, Binge, and Heavy Alcohol Use among
Persons >12 years old (2012)
Percent Using in Past Month
Current Use (Not Binge)
Binge Use (Not Heavy)
Heavy Alcohol Use
70
60
57.4
51.9
50
43.2
40
30
36.9
30.2
23.9
25.1
23.2
6.8
5.1
Two or
More
Races
Hispanic
or Latino
20.6
20
10
41.8
41.7
12.7
7.6
4.5
8.5
1.7
0
White
SAMHSA NSDU 2013
Black or
African
American
American
Indian or
Alaska Native
Asian
Note: Due to low precision, estimates for Native Hawaiians or Other Pacific Islanders are not shown.
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Past Year Substance Dependence or Abuse
among Blacks/African Americans
10
9
2011
8.9
2012
8
7.2
Percentage
7
6.2
6
5.2
5
4
3
4.1
3.1
2
1
0
SAMHSA NSDUH 2013
Illicit Drugs
Alcohol
Drugs & Alcohol
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College Students, Illicit Drugs, & Race/Ethnicity
Among full-time college students aged 18 to
22 in 2012, the rate of current illicit drug use
was:
• 25.6% for Blacks
• 22.7% for Whites
• 20.6 % for Hispanics
• 13.2% for Asians
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Students in HBCUs Use Less Substances
Benefits of student engagement and leadership are
demonstrated by historically black colleges and
universities (HBCUs), which have a strong emphasis
on character development and community service:
• Students attending historically black colleges and
universities – regardless of their race/ethnicity –
use all forms of substances at much lower rates
than other students.
National Center on Addiction and Substance Abuse (CASA), Columbia University.2007.
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Increase in Past Year Mental Illness &
Co-occurring Disorders in Blacks/African Americans
20
18
16
18.6
2011
16.3
2012
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Percentage
12
10
8
6
2.7 3.3
4
2
2.8
3.4
0
Any Mental Illness Co-occurring SUD/AMI
SAMHSA NSDUH 2013
Serious MI
0.6 0.9
Co-occurring SUD/SMI
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Unmet Needs: Over 20 Million Individuals in
the US went Untreated in 2012
3.7% 1.7%
Didn't feel they
needed Tx
94.6%
Felt they needed Tx
but made no effort
Felt they needed Tx
and made effort
Individuals >12 years old
SAMHSA NSDUH 2013
Tx = treatment
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Unmet Needs: Blacks/African Americans
Substance Abuse Treatment in 2012
In 2012, 12.7% of Blacks/African Americans who
needed treatment for illicit drugs or alcohol
received it – that figure was down from 14.9% in
2011.
In 2010 (the most recent data available), among
non-Hispanic Blacks in treatment, only 56%
discharged actually completed the treatment or
transferred to another program.
• This compares to 61% completion among whites
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and 57% completion among Hispanics.
Unmet Needs: Blacks/African Americans
Quality of MH Treatment and Access
 African Americans, Latinos, and Asian Americans with
mental health needs are less likely than whites to
receive treatment.
• If treated, they are likely to have sought help in
primary care, as opposed to mental health specialty
care; and African Americans are less likely than
whites to receive evidence-based mental health care
in accordance with professional treatment
guidelines.
 23% of African Americans reported communication
problems with their doctor.
In the Nation's Compelling Interest: Ensuring Diversity in the Health-Care Workforce (2004). Institute of Medicine
http://www.iom.edu/Reports/2004/In-the-Nations-Compelling-Interest-Ensuring-Diversity-in-the-Health-Care-Workforce.aspx
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Behavioral Health & HIV/AIDS
Substance abuse and mental illness can put individuals at
higher risk for HIV infection; contribute to overall disease
burden; and compromise treatment.
 At some point in their lifetimes, an estimated 1 in 16
African American men and 1 in 32 African American
women will be diagnosed with HIV infection.
• In 2011, an estimated 15,958 African Americans were
diagnosed with AIDS in the United States.
• By the end of 2010, an estimated 260,821 African
Americans ever diagnosed with AIDS had died in the
United States.
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http://www.cdc.gov/hiv/risk/racialethnic/aa/facts/index.html
Estimated Rate for New HIV Infections
in the U.S. in 2010
http://www.cdc.gov/nchhstp/newsroom/docs/CDC-HIV-AA-508.pdf
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New HIV Infections in the U.S. for Blacks by
Transmission Category (2010)
http://www.cdc.gov/nchhstp/newsroom/docs/CDC-HIV-AA-508.pdf
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Today’s Focus Areas for Tomorrow’s Leaders
Challenges, Trends, & Unmet Needs
Solutions
• Health Reform and the ACA
• Diversified Workforce
• SAMHSA Initiatives
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We Must Consider the Diverse
Determinants of Health
Social Determinants: e.g. insurance status; health system access &
quality; socioeconomics & employment status; educational
attainment; gender; food security status; availability of housing
and transportation; racism; etc..
 Behavioral Determinants: e.g. patterns of overweight and obesity,
exercise norms, and use of illegal drugs, tobacco or alcohol.
 Environmental Determinants: e.g. lead exposure, asthma triggers,
workplace safety factors, unsafe or polluted living conditions.
 Biological and Genetic Determinants: e.g. family history of heart
failure & inherited conditions such as hemophilia and cystic
fibrosis.
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National Stakeholder Strategy for Achieving Health Equity
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Being Uninsured or Underinsured are Primary
Reasons People have not Received SAT
No Health Coverage and Could
Not Afford Cost
38.2
Not Ready to Stop Using
26.3
Had Health Coverage But Did Not
Cover Treatment /Cover Cost
10.1
No Transportation/Inconvenient
8.2
Reasons people gave for
not receiving SAT
who needed and made an
effort to get treatment
(2009-2012 Combined)
Might Cause Neighbors/Community
to Have Negative Opinion
7.9
> 12 years old
Might Have Negative Effect on Job
9.5
Did Not Know Where to Go for Treatment
8.9
Did Not Have Time
7.1
0
SAMHSA NSDUH 2013
10
20
30
Percent Reporting Reason
40
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African Americans and the Cost of Care
18.3
20.7
Did not get dental care due to cost
10.4
10.8
2011
13.7
15.6
Did not get prescription Drugs due to
cost
2010
8.3
9.5
2001
1997
15.4
17.4
Did not get or delayed medical care
due to cost
10.3
10.8
0
CDC, Health, United States, 2012
5
10
15
20
Percentage
25
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Snapshot of U.S. Uninsured <65 Years Old
http://kff.org/medicaid/issue-brief/medicaid-a-primer/
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Solutions: ACA Medicaid Expansion
Expanding
Not Expanding
Open Debate
26 expanded*
19 Not expanded
6 Open Debate**
http://kff.org/health-reform/slide/currentstatus-of-the-medicaid-expansion-decision/
*25 states + Washington, D.C.
** Some states are currently pursuing
or considering expansion
Current as of January 28, 2014
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Solutions: ACA Marketplace Subsidies
17,187,000 People Eligible for Tax Credits
779,000
New York
715,000
Pennsylvania
 KFF estimates
1,587,000
Florida
1,903,000
California
2,049,000
Texas
http://kff.org/health-reform/
Other States:
10,154,000
that > 17 million
people who are
now uninsured,
or who buy
insurance on
their own, will be
eligible for
premium tax
credits in 2014.
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Nonelderly Blacks & African Americans in
the U.S. Eligible for Medicaid/Subsidy
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Solutions: Health Reform & ACA Services
Prevention Services
10 Essential Health
Benefits
MHPAEA
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Free Prevention Services
Health reform requires health plans to cover a number of
preventive services related to behavioral health without
cost sharing (for plans effective on or after 09/23/10).
Adults
● Alcohol misuse screening and counseling
● Tobacco use screening & cessation interventions
● Depression screening
● HIV screening for those at higher risk
● And more…
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10 Essential Health Benefits
1) Ambulatory patient
services
2) Emergency services
3) Hospitalization
4) Maternity and newborn
care
5) Mental health and
substance use disorder
services, including
behavioral health
treatment
6) Prescription drugs
7) Rehabilitative and
habilitative services and
devices
8) Laboratory services
9) Preventive and wellness
services and chronic
disease management
10) Pediatric services,
including oral and vision
care
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U.S. Mental Health Parity and Addiction Equity Act
MHPAEA Final Rule published
November 8, 2013.
Requires insurance groups
that do offer benefits for
mental health or substance
use disorders, to provide the
same level of coverage that
they do for general medical
treatment.
http://www.gpo.gov/fdsys/pkg/FR-2013-11-13/pdf/2013-27086.pdf
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Today’s Focus Areas for Tomorrow’s Leaders
Challenges, Trends, & Unmet Needs
Solutions
• Health Reform and the ACA
• Diversified Workforce
• SAMHSA Initiatives
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Unmet Need: Diversified BH Workforce
 According to the American Psychological Association,
two main issues related to health disparities and the
behavioral health workforce that should be
considered in the context of public policy include:
• Increasing the number of racial and ethnic
minority mental/behavioral health professionals
• Creating a culturally competent workforce to
meet the needs of the expanding minority
population of the United States.
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SAMHSA Solutions:
Minority Fellowship Program (MFP)
SAMHSA program supported by three
centers.
 Purpose: to facilitate the entry of ethnic
minority students into mental health careers and
• increase the number of psychologists,
psychiatric nurses, psychiatrists, and social
workers trained to teach, administer, and
provide direct mental health and substance abuse services
to ethnic minority groups.
 In his 2014 budget, the President includes funds to train
masters-level mental health specialists, which would expand
the program to include nurses, counselors who work in the
schools, and others.
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Today’s Focus Areas for Tomorrow’s Leaders
Challenges, Trends, & Unmet Needs
Solutions
• Health Reform and the ACA
• Diversified Workforce
• SAMHSA Initiatives
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SAMHSA’s 2014 Discretionary
Funding Initiatives
 Cooperative Agreement for the Historically Black
Colleges and Universities Center for Excellence in
Behavioral Health (closes 4/7)
 Minority Serving Institutions (MSI) Partnerships with
Community-Based Organizations (CBO) (closes 4/16)
 Minority Fellowship Program (closed 3/17)
 Drug-Free Communities (DFC) Support Program
(closed 3/26)
 And more… http://beta.samhsa.gov/grants/grantannouncements
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SAMHSA’s Discretionary Services Programs
 CSAT’s Discretionary Programs have served 738,335
Black or African American Clients since 2002
30%
23.5%
25%
18.6% 20.7%
20%
14.3%
13.0%
15%
10%
7.3%
5%
0.1%
2.5%
0%
10-12
SAMHSA SAIS GPRA Data 2002-2014
13-17
18-24
25-34
35-44 45-54
Age Groups
55-64
65+
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SAMHSA’s Discretionary Services Programs:
Top 5 Substances Used by Blacks/African Americans
Substance used at Active Grants
intake
Alcohol: Any Use
42.6%
Cumulative
2002-current
45.7%
Marijuana/Hashish
26.1%
26.7%
Cocaine/Crack
12.6%
20.3%
Heroin
2.3%
6.1%
Hallucinogens/
Psychedelics
1.1%
1.2%
SAMHSA SAIS GPRA Data 2002-2014
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SAMHSA’s Programs Work:
General Outcome Measures
General outcomes measures for all CSAT discretionary
programs since 2002:
African American/
At Intake
Black Clients reporting…
6-Month Difference
Follow-up
No substance use
48.7%
72.4%
 48.5%
Employed/In school
26.2%
40.0%
 52.8%
Being housed
32.2%
41.4%
 28.4%
No social consequences
73.0%
87.7%
 20.2%
SAMHSA SAIS GPRA Data 2002-2014
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SAMHSA’s Programs Work:
Mental Health Outcome Measures
Mental Health outcomes for all CSAT discretionary
programs since 2002:
African American/
Black Clients reporting…
Experienced Depression
Experienced Anxiety
Experienced Hallucination
Trouble understanding,
concentrating, or
remembering
Trouble controlling violent
behavior
Attempted suicide
SAMHSA SAIS GPRA Data 2002-2014
Intake
36.8%
34.0%
6.2%
24.4%
6 Month Difference
Follow Up
 25.9%
27.3%
 25.2%
25.4%
 38.1%
3.8%
 31.4%
16.7%
9.0%
5.8%
 35.6%
1.5%
0.6%
 60.3%
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New Media & High Risk Populations:
SAMHSA’s Minority AIDS Initiative
Minority AIDS Initiative (MAI) Program: Using
New Media to Prevent Substance Abuse &
HIV/AIDS for Populations at High Risk.
• Utilizing new media to promote targeted SA
and HIV prevention messages to selected
racial/ethnic populations at high risk for SA
and HIV infection.
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Mobile Technology:
SAMHSA’s Mental Health App
Mental Health Recovery App
Developing technical specifications for a
mobile app to support patients in recovery
from mental disorders and co-morbid
substance use disorders
Developing mHealth policy
o Endorsement/certification and
maintenance of apps
o
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SAMHSA Supported A-CHESS
 Addiction- Comprehensive
Health Enhancement Support
System (A-CHESS)
• Connection with a support team
(other ACHESS users)
• Photo sharing, discussion group
and healthy event planning
• Use of GPS to detect when user is
near a high-risk location (for
example, a liquor store)
• Video chat with counselor or
discussion group
http://chess.wisc.edu/chess/projects/AddictionChess.aspx 45
 SAMHSA’s Prevent High-risk
Drinking among College
Students Challenge:
• Prevent high-risk drinking among college students
through cost-effective, portable, technology-based
products.
• Products to effectively reach college students, parents,
administrators, faculty, and staff.
– BeWise (Syracuse U.)
– Expectancy Challenge Alcohol Literacy Curriculum
app (University of Central Florida)
http://collegestudentdrinking.challengepost.com/
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 SAMHSA’s Primary Care Suicide Prevention App Challenge
Assist in delivering evidence based practices to primary
care providers whose patients present with suicidal
ideation
• Develop mApp that provides care continuity and
follow-up linkages for someone at risk for suicide who
was discharged from an inpatient unit or emergency
department.
– Relief Link , Emory University
– MyPsych
– ReachZ & Companion
•
http://suicidepreventionapp.challengepost.com/
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Closing Thoughts
http://minorityhealth.hhs.gov/npa/
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Unmet Needs:
Disparities in Educational Attainment
“Numerous studies, including those of the National Center
for Education Statistics (NCES), have documented persistent
gaps between the educational attainment of White males
and that of Black, Hispanic, American Indian/Alaska Native,
and Native Hawaiian/Pacific Islander males. Further, there is
evidence of growing gaps by sex within these racial/ethnic
groups, as females participate and persist in education at
higher rates than their male counterparts.”
Source: Ross, T., Kena, G., Rathbun, A., KewalRamani, A., Zhang, J., Kristapovich, P., and Manning, E.
(2012). Higher Education: Gaps in Access and Persistence Study (NCES 2012-046). U.S. Department of
Education, National Center for Education Statistics. Washington, DC: Government Printing Office.
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Solutions: My Brother’s Keeper
http://www.whitehouse.gov/my-brothers-keeper
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LIFT EVERY VOICE AND SING!
 Your voices can be heard through your involvement in the
Lonnie E. Mitchell mini-grants by:
• Promoting behavioral health awareness through
behavioral health trainings, screenings/referrals, and
through serving as student intern at behavioral health
sites; or
• Implementing a College Response Program to address
campus specific behavioral health issues through
prevention, early detection and treatment of prevalent
mental health disorders and alcohol problems.
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BE VISIBLE!
 As a visible person you can make a difference.
 Be aware of the challenges faced by you and others
in the African American community.
 Be a leader – inspire others to make a difference.
 Use the spotlight to focus attention on the ongoing
needs of the African American community.
Make your visibility count!
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SAMHSA: Helping People Help Themselves
THANK YOU!
[email protected]
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