Stakeholder Engagement: Primary Prevention Services...2018 Stakeholder Engagement Overview • Engage stakeholders for input on policy recommendations from Minnesota’s Plan for the

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8/8/2018 Minnesota Department of Human Services | mn.gov/dhs 1

Teleconference call information is available in the Event info section

Stakeholder Engagement: Primary Prevention ServicesTuesday, August 7, 2018: 12 – 1 PM


Presenter Today: Phyllis Bengtson, Primary Prevention Policy Lead

Primary Prevention, Behavioral Health Division

Teleconference call information is available in the Event info section of the WebEx.

WebEx Technical Difficulties

• For technical difficulties please send your comments to “Jacob Owens” by selecting his name from the drop down menu in the Q&A section.


Today’s Agenda

• Stakeholder Engagement Overview

• Primary Prevention Planning & Implementation (P&I) Strategies & Outcomes

• Policy recommendations

• Questions/survey?

• Wrap-Up


2018 Stakeholder Engagement Overview

• Engage stakeholders for input on policy recommendations from Minnesota’s Plan for the Prevention, Treatment and Recovery of Addiction.

• The report was developed with stakeholder engagement input from a core and fiscal stakeholder workgroup that was convened in 2016. The core workgroup incorporated and built on the recommendations of the 2013 Legislative Report: Minnesota's Model of Care for Substance use Disorder and the input collected in the fall 2015 ADAD listening sessions.

• Several of the policy recommendations were included in legislation that passed as part of SUD reform legislation in 2017 (i.e. care coordination, peer recovery support, comprehensive assessments, direct reimbursement and withdrawal management).


https://edocs.dhs.state.mn.us/lfserver/Public/DHS-7269-ENG

Stakeholder Engagement Overview

We will host WebEx sessions to review the policies that were not passed into law in the 2017 legislative session.

• Sub-workgroups will review policies, provide updates and gather feedback.

• The purpose of the primary prevention workgroup is to:

• Provide information on strategies currently being implemented in MN

• Solicit information on a proposed legislative ‘ask’ for additional primary prevention funding.


“Primary Prevention” WebEx schedule

Four Primary Prevention WebEx sessions will be held

• Tuesday, Aug. 7th 12-1 PM – P&I Strategies & Outcomes

• Thursday, Aug. 9th 10-11 AM – SPF-PFS Strategies & Outcomes

• Tuesday, Aug. 14th 10:30-11:30 AM – RPCs, MPRC, SEOW

• Thursday, Aug. 16th 12-1 PM – SPF Rx Strategies


Primary Prevention Participant Engagement Process

• Information will be collected from WebEx participants via:

• [email protected] with “Primary Prevention” in the subject line.

• Input emailed directly to sub-workgroup lead: [email protected]

• Input during the WebEx via polling and/or a survey: Polling questions will appear on the right hand of the screen, located in the “Polling” tab

• Audio will be muted while polling is commencing


mailto:[email protected]


Primary Prevention

Expand the Primary Prevention Planning and Implementation Program, which focuses on environmental strategies and has

demonstrated positive outcomes and improved health.


Primary Prevention

• Our Primary Prevention funding comes from the Substance Abuse & Mental Health Services Administration (SAMHSA) Block Grant

• 20% Primary Prevention Set Aside

• Federal Definition of Primary Prevention: Services for those who have never been in CD Treatment nor have ever been assessed as needing CD Treatment

Cohort 1 P&I Communities

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Presentation Notes

Does NOT mean the entire county’s geographic area was covered by the P&I grant

Cohort 1 and 2P&I Communities

Cohort 1, 2 and 3 P&I Communities

Why Focus on Alcohol?Why not Heroin?

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.Alcohol still the most used drug by Jr. & Senior High youth in MN (8, ( & 11th grades, 2016 MSS) 13.9% used alcohol in the past 30 days 12.8% used Tobacco or Nicotine win the last 30 days 8.6% used Marijuana in the past 30 days 4.7% used Prescription Drugs not prescribed to them in the last 30 days 0.6% used Heroin in the last 12 months Other Drugs under 2% used in the last 12 months Reduce alcohol use by youth also reduces youth use of other drugs

8/8/2018

23.5

7.2

29.3

12.3

0

5

10

15

20

25

30

35

Alcohol-related deaths Drug overdose deaths

Rate

per

100

,000

2010 20102016 2016

Minnesota Death Certificate data; Alcohol rates calculated using CDC’s Alcohol-Related Disease Impact (ARDI) application; www.cdc.gov/ardi

Alcohol-related deaths compared with drug overdose deaths

8/8/2018

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In 2016 Opioid overdoses were responsible for. . . 395 Deaths 800 Inpatient Hospitalizations 1,451 Emergency Room Visits 2,958 EMS Responses In Minnesota during 2016 there were estimated to be 1,745 deaths related to excessive alcohol use. Note: These deaths include those that are 100% attributable to alcohol AND the alcohol attributable fractions of deaths from 54 causes that are estimated to be due to alcohol use. For the specific causes of death included: https://nccd.cdc.gov/DPH_ARDI/Info/ICDCodes.aspx

P&I Project Funding Process

•Competitive selection process based on:

• underage drinking levels

• Community Readiness

•Fund full-time grant coordinator

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Community Readiness – high level of community commitment to work on this issue

P&I Project Components

•Coalition Leadership

•P&I Coordinator housed in the High School

•Extensive training

•Conduct a Community Needs Assessment & Develop a Strategic Plan

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Communities that have to ‘Form’ a new coalition do as well and often better than those with an existing coalition. Mention Regional RPC system MN Has for TA Each does an extensive needs assessment for their community and then develops a Strategic Plan to address WHY youth alcohol use is happening in their community. The plan is revisited annually for the next four years.


•Evidenced-Based School Curriculum

•Responsible Beverage Server Training

•Alcohol Compliance Checks

•Youth Involvement

• Youth Groups - Youth Leadership Academy (YLA) – Photo Voice


• Coalition Leadership

• Conduct a Community Needs Assessment & Develop a Strategic Plan

• Extensive training

• Evidenced-Based School Curriculum

• Youth Involvement

• Youth Groups

• Youth Leadership Academy (YLA)

Youth Leadership Academy

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Presentation Notes

Each year, select students attend a Youth Leadership Academy, where they get together with youth from around the State to network and share ideas on how to make a positive impact on their peers and community. The group is open to any student who would like to participate. The students involved have many opportunities and experiences that will help them grow as leaders. Youth groups each do PhotoVoice & select one environmental change to work on each year.

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Presentation Notes

Each Youth group does a Photo Voice Project, from which they select at least one environmental ‘Concern’ to work toward addressing each year. Mention the change in the School Bus transfer location implemented by one P&I Community Youth group within a week Another did a presentation to their County Board on why they wanted a Social Host Ordinance. It passed on a vote that night, where previously it had failed to do so more than once.

Planning & Implementation (P&I) Grants

•Social Host Ordinance/focus on environmental strategies

•Media Campaign using the Positive Community Norms framework

• Integrating Science of the Positive & Positive Community Norms frameworks into all other strategies/activities

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More than media: Positive messages are meant to spur conversations and to get the students and community to think about what’s really happening around underage drinking and other drug use. We want to challenge the misperception that all kids are using and celebrate the untold goodness of our community. Together we can prevent underage substance use! Integrate a positive frame into all strategies.

SpiritWhat is the Why behind our work?

ScienceData-Driven Decisions, best

practices, continued learning

ActionProactive not Reactive; promote

health

ReturnReflect, evaluate, learn

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Presentation Notes

Action – focus on the good things you want to increase.

Social Norms Theory says…we tend to do (or believe)

what we thinkMOST people do (or believe).

and often what we think most other people do is wrong!

(the perceived norm)

Presenter

Presentation Notes

Read Slide, and add Suggested Speaking Points: So if we think most people drink in a certain situation (like at grad parties or after the homecoming dance), we are more likely to drink as well…because “that’s just what we do here”. If we think most people speed on a certain stretch of highway, we are more likely to speed too…because everyone else is.... The reverse can be true too… If we think most people believe smoking is harmful, we are also more likely to believe smoking is harmful.

Misperceptions of positive healthy norms that exist in a community are a ‘risk factor’

MOST (88%), Minnesota High School students in the 10 Cohort-2 schools, reported using alcohol less than monthly.

However, 53% of these same students perceived that MOST students drink monthly or more often.

This Misperception of the positive healthy norm that exists in these communities is a “Risk Factor” for alcohol use.

These students were 6.9 times more likely to drink monthly than students who did NOT misperceive the norm.

8/8/2018 Source: ten schools, MN P&I 2017 PCN Student Survey, grades 7-12, n=6789 25

Misperceptions of positive healthy norms that exist in a community are a ‘risk factor’

MOST (92%), Minnesota High School students in 10 schools, reported using marijuana less than monthly.

However, 47% of these same students perceived that MOST students use marijuana monthly or more often.

This Misperception of the positive healthy norm that exists in these communities is a “Risk Factor” for alcohol use.

These students were 7.5 times more likely to use marijuana monthly than students who did NOT misperceive the norm.


Correct Perceptions are NOT ‘just neutral’ – They are a “PROTECTIVE FACTOR”

MOST (88%), Minnesota High School students in the 10 Cohort-2 schools, reported using alcohol less than monthly.

47% of these same students correctly perceived that MOST students drink less than monthly.

This correct perception of the positive healthy norm that exists in these communities is a “Protective Factor” for alcohol use.

These students were 6.9 times less likely to drink monthly than students who misperceived the true norm.


Correct Perceptions are NOT ‘just neutral’ – They are a “PROTECTIVE FACTOR”

MOST (92%), Minnesota High School students in 10 schools, reported using marijuana less than monthly.

53% of these same students correctly perceived that MOST students use marijuana less than monthly.

This correct perception of the positive healthy norm that exists in these communities is a “Protective Factor” for alcohol use.

These students were 7.5 times less likely to use marijuana monthly than students who misperceived the true norm.


Overall...• Most youth are making good decisions and have healthy,

protective beliefs about alcohol, tobacco, and other drugs.

• Many youth drastically over-estimate the prevalence of alcohol, tobacco, and other drug use among their peers, which puts them at greater risk for using these substances themselves.

• Any youth using substances which are both illegal and dangerous is too many.

PCN Messaging

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All messages & media must be pilot-tested with the intended audience it is to reach, to be sure they Perceive the message meant to be sent.

But “Does this work?”

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.

Assessment of Change Over Time

• Annual Student Surveys• All students grades 7-12

• High participation rates

• Limitations• Self-report

• Did not capture data on each strategy, only on the total mix of strategies

Presenter

Presentation Notes

PCN Survey done each year 7th – 12th grade (some included 6th grade) – C-1 & C-2 C-3 will be one year 1, 3 & 5. The PCN Survey measures actual behavior and attitudes, along with student perceptions of their peers behaviors and attitudes. The data gives us a sense of HOPE as we discover that MOST students are making healthy choices. Yet we are CONCERNED because some students are using and many are misperceiving the norm. AND . . . the data doesn’t seem right . . .We see substance use all over the news and TV, we hear stories about underage drinking parties, But do these represent the norm in our community? The news only shares the most sensational stories. We don’t hear about the students that hung out with their friends at the coffee shop on Friday night, and we don’t reminisce with our pals about our quiet nights in. What stands out isn’t necessarily that we stand for. We need to question our perceptions!

Methodology

• Online survey administered in either February or March.

• Depending on the school district, students surveyed were either in 6th-12th grade or 7th-12th grade.

• Response rate goal of 85%. An overall response rate of 80% reached.

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“Everyone Lies On Those Surveys!”

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How can I trust that the data is accurate? Considerable research on the validity of self-reported data, finds that students who feel their answers are anonymous and cannot be traced back to them are likely to tell the truth on a survey. The PCN survey has been cleaned and analyzed by data professionals who look for surveys that show patterns and answers that indicate a student may not have been truthful. Those surveys have been removed from the data set.

“How often do you think most students in your school use alcohol?”(Grades 7-12, n=6446) MN – DHS-PCN Student Data from P&I Project 2017 – Q16e

10 school districts in Cohort 3 MN DHS ADAD Positive Community Norms Student Survey May 2017

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Never Tried once ortwice

Once or twicea year

Once amonth

Twice amonth

Once a week Daily

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Presentation Notes

While it is common to think that students may not be truthful when they take the survey. Here’s something to keep in mind. . . this survey was given to students in 10 schools in MN, and in all communities the responses came back strikingly similar. Most student are not using, and most students misperceive this norm.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Never Tried once ortwice

Once or twicea year

Once a month Twice amonth

Once a week Daily

“How often do you use alcohol?”(Grades 7-12, n=6446) MN – DHS- PCN Student Data from P&I Project 2017 –Q15e

10 school districts in Cohort 3 MN DHS ADAD Positive Community Norms Student Survey May 2017

Between 2004 to 2013 in the first cohort of P&I schools

• 9th grade alcohol use in the previous 30 days went from:

• 28.6% above the state average to

• 4.8% below average

Cohort 1 P&I

0%

5%

10%

15%

20%

25%

30%

35%

40%

2001 2004 2007 2010 2013

9th grade 30-day alcohol use, MSS

P&Is MN

Cohort 2 P&Is: Students who have ever used alcohol

Data from cohort 2 PCN survey 2012-2016

• 66 percent reduction in monthly use of Meth

• 60 percent reduction in monthly use of other illegal drugs (includes heroin)

• 55 percent reduction in monthly use of over the counter drugs for the purpose of getting high

• 50 percent reduction in the use of prescription drugs without a doctor’s prescription

Presenter

Presentation Notes

We spend a lot of time looking at the quantitative data we collect at survey time. It’s equally important to look at the qualitative data; things we hear, see, and experience on a daily basis that indicate students ARE making good choices and changes ARE happening within the community. These stories and conversations both ‘change’ community norms (the culture) and are indicators that ‘change’ is happening

P&I Community Member Comments . . .

“Our community has totally changed how we look at kids”

8/8/2018

“This has given us ‘hope’ up in the Iron Range.”

“I am excited that people are beginning to have the tough conversations about

alcohol within their families.”


Lesson’s Learned• Positive approach is beneficial

• Key to give ownership to the community – the Solutions are in the Community

• Misperception of healthy community norms are ‘Risk Factors’

• Correct perception of healthy community norms is a ‘Protective Factor’.

• It’s not the big media; it’s the conversations

• Youth are powerful agents for change

• Comprehensive community approach is KEY!

Presenter

Presentation Notes

Positive approach – people want to be a part of positive things Misperceptions Matter: Northeast Region 8th, 9th, & 11th graders who think most students at their school drink monthly or more often are 6 times more likely to report that they themselves drink alcohol monthly or more often. MSS 2013.

Ways to Stay Informed

• Visit our website to:• Subscribe for email updates (e-Memo) to receive updates from the

Behavioral Health Division on SUD

• Learn more about substance use disorder policies and procedures, initiatives, workgroups, training and conferences, grant announcements, access forms and more

Look for our “Friday’s Digest” E-memo!

• We want to hear from you about YOUR substance use disorder system. Send input to: [email protected]



Next Primary

Prevention WebEx:Aug. 9th

10-11 AMSPF-PFS

Thank you for joining usBehavioral Health Division


Documents

Stakeholder Engagement: Primary Prevention Services...2018 Stakeholder Engagement Overview • Engage stakeholders for input on policy recommendations from Minnesota’s Plan for the