Archive for the ‘Behavioral Health’ category

Alcohol Treatment & Interventions in Arizona

January 23rd, 2015

WSubstance abuse causes a host of bad public health outcomes including unintentional injuries, accidents, risk of domestic violence, medical problems, and even death…and alcohol abuse is at the top of the list.  Drinking too much increases your chances of being injured or even killed.  Alcohol is a factor in about 60% of homicides, 50% of severe trauma injuries, and 40% of car crashes and suicides.  Clearly, alcohol abuse prevention is key to improving public health outcomes in Arizona.

Last year alcohol remained the most common substance used by those in treatment for substance abuse in Arizona.  Thirty-one percent (31%) of folks that receive substance abuse services through our behavioral health programs sought help for alcohol dependence or abuse.

For most people, a combination of medication and behavioral therapy is most successful.  Medication Assisted Treatment is an approach that includes drug intervention as part of a comprehensive substance abuse treatment plan.  Additional behavioral therapies include peer and family support groups, outpatient counseling, or residential treatment.

Arizona’s substance abuse treatment services are funded through a variety of sources including private insurance, Medicaid, grants as well as state dollars.  ADHS spent about $128M in service funding for substance abuse treatment and prevention last year via Medicaid and a number of federal grants including the Substance Abuse Prevention and Treatment Block grant, Projects for Assistance in Transition from Homelessness grant, Screening, Brief, Intervention, and Referral to Treatment (SBIRT) grant, and the State Youth Treatment Grant, Prevention Framework Partnership for Success grant.

Our 2015 substance abuse prevention and treatment program goals include: 1) Using SBIRT in emergency rooms and with primary care physicians in Northern Arizona; 2) Increasing the use of evidenced-based practices in substance abuse prevention and treatment; 3) Improving the network of substance abuse prevention services providers; 4) Continuing to expand the availability and use of medically-assisted treatment options using federal grant funds; 5) Implementing interventions in the Arizona Prescription Drug Misuse and Abuse Initiative; and 6) Continuing to integrate peer and family support services and self-help participation.

In 2015 we’ll also be implementing a statewide media campaign targeted at reducing underage drinking.  The campaign will be designed to increase awareness around the dangers of alcohol use as well as to provide statistics and relevant laws.

Alcohol Poisoning in Arizona

January 22nd, 2015

alcoholpoisoningExcessive alcohol use is the 4th leading preventable cause of death in the US.  In fact, excessive drinking causes about 10% of deaths among 20–64 year olds…with binge drinking responsible for about half of that 10%.  Nationally, alcohol is a factor in about 60% of homicides, 50% of severe trauma injuries, and 40% of car crashes and suicides.  Yet, about 13% of Arizonans (780,000 adults) said that they binge drink in our 2013 survey.  Interestingly, only about 10% of binge drinkers are alcohol dependent.

A report published by the CDC this month found that there were 2,221 alcohol poisoning deaths in the US in 2012.  Keep in mind that alcohol poisoning deaths are just a small subset of alcohol attributable deaths.  Most of the deaths (1,681 or 76%) were among 35–64 year olds (mostly men).  The highest death rate from alcohol poisoning was among men aged 45–54 years old.  Surprisingly (at least for me), only 2% were under 21.

Recently we took a deeper dive into the Arizona data.  We found that about 2.5% of all emergency room visits and 4.5% of inpatient hospitalizations (4,500/100,000) were related to excess alcohol use in 2013.  Emergency department visits, hospitalizations and deaths were most common in the 45-54 male age group.  Interestingly, we found that unmarried men 45-54 years old were at the highest risk for all categories.  In fact, unmarried men represented more than 30,000 of the approximately 40,000 emergency department visits for causes related to alcohol in 2013.

Being married decreased the odds of an ER visit for alcohol by 40% after adjusting for age, gender, race and ethnicity, and insurance status (as a proxy for income).  Odds for an alcohol related ER visit was highest among American Indian population (7 times) compared to other race and ethnicities.

Tribal Legislative Day to Focus on Suicide Prevention

January 21st, 2015

navajonationSince 1995, the Arizona Commission of Indian Affairs, in cooperation with representatives from the state’s Indian nations, hosts an Indian Nations and Tribes Legislative Day. This year’s event will focus on the health and wellness of native youth and will take place Tuesday, January 20th on the Capitol lawn in Phoenix.

This year’s program will include a panel discussion on suicide prevention among American Indian teens.  The conversation is being organized by ADHS and will include panelists from the Substance Abuse Mental Health Services Administration, the Northern Arizona Regional Behavioral Health Authority, the Suicide Prevention Resource Center and more.

We’ll be encouraging attendees to discuss the impact of suicide on their reservations and dialog about culturally competent solutions.  For more information visit:

Intervention Snapshot: SBIRT

January 20th, 2015

SONY DSCThrough our Screening, Brief Intervention and Referral to Treatment (SBIRT) grant, folks are given a brief assessment which inquires as to individual’s substance use in primary care and emergency room settings.  People who screen positive (or who are self-referred) are able to access an array of treatment services.  In general, services can be grouped into seven categories: Crisis, Support, Inpatient, Outpatient, Medical/Pharmacy, Residential and Rehabilitation.

Outcomes have shown a reduction in alcohol use, improvement in quality-of-life measures (like employment), housing stability, lower arrest rates, and a reduction in risky behaviors, including fewer unprotected sexual encounters.

Statewide Heroin Broadcast This Week

January 12th, 2015

hooked2015Every broadcast TV station and most radio outlets across Arizona will air simultaneously a 30-minute commercial-free investigative report produced by ASU student journalists on the growing perils of heroin and opioid use on Tuesday, January 13, at 6:30 pm.  You may remember a similar broadcast a few years ago about methamphetamine use.  That broadcast did a great job raising the awareness of that public health issue – let’s hope this heroin broadcast does the same.

Follow the conversation on Twitter with #HookedAZ

Staying in the Saddle

January 9th, 2015

Rendered Arizona FlagWe’ve had a great run together since I accepted the Interim ADHS Director position 6 years ago.  I’m grateful to all of you for trusting me in this important position and for working together for the benefit of the folks of Arizona.  We’ve made tremendous progress toward our Vision of Health and Wellness for all Arizonans over the last 6 years.  The public health interventions we implemented are based on evidence and incorporate measurable performance measures to benchmark our progress.

We overhauled our regulation of licensed healthcare institutions by developing and implementing new and modern regulations that are aligned with evidence-based criteria.  Because the new regulations are focused on public health outcomes, we set the stage for improving the quality of care in Arizona’s licensed healthcare institutions for years to come.

We shifted the Department’s behavioral health system to focus on the core principles of Recovery and adopted outcome-based performance measures to monitor and to improve the effectiveness of Arizona’s behavioral health system, resulting in real and measurable improvements in people’s lives.  We integrated physical and behavioral healthcare for folks living with a serious mental illness – a reform that will continue to improve outcomes.  We implemented evidence-based interventions at the Arizona State Hospital that are measurably improving the quality of care for our patients and families.

Our public health preparedness programs are world-class and our prevention activities continue to be used nationally as models of excellence and best practices.  We made tremendous strides toward: 1) Improving the State’s ability to prepare for and respond to communicable disease outbreaks; 2) Reducing obesity and smoking rates; 3) Lowering teen pregnancy rates; 4) Reducing healthcare associated infections; 5) Improving the public health effectiveness of Arizona’s pre-hospital system; 6) Reducing prescription drug misuse and abuse; 7) Improving survival after an out of hospital cardiac arrest; 8) Developing a modern trauma system in rural Arizona; 9) Improving maternal and child health in high-risk communities; and 10) Using data to drive our surveillance and intervention initiatives.

Our Operations teams have made our business operations more transparent, efficient, and customer friendly.  Our information technology, procurement, accounting, administrative council and rules, audit and special investigations and personnel teams implemented quality improvement measures that have and will continue to improve the efficiency of our Agency.

Finally, we’re on track toward national accreditation as a state health department, completing the State’s first comprehensive State Health Assessment in 2014.  We’re also on track to developing the first ever Arizona Health Improvement Plan.

This week Governor Ducey’s team asked me to stay on as the ADHS Director, and I accepted.  I’ll be working with our new Governor and his team in the coming days and weeks as we press ahead with our Vision of Health and Wellness for all Arizonans.

State Health Assessment & Arizona Health Improvement Plan

January 9th, 2015

Health IssuesTo better understand the health status of Arizona’s population, we partnered with the county health departments to conduct Community Health Assessments in 2014.  We used the Community Health Assessments to develop a comprehensive State Health Assessment, which became basis for putting together an Arizona Health Improvement Plan (AzHIP).

We began developing the AzHIP in late 2014 by prioritizing the 15 leading public health issues in the State Health Assessment and we’re well on our way to developing strategies to “move the needle” on the priority public health issues and to achieve improved health outcomes over the next 5 years.

The AzHIP will provide direction on how to improve the health of Arizonans in the next 5 years by aligning partnerships and resources to work collectively on shared health improvement goals and strategies.  The Arizona Health Improvement Plan (AzHIP) that we finalize and begin implementing in 2015 will include: 1) Community health priorities, objectives, strategies, measures, and time framed targets; 2) Policy changes needed to accomplish objectives; 3) Individuals and organizations responsible for implementation; and 4) Measurable health outcomes or indicators.

Using our Managing Excellence executive team, we’ll be updating our Strategic Plan and Strategic Map in early 2015, aligning our top strategic priorities with the resources needed to accomplish our objectives.

Improving Outcomes at the Arizona State Hospital

January 2nd, 2015

ASH-feature_homeA key priority of our agency during 2014 was to improve outcomes among patients on their path to Recovery at the State Hospital. Our Hospital team cares for people who have mental health issues, whether for civil reasons or committed through the criminal courts. We also oversee the Arizona Community Protection and Treatment Center.

In 2013 we began the transition to a new model with a cohesive team approach where direct care staff is fully engaging in all aspects of care. This “Culture of Care” creates a better therapeutic environment for patients and residents to live and improve safety for everyone. We’ve trained more than 700 staff on Non-Violent Crisis Intervention, an evidence-based, best practice for early intervention and de-escalation created by the Crisis Prevention Institute. That’s allowed us to focus our staffing on direct patient care and overall hospital safety. In the past few years, we’ve been able to maintain a good staff to patient/resident ratio by repurposing positions from administration and other supporting areas to areas that work directly with patients/residents on a daily basis.  Our interventions have reduced injuries by 44% since 2012.

Some other major changes to safety and security at the hospital in the last couple of years include new scheduling to increase the number of staff available during high patient activity times, safer procedures when patients have to leave the hospital and revamping the way we review incidents with patients and staff. The staff and leadership at the hospital have made tremendous strides to make it a better and safer place to work, live and reach recovery.

Prescription Painkiller Misuse and Abuse

December 30th, 2014

communitydashboardThe misuse and abuse of prescription painkillers continued to be a major public health challenge in 2014.  Misuse and abuse of opiate prescription painkillers continued to kill more than car crashes in 2014….but we also completed some key interventions this year.

In 2014 we released new Arizona Opioid Prescribing Guidelines for Arizona clinicians.  They’re a voluntary, consensus set of principles and best practices for prescribing opioids.  The Guidelines were built using the expertise of practitioners from across Arizona including representatives from professional associations, health plans, academic institutions, federal healthcare providers, and many others.

The new guidelines balance appropriate treatment of pain with approaches to more safely prescribe opioids.  They’re geared for clinicians in primary care and specialty outpatient settings who treat acute pain and/or manage chronic pain but not end of life care or pain management due to malignancy.  The new guidelines complement other statewide best practices for Emergency Department Controlled Substance Prescribing and Dispensing Controlled Substances.

The guidelines are posted on the ADHS clinicians’ website.  There, you’ll find the complete, comprehensive guidance document and a 1-page summary for each of the Guidelines for acute and chronic pain.  Please encourage your Stakeholders to link their websites with these important new documents.

Tobacco Use

December 29th, 2014

smoking2The Top 5 things that kill people in Arizona: heart disease, cancer, lung diseases like emphysema and chronic bronchitis, stroke, and injuries.  In fact – these 5 conditions cause 63% of all deaths – which is nearly 18,000 people each year in Arizona (about 50 people/day).  Tobacco use is a major factor in 4 out of the 5 leading causes of death: heart disease, cancer, lung disease, and stroke.  It causes about 1/3 of heart disease and cancer, and most emphysema.

We developed a new strategic plan to improve the effectiveness of our smoking cessation resources via the Arizona Smokers’ Helpline and launched Project Quit a couple of years ago.  Both are paying dividends.  Over the last year the adult smoking rate dropped 2%…going from 19% 2011 to 17% today.  The youth smoking rate fell from 17% to 14%.  We’ve had a 30% drop in our Arizona youth smoking rate over the last 4 years meaning that there are 110,000 fewer kids smokers today than four years ago.