Yale Psychiatry Grand Rounds: "SAMHSA's Work Advancing the Nation's Behavioral Health: Federal Policies, Strategies, Services, and Supports"

Transcript

• 00:00Special grand rounds,
• 00:03both because of the speaker,
• 00:06undersecretary,
• 00:09Miriam,
• 00:10Duffin Rittman, and also because,
• 00:13it's a special memorial
• 00:16or honorary,
• 00:17grand rounds.
• 00:19There we go.
• 00:21It's a special on,
• 00:22grand rounds honoring the memory
• 00:24of, Mike Cerniak.
• 00:26Before I get there, a
• 00:27couple of,
• 00:29announcements.
• 00:30Next week,
• 00:32the Grand Rounds speaker is
• 00:33Richie Davidson. Some of you
• 00:36are probably familiar with his
• 00:37work. He's one of the
• 00:38leading,
• 00:40cognitive neuroscientists
• 00:42studying emotion, emotion regulation. He's
• 00:44at the University of Wisconsin,
• 00:45a real,
• 00:47trailblazer in this area.
• 00:51This Saturday,
• 00:52if you have not already
• 00:54signed up, is,
• 00:56the department party,
• 00:58which is at the what
• 01:00used to be called the
• 01:01graduate club.
• 01:03And if you want to
• 01:04sign up, you you should,
• 01:06contact
• 01:07the,
• 01:09I think the residency office
• 01:10is is keeping track. But,
• 01:12if you can't,
• 01:14figure out how to sign
• 01:15up,
• 01:18you can come and pay
• 01:20when you get there.
• 01:22I think that's okay.
• 01:24If I'm wrong, someone will
• 01:25correct me.
• 01:29Okay.
• 01:32Alright.
• 01:33So
• 01:35we're really excited, as I
• 01:36said, to have Miriam back,
• 01:39back home,
• 01:41to talk about SAMHSA, which
• 01:43he has been leading,
• 01:45and such an important national
• 01:47initiative.
• 01:49I'll talk about I'll introduce
• 01:51Miriam,
• 01:52to you a little bit
• 01:52more in just a minute.
• 01:54But I did wanna talk
• 01:55about Mike Cerniak a little
• 01:57bit. This is this is
• 01:58Mike,
• 02:00who all of you know,
• 02:02was CEO of CMHC,
• 02:04professor of psychiatry, and he
• 02:06passed away,
• 02:07in May of this year.
• 02:10Mike
• 02:10left a legacy of leadership.
• 02:13From two thousand nine to
• 02:14two thousand twenty four,
• 02:16he was CEO of the
• 02:18Connecticut Mental Health Center. And
• 02:19while he was the director
• 02:21of CMHC,
• 02:23he fostered a community that
• 02:25initiated many important,
• 02:30programs.
• 02:32Not that he started them
• 02:34all himself, but that he
• 02:35created the climate and supported
• 02:38and fostered these kinds of
• 02:39in, initiatives,
• 02:41such as,
• 02:44the initiation of the medical
• 02:45clinic inside,
• 02:47CMHC
• 02:48to foster overall health
• 02:50knowing that the a lot
• 02:52of the increased mortality
• 02:54associated with mental illness
• 02:57is medical mortality, not suicide.
• 03:00He initiated
• 03:01the farmer's market. He promoted
• 03:03cycling,
• 03:05and fostered,
• 03:07collaborations with the greater New
• 03:08Haven community
• 03:10with programs that you're probably
• 03:11familiar with now, the Compass
• 03:13program
• 03:14in collaboration with the mayor's
• 03:15office,
• 03:17and street psychiatry,
• 03:19which obviously,
• 03:21developed within Connecticut mental health
• 03:22center as well.
• 03:24And he really fostered the
• 03:25notion of public psychiatry
• 03:28as a specialty,
• 03:30as an educational
• 03:31academic
• 03:32initiative,
• 03:35in collaboration
• 03:36with the Department of Mental
• 03:37Health and Addiction Services,
• 03:40creating the division within the
• 03:41department
• 03:42and,
• 03:43with Gene, the the, public
• 03:45psychiatry fellowship.
• 03:49Prior to that, he was
• 03:51chief of another organization. He
• 03:53was the chief of psychiatry
• 03:55at VA Connecticut.
• 03:57He was the director of
• 03:58the neuropsychiatry
• 04:00firm, which treats,
• 04:02patients with chronic mental illness
• 04:05at VA Connecticut,
• 04:08and was director of the
• 04:09treatment refractory inpatient unit. He
• 04:12was the person who started
• 04:13clozapine treatment
• 04:15within the Connecticut mental health
• 04:16center.
• 04:19He's been honored in many
• 04:20ways. I just cite two
• 04:22of his most important department
• 04:24awards because I think they
• 04:25really
• 04:26tell you a lot about
• 04:27who he was.
• 04:29He received the chairman's award,
• 04:30which is for,
• 04:32initiatives,
• 04:33pro
• 04:34programmatic
• 04:35innovation,
• 04:36and he received
• 04:37the Fleck award, which is
• 04:39for the model
• 04:41clinician educator scientist.
• 04:44And,
• 04:45I think that tells you
• 04:46a lot about who he
• 04:47was,
• 04:49as a psychiatrist.
• 04:51So what do we love
• 04:53what did Michael love? And
• 04:55that top picture,
• 04:57it was the picture
• 04:59for Michael's residency application in
• 05:02nineteen eighty six.
• 05:04You know,
• 05:06it's amazing that we took
• 05:07him. It it it it
• 05:09looks a little bit like
• 05:10a like a police
• 05:12photo. You know?
• 05:14But,
• 05:15but,
• 05:16you know, in some ways,
• 05:17he didn't really change that
• 05:18much from,
• 05:20eighty six to now.
• 05:23But, first and foremost,
• 05:26Michael cared deeply for and,
• 05:30and family was extremely,
• 05:32important to him and and,
• 05:36as many,
• 05:37as you who you all
• 05:39know and Alex and Zoe,
• 05:41their kids.
• 05:43His work was extremely important
• 05:45to him.
• 05:45His colleagues, his students,
• 05:48his patients,
• 05:50The work that he did,
• 05:52was deeply meaningful to him.
• 05:54It sustained him,
• 05:56up until the end.
• 05:59He was a sports fan.
• 06:01You know, he was a
• 06:03very, very avid,
• 06:05cycler,
• 06:06and he was a a
• 06:07a
• 06:08a once Zoe went to
• 06:10the University of Michigan in
• 06:11particular,
• 06:12he he became an avid,
• 06:15football fan, a University of
• 06:16Michigan football fan. It was
• 06:17a treat
• 06:18to watch, football games with
• 06:20him.
• 06:22And he loved fast cars.
• 06:25He got a little sporty
• 06:26car himself,
• 06:27and he and he, towards
• 06:29the end of his life,
• 06:30he enjoyed watching
• 06:32formula one racing.
• 06:34So,
• 06:37he he really was, you
• 06:38know, a sports nut. And
• 06:40then, of course, his food
• 06:42issues.
• 06:44He was a big pretzel
• 06:46fan. He was he was
• 06:47not only he he approached
• 06:49pet pretzels the way some
• 06:51people approach
• 06:52fine wine. You know? I
• 06:54I once called him
• 06:56I once called him in
• 06:57the Philadelphia airport saying I
• 07:00sent him a picture
• 07:01of,
• 07:03Auntie Annie's pretzels, you know,
• 07:05which you can get, I
• 07:06guess, in a number of
• 07:07airports. But I I I
• 07:08thought, you know, I I
• 07:09was gonna order a pretzel
• 07:11and celebrate with him my
• 07:13my mastery of pretzels. And
• 07:15he sent me back a
• 07:16note. Don't do it. There's
• 07:18a better pretzel place in
• 07:20the airport. Let me give
• 07:21you directions to where that
• 07:23that that that those pretzels
• 07:24can be found.
• 07:26And and I learned from
• 07:27Bob
• 07:28Cole that he's also was
• 07:29also a, peanut M and
• 07:31M's fan as well, which
• 07:33many of us are secretly.
• 07:35So,
• 07:37that gives you a little
• 07:38bit of a feel,
• 07:40for Michael,
• 07:42And
• 07:43I think there's nobody,
• 07:46who could better,
• 07:49present at a grand rounds,
• 07:53in Michael's memory
• 07:55than Miriam,
• 07:56who
• 07:57has had her career
• 07:59in public psych public mental
• 08:01health,
• 08:02innovative
• 08:03services development of innovative services
• 08:06and the delivery of those
• 08:07innovative and impactful services from
• 08:09a recovery
• 08:11oriented perspective,
• 08:13something that you developed here
• 08:15with probably with Larry Davidson
• 08:17and and and has applied
• 08:19through her leadership positions.
• 08:22As you know,
• 08:24she has been a leader
• 08:25and an innovator throughout her
• 08:27career
• 08:28as, the undersecretary,
• 08:30for substance abuse and mental
• 08:31health,
• 08:32as commissioner of DMIS
• 08:34from two thousand fifteen to,
• 08:36twenty twenty one, addressing the
• 08:38crises of that time,
• 08:41senior adviser to the SAMHSA
• 08:43director before then working a
• 08:44number of issues that that
• 08:47had informed her career to
• 08:48that point in which she
• 08:49would champion in her leadership
• 08:52positions,
• 08:53behavioral health equity, workforce development,
• 08:56and as a twenty year
• 08:58member of our faculty,
• 09:00as,
• 09:01up to, adjunct associate professor.
• 09:08She,
• 09:10got her PhD from Purdue
• 09:12and then came here for
• 09:13her postdoc,
• 09:15in two thousand and two.
• 09:16I hope
• 09:18giving the age the, years
• 09:20is not, revealing anything,
• 09:22that you don't want me
• 09:23to reveal. But,
• 09:25but,
• 09:26but, really, you can see
• 09:28what a long standing and
• 09:29deep connection
• 09:30she has to this department.
• 09:32And she's received numerous
• 09:34honors
• 09:35and recognition
• 09:36for her work,
• 09:38and,
• 09:39which is which is remarkable
• 09:41because being the leader,
• 09:43being the commissioner of,
• 09:45Demus and being, the head
• 09:47of SAMHSA, those are thankless
• 09:49jobs. But even so,
• 09:51she's received a number of
• 09:53honors,
• 09:54the human values award from
• 09:56the Art of Living Foundation,
• 09:58child children's mental health,
• 10:00champion award from ACAP,
• 10:02distinguished public service award,
• 10:04state service award, etcetera.
• 10:08You know, you it's just
• 10:09a testimony to your,
• 10:12to your leadership. We're deeply
• 10:14appreciative of taking time from
• 10:16your incredibly busy schedule to
• 10:18come and speak with us
• 10:19today, and,
• 10:20and, we welcome you back.
• 10:31Thank you so much, doctor
• 10:32Crystal for that warm welcome,
• 10:34and
• 10:35thank you everyone for for
• 10:37being here. It is so
• 10:38wonderful to to be able
• 10:39to be back.
• 10:40It does feel very much
• 10:42like coming home, whenever I'm,
• 10:44anywhere near,
• 10:46Yale and New Haven.
• 10:48You know, I I wanna
• 10:49say a couple of words
• 10:50about Michael as well. You
• 10:51know, I I had the
• 10:52opportunity
• 10:53just to work with him
• 10:54really closely as, you know,
• 10:56when I was on faculty,
• 10:57but then also at Demus.
• 10:58And,
• 10:59one of my favorite memories,
• 11:01I remember I was, you
• 11:02know, going up for one
• 11:03of my faculty reviews. I
• 11:04don't even remember which level.
• 11:07And I was a little
• 11:07nervous. And, you know, I
• 11:08remember going into Michael's office.
• 11:10And,
• 11:10and I walked in. I
• 11:12see him on a treadmill,
• 11:13his treadmill desk.
• 11:14And it just totally broke
• 11:16the ice. He was so
• 11:17excited about that desk. And,
• 11:20and and I got excited
• 11:21about it. In fact, I
• 11:21was trying to figure out
• 11:22a way to to get
• 11:23state dollars to pay for
• 11:24something like that. And, of
• 11:25course, we of course, we
• 11:27never quite got there. But,
• 11:29he was he was just
• 11:30excited to give me information
• 11:31about the desk and how
• 11:32to get it and,
• 11:34and just all the value,
• 11:35all all the sort of
• 11:36information about how the sitting
• 11:38is the new smoking and
• 11:40and the desks are just,
• 11:41these treadmill desks are the
• 11:42thing thing of the future.
• 11:44So, it was that was
• 11:46certainly an important memory. And,
• 11:48I just always appreciated also
• 11:50just his,
• 11:51his wisdom and,
• 11:53advice and guidance,
• 11:55as we met,
• 11:57you know, going over just
• 11:58my,
• 11:59tenure at BL and and
• 12:01things I needed to do
• 12:02to get to the next
• 12:03step.
• 12:04And then I also really
• 12:05appreciated his leadership when I
• 12:06was commissioner. I mean, always
• 12:08had such really creative ideas,
• 12:10that he brought to the
• 12:11table just with excitement around
• 12:14like how to take the
• 12:14work to the next level.
• 12:17And and I think that
• 12:18spread and it permeated, you
• 12:19know, across the other LMHA
• 12:21directors as well. And,
• 12:23and he often got folks
• 12:24excited about, you know, some
• 12:26of the innovations that CMHC
• 12:28was implementing, often with a
• 12:30focus on, you know, being
• 12:31person centered and meeting people
• 12:33where they're at. And,
• 12:35you know, one
• 12:37thing in particular I remember
• 12:39is is some of the
• 12:40work, you know, during COVID.
• 12:41I remember him sharing that
• 12:42how, there was a cooking
• 12:43group that CMHC was putting
• 12:45in place, and the food
• 12:47was being delivered,
• 12:48to people's homes, and then
• 12:49they would cook the meals
• 12:50together.
• 12:51And just hearing him share
• 12:52about that,
• 12:54with just such pride that
• 12:55CMHC was implementing an initiative
• 12:58so so my my heart
• 12:58goes out, you know, to,
• 12:59to Michael's family,
• 13:01to CMHC community. His legacy
• 13:03is strong.
• 13:11It will continue to live
• 13:12on. I know as I
• 13:13have been in my role
• 13:14even at SAMHSA,
• 13:16you will hear echoes,
• 13:17echoes of the principles and
• 13:19values that have been part
• 13:20of the work here at
• 13:21CMHC,
• 13:23part of what he brought
• 13:24to to the work,
• 13:27even across Demus as as
• 13:29his passion and vision spread
• 13:31to the other LMHA directors.
• 13:34So so with that, I
• 13:36dedicate this talk to Michael
• 13:37as well,
• 13:38and his impact on my
• 13:40values in my career.
• 13:42And so I'm gonna I'm
• 13:43gonna dive right in.
• 13:46I'm gonna am I
• 13:48doing the slides? Is it
• 13:49this? You can use that
• 13:51or you can use the
• 13:52arrows on the table. Oh,
• 13:53fan. Oh, this is this
• 13:54is a nice room. Okay.
• 13:56Okay.
• 13:57So this is what we're
• 13:58gonna do. You know, I'm
• 13:59gonna talk about,
• 14:01a range of areas. I
• 14:03wanna start real quickly with
• 14:04just SAMHSA. Quick overview who
• 14:05we are. We we've expanded,
• 14:07over the last three years,
• 14:09and I'm gonna talk about
• 14:10some of our recent NSDU
• 14:12data. You know, we're really,
• 14:13really thrilled about the NSDU.
• 14:15We were able to get
• 14:16it out much earlier than
• 14:17we ever have. So I'll
• 14:18talk a little bit about
• 14:20that. Talk about some of
• 14:21our behavioral health policies, programs,
• 14:23initiatives,
• 14:24a lot of resources.
• 14:26I'm gonna share resources throughout,
• 14:28and you'll see there's a
• 14:29lot of QR codes. We
• 14:31we love the QR codes.
• 14:33In fact, my team knows
• 14:34that put them if there's
• 14:36any type of resource, add
• 14:37a QR code on there
• 14:37because it's just it's just
• 14:38a way to be able
• 14:39to share information and allow
• 14:41people to sort of bookmark
• 14:42it and have it on
• 14:43their phones.
• 14:44So there'll be a lot
• 14:45of QR codes, and I'll
• 14:46in some instances, I'll share
• 14:47the code. I may not
• 14:48say too much about the
• 14:49resource itself, but mostly I
• 14:51just wanna be able to
• 14:52give, give you that information.
• 14:54Okay. And then we'll I'm
• 14:56gonna try to be really
• 14:57disciplined
• 14:58and and leave I think
• 14:59we end at eleven fifteen.
• 15:00I'm gonna try to end
• 15:01by, like, five to eleven
• 15:02so we can have twenty
• 15:03minutes of discussion.
• 15:05I love the the sort
• 15:06of back and forth and
• 15:07discussion. I come from a
• 15:08big family.
• 15:09And so,
• 15:11being back here at the
• 15:13in the CMHC and and
• 15:14sort of Yale family, I
• 15:16I definitely welcome and want
• 15:17that some of that discussion.
• 15:19So this is who we
• 15:19are now. You know, we
• 15:20we added we have a
• 15:22number of offices and centers.
• 15:23The center the the centers
• 15:25remain the same.
• 15:26Center for Mental Health Services,
• 15:27Substance Abuse Prevention, Treatment, and
• 15:29and, CBIS, Behavioral Statistics and
• 15:32Quality. We have lots of
• 15:33offices.
• 15:33The one of the reasons
• 15:35I'm showing this is, we
• 15:36were thrilled that we off
• 15:37we we started the Office
• 15:38of Recovery. It's the first
• 15:40off
• 15:41office of recovery in government.
• 15:43We right now have language
• 15:44in the president's FY twenty
• 15:46five budget, which we hope
• 15:47ultimately will be voted on,
• 15:48that would codify the Office
• 15:49of Recovery in statute. It
• 15:51would be a formal part
• 15:52of SAMHSA.
• 15:53And so we are we
• 15:54are lighting some candles that
• 15:56that actually,
• 15:57that gets a vote and
• 15:58that the Office of Recovery
• 15:59may remains because it is
• 16:00an important office, and they're
• 16:02doing amazing work in the
• 16:03short three years that they've
• 16:04been there. The other office
• 16:06that we really had to
• 16:07off, start is the,
• 16:09the nine eight eight crisis
• 16:11coordinating office. As you know,
• 16:12nine eight eight is one
• 16:13of the major initiatives across
• 16:14SAMHSA, so we felt it
• 16:15was really important that that
• 16:17office,
• 16:18be stood up within my
• 16:19office to be able to
• 16:19help coordinate some of the
• 16:20work across the country,
• 16:22as it relates to nine
• 16:23eight eight. So we're also
• 16:24looking to to codify that
• 16:26and have that be a
• 16:27formal part of our statute
• 16:28language as well.
• 16:31I just wanted to share
• 16:32a little bit about our
• 16:33budget. I mean, one one
• 16:34thing that
• 16:37I I think in this
• 16:38in this moment of transmit,
• 16:40transition,
• 16:41gives us hope really is
• 16:43that,
• 16:44behavioral health challenges and and,
• 16:46the work that we do
• 16:47has been bipartisan.
• 16:49While other agencies have seen
• 16:51decreases in their budget, we
• 16:52have consistently seen increases.
• 16:54When I sent my first
• 16:55email to staff, there were
• 16:56about three hundred and fifty
• 16:57two employees. We now have
• 16:58about nine hundred and fifty
• 16:59two. So we almost tripled
• 17:00in
• 17:01size. And that is in
• 17:03part, I think, because, from,
• 17:04both sides of the aisle,
• 17:06folks recognize that as a
• 17:07nation,
• 17:08we're still struggling with respect
• 17:10to behavioral health. Right?
• 17:11We know there were challenges
• 17:12before COVID.
• 17:14COVID exacerbated things, and I
• 17:15think we're still seeing some
• 17:16of the ripple effects.
• 17:17And so we're closely watching
• 17:19data.
• 17:20Actually, the data slide is
• 17:22next. Oh, it's after this.
• 17:23But you'll see in a
• 17:24moment, I'll I'll show some
• 17:25of our data. We're closely
• 17:26watching our NIST and other
• 17:28data to really,
• 17:29watch some of those trends,
• 17:31to see are we making
• 17:32an impact in terms of
• 17:33some of the things we're
• 17:34we're putting in place,
• 17:36in terms of some of
• 17:37the areas we're focusing on.
• 17:38So this is our strategic
• 17:39plan. It's a twenty twenty
• 17:40three, twenty twenty six, strategic
• 17:42plan.
• 17:43In twenty twenty one, when
• 17:44I first started, we put
• 17:45out an interim strategic plan.
• 17:48Very similar to this. There
• 17:49were a few few differences.
• 17:52There are a few differences,
• 17:53and and what we did
• 17:54with the interim plan is
• 17:55we did focus groups.
• 17:57We we put it out
• 17:58for public comment. We really
• 17:59wanted to get input from
• 18:00folks steeped in the work
• 18:02to see, are we getting
• 18:03it right? Are there other
• 18:04areas we need to include?
• 18:06And so one area that
• 18:07changed was initially we had,
• 18:09you know, preventing overdose.
• 18:11And we heard strongly from
• 18:13the field that it's important
• 18:14to, in language, have language
• 18:16in there around sort of
• 18:17prevention,
• 18:18That primary prevention is so
• 18:19important. And and we agree.
• 18:21We agree. We had
• 18:22action steps in there related
• 18:24to primary prevention.
• 18:26But it was important to
• 18:27have it out front because
• 18:28that's also an area of
• 18:29our budget where traditionally, if
• 18:30you if we go back,
• 18:31you see,
• 18:34the Center for Substance Use
• 18:36Prevention, the the the resources
• 18:37for that from a prevention
• 18:39perspective,
• 18:40don't don't match what we
• 18:41see within the other centers.
• 18:43So so we wanted prevention
• 18:44to be sort of, upfront
• 18:46there.
• 18:47Correction.
• 18:48So that was one change.
• 18:49Another change was, the there
• 18:51was a a goal around,
• 18:53increasing access to crisis care.
• 18:55We got strong feedback that,
• 18:56you know what? It's not
• 18:57just crisis care.
• 18:58It's increase,
• 19:00increased access to crisis care
• 19:01and mental health
• 19:05vision that we have in
• 19:06place related to,
• 19:08the full crisis care continuum
• 19:09and the full behavioral health
• 19:11care continuum. But these are
• 19:12the other areas we're focusing
• 19:13on, you know, addressing the
• 19:15resilience and and mental health
• 19:16of children, youth, and families,
• 19:18you know, also promoting,
• 19:20integration,
• 19:21primary care and behavioral health.
• 19:23We know that that is
• 19:23so important. The areas around
• 19:25the outside are our cross
• 19:26cutting areas. We see that
• 19:28as undergirding everything that we
• 19:29do.
• 19:30And you'll see that in
• 19:31the language,
• 19:32in the in some of
• 19:34the different,
• 19:35projects I'm going to talk
• 19:36about.
• 19:37One thing that we've done
• 19:38in, in our notice of
• 19:39funding opportunities
• 19:41and,
• 19:42and any project where we
• 19:43could get the language in
• 19:44there,
• 19:45we included language related to
• 19:47equity, you know, addressing equity,
• 19:49looking at data,
• 19:51looking at groups that may
• 19:52not be accessing or underutilized
• 19:54or under resourced within the
• 19:56particular project or program area.
• 19:58And so grantees are required
• 20:00to do work, with respect
• 20:01to that. Trauma informed recovery,
• 20:04a commitment to data and
• 20:05evidence. So all of these
• 20:06areas are part of our,
• 20:08current strategic plan.
• 20:11Our NSDUH. So, you know,
• 20:12I wanted to show the
• 20:13NSDUH in in part because
• 20:15the the QR codes. Again,
• 20:16we were able to get
• 20:17this out as early as,
• 20:19as early as it's ever
• 20:20gotten out in SAMHSA history.
• 20:22And and we're trying to
• 20:23get it out early and
• 20:24earlier so that,
• 20:26we can get it closer
• 20:27to real time. You know,
• 20:28the thing about the NSDUH
• 20:29is by the time it
• 20:30comes out, it's always one
• 20:31year behind. Right? Because there's
• 20:33one year of data collection,
• 20:34and then we we try
• 20:35to take I'm asking for
• 20:37six months or less,
• 20:38you know, to be able
• 20:39to summarize everything and get
• 20:41the report out. So some
• 20:42of what we see,
• 20:43in terms of some of
• 20:44the data trends,
• 20:46you know, it's been fairly
• 20:48steady. We haven't seen,
• 20:50significant jumps,
• 20:51but we're optimistic that with
• 20:53some of the things
• 20:54put in place, not just
• 20:54at SAMHSA,
• 20:56but across HHS, that maybe
• 20:57we'll begin to move the
• 20:58needle on on some of
• 20:59these trends that have been
• 21:00fairly consistent. But, you know,
• 21:02consistently, we see about one
• 21:03in four individuals,
• 21:04report having a mental health,
• 21:06condition about one in six
• 21:07struggling with substance use. About
• 21:09one in twelve report having
• 21:10both.
• 21:11For the first time in
• 21:12the NSDUH last year,
• 21:14we had data about recovery.
• 21:15And what we see is
• 21:16about two and three individuals
• 21:18who ever reported,
• 21:19having a mental health challenge
• 21:21reported that they were in
• 21:22recovery,
• 21:23report their recovery.
• 21:25And about three and four
• 21:26individuals who ever reported having
• 21:28a substance use challenge,
• 21:30reported that they were in
• 21:31recovery. So we have a,
• 21:33an additional report that we're
• 21:34gonna do that looks at
• 21:36just,
• 21:37individuals who report that they're
• 21:38in recovery and and disaggregates
• 21:40and looks at the data
• 21:41based on that.
• 21:42We also have a companion
• 21:43report where we break all
• 21:45the data down by race
• 21:46and ethnicity.
• 21:47And so that that has
• 21:49been an important change within
• 21:50the NSDU as well.
• 21:51And then finally, we're just
• 21:52trying to make the data
• 21:53more accessible. Like, NSDU, that
• 21:54report is a be it
• 21:56is a beast. I think
• 21:57that's in part why it
• 21:58took so long to get
• 21:59it out. But we're really
• 22:00asking that it be or
• 22:01I certainly asked my team
• 22:02to just, you know, simplify
• 22:04it a little bit, make
• 22:04the data a little bit
• 22:05more accessible. And so we
• 22:06worked with a contractor
• 22:08and have done these wonderful
• 22:09infographics
• 22:10that that shows some of
• 22:11the,
• 22:12trends and just presents the
• 22:13data in a little bit
• 22:15different way, and so hoping
• 22:16to increase uptake.
• 22:18And then the other thing
• 22:19we wanna let folks know
• 22:20is that, this data is
• 22:22available upon request.
• 22:24So we're we want folks,
• 22:25you know, request this data,
• 22:26do some additional analysis on
• 22:28it. It's a huge database.
• 22:29There's ton we don't even
• 22:31report everything
• 22:32that's in the that that
• 22:33we collect necessarily in the
• 22:35report. So,
• 22:36I invite folks to to
• 22:38do do,
• 22:39request some of that data
• 22:40and take a look at
• 22:41it.
• 22:43Okay. So the next set
• 22:44of slides, I'm gonna talk
• 22:45about just some of our
• 22:45initiatives that align with those
• 22:47strategic priority areas,
• 22:49and the cross cutting principles
• 22:50that I mentioned as well.
• 22:52I'm gonna try to give
• 22:53just a few examples within
• 22:54each area,
• 22:56and then I I might
• 22:57skip over a few just
• 22:58in the interest of time
• 22:59because I think we have,
• 22:59like, three or four examples
• 23:01within each area. But I'll
• 23:02make these slides available. And,
• 23:03mostly, I just wanna be
• 23:05able to share some of
• 23:05the areas, but also share
• 23:07some of the resources
• 23:08with those three free QR
• 23:09codes.
• 23:11Oh, we ended eleven thirty?
• 23:13Oh, I just got ten
• 23:14extra minutes.
• 23:16Thank you. Thank you.
• 23:18That is awesome.
• 23:20I'll slow down a little
• 23:21bit then.
• 23:23Okay. So I wanted to
• 23:24talk about, you know, the
• 23:25nine eight eight, suicide and
• 23:27crisis lifeline. That's probably been
• 23:28one of our our biggest,
• 23:30transformation
• 23:31initiatives, I would say.
• 23:33You know, on on day
• 23:34one,
• 23:36certainly after my confirmation, some
• 23:38of the,
• 23:39some of our discussions were
• 23:41that, you know, we we've
• 23:42gotta figure this out. We've
• 23:43gotta figure it out fast,
• 23:44and we have to knock
• 23:44it out of the park.
• 23:45We can't have we don't
• 23:46want,
• 23:47some of the challenges that
• 23:48sometimes initiatives like healthcare dot
• 23:50gov,
• 23:51experience because it's just that
• 23:53important. We won't don't wanna
• 23:54taint people's,
• 23:56perceptions of what it is
• 23:58and then reduce the likelihood
• 23:59of their ax accessing the
• 24:01support. So right out of
• 24:02the gate, we knew that
• 24:03it it it had to
• 24:05be able to accommodate the
• 24:06calls coming in. We didn't
• 24:07want people waiting a long
• 24:08time,
• 24:10and we wanted to be
• 24:10able to have broad access
• 24:12not only across the states,
• 24:13but across the territories as
• 24:14well.
• 24:15And so initially,
• 24:17you know, nine eight eight,
• 24:18the ten digit number, it
• 24:20was funded at twenty three
• 24:21million.
• 24:22So in two thousand seven,
• 24:23when it started, about twenty
• 24:24three million. It had steady
• 24:25funding at about twenty three.
• 24:27I think one year, it
• 24:27went up to maybe forty
• 24:28five million. There were largely
• 24:30volunteers,
• 24:32and
• 24:33it was sometimes around the
• 24:34clock, but most not always
• 24:35twenty four hours.
• 24:37And so
• 24:39the investment is significant. It
• 24:40went up from the twenty
• 24:42three million to one point
• 24:43five or one point five
• 24:45billion,
• 24:46within the first maybe twenty
• 24:48months or so.
• 24:49And now we're probably closer
• 24:50to about two billion, and
• 24:52that doesn't include the resources
• 24:53related to,
• 24:55some of the other areas.
• 24:56That was really important because
• 24:57there are over two hundred,
• 24:59crisis call centers across the
• 25:00country. There are backup centers,
• 25:02and then there are subnetworks
• 25:03within the overall nine eight
• 25:05eight as as well. So
• 25:05a person can press one
• 25:07to get connected to the
• 25:08veterans line, press two to
• 25:09the Spanish subnetwork,
• 25:11press press three to the
• 25:12LGBTQ plus line, and press
• 25:15four, which is really cool,
• 25:16in the state of Washington
• 25:17to be connected to the
• 25:19native strong
• 25:20line, which is run by
• 25:21Native American individuals, four Native
• 25:23American individuals.
• 25:25And we see many other
• 25:26states now asking for TA
• 25:27around that, so we expect
• 25:28that that's gonna expand as
• 25:29well.
• 25:30So you'll see, you know,
• 25:32within the first,
• 25:34two years,
• 25:35in some ways, it's bittersweet
• 25:37that that ten million contacts
• 25:39came in across call, text,
• 25:41and chat.
• 25:42Ten million.
• 25:43We see the greatest volume
• 25:45coming in in terms of
• 25:46the texts.
• 25:48Chat for the first year
• 25:49was second, but now chat
• 25:51we we is is,
• 25:52slowing down significantly
• 25:54so. So the greatest volume
• 25:55comes in through,
• 25:57text and also through calls.
• 25:59Chats, we think that that's
• 26:00decreased because people don't necessarily
• 26:02like, they're not in front
• 26:02of their computers. Right? But
• 26:04people have their phones with
• 26:05them, like, all the time
• 26:06all the time. So that's
• 26:07why we think we see
• 26:08the greatest volume coming in,
• 26:10through that through the text.
• 26:13Within this past September, within
• 26:15just that month,
• 26:16we got about six hundred
• 26:17and fifty thousand contract contacts.
• 26:21We anticipate, you know, might
• 26:22have been,
• 26:23thoughts or feelings about the,
• 26:24the this is the political
• 26:25climate,
• 26:27leading up to, you know,
• 26:28election. We saw significant spikes
• 26:30there as well.
• 26:32One of the things we're
• 26:33working on is working to
• 26:35get the word out about
• 26:36nine eight eight. You know,
• 26:37it's so important that the
• 26:39first year, two years,
• 26:41was around just standing it
• 26:42up, you know, and making
• 26:44sure that it could accommodate
• 26:45the the volume of calls
• 26:46we knew that were coming
• 26:47in.
• 26:48But we've worked on partnerships,
• 26:49and so we were thrilled
• 26:50that, like, the NFL,
• 26:52many of the players wear
• 26:53nine eight eight cleats, and,
• 26:56so we were really thrilled
• 26:57about that.
• 27:01You know, it is we
• 27:02know that there is so
• 27:03much work to do. I
• 27:04mean, right now, yes, we
• 27:05can meet the volume of
• 27:06calls that come in, and
• 27:07we have extra capacity.
• 27:09We always try to have
• 27:10a certain percentage of extra
• 27:12capacity because we do see
• 27:13whenever there is a a
• 27:15significant event that happens more
• 27:16broadly, we see spikes in
• 27:17calls.
• 27:18But there's still still challenges.
• 27:20We know that there are
• 27:21there are workforce shortages.
• 27:23It's been important that we
• 27:24pay attention to the wellness
• 27:25of the staff across the
• 27:27two hundred call centers.
• 27:28There are,
• 27:29financial issues and challenges with
• 27:31respect to it as well.
• 27:32We know our resources
• 27:34certainly is helping to staff
• 27:35up the different call centers.
• 27:36It's helping to staff up
• 27:37the rest of the crisis
• 27:38care system.
• 27:39But, thankfully, one thing we're
• 27:41seeing is the states are
• 27:42beginning to
• 27:43have in place,
• 27:45different taxes and fees that
• 27:46are are helping with supporting
• 27:48the full continuum of care
• 27:49as well.
• 27:51Awareness remains a challenge.
• 27:53Often when I do,
• 27:54presentations, I'll ask, you know,
• 27:55how many folks have heard
• 27:56of nine eight eight?
• 27:58And and, I'm not yet
• 27:59to the point where,
• 28:01sometimes not even fifty percent
• 28:03of the room, but, you
• 28:04know, but I've done a
• 28:05few, about four thousand thousand
• 28:06people and not fifty percent
• 28:08of the room, but a
• 28:08lot. You know, a lot
• 28:09of hands have gone up.
• 28:11And so now we're actually
• 28:12doing paid,
• 28:13you know, paid advertising,
• 28:16to be able to help
• 28:17get the word out.
• 28:18And and I have to
• 28:19say, I love the way
• 28:20the states are also using
• 28:21the resources,
• 28:23to do,
• 28:24paid advertising and other advertising
• 28:26to help get the word
• 28:27out about nine eight eight.
• 28:28And these are just a
• 28:28few examples.
• 28:30One school in Florida, they
• 28:32have these really cool stickers
• 28:33that the kids can put
• 28:34on their laptops, on their
• 28:35water bottles,
• 28:37about nine eight eight.
• 28:38That that graphic in the
• 28:40middle,
• 28:41there was
• 28:42a Native American reservation we
• 28:44went to in Oklahoma,
• 28:46and they had all kinds
• 28:47of culturally congruent sort of
• 28:48signs and language related to
• 28:50sort of accessing nine eight
• 28:52eight,
• 28:53all across the reservation.
• 28:55And then here in Connecticut,
• 28:57there's been some dump trucks
• 28:59that have had had information
• 29:00about prevention and nine eighty
• 29:02eight as well.
• 29:03The other thing, whenever I'm
• 29:05driving and I see the
• 29:06billboards, I often tell my
• 29:07husband, look, stop. I gotta
• 29:08take a picture.
• 29:09And sometimes we have to
• 29:10go up to the next
• 29:11exit and turn around and
• 29:12come,
• 29:13because I love to get
• 29:14a picture of it, and
• 29:15then we put it out
• 29:16on social. We love doing,
• 29:17like, kudo tweets,
• 29:18for for different, billboards that
• 29:20we see going up.
• 29:22Truth be told, there's one
• 29:23on ninety five that I'm
• 29:24so trying to get. And
• 29:25but I just I just
• 29:26can't quite get it. There's
• 29:27not a shoulder, but there's
• 29:28always traffic there. But
• 29:31I'm gonna get it eventually.
• 29:32It's it's a good one,
• 29:34nine eight eight. And, I'd
• 29:35love to get a picture
• 29:36of it and give give
• 29:37New Jersey a shout out
• 29:39because it's at a good
• 29:40spot. It's where there's traffic,
• 29:41and, so I'm I'm you
• 29:43know, for the cause
• 29:44for the cause. I'm gonna
• 29:45get that one.
• 29:48The wrong way. So, you
• 29:49know, the other areas we're
• 29:50working on is geo routing.
• 29:52Geo routing is so important
• 29:53because, initially, when nine ninety
• 29:55eight started,
• 29:56the calls would go just
• 29:57to whatever area code. But
• 29:59now we're working with, FCC,
• 30:02with the cell phone carriers,
• 30:03and now a call will
• 30:05ping off the local cell
• 30:06tower, and then it'll go
• 30:08to the closest call center
• 30:09wherever the person is.
• 30:11So,
• 30:12no longer if I'm in
• 30:13DC
• 30:14will my call. If I'm
• 30:15in DC and I call,
• 30:17my call will come to
• 30:18will go to DC as
• 30:19opposed to come to Connecticut
• 30:20if I use my personal
• 30:21phone.
• 30:23This graphic here is a
• 30:24graphic, that's in one of
• 30:26the MBAs. So the Indiana
• 30:27Pacers,
• 30:29has this on their in
• 30:30in their locker room area.
• 30:32And so just another example
• 30:33of of some of the
• 30:34great, work to raise awareness.
• 30:37We're doing a lot of
• 30:37work related to interoperability,
• 30:40trying to develop standards
• 30:41so that the call centers
• 30:43know when to pass a
• 30:44call on from nine one
• 30:46one to nine eight eight
• 30:47and vice versa. So that's
• 30:48another important area as well.
• 30:54Their overall vision for for
• 30:55crisis is that, you know,
• 30:57people have
• 30:58a,
• 30:59place to call, that they
• 31:00have folks to respond, and
• 31:02a safe place to go.
• 31:03And so this is one
• 31:04of the grants that we
• 31:05just love because it's an
• 31:06opportunity for,
• 31:08states to be able to
• 31:09continue to scale up and
• 31:11expand their crisis,
• 31:12mobile crisis teams,
• 31:14that will help with that
• 31:15sort of someone to respond,
• 31:17piece.
• 31:18Right now, we have about
• 31:19fifty grantees across the country.
• 31:21They're doing really creative work,
• 31:23in terms of, expanding their
• 31:24mobile crisis teams.
• 31:26And you'll see the level
• 31:27of reach,
• 31:28in terms of about, you
• 31:29know, twenty four thousand individuals
• 31:31screened for suicidal ideation,
• 31:32about two thousand seven hundred
• 31:34individuals diverted from law enforcement.
• 31:36And that's really our goal.
• 31:38You know, for individuals that
• 31:39are one of the goals,
• 31:40certainly. For individuals that are
• 31:41in crisis, we are trying
• 31:42to minimize,
• 31:43unnecessary contact with law enforcement
• 31:46and divert them and get
• 31:47them connected to needed behavioral
• 31:48health services and supports,
• 31:50to help to help,
• 31:52individuals connect and experience recovery.
• 31:58So next, we're gonna talk
• 31:58about CCBHCs. And so this
• 32:00is the other part of
• 32:01the model, like where where
• 32:02folks where to connect folks.
• 32:04And you all know this
• 32:05well. I mean,
• 32:07CMHC,
• 32:08I think I know it
• 32:08was a long time CCBHC,
• 32:10and there are ten of
• 32:11them
• 32:13across the state of Connecticut.
• 32:13This is another model that,
• 32:14that we love and, thankfully,
• 32:16that congress loves.
• 32:18Right now, there is legislation
• 32:20that,
• 32:21every two years, ten more,
• 32:23CCBHCs will be added to
• 32:24the Medicaid demonstration,
• 32:26And that is so important
• 32:27because it helps the sustainability
• 32:29of the model.
• 32:30It means that the the
• 32:31wraparound services and supports that
• 32:33are part of the CCBHC
• 32:35model, that they will be
• 32:36able to be Medicaid reimbursed
• 32:38and states can receive,
• 32:39the Medicaid match,
• 32:41which can help with sustaining
• 32:42again those models.
• 32:44We have recently expanded the
• 32:45model, you know, because we
• 32:46wanted to as part of
• 32:48our our work around integration,
• 32:51you know, we wanted to
• 32:52be able to have more
• 32:53opportunities for people to connect
• 32:55with substance use services.
• 32:57And so now there's a
• 32:58requirement around addiction medicine staffing.
• 33:00There's language in there around
• 33:01harm reduction,
• 33:03and,
• 33:04you know, needing to offer
• 33:06and and think about innovative
• 33:08ways to expand access to
• 33:09harm reduction,
• 33:11emphasis on, additional buprenorphine prescribing.
• 33:14We know often that,
• 33:16individuals,
• 33:17who
• 33:18may be struggling with opioid
• 33:19use disorder, that buprenorphine
• 33:21is a a real viable
• 33:23and valuable evidence based practice,
• 33:25that can help people move
• 33:26into long term recovery. So
• 33:29really working to expand the
• 33:30CCBHC
• 33:31certification model.
• 33:33We're excited. I know Connecticut,
• 33:36has,
• 33:37I I believe applied, actually.
• 33:39Connecticut has applied for the
• 33:41CCBHC
• 33:43planning grant to ultimately be
• 33:44part of the demonstration. And
• 33:46and that's what we're wanting
• 33:46to see,
• 33:48in terms of more states,
• 33:49more and more states becoming
• 33:50part of the demonstration to
• 33:51be able to help with
• 33:52that sustainability.
• 33:53Right now, there's a lot
• 33:54of love from Congress because
• 33:55we again, our budget has
• 33:57continued to expand there,
• 33:58but we don't know how
• 33:59long that's gonna last. And
• 34:00so to the extent that,
• 34:02states can have their CCBHCs
• 34:04be part of the the
• 34:04Medicaid demonstration,
• 34:06it adds an extra layer
• 34:08of,
• 34:09a possibility and opportunity with
• 34:11respect to sustainability.
• 34:16In terms of the data,
• 34:17when we look at the
• 34:17CCBHC data, I mean, it,
• 34:19it just,
• 34:21it it it it within
• 34:22six months, you know, we
• 34:23see the data going in
• 34:25in all the right directions.
• 34:26So we see within six
• 34:28months,
• 34:29reports of overall well-being improving,
• 34:31positive functioning in everyday life,
• 34:34people attending more school, employment,
• 34:37daily activities, feeling more socially
• 34:39connected.
• 34:41And so that makes a
• 34:41difference. And then in terms
• 34:42of reductions, we see reductions
• 34:44in hospitalizations,
• 34:45reductions in in,
• 34:47in ER use and homelessness
• 34:48and incarceration.
• 34:50We're doing a more in-depth
• 34:51evaluation of the model because
• 34:53we now have,
• 34:55quite a bit of data.
• 34:56This is based on about
• 34:56a million participants, including
• 34:58the ten CCBHCs here in
• 35:00Connecticut. Connecticut's knocking it out
• 35:01of the park, by the
• 35:02way, I will say, with
• 35:03the CCBHCs.
• 35:04So kudos
• 35:05to the amazing work that's
• 35:07happening.
• 35:08But we're doing a more
• 35:09in-depth evaluation because we do
• 35:10wanna see with the ten
• 35:11different services,
• 35:13what makes a difference,
• 35:15in terms of the different
• 35:16constellations of CCBHCs. Some CCBHCs
• 35:19have,
• 35:20mobile,
• 35:21you know, mobile components. Some
• 35:22CCBHCs,
• 35:24are also FQHCs. We have
• 35:26a growing cohort. So cool.
• 35:28We have a growing cohort
• 35:29that are also FQHCs, and
• 35:30so looking to, do an
• 35:32in-depth analysis to look at
• 35:34some of those differences as
• 35:35well.
• 35:37So I did wanna share
• 35:38this before,
• 35:39I move on and talk
• 35:40about some of our work
• 35:41in the substance use space.
• 35:43This is the update of
• 35:44the,
• 35:46this is our new twenty
• 35:47twenty four National Suicide Prevention
• 35:48Strategy.
• 35:49The last time the strategy
• 35:51was updated was about ten
• 35:52years ago. So it was
• 35:53it was, like, well past
• 35:54time for it to be
• 35:55updated.
• 35:56And the the important thing
• 35:57I think about this new
• 35:58update,
• 35:59is that there's a greater
• 36:00funk focus on equity. You
• 36:02know, when we look at
• 36:03our data disaggregated, we see
• 36:04particular groups that are still
• 36:05really struggling.
• 36:07Native American individuals,
• 36:08African American,
• 36:11young people have increased rates
• 36:13of suicide.
• 36:15LGBTQ individuals increase rates of
• 36:17suicide. So there's a greater
• 36:18focus on,
• 36:19on equity.
• 36:21The other thing is we
• 36:22did a lot of listening
• 36:23sessions and focus groups and
• 36:24a lot of input from
• 36:25people with lived experience in
• 36:26terms of what will make
• 36:27a difference.
• 36:28And so there's a lot
• 36:29of content in there that
• 36:31really was informed by individuals
• 36:33and family members with lived
• 36:34experience.
• 36:36And then data driven, a
• 36:37lot of information about youth
• 36:38and social media, which I'll
• 36:39talk about in a moment.
• 36:41There's so many challenges there
• 36:42with respect to social media
• 36:44use,
• 36:45and the ripple effects it's
• 36:46having within homes and families
• 36:48and particularly among young people.
• 36:50So,
• 36:52the the next,
• 36:55initiative I wanted to talk
• 36:56about is we know that,
• 36:57you know, trauma, communities also
• 36:59can experience crisis and trauma.
• 37:02So this grant is is
• 37:03one in which recast, it's
• 37:05for, you know, resilience after
• 37:07stress and trauma.
• 37:08It's a grant really focused
• 37:10on and for communities that
• 37:11experience some form of civil
• 37:13unrest,
• 37:14social unrest,
• 37:16you know, community unrest
• 37:18associated with gun violence,
• 37:20or any other,
• 37:22any other sort of instance
• 37:24that that sort of rocks
• 37:25and shakes a community.
• 37:27And the wonderful thing about
• 37:28this is it's fairly flexible.
• 37:30You know, we we try
• 37:31to keep the parameters broad
• 37:32so that communities could sort
• 37:34of think about the types
• 37:34of coalitions they wanna build,
• 37:37to address the challenges that
• 37:38they're seeing.
• 37:39And when I've had opportunities
• 37:40to go visit some of
• 37:41these programs, it's such a
• 37:43cool grant, and we're sort
• 37:44of advocating as much as
• 37:45we're able to do that,
• 37:46which, I mean, advocating is
• 37:48not the right word, but
• 37:48whenever we have opportunities sharing
• 37:50with members of Congress and
• 37:50others just the impacts that
• 37:51we're seeing here. For example,
• 37:51the city of New and
• 37:51others just the impacts that
• 37:52we're seeing here. For example,
• 37:52the city of Newark,
• 37:54Milwaukee, excuse me, created a
• 37:55a a grant that they
• 37:56call, the Healing Hubs net
• 37:56network.
• 37:57It's it's geared towards helping
• 37:59at risk youth who have
• 38:00experienced,
• 38:05either experienced or witnessed community
• 38:07violence.
• 38:08They've brought together rather brought
• 38:10together a coalition of churches,
• 38:12grassroots organizations,
• 38:13libraries,
• 38:14just a broad range of
• 38:16other community organizations,
• 38:18to be able to wrap
• 38:18themselves around the young people
• 38:20and and the communities around
• 38:21helping to promote resilience and
• 38:23wellness and healing from that
• 38:24community based trauma.
• 38:26And so we're really excited
• 38:28about the work happening there.
• 38:29In Florida,
• 38:31they developed
• 38:32a program for,
• 38:34for children as well around
• 38:35sort of healing and recovering
• 38:37from community violence. I believe
• 38:39in Florida, there was a,
• 38:41this might have been in
• 38:42response to one of the
• 38:43shootings that Florida experienced. But,
• 38:45again, some of the goal
• 38:47is to bring people a
• 38:48broad range, taking a multisystem
• 38:50approach,
• 38:51to be able to bring
• 38:52a broad range of community
• 38:53sort of assets and stakeholders
• 38:55together to wrap themselves around,
• 38:57the kids in the community,
• 38:59to be able to help
• 38:59promote health and healing.
• 39:04Okay.
• 39:05So I'm gonna switch gears
• 39:06a little bit now and
• 39:07talk about some of our
• 39:08work within the, substance use
• 39:10space.
• 39:11And I'm I'm looking at
• 39:12time. I'm gonna probably go
• 39:13just about ten minutes more,
• 39:15maybe ten, fifteen minutes more
• 39:16because I do wanna make
• 39:17sure that we have time
• 39:17for discussion.
• 39:19So I might skip through
• 39:19some of these.
• 39:21One thing that we see
• 39:22we've been watching this data
• 39:23really, really closely to try
• 39:25to get a better handle
• 39:26even by by region. Certainly,
• 39:27when we look overall, we
• 39:28see about a fifteen, or
• 39:29fourteen point five percent decrease
• 39:30in overdose deaths. And so
• 39:32that,
• 39:39that's important. It's the first
• 39:41time we've seen that in
• 39:42five years.
• 39:44But we know the rates
• 39:45are still just way they're
• 39:46high. They're still high.
• 39:49And so we know that
• 39:50there's a lot more work
• 39:51that we need to do,
• 39:52But we're grateful, and it's,
• 39:54I think, something that for
• 39:55the first time we're seeing
• 39:56decreases.
• 39:57One thing that we've done
• 39:58is we've tried to work
• 40:00on
• 40:01multiple really a multi front,
• 40:04approach and initiative around addressing
• 40:06some of the patterns and
• 40:07trends that we're seeing.
• 40:10So taking a policy perspective,
• 40:12working in terms of grants
• 40:13and and increasing access,
• 40:15working in terms of, expanding
• 40:18the number of providers who
• 40:19can prescribe,
• 40:21increasing access to,
• 40:23you know, MOUD, some medications
• 40:25for opioid use disorder,
• 40:27expanding access to naloxone. So
• 40:29I'll talk about some of
• 40:30these areas,
• 40:31in the next set of
• 40:32slides.
• 40:33A big part of this
• 40:34was was sort of creating
• 40:35a framework around which to,
• 40:38to conceptualize all the different
• 40:40areas of work that we
• 40:41knew we needed to move
• 40:42forward.
• 40:43So one was, you know,
• 40:44developing an overdose prevention strategy,
• 40:45which has four different pillars.
• 40:47So taking thinking about primary
• 40:49prevention, thinking about harm reduction,
• 40:51evidence based treatment,
• 40:53and also recovery supports. And
• 40:54I would say our our
• 40:55work largely buckets into those
• 40:57areas.
• 40:58I'll talk first about some
• 40:59of the work within the
• 41:00the SOAR and TOR. That's
• 41:02probably our largest,
• 41:04grant addressing opioid use disorder.
• 41:06Congress has significantly,
• 41:08kept these resources,
• 41:09steady, and we've actually seen
• 41:10some increases here as well.
• 41:13And what we see is
• 41:14that in terms of the
• 41:14number of services provided, and
• 41:16this is with the last,
• 41:17cohort,
• 41:18so from,
• 41:20you know, twenty twenty three,
• 41:21twenty twenty four data,
• 41:22that about one point three
• 41:23million people have been connected
• 41:25to services.
• 41:26We see we're seeing really
• 41:28significant decrease of nalox or,
• 41:30dissemination
• 41:31of naloxone,
• 41:32and I think that that
• 41:33is making a that's making
• 41:34a difference.
• 41:35You know, we've seen about
• 41:36five hundred and fifty one
• 41:38thousand,
• 41:39overdoses reversed.
• 41:41And and so that's five
• 41:42hundred and fifty one thousand
• 41:44opportunities, you know, for an
• 41:45individual to
• 41:47experience recovery and connect to
• 41:49services. And so that naloxone
• 41:51saturation work, I think, has
• 41:52been so valuable.
• 41:55This slide here shows just
• 41:57some of the work we're
• 41:57doing with respect to naloxone
• 41:59saturation.
• 42:00It's been really helpful to
• 42:01be able to do policy
• 42:03academies. So we bring teams
• 42:04of states together,
• 42:06about usually eight to ten
• 42:07people,
• 42:08together from different states, and
• 42:09they're able to,
• 42:11engage in planning together around,
• 42:14you know, ways to,
• 42:16strengthen their naloxone plans.
• 42:19Again, as part of the
• 42:19SOAR grant, grantees were required
• 42:21all states are required to
• 42:22develop a naloxone dissemination plan.
• 42:25And then, you know, we
• 42:26have,
• 42:27do these policy academies to
• 42:29bring states together to refine
• 42:30the plans, to learn from
• 42:32each other.
• 42:33And then we've also had
• 42:34sort of ongoing,
• 42:36bimonthly,
• 42:37learning communities where states can
• 42:38come together and share about
• 42:40their naloxone saturation plans as
• 42:41well. And so you see
• 42:43some of the
• 42:44the
• 42:46increases
• 42:46in terms of the naloxone
• 42:48saturation plan dissemination, about forty
• 42:50one percent increase,
• 42:52in terms of dissemination of
• 42:53the plan. And,
• 42:54the states are doing really
• 42:55creative work in terms of
• 42:57getting naloxone
• 42:58out. So we see it
• 42:59through mail, through vending machines,
• 43:01through,
• 43:02you know, community,
• 43:05like, vans. And now we
• 43:06have RVs, some of the
• 43:07RVs. You know, folks may
• 43:08not know I'm a camper.
• 43:09I love camping.
• 43:11So it's been so cool
• 43:12to see the way some
• 43:13of these RVs have been
• 43:14retrofitted and now are full
• 43:16roving community clinics
• 43:18that have, that disseminate harm
• 43:19reduction, that can do low
• 43:21dose induction.
• 43:23Some have areas in the
• 43:24back where they can do
• 43:25groups,
• 43:26and so it's been wonderful
• 43:28to to see these.
• 43:29And we've included language in
• 43:31our grants that,
• 43:33block grant can be used
• 43:34to purchase,
• 43:35vans or v grants or
• 43:37or vans or RVs or
• 43:39any type of vehicles as
• 43:40well as, SOAR in any
• 43:42one of our other grants
• 43:43as well.
• 43:45Okay. Let's see if there's
• 43:46anything else we wanted to
• 43:47say there. Okay. I'm gonna
• 43:48continue on.
• 43:50This slide again just shows
• 43:51some of the decrease,
• 43:52in the previous two years.
• 43:53So the the this slide
• 43:55here, this first one,
• 43:56you know, we see about
• 43:57forty one percent decrease looking
• 43:59across,
• 44:00you know, across
• 44:02I think that one was
• 44:02in in twenty twenty four
• 44:04twenty twenty three to twenty
• 44:05twenty four. And then we
• 44:06look twenty twenty two to
• 44:08twenty twenty three, we see
• 44:09a thirty one percent,
• 44:10increase in the dissemination of
• 44:12naloxone. So really important work
• 44:13in terms of getting naloxone
• 44:15out there.
• 44:16The other area I won't
• 44:17I won't go into this
• 44:17too much, but I did
• 44:18wanna give the QR code.
• 44:20You know, we were able
• 44:20to also update, forty two
• 44:22CFR part eight, and that
• 44:24was really important. That had
• 44:25not been touched
• 44:26in about twenty years, twenty
• 44:28years. So it was important
• 44:29to be able to update
• 44:30that.
• 44:30And, essentially, that it it
• 44:32increases access, expands access to,
• 44:35buprenorphine
• 44:37and to,
• 44:38you know, it increases,
• 44:40telehealth access.
• 44:41It includes nurse practitioners and
• 44:44prescribers of buprenorphine,
• 44:46a lot more language related
• 44:48to harm reduction and incorporating
• 44:49harm reduction. And so,
• 44:51that was a really important
• 44:52update in terms of being
• 44:53able to,
• 44:55expand access to buprenorphine,
• 44:57and OTPs.
• 44:59So there's a QR code
• 45:00for that.
• 45:03Keep going the wrong way.
• 45:04Think of something I'm a
• 45:04lefty.
• 45:06Another resource I wanted to
• 45:07share is our overdose prevention
• 45:09strategy or, excuse me, our
• 45:11harm reduction,
• 45:12framework.
• 45:13The harm reduction framework, this
• 45:14this came about again, you
• 45:16know, we're
• 45:17we we often use a
• 45:18philosophy, nothing about us without
• 45:19us, because
• 45:21community members, again and again,
• 45:22have said it is so
• 45:23important for us to be
• 45:24at the table.
• 45:25And I love hearing that
• 45:26because that's that's the space
• 45:27from which I love to
• 45:28work. So,
• 45:30I've been grateful in my
• 45:31time as assistant secretary that
• 45:32people have continued to show
• 45:33up,
• 45:34when we've invited them in
• 45:35for either virtual coffee hours
• 45:37or,
• 45:39or summits or different steering
• 45:41committees to develop these resources.
• 45:43They've continued to show up,
• 45:44and it's helped us to
• 45:45really be able to to
• 45:46put these together.
• 45:48So the harm reduction framework
• 45:49was developed from a harm
• 45:51reduction steering committee that was
• 45:52put together put together after
• 45:54we did a harm reduction
• 45:55summit.
• 45:56And then, doctor Gupta and
• 45:58I also did a series,
• 45:59or we did at least
• 46:00one anyway,
• 46:03listening session, probably the largest
• 46:05harm reduction
• 46:06meeting that the country has.
• 46:09And so people were loud
• 46:10and clear that they wanted
• 46:11to be involved, that harm
• 46:12reduction had to be,
• 46:14had to be person centered,
• 46:15it had to be community
• 46:16driven.
• 46:17And so all of those
• 46:18principles are outlined within the
• 46:20the harm reduction,
• 46:22framework,
• 46:23that has to take a
• 46:23rights and reparative justice,
• 46:26perspective. And so there's language
• 46:27in there around it's like
• 46:28how to conceptualize that and
• 46:29how to really frame,
• 46:31reparative social justice and what
• 46:32that looks like, with respect
• 46:34to harm reduction and really
• 46:35allowing communities and centering that
• 46:37work in communities,
• 46:39to be able to disseminate
• 46:40disseminate harm reduction
• 46:42supplies.
• 46:44Okay.
• 46:46The other thing that we're
• 46:47really focusing on,
• 46:49and I've loved this because,
• 46:51right now, young people there
• 46:52are young people across the
• 46:53country that are just amazing.
• 46:55They they are change makers.
• 46:56They are fired up.
• 46:58They wanna be involved.
• 47:00They have ideas around what
• 47:02systems need to do to
• 47:03make their lives better,
• 47:04what we need to not
• 47:05do
• 47:06to,
• 47:07make their lives better.
• 47:09And so what we decided
• 47:10to do was to come
• 47:11up with a we called
• 47:12it our Fentanylert Challenge.
• 47:14And, we asked young folks
• 47:16to come up with ideas
• 47:17around,
• 47:18a campaign to educate other
• 47:19young folks around the dangers
• 47:21and harms
• 47:22of fentanyl
• 47:23that, we know is being
• 47:24pressed into fake pills. And
• 47:26increasingly, unfortunately, we're seeing overdoses
• 47:28among young people.
• 47:30And so what the young
• 47:31people came up with, we
• 47:32were we were astounded. We
• 47:33had over two hundred applications.
• 47:35So for one, it was
• 47:36hard for us to pick.
• 47:37It was hard for us
• 47:38to pick, you know, just
• 47:40six winners, twenty five runner
• 47:41ups.
• 47:42I was part of the
• 47:43judging team for this, and,
• 47:45it was really hard to
• 47:46choose. They did an amazing
• 47:47job.
• 47:48We found young people that
• 47:49already
• 47:50had started
• 47:51profit organizations around disseminated information
• 47:54around fentanyl and harm reduction.
• 47:55So let me just show
• 47:56this clip real quick. It's
• 47:57short, but it's a compilation
• 47:59of Sense alert challenge winners.
• 48:01Yeah.
• 48:02Dark Road, Washington.
• 48:05I was focused on myself,
• 48:07never asked how you was
• 48:08doing. Now I'm seeing it
• 48:09was better you was doing.
• 48:10Man, I always thought that
• 48:11you was stronger. I thought
• 48:12you was a father. You
• 48:14had something to lose. Who
• 48:15gonna care for your daughter?
• 48:16Stay strong. That's what you
• 48:17was telling me to do.
• 48:19Now I'm staring through your
• 48:20window seeing your body turning
• 48:21blue.
• 48:22Escape Room, Maryland.
• 48:24Seven out of ten fake
• 48:25prescription pills seized by the
• 48:27DEA
• 48:28contained a potentially lethal dose
• 48:29of fentanyl.
• 48:30With no luck in finding
• 48:31her at school or her
• 48:32favorite hangout spots, you decide
• 48:34to search her bedroom for
• 48:35any kind of flu you
• 48:36can get your hands on.
• 48:37With time ticking, you have
• 48:39to find your friend before
• 48:40it's too late. Can you
• 48:41do it?
• 48:42Narcotic Nightmare Game, California and
• 48:44Hawaii. We would like to
• 48:45introduce our new game, Narcotic
• 48:47Nightmare, which allows youth to
• 48:49investigate the fatal formula inflicting
• 48:51the main character in the
• 48:52game's plot.
• 48:53In the game, players act
• 48:54as investigators
• 48:55tasked with uncovering mysteries surrounding
• 48:57various substance related deaths.
• 48:59Project Fentanyl, New York.
• 49:02For ninety percent of American
• 49:03teens using social media on
• 49:05a regular basis, it is
• 49:06a great place to promote
• 49:07fentanyl awareness. My videos feature
• 49:09three different fentanyl related topics
• 49:11that all teens should be
• 49:12familiar with.
• 49:13These topics are fentanyl overdose
• 49:15symptoms, the benefits of Naloxone
• 49:17nasal spray and how to
• 49:18properly use it, and the
• 49:19dangers of fake pills and
• 49:20emerging drug contaminants.
• 49:22Safe Youth Ambassadors, Florida.
• 49:25For over a year, we've
• 49:26researched fentanyl facts that we
• 49:28thought teens could relate to
• 49:29with a focus on the
• 49:30dangers of counterfeit pills bought
• 49:32on social media.
• 49:33We met with police,
• 49:35legislators,
• 49:36and victims' families,
• 49:38and then combined all what
• 49:39we learned into a nine
• 49:41minute multimedia
• 49:42presentation to share with our
• 49:44peers.
• 49:45Show, don't tell, New Jersey.
• 49:47The best way to educate
• 49:48teens is to encourage young
• 49:50animators to create short animated
• 49:52videos that visualize the symptoms
• 49:54and effects to give teens
• 49:56a deeper understanding on how
• 49:58fentanyl affects one's body.
• 50:00Congratulations, winners. To learn more,
• 50:02visit samhsa dot gov slash
• 50:04ventilert.
• 50:06I mean, are there it's
• 50:07so innovative in terms of
• 50:09what the young folks put
• 50:10together.
• 50:11And so take a look
• 50:12at those. I mean, help
• 50:13share it. I see our,
• 50:15numbers of folks joining. It's
• 50:16starting to slow, so we
• 50:18will go ahead and get
• 50:19started.
• 50:21Welcome everyone to today's
• 50:23Okay.
• 50:25Technology.
• 50:27Yeah. So those are on
• 50:28our website, and so you're
• 50:29welcome to share those, to
• 50:30look at some of the
• 50:31others.
• 50:32The kids did see receive
• 50:34resources to be able to
• 50:35help continue to scale up
• 50:36and and build out those,
• 50:38build out some of that
• 50:39work.
• 50:42K. So this is, I'm
• 50:43gonna shift gears just a
• 50:44little bit. This is, I
• 50:45wanted to talk about Project
• 50:46AWARE,
• 50:47another grant focusing on sort
• 50:49of,
• 50:50resilience among children, youth, and
• 50:52families.
• 50:53This is a school based
• 50:54grant.
• 50:55It is a grant where,
• 50:57schools are able to put
• 50:58together,
• 51:00they they do quite a
• 51:01bit of training. Actually, I
• 51:02didn't even put together, but
• 51:03but they they do quite
• 51:04a bit of training related
• 51:05to,
• 51:06recognizing young folks that may
• 51:08be struggling, connecting young folks
• 51:10and families to services and
• 51:11supports,
• 51:13putting together really coalitions and
• 51:15and collaborations
• 51:16with within,
• 51:18state education,
• 51:19agencies and behavioral health,
• 51:22organizations and community resources.
• 51:25And so,
• 51:26this is another area where
• 51:28it, just the impact on
• 51:29young people,
• 51:31has been so significant. In
• 51:32the in the picture there,
• 51:33I had gone to a
• 51:34Project AWARE,
• 51:35school, grantee in the state
• 51:37of Rhode Island,
• 51:38and they're doing so much
• 51:39with just using space,
• 51:41space
• 51:42in terms of creating healing
• 51:44spaces.
• 51:45The schools had, they had
• 51:47time out rooms,
• 51:48which were equipped with all
• 51:50types of things for young
• 51:51people to be able to
• 51:51de stress.
• 51:53Many of the rooms were
• 51:53designed in part with input
• 51:55and feedback from the kids.
• 51:57They also had, like, the
• 51:58classrooms
• 51:59were, like, these central rooms,
• 52:01and then they had, like,
• 52:02pods off of each of
• 52:03them. And so they did
• 52:04a lot of work where
• 52:05kids could interact with kids
• 52:06across multiple age groups.
• 52:09And and so sometimes they
• 52:10would bring them all into
• 52:11the bigger pod, and then
• 52:13other times they would have
• 52:14them go out into the
• 52:15smaller pods based on, sort
• 52:16of, their age and their
• 52:17their class, and it was
• 52:18just such a cool fluid
• 52:20space.
• 52:21Their cafeteria, they had,
• 52:23again, same thing, like, really
• 52:25cool tables and colors, and
• 52:27and,
• 52:28they had this one area,
• 52:29stadium seating in the cafeteria
• 52:31where the kids, if they
• 52:31didn't wanna eat at the
• 52:32table, they could just go
• 52:33with their lunches and just
• 52:34sort of convene together in
• 52:36just stadium seating area.
• 52:38And and then while all
• 52:40that's going on, there's a
• 52:41lot of sort of education
• 52:42and awareness building both for
• 52:44the kids and for the
• 52:45faculty around sort of mental
• 52:47health and sort of being
• 52:48working to identify kids that
• 52:50may be struggling and connecting
• 52:51them to services and supports.
• 52:54I won't say too much
• 52:55around around this just in
• 52:56the interest of time. The
• 52:57the one thing is, this
• 52:58we did a youth summit.
• 53:00It was amazing. It was
• 53:01led by the kids, by
• 53:02by young folks.
• 53:04We we work with them
• 53:05to do the planning. They
• 53:06came up with a schedule.
• 53:07They wanted to start at
• 53:08nine and end at ten.
• 53:09I'm like, like, oh, good
• 53:09Lord. It was, it was
• 53:10a long day, but it
• 53:11was so, it was so
• 53:11fun. I mean, they just,
• 53:13they, they just put things
• 53:13together in ways that are
• 53:14not,
• 53:21that we that just wasn't
• 53:22even on our radar screen.
• 53:23They told us our graphics
• 53:24are tired. Our graphics are
• 53:25tired and old. So
• 53:29so so we got,
• 53:30we and I might even
• 53:32remember one of the young
• 53:33folks recommended, like, this digital
• 53:34storyteller
• 53:35that as the different breakouts
• 53:37and things were happening throughout
• 53:38the throughout the meeting,
• 53:41the digital storyteller was developing
• 53:42these graphics capturing all of
• 53:44what they were saying. And
• 53:45so we have pages and
• 53:46pages
• 53:47of of, like, graphics like
• 53:48this capturing,
• 53:49their their discussions.
• 53:51And then
• 53:52there's ultimately about a hundred
• 53:54kids came together. There's now
• 53:55ten teams, and then we're
• 53:56working with those teams. Each
• 53:57team has a mentor, and
• 53:58we're continuing to work with
• 54:00them around what sort of
• 54:01what would make a difference.
• 54:02The big takeaway is they
• 54:03said, you know, we need
• 54:04more healing spaces. We need
• 54:05spaces where we can come
• 54:07together that are safe, where
• 54:08we can just be with
• 54:08each other.
• 54:10And,
• 54:11and then someone says talk
• 54:13about mental health or talk
• 54:14about wellness or talk about,
• 54:16so they talk about more
• 54:16healing spaces, more focus on
• 54:18mental health, discussions of mental
• 54:19health in schools.
• 54:21You know, that that was
• 54:22a request as well.
• 54:25I'm gonna have this be
• 54:26my my last slide, and
• 54:27then I'll make these available.
• 54:28You know, there's a lot
• 54:29of content that I didn't
• 54:31get to related to our
• 54:31office of behavioral health equity.
• 54:33Really
• 54:34great stuff going on there
• 54:35with respect to,
• 54:37we're we're scaling up our
• 54:39disparity impact statement. So
• 54:41the disparity impact statement is
• 54:42a statement that all grantees,
• 54:44our discretionary grantees work with,
• 54:46to be able to look
• 54:47at disparity populations that might
• 54:48be, they might be serving.
• 54:51And then, you know, we'll
• 54:52give additional follow-up and follow-up
• 54:54TA around sort of addressing
• 54:55disparities within this grant.
• 54:58This particular,
• 55:00project here, this is a
• 55:01there was a task force
• 55:03chaired by, myself
• 55:05and,
• 55:06commerce, so assistant secretary Allen
• 55:08Davidson,
• 55:09really to try to get
• 55:10at some of the challenges
• 55:11that we're seeing with in
• 55:12terms of, kids' online health
• 55:14and safety.
• 55:15We did a series of
• 55:16focus groups in in California.
• 55:18We met with, all the
• 55:19big so Facebook, Meta, Instagram,
• 55:22you know, all all the
• 55:23big,
• 55:25sort of social media groups
• 55:26and and did some,
• 55:28a day long sort of
• 55:29listening session, working session with
• 55:31them. We did focus groups
• 55:32with family members, kids across
• 55:34the country,
• 55:36and then ultimately did a
• 55:37lit review of all of
• 55:38what we're seeing in terms
• 55:39of online and social media.
• 55:41And we know,
• 55:42you know, the the the
• 55:43gist of it is that
• 55:44that it's, you know, it's
• 55:45not all it's not all
• 55:46bad. And the young folks
• 55:48said, like, you know, don't
• 55:49throw the baby out with
• 55:50the bathwater, although they didn't
• 55:51use those exact words, but
• 55:52they're like, you can't get
• 55:53rid of it totally.
• 55:54Because for some of us,
• 55:57it is an important way
• 55:58that we engage with each
• 55:59other and provide social connection.
• 56:01For LGBTQ
• 56:02youth,
• 56:03young people who who feel
• 56:05at the margins, they've been
• 56:06able to connect with other
• 56:07other young folks or, around
• 56:09special interest groups that are,
• 56:11you know, that are that
• 56:12are,
• 56:13positive.
• 56:15And so the these are
• 56:16a set of resources around
• 56:17sort of conversation starters for
• 56:19families.
• 56:20We develop an overarching report
• 56:22and then sort of one
• 56:23pagers to help families sort
• 56:24of have conversations with young
• 56:25folks around social media to
• 56:27maybe develop. We fund a
• 56:28social media center of excellence,
• 56:30to maybe develop social media
• 56:32plans.
• 56:33There's a template
• 56:34around sort of families really
• 56:35developing a plan together,
• 56:37balancing sort of screen time
• 56:39with no screen time or
• 56:40balancing,
• 56:42when the family will will
• 56:44use media versus not. So
• 56:46take a look at that
• 56:46as well. There's a QR
• 56:47code there.
• 56:48But I'm gonna stop there
• 56:49so we can have time
• 56:50for for, discussion.
• 56:52And, again, thank you so
• 56:53so much for the invitation
• 56:54to be here. It's just
• 56:55such a such a pleasure
• 56:56to be able to,
• 56:58see everyone.
• 56:59I applaud the work that's
• 57:00happening in in Connecticut and
• 57:02that you all are doing.
• 57:03We we I reported the
• 57:04some of the data overall,
• 57:06but we also do look
• 57:07by region. And so,
• 57:09you know, I get the
• 57:09nine eight eight data every
• 57:10day. And so we we
• 57:12do see what,
• 57:13Connecticut's doing a great job.
• 57:16And so we're grateful for,
• 57:17all the work that's happening
• 57:18here.
• 57:19So I'll so I'll stop
• 57:20there and and happy to
• 57:21take any questions that folks
• 57:23might