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Module I:
Introduction
2
Purposes Provide an overview and rationale for the
program. Introduce the curriculum developed for
the programs. Identify the accomplishments of the first
five years of the initiative.
3
Learning ObjectivesHealth Care Professionals will be
able to: Discuss the program rationale. Identify the relevant goals and objectives
of Healthy People 2010.
4
Learning Objectives (continued)
Define the role of health care professionals in meeting the challenge of substance use disorders.
List the basic substance use related competencies germane to all health care professionals.
5
Learning Objectives (continued)
Discuss the recommendations of the Strategic Planning Document of the HRSA-AMERSA-CSAT/SAMHSA Interdisciplinary Program to improve Health Professional Education in Substance Abuse.
Discuss the organization and accomplishments of the Faculty Fellowship component of the program.
Discuss a model of the process of cultural competence.
Identify evolving trends in prevention and treatment of substance use disorders.
6
Outline of Syllabus Module 1: Introduction Module 2: Overview of Substance Use
Disorders Module 3: Screening and Assessment Module 4: Intervention and Referral Module 5: Motivational Interviewing Module 6: Prescription Drug Abuse
7
Outline of Syllabus (continued)
Module 7: Identifying and Assisting
Children of Substance Abusing Parents Module 8: Substance Abuse and the Elderly Module 9: Community-Based Substance Abuse
Prevention Module 10: Population Health and Substance Abuse Module 11: Curriculum and Evaluation
8
Program Overview and Rationale
HRSA-AMERSA-SAMHSA/CSAT
Interdisciplinary Program in Substance Abuse Education
9
Substance Use Disorders 119 million (50.1%) American aged 12 or
older use alcohol. 54 million (22.6%) binge drink 16.1 million (16.8%) drink heavily.
NSDUH, 2004.
10
Substance Abuse Disorders 19.5 million (8.2%) use illicit drugs 70.8 million (29.8%) use tobacco
NSDUH, 2004
Overall drug and tobacco use among teens has declined but inhalant and vicodin use has increased.
MTF, 2004
11
Healthy People (HP) 2000 Goals: Reached
Increase in average age of first marijuana use
Decline in cocaine use
12
Alcohol-related crashes Average age of first cigarette Alcohol use - ages 12 to 20 Tobacco use - ages 12 to 17
HP 2000 Goals: Some Progress
13
Average age of first alcohol use Marijuana use - ages 12 to 25 Heavy drinking - high school students Heavy drinking - college students
HP 2000 Goals: No Progress
14
Drug-related emergency room visits Drug-related deaths, especially
among African Americans and Hispanic Americans
HP 2000 Goals: Regression
15
Healthy People 2010
Reduce substance abuse to protect health, safety and quality of life for all, especially children (25 objectives related to this goal).
Reduce illness, disability, and death related to tobacco use and exposure to secondhand smoke (21 objectives related to this goal).
Other goals relate indirectly.
16
Healthy People 2010 -Indirect Goals/Objectives
Access to Quality Health Services1-3 Counseling about health behaviors.1-7 Core competencies in health provider training.
Educational and Community-Based Programs7-2 School health education.7-3 Health-risk behavior information for college and university students. 7-5 Worksite health promotion programs.7-6 Older adult participation in employer-sponsored health promotion activities.
17
Healthy People 2010 -Indirect Goals/Objectives (continued)
Educational and Community-Based Programs (continued)
7-7 Patient and family education.
7-10 Community health promotion programs.
7-11 Cultural appropriate community health promotion programs.
HIV prevention
13-8 HIV counseling and education for persons in substance abuse treatment.
18
Healthy People 2010 -Indirect Goals/Objectives (continued)
Injury and Violence Prevention
15-15 Deaths from motor vehicle crashes
15-32 Homicides
15-34 Physical assault by intimate partners
15-35 Rape or attempted rape
Maternal, Infant, and Child Health16-17 Prenatal substance exposure
16-18 Fetal alcohol syndrome.
19
Healthy People 2010 -Indirect Goals/Objectives (continued)
Mental Health and Mental Disorders18-10 Treatment for co-occurring disorders.
Occupational Safety and Health20-9 Worksite stress reduction programs.
Public Health Infrastructure23-8 Competencies for public health workers.23-17 Prevention research.
Sexually Transmitted Diseases25-11 Responsible adolescent sexual behavior.
20
Workforce DeficienciesPrimary and secondary substance abuse
prevention is effectiveFew health care professionals engage
regularly in primary and secondary prevention
All of the U.S. is underserved with regard to substance abuse services
21
Needs
Routine screening, brief intervention, and referral
Identification and assistance for affected family members
Attention to substance use by elderly Health professional involvement in
community prevention efforts
22
Insufficient emphasis on substance abuse in education and training
Health professional workforce is deficient in basic competencies
Insufficient numbers of faculty able to teach and model these competencies
Barriers
23
Previous Faculty Development Programs (FDP’s)
NIAAA, NIDA, HRSA, CSAP
Effective for many participants Some ripple effects Short-lived; limited sites Federal effort not coordinated Little interdisciplinary synergy
24
Main Objectives
Produce a strategic plan for health professional education and training
Conduct a faculty devel. program for fellows from multiple disciplines
Build regional training and national electronic communication networks
25
Targeted Disciplines
Dentists Dieticians Nurses Nurse midwives Nurse practitioners Occup. therapists Pharmacists
Physical therapists Physicians Physician assistants Psychologists Public health
Social workers Speech path/audiologists
26
Strategic Planning Document
Magnitude of problem Effective ways to address problem Health care professionals’ involvement State of health professional education Trends in health care delivery Recommendations for all disciplines Discipline-specific recommendations
27
Strategic Planning Document(continued)
For all recommendations: Rationale Responsible parties Suggestions for implementation
28
Strategic Planning Staff Director of Strategic PlanningMary Haack, RN, PhD, Assoc. Prof.Rutgers University School of Nursing
Associate Director of Strategic PlanningHoover Adger, MD, Assoc. Prof.Johns Hopkins Univ. Medical School
Professional Editor –Linda Harteker, MA
29
Strategic Planning Advisory Committee
Addict. Psych. - Kathleen Brady, MD, PhD Allied Health - John Bonaguro, PhD Allopathic Med. - David Lewis, MD Dentistry - Arden Christen, DDS, MSD, MA Geriatrics - Kristen Barry, PhD Nursing - Madeline Naegle, RN, PhD Nurse Midwife - Pat Paluzzi, CNM, DrPH
30
Strategic Planning Advisory Committee(continued)
Nurse Pract. - Elias Vasquez, PhD, NNP Osteopathic Med. - Richard Butler, DO Pharmacy - Ernest Dole, PharmD Phys. Ass’t - C. Judd, PA-C; P.Morgan, PA-C Psychology – William Miller, PhD Public Health - Chris Ringwalt, MSW, DrPH Social Work - Lala Straussner, DSW
31
Project Goals for Health Care Professionals: Faculty Development
Improve and expand substance abuse curricula in health professional schools and
training programs in order to
Produce health professionals who will help the U.S. meet its Healthy People 2010 goals
on substance use/abuse
32
Clinic-based screening, assessment, intervention, and referral
Clinic-based identification and assistance of children and adolescents with affected parents
Community-based prevention
Primary Learning Objectives
33
Geriatric issues Population health Prescription Drug Abuse Pedagogy Curriculum design and evaluation Presentation/publication
Other Important Learning Areas
34
Role of Health Care ProfessionalsBasic competencies germane to all health care
professionals: Overview of substance use disorders Screening and assessment Intervention and referral Motivational interviewing* Identifying and assisting children of substance abusing
parents Recognizing and assisting elderly substance abusers Community-based substance abuse prevention* Recognizing population trends in substance use disorders.
* Level of competency varies by profession
35
Interfaculty Fellow Learning Groups (IFLG’s) Faculty apply as interdisciplinary faculty
learning groups 3 faculty fellows per IFLG with geographic
proximity Each IFLG has 3 disciplines Collaborative projects
36
Regional Structure - Cohort 1 & 2
Regional Director
MentorMentor
Fellow FellowFellow FellowFellow Fellow
37
FDP Learning Activities
AMERSA National Conference plus special FDP workshops
Spring regional meetings Annual mentor visits Learning contract Monthly contacts with mentors
38
FDP Learning Activities (continued)
Interdisciplinary clinical and educational projects
Interactions with IFLG FDP distance learning activities Present projects at meetings Publish peer-reviewed articles
39
Evaluation Team
Rebecca Henry, Ph.D.
Rich Brown, MD, MPH
Monina Lahoz, PhD
Marianne Marcus, RN, EdD
Jeff Morzinski, PhD
Gene Schoener, PhD
40
Evaluation Plan
Administrative, process, and outcome measures
Outcomes evaluation driven by objectives
41
Evaluation - Strategic Planning
Process Administration runs smoothly Meetings achieve aims
Outcome Reviewers rate document highly Document receives publicity Document stimulates change
42
Evaluation - Fellowship
Administrative Planning occurs on schedule Fellow & mentor recruiting succeeds re
numbers and diversity Fellow-Mentor contacts occur Mentor-Director contacts occurs Fellows exhibit consistent progress
43
Evaluation - Fellowship (continued)
Process - Fellows Application process Expectations - clear and appropriate Training events Mentor contacts Accessibility of guidance Overall experience
44
Evaluation - Fellowship (continued)
Process - Mentors Selection process Involvement with fellows Progress of fellows Support from project Compensation Overall experience
45
Evaluation - Fellowship (continued)
Process - Activities Participant satisfaction Best aspects; suggestions
Process - Infrastructure Awareness, use, suggestions Activities, income
46
Evaluation - Fellowship (continued)
Knowledge and Attitude Outcomes 30-item knowledge test SAAS treatment optimism Readiness to change clinical and field
practices
47
Evaluation - Fellowship (continued)
Competency Outcomes Self-efficacy and confidence OSCE stations Presentations Publications
48
Evaluation - Fellowship (continued)
Curricular Outcomes Teaching activities Trainee contacts - number, time Curricular presence
49
Evaluation - Fellowship (continued)
Distance Learning Programs Knowledge objectives Attitude objectives Competency objectives
50
Evaluation - Fellowship (continued)
Career Emphasis Outcomes Professional time allocations Professional organizations Professional activities
51
Fellowship Administration
Fellowship Director
Marianne T. Marcus, RN, EdD, Professor
UT-Houston School of Nursing Associate Director of Fellowship
Richard L. Brown, MD, MPH, Assoc. Prof.
University of Wisconsin Medical School
52
Regional Directors
Toni Graham, RN, MSW, PhD, CWRU Theresa Madden, DDS, PhD, OHSU Marianne Marcus, RN, EdD, UT-Houston Gene Schoener, PhD, Wayne State Univ.
(website) Lala Straussner, DSW, New York Univ.
53
Syllabus
Designed and edited by Judie Pfeifer, MEd Borrowed from previous syllabi on
substance abuse Tailored for multidisciplinary use Updated with recent articles
54
Fellowship Advisory Committee
Addict. Psych. - John Chappel, MD Allied Health - John Bonaguro, PhD Allopathic Med. - Michael Fleming, MD,
MPH Dentistry - Karen Crews, DMD Geriatrics - Allison Moore, MD Nursing - Madeline Naegle, RN, PhD Nurse Midwife - Pat Palluzi, CNM, DrPH
55
Fellowship Advisory Committee (continued) Nurse Practitioner - Elias Vasquez, PhD,
NNP Ostoepathic Med. - Richard Butler, DO Pharmacy - Anthony Tommasello, PharmD Physician Ass’t - Janice Cooney, PA-C Psychology - Bruce Liese, PhD Public Health - Chris Ringwalt, MSW, DrPH Social Work - Lenore Kola, PhD
56
Administrative Group Project Director Richard L. Brown, MD, MPH
Project Manager Doreen MacLane-Baeder
Project Assistants Christine Benz, June Daws
57
Initial Project Officer Team
Dr. Ruth Kahn, Lead Dr. Mildred Brooks-McDow Dr. Marcia Starbecker Dr. Suzanne Cable Dr. Terri Spears
58
Accomplishments
Strategic Plan published 2002. Website now a valuable resource. Thirty-nine faculty fellows from 20
institutions trained.
59
Faculty Development: Project MAINSTREAM
Two cohorts: 39 fellows; 13 IFLGs10 physicians4 social workers11 nurses3 dentist2 physicians’ assistants2psychologists3 public health professionals2 pharmacists2 occupational therapists
60
Accomplishment - Curriculum
10,170 trainees reached by fellows. Based on clinical caseloads in generalist
settings approximately 126,275 patients could be reached by trainees daily.
66,995 hours of substance abuse content offered.
Each trained received 6.58 hours of instruction.
61
Evaluation Training experience evaluated positively. Mentoring rated positively. Interdisciplinary collaboration valued. Grants, manuscripts and evidence of
durable career change reported. New modules added based on fellow
feedback.
62
Website Development Valuable resource for Project
MAINSTREAM. Used by academics and organizations
outside of project. www.projectmainstream.net
63
HRSA-AMERSA-SAMHSA/CSAT Model Shows promise for improving services in
generalist health care settings. Strategic Plan and website are valuable
resources. Project MAINSTREAM results in
impressive outcomes.
64
Cultural Competence
Increased concern for cultural competence among all health care disciplines.
Impetus: concern for adequacy of services for members of ethnic minority groups.
Flexible changing process. Each person is unique within their culture.
65
Culture
“Sum total of a group’s lifeways, including material culture, world view, social organization, symbols, status, child raising, language, technology and citizenship.”
(Westermeyer, 1999) Acquired by experience. Transmitted from one generation to another.
66
Ethnicity
“...peoples from diverse cultural groups who share a common culture” (Westermeyer, 1999).
Characteristics: identity with a national origin, religious practice, language besides English, dress, diet, non-national holidays or ceremonials, family rituals, etc. (prescribed and proscribed substance use).
67
Subculture
Group within the culture with distinct characteristics but cannot exist independent of the group.
Subcultures and substance use: crack houses, opium dens, taverns, cocktail lounge.
68
A Culturally Competent Model of Care
Campina-Bacote, 1991
Cultural Knowledge (CK)
Cultural World Views,Theoretical and Conceptual
Framework
Cultural Skills (CS)Cultural Assessment Tools
Cultural Awareness (CA)Cultural Sensitivity,
Cultural Biases
Cultural Encounter (CE)Cultural Exposure,Cultural Practice
Cultural Competence (CC)
69
Diversity Within Culture Age Gender Level of acculturation Generation
• first generation• second generation
Sexual orientation Rural/Urban
70
Changing Frontiers in Prevention and Treatment
Faith-based settingsFamily drug courtsCriminal justice treatment initiativesComplementary and alternative
therapies
71
Summary
Overview and rationale Healthy People 2010 Role of health care professionals Accomplishments of HRSA-AMERSA-
SAMHSA/CSAT Program Cultural competence Changing frontiers