December 9, 2014
Community Meeting to Inform the Strategic Plan Update
WELCOME & INTRODUCTIONS
2
Agenda
3
Welcome & Introductions
Data Presentation
Breakout Session – Group Review & Prioritization
Breakout Session – Identifying Potential Strategies
Wrap-Up & Closing
Meeting Goals
4
Disseminate data on substance use and related issues
to stakeholders
Gather community input on identifying and
prioritizing key issues to be
included in the Strategic Plan
Update
Provide the opportunity to begin thinking
about strategies to address the
identified priorities
Meeting Agreements & Norms
5
To build our ability to work together, we…
• Agree to participate
• Learn from other’s questions and comments
• Focus on interests, not positions
• Try to see the whole picture
• Be open to the possibilities
To show respect and courtesy, we agree
to…
• Have one person speak at a time
• Focus on one process
• Express disagreement with ideas, not people
• Keep our comments short
• Use the parking lot
• Turn off electronics
To promote understanding, we
agree to…
• Use inquiry more than advocacy
• Ask for clarifications versus assuming
• Uncover underlying assumptions
Kristen Law
Leigh Steffy
DATA PRESENTATION
6
Setting the Stage
Getting Grounded in Local Data
County Health Rankings: Marin Ranks High In Most Indicators
Marin County ranked in the top 5% in: - Premature death rate - Adults self reported health -Mentally unhealthy days - Adult obesity - Teen birth rate - Uninsured adults - Primary care physicians per capita - High school graduation - Unemployment - Children in poverty - Physical activity - Violent crime rate High food environment index -Low rate of preventable hospital stays -Low violent crime rate
Ranked in the top 10% in: -Low percent of adults reporting fair or poor health
-Low average number of mentally unhealthy days
-High access to exercise opportunities
-High dentists per capita
-High mental health providers per capita
-High percent with some college
Ranked in the top 25% in: -Low number of physically unhealthy days - Adults without social/emotional support - Low percent driving alone to work
Ranked in the top 15% in: -Low percent of adults who smoke - Low percent of children in single-parent households - Low average daily air pollution
Marin County ranked in the bottom 50% in: - 1Excessive Drinking
-2Drug poisoning mortality rate
1 Data collected from Behavioral Risk Factor Surveillance System 2006-2012 (2005-2010 for social support indicator) and may vary from other local sources used in county health reports and factsheets. 2 Drug poisoning deaths was an additional measure and did not contribute to the overall county health rankings.
Marin vs Marin
• Healthiest county in California
• Healthiest county for young people in America
• High income inequality
• Alcohol consumption, particularly binge drinking across the age span, is in the top 5%
The Three Cs
Source: Christin Borbely, PHD
• Consumption
• Contributing Factors
• Consequences
CONTRIBUTING FACTORS Perceived Harm Access and Availability Access to Services Mental Health Risk and Protective Factors
0
10
20
30
40
50
60
Great Moderate Slight None
Pe
rce
nt
Most Marin Youth are Aware That Binge Drinking* is Harmful
7th
9th
11th
Non Trad
*Five or more drinks in one sitting.
Source: California Healthy Kids Survey (2013-14)
0
10
20
30
40
50
60
70
Great Moderate Slight None
Marin Youth’s Perception about the Harm of Smoking Marijuana* is More Variable
7th
9th
11th
Non Trad
*Smoking Marijuana once or twice a week.
Source: California Healthy Kids Survey (2013-14)
Most Marin Youth Say that Marijuana and Alcohol are Easy to Access
0
10
20
30
40
50
60
70
80
90
Easy
Perceived Difficulty to Obtain Marijuana
7th
9th
11th
0
10
20
30
40
50
60
70
80
90
Easy
Perceived Difficulty to Obtain Alcohol
7th
9th
11th
Source: California Healthy Kids Survey (2013-14)
0
5
10
15
20
25
Pe
rce
nt
Source: California Healthy Kids Survey (2013-14)
11th Graders In Marin Access Alcohol and Drugs from Parties and Friend’s Houses
0
5
10
15
20
25
30
35
40
Very Likely Likely Not Likely Don't know
Likelihood of Finding Help at School to Reduce Substance Use
7th
9th
11th
Non Trad
More than half of Marin 7th, 9th, 11th and NT students don’t know if help is available or think help is not likely available at school
Source: California Healthy Kids Survey (2013-14)
Access to Substance Use Treatment and Recovery Support Services County Funded Service Capacity for FY 2014/15
Service Contracted Providers
Annual Capacity
Adult Residential Substance Use Treatment Men, Women, Women with Children 1
91 Clients (29.4 Beds)
Community Based Adult Outpatient Substance Use Treatment
General Population, Adult Drug Court, Justice-Involved, Women/Perinatal, Safety Net, Spanish Speaking (starts in January)
2 241 Clients
In Custody Adult Engagement/Outpatient Substance Use Treatment
1 416 Clients
Outreach and Engagement Program Co-Occurring Mental Health and Substance Use 1 40 Clients
Narcotic Replacement Therapy Methadone
1 163 Clients
Adult Residential Detox
1 1,275 Clients
(14 Beds)
Adolescent Outpatient Substance Use Treatment Outpatient Drug Free, Intensive Outpatient, Juvenile Drug Court 2 92 Clients
*Additional services are available for adults eligible for AB 109 and SB 678-funded services, including Sober Living, Thinking for a Change and Recovery Coach/Care Manager services
0
5
10
15
20
25
30
35
40
45
Yes
Chronic Sadness or Hopeless Feelings in the Past 12 Months
7th
9th
11th
Non Trad
One in four high school students reported feeling chronic sadness and hopeless feelings in the past year
Source: California Healthy Kids Survey (2013-14)
0
10
20
30
40
50
60
70
High Medium Low
School Connectedness
7th
9th
11th
Non Trad
Source: California Healthy Kids Survey (2013-14)
0
10
20
30
40
50
60
70
High Medium Low
Academic Motivation
7th
9th
11th
Non Trad
Source: California Healthy Kids Survey (2013-14)
CONSUMPTION Prevalence of Adult Alcohol, Tobacco and Other Drug Use
Prevalence of Youth Alcohol, Tobacco and Other Drug Use
0
5
10
15
20
25
30
35
40
18 + 21 - 64 65 +
Percent of Marin Adults Reporting Binge Drinking in the Past Year
Source: California Health Interview Survey (2011-12)
Substance Use Treatment Admissions (FY 2013/14)
Treatment Modality Unduplicated Clients Admitted
Number of Admissions
Adolescent: Outpatient Treatment 73 74
Adult: Outpatient Treatment 132 137
Adult: Residential Treatment 109 113
Adult: Narcotic Replacement Therapy 62 62
Adult: Residential Detoxification 604 968
TOTAL 980 1,360
0
50
100
150
200
250
300
350
Treatment Detox
Age of Clients Admitted
Under 18
18-25
26-35
36-45
46-55
56-65
65+
Source: Marin WITS
71.5 74.2
28.5 25.8
0%10%20%30%40%50%60%70%80%90%
100%
Treatment Detox
Gender of Clients Admitted
Female
Male
Source: ITWS
0
20
40
60
80
100
120
140
160
180
200
Alcohol Marijuana Meth Crack Opiates Heroin Other
Nu
mb
er
of
Ad
mis
sio
ns
Primary Substance Use by Age Marin Adult Treatment Admissions
(July 2013 – June 2014)
70+
60-69
50-59
40-49
30-39
20-29
Heroin and Prescription Opiates are used more heavily by individuals that are 20 to 29 years old
Source: Marin WITS
0
10
20
30
40
50
60
70
80
90
100
5-9 10-12 13-14 15-16 17-18 19-24 25-29 30-35 36-40 41+
Age of First Use – Marin Adult Treatment Admissions (July 2013 – June 2014)
Age of First Use Other
Age of First Use Heroin
Age of First Use Opiates
Age of First Use Crack
Age of First Use Meth
Age of First Use Marijuana
Age of First Use Alcohol
Source: Marin WITS
Prevalence of Co-Occurring Substance Use and Mental Health Issues
• Approximately 10 million people in the US meet criteria for co-occurring mental health and substance use disorders in any given year
• In 2013, national data indicates that 3.2% of adults had a co-occurring mental illness and substance use disorder and 1.4% of adolescents had a co-occurring major depressive episode and substance use disorder
• Applied to Marin, this would translate to approximately 6,200 adults and 400 adolescents
Source: National Survey on Drug Use and Health (2013)
0
10
20
30
40
50
60
Percent of Adults Reporting a Co-Occurring Disorder at Treatment
Admission
FY 2011/12 FY2012/13 FY 2013/14
Source: ITWS
0
5
10
15
20
25
30
35
40
45
50
Age of Onset (14 yrsold or less)
Used 3 days ormore in last 30 days
Have binged in thelast 30 days
Marin County Youth are Drinking Too Early, Too Often and Too Much
7th grade
9th grade
11th grade
Non Traditional
By 11th grade, 65% of youth have consumed alcohol. Almost 50% have consumed 4 or more times.
Source: California Healthy Kids Survey (2013-14)
14
10
5
25
20 20
48
42 41
59
52
43
0
10
20
30
40
50
60
70
2009 2011 2013
Pe
rce
nt
Trend in 30 Day Use
7th
9th
11th
Non Trad
6 4
1
15
11 10
33
28 29
53
38 36
0
10
20
30
40
50
60
70
2009 2011 2013
Pe
rce
nt
Trend in Binge Drinking, Last 30 Days
7th
9th
11th
Non Trad
Source: California Healthy Kids Survey (2009 – 2013)
0
10
20
30
40
50
60
Age of Onset (14 yrs old orless)
Used 3 days or more in last 30days
Marin Youth are Consuming Marijuana Too Early and Too Often
7th grade
9th grade
11th grade
Non Traditional
Source: California Healthy Kids Survey (2013-14)
By 11th grade, 51% of youth have used marijuana. Almost 40% have used 4 or more times.
6 6 3
20 16 16
36 35 31
60
53 49
0
10
20
30
40
50
60
70
2009 2011 2013
Pe
rce
nt
Trend - Marijuana, Last 30 Days
7th
9th
11th
Non Trad
Source: California Healthy Kids Survey (2009 – 2013)
Source: California Healthy Kids Survey (2013-14)
Marin Youth Have Used Prescriptions Medicine for Non-medical Purposes in the Last 30 Days
0
2
4
6
8
10
12
14
Yes
7th
9th
11th
Non Trad
By 11th grade, 16% of youth have used prescription painkillers, 7% have used 4 or more times.
4
12
0
2
4
6
8
10
12
14
2013-14
Cu
rre
nt
% C
iga
rett
e S
mo
kin
g.
Report Year
California Healthy Kids Survey in Marin
9th Graders
11th Graders
CONSEQUENCES Problems Related to Adult and Youth Substance Use
Percent of Arrests in Marin County in 2010 that were Drug Offenses
0%
10%
20%
30%
40%
50%
60%
Source: CA Attorney General
Most DUI Arrests Report Consuming Their Last Beverage at a Bar, Restaurant or in a Home
0
10
20
30
40
50
Source: Place of Last Drink Survey (2012-13) *1,246 POLD surveys collected in 2012-2013
Marin County Hospitalizations and Emergency Room
Visits for Alcohol and Drug Use
Year Number Of Hospitalizations
Number of Emergency Room Visits
2010 1,737 2,557
2011 1,837 2,651
2012 1,882 2,986
Total 5,456 8,194
Source: CDPH statistics non-fatal hospitalizations and emergency room visits for Marin County
Number of Adult Deaths in Which Alcohol and/or Other Drugs Were a Factor
Year Number of Deaths
2008 62
2009 58
2010 55
Total 175
Source: CDPH Vital Statistics Death Statistical Master and Multiple Cause of Death files
In FY12-13 42.25% of Adult PES Admissions also had a Substance Use Diagnosis
499
365 No
Yes
Source: Share Care
Marin Youth Report Experiencing Many Problems When Using Alcohol and Drugs
0
5
10
15
20
25
30
35
9th
11th
Non Trad
Source: California Healthy Kids Survey (2013-14)
Marin Youth Report Experiences Related to Abuse/Dependency while Using Alcohol and Other Drugs
0
5
10
15
20
25
30
35
9th
11th
Non Trad
Source: California Healthy Kids Survey (2013-14)
0
5
10
15
20
25
30
Yes
Ever Seriously Considered Attempting Suicide, Past 12 Months
9th
11th
Non Trad
Source: California Healthy Kids Survey (2013-14)
0
5
10
15
20
25
30
Yes
Ever Attempted Suicide
7th
9th
11th
Non Trad
Marin Youth Reporting Considering or Attempting Suicide
Breakout Activity – Group Review &
Prioritization
1. Identify individual
Top 3 priorities
2. Share with group
3. Identify group’s Top
3 priorities
What is notable about this data?
What are key issues that are concerning with this data?
What connections are there across the various categories of data presented here?
Which priorities affect individuals and groups of greatest concern? Which priorities lead to higher risks?
Which priorities build on and extend work already happening in this area?
Which priorities are grounded in data?
Which priorities are both important and feasible to affect in the near-term
46
Activity Questions to Consider
Breakout Activity – Group Review &
Prioritization
1. Identify individual
Top 3 priorities
2. Share with group
3. Identify group’s Top
3 priorities
What is notable about this data?
What are key issues that are concerning with this data?
What connections are there across the various categories of data presented here?
Which priorities affect individuals and groups of greatest concern? Which priorities lead to higher risks?
Which priorities build on and extend work already happening in this area?
Which priorities are grounded in data?
Which priorities are both important and feasible to affect in the near-term
47
Activity Questions to Consider
Wrap-Up & Closing 48