Substance Abuse And Mental Health Services Strategic

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Substance Abuse and MentalHealth Services AdministrationStrategic PlanFY2019 – FY2023

SAMHSA Strategic Plan – FY2019-FY2023Table of ContentsIntroduction . 1Vision and mission of the Substance Abuse and Mental Health ServicesAdministration . 2Core principles . 2Priorities, Goals, and Measurable Objectives . 4Priority 1: Combating the Opioid Crisis through the Expansion of Prevention,Treatment, and Recovery Support Services . 4Priority 2: Addressing Serious Mental Illness and Serious Emotional Disturbances. 10Priority 3: Advancing Prevention, Treatment, and Recovery Support Services forSubstance Use . 16Priority 4: Improving Data Collection, Analysis, Dissemination, and Program andPolicy Evaluation . 20Priority 5: Strengthening Health Practitioner Training and Education. 24Key Performance and Outcome Measures . 28Priority 1: Combating the Opioid Crisis through the Expansion of Prevention,Treatment, and Recovery Support Services . 28Priority 2: Addressing Serious Mental Illness and Serious Emotional Disturbances. 30Priority 3: Advancing Prevention, Treatment, and Recovery Support Services forSubstance Use . 32Priority 4: Improving Data Collection, Analysis, Dissemination, and Program andPolicy Evaluation . 34Priority 5: Strengthening Health Practitioner Training and Education. 35

SAMHSA Strategic Plan – FY2019-FY2023IntroductionThe Substance Abuse and Mental Health Services Administration (SAMHSA) is theagency within the U.S. Department of Health and Human Services (HHS) that leadspublic health efforts to advance the behavioral health of the nation and to improve thelives of individuals living with mental and substance use disorders, and their families.The SAMHSA Strategic Plan FY2019-FY2023 outlines five priority areas with goals andmeasurable objectives that provide a roadmap to carry out the vision and mission ofSAMHSA over the next four years. The five priority areas are:1. Combating the Opioid Crisis through the Expansion of Prevention, Treatment,and Recovery Support Services2. Addressing Serious Mental Illness and Serious Emotional Disturbances3. Advancing Prevention, Treatment, and Recovery Support Services for SubstanceUse4. Improving Data Collection, Analysis, Dissemination, and Program and PolicyEvaluation5. Strengthening Health Practitioner Training and EducationFor each priority area, an overarching goal and series of measurable objectives aredescribed in the Strategic Plan. Following the discussion of SAMHSA’s priority areasare examples of key performance and outcome measures SAMHSA will use to trackprogress. Given the broad range of issues and populations that SAMHSA addresses,this Strategic Plan is not intended to be an inventory of all objectives or activitiesSAMHSA will pursue. Rather, the Strategic Plan presents priority goals and objectivesreflecting important changes and outcomes that SAMHSA aims to achieve over the nextfour years.The SAMHSA Strategic Plan FY2019-FY2023 aligns with the U.S. Department of Healthand Human Services Strategic Plan FY2018-FY2022. Specifically, the Priorities, Goals,Measureable Objectives of the SAMHSA Strategic Plan FY2018-2023 will serve toadvance HHS Strategic Goal 1, Objective 1.4 to Strengthen and Expand the HealthcareWorkforce to Meet America’s Diverse Needs; HHS Strategic Goal 2, Objective 2.3 toReduce the Impact of Mental and Substance Use Disorders through Prevention, EarlyIntervention, Treatment and Recovery Support; and HHS Strategic Goal 4, Objective4.1 to Improve Surveillance, Epidemiology, and Laboratory Services.Page 1 of 36

SAMHSA Strategic Plan – FY2019-FY2023Vision and mission of the Substance Abuse and MentalHealth Services AdministrationVision: To provide leadership and resources – programs, policies, informationand data, funding, and personnel – advance mental and substance use disorderprevention, treatment, and recovery services in order to improve individual,community, and public health.Mission: To reduce the impact of substance misuse and mental illness onAmerica's communities.Core principlesSAMHSA’s work is guided by five core principles identified by the Assistant Secretaryfor Mental Health and Substance Use that are being infused throughout the Agency’sactivities. The five core principles are:Supporting the adoption of evidence-based practices.SAMHSA is committed to advancing the use of science – in the forms of data; researchand evaluation; and evidence-based policies, programs and practices – to improve thelives of Americans living with substance use disorders and mental illness, as well astheir families.Increasing access to the full continuum of services for mental and substance usedisorders.Through grant funding, a new approach to national, regional, and local training andtechnical assistance, the dissemination and adoption of evidence-based practices, andoutreach and engagement, SAMHSA will work to ensure all Americans understand andaccess to a comprehensive continuum of mental and substance use disorder services,including high-quality, evidence-based prevention, treatment, and recovery supportservices.Engaging in outreach to clinicians, grantees, patients, and the American public.SAMHSA is dedicated to engaging clinicians, grantees, states, people who have mentaland substance use disorders, their family members, and other stakeholders to improveaccess and quality of mental and substance use disorder care in every communityacross the nation and to combat the stigma that continues to be a barrier to manyAmericans seeking and receiving help.Page 2 of 36

SAMHSA Strategic Plan – FY2019-FY2023Collecting, analyzing, and disseminating data to inform policies, programs, andpractices.SAMHSA will enhance its data collection, outcomes, evaluation, and quality supportefforts to enhance health care and health systems integration; to identify and to addressmental and substance use disorder-related disparities; to identify what works;, and tostrengthen and to expand the provision of evidence-based behavioral health servicesfor Americans. Such performance-based efforts will be conducted by SAMHSA alongwith federal, state, territorial, tribal, and community partners, will directly improve thedelivery of services, promote awareness, and will inform the development of policy andprogrammatic initiatives.Recognizing that the availability of mental and substance use disorder services isintegral to everyone’s health.SAMHSA will lead efforts to advance the recognition of mental health and freedom fromaddiction as being essential to overall health. Such recognition and focus will help toimprove access to and integration of services, support the development of financingmechanisms to support and sustain positive outcomes, and address gaps anddisparities in service delivery.Page 3 of 36

SAMHSA Strategic Plan – FY2019-FY2023Priorities, Goals, and Measurable ObjectivesPriority 1: Combating the Opioid Crisis through the Expansion ofPrevention, Treatment, and Recovery Support ServicesGoalReduce opioid misuse, use disorder, overdose, and related health consequences,through the implementation of high quality, evidence-based prevention, treatment, andrecovery support services.OverviewThe opioid crisis continues to have devastating effects on individuals, families, andcommunities across the United States. In 2017, 11.1 million Americans 12 years orolder reported misuse of prescription opioids, nearly 900,000 reported heroin use, and2.1 million had an opioid use disorder in the past year; and more than 42,000Americans died from an opioid overdose in 2016. 1,2 In addition, opioid misuse andopioid use disorder are contributing to rising rates of hospital emergency departmentvisits, 3 neonatal abstinence syndrome, 4 and viral hepatitis associated with opioidinjection, 5 among others. Since 2013, the proliferation of such highly potent syntheticopioids such as fentanyl and carfentanil has further fueled a dramatic increase inoverdose deaths and underscores the urgent need for action.2 SAMHSA is leadingefforts to support the implementation of the full range of prevention, treatment, andrecovery support services that can bring an end to the opioid crisis.Substance Abuse and Mental Health Services Administration. Results from the 2017 National Survey onDrug Use and Health. 2018.1Jones CM, Einstein EB, Compton WM. Changes in synthetic opioid involvement in drug overdosedeaths in the United States, 2010-2016. JAMA. 2018;319(17):1819-1821.2Kantor-Vivolo, Seth P, Gladden RM, Mattson CL, et al. Vital Signs: trends in emergency departmentvisits for suspected opioid overdoses – United States, July 2016-September 2017. MMWR Morb MortalWkly Rep. 2018;67(9):279-285.3Winkelman TNA, Villapiano N, Kozhimannil KB, Davis MM, Patrick SW. Incidence and costs of neonatalabstinence syndrome among infants with Medicaid: 2004-2014. Pediatrics. 2018;141(4). Pii:e20173520.4Zibbell JE, Asher AK, Patel RC, Kupronis B, et al. Increases in acute hepatitis C virus infection related toa growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J PublicHealth. 2018;108(2):175-181.5Page 4 of 36

SAMHSA Strategic Plan – FY2019-FY2023Measurable ObjectivesObjective 1.1: Strengthen public health surveillanceHow we will accomplish our objective: Revise SAMHSA’s surveys to collect additional information related to opioidmisuse, opioid use disorder, and overdose, as well as receipt of services,such as medication-assisted treatment (MAT) for opioid use disorder, trainingfirst responders and community members on overdose prevention and use ofnaloxone, and the availability of recovery support services among people withopioid use disorder.Implement a new Drug Abuse Warning Network (DAWN) survey to providehospital emergency department data to communities about the evolvingopioid crisis.Collaborate with SAMHSA grantees to improve the collection of grantee data,including through the implementation of a new innovative client-based datacollection system that can be used to identify and disseminate information oneffective opioid-related prevention, treatment, and recovery supportprograms, practices, and policies.Partner with federal, state, tribal, territorial, and local partners on surveillanceinitiatives that improve the timeliness and specificity of opioid-related data.Collaborate with federal, including the Centers for Disease Control andPrevention (CDC), state, tribal, territorial, and local partners on surveillance ofcomorbidities associated with opioid misuse and opioid use disorder,including co-occurring substance use disorders.Objective 1.2: Advance the practice of pain managementHow we will accomplish our objective: Promote technical assistance, training, and effective educational strategies toclinicians, policy makers, and the public on the risks of opioid painmedications.Support the dissemination and adoption of evidence-based guidelines foracute and chronic pain management in both general and high-risk populationsto mitigate the risk of opioid misuse, use disorders, and overdose, and toimprove the care of individuals living with chronic pain. 6e.g., Centers for Disease Control and Prevention (CDC) Guidelines for Prescribing Opioids for ChronicPain line.html6Page 5 of 36

SAMHSA Strategic Plan – FY2019-FY2023 Increase understanding and support of multi-disciplinary, multi-modal painmanagement approaches among clinicians, patients, the public, andpolicymakers to ensure that non-pharmacologic (including psychologicinterventions, procedures, and complementary and alternative approaches)and non-opioid pharmacologic options are readily accessible for patients andclinicians.Develop and disseminate clinical practice guidelines to healthcareprofessionals on evidence-based treatment of co-occurring substance useand mental disorders and pain disorders.Collaborate with the National Institutes of Health (NIH), CDC, HealthResources and Services Administration (HRSA), and education accreditationbodies to advance pain management and substance use education to be coretraining elements in colleges, universities, and health professional schools,including through work in SAMHSA’s Regional Offices.Objective 1.3: Improve access to, utilization of, and engagement and retention inprevention, treatment, and recovery support servicesHow we will accomplish our objective: 7Develop and disseminate educational materials and science-basedmessaging to educate the public about not sharing medications, safe storageof medications, and safe disposal of medications.Develop and disseminate communication materials and other resources toincrease understanding of families and caregivers on facts around privacy ofinformation and access to records. 7Leverage SAMHSA’s Provider’s Clinical Support System – Universities toexpand access to MAT services for persons with an opioid use disorderseeking or receiving MAT through ensuring the education and training ofstudents in the medical, physician assistant and nurse practitioner fields.Support, through SAMHSA funding, training, and technical assistance, theadoption of evidence-based policies, programs, and practices to preventopioid misuse, and to diagnose and treat opioid use disorders and cooccurring substance use and mental disorders.Utilize SAMHSA’s new approach to technical assistance for opioids thatengages localized expert teams of clinicians, preventionists, and recoveryspecialists to provide technical assistance to states, communities, andhealthcare providers on addressing the opioid crisis.e.g., the Health Insurance Portability and Accountability Act (HIPAA).Page 6 of 36

SAMHSA Strategic Plan – FY2019-FY2023 Utilize SAMHSA’s Regional Prevention Technology Transfer Centers incollaboration with SAMHSA’s Regional Addiction Technology TransferCenters to educate providers and other stakeholders on opioid use disorderprevention, treatment, and recovery.Leverage SAMHSA funding to expand access to MAT and recovery supportservices 8 for individuals with opioid use disorder, including through efforts toincrease the number of MAT providers and programs, the advancement oftelehealth approaches and use of mobile technologies, and through theimplementation of comprehensive service delivery models.Facilitate collaboration between primary care and specialty care providersand the recovery community to support the development and implementationof comprehensive and integrated systems of care that provide the fullspectrum of treatment and recovery support services for people with opioiduse disorder.Partner with the Agency for Healthcare Research and Quality (AHRQ),HRSA, and the United States Department of Agriculture (USDA) to expanduse of telehealth and e-prescribing protocols for opioid-related crisis responseand treatment and to expand access to MAT in rural and remote areas.Collaborate with CDC and other stakeholders to advance efforts to screen,prevent, and address the infectious disease complications of opioid usedisorder, 9 particularly among people who inject drugs.Leverage SAMHSA funding, training, and technical assistance to increaseaccess to MAT and behavioral therapies and ongoing recovery supportservices for individuals with opioid use disorder involved in the criminal justicesystem.Disseminate patient education information to clinicians regarding the dangersof opioid use by girls and women of childbearing age, and those who areconsidering pregnancy or are pregnant.Support efforts, in collaboration with other federal and nonfederal partners, toensure that substance-exposed infants and their mothers are identified,treated, and receive long-term follow up to monitor/prevent long-termconsequences.Collaborate with the Centers for Medicare & Medicaid Services (CMS) andother public and private payers to support the implementation of paymente.g., MAT, recovery coaches, vocational training and employment services, legal services, and safe andsupportive housing89e.g., HIV, HCV, infectious endocarditisPage 7 of 36

SAMHSA Strategic Plan – FY2019-FY2023policies that can sustain evidence-based opioid prevention, treatment, andrecovery support services.Objective 1.4: Target the availability and distribution of overdose-reversing drugsHow we will accomplish our objective: Develop and disseminate educational and training materials to firstresponders and the public on how to respond to an opioid overdose withnaloxone.Leverage SAMHSA funding, training, and technical assistance to supportstates and communities in the design and implementation of preventionsystems to support first responders and lay audiences in overdose preventionand naloxone administration.Support community and peer intervention models that encourage overdosesurvivors to seek evidence-based treatment and recovery support services.Provide guidance to federal grantees on how program resources can be usedto support state and local efforts to prevent opioid overdoses and encourageat-risk populations to seek treatment.Promote opioid overdose prevention planning for those working with criminaljustice populations pre- and post-release from jail, prison, or detentioncenters.Increase availability of naloxone for emergency medical technicians,hospitals, jails/prisons, and primary care through work in SAMHSA’s RegionalOffices.Collaborate with first responders and community crisis lines to providetelehealth services related to naloxone use and overdose response.Page 8 of 36

SAMHSA Strategic Plan – FY2019-FY2023Objective 1.5: Support cutting-edge research on pain and addictionHow we will accomplish our objective: Conduct service delivery research and evaluations to identify effective opioidrelated prevention, treatment, and recovery programs, practices, and policies.Utilize SAMHSA’s National Mental Health and Substance Use PolicyLaboratory in collaboration with external partners, including states, tribes,local jurisdictions, and non-government entities, to identify and evaluatepromising approaches to address opioid misuse, opioid use disorder, andoverdose and to support the replication and scaling of opioid-relatedevidence-based programs, practices, and policies.Engage with federal partners such as ASPE, NIH, CDC, CMS, and AHRQ toidentify research needs and to advance priority research on pain, addiction,and overdose.Page 9 of 36

SAMHSA Strategic Plan – FY2019-FY2023Priority 2: Addressing Serious Mental Illness and Serious EmotionalDisturbancesGoalReduce the impact of serious mental illness (SMI) and serious emotional disturbance(SED) and improve treatment and recovery support services through implementation ofthe comprehensive set of recommendations put forward by the InterdepartmentalSerious Mental Illness Coordinating Committee (ISMICC).OverviewIn 2017, 4.5 percent (11.2 million) of Americans 18 years or older had an SMI, 10 and it isestimated that 6.8 to 11.5 percent of children and youth have an SED. 11 Individuals withSMI often have multiple mental disorders,10 co-occurring substance use disorders,10have a substantially elevated risk for suicide, 12 and are at increased risk forhomelessness and involvement with the criminal justice system. 13,14 Yet, despite thewell-documented health and social impacts of SMI and SED on individuals, families,and communities, only a fraction of individuals with these disorders receive theevidence-based care they need.9,10 To address this priority area, SAMHSA is focusingits efforts on the guidance and recommendations provided by the ISMICC – a newfederal advisory council authorized by the 21st Century Cures Act to improve the livesof people living with SMI or SED.Substance Abuse and Mental Health Services Administration. Results from the 2017 National Surveyon Drug Use and Health. 2018.10Interdepartmental Serious Mental Illness Coordinating Committee. The Way Forward. Federal Actionfor a System That Works for All People Living with SMI and SED and Their Families and Caregivers.2017. Available at: -RTC/PEP17-ISMICC-RTC.pdf11Hor K, Taylor M. Suicide and schizophrenia: a systematic review of rates and risk factors. Journal ofPsychopharmacology. 2010;24(4 Suppl):81-90.1213U.S. Department of Housing and Urban Development (HUD). HUD 2016 continuum of care homelessassistance programs homeless populations and subpopulations. Available agement/published/CoC PopSub NatlTerrDC 2016.pdfSteadman HJ, Osher FC, Robbins PC, Case B, Samuels S. Prevalence of serious mental illnessamong jail inmates. Psychiatric Services. 2009;60(6):761-765.14Page 10 of 36

SAMHSA Strategic Plan – FY2019-FY2023Measurable ObjectivesObjective 2.1: Strengthen federal coordination to improve careHow we will accomplish our objective: 15Collaborate and align efforts with federal partners through inter and intradepartmental initiatives 15 to:o Improve care across the lifespan for people with SMI or SED bydeveloping a comprehensive continuum of care, including a list of coreservices that encompass evidence-based prevention, treatment, andrecovery supports to address such issues as crisis services, earlymental illness including first-episode psychosis (FEP), suicide, trauma,homelessness, criminalization and outreach and engagement.o Convene expert panel meetings on various topics, such as cooccurring disorders, school mental health, older adult issues, inpatientcare, and psychotropic medications, to gather input on actions toimprove care and policy development.o Leverage SAMHSA resources, including funding, training, andtechnical assistance, such as the Promoting Integration of Primary andBehavioral Health Care grants and the Center for Integrated HealthSolutions, to improve the integration of primary healthcare withservices for mental illness and substance use disorders.o Work with partners to improve data collection and use of qualitymeasures, including program evaluations to improve service delivery,quality of care, and outcomes and identify, expand, and maximize theuse of evidence-based practices by evaluating promising approachesand achieving wide-scale adoption of evidence-based practices forSMI and SED.e.g., ISMICC and the HHS Behavioral Health Coordinating CouncilPage 11 of 36

SAMHSA Strategic Plan – FY2019-FY2023Objective 2.2: Facilitate access to quality care through services expansion, outreach,and engagementHow we will accomplish our objective: 16Define, implement, and disseminate guidance for a national standard for crisiscare, including increasing awareness and use of Psychiatric AdvancedDirectives, and reassessment of involuntary civil commitment standards andprocesses.Review and assess treatment-planning practices to develop and disseminateguidelines to practitioners in order to improve quality of care.Increase professional development by expanding the quantity and quality ofthe mental health workforce through outreach and partnerships with federalagencies such as HRSA and CMS; professional organizations and graduateschools; provider training and technical assistance; the use of trained peerprofessionals in diverse settings; and outreach to underserved populations.Increase the mental health literacy of the public by training school personnel,first responders, law enforcement, faith communities, and primary careproviders to understand and be able to detect the signs and symptoms ofmental illness and engage and connect individuals to care.Utilize SAMHSA funding, training, and technical assistance to develop andsupport innovative approaches to providing behavioral healthcare in specialtyand primary care settings, including expanding efforts for screening, effectivetreatment planning, and on-going care engagement.Develop and disseminate communication materials and other resources toincrease understanding among families and caregivers on facts aroundprivacy of information and access to records. 16Leverage SAMHSA funding to engage individuals living with SMI or SED whomay be experiencing homelessness in treatment, housing, and other recoverysupport services.Work with federal and nonfederal partners to expand the use of telehealth,electronic health records, and other health information technologyapproaches to facilitate the provision of evidence-based and coordinatedcare.Expand, through collaborations with the Department of Education and stateand local education stakeholders, student access to and engagement in thecontinuum of mental health services and supports in primary and highereducation settings.e.g., the Health Insurance Portability and Accountability Act (HIPAA).Page 12 of 36

SAMHSA Strategic Plan – FY2019-FY2023 Utilize SAMHSA Regional Administrators to advance efforts related to SMIand SED - including the promotion of televideo/telehealth crisis responseservices and Assertive Community Treatment (ACT) - in partnership with firstresponders, and deflection/diversion community crisis lines.Develop and disseminate training standards for disaster workers who deliverdisaster-related mental and substance use disorder services andreferral/linkage services to the public, including individuals who have SMI orSED.Objective 2.3: Improve treatment and recovery by closing the gap between what worksand what is offeredHow we will accomplish our objective: Use SAMHSA funding, training, and technical assistance and collaborationswith federal and nonfederal partners to adopt a comprehensive continuum ofcare throughout the nation for individuals with SMI or SED that includesmaking available high-quality acute care, such as the National SuicidePrevention Lifeline, Disaster Distress Helpline, crisis centers, respites, mobilecrisis teams, alternatives to emergency rooms, inpatient services, assistedoutpatient treatment, assertive community treatment, certified communitybehavioral health clinics, partial hospitalization programs, intensive outpatientprograms, supported housing, including group homes and apartments incommunities.Prioritize the early identification and intervention for children, youth, andyoung adults by promoting best practices for mental health and substanceuse screening in schools and supporting mental health consultation andtraining of the youth-serving workforce.Develop a national network of regionally based training and technicalassistance centers to better equip behavioral health professionals and othersto meet the needs of individuals living with or at risk for developing SMI orSED.Leverage SAMHSA resources through funding, training, and technicalassistance, including through the new Clinical Support System for SeriousMental Illness (CSS-SMI), to increase the quality of clinical care by improvingmedication management – including the use of clozapine, otherantipsychotics, and long-acting injectable antipsychotic medications – as wellas recovery services, including supported housing, supported employment,family psychoeducation, FEP programs that have high fidelity to theCoordinated Specialty Care model, ACT, and peer-delivered services.Page 13 of 36

SAMHSA Strategic Plan – FY2019-FY2023 Use SAMHSA’s National Mental Health and Substance Use Policy Laboratoryand Evidence-Based Practices Resource Center to consolidate and improvethe dissemination and translation of research findings and the adoption ofevidence-based practices among the behavioral health workforce, clinicians,policymakers, peers, and family members.Foster the agency’s Zero Suicide efforts by promoting comprehensive suicideprevention efforts in health and mental health and substance use disordersystems.Expand – through SAMHSA funding, training, and technical assistance, andcollaborations with federal and nonfederal partners – the supply of mentalhealth providers and the delivery of high-quality treatment and recoverysupport services across the United States, particularly in underserved andrural areas, especially those found in culturally diverse communities and intribal nations.Increase the delivery of systems of care for children, youth, and familiesaffected by SMI or SED by expanding transition-age youth services, childtrauma services, school-based care, early childhood services, and efforts foryoung people who are at clinically high risk for developing psychosis.Expand, through SAMHSA funding, collaborations, training, and technicalassistance, efforts to address the needs of individuals living with SMI or SEDwho have co-occurring addictions, intellectual and developmental disabilities,hepatitis C virus, and/or HIV/AIDS, including making integrated servicesreadily available, incorporating tobacco dependence treatment into mentalhealth services, and increasing the number of providers traine

The SAMHSA Strategic Plan FY2019-FY2023 aligns with the U.S. Department of Health and Human Services Strategic Plan FY2018-FY2022. Specifically, the Priorities, Goals, Measureable Objectives of the SAMHSA Strategic Plan FY2018-2023 will serve to advance HHS Strategic Goal

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