PREVENTION STANDARDS AND PRACTICES MANUAL Substance Use Prevention .
PREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 1 of 78
Table of ContentsIntroduction. 4Substance Abuse Prevention and Treatment (SAPT) Block Grant (BG) . 5Prevention Services Frameworks . 5SAMHSA’S Strategic Prevention Framework (SPF) . 7Center for Substance Abuse Prevention (CSAP) Strategies and Activities . 9The Institute of Medicine Classification System . 10Los Angeles County Substance Abuse Strategic Prevention Plan . 11Priority Areas. 11County Goals and Objectives . 12County Logic Model . 12Prevention Provider Network . 17Prevention Program Services and Requirements . 20Agency-led Community Assessment . 20Logic Model . 21Work Plan(s) . 21Evidence-based and Innovative Programs . 23County Coalitions/Groups . 25CCP Providers - Program Deliverables . 27PEP Providers - Program Deliverables . 29Data Reporting and Evaluation . 32Required Reports . 33Policy and Procedures . 35Quality Assurance Plan. 35Quality Control . 35Staffing Requirements . 36Contract Change Requests. 40Materials Review Guidelines. 42Materials, Supplies, and/or Equipment . 44Finance . 45Reimbursement Structure . 45Monthly Provider Invoices . 45Annual Budget. 47Cost Report . 47Budget Augmentation Approval Request Process . 48SAPT BG Allowable Costs . 51Appendices . 55Policy And Procedure No: 4023. 55FY 2022-2023 Prevention Provider Network . 61Recommended Evidence-Based Interventions . 64Prevention Institute: Spectrum of Prevention . 77Strategic Prevention Framework (SPF) . 78PREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 2 of 78
Prevention Standards and Practices ManualThe Prevention Standards and Practices Manual (cited as Prevention Standards and Practices in theSubstance Use Prevention Services (SUPS) Statement of Work (SOW) and hereafter as PreventionProgram Manual) provides contractual requirements as outlined in the SUPS SOW and includes policiesand procedures associated with these requirements.This manual is consistent with the following Substance and Mental Health Services Administration(SAMSHA) Substance Abuse Prevention and Treatment (SAPT) Block Grant (BG), also known as SABG,Prevention Set-Aside requirements: Federal Substance Abuse and Mental Health Services Administration (SAMHSA) StrategicPrevention Framework (SPF) planning process;California Department of Health Care Services (DHCS) Primary Prevention Substance UseDisorder Data Service (PPSDS) System;SAMHSA’s Center for Substance Abuse Prevention (CSAP) prevention strategies;Institute of Medicine (IOM) classificationThe intent of this manual is to clarify expectations of the SUPS contract and the overall ability of SAPCPrevention to effectively implement services that achieve the stated goals, objectives, and outcomes, asoutlined in the Strategic Prevention Plan. Although differences may exist among individual programs, thePrevention Manual intends to ensure that all SUPS contracted programs share a common understanding ofthe SUPS contract requirements and program principles and practices.The Prevention Manual will be updated and modified as needed over the course of the contract term torefine contract expectations and adjust to advances in the prevention field, including any changes to theSAPT BG funding requirements. Any updates to this manual will be provided to SUPS Providers in writingand will be referenced in the Statement of Work (SOW).PREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 3 of 78
IntroductionVisionHealthy communities that are safe and free from substance use problems.MissionTo implement effective prevention initiatives, guided by best practices and data, to systematically reducecommunity substance use problems.SAPC’s Commitment to PreventionWhen addressing public health challenges, including substance use, the Los Aneles County (LAC)Department of Public Health (DPH) looks not only at implementing effective prevention strategies(e.g., policy development, advocacy, media efforts, education, and services) but also at the impact of thephysical and social environments on health (e.g., land use, safety, poverty, educational attainment).The Substance Abuse Prevention and Control (SAPC) will work collaboratively with prevention providerson an on-going basis to assess community needs and resources to develop effective, culturally responsiveprevention strategies. Particular emphasis will be placed on promoting the inclusion of allprovider/community members and their diverse perspectives, ideas, and strategies.This will build rapport and credibility at the local level and improve the efficiency of prevention serviceswithin LAC.PREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 4 of 78
Substance Abuse Prevention and Treatment (SAPT) Block Grant(BG) Prevention Set Aside Funding RequirementsSUPS providers are funded with federal Substance and Mental Health Services Administration (SAMSHA)SAPT Block Grant, Prevention Set-aside Funds. Title 42, U.S.C. Section 300x-22(a) requires theDepartment of Health Care Services (DHCS) to spend a minimum of twenty percent of the total SAPT BGAward on primary prevention services. Primary prevention is defined as strategies, programs, and servicesdirected at individuals who have not been determined to require treatment for a substance use disorder. Acounty’s spending of the primary prevention funds that DHCS allocates is integral to meeting federal SAPTspending requirements. For the SAPT Primary Prevention Set-Aside, counties must have an activePrevention Strategic Plan that adheres to SAMHSA’s Strategic Prevention Framework (SPF). Priority areasare identified in the plan and strategies are selected based on evidence, where applicable, that will bestaddress the priority areas and populations being served.Strategies may consist of both individual- and population-based services, using the six preventionstrategies identified by SAMHSA’s Center for Substance Abuse Prevention (CSAP). The 6 CSAPstrategies are 1) Information Dissemination, 2) Education, 3) Alternative, 4) Problem Identification andReferral, 5) Community-Based Process, and 6) Environmental.Prevention Services FrameworksThere are four distinct frameworks that when combined guide the development of comprehensive,culturally competent, and effective prevention services that aim to strengthen individuals, families andcommunities. Prevention services will utilize the following four frameworks collectively:1. The Spectrum of Prevention2. The Substance Abuse and Mental Health Services Administration (SAMHSA) Strategic PreventionFramework (SPF)3. SAMHSA Center for Substance Abuse Prevention (CSAP) Strategies4. Institute of Medicine (IOM) Classifications for PreventionThe use of the SPF, CSAP strategies, and the IOM classifications are required by the CaliforniaDepartment of Health Care Services (DHCS) and included as part of the mandatory reporting requirementsfor the web-based Primary Prevention Substance Use Disorder Data Service (PPSDS) System.Additionally, use of the Spectrum of Prevention is required by DPH to ensure a comprehensive strategy forprevention services.PREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 5 of 78
THE SPECTRUM OF PREVENTIONThe Spectrum of Prevention is a systematic tool that promotes a range of activities for effective prevention.The Spectrum of Prevention has been effectively used nationally in prevention initiatives for traffic safety,violence prevention, injury prevention, nutrition, and fitness.The Spectrum framework identifies six levels of intervention (see chart below) and helps people movebeyond the perception that prevention is merely education. At each level, the most important activitiesrelated to prevention objectives are defined. As these activities are identified, they lead to interrelatedactions at other levels of the Spectrum. All six levels are complementary and synergistic: when usedtogether, they have a greater effect than would be possible from a single activity or initiative. 1Spectrum of Prevention Levels1DefinitionSupporting self-efficacy, knowledge andskill acquisition for individualsEnhancing an individual's capability ofpreventing injury or crime andpromoting well-beingPromoting Healthy CommunitiesSupporting groups of people withinformation and resources to promotehealth and safety and mobilize theircommunities and neighborhoods.Educating ProvidersInforming providers who will transmitskills and knowledge to othersFostering Coalitions and NetworksBringing together groups andindividuals for broader goals andgreater impactChanging Organizational Practices andCommunity NormsAdopting regulations and norms toimprove health and safety and creatingnew modelsInfluencing Policy LegislationDeveloping strategies to change lawsand policies to influence spectrum-prevention-0PREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 6 of 78
SAMHSA’S STRATEGIC PREVENTION FRAMEWORK (SPF) 2The SPF is a five-step planning process that systematicallyguides the development of prevention services. Central toall steps is ensuring that efforts are culturally andlinguistically competent, and sustainable. By addressingeach of these steps, prevention services should address theneeds of the specific target community(ies) andpopulation(s), enhance protective factors and reduce riskfactors, build community capacity and collaboration,develop goals and measurable objectives, and emphasizeevaluation to ensure the program achieves the intendedoutcomes.The following is a brief description of each SPF step andmust address cultural competence and sustainability as afundamental element within each step. Step 1: Assessment: What is the problem, and how can I learn more?Step 2: Build Capacity: What do I have to work with?Step 3: Plan: What should I do and how should I do it?Step 4: Implement: How can I put my plan into action?Step 5: Evaluate: Is my plan succeeding?Practicing Effective PreventionAccording to SAMHSA's Center for the Application of Prevention Technologies, practicing effectiveprevention means:a. Gathering and using data to guide all prevention decisions-from identifying which substance useproblems to address in a community, to choosing the most appropriate ways to address theseproblems, to determining whether selected interventions and strategies are making progress inmeeting prevention needs.b. Working with diverse community partners to plan and deliver culturally appropriate, effective, andsustainable prevention practices that are a good fit for the populations being served.2Strategic Prevention Framework. (n.d.). Retrieved .pdfPREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 7 of 78
c. Understanding and applying prevention research so that prevention efforts are informed by bestpractice and shown to influence risk and protective factors associated with prioritized substancemisuse and related health problems at the community, State, territory, and tribal levels.To practice effective prevention, providers must understand substance misuse prevention within thelarger context of behavioral health, apply SAMHSA's Strategic Prevention Framework (SPF), incorporateepidemiology into prevention planning to help focus and refine prevention activities based on patterns ofsubstance misuse, and related consequences; and apply prevention approaches that address thosefactors that contribute to or protect against identified problems, and that are a good match for thecommunity.SAPC will ensure compliance with these guidelines through contract development and processing,contract compliance and monitoring (Attachment A). Providers must obtain the required training specificto the practice of effective prevention. Utilizing SAMHSA's Strategic Prevention Framework as a part oftheir contractual requirement, SUPS contracted providers must ensure that their staff receive 24 hours ofprevention training per fiscal year.Cultural Competency and SustainabilitySUPS providers must provide programs that are culturally competent and sustainable. CulturalCompetency is as a set of behaviors, attitudes, and policies that come together in a system, agency, oramong professionals to enable effective work in cross-cultural situations. Such programming respects,and is responsive to, the health beliefs, practices, and cultural and linguistic needs of diverse individualsand is more likely to bring about positive change. Sustainability is the multiple factors that contribute toprogram success over the long-term including continued community support and engagement, stableinfrastructure, and available resources and training.Social Determinants of HealthSocial determinants of health explore diverse societal factors that influence health, including substance userisk and protective factors. In participating in substance use-related outreach and education, Provider isrequired to address the social determinants of health to fully address the community and systems-levelfactors that directly and indirectly impact substance use and misuse within communities.PREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 8 of 78
CENTER FOR SUBSTANCE ABUSE PREVENTION (CSAP) STRATEGIES AND ACTIVITIES 3The SAMHSA CSAP has classified common prevention activities into six major categories termed“strategies.” These CSAP strategies, and the associated activities, are basic definitions that broadlydescribe the most frequent types of efforts for each term. An effective prevention program should beknowledgeable of these strategies and activities but base the program design on how tocomprehensively address the actual needs of the target community(ies) through evidence-basedinterventions and services with the proven ability to achieve the desired results.1. Environmental Strategy - focuses on establishing or changing community standards, codes, andattitudes thereby influencing incidence and prevalence of alcohol and other drug use within thecommunity. The strategy depends on engaging a broad base of community partners, focuses onplaces and specific problems, and emphasizes public policy.2. Community-Based Process Strategy - focuses on enhancing the capacity of the community toaddress AOD issues through organizing, planning, collaboration, coalition building, and networking.3. Information Dissemination Strategy - focuses on improving awareness and knowledge of the effectsof AOD issues on communities and families through “one-way” communication with the audiencesuch as speaking engagements, health fairs, and distribution of print materials.4. Problem Identification and Referral Strategy – focuses on identifying individuals who haveinfrequently used or experimented with AOD who could change their behavior through education.The intention of the screening must be to determine the need for indicated prevention services andnot treatment need.5. Education Strategy – focuses on “two-way” communication between the facilitator and participantsand aims to improve life/social skills such as decision making, refusal skills, and critical analysis.6. Alternative Strategy – focuses on redirecting individuals from potentially problematic situations andAOD use by providing constructive and healthy events/activities.Center for Substance Abuse Prevention Strategies and CSAP Activities Definitions (Approved July 24, 2017, Updated August 17,2017). Retrieved from SAP-Strategies.pdf3PREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 9 of 78
THE INSTITUTE OF MEDICINE CLASSIFICATION SYSTEM 4The IOM model divides the continuum of services into three parts: prevention, treatment, andmaintenance. The prevention classifications are further subdivided into universal, selective, andindicated. The IOM category is assigned by looking at the risk level of the individual or group receivingthe service. Universal Prevention: “Targets the entire population (national, local community, school, andneighborhood), with messages and programs aimed at preventing or delaying the (ab)useof alcohol or other drugs. All members of the population share the same general risk forsubstance (ab)use, although the risk may vary among individuals.”Universal Direct: “Interventions directly serve an identifiable group of participants but who havenot been identified on the basis of individual risk, (e.g., school curriculum, afterschool program,parenting class). This also could include interventions involving interpersonal andongoing/repeated contact (e.g., coalitions).”Universal Indirect: “Interventions support population-based programs and environmentalstrategies, (e.g., establishing substance use policies, modifying substance use advertisingpractices). This also could include interventions involving programs and policies implemented bycoalitions.”Selective Prevention: “Targets subsets of the total population at risk for substance misuse byvirtue of their membership in a particular population segment. Selective prevention targets theentire subgroup regardless of the degree of risk of any individual within the group. The selectiveprevention program is presented to the entire subgroup because the subgroup is at higher risk forsubstance misuse than the general population. An individual’s personal risk is not specificallyassessed or identified and is based solely on a presumption given his or her membership in theat-risk subgroup.”Indicated Prevention: “Targets individuals who do not meet the Fifth Edition of the Diagnostic andStatistical Manual of Mental Disorders (DSM-5) criteria for abuse or dependence, but who areshowing early danger signs, such as failing grades and consumption of alcohol and other gatewaydrugs. The mission of indicated prevention is to identify individuals who are exhibiting potentialearly signs of substance abuse and other problem behaviors associated with substance use, andto target them with special programs.”In all cases, these prevention services shall be directed at individuals who never received nor requiretreatment services, and do not/would not meet criteria for a substance use disorder according to the FifthEdition of the DSM-5. A screening and/or assessment shall not be conducted for the sole purpose ofmaking this hnvgov/content/Meetings/Bidders 20Classifications-rev10.20.14.pdfPREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 10 of 78
Los Angeles County Substance Abuse Strategic Prevention PlanDPH-SAPC developed a five-year substance abuse Strategic Prevention Plan (SPP). The purpose ofthe SPP is to define the steps necessary to achieve SAPC’s vision, mission, and goals. The Fiscal Year2020-2025 SPP is consistent with the Substance Abuse and Mental Health Services Administration’s(SAMHSA) Strategic Prevention Framework (SPF) process.PRIORITY AREASThe first phase of the FY2020-2025 SPP process was to conduct a comprehensive communityassessment collecting needs and resource data describing the AOD issues across the eight SPAs withinthe county. Through the assessment process, the following four priority areas were defined.Priority 1: Alcohol UseProblem Statement: Alcohol consumption rates among youth are high due to low perception of harm,availability of alcohol to teens by retailers, lack of life skills to develop resiliency around their own healthand wellness, and the use of alcohol prior to sexual intercourse.Priority 2: Marijuana UseProblem Statement: Marijuana use is a priority in LAC following legalization. The low perception of harmby youth, increased availability of marijuana by retailers, lack of resiliency skills, and use of marijuanaprior to sexual intercourse among youth contribute to increased marijuana use among youth.Priority 3: Methamphetamine UseProblem Statement: Methamphetamine use is a priority in LAC. Use of methamphetamines prior tosexual intercourse among youth, a lack of community awareness of methamphetamine use, and thelack the life skills to develop resiliency around health and wellness among youth contribute to increasedmethamphetamine use among youth and adults.Priority 4: Prescription Drug MisuseProblem Statement: Excessive prescribing among adults, lack of community awareness of properdisposal methods, lack of resiliency skills around prescription drug use among youth, and the use ofprescription drugs prior to sexual intercourse among youth contribute to an increase of the misuse andabuse of prescriptions drugs.PREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 11 of 78
COUNTY GOALS AND OBJECTIVESGoal 1: Decrease Alcohol Use Among YouthObjective 1.1: Increase perception of underage alcohol use as harmful.Objective 1.2: Reduce retail availability of alcohol to underage youth.*Objective 1.3: Increase youth resiliency for underage drinking.*Objective 1.4: Decrease in high school students who report having consumed alcohol prior tosexual intercourse.Goal 2: Decrease Marijuana Use Among YouthObjective 2.1: Increase youth perception of underage marijuana use as harmful.Objective 2.2: Reduce retail availability of marijuana to underage youth.*Objective 2.3: Increase youth resiliency for marijuana use.*Objective 2.4: Decrease in high school students who report having used marijuana prior tosexual intercourse.Goal 3: Decrease Methamphetamine Use Among Youth and AdultsObjective 3.1: Increase community awareness of the harms of methamphetamine.*Objective 3.2: Increase youth resiliency for methamphetamine use.*Objective 3.3: Decrease in high school students who report having used methamphetamineprior to sexual intercourse.Goal 4: Decrease Prescription Drug Misuse or Abuse Among Youth and AdultsObjective 4.1: Decrease in prescribing of opioid drugs for adults.Objective 4.2: Reduce youth access of prescription drugs.*Objective 4.3: Increase youth resiliency for prescription drug use.*Objective 4.4: Decrease in high school students who report having consumed prescription drugsprior to sexual intercourse.* These objectives only apply to the Student Well-Being Centers and do not need to be incorporated into CCP,PEP, and FNL contracts.COUNTY LOGIC MODELThe following logic models should be used in conjunction with the County Goals and Objectives. Itshould also be used to guide the development of Provider’s work plans to ensure that the County Goalsand Objectives are achieved.PREVENTION STANDARDS AND PRACTICES MANUALSubstance Use Prevention ServicesJuly 2022 Version 2.0Page 12 of 78
Priority Area 1: Alcohol UseProblem Statement: Alcohol consumption rates among youth are high due to low perception of harm, availability ofalcohol to teens by retailers, lack of life skills to develop resiliency around their own health and wellness, and the useof alcohol prior to sexual intercourse.Goal (Behavioral Change): Decrease Alcohol Use Among YouthObjectiveStrategiesWhat is going to happen as a result ofIndicatorsimplemented strategies?What do we want toWhat CSAPShort TermIntermediateLong Termaccomplish?strategies will theOutcomesOutcomesOutcomesHow will thecounty implementto accomplish theobjective?Objective 1.1: By2025, the numberof youth whoperceive underagealcohol use asharmful willincrease by 3% asmeasured byCHKS 5 or othersurvey.Objective 1.2: By2025, reduce retailavailability ofalcohol to teens by3% as measuredby AlcoholBeverage Controlinfractions.Objective 1.3: By2025, youthresiliency forunderage drinkingwill increase by 3%as measured bypre/post surveys.Objective 1.4: By2025, there will bea 3% decrease inhigh schoolstudents who reporthaving consumedalcohol before lastintercourse asmeasured bypre/post entation:measures processchange.Measures change incontributing factorsand/or change inknowledge or skills.Countymeasure whathappened?By 2022, the numberof youth whoperceive underagealcohol use asharmful will increaseby 1% as measuredby CHKS comparedto baseline.By 2024, the numberof youth who perceiveunderage alcohol useas harmful willincrease by 2% asmeasured by CHKScompared to baseline.By 2025, the numberof youth whoperceive underagealcohol use asharmful will increaseby 3% as measuredby CHKS comparedto baseline.CHKS orother surveyBy 2022, reduceretail availability ofalcohol to teens by1% as measured byAlcohol BeverageControl infractions.By 2024, reduce retailavailability of alcoholto teens by 2% asmeasured by AlcoholBeverage Controlinfractions.By 2025, retailavailability of alcoholto minors will havedecreased by 3% asmeasured by AlcoholBeverage Controlinfractions.AlcoholBeverageControl da
total SAPT BG Award on primary prevention services. Primary prevention is defined as strategies, programs, and services directed at individuals who have not been determined to require treatment for a substance use disorder. A county's spending of the primary prevention funds that DHCS allocates is integral to meeting federal SAPT spending .
prevention of substance misuse. This "prevention set-aside" is managed by the Center for Substance Abuse Prevention (CSAP) in SAMHSA and is a core component of each state's prevention system. On average, SAPT Block Grant funds make up 68% of primary prevention funding in states and territories. In 21 states, the prevention set-aside .
Intrusion Prevention: Signature Policies 201 Intrusion Prevention: Signature Policies - New 203 Intrusion Prevention: Sensors 204 Intrusion Prevention: Sensor - New 205 Intrusion Prevention: Sensor - Associating Sensor to a Firewall Policy 206 Intrusion Prevention: Alerts and Reports 208 Intrusion Prevention: View Rule File 210
Integration of substance abuse prevention, mental health promotion and primary care across the lifespan Shifting from the delivery of prevention services to the development of Prevention Systems that deliver prevention services based on the Strategic Prevention Framework Focus more on population level or environmental change
Recommended Practices for Prevention of Deep Vein Thrombosis The following Recommended Practices for Prevention of Deep Vein Thrombosis were developed by the AORN Recommended Practices Committee and have been approved by the AORN Board of Directors. They were presented as proposed . implementing the protocol in the perioperative area and .
To create successful prevention programs, one must use data to assess the needs , prioritize and commit to the purpose , establish actions and measurements , use problem prevention actions , evaluate measured results to improve prevention outcomes , and use a competent proficient and properly trained workforce.
The RACGP Infection prevention and control standards for general practices and other office-based and community-based practices recognises the increasing need for a broader guide to infection prevention and control for use not just in general practice, but in the varied settings of clinical practice outside the hospital setting.
Prevention of Drug use anD Problematic use Prevention of Drug use anD Problematic use 1 UN Office on Drugs and Crime. International standards on drug use prevention. Vienna, 2013, p 1. introDuction Prevention of drug use, particularly among young people, is almost always a central goal in national policies on illicit drugs, as well as in
CBSE Sample Paper Class 11 Maths Set 2 Solution. 1 cos2 1 cos4 1 2 2 x x cos2x cos4x 0 2 cos3x cos x 0 Cos3x 0 6 3 0 2 6 3 x n Cosx x k n n is integer π π π π π π 8. Solution: 30 40 60 4 7 2 4 10 4 15 4 ( ) . ( ) ( ) 1 1 1 1 1 i i i i i i i i 9. Solution: Substituting the points (0, 0) and (5, 5) on the given line x y – 8 0 0 .
