DIVISION OF BEHAVIORAL HEALTH SERVICES
SUBSTANCE ABUSE
PREVENTION AND WELLNESS
SERVICES PLAN
NOVEMBER 2014
2014 SUBSTANCE ABUSE
PREVENTION AND WELLNESS SERVICES PLAN
Salt Lake County Department of Human Services
Division of Behavioral Health Services
INTRODUCTION
This document is the result of the Division’s prevention planning process, and will provide a
description or context for the Division’s role and priorities.
Utah, as required by state law (Title 17-43-201 et. Seq. of the Utah Code), is one of 23 states
within the U.S. to deliver its public substance abuse services through county government. Salt
Lake County (SLCo) through its Division of Behavioral Health Services (DBHS) has been
providing substance abuse treatment and prevention services on behalf of the citizens of SLCo
for more than 30 years. The SLCo behavioral health system is one of the largest in the
Intermountain West. SLCo, like many large urban counties and governmental agencies across
the U.S., delivers services in the private sector through a system of providers contracted on the
basis of a public-private partnership model. While SLCo could choose to deliver services
directly, the public-private partnership model works well for SLCo while there is an abundance
of diverse and qualified private and governmental service/provider agencies. Historically, this
partnership has maximized the public dollar.
COUNTY BID PROCESS
SLCo purchases its system of care through a competitive bid process, and issues a Request for
Proposals (RFP) on a cycle of one to four years. In this upcoming cycle, prevention services will
be bid for a period of one year, with an option to renew for an additional three years. It is
anticipated the RFP will be issued mid-January 2015 with contracts beginning starting July 1,
2015.
Once the RFP process is finalized and providers are selected, a contract for services is
negotiated between SLCo and the successful agencies that are then referred to as its panel of
providers. During the contract period, SLCo may purchase new services from within its panel
of providers unless the current panel is unable to provide these new services.
Salt Lake County has a long history of providing the most innovative and effective prevention
services in the state. We are committed to a high level of excellence and remaining a leader in
prevention science. We continue to follow the Strategic Prevention Framework (SPF)
developed by the Substance Abuse Mental Health Services Administration (SAMHSA) to
implement comprehensive community level prevention strategies within Salt Lake County. We
recognize the prevention needs of Salt Lake County change frequently. We are committed to
change or modify our services based on the needs of our population. We also recognize there
are several other organizations operating within Salt Lake County that are committed to
providing high quality prevention services. We embrace a healthy relationship with these
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organizations and look for opportunities to support their efforts. We look for opportunities to
collaborate with mental health, public health, and primary care providers to provide
comprehensive coverage of prevention services within Salt Lake County.
SUCCESSFUL PREVENTION EFFORTS
In the recent past, Salt Lake County has seen many successes and a few areas of concern in the
data regarding substance use. All data represented in this section is from the Utah Student
Health and Risk Prevention (SHARP) survey. Reports can be found at
www.dsamh.utah.gov/prevention
Alcohol use among sixth, eighth, tenth, and twelfth graders in Salt Lake County has seen
consistent decreases in the trend data over the past ten years. It is significant to note the alcohol
use decrease is being seen while total alcohol sales and consumption in the State of Utah is
increasing significantly. Alcohol use as of 2013 was 8.9% down from a high of 15.1% in 2005.
Salt Lake County’s 30-day alcohol consumption among youth is consistently higher than the
State of Utah numbers, though that gap between the county and the State has been narrowing
over the past several years.
Overall, 30-day substance use in Salt Lake County remains well below the National numbers and
slightly higher than State averages. Over the past decade, a majority of substances have seen
consistently low usage and some have seen consistent decreases. A select few have seen some
modest spikes. Marijuana has seen some slight but consistent increases in consumption among
youth.
Marijuana use among sixth, eighth, tenth, and twelfth graders in Salt Lake County is seeing
consistent minor increases in recent history. 30-day marijuana usage in Salt Lake County is up
from a low of 5.6% in 2007. Marijuana use as reported in 2013 was at 8.3% compared to the
State number of 5.8%.
Prescription drug use among sixth, eighth, tenth, and twelfth graders had seen a minor increase
from 2003 to 2013 but has recently seen a significant decrease from 2011 to 2013. Current 30day usage among the above listed grades in Salt Lake County is 2.3% which is the same as the
Utah usage for the same grades.
CURRENT PREVENTION PRIORITIES
Salt Lake County currently provides a comprehensive array of prevention services ranging from
early pregnancy programs, to educating the elderly. It is the County’s goal to lead the state in
effective and innovative prevention programming. The Division of Behavioral Health Services
prioritizes the following:
1. Services Based on Salt Lake County’s Risk and Protective Profile
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Risk Factors and Protective Factors- Services purchased by Salt Lake County will be
designed to address one or more of the following factors.
Risk Factors identified that need to be reduced:
1. Parental Attitudes Favorable to Antisocial Behavior (Family Domain)
2. Attitudes Favorable to Antisocial Behavior (Peer Individual Domain)
3. Early Initiation of Drug Use (Peer Individual Domain)
4. Perceived Risk of Drug Use (Peer Individual Domain)
Protective Factors identified that need to be strengthened:
1. Rewards for Prosocial Involvement (Community Domain)
2. Opportunities for Prosocial Involvement (Family Domain)
3. Family Attachment (Family Domain)
4. Rewards for Prosocial Involvement (Family Domain)
2. A Full Continuum of Evidence-Based Services- The Division’s goal is to provide services
across the life span, including prenatal, early development, adolescent, early adulthood,
parents and older adults. Funding for services are based on populations within the Institute
of Medicine (IOM) categories and framework:
Universal—Strategies presented to large groups without prior screening, providing
information and skills applicable to the entire population.
“Prevention interventions that are targeted to the general public or a whole population
group that has not been identified on the basis of individual risk. The intervention is
desirable for everyone in that group.”
Selective—Strategies presented to population subsets at risk for substance abuse.
“Prevention interventions that are targeted to individuals or to a subgroup of the
population whose risk of developing mental, emotional, or behavioral disorders is
significantly higher than average. The risk may be imminent or it may be a lifetime risk.
Risk groups may be identified on the basis of biological, psychological, or social risk
factors that are known to be associated with the onset of a disorder. Those risk factors
may be at the individual level for non-behavioral characteristics (e.g., biological
characteristics such as low birth weight), at the family level (e.g., children with a family
history of substance abuse but who do not have any history of use), or at the
community/population level (e.g., schools or neighborhoods in high-poverty areas).”
Indicated—Strategies presented to groups of individuals who do not meet DSM-IV
criteria for addiction, but are showing early signs of substance abuse and problem
behaviors. “Prevention interventions that are targeted to high-risk individuals who are
identified as having minimal but detectable signs or symptoms that foreshadow mental,
emotional, or behavioral disorder, as well as biological markers that indicate a
predisposition in a person for such a disorder but who does not meet diagnostic criteria at
the time of the intervention.
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3. All Services Provide Evidence-Based Interventions- All contracted providers must
implement evidence-based SUD programs with fidelity. Evidence-based status of programs
can be determined by the following methods:
1. Inclusion in private or federal registries that identify SUD evidence-based
interventions proven to result in sustained positive benefits to individuals or
communities
2. Have been reported in peer-reviewed journals (with positive effects of achieving the
primary targeted SUD outcome); or
3. Have documented effectiveness supported by other sources of information, the
consensus judgment of informed experts, and receive a minimum rating of Tier III by
the Utah SUD Evidence-based Workgroup.
Evidence-Based prevention programs can be cost effective. For each dollar invested in
prevention, there can be a savings of up to $10 in treatment costs.
4. Collective Impact/Service and System Integration - Collective impact means that
programs are integrated with other community partners, working toward shared goals, with a
clear understanding on how those programs support common approaches. Collective impact
shifts prevention programing from one entity providing services to a partnership with other
groups within the county. Examples of Collective impact might include working with
townships, coalitions, school districts, government agencies, or other agencies on shared
impacts or outcomes. The Division understands the importance of system integration and
expects that all contracted programs coordinate with other social service agencies where
possible. This includes funding collaborative programming and services that are mutually
supportive.
5. Easier Access to Services- SLCo continues to seek a geographically diverse distribution of
services throughout the Salt Lake Valley. SLCo also contracts for after school, evening, and
weekend services that increase positive attachments to schools and communities in underserved, high-risk areas during times of the day which are convenient for citizens.
6. Emerging Community ConcernsThe County is concerned with the current trend that despite not having legal access to Ecigarettes, Utah youth are three times more likely to report current use than adults.
Additionally, the State has seen increased adolescent use of E-cigarettes from 1.9% in 2011
to 5.9% in 2013.
The County is also concerned with the current increase in adolescent use of marijuana, as
reported by SHARP survey data.
7. Services to Areas of Greater Need- SLCo recognize community needs are not equally
disbursed throughout the community, but may be concentrated in different areas of the
county. SLCo focuses on identifying areas of high need within the county and providing
services to these individual areas.
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8. Services Provide Diverse and Culturally Relevant Prevention- SLCo contracts for
programs that are designed & implemented with sensitivity regarding diversity, and the many
barriers that age, race, religion, ethnicity, language, gender, class and other factors that play
in providing effective interventions.
9. Services that Enhance Parental Involvement as well as Caring, Supportive Adult
Relationships- SLCo prioritizes services that provide opportunities for building healthy
relationships with pro-social adults/role models/mentors.
10. Well Planned and Documented Services- SLCo requires providers to track, document and
analyze impact, including but not limited to:
I. Process/Billing Data using the web-based WITS (Web Infrastructure Treatment
Services) system includes date and type of service, direct hours and number of
participants with associated demographics (gender, age, race and ethnicity).
II. Knowledge, Attitudinal and Behavioral Changes in participants (using Pre &
Post Tests whenever possible
III. The Use of Logic Models
SLCo continues to emphasize quality assurance and increased accountability for public funds
through planning and goal setting with logic models, record retention, reporting (including a
year-end summary), utilization monitoring, program site visits and administrative reviews.
11. Community Coalitions- SLCo supports community coalition building and organizing
collective support in creating healthy communities, schools and families.
FUTURE DIRECTION
The next two to four year period will be one of transition. Factors that will shape SUD
prevention in the near future include: SUD prevention working more integrated with the
County Health Department. This integration will facilitate a more collective impact
approach, where shared community assessment data and shared impacts will be looked
at collaboratively. This may affect the type of services to provide, as well as they
method of providing those services.
Medicaid Expansion or other health coverage initiatives may drive change in prevention.
With increased opportunities for integrating SUD prevention with primary health, and
the likelihood that some SUD prevention services would be reimbursable by other 3 rd
party payers, SUD prevention (particularly Indicated Prevention) will need to
accommodate increased accountability and confidentiality requirements, among other
things.
SLCo will work with its panel of providers to prepare for any transition, and may choose
to conduct a new RFP with different priorities to address in the next two to four years.
The following, are areas of importance.
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Increased access to services for SLCo residents – It is the mission of SLCo to provide
access to prevention services to as many of its residents as possible. Exploration of
prevention and wellness services through the private sector and public sector will be a
major goal in up-coming re-bid cycles. Creative ideas, innovative approaches and sound
partnerships between, providers, and consumers will be the hallmark of an effective system
of care. SLCo will being doing a new needs assessment in the year 2015. The needs
assessment in 2015 may result in this contract not being extended past the first year.
More focus on earlier prevention- Research-based prevention programs focus on
intervening early in a child’s development to strengthen protective factors before problem
behaviors have the opportunity to develop.
Emphasis on proactive, healthy choices and wellness – SLCo will promote services in
which whole-health choices and healthy lifestyles are emphasized. This includes attention to
preventative health care including but not limited to exercise, tobacco cessation, as well as
stabilization and control of other co-occurring issues such as diabetes, high blood pressure
and obesity.
Prevention-Ready Communities- SLCo will support and participate with prevention
prepared communities. Prevention prepared communities are communities that have been
organized, including individuals, families, schools, faith-based organizations, workplaces,
and neighborhoods, and have been trained in prevention planning and evaluation. Prevention
ready communities are prepared to mobilize into action and address their community’s needs
and priorities. SLCo supports the Communities That Care (CTC) model of community
planning.
Closer integration with mental health services – A more focused integration with mental
health services is necessary in order to better serve SLCo residents. The shared focus on
promoting mental health and preventing substance abuse is critical to behavioral health
services, now and in the future. SLCo supports SAMHSA’s Strategic Initiative #1, believing
that the practice of promoting mental health and preventing substance abuse share common
risk and protective factors.
Parity of coverage for behavioral health – Most health care plans require behavioral health
to be provided or covered on a level which assures parity with general physical health care
coverage. This is a major opportunity/risk and will evolve over time with new regulations
from the federal government. In addition, the drive toward compulsory coverage under HCR
means most SLCo residents have a behavioral health benefit. These types of changes offer
numerous challenges including: designing a system to meet the needs of both the private
sector and public sector systems; providing successful service models; and working together
to develop services that meet the needs of the residents of SLCo.
Changes in reimbursement mechanisms – SLCo may revise how it reimburses for
services moving away from a strict Fee for Service (FFS) basis to a case rate or other
reimbursement system. Traditionally, SLCo reimburses on a monthly FFS basis after the
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delivery of services. While we are prepared to make changes to our reimbursement system,
we do NOT anticipate making changes to this contract cycle.
Focus on impact and outcome based prevention- It is the County’s goal to make an
impact on SUD misuse and abuse. Resources will be spent on services with measurable
results, and quantifiable impact in our communities. As more local data are acquired, more
emphasis will be placed on making a positive impact on those data.
REFERENCE WEBSITES
Blueprints for Healthy Youth Development
http://www.blueprintsprograms.com/allPrograms.php
National Institute on Alcohol Abuse and Alcoholism
http://www.niaaa.nih.gov
National Institute on Drug Abuse (NIDA)
http://www.nida.nih.gov/index.html
http://drugabuse.gov/prevention/principles.html
National Registry of Evidence-based Programs and Practices (NREPP)
http://www.nrepp.samhsa.gov/
Salt Lake County Division of Behavioral Health Services
http://slco.org/behavioralHealthServices
Substance Abuse and Mental Health Services Administration
http://www.samhsa.gov
Substance Abuse and Mental Health Services Administration
Knowledge Application Program
(Source for best practice standards)
http://www.kap.samhsa.gov/products/manuals
Substance Abuse and Mental Health Services Administration (SAMHSA’s)
National Registry of Evidence-Based Programs and Practices (NREPP)
http://www.samhsa.gov/newsroom/press-announcements/201012070115
Substance Abuse and Mental Health Services Administration
(Strategic Initiatives)
http://www.samhsa.gov/about-us/strategic-initiatives
Utah Department of Health/Health Care Financing Administration
(Source for information and manuals on Utah’s Medicaid Program)
www.health.utah.gov/medicaid
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Utah Department of Human Services
Office of Licensing
(Source for program licensing information)
http://hslic.utah.gov/
Utah Division of Substance Abuse and Mental Health
(Source for information and statistics on substance abuse and mental illness in Utah)
http://www.dsamh.utah.gov
Utah Student Health and Risk Prevention Survey
http://dsamh.utah.gov/data/sharp-survey-reports/
Utah State Epidemiological Outcomes Workgroup Online Data System
(Utah Social Indicator data resource)
http://www.bach-harrison.com/utsocialindicators/Reports.aspx
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