Module I:
Introduction
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.
2
Learning Objectives
Health Care Professionals will be
able to:
 Discuss
the program rationale.
 Identify the relevant goals and objectives
of Healthy People 2010.
3
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.
4
Learning Objectives (continued)
Discuss the recommendations of the Strategic
Planning Document of the HRSA-AMERSACSAT/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.

5
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
6
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

7
Program Overview and
Rationale
HRSA-AMERSASAMHSA/CSAT
Interdisciplinary Program in
Substance Abuse Education
8
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.
9
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
10
Healthy People (HP) 2000
Goals: Reached
 Increase
in average age of first
marijuana use
 Decline in cocaine use
11
HP 2000 Goals: Some Progress
 Alcohol-related
crashes
 Average age of first cigarette
 Alcohol use - ages 12 to 20
 Tobacco use - ages 12 to 17
12
HP 2000 Goals: No Progress
 Average
age of first alcohol use
 Marijuana use - ages 12 to 25
 Heavy drinking - high school students
 Heavy drinking - college students
13
HP 2000 Goals: Regression
 Drug-related
emergency room visits
 Drug-related deaths, especially
among African Americans and
Hispanic Americans
14
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.
15
Healthy People 2010 -Indirect Goals/Objectives
Access to Quality Health Services
1-3 Counseling about health behaviors.
1-7 Core competencies in health provider training.
Educational and Community-Based Programs
7-2 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.
16
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.
17
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 Health
16-17 Prenatal substance exposure
16-18 Fetal alcohol syndrome.
18
Healthy People 2010 -Indirect Goals/Objectives
(continued)
Mental Health and Mental Disorders
18-10 Treatment for co-occurring disorders.
Occupational Safety and Health
20-9 Worksite stress reduction programs.
Public Health Infrastructure
23-8 Competencies for public health workers.
23-17 Prevention research.
Sexually Transmitted Diseases
25-11 Responsible adolescent sexual behavior.
19
Workforce Deficiencies
 Primary
and secondary substance abuse
prevention is effective
 Few health care professionals engage
regularly in primary and secondary
prevention
 All of the U.S. is underserved with
regard to substance abuse services
20
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
21
Barriers
 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
22
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

23
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
24
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
25
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
26
Strategic Planning Document
(continued)
For all recommendations:
 Rationale
 Responsible parties
 Suggestions for implementation
27
Strategic Planning Staff
Director of Strategic Planning
Mary Haack, RN, PhD, Assoc. Prof.
Rutgers University School of Nursing

Associate Director of Strategic Planning
Hoover Adger, MD, Assoc. Prof.
Johns Hopkins Univ. Medical School

Professional Editor –
Linda Harteker, MA

28
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
29
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

30
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
31
Primary Learning Objectives
Clinic-based screening, assessment,
intervention, and referral
 Clinic-based identification and
assistance of children and
adolescents with affected parents
 Community-based prevention

32
Other Important Learning Areas
Geriatric issues
 Population health
 Prescription Drug Abuse
 Pedagogy
 Curriculum design and evaluation
 Presentation/publication

33
Role of Health Care Professionals
Basic 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
34
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
35
Regional Structure - Cohort 1 & 2
Regional Director
Mentor
Mentor
Fellow
Fellow
Fellow
Fellow
Fellow
Fellow
36
FDP Learning Activities
 AMERSA National
Conference plus special
FDP workshops
 Spring regional meetings
 Annual mentor visits
 Learning contract
 Monthly contacts with mentors
37
FDP Learning Activities
(continued)
 Interdisciplinary
clinical and educational
projects
 Interactions with IFLG
 FDP distance learning activities
 Present projects at meetings
 Publish peer-reviewed articles
38
Evaluation Team
Rebecca Henry, Ph.D.
Rich Brown, MD, MPH
Monina Lahoz, PhD
Marianne Marcus, RN, EdD
Jeff Morzinski, PhD
Gene Schoener, PhD
39
Evaluation Plan
 Administrative,
process, and outcome
measures
 Outcomes evaluation driven by
objectives
40
Evaluation - Strategic Planning
Process
 Administration runs smoothly
 Meetings achieve aims
Outcome
 Reviewers rate document highly
 Document receives publicity
 Document stimulates change
41
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
42
Evaluation - Fellowship
(continued)
Process - Fellows
 Application process
 Expectations - clear and appropriate
 Training events
 Mentor contacts
 Accessibility of guidance
 Overall experience
43
Evaluation - Fellowship
(continued)
Process - Mentors
 Selection process
 Involvement with fellows
 Progress of fellows
 Support from project
 Compensation
 Overall experience
44
Evaluation - Fellowship
(continued)
Process - Activities
 Participant satisfaction
 Best aspects; suggestions
Process - Infrastructure
 Awareness, use, suggestions
 Activities, income
45
Evaluation - Fellowship
(continued)
Knowledge and Attitude Outcomes
 30-item knowledge test
 SAAS treatment optimism
 Readiness to change clinical and field
practices
46
Evaluation - Fellowship
(continued)
Competency Outcomes
 Self-efficacy and confidence
 OSCE stations
 Presentations
 Publications
47
Evaluation - Fellowship
(continued)
Curricular Outcomes
 Teaching activities
 Trainee contacts - number, time
 Curricular presence
48
Evaluation - Fellowship
(continued)
Distance Learning Programs
 Knowledge objectives
 Attitude objectives
 Competency objectives
49
Evaluation - Fellowship
(continued)
Career Emphasis Outcomes
 Professional time allocations
 Professional organizations
 Professional activities
50
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
51
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.
52
Syllabus
 Designed
and edited by Judie Pfeifer, MEd
 Borrowed from previous syllabi on
substance abuse
 Tailored for multidisciplinary use
 Updated with recent articles
53
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
54
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
55
Administrative Group
 Project
Director
 Richard L. Brown, MD, MPH
 Project
Manager
 Doreen MacLane-Baeder
 Project Assistants
 Christine
Benz, June Daws
56
Initial Project Officer Team
 Dr.
Ruth Kahn, Lead
 Dr. Mildred Brooks-McDow
 Dr. Marcia Starbecker
 Dr. Suzanne Cable
 Dr. Terri Spears
57
Accomplishments
 Strategic
Plan published 2002.
 Website now a valuable resource.
 Thirty-nine faculty fellows from 20
institutions trained.
58
Faculty Development: Project
MAINSTREAM

Two cohorts: 39 fellows; 13 IFLGs
10 physicians
4 social workers
11 nurses
3 dentist
2 physicians’ assistants
2psychologists
3 public health professionals
2 pharmacists
2 occupational therapists
59
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.
60
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.
61
Website Development
 Valuable
resource for Project
MAINSTREAM.
 Used by academics and organizations
outside of project.
 www.projectmainstream.net
62
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.
63
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.
64
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.
65
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).
66
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.
67
A Culturally Competent Model of
Care
Cultural Knowledge (CK)
Cultural World Views,
Theoretical and Conceptual
Framework
Cultural Awareness (CA)
Cultural Sensitivity,
Cultural Biases
Cultural Skills (CS)
Cultural Assessment Tools
Cultural Encounter (CE)
Cultural Exposure,
Cultural Practice
Cultural Competence (CC)
Campina-Bacote, 1991
68
Diversity Within Culture
 Age
 Gender
 Level
of acculturation
 Generation
• first generation
• second generation
 Sexual
orientation
 Rural/Urban
69
Changing Frontiers in
Prevention and Treatment
 Faith-based
settings
 Family drug courts
 Criminal justice treatment initiatives
 Complementary and alternative
therapies
70
Summary
Overview and rationale
 Healthy People 2010
 Role of health care professionals
 Accomplishments of HRSA-AMERSASAMHSA/CSAT Program
 Cultural competence
 Changing frontiers

71