The Importance of Addressing Stigma: One of the most consistent themes heard during today's policy deliberations surrounding the consequences of integrating behavioral health services within primary care is the potential for addressing the historical stigma attached to receiving mental health and/or substance abuse care. There clearly is no quick and easy solution. Senior colleagues might recall the almost universal silence associated with receiving a cancer diagnosis during their parents' time -- just a few decades ago -- prior to the significant advances in treatment which are heralded today. The impressive pubic engagement efforts of the American Cancer Society, the Susan G. Komen Walks, Department of Defense cancer funding initiatives, etc. are relatively recent phenomena. Perhaps during the coming decade the particularly debilitating barrier of stigma will also be successfully overcome; especially, we would suggest, with the unprecedented advances occurring seemingly daily within the communications and technology fields. The Fiscal Year 2014 budget for the Substance Abuse and Mental Health Services Administration (SAMHSA) includes $13.6 million for an exciting Public Awareness and Support (PAS) initiative.
The Administration: The rapidly changing healthcare environment, the critical role behavioral health plays in achieving national health status objectives, and advances in communications technology provide new opportunities to change the way behavioral health is viewed and services are delivered in the United States. The unmet need for prevention, treatment, and recovery support services provides a vast untapped market for SAMHSA products and services. Opportunities to prevent or intervene early to reduce disability and death associated with mental and substance abuse disorders are often missed. The Departments of Health and Human Services (HHS) and Education are working to facilitate a national dialogue on the mental and emotional health of young people. About 60% of adults experiencing a mental disorder did not receive treatment and nearly 90% of people who needed substance abuse treatment did not receive care, according to the 2010 National Survey on Drug Use and Health. For children and adolescents, only about 1 in 5 receives the treatment they need for diagnosable mental health and substance use disorders. Expenditures on mental and behavioral health and substance use treatment for children and adolescents alone approximate $12 billion annually.
By learning to recognize the signs and symptoms of mental illness and substance abuse, friends and family members can help their loved ones take action and seek care. Trained health professionals can also work with patients and families to identify problems early. By confronting fear and misunderstanding with facts, raising awareness about the effectiveness of prevention and treatment, and improving knowledge about when and where to seek help, SAMSHA can bring mental illness and addictions out of the shadows and help the nation achieve the full potential of prevention and treatment for mental illnesses and substance abuse. The SAMSHA Office of Communications, through the Communications Governance Council (CGC), is charged with setting the strategic direction and policy for SAMSHA's public communication activities. The CGC is working to assure research based approaches are used to influence behavior change for the sake of improving health, preventing injuries, protecting the environment, and/or contributing to the community. Individual behavioral change involves five basic steps: knowledge, approval, intention, practice, and advocacy. To employ the best communication practices and technologies that focus on creating and sustaining behavior change, SAMHSA is putting into place a new science-based life cycle approach for public education communications efforts. The lifecycle provides a five step process for planning, creating, disseminating, promoting, and evaluating educational information produced and distributed by SAMHSA.
SAMHSA's Public Engagement Platform (PEP) and Project Evolve, SAMHSA's web consolidation and modernization project, are funded through the Public Awareness and Support budget line. These two initiatives provide the wide infrastructure required to advance Strategic Initiatives by engaging audiences in a meaningful way. The internet is the primary way people engage with the government. SAMHSA has prioritized the internet as a strategic business and communications asset and launched Project Evolve to consolidate and modernize SAMHSA's web presence. Elimination of redundant web development efforts is a key objective for this project and the installation of a Web Content Management System will result in lower overall costs, greater efficiency, increased effectiveness, and improved service for visitors. Related project activities include audience analysis, usability testing, and planning for the prioritized migration of information from other sites to a consolidated SAMHSA.gov.site.
Consistent with the draft Federal Digital Strategy, the project is working to support the development of quality content and effective communications governance, and the use of modern communications platforms all to increase efficiencies in SAMHSA's web based communication efforts with the long term goals of improving customer satisfaction and achieving cost savings to the agency. SAMHSA's PEP provides the agency's programs a consumer-oriented fulfillment system. SAMHSA's online store (http://store.samhsa.gov) is it's most highly visible customer interface and works in concert with a call-in contact center, warehouse, email updates, exhibit program, and strategic partnerships to fulfill the publication needs of public and health services providers. The various channels of communication managed by the Office of Communications generated more than 24 million customer interactions last year and enabled SAMHSA to gather data that illuminate the "voice" of SAMHSA customers and how well they are being served by the agency.
Through its Knowledge Management System, SAMHSA integrates content, operations, and data collection and analytics on all PEP customer interactions. These touch points annually include about 500,000 inquiries to the contact center; 143,400 publication orders; 21.3 million publication copies shipped; 1.7 million SAMHSA Store visitors; 530,000 PDF documents downloaded; 11.9 million email updates delivered; and 12,000 exhibit booth visitors. SAMHSA's email update service has grown to nearly 193,000 subscribers. PEP also distributes a bi-weekly electronic resource entitled SAMHSA Headlines that provides the behavioral health field with the latest news, upcoming events, resources, and a quarterly newsletter, SAMHSA News, that provides in-depth information on key SAMHSA developments and findings.
Just as Americans are aware of the connection between hypertension, stroke, and heart disease and accordingly take action to monitor their blood pressure they can become aware of the connection between mental and substance use disorders and physical health and take action to prevent and treat these conditions. SAMHSA's PEP and new Web Program provides prevention, treatment, and recovery support programs the communication channels need to reach public and professional audiences with critical behavioral health information.
The Public Awareness and Support Initiative (http://www.samhsa.gov/publicAwareness/) continues to be driven by research with SAMHSA stakeholders – including web-based public engagement strategies/platforms – and applies the communications and marketing principles of customer research and audience segmentation, message development and evaluation. Because it is based on consumer needs and input, the Initiative is dynamic and continues to evolve based on the shifting landscape of communications technologies and government involvement with the public. It strengthens the agency's role in "Supporting the field with Information/ Communications" by conducting and sharing information from national surveys and surveillance; vetting and sharing information about evidence-based practices (e.g., National Registry of Evidence-based Programs and Practices [NREPP]); using the Web, print, social media, public appearances, and the press to reach the public, providers (e.g., primary, specialty, guilds, peers), and other stakeholders; and listening to and reflecting the voices of people in recovery and their families. The requested budget will aid SAMHSA's efforts to research the best methods of collaboration with its stakeholders, which will improve its messaging and marketing; and as a result, more accurately reflect the voices of people and families in recovery.
Interesting Developments in Other Health Professions: Being primarily located, by choice, in my "new career" in the Daniel K. Inouye Graduate School of Nursing at the Uniformed Services University of the Health Sciences (USUHS) (DoD), I have become increasingly aware of changes evolving within the broader health professions community. I have been impressed by the continuing growth of dual degree opportunities involving Schools of Nursing and, for example, public health, business, informatics, law, religion (hospice care), as well as nursing's systematic efforts to fully implement the recommendations of the Institute of Medicine (IOM) report The Future of Nursing: Leading Change, Advancing Health. This includes ensuring that professional nurses will be able to practice to the full extent of their education and training; achieve higher degrees of education and training through an improved education system that promotes seamless academic progression; be full partners in redesigning health care in the United States; and, requiring better data collection and information infrastructure for developing effective workplace planning and policy making. In essence, our colleagues in nursing should be actively involved in playing a fundamental role in the transformation of our nation's health care system. At the visionary Fall Semiannual Conference of the American Association of Colleges of Nursing (AACN), the participants were asked to develop the "capacity to wonder" how they might continue to make outstanding contributions to the nation. Lt. General Patricia Horoho, the first woman and first ever non-physician military Surgeon General, urged the audience to "think differently" and "change the fundamental conversation," asking the Deans: "How much health is actually included in today's curriculum?"
This Fall, the Tri-Regulator Leadership Collaborative met to review issues of mutual concern and set an agenda of work for the ongoing collaboration between the Federation of State Medical Boards (FSMB), the National Association of Boards of Pharmacy (NABP), and the National Council of State Boards of Nursing (NCSBN). The schedule of work agreed upon included: Preparation for a historic, joint meeting of the governing boards of each organization in February, 2014. A proposed position statement on interprofessional team-based care for adoption by each organization. Assessing the public protection issues related to practice between and among countries and other international issues related to the regulation of health care practice. Encouraging regular dialogue between U.S. medical, pharmacy and nurse licensing boards, including facilitation of dialogue with board members of each respective organization. And, Planning for the second Tri-Regulator Symposium to be held in 2015. The FSME, NABP, and NCSBN formalized their advocacy partnership in 2011 with the creation of the Collaborative. Together, their various state member boards regulate a combined 5 million physicians, pharmacists, and nurses in the United States. Also this Fall, Rutgers University announced the establishment of a dual doctorate in Pharmacy/Medicine at the Robert Wood Johnson Medical School and Ernest Mario School of Pharmacy. The new PharmD/MD program will be the first of its kind which "could become a model to better prepare the experts who will drive national health-care policy in the wake of the Affordable Care Act." Those who enroll in the program are expected to take 10 years to obtain their degrees.
USUHS: "At USUHS we have a health policy seminar dedicated to exposing students to the many professions that interface with public policy, such as psychology, nursing, and education. The seminar features speakers who informally discuss their journeys to policy-related fields and how policy experiences influenced their career trajectories within military and civilian sectors. Speakers discuss the different skills necessary to work within policy, including building interpersonal relationships, being persistent, and focusing upon the 'big picture.' A recent speaker, Anthony Principi, twice serving as Secretary of the Department of Veterans Affairs, discussed his vision and rationale for the difficult decision to consolidate and restructure the VA hospital system in 2004. Stephen Trachtenberg, author and former President of The George Washington University, shared stories from the perspective of a visionary university president, highlighting the successes and difficulties of working within the education policy system. Another speaker, Clyde Hart, current communications director of the American Bus Association and former U.S. Senate confirmed Maritime Administrator and Capitol Hill staffer, encouraged students to take advantage of any opportunity to work on Capitol Hill, identifying it as the one place where he learned the most simply by listening and watching. Since the class includes students in both psychology and nursing, we are able to engage in interdisciplinary dialogue related to many areas within policy. Towards the end of the quarter, students are encouraged to do a field site visit. Past site visits have included visiting the American Psychological Association (APA), the federal or state offices of Congress (my mother and I visited our local Congressman in Mississippi), and the Health Resources and Services Administration (HRSA). Through the seminar discussions and field experiences, students are exposed to the ways policy impacts every aspect of our lives and how we will be able to utilize our knowledge, skills, research, and clinical expertise to inform policy decisions [Omni Cassidy]."
Although there are steadily increasing numbers of public policy courses and relevant texts being offered/published within schools of nursing, this is not the case within psychology's educational institutions. Perhaps a relevant analogy -- Today psychology is progressing nicely on addressing the complex issues surrounding Telepsychology. Yet, in 2003 the Kaiser Family Foundation reported that "About 80% of U.S. residents who use the Internet have searched the Web to seek out health information, and most say doing so helps improve their quality of care." Psychology's next generation must become more responsive to the changing times. Some definitely are: "We met at the 2011 APA Convention in DC at the Speed mentoring opportunity for students and Early Career Psychologists. After much ambivalence, I'm finally taking the plunge. My colleagues in the Indian Health Service (IHS) and Steve Tulkin have encouraged me to pursue RxP authority. In January 2014, I'll start the Alliant University Postdoctoral Masters in Clinical Psychopharmacology program. I do like to believe that you planted the seed those few years ago. Wish me luck. Thanks. [Casey McDougall]."
The IOM Forum on Global Violence Prevention: Our nation's Capital hosts many exciting policy discussions, which can be transformational. A new summary brochure produced by the IOM Forum on Global Violence Prevention details the origin, operation, and accomplishments of the Forum. Established in 2010, it has brought together global experts from all areas of violence prevention and mitigation to facilitate multisectoral dialogue and exchange on a range of cross-cutting global violence prevention issues. Several times per year, the Forum convenes expert workshops that explore these issues and opportunities for advancing proven or evidence-informed prevention efforts. Violence is a major global public health problem, with multisectoral consequences for business, law enforcement, and other sectors, the impact of which is borne not only by the victims, but also by families, communities, and societies. In 2001, violence accounted for 45 million disability-adjusted life years lost, with low- and middle-income countries bearing the largest burden. The exact costs of violence, which include adverse health outcomes, lost productivity and economic opportunity, community deterioration, and effects on the next generation, are difficult to determine, but there is little doubt that the direct and indirect costs are great. As quoted by the Forum's co-chair Mark Rosenberg from the Taskforce for Global Health: "In most people's minds, violence is seen as unmitigated evil, something that we have had to live with since time immemorial, and not something that we can prevent." Nevertheless, violence can be prevented.
The past quarter-century has witnessed a shift in thinking about violence – from the assumption that violence is inevitable to an emerging scientific understanding among many different stakeholders that, through effective approaches, prevention is possible. Violence is complex, whether interpersonal, self-directed, or collective, and, when not prevented, fosters more violence. Effective prevention requires cross-sectional approaches developed through dialogue and collaboration among researchers, practitioners, and policy-makers whose perspectives reflect different disciplines and experiences.
During its first three operational years, the Forum explored different but related aspects of violence in a series of public workshops. The existence of linkages and common risk factors within types of violence, as well as between different types of violence, was a constant thread through all the workshops and related activities. Understanding these relationships is critical to preventing violence. The Workshop on Preventing Violence Against Women and Children, for example, found the following key themes. * The value of research and interventions that address violence against both women and children rather than treating them as "siloed" types of violence. * The intergenerational transmission of violence. * The need to address gender norms and roles of men and boys as part of the solution. * The research and intervention gap in low- and middle-income countries. And, * The need for responses that are multisectoral and are cross-cutting fields of violence prevention. This workshop was webcast globally, allowing for the inclusion of more than 300 remote participants in more than 20 countries.
Key themes from the Workshop on Communications and Technology for Violence Prevention were: * The ability of information and communications technologies (ICT) to facilitate cross-sectoral solutions. * The potential of ICT as a platform for scaling up effective interventions. * The need for new methodologies for effective evaluation of interventions utilizing rapidly changing ICT. And, * The opportunity for ICT as a tool to better reach vulnerable populations and address health disparities. Following the momentum of this workshop, one of the Forum's sponsors, the Avon Foundation for Women, partnered with the IOM in a global mobile- and Web-based app challenge: Ending Violence @ Home. The challenge brought together individuals from the fields of domestic violence prevention and communication technologies, raising awareness about and helping prevent domestic violence against women and children. This was a globally-issued challenge, and teams from both the United States and abroad entered. The numerous submissions covered a wide array of innovative approaches to prevent violence at home. The four winning submissions showcased three different approaches: changing cultural attitudes about violence against women, preventing dating violence on university campuses, and equipping health care providers to detect and prevent domestic violence. Other workshops include: Social and Economic Costs of Violence, Contagion of Violence, Evidence for Violence Prevention Across the Lifespan and Around the World, and Elder Abuse and Its Prevention [www.iom.edu/globalviolenceprevention]. There is tremendous potential for the behavioral sciences to contribute to a healthier society. Aloha,
Pat DeLeon, former APA President – Division 29 – November, 2013
