1. Screening for Island Mental Health Issues and Substance Abuse: An interdisciplinary approach A project by students of the University of Massachusetts Graduate School of Nursing and School of Medicine

2. “It is becoming clearer and clearer that mental health agencies cannot directly and alone solve the mental health problems that confront a community, and that the mental health system is simply a part of the network of community agencies which overtly or covertly provide mental health services.” “It is becoming clearer and clearer that mental health agencies cannot directly and alone solve the mental health problems that confront a community, and that the mental health system is simply a part of the network of community agencies which overtly or covertly provide mental health services.” Milton Mazer, People and Predicaments

3. Introduction According to the 2005 Martha’s Vineyard Health Report, rates of substance abuse and mental health issues are higher on the island than the national average. According to the 2005 Martha’s Vineyard Health Report, rates of substance abuse and mental health issues are higher on the island than the national average. Research has shown that people in rural areas are less likely to seek help for mental health issues than they are for physical conditions. Research has shown that people in rural areas are less likely to seek help for mental health issues than they are for physical conditions.

4. Introduction Introduction Last year’s research found that there is a need for more screening of mental health and substance abuse issues on the island. Last year’s research found that there is a need for more screening of mental health and substance abuse issues on the island. In addition, only 12-15% of individuals surveyed in the Martha’s Vineyard Health Report indicated that their provider discussed alcohol use with them. In addition, only 12-15% of individuals surveyed in the Martha’s Vineyard Health Report indicated that their provider discussed alcohol use with them.

5. Research in action, courtesy of Oak Bluffs nightlife

6. Introduction Screening should be done via an interdisciplinary approach, not exclusively by mental health workers and Primary Care providers. By increasing the number of professionals screening for illness, a greater population can be reached. Because of this, any screening tool must be useful in a wide variety of settings. Screening should be done via an interdisciplinary approach, not exclusively by mental health workers and Primary Care providers. By increasing the number of professionals screening for illness, a greater population can be reached. Because of this, any screening tool must be useful in a wide variety of settings.

7. Process of Developing the Tool Research was undertaken to look at existing tools used by the health care fields and the information that was extracted from these tools was chosen for its’ likelihood of applying to issues facing the island community. Research was undertaken to look at existing tools used by the health care fields and the information that was extracted from these tools was chosen for its’ likelihood of applying to issues facing the island community. The questions found within this tool come from frequently used professional modules and therefore have been demonstrated to be effective in a variety of settings. The questions found within this tool come from frequently used professional modules and therefore have been demonstrated to be effective in a variety of settings.

8. Process of Developing the Tool Alcoholism, substance abuse, anxiety and depression were shown to be more prevalent on the island than the national averages, according to the Martha’s Vineyard Health Report. Alcoholism, substance abuse, anxiety and depression were shown to be more prevalent on the island than the national averages, according to the Martha’s Vineyard Health Report. Based upon this data, these four topics were chosen to be components of the tool. Based upon this data, these four topics were chosen to be components of the tool.

9. Process of Developing the Tool The combined background of the students involved in creating this tool included various clinical and educational experiences that facilitated effective teamwork and a diverse knowledge base. The combined background of the students involved in creating this tool included various clinical and educational experiences that facilitated effective teamwork and a diverse knowledge base.

10. Martha’s Vineyard Comprehensive Screening Tool

11. The tool is divided into two main segments, one screening for alcohol and substance use, and the other for depression and anxiety. The tool is divided into two main segments, one screening for alcohol and substance use, and the other for depression and anxiety. Each question is weighted and a combined score of 2 or greater in either of the two main sections should result in further evaluation or referral. An exception is the two noted questions, which should result in immediate referral. Each question is weighted and a combined score of 2 or greater in either of the two main sections should result in further evaluation or referral. An exception is the two noted questions, which should result in immediate referral. The questions asked are based on general signs and symptoms of alcoholism, substance abuse, depression and anxiety, and are by no means diagnostic of any one specific illness or disorder. The questions asked are based on general signs and symptoms of alcoholism, substance abuse, depression and anxiety, and are by no means diagnostic of any one specific illness or disorder.

12. Companion to the Tool

13. Interviewing Island Professionals Vineyard Nursing Association Vineyard Nursing Association Wampanoag Tribal Health Center Wampanoag Tribal Health Center Rural Health Clinic (PA and Psychiatrist) Rural Health Clinic (PA and Psychiatrist) Elder Services, MVH Elder Services, MVH ER, MVH ER, MVH Substance Abuse Counseling Substance Abuse Counseling County Sheriff County Sheriff Island Counseling Center Island Counseling Center

14. Interviewing Island Professionals Questions for Interviewees Are there methods you use to screen for mental illness/substance abuse? If so, are there questions you adapt or wish were included in these tools? What are the strengths of the tools that you use? Are there methods you use to screen for mental illness/substance abuse? If so, are there questions you adapt or wish were included in these tools? What are the strengths of the tools that you use? Do you feel that this tool would be useful to you in your role in dealing with members of the community? Do you feel that this tool would be useful to you in your role in dealing with members of the community? Do you think that we should ask patients if they feel that they have a drinking or substance abuse problem? Do you think that we should ask patients if they feel that they have a drinking or substance abuse problem? What should be included in this tool to make it island-specific? What should be included in this tool to make it island-specific? Do you feel that substance abuse and alcoholism can be combined in the same questions (as demonstrated by this version of the tool), or do you feel that these should really be kept separate? Do you feel that substance abuse and alcoholism can be combined in the same questions (as demonstrated by this version of the tool), or do you feel that these should really be kept separate? Do you think that this can be used as an interdisciplinary tool? Do you feel that there should be separate tools used by different providers/law enforcement? Do you think that this can be used as an interdisciplinary tool? Do you feel that there should be separate tools used by different providers/law enforcement?

15. Interviewing Island Professionals Feedback from interviews included: Feedback from interviews included: – Keep the tool brief – Use simple wording – Questions should yield yes/no responses – For simplicity, combine alcohol and substance abuse questions, but mention both. – Keep it general to be used by different professionals. – Separate alcohol and substance abuse as two unique issues. – Ask patients directly if they feel that they have an issue.

16. Interviewing Island Professionals This feedback resulted in significant changes in the scoring, question type and wording of the screening tool. This feedback resulted in significant changes in the scoring, question type and wording of the screening tool. One question that was added as a result of feedback related to isolation from society and daily activities. One question that was added as a result of feedback related to isolation from society and daily activities.

17. Recommendations Use of the tool should be encouraged for a variety of professionals, including medical professionals, law enforcement officers, counselors, religious officials, and other community service providers. Use of the tool should be encouraged for a variety of professionals, including medical professionals, law enforcement officers, counselors, religious officials, and other community service providers. The tool must be adapted for use for non- English speaking clients (i.e. Portuguese, Spanish). The tool must be adapted for use for non- English speaking clients (i.e. Portuguese, Spanish).

18. A Growing Need We feel that there is a grave lack of critical resources on the island. If this tool is effective, the need for the following resources will only increase: We feel that there is a grave lack of critical resources on the island. If this tool is effective, the need for the following resources will only increase: ◊ The island desperately needs more social workers, mental ◊ The island desperately needs more social workers, mental health counselors and other professionals. health counselors and other professionals. ◊ The hospital needs detox programs and a crisis stabilization ◊ The hospital needs detox programs and a crisis stabilization unit as well as psychiatric support staff unit as well as psychiatric support staff ◊ More support groups must be developed, including a Portuguese AA ◊ More support groups must be developed, including a Portuguese AA ◊ Non-English support groups and providers are in short supply, ◊ Non-English support groups and providers are in short supply, especially those catering to the Portuguese-speaking especially those catering to the Portuguese-speaking community community ◊ Greater support for and understanding of the unique ◊ Greater support for and understanding of the unique needs of mental health and substance abuse populations needs of mental health and substance abuse populations throughout the island community. throughout the island community. ◊ Continually updated, detailed information on referral processes ◊ Continually updated, detailed information on referral processes

19. Opportunities for Future Study A detailed implementation plan for the utilization of the screening tool A detailed implementation plan for the utilization of the screening tool A study of who is using the tool A study of who is using the tool A study of the tool effectiveness A study of the tool effectiveness A count of the number of referrals made from those professionals A count of the number of referrals made from those professionals A study of ways to improve the tool to meet the changing needs and diversity of the island community A study of ways to improve the tool to meet the changing needs and diversity of the island community

20. Thank You… Cindy Mitchell, Murray Frank, Tom Bennett, Olga Church, Terry Appenzellar, Ron Rappaport Cindy Mitchell, Murray Frank, Tom Bennett, Olga Church, Terry Appenzellar, Ron Rappaport Suzanne Cashman Suzanne Cashman Rural Health Clinic, Health Care Access Program, Island Counseling Center, Martha’s Vineyard Hospital Rural Health Clinic, Health Care Access Program, Island Counseling Center, Martha’s Vineyard Hospital Interviewees: Joyce Cleavenger, Carol Ann Lindsey, Betsy Van Landingham, Jacque Cage, Hazel Teagan, Michael McCormack, George Cohn, Tom Bennett. Interviewees: Joyce Cleavenger, Carol Ann Lindsey, Betsy Van Landingham, Jacque Cage, Hazel Teagan, Michael McCormack, George Cohn, Tom Bennett.

22. References Martha’s Vineyard 2005 Health Report Martha’s Vineyard 2005 Health Report Mazer, Milton. People and Predicaments. Cambridge, MA, Harvard College, 1976. Mazer, Milton. People and Predicaments. Cambridge, MA, Harvard College, 1976. AUDIT screening tool AUDIT screening tool CAGE screening tool CAGE screening tool Hamilton Anxiety Scale Hamilton Anxiety Scale Hamilton Depression Scale Hamilton Depression Scale Michigan Screening tool Michigan Screening tool “Utilization of mental health services in rural and remote communities”, Journal of Rural Community Psychology. Vol. E7, Spring, 2004. “Utilization of mental health services in rural and remote communities”, Journal of Rural Community Psychology. Vol. E7, Spring, 2004.