1 Mental Health and Substance Abuse Services Division Association of Substance Abuse Providers Mike Maples October 5, 2011

Page 2 John Austin Peña Primary Care and Substance Abuse Treatment Facility

Page 3 John Austin Peña Primary Care and Substance Abuse Treatment Facility Hidalgo County is one of the top 10 counties in terms of population in the State of Texas, and growing fast. 47% of the community is either uninsured or underinsured so the access to these low cost services is vital.. Incorporating primary care into the substance abuse treatment plan will ensure coordinated care for the adolescents undergoing treatment. The 13,000 sq ft outpatient facility will be located in Edinburg and will be able to manage a caseload of up to 150 individuals. This will be the only public substance abuse treatment facility for adolescents in the Rio Grande Valley This is the first public/private partnership implemented by the County.

Page 4 John Austin Pena Primary Health Care and Substance Treatment Abuse Facility

Page 5 Medicaid Earnings FY2011 Paid Claims for Medicaid Adults (>=21) TMHP $ 1,026,412 HMO $ 702,429

6 Money Follows the Person Pilot DSHS pilot designed to help adults with mental health and substance use disorders leave nursing facilities and become independent in the community (Pilot sites in San Antonio and Austin areas). Part of the State’s much larger Money Follows the Person federal Demonstration (in partnership with DADS, HHSC and their providers.) Provides Cognitive Adaptation Training and substance abuse services up to 6 months before and up to one year after relocation to the community. Substance abuse services include assessment, counseling, community linkage, transportation and peer support adapted to individual needs 80 % of participants currently enrolled in the Pilot have maintained sobriety in the community. Substance Abuse services have helped prevent relapse and assisted individuals in resuming recovery after relapse

Rider Study of the State Mental Health System. Out of funds appropriated above the Department of State Health Services (DSHS) shall contract with an independent entity not later than December 1, 2011, to review the state's public mental health system and make recommendations to improve access, service utilization, patient outcomes, and system efficiencies. The study shall review current service delivery models for outpatient and inpatient care, the funding levels, financing methodologies, services provided, and community-based alternatives to hospitalization. The review should look to other states for best practices or models that may be successful in Texas. The study shall also review and recommend “best value” practices that the state's public mental health system may implement that will maximize the use of federal, state and local funds. DSHS shall submit the final report to the Legislative Budget Board, the Governor, Senate Health and Human Services Committee, and House Public Health Committee not later than September 1, 2012 Page 7

Page 8 Opioid Abuse on the Rise: Nationally

Page 9 Public Health Impact of Opioid Analgesic Use Treatment admissions are for primary use of opioids from Treatment Exposure Data set Emergency department (ED) visits are from DAWN,Drug Abuse Warning Network, Abuse/dependence and nonmedical use in the past month are from the National Survey on Drug Use and Health For every 1 overdose death there are

Page 10 Leading Types of Prescribers of Opioid Analgesics, U.S., 2009 Volkow ND, et al. Characteristics of opioid prescriptions in JAMA 2011;305:

Page 11 Opioid Deaths in Texas *T40.2—code includes poisoning by codeine, morphine, oxycodone, vicodin, etc. opioids other than opium (T40.0), heroin (T40.1), methadone (T40.3) and other synthetic narcotics (T40.4)

Page 12 Opioid Abuse on the Rise: Texas Indicators of Abuse of Opiates in Texas 1998 – 2010 DSHS Treatment Admissions a "Other Opiates" refers to those other than heroin bThe DSHS treatment data collection changed in 2010 with fewer clients being reported for all drugs after Sources: Poison Control Centers, Department of State Health Services (analysis by J. C. Maxwell); and NFLIS.

Other…. CMBHS Advisory Committee Insurance Providers Detox Protocols Medication Assisted Therapy Behavioral Health Institute Maintenance of Effort Senate Proposal for SAMSHA Funding Page 13