National Affordability Summit Sets the Stage for Local Healthcare Affordability Event

KHC representatives at the NRHI National Affordability Summit pledge to “do my part by collaborating with others to improve health, reduce price, and eliminate waste.”

“I’ll do my part by collaborating with others to improve health, reduce price, and eliminate waste” was the pledge that purchasers, payers, providers, patients, and policymakers across the country committed to at our nation’s capital at the Network for Regional Healthcare Improvement’s (NRHI) National Affordability Summit earlier this month. Several KHC members attended the summit, including Teresa Couts, UAW/Ford and KHC; Don Lovasz, KentuckyOne Health Partners; Amanda Elder, LG&E; Emily Beauregard, Kentucky Voices for Health; Stephanie Clouser, KHC; and myself.

Dr. Stuart Altman kicked off the event; he is an economist with five decades of experience working on federal, state, private, and academic health policy. His humorous keynote kept folks engaged despite the bleak prediction of family premiums rising to 100% of the US median household income by 2033 if trends continue on this trajectory. The current average family health insurance premium is approaching $20,000 per year. He gave examples of how America can change this trend by collectively eliminating the 33% waste that is estimated in medical spending. He encouraged consumers to become more engaged and employers to better control their healthcare spending. He used Massachusetts as an example of how states should track healthcare spending as total spending to include Medicare, Medicaid, and commercial payments, not just their Medicaid spending. Since 2012, Massachusetts went from one of the highest healthcare spending states to among the lowest.

Mylia Christensen of HealthInsight, also the NRHI affordability chair, presented the amazing work that is happening across the country to reduce healthcare spending by improving health, reducing price, and eliminating waste. The KHC’s Kentucky Core Healthcare Measures set was one of the projects featured by regional healthcare improvement collaboratives as a way of eliminating administrative waste. The KHC team was proud for our work to have been featured among the dozen or so strategies featured across the nation to address healthcare affordability.

At lunch, I had an enjoyable conversation with a very, soft-spoken woman with kind eyes and a quick smile. I liked her immediately. It was to my surprise when she joined the stage that afternoon as the self-described “tough negotiator grandma” who reduced Montana’s employer healthcare spending and returned big funds to the state’s budget. Marilyn Bartlett was tough indeed, and she had just proven what employers and states can do to reduce healthcare spending through referenced-based pricing and drug pricing transparency. She was my favorite speaker of the day, and I hope one day we can have her come to Kentucky to speak about her work.

One of the main takeaways from the event was that communities should not blame any healthcare sector for the current healthcare spending issues but should rather come together to solve the issues collectively. That’s what the KHC has planned for its affordability summit on Tuesday, December 4. Any stakeholder is invited to attend, and the group will identify at least two to three solutions that we can implement around healthcare affordability at this event. We invite you to join us and be part of the solution.

SBIRT: Why Should I Care?

(Note: this guest post was written by Mallori De-Salle, Outreach Coordinator and Lead SBIRT Trainer, Indiana Prevention Resource Center)

I hate thinking about what I’m not doing ‘right’ when it comes to my health. I eat pizza. I’m not overweight, so it must not be a problem. I add salt to my food (without tasting it). I don’t have high blood pressure, so it must not a problem. I drink coffee in the morning, mid-day, and sometimes in the evening. I still sleep, so it must not a problem. This is my logic when deciding if I have to make a change. If it isn’t a problem, I don’t think about the health behavior at all. So, why should I care about how much alcohol I drink, if it’s not a problem?

Does this sound familiar? It’s not a problem, so why even think about it? Is the lack of highly problematic symptoms of an illness the only way to measure the existence or severity of a health problem? Or could we as an “illness focused” culture be missing an opportunity to focus on wellness instead of lack of illness?

For decades, our healthcare system has operated under the belief that “health” is defined through the absence of symptoms. In other words, concerns aren’t addressed or even considered a problem until the symptoms can be diagnosed. But, is it possible that problems exist on a wider spectrum? Is it possible that you or I could improve our health by reducing our risks even before problems are visible? Think about using a seat belt. Most of us wear seat belts automatically. It’s a habit (thank you public health) that we no longer think about. We wear seat belts, but not because it makes us better drivers or because we plan to crash. We wear seat belts as prevention because it lowers our risk IF we experience a situation where harm is possible. Not wearing a seat belt increases your “risk” for harm, even in minor vehicle incidents and most importantly, in severe circumstances. Wearing a seat belt doesn’t remove the risk of crashing; it reduces the risk of harm WHEN a crash occurs. Seat belts lower risk for a problem that doesn’t even exist yet.

Seat belts are fairly concrete (actually they are fabric, but you understand). However, other health behaviors, such as alcohol or substance use, can be more abstract. What if we look at alcohol or substance use as a health behavior that can either increase or decrease our risk for experiencing harm, much like our current views on seat belts? Public health is back again with a new preventive practice to do just that!

SBIRT, or Screening, Brief Intervention, and Referral to Treatment, is a public health approach which changes how we view alcohol use. Instead of simply looking for indications of diagnosable problems, it examines all levels of use and how use impacts all levels of wellness. This suggests that wellness can be enhanced by understanding that health is not simply the absence of illness. SBIRT asks all patients (even the little neighbor lady down the street) annually about their alcohol or substance use. Doing so helps increase the chances that a person considers how their level of use is influencing their quality of health. SBIRT is not a diagnostic process, but instead a conversation that helps support intrinsic motivation for behaviors that support wellness and not just the avoidance of illness (in this case, addiction). SBIRT, like all other new movements, viewpoints and culture shifts (remember how people hated seat belts at first?) takes time to feel comfortable. Once it is in place, everyone starts to think, “Why haven’t we been doing this?” So, buckle up! SBIRT is taking the driver’s seat and letting us know that improving our health, wellness, and happiness is why we should care.

For more information on SBIRT or to download KHC’s toolkit for primary care providers, click here

QPR Reflections: Suicide Prevention Training Hits Home

A couple of weeks ago, the Kentuckiana Health Collaborative held its September Community Health Forum. The topic was youth mental health, and the date coincided with National Suicide Prevention Week. After the Forum, the KHC hosted a Question, Persuade, Refer (QPR) training as part of a goal to set a record for people trained in one week. Similar to CPR, QPR is a 90-minute training course designed to support an emergency response to someone in crisis. It was designed to equip individuals with the tools they need when someone in their life is facing a suicide crisis.

I was in that position last year, trying to convince the person I loved most in the world not to take their own life. It’s an experience I don’t wish on my worst enemy. I’m at a year of therapy and counting, and although I am a much stronger person for the experience, I wish I had never been through it.

In the end, my loved one didn’t take their life, and they got the talk therapy and medication needed to push through. Multiple people have credited me with that outcome. I’m not sure if I agree with that, but I do admit that my involvement might have had a positive impact and recognize now the power that even one individual can have in moments of crisis.

Hence the need for trainings like QPR. Suicide is the 10th leading cause of death in the United States, and it’s estimated that for every death by suicide, there are 25 more attempts. It happens more commonly than we’d like to believe. During National Suicide Prevention Week, more than 2,200 people in Louisville were trained in suicide prevention in 50 locations across the city.

I’ll admit that I was slightly disappointed by the QPR training. I guess I thought that it would reveal one magic thing that I could have said or done differently, to make the situation turn out more smoothly than it did in my case. I was disappointed to find that there is no magic bullet to be had. People are complex. These situations are complex. There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

There is no one-size-fits-all approach to suicide prevention. It all comes down to being persistent, really listening to what someone else is telling you either with their words or actions, and not being afraid to have the tough conversations.

I don’t think I was prepared for the traumatic memories that QPR would bring up. Much of the 90-minute session was devoted to recognizing the signs and behaviors of distressed loved ones. I can say that from my personal experience, what was taught in QPR related to this was almost word-for-word what I experienced. I had to leave the room more than once in tears. But I always returned, determined to see it through. Then came the disappointing part of the training. The part where I discovered that there is no perfect phrase that can talk someone off the proverbial ledge. But that doesn’t mean that we can’t have an impact on the situation. We can all create safe spaces for our loved ones to talk to us when they are struggling, and we can together get through the tough times.

I had nightmares that evening about those past traumas. But then, a funny thing happened. The nightmares that I’d been accustomed to having for the last year stopped. Situations and places that used to trigger me no longer did. And I realized that it was a direct result of the QPR training. I had long ago forgiven myself for what I had seen as failings when I was faced with the crisis, but it turns out that I didn’t need to be forgiven at all. By participating in the training, I realized that I did probably more in that situation than I should have been able to. It wasn’t blind luck that prevented my loved one from taking their life. And that was the closure that I didn’t know that I needed.

It sounds like a cliché to say that you never think it will happen to you until it does. But that’s exactly how it is. And I would recommend that anyone learn how to have that conversation and develop that vocabulary, through QPR or a similar program. Because you never know when you might need those skills.

Round Table Reflections – Understanding Employer Needs, Goals, and Challenges for Opioid Use Disorder

Last week, the Kentuckiana Health Collaborative (KHC) convened a group of employers and experts at the LG&E/KU Cane Run Power Plant to discuss the needs, goals, and challenges facing employers as they address opioid use disorder (OUD) in their workforces. The event was conceptualized as a focus group to guide the development of the KHC’s newest project as part of the Kentucky Opioid Response Effort (KORE). With an expected release date of April 2019, the KHC is developing a toolkit for employers in implementing best practices for supporting prevention, treatment, and recovery from OUD in the workplace.

Attendants of the focus group were carefully chosen. It was important that the discussion represented multiple perspectives dependent on the size, industry, and status of OUD initiatives of employers. Experts were brought in to provide technical expertise and give additional insight.  The conversation was broken up into five domains: key metrics for evaluation, prevention, benefit design, treatment, and recovery. For each domain, our conversation was shaped by identifying goals, challenges, pertinent information for the toolkit, and any knowledge of best practices.

The focus group revealed many outstanding themes. First and foremost, there was a resounding amount of enthusiasm and recognition from employers in their role to address OUD not only in their employees, but in their communities. This was especially true when discussing prevention efforts. Another prominent point was the importance of building a culture of wellbeing and trust within the workplace. By doing so, prevention, treatment, and recovery among employees could be supported. A component of this culture would be innovation, particularly around mitigating the many barriers than often arise for employees in accessing treatment and maintaining recovery. Insurance coverage that is friendly towards virtual treatment options, Medication Assisted Treatment (MAT), defined treatment guidelines, and affordable deductibles was repeatedly addressed. Employers also recognized the importance of data and insurance benefit design in tackling this issue. Addressing OUD in the workplace will be a individualized process, as many barriers exist in implementing these changes and these barriers vary based on each employer’s demographics and capabilities. Despite this, the willingness of employers to engage in such a vibrant and transparent conversation left many of the group’s participants filled with hope and excitement for their organization’s future.

In conjunction with evidence-based research, information collected from this discussion will guide the development of the KHC’s employer toolkit. The KHC will continue to convene employers during our monthly Worksite Addiction Meetings. If you are an employer who is interested in joining this group or would like to share your perspective, please contact me at nmiddaugh@khcollaborative.org.

KHC Joins Coalitions Across the Country to Address Healthcare Affordability

Kentucky, like the rest of the United States, has a problem. Healthcare costs continue to rise. However, paying more for healthcare does not mean we get better healthcare services, and it does not mean we are healthier as a result. We pay too much for care and it is causing financial, emotional, and clinical harm to individuals, businesses, and communities.

The current situation is unsustainable; harder choices are coming. There are proven approaches to make headway, but we have to work together to achieve success. We can’t blame the current state of affordability on any individual group of people. We all created the situation. It will take all of us working together to solve it.

Healthcare costs continue to rise. However, paying more for healthcare does not mean we get better healthcare services, and it does not mean we are healthier as a result.

The KHC has long been a trusted partner in reporting healthcare quality performance data. But you can’t address quality without also looking at value. Solving one issue in isolation does not achieve the healthcare affordability goal. Healthier populations use fewer healthcare resources. Healthier populations create more productive communities. Unnecessary services are causing clinical, emotional, and financial harm. Administrative waste is a financial burden on patients and providers while also burning out providers.

To begin the conversation locally around healthcare affordability, the KHC has joined the Network for Regional Healthcare Improvement (NRHI) and other regional coalitions across the country to bring healthcare affordability to the forefront of healthcare transformation efforts. The movement is focused on health, price, and waste — the three drivers of affordable healthcare. In joining this effort, NRHI and its coalitions like KHC will leverage their collective strengths on efforts to improve affordability while preserving and improving quality. In addition, partnering with other national entities committed to solving the healthcare affordability problem will strengthen the effectiveness and reach of these efforts.

The campaign, called Affordable Care Together, is an approach that puts communities at the center of the solution; the movement is led by neutral, non-profit conveners who build on existing, multi-stakeholder efforts to improve health, reduce price, eliminate waste, and collectively create greater awareness and solutions.

As part of Affordable Care Together, myself and KHC leaders Teresa Couts, Randa Deaton, Emily Beauregard, Don Lovasz, and Amanda Elder will join leaders from every segment of the U.S. healthcare system at the Ronald Reagan Building in Washington, D.C. for a day-long summit next week, addressing our country’s healthcare affordability crisis. We will bring back the lessons and ideas that we learn and put them to use, hosting a Community Health Forum in December called “The Path to Affordable Healthcare.” The half-day event will bring together key healthcare stakeholders and like-minded local change agents, who will help develop a community action plan to address healthcare affordability in our community.

Look in coming weeks for more content on healthcare affordability, including reflections from the summit in Washington, D.C. There are ways we can work together to change the system and make it sustainable for current and future generations. By working together, we can make a difference.

 Learn more about Affordable Care Together

Students and Adults Work Together to Generate Ideas for Youth Mental Health at “Ideathon”

Prior to last Saturday’s StAMINA Youth Mental Health Ideathon, the concept of an “ideathon” was easy enough for me to imagine, much like a danceathon but just a whole day of generating ideas around supporting youth mental wellness. With this in mind, I didn’t expect the StAMINA Ideathon to be as engaging, organized, inspiring, and productive as it turned out to be. Even my teenage son, who does not typically spend his Saturdays hanging out with his mom, was completely engaged in the process, and we both left energized by the possibilities to make a positive impact on youth mental health.

StAMINA (Student Alliance for Mental Health Innovation and Action) discussed the findings of its new research on youth mental health at the KHC’s Community Health Forum on September 11, and the subsequent Ideathon, designed to generate ideas to address the findings of that research, was held on September 15. Amanda Tu, a Junior at Stanford and sister of StAMINA founder Allison Tu, led Ideathon participants through the design thinking process as defined by Standford’s d.school. The process for design thinking is comprised of five steps: empathize, define, ideate, prototype, and test. Since the empathizing and defining had already been completed through the research, the focus of the Ideathon was to “ideate” and begin to “prototype.”

Ideathon participants were led through the design thinking process as defined by Standford’s d.school.

There were about 50 people in attendance that were divided into several small teams of five to seven individuals. Participants included students, parents, grandparents, guidance counselors, mental health advocates, pediatricians, public health officials, and more. The groups were carefully divided into teams representing unique perspectives. Nearly half of the day was spent in our groups discussing solutions to the problems identified in the research, sorting the ideas, selecting the top idea, prototyping the idea, and, finally, pitching the idea to the group.

All seven teams generated detailed ideas and then presented their pitch and skits to all of the participants. The process was fun, and there was a lot of laughter and energy during the skits. The top three ideas selected included a student-led podcast on mental health, an app with mental health resources, and dinner card conversation starters for parents and students. The StAMINA and KHC teams will now analyze which ideas are feasible with current resources to be advanced in our community.

The winning team’s idea included a podcast that addresses youth mental health issues.

Tamlin Hall filmed the entire StAMINA event, conducted one-on-one interviews, and will be putting together a video of the event. Tamlin is an award winning filmmaker, whose movie “Holden On” tells the true story of his childhood friend, Holden Layfield, who struggled with mental illness as a teenager.

StAMINA’s three-prong approach is now moving from the learn and build phase to action. Allison Tu, founder of StAMINA, often explains to adults that it is the students that are experiencing their own mental health, and it only makes sense that they are the ones to help find the solutions. It’s clear from this work that she is right that a student led approach will realize the best results; it’s already happening.

See StAMINA founder Allison Tu talk about her group and Ideathon on WHAS.

 

Variety of Viewpoints Makes for Engaging, Motivating Bost Forum

The opioid crisis in Kentucky, and across the country, continues to be a hot topic in healthcare. For the second straight year, the Howard L. Bost Memorial Health Policy Forum, convened by the Foundation for a Healthy Kentucky, chose substance use (with a heavy emphasis on opioid use) as the theme for the day.

While some might expect a day devoted to yet more discussion around substance use in the Commonwealth to be full of familiar, tired conversations, the Bost Forum was anything but. All of the KHC’s staff members attended the forum, and each of us left chattering excitedly about the speakers that left us inspired, motivated, fired up, and more.

For each of us, different speakers provided a spark or connection. As a reflection on the day, each member of the KHC shared something that stuck with them about a particular speaker. Read KHC staff reflections in their own words below.

 

Keynote Speaker Barry Meier

Randa Deaton – Co-Executive Director

Over 200,000 Americans have died from overdoses related to prescription opioids from 1999-2016. This year’s Bost keynote speaker, Barry Meier, is the award-winning reporter whose special report in the New York Times created national interest in OxyContin. His 2003 book, “Pain Killer,” exposed the rise of the billion dollar pain management industry excesses and abuses, and he felt confident his reporting efforts would help solve America’s opioid crisis. Fifteen years later, the alarm bells are only now ringing within the government, and he has released an updated version of his book. His passion for holding the organizations accountable for this public health crisis could be felt through the room. More importantly, he conveyed the tragedy in waiting for the alarm bells to go off after 200,000 Americans have already died. The key takeaway was for those in public health to get in front of these dangerous public health trends to avoid this type of crisis in the future.

 

Breakout Discussion panelists: Alternatives to Opioids

Michele Ganote – Event and Communications Coordinator

There are many alternatives to opioids, with the obvious being over-the-counter pain relievers such as Tylenol and Advil. Each panelist discussed the many other options available for dealing with and treating chronic pain and how important it is to focus on the “why” of the pain and not just mask the pain with medication. I often hear about deep breathing or meditation for stress and anxiety, but before yesterday I hadn’t thought much about it for pain and recovery. Dr. Mel Pohl, CMO for the Las Vegas Recovery Center, suggested we all meditate daily. Meditation or mindfulness is commonly used in recovery at the Las Vegas Recovery Center. I found Danesh Mazloomdoost, MD, Wellward Regenerative Medicine, to be passionate about his work with “regenerative medicine,” a new medical field that studies how the body heals and how science can enhance this process. I look forward to reading his book, “50 Shades of Pain.” Other alternatives to opioids for patients living with chronic pain were physical therapy, massage, acupuncture, cognitive behavioral therapy (CBT), avoiding alcohol, eating healthy, keeping a positive attitude, distracting yourself from pain, and planning for a bright future.

 

KET Series on Addiction (Presented by host Renee Shaw)

Teresa Couts – Co-Executive Director

Shortly after lunch, Renee Shaw, KET, presented a video from the KET Series on Addiction. The video featured Butler High School in Louisville, KY, which has implemented the national program Sources of Strength. The mission is to provide the highest quality evidence-based prevention programs for suicide, violence, bullying and substance abuse by training, supporting, and empowering both peer leaders and caring adults to impact their world through the power of connection, hope, help, and strength. A group of students at Butler High School are training to save lives and improve the mental health of their fellow classmates. Butler health teacher Mary Wurst brought the group together after some of the students came to her for advice or guidance during their own struggles. Now, these students are using their experiences to give back to their classmates who might be in need. Butler is among the first Jefferson County Public Schools to help identify and support students who may be struggling. One student stated that “so many people are still alive because of this program and because of the coping mechanisms we’ve learned.”

 

Nancy Hale, Operation UNITE (part of the panel on Kentucky’s Addiction Burden)

Natalie Middaugh – Project Coordinator

The morning panel at the Howard L. Bost Memorial Health Policy Forum convened representatives with diverse perspectives to explore Kentucky’s addiction burden. A highlight of these perspectives was from Nancy Hale, President/CEO of Operation UNITE. Operation UNITE is a nonprofit organization serving 32 counties in eastern and southern Kentucky that utilizes a collaborative model to prevent substance abuse and facilitate recovery. It is difficult to find a conversation focused on addressing the substance and opioid use epidemic that does not emphasize the necessity of strategic partnerships. Operation UNITE is a long-standing and successful example of how these strategic partnerships can affect meaningful change.

 

Alex Elswick, Voices of Hope (part of the panel on Kentucky’s Addiction Burden)

Stephanie Clouser – Data Scientist

Alex Elswick, Co-Founder of the non-profit organization Voices of Hope, talked about the recovery process for substance use disorder and the importance of supporting people in recovery. Alex, himself a person in long-term recovery, said that we need to give more than lip-service to those in recovery. Everyone loves a great comeback story, but we need to support those who are actively going through treatment as well. Alex is “not in recovery because I pulled myself up by my bootstraps,” but because he had access to the resources he needed to get better, and we need to support individuals by addressing the barriers to those resources.

Keep Your Eyes Wide Open – Technological Advancements Are Rapidly Changing Our Future

Brenda Miles

(Note: This guest post was written by Brenda Miles, retired Director of Benefits for Papa John’s International. Brenda is a business development consultant for the KHC Employer and Healthcare Purchaser Network.) 

The recent KY SHRM conference in Louisville was well worth the time invested. As a long-time HR and employee benefits professional, the difficult part was choosing from the robust line-up of informative and action-oriented topics and amazing speakers.

One standout for me was a keynote presentation by author and speaker Jack Uldrich. Focused on helping organizations plan for the future, Uldrich spoke on “Business as Unusual: How to Future-Proof HR Against the Trends Transforming Tomorrow.” His lively and interactive presentation emphasized the importance of awareness, humility, and action:

  • Awareness of the rapid, staggering pace of change resulting from emerging technologies
  • Humility to unlearn the truths we knew for years that may no longer be true
  • Action to regularly take time to think about the future and what those changes mean to us and our businesses, so we can prepare accordingly

He described how the collection and analysis of “big data” is helping businesses understand consumer behavior more than ever before. The expansion of data scientists in the workforce help businesses understand the data to design strategies for products and services more highly valued by consumers. From a health standpoint, we are seeing companies such as Amazon move into the pharmacy and telemedicine space, manufacturers expand wearable robotics to reduce worker safety, genomics to predict disease and design treatment for improved outcomes, and the application of artificial intelligence to identify and aid in mental health initiatives.

I was proud to see the Kentuckiana Health Collaborative participate as a first-time exhibitor at the conference. They bring multi-stakeholder professionals together to learn from each other. The approach is a perfect complement for employers as they try to understand the dynamics and complexities of the health care delivery system as it impacts their health plans and covered employees.

So, keep your eye on the Kentuckiana Health Collaborative (KHC), the Society for Human Resource Management, and the International Society of Certified Employee Benefits Specialists for more information as technology changes the future in healthcare and employer-sponsored health plans.

PRESS RELEASE: High School students examine mental health stigma in KY teens


Findings: Adult, peer views on mental health contribute to stigma

Press Release by Hayley Kappes, University of Louisville

LOUISVILLE, KY September 6, 2018 – Parents who refuse to take their children to therapy because they don’t believe in mental health treatment. School counselors who have told students to stop crying because they’re “fine.” Teens further ashamed of mental illness because of negative portrayals in the media. These are some of the experiences that a high school student group, mentored by a University of Louisville clinical psychologist, has gathered from peers across Kentucky during yearlong research into factors that contribute to mental health stigma in teens.

Allison Tu

Allison Tu, a senior at duPont Manual High School who led the student group, and Stephen O’Connor, PhD, associate director of the UofL Depression Center who guided the students in research, will present findings during the Kentuckiana Health Collaborative Community Forum on Tuesday, Sept. 11, from 8 to 10 a.m. at the UofL Clinical and Translational Research Building, 505 S. Hancock St. After the forum, a Question. Persuade. Refer. (QPR) Suicide Prevention Training by the Louisville Health Advisory Board will take place.

The student group, comprised of teens across the state, is called the Student Alliance for Mental Health Innovation and Action (StAMINA) and is supported by the Kentuckiana Health Collaborative, a nonprofit organization that aims to improve health and the health care delivery system in greater Louisville and Kentucky.

StAMINA conducted a needs assessment of the state and held focus groups in urban and rural areas with high school students and parents to uncover what interferes with students acknowledging they have mental health issues and receiving treatment. The group also interviewed mental health professionals and pediatricians.

Factors that contributed to mental health stigma among high school students included negative representation of mental health in media and stigma from peers and parents who do not have a positive attitude about mental health, Tu said. The group found differences between rural and urban residents.

“Because there is more racial and ethnic diversity in urban settings, one of the big drivers of mental health stigma is ethnic heritage,” Tu said. “African-American and Asian-American students talked a lot about how culturally, mental health was often ignored. With rural students, generally there was more stigma resulting from religious factors. Some students said they would talk to their parents about mental health issues, and their parents would respond, ‘you’re not praying enough.’”

Stephen O’Connor, PhD

Messages that parents express about mental health impact a child’s views, said O’Connor, who guided the research design, and taught the students how to lead focus groups and conduct qualitative data analysis.

“The gatekeeper for getting children to treatment is often going to be a parent, so parental views on mental health are likely going to impact whether a child is taken to treatment,” O’Connor said. “The parent also is helping the child understand what they’re experiencing, so if the parent doesn’t have a good idea about what symptoms of mental illness represent, then the child is probably not going to understand either.”

Solutions to mental health stigma among teens may include a new mental health education requirement for high school freshmen or a social media campaign to amplify the visibility of resources, said Tu, who also stressed the need for parents to be educated on mental health issues and resources available for their children.

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SBIRT Toolkit Released for Healthcare Providers to Address Opioid Crisis

In recent years, the misuse, addiction, and overdose of opioids has grown to epidemic levels at the national, state, and local levels. Kentucky is no exception, with its opioid epidemic ranking among the worst in the nation. As of 2016, Kentucky ranked fifth among states with the highest number of drug overdose related deaths. With 33.5 deaths occurring per 100,00 people, the state experienced a 142% increase from 2010.

Significant action has been taken by a multitude of stakeholders in response to this epidemic. A prominent force has been the work completed as part of the Kentucky Opioid Response Effort (KORE). KORE is part of the Opioid State Targeted Response (STR) grants, created by the 21st Century Cures Act and administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). The purpose of KORE is to implement a comprehensive targeted response to Kentucky’s opioid crisis by expanding access to a full continuum of high quality, evidence-based opioid prevention, treatment, recovery, and harm reduction services and supports in high-risk geographic regions of the state. Earlier this year, the Kentuckiana Health Collaborative (KHC) began a project in partnership with KORE to increase awareness and utilization of Screening, Brief Intervention, and Referral to Treatment (SBIRT) among primary care providers as a means of addressing unhealthy substance use among their patient populations.

SBIRT is public health approach to identifying and intervening with patients who are participating in risky substance use behaviors. As a system change initiative, SBIRT challenges traditional approaches to identifying and intervening with Substance Use Disorder (SUD) by viewing behaviors, problems, and interventions on a continuum. SBIRT focuses on reaching the 15%-25% of the population who are excessively using substances, while still intervening with the 5% needing traditional treatment and positively reinforcing behaviors of the 75%-85% who are abstinent/responsibly using. The bulk of health, social, and economic costs associated with substance use are associated with excessive use rather than addiction or substance use disorders. By addressing the population excessively using, primary care providers can negate the negative effects of these costs and prevent the progression of substance use behaviors. There is substantial evidence for the use of SBIRT in reducing risky behaviors related to alcohol, and its application for opioid use is accumulating and promising.

The KHC has developed a toolkit, titled “Screening Brief Intervention, and Referral to Treatment (SBIRT) – Addressing Unhealthy Substance Use in Primary Care Settings” that is being distributed to over 4,000 primary care providers and 400 group practice managers throughout the state of Kentucky. The KHC will also be holding a complementary webinar on Wednesday, October 10, 2018. Webinar registration and additional information can be found here.

SBIRT is a practical and promising approach to addressing the growing opioid epidemic in Kentucky. Join us in learning more about this initiative and encouraging its adoption throughout the Commonwealth.

View Toolkit