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Systems of Care Special Program: Systems of Care and Substance Use Disorders in Youth: Gaps and Successes in the Real World

The 2015 Special Program provides child and adolescent psychiatrists (CAPs) and other mental health providers with the knowledge, skills, and appropriate attitudes needed to better serve youth with substance use disorders (SUDs) and co-occurring disorders.

The community systems of care model now serves as the conceptual framework defining the organization of public children’s mental health and other social welfare programs across the nation. When successfully implemented, systems of care define a needed standard of care for public mental health services. This framework is equally relevant when adapted to the needs of youth with SUDs and co-occurring disorders. The model now widely informs practice and planning efforts, even in locales lacking the resources and/or initiative to implement comprehensive program reform. Elements of the system of care model have been found relevant and adopted by private and commercial care systems.

CAPs can have a number of different roles working with youth and young adults with SUDs: as a diagnostician, therapist, psychopharmacologist, treatment team member, and advocate. In order to be effective in these various roles, CAPs must have the background and skills to address the needs of these youth and be able to work with other clinical and support agency staff. CAPs may be leaders in service development, reviewing needs for quality improvement and system change. SUDs are highly prevalent nationally, and many SUDs have their onset in adolescence. The majority of adult SUDs begin in adolescence. According to the Monitoring the Future study, illicit drug use in the past year among youth was at 27% in 2014. 37% of 12th graders had used alcohol in the past month, and while cigarette usage rates have dropped, e-cigarette and hookah use among youth has continued to rise. Rates of substance use disorders are also high in populations seeking treatment for mental health problems: one national study of mental health service users found that 20% of those 16-25 year olds seeking help for a primary diagnosis of mental health disorder had a co-occurring substance use disorder.

Given the high prevalence of SUDs in youth, it is important that CAPs understand the complexities of SUDs and how to best serve individuals needing professional care and support. CAPs should have an understanding of the systems and supports available to the population, including organized treatment models for those with exceptional need. CAPs should be familiar with system of care principles and evidence-based, promising programs to enhance their capacity to be advocates for the needs of youth with SUDs and their families.

This full-day program begins with an introduction by Gary Blau, PhD, Director of Children and Family Services for the Substance Abuse and Mental Health Services Administration (SAMHSA), highlighting the federal policy agenda for addressing the needs of youth with SUDs and co-occurring disorders. The day will then be divided into two parts, each with several talks and an opportunity for smaller group discussion, called “table top discussions.” Discussions will be structured with guiding questions and an opportunity for feedback from the speakers.

The first part, entitled “Treatment in a Real-World Scenario,” consists of three talks and a discussion/panel. Alessandra Kazura, MD discusses evidence-based treatments for SUDs. A youth from the AACAP Youth Connect, Hayley Winterberg, then describes her personal experience with an SUD and her journey to recovery. A local family from San Antonio, TX is also included in this portion of the program. Marc Fishman, MD then speaks about the use of the American Society of Addiction Medicine (ASAM) criteria and the strength and limitations of these criteria. During the lunchtime break, poster presentations describing system of care work projects completed by the SAMHSA-CMHS CAP fellow awardees are available for viewing and discussion with the awardees.

The second part of the day, entitled “Systems and Clinical Practice” consists of three talks and a panel. Catherine A. Martin, MD addresses the issue of tobacco use and its treatment; David Louis Atkinson, MD addresses the treatment of marijuana and the impact of systems issues on outcomes; and Yifrah Kaminer, MD, MBA acts as a discussant to summarize the day’s talks and reflect on broader policy/system implications. These talks are followed by a panel and discussion period.

CAPs working with youth affected by SUDs have the potential to have a profound impact on the health and welfare of these individuals and their families. It is well known that there are gaps in the system to address the needs of youth with SUDs, but CAPs have the capacity to influence the way the system is structured and how services are provided within it. Knowledge and awareness of system of care principles and practices, and appreciation of the unique demographics, co-morbidities, and developmental issues of the population, can enhance their effectiveness and professional fulfillment. CAPs can have a positive impact when there is a greater understanding of the evidence-base in treatment, factors that promote resiliency and recovery, ways to engage youth and families, and treatment needs of specific populations impacted by SUDs.

Monday, October 26, 2015: 8:00 AM-5:00 PM
8:00 AM  
Welcome and Introductions
8:15 AM  
The National System of Care for Youth With Substance Use and Co-Occurring Disorders: A SAMHSA Perspective
Milangel T. Concepcion Zayas, MD, MPH Children's National Medical Center, Washington, DC
9:00 AM  
Practical Use of the ASAM Criteria in an Impractical World
Marc Fishman, MD The Johns Hopkins University, Baltimore, MD
9:45 AM  
Inspiration Nation: A Youth's Story of Recovering From Substance Abuse and Helping Others
Hayley Winterberg , Buckeye, AZ
10:30 AM  
10:40 AM  
Evidence-Based Treatment for Adolescent Substance Use Disorders and Dissemination in Systems of Care
Alessandra N. Kazura, MD Maine Medical Center, Portland, ME
11:25 AM  
Table Top Discussion: Overcoming Barriers to Implementing Best Treatment
11:45 AM  
Panel Discussion With Drs. Kazura, Fishman, and Youth Speaker – Questions From Table Top Discussions
12:15 PM  
Lunch and Poster Session
1:30 PM  
Systems Issues in Tobacco Cessation for Youth
Catherine A. Martin, MD University of Kentucky College of Medicine, Lexington, KY
2:15 PM  
Issues in Marijuana: Legal and Systems-Based Challenges
David Atkinson, MD University of Texas Southwestern Medical Center at Dallas, Dallas, TX
3:00 PM  
3:10 PM  
Where Do We Go From Here? Next Steps for Clinicians and Systems
Yifrah Kaminer, MD University of Connecticut Health Center, Farmington, CT
3:50 PM  
Table Top Discussion: Impact of Systems on Youth
4:10 PM  
Panel With Drs. Martin, Atkinson, Kaminer – Questions From Table-Top Discussions and Moderated by Dr. Chenven
4:40 PM  

Sponsored by the AACAP Substance Abuse and Addiction Committee and the AACAP Community-Based Systems of Care Committee

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