Priority Health Topic: Mental Health


Objective 13: Reduce the percentage of adolescents (high school students in grades 9-12) who felt sad or hopeless enough every day for 2 weeks or more in a row that they stopped doing some usual activities during the past 12 months

Background & History

Mental health remains a significant concern of Alaskans as outlined by the State Health Assessment. The HA2020 plan included indicators (LHI 8 & 9) on mental health for both adolescents feeling sad and hopeless and adults feeling mentally unhealthy, neither of which met their target for 2020. The HA2030 team decided it was important to keep both indicators in the HA2030 plan to be able to target strategies and actions for both of those age groups. The HA2030 plan strategies also aligned with several statewide plans, such as the Alaska Mental Health Trust’s Comprehensive Integrated Mental Health Program Plan.

Target: 31%

Strategy 1: Provide programs, services and opportunities that support all young people in developing a sense of competence, usefulness, belonging, and empowerment by increasing protective factors and reducing risk factors associated with adolescent depression and suicide.

Sources:

  • https://www.tfah.org/report-details/adsandadolescents/
  • https://www.nap.edu/read/25201/chapter/1
  • https://www.cdc.gov/violenceprevention/pdf/connecting_the_dots-a.pdf
  • https://doi.org/10.1542/peds.2016-1758E
  • https://www.cdc.gov/violenceprevention/childabuseandneglect/aces/fastfact.html,
  • https://safealaskans.org/our-work/tools-resources/, Daphne J. Korczak, D., et al (2017), Johnson K.E. Taliaferro, L.A. (2011), Strandheim A, , et al (2014), Smith, SS (2014)., Daphne J. Korczak, D., et al (2017) Children’s Physical Activity and Depression: A Meta-analysis. Pediatrics. Vol 139, number 4, April 2017 American Academy of Pediatrics DOI: 10.1542/peds.2016-2266, Johnson K.E. Taliaferro, L.A. (2011) Relationships between physical activity and depressive symptoms among middle and older adolescents: a review of the research literature. J. Spec Pediatric Nursing Oct 16 (4) 235-51. . doi: 10.1111/j.1744-6155.2011.00301.x., Strandheim A, , et al (2014) Risk factors for suicidal thoughts in adolescence-a prospective cohort study: the Young-HUNT study BMJ Open 2014;4:e005867. doi: 10.1136/bmjopen-2014-005867, Smith, SS (2014). “The Effects of Physical Activity on Suicidal Ideation in Adolescents” (2014). College of Science and Health Theses and Dissertations. 82.
  • https://via.library.depaul.edu/csh_etd/82, Keles, B., et al, (2019) – A systematic review: the influence of social media on depression, anxiety and psychological distress in adolescents. International Journal of Adolescence and Youth.25(4):1-15 · March 2019 DOI – 10.1080/02673843.2019.1590851, George, M. Editorial (2019) The Importance of Social Media Content for Teens’ Risks for Self-harm. Journal of Adolescent Health. 65 (2019) 9e10 1054-139X/! 2019, Riehm KE, et al. (2019) Associations Between Time Spent Using Social Media and Internalizing and Externalizing Problems Among US Youth. JAMA Psychiatry. Published online September 11, 2019. doi:10.1001/jamapsychiatry.2019., Twenge, J. M., Joiner, T.E., Rogers, M.L., & Martin, G.N. (2018). Increases in depressive symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010 and links to increased new media screen time. Clinical Psychological Science, 6, 3-17. Doi:10.1177/2167702617723376, Twenge, J. M., Martin, G. N., & Campbell, W. K. (2018). Decreases in psychological well-being among American adolescents after 2012 and links to screen time during the rise of smartphone technology. Emotion, 18(6), 765–780.
  • https://doi.org/10.1037/emo0000403, Yalda T. et al. (2017) Benefits and Costs of Social Media in Adolescence Pediatrics November 2017, 140 (Supplement 2) S67-S70; DOI:
  • https://doi.org/10.1542/peds.2016-1758E, Editorial (2019) Youth Social Media Use and Health Outcomes: #diggingdeeper Journal of Adolescent Health. # 64, Quinn, M. (2018) Internet “Challenges” and Teenagers: a Guide for Primary Care Providers. Clinical Advisor, Durbin, J. (2018) Social Media and Adolescents: What Are the Health Risks? Clinical Advisor

Action Step 1

ActionCollaborate prevention efforts with state, Tribal, regional and community organizations utilizing the shared risk and protective factors approach to reduce adolescent depression and suicide
MeasureMeasure is in development. There is a work group that just resumed that is focusing on collaboration of partners for the purpose of utilizing the “Shared Risk and Protective Factors” framework. Almost 40 people attended this, and want to work toward collaborative prevention efforts, and this is the tool that supports that work.
Timeframe2020-2030
Key Partners• Center for Safe Alaskans
• State of Alaska Department of Health and Social Services Division of Public Health, Section of Chronic Disease Prevention and Health Promotion & Office of Substance Misuse & Addiction Prevention
• Alaska Native Tribal Health Consortium
• State of Alaska Department of Health and Social Services Division of Behavioral Health
• Alaska Mental Health Trust Authority
• Alaska Suicide Prevention Council
• Alaska Mental Health Board
• Statewide and regional non-profits and Tribal organizations
• Partnership with the Alaska Association of School Board and the Department of Education and Early Development

Action Step 2

ActionIncrease the protective factors impacting adolescent depression and suicide such as:
• Supportive adults and connections (LHI 17)
• Youth feeling valued and mattering to others (LHI 18)
• Social, emotional competence and self-regulation skills
• Attending a school with a positive climate (safe, supportive and encouraging)
• Participating in quality after-school activities and structured meaningful activities
• Sense of cultural identity and connection
• Regular physical activity (LHI 16)
MeasureBiannual measurement using YRBS.
• Percent of 9-12 grade students who: have 3 or more supportive adults (#93); feel like they matter to others (#96); are able to control their emotions and stay calm when needed (#98, 99); have caring teachers that give a lot of encouragement (#95); participate in out of school activities and clubs(#97).
• Annual measurement using School Climate and Connectedness Survey (SCCS) – although this includes 6-8th graders.
• Percent of 6-12 grade students who report social emotional learning skills (SCCS).
• Percent of 6-12 grade students who have a strong sense of belonging to their culture (SCCS)
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services Division of Public Health, Section of Chronic Disease Prevention Health Promotion & Office of Substance Misuse and Addiction Prevention
• State of Alaska Department of Health and Social Services, Division of Behavioral Health, Prevention and Early Intervention
• Alaska Children’s Trust/Alaska Afterschool Network
• State of Alaska Department of Education and Early Development
• Alaska Mental Health Trust Authority
• Association of Alaska School Boards/ Initiative for Community Engagement
• Center for Safe Alaskans/Anchorage Youth Development Coalition
• Rural Alaska Community Action Program/ Resource Basket
• Regional non-profits and Tribal organizations

Action Step 3

ActionReduce the risk factors associated with adolescent depression and suicide:
• Reduce Adverse Childhood Experiences (ACEs) (See LHI 25)
• Easy access to firearms
• Use of substances (alcohol and other drugs)
• Prior suicide attempts
• Exposure to Violence
• Excessive Screen Time/Social Media usage
MeasurePercent of adolescents (9-12th grade students) who report: attempted suicide in the past year(YRBS #29); use of alcohol in the past 30 days; access to and being ready to fire a gun within 4 hours (YRBS #18); having experienced forced intercourse or other sexual activities or dating, physical/sexual violence(YRBS #19-22); students who use electronics for something that is not school work for 3 or more hours per day (YRBS #83). (See YRBS for exact verbiage, frequency and time duration)
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services Division of Public Health, Section of Chronic Disease Prevention Health Promotion & Office of Substance Misuse and Addiction Prevention
• State of Alaska Department of Health and Social Services, Division of Behavioral Health, Prevention and Early Intervention
• Alaska Children’s Trust/Alaska Afterschool Network
• State of Alaska Department of Education and Early Development
• Alaska Mental Health Trust Authority
• Association of Alaska School Boards/ Initiative for Community Engagement
• Center for Safe Alaskans/Anchorage Youth Development Coalition
• Rural Alaska Community Action Program/ Resource Basket
• Regional non-profits and Tribal organizations
• Division of Vocational Rehab
• Office of Children’s Services

Strategy 2: Identify adolescents at risk of or experiencing severe depression and immediately connect them to trauma-informed/sensitive screening, treatment, and social support services.

In February 2016, the Joint Commission, the accrediting organization for health care programs in hospitals throughout the United States, issued a Sentinel Event Alert recommending that all medical patients in all medical settings (inpatient hospital units, outpatient practices, emergency departments) be screened for suicide risk. Using valid suicide risk screening tools that have been tested in the medical setting and with youth, will help clinicians accurately detect who is at risk and who needs further intervention.

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program ensures that the health needs of children and youth are identified and treated early, before more complex and critical health conditions develop. EPSDT is a federally-mandated Medicaid benefit for all recipients aged 0-21. Comprehensive health screenings, diagnostic services and treatment services, including mental health screenings, are included in the EPSDT program.  The EPSDT program’s focus is on promoting the physical, mental, social, emotional and behavioral health. Services are available to all Medicaid/Denali KidCare-eligibile children, youth and young adults under age 21.  For more information about the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program you can visit: http://dhss.alaska.gov/dhcs/Pages/epsdt_hcs.aspx

Action Step 1

ActionImplement universal screening for suicide risk and depression in all primary, hospital (especially emergency department care), behavioral health, and crisis response settings.
Measure• Increase the number of primary care, hospital, behavioral health and emergency room departments universally screening for suicide risk
• A measurement needs to be developed to track this
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services Division of Behavioral Health
• Alaska Native Tribal Health Consortium
• Tribal Health Organizations
• Alaska Mental Health Trust Authority
• Healthcare organizations in the community

Action Step 2

ActionEncourage all pediatric and primary care practitioners to use trauma sensitive, age and culturally appropriate, evidence based screenings for adolescents eligible for the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Program.
• Comprehensive health screenings, diagnostic services and treatment services, including mental health screenings, are included in the EPSDT program.
MeasureTo be determined
Timeframe2020-2030
Key Partners• State of Alaska Department of Health and Social Services, Division of Health Care Services
• Alaska State Hospital Nursing Association (ASHNA)
• Alaska Primary Care Association

Objective 14: Reduce the mean number of days in the past 30 days adults (aged 18 and older) report being mentally unhealthy

Target: 3.5

Strategy 1: Reduce the impact of mental health and substance use disorders through prevention and early intervention at the individual, family, and community level.

SAMHSA provides an overview of the importance of prevention and the role it can play in reducing the impact of substance use and mental health concerns. https://www.samhsa.gov/find-help/prevention

The National Council for Behavioral Health provides guidance regarding the use of prevention for Substance Use, Misuse, and Addiction Prevention. https://www.thenationalcouncil.org/wp-content/uploads/2017/05/Prevention-Paper-FINAL.pdf?daf=375ateTbd56

http://www.dhss.alaska.gov/Commissioner/Pages/MentalHealth/default.aspx

Action Step 1

ActionPromote help-seeking and reduce stigma and barriers to seeking treatment for mental health issues.
• Maintain and promote the statewide crisis line as a resource available to all Alaskans.
• Support a trauma informed and a culturally and Tribal relevant system
• Develop and support campaigns to educate about mental health and reduce stigma around help-seeking and mental health treatment.
• Provide technical assistance to community wellness coalitions to create and strengthen supportive environments in local communities.
Measure• Increase in the number of contacts received by the Careline
• Increase in number of service participants using outpatient behavioral health services
• Reduce the negative economic impact of alcohol and drug misuse in Alaska
Timeline2020-2030
Measure• State of Alaska, Department of Health and Social Services Division of Behavioral Health
• State of Alaska, Department of Health and Social Services Division of Public Health
• Alaska Mental Health Trust Authority
• Alaska Native Tribal Health Consortium

Action Step 2

ActionSupport the integration of primary and behavioral healthcare systems by increasing the number of primary care providers who have adopted policies and procedures related to early access of care. Examples of this include Screening, Brief Intervention, and Referral to Treatment (SBIRT), routine screening for suicide risk, and utilization of the ASAM level of care instrument in all primary, hospital (especially emergency departments), behavioral health, and crisis response settings.
Measure• Increase the # of sites that have adopted SBIRT
• Increase the # of sites incorporating policy and procedures related to early access of care, and universal screening for suicide risk (2022-2030)
• Percentage of behavioral health/substance use disorder providers trained in the use of level of care/service intensity tools
Timeline2020-2030
Measure• Alaska Native Tribal Health Consortium
• Tribal Health Directors and Tribal Behavioral Health Directors
• Alaska Native Health Board
• Southcentral Foundation
• State of Alaska Department of Health and Social Services Division of Behavioral Health
• State of Alaska Department of Health and Social Services Division of Public Health, Office of Substance Misuse and Addiction Prevention
• Emergency Departments at statewide hospitals
• Alaska Mental Health Trust Authority
• Alaska State Hospital and Nursing Home Association
• Alaska Behavioral Health Association
• Alaska Training Cooperative
• All Alaska Pediatric Partnership
• American Academy of Pediatrics

Action Step 3

ActionIncrease the number of workplaces trained in effective tools and resources for addressing substance misuse in workplace.
Measure# of employer Toolkit trainings held
Timeline2020-2022
Measure• State of Alaska Department of Health and Social Services Division of Public Health Office of Substance Misuse and Addiction Prevention
• State of Alaska Department of Health and Social Services Division of Behavioral Health
• Alaska Mental Health Trust Authority

Action Step 4

ActionIncrease access to continuing education opportunities for healthcare, behavioral health, and public health workforce, i.e. Project ECHO, DEED eLearning modules, mental health first aid, Behavioral Health Aides and Peer Support Certification.
Measure• # of project echo provider trainings
• # of school staff trained – Statewide Suicide Prevention Council
• # MH first aid trainings – Statewide Suicide prevention Council
• # of BHA certifications
• # of Peer support certifications (2022-2030)
Timeline2020-2030
Measure• Alaska Native Tribal Health Consortium (project ECHO)
• Department of Education and Early Development (eLearning modules)
• Alaska Training Cooperative (Mental Health First Aid)
• State of Alaska Department of Health and Social Services Division of Public Health, Office of Substance Misuse and Addiction Prevention
• UAA
• State of Alaska Department of Health and Social Services Division of Behavioral Health
• Alaska Mental Health Trust Authority
• Association of Alaska Schoolboards
• Statewide Suicide Prevention Council

Strategy 2: Improve treatment and recovery support services to reduce the impact of mental health and substance use disorders.

The Substance Abuse Mental Health Services Administration (SAMHSA) developed the National Guidelines for Behavioral Health Crisis Care – A Best Practice Toolkit, Knowledge Informing Transformation. “This National Guidelines for Behavioral Health Crisis Care Best Practice Toolkit (National Guidelines for Crisis Care) responds to SAMHSA’s mission by providing science-based, real-world tested best-practice guidance to the behavioral health field. The Toolkit reflects careful consideration of all relevant clinical and health service research, review of top national program practices and replicable approaches that support best practice implementation.” https://www.samhsa.gov/sites/default/files/national-guidelines-for-behavioral-health-crisis-care-02242020.pdf

National Action Alliance for Suicide Prevention: Crisis Services Task Force. (2016). Crisis now: Transforming services is within our reach. Washington, DC: Education Development Center, Inc.
https://www.thenationalcouncil.org/wp-content/uploads/2017/05/Prevention-Paper-FINAL.pdf?daf=375ateTbd56

Additional information about Alaska’s 1115 Medicaid Waiver Demonstration Project can be accessed at http://dhss.alaska.gov/dbh/Pages/1115/default.aspx .

Action Step 1

ActionExpand mental health and substance use disorder treatment services, as well as community-based recovery supports.
This includes:
• Increase access to community-based crisis intervention and stabilization services;
• Increase access to peer support services for youth, families and adults;
• Expand access to medication assisted treatment and withdrawal management services, particularly ambulatory withdrawal management;
• Improve linkages to care for mental health, substance use disorder treatment, and community supports.
• Expand the use of Assertive Community Treatment in communities with high utilizers of emergency department and inpatient hospital services.
• Expand culturally appropriate wrap-around behavioral health treatment and rehabilitative services where the client is (in vivo) as well as clinic settings
• Increase the coordination of services with Tribal health providers
• Increased use of telemedicine and use of digital and mobile technologies in delivery of mental health and substance use disorder services.
Measure• Increase the # of outpatient service providers in each region offering 1115 MH/SUD services
• Other OPTUM/ASO measures that will be available
Timeline2021-2030
Measure• State of Alaska Department of Health and Social Services Division of Behavioral Health
• Tribal Health Organizations
• Alaska Mental Health Trust Authority
• Healthcare organizations in the community
• Advisory Board on Alcohol and Drug Abuse
• Alaska Mental Health Board
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