> Expert Panel Meeting\
> Older Americans Substance Abuse\
> and Mental Health\
> Technical Assistance Center\
> March 29, 2005

**Meeting Summary**

**August 18, 2005**

TABLE OF Contents

Chapter Page

[I Welcome 1](#__RefHeading___Toc109034621)

[A. Welcome and Introduction 1](#a.-welcome-and-introduction)

[B. Center for Substance Abuse Prevention
1](#b.-center-for-substance-abuse-prevention)

[C. Center for Substance Abuse Treatment
1](#c.-center-for-substance-abuse-treatment)

[D. Office of Policy, Planning, and Budget
1](#d.-office-of-policy-planning-and-budget)

[II INTRODUCTIONS AND OVERVIEW OF CENTER
3](#__RefHeading___Toc109034626)

[A.](#a.-presentation-by-jennifer-solomon-task-order-officer)
Presentation by Jennifer Solomon, Task Order Officer 6

[B. Presentation by Stephen Bartels and Frederic C. Blow, Scientific\
Co-Directors
7](#b.-presentation-by-stephen-bartels-and-frederic-c.-blow-scientific-co-directors)

[III QUESTION AND ANSWER SESSION 11](#__RefHeading___Toc109034629)

IV introduction to SAMHSA\'s NATIONAL REGISTRY OF\
EVIDENCE-BASED PROGRAMS AND PRACTICES 13

V QUESTION AND ANSWER SESSION 15

VI Additional discussion of prevention/early

intervention 17

VII Question and answer
session........................................... 18

VIII overview of goals for breakout sessions 19

IX breakout: small workgroup discussions 23

X reports to full expert panel 24

A. State Breakout Group 24

B. Community Breakout Group 24

C. Provider Breakout Group 25

D. Consumer Breakout Group 25

E. Partnership/Coalition
Development...................................... 27

XI full group discussion 27

Appendix

A AGENDA A-1

B SMALL GROUP BREAKOUTS B-1

Table

1 Product Grid 19

[]{#__RefHeading___Toc109034621 .anchor}I. Welcome

# A. Welcome and Introduction

Jennifer Solomon, MA (Public Health Analyst, the Center for Substance
Abuse Prevention \[CSAP\]) of the Substance Abuse and Mental Health
Services Administration (SAMHSA) serves as Task Order Officer of the
Older Americans Substance Abuse and Mental Health Technical Assistance
Center. The Expert Panel was convened on March 29, 2005, to provide
guidance to the Center. The meeting was held at the SAMHSA offices in
Rockville, Maryland. Jennifer Solomon brought the Expert Panel meeting
to order at 9:00 a.m. The meeting began with several executive level
briefings.

# B. Center for Substance Abuse Prevention 

Jennifer Solomon introduced Bob Stephenson, MPH, Acting Deputy Director
of CSAP. Bob Stephenson reported that he was serving as the
representative for Beverly Watts Davis, the Director of CSAP, who was
unable to attend the meeting. As Director of Workplace Programs at CSAP,
Bob Stephenson stated that he is always looking for more effective---and
more cost-effective---ways to prevent substance abuse. The Center has
great promise to assist in this effort.

# C. Center for Substance Abuse Treatment 

Richard Kopanda, Deputy Director of the Center for Substance Abuse
Treatment (CSAT), then spoke. He welcomed the Expert Panel members on
behalf of H. Westley Clark, MD, JD, MPH, Director of CSAT.

# D. Office of Policy, Planning, and Budget 

Daryl Kade, MA, Associate Administrator of SAMHSA's Office of Policy,
Planning and Budget, and older adult matrix lead, reviewed the process
of setting priorities in the agency. The process is based on the Matrix
of Programs and Principles, which contains 11 priority areas, one of
which is Older Adults. The priority areas include:

-   Mental Health System Transformation

-   Strategic Prevention Framework

-   Substance Abuse Treatment Capacity

-   Children and Families

-   Seclusion and Restraint

-   Co-occurring Disorders

-   Disaster Readiness and Response

-   Homelessness

-   HIV/AIDS and Hepatitis

-   Criminal and Juvenile Justice

-   Older Adults

[]{#__RefHeading___Toc109034626 .anchor}II. INTRODUCTIONS AND OVERVIEW
OF CENTER

# A. Presentation by Jennifer Solomon, Task Order Officer

#### 

#### INTRODUCTIONS OF ATTENDEES

Jennifer Solomon asked each member of the Expert Panel, Federal
representatives, and other attendees to identify him or herself briefly.

####  

-   Nancy S. Bohman

    Retired teacher and community activist\
    Board of Directors of San Antonio Fighting Back

-   Carol Colleran, CAP\
    Executive Vice President of Public Policy and National Affairs

    Hanley Center

-   Carol D\'Agostino, CSW, CASAC\
    Director

    Geriatric Addictions Program

    LIFESPAN of Greater Rochester

-   Gayathri Dowling, PhD\
    Deputy Branch Chief\
    Science Policy Branch in the Office of Science Policy and
    Communications, National Institute of Drug Abuse, National
    Institutes of Health

-   Larry Dupree, PhD\
    Chair

    Department of Aging and Mental Health\
    Louis de la Parte Florida Mental Health Institute

-   Jim Firman, EdD, MBA\
    President

    National Council on the Aging

-   R. Turner Goins, PhD\
    Associate Professor\
    Department of Community Medicine and Associate Director for Research
    at the Center on Aging, School of Medicine

    West Virginia University

-   Catherine Gordon, RN, MBA\
    Senior Public Health Analyst\
    Office of the Director

    Centers for Disease Control and Prevention

-   Mary Guthrie\
    Acting Director\
    Center for Planning and Policy Development

    U.S. Administration on Aging

-   Kevin Ann Huckshorn, RN, MSN, CAP\
    Director\
    Office of Technical Assistance and National Technical Assistance
    Center

    National Association of State Mental Health Program Directors

-   Julie E. Jensen, PhD\
    Director

    Washington Institute

-   Denise Juliano-Bult, MSW

    Chief

    Systems Research Branch in the Division of Services and Intervention
    Research National Institute of Mental Health, National Institutes of
    Health

-   Christopher A. Langston, PhD\
    Senior Program Officer\
    John A. Hartford Foundation, Inc.

-   David Oslin, MD\
    Assistant Professor of Psychiatry

    University of Pennsylvania Medical Center and the Philadelphia
    Veterans Hospital

-   Louise Quijano, MSW\
    Doctoral Candidate

    Baylor College of Medicine

-   Marcia Scott, PhD\
    Division of Epidemiology and Prevention Research

    National Institute on Alcohol Abuse and Alcoholism, National
    Institutes of Health

-   John Shipherd\
    New York State Office of Alcoholism and Substance Abuse Services

**[Substance Abuse and Mental Health Services
Administration]{.underline}**

Joe Gfroerer

Ingrid Goldstrom, MSc

Kevin Hennessy, PhD

Betsy McDonel Herr, PhD

Daryl Kade, MA

Richard Kopanda

Stephen LeBlanc

Lisa Park, MSW, Alternate Task Order Officer

Pamela Roddy, PhD

Jennifer Solomon, MA, Task Order Officer

Bob Stephenson, MPH

Paul Wohlford, PhD

**[The U.S. Administration on Aging]{.underline}**

Diana Lawry, MEd

Katrina Morgan, MHS

**[The National Council on the Aging]{.underline}**

Alixe McNeill, MPA

Nancy Whitelaw, PhD

**[Westat/Center Staff]{.underline}**

Stephen Bartels, MD, MS, Scientific Co-Director

Frederic C. Blow, PhD, Scientific Co-Director

Laurie Brockmann, Research Assistant

Dianne McElroy, MA, Project Manager

Garrett Moran, PhD, Corporate Monitor

Rebekah Muck, Research Associate

Lisa Patton, PhD, Project Director

Aricca Van Citters, Research Assistant

Two invited and confirmed members were unable to attend the meeting.

# OVERVIEW OF THE OLDER AMERICAN SUBSTANCE ABUSE AND MENTAL HEALTH TECHNICAL ASSISTANCE CENTER

Jennifer Solomon then presented an overview of the Center's mission:

To enhance the quality of life and promote the physical and mental
well-being of older Americans by reducing the risk for and incidence of
substance abuse/misuse and mental health issues late in life.

The Center's overarching goal is to create sustainable changes in the
field of geriatrics around substance abuse and mental health, for
recognizing and planning for these issues. Its key activities include:

-   Helping States develop State plans for substance abuse and mental
    health.

-   Identifying evidenced-based programs for older adults on substance
    abuse, mental health, health promotion, and health education.

-   Offering training and technical assistance to States, communities,
    and health and social service providers.

The Expert Panel, in turn, will play the vital role of helping narrow
the objectives and define specific products and processes that will help
the Center achieve its mission. The objectives of the Expert Panel
meeting were to:

-   Familiarize the Expert Panel with the Center's priorities, goals,
    and objectives.

-   Identify priority areas for technical assistance and training.

In terms of expected accomplishments for the meeting, it is anticipated
that center staff and SAMHSA will be able to use the expertise of the
Expert Panel regarding advice and guidance on how best to develop, plan,
communicate, and disseminate information on a range of issues related to
substance abuse and mental health programs and initiatives for older
adults.

The Center will form and maintain partnerships with a variety of other
organizations to identify and disseminate evidence-based programs and
help to develop substance abuse and mental health State plans for older
adults. These organizations include:

-   The U.S. Administration on Aging.

-   State and territorial aging, mental health, and substance abuse
    agencies.

-   Other SAMHSA Technical Assistance Centers, such as the Centers for
    the Application of Prevention Technologies and the Addiction
    Technology Transfer Center Network.

-   The National Council on the Aging.

-   Professional associations.

The Center will have a regularly updated web site, where mental health
and substance abuse consumers and providers may find resources,
including effective programs, training activities, professional
conferences, and links to other aging-related web sites. It will also
have a quarterly electronic communication containing professional
articles, highlights of successful programs and practices, and the most
current behavioral health information on the needs of older Americans.
Jennifer Solomon concluded by stressing the importance of the Center's
mission and the recommendations of the Expert Panel.

Jennifer Solomon briefly reviewed SAMHSA's progress to date in
addressing the needs of older citizens. Demographic trends are clear. As
the baby boomers grow older they will challenge the nation's system for
caring for those with substance abuse and mental health issues. The
sheer numbers of baby boomers, as well as their longevity and specific
drug-abusing behavior, will create systemic challenges unseen in the
past. In helping assess these trends, she said, the Center's Scientific
Co-Directors, led by Frederic Blow, PhD, of the University of Michigan,
and Stephen Bartels, MD, MS**,** of Dartmouth University, has been
invaluable. Lisa Patton, PhD, of Westat, serves as Project Director.

# B. Presentation by Stephen Bartels and Frederic C. Blow, Scientific Co-Directors

Jennifer Solomon introduced Stephen Bartels and Frederic Blow,
Scientific Co-Directors for the Center, who gave their presentation
jointly. In thinking about preventing substance abuse and addressing
mental health needs**,** it is critical to note that the expected
increase in the numbers of older citizens will result in a concomitant
increase in substance abuse and mental illness among the elderly. Older
adults' overall health and functioning will be adversely affected by
both substance abuse and mental illness. Further, the total financial
cost for addressing or failing to adequately address these issues will
rise significantly. Prevention messages need to be tailored to address
older adults' particular needs.

Rates of depression and anxiety among older adults differ depending on
the setting. For example, fewer than 5 percent of those over 55 living
in the community report major depression, compared to 7 percent in
primary care settings, and 4 percent to 15 percent in nursing homes.
Depressive symptoms have been reported at rates ranging from 3 percent
to 26 percent in the community, 7 percent to 12 percent in primary care
settings, and 16 percent to 30 percent in nursing home populations. With
anxiety disorders, we see rates of 2 percent to 12 percent in community
samples, with generalized anxiety disorder and phobias most common.
Anxiety symptoms are found in up to 24 percent of older adults in the
community and more than 40 percent in hospital settings. To some degree,
prisons and nursing homes have become the new mental hospitals.

Alcohol poses greater risks for older adults as compared to younger
adults because it interacts with other drugs (both prescription and over
the counter) and can have unpredictable effects in combination with
these drugs. Studies suggest the following rates of substance abuse
among older adults:

-   Alcohol: 2--18 percent.

-   Psychoactive Prescription Drugs: 2--4 percent.

-   Other Illegal Drugs (marijuana, cocaine, narcotics): less than 1
    percent.

In 2002, more than 616,000 adults age 55 or older reported alcohol
dependence in the past year. Alcohol misuse (binge and heavy drinking)
is the area of greatest concern among this population. There are some
indications that baby boomers are likely to retain previous patterns of
drug use established by their particular age groups. Thus, abuse of
cocaine, marijuana, and narcotics among older adults is expected to rise
substantially over the next few years, along with abuse of multiple
drugs simultaneously.

In recent years, discussion regarding the importance of identifying and
disseminating evidence-based practices (EBPs) has been at the forefront
for SAMHSA, other government agencies, and industry. Social scientists
have been called upon to examine measurable performance standards and,
of particular importance to this group, to increase knowledge regarding
successful techniques for addressing substance abuse and mental health
issues. For example, in the areas of the prevention and early
intervention of substance abuse, EBPs include brief alcohol
interventions, conducted both in health clinic and home settings. Brief
alcohol interventions have been shown to reduce alcohol use among older
adults for at least 12 months and seem to reduce alcohol-related harm
and health care utilization during that same timeframe.

Different models of mental health services, including Integrated Mental
Health Services in Primary Care and Community Multidisciplinary Outreach
Services, have been examined. Several evidence-based treatment
interventions have been developed for older adults with depression. In
addition, EBPs have been developed for prevention and early intervention
of co-occurring disorders. EBPs, which have been established largely for
younger persons, must be translated to older persons, for example, in
the Integrated Dual Diagnosis Treatment model.

Technical assistance and on-site training are regarded as highly
important by most State mental health program directors. Nearly 90
percent, when surveyed, call technical assistance and training either
"very" or "extremely" important. By similar margins, they favor
dissemination of EBPs for older adults along with greater funding for
such endeavors.

On the basis of these survey findings, the top two priorities for the
Center should be:

-   Providing technical assistance with respect to the prevention and
    early intervention of substance abuse, medication misuse and abuse,
    mental health disorders, and co-occurring disorders.

-   Disseminating and implementing evidence-based and promising
    practices.

Target audiences include States, policymakers, community leaders,
organizational and administrative leadership, providers, health care
practitioners and service providers, consumers, and older adults and
their caregivers, families and concerned others.

For the past few years, SAMHSA has maintained a national registry of
effective programs and practices, called the National Registry of
Evidence-based Programs and Practices (NREPP). Through the Center,
programs may be nominated to NREPP through the following procedure:

-   The U.S. Administration on Aging and other partner organizations
    provide candidate NREPP programs.

-   The staff of the Center (two or three members) conducts an initial
    review.

-   The Center determines if the program is ready for NREPP nomination.

-   Where gaps or deficits are identified, Center staff offer support
    and linkages to further technical assistance.

Programs that do not make the final cut will receive review information
on areas to improve, as well as technical assistance regarding these
needs. Programs will be encouraged to reapply as appropriate. Kevin
Hennessy, SAMHSA's Science to Service Coordinator, later provided the
Expert Panel with a thorough overview of the NREPP.

[]{#__RefHeading___Toc109034629 .anchor}III. QUESTION AND ANSWER SESSION

**Q.** Jim Firman asked how the NREPP system will distinguish medication
abuse from issues related to medication interactions, underuse of
medication, and other medication problems.

**A.** Frederic Blow answered that that remains to be defined.

**A.** Stephen Bartels agreed that EBPs in these areas has not been
consistently defined. Varying levels of rigor exist across programs and
practices and the evaluations conducted. "Promising practices" and
"value-based practices," such as peer support, must also be considered.

**Q.** Nancy Bohman asked how the Center will be able to identify all of
the elderly in the community, ensuring that elderly consumers' needs are
properly met.

**A.** Frederic Blow answered that the Center's focus is not primarily
individuals but rather State and community-level providers, with an
emphasis on substance abuse prevention rather than treatment.

**Q.** Denise Juliano-Bult asked whether the Center will do extension
services (on the model of the agricultural extension), which have proven
valuable at NIMH.

**A.** Frederic Blow and Stephen Bartels agreed that the Center should
consider using this model.

**Q.** Catherine Gordon asked for clarification about the Center's
budget.

**A.** Jennifer Solomon responded that the budget is limited, and this
is another critical reason for the Center to focus on
relationship-building and leveraging all possible resources. Jennifer
Solomon also noted that simply establishing the Center and its Expert
Panel is a positive move and that generating more knowledge in the area
of older adults is critical.

**A.** Frederic Blow added that the Center staff needs the Expert
Panel's help in terms of relationship-building and effectively enhancing
capacity.

**A.** Stephen Bartels added that there is newfound recognition for the
importance of addressing the substance abuse and mental health needs of
this population. The need for extensive social marketing is gone.
However, States are cutting funding in these areas. EBPs in the areas of
substance abuse prevention and early intervention can help serve to
expand limited resources.

**A.** Kevin Huckshorn pointed out that one can have great success in
putting together communities of interest in the States.

**Q.** Denise Juliano-Bult asked what the age threshold for the Center
is.

**A.** Jennifer Solomon stated fifty-five and up, although there is
still opportunity to discuss whether that should be changed.

**A.** Frederic Blow suggested that perhaps the age should be even
younger in order to coordinate with retirement planning.

**A.** Stephen Bartels pointed out that no matter where you make the
cut, the cohort of baby boomers is huge.

**Q.** Jim Firman asked what would constitute success for the Center
noting that, with a limited budget, success must be defined very
carefully.

**A.** Stephen Bartels agreed, stating that we need the Expert Panel's
advice on the scope. The value of the Center will be judged on its
products.

The group turned to a discussion of the need for clear definitions.

-   David Oslin said that it is important to define everything
    carefully. The standards of EBPs first of all must be very clear.
    Second, the interventions that the Center will focus on need to be
    defined. What are the models? Do they include treatment?

-   Nancy Bohman added that you need to identify the interface between
    interventions at different levels - individual, provider, community.

-   Julie Jensen added that Gatekeeper programs are the main early
    interventionists. Connections to services help to avoid more
    negative outcomes. Prevention needs to begin as early as possible.

-   Turner Goins stated that the distinction between prevention and
    early intervention needs to be made clear.

-   Marcia Scott noted that speaking the language of the service
    providers is critical.

**IV. Introduction to SAMHSA's National Registry of Evidence-based
Programs and Practices**

Jennifer Solomon introduced Kevin Hennessy, SAMHSA's Science to Service
Coordinator, who reviewed the history and status of the NREPP process,
which is intended to be "a voluntary rating and classification system
for substance abuse and mental health prevention and treatment
interventions." SAMHSA's vision, Kevin Hennessy said, is for "NREPP to
become a leading national resource for contemporary and reliable
information on the scientific basis and practicality of substance abuse
and mental health prevention and treatment interventions." This will
serve to support the successful replication of these approaches
nationwide. NREPP is being branded as a signature SAMHSA product, and
the new version will be launched in fall 2005.

NREPP was launched in 1998 by SAMHSA's Center for Substance Abuse
Prevention, as the National Registry of Effective Prevention Programs.
Over the next 5 years it reviewed and rated about 1,100 substance abuse
prevention programs, and offered information on more than 150 of them on
the website. In 2004, NREPP was expanded to include substance abuse
treatment and mental health promotion and treatment programs. An
evaluation process determines if the program is appropriate for
dissemination to the field and is rated by three qualified independent
reviewers who base their scores on scientific merit and utility.
Programs receiving an NREPP rating fall into one of four categories: (1)
Program or Practice of Interest (2) Emerging (3) Conditionally Effective
and (4) Effective Program or Practice. The numbering was set up to
reflect a range of scores assigned when reviewing each individual
outcome measure (0-4, with 0 being no evidence and 4 being the highest).
A recent revision of NREPP offers many opportunities for expanded
inclusion of older adult programs into the new NREPP.

NREPP will have several purposes including the following:

-   To influence SAMHSA discretionary and block grant investments.

-   To serve as a resource for States and communities seeking to
    implement evidence-based mental health and substance abuse
    prevention and treatment services.

-   To provide an important tool for public and private purchasers in
    selection of effective services.

The new NREPP system is expected to be fully transparent to its target
audience. The revamped NREPP criteria include detailed ratings on 19
different factors. NREPP is intended to become a primary source of
information on the strength of evidence in support of substance
abuse/mental health promotion, prevention and treatment programs and
practices.

Kevin Hennessy said that he is excited to collaborate with the Center
and that it can play a key role by helping to identify quality programs
for NREPP review.

V. Question and Answer Session

**Q.** The first set of questions was directed to Kevin Hennessy of
SAMHSA. Christopher Langston asked Kevin Hennessy what he could say
about the distribution of ratings in the original NREPP since he had
stated that they were not precise enough.

**A.** The old version had too many programs that fell into the
"effective" category (the middle ranking).

**Q.** Kevin Ann Huckshorn asked whether the NREPP contains proprietary
programs.

**A.** Yes.

**Q.** Jim Firman suggested that the Center promote dissemination or
diffusion of good ideas and products. It may be possible to see effects
before and after particular activities and programs are put into place.

**A.** The NREPP is basically designed to identify individual programs
but meta-analysis could expose patterns of programs that work well.

**Q.** Jim Firman asked whether SAMHSA's information toolkits might be
mentioned as a model.

**A.** Yes, the "Get Connected! Toolkit" was developed by SAMHSA and the
National Council on the Aging and is available for distribution.

**Q.** Julie Jensen said that when she has a request for information on
her program, which is part of NREPP, she hands out large numbers of the
"Get Connected! Toolkit." However, few people know about the toolkit and
it needs to be promoted, particularly for clinicians working with older
adults.

**A.** The new version of NREPP should make it easier to find
information of this kind.

**Q.** Nancy Bohman stressed the importance of information that is easy
to understand and tailored to different classes of users, such as
consumers and clinicians.

**A.** Each program will be classified according to appropriate users,
Kevin Hennessy answered. Practical information about how to get on the
NREPP will also be available to interested programs.

The session continued with discussion regarding other topics.

**Q.** Catherine Gordon said that the Centers for Disease Control and
Prevention is running a 2-year evidence-based review of depression
treatments.

**A.** Jennifer Solomon stated that she is aware of this work.

**A.** Kevin Hennessy said he, too, is aware of it, since he sits on the
"investors group."

**Q.** Another panel member suggested that funds are needed to support
the NREPP submission process.

**A.** Kevin Hennessy answered that Westat will be the source of some
free technical assistance. Once the new NREPP web site is up, it will be
fairly easy to use.

**A.** Jennifer Solomon stressed the need to have basic "how-to"
information on EBPs and how to use them.

**A.** Lisa Patton promised the group that the Center is looking for all
relevant programs.

**Q.** Larry Dupree asked what makes the Center unique and asked to have
the Center's role defined.

**A.** Stephen Bartels replied that developing the Center identity and
role is part of what is needed from the Expert Panel.

VI\. Additional Discussion of Prevention/Early Intervention

In a departure from the schedule, Stephen Bartels and Frederic Blow
discussed the options for additional early intervention and prevention
training resources. They displayed a graphic (drawn from the later
session on "Overview of Goals for Breakout Sessions") headed
"Prevention/Early Intervention Curriculum."

Stephen Bartels pointed out that the Center's scope will include early
interventions and prevention, as well as treatment and health services.
This broad scope presents an organizational challenge. The jointly
developed and supported SAMHSA, the National Council on the Aging and
the U.S. Administration on Aging "Get Connected! Toolkit" and associated
materials can serve as models for developing training curricula in the
area of early intervention and might be replicated in this case.

Frederic Blow added that we need to look at the risks of substance abuse
and mental health problems throughout the life course and how to be
innovative in working with older adults.

Stephen Bartels posed several questions, including where should the
Center be in three years? What are the objectives that are relatively
easily obtained and what requires a longer-term perspective?

VII\. question and answer session

**Q.** R. Turner Goins asked what prevention means. It is a semantics
problem.

**Q.** Louise Quijano asked if we might bring pieces of treatment closer
to referral.

The questions are open to further investigation and/or discussion. The
following brainstorming comments were made with regard to the prevention
and early intervention.

**C.** Carol Colleran commented that it is difficult to do prevention
and early intervention without also doing treatment.

**C.** Julie Jensen remarked that early intervention is the gatekeeper
to the prevention of worse outcomes, based on connecting to service and
individualized need.

**C.** Christopher Langston observed that it is hard to think about
prevention and not treatment. It is also hard to think about prevention
starting at age 55.

**C.** Kevin Hennessy suggested thinking about it in terms of the
prevention framework (i.e., universal, selective, indicated).

**C.** Denise Juliano-Bult added that early intervention might be a
gatekeeper model---the intervention is actually getting people together.

**C.** Marcia Scott stressed that there is a need to develop and define
a vocabulary to transcend information to target audiences.

**C.** David Oslin noted that some of the terms are very charged.

VIII\. Overview of Goals for Breakout Sessions

Since the group was to form four parallel breakout groups (to discuss
the State, Community, Providers, and Consumers) later in the afternoon,
Stephen Bartels and Frederic Blow led a discussion regarding the
objectives of the breakout discussions. To shape the discussion, they
introduced a matrix labeled "Product Grid" (Table 1). The Product Grid
was introduced as a discussion guide to be used to prompt thinking in
each of these areas and to solicit ideas regarding recommendations in
these areas. Each of the four breakout groups was asked to consider
recommendations in the areas of State/Agency Planning and
Implementation, Development and Dissemination of Resources, and
Promotion of Resources and Enhancement of Partnerships.

Table 1. Product Grid

  ----------------- ------------------ ----------------- -----------------
                    **State/Agency     **Develop and     **Promote
                    Planning and       Disseminate       Resources and
                    Implementation**   Resources**       Enhance
                                                         Partnerships**

  **State**                                              

  **Community**                                          

  **Providers**                                          

  **Consumers**                                          
  ----------------- ------------------ ----------------- -----------------

Priorities for the new Center, Stephen Bartels and Frederic Blow
proposed, should be to provide technical assistance with respect to (a)
prevention and early intervention of substance abuse; medication misuse
and abuse; mental health disorders; co-occurring disorders and (b)
dissemination and implementation of evidence-based and promising
practices**.**

The Scientific Co-Directors acknowledged that State and agency plans are
highly variable and should be assessed individually. They concluded with
a series of specific discussion questions, keyed to the specific
headings found in the product matrix.

**State/Agency Planning and Implementation**

-   What initiatives will best promote State planning and implementation
    of prevention and early intervention strategies?

-   What communication mechanisms need to be set up to encourage and
    facilitate planning?

-   Who should be contacted in order to engage States/agencies in
    adapting initiatives to plan and implement evidence-based prevention
    and early intervention strategies?

-   What are the short-term and long-term approaches to meeting these
    priorities?

**Develop and Disseminate Resources**

-   What products should be developed at these different levels to
    address prevention and early intervention?

-   What media or communication mechanisms should be utilized to
    disseminate resources?

-   Who are the primary targets for these materials?

-   What are the short-term and long-term approaches to meeting these
    priorities?

**Promote Resources and Enhance Partnerships**

-   What initiatives will best promote partnerships in developing early
    intervention?

-   What communication mechanisms need to be established to promote
    partnerships?

-   What are the primary constituencies that should be targeted in order
    to promote resources and enhance partnerships?

-   What are the short-term and long-term approaches to meeting these
    priorities?

Frederic Blow concluded by reminding the group that they can provide
valuable help by describing specific lessons learned from other
projects. After a brief review of the agenda for the rest of day, he
stressed a final question: "If we can produce only three "deliverables"
in the next year, what should they be?" Pre-breakout discussion and
recommendations followed.

**Pre-Breakout Discussion**

-   Carol D'Agostino said the problem is basic access.

-   Frederic Blow responded that you need to document that early
    intervention and prevention are possible and cost-effective.

-   Christopher Langston agreed that it is important to document how the
    system works.

-   Denise Juliano-Bult asked, on the State level, what agencies should
    be involved? NIMH has just contacted all of the children's programs
    of mental health and substance abuse.

-   Larry Dupree suggested that training should be focused to help
    inform the State officials that matter.

-   Nancy Whitelaw asked who the Center's target audience is. We can
    document the effectiveness and cost-effectiveness of particular
    States and give them a greater number of evidence-based programs to
    use.

-   Kevin Ann Huckshorn asked what specific target we should have in
    mind. Stephen Bartels replied that we should examine the two or
    three programs with the greatest payoff.

-   Julie Jensen stated that, in Washington, as in other States, you
    need to build continuity and consensus among the main players,
    because policymakers have a variety of things competing for their
    attention. It needs top-level attention. Stephen Bartels agreed. You
    can boil it down to "Depression is diabetes." We need to make those
    cases.

-   Larry Dupree said that in 2002 (for the President's New Freedom
    Commission on Mental Health) we looked at Florida's health plan. In
    most States there is no policy on the elderly.

-   Carol Colleran suggested that we need to develop screening
    instruments, for use by low-cost personnel (triage nurses at
    emergency rooms, for example). The language is key. Asking "Do you
    have an alcohol problem?" can be too direct.

-   Christopher Langston agreed. In addition, he said general medical
    centers need to be involved. People age 65 and over have Medicare.
    Stephen Bartels also agreed, adding that there's a "Welcome to
    Medicare" assessment that should be used to identify problems.

-   Betsy McDonel Herr suggested that the Center can dovetail with other
    SAMHSA products, such as the Center for Mental Health Services, and
    various SAMHSA toolkits (including the Get Connected! Toolkit).

-   Catherine Gordon said she is struck by the number of elderly who end
    up in primary care without being screened previously for mental
    health and substance problems. Personnel there need help with simple
    screening tools.

-   David Oslin said the "Welcome to Medicare" assessment could be used
    as a screening tool. The physician or physician's assistant in those
    situations should be targeted with information.

-   Marcia Scott suggested that State agencies be given well-crafted
    information on screening techniques.

-   Carol D'Agostino suggested that personnel there be given simple
    algorithms to screen more complex combinations of mental health and
    substance abuse problems.

-   Julie Jensen said it takes only one person per State to make a
    difference, but identifying and reaching that person is hard.

Stephen Bartels summarized the foregoing by suggesting the following:

1.  State organizations are critical.

2.  Medical providers are a critical link (e.g., Medicare).

3.  General purpose screening (some algorithm to screen comorbidities of
    alcohol, drugs and depression) should be a goal.

IX\. Breakout: Small Workgroup Discussions

From 1:15 to 3:15 p.m., the Expert Panel members met in four separate
breakout groups (Breakout Group members and facilitators can be found in
Appendix B). Each breakout group discussed their separate topics (State,
community, providers, and consumers) before reconvening to report their
findings to the group.

X. Reports to Full Expert Panel

After the full group reconvened, each of the four breakout groups
presented highlights from their discussions. Some groups chose to follow
the grid format while others chose not to use the grid.

**A. State Breakout Group**

-   Recommendations:

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-   Provision of technical assistance to Federal and State policymakers.

-   Development and testing of State and/or multistate approaches.

-   Support of ongoing followup by State teams, to include a series of
    focus groups with State leaders to determine needs and provide
    training.

-   The identification of EBPs that can have the greatest impact on the
    largest number of older adults, i.e., practices and programs, that
    are fairly low-cost and can be readily implemented in a range of
    communities.

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-   The Center should engage policymakers and providers at the Federal
    and State levels in several ways:

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-   Developing consensus statements about standards of care.

-   Producing and carrying out focus groups with State officials to
    identify multistate needs.

-   Conducting pilot tests to accelerate the adoption of new approaches.

-   Continually revising the menu of technical assistance products and
    services.

-   Conducting internal reviews of its strategies for responding to
    requests.

B.  **CoMMUNITY Breakout Group**

-   The Center should develop and test several products:

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-   Clear presentations (in a variety of media), informing audiences of
    the key points of substance abuse and mental health issues for older
    adults. The use of actual case studies can serve to make the
    presentations as realistic and as engaging as possible.

-   The Center web site should offer interactive tools to test
    consumers' risks of drug interactions and other problems. (A
    "Medication Management Wizard" might be one example.) Feedback from
    web site users should be encouraged.

-   Information on local, State, and regional programs that have been
    screened by the NREPP system.

C.  **Provider Breakout Group**

The provider breakout group recommended that the Center focus on
informational products, appropriate to an array of audiences and focused
on a range of topics.

-   Four products were recommended:

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-   Technical reports in the Center's newsletter.

-   Brochures and posters for professionals at all levels of the system,
    alerting them to screening opportunities such as the "Welcome to
    Medicare" assessment.

-   Lists of active partnering organizations such as providers (e.g.,
    American Association of Retired Persons, National Association of
    Social Workers).

-   A systematic scan/review of prevention/early intervention tools,
    including screening of the NREPP.

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-   Additional Recommendations:

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-   Help develop user-friendly, informative documents appropriate to a
    range of medical, substance abuse, and mental health professionals.

-   Highlight the simplest approaches, sensitive to the time and
    financial pressures of medical providers.

-   Systematically review prevention/early intervention tools and
    screening alternatives.

-   Identify and support programs through the NREPP process, promoting
    accepted programs throughout the country.

D.  **CONSUMER BREAKOUT GROUP**

-   Two products were recommended:

    -   A briefing paper on senior advocacy groups promoting mental
        health and preventing substance abuse.

    -   Technical assistance to State governments and State consumer
        organizations around mental health and substance abuse efforts.

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-   Additional Recommendations:

    -   "Did You Know" and anti-stigma campaign that address stigma
        reduction and knowledge development among the target population.

    -   Medicare Management Wizard provides easily accessible on-line
        assistance to identify the use of interactions of medications
        among older adults.

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-   Potential partners:

    -   American Association of Retired Persons

    -   National Council on the Aging

    -   Pharmaceutical companies

    -   U.S. Administration on Aging

    -   Professional organizations

        **E. PARTNERSHIP/COALITION DEVELOPMENT**

        The overarching issue of partnership or coalition development
        was also addressed by the Expert Panel. For the sake of
        cost-effectiveness, the Center must take advantage of the widest
        possible network of organizations in the public, private, and
        nonprofit sector.

Strategically, the Center should work to promote partnerships through:

-   Staff presenting at conferences.

-   Disseminating existing resources for States and local providers of
    services.

-   Brokering knowledge of aging.

Potential partners include:

-   The National Institute on Alcohol Abuse and Alcoholism (NIAAA),
    which has a variety of effective teaching materials and curricula
    aimed at discouraging underage drinking. These materials and methods
    could be adapted to meet the needs of the target population of older
    adults.

-   The National Association of Social Workers, among other professional
    associations, includes many members who provide services to the
    aging.

-   Other Federal agencies such as the Centers for Medicare and Medicaid
    Services of the U.S. Department of Health and Human Services have
    much to contribute in both knowledge and resources.

-   Other recommended partners include the American Association of
    Retired Persons, the American Society of Addiction Medicine , and a
    wide range of professional associations.

The Center should offer:

-   Clear information on how to access its services.

-   Clear information regarding how the Center will respond to requests.

-   Provision of technical assistance materials to help users get the
    most out of the evidence-based programs and practices that the
    Center will be identifying and promoting.

XI\. Full Group Discussion

**Post-Breakout Discussion**

The Expert Panel discussed the breakout presentations and other critical
elements of the Older Americans Center and its role.

-   Nancy Whitelaw suggested that an important product would be a review
    of solid evidence for NREPP. Stephen Bartels agreed. It is necessary
    to capture a systematic, thorough review of the evidence base for
    prevention/early intervention for substance abuse and mental health
    in the case of older adults. For example, you might: (a) "grade"
    level of evidence; (b) take advantage of existing reviews (e.g.,
    screening); and (c) do a literature review article/monograph as the
    main product.

-   Carol D'Agostino asked for a definition of "prevention." Is it well
    enough defined? Stephen Bartels replied that policy analysts
    distinguish "prevention" from "early intervention." The latter is on
    a stronger footing.

-   Carol D'Agostino then asked if "coalitions" are synonymous with
    "partnerships." Carol Colleran said she finds partnerships a more
    inviting term, since it implies equality. David Oslin opined that
    there are several kinds of partnerships/coalitions.

-   Carol D'Agostino pointed out that the NIAAA social work curriculum
    recommended in the "Building Partnerships and Coalitions" breakout
    group is something that already exists for training purposes.

-   David Oslin thought the web-based interface for "Welcome to
    Medicare" providers to use was promising. Julie Jensen agreed and
    suggested steering geriatric medical centers in that direction.

-   The breakout group on "Involving State and Federal Policymakers" had
    pointed to the need to rethink the Center's strategy for responding
    to requests for information from States and providers.

-   Nancy Whitelaw stated that the Center, with its small staff, needs
    to have an explicit strategy for answering requests for information.
    Lisa Patton agreed that the Center tries to identify specific EBPs
    with the greatest impact.

-   Stephen Bartels said we have to decide what our strategy for
    responding is. We are not a data warehouse.

**Next Steps**

Jennifer Solomon asked Stephen Bartels to review the final agenda items:
The three concrete measures that will set the pace for the Center and
its many partners.

1.  *Summary of Recommendations.* Prepare a summary of the Expert
    Panel's recommendations.

2.  *Comments on Summary.* Distribute the Expert Panel summary.

3.  *Center Strategic Plan.* The Center's strategic plan will key into
    the SAMHSA plan, and spell out in measurable terms its goals and
    objectives and resources.

Jennifer Solomon adjourned the meeting at 5:00 p.m.

Appendix A. Agenda

+---------------+------------------------------------------------------+
| **8:30 a.m.** | **Shuttles Arrive at SAMHSA**                        |
+---------------+------------------------------------------------------+
| **8:30 -      | **Continental Breakfast**                            |
| 9:00**        |                                                      |
+---------------+------------------------------------------------------+
| **9:00 -      | **Welcome**                                          |
| 9:40**        |                                                      |
|               | Beverly Watts Davis, Director, CSAP                  |
|               |                                                      |
|               | Daryl Kade, Director, Office of Policy, Planning and |
|               | Budget                                               |
|               |                                                      |
|               | Richard Kopanda, Deputy Director, CSAT               |
+---------------+------------------------------------------------------+
| **9:40 -      | **Introductions and Overview of Center**             |
| 10:30**       |                                                      |
|               | Jennifer Solomon, Task Order Officer                 |
|               |                                                      |
|               | Lisa Park, Alternate Task Order Officer              |
|               |                                                      |
|               | Fred Blow, Scientific Co-Director                    |
|               |                                                      |
|               | Steve Bartels, Scientific Co-Director                |
+---------------+------------------------------------------------------+
| **10:30 --    | **Question and Answer Session**                      |
| 10:45**       |                                                      |
+---------------+------------------------------------------------------+
| **10:45 --    | **Morning Break**                                    |
| 11:00**       |                                                      |
+---------------+------------------------------------------------------+
| **11:00 --    | **Introduction to SAMHSA's National Registry of      |
| 11:30**       | Evidence-based Programs and Practices (NREPP)**      |
|               |                                                      |
|               | Kevin Hennessy, Science to Services Coordinator      |
+---------------+------------------------------------------------------+
| **11:30 --    | **Question and Answer Session**                      |
| 11:45**       |                                                      |
+---------------+------------------------------------------------------+
| **11:45       | **Overview of Goals for Breakout**                   |
| a.m. - 12:00  |                                                      |
| p.m.**        |                                                      |
+---------------+------------------------------------------------------+
| **12:00 -     | **Lunch**                                            |
| 1:00**        |                                                      |
+---------------+------------------------------------------------------+
| **1:00 -      | **Overview of Goals for Breakout (cont.)**           |
| 1:15**        |                                                      |
+---------------+------------------------------------------------------+
| **1:15 -      | **Breakout: Small Workgroup Discussions**            |
| 3:15**        |                                                      |
+---------------+------------------------------------------------------+
| **3:15 -      | **Afternoon Break**                                  |
| 3:30**        |                                                      |
+---------------+------------------------------------------------------+
| **3:30 -      | **Report to Full Expert Panel**                      |
| 4:30**        |                                                      |
+---------------+------------------------------------------------------+
| **4:30 -      | **Full Group Discussion**                            |
| 5:00**        |                                                      |
+---------------+------------------------------------------------------+
| **5:00 p.m.** | **Shuttles Depart from SAMHSA**                      |
+---------------+------------------------------------------------------+

Appendix B.

**Small Group Breakouts**

**Community (Dianne McElroy, Facilitator)**

Nancy Bohman

> Turner Goins
>
> Julie Jensen
>
> Marcia Scott
>
> Nancy Whitelaw

Diana Lawry

**Consumer (Aricca Van Citters, Facilitator)**

Carol Colleran

> Carol D'Agostino
>
> Larry Dupree
>
> Alixe McNeill
>
> Katrina Morgan

**State (Lisa Patton, Facilitator)**

> Gayathri Dowling
>
> Kevin Huckshorn

Denise Juliano-Bult

> Garrett Moran
>
> John Shipherd

**Provider (Laurie Brockmann, Facilitator)**

Catherine Gordon

> Mary Guthrie
>
> Christopher Langston

David Oslin

Louise Quijano