Baseline Opioid Survey: Access, Consumption, Consequences, and Perceptions among Young Adults in Alaska

In September of 2015, SAMHSA awarded the Partnerships for Success (PFS) grant to the State of Alaska  Department of Health and Social Services, Division of Behavioral Health (DBH). The PFS grant program is  a five‐year effort that focuses on preventing and reducing substance use and building prevention  capacity at both the state and community levels. DBH provides leadership for the project and facilitates  the conduct of project activities by community‐level coalitions. Additionally, DBH contracted with the  Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA)  to conduct a comprehensive evaluation of the PFS project.   Using a data‐informed prioritization process to narrow the substance abuse focus of the grant, the State  Epidemiological Outcomes Workgroup chose two PFS priority areas: 1) non‐medical use of prescription  opioids among 12‐25 year olds; and 2) heroin use among 18‐25 year olds. Data on the use of and  consequences related to prescription opioids and heroin in Alaska are described below.  Partnerships for Success (PFS) Priority Area: Non‐Medical Use of Prescription Opioids  Data from the National Survey on Drug Use and Health (NSDUH) indicate that young adults aged 18‐25  consistently have the highest percentage of non‐medical use of prescription pain relievers in Alaska  compared to youth aged 12‐17 and adults aged 26 and older (see Figure 1).1,2,3 While small decreases in  use were observed among all age groups from 2009 to 2014, the age‐specific pattern remained  consistent.   Figure 1. Past year non‐medical use of prescription pain relievers in Alaska from 2009 to 2014 by age  Additional data requested from NSDUH (see Table 1) indicated no significant change in non‐medical use  of prescription pain reliever estimates among 12‐25 year olds in Alaska between years 2007‐2010 and  2011‐2014 but a decreasing trend was observed for past year use and past year prescription pain  reliever dependence or abuse.4 0 5 10 15 2009-2010 2011-2012 2013-2014 Percentage 12-17 years 18-25 years 26+ years 4 Table 1. Past year non‐medical use of prescription pain reliever estimates among individuals aged 12  to 25 in Alaska from 2007 to 2014  1 Dependence/abuse is based on definitions found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM‐IV)  Estimates of past year non‐medical use of prescription pain relievers among individuals aged 12 and  older in Alaska are slightly higher than national estimates but both follow a small decreasing trend in use  from 2009 to 2014 (see Figure 2).1,2,3 Figure 2. Past year non‐medical use of prescription pain relievers among individuals aged 12 and older in  the U.S. and Alaska from 2009 to 2014  Other indicators related to non‐medical use of prescription opioids in Alaska have also decreased slightly  or stabilized in recent years. Treatment admissions for synthetic opiates (opiates or synthetics including  Methadone, Oxycodone, or Oxycontin) as a primary, secondary, or tertiary substance of abuse have  stayed relatively stable from 2013 to 2015 (1,052 to 1,011 treatment admissions), according to the  Alaska Automated Information Management System (AKAIMS).5  Age‐adjusted overdose death rates in  Alaska have decreased from 11.2 per 100,000 in 2009 to 8.5 per 100,000 in 2015. Although overdose  deaths from prescription opioids are decreasing, Alaska still has higher rates of overdose deaths from  prescription opioids than the nation overall (7.3 vs. 5.1 per 100,000 in 2012).6 Funded by the Substance Abuse and Mental Health Services Administration, Center for Mental  Health Services (Grant #SP020783) through the State of Alaska, Division of Behavioral Health Background / Survey Methods / Prescription Opioids / Heroin / Conclusion / Reference

Baseline Assessment: Alaska's Capacity and Infrastructure for Prescription Opioid Misuse Prevention

The State of Alaska Department of Health and Social Services (DHSS), Division of Behavioral Health (DBH) was awarded the Partnerships for Success (PFS) grant by the Substance Abuse and Mental Health Services Administration (SAHMSA) in 2015. DBH contracted with the Center for Behavioral Health Research and Services (CBHRS) at the University of Alaska Anchorage (UAA) to conduct a comprehensive project evaluation. As part of the evaluation, CBHRS performed a baseline assessment of the state’s capacity and infrastructure related to prescription opioid misuse prevention. Researchers conducted interviews with key stakeholders representing state government, healthcare agencies, law enforcement, substance abuse research, and service agencies. Interviews were semistructured, with questions addressing five domains of interest: (1) state climate and prevention efforts; (2) partnerships and coordinated efforts; (3) policies, practices, and laws; (4) data and data monitoring; and (5) knowledge and readiness. Thirteen interviews were conducted and analyzed using a qualitative template analysis technique combined with a SWOT analysis (i.e. strengths, weaknesses, opportunities, and threats). Emergent themes are displayed in Table 1 below. Table 1. Emergent themes from SWOT analysis Strengths Weaknesses Opportunities Threats (1) New and revised policies and guidelines (2) Activities and partnerships between state agencies and communities (3) Knowledge and awareness of state leadership (1) State policy limitations (2) Insufficient detox, treatment, and recovery support resources (3) Lack of full coordination within state agencies and with communities (1) Education enrichment (2) Policy improvements (3) Expansion of treatment, recovery, and mental health support (1) State fiscal crisis (2) Prescribing practices (3) Complexity and stigma of addiction (4) Legislative support Despite limitations in sample representativeness and interview timing, participants agreed that agencies, communities, and organizations across Alaska have demonstrated great concern about the opioid epidemic and that this concern has translated into considerable efforts to address and prevent opioid misuse. Participants also noted a variety of opportunities as targets for future work, many of which would address some of the current weaknesses that exist. Results yielded clear recommendations for increasing awareness and providing education to a variety of groups, further improving relevant policies to promote prevention, and expanding services for prevention and treatment.State of Alaska, Division of Behavioral Health Grant #SP020783Executive Summary / Introduction / Methodology / Results / Discussion / Reference

How do we meet the spiritual needs of residents in aged care facilities?

A descriptive qualitative approach was used to explore the spiritual needs of residents (n=16) living in a residential aged care facility in regional Western Australia. A constant comparison method of analysis identified three central themes: spirituality - I don’t know what you mean; end of life is no joy at all and sources of support. This study adds to a broader understanding of the issues associated with ageing from the residents’ perspective

Inclusion Of Students With Mild To Moderate Disabilities In Grades 1-5 Mainstream Language Arts Classrooms

The research question addressed in this capstone project was what are best practices for creating an inclusive language arts program in grades 1-5 in an elementary school? It documents the history of special education and inclusion in the United States, least restrictive environment (LRE), benefits and barriers to inclusion as well as strategies to create an inclusive language arts setting. The author uses research to prepare and present a PowerPoint presentation to licensed teachers to be used as staff development. The PowerPoint presentation addresses the history of special education and inclusion, how LRE is determined, benefits and barriers to inclusion, strategies for creating an inclusive language arts setting as well as how students are selected for inclusion in language arts, service time for students in this setting as well as a comparison of standardized test scores between a school using the inclusive language arts model and one which does not. Supplemental material are also provided for ongoing staff development including information on specific disabilities

Navigating through the pitch landscape : an examination of clients, consultants, and advertising agencies during the pitch process

textThe pitch process is critical for both clients and agencies as it is the time period when clients are trying to identify the best agencies to hire and agencies are trying to win business. There are a multitude of variables that play a large role in the success of a client-agency relationship; however, the specific actions, events, and dynamics that occur during the pitch process can be especially important in setting the tone and influencing the outcome of the partnership. Many studies have examined various dynamics and phases of the client-agency relationship, but few have specifically focused on the earliest phase; the pitching process. This study fills this void by providing insights from clients, advertising agencies, and third-party consultants involved in all aspects of the pitching process to better understand the dynamics of the beginning stages of the client-agency life cycle. The literature review examines personal relationships, business relationships, and client-agency relationships and includes examples of relationship development models. Although these models provide a good backdrop for the way a client and an agency develop their relationship, they do not delve into specific aspects of the Pitch. Social Exchange Theory (SET) and Expectancy Confirmation Theory (ECT) provide insights both into how the pitch process facilitates exchange between clients and agencies and the ways in which all parties involved in a pitch have certain expectations. The extent that expectations are either confirmed or disconfirmed can lead to increased or decreased satisfaction with the overall pitch process. The four main research questions driving this study related to attraction, trust, and satisfaction. Respondents were asked how both attraction and trust were experienced and could be accelerated during the pitch process and were asked to identify the various components that were involved in the “most-satisfying” and “least-satisfying” pitches. The results indicated that both logistical and relational factors played a key role in the way in which a pitch process was experienced and although clients, agency professionals, and consultants shared many thoughts, each constituency offered a unique perspective. This research brings attention to the level of disconnect that occurs among the various constituencies and makes recommendations regarding ways to improve the pitching landscape.Advertisin

A study of the relationships between the behaviour of cetaceans and vessel traffic using two case studies : Killer whale (Orcinus orca) and Humpback whale (Megaptera novaeangliae : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Conservation Biology, Massey University, Auckland, New Zealand

Two studies were carried out to describe the relationship between vessel presence on the behaviour of both whales and dolphins. Each study conducted focal follows on members of two endangered sub-populations using a land-based theodolite station in order to track and mark positions of opportunistic vessel traffic in relation to animal surfacings. Southern resident killer whales (Orcinus orca) were theodolite tracked during the months of May-August for three field seasons (1999-2001), off San Juan Island, Washington State, U.S.A, in an independent study. Migrating humpback whales (Megaptera novaeangliae) were theodolite tracked off Moreton Island, Queensland, Australia during 2005 from May-September in partial fulfilment for a Master of Science degree. For each study, four dependent whale variables were analysed in relation to two boat variables. Whale variables included mean time per dive (dive time), swimming speed, directness of path traveled (directness index) and the number of surface behaviours per hour such as breaches or tail-slaps (surface active behaviour). The two boat variables included a count of the number of boats within the study area during each tracking session (boat count) and the point of closest approach (PCA) by a vessel to the focal animal during the tracking session. Southern resident killer whales were found to decrease path directness with the point of closest approach of vessels. As whales adopted a more circuitious path, distance travelled increased by 9.5% when boats were within 100 m. Humpback whales significantly decreased their rate of surface active behaviour by 50% when boats were present. This thesis presents data that show a snapshot of the levels to which both species are exposed to vessel traffic, as well as subtle short-term behavioural responses in relation to vessel presence. I compare the impacts of vessel traffic identified for the two species, and suggest possible long-term population consequences due to potential interruptions of foraging and/or social behaviours. I discuss limitations of small data sets such as these and discuss ways in which further research can be better designed. Deliberate planning of vessel effect studies and their subsequent analyses can provide conservation managers useful information for determining recovery strategies of endangered whales and dolphins

Using Implementation Science to Guide the Integration of Evidence-Based Family Interventions Into Primary Care

This article is a demonstration of how an implementation-science (IS) framework can be coupled with the measurement of implementation outcomes to effectively integrate evidence-based family interventions in primary care. The primary care environment presents a number of challenges for successfully integrating such interventions. However, IS methods can improve the prospect of successfully implementing a new intervention while simultaneously and rigorously evaluating the impact on salient outcomes. We used our experiences across 2 pilot trials in which the family check-up (Smith, Montaño, Mauricio, Berkel, & Dishion, 2016), an evidence-based family intervention, was integrated into primary care. In these pilot trials, the exploration, preparation, implementation, and sustainment (EPIS) framework and the Proctor et al. taxonomy of implementation outcomes were used to guide the implementation and evaluate its success. Grounding our presentation in our pilot work offers an illustration of applying the EPIS framework and outcomes measurement to real-world problems and contexts. When embarking on new efforts to integrate behavioral interventions into health-care settings, the application of IS frameworks and measurement strategies can create generalizable knowledge that substantively contributes to a sparse literature. Today, those “in the trenches” who are translating evidence-based interventions to their setting can contribute to the corpus of research in integrated care by using IS methods to plan a new program and evaluate its feasibility, adoption, and reach