In this report, the Trust for America's Health (TFAH) examines how to help move towards a strong prevention-oriented, continuum-of-care approach to substance misuse--looking at policies and programs that have a high impact for improving the well-being of America's youth. Section 1 reviews 10 examples of important policy indicators or programs that states may have in place that can have an impact on the well-being of children and youth and/or have been connected with preventing and reducing youth substance misuse. The indicators reflect a range of types of policies that support a prevention-intervention-treatment approach--from supporting healthier schools and communities to limiting access to substances to providing positive support and treatment. While it is not a comprehensive evaluation, taken collectively, the indicators help show trends of progress and gaps in youth policy development. Section 2 features recommendations for modernizing the nation's strategy for addressing youth substance misuse by implementing a research-based public health approach. Some key elements include: (1) The most effective approach to reducing substance misuse is by preventing it before it starts. To fill the gap between research on evidence-based programs and their implementation there needs to be increased focus on: (2) Starting programs when children are younger--including programs focused on early childhood development--which yields a bigger payoff for later prevention. Programs often start too late to have the desired impact. Continuing support must also be sustained throughout the tween, teen and young adult years, particularly during transition times such as starting middle and high school or college, leaving home for the first time or starting in the workforce. (3) Building community-wide efforts--where school-based and community programs are part of a coalition to implement comprehensive prevention services that employ a range of interrelated strategies matched to a particular community's needs. Optimal efforts reinforce each other--and work together to leverage all available resources, expertise and support across multiple sectors--and can build on existing strengths in a community rather than reinventing or competing with them. This includes: (1) Gaining an understanding of the needs, trends and existing resources within a community--and matching the best evidence-based approaches with a community's priorities; (2) Having access to an expert "backbone" organization that can provide end-to-end support from selection to implementation to evaluation to continuous quality improvement of programs; (3) Ensuring sufficient and sustained cross-sector funding; and (4) Engaging youth, youth advocates and parents in the planning, implementation and evaluation of programs and practices. (5) A renewed energy is needed to gain support for the adoption and implementation of evidence-based and sustained school-based programs--moving beyond decades of ineffective approaches. It also involves making substance misuse prevention one part of an integrated set of positive youth development goals--including supporting broader academic achievement goals. Effective approaches also require acknowledging that substance misuse is a problem that impacts all communities and that adopting programs should not come with a stigma. By focusing on prevention, it helps reinforce that these programs are to the benefit of all students. Advancing these goals must include: (6) Providing education and reaching out to engage parents, educators, the larger community and policymakers to understand the advances in the most recent research about what works and why; (7) Integrating school-based and community-based programs--schools cannot and should not be expected to solve the problem on their own--and to have the end-to-end support of expert networks; and (8) Improving school climate--through positive behavior initiatives, increasing the number of specialists trained to treat substance use and mental health disorders, and improving the integration and interactive support between healthcare and education--two sectors that routinely help children and teens but are often siloed. (9) Routine screening and brief intervention are essential as children enter the tween and teen years--to help identify risks and problems and quickly connect individuals to services and support. Evidence supports that earlier intervention is constructive versus denial or waiting until a problem becomes too serious to ignore. This approach is recommended by the American Academy of Pediatrics (AAP) and the National Institute on Alcohol Abuse and Addiction (NIAAA). Screening--via age-appropriate questionnaires developed by health and social service professionals--can help identify teens and youth at risk for substance misuse. Brief interventions--even a few minutes of counseling--have been shown to help reduce alcohol and drug misuse in youth. And these efforts can help identify needs and connect youth and their families with services and support. Early brief interventions that prevent and reduce substance misuse also reduce the number of individuals later needing treatment. This should be part of a regular continuum of childhood screenings that start at birth and help track a child's milestones and development at particular stages--and identify when extra support is needed. (1) There is a major treatment gap for substance misuse and dependence in the country--where only an estimated one in 10 individuals who need treatment receive it.10 It is time to leverage resources and opportunities from the Affordable Care Act (ACA), mental health parity laws (requiring health insurance plans to cover mental health and substance use disorder services at least to the extent that the plans cover other medical services) and federal, state and local support to ensure that all individuals who need treatment receive it--and that treatment standards are brought up-to-date with the latest evidence-based approaches. Success will require cooperative efforts from a wide range of partners, including parents, families, youth advocates, youth groups, mental health professionals, pediatricians and a range of other healthcare providers, hospitals, insurers, social service providers, schools, colleges, the foster care system, juvenile justice settings, community- and faith-based groups--as well as effective government policies and programs.
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