Youth Opioid Response: Marin Final Report and Action Plan August 14, 2020 Table of Contents Executive Summary ............................................................................................................... 3 Introduction .......................................................................................................................... 4 Methodology ......................................................................................................................... 4 Marin County Profile .............................................................................................................. 5 Marin County Demographics ..........................................................................................................5 Marin County Health Indicators ......................................................................................................7 State of Adolescent Behavioral Health Screenings in Marin County .................................................9 School Health and Wellness Profiles ............................................................................................. 10 Key Findings ........................................................................................................................ 13 Adolescent Needs ........................................................................................................................ 13 Parent Needs ............................................................................................................................... 15 School Needs ............................................................................................................................... 16 Policy Needs ................................................................................................................................ 17 Spotlights on Promising Practices ......................................................................................... 19 Path to Impact: A Framework for Charting a Path Forward .................................................. 22 Capturing the Current State.......................................................................................................... 22 Illustrating the Ideal State ............................................................................................................ 23 Action Plan .......................................................................................................................... 23 Vision Statement ......................................................................................................................... 23 Actions for 2020 and Beyond ........................................................................................................ 23 Conclusion ........................................................................................................................... 24 Appendix I. .......................................................................................................................... 25 Community Groups Supporting Adolescent Behavioral Health ......................................................................... 25 Education and Assessment Resources ............................................................................................................... 25 Appendix II.: Community Meeting 1 Summary ...................................................................... 26 Brief Summary ............................................................................................................................. 26 Takeaways ................................................................................................................................... 26 1 Appendix III. Community Meeting 2 Summary ...................................................................... 27 Brief Summary ............................................................................................................................. 27 Framing the Meeting .................................................................................................................... 27 Key Takeaways from the Meeting................................................................................................. 27 2 Executive Summary The YOR Marin Project set out to examine Marin County’s needs surrounding opioid use disorder and co-occurring condition prevention and treatment for high school-age adolescents (13 to 17 years old). Key areas of interest included the prevention and treatment of co-occurring mental health conditions, and how high schools can be leveraged as part of any solution or strategy pursued to tackle youth OUD or co-occurring conditions. Over the course of 2019 to 2020, the YOR Marin Project team conducted an environmental scan, interviews, focus groups and community meetings with community members to understand where gaps exist in meeting adolescent and family needs. The team identified key findings, best practices from other jurisdictions, and developed a logic model to explain the current state of behavioral health prevention and treatment, and the ideal state community members wish to see develop. Within that spectrum, community members and the YOR Marin Project team determined that identification of needs and navigation to services and supports are top needs along that spectrum. As part of the grant project, the YOR Marin Project team developed and action plan for next steps that county agencies and community members can take to tackle existing needs. Action plan items identified by the Project include • House YOR project within RxSafe Marin as an ongoing RxSafe Marin action team • Assess wellness capabilities across high schools and identify where gaps exist • Explore public-private partnership to sustain public high school wellness in Marin County • Analyze what policies need to be changed at the state and/or local level for high school wellness to succeed • Develop and adapt existing trainings for teachers, families and adolescents to better prevent and identify opioid use disorder (OUD) • Create a partnership with Crisis Text Line • Develop navigation for case management services to track access to treatment and address follow up needs • Create a data dashboard to track key youth behavioral health indicators in Marin County • Consider a pilot study of universal screenings 3 Introduction The opioid crisis and its effects on the public’s health have been well-documented, and adolescents have not been immune to this crisis. Fatal overdoses for adolescents and young adults age 15 to 24 years more than tripled from 1999 to 2014,i and in 2016, 3.6% of adolescents age 12 to 17 reported misusing opioids over the past year.ii In California, 3.5% of youth age 12 to 17 reported misusing pain medications in the past year, and 0.6% of reported having SUD for pain medication from 2015 to 2016.iii Even more concerning, 21.8% of students in grade 11 report having used prescription pain medications at least once to get high.iv In Marin County, student-reported survey data suggests that use of any drugs is up for both 9th and 11th graders, with particular specific increases in heavy drug use and marijuana.v Opioid use and substance use more generally involve complex biological, social, cultural and economic factors, and often present with co-occurring mental health conditions. As community members dedicated to improving adolescent health, individuals from several organizations including Marin County Behavioral Health and Recovery Services, RxSafe Marin, Marin County Office of Education, Tamalpais Union High School District Wellness and BluePath Health secured funding through the California Department of Health Care Services’ Youth Opioid Response (YOR) California grant opportunity to conduct a needs assessment for community planning purposes. The goal of YOR California is “to improve and expand access to a continuum of opioid use disorder (OUD) prevention, intervention, Medication-Assisted Treatment (MAT), and other treatment and recovery services for youth (ages 12-24) and their families, thereby preventing opioid overdose-related deaths.” This community planning project—the YOR Marin Project—specifically aimed to examine community needs surrounding opioid use disorder and co-occurring condition prevention and treatment for high school-age adolescents (13 to 17 years old). We particularly sought to examine how high schools might be leveraged as access points for prevention and treatment, given that high-school age adolescents spend nearly six hours per weekday at school. Our team approached this examination with the understanding that while high schools can be effective access points, the burden should not be solely placed upon the education system to tackle adolescent health needs, and that multi-sector organizations serving youth should and can be engaged in this work. Methodology The YOR Marin Project team pursued a multi-phased approach to gathering data for this project. First, the team conducted a literature and secondary data review to understand the current state of opioid use, other substance use, and mental health prevention and treatment for adolescents in Marin County. The team analyzed county data on utilization, claims and resources currently available for Marin County residents, to the extent these data were publicly available. 4 This also included an accounting of best practices for prevention and treatment, including for use in educational settings. Second, the team conducted stakeholder interviews