HEALTH AND HUMAN SERVICES COMMITTEE MEETING

• MONDAY, DECEMBER 6, 2010 8:30A.M.

MINUTES

MEMBERS PRESENT: Commissioners Jeanne Pearl·Wright, Theresa Abed, Linda Keefe, Art Luna, Leo Farhat and Blake Mulder.

MEMBERS ABSENT: Commissioner Dale Barr.

OTHERS PRESENT: Commissioner Joe Brehler, Dr. Jack Jesse, Sara Lurie, Colette Scrimger, Ronda Rucker, Sue Hoffman and John Fuentes.

The December 6, 2010 regular meeting of the Health and Human Services Committee was called to order at 8:31 a.m. by Chairperson Wright.

Commissioner Mulder moved to approve the minutes of the November 1,2010 regular meeting, as presented. Commissioner Farhat seconded. Motion carried.

• Colette Scrimger requested that she be allowed to provide an update from the Health Department in order to attend another meeting.

Commissioner Farhat moved to approve the change to the agenda. Commissioner Keefe seconded. Motion carried.

Ms. Scrimger discussed the Dental Clinic, which began seeing patients on December 2, 2010: Also discussed Was the pending application for Federally·Qualified Health Center status. It is anticipated that there will be as many as 18 submissions from Michigan.

Ms. Scrimger also discussed a grant being sought by the Health Department with the Grand Ledge Public Schools to create a school·based Health Center for the student population of the School District. .A similar application was previously pursued with Maple Valley School District, however was unsuccessful due to the size of the targeted population. It was also reported that the Wisewoman program commenced Friday, November 26, 2010.

Chairman Brehler discussed the cash start·up advance provided to Michigan Community Dental Clinics (MCDC). The contract with MCDC provided for this advance to be repaid to the County within 24 months, with an option for the County to allow MCDC to utilize the funds for the Dental Assistance fund, to provide funding to further discount fees for services for indigent individuals. This option had been previously discussed by the Board although to date has not

•been formalized. Discussion held.

Commissioner Luna moved to recommend to the Ways and Means Committee that the County exercise its option to allow MCDC to retain the funds to fund the Dental Assistance fund. Commissioner Farhat seconded. Motion carried. •Dr. Jack Jesse and Sarah Lurie were present to discuss the strategic plans of the Recovery­Oriented System of Care program and Eaton County Substance Abuse Advisory Group, respectively; Ms. Lurie reviewed the ECSAAG 5 year strategic plan (attached). Dr. Jesse reviewed to ROSC program strategic plan (attached). Discussion held.

Commissioner-elect Sue Hoffman was present to introduce herself and provided thanks to the members of the Committee for their efforts in the area of human services.

. The members of the Committee requested that the Committee receive quarterly updates on the activity of the dental clinic.

Commissioner Farhat moved to adjourn the December 6, 2010 meeting of the Health and Human Services Committee at 9:39 a.m. Commissioner Abed seconded. Motion carried.

The next regular meeting of the Health and Human Services Committee is tentatively scheduled to be held on Monday, January 10, 2011 at 8:30 a.m. in Conference Room 101 of the Courthouse.

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Eaton CountySubstance Abuse Advisory Group

...Providing our community with substance abuse prevention strategies and solutions

Executive Summary 2010-2015 Strategic Prevention Plan

Introduction The mission of the Eaton County Substance Abuse Advisory Group (ECSAAG) is to collaboratively address the substance abuse prevention and treatment needs of the Eaton County community. ECSAAG is a formalized, multi-sector, county-Wide coalition with representation from several agencies, businesses, and communities throughout Eaton County. Together, the coalition is working to achieve the vision of reducing use and misuse of alcohol, tobacco, prescription and over-the-counter medication, marijuana, and reducing suicides by planning, coordinating, and evaluating substance abuse prevention and treatment services in Eaton County.

Central to the ECSAAG strategic plan is the development of local prevention groups in each of eight identified Eaton County communities that allow the communities to direct their local initiatives. Each local group develops a prevention plan based on local needs assessment and alignment with ECSAAG goals. This structure is designed to encourage community ownership, to support and sustain local efforts, to deepen the reach of ECSAAG initiatives, and ultimately, to create significant population level changes in the county core measures. ECSAAG staff supporting local efforts are trained in cultural competence and have a long-standing history of collaborating with local communities on substance abuse prevention efforts.

The strategic Prevention Framework (SPF) The SPF is a capacity building process for demonstrating and documenting outcomes and is designed to impact population level change. The five steps that comprise the Strategic Prevention Framework will enable communities region-Wide to build the infrastructure necessary for effective and sustainabie

prevention. Cultural competence and sustainability must also be infused within the SPF five steps. The SPF is a public health approach to prevent and reduce substance-related problems and/or consequences and involves the folloWing five specific steps;

1. Needs Assessment: profile population needs, resources, and readiness to address needs and gaps 2. Capacity Building: mobilize and/or build capacity to add ress those needs 3. Strategic Planning: develop a comprehensive strategic plan 4. Implementation: implement evidence-based prevention programs, policies, and practices 5. Evaluation: monitor, evaluate, sustain, and improve or replace those strategies that fail

Based on the assessment of the local data we have collected and reviewed, our strategic prevention goals for 2010-2015 are as follows:

ECSAAG Goal Statements 1. capadty Building: Eaton County will continue to buiid infrastructure to sustain substance abuse prevention in communities and institutionalize the SPF five steps. 2. Alcohol: To reduce alcohol involved traffic fatalities, injuries, and crashes due to the use/misuse of alcohol by youth and adults in Eaton County. 3. Tobacco: To reduce tobacco-related death due to tobacco use and exposure to secondhand smoke by youth and adults in Eaton County. 4. Prescription Drugs: To reduce poisonings and deaths due to over-the-counter and prescription drug misuse and abuse by youth and adults in Eaton County. 5. Marijuana: To reduce the use/misuse of marijuana by youth and aduits in Eaton County. 6. SUicide Prevention: To reduce the incidence of death due to suicide in adults and youth through improved access to and community linkages with mental health and substance abuse services in Eaton County.

Braided Funding: ECSAAG funding includes dollars allocated from Mid-South Substance Abuse Commission (MSSAC), SAMHSA Drug Free Communities Grant, SAMSHA Strategic Prevention Framework-State Incentive Grant, and Eaton County Juvenile Justice Millage. Funds support coalition staff through Prevention Program services of Eaton Intermediate School District (PPS/EISD). Funds also support initiatives through local agencies such as the Barry­

THE DATA... Alcohol People driving in Eaton County are more likely to be injured in an alcohol-related crash per 100 miles of road, than across the State of Michigan. (Michigan Annual Drunk Driving Audit). 9,2% of 7th graders, 28.5% of 9th grade students and 43% of 11th grade students reported use of alcohol in the past 30 days on the 2008 MiPHY Tobacco 120 Eaton County residents died of smoking dgarettes in 2007 r and an additional 16 died from secondhand smoke. (MDCH Tobacco Fact Sheet). 14% of all deaths in Eaton County in 2~07 were~ireg!Y ,caused by smoking cigarettes, ~q,a~()th~t~;1_'f9; 'of all deaths were indirectly caused by ""condlland.~rnOke. Sixteen out of every 100 Eaton OJ#rity deaths~re ta~sed directly or indirectly by tobaceo. Prescription DJ1IlI$ '., Between 1999-2004,~~tet\r~~r9irig deaths in the U.s. due to pois(>ning~ ~hoWSthaf nearly all of such deaths are attributed:t<t.dnugs,II1Q$t;dr~g poisonings result from abuse of.A~rjp.boJT or llle(lal drugs. In the 2008 Eaton Co. MiPHY, 7·,~.,*,or7thgraders and 9.5% of 11th graders report havi"9 ·ysedpres.crlptlon medications not prescri~d tcHhem, at l~st once in the last 30 days. Marijuana In the 2008 Eaton Co. MiPHY, nearly half (47.9%) of 11ttl graders report having smoked marijuana at some point in their lifetime, 24.9% of them have used marijuana in the past 30 days. SUidde Suicide was the cause of death in over 13% of all deaths occ~rring to 20-44 year aids in 2006. Teenage suicide is a significant problem in Eaton County, with over 1 in 12 deaths in children under 20 caused by suicide. In the 2008 Eaton Co. MiPHY, 22,2% of 7tb

qraders have seriously considered attemptinq suicide.

Eaton District Health Department and City of Grand Ledge. PPS/EISD is the fiduciary agency for ECSAAG funds allocated to agencies. Local prevention groups supported by ECSAAG include Eaton Rapids Alliance for Substance Abuse Elimination, Grand Ledge Communities Mobilizing for Change on Alcohol, the Charlotte Area Prevention Group, Recovery Oriented Systems of Care, and Suicide Prevention of Eaton County. Strong partnerships have been forged through collaborative planning and braiding of resources to meet ECSAAG strategic plan goals to reduce drug and alcohol-related consequences in Eaton County.

SWOT Analvsis: On March 9th and April 13th 2010, ECSAAG members completed a Stfengths Weaknesses, Opportunities, and Threats (SWOT) Analysis to assist ECSAAG members in preparation of the development of our new five-year strategic plan. Four questions about ECSAAG's strengths, weaknesses, opportunities, and threats were posed to the group The gfOUp'S collective responses were identified below:

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strengths: Diversity of partiCipants and views Br<IJded tesourqlS Includes n:eactment and rel::overy representatives

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Oppgrtlmities: .' provic:je regiOnal training ; ..... In'{~lve yout))t99el:theiri»rspeetives . i., .' IdW1tify other community pa,,"¢r$ SUch lilS ~~'!lfOyps .... . .... . . .' c" .'. .' .

Weaknesses: Not as well known in the county as we should be Need more media exposure

I Increase funding sustainability

Threats: Eiimination of prevention programming in schools Economic downtUrn/increased crime Reacting to problems rather than being proactive

facebook •1790 E. Packard Hwy., Chariotte, MI 48813 (517) S41-8767 www.eatondnuqfree.com ECSMG efforts are funded through Mid-South Substance Abuse Commission, SAMSHA, Drug-Free Communities, SPF-SIG, and Eaton County Juvenile Justice Millage

¥(it~!? 2011 Medication Take--Back Events

Sponsored by Eaton County Department of Resource Recovery • Rethinking our dependence on natural resources by Reducing, Reusing &: Recycling

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Dispose of unwanted medications with hazardous waste, not in the trash or in the toilet. Liquid captured in landfills can end up in waterways and in groundwater since water treatment plants are unable to screen for medications.

Traces of pharmaceuticals have been found in the Great Lakes; this can cause a negative impact on the ecosystem by leading to reproductive and developmental problems 'In fish and other animals.

Eaton County Department of Resource Recovery will accept all unwanted medications during two Medication Take-Back Events and the three Household Hazardous Waste Events that occur annually in the months of May, July and September.

HGB Wellness Fair March 2011

Household Hazardous Waste Events May 13, 2011 July 15, 2011 September 16, 2011

Eaton Rapids Medical Center Fall 2011

Make good choices to benefit the environment, dispose of home toxics the right way. Utilize free local collections of household hazardous waste instead of landfilling.

Eaton County Department of Resource Recovery 1045 Independence Blvd, Charlotte, MI 48813 (517) 543-3686 or recyc/e@eatoncounty.org

• GAny Any item brought to the collection that is deertJ~4 unilcceptilble witt be returnecltQ~lJeparticipant. PleaseCilllthe clepartment if y'Ou

lJilvea qUe!itiolfa-bout a specific item prior to the day of the collection: ~ ----,=f""S",':t.",,7:4}-,,54~:~IUI~,or email recycle@eatoncounty.org.

Eaton County Spring 2011 Book Recycling &:: Document Shredding Event •

DATE & TIME: TAX DAY! Friday, April 15, 2011 from 2pm-6pm

LOCATION: Charlotte Area Recycling Authority 201 Hall Street, Charlotte, MI 48813

WHAT TO BRING: hard cover & soft cover books magazines telephone books cardboard boxboard (cereal boxes, shoe boxes, etc.) private, residential documents to be shredded •

This is a free event organized by the Eaton County Department of Resource Recovery.

Library groups and used book sellers will be on site to choose books for reuse.

For information on recycling or proper disposal of items not accepted at this event, please contact the Department of Resource Recovery at the number listed below.

Eaton County Department of Resource Recovery 1045 Independence Blvd, Charlotte, MI 48813 (517) 543-3686 or recycle@eatoncounty.org

Any item brought. to the collection that is deemed unacceptable will be returned to the participant. Please call the department if you have a •

question about a specific item vrior to the day of the collection: (517) 543-3686 ot' email recyCle@.eatoncounty.org.

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Eato~0J\t;()UntySubstance Abuse Advisory Group

• our community substance abuse prevention straten'...Providinn" WIth "Ies and solutions

Includes the 2010-2015 T . County T bacco Strategic Plan for Ingha linton and Eaton Counties n- o m, C' ,

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Eatori'CountySubstance Abuse Advisory Group

...Providing our community with substance abuse prevention strategies andsolutions

2010 - 2015 Strategic Prevention Plan

Introduction

The mission of the Eaton County Substance Abuse Advisory Group (ECSMG) is to collaboratively address the substance abuse prevention and treatment needs of the Eaton County community. ECSMG is a formalized, multi-sector, county-wide coalition with representation from several agencies, businesses, and communities throughout Eaton County. Together, the coalition is working to achieve the vision of reducing use and misuse of alcohol, tobacco, prescription and over-the-counter medication, marijuana, and reducing sUicides by planning, coordinating, and evaluating substance abuse prevention and treatment services in Eaton County.

•central to the ECSMG strategic plan is the development of local prevention groups in each of eight identified Eaton County communities that allow the communities to direct their local initiatives. Each local group develops a prevention plan based on local needs assessment and alignment with ECSMG goals. This structure is deSigned to encourage community ownership, to support and sustain local efforts, to deepen the reach of ECSMG initiatives, and ultimately, to create significant population level changes in the county core measures. ECSMG staff supporting local efforts are trained in cultural competence and have a long-standing history of collaborating with local communities on substance abuse prevention efforts.

ECSAAG Membership/Community Partners

The members and community partners included in the planning and development of the 2.010-2.015 ECSMG Strategic Prevention Plan include:

ECSAGG Members*

• Barry-Eaton District Health Dept. • Eaton Rapids Alliance for Substance Abuse

• CEI-CMH/Eaton County Elimination (ERASE) Counseling Center • Eaton Rapids Police Department

• Charlotte Police Department • Friends of Chrystal • The County Journal • Gail Duncan • Eaton BehaVioral Health • General Federation of Women's Club-Charlotte

• Eaton County Board of Commissioners • Grand Ledge Police Department • Eaton County Juvenile Court • Olivet College • Eaton County Strong • Potterville Public Schools

Families/Safe Children • Recovery Network, Inc. • Eaton County United Way • UAW-GM • Eaton Great Start • Youth Enrichment Services (YES) center

Eaton Intermediate School District *Voting members with signed Memorandums of Understanding

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ECSAAG Partners*

• Bellevue Police Department • Michigan State Police • Charlotte Public Schools • Mid-South Substance Abuse Commission • Eaton County Circuit Court • Olivet College • Eaton County Prosecutor's Office • Olivet Police Department

• Eaton County Resource Recovery • Olivet Public Schools

• Eaton County Sheriff's Department • Potterville High School PALs and Teens Against • Eaton Rapids ABC Tobacco Use (TATU)

• Eaton Rapids High School Interact • Potterville Police Department Youth • Prevention Network

• Eaton Rapids High School PAls • Vittoz Consulting

• Eaton Rapids Middle School PAls • Waverly Coaches Association

• Eaton Rapids Public Schools • Waverly High School PAls

• Grand Ledge High School PAls • Waverly Middle School PAls

• Grand Ledge Middle School PALs (Beagle and Hayes)

*No formal Memorandums of Understanding

Prior to the completion of this strategic prevention plan, community partners were asked to sign Memorandums of Understanding (MOU) solidifying, documenting, and formaliZing the relationships between community partners and ECSAAG.

Braided Funding

ECSAAG funding includes dollars allocated from Mid-South Substance Abuse Commission (MSSAC), SAMHSA Drug Free Communities Grant, SAMHSA Strategic Prevention Framework-State Incentive Grant (SPF-SIG), and the Eaton County Juvenile Justice Millage. Funds support coalition staff through Prevention Program Services of Eaton Intermediate School District (PPS/EISD). Funds also support initiatives through local agenCies such as the Barry-Eaton District Health Department (BEDHD) and City of Grand Ledge. PPS/EISD is the fiduciary agency for ECSAAG funds allocated to contracted agencies. Local prevention groups supported by ECSAAG include Eaton Rapids Alliance for Substance Abuse Elimination (ERASE), Grand Ledge Communities MobiliZing for Change on Alcohol (CMCA), Charlotte Area Prevention Group, Recovery Oriented Systems of Care (ROSC), and Suicide Prevention of Eaton County (SPEC). Strong partnerships have been forged through collaborative planning and braiding of resources to meet ECSMG strategic plan goals of reducing drug and alcohol-related consequences in Eaton County.

Planning

ECSMG has utilized the Strategic Prevention Framework (SPF) model to prioritize data and to create a strategic plan that builds local prevention efforts and targets reductions in youth and adult use of alcohol, tobacco, prescription and over-the-counter medications, marijuana, and other drugs. SPF is a public health

approach to prevent and reduce substance-related problems and involves the following five specific steps:

1. Needs Assessment - profile population needs, resources, and readiness to address needs and gaps 2. Capacity Building - mobilize and/or build capacity to address those needs 3. strategic Planning - develop a comprehensive strategic plan 4. Implementation - implement evidence-based prevention programs, policies, and practices 5. Evaluation - monitor, evaluate, sustain, and improve or replace strategies that fail

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Committee Structure

• The alcohol committee, tobacco committee, data committee, and prescription drug committee were formed and each assigned staff support. The subcommittees are responsible for utilizing data to identify and implement evidenoe-based and best practice strategies. Additionally, ERASE, Grand Ledge CMCA, the Charlotte Prevention Group, ROSC, and SPEC receive staff support and present their recommendations yearly to ECSAAG for review, discussion, and formal approval for placement in the annual implementation plan. An organizational chart outlining the funding and committee structure of ECSAAG can be found in AppendiX A.

Goal Statements

The goals included in the 2010-2015 ECSAAG Strategic Prevention Plan are based on problem statements developed by our coalition and MSSAC. They are derived from several years of local needs assessments and data analySis. The first ECSAAG goal statement involves the continued emphasis on building and sustaining local capacity to sustain the coalition through identification of long-term goals and objectives. The additional goal statements encompass the priority substanoe abuse consequence areas that are being targeted by ECSAAG.

Goal 1: Capacity Building

Capacity Building Problem Statement: While ECSAAG has been successful over the past five years with data collection, community collaboration, planning, implementation, evaluation, and securing additional funding beyond MSSAC, there are areas for improvement! In the next five years, ECSAAG intends to accomplish the follOWing:

• • refine efforts to collect and report local data, prioritize the data indicators, and increase ability to

track them over time • build capacity by conducting an inventory and analysis of county resources supporting prevention

efforts • recruit new membership, identify gaps in services and explore potential enhancements to current

prevention services and braided funding opportunities • develop comprehensive planning documents that allow for the appropriate documentation of

processes, outcomes, and achievements (i.e. logic models, agency action plans, etc.) • conduct annual evaluations to include year-end outcomes surrounding the implementation of

evidence-based prevention programs, poliCies, and practices • continue to seek funds for local prevention efforts • broaden ECSAAG's capacity (skills, abilities, networks, and resources) to establish a sustainable and

effective system of prevention and community wellness for the local communities served in Eaton County

• revitalize ECSAAG to appropriately and effectively carry out the five steps of the SPF and sustain the outcomes that have been achieved in Eaton County

Goal 1 - Capacity Building: Eaton County will continue to build infrastructure to sustain substance abuse prevention and community wellness in local communities and institutionalize the SPF five steps, as evidenced by the:

,/ Development of concise, data-driven problem statements ,/ Development of annual county communication plans ,/ Partnership agreements and/or memorandums of understanding, established and renewed annually ,/ Provision of training and orientation to new county prevention staff, coalition members, county

coalition networks, and regionally

• ,/ Enhancement of early problem identification protocol, referral systems, and Recovery Oriented

Systems of Care

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if Development of comprehensive strategic plans if Annual development/renewal of substance abuse specific logic models if Annual development of agency action plans if Annual development of implementation plans identifying effective evidence-based policies, practices, •

and programs if Evaluation report produced annually with recommendations for quality improvement ./ Fund development to sustain comprehensive prevention efforts in all goal areas

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Goal 2: Alcohol

•Alcohol Problem Statement Consequences: Early use of alcohol and prevalence of underage drinking in Eaton County contributes to traffic crash injuries. According to the 2008 Michigan Annual Drunk Driving Audit, people driving in Eaton County are more likely to be injured in an alcohol-related crash per 100 miles of road than across the State of Michigan. Eaton County's rate of alcohol related crash was 3.24, compared to Michigan's rate of 3.22. In addition to serious health conditions, alcohol use is linked to injuries and deaths from traffic crashes, falls, fires, and drowning. It is also a factor in homicide, SUicide, domestic violence, and chiid abuse.

Binge drinking, defined as those who report having four (for women) to five (for men) or more drinks of alcohol on a single occasion, results in high blood alcohoi levels, which can cause blackouts and even death. Binge drinking also increases the likelihood of other rjsky behaviors, such as unsafe sex, driving under the influence, and the use of illicit drugs. According to the Barry-Eaton Behavioral Risk Factor Survey (BRFS, 2006), 9.2% of Eaton County adults reported binge drinking on one or more of the past 30-days. An estimated 4.1% of aduits in Eaton County report heavy drinking, that is, on average consuming more than two alcoholic beverages per day for men and more than one alcoholic beverage per day for women. About 56.8% of adults in Eaton County report that they had any drinks of beer, wine, wine cooiers, or liquor in the past 30 days (BRFS, 2006). An estimated 4.3% of Eaton County adults who drink report having driven at least once in the past 30 days when they perhaps had too much to drink (BRFS, 2006).

According to the 2008 Michigan Profiie for Health Youth Survey (MiPHY, 2008) report, 9.2% of 7th graders, 28.5% of 9th graders and 43% of 11th graders reported use of alcohol in the past 30 days. Just over 26% of 11th grade students reported binge drinking (5 or more drinks of alcohOl in a row, within a couple of hours, during the past 30 days) and 12.5% of 7th grade students reported they had their first use of alcohol prior to 11 years old (MiPKY, 2008).

•Contributing Factors: In order to understand why these consequences and corresponding alcohol consumption patterns occur so frequently in society today, we must identify and analyze the intervening variabies and contributing factors, or more specifically, the causal factors surrounding this public health issue. Risk and protective factors prOVide one such mechanism. By targeting youth risk and protective factors, we will impact adult misuse of alcohol over time, One of the most heaviiy targeted risk factors in the field of prevention continues to be youth perception of risk surrounding alcohol. Below are some examples of contributing factors ECSAAG has identified:

,( Too many Eaton County Youth do not perceive regular alcohol use as having moderate or great risk or disapprove of their peers use of alcohol. According to 2008 MiPHY data, only 69.4% of 7th grade students perceive regular alcohol use a moderate or great risk. In the same report, 81.7% of 7th grade students identify alcohol use by peers as wrong or very wrong. This drops in 9th grade to 59.9% and further to 42.2% in 11th grade. The lack of coordinated youth-led initiatives in Eaton County that create a positive youth culture supportive of non-use of substances contributes to this problem.

,( Too many Eaton County youth are starting to use alcohol regularly at an early age and the percentage of yOllth using alcohol regularly increases almost five-fold from 7th to 11th grade. According to 2008 MiPHY data, 30-day use is 9.2% in 7th grade and increases to 43% in 11th grade.

,( There are gaps in the areas of parental notification, police notification, progressive discipline, prevention education, problem 1.0. and referral, and a separate athletic code of conduct. In revieWing of all Eaton County School Substance Abuse Policies and Athletic codes of

• condllct and comparing them to best practices, there is a lack of enforcement of school sllbstance abuse policies in Eaton County. ECSAAG's analysis of High School Incidence Data shows that the three year average of suspensions per 1,000 stlldents due to a sllbstance violation is 17.4 while

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17.74% of Eaton County 10th graders who took the Prevention Needs Assessment survey in 2006 (PNA, 2006) reported they came to school drunk or high.

if Both parents and youth identify alcohol as readily available to youth in their community. • 2009 Parents Who Host Parent Survey results showed that 72% of the parents surveyed felt it was easy for youth to get alcohol. According to the 2008 MiPHY Report, 46% of 7th graders, 74% of 9th graders, and 84.6% of 12th graders reported that it was sort of easy or very easy to get alcohol.

if We have identified few organized and aligned prevention initiatives in all local communities in Eaton County. Only four of the eight identified communities in Eaton County have a local prevention plan. This makes it less likely to reach the population level reductions needed in underage drinking and adults' misuse of alcOhol.

Through prioritization of the data, ECSAAG has identified key indicators in the county around alcohol use and related consequences. The alcohol related goal for ECSAAG is:

Goal 2 - Alcohol: To reduce alcohol involved traffic fatalities, injuries, and crashes due to the use/misuse of alcOhol by youth and adults in Eaton County. The following objectives were reviewed and approved by ECSAAG within the development of this strategic plan.

2.1 Community Norms: To correct the misperceived community norms involving alcohol use/misuse

2.2 Enforcement and Adjudication: To support and/or enhance the effective enforcement and adjudication of alcohol involved violations

2.3 Social Availability: To reduce youth social access to alcohol, and to impact adult social access to alcohol

2.4 Retail Availability: To reduce youth retail acoess to alcohol, and to impact adult retail access to alcohol

2.5 Laws and Policies: To support and/or enhanoe laws and policies that reduoe alcohol misuse •

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Goal 3: Tobacco

• Tobacco Problem Statement Consequences: In 2007, 120 Eaton County residents died from smoking cigarettes, while an additional 16 died from secondhand smoke. Of all deaths in Eaton County in 2007, 14% were directly caused by smoking cigarettes, and another 2% of all deaths were indirectly caused by secondhand smoke. Sixteen outofevery100 Eaton County deaths are caused directly or indirectly by tobacco (MDCH Tobacco Fact Sheet). According to the 2006 Barry-Eaton Behavioral Risk Factor Survey, 20.4% of Eaton County adults are current smokers and 19.4% of adults reported that smoking is allowed indoors in their home. According to the 2008 MiPHY report, 15.3% of the high school students surveyed smoked cigarettes during the past 30 days and 5.3% smoked cigarettes on 20 or more of the past 30 days. Below are some examples of contributing factors ECSAAG has identified:

Contributing Factors: v" When youth can access tobacco easily, they are more prone to smoking behavior and tobacco

addiction. In Eaton County, 70.8% of high school and 40.9% of middle school youth consistently report "easy" or "very easy" access to cigarettes, higher than the tri-county area (MiPHY 2008)

v" There are limited quit tobacco programs in Eaton County

v" There is a lack of smoke-free policies at the Barry-Eaton District Health Department, as is the case with the other health departments in Ingham and Clinton counties

v" There is a large gap in youth who perceive their friends are using tobacco and those who actually did use tobacco. According to the 2008 PNA, 83% perceive their friends used when only 19% actually did use (PNA, 2008)

• ECSAAG collaborated with Ingham Substance Abuse Prevention and the Clinton Substance Abuse Prevention Coalition in 2009 and 2010 to develop a regional strategic plan for these three counties: Clinton, Eaton, and Ingham, known as the Tri-County area. The tobacco related goal for ECSAAG is:

Goal 3 - Tobacco: To reduce tobacco-related death due to tobacco use and exposure to secondhand smoke by youth and adults in Eaton County. The following objectives were reviewed and approved by ECSAAG within the development of this strategic plan.

3.1 Community Norms: To correct the misperceived community norms involving tobacco use and exposure

3.2 Laws and Policies: To support and/or enhance laws and policies that reduce tobacco use and exposure

3.3 Promotion: To reduce the product promotion of tobacco 3.4 Social Availability: To reduce youth social access to tobacco, and to impact adult social

access to tobacco

3.5 Retail Availability: To reduce youth access to tobacco, and to impact adult retail access to tobacco

The complete Tri-County Strategic Plan accompanies the ECSAAG Strategic Plan in Appendix B.

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Goal 4: Prescription Drugs

Prescription Drug Problem Statement Consequences: One of the fastest growing problem areas in the substance abuse field involves the misuse and abuse of over-the-counter (OTe) and prescription drugs by youth and adults. The data presented below will illustrate a corresponding and dramatic increase in the number of poisonings and deaths associated with the abuse of prescription and OTC drugs. Additional data and analysis is needed surrounding this growing trend, although the available data speaks volumes. For example, research on deaths in the U.S. due to poisonings from 1999-2004 shows nearly all are attributed to drugs, and most drug poisonings result from the abuse of prescription and illegal drugs. The more striking finding was the number of total deaths due to poisonings increased by 62% in those five years, from 12,186 deaths in 1999 to 20,950 deaths in 2004. In particular, unintentional poisoning deaths involving psychotherapeutic drugs, such as sedative-hypnotics and anti­depressants, grew 84% from 1999 to 2004. Within the same time frame, the Centers for Disease Control (CDC) reported that unintentional poisoning deaths involVing narcotics and hallucinogens grew 55%, with research suggesting that this increase is attributed primarily to prescription painkillers (CDC, 2007).

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The data surrounding adult abuse of OTC and prescription drugs and the youth data that follows prOVides further insight into this legitimate public health issue. Between 2002 and 2004, an estimated 534,000 people in Michigan reported non-medical use of any prescription drug in the past year. The Michigan Treatment Episode Data Set (TEDS) shows an 182% increase (1,929 to 5,442) from 2002 to 2007 in the number of admissions into Michigan's publicly funded substance use disorder treatment system for people reporting prescription drug abuse as a problem at the time of admission. Based on 2008 Eaton County MiPHY data, 7.8% of 7th graders have taken a prescription drug without a doctor's prescription and 9.5 % of 11th graders report having used prescription medications not prescribed to them at least once in the last 30 days; 11.5% of 9th graders and 14.4% of 11th graders reported they took painkillers without a doctor's prescription at least once in the past 30 days.

Additionally, in 2008, Michigan voters overwhelmingly voted in a medical marijuana law which went into effect in April of 2009. The law allows registered patients and caregivers to legally possess up to 2.5 ounces of usable marijuana and to grow up to 12 plants, which must be kept in an enclosed, locked facility for medical purposes. While the law legalizes the possession and medical use of marijuana, it does not address the acquisition of the marijuana, nor does it set up a legal supplier or distribution network. Registered patients and caregivers may legally grow marijuana, but the question remains as to how the caregiver or patient will legally acquire the original marijuana or marijuana seeds. ECSAAG will monitor the consequences of the law in Eaton County and determine what, if any, actions should be taken.

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Contributing Factors: While we currently have no local data available, according to the SAMSHA 2006 National Survey on Drug Use and Health, adults and youth have easy access to prescription and over-the-counter drugs. Local school districts are reporting anecdotally that students are bringing medications to school for recreational use and local service proViders describe accidental poisonings and death have occurred in recent months, We have identified the follOWing contributing factors:

v' There is a lack of coordination of existing resources and a lack of community knowledge or expertise surrounding Jaws

v' There is a lack of data availability and analysis for decision making

v' Teens believe there is "nothing wrong" with using prescription drugs once in a while and view prescription and OTC as safer than illegal drugs even if they are not prescribed for them by a doctor

v' Both adults and youth have easy access to the drugs; they are stealing them, buying them, or getting a prescription for themselves or a family member

Unfortunateiy, reliable, local supporting data are currently not available regarding the intervening variables. ECSAAG will identify additional data indicators and evidence-based strategies to employ. The prescription and OTC drug-related goal for ECSAAG is:

8

•

Goal 4 - Prescription and OTC Drugs: To reduce poisonings and deaths due to over-the-counter and prescription drug misuse and abuse by youth and adults in Eaton County.

• The following objectives were reviewed and approved by ECSAAG within the development of this strategic plan:

4.1 Social Availability: To reduce youth and adult social access to over­the-counter and prescription drugs

4.2 Promotion: To impact the promotion, prescribing, and distribution practices of over-the-counter and prescription drugs

4.3 Community Norms: To correct the misperceived community norms related to over-the-counter and prescription drug misuse and abuse

4.4 Laws and Policies: To support and/or enhance laws and policies that reduce over-the-counter and prescription drug misuse and abuse

•

• 9

Goal 5: Marijuana

Marijuana Problem Statement Consequences: Over half (52.5%) of Eaton County 9th grade students and nearly two-thirds (73.4%) of 11th graders report in the 2008 MiPHY that it is easy for them to get marijuana (MiPHY, 2008). Nearly half (47.9%) of 11th

graders report having smoked marijuana at some point in their lifetime, and 24.9% of them have used marijuana in the past 30 days. Eaton County youth report using marijuana at higher rates than peers in Ingham and Clinton counties (MiPHY, 2008). Over 90% of high school students report that their parents felt it would be wrong or very wrong for them to use marijuana (MiPHY 2008).

•

Schools and the Eaton County Juvenile Court report that youth are using marijuana at unacceptable rates. Based on records from the past four years from the Grand ledge High School In School Probation Program (ISPP), 86% of students participating in ISPP became eligible for the program because they were caught in possession or under the infiuence of marijuana, other drugs, or with drug paraphernalia (note: the vast majority of these offenses involved marijuana, while only a handful involved another drug).

Of the nine students participating in the Eaton Rapids In School Probation Program (ERISPP) during the 2009-10 school year, seven of them were referred for using or possessing marijuana.

Of the 45 admissions to the Eaton County Delinquency SAFE-T Program from 2007-2009, 37 (82.22%) reported using marijuana in the past 30 days and 44 (97.77%) had ever used marijuana. The youth reported their age of onset for using marijuana was 12.7 years of age.

The Drug Abuse Warning Network (DAWN), a system for monitoring the health impact of drugs, estimated that, in 2002, marijuana was a contributing factor in over 119,000 emergency department (ED) visits in the United States, with about 15 percent of the patients between the ages of 12 and 17, and almost two-thirds male.

Contributing factors: While we have few local data available for analysis and decision making beyond the data listed above, marijuana is shown to be the most commonly used illicit drug in the nation (Nationai Survey on Drug Use and Health, 2003). The coalition's consensus is that marijuana is a large problem in our community and a priority goal area. ECSAAG has identified several intervening variables:

•

"' Youth and their parents do not see marijuana as harmful. Oniy 53.1% of Eaton County 11th

graders think that marijuana use by theirs peers is "wrong" or "very wrong." Michigan voters overwhelming voted in a medical marijuana law.

"' Marijuana is perceived to be easy for youth to get. Nearly two-thirds (73.4%) of 11th graders report in the 2008 MiPHY that it is easy for them to get marijuana

"' Alcohol and tobacco use are strong predictors of marijuana use. 2009 NIDA study showed that among youth in all age groups studied, the two strongest predictors of marijuana initiation were: l)alcohol and tobacco use, and 2)being offered marijuana by someone

./ Lack of knowledge/expertise surrounding laws and policies and social access to marijuana

./ Lack of data availability and analysis for decision making

ECSAAG will identify additional data indicators and evidence-based strategies to employ. The marijuana related goal for ECSAAG is:

• 10

GoalS - Marijuana: To reduce the use/misuse of marijuana by youth and adults in Eaton County. The following objectives were reviewed and approved by ECSAAG within the development of this

•strategic plan:

5.1 Social Availability: To reduce youth and adult social access to marijuana 5.2 Promotion: To reduce the promotion, prescribing, and distribution practices

of marijuana 5.3 Community Norms: To correct the misperceived community norms

involving marijuana 5.4 Laws and Policies: To support and/or enhance laws and policies

that reduce marijuana misuse and abuse

•

• 11

Goal 6: Suicide Prevention

Suicide Prevention Problem Statement Consequences: In the Substance Abuse and Mental Health Services Administration White Paper Substance Abuse and • Suicide Prevention: Evidence and Imp/ications-A White Paper(SAMHSA, 2008), substance abuse is listed as one of the greatest risk factors for suicide. Eaton County youth are reporting sUicidal thoughts and behaviors at alarming rates. Of Eaton County 7th graders, 22.2% reported they have seriously considered suicide as compared to 17.7% in Ingham and 17.0% in Clinton County (MiPHY, 2008). Of 7th graders, 14% reported they had made a plan about how they would attempt suiCide, and 48 Eaton County 7th graders (6.9%) reported they've actually attempted suicide one or more times in the past year (MiPHY, 2008). Of Eaton County 9th and 11th grade students surveyed, 8.5% reported they had actually attempted suicide one or more times during the past 12 months. Of the high school students surveyed, 4.1% had a suicide attempt resulting in an injury, poisoning, or overdose that had to be treated by a doctor or nurse during the past 12 months. This figure is high compared to 2.6% reported in the 2007 Michigan Youth Risk Behavior Survey (YRBS) sample.

Suicide accounts for 11% of all deaths for Eaton County youth under 20 years (2007 MDCH Vital Statistics). Seven suicide deaths and one undetermined intent death (possibly suicide) occurred in the IS-24 age group from 2002 to 2006 (CDC WONDER). Eaton County suicide has occurred evenly between both male and females, unlike the national pattern.

Over the past ten years the average number of suicides for all of Eaton County residents has been rising. Overall rates for the past five years show that Eaton County residents are more likely to die by suicide than residents of the state as a whole (MDCH Vital Statistics, 2008).

Contributing Factors: During the Eaton County suicide prevention strategic planning process, residents identified the county's rural culture and its majority white population as risk factors for suicide. other factors include insufficient access to mental health services and substance abuse services. Committee members consider ready access to guns due to a gun-owning farming and/or hunting culture as a risk factor; two-thirds of Eaton County suicides in 2007 occurred by firearm (12 out of 18) (MDCH). • While we currently have few reliable, local supporting data currently available, we have identified several intervening variables:

,f There is a lack of funding streams dedicated to suicide prevention in Eaton County

,f There is a lack of training available for schools, physicians, first responders, clergy, and other professionals responsible for responding and intervening in situations of potential suicide

,f There is a lack of community-based resources that provide support to individuals who are experiencing depression or suicidal ideation or have been affected by another's suicide. Local resources do not have the capacity to handle the increased demand

ECSAAG will identify additional data indicators, contributing factors, intervening variables and evidence­based strategies to employ. The suicide prevention goal for ECSAAG is:

•12

Goal 6 - Suicide Prevention: To reduce the incidence of death due to suicide in adults and

•youth through improved access to and community linkages with mental health and substance abuse services in Eaton County. The following objectives were reviewed and approved by ECSMG within the development of this strategic plan.

6.1 capacity BUilding: Mobilize and build capacity to address suicide prevention

6.2 Community Norms: Correct the misperceived community norms involVing suicide

Evaluation

ECSMG uses the Data in Action format and continues to refine the data set collected yearly. ECSMG will also utilize the MSSAC Needs Assessment Toolkit and Outcome Evaluation Monitoring Tool to assist in analyZing trend data surrounding the identified priority consequence areas (Alcohol involved traffiC fatalities, injuries, and crashes; tobacco related death; and poisonings and death due to OTC and prescription drug abuse), associated consumption patterns, and risk and protective factors over time.

•

In addition, beginning in 2008, pre/post and process data for programs and other evaluation milestones were collected and reported on in an ECSMG Annual Process Evaluation Report. In addition, the ECSMG data committee produced localized reports for each community prevention group using their MiPHY results and other local data to assist in their planning efforts and will continue to assist data analysis of future survey efforts to show outcomes in targeted local efforts. An annual evaluation report will be completed examining the three levels of the coalition work: Levell) coalition infrastructure, process, and functioni Level 2) coalition interventlonsi and Level 3) community change (enVironment, policies, or practices). Each committee and iocal community group provides a summary report to the coalition on each of the three levels related to their goal area or focus. An overall outcome report will be reviewed by ECSMG with recommendations for quality improvement. The report will be submitted to MSSAC at year end.

Capacity Assessment

Key Leader Survey: In August 2009, 11 Key Leader interviews were conducted in Eaton County. The Key Leaders were asked what they knew about ECSMG, their impressions about the important issues that youth and adults face in Eaton County, as well as the factors contributing to substance abuse in Eaton County communities. Their responses were frank and valuable. This input resonated With the members of ECSMG, and has helped in the strategic planning process. Key leaders were asked to identify factors contributing to substance abuse in Eaton County.

The Key Leaders' Responses: Hopelessness

Lack of parental or community support Peer pressure/acceptance

Access and availability of drugs/alcohol Lack of enforcement

Advertising/societal norms

• 13

Cultural Competence

On May 11, 2010 at the ECSAAG Annual Meeting, in preparation of our strategic planning, an activity to gather input on incorporating cultural competence into community readiness, ieadership, and evaluation was • conducted. By definition, culture is ever present and pervades all aspects of identity--whether individual or group. Coalitions must first understand a culture before attempting to alter systems, policies, or group norms. They need to recognize that an individual can identify with muitiple groups. Diversity encompasses much more than racial or ethnic identification. Culture is shared values, traditions, norms, and customs. For example, culture affects people's perceptions about substance use, abuse, and related problems.

Participants were asked questions about how ECSAAG can identify the cultural groups and designations across Eaton County. A few responses include:

v' African American and Hispanic representatives v' Gay/Lesbian community v' Businesses v' Seniors v' Youth

They were asked how barriers to participation in ECSAAG could be removed. A few responses include: v' Lack of time/ability/willingness to attend meetings v' Need to figure out more meaningful ways to participate than meetings v' Stigma around substance abuse

It was also asked how culture could be incorporated into the ECSAAG strategic planning and assist in conveying ECSAAG's message to the diverse networks in Eaton County. Participants provided the follOWing valuable information:

v' Utilize the media as much as possible v' Personally invite members from minority groups to participate in the meetings and events v' Focus more outreach into the communities v' Utilize social media networks v' Have a presence at festivals and cultural holiday events •

Each of the committees and community groups will incorporate cultural competence into their strategic planning processes and in conveying ECSAAG's plan to groups across the county and region.

•14

ECSAAG'S Strengths, Weaknesses, Opportunities, and Threats (SWOT Analysis)

•On March gthand April 13th

, 2010, ECSAAG members completed a SWOT Analysis to assist ECSAAG members in preparation for the development of a new five-year strategic plan. Four questions about ECSAAG's strengths, weaknesses, opportunities, and threats were posed to the group. The group's collective responses are identified below:

Strengths

• Access to resources and inforrnatiOh .:. d~t;l9'lthering • Key leaders recognize ECSAAG(srple in data • Agency sharing, no turf issues, wiiling to give

resources • Juvenile Justice Millage braided funding' • Conscious of not re-creating things that already exist • Coalition is an avenue to promptly move issues and

projects forward • Diversity of the community represented • Data give opportunity to bring forth an issue, both

locally and statewide • Ability to get surveys implemented and to use data • Gqod, productive staff with ability to work in

communities • . J:xpertise in coalition leadership

.• tireatattendance at meetings . ; ""'''' .W6rkingsubcommittees drive Implementation Plans

"';Steadygrowth and evolution ." Co.9Ii~(m indudestreatment and recovery

X;;.~i;·~lJ~nQnlYOf 1()911 groups with collaboration ~~~i~e '.

....~:~~e~~~a~~~i:r~~:,nceto coalitions across

OPPortunities

• Opportunities to go beyond county borders, train regionally, mentorship to other coalitions. Market ECSAAG as leaders and trainers to the state

• Use regional (REMe) summer technology institute as a potential training model

• Tri-county collaboration allows us to braid funds and utilize common media market

• Different perspectives and strengths enhance efforts • Involve students to gain their perspectives • Identify other collaborative partners, service groups,

clubs, LCC, MSU, Davenport • Internships will help us expand reach • Mental health parity with passage of new laws. People

will have more access to care • Prevention funds that might be coming through

healthcare reform • Expand our collaboration to build on ROSC

Weaknesses

• Not as well known in the community as we shOUld. be...ECSAAG Name?

• COmmunity may not understand ECSAAG's role • Due to growth and expansion, our focus on miS$ion

gets lost • Not in the media enough. Need a designated media

person to drive the community plan • Need some private foundation support • Need participation from local township

representatives who can take issues back to decision makers.

• Flow chart improved to show another level of participation - (i.e., what is happening In communities)

• Tum up the volume on urgent needs. Get loud, tough rlqw, mqre than ever! Get people involved

• Prepared responses to submit when hot-button issues cpm)i!up!

.' ~~JVe .~. specific reason for meetings, action oriented • "~~ll peed to bring other diverse perspectives to the

Threats

• Over-regulations, licensing reouirements (i.~.

requiring credentials might keep us from prOViding some really good services)

• Not become reactive and negative - look for opportunities, new partners, etc.

• Loss of police personnel threatens ability to enforce laws

• More competition for funding (need grant writers/training)

• School cuts limit prevention implementation • DARE eliminated in Charlotte • 40th in nation economically/economic downturn • Increased crime

ECSAAG will continue to discuss these SWOT indicators in depth at upcoming ECSAAG Communications

• Committee meetings, and identify action steps to incorporate SWOT into annual implementation plans.

15

Conclusion

ECSAAG has identified mUltiple prospects for the coming five years. ECSAAG intends to conduct regional trainings and offer mentorship to other coalitions. With the successful completion of the pilot project in • Eaton County, ECSAAG hopes to partner with other Eaton County agencies to expand the Recovery Oriented System of care (ROSC) within the county and assist other county prevention coaiitions in their efforts to implement ROSC. With braided funding, ECSAAG intends to collaborate with Ingham and Clinton Counties to utiiize a common media market for prevention activities. By identifying other collaborative partners such as MSU, LCC, service groups and youth, ECSAAG hopes to gain additionai perspectives and opportunities for growth.

In conclusion, utilizing the Strategic Prevention Framework model and a thoughtfui planning process that resulted in the goals and objectives outlined above, ECSAAG feels confident that a comprehensive strategic plan for 2010 - 2015 has been created and will result in reductions of substance use and abuse problems as well as incidences of suicide in Eaton County.

• Special thanks to the members ofECSMG and its committees and local community groups, Mid-South Substance Abuse Commission, the Eaton County Human services Collaborative, and the Eaton County Board of Commissioners for their assistance in developing the 2010-2015 Strategic Prevention Plan.

Chairperson: Jeanne Pearl-Wright Chair Elect: Loretta Williams ECSAAG Staff: Sara Lurie, Nancy Bernthal, Polly Brainerd, Gary Owen (PPS/EISD), Anne Barna (BEDHD), and Mary Jo Pangborn (CMCA) Dated: June 18, 2010 www.eatondrugfree.org

substatlc~ IJb"se cOMmission

...Providing our community with substance abuse prevention strategies and solutions

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• • •

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, ' ..,~~....

ECSAAG - A Workgroup of Eaton County Human Services Collaborative Council APPENDIX A

Mid~South Subsunce Abuse Commission ECSAAG and Committee Infrastructure

Data Analysis (Barry~Eaton District Health Department) Choices Parenting Component

Parent Nurturing Programs

Eaton County Recovery Oriented Systems of care Eaton County Early IntelVention Programs Coordination (support to In School Probation, Tru8no,r Intervention

Program, Leadership & Resiliency)

General Federation of Women's Club· Charlotw Medicine Abuse Awareness Disposal Events Promotion

I-' --.J

Suicide Prevention of Eaton County ISPEC) Capacity Building

Community Awareness ReSQUrce Directory

Tr~CountyStrltegic Pion

Tobacco Committee Cessation Resources

'---0 Smoke-Free Air Youth A<ass._/

Marijuana Awareness Public Awareness

Policy Development

(Eaton County Substance

~lJSe Advisory Group)

-~ '-.""T-~-""

WORKGROUPS Pre5cription Drug Abuse CommitteeT·····

Recovety Orientated System of Care AdVlsOry Group

.Eaton COUnty Pilot Project Support and Guidance

/I

~ .

Alcohol Committee Charlotte Community Prevention Group

Grand ledge Communities MobiliZing for Change on Alcohol (CMCA)

Eaton Rapids Alliance for Substa nee Ab.use Ellmination (ERASE)

Youth A<aSS ElrJy lntelVention

Community-Ou\l'each

DrUB FrH Community Grant Community Outreach and

OrganIzation

Youth Access

Youth and Parent Engagement

FUNDERS Smoke-Free Air

I ECSAAG ----­

Juvenile Justice Millage Support to Early Intervention Programs

In School Probation (City of Grand Ledge and Grand Ledge Schools)

Truancv Intervention program (Juvenile Court/ Eaton Counseling Center, and Eaton ISO)

Cl10rees Early ~ntervent!on Program (Eaton Behavioral Health and Eaton ISO)

MI Dept. 01 Community Heath/Toba<co Section Barry-Eaton Health Department

Safe Storage & Disposal Awareness Public Awareness

Policy Development

Dati Committee Data Collection

Needs Assessment evaluation

Communications Committee Annual Communication Plan

Development Implementation

APPENDIX 8: Tri-County Tobacco Prevention Strategic Plan 2010-2015 Clinton, Eaton, and Ingham Counties

Introduction: This Tri-County Tobacco Strategic Prevention Plan is a testament of the Mid-South SUbsta! Abuse Commission's (Mid-South) commitment to the continued collaboration among county prevention providers and community prevention networks that began with the 2005-2009 strategic planning process. The partnerships fostered and expanded in the development of the 2010-2015 Tri-County Tobacco Strategic Plan symbolize the overall growth of the region in the past five years. This plan was designed to replace individual tobacco plans in three of the nine strategic plans in Mid South's nine-county region. Those three counties are Ingham, Clinton, and Eaton counties.

Demographical Description: The Tri-County area, composed of Clinton, Eaton, and Ingham counties is located in south central Michigan. According to the Michigan 2000 census, the total population of the three counties is 456,420 residents. Ingham County is the largest with 279,275 residents, followed by Eaton, with 107,390, and Clinton with 69,755. The City of Lansing is both the state capital and the largest city, located predominately in Ingham County, with a population of 114,276. While most of the city of Lansing is geographically located in Ingham County, parts of the city limits cross county lines into Clinton County to the north and Eaton County to the west. Eaton, Clinton, and out-county Ingham are predominately rural, distinguishing Lansing as the heart of the Tri-County area. In addition to Lansing, the City of East Lansing is in Ingham County and has a population of just over 46,000. Michigan State University is located there also, with a student population of 46,648. The Tri-County area is rich with recreational activities, from small community festivals and carnivals to Big Ten athletic events to parks and recreation, an annual art fair, summer theater, and summer musiC festivals. While many of these events are smoke free, many are not, or existing policies are inadequately enforced. Adult use, youth use, and environmental tobacco smoke in the Tri-County area is the focus of this plan.

Methodology for developing the Tri-County Tobacco Strategic Plan: This strategic Plan. developed as a result of a community process modeled after the "Strategic Prevention Framework" to create regional and local systems change. This planning process increases capacity (skills and abilities) and organizes infrastructure (agencies, staff, and other resources) in local communities to create positive, lasting population­level change involVing substance use and abuse. The Substance Abuse and Mental Health Services Administration's (SAMHSA) Strategic Prevention Framework enables communities nationwide to build the infrastructure necessary for effective and sustainable prevention. The SPF is designed to impact population level change and is built on outcomes-based prevention, focusing on both consequences and consumption patterns for the entire life span, rather than a particular age group. Population level change means that the focus is on entire populations, such as entire communities. Cultural competence and sustainability must also be infused within the SPF five steps, as visually represented in the symbol below:

•18

Three sessions were held over a three-week period with key stakeholders and community members invited. _ions were held, by problem area, in each of the three counties. Ingham County hosted the session on _It tobacco and cessation; Eaton hosted Clean Air, Environmental Tobacco Smoke, and Asthma; and Clinton County hosted the Youth Tobacco Use workshop. Key data indicators were reviewed, prioritized, discussed and appropriate strategies identified. Strategies were voted on and compiled into logic models for change. All community stakeholders met one final time to review the final models and vote on acceptance of the models. These outcomes were then used to guide the strategic plan.

Tobacco Problem Statement: Tobacco kills more people than AIDS, alcohol (chronic liver disease and cirrhosis), auto accidents, cocaine, heroin, murders, and suicides combined. In 2007, there were a total of 7,387 deaths in the Mid-South region with 1,089 of those deaths, or 14.7%, directly linked to tobacco use.! Smoking-related illnesses include, but are not limited to: heart disease, stroke, respiratory diseases, lung cancer, and other tobacco-related cancers. There were also 144 deaths to non-smokers in the Mid-South region due to secondhand smoke exposure. Research shows that even 30 minutes of exposure to secondhand smoke can cause heart damage in a non-smoker similar to that caused by the smoking of a habitual smoker. !

Tobacco Data and Issues in the Tri-County area: Adult use in the Tri-County area is delineated by significant differences in use by age, level of education, employment status, and income level. The unemployment rate in the region hovers near 11%, one of the highest in the nation. Plant closings and financial difficulties of General Motors has had a huge impact on this region, and adults who reported being unemployed also reported the highest prevalence of smoking'. Demographically, 2006 Behavior Risk Factor Survey (BRFS) data indicates one in three adults between the ages of 18-35 are current smokers. Of current smokers, 31.1% have a high school diploma, and 36.3% of current smokers have less than a high school diploma. The highest incidences of current smokers, or 38.2%, earn less than $15,000 per year, and 27% earn between $15,000 and $24,000 annually. Of current smokers, 30.5% earn between $25,000 and $35,000 • year. In the Tri-County area, 36.8% of adult smoker's report they are unable to work, 41% report they .e been out of work a year or less, and 43.7% report they have been unemployed a year or more.'

Environmental tobacco smoke (ets), or secondhand smoke, is also an issue regionally. In the Tri-County area, there is a social class disparity in indoor smoking practices by education level, household income, and age. Also, there is no difference in the indoor smoking practices in the home between households with children present and households without children. The highest %age of households with children that allow smoking indoors are highest among households with income less than $35,000 per year. The highest prevalence of smoking in the home where children are present is among persons between the ages of 18 and 24. '

The problem of youth access to tobacco is a problem in our country, state, and local counties. When youth can access tobacco easily, they are more prone to smoking behavior and tobacco addiction. In the Tri-County area, 66% of high school and 35.6% of middle school youth consistently report "easy" or "very easy" access to cigarettes. However, only 15.8% of our Tri-County youth report being able to purchase their own cigarettes. Since most youth are not purchasing tobacco products, impacting social access and community norms becomes the obvious strategy for reducing tobacco access. Even more alarming is the age of onset (age 12.5) for the Tri-County area. '

Key contributing factors and highlights: There are decreased quit tobacco programs in Ingham County, limited qUit tobacco programs in Eaton County, and no quit tobacco programs in Clinton County. There is a lack of smoke-free policies at the health departments of all three counties. Also, there is a large gap in youth who perceive their friends are using tobacco and those who actually did use tobacco; 83% perceive their friends used when only 19% actually did use. 3 Another key issue is a disparity in ethnicity and tobacco use. Hispanic youth have the highest percentage of recent cigarette use, and white students have the highest &entage of frequent cigarette use. Respectively, 17.5% of Hispanic youth, 14.2% of white youth, and ~% of black youth have smoked in the past 30 days, and 28.7% of Hispanic 24.7% of white, and 16.3% of

19

black youth have ever used tobacco in their lifetime. Finally, 5% of Hispanic, 2.7% of black, and 6% of white middle and high school students have smoked 20 or more cigarettes in the past 30 days,3

What Can We Do About It? The Strategic Plan: The identified data indicators involving tobacco use, secondhand smoke exposure, and their related consequences ultimately provide a second opportunitvA change, The time is now to address this major public health issue, We have allies, networks, and policies'. we have never had before to assist the prevention field in reducing tobacco related death due to tobacco use and exposure to secondhand smoke. Our objectives include:

Community Norms: To correct the misperceived communityr!or01Sinvolylllfj" <.'

tobacco use / misuse .

Enforcement and Adjudication: To support and/or enhance the effective enforcement and adjudication of tobacco involved violations

Social Availability: To reduce youth social access to tobacco, and to impact adult social access to tobacco

~etail Availability: To reduce youth retail access to tobacco, and to impact adult retajlj'lcceSs to tOQacco

.~~9ndP?fl¢ie~: TO support and/or enhance laws and policies that reduce

. t¢P9C(l(:n'l,\(S!'l~(

The vision for the Tri-County area is that by 2015: • • The Tri-County area will report a reduction in the percentag~ Of~qlTl~f~P~~~!~~~~;~5

permitted inside the home as measured on the Behavior Risk Factor Sl,Jrvey (BRFS), ;!';((;;;.;,.•Z • There will be a reduction in the percentage of homes reporting smoking .is permjttedln~ijj~~e;.~\;im~·

where children are present on the BRFS. .. ..... . • There will be a decrease in the percentage of students reporting they have ever used tot:>a(X:o an.d'li

decrease in use in the past 30 days as reported on the Michigan Profile for Healthy YO\lth(MiPH)'). • The Tri-County area will see tobacco prevention and treatment services are more· avail9bJe,

accessible and affordable for everyone in Eaton, Clinton, and Ingham counties. • The Tri-County area will see cultural and social norms shift so that tobacco use by adults and youth

in the county is perceived as negative behavior by all community members. • Youth access to tobacco in all three counties will be reduced as evidenced by compliance checks and

county Synar rates. • Smoke free campuses initiated at Ingham County Health Department, timeline developed for Barry­

Eaton and Clinton health departments. . .. ~Tobacco taxeS will be allocated for health and quit tobacco services as evidenced by legislation.

• There WiIf.be a clean air policy passed statewide as evidenced by legislation.

---_._-----------------'

•20

Summary:

These objectives cannot be reached without a collaborative, cooperative, and shared effort of all of the sectors _e Tri-County area. This plan is a result of many hours of data review, assessing what resources are '-ady in the community and where service gaps exist, strategies that could be implemented, and how those outcomes will be measured. This plan is a result of a joint venture between the Ingham Substance Abuse Prevention Coalition, the Eaton County Substance Abuse Advisory Group, and the Clinton County Substance Abuse Coalition.

•

1 Michigan Department of Community Health, Division for Vital Records and Health Statistics and Centers for Disease Control and Prevention; CDC Wonder Online Database and SAMMEC Online Database, 2007 .

06 Behavior Risk Factor Survey id-$outh Substance Abuse Commission, Prevention Needs Assessment 2008

•

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• .. .Providing our community with substance abuse prevention strategies andsolutions

ECSAAG FAST FACTS

Purpose:

The mission of the Eaton County Substance Abuse Advisory Group (ECSAAG) is to collabora.tively at::l(I~~'t!h.e;)

substance abuse prevention and treatment needs of the Eaton County community. ECSAAG is 3 ~;~~:~~~:~>/ multi-sector, county-wide coalition with representation from several agencies, businesses, and 0 throughout Eaton County. Together, the coalition is working to achieve the vision of reducing use and llli:sU!I\!!:(lf alcohol, tobacco, prescription and over-the-counter medication, mqrijuana, and reducing suicides by planhi.n91 i). coordinating, and evaluating substance abuse prevention and treatment services in Eaton County.

Coalition Activities and COmmittees: • Data Committee • Alcohol Prevention Committee • Tobacco Prevention Committee • Prescription and Over-The-Counter Drug Prevention Committee • Suicide Prevention of Eaton County (SPEC) • Eaton Rapids Alliance for Substance Abuse Elimination (ERASE) • Grand Ledge Communities Mobilizing for Change on Alcohol (CMCA) • Recovery Oriented Systems of Care (ROSe) • Charlotte Prevention Group • Potterville Prevention Group

Pattfdpanl$:

Eaton County has successfully convened a wide variety of stakeholders from around the county in health, human services, courts, law enforcement, substance abuse prevention and treatment prOViders, schools, colleges and universities, local mental health providers, UAW-GM, locai businesses, and interested community .members.

$taffs\lilpoJt Is PrOvid\!!d through collaboration between Prevention Program Services of the Eaton Intermediate SGhoolDjstritt!Prevention Program services (EISD/PPS), Barry Eaton District Health Department, and the City of Grand Ledge.

FU"~',:',\,t~'!_""",_"" , .' F!1ndf~iSpr9'1'idedt!hroughMid-SouthSubstance Abuse Commission, the Substance Abuse and Mental Health Sel'\ll~Agen.¢y(SJ\.MHSA) under the Drug Free Communities Grant, and the Eaton County Juvenile Justice Millage.' .

www.eatondrugfree.org Find us on facebott

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•

Recovery Oriented Systems of Care

• Five -Year Strategic Plan 2010 - 2015

Jack G. Jesse, Ph.D., LMSW, CAAC Eaton Behavioral Health - Division Director

• 1

Mission Statement - ROSe

The Recovery Oriented Systems of Care initiative is committed to providing quality peer to peer coaching, mentoring, and community-based resources to consumers of the Eaton Behavioral •Health program that promote their long-term health and well being. Core values of integrity, dignity, and respect are an integral part ofproviding these services. Promoting collaboration and coordination of activities that prevent or reduce the incidence of substance use and other behavioral health concerns in our community is a continuing focus of ROSC.

Mission Statement - Eaton Behavioral Health

Eaton Behavioral Health is committed to providing quality services for the members of the community who are affected by problems related to substance use and other co-occurring behavioral health concerns. We promote and provide innovative, research-supported, accessible and affordable skills and programs that improve the well being and quality oflife for these members of the community. Integrity, dignity and respect are core values inherent in the provision of these services.

Five-Year Strategic Plan

2010-1015 •Vision: Eaton Behavioral Health and the Barry-Eaton District Health Department are committed to developing a national model ofexcellence for the Recovery Oriented Systems of Care initiative. We envision a system of care that empowers consumers and the community as a whole creating a dynamic force of thinking and actions that create abundant health and wholeness. We envision a partnership of individuals and agencies harnessed together creating a new environment for an enlightened partnership that becomes a foundation for lasting change in producing barrier free services for anyone wanting a healthy lifestyle.

Goal #1: Recruit, train and sustain 10 new Peer Lifestyle Coaches (PLC's) per year.

Strategy #1: Based on identified client needs, utilize the media and other recruitment tools and strategies to contact and encourage community participation in the coaching aspect of ROSC. IdentifY persons who can help to meet the three top needs ofconsumers: employment, adequate housing, and continuing health and sobriety.

Strategy #2: Develop and utilize enhanced training modules for PLC's that continue to meet the standards for 24 hours of training in the 12 identified critical areas. Training may be organized so that it is ongoing, eliminating any waiting period for coaches to begin the process.

Person(s) responsible: Peer Lifestyle Coach Coordinator, staff, Advisory Board members.

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Goal #2: Expand skill-building choices ofthe ROSC initiative to include the areas of nutrition, mood management, smoking cessation, family support and additional health enhancing activities.

Strategy #1: IdentifY, organize and promote at least one new activity or skill in each of the identified areas: nutrition, mood management, smoking cessation, family support and health enhancement. Anyone of these areas maybe organized, staffed and promoted by PLC's. The needs of consumers and the community will be the focus of these choices.

Strategy #2: Utilize collaborative partners to promote and support ongoing skill building and activities in the identified areas. Collaborative partners will be encouraged to utilize current resources as well as assimilating new strategies that increase choices and availability of those skills and activities. An example might be promoting walking and bicycling paths and expanding those options in various areas ofthe community to make them more accessible.

Person(s) responsible: All EBH staff and collaborative partners.

Goal #3: The ROSC will identifY five new sources for financial support with the idea ofbeing able to compensate PLC's in a way that would encourage long-term retention of coaches and sustainability of the program as a whole.

Strategy #1: IdentifY 10 federal or state level grants and 10 potential foundations to submit grant or foundation requests. These grants will be sought the most intensely during the first year of the five-year strategic plan.

Strategy #2: IdentifY any community partners that may want to join in the application process.

Strategy #3: Apply to one grantor or foundation quarterly.

Persons) responsible: Peer Lifestyle Coach Coordinator, EBH - Div. Director, EISD staff and designated Advisory Board members, MSSAC staff.

Goal #4: SolidifY a data collection and evaluation plan that measures both program output and client outcomes.

Strategy #1: Continue to utilize the Quality of Life Survey at the beginning and end of ROSC involvement.

Strategy #2: Continue to utilize the Pre-treatment Survey and the Post-treatment Survey to collect data regarding connections to community and utilization rates for services offered.

Strategy #3: Develop a data base in Access or another program in order to track data.

Strategy #4: Analyze data yearly to become a part of the Annual Report

Person(s) responsible: Peer Lifestyle Coach Coordinator, EISD & EBH staff and student interns.

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Goal #5: Training ofROSC coaches will implement a training module that focuses on skills to reduce anxiety, lessen the impact of trauma, and increase coping and resiliency.

Strategy #1: Staffwill develop a 2-4 hour training module that includes development of •skills including EFT, NAEM, mindfulness, and Basic States training.

Strategy #2: Avenues will be developed that make available and promote these skills among ROSC consumers, including individual and group sessions, working with their coach, primary therapist or other settings.

Person(s) responsible: Peer Lifestyle Coach Coordinator, EBH - Div. Director

Goal #6: ROSe staff and coaches will work to increase community involvement as an advisory group and in implementing skills and activities within the community that build cohesiveness, increase connectivity with consumers, and engage community and faith-based groups to participate in the ROSe initiative.

Strategy #1: Identify eight community members to participate on the ROSe Advisory Board that will be willing to meet on a quarterly basis. Specific Advisory Board functions will be identified.

Strategy #2: Identify ten new community organizations that are willing to sign a Strategic Community Involvement Agreement to promote the vision and mission ofthe ROSe initiative. This Agreement will outline the responsibilities of each party to the initiative. •

Strategy #3: Identify six community andlor faith-based activities or skills that would lead to a stronger integration of the ROSe initiative with the greater community. These activities and skills must have the criteria of increasing connectivity with the community, be health promoting andlor health sustaining and build cohesiveness.

Person(s) responsible: Peer Lifestyle Coach Coordinator, EBH- Div. Director, staff and coaches, Advisory Board members, ECSAAG members

Goal #7: Develop a prevention and support network for adolescents connected to the Rose initiative that provides resources, activities and supports for adolescents. An example would be Peer Lifestyle Coaches that engage teens in out-of-doors activities such as fishing, gardening, kite making and flying, where a range of positive, pro-social activities are made available. Another example would be to develop or integrate an existing web page as a potential source to find support from other clean and sober teens.

Strategy #1: Identify at least a dozen pro-social activities that would engage teens and connect them to coaches and established groups for life-long integrated support.

Strategy #2: Identify an equal number of coaches that share a common interest who could pair up with the teens.

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Strategy #3: Identify web based resources for teen recovery support and add it to the • ROSC resource listing.

Strategy #4: Flood the community with infonnation regarding the offerings and opportunities by way of fliers, brochures and the Internet.

Person(s) responsible: Peer Lifestyle Coach Coordinator, Peer Lifestyle Coaches, community partners including the ErSO

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• www.detnews.com·Th.eDetroitNews Il\tp:/ldetnew•.com(article/20101116/BIZ/11160401November 16, 2010

Mich. workers hit hardest in u.s. by loss of employer health care MELISSA BURDEN The Detroit News

About 1 million Michigan residents lost their health insurance through their employers between 2000-01 and 2008-09, one of the largest percentage declines among the states, accoldillQ to a report released today from the Economic Policy Institute.

The number ofpeople in Michigan vvho haw insurance through their jobs fen to 5.7 m~fion from 6.6 million over the time peliod, a drop of 10.4 percentage points, said the Institute, a labor-supported research organization in Washington, D.C. The percentage-point decline \Nas second highest behind Indiana, whose rate fell 11.4 percentage points.

• Due to sharp declines in the economy, the percentage of U.S. residents under 65 who have health insurance through their employer dropped for the ninth year i1 a row, to 58.9 percent in 2009 from 61.9 percent in 2008. Duling the decade, the percentage of adults who get health insurance through the . workplace fell from 76.4 percent to 66.1 percent, accon:Iing to the report.

While the Patient Protection and Affoldable Care Ad. - President Baraek Obama's health refonn law - will make seculing and keeping health insurance easier and cheaper for Amelicans,the institute said, the "poor labor market will likely lead to further losses in insurance coverage before this major relief takes effect in 2014."

Health refonn already has helped expand health care coverage to thousands of Michigan residents, . according to the Michigan League for Human Services.

© Copyright 2010 The Detroit News. All rights reserved •

• http://delnews.comfarticle/20101 I 16/BIZII I I60401&template=printart 12/5/2010

• Michigan League FOR Human Services

July 2010

.Why federal health care reform is good medicine for Michigan

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Heallh care reform, thePatientProtection andAffordable Care Act, or simply the Affordable Care Act, signed on March 23, 2010, caps a century ofefforts to make health care available to all.

The law requires that all categories of individualsorfamilies eligible for Medicaid or MlChild as ofMarch 23, 2010 remain eligible. They cannot be cut because of tight budgets.

It eliminates out-of-pocket costs for proven preventive services.

As ofSep!. 23, 201 0, an estimated 32,800 . young adults can stay on or re-enroll in

their parents' plans until age 26, even ifthey are notcollege students, or IRS-defmed dependents.

More oversight ofpremium increases is required under the new law.

Help is on the way for uninsured persons with pre-existing conditions. As ofSep!. 15,2010, individualswill be able to enroll in subsidized progrnms that will begio coverage on October I, 20IO. The federal government will provide $141 million to Michigan for subsidies for these programs.

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.Seniors in Michigan caught 10 the Medicare Part D "donut hole" are getting $250 checks to help pay for their drug costs. If similarnumbers ofseniors reach the "donut hole" in2010 as last year, approximately 134,000 seniors will be helped this year.

You can't lose your insurance ifyou become ill or your child can't be excluded from coverage because ofa pre-existing condition. No lifetime limits,either.

Tax breaks are available for small businesses that cover at least halfthe cost of health care coverage for theiremployees. Up to 132,000 small businesses could be helped bythis provision.

The Office ofHealth Insurance Consumer Assistance was established to provide

information and ensure compliance with the law.

Source of Michigan numbers: www.healthreform.gov, The Afford.ble Care Act: Immediate Benefits for

Michigan.

• 1223TURNER STREET, SUrrEG-1:LANSING. MICHIGAN48906

517.4117.5436/PHONE· 517 .371 A546/FAX' WWW.MILHS.OR.G A UNITED WAY AGENCY