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Betty Ferdinand, Chair of the National Association of PASRR Professionals, offers comments on SAMSHA's strategic plan for 2015-2018:


August 18, 2014

Overall Comments: 

The National Association of PASRR Professionals (NAPP) appreciates the opportunity to comment on SAMHSA’s draft strategic plan for 2015-2018.  The importance of collaboration across the continuum of care cannot be overstated.  

In principle, NAPP supports SAMSHA’s six strategic initiatives.   NAPP also supports the importance of addressing the identified high risk populations – acknowledging that aging adults fit within some of these population groups as well.

NAPP agrees that prevention, treatment and recovery forms the basis of a solid foundation of support for all disabling conditions and for persons of all ages. While NAPP recognizes that the purpose of this document is to identify priority areas that are critical to moving the behavioral health agenda forward, it is equally as important to not lose sight of other important populations.   NAPP urges SAMSHA to reevaluate the writing of this document and include aging adults wherever age demographics are mentioned.   

NAPP recognizes that SAMSHA sets the tone for state policy makers and the resulting service delivery systems.  Consequently, it is critical that SAMSHA acknowledges in its plan the growing population of older adults, and their need for mental health and/or substance abuse services. 

Older adults may suffer from many different kinds of mental health conditions, including depression, anxiety, schizophrenia, bipolar disorders, and substance abuse problems.  These conditions can lead to a decreased quality of life for older adults and their family members.  Mental health conditions also can result in premature and, in some cases unnecessary and avoidable institutionalization.  Bottom line, mental health is vital to physical health; both are critical to optimal functioning and aging well.  Therefore, the provision of quality behavioral health services, as well as quality community services, is of utmost importance across the lifespan. 

Strategic Initiative 1:  Prevention of SA/MI

NAPP supports SAMHSA’s efforts in identifying prevention of SA/MI as one of its six strategic initiatives.     As stated in the document, prevention reduces health care costs, reduces the severity of disabling conditions, and improves productivity. Generally speaking, the document recognizes the importance of prevention for every individual with a disabling condition, that is, youth, adults and families. 

While the document acknowledges the importance of communities and systems and the importance of policy and programs that provide a comprehensive approach to preventing substance and promoting good mental health, the document does not clearly address issues specific to older adults.

It is important that SAMHSA continues to promote access, comprehensive assessments and evaluation, and the provision of services throughout the continuum of care for all Americans who are challenged by a disabling condition, at any age.  While the identification of populations of high risk provides a basis for prioritization within this plan, it also creates an unintentional perception that there is a lack of concern for low to moderate risk populations. 


Strategic Initiative 2:  Health Care and Health Systems Integration

NAPP supports SAMHSA’s efforts in identifying the importance of integration efforts and increased access to appropriate high quality prevention, treatment, recovery and wellness services and supports. NAPP also supports SAMHSA’s efforts to reduce disparities between the availability of services, and improved coordinated care and access to services.  Fragmentation, lack of coordination and collaboration, and service systems that are developed in such a way that they are essentially inaccessible to the general public, ultimately results in poor quality and higher cost of care for a vulnerable population that is already at risk. 

NAPP supports SAMHSA’s emphasis on the integration of behavior and physical health initiatives and to promote a comprehensive system of access and service-delivery.  NAPP requests SAMSHA to mention its efforts and the importance of collaboration with, for example,  the Administration on Aging and/or Community Living in developing and promoting work towards evidence-based practices in health and behavior health care benefitting the older adult population.


Strategic Initiative 3:  Trauma and Justice

NAPP supports SAMHSA’s emphasis on a trauma-informed approach to service-delivery.  The effects of trauma cannot be overstated in appropriately evaluating and treating the individual, at any age.  NAPP supports SAMHSA’s efforts to create a comprehensive approach that focuses on the importance of trauma and resulting behavioral health issues for children, youth, adults, families and communities.  NAPP urges SAMHSA to clearly include the older adult as a high risk population that are particularly vulnerable to abuse/neglect and other forms of trauma and violence.    

It is important that SAMHSA continues to promote adequate systems of appropriate care throughout health, behavioral health and related systems, and promote a system of preparedness that is comprehensive, yet flexible, and able to support all individuals experiencing trauma. 


Strategic Initiative 4: Recovery Support

NAPP supports SAMHSA’s approach to life in recovery:  health, home, purpose and community.  Supporting communities to develop service-delivery systems that are readily accessible and that are defined not only by policy and procedure but by the individual’s need is critical to recovery for individuals with disabling conditions of all ages. 

NAPP promotes SAMHSA’s efforts to further identify best practices and strategies through outreach efforts and dialogue.  NAPP supports SAMHSA’s efforts to create a service-delivery system where the individual is able to participate in the dialogue, resulting in a support system that is person-centered.  NAPP’s experience is that through a coordinated effort of funding streams, innovation and creativity, states are able to find new opportunities through collaboration. 

NAPP strongly urges SAMHSA to clearly address the older adult population in its efforts toward recovery support.  As Americans live longer, the need for effective integrated health and behavioral health to prevent social isolation, unnecessary institutionalization and high suicide rates.    


Strategic Initiative 5: Health Information Technology

NAPP supports SAMHSA’s efforts to promote health information technology.  NAPP also supports the importance of protecting privacy, confidentiality and security of health information.  The necessity of service-delivery systems to gain expertise in these areas is critical to the development of well-managed systems of care.  This strategic goal should clearly include the long term care systems and aging service organizations as a vital part of the healthcare delivery system. 


Strategic Initiative 6:  Workforce Development

NAPP supports SAMHSA’s efforts to address the impact that behavioral health workforce issues have on the infrastructure of the health care delivery system.  NAPP also supports SAMHSA’s efforts to promote technical assistance, training, and outreach to strengthen the capabilities and availability of health care professionals, particularly in the area of geriatric behavioral health.  Recognizing the importance of traditional and non-traditional professionals in the provision of health care to all risk populations is critical in addressing the healthcare workforce shortage. 


On Behalf of the National Association of PASRR Professionals



Betty Ferdinand, Chair

Welcome to the National Association of PASRR Professionals!

NAPP seeks to be the principal leader in re-balancing long-term care by providing education to stakeholders implementing PASRR programs, and advocating for individuals diagnosed with mental illness, intellectual disability, and/or related conditions; NAPP strives to maximize every individual’s independence, level of functioning, and quality of life.

Upcoming Events

  • September 8th from 1-2:30pm EST. PTAC Webinar: An Overview of Olmstead Planning
  • September 23rd Networking with NAPP Call. 1pm EST.

2014 PASRR & Aging Confernce

March 1, 2014

The 2014 PASRR and Aging Conference was a great success! 39 states were represented this year and we hope to gain even more support for the 2015 conference.

Stay tuned for details!

Meeting Olmstead Requirements

Learn About Olmstead and ADA

This year marks the 15th anniversary of the U.S. Supreme Court Olmstead Decision, finding it is a direct violation of the Americans with Disabilities Act to retain individuals with mental disorders in institutions when their needs can be met in the community.

Learn what other states are doing to prepare for implementing Specialized Services.

July 1, 2014

Centers for Medicare and Medicaid Services (CMS) is heavily focused on assuring that individuals with mental illness, intellectual disabilities, and related conditions have their overall needs met through the delivery of any services and supports that promote quality of life and independence.

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