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HomeMy WebLinkAboutMINUTES - 08211990 - IO.3 „ I.O.-3 HOA91) OF SUPERVISORS Contra it t o FROM: Internal Operations Committee ` Costa is DATE: County cn August 13, 1990 �srq'ciir+` SUBJECT: Proposed Response to the Report of the 1989-90 Grand Jury: "Treatment Programs for Drug and Alcohol Abuse” SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATIONS 1. Adopt this report of our Committee as the Board of Supervisors' response to the Report of the 1989-90 Grand Jury: "Treatment Programs for Drug and Alcohol Abuse." 2. Remove this item as a referral to our Committee. BACKGROUND On May 29, 1990 the 1989-90 Grand Jury submitted the report entitled "Treatment Programs for Drug and Alcohol Abuse" which was subsequently referred to the Internal Operations Committee. On August 13, 1990 our Committee met to discuss the recommendations and review proposed responses. At the conclusion of these discussions we prepared the attached response utilizing a format suggested by a previous Grand Jury which requested that responses clearly specify: A. Whether the recommendation is accepted or adopted; B. If the recommendation is accepted, a statement as to who will be responsible for implementation and a definite target date; C. A delineation of constraints if a recommendation is accepted but cannot be Implemented within the calendar year; and D. The reason for not adopting a recommendation. Responses to Grand Jury recommendations coming from our Committee will follow this format as closely as possible. CONTINUED ON ATTACHMENT: _ YES SIGNATURE: RECOMMENDATI(O�NO,OF`'COOUUNTY ADMINISTRATOR -RECOMMENDATION OF BOARD COMMITTE -APPROVE • OTHER .. SIGNATURES: N1CPeak S pervisor T. Powers ACTION OF BOARD ON ALIguS t�Z, ;, 1990 APPROVED AS RECOMMENDED X OTHER - VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS(ABSENT III, I V AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. CC: County Administrator ATTESTED �-Jjo--w• a/. /990 Grand Jury Foreman PHIL RATQNELOR,CLERK OF THE BOARD OF Health Services Director nSUPERVISORS AND COUNTY ADMINISTRATOR M382 (10/88) BY 'DEPUTY TREATMENT PROGRAMS FOR DRUG AND ALCOHOL ABUSE Recommendation No. 1 Take the lead in establishing a coordinated reception process that will accurately access a potential patient's needs and see that the patient is entered in the appropriate program, whether it is operated by the County, contracted for by the County or operated by a private non-profit organization. Response A. Accept this recommendation and agree that the Health Services Department will continue to work on its implementation. B. Currently, patients needing drug treatment services may be assessed by regional outpatient counseling services and then referred to more appropriate service or admitted for ongoing intervention or treatment services. It is the professional opinion of Health Services Department staff that a decentralized intake and referral system is superior to a centralized intake and referral system because the decentralized system reduces barriers to patients taking the first step and because it is less costly. During the mid-70's the National Institutes of Drug Abuse funded nationwide a number of central intake units (CIU's) and determined that they were very costly and may not have been the best strategy for getting a resistant population group into treatment. The Health Services Department agrees that clearer procedures, more standardization, and increased training can improve the assessment and referral process. This may be accomplished through: 1. Development of a standardized screening and referral policy for all County funded alcohol and drug providers; and 2. Increased training of alcohol and drug providers as to the importance of collaborative assessment and referral procedures. The Health Services Department is currently implementing an improved client information system for County-operated programs. This system will allow County, and eventually contract programs, to determine important information regarding a client's previous treatment episodes and availability of treatment programs. Recommendation No. 2 Provide measures to maintain the motivation of people who request treatment but for whom no program openings are immediately available. Response A. We accept this recommendation. B. The Drug Program Office, Health Services Department, is currently developing a forward utilization review and quality assurance system for residential services and outpatient services. An important component of this new procedure will be to maximize program productivity through the use of groups and to provide closer review of appropriateness of care issues. From this process, more immediate intervention strategies, such as "waiting list groups," will be developed. Recommendation No. 3 Improve the physical conditions and staff compensation in County-operated facilities. Response A. We accept this recommendation within funding constraints. B. The Board of Supervisors is committed to upgrading program physical plants. The Health Services Department is reviewing current compensation levels of alcohol and drug program staff. During FY 1989-90, the Drug Abuse Program Office has expended more than $75,000 in upgrading the two County-operated residential programs. In addition, more than $200,000 in federal funds has been directed toward all County-funded drug programs to upgrade their facilities through the purchase of fixed assets such as equipment and furniture. C. Funding availability will impact this recommendation. Recommendation No. 4 Establish as the first priority for the use of any additional funding the operation within the County of an adolescent residential treatment facility, such as the Thunder Road facility in Alameda County. Response A. We accept this recommendation within funding constraints. B. In FY 1989-90, the Drug Abuse Program Office set aside approximately $100,000 to support the provision of services through a residential youth program slated to be built and operated by Bi-Bett Corporation. The facility is presently scheduled to open in late 1990 or early 1991. If further delays are experienced, it is the intent of the Drug Abuse Program Office to aggressively seek out alternative solutions for the provision of youth residential services. Recommendation No. 5 Establish as the second priority the opening of additional, conveniently located treatment facilities for pregnant abusers. Response A. We accept his recommendation within funding constraints. B. The Health Services Department, in collaboration with the Youth Services Board, has formed a multi-disciplinary committee charged with providing a work plan for the development of residential services for alcohol and drug abusing pregnant women and their infants and children. This Committee for Perinatal Residential Services will be responsible for: • Identifying possible sites for the residential program. • Identifying possible funding sources for the program. ♦ Developing program framework. The first meeting of this time-limited group is scheduled for August 21, and it is anticipated that the Committee will make steady progress toward achieving the desired goals stated in the Grand Jury report. Recommendation No. 6 Develop and formulate an evaluation and monitoring plan for private treatment facilities comparable to the one in use for County facilities. This plan should also provide for the maintenance of accurate statistics on the number and type of patients undergoing treatment in the County. Response A. We concur with the recommendation regarding statistics. B. There are two parts to this recommendation. With respect to the first part, there is no statutory authority to require evaluation and monitoring plans from non-County funded alcohol/drug service providers. The only reference made to private providers in the Title 9 regulations is that they register with the Drug Abuse Program Administrator, but there are no sanctions available if providers do not. Private agencies provide important resources for the residents of Contra Costa County but are generally reluctant to provide program specific information to governmental entities such as our Alcohol and Drug Program Office. With respect to the second part, the County is in the process of implementing an alcohol and drug client information system. This system will collect client specific information such as the last treatment episode for a specific client, and also will collect aggregate information which looks at the total number of preventions provided by each provider during each month. This information is important to the individual programs and Alcohol and Drug Program Administrations in making sound management decisions. A REPORT BY THE 1989-90 CONTRA COSTA COUNTY GRAND JURY 1020 Ward Street Martinez, CA 94553 (415) 646-2345 RECEIVED NAY 3 0 1990 In,EAT[H:tOR ClPtr. Fn' "f:UFC -11Ota 6 .. Cc?STA CG nAr REPORT ON TREATMENT PROGRAMS FOR DRUG AND ALCOHOL ABUSERS APPROVED BT THE GRAND. JURY: DATE: 0?9 9d DONALD G. HA CR GRAND J Y F ACCEPTED CR FI ING: n ^ DATE: NO SPELLBERG PRES2X6NG JUDGE 0 THE SUPERIOR COURT REPORT ON TREATMENT PROGRAMS FOR DRUG AND ALCOHOL ABUSERS SUMMARY Contra Costa County has a growing and serious problem with the illegal use and abuse of alcohol and other drugs. one aspect of coping with the problem is the treatment and rehabilitation of abusers. Treatment programs are offered in the County by a variety of private organizations and the County itself, but there is a growing waiting list for service. Expansion, coordination and oversight of the whole range of services are needed if the need is to be met fully. - -1- INTRODUCTION The Contra Costa County Community Drug and Alcohol Action Plan, developed over the past two years by County officials and a wide variety of community groups, and submitted for endorsement by voters at the June 5, 1990 election, begins as follows: "Contra Costa County has a serious and growing problem with the illegal use and abuse of alcohol and other thugs. The problem involves all age groups, all ethnic and ' social groups, all economic levels of the community and all geo- graphic areas of the County. " Later in the plan, the following declaration is made: "If the community is serious about dealing with the drug problem, there must be available adequate, local, affordable treatment facilities to help people, including young people, plagued by drug abuse. " This report focuses on the treatment facility situation in Contra Costa County. FINDINGS 1. Alcohol abuse and illegal drug abuse are both significant parts of the overall "drug problem" confronting the County and the nation. 2. The majority of abusers are users of both alcohol and illegal drugs. 3 . Treatment for both alcoholism and drug addiction are basically the same after the detoxification period. 4. There is no one accepted treatment formula, but most programs involve detoxification, physical rebuilding, psychological strengthening and aftercare. 5. The psychological strengthening phase usually includes some philosophical component, such as the Twelve Step approach developed by Alcoholics Anonymous. 6. Aftercare involves altering the environment of the patient and continuing involvement in support groups. Full involvement of the patient's family is vital. 7. Addicted adolescents, pregnant women and new mothers require programs geared to their interests and problems. -2- 8. Treatment will not be successful unless the individual wants to undergo it. Motivating an addict to undertake treatment requires a special skill; several attempts at treatment may often be undertaken by a patient before successful completion of the program. 9. Successful completion of a treatment program does not mean a complete return to pre-addiction normality. Constant awareness of the possibility of a relapse is critical. 10. Treatment programs in the County are offered by private for-profit organizations, private non-profit organiza- tions and by the County. 11. The Contra Costa County Health Services Department 1989-90 Resource Guide for drug and alcohol services lists more than 50 public and private organizations providing services for abusers. Most specialize in the abuse area, but some are general counseling services equipped to treat abusers. 12. Some County programs are operated by the County and some are operated by other organizations under contract with the County. 13. Most private for-profit programs are hospital-based, requiring approximately four-week residency and costing around $10,000. Many are followed by an extended period of weekly outpatient meetings. 14. Most private non-profit programs are outpatient, with patients involved from one to five days a week. A sliding fee scale is typical for these programs. 15. County programs consist of both residential "social model" and outpatient programs. Social model programs are group living and counseling programs. 16. A County residential program is based on a nine-month residency and costs the County about $45 per patient per day. In some cases, part of the cost is covered by direct payment to the County of welfare payments a patient is entitled to receive. 17. County out-patient programs include both methadone treatment centers for heroin addicts and counseling- support programs for other alcohol and drug abusers. 18. The County does not operate or contract for an adolescent residential treatment facility in the County. It does place a limited number of youth in private facilities outside the County, such as the Thunder Road facility in Oakland. -3- 19. All County drug programs are monitored and evaluated through a process involving the State Department of Alcohol and Drug Programs, the County Drug Program Administration and the local Drug Abuse Advisory Board. 20. In fiscal year 1989, the County expended $7. 6 million on drug and alcchol treatment activities. Of this amount, $1.5 million came from County funds, with federal and state allocations and user fees making up the remainder. 21. There is no cent_al registry of clients of all the service providers, so there is no actual total of individuals receiving treatment at any one. time or during the course of a year. 22. County-funded facilities treated nearly 8,700 people in 1989, which represents just over one percent of the County' s populaticn. The total includes 3 ,000 detox patients, 707 residential recovery patients and about 5,000 outpatients. 23. County officials report that the population being treated is getting younger and that waiting lists are getting longer, now extending to six months in some instances. 24. The County pay scale for drug treatment facility counselors and directors is quite low, resulting in frequent turnovers and vacancies. 25. Finding a site for new drug treatment facilities is most difficult because of people' s strong opposition to drug centers in their neighborhoods. CONCLUSIONS 1. Continuing evaluation of drug and alcohol treatment programs is essential if effectiveness is to be maintained. 2. Placement of a patient in a program promptly on request for treatment is advisable to prevent dissipation of motivation. 3. Early placement of a patient into the appropriate type and style of treatment program is a critical element in successful treatment. 4. Contra Costa County does not have sufficient treatment slots to provide prompt placement of all applicants. -4- 5. The physical condition and staffing levels of County residential treatment facilities fall far below desired standards and detract from the effectiveness of the programs. 6. Private for-profit treatment programs are priced beyond the reach of most people unless some insurance coverage is present. This leads to heavy reliance on County programs. 7. Drug and alcohol rehabilitation require services beyond those related directly to addiction. The provision of employment and educational counseling, temporary financial support, housing assistance and health services is essential. S. There is a critical need in the County for a youth residential facility, expanded facilities for pregnant women and additional treatment facilities for cocaine abusers. RECOMMENIDAMONS The 1989-90 Contra Costa Grand Jury recommends that the Director of the Health Services Department: 1. Take she lead in establishing a coordinated reception process that will accurately assess a potential patient's needs and see that the patient is entered in the appropriate program, whether it is operated by the County, contracted for by the County or operated by a private non-profit organization. 2. Provide measures to maintain the motivation of people who request treatment but for whom no program openings are immediately available. 3 . Improve the physical conditions and staff compensation in County-operated facilities. 4. Estab- ish as the first priority for the use of any additional funding the operation within the County of an adolescent residential treatment facility, such as the Thunder Road facility in Alameda County. 5. Establish as the second priority the opening of additional, conveniently located treatment facilities for pregnant abusers. 6. Develcp and formulate an evaluation and monitoring plan for private treatment facilities comparable to the one in use for County facilities. This plan should also -5- ' .. a ', •. .+r• r '1 provide for the maintenance of accurate statistics on the number and type of patients undergoing treatment `n the County. COMMENTS 1. County personnel who staff the drug and alcohol abuse programs whom we encountered are skilled, experienced and deeply committed. 2. The Contra Costa County Community Drug and Alcohol Action Plan is a great accomplishment and deserves the support and participation of every citizen. Those In the community who are not directly affected by the abuse of alcohol and other drugs can and must serve as positive role models. 3 . As the Action Plan points out, treatment is just one of several actions required to control the drug problem. The rehabilitation of one group of abusers while a new group is created results in no net gain for the community. , Prevention of abuse through educaticn, inter-7ention and law enforcement goes hand-in-hand wi=h treatment in a comprehensive campaign. -6-