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HomeMy WebLinkAboutMINUTES - 12041990 - S.1 TO: BOARD OF SUPERVISORS FROM: Contra Costa DATE: Supervisor Tom Torlakson County 7 December 4, 1990 SUBJECT: Report on the Impacts of Perinatal Substance Abuse SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECO14MENDED ACTION: 1. Refer to Health Services Director and Director of Social Services to identify ways the two departments can work together more effectively to treat "at risk families" (at risk families are those identified by Child Protective Services, women already having one addicted baby or a pregnant woman with substance abuse problems) and to set up referral system for women treated at county hospital for suspected substance abuse (currently patients are held for the maximum seventy-two hours and then released with no plan or requirement for follow-up) . 2. Direct the Health Services Director and Social Services Director to. coordinate efforts to apply for additional funding for family-oriented approaches to treatment and prevention service for substance-addicted mothers. 3 . Request a report from the Youth Services Board on the status of options for residential drug treatment for women and their children. There is no county residential treatment for drug addicted women and their children. The county needs to actively pursue funds for a .residential treatment program. 4. Request a progress report from ADAPT (Alcohol Drug Abuse Pregnancy Task Force) on the development of a system coordination process for case management that will enable agencies to work more closely to serve the needs of families with substance abuse problems. 5. Direct the Social Services Director to: a) Identify ways to assist grandmothers, who are currently caring for the babies of their substance-addicted children. The Director should identify programs, grants and other other funding sources that will provide grandparents with the training, financial and emotional support they need, and b) Prepare an evaluation of program, licensing and fiscal policies and casework practices in order to eliminate barriers which prevent foster care and permanent placements in the home of a relative whenever reasonably possible, or in a home of the same racial and cultural background as the child in the absence of a relative./' CONTINUED ON ATTACHMENT: X YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S) ACTION OF BOARD ON December 4 1990 APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS X UNANIMOUS (ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE AYES: NOES: AND CORRECT COPY OF AN ACTION TAKEN ABSENT: ABSTAIN: AND ENTERED ON THE MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. CC: Health Services Director ATTESTED O rn y /?!Po Social Services Director Phil Batchelor, Clerk of the Board of County Administrator Supervisors and County Administrator J�.�.� M382/7-83 BY DEPUTY r, An independent newspaper serving the Greater Bay THEAreafrom Oakland since 1874 ROBERT C. MAYNARD Editor and Publisher NANCY HICKS MAYNARD Deputy Publisher LEROY F. AARONS DONN TICE RICHARD E.WYCKOFF Senior Vice President Vice President General Manager News Safes MARY ELLEN BUTLER ERIC NEWTON BELINDA TAYLOR`` WILLIAM WONG Editorial Page Editor Managing.Editor Deputy Managing Editor Associate Editor A-8 Tuesday, November 20, 1990 Oakland, California ® ell familiesfigh' erac Crack cocaine hurts more than just those` who use it. Whencrack addicts are women with children, grandparents often end up The intergenerational project caring for the children left helpless .by the makes Oakla mothers' addiction. nd a national leader in While that's the situation many families efforts to respond to some of the find themselves in nationwide, Oakland is the one city from among 200 applicants to poor family conditions that win a federal grant to help grandparents and ContribUt.e to the crack crisis. children learn to better cope with the dilem- ma. The intergenerational project, when combined with other existing programs, agencies to go to for help and protection. makes Oakland a national leader in efforts Grandparents suddenly forced to take to respond to some of the poor family condi- care of babies will learn modern child-rear- tions that to to the crack crisis. ing techniques which.may be very different The $72,000 grant was awarded to the from years ago. Older children will be city's Department on Aging by .the federal helped .to strengthen their self-esteem to Administration on Aging, part of the Depart- avoid falling into. the drug trap themselves. ment of Health and Human Services. Com Oakland beat out 200 other cities for the bined with $44,000 in support services, most- ly from the city, the $116,000 pilot program nature'of,the existing programs that address is funded for 16 months. Nobody knows the exact dimensions of the crack crisis. The Oakland Crack Task Force, for example,.is a consortium of oraals the crack crisis except that it is pervasive. nizations, agencies, churches and individuals Because crack addiction has been particular- that works to educate the community about ly deadly among ,young women of childbear- Y ing age, thousands of grandparents in Ala- drug abuse. At least three prenatal and post- meda County are taking care of children natal projects carried out through Highland dislocated by the abuse. General Hospital and other health agencies In another indicator, the number of chil- work to help crack=addicted pregnant wom- dren in foster care in Alameda County rose en, new mothers and infants to overcome the from 1,500 in 1986 to 3,200 in 1990. Many of chemical dependencies that make them sick. the foster parents are, in fact, grandmoth- Mandela House, the privately run home ers. But because obsolete state laws forbid where pregnant women can go to get off grandparents from getting foster-care pay- crack before delivering their babies,serves ments, many are hard-pressed to provide as a national model for residential pro- adequate care for the children. grams. The new program will start by training The illegal crack trade must continue to 50 grandparents and 30 children aged 10 to 'be fought at the law enforcement level. But 12 to be peer counselors. They will then the demand for crack must be lessened at train and help 240 grandparents and chil- the root level. The intergenerational project dren, eventually forming what the city hopes Will also be run .on a collaborative basis, will become an army of support counselors. joining the other programs working quietly Among the things the trainees will learn throughout the community to attack the are how not to be enablers by, for example, problem where it begins: among individuals giving the addict money to buy drugs. If and families that desperately need to be threatened, they will learn what community strengthened to withstand the lure of drugs. Impacts of Perinatal Substance Abuse PAGE TWO BACKGROUNb INFORMATION Contra Costa like most areas throughout, the 'state is suffering from the effects of the substance abuse problem. This problem has invaded every aspect of our lives--our families, our neighborhoods and our workplaces. The hardest hit has been our families. Increasing numbers of our children are in the care of Child Protective Services and Foster care families because of problems of substance abuse. • In 1989 of the 9,680 cases reported to Child Protective Services 190 of these cases were a result of substance abuse problems. (Source: Contra Costa Health Services Department) Our Health Service staff estimates that each year a minimum of 500 Contra Costa Infants test positively for exposure to drugs at birth. The department also reports that each month over 860 referrals for child abuse and neglect are received. Social Service staff finds that after investigation 60-700 of all child abuse and neglect cases are linked to parental drug and alcohol abuse. The care of drug-exposed infants is costly to Contra Costa' s taxpayers. Currently over 40 drug-exposed infants in placement have such special needs that their foster families receive "difficulty of care" rate increases of up to $422 per month over the basic foster care rate of $294 per month. Over 1400 women a year--6 callers a day--seek treatment at the county' s 15-bed residential facility for alcoholic women and their children. This treatment translates to cost of $50 per day. Sixty percent of the callers are primarily drug users and must be referred to a smaller drug program which cannot accommodate children. Social impacts are evident in the increased number of cases of homelessness, child abuse and AIDS. The full impact upon infants and young children will not be discovered for years to come. Although some children are born with obvious learning disorders, and handicaps, some problems will not become obvious until a child reaches school age. Impacts of Perinatal Substance Abuse PAGE THREE It appears that the families hardest hit by substance abuse are lower income minority families. According to a report by the county' s Health Services Department, The Crack Cocaine Problem in Contra Costa County, the problem manifests itself "through increased levels of homelessness, abuse and AIDS. . .All communities are at risk, but black lower income communities are currently bearing the brunt of the epidemic. " From the data available, it is apparent that the problem of substance abuse is . passed on from one generation to the next. Of the 135 women suspected of substance abuse who were interviewed by ADAPT, 60o were children of substance abusers. My office has had distressing calls from grandmothers who care for their grandchildren. Although it is not unusual for grandparents to take care of their grandchildren while the grandchildren' s parents are at work or in school. Increasing numbers of children, however, are living with their grandparents full-time because their parents are addicted to crack cocaine. Crack cocaine is a particularly volatile and dynamic drug, it has a profound affect on the user. Drug dealers often take advantage of the addictive nature of crack, selling drugs to these mothers, "on credit" , just before the first and fifteenth of the month and then demanding payment when the mothers receive their "welfare" check. Consequently, the children never receive the benefits of the money and are deprived of life' s basic necessities. Additionally, some of these children need special care, because they have been exposed to crack or alcohol in the womb or have been neglected and suffer physical and psychological damage. Perhaps the most quantifiable evidence that substance abuse is having a destructive affect on our families is the dramatic increase in Child Protective Service cases. In the last 2 1/2 years, protective services custody cases have increased from 350 to 756 county- wide. * We have also experienced an increase in the number of foster care placements for infants and young children ( 0-6 years old) . Placements have increased 89% from 1985 to 1989 -- from 210 children to 402. Parental drug and alcohol use is the major reason for the growth in placement of young children. Several Child Protective Services Workers have related to me that there have been numerous cases where women who have history of substance abuse who have given birth to a child they have knowingly exposed to drugs in the womb. Even more tragic, many of these women have other children at home who may or may not have Impacts of Perinatal Substance Abuse PAGE FOUR been similarly exposed. These women did not receive any medical help during their pregnancies and the affect on the children is unknown. Just recently according to reports from Social Workers, two addicted women gave birth the same week in Los Medanos Hospital in Pittsburg. Each of these women had other children at home who may or may not have been exposed to drugs in the womb. With with increasing use of "Crack" , "Crank" , Alcohol and other drugs among pregnant women, most of the Social Workers I spoke to agreed, that these women only represent the "tip of the iceberg" . Early prevention education and timely intervention is more cost effective than treatment after the fact. Nevertheless, it is my understanding that in Child Protective cases, assessments for suspected substance abuse often do not take place until some time after the child is removed from the home. Home assessments must be done at the time of the initial intervention, so that the parent can enter into treatment earlier and families can be reunited sooner. Families as well as individuals are affected by an individual family member' s substance abuse. A coordinated effort is needed to effectively and quickly intervene and treat whole families. Families require a variety of services to remain drug-free, independent and stress free. Low income families have special needs including transportation, parenting skills, and coordinated case management to reduce family stress. Contra Costa County must continue to provide and expand these needed services. Sometimes the stress generated from the frustration of going from agency to agency, the lack of transportation and the lack of independent living skills can lead a person back into substance abuse. The lack of coordination between agencies can lead to a duplication of effort, decreasing the effectiveness of the involved agencies and conceivably allowing someone in need to slip through the "bureaucratic cracks. " To be successful, services to families and children must be undertaken in a coordinated and cost effective manner. Contra Costa County must actively promote more effective cooperation among staff serving children and families. We need to devise a cooperative case management system Impacts of Perinatal Substance Abuse PAGE FIVE that involves all the agencies concerned with treatment and prevention including probation, social services and health services to deal with this growing problem. Contra Costa County has experienced some significant success in treating this problem, but because of the substantial budgetary cutbacks at the state level, there is not enough funding to provide necessary services for the growing need in our community. Contra Costa County needs to aggressively pursue additional funding sources to implement a coordinated program to address the needs of the victims of substance abuse in our county and to detect families and individuals at risk earlier. The county must continue to aggressively seek funding to invest in strategies. which keep families safely together and prevent the need for out-of home placement. * All statistical data from the Alcohol/Drug Abuse and Perinatal Task Force of Contra Costa County (ADAPT) . R.� EN EI As Contra Costa County enters the last decade of the 20th Century, it is confronted with an unparalleled challenge. During the last several years the County has inade tremendous gains in productivity, ,Although it has iiiiplemented many cost saving measures and saved millions of dollars, these gains have been offset by the problem of continually striving to handle increased demands for services without the necessary revenue resources from the local tax base, State or Federal Governments. New state mandates without funding, as well as major cutbacks in State and Federal funding, have created a severe fiscal crisis in counties--statewide. Redevelopment agencies in the cities and annexations to cities are coIiil)oujldiiig the problem. Ilie JbIlowing facts denwiistrafe this incredible increased demand for services. Jan 1, 1981 Jan 1, 1989 May 1.1990 Contra Costa Population 663,700 773,500 80000 Amount of Increase 16.5%v 20.53% (Source: Association of Bay Area Governments) 'Iota[ :Job Growth Projected 96,740 33% 1990-2005 Projected New Households 77,100 25,4%a 1990-2005 `Intal Bay Area Job Growth Projected 1990-2005 880,880 28.7% Projected New Households 422,120 18.5% 1.990-2005 ,TN' C N S1CS Coin t or eftd ivanduteil 5t"dAfils and.-'` fem re o Costs have increased from $11.5 million to $19.8 million over the last five years. o Represents a 72% increase over the last five years.. o County hears 100%© of cost while only 14.6% of population comes from incorporated area. o Increases in County Inmate Population: July '81 July 189 Martinez 360 790* Work furlough 78 109 Marsh Creek 91 491 Total in system 529 1390 0 163% increase in inmate population from July 1981 to July 1989. o Current Inmate Population (3/7/90) Martinez 813* Wk Iiurlough 120 Marsh Creek 467 Total in system 1400 *Martinez built to accommodate 386 inmates o Cost to build Richmond facility New jail built for minimum staffing 64:1 $48 Million to build $12.2 Million to operate o Cost to keep a juvenile in system for one year - $30,000 I LON�Y` CO T IL N S o Up from 2000 in (1988) to 2800 (1989) Represents a 40% increase o Approximately 75% of the felony court filings are drug and alcohol related. The Department is currently staffed at a level equal to that which was in place in 1969, yet the volume of work has increased nearly 50% over that span of till-le. Jlir ' o C.otita.ty beans 4.00% of General Assistance Program by State mandate: INCREASES IN lY1ANDArED SERVICE General.Assistance Program 1984-5 1988-9 % Increase $41035,139 $8,9592668 122 % 25,187 cases 41,298 cases 63.9% .AIDC1'rourarra 1984-5 1988-9 % Increase $60,340,864 $852245,942 41% 139,228 cases 158,966 cases 14% o licaltli Services staff estimate that each year a minimum of 500 Contra Costa infants are positive for exposure to drugs at birth. o Currently, over 40 drug-exposed infants in placement have such special needs that their foster families receive "difficulty of care"rate increases of up to $422 per rnontli over the basic foster care rate of$294 per month. o The nuinber of foster care placements for infants and young children (0-6 years old) increased 89% from :19135 to 1988--from 210 children to 402. Parental drug and alcohol use is the major reason for the growth in placement of young; children. o Over 1400 women a year--6 callers a day--seek treatment from the county's 15-bed residential facility for alcoholic women and their children. Sixty percent of the callers are primarily drug users and must be referred to a smaller drug program which cannot accomaiodate children. E , F?very year, one out of every 750 baIbies is horn with"fetal Alcohol Syndrome", the only birth defect that is 100% preventable! Pa_riug for Perinatal Substancc Abuse Intervention&Treatment(Estimates of relative costs o $50 a day to provide residential treatment fora pregnant or newly-delivered wOrnari and her infant. o $3 a clay to intervene and provide intensive outpatient substance abuse counseling for a pregnant or newly delivered woman. o $17 to provide intensive counselijig for 6 weeks to help a family resolve porblems and avoid foster erre placement. �ajjng the C:utiseyueuces of Pet.uat.al Substance Abuse c:r $3000a clay for an intensive care nursery for the seriously ill substance-exposed infant. o $25 a day to provide special education for a child with learning and behavior problems due to drug or alcohol exposure. Special services will be needed froiu preschool through 1-2tli grade. o $17 a clay to provide lifetime medical and rehabilitative services to a fetal alcohol syndrome baby. (Assumes 65 years duration.) L) $10-24 a day to plce a drug or alcohol exposed infant in foster care. The average length of placement is 19 1/2 rnontlhs. o $16 a clay for intensive family support and intervention services for an infant handicapped or at risk of h,urdicaps due to prenatal drug or alcohol exposure. Additional In-ipacts on Health Services: Although alcohol and drug abuse problems are at an all time high, the State ltas cut: funding in critical areas while counties experience an increased demaiid foe- services. Oven the last: 10 years the state has greatly reduced ttte State progratn froth the 36,000 beds available 10 years ago to the less titan 5,000 beds available today. 1:7t_tring last year's state budget, process, Governor Deukmejian irtitiated t bt.idget item t:ltat resulted itt a $2.5 rttillion reduction in Mental 1lealth Services funding statewide. Altltougli more severe cuts had been anticipated, the'. rcCluction. seriously impacted counties' ability to provide adequate ►trental itc,dth care services. X l 'AC "lyu Ui" A C . PRC :B1 M r OU -, o $200 million of the $600 million County budget deals with substance abuse problems. o 70% of inmates are in custody for drug or alcohol related crimes. o 60% of the referrals to the I-Iigh Risk Infancy Program are drug- related. o Approximately 80%v of homeless and other emergency assistance cases are due to drug and alcohol abuse. o 25%v or the child welfare intake referrals are specified as drug- related. o One-third to one-half of the caseload in the Social Service Department is related to drug and alcohol abuse. o Last year (1989), there were 9,680 cases reported to the Child l.'rotective Services Unit - 1.9% of these cases were a result of substance abuse problems. o In the last 24/2 years, Protective Services custody cases increased from 350 to 756 county-wide (116% increase). MEDICALLY IN:D!GEN�'"VY,T Another area of challenge that is currently facing the Health Departinerit is the area of treating medically indigent adults. In 1982, the State "dumped" onto the counties the responsibility to administer the program to provide medical services for indigent adults. The State guaranteed that if elle countieS would adlrlinister the prOgram, the State would fully fund it. However, State funding has corltiliue(l to decrease in each of the last five years. It: is estimated that in -1988-89 the counties, statewide, funded over 55 percent of the cost of the MIA Program. In 1982, the State spent $-1.3.5 lliilllon to run the MIA program in Contra Costa as l.)art of their Medi-cal Program. Since the County has taken over the administration of thiS pl•ogralll per Stale mandate, the State allocation has fallen to $10 inillloll--leaving Contra Costa County short by over $3 luillion.