HomeMy WebLinkAboutMINUTES - 12151998 - D14 FRS#32
TO: BOARD OF SUPERVISORS .`y.._�.-- CONTRA
COSTA
FROM: FAMILY& HUMAN SERVICES COMMITTEE ,,, _
` COUNTY
DATE: December 16, 1998
SUBJECT: Study of Youth Alcohol and Drug Treatment Access and Utilization
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
RECOMMENDATiON(S):
1. ACKNOWLEDGE the fine work of the Community Substance Abuse Services and Substance
Abuse Advisory Beard in developing the Study of Youth Alcohol and Drug Treatment Access
and Utilization.
2. ACKNOWLEDGE the importance of addressing alcohol and drug use among youth, including
the need for
• more treatment services
■ greater collaboration
■ leveraged and blended funding strategies.
3. EXPRESS appreciation for the leadership of the Mt. Diablo Unified School District and
Acalanes SchoolDistrict in developing annual surveys of alcohol and drug use among its
student populations. Urge all school districts to work together to develop a common survey
and to release the data annually.
CONTINUED ON ATTACHMENT: ,-YES SIGNATURE:
RECOMMENDATION OF COUNTY ADMINISTRATOR—RECOMMENDATION OF BOARD COMMITTEE
—APPROVE —OTHER
SIGNATURE(S): Donna rber
".rkeSau nier
ACTION OF BOARD ON APPROVED AS RECOMMENDEDY OTHER
SEE ADDENDUM FOR ACTION OF THE BOARD
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A
UNANIMOUS(ABSENT HIEN ,- I TRUE AND CORRECT COPY OF AN
AYES: NOES- ACTION TAKEN AND ENTERED
ABSENT: ABSTAIN: ON MINUTES OF THE BOARD OF
SUPERVIS ON THE DATE SHOWN.
Contact:Sara Hoffman,335.1090
ATTESTS
cc: CACI P L BATCHELOR,CLERIC OP
Chuck Deutschman,Community Substance Abuse Services THE BOARD OF SUPERVISORS
Amelia -DelValle,Community Substance Abuse Services COUNTY ADMINISTRATOR
Torn Aswan,substance Abuse Advisory Board(vis Health Services)
BY ND EPUTY
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Study of Youth Access and Utilization of AOD Treatment Services
in Contra Costa 'County
One is the differing conceptions of treatment among probation officers. A lot of
probation officers think there are enough substance abuse treatment slots in the county to
handle all of the youth who need treatment. However, it appears that many probation
officers confuse the specifics of substance abuse treatment and with different types of
counseling. Substance abuse treatment is thus confused with counseling or other types of
therapy.
On the other hand, there are very specialized''views of treatment basedon specialized
mental health and substance abuse problems. For example, some probation officers
believe that most of the youth who come in for placement have substance abuse issues.
However, most are not your good old fashioned simple substance abuse delinquent--with'
no other problems. Many of the youth who are ordered to the placement committee are
not like that. Most have other problems--violence, sex offenders, mental illness, gang
affiliation,etc. There are not enough treatment slots for these types of youths.
As with most things in life, money is an issue. There is not enough money to provide all
of the specialized treatment that county youth need. Although this remains somewhat
unclear, it appears that the probation department has a pest of money--about$7 million--to
provide for out-of-home placements. With a finite amount of money, there is always a
concern as to how to allocate it. Although there is undoubtedly genuine concent on the
part of the probation department to provide'high quality'treatment for wards of the court,
there is also a motivation to spend the money on the probation department's own
programs. Those programs include the new diversion program and the Summit program.
Related to fiscal concerns is the philosophical conflict over how to handle juvenile drug
cases--or any juvenile cases for that matter. There is a general rule in juvenile justice
philosophy--employ the "least restrictive alternative possible while maintaining public
safety and taking care of the needs of the child. Thus, there is conflict in whether it
would be preferable to provide drug treatment on an out-patient basis, or on an in-patient
basis. It is possible that in-patient treatment may be best for the youth, but it is not
necessarily the least restrictive alternative.
For example, some probation officers contend that Thunder Road may be too long of a
program for some youth. If the Thunder Road program is really long (9-12 months), they
may be "putting themselves out of business." Even if youth had a substance abuse
problem, they would not want to go to a long treatment program, but instead want to go
to the camp or boys ranch for a shorter period of time--like six months.
Relating it back to the community approach, one probation states that the court wants to
use, and that the probation department is successful in implementing, "intermediate"
sanctions. These intermediate sanctions, in her mind, include remaining in the home and
going to out-patient treatment, going to school, community services, etc., etc.--all
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combined with good (intensive) supervision by the probation department. It is that
supervision that has improved in recent years.
Treatment entry for most drug abusing adolescents often follows some rather dramatic
behavioral dysfunction, overdose, delinquency, drug related offense, truancy, family
related assaults, intensive family conflict, , emotional breakdowns or severe decrements
in performance noted by concerned others. Even in severe drug dependency among
young people, completed voluntary self-referral to treatment is unfortunately rare. three
primary system sin the network of adolescents influence them to seek help.--peers, family,
and school. To the extent that referral comes first from other systems e.g. criminal justice
system the problem is even more likely to be severe.
Yet public and private school systems have profound advantages for implementing early
intervention programs. First and foremost, except for dropouts, they capture youths for a
significant part of their day. They have considerable power within their domain to
influence the informational and attitudinal environment surrounding youth.'
OVERALL SYSTEM RECOMMENDATIONS
• Improve the communication and collaboration across all systems regarding the
identification and referral of youth in need of AOD-related; services, and
encourage joint planning efforts across systems when seeking new program
directions, e.g., adolescent drug court, regional screening centers, one-stop
service centers,etc.
• Provide opportunities for cross-training of staff in law enforcement,probation,
the schools, and AOD treatment providers. Training might include
information on addiction medicine, the AOD system of care, probation's
continuum of care, location and entrance criteria for ACID programs serving
youth,etc.
• Develop written Memorandums of Understanding (MOU) between the law
enforcement, probation, the schools, and ACID treatment providers describing
how youth with AOD problems will be identified, and each systems specific
response once youth have been identified, e.g., referral to REACH Project, or
New Connections,or CARE'Team, etc.
• Use empirical data to target youth at risk and develop multi-disciplinary teams
comprisedof representatives from all four systems to work together to
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marshall the resources of all four systems to intervene with youth who may be
using but who could still benefit from targeted secondary prevention efforts.
• Develop a core of standardized variables designed to identify AOD problems
among youth, ensure these variables are imbedded in the intake forms in the
juvenile justice, social services, mental health, prevention, law enforcement
systems. Ideally this information would be routinely entered into an
electronic database, but if this was not possible,it would at least be possible to
undertake "window studies," looking at data across systems for a given time
frame, e.g., two weeks, three months,etc.
• Involve youth in the development of a youth continuum of AOD services
within the county's system of care that would focus on engaging and retaining
youth.
• In order to reduce the stigma against drug and alcohol treatment and thosein
recovery, and to encourage those who need help to seek it, undertake a social
marketing plan to emphasize that treatment works.
• Consider "ane-stop-shopping" service model for youth, currently being
successfully used in the city of Fairfield and in Alameda county.
• Work with probation, schools, mental health, health services, and substance
abuse personnel to find better ways to share information. In order to better
serve youth in a more integrated and comprehensive way, these systems need
to negotiate ways to share information while still protecting the confidentiality
of youth, e.g., use of Qualified Service Agreements or Memoranda of
Understanding which specify the ways in which information can and cannot
be used,even after informed consent has been obtained.
• Move from an approach to youth AOD use that focuses on the most seriously
affected to one that is more prevention driven. At the same time find ways to
more effectively target and serve high-risk youth.
LAW ENFORCEMENT RECOMMENDATIONS
• Provide a general resource list describing adult and youth AOD treatment
services available in the CSAS system of care (including location, hours,
entrance criteria, etc.) to law enforcement agencies. Also provide an
abbreviated "care card" that could be carried by all law enforcement
personnel, and would include local treatment resources for youth.
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• Provide more training for law enforcement personnel regarding the nature of
addiction and drug-related problems.
• Consider "importing" Antioch's youth diversion model to other areas of the
county. The commitment made by the Antioch Police Department ($92,000)
is substantial, but worth every cent according to their Chief.
• Develop a written "how to" which describes in detail Antioch's Youth
Diversion Panel model, including costs, methods and extent of collaboration
among systems that are required, etc.
• Utilize a youth diversion model (like Antioch's) that alloys for "courtesy
referrals,"that is, a young person can be referred to the Youth Diversion Panel
even if no crime has been committed, if it is determined that the young person
could benefit from the Panel's services.
• Find alternative approaches to respond more effectively to youth with AOD
problems that do not have parental support.
PROBATION RECOMMENDATIONS
• Provide more training for the probation department regarding the nature of
addiction and drug-related problems.
• Provide cross-training opportunities for probation officers and AOD treatment
providers to learn how the other works, and how the two systems work can
together more productively,etc.
• Provide training abut the distinction between substance abuse treatment and
other types of treatment.
• Promote out-patient treatment for youthful substance abusers who remain in
the community.
SCHOOL-BASED RECOMMENDATIONS
• More training for school personnel on how to identify AOD use by students,
and what to do once these youth have been identified. These training sessions
should include youth educators as well as adult educators.
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0 Increase the number of school-based prevention programs, including support
groups, and ensure adequate dispersion throughout the county.
* Schools have the best access to youth. However, in most schools there is not
an adult on campus with whom a young person could talk about AOD
problems without incurring consequences. Put substance abuse counselors at
every secondary school. Hire one less teacher and use funds to hire
counselors. Teachers could then refer students who may have AOD problems
to individuals trained to interview, screen,and assess students if needed.
0 Institute an elective class, built into the academic schedule, that would allow
youth who may themselves be considering AOD use or concerns about the use
of alcohol and drugs by others (friends, family, etc.) to learn about ways to
deal with these situations without having to self identify, or be labeled as a
substance abuser.
e Have more prevention education available to students (elementary and middle
school) on school sites. A structured curriculum for 6th graders (or younger)
is needed and should be part of the regular educational curriculum.
• Work with university teacher training programs to encourage inclusion of a
curriculum that would better train and prepare teachers (including elementary
school teachers) to recognize AOD problems among youth, and to make
appropriate referrals.
• Focus general prevention education on elementary school age youth.
Concentrate more targeted prevention education (peer support groups) for
youth who are themselves experimenting with alcohol or drugs, or have
family members who are using in middle,junior, and high schools.
Measure effectiveness of"Saturday classes" currently being used by schools
as a sanction for youth caught high on alcohol or drugs on campus to
determine whether it is an effective approach and impacts recidivism.
Conduct anonymous, countywide AOD use prevalence surveys in junior and
high schools, asking about AOD use as well as frequency. These studies
would allow more accurate assessments of AOD youth services needs.
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• Institute more alternative activities and community-based resources focused
on alternative and necessary small school students who are by definition at
higher risk of AOD use.
CSAS RECOMMENDATIONS
• Improve accuracy of CADDS reporting generally.
• Try to secure funding to expand the intensity of youth treatment currently
available within the county (including high intensity outpatient services, and
possibly low and high intensity residential treatment).
• Ensure treatment and prevention providers are accurately reporting on all
youth who are receiving treatment services--whether in groups or on
individual basis.
• AOD treatment providers should spread the word to staff in the other
"systems" that treatment works. While client confidentiality guidelines must
be adhered to, treatment programs could provide feedback to lav enforcement,
schools, and probation regarding the impact of their treatmentreferrals in the
aggregate, e.g., probation referred 30 youth to treatment this month, 50%
entered and are still in treatment, 25% never showed up, and 25% left before
30 days, etc.
PARENT/FAMILY RECOMMENDATIONS
• Provide AOD treatment on school campuses.
• Provide more parent education regarding how to identify if their child is using
alcohol or drugs, and what to do once identified. These training sessions
should include youth educators as well as adult educators.
• Provide groups for parents who need support to stop enabling their children's
use of alcohol and/or drugs.
YOUTH RECOMMENDATIONS
• If money and resources are limited, first target youth who experimenting with
alcohol and drugs.
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• Focus general prevention efforts on younger children(below 6th grade).
+ See focus group report attached.
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YOUTH FOCUS GROUP REPORT
As part of this study of why youth comprise such a small percentage of Contra Costa
County's publicly funded treatment population, a focus group of youth.. (mostly in
treatment) was held in August, 1998. A total of 14 youth participated, 4 % were White,
20% African American, and 40% were Latino. The group was conducted at 595 Center,
Martinez, and respondents were paid$10 for their participation.
How many had been in outpatient or residential treatment for alcohol or drug use?
Included in the group were fourteen youth, 10 of whom were currently in treatment,and 2
who were not in treatment and did not use alcohol or drugs.
Describe the circumstances that caused you to enter treatment.
Most of the youth indicated they were out of control with their AOD use prior to entering
treatment. Almost all of them described coming to school high on their drug of choice.
In virtually all cases,their drug use was discovered by their parents or a probation officer,
but was seldom identified by school staff: In several cases parents reported their child's
drug use to a police officer.
In your opinion why did you first start using drugs and/or alcohol?
A number of reasons for using were identified by the group. Most frequent were: 1) to
deal with problems at home; 2)to prove myself to my friends; 3)as a way to get closer to
an older sibling; and 4)to reduce stress and/or depression.
How old were you when you first started using alcohol and/or drags?
Of the 12 youth who report using alcohol/drugs, 3 (25%) reporting first using it by age 7.
Another 25% report first using before the age of 10. All 12 (100%) report first using by
13 years of age.
What did you use and how often?
Marijuana, alcohol and amphetamines were the drugs of choice for the group as a whole.
"Virtually all 12 of the youth who reported using,reported using daily or almost daily.
When asked what other drugs are used by their friends, youth mentioned: white out, glue,
gasoline, formaldehyde, LSD,peyote, angel's trumpet, PSP,and prescription drugs.
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How did you acquire your alcohol or drugs?
Parents (both having it provided by parents and stealing it from parents), stealing it from
Safeway or Payless, older friends, and relatives were the ways most youth described
getting their drug of choice (primarily alcohol, marijuana or amphetamines).
Who first discovered you were using alcohol and/or drugs?
In almost every case, youths' drug taking behaviors were first discovered by parents
(33%), older siblings (25%), other relatives (25%), group home counselor (17%).
However, little was done to seek treatment for any of the respondents at the time of first
discovery.
What did this person do once they found.out?
Alarmingly, in several instances the discovery of a youth's drug and alcohol use served as
an invitation to for that youth to begin using with a parent or a sibling. In a few cases
parents actually turned their child in to the police. One young girl reported being sent to
Walnut Creek Hospital because her parents thought she was mentally ill--they did not
recognize her erratic behavior as amphetamineaddiction. (She later entered more
appropriate substance abuse treatment.)
How many of your friends who use alcohol and/or drugs have been caught using?
According to respondents, very few of their friends have been caught for using alcohol or
drugs. Even those youth whose friends may have been under the influence at the time
they committed another crime report their friends not being confronted with their drug
use.
What happened to them when they were caught?
Those youth who had committed other more serious crimes were sent to Byron's Boys
Ranch,others received only minor, if any sanctions.
Do you think what happened was fair or right?
Most respondents believed that something'needed to be done to interfere with their AOD
use (now that they themselves are in treatment)but indicated it would be better for kids to
get the help they need to stop using drugs rather than just being punished.
If not,what do you think should have happened?
(See above)
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What are the main reasons you believe young people use alcohol and/or drugs?
Respondents revealed the following reasons as why people use drugs: stress, boredom,
trying to fit in with your friends,weight loss, abuse at home,to feel cool, to not feel or to
cover up your feelings, and to be self-destructive--wanting to die.
What drugs do you consider serious drugs?
Heroin, cocaine, PSP, and LSD were considered as serious drugs. Alcohol, glue, ecstasy,
marijuana and amphetamines were not considered to be serious drugs.
What percentage of your friends use alcohol? drugs? tobacco?
(Research shows that young people who use drugs often over estimate their use by other
youth.) Among youth respondents 13 of the 14 (93%) youth said their friends use alcohol
and/or drugs. They also believe that 75%of all students smoke cigarettes or cigars.
What percentage of your friends come to school high on alcohol or drugs?
Among the 12 youth who report themselves using alcohol or drug, half believe that 50%
of their friends come to school high, one-third believe 75% of their friends come to
school high,and 1 youth indicated that all of her friends(100%)come to school high.
What do you think should happen to youth that are caught using alcohol or drugs at
school?
The majority of youth believe that expelling students or sending them home is an
ineffective way to deal with a student's alcohol or drug problem. They believe that most
students who are using would happily not come to school, preferring to stay home and get
high. They believe there are too many youth that use alcohol and drugs at school to expel
all of them from school anyway. In-school suspension was mentioned as a"punishment"
that makes an impression on youth, but that it is not as effective as a class or providing
free treatment that really tried to help these kids stop using.
What do you think should happen to youth that are caught by police using alcohol
or drugs in public?
Respondents generally understood that the police have a job to do and if they are caught
under the influence of alcohol and drugs, that the police need to act. Some suggested
alternative approaches for dealing with these youth including: telling their parents, or
giving them a chance to seek treatment for their addiction. If youth do actually get help
and step using alcohol or drugs, the police should just let it go (unless they committed
some other crime as well).
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What do you think parents should do if they catch their teenager using alcohol or
drugs?
Get their kids help.
For those of you who have been, or are currently in treatment, are you fearful of
returning to school, and the impact it might have on your recovery?
Most respondents indicated some nervousness about going back into an environment in
which they have used in the past. (Unlike adults, youth often don't have the luxury of
moving away to a place where they will not encounter people with whom they formerly
used.)
Respondents indicated that "just do it one day at a time," "it's hard to get rid of your old
friends, but you have to if your serious about staying clean," "go to meetings (12 step,)",
and "fill your time with school and work" as possible approaches to support their
recovery.
In your opinion, is there any support at school-for youth in recovery?
All respondents stated there are virtually no on-campus services or support available to
help youth maintain their recovery.
What could be done to help more youth that need drug and alcohol treatment
receive the help they need?
More than half of the respondents believe that on-campus 12 step meetings led by other
youth or young adults would be helpful. They were not afraid of being labeled as former
drug users, and believed that having meetings on-campus would help not only those
youth who are in recovery,but provide a non judgmental place for youth who may still be
using.
Other suggestions included:
1) Give parents more information about what kinds of help are available for their
children.
2)Authorities shouldn't lie about drugs. They shouldn't tell you that it's not fun because
if you try it and find out that it is fun, you don't believe anything else they tell you—like it
can wreck your life, addict you,etc.
3) Have peer speakers that come to the schools to talk about drug/alcohol use. It makes it
more believable to hear information from someone"who's been there."
4) Have more treatment options available for youth who don't have money.
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1,4 B
CONTRA COSTA COUNTY
SUBSTANCE ABUSE ADVISORY BOARD
"The mission of the Substance Abuse Advisory Board is to assess family and community
needs regarding treatment and prevention of alcohol and drug abuseproblems and
report the findings and recommendations to the Health Services Department, the Board
of Supervisors and the communities that we serve. "
FY 1997-1998
ANNUAL REPORT
SUBMITTED TO
CONTRA COSTA COUNTY BOARD OF SUPERVISORS
November 15, 1998
9 A71
Introduction
In the Spring of 1997 the Substance Abuse Advisory Board(SAAB) held a retreat
to establish strategic benchmarks for fiscal year 97-98. The outcome was the
identification of three priorities defined as the hallmark of action that would drive
SAAB's unified effort to address the multiple needs of the community as they
pertain to substance abuse treatment and prevention in Contra Costa County.
These priorities are:
`:• To increase Substance Abuse Treatment and Prevention Services for Youth;
�:• To increase active support and involvement in public policy and
environmental strategies as powerful tools for effective substance abuse
prevention;
:• To strengthen the internal organization of SAAB to become a more effective
and visible board.
SAAB"s commitment to youth and the firm belief that Treatment Works are the
guiding principles for advocacy and community efforts displayed by its members
and board actions during this past year.
Having face-to-face contact with clients at many of the Community Substance
Abuse System of Care programs, interacting with clients and their families during
graduation programs, being actively involved in the community and talking to
youth inspires and reinforces our desire to advocate for those who suffer from
substance abuse problems, to reduce the stigma attached to people in recovery,
and to promote rehabilitation rather than incarceration.
The Substance Abuse Advisory Board report is a summary of accomplishments
and milestones achieved by a group of volunteers committed to a Drug and
Alcohol Free Contra Costa County. As we prepare to close another year we hope
to give our constituencies a report of the charges and actions we took during the
year, and to inspire the reader to support the efforts of those already working
towards a Drug and Alcohol Free Contra Costa County: we need your help
because there is still a lot of work that needs to be done! We also want to take
this opportunity to thank the community-based providers and the Community
Substance Abuse Services Division staff for their support, and most importantly,
the clients and families for giving us the honor of serving them to the best of our
abilities.
`may%s'•,
•.# TO INCREASE SUBSTANCE ABUSE TREATMENT AND PREVENTION
SERVICES FOR YOUTH
1- The Community Substance Abuse Services Division 1997 Substance Abuse
Problem impact Data Report show a small number of youth under the age of
18 in subsidized AOD treatment. Although SAAB was consented about the
small number of youth in treatment, we were most preoccupied with the
contrasting information from other systems that serve youth such as schools,
social services, probation, etc. which contended that alcohol and drugs were
present in the majority of their juvenile cases. We understood the complexity
of the problem and the need for creative solutions but this did not stop our
decision to address the questions. As a result of our concerns the Substance
Abuse Advisory Board formed a Client and Family standing committee and
requested support from the Board of Supervisors and the Community
Substance Abuse Services Division to conduct a study of youth access and
utilization of alcohol and drug services in Contra Costa County.
(1) The Client and Family Committee was formed towards the end of 1997.
The members conducted three interactive client/family focus groups to solicit
input from constituents about existing services and unmet needs. The
client/family participants represented a wide range of different ages and
geographical areas. The intent of these sessions was to provide feedback to
SAAB and to CSAS in three specific service areas: Access to Care, Cultural
Competence and Quality of Services, and Support for Recovery. Overall, the
results were positive and the feedback from participants reflected for the most
part satisfaction with the services received. Nonetheless, the youth participants
pointed out the need for a safe and sober environment after treatment to support
the recovery process. The Client and Family Committee is also active in the
CSAS System of Gare planning process and instrumental in the development of
a federal grant proposal to fund the Partners in Recovery Alliance (PIRA), a
project to organize the recovery community to advocate in behalf of clients and
their families, and to actively participate in substance abuse policy'development
and service delivery.
{2j The AOD Youth Study conducted by MK Associates with assistance from
the Substance Abuse Advisory Board members obtained factual information to
help SAAB understand the disparity between a small number of youth served by
publicly funded Substance Abuse Treatment Programs and the reported high
number of youth with alcohol and drug related problems seen by other service
delivery systems. Data collection involved interviews with key people in different
systems, analysis of secondary data, and focus groups.
Results and recommendations did not surprise SAAB, the data is a factual
reminder that solutions to critical problems deserve holistic interventions, that we
cannot scapegoat or point fingers at different systems serving youth nor can we
continue to deny that substance abuse is a problem in all our communities. The
AOD Youth Study recommendations have been presented to the Children and
Human Services Committee of the Board of Supervisors. All in all, the main
finding and most significant recommendation is the need for increased cross-
systems collaboration and communication. As important is the recommendation
to strengthen a Youth and Family continuum of AOD services tailored to youth,
inclusive of parents and caregivers, and sufficiently funded to provide intensive
outpatient and residential treatment, educational and support groups, and
linkages between different service delivery systems. Youth overwhelmingly
stresses the importance of getting involved in treatment and creating a safe and
substance abuse free environment in school and communities to support their
recovery. For more information on the study please contact....
�.* TO INCREASE ACTIVE SUPPORT AND INVOLVEMENT ' IN PUBLIC
POLICY AND ENVIRONMENTAL. STRATEGIES AS POWERFUL. TOOLS
FOR EFFECTIVE SUBSTANCE ABUSE PREVENTION
The Substance Abuse Advisory Board in collaboration with the Partnership
Forum Alliance has been instrumental in supporting community efforts aimed at
the reduction of alcohol availability and youth access to alcohol in Contra Costa.
In monitoring the amount of retail alcohol, the Public
Policy/Education/Partnership Committee of SAAB has realized that Contra Costa
communities are already oversaturated. To mitigate this situation, SAAB invited
the Alcohol Beverage Control Director to help us understand more objectively the
nature of the problem. Following his presentation two training sessions were
conducted one on Conditional Use Permits, and one on Alcohol Policies as Tools
to Prevent Crime -No More Lizard Lounges- that brought elected'officials, law
enforcement, city planners, merchants and community activists together to learn
effective ways to promote healthy communities.
SAAB has also worked side by side with local Municipal Advisory Councils, local
governments and city councils to establish moratoriums on new alcohol licenses
in El Sobrante, successfully opposed concurrent sales of alcohol at gas stations
in Orinda, and has build close linkages with the County Planning Department.
Despite the effort to educate ourselves and others about alcohol availability,
sales to minors, and concentration of alcohol licenses, SAAB has come to the
conclusion that specific policies have to be developed in Contra Costa to limit the
alcohol outlet problems and to ensure that sales to minors is stopped. The
committee is now considering alternatives proven successfully in other counties,
namely the creation of a countywide alcohol policy or policy platform that
includes mandatory responsible beverage service, moratoriums of licenses were
there already is oversaturation, land associated sales restrictions etc.
Perhaps the best result of this coordinated effort has been the ability of SAAB to
form alliances with local merchants and to establish friendly relationships based
on "we want your business, but sell responsibly". At the "No More Lizard
Lounges" awards were presented to six merchants who already refuse to sell
alcohol to minors and are practicing "good neighbor" responsible sales of alcohol
in their communities.
❖ TO STRENGTEN THE INTERNAL ORGANIZATION OF SAAB T4 BECOME A
EFFECTIVE AND VISIBLE BOARD
Part of the desire to strengthen SAAB evolves from the in depth understanding of
our responsibility and mandate as a Board. For this purpose SAAB held two
strategic planning retreats and a Board development retreat to better define the
scope responsibilities and their plan of action for this year.
The first retreat planted the seeds of our personal and collective identity,
provided direction to our actions as we keep sight of the needs of the
communities we serve. We have been able to develop a unified vision at the very
onset, enabling us to respond in a concerted fashion to issues and concerns. We
have established credibility and build visibility to continue advocating for the
silent faces of our constituents. We believe we now face a biggerchallenge, to
empower those we serve, so that they no longer remain silent.
Credit for the visibility of SAAB goes to the Public Relations Committee and their
proactive development of a weekly televised program CCC: A Closer Look to
increase community awareness about alcohol and drugs and to highlight the
treatment and prevention resources that are available.
In the process of our development as a Board, we have learned from our
mistakes. We are now more knowledgeable about existing regulations that guide
open meetings in California, we understand that pointing mistakes alone does
not produce results, that we must actively voice concerns while proactively
engaging the community to find solutions. Advocacy, innovation, and problem
solving inclusive of those we serve is the result of our commitment to raise the
Substance Abuse Advisory Board standards for excellence.
FHS#32
RECOMMENDATION(S) c�rr Vd:
4. REQUEST the School Superintendent's Council, public Managers' Association, City/County
Relations Committee and Mayors' Conference closely review the findings of the report and
consider how they can best support implementation of its recommendations.
5. ADOPT a position of support for increased state funding of youth alcohol and drug prevention
and treatment services and add the issue to the County's 1999 legislative agenda.
6. REQUEST that the Community Substance Abuse Services and Substance Abuse Advisory
Board continue their efforts to work collaboratively to expand the resources available for
alcohol and other drug treatment services and to develop an action plan on the study
recommendations.
BACKGROUNDIREASON(S) FOR RECOMMENDATION(S):
Can November 9, 1998, the Family and Human Services Committee met with Tom Aswad, Chair,
Substance Abuse Advisory Board; Bill Walker, Health .Services Director; Chuck Deutschman, Community
Substance Abuse Services Director; and Amalia Gonzales-DelValle, Substance Abuse program
Manager to review the Study of Youth Alcohol and Drug Treatment Access and Utilization developed
by the department and the Substance Abuse Advisory Board (SAAB). The study was designed to
facilitate better understanding of alcohol and drug use. Focus groups were held with representatives
of schools, law enforcement, probation, substance abuse providers, parentslfamiles and youth. The
report includes the results of the focus groups as well as the system's response the following four
questions:
How is the problem of alcohol and other drug (AOD) use among young people
perceived and defined?
z► How are youth with AOD problems identified?
a- What happens once a youth with AOD problems is identified?
a What barriers exist that tend to prevent youth with AOD problems from receiving
treatment?
The report recommends ways to improve the overall system and also within law enforcement, probation,
schools, community substance abuse services and from the perspective of parents/families and youth.
Chuck Deutschman explained that there was not a vision for youth in California or in Contra Costa
County across the divisions and disciplines about what should be done in each of the systems. He also
stated that funding does not necessarily follow need (more money is being spent on felons than youth).
Amala Gonzales-DelValle concurred, sharing key findings of the report with committee members.
These were:
• Youth with alcohol and drug problems are not being identified in sufficient numbers.
• Once identified, youth with AOD problems who require publicly funded treatment
are not being referred in sufficient numbers.
• Chemical dependency is a family disease. Young people with drug and alcohol
problems also have a host of other problems that require comprehensive and
coordinated' assistance.
• In Contra Costa County, it is estimated that a minimum of 800 youth (and their
families) require publicly funded AOD treatment (now serving 99 clients).
• Comprehensive drug treatment programming is effective in reducing chemical
dependency and should be available "on demand" for both youth and adults.
2
FHS#32
Ms. Gonzales-DelValle noted that four major studies all showed that savings were much greater than
expenditures, for treatment. One study showed that$4.00 to$7.00 were saved for every dollar spent
on treatment and another showed $5.30 saved. She also stated that it was much less costly to provide
for prevention or treatment of youth rather than wait until they are in the justice system.
Tom Aswad, Chair of the SAAB, stated that the recommendations in the report are a comprehensive
view from the perspective of service providers, youth and their families. He felt that it was very
necessary to increase linkages between services and noted that youth are giving consistent advice, but
that the systems do not follow through.
Shirley Marchetti, LEACH, felt that the report was excellent and agreed that we ask youth, what needs
to be done but we don't follow up on their recommendations. She said that the partnership of her
organization with the Antioch Police Department was very productive and believed in the "shared"
responsibility concept.
Joseph Partansky, member of the public, spoke of the need for increased youth advocacy and
mentioned"Yo", a Say Area youth newspaper, as well as Concord's efforts to develop a youth advocacy
directory. He felt that in all youth issues, we need to extend the "loop" and increase outreach efforts.
Ellen Peterson, SAAB board member, spoke of the difficulty of a youth undergoing treatment and then
going back to the high school where drugs or alcohol are readily available. She supported Alcoholics
Anonymous (AA) efforts on campus, but cited resistance to allowing AA on some campuses.
Mickey Marchetti, LEACH, expressed his appreciation for the efforts to develop the report. and felt it
set an excellent example in providing a focus for future action. He also expressed the need to begin
to move forward quickly.
Supervisor Donna Gerber mentioned that she was present at the Acalanes High School meeting on the
alcohol/drug survey of high school students. She was impressed by the number of people at the
meeting to hear the results, including the number of young people. She heard very little denial by the
attendees of the urgency of the alcohol/drug problem and felt this was very encouraging. Ellen
Peterson responded that it is very necessary to take advantage of this momentum to move forward.
Supervisor Gerber suggested that action needs to occur in three areas:
1. coordinate with the cities on AOD issues,
2. prioritize the recommendations from youth and begin to take action;
3. provide 800 numbers for treatment as well as 12 step programs in the schools.
Supervisor DeSaulnier asked about what percentage of the community substance abuse's $12 million
budget is spent on children and youth. Ms. Gonzales-DelValle explained that approximately $1.8 million
is spent on the youth prevention programs and that this is all federal revenue. Supervisor DeSaulnier
expressed his frustration on the AOD issue, citing it was a disease, that we have poor delivery of service
and this needs to be talked about in more forums, such as the Future Corps and the Policy Forum. He
also said that the County needs a single position to coordinate youth issues.
Bill Walker, Health Services Director, said that he thought that the report should be titled "The Tragedy
of Denial," since AOD is denied by many parents, schools, probation, welfare workers and health
professionals. There is a denial, he said, that treatment works; however, often times, funding is a major
problem. Few health plans provide for alcohol and drug systems. He felt that we need to carefully look
at our systems to ensure communication among line staff in different disciplines; to encourage 12 step
recovery programs in the schools; and to move forward now that the issue is in the public eye.
Both Supervisors Donna Gerber and Mark DeSaulnier agreed that the Board needs to take the
leadership in legislative advocacy to begin to move the recommendations of this report forward; to
develop a collaborative action plan, and to support 12 step programs in the schools. Supervisor
DeSaulnier suggested that the AOD issue needs to be framed as a health problem and urged Dr. Walker
and Mr. Deutschman to work'with the Superintendent's Council.
Chuck Deutschman felt that it was very important to support the schools in continuing to develop annual
surveys of alcohol and drug use among their students. He praised Mt. Diablo and Acalanes districts
for releasing their'data. Not all districts do an annual survey (some do focus groups instead) and the
3
FHS#32
methodologies used for the surveys are not consistent among districts. Good data is seen as a key
element in addressing the alcohol and drug problem.
As part of the emphasis on data, the community substance abuse services systems of care has identified
primary prevention performance,outcomes which are being used by multiple providers of service.
Committee members agreed to discuss the report and the issues surrounding alcohol and drug use with
the Board of Supervisors and to recommend that the Board take action to encourage all public agencies
to work collaboratively on the issue and to urge all school districts to join with Mt. Diablo and Acalanes
in developing uniform annual surveys that are publicly distributed.
4
ADDENDUM
D.14
December 15, 1998
On this elate,the Board of Supervisors considered a written report from the Family and Human
Services Committee on access to and utilization of alcohol and drug treatment programs for
youth concurrently with an oral report from Tom Aswad of the Substance Abuse Advisory
Board(SAAB).
Mr. Aswad provided the Board of Supervisors with joint recommendations (Exhibit A)of
SAAB and Health Services Department-Community Substance Abuse Services.
Mr. Aswad commented on the need to create in-County,publicly funded residential alcohol and
drug treatment; more publicly funded intensive outpatient treatment; ensurance of the presence
of alcohol and drug support groups in the schools; focusing prevention efforts on high-risk
youth; and implementation of a youth diversion model similar to that of the Antioch Police
Department and Reach program in East County.
Mr.Aswad requested that the Board appoint a member of SAAB to the Proposition 10
Committee,direct SAAB to initiate a time-limited task force to develop a core set of alcohol and
drug abuse variables for use by all systems with youth clients to facilitate improved
collaboration,and to charge SAAB to meet with the Superintendent of Schools.
Supervisor Gerber recommended to the Board that the report from the Family and Human
Services Committee be amended to include the specific requests made by SAAB.
Supervisor DeSaulnier seconded the motion. Following Board comments the motion passed by
unanimous vote,and the Board took the following actions:
1. ACKNOWLEDGED the work of the Community Substance Abuse Services and
Substance Abuse Advisory Board, and the importance of addressing alcohol and drug use
among youth, including the need for more treatment services, greater collaboration and
leveraged and blended funding strategies;
2. EXPRESSED appreciation for the participation of Mt Diablo Unified and Acalanes
School Districts in youth substance abuse surveys;
3. REQUESTED the School Superintendent's Council, Public Managers"Association,
City/County Relations Committee and Mayors' Conference review the report for future
implementation;
4. ADOPTED a position of support for increased state funding, adding the issue to the
County's 1999 legislative agenda;
5. REQUESTED the Community Substance Abuse Services and Substance Abuse
Advisory Board continue their efforts to work collaboratively to expand the resources
available for alcohol and other drug treatment services and to develop an action plan on
the study recommendations;
6. DIRECTED that a member of the Substance Abuse Advisory Board should be appointed
to the Proposition 10 Commission;
7. DIRECTED the Substance Abuse Advisory Board to initiate a time-limited task force to
develop a core set of standardized alcohol and drug abuse variables for use by all
systems with youth clients to facilitate improved collaboration;
8. CHARGED the Substance Abuse Advisory Board to meet with the Superintendent of
Schools to develop strategies to facilitate the collection of alcohol and drug prevalence
data among youth.
..... ..... ..... ..... .... ....
EXHIBIT A
Wil l SAM B. W A I KI R, W""D. CONT P COS iA
Htvr:i stns-r_fs Di;rrr,o:, COMMUNITY
Ciw( i Dwlx'HMAN
Dai<,r>ii SUBSTANCE-
sl
ABUSE SERVICES
CONTRA COSTA
_ _ _ —
Suit
HE A L T H SERVICES � n r ar inez' Cal4 320
Martinez, Calrfornia
9t 553
CP, h (925) 313 f300
V D qax (925) 313-6390
Memomdum D E I
yN`E`i�r� los IA
To: Barbara Grant
CCC Clerk of the Board
Fax#335-1913
From: Fatima Matal Sol e1
Date: 12/17/98
Re: SAAB Recommendations to the Board of Supervisors on AOD
Youth Study
Per Sup lervisor Donna Gerber's request attached you will find the joint—SAAB-
Substance Abuse Advisory Board and HSD/Community Substance Abuse Services
Division's Recommendations to the Board of Supervisors which were presented last
Tuesday, December 15, 1998.
Following Donna Gerber's directions the recommendations should be included as
part of the report from the Family and Human Services Commission and therefore
reflected in the minutes or report generated after the Board of Supervisor's meeting
on December 15, 1998
Should you have any questions, please call me at your earliest convenience at 313-
6311. Hard copy to follow.
r
i �1� Contra Costa Corrm,mity Sc'ostarce Abuse Ser✓ices • Contra Costa Emergency Medical Services Cor!�a Cosa Environmental Heal`h • centra Cosa Health Plan
V' Contra Costa Hazardous Materials programs •Contra Costa Mental Heakh Contra Costa Pshlic Healt� Contra Costa Req�onal Medial Center Contra�o,ta Health Centers
�ref
EXHIBIT A
Joint SAAB and HSDICSAS Recommendations to
the Board of Supervisors
Recommendations fall into three broad areas.
Expanded AOD treatment services for youth
Improved collaboration
Blended funding for children's services
Expanded AOD Treatment Services
➢ Create in-county, publicly funded residential AOD treatment for youth.
A Create more publicly funded intensive outpatient AOD treatment servicesfor county youth.
➢ Ensure that alcohol and other drugs support groups are present on all middle and high schools
in the county.
➢ Focus prevention efforts on high-risk youth.
➢ Implement the youth diversion model developed by the Antioch Police Department and the
Reach Project, in other locales in the county.
Improved Collaboration
➢ Initiate a time-limited, multi-disciplinary task force to develop a core set of standardized AOD
screening variables and to identify a standardized AOD screening tool that would be used by
all systems with youth clients. Task force would include representation from CSAS, Social
Services, Mental Health, Probation, etc. Task Force would report progress back to the Board
of Supervisors in 6 months.
➢ Charge the Substance Abuse Advisory Board to meet with the Superintendent of School and
representatives from key school districts to identify barriers and develop strategies to facilitate
the collection of AOD prevalence data in all middle and high schools in the county.
Blended Funding for Children's Services
➢ Allocate a specific percentage of general funds to support multi-disciplinary AOD services for
youth.
➢ Appoint a member of the Substance Abuse Advisory Board to the Proposition 10 Commission.
➢ Request that the State delegation advocate for a multi-year strategic plan for youth services that
focuses on the problem of youth substance abuse.
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INDEX
Executive Summary
Introduction
Methodology
Background ............................................................................................................ i
TreatmentEstimates................................................................................. 2
Contra Costa County Treatment Clients...........................................................4
Children,Youth& Family Services: A Continuum of Care 11
Service Priorities,Portals of Entry and Practice Principles........................... 11
Youth Continuum of Services...................................................................... 13
A. Prevention.............................................................................. 13
B. Treatment...............................................................................18
Findings: A Tate of Four Systems 19
(1) How is the problem of AOD use among young people perceived and defined?............ 19
Schools................................................................................................ 20
Law Enforcement.................................................................................... 21
Probation.............................................................................................. 21
(2) How are youth with AOD problem identified? 22
Schools................................................................................................ 22
LawEnforcement.................................................................................... 24
Probation.............................................................................................. 24
Substance Abuse Providers......................................................................... 26
Parents/Fam i lies...................................................................................... 26
(3) What happens once a youth with AOD problems is identified? 26
Schools.......................................................................................l........ 27
LawEnforcement.................................................................................... 32
Probation.............................................................................................. 34
(4) What barriers exist that tend to prevent youth with AOD problems from receiving treatment? 36
Schools...................................................................................... ....... 36
LawEnforcement.................................................................................... 38
Probation.....................................................................................I........ 40
Substance Abuse Providers......................................................................... 41
Parents/Families........................................................................... .........41
Systems Contradictions—or other issues 42
Schools.......................................................................................I..........42
Law Enforcement or Social Service Agencies....................................................42
Arrest Data/Crime Statistics.........................................................................43
Probation............................................................................................... 43
Recommendations 45
OverallSystem........................................................................................ 45
LawEnforcement...........................................................................I.......... 46
Probation............................................................................................... 47
School-Based.......................................................................................... 47
Community Substance Abuse Services............................................................ 49
Parent/Family.......................................................................................... 49
Youth....................................................................................................49
Youth Focus Group Report 51
Study of Youth Access and Utilization of AOD Treatment Services
in Contra Costa County
INTRODUCTION
In the 'Winter of 1997, members of Contra Costa County's Substance Abuse Advisory
Board raised a concern that based on indicator data provided to them by the Community
Substance Abuse Services Division, it appeared a relatively small proportion of those
receiving subsidized alcohol and other drug (AOD) treatment services in the county in
1996/97 were youth between 12-17 years of age. This assertion seemed in sharp contrast
to reports from staff in social services, probation, law enforcement, and schools who
suggested that alcohol and drugs were present in the majority of problems',faced by young
people. Substance Abuse Advisory Board members then brought their concerns to the
County Board of Supervisors, who commissioned further study of this issue. M. K.
Associates, a public health and social science research firm, was hired to complete the
study, which was funded by the Community Substance Abuse Services Division (CSAS)
of the Contra Costa County Department of Health Services.
METHODOLOGY
M. K. Associates staff worked with members of the Substance Abuse Advisory Board to
develop the study design and standardized interview protocols. Data collection methods
included key informant interviews with more than 50 people in law enforcement,
probation, public school, and alcohol and drug treatment providers, and analyses of
secondary data of the "in-treatment" population. (A complete list of interview subjects
may be found in Appendix A.)
Once a draft report was completed, a series of three multi-disciplinary and regional focus
groups and one youth focus group were convened to test draft recommendations, and to
assess the extent to which study findings resonated with personnel from the various
systems. The focus groups were facilitated by M. K. Associates staff, Debra Nilson
(Substance Abuse Advisory Board) and John Reardon(CSAS).
BACKGROUND
Adolescence is a complicated, challenging, and often chaotic phase of life, involving
efforts to resolve the dependency-independence-counter-dependency struggle with
parents; the challenge of integrating an emerging sexuality, and various peer pressures;
the challenge of learning, of performing well in high school, of going to college or
planning a career. Adolescents are cast into a limbo between the safe reality of
childhood, ruled by simple laws of consistency and fairness, and the complete
indeterminate reality of adulthood(Baumrind, 1983).
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Ji
One consequence or these adolescent challenges and struggles can be the use and abuse
of alcohol and other drugs. But who are adolescent alcohol and drug users?
Unfortunately, it is just as difficult to understand alcohol and drug users as it is
adolescents in general. Youth who use alcohol and other drugs are not easily
characterized. Drug use, like adolescence, is a complex phenomenon. Drugs are readily
available to most young people, yet only some become seriously involved. Adolescence
is a time of risk-taking, but only a very small percentage will experiment with such drugs
as heroin, cocaine, and PCP. It is a time when peer groups become increasingly
significant as a socializing influence, yet only some succumb to group pressure to use
drugs regularly.
Research shows adolescents use drugs for a host of reasons including 1) drugs are often
readily available; 2)they provide a quick, easy,and frequently cheap way to feel good; 3)
they offer a means of gaining acceptance in peer relationships, and 4) they may help
modify unpleasant feelings, reduce disturbing emotions, alleviate depression, reduce
tension, and help cope with life pressures (Beschner and Friendman, 1979). Researchers
have found that many individuals use marijuana to alleviate anxiety and stress (Lipton
and Marel, 1980; Jalali et al., 1981).
For some adolescents, drug use goes well beyond experimental and occasional
recreational use and may signal serious adjustment problems. These adolescents are
generally compulsive, dedicated users with serious personal problems who rely on drugs
as self-medication to cope with their problems, not unlike some adults (Wesson et al.,
1977 Kandel, 1982). These adolescents,possibly as many as five percent of teens aged 1
14 to 18, have serious drug-related problems and need specialized substance abuse
treatment.
Treatment Estimates
In order to answer the question of whether there are too few young people represented
among the county's subsidized treatment population, M. K. Associates staff used three
methodological approaches. First, we compared the percentage of youth in treatment in
Contra Costa County to youth in all other California counties. Second, in order secure a
more precise estimate, the percentage of youth in treatment in Contra Costa County was
compared to other large California counties (that is, those with more than 7,500 total
annual treatment clients). The last method used was to develop an actual "expected
number of youth needing subsidized treatment" in Contra Costa County, using U.S.
Census Bureau estimates and 1998 estimates from the California Departmentof Alcohol
and Drugs.
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Youth treatment admissions comprised only about 1%of the total treatment population in
Contra Costa County's publicly-funded AOD treatment programs. When that percentage
is compared to other California counties, data reveal that only two other counties have
similar percentages--Butte and San Joaquin counties.
However, a number of counties in which the percentage of youth in treatment, relative to
the total in-treatment population, was considerably higher than 1% were small rural
counties. In order to find a more comparable measure, investigators looked at treatment
admissions among those counties with a total treatment population of 7,500 or more. Out
of the 58 counties in California, six counties had total treatment populations of 7,500 or
more, including: Contra Costa, Fresno, Los Angeles, San Bernadino, San;Francisco, and
Santa Clara. Among these six counties,. Contra Costa County youth comprised the
smallest percentage (1.0%) of total treatment clients, followed by San Francisco (1.4%),
Fresno (1.8%), Los Angeles (3.7%), and San Bernadino (3.6%). Among the large
counties, youth comprised the largest percentage of total treatment clientsin Santa Clara
County(7.6%), over seven times higher than the percentage in Contra Costa County.
Breakdown of Percentage of Youth in 1996 Treatment
Pop. by Counties with TX Pop. Exceeding 7,500
County Youth in Total TX Pop.
Contra Costa 99 1.0
Fresno 142 1.8
Los Angeles 1747 3.7
San Bernadino 281 3.6
San Francisco 229 1.4
Santa Clara 567 7.6
CA Dept.of Alcohol and Drug Programs, 1996/97 CADDS data
According to 1996 U.S. Census Bureau population estimates, there are approximately
70,727 children between 12 and 17 years of age in Contra Costa County. Of these, we
estimated that 14.1% (9,972) are uninsured and thus most likely to need subsidized
treatment.' Next we estimated the percentage of youth needing treatment by using
California Department of Alcohol and Drug and other researcher's estimates of 5 to 8%.
Applying this percentage to the number of uninsured youth in the county, we calculated
that between 498 and 797 youth in Contra Costa County may require subsidized
treatment for alcohol and/or drug use or abuse. In 1996/97, the latest year for which we
' Derived from U.S. census data on%of uninsured children in California.
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Study of Youth Access and Utilization of AOD Treatment Services
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have complete data, 99 youth under 18 years of age received subsidized treatment in the
county. Obviously these data are merely estimates and cannot be considered as hard
empirical evidence of the county's unmet treatment needs; however, these data do
suggest that a gap exists between the number of youth who need treatment and the
number actually receiving it.
It is important to stress that the number of youth in treatment may be undercounted for a
variety of reasons. The central issue is the manner in which alcohol and drug treatment
cases are calculated by the state. The State of California has a centralized data collection
system called the California Alcohol and Drug Data System (CADDS). This system
collects data on persons specifically receiving alcohol or drug treatment from a publicly-
funded drug treatment program. Thus, persons who receive treatment in a private facility
(e.g., Kaiser Walnut Creek, New Bridge, CPC, etc.) are not included in the system.
Moreover, there may well be a number of youth receiving treatment for alcohol and/or
drug problems from the mental health system (and these youth are not reported to the
state's drug and alcohol database). Similarly, youth in the juvenile justice system may
receive treatment from "in-house" professionals (again, these youth are not reported to
the state's database). It may also be that some alcohol and drug treatment providers do
not adequately complete the relevant state reporting forms. In addition, conflicting
definitions of what constitutes "intervention" vs. "treatment" may also contribute to
lower counts. For example, according to treatment provider interviews, prior to 1997/98,
providers had 30 days to complete the requisite paperwork, including CADDS. If a
juvenile were admitted to treatment but did not stay beyond 30 days, often a CADDS
would not be completed by the treatment provider and the youth's treatment would thus
go uncounted.
The next series of tables report on the number of youth and adults in publicly-funded
treatment(for whom a CADDS was completed), and their characteristics.
Contra Costa County Treatment Clients
Between July 1, 1996 and June 30, 1997, a total of 10,199 individuals were admitted to
-treatment in Contra Costa County, of these, approximately 99 (1%) were under 18 years
of age. A total of 75 youth were discharged during the same time period. Of these, 52
were admitted and discharged during 1996/97, and 23 were discharged in 1996/97, but
were admitted in 1995/96. In Contra Costa County, providers funded by the Community
Substance Abuse Services Division(CSAS) are required to complete a CADDS forM2 on
any client whose treatment is in any way subsidized with public funds. Data in the next
2 Statewide ADP standardized data base.
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Study of Youth Access and Utilization of AO►D Treatment Services
in Contra Costa County
tables are derived from analysis of all CADDS forms submitted to the state by Contra
Costa County providers between July 1, 1996 and June 30, 1997
As data indicate, two-thirds (66.7%) of all youth in treatment are White, compared to
only 45.3%among adult treatment clients. The rates of Asian/PI and Latinos in treatment
also decrease among adult treatment clients. In contrast, while African Americans
comprise only 4% of youth in treatment, they comprise fully 42.8% of the adults in
treatment. These data imply several possibilities: 1) the onset of drug use among African
American youth is delayed compared to other youth--occurring after the age of 18; 2)
youth provider staff may not be adequately engaging African American youth; 3) African
American youth may manifest their drug and/or alcohol or "acting out" behaviors in such
a way that they are more often referred to the juvenile justice system than to the treatment
system, or 4)African American youth are more likely to be charged with felony drug use-
-and thus receive more severe(non-treatment-related) sanctions than do White youth.
Ethnic Breakdown of Youth vs.Adults in Treatment
1996/97--Contra Costa County
Under I8 Years 18 and Over
No. % No. %
White 66 66.7 4,577 45.3
African American 4 4.0 4,322 42.8
American Indian 0 0.0 48 .5
Asian/Pl 10 10.1 101 1.0
Latino 14 14.1 960 8.4
Other 5 5.1 192 1.9
Total 99 100.0 10,100 100.0
The following table breaks down juvenile drug arrests by ethnicity. As data indicate, four
out of five youth arrested for felony drug offenses are African American compared to
only 20% for all other youth. Whites comprised the greatest proportion of felony
dangerous drug arrests (including methamphetamine), and felony marijuana arrests.
White youth comprised 100% of all DUI felony arrests. White youth also make up more
than three-quarters of misdemeanor marijuana and misdemeanor DUI arrests.
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Ethnic Breakdown of Felony and Misdemeanor Drug Arrests
1996--Contra Costa County
African White Latino Other Total
American
No. % No. % No. % No. % No. %
Felony Narcotics 63 80.7 4 5.1 11 14.1 0 0.0 78 100.0
Felony dangerous 7 19.4 20 55.5 7 19.4 2 5.5 36 100.0
drugs
Felony marijuana 23 35.4 26 40.0 11 16.9 5 7.7 65 100.0
Felony DUI 5 100,0 1 5 100.0
Misdemeanor 30 13.3 162 71.7 28 12.3 6 2.6 226 100.0
marijuana
Misdemeanor 2 3.2 49 77.7 9 14.3 0 U 6-3 100.0
DUI
Among youth in treatment, marijuana, followed by alcohol and methamphetamines are
the primary drugs of choice. Among adult treatment clients, alcohol, heroin, cocaine, and
methamphetamines are the most widely used drugs of choice. Alcohol is the primary
drug of choice among half of all adults in treatment, and the drug of choice for one in
four adolescents. According to law enforcement personnel, alcohol use among youth is
the most prevalent and more troublesome, although these trends are not reflected in the
arrest statistics. This may be due in part to the fact that alcohol use by youth tends to be
minimized by parents and other adults, often being seen-as a rite of passage, and going
unreported. Misdemeanor use of alcohol is also underreported because according to law
enforcement personnel, there is little point in arresting youth because charges are seldom
filed on youth for misdemeanor use of drugs or alcohol. The exception to these practices
seems to be law enforcement jurisdictions with their own diversion programs.
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Primary Drug Among Youth vs. Adult Drug Users
1996/97--Contra Costa County
Primary Drug Under 18 Years 18 and Over
No. % No. %
Heroin 1 1.01 3,022 29.9
Alcohol 25 25.3 5,164 51.1
Barbiturates 0 0.0 6 .1
Other sedatives 0 0.0 2 0.0
Methamphetamines 20 20.2 814 8.1
Other amphetamines 0 0.0 16 .2
Ocher stimulates 0 0.0 1 0.0
Cocaine/Crack 2 2.0 9113 9.0
Marijuana 50 50.51 129 1.3
PCP 0 0.0 3 0.0
Other hallucinogens 1 1.0 2 0.0
Tranquilizers 0 0.0 3 0.0
Other Opiates 0 0.0 25 .3
Other 0 0.0 6 .1
Total 99 100.0 10,106 100.0
Among youth in treatment, more than four out of five youth (84.4%) indicated they first
used their primary drug of choice under the age of 15, and 100% reported;its first use by
age 18. (These data suggest that identification of youth with AOD problems, and
prevention education for high-risk youth, should begin as early as middle and/or junior
high school through 10th grade; and that general prevention education focus on
elementary age youth). In contrast, 31.6% of adults reported first use of their drug of
choice under 15 years of age. (This is likely because the presenting drug of choice for
adults tended to be "hard drugs" and the initial use of this drug often occurred after the
age of 17). However,like youth currently in treatment in the county, adult use of alcohol
and marijuana(gateway drugs) likely also begun at an early age.
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Age of First Use--Youth vs. Adults
Under 18 Years 18 and Over
No. % No. %
Under 15 81 84,4% 3,169 31.6
15-17 years 15 15.6% 2,380 23.7
18-20 years 0 0.0 1,691 16.8
21-25 years 0 0.0 1,260 12.6
26-30 years 0 0.0 702 6.9
31-35 years 0 0.0 448 4.5
Over 35 0 0.0 387 3.9
L Total 96 100.0 10,037 100.0
Frequency of use helps clinicians determine the acuity of drug use among clients. Close
to three-quarters (70%) of all youth in treatment reported minimum use of 1-2 times per
week. Slightly more than 40% of youth in treatment reported daily use of their drug of
choice, 12.1% reported 3 to 6 times per week, and 30.3% reported using their drug of
choice 1-2 times per week. Among the adult treatment population, 77.6% reported daily
use.
Frequency of Use--Youth vs. Adults
Frequency Under 18 Years 18 and Over
No use in 30 days 8 8.1 659 6.5
1-3 times past month 8 8.1 469 4.7
1-2 times per week 30 30.3 571 5.7
3-6 times per week 12 12.1 550 5.5
Daily 41 41.47,817 1 77.6
Total i 99--t 100.0 10,164 100.0
Data in the following table show the referral source for both youth and adult treatment
clients. Data indicate that young people are far less likely to self refer or be referred to
treatment by a family member than are adults (26.3% vs. 80.0%). One quarter of the
youth are referred by the juvenile justice system, 22.2% are referred by schools, and
community referrals constitute about 15.2% of youth referrals to treatment. Among
adults, four out of five are self-referred, followed by criminal justice referrals (6.8010), and
other community referrals (5.3010). These data demonstrate that youth are more likely to
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receive a "system" referral to treatment than are adults, and less likely to be referred by
self or another individual, e.g., family, friends, etc.3
Referral to TX Source--Youth vs. Adults
Under 18 Years 18 and Over
No. % No. %:
Individual(Self) 26 26.3 8063 80.0
Care Program 2 2.0 380 3.8>
Other.Health Care 7 7.1 369 3.7'
School 22 22.2 8 .1
Employer/EAP 1 1.0 13 .1
Court/Justice system 26 26.3 685 6.8'
12 Step 0 0.0 18 .2
Other Commun.referral 15 15,2 538 5.3'
Total 1 99 100.0 10,074 1 100.0
Of total treatment admissions during 1996/97, more than four out of fiveyouth (86.8%)
were referred to outpatient treatment, and 12.1% to residential treatment. In contrast,
among adult clients, slightly more than half (51.3%) were admitted to detox, 25.2%
methadone maintenance, 15.4% to outpatient, and 8% to residential treatment of 30 days
or longer. However, when detox cases are removed from the analysis, 31.7% of adults
were admitted to outpatient treatment, 16.5% to residential treatment (30+ days), and
51.8%to methadone programs.
Breakdown of Admission Type--Youth vs. Adults
Under 18 Years 18 and Over
No. % No. %
Detox 0 0.0 5,183 51.3
Outpatient 86 86.8 1,560 15.4
Residential 30 days+ 12 12.1 813 8.0
Methadone Maintenance. 1 0.1 2,550 25.2
Total 99 1 100.0 10,106 100.0
As data indicate in the table below, New Connections, Tri Cities, San Ramon Valley
Discovery Center,REACH Project, and Thunder Road were responsible for treating more
than 80%of all youth treated in publicly-funded programs.
3 Includes detox clients.
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Breakdown of Youth and Adult Admissions by Provider
July 1, 1996 -June 30, 1997
Provider Under 18 Years 18 and Over
CJTP-West 81 .8
CJTP-East 98 10
63 .6
Neighborhood House 1481 14.7
Ozanam Center 86 .9
Shennum Detox 2661 26.4
Gregory Recovery.(closed)
1 1.0 29 .02
Rectory
36 .0
Diablo Valley Ranch4 3
BAART-Richmond 259 2.6
1897 18.8
BAART-Pittsburg 1 1.0 862 8.6
La Casa Ujima 58 .6
Family Recovery 5 .04
Ujima West 1 1.0 93 .9
Tri-Cities 20 20,0 78 .8
San Pablo Discovery 4 4.0 199 2.0
San Ramon Valley Disc. 14 14.0 32 .3
Wollum House 44 A
EastCountyDetox 1137 11.3
Thunder Road 12 12.1 0 0.0
New Connections-Pi sburg 7 7.1 31 .3
New Connections-Central 24 24.2 47 .5
Discovery House 95
REACH Project 13 13.1 .9
Sojourne 84 .8
193 1.9
Born Free-Martinez 1 1.0 74 .7
Born Free-Richmond 92
Born Free-Pittsburg 84 8
Ujima East 75 1 in
Sunrise House 112 1.1
-Total 99 100.0 10,070 100.0
Discharge status is One way to monitor treatment effectiveness. In 1995/96, the success
rate for youth in outpatient and residential treatment ' was 42% compared to 30% for
4
The number of youth in treatment includes both subsidized and non-subsidized
treatment clients.
' Includes only subsidized youth treatment clients. An additional 9 youth clients were
private pay.
Includes completed as well as those who left TX with satisfactory progress
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those 18 years of age or older. While data for the current year are not yet complete, for
the first ten months of 1997/98 (July through April), the success rate for youth in
treatment is 51.9%, and 52.1% for adults (including detox). Another way to look at
treatment success is to calculate the number of people in treatment who require more than
one "dose" of treatment. When youth treatment data for the five year period between
1993 and 1997 were reviewed, it was found that of the 703 youth treated by Contra Costa
County's subsidized outpatient and residential treatment programs, only 6% received
more than one treatment episode in the five year period. Among those receiving
outpatient treatment only, 5% received more than one treatment dose; for;those receiving
only residential treatment, 2% had more than one episode; and for those who received
both residential and outpatient treatment over the five year period, 36% received one
additional treatment dose(of either residential or outpatient).
CSAS Children,Youth and Family Services--A Continuum of Care
A variety of prevention and treatment services are available to youth in Contra Costa
County through the Contra Costa County Community Substance Abuse Services
Division. These services are designed to assist communities, families and individuals in
reducing and preventing substance abuse; discouraging youth access and use of alcohol, .
tobacco and other drugs; and encouraging communities to change conditions that
contribute to substance abuse related problems.
Decreases in CSAS funding over the past five years have required the Division to
increase its focus on program efficiency and efficacy, and to prioritize its service
populations. Current service priorities are as follows:
Children, Youth and Family services are designed to assist communities, families and
individuals to reduce and prevent substance abuse; discourage youth access and use of
alcohol, tobacco and other drugs; and encourage communities to change ;conditions that
contribute to substance abuse related problems.
Service Priorities
• Children and youth whose parents have alcohol or drug addiction, are in
treatment or recovery;
• Families and significant others that suffer the effects of another person's
alcohol or drug addiction,abuse or dependency problems;
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• Populations and groups with special needs such as preschoolers, school
dropouts, youth in juvenile detention facilities or juvenile justice system,
runaway and homeless children and youth, pregnant and parenting teenagers,
children and youth served by social welfare systems;
• Immigrants, refugees, racial and ethnic minorities, particularly Native
Americans, African Americans, Latinos and Asian Pacific Islanders;
• Residents of public housing, families and individuals living in communities
subsidized by local and/or federal government or defined as enterprise zones;
• School sites with high level of truancy or serving children and youth unable to
function in regular settings e.g., continuation, community and alternative
schools.
Portals of Entry
The Access Unit, a centralized management and information system is one of many
portals of entry. Access provides substance abuse information, problem identification and
referrals, screening, placement, registration and care coordination services to Contra
Costa County residents.
Other portals of entry are Schools, Juvenile Justice System, Children's Protective
Services, and Health Services. To address service priorities described above, formal
linkages with Mental Health, Public Health, Foster Care, Group Homes, Homeless
Shelters, and other Youth Diversion programs i.e., Safe Futures, Juvenile Drug Court,
and Independent Living Skills Programs will be developed.
Practice "Principles":
1. CSAS recognizes that youth experimentation, use, and abuse of alcohol and other
drugs is impacted by family and community norms.
2. Given that a large percentage of youth are referred rather than self-referred, the
substance abuse problem among youth tends to be ascribed rather than self-defined.
3. Although youth experimentation and use of alcohol and tobacco is illegal, these
substances are still accessible and available to young people. Thus, experimentation
and use, is to an extent perceived by youth to be"a rite of passage into adulthood".
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4. Given different levels of"awareness of the substance abuse problem and readiness to
change" among youth, CSAS prevention and treatment servicesinclude youth
identified as "high risk" i.e., children of substance abusers, youth that are
experimenting or using alcohol and other drugs.
5. Prevention and treatment services are tailored to a variety of cultural and ethnic
populations.
6. Services engage (1) youth, (2) parent or caregiver, and (3) the environment in which
the youth substance abuse problem is identified e.g.,the family, group or foster home,
child welfare, school, criminal justice system, etc. but are not contingent on parental
participation.
Youth Continuum of Services
A. Prevention
The goals of prevention services are (1)to reduce alcohol and drug use and availability of those
substances in the community;(2)to reduce alcohol and drug use among school-aged youth,and(3)
to increase the use of prevention activities that are research-based and outcome driven.
CSAS's prevention services are funded by the California Alcohol and Drug Programs
Title IV "Safe and Drug Free Schools and Communities" (SFDS) Grant Program, and
Title 45 of the united States Code of Federal Regulations(C.F.R. 96.125);which governs
the Substance Abuse Prevention and Treatment (SAPT) Block Grant Primary Prevention
Set-Aside required strategies listed below:
EDUCATION: This strategy involves two-way communication and is
distinguished from the Information Dissemination strategy by the fact that
interaction between the educator/facilitator and the participants is the basis of its
activities. Activities under this strategy aim to affect critical life and social skills,
including decision-making, refusal skills, critical analysis (e.g., of media
messages),and systematic judgment abilities.
ALTERNATIVES: This strategy provides for the participation of target
populations in activities that exclude alcohol, tobacco and other drug use. The
assumption is that constructive and healthy activities offset the attraction to, or
otherwise meet the needs usually filled by alcohol, tobacco and other drug and
would,therefore,minimize or obviate resort to the latter.
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PROBLEM IDENTIFICATION AND REFERRAL: This strategy aims to
identify those who have indulged in illegal/age inappropriate use of tobacco or
alcohol and those individuals who have indulged in the first use of illicit drugs in
order to assess if their behavior can be reversed through education. It should be
noted, however, that this strategy does not include any activity designed to
determine if a person is in need of treatment.
COMMUNITY-BASED PROCESS: This strategy aims to enhance the ability
of the community to more effectively provide prevention and treatment services
for alcohol, tobacco and drug abuse disorders. Activities in this strategy include
organizing, planning, and enhancing efficiency and effectiveness of service
implementation, interagency collaboration, coalition building, and networking.
ENVIRONMENTAL: This strategy establishes or changes written and
unwritten community standards, codes and attitudes, thereby influencing
incidence and prevalence of the abuse of alcohol,tobacco, and other drugs used in
the general population. This strategy is divided into two sub-categories to permit
distinction between activities which center on legal and regulatory initiatives and
those, which relate to the service and action-oriented initiatives.
Requirements
To ensure performance and compliance with funding requirements, CSAS's prevention
services require standardized data collection and measurement of outcomes. To reduce
service duplication and to increase cost-effective collaboration and community-wide
planning, prevention providers are required to join School District Safe and Drug Free
School and Community Coalitions I their service area, as well as local alcohol and drug
prevention coalitions.
Prevention providers are also required to dedicate a percentage of their 20% set aside
[35% of funding allocation] to community-based process strategy to (a) reduce service
duplication and (b) increase cost-effective collaboration and community-wide planning.
For example, school based services require membership in Safe and Drug Free School
and Community Coalitions and other local coalitions involved in AOD prevention. On
the other hand, CSAS providers are expected to provide information and distribute
materials pertinent to their program to clients and general population without
compensation.
AOD education services require a curriculum approved by CSAS e.g. purpose, goals and
objectives, lesson plan and corresponding pre- and post- tests. This strategy is usually
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delivered to a classroom or a specific group of people from a general population (students
in a school site, family of clients from a program, residents from a particular service
area). For details on,"closed" and "open groups", general or specific populations refer to
CSAS Prevention Activities Data System Forms and Unit of Analysis in PADS Section.
The Problem Identification and Referral strategy is discouraged unless',(1) provider is
able to identify special needs of a target population in their service area and (2) articulate
the rationale for making referrals to a particular service such as employee/assistance,
DUI/DWI, Men or Women's Alternative to Violence, Student Assistance Programs, 12
step groups; etc.
Services
Community Partnership - CSAS prevention services provide technical assistance,
training, and resources to regional substance abuse AOD coalitions and grassroots
organizations. The Community Partnership is a bottom up approach to substance abuse
prevention based on coalition building, collaboration, and environmental strategies to
promote "A Drug and Alcohol Free Contra Costa County"
The Community Partnership initiatives engage those most affected by the AOD problem
in the planning, implementation, and evaluation of proposed solutions through the
following activities:
Mini-grants are offered to grassroots groups through a proposal process, which is both a
vehicle for skill development and an effort to recruit community members to join
substance abuse coalitions.
Citizen development focused on building leadership capacity in the community. The
strategy is to recruit and bring out new and emerging leaders to define the local
prevention agendas in their communities.
Pro-active community outreach to constituencies that are not represented in the substance
abuse coalitions. The strategy is to use culture specific outreach that is appropriate to the
yet-to-be-reached citizens.
Organizing the community to identify issues, target solutions and pursue goals. The
strategy is to encourage collaboration, facilitate problem solving, acknowledge power
differentials and build alliances.
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Partnership Forum - CSAS Administration staffs an alliance of local prevention groups
that work with the Substance Abuse Advisory Board (SAAB) to implement the county's
Substance Abuse Action Plan. In 1995 SAAB formally included the Partnership Forum in
two of its standing committees, the Public Policy and Public Relations Committees. The
intent, to bring together SAAB members appointed by the Board of Supervisors and
concerned citizens, volunteers, providers and consumers of substance abuse services that
form the Partnership Forum Alliance. Special emphasis has been placed in recruiting
youth and people in recovery. The intent, to encourage community residents and
appointed members of the Substance Abuse Advisory Board to articulate and evaluate
initiatives, recommend policies and advocate for AOD services.
Examples of some of the current Community Forum Alliance supported initiatives are
listed below:
CSAS System of Care — A process to develop, implement and evaluate publicly funded
substance abuse services which involves CSAS administration, CSAS county operated
and contract providers, and the Substance Abuse Advisory Board;
Los Medanos and Pegasus Mentor Projects — A project to in*crease representation of
minority and low income people in health care professions and to provide opportunities
for high school students to interact informally with adult role models in the employment
arena. Los Medanos serves youth residents from a Housing Project in Bay Point and
Pegasus serves Richmond High School students.
Las Casitas — A collaborative process to provide technical assistance and training to
Housing Project Resident Councils in Contra Costa County.
Partners In Recovery Alliance [PIRA] — A voluntary alliance of AOD treatment alumni
organizations, recovery groups, CSAS administration and the Substance Abuse Advisory
Board. PIRA's mission is to: (a) advocate for improved AOD treatment services; (b)
promote local, regional, and statewide recovery groups; (c) promote empowerment,
education,recovery,rehabilitation,and socialization of all persons in recovery.
Alcohol/Drug Sensitive Information Planning System/Geographic Information System
[ASIPS/GIS] — A community-based process to collect alcohol/drug problem information
from local sources, including public agencies and community groups involved in the
prevention and reduction of local alcohol and drug problems. The intent is to educate,
organize and mobilize communities to pursue strategies aimed to reduce or eliminate
high-risk environments of alcohol and drug use and availability.
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Youth Slurry — An attempt to explore why publicly funded AOD treatment services in
Contra Costa County are underutilized by youth between the ages of 12 and 17.
Concurrent with the study the CSAS System of Care convened a series of work sessions
to critically assess the current level of youth AOD services, develop a proposal for a
Children, Youth and Families continuum of care and advocate for increase funding for
youth AOD services.
Client Families — Prevention services are provided at outpatient drug-free treatment
programs, in schools, and community centers. To ensure linkages between different
service components, outreach to treatment clients, their children and families, is provided
on site at outpatient, detox and residential programs. Services include presentations,
dissemination of information and educational materials, education and support groups,
problem identification and referrals.
General Population — Information dissemination, community campaigns, alcohol and
drug free events, education and environmental strategies provide low intensity and high
volume AOD information to children, youth, parents and the community at large. The
intent is change in knowledge and attitudes, changing community norms and policies to
reduce alcohol and drug access_ to youth, monitor alcohol outlet density and promote .
responsible merchant practices.
High Risk Groups - "Youth considered to be "at risk" for substance abuse addiction
because: (a) they are members of an identified peer or family group within which other
individuals abuse alcohol or drugs or, (b)have a current history of behavioral problems at
home, school, or community that are directly related to use of alcohol and drugs, are
referred to educational groups to modify or change behaviors that puts them at risk.
This prevention strategy accommodates youth that are using alcohol or drugs but do not
believe this is a problem for them as well as youth that have tested positive or have been
found to use alcohol or drugs and are required to attend a program. Standardized
screening is required to establish the "problem" in terms of expected behavioral changes.
Screening results are used to develop a contractual agreement specific to each youth,
which includes a plan to change or reduce the problem behavior. High risk groups
educational services are structured in terms of (a) a set number of hours of group
sessions, (b) discussion and strategies for behavior change; (c) evaluation of behavior
change; and(d)referrals.
B.Treatment
Assessment
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A youth referred to a treatment program for assessment fits the same criteria than a youth
referred to a "high risk" group but the severity of use and behavioral problems have
resulted in more serious consequences. Standardized assessment is required to establish
the severity of addiction, emotional, psychological, or environmental conditions that
contribute to the AOD problem. Results determine treatment placement or appropriate
referral to mental health, child protective services, etc.
Outpatient Low Intensity
Outpatient low intensity treatment services are structured in terms of treatment
philosophy and(a)number and length of group treatment sessions; (b) number and length
of educational groups and topics covered; (c) number and length of individual sessions;
(d) number and length of family sessions; (e) criteria for accepting or terminating youth.
Standardized assessment and treatment plans are required. Modality includes after care
and relapse prevention. Treatment dosage ranges from one to seven hours per week for
sixteen to twenty four weeks(4-6 months).
Outpatient High Intensity
Outpatient high intensity treatment services are structured in terms of treatment
philosophy and (a) number and length of group treatment sessions; (b) number and length
of educational groups and topics covered; (c) number and length of individual sessions;
(d) number and length of family sessions; (e)criteria for accepting or terminating youth.
Assessment and treatment plans are required. Modality includes after care and relapse
prevention. Treatment dosage ranges from nine to eleven hours per week for sixteen to
twenty four weeks(4-6 months).
Residential Low Intensity
Residential low intensity treatment services are structured in terms of treatment
philosophy and(a)number and length of group treatment sessions; (b) number and length
of educational groups and topics covered; (c) number and length of individual sessions;
(d) number and length of family sessions; (e)criteria for accepting or terminating youth.
Assessment and treatment plans are required. Modality includes after care and relapse
prevention. Treatment dosage is twenty four hours per day for thirty days (I month).
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Residential Hijah Intensity
Residential high intensity treatment services are structured in terms of treatment
philosophy and (a) number and length of group treatment sessions; (b) number and length
of educational groups and topics covered; (c) number and length of individual sessions;
(d)number and length of family sessions;(e)criteria for accepting or terminating youth.
Assessment and treatment plans are required. Modality includes after care and relapse
prevention. Treatment dosage is twenty four hours per day for sixteen to twenty four
weeks(4-6-months).
FINDINGS. A TALE OF FOUR SYSTEMS
The next section of this report focuses on findings from the more than 60 interviews
conducted with representatives from police departments, probation, school staff, and
CSAS funded treatment providers. Interviews with people within the four systems sought
to answer four basic questions: 1) How is the problem of AOD use among young people
perceived and defined by the various systems? 2) How are youth with AOD problems
identified? 3) What happens to youth with AOD problems once they have been
identified? and 4) ghat barriers exist that prevent youth who need subsidized AOD
treatment from receiving it?
1) How is the problem of AOD use among young people perceived and defined?
Perhaps the greatest surprise was the apparent lacy of awareness of people in one system
about how people in the other systems identified or dealt with youth with alcohol or drug
problems'. Differences in philosophy and mission also seem to affect the'ways'in which
each system regards the other's efforts to resolve the problem of drug and alcohol use by
youth in the county, ultimately discouraging cooperation and collaboration'. This is not to
say that there are not individual instances where cooperation and collaboration among
systems is exemplary,or that the work being done by individual systems is not good.
These differences in definition of the "problem," in language used to describe the
problem, and differences in the understanding of its root causes tend',to discourage
collaboration among agencies dealing with youth with AOD problems. The differences
in mission among the four systems also affect the way alcohol and drug use among 12-17
year olds is perceived. Categorical funding also discourages real collaboration,
sometimes preventing any system of treating youth with AOD problems within the
content needed to really address the problem fully. The result is often ineffective
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communication and collaboration among the four systems to the detriment of young
people needing help.
Schools
Many of the school staff interviewed reported that they do not feel sufficiently trained to
recognize alcohol or drug problems among their students. In the past, school counselors
were present on many school campuses and it was the counselors who would try to
intervene with a student whom they perceived might have a problem with alcohol or
drugs. At present, where counselors still exist, they have caseloads in the hundreds and
are able to provide only academic counseling at best. The line between what constitutes a
mental health problem, an alcohol or drug problem, an adolescent development problem,
or a combination of any or all of the three is murky at best and also tends to contribute to
school staffs' unwillingness to "label" a young person as misusing alcohol and/or drugs.
The antecedents for drug and alcohol use and those of delinquency are difficult to
distinguish,and often look similar,e.g.,a drop in grades,truancy, a change in friends, etc.
"Normal" teen behavior can be amazingly similar to the signs of youth who are using
drugs, at risk of running away,or are suicidal.
You hear drug use in on the increase" said one respondent,
"But fewer kids are getting busted for using. " Police liaisons
and others are just not seeing it on many campuses. Most ofthat
behavior is occurring off campus (where truancy comes in).
A number of respondents indicated that they see alcohol and drug use by some young
people as a way to relax and escape family or peer problems. Additionally, several
school staff interviewed also stated they were reluctant to confront parents with the issue,
fearing a backlash from parents who are unable or unwilling to believe their child is using
drugs and/or alcohol.
Finally, several school staff indicated that it is unfair to expect schools to be "all things to
all kids." It is difficult enough these days to try to educate youth without also trying to be
parent, social worker, and police officer. Others expressed reluctance to identify students
as AOD users, fearing parental wrath, and in some cases legal liability.
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Laty Enforcement
For law enforcement officials,the issue is more clear. Alcohol and drug use by minors is
a crime and as such police officers are required to arrest any young person they find who
is using or selling drugs or alcohol. Law enforcement officials also tend to see AOD use
by youth as a family problem or a character flaw rather than a treatable,chronic disease.
The perception of the alcohol and drug problems among youth also depends on how
"problem" is defined. In terms of volume--both for the police and the youth--alcohol
seems to be more of a problem in most of the county. The average police officer's time is
more likely to be spent dealing with alcohol use among youth than with the use of other
drugs. Alcohol is also considered a problem because, according to some respondents, it
is a "gateway drug," and more likely to produce aggressive and sometimes violent
behaviors in young people compared to marijuana use.
Harder, or illegal, drugs are also a problem in terms of the crime associated with their
acquisition and use. Respondents mentioned that a wide variety of drugs are consumed
by youth in the county, although use patterns vary by community. Some respondents felt
that powered cocaine is a problem in some of the more affluent areas. Some respondents
said that in the past three years, there has been an "explosion" of methamphetamine use.
In some parts of the county, according to respondents, rock cocaine use is much more
prevalent. Some respondents feel that there is even some degree of heroin use among
youth, although most respondents felt that injection drug use is minimal,>among county
youth.
In some areas of the county (usually in the less affluent areas, according to some
respondents), the sale of drugs is a much more significant problem. Drug sales are
associated with other crimes, such as violence and gang activity.
Probation
Probation officials' first concern is public safety. Beyond that, as part of the juvenile
justice system, they believe in the rehabilitation of youthful offenders, and make every
effort to see that the least restrictive alternative is used to deal with them. However,
resource availability also affects policy directions. Ten years ago, after funding cuts
required lay-off of a number of probation officers, out-of-home placements began to
increase, and in home placements were reduced because with fewer officers, it was
impossible to provide adequate supervision to youthful offenders and ensure the public
safety. Over the past few years the number of probation officers has increased, and as a
result, there are fewer out-of-home placements, and a greater number of in home
placements.
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However, interviews with probation staff and others throughout the juvenile justice
system indicate that many view the AOD treatment provided by group homes and county
funded AOD treatment providers as virtually identical. When asked about residential
AOD treatment options, one probation officer stated "that of the more than 30 group
homes in the county, he would only send kids to about four."
The Office of Criminal Justice Planning's Safe Futures funding is one of the largest
sources of outside funding to address alcohol and drug problems among youthful
offenders.
2. How are youth with AOD problems identified?
According to law enforcement personnel, school staff, and youth themselves, the use of
alcohol and drugs by Contra Costa youth is more widespread that is at first obvious by
reviewing alcohol and drug arrest data, school Substance Abuse Review Board (BARB)
data, AOD treatment statistics, or probation records. Generally, only those youth who
cause problems in relation to their use tend to be identified and receive services.
Furthermore, according to data on youth in treatment, they are far less likely to be
referred to treatment by a parent, family member or self than are adults (26.3% vs.
80.0%). Youth users have more denial about their use of alcohol and drugs, often seeing
it as a "rite of passage," rather than indicative of any personal problem. Therefore, the
majority of juvenile substance abusers in need of treatment must rely on the schools, law
enforcement, probation, CSAS providers, and in some cases parents to identify when
youth are in need of alcohol and drug treatment.
Schools
While overwhelmingly school staff interviewed indicated that alcohol and drug use
constitute a major problem among youth in the county, they also seemed to believe that
drug use on campus is a relatively small problem. When asked "to what extent AOD is a
problem on campus," some said that, on the surface, AOD-related problems are not as
prevalent as problems arising from non-drug-based conflicts and relationships. Others
said that while there is no question that substance abuse is an issue for students, not too
much is actually visible on campus, or obvious during school hours. However, based on
their conversations with students, other respondents said that many more youth have
AOD problems and come to school high than are identified or caught.
One school counselor observed that "AOD use is hardly ever the major issue" with the
students she sees. Most referrals are about youth who are deeply troubled in a variety of
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ways. AOD issues may surface later, after they've had a chance to talk, but do not
present as the problem. The youth she sees have problems that focus more around self-
esteem and anger. Adolescents struggle to create a lifestyle in whichthey have self-
respect and friends. Alcohol and drugs are used to relax and forget about the bad things
happening in their lives.
Some respondents reported AOD problems are more likely to be faced by young people
with little family support. And, that these youth get the "short end of the stick," with
some seen as "throwaway Fids": they run away, and manage to muddle through on their
own, in spite of, rather than because of a system-based response. Most go unnoticed, but
even those who are identified as having a problem, if their parents are uncooperative, or
themselves using, are likely to receive a.more punitive response than',are youth with
familial support. Another respondent said that youth need to feel that they are the issue,
not drugs or alcohol, so he was reluctant to pose the problem as an AOD problem, rather
than a family problem.
All school staff interviewed agreed that suspension data do not reflect the full scope of
the alcohol and drug problems on campus, nor describe what is actually happening.
Except for"suspicious behavior," on the surface there is little objective evidence of AOD .
use. Most youth tend to be very "subtle" about using alcohol and drugs on campus,
leaving few clear signs. Alcohol tends to bring out more disruptive, ;aggressive and
confrontational behavior, and of course can be smelled. But few alcohol-related
problems are seen on campus. Students tend not to come to school drunk or hung over
since it is easier to detect. Alcohol is more of an off-campus problem (i.e., drinking and
driving). Marijuana has a more loin key, mellowing effect, interfering with the ability of
students to focus in class, thereby impeding their learning process, but is more difficult to
detect. But teachers often don't make that connection. Instead, they see students as tired,
sleepy,or uninterested,rather than"high."
According to school staff, one indication of AOD problems is absenteeism or truancy
when students may cut class to smoke a joint or a cigarette. This can also happen with
alcohol, but it's easier and quicker to smoke a joint. Other red flags include poor grades,
increased number of disciplinary problems, cutting classes, tardiness, less interaction and
interest in class. Generally, by the time a student is identified by the school as having a
problem,their grades probably have slipped, attendance has become erratic and they may
have already been caught in an AOD-related incident.
While school staff appeared to be reluctant to identify youth with AOD problems, it was
most likely to occur when there were CSAS prevention/treatment providers on campus
and available to deal with youth once identified.
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Law Enforcement
Virtually all of the law enforcement respondents, from chiefs of police to patrol officers,
believe that the use and abuse of alcohol and other drugs constitute a serious problem in
Contra Costa County among adults as well as youth. The nature and extent of the
problem varies by region and specific community throughout the county.
In any event, law enforcement officers identify AOD problems among youth by using
two simple and straight forward methods--both related to the traditional mission of law
enforcement. First, an officer might respond to a complaint and find a youth in
possession of alcohol or other drugs. Second,'an officer might encounter a youth'under
the influence of alcohol or other drugs. Either instance would constitute a crime in the
normal sense of the term. And the youth could therefore be arrested and taken into
custody.
Generally speaking, law enforcement agencies do not conduct significant investigations
to determine if a particular youth has an"alcohol'or drug problem,"or if substance abuse
is causing the behavior. if the charge for which the youth has been arrested is a drug or
alcohol offense, e.g., sales, possession, under the influence, etc., from a law enforcement
perspective that young person has an AOD problem. Law enforcement officers see their
job as arresting offenders, and in the case of juveniles, to turn over these youth to
probation or their families. However, a law enforcement agency typically has files on
youth who have been arrested in the past(at least in their own jurisdiction). So if a youth
is arrested on multiple occasions for alcohol or drug-related offenses, the agency will
have an indication that the youth has an alcohol or drug problem.
Probation
The probation department does not conduct a standardize alcohol/drug screening to assess
youth for alcohol or drug problems. The screening that takes place is on a more informal
(although not necessarily arbitrary) level or scale. Recognition of a young person's
alcohol or drug problem relies on the experience of the intake probation officer, and the
officer charged with preparing a pre-sentencing report. Therefore, identification of an
AOD problem in a youthful offender is likely to occur only when the young person has
penetrated further into the juvenile justice system.
Sometimes drug problems are very obvious to the probation department--the presenting
problem (i.e., the specific offense) is for alcohol or drugs. Other than that, probation
officers simply ask relevant questions. They appear to have a very informal and
unstructured system. The intake probation officer will talk to the youth and that
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probation officer may learn some relevant facts at that point. Many of the youths have
also been in the system in the past, so the probation department therefore have files on
them. The probation officer will look through the youth's file to see if there is any
indication of a drug or alcohol problem--such as multiple arrests in the past for drug-
related offenses.
Information gathering appears to be done in a cumulative fashion, depending on how far
a youth penetrates into the juvenile justice system. The first point of screening is at
probation intake, when a youth would first be brought to the probation department by a
law enforcement agency. The intake officer (of the probation department) reviews the
facts and circumstances of the case (e.g., whether the youth was under the influence, was
in possession of drugs, etc.), and the youth's prior record (including possible drug-related
offenses). The intake officer also interviews the youth and any other key players (such as
the complainant and/or the youth's parents). A compilation of these sources then suggest
to the intake probation officer whether the youth has a drug or alcohol problem.
The second point of review comes in juvenile court, if the youth is found to have
committed the alleged offense. A dispositional hearing is ordered by the juvenile court
judge, and a probation officer is assigned to write a dispositional (pre-sentence) report.
The main goal of the disposition (and dispositional report) is to determine the main type
of sanction that will be imposed. The two main categories are in-homeplacement and
out-of-home placement. The probation officer conducting the dispositional investigation
(and preparing the report) will again review the circumstances of the instant case,review
the youth's record, interview the youth, and interview all relevant parties--such as the
youth's parents. The officer then makes reasonable inferences about the youth's drug
problem.
If the officer writing the dispositional report has a specific interest in placing the youth in
the department's new Diversion Program, an additional level of review tales place. This
screening is done by the probation officer and the head of the Diversion Program. In this
instance, the probation officer (PQ) and the head of the Diversion 'Program meet
(somewhat informally) and they go over the case. The PO has already interviewed the
youth, so they look at his or her record, etc. Substance abuse is just one of many factors
they consider. There is no formal substance abuse screening,per se.
If the PO wants to recommend an out-of-home placement, the screening is done by the
out-of-home placement unit screening. Again, they are using the term "screening" in a
general sense. The youth comes to that screening, and the committee members asks him
or her about a wide variety of issues--including substance use and abuse. The screening
is thus part of the formal interview process.
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Substance Abuse Treatment Providers
CSAS funded prevention/treatment providers are present on more than -- of the county's
more than 222 public elementary, middle, junior, and high schools. At schools where
prevention/treatment providers are present, school staff often refer youth to these
programs for screening and in some cases assessment. If youth are judged to be at risk of
using or are beginning to experiment with alcohol or drugs, they are assigned to a high-
risk prevention group. In these groups, youth work,on behavior change and learn about
the consequences of alcohol and drug use. If youth in one of the high-risk groups later
reveals habitual use of alcohol and/or drugs, providers work to get these youth into AOD
treatment. .Most often treatment occurs at the offices of AOD funded providers, although
at least one CSAS funded agency (in South County) currently provides on-campus
treatment.
A number of schools also have other programs on campus to deal with troubled youth
(CARE teams, intensive probation officers, staff paid by Safe Futures, etc.) with slightly
different purposes; however, it does not appear that there is good communication or
collaboration among these programs and ,between these programs and CSAS funded
prevention/treatment providers.
Parents/Families
It would seem on the surface that parents would be the first to identify an alcohol or drug
problem in their child. However, this is often not the case. Many parents are uneducated
about substance abuse and unaware of the signs of use and/or abuse. In other instances
parents are unable to determine the difference between an emerging AOD problem and
what they might interpret as "normal" adolescent acting out. In other instances they are
unwilling to face the fact that their child has an AOD problem because of the stigma
attached to substance abuse, and may be reluctant to seek help for their child unless they
are able to provide private therapy and thus able to keep the problem a secret.
3. What happens once a youth with AOD problems is identified?
Identification of an AOD problem among county youth in only the first step towards
receipt of services. The next step is to determine how each system responds once an
AOD problem has been identified. Again, each system's response is based on its primary
mission with little interaction among systems.
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Schools
Schools respond to a student's use of alcohol or drugs in similar ways. What is described
below are the policies of six of the county's school districts. In 'West County USD, a
student found in possession of or using alcohol or drugs is cited by school police, taken to
the dean's office, and the parents are notified. Students may be suspended and are
referred to the CARE team (there is one at each secondary school in the district and is
connected with support services for students needing on-site support), which sends them
to a five-hour, four-week Saturday CARE class.
If kids are caught using drugs/alcohol at school they are referred to the dean or other
administrator. If the student is found in possession, he or she is cited by police, brought
to dean's office, and referred to an intervention class (five hour class which runs for four
Saturdays). According to the DATE Coordinator, about 60% of kids complete the class.
There is a CARE team at every secondary school site that gets referrals for students who
need to be seen. (This is separate from intervention of treatment.) Parents are informed
about the class and a letter also goes to the CARE team leader who encourages students
to attend class or refers them to an on-site support group.
A police officer is assigned to Richmond High School, and there are probation officers on
site at the three high schools. When school staff get referrals from probation for some
kind of diversion, students are referred to Saturday class.
There are several reasons youth are not in treatment: 1)the student has not been identified
as having a problem; 2) the student is not yet failing school; 3) the parents have not been
informed and are unaware there is a problem; 4) no treatment facility in the county is
geared to adolescents.
According to a Communities in Schools liaison, students caught using, or for suspicion of
use, are referred to the Saturday class. Last year, San Pablo Discovery Center provided
ongoing "therapy" for students caught for using or for suspicion of using at Richmond
High School. However, the county discontinued that service and San Pablo Discovery
Center is now closed. The Center for Human Development's MEAT family works with
students regarding AOD issues, and Tri Cities comes in and works with students who
have anger problems and other behavioral problems that have proven to be antecedents of
AOD use and delinquency.
Staff at several schools in the district reported that the AOD referral process could
definitely be improved. According to these staff, "Many kids have problems that go
unrecognized. There are no sanctions for kids who do not follow through with a referral."
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One CARE Team leader indicated that the original purpose of the CARE team was to
decide what to do with students using drugs and alcohol, and make recommendations to
their parents. After a while, however, they discovered that many parents would not
follow through, and many were using drugs themselves or were otherwise unwilling to
come in. She was then asked to run groups. According to one respondent, almost all of
the students in her groups use drugs, although they talk about many things in addition to
drug use, e.g., family life, school performance, friends, etc. The CARE staff at Kennedy
High School reported that she provides group sessions to 60 youth per week--ane group
per class period. The groups meet weekly and last for the entire school year. The
respondent also makes individual appointments because the youth have so many survival
issues. As far as she knows, she is the only on-campus resource available to students.
"Kids never present with AOD problems alone; it is usually some
serious personal problem and the AOD use comes out later. Very
few of the problems involving students are AOD related at their
core. They are more about self-esteem and anger. Drugs are used
to relax and forget about the bad things that are happening.''
Several of the CARE team staff indicated that the schools are not doing a good job of
referring students--i.e., they should be receiving many more referrals from school staff
than they do. (In fact the majority of referrals are from other students.)
In Mt. Diablo USD, the district has a zero-tolerance, multi-level process dealing with
students caught under the influence or in possession of, or selling alcohol or drugs. For a
first non-selling offense, the police and parents are notified, the student is suspended, a
principal's conference is scheduled and a recommendation for expulsion is considered. If
the student is not recommended for expulsion, the student is placed on a behavior
contract, the student is refereed to an AOD counselor, and the family is referred to an
AOD workshop. For a second non-selling offense,the same process occurs as in the first,
except the student is recommended for expulsion(which is required by district policy). A
first offense involving selling involves the same process as in a second non-selling
offense, including expulsion,which is required by the Education Cade.
According to a student survey conducted in Mt. Diablo Unified School District in 1997,
about one-half of middle school students and many high school students believe that
"alcohol, marijuana, other drugs and tobacco use are a problem at school."
According to the Director of Student Services, marijuana is the drug most often used at
school, but alcohol is used most overall. However, of 37,000 students in the district, only
(.01%) were expelled for drug and alcohol offenses last year.
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"On the surface, AOD-related problems are not as prevalent as
problems arising from non-drug-based conflicts and relationships.
There is, however, a substantial correlation between weapons and
drugs. Suspension data probably don't reflect the full scope ofthe
problem, and do not accurately describe what is happening on
campus. Student focus groups reveal that students say AOD data are
low and underreported "
According to California Safe School Assessment Program,which began collecting school
crime data in 1995, drug crimes (along with battery, assault, robbery, sex offenses,
weapons, and property crimes) must be reported to the state. The 1995/96 school data
released in 1997 by school district, provides data on rates per 1,000 students. Mt. Diablo
was cited in the 1997 report as one of eight districts in California as exemplary in making
the district's school safe. According to the report, there was an overall rate of 3.80 drug-
related reportable crimes per 1,000 students in the state overall, compared to 3.21 per
1,0.00 in Contra Costa County,and 1.84 in Mt. Diablo.
There are AOD counselors at each school according to district staff. The counselors see
students based on three referral sources: 1) those referred for disciplinary reasons; 2) .
those referred by parents, and 3) students who self-refer. Counselors at each school
generally have full caseloads.
Each middle and high school has a substance abuse counselor and access to tobacco
information and cessation. Referrals for AOD problems are made to: the Alcohol
Council, AA, AlanonlAlateen, Cocaine Hotline, New Connections, Teen Substance
Abuse Program(Kaiser)and Thunder Road.
Antioch USD also has a zero-tolerance policy for students caught using alcohol or drugs
on campus. These are expellable offenses. First offenders go before the Youth
Intervention Panel (YIP), composed of police, probation, school representatives, and
counseling agency representatives. For a first offense that involves possession, the
student would be transferred to another school site, and receive suspension and a police
citation, appear before the YIP at the police station, and be referred to counseling. If the
incident involves a weapon or drug sales or possession of a large quantity, the student
could be expelled. For second offenders, the case is turned over to the probation
department.
According to the Assistant Superintendent of Educational Services, and the District Head
of Child Welfare and Attendance, the "perception of AOD problems is greater than actual
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disciplinary data bear out." The majority of school suspensions are due to "willful
defiance" and physical injury.
When a student under the influence of AOD has been identified in Pittsburg USD, the
student is escorted by campus security to the school administrator. The student is
suspended for a period of time(e.g., five days)and might even be expelled, depending on
the circumstances. A report is filed with the police for drugs, alcohol or weapons,
The DATE Coordinator and the Assistant Dean for Attendance and Discipline both report
that substance abuse is an issue in the district. They were not sure how many of the
problems involving students are AOD related. They estimated that maybe 35% are AOD
related. The Healthy Kids Survey(which is now being field tested) should provide better
information about actual student AOD use. Disciplinary referral data indicate that only
about 3%are AOD related.
According to California Safe Schools Assessment, rates of reported drug crimes showed
Pittsburg Unified with a low rate (1.1 per 1,000 students, compared to the county overall
rate of 3.21 and state overall rate of 3.80).
Pursuant to district policy regarding students under the influence of AOD (and whether
AOD is the underlying or secondary problem), the student is escorted by campus security
to the school administrator. The student.is suspended for a period of time (five days) and
might even be expelled depending upon the circumstances. A report is filed with the
police for drugs, alcohol and weapons offenses. The District is just beginning to collect
data on AOD involvement in other offenses.
Students with AOD problems are sometimes referred to New Connections or NEAT
family support groups. These referrals involve students who have not yet been expelled
but there is good reason to suspect they may have an AOD problem. Agencies on
campus everyday include: Neat family, Planned Parenthood, Rape Crisis, Previous Life
and a higher education guidance program.
School staff estimate that about 60% of students who need AOD intervention either do
not get it, or do not get appropriate services. According to school staff there are no
treatment programs in East County that are easily accessible to youth. The only program
is New Connections which is not always accessible. Transportation is sometimes an
issue, or time is too limited and some students cannot attend. Neat Family support
groups are accessible and available in two junior highs and the high school.
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The collaboration among systems has improved in last two or three years as part of the
district's effort to help see that students get the services they need. However, sometimes
people in the community are not very cooperative, and community norms support AOD
use among youth. For example, Pittsburg has a community norm that young people use
alcohol as a rite of passage. This is true for girls as well as boys.
However, young people do not show up in treatment programs for a number of reasons: a
lack of available programs with space; insufficient support for non residential treatment;
some youth are seen as "throwaway kids," etc. Truancy is not always seen as an
important issue to other agencies, such as the District Attorney; and action is not taken
early enough to really intervene in a young person's downward spiral. A lot of work still
needs to be done regarding the various systems that interact with youth and identify youth
with AOD problems The district is presently trying to find ways to better collaborate
with the juvenile justice system to get parents involved with students identified as having
AOD and other problems.
For the first violation, the Martinez USD contacts parents and police. A five-day
suspension-can be reduced to three days with parental involvement in the student's drug
or alcohol abuse assessment by a state licensed agency. A list of suggested agencies
and/or services is provided by the district to the student and/or parent. Verification of
parental assessment participation needs to be provided to the school by the agency. The
student is restricted from school activities for 30 calendar days. Failure to complete an
assessment results in an additional 90 day ineligibility for all school-sponsored activities.
In addition, the student could be expelled and referred to a community counseling
program. For second and subsequent violations, when intervention efforts fail and the
student continues to use or possess alcohol or ether drugs at school or any school activity,
the student is recommended for expulsion. The Board of Education may suspend the
expulsion and assign the student to a school, class or treatment program. With the
consent of the parent, a student expelled for offenses involving alcohol or drugs may be
required to enroll in a county-sponsored treatment program prior to being readmitted.
According to a DATE Coordinator, `.`after talking with school counselors and police
officers," AOD use among students in the district constitutes only a small (1-3%) portion
of the problem.
District and school staff collaborate with the law enforcement liaison. The SELPA also
works with the district on expulsion hearings,and counsels with parents.
School staff'cite several reasons the number of youth in subsidized treatment is relatively
small. These include: 1) students with AOD problems tend to drop out of high school; 2)
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students may need treatment but are not identified because they are not causing problems,
or no one has intervened with the student; 3) programs are costly if students don't know
where to look for help; and 4) many students are still in denial, don't want help, and are
adept at hiding their use of alcohol and/or drugs.
Alcohol and drug use is not perceived as much of a problem in the Moraga Unified
School District, according to the Superintendent. While district staff believe there is
some level of experimentation with alcohol and drugs that may be of concern (more with
alcohol than with drugs), a very small percentage of problems involving youth at school
are AOD related. There are virtually no disciplinary referrals each year but staff believe
the ones they do have are AOD related.
According to the Superintendent, the district has a "zero-tolerance policy" regarding
students found to be under the influence of alcohol or drugs. However, this policy is
rarely invoked. The Superintendent indicated that school staff do make referrals for
students with AOD problems, and believes these students would be referred to a
psychologist who works for district. The district has no programs for students with AOD
The district recently completed an AOD survey of middle and high school students and
the Superintendent indicated he would be willing to share the results with CSAS if he
received a letter from the Director of CSAS requesting a copy.
Law Enforcement
The juvenile justice system vests an enormous amount of discretion in the hands of
officials--from law enforcement officers to probation officers to judges. Discretion in law
enforcement is evident at the department level(i.e., differing policies and procedures) and
at the individual officer level,where discretionary actions are the norm.
Thus, a wide variety of actions may take place when a youth is identified who has
committed an alcohol or drug offense. The variation depends in part on the nature of the
offense and in part on the policies of the individual police departments.
Some officers may take a youth (particularly minor offenders) home, rather than effect an
arrest. This practice varies somewhat throughout the county. Some respondents
indicated that such a practice is more prevalent in the affluent areas of the county than in
the impoverished areas. It would also depend on the circumstances of the incident, If it
were some sort of"kegger" party and "alcohol is present," then the officers may just try
to take intoxicated youth home to their parents.
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"Arresting" a youth is a very common option. if a law enforcement officer discovers a
youth in possession of or under the influence of alcohol or other drugs, the officer could
arrest the youth or take the youth into custody. 'Whether an arrest is made depends in part
on how one defines "arrest." If by `.`arrest," one means to put in handcuffs and take to
juvenile hall for booking, then the answer is no, police usually do not arrest youth for
alcohol or minor drug offenses alone. But if one uses the legal definition of arrest--i.e., to
take a person into custody in a manner prescribed by law--then law enforcement agencies
arrest youth for alcohol and drug offenses with some frequency. Law enforcement
agencies commonly take an intoxicated youth into custody, take the youth the to the
police station, and then release the youth to the custody of the parents. Naturally, the
police arrest a youth on a serious drug offense, such as selling drugs to minors or the
possession of larger amounts of a heavy drug like meth, heroin, or crack.
Cance a youth is in custody, the law enforcement agency also has a variety of options.
The youth might be released directly to the parents. Some departments have what they
call an "informal arrest." This is where the youth is taken into custody on a less serious
offense,such as being drunk at a party. The youth is then released to the parents without
any other official action taken.
Another possibility is to issue a citation or refer the youth to the police department's own
diversion program--often called a Youth Services Bureau (YSB). (Some police
departments have diversion programs and some do not.) The appearance by the youth
(usually with the parents) before the YSB is supposed to take place in a short time frame-
-typically within one week. At the YSB, an intake and assessment are done. There are
in-person interviews with the child and the child's parents. And then a referral is made.
Normally,a YSB does not provide a lot of services per se. YSB staff make referrals to a
variety of agencies. Naturally, the nature of the referral depends on the type of case, the
motivation of the youth and parents, and the amount of money available to the family (or
insurance),and related factors.
For example, if the family belongs to Kaiser, the YSB staff may refer to the Kaiser
adolescent drug program. Several departments, particularly in mid-county, refer to New
Connections. Several other programs are used as referral agencies by those departments
that have YSBs. It is important to note that many departments do not have their own
diversion program's and do not refer cases to drug treatment programs (or any other type
of program).
What happens at this point depends in part on the resources of the family and youth.
Some families have the motivation and resources to attempt to deal with the drug
problem without further governmental (juvenile justice) intervention. As an officer in
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one affluent city stated, "the parents [in his city] won't allow their kids to go to juvenile
hall." This officer contended that there is a lot of political pressure on the part of the
parents to handle the cases informally. Part of this is possible because the parents often
have the resources to do something about the problem on their own. This respondent also
stated that parents send their kids to in-patient drug treatment, and even to out-of-state
treatment programs. If that happens, the police may be less concerned about pursuing
any legal action.
Another option for law enforcement is to issue a citation to the probation department. In
this instance, a youth would again probably be released to the parents by the law
enforcement agency. But the citation would require the youth to appear at the probation
department to discuss the case with a probation officer. This process is discussed below.
A final option for law enforcement is to transport the youth to the probation department
(juvenile hall) for possible intake (booking) into the probation system. As will be
discussed in more detail below, this option is not commonly exercised because the
juvenile hall is usually over-crowded and the intake probation officer will refuse to accept
any but the most serious juvenile offenders. The intake probation officer will not admit
minor drug offenders into the system, so the police do not even attempt to take such cases
to juvenile hall. One police department even has police officers call the juvenile hall and
discuss the case with the intake officer. If the intake officer indicates that he or she will
not accept the youth, then the arresting officer simply issues a citation and releases the
youth.
Probation
As with law enforcement agencies, a wide variety of possible actions may be taken at the
probation department level. Generally speaking, the youth may be released immediately
by a probation officer, or the youth may penetrate deeper into the juvenile justice system.
A police officer could bring a youth to the "intake unit" of the probation department--at
juvenile hall. The intake officer has a couple of main choices. The intake officer can
release the youth to his parents or some responsible relative or guardian. This, naturally,
is done in less serious cases, when the parent or guardian seems relatively responsible,
and when it appears that the youth will not get into any further trouble or run away from
the jurisdiction.
At intake, the probation officer can decide to handle the case informally. The department
has statutory authority to place a youth on "informal probation." This means that the
youth will be "on the books" for a period of six months. If the youth behaves properly,
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the probation department will drop the case and never refer it to the DA. If the youth
does not behave, the probation department will refer the case to the DA. Not
surprisingly, the youth they handle on informal probation have committed Iess serious
offenses,have a relatively stable family life, and have some sort of hope of staying out of
trouble.
The intake probation officer may also decide to detain the youth if it is a serious crime, if
there is no one to release the youth to, or if appears that the kid will flee justice or commit
new crimes. If the youth is detained, the probation officer determines if the youth is
already on probation. If the youth is already on probation, the current supervising
probation officer will be notified and he or she will help determine what to do next. If the
youth is not currently on probation, the youth is designated as a "new case in court," and
the youth will be assigned a new probation officer. This probation officer will then help
determine the next steps.
The deputy district attorney (DA) is responsible for filing a formal petition (i.e., a
criminal complaint) in order to get the case before the court. The DA may decide not file
the case. This would usually occur because of"evidence problems"--i.e., a weak case. It
does not mean that the DA does not want the youth in court; it is just that the DA does .
not have a good case, and the case would probably be dismissed by the court.
If the case goes to juvenile court and there is a finding of delinquency--that is, the youth
is guilty of the offense, several things could happen. The juvenile court may put the
youth on probation, or in a diversion unit, or in some sort of residential;(out-of-home)
placement. The court usually orders"drug treatment"as a condition ofprobation.
What happens to the youth depends in part on the nature of the case. For the less serious
cases, the youth will be placed on probation with various terms and conditions. Among
the terms and conditions are to seek some sort of drug treatment. This may include, for
example, NA or AA. The drug treatment condition will be specified in the court order.
Theoretically, the supervising probation officer is supposed to keep trackof this, but in
reality (because the Probation Department is understaffed), POs on regular caseloads
have a difficult time following up on their probationers.
If the youth's problem is more serious and requires more intensive supervision, the youth
may be placed in the probation department's"diversion"program. This program is called
a diversion program,but it is different from traditional diversion programs. In the normal
sense of the term, diversion means diverting a youth from entry into the juvenile justice
system in the first place. That is, not getting into the probation and the court system. The
Contra Costa County Probation Department Diversion Program really means diversion
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from placement. A youth has to be a ward of the court (a 602 W&I) to be placed in the
probation diversion program. The whole idea of the program is to keep youth from going
to an out-of-home placement. Thus, the idea is to keep more youthin the community, in
part because keeping some youth in the community fosters better rehabilitation, and in
part because it saves money.
The diversion program has five caseloads,more or less based on geography. Each of the
five caseload or units above has about 20 to 25 youth. And each of the caseloads has one
full time certified probation officer and one full time probation counselor (similar to the
type of counselor one would find in juvenile hall,except that he or she is out in the field).
With this intensive caseload,the two probation staff are able to "hound"the youth well sty
that he or she stays in school and goes to treatment.
The diversion program refers youth to (and makes sure the youth does goes to) a couple
of main programs--including drug treatment programs. First is New Connections, the
county-run program. Second is Families First,a family therapy program.
In the more serious cases, the juvenile court will order some form of residential
treatment--that is an out-of-home placement--and perhaps recommend a drug treatment
program. That is, if alcohol or drugs are an "overwhelming problem" for the youth,'the
court will order residential placement. The juvenile court does not mandate a specific
drug treatment program in the commitment order. Rather, the juvenile court orders an
out-of-home placement, and refers the case to the Probation Department's Out-of-Home
Placement Committee, which will make the specific placement choice.
The Placement Committee usually has about 15 to 20 youth per month ordered to it by
the court. The Placement Committee tries to take all factors into consideration and make
the most appropriate placement for each individual youth. The Placement Committee has
many factors to consider, such as the youth's specific problems or issues (such as
substance abuse, mental health, sexual orientation, gang affiliation), as well as the
willingness and, ability of the parents to participate in any specific program, and cost
factors.
4. What barriers exist that keep tend to prevent youth with AOD problems from
receiving treatment?
Schools
Lack of Awareness is a critical issue. Most young people do not perceive their drug use
as a problem, largely because they are early in their drug taking career. For many, drug
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use is a regular part of their daily lives. Drug use is related to environmental, culture, and
adaptational issues of adolescence such as peer pressure and family influence(Jalali et al.,
1981). When asked directly if they feel that drug use is a problem or if they want help in
reducing their drug use, the majority of young people say no. The lack of insight into the
potential consequences of drug use on their lives and the lack of motivation to reduce the
extent of their drug use are serious impasses that human service providers must overcome
before the drug problem can be addressed.
A related issue is denial on the part of adults in the young person's sphere. Parents tend
to be in denial, either because they are unable to identify the signs of AOD use and/or
abuse in their child, or they are unwilling to see the signs. In some families, youth get
drugs or alcohol from their parents. Sometimes the family is unwilling to change.
Teachers and staff are often unable or unwilling recognize students' AOI) problems, in
part because some staff do not believe it is the school's job, and others because they feel
there are inadequate resources available to address the problem, once identified. The
strong denial systems at work make it difficult for schools to do much,especially because
there are so few school counselors anymore.
Identifying young people who are using alcohol and drugs is difficult according to school
staff; young people are adept at hiding their use of alcohol or drugs from family and
teachers. It can take a while before some of the more serious signs, like failing in school,
become apparent.
Unwillingness to seek help is a critical issue. Youth do not want to quit, do not want to
be in treatment, or are not willing to change their lifestyle. Maybe it is 'still fun to get
high and they haven't reached the point where the consequences of their behavior have
become serious enough to motivate them to quit. Young people can live a marginal
lifestyle for quite a while. Doing drugs is more fun than doing nothing or playing video
games.
Cost is always an issue. Many parents cannot afford the cost of treatment. Few resources
exist for parents who do not have insurance. And, even if resources are available, parents
and school staff are often unaware of them.
Accessibility often hinders entry into treatment. Lack of transportation can be an issue for
youth, or the time of a program is too limited, making it difficult for students to attend.
The social stigma attached to being identified as a substance abuser often stands in the
way of people seeking help. In some cultures, seeking professional help is frowned upon
as a potential betrayal of family privacy. Parents are often reluctant to refer their
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youngsters to treatment because of the stigma associated with drug use and/or seeking
professional help.
In making a commitment to treatment,adolescents are frequently confronted with another
dilemma--the possibility of giving up or changing their peer relationships. Being
ostracized from the peer group--leaving, one's drug-using friends behind to join a
treatment program--is difficult choice for an adolescent. Beginning in early adolescence,
the peer group becomes increasingly significant as youth become less dependent on
parents.
Adolescent drug abusers are difficult to treat--their problems are multidimensional. They
are going through a difficult developmental phase--trying to become independent,
initiating interpersonal/sexual relationships, and some problems are beyond their control:
emotional upheaval, alienation, insecurity about sex roles and personal identity, and
uncertainty about future goals are the norms.
Treatment programs offering specialized treatment approach (i.e., unideminsional
programs), such as traditional therapeutic community, pose another potential barrier.
Many drug treatment programs are organized around particular concepts and
philosophies. The adolescent client must adjust to the program; most programs will not
adjust to the adolescent client.
Distrust by potential clients is a barrier. The treatment approach can limit access to those
needing to explore a variety of ways to change and grow.. Although many young people
are in urgent need of psychiatric, medical and other kinds of help, they are often too
distrustful to utilize existing professional services and institutions.
La►v Enforcement
A variety of issues (or barriers) prevent or deter law enforcement agencies from helping
youth get treatment from alcohol or drug problems. These issues can be divided into
several categories.
First are system issues--that is, problems in the juvenile justice system per se. As alluded
to above, the probation department is very selective in the cases it accepts into juvenile
hall; thus, many alcohol and drug offenders never make it into the probation system.
As a result, police departments rarely take arrested youth to juvenile hall because the hall
is dreadfully overcrowded and the intake probation officer will not accept minor cases.
The juvenile hall will only accept the most serious cases, such as those involving
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violence. The police therefore do not even bother taking minor drug or alcohol offenders
to the juvenile hall. Thus, the vast majority of drug and alcohol offenders never make it
to juvenile hall or into the juvenile probation system.
Second, there are legal issues. Only the juvenile court can order (legally mandate and
enforce)a youth into drug treatment. Law enforcement does not have that legal authority.
Thus, law enforcement officers do not have the "leverage" to get a youth into a drug
treatment program. It is possible for youth to get into a treatment program without being
under court order. But these voluntary admissions are problematic. For one, they are
very expensive--families have to pay themselves if there is no court order. Also, some
youth will not want to be there and will run away. Because it is difficult to get youth
with drug problems into the probation department or into drug treatmenton a voluntary
basis, many police officers "give up." They see it as a "revolving door" problem, and
they get frustrated and cease making referrals.
Third, there is a lack of collaboration among agencies in the juvenile justice system--and
related agencies. To the extent there is any collaboration, it is generally limited to the
juvenile probation department and the DA's office. There is not a lot of collaboration
with substance abuse treatment programs. Police departments on occasion refer parents
and youth to some type of drug program, not on a regular basis. Law enforcement
agencies in general do not know much about drug treatment or about the specific drug
treatment programs in their community.
Fourth, and related to the above, there is a lack of communication/marketing on the part
of the drug treatment programs (or possibly the county's Community Substance Abuse
Services Division). As one police chief stated,"we have a basic lack of communication."
That is, he said that he (and other law enforcement officers) had never heard anything
about drug treatment programs funded by the county. Most of the lav enforcement
respondents were never aware that the county sponsored any such treatment programs,
particularly one that was not being fully utilized. One distinct possibility for under
utilization, according l to law enforcement personnel, is the fact that the county does not
properly do outreach to police agencies and inform agencies of the 'existence and
availability of such a program. If drug treatment programs were better publicized, it was
suggested,then officers might make referrals in appropriate cases.
Fifth, money and resource limitations are an issue. In a private (or voluntary) referral to
Thunder Road, the client has to pay the full amount. The police do not pay for the
client's treatment. Unless there is a commitment from the court, the client has to pay.
There are not that many families that have the money to pay for such expensive
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residential treatment. Law enforcement agencies often feel helpless when faced with this
situation.
Related to this is the variation in money and resources among different communities in
the county. Some law enforcement respondents contended that in more affluent
communities, youth are not getting into the formal juvenile justice system because their
cases are handled informally by the parents. Many parents have the resources to send
their kids to different treatment programs (including Thunder Road), and even out of
state. So, proportionately, kids from south county, for example, are more likely to get
into some form of private drug treatment programs--and not go through the official
juvenile justice system.
Probation
System problems affect the probation department as well. As mentioned, juvenile hall
cannot handle all of the youth police arrest for alcohol and drug offenses. The county's
juvenile hall was built many years ago, when the county population was but a fraction of
what it is now. There simply is not enough space in juvenile hall. Moreover, there are
not enough probation officers to supervise youth who get into trouble for alcohol and
drug offenses. In 1992, the probation department had to fire about 58 officers because of
budget cut-backs. There has been some improvement--more hiring-but the juvenile hall
is still over-crowded. Thus, the probation department cannot take minor drug and alcohol
cases into juvenile hall.
"Denial" is another significant problem. One probation officer said that a lot of kids are
"in denial,"that is,the don't feel that they have problems and therefore do not want to go
to treatment. If they go to treatment and do not adjust well, they will simply run away. If
they run away or exhibit other behavior problems in the treatment program, they may be
terminated from the program. Thus,,it is difficult to keep many youth enrolled in their
treatment program. Probation officers also contend that parents are often in denial, and
therefore do not want their child to go into treatment. Many treatment programs will not
accept a youth in the first place if the parents will not participate in the treatment process.
One probation officer stated that "youth are very difficult to work with." They have
multiple problems--rage, anger, running away--and families often will not work with the
department or any program. Thus, it is often difficult to place youth in a good program.
As one probation officer stated, "just because you have a lot of kids with drug problems
does not necessarily mean that you have a lot of good candidates for ding treatment
programs."
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A final issue is the apparent growing need for specialized treatment. Treatment programs
often specialize in treating one type of problem--for example, drug problems. Treatment
programs often do not have the capacity to treat youth with multiple problems, such as
substance abuse combined with mental illness problems, or sexual actingout. Probation
officers contend that they are receiving from the juvenile court more youths with multiple
problems; as a result, it is more difficult to find appropriate placements'. Regular drug
treatment programs might not be appropriate for a person with a dual diagnosis.
AOD Treatment Providers
The lack of low cast, easily accessible treatment is a barrier. For youth who need
residential treatment, there is no subsidized in-county treatment available. Residential
treatment at Thunder Road (Oakland)or Walden House (San Francisco) is generally only
available to youth who have committed serious enough crimes to be on probation, require
out-of-home placement, and therefore who are subsidized by the probation department.
Because AOD use among teenagers is often viewed a family problem, most CSAS
providers put a heavy emphasis on parental involvement. However, marry parents want
treatment providers to "fix their kids" and to participate only minimally if at all. If.
parents are unwilling to support their teenager's recovery, it decreases the chances the
young person will enter and remain in treatment, and it negatively affects the outcome.
ParentslFamilies
One might think that parents would be the first to notice alcohol and or drug use among
their adolescent children. However, this is often not the case. There are a number of
issues that prevent parents from identifying AOD problems in their children, and once
identified, from attaining the help needed. These include: 1) they are uneducated about
what signs to look for; 2)they often"enable"the youthful user in the mistaken belief they
are protecting their children; 3) distrust of the "system" generally; 4) a lack of
money/resources to help; 5) fear their child will be "officially" identified as a
druglalcohol abuser and that will affect their life choices; 6) parents condone or are
passive about their children's use of alcohol or drug use because they themselves use one
or both of these substances and do not believe it to be a problem.
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V.
System contradictions--or other issues
Schools
The school system also has many disadvantages as a source of early intervention. As
drug-using youth progress trough the grades, more and more drop out and become
immune from school-based programs. The same naivete that haunts parents also can
affect school administrators and teaching staff. Signs of significant drug use may be
subtle. There is often a similar reluctance to admit a problem. Many school
administrators see their domain limited to basic academic education and are reluctant to
take on the in loco parentis function they feel is associated with behavioral health
problems such as drug abuse. Some school boards have policies against getting involved
in the drug use and abuse of their students. Some school principles still deny drug use is
occurring in their schools.
Law Enforcement Agency or Social Service Agency
There is an age-old issue (or contradiction) in the field of law enforcement--and this is
particularly true when working with juveniles andp articularly true when dealing with
drug offenders. That issue (or conflict) is the extent to which a police department should
concentrate on law enforcement per se, and to what extent it should be concerned with
the personal (medical, drug abuse, mental health, social service) problems of the people
the police officers come into contact with. Part of the conflict is related to philosophy
(punish or treat) and part to financial resources (that is, some departments do not have
enough money to do any more than arrest suspected law violators).
This issue (or conflict) plays out in inconsistent handling of juvenile drug offenders by
different law enforcement agencies within the county. Some departments,for example,
have established Youth Service Bureaus that specialize in working with youth and
solving the problems that individual youth face. These departments attempt to deal
directly with the youth's underlying problems--including drug problems. Thus, a youth
may come to the YSB with a drug problem and YSB the counselor would work it out
with the parents to have the youth voluntarily enter a drug treatment program.
On the other hand, there are also police departments that stay close to their traditional law
enforcement role. Their view is that they should arrest people who break the law
(juveniles or adults) and take them to the proper authorities. For juvenile law breakers,
no matter what their underlying problem, these departments choose to arrest the youth--
and then either issue a citation to the probation department in minor cases or directly
transport the juvenile to juvenile hall in more serious cases. One respondent stated that--
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from the police paint of view--they have no legal authority (or leverage) to send a youth
to such a drug treatment program. Even a YSB cannot commit someone to treatment.
Thus, some departments choose not to get involved in drug treatment issues at all,
Arrest Data/Crinte Statistics
Juvenile crime data, and specifically drug arrest data, are very deceptive and inaccurate.
There remains a mystery of the low drug arrest statistics in Contra Costa County. All law
enforcement respondents said that the official number of drug arrests published by the
State Bureau of Criminal Statistics (BCS) for Contra Costa County sounded extremely
low.
It appears that this anomaly is related to how arrest data are collected and processed. All
law enforcement respondents believed that there is a lot more substance abuse in Contra
Costa County than is reflected in the official crime data. And there are more arrests than
are reflected in the official data.
To a great extent the issue relates to how law enforcement agencies define and count
arrests. The California Penal Cade definition of arrest is "taking a person into custody in
the manner prescribed by law." Based on that legal definition, police departments
throughout the county arrest youth for alcohol and drug offenses with great frequency--
and many of those arrests are never counted in the official statistics. However, most
police departments do not call those types of actions arrests. Normally, if a youth is
taken into custody and taken to the police station, the police consider this to be a
"detention," not an arrest. As a detention, there is no formal paperwork completed and
sent to BCS. There are many such cases,but exact figures are not available.
A second factor related to how drug arrests are processed is what is called"the hierarchy
mile." This rule of counting crime holds that only the most serious crime will be counted
in the statistics--if there are multiple offenses in one incident, Thus, if a youth gets
arrested for assault with a deadly weapon(ADW) and possession of meth,only the ADW
gets officially recorded. Because of this rule, a lot of drug-related cases are lost or
"masked" in the official crime data,because they are recorded as some other crime.
Probation
Probation also faces several important issues that are related to substance abuse treatment
for juveniles.
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