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TO: BOARD OF SUPERVISORS ���•- ----LM_�.°�, Contra
FROM: FAMILY AND HUMAN SERVICES COMMITTEECosta
DATE: NOVEMBER 30, 2004
SUBJECT: ALCOHOL AND DRUG TREATMENT PROGRAMS co
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County
FOR YOUTH
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATION:
ACCEPT report from Health Services Department Alcohol and Other Drugs Services Division on the
AOD youth,family and community system of care and single point of entry for youth AOD programs,
as recommended by Family and Human Services Committee.
FISCAL IMPACT:
None
BACKGROUND:
Alcohol and other drugs treatment programs for youth were evaluated in 1998,with review of that
evaluation and subsequent follow-up referred to the Family and Human Services Committee. Since
the initial referral, there have been annual and periodic reports presented to the Board of
Supervisors through the Family and Human Services Committee on the status of alcohol and other
drugs programs for youth.
The Health Services, Probation and Employment and Human Services departments were directed
by the Board of Supervisors in December 2003 to explore the possibility of implementing one
consolidated point of entry for youth alcohol and other drug treatment services. The issue was
referred to Family and Human Services Committee.
The enclosed report describes progress to date and future directions for addressing disparities in
youth access to treatment in the context of$2 million in revenue reductions this fiscal year. An
update of the Youth System of Care is presented, along with data and analysis of utilization,
caseload and gaps in the system.
CHILDREN'S IMPACT STATEMENT:
The service provided to youth by the AOD Services Division support the outcome:"Youth are
Healthy and Preparing for Adulthood."
CONTINUED ON ATTACHMENT: X YES SIG ATURE: r
RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
APPROVE OTHER
SIGNATURE(S):
ACTION OF BOARD ON Aovc/ APPROVE AS RECOMMENDED O
VOTE OF SUPERVISORS
1 HEREBY CERTIFY THAT THIS IS A TRUE
)lr UNANIMOUS (ABSENT ) AND CORRECT COPY OF AN ACTION TAKEN
AND ENTERED ON THE MINUTES OF THE BOARD
AYES: NOES: OF SUPERVISORS ON THE DATE SHOWN.
ABSENT: ABSTAIN:
ATTESTED el,*1l C-,7d
JOHN SWEETEN,CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
Contact Person:
CC: Dorothy Sansoe(5-1009)
Health Services AOD
BY: DEPUTY
WILLIAM B. WALKER, M.D. CONTRA COSTA
HEALTH SERVICES DIRECTOR
ALCOHOL AND
HAVEN FEARNz OTHER DRUG SERVICES
DIRECTORA . } 597 Center Avenue, Suite 320
Martinez, California
CONTR.� COSTA
94553
Ph (925) 313-6350
HEALTH SERVICES Fax (925) 313-6307
To: Family and Human Services Committee, Contra Costa County Board of Supervisors
From: Alcohol and Other Drugs Services Division, Health Services Department
Re: AODS Youth System of Care
Date: 25 October 2004
RECOMMENDATION:
Accept this report from the Health Services Department Alcohol and Other Drugs Services
Division regarding progress and future directions for the Youth, Family and Community system
of care. 01
DISCUSSION:
In December 2004, Alcohol and Other Drugs Services (AODS) presented to the Family and
Human Services Committee a strategy for addressing disparities in youth access to
treatment. This discussion of progress to date and future directions is presented in the
context of$2 Million in revenue reductions for this fiscal year. While a major accomplishment
in the ensuing program restructuring was that we were able to hold youth services harmless,
there were secondary impacts nonetheless.
Last year's report provided data on youth services in prevention and treatment documenting
modest growth in prevention and a reduction in treatment capacity. In FY 03-04, despite our
intent to minimize the impact of budget cuts on youth services, we did suffer some losses. In
FY 04-05,the number of youth treatment clients is expected to decrease by 15%. Prevention
services are funded through earmarked federal funds. Revenue, programs and caseloads for
these services held steady,
The key programmatic recommendation from last year concerned the reduction of the
disparity in youth access to AOD treatment by developing a single point of entry for youth
seeking those services. Countywide revenue reductions affecting all departments prevented
much progress on this front, but important preliminary discussions and analysis have been
conducted and we are well positioned to move forward on this issue.
Contra Costa Alcohol and Other Drug services Contra Costa Emergency Medical Services Contra Costa Environmental Health Contra Costa Health Plan
Contra Costa Hazardous Materials Contra Costa Mental Health Contra Costa Public Health Contra Costa Regional Medical Center Contra Costa Health Centers
Youth System of Care Update
In FY 03-04, key milestones in the Youth And Family System of Care were the following.
13 A series of interdepartmental meetings were held with the HSD Director's Office,
Probation, Children and Family Services, the Mental Health Children's Services Division and
AODS to discuss and shape key elements of the single point of entry.
13 The restructuring of the Sojourne community counseling center as a dedicated youth
outpatient treatment facility.
13 Staff reductions resulting in the loss of 2 youth counselors and the Program Supervisor
position occupied by the Juvenile Drug Court Coordinator position.
The loss of treatment and case management services at the Orin Allen juvenile detention
facility.
13 Restructuring of the Juvenile Drug Court treatment program in East County took place
subsequent to a 50% reduction in grant funding supporting those services, AODS took
action to preserve the program by replacing grant funds with more stable federal block
grant revenue. The drug court treatment program was thus preserved and safeguarded.
However, net treatment capacity in East County was reduced as the drug court caseload
was transitioned into existing slots.
Through collaboration with the courts and probation department we have been able to
increase the number of residential treatment placements for Juvenile Drug Court clients.
13 Further steps have been taken to increase revenue through Drug Medi-Cal [DMC]
reimbursements. Specific activities included training and readiness assessments
conducted by state staff. We expect contract provider billing in Central and East County to
begin by December 2004. Additional providers in East and West County should be ready
to start billing by Spring 2005.
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Utilization, Caseload and Gaps
Since Fiscal Year 01-02, the number of youth admitted to AODS treatment programs has
steadily decreased. Figure 1 displays this decline.
Figure 1
Since FY 01-02,Treatment Admissions Have Decreased by 38%
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FY 01-02 FY 02-03 FY 03-04 FY 04-05(Est.)
Treatment Admissions 658 586 528 407
Fiscal Year
The tables that follow show characteristics of the youth treatment caseload as seen over the
past four years. The gender breakdown seen seen in Table 1 has been relatively stable. The
youth caseload has a slightly greater representation of males relative to the adult caseload
(71%vs. 69%).
Table 1
Youth Caseload Gender
Gender FY 01-02 FY 02-03 FY 03-04 FY 04-05(Est.)
Count Percent Count Percent Count Percent Count Percent
Male 443 73% 361 72% 359 75% 288 71%
Female 161 27% 143 28% 122 25% 118 29%
Total 604 1000/0 504 1000/0 481 1000/0 407 100%
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Table 2 displays the race/ethnicity of young persons admitted to AODS treatment providers.
Relative to prior years, estimates for FY 04-05 show reduced percentages of African
American and Asian/Pacific Islander clients and greater proportions of Latino and White
youth. Latino and Asian/Pacific Islander clients are seen at nearly twice the rates they are
seen in the adult caseload.
Table 2
Youth Caseload Race/Ethnicity
Race/Ethnicity FY 01-02 FY 02-03 FY 03-04 FY 04-05(Est.)
Count Percent Count Percent Count Percent Count Percent
White 315 52% 242 48% 214 44% 194 48%
African American 125 21% 133 26% 133 28% 85 21%
Latino 100 17% 61 12% 72 15% 95 23%
Asian/Pacific Islander 33 5% 59 12% 42 9% 28 7%
Native American 25 4% 5 1% 20 4% 5 1%
Unknown 6 1% 4 1% 0 0% - 0%
Total 604 100% 504 100% 481 100% 407 100%
Alcohol and Marijuana have consistently been the two most frequently identified drug
problems that bring young people to treatment. For adults, alcohol accounts about 20% of
admissions, but marijuana is replaced by methamphetamine and heroin. Table 3 shows the
type of AOD problem reported at admission for youth.
Table 3
Youth Caseload Primary Problem at Admission
AOD Problem FY 01-02 FY 02-03 FY 03-04 FY 04-05(Est.)
Count Percent Count Percent Count Percent Count Percent
Alcohol 120 20% 72 14% 59 12% 95 23%
Methamphetamine 38 6% 29 6% 37 8% 28 7%
Marijuana 406 67% 351 70% 340 71% 222 55%
All Others 14 2% 13 3% 14 3% 9 2%
None 26 4% 39 8% 31 6% 52 13%
Total 604 100% 504 100% 481 100% 407 100%
As Table 4 shows, nearly all treatment capacity available for youth is in outpatient modalities.
Only a few dedicated residential treatment beds are available. For adults, nearly half of all
treatment admissions are to residential programs.
Table 4
Youth Admitted to Treatment
Modality FY 01-02 FY 02-03 FY 03-04 FY 04-05(Est.)
Count Percent Count Percent Count Percent Count Percent
Outpatient Counseling 535 89% 453 90% 454 94% 369 91%
Day Treatment 43 7% 29 6% 6 1% 24 6%
Residential Detox 4 1% 6 1% 4 1% 9 2%
Narcotic Treatment 2 0.3% 2 0.4% 0 0 0 0
Residential Treatment 20 3% 14 3% 17 4% 5 1%
Total 604 100% 504 100% 481 1000/0 407 100%
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Funding Levels
Since FY 02-03, funding earmarked for youth treatment services has decreased by 23%.
This reduction was in large part due to changes in revenue for Juvenile Drug Court Treatment
programs. Residential treatment funding and capacity have remained essentially static.
Table 5
Youth Treatment Funding Levels
Modality FY 02-03 FY 03-04 FY 04-05
Day Treatment $344,658 0 0
Outpatient Counseling - Contracts $321,744 $437,548 $3221663_
Outpatient Counseling -County $167,541 $159,111 $295,967
Residential Treatment $102,150 $106,097 $106,097
Total $936,093 1 $702,756 $724,727
The Treatment Gap
The Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S.
Department of Health and Human Services conducts an annual national survey of AOD use.
Survey findings for 2002 support an estimate that approximately 12,500 youth between the
ages of 12 and 18 need treatment for AOD abuse or dependence in Contra Costa County.
It must be noted that not all who need treatment seek it and not all who seek treatment look
for it in the public sector. An unknown portion of those 12,500 young persons may have
received treatment from sources other than those financed by ADDS. Nonetheless, we know
that in 2002 only 550 youth were admitted to an AODS treatment slot.
The typical adult Contra Costa County AOD treatment client started AOD use at age 15 or
earlier. After approximately 20 years of AOD abuse and dependence, they enter treatment in
their mid 30's. Effective AOD treatment for youth can change that pattern.
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Policy Directions for FY 04-05
Single Point of Entry and Collaboration - Most youth needing AOO treatment are multi-
system clients. Meaningful collaboration with other departments is essential for effective
service planning and care coordination. To the extent that departments with mutual interests
in the same client can work together for the same outcomes, there will be better outcomes
for the client and more cost-effective services for the county.
From our discussions on the single point of entry concept,we recognize at this point that what
is needed may not be a single access point and potential bottleneck and barrier to access but
rather multiple access points distributed countywide. The key issue is that screening
[financial, clinical, etc.] is standardized, applied uniformly across the system, and is appropriate
to the scope of practice of the personnel doing the screening. The centralized function, we
believe, should be interdepartmental care coordination and case management services.
Ultimately, the goal is to expedite access to needed services and to ensure that AOD
treatment is a part of the service plan in the department or division from which the youth was
referred.
In addition, we plan to expand collaborative partnerships with schools to bring outreach and
treatment services to students. These partnerships will build upon our current programmatic
and planning linkages with school site SELPA programs.
Funding and Capacity Expansion- AOOS will continue to pursue Drug Medi-Cal (DMC)funding
as a means to finance expansion of outpatient treatment capacity for youth. The primary
treatment modality serving youth is outpatient counseling. This is in part driven by cost
considerations, but is also the most appropriate way to serve youth and to engage, if at all
possible, the family. Our plan is to continue to assist programs in taking advantage of this
revenue source.
An RFP for outpatient services will be issued in FY 05-06. Solicitation of expanded youth
treatment services will be a separate track in this process and will provide an opportunity for
shifting funds from adult to youth services.
We are examining the feasibility of creating a county operated youth outpatient treatment
program in Martinez utilizing existing staff and facilities.
Program Practice and Staff Development - A treatment system for youth requires
specialized programs and staff with specialized training and credentials. Programs and
service models designed for adults are not appropriate for young persons. While separate
treatment tracks for youth and adults are possible within the same program, it is not
appropriate to blend the two caseloads.
Programs serving youth must adhere to the Youth Treatment Guidelines issued by the state
Department of Alcohol and Drug Programs. Treatment must be family centered and be able
to work with family systems in which parents may be part of the problem. In addition, a small
but growing concern is meeting the special needs of youth clients who are themselves
parents. At present,they can only be seen in adult programs.
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Creating professional skill development opportunities for provider staff is another priority.
Building upon our experience in capacity building efforts for prevention providers, we plan to
increase training opportunities for staff in treatment programs. As the opportunity presents
itself, both for county and contractor staff, we must recruit more certified/credentialed staff
to work with youth.
Youth System of Care - Our ultimate goal is a system of care for youth within ADDS. In light
of the current status of youth treatment services, the first step will be to better differentiate
youth services currently provided within the overall system. From a clearer identification of
the resources allocated to youth TX, the next steps are to separate youth services from the
adult system and then grow capacity.
Conclusion and Next Steps
Youth treatment services within AODS continue to evolve. The need for treatment far
exceeds the resources available. However, even though capacity has diminished over the past
few years, qualitative improvements continue. Ultimately, the goal of AODS is to create a
system of care for youth that addresses the following objectives:
Close collaboration with Juvenile Probation, CFS, and Children's Mental Health
systems.
A uniform approach to AOD screening and assessment of youth throughout the
county.
Appropriately skilled and credentialed staff in specialized youth treatment programs.
Programs supported by a mix of Drug Medi-Cal, Federal Substance Abuse Block Grant,
and other funds. The intent is not to rely entirely on new funding, but rather to utilize
existing funds in an efficient manner.
The single point of entry concept needs to move from the discussion to the design stage. If
this is indeed a viable model for more effectively connecting youth to needed AOD treatment
within a multi-system service plan, then a review of the conclusions to date and a re-
commitment to move forward from each agency will be required. A vision has emerged of a
youth treatment system that builds on current successful collaborative models, however, the
resources to build such a system are not in hand. There are possible funding sources to be
explored, but that exploration should be driven by a clear shared vision of what is to be built.
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