SACCSC Best Practices August 2008 Report Treatment Systems www.sisqtel.net/armstrng/best_practicesMarcia2.htm

1. SACCSCBest PracticesAugust 2008 ReportTreatment Systems www.sisqtel.net/armstrng/best_practicesMarcia2.htm

2. TREATMENT FINDINGS • 9 Telephone interviews with Glenn, Lassen, San Mateo, Kern, Sonoma County Alcohol and Other Drug (AOD) Department Heads; former Mendocino Co. Public Health Director; State of Montana contacts; Montana consortium provider

3. STRATEGIC PLANNINGFRAMEWORKS • San Mateo County Plan • Mendocino Public Health Model • State of Montana High Level Summit

4. San Mateo Strategic Plan • Perspective - A chronic, relapsing brain disease • Vision – comprehensive, continuous and integrated care • Best practices – community centered, evidence based, gender specific, ethnic and culturally responsive • Challenges – capacity and resources • Barriers – fragmented services, financing, information sharing and underserved populations • Desired client outcomes – sober & in recovery; stable housing; employment/basic supports; children in safe, supportive & stable families; children & youth engaged in pro-social activities (asset development) • Priority resource allocation – identify and prioritize targeted populations (adults in criminal system, families with children, homeless and youth)

5. San Mateo Strategic Plan contin. • Improve 5 cross-cutting areas • Meth; co-occurring disorders; cultural responsiveness; service integration; data collection, analysis and reporting. • Full treatment continuum with treatment on demand capacity • increase availability of treatment; continue care during recovery; case management to follow clients across systems and time; enhance relapse prevention interventions; increase trauma treatment interventions; recruit and train personnel; enhanced use of technology; facilitate a broad community approach.

6. Public Health ModelMAPP – Mobilizing for Action Through Partnership and Planningwww.naccho.org/topics/infrastructure/MAPP/index.cfm • Perspective – substance abuse is among many public health issues • Core team does preparatory footwork, then convenes broader community group • Arrive at shared community vision and values • 4 assessments done (community strengths, public health assess., community health assess, emerging issues) • Identify and prioritize issues • Goal statements and broad strategies • Action plan for implementation

7. Montana Mental Health Legislative Focus Summit Perspectives – This summit had high level representatives from different groups • Mental Health Consumers • Law Enforcement/Corrections • Mental Health Providers • Counties/State Elected Officials

8. Montana Summit (contin.) Mental Health/AOD Consumers “Values”: • Community-based services • Immediate access to mental health care • Recovery should be the target for all treatment planning • Family and advocate involvement is an important part of the process • Decriminalization of mental illness

9. Montana Summit (contin.) Law Enforcement/Corrections “Values”: • Available service array as close to home as possible • Investment at the “front end” pays dividends • Leverage and share resources through partnerships • Create incentives and resources to recruit an adequate mental health workforce at all levels of care and the custody continuum

10. Montana Summit (contin.) Mental Health Providers’ “Values”: • Person-centered and family directed care system • Community-based continuum of care • Accessible care Counties/State Elected Officials’ “Values”: • Importance of community-based services.

11. Montana Summit (contin.) Criteria for Prioritizing Critical Needs • Does it save lives? • Are the costs worth the benefits in terms of improved services and/or system? • Is it sustainable? • Would it clarify “definitions” and “practices” resulting in better services and outcomes? • Would it preserve or promote public safety at the community level? • Would it preserve or promote individual safety? • Does it provide services for the most people underserved now?

12. Montana Summit (contin.) Criteria for Prioritizing Critical Needs • Does it serve a new population not currently served? • Would it contribute to geographic equity? • Is it consumer driven? Does it hold the consumer in high regard and provide them with a choice? • Does it allow for different cultural standards? • Does it have a proven track record (evidence-based)? • Does it incentivize? • Are kids and adults treated equitably? • Does it advance the overall system to support the consumer (i.e., electronic medical records)?

13. SERVICE MODELS • NIATX • CISC Recovery Model • Kern Co. /Court Partnership Model • Kern Co. public/private service model • Perinatal Programs

14. NIATX (Network for the Improvement of Addiction Treatment) Washington Circle Research indicates that access to and retention in treatment are the biggest predictors of success • Reduce waiting time between first request for treatment and first treatment session • Reduce the number of patients that are no shows. • Increase admissions for treatment • Increase continuation of treatment from first -4th treatment session https://www.niatx.net/Home/Home.aspx?CategorySelected=HOME

15. CISC (Comprehensive, Continuous, Integrated System of Care) All programs dual diagnosis or co-occurring disorder capable • System level change • Efficient use of resources • Incorporation of “best practices” • Integrated treatment philosophy http://www.zialogic.org/CCISC.htm

16. Kern County/Court partnership • Define the four levels of service available and what is delivered at each level • Define what constitutes successful completion • Demonstrated abstinence last 3-5 months of treatment • 85% participation last 3-5 months of treatment • Have a social support network in place (family, AA sponsor) • Credible plans for addressing any health needs • A job or enrolled in work training or schooling • Progress reports include attendance, level of participation, results of drug screens, diagnosis and fee compliance • Prop. 36 clients required to sign an irrevocable permission to share information, (which is allowed)

17. Kern County Service Model • Anything less than 90 days is a waste of time. The longer the treatment, the better the outcome. Their treatment maximum is 10 months (plus 45 days residential) • Match client to appropriate level of care through assessment • ASI – tells severity of condition • ASAM matches to appropriate level of care • Socrates – measures motivation • Findings of thousands of assessments • 5% needed in-patient because of physical conditions (45 days) • 15% needed intensive outpatient (90 days with sober living) • 80% needed outpatient services (have a support network and are stable)

18. Kern County (contin.) • Kern County is 8,300 sq. miles. They have a central assessment center co-located with the court, but their treatment centers are geographically based. County acts as the “Gatekeeper” for services. • They have 34 clinic sites (county and community based). • Federal Qualified Health Clinics can develop substance abuse clinics and provide up to 20 hours of treatment a week. • (In Siskiyou County HRSA supported health centers include karuk tribal clinic in Yreka and Happy Camp, Butte Valley Health in Dorris and Tulelake Health Center.)

19. Perinatal/Parental Programs • Universal screening of all pregnancies by medical providers and Public Health using Chasnoff’s 4P’s screening tool. (Providers then refer to County specialist services) • All CPS clients assumed to have a substance abuse problem unless proven otherwise. • Different court track for women in reunification plans with infants

20. Funding Strategies • Special pots of money for services to targeted groups and Medi-Cal coverage for those with dual diagnosis leaves other clients falling through the cracks. • “Minor Consent” program allows County to access Medi-Cal system as a way to fund AOD services for adolescents (Kids seeking treatment without parental permission) • Charge for services beyond UDAP levels.

21. Funding Strategies • The state reviews County “waiting lists,” but only counts the time people wait for assessment and not how long they wait for a treatment program slot. You can ask for more money by documenting program waits, but it requires that you ask 10-12 questions of each client and provide monthly tracking figures. • If the County program is drug Medi-Cal certified, you can get more money. (35 counties out of 58 are.)