Learning Objectives

Identification & Referral for Persons with Substance Use Disorders: The North Carolina Work First/CPS Substance Abuse Initiative

Learning Objectives • Ability to describe the state laws governing the Work First/CPS Substance Abuse Initiative. • Ability to explain the collaborative partnerships at the state and local level. • Develop an understanding of the state policies that inform the execution of this Initiative. • Ability to list the activities that encompass the role of the Qualified Professional in Substance Abuse for this Initiative.

The Law • In 1997, the NC General Assembly passed N.C. General Statute 108A-29.1 The law states: • Each applicant or current recipient who is determined to be addicted to alcohol or drugs, and in need of substance abuse treatment, shall be required to participate in substance abuse treatment in order to receive Work First benefits; and • The applicant or recipient must submit to random toxicology screening as a part of their treatment. http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/BySection/Chapter_108A/GS_108A-29.1.html

The Law General Statute 108A-29.1 • Any applicant or recipient who fails to comply with treatment requirements becomes ineligible for cash assistance. • Applicants or recipients shall be considered to be receiving benefits for purposes of determining eligibility for Medicaid. • The children of any applicant or current recipient shall remain eligible for benefits, and these benefits shall be paid to a protective payee.

The Law General Statute 108A-29.1 • An applicant or current recipient shall not be regarded as failing to comply with the requirements of this section if an appropriate drug or alcohol treatment program is unavailable. • Area mental health authorities (now Local Management Entities/LMEs) are responsible for administering the provisions of the law. • Requirements of the law may be waived or modified in the case of any individual applicant or recipient to comply with Medicaid eligibility.

The Law General Statute 108A-25.2 The law states: Individuals convicted of Class H or I controlled substance felony offenses are eligible to participate in the Work First and food stamp program: Six months after release from custody if no additional controlled substance felony offense is committed during that period & successful completion of or continuous active participation in a required substance abuse treatment program determined appropriate by the area mental health authority; http://www.ncga.state.nc.us/EnactedLegislation/Statutes/HTML/BySection/Chapter_108A/GS_108A-25.2.html

The Law General Statute 108A-25.2 OR If not committed to custody, six months after the date of conviction, if no additional controlled substance felony offense is committed during that period, and successful completion of or continuous active participation in a required substance abuse treatment program determined appropriate by the area mental health authority.

Test yourself ? • Urine toxicology screening is part of the application process for Work First or Food and Nutrition Services. True or False? • Individuals convicted of a Class H or I Controlled Substance felony will only be assessed for abuse of the substance they were convicted of having used/possessed. True or False?

Test yourself ? • Urine toxicology screening is part of the application process for Work First or Food and Nutrition Services. False, it may only be part of treatment under this Initiative. • Individuals convicted of a Class H or I Controlled Substance felony will only be assessed for abuse of the substance they were convicted of having used or possessed. False, the applicant will be assessed for all substances of abuse or dependence, including alcohol.

Collaboration and Coordination

State Level Collaboration & Coordination State Memorandum of Agreement Joint Responsibilities of the DMH/DD/SAS and DSS • Develop and provide training for County DSS and LME/Provider re: Initiative. • Provide technical assistance to County DSS & LMEs/Providers re: Work First/CPS SA Initiative program development.

State Level Collaboration & Coordination Responsibilities of the Division of MH/DD/SAS • Provide funding to LME’s to assist with hiring Qualified Professionals in SA and fund non-Medicaid reimbursable expenditures. • Develop consent for release of information in accordance with 42 CFR Part 2: Confidentiality of Alcohol and Drug Patient Records and HIPPA.

State Level Collaboration & Coordination Responsibilities of the Division of Social Services • Develop policies and procedures for County DSS to follow in implementing and administering the Work First/CPS Substance Abuse Initiative requirements. • Implement standardized consent for release that is 42 CFR Part 2 compliant.

Local Collaboration & Coordination Requirements of the LME and County DSS: • Development of Local MOA between LME and County DSS. • Establish Populations to be Served. • Establish Procedures Surrounding the Services of the QPSA. • Provider Contract Expectations.

Memorandum of Agreement DSS and LME jointly agree to: • Develop a reporting system of non-compliance by consumers. • Abide by confidentiality regulations. • Arrange for appointments for the consumer and coordinate planning for child care and transportation. • Inform the consumer about the method of payment for SA or MH treatment. • Maintain regular contact regarding consumers progress in treatment.

Memorandum of Agreement DSS Agrees to: • Explain to consumer the substance abuse assessment and services provided by QPSA. • Adhere to Confidentiality and completing proper release forms. • Screen all Work First applicants for possible substance abuse. • Offer voluntary screening for mental illness. • Refer all eligible applicants for services with an H or I Controlled Substance Felony to the QPSA for a substance abuse assessment.

Memorandum of Agreement DSS Cont… • Make appropriate referrals to QPSA. • Arrange for child care and transportation for consumers with children, who are receiving substance abuse services. • Inform QPSA when ‘protective payee’ status becomes effective. • Designate staff person to serve as liaison under this MOA.

Memorandum of Agreement LME agrees to: • Arrange for appointment for assessment of consumer. • Provide assessment of substance abuse and mental health for Work First consumers as needed. • Refer for treatment when assessment indicates. • Authorize appropriate level of treatment recommended by QPSA. • Items in orange carried out by contracted QPSA provider

Memorandum of Agreement LME cont… • Provide case support services for consumer. • Provide treatment compliance reports to DSS staff. • Participate in interagency staffing with DSS. • Liaison between treatment providers and DSS. • Provide SA and MH training to staff by QPSA. • Items in orange carried out by contracted QPSA provider

Test yourself ? • If a WF recipient does not have transportation to mandated treatment, WF will cease. True or False? • The QPSA is not an employee of DSS. True or False?

Test yourself ? • If a WF recipient does not have transportation to mandated treatment, WF will automatically cease. False. DSS and the QPSA work with the recipient to address barriers to treatment. • The QPSA is not an employee of DSS. True. In certain circumstances, DSS has been contracted by the LME to provide the QPSA services, but in general the QPSA is an employee of a private behavioral health agency.

Policy

Populations served Work First Food and Nutrition Services Child Protective Services Qualified Professional in Substance Abuse Assessment

North Carolina DSS Work First Policy 104B Required Substance Abuse Screening Of All Adult Work First Applicants/Recipients • Conducting the Screening for Substance Abuse: DSS staff responsible for administering verbal screening to all applicants. • Screening Tools for Substance Abuse: Audit and DAST 10 validated verbal screening tools. • Behavioral Indicators: Behavioral Indicator Check list. http://info.dhhs.state.nc.us/olm/manuals/dss/csm-95/man/WF104B.htm#TopOfPage

Expansion of the Initiative Mental Health Services 2001 • Voluntary mental health screenings were added as a part of the Initiative. • The mental health screening tool used is the Emotional Health Inventory (EHI). • QPSAs will provide screening, case support, facilitate assessment, and communicate compliance with treatment to WF as requirement of the Mutual Responsibility Agreement (MRA).

Referral from Work First to QPSA Audit Screening and DAST Screening Negative Positive Negative Positive Work First Application or at any other time considered appropriate Emotional Health Inventory Negative Positive Behavioral Health Indicator Checklist No Check One or more No Referral Qualified Professional in Substance Abuse No Referral Work First Benefits Policy 104B

North Carolina DSS Work First Policy 104BNon Compliance • Non-Compliance for Applicants and Recipients of SA Treatment. • Non Compliance for SA for Applicants & Recipients who have Previously Received WF Assistance.

North Carolina DSS Food and Nutrition Policy 290 • All applicants identified by the FNS staff as having a Class H or I Controlled Substance Felony, who are eligible to apply, are referred to the QPSA for a substance abuse assessment. • Applicants are referred to the QPSA even if they state they are currently engaged in treatment. • If treatment is indicated, the applicant must engage in treatment as a condition for receiving FNS benefits. http://info.dhhs.state.nc.us/olm/manuals/dss/ei-30/man/FSs290.htm#P12_92 Class H or I Controlled Substance Felons

Referral from Food and Nutrition Services to QPSA Food and Nutrition Services Application Eligible Class H or I Controlled Substance Felon? NO YES Qualified Professional in Substance Abuse

North Carolina DSS Food and Nutrition Policy 290 Compliance • Applicant is disqualified when Food and Nutrition Services is notified that the individual has failed to follow through with the required assessment and/or treatment. • Compliance with a substance abuse treatment program is waived for individuals who reside in counties whose QPSA require an assessment fee.

Expansion of the Initiative Child Welfare Cases 2001 • QPSA services expanded to serve substantiated cases of child abuse, neglect and/or dependency that involve substance abuse or cases found ‘in need of services’ that involve substance abuse. • The QPSA provides assessment and case support for families with substance abuse or dependency diagnoses. http://www.ncdhhs.gov/dss/dcdl/famsupchildwelfare/fscw-15-2004.pdf http://www.ncdhhs.gov/dss/dcdl/famsupchildwelfare/fscw-15-2004a1.pdf http://www.ncdhhs.gov/dss/dcdl/famsupchildwelfare/fscw-15-2004a2.pdf http://www.ncdhhs.gov/dss/dcdl/famsupchildwelfare/fscw-15-2004a3.pdf

DSS Child Protective Services • Substantiation or finding of services needed based on SA being part of substantiation. • Work First and H or I Controlled Substance Felons have legislative priority. • CPS may have limited access. • If QPSA is not available, CPS will refer to outside provider for assessment.

Referral from CPS to QPSA CPS assessment results in substantiation or a finding that the family is in need of services and substance abuse was identified as one of the factors Currently in Substance Abuse Treatment? Yes (verified) No Family continue in Substance Abuse Treatment Qualified Professional in Substance Abuse QPSA QPSA able to provide assessment QPSA not available to assess due to priority WF and FNS referrals CPS worker refers to LME or assessment agency used by county CPS SA assessment

Test yourself ? • All WF applicants must have a mental health screening. True or False? • The QPSA provides substance abuse assessments on all involved with CPS. True or False?

Test yourself ? • All WF applicants must have a mental health screening. False, verbal mental health screening is voluntary on the part of the applicant. • The QPSA provides substance abuse assessments on all involved with CPS. False, the QPSA only provides assessments for families whose cases have been found ‘in need of services’ or substantiated, with indication of substance abuse, time permitting.

Work First/CPS SA Initiative:Role of the Qualified Professional . • Arrange for appointment for assessment of consumer. • Provide assessment of Substance Abuse for Work First (WF) and Food and Nutrition Services (FNS) applicants and consumers as needed. • Provide assessment of Mental Health for WF consumers as applicable. • Provide assessment of Child Protective Services (CPS) referrals as applicable. • Refer for treatment when assessment indicates. • Provide case support services for consumer. • Track the provision of consumer services relevant to WF/FNS/CPS participation. • Provide treatment compliance reports to DSS staff.

Work First/CPS SA Initiative:Role of the Qualified Professional QPSA role continued • Follow up with treatment providers regarding participation in treatment with signed consent. • Liaison between treatment providers and DSS. • Report to county DSS information that relates to the Mutual Responsibility Agreement (MRA) with signed consent. • Participate in interagency staffing with DSS. • Provide case consultation with DSS staff. • Provide SA and MH training to DSS staff. • Provide orientation to the WF/SA Initiative for WF clients. • Data collection: WF/CPS SA Initiative Quarterly Project Report, submitted by the LME.

Work First/CPS SA Initiative: Screening & Assessment Tools • The AUDIT and DAST-10 are used to screen all Work First applicants and recipients. • The Substance Abuse Behavioral Indicator Checklist II is used by Work First DSS workers to identify consumers at risk who may not be identified by the AUDIT or DAST-10 screening tools. • The Substance Abuse Disorders Diagnostic Schedule (SUDDS-IV) or other DMH/DD/SAS approved standardized assessment tools, are used by QPSAs as a part of a comprehensive clinical assessment with all referrals.

Work First/CPS SA InitiativeAccountability • State Level Monitoring-Annual Audits • Audit Tools (Individual and Program) • Plan of Correction • Local Level Monitoring-LME • Quarterly Reports • Review of report

Billing • Medicaid and State Comprehensive Clinical Assessment Codes http://www.ncdhhs.gov/mhddsas/servicedefinitions/servdefupdates/dmadmh11-5-07update36.pdf • State Integrated Payment and Reimbursement System Target (IPRS) Populations http://www.ncdhhs.gov/mhddsas/iprsmenu/index.htm

Funding • Non-Unit Cost Reimbursement (Non-UCR) SAPTBG funds areallocated to the LME. • IPRS Target Population, Adult SA DSS involved • Medicaid

Work First/CPS SA Initiative Collaborative Trainings and Technical Assistance • Regional/Statewide Meetings • Cross training for LMEs, QPSA’s and DSS • Technical assistance (e.g. phone, onsite, etc) Questions? contact: Melissa.godwin@dhhs.nc.gov or Starleen.scott-robbins@dhhs.nc.gov

Learning Objectives