- Report Published -
|Substance Abuse Services Council Annual Report and Plan - 2011|
|Substance Abuse Services Council|
|§ 2.2-2696 (F.5.)|
|The Substance Abuse Services Council spent the year learning about strategic plans that have been developed by several state agencies that involved the delivery of substance abuse treatment services. Among these agencies is the Department of Behavioral Health and Developmental Services (DBHDS), which was charged by the Governor with developing an interagency strategic plan to address the need for substance abuse treatment services. DBHDS was already involved in developing an overall agency strategic plan, "Creating Opportunities: A Plan for Advancing Community-Focused Services in Virginia," and built on this initiative to develop a substance abuse service-specific plan that included input from public and private providers and eight other state agencies. The resulting report, "Creating Opportunities for People in Need of Substance Abuse Services: An Interagency Approach to Strategic Resource Development," has been reviewed and approved by the secretaries of Public Safety and Health and Human Resources and accepted by the Governor’s Office. It is posted on the DBHDS website (http://www.dbhds.virginia.gov/documents/omh-sa-InteragencySAReport.pdf). After reviewing the interagency plan, the Council endorsed it and has highlighted those initiatives in this annual report.|
The scope of the substance abuse problem in Virginia is significant and has been documented by several sources. The National Household Survey on Drug Use and Health (NSDUH) indicates that, in the year prior to the survey (2006, 2007, 2008), 22.9% of Virginians age 12 and older participated in an episode of binge drinking and that nearly 5% used pain relievers for a nonmedical use. More than 7% needed but did not receive treatment for alcohol use, and 2.45% needed but did not receive treatment for illicit drug use. Data from the Virginia Department of Health Office of the Chief Medical Examiner (OCME) indicate that the number of deaths caused by drugs increased 32% over the period 2003 to 2009, with more than 60% due to prescription drugs in 2009.
A variety of state agencies are involved in either directly providing treatment to people with substance use disorders, or providing supports and services to people who need treatment services.
• DBHDS funds 40 community services boards (CSBs) to support their role as the major provider of publicly-funded community-based substance abuse treatment. In 2009, CSBs provided treatment to 36,661 individuals.
• The Department of Corrections (DOC) estimates that 75% of the offenders under its supervision need treatment. Over 38,000 offenders are incarcerated in DOC institutions, and it provides active supervision to an additional 53,400 offenders in the community.
• The Department of Juvenile Justice (DJJ) screened 5,800 youths in 2010, the majority of whom were served in community settings. Of the 608 committed to custody, 85% received treatment while in DJJ facilities.
• The Department of Criminal Justice Services (DCJS) supports local community-based probation and pretrial services. It provides screening and assessment services for offenders as well as purchasing treatment services. In 2010, DCJS drug tested 11,364 individuals and placed 2,858 offenders in counseling.
• The Department of Rehabilitative Services (DRS) provides vocational rehabilitation counseling especially designed for people with substance use disorders to people receiving treatment in 18 CSBs with significantly positive results.
• The Department of Social Services (DSS) provides supports to those seeking recovery and helps to mitigate the impact of addiction on families. When the need for services is identified, the local DSS collaborates with CSBs to facilitate access.
• The Department of Health (VDH) provides health-related supports and makes referrals to CSBs for treatment services. VDH has also integrated screening into some services that target at-risk families.
• The Department of Medical Assistance Services (DMAS) administers Medicaid reimbursement for eligible treatment services provided to people who meet eligibility requirements.
• The Department of Health Professions (DHP) is home to the Prescription Monitoring Program that tracks all filled prescriptions of certain schedules of pharmaceuticals and provides a database that can be utilized by pharmacists and prescribers to prevent overprescribing these medications.
DBHDS hosted numerous meetings and conference calls with public and private providers, and then hosted three meetings with these state agencies to develop this strategic interagency plan, which will involve multi-stage funding and implementation.
A. PROPOSALS TO EXPAND CAPACITY NEEDED TO ASSURE TIMELY ACCESS TO SERVICES
Proposal 1: Enhance Substance Abuse Case Management Capacity. Two-thirds of CSBs report inadequate case management capacity, yet this is the service that can facilitate efficient and effective use of limited existing resources at the local level. Funds are needed to support case management services for people with substance use disorders.
Proposal 2: Develop Capacity to Serve Adolescents with Substance Use and Co-Occurring Mental Health Disorders. NSDUH data indicate that one in five adolescents regularly engage in binge drinking, but CSB utilization data indicate that fewer than 10% of admissions to substance abuse services are adolescents. CSBs often lack the appropriately trained workforce to provide treatment to adolescents, many of whom have a co-occurring mental health disorders that complicates their recovery. Funds are needed to support adolescent services and training in evidence-based treatment.
Proposal 3: Expand Project Link. Project Link is program of coordinated services designed to meet the needs of pregnant women who are abusing drugs or alcohol that is currently operating in 8 CSBs. Initially implemented in 1990, it has proven to be effective at improving pregnancy outcomes and reducing substance abuse among participating women. Funds are needed to expand this service so that it is available statewide.
Proposal 4: Expand Peer-run Support Services. Peer-run supports include emotional support (ex: peer-led groups), informational support (ex: life skills classes), instrumental support (ex: child care or transportation), and social supports (ex: sober social events). These types of supports provide another approach to improving access to needed services, however, only half the CSBs report using these types of services. DBHDS has funded five peer-run centers to provide these types of services, and another one is currently funded by a federal grant. Funds are needed to support expanding these types of services.
Proposal 5: Enhance Uniform Screening and Assessment of Mental Illness and Substance Use Disorders. Many CSBs are not using validated assessment instruments to determine the extent of an individual’s problem with substance use, nor or they determining the extent to which mental illness may be present. Without an accurate clinical assessment, it is very difficult to develop a viable treatment plan. Funds are requested to support positions at CSBs and provide training in conducting accurate assessments.
Proposal 6: Implement a Structured Systems Improvement Practice Model such as the Network to Improve Addiction Treatment (NIATx). NIATx is a systems-engineering approach to quality improvement developed specifically for clinical substance abuse treatment programs. Its low-cost disciplined methods support an organizational culture of team-based problem solving that resolves issues efficiently. NIATx is free but does require dedicated focus. Funds are needed to support DBHDS staff to lead, coordinate and train CSBs in this statewide effort.
B. PROPOSALS NEEDED TO FILL GAPS IN THE SERVICES ARRAY
Proposal 1: Expand Access to Identification and Intervention for Offenders with Substance Use Disorders in Community Correctional Settings. Untreated substance abuse has been estimated to cost Virginia $613 million annually, mostly in criminal justice costs. As discussed, DOC, DJJ and DCJS estimate that significant numbers of individuals in the criminal justice system have a substance abuse issue of some degree. Funds for this initiative would be allocated to these agencies to purchase treatment services from any qualified provider, and services would be supervised locally to meet rigorous professional standards, including the use of evidence-based practices.
Proposal 2: Expand Intensive Outpatient Services. People receiving treatment for substance use disorders need to receive it at a level of intensity that is adequate to support change. Due to a lack of staff, only about one-third of CSBs are able to offer services at this level of intensity. Most offer only hourly outpatient services at a frequency of about one per week. Intensive outpatient services are offered multiple times per week for several hours each day. Funds would support additional CSB staff to adequately provide intensive outpatient services.
Proposal 3: Expand Capacity for Community-based Residential Medical Detoxification. Currently CSBs report only about 100 beds available for medical detoxification, a residential services lasting between three to seven days that provides medically supervised withdrawal from alcohol, sedatives, opiates and other dangerous drugs. Once discharged, the person is referred to the appropriate level of treatment for ongoing counseling and supports. Funding is needed to support expanded capacity for this service.
Proposal 4: Expand Capacity for Community-based Residential Medical Detoxification. Approximately half the CSBs lack access to medication assisted treatment, essential to the treatment of dependence on opioids which are increasing in use. As the previously cited data from the Office of the Chief Medical Examiner indicates, abuse of prescription opioid medications is an increasing cause of death in the Commonwealth. Currently there are 19 methadone clinics in Virginia, and while methadone is a highly effective approach to treating opioid dependence, it requires daily attendance at a clinic that may interfere with employment. Buprenorphine, a medication that can be prescribed by a specially trained physician and self administered, can provide excellent results when coupled with counseling and other supports. Funding is needed to support purchase of this medication, physician time and training for physicians.
Proposal 5: Develop Residential Treatment Capacity for Pregnant Women and Women with Dependent Children in Southwest Virginia. Currently there are only three publicly-funded residential treatment programs for women who are pregnant or who have dependent children. Research indicates that women are more likely to enter and stay in treatment if they can bring their children with them, and the results for the children are also better as part of the treatment focuses on improved knowledge and skills about parenting. Because abuse of prescription pain medication has reached epidemic proportions in this region and because it is geographically isolated from the rest of the state, women in this region lack access to this type of service. Funding is needed to establish and operate a residential program designed to meet the needs of these women.
Proposal 6: Re-establish Transitional Therapeutic Communities for DOC. Until 2009, when funds were eliminated due to budget cuts, DOC purchased intensive community-based residential services (transitional therapeutic communities) for 300 offenders returning to the community after being in special prisons that provided intensive substance abuse treatment services. Evaluation indicated a significantly lower rate of recidivism for offenders who completed both the institutional program and the community program as compared to those who completed on the institutional program. This proposal would fund the re-establishment of these transitional therapeutic communities.
C. PROPOSALS TO PROVIDE ADDITIONAL SERVICES AND SUPPORTS NEEDED TO SUSTAIN A RECOVERY ORIENTED SYSTEM
Proposal 1: Expand Department of Rehabilitative Services Substance Abuse (SA) Vocational Counselors Project. Stable employment is a key component of successful recovery from substance use disorders. Since 1988, DRS has provided specialized vocational counseling services to people in treatment for substance use disorders at CSBs. Evaluation indicates that clients who receive this specialty counseling cost less to serve, uses DRS resources for a shorter period of time, are more likely to achieve successful employment and have higher earnings that clients served by a general DRS vocational counselor. Currently, through a memorandum of agreement between DBHDS and DRS, 21 vocational counselors provide these services at 18 CSBs. This proposal would expand the number of vocational counselors so that every CSB would have access to a specialty vocational counselor.
Proposal 2: Expand Access to Housing Options Available to Adult Offenders in the Community. Stable housing, along with a sober and supportive environment is a critical need of offenders returning to the community. Returning offenders often lack financial resources to pay for housing when they first return. One option is to explore self-run households of four to six same gender individuals in recovery who rent a house and live under self-developed rules and agree to being sober. Individuals must make a minimum deposit and contribute financially to the operation of the house. Many recently returning offenders are not able to make this monetary contribution. DOC is already engaged in a pilot in which it pays the initial costs for individual offenders to start or join such a residence. Funds for this initiative would expand this pilot.
Proposal 3: Establish Capacity for Supported Living Services. Lack of a safe, sober place to live is also a barrier for others in recovery. Supported living services can provide an option to placing a person in an expensive residential treatment program because they are homeless when such an intense placement is not clinically indicated. Supported living services would provide housing and additional supports such help with transportation to treatment and employment, case management and support groups and could be managed as a peer-run service. As they became employed, residents would contribute to the costs of living in the facility.
Proposal 4: Create a Multi-Agency Work Force Development Capacity Focusing on the Treatment of Substance Use Disorders. In the last 20 years, a substantial body of knowledge has evolved concerning effective treatment for substance use disorders, including the knowledge that specific populations (e.g., women, adolescents, criminal justice populations) respond better to some treatments than others. DOC and DJJ have trained their workforces to utilize appropriate evidence-based practices for the populations they serve, but when these offenders return to the community, providers are often not familiar with these clinical approaches. In addition, a variety of studies indicate that CSB staff lack access to appropriate clinical supervision that would help them utilize these or other evidence-based practices. Funds are needed to support promotion, coordination and collaboration necessary to integrate these practices into publicly-funded community-based treatment settings.
Proposal 5: Develop an Ongoing Evaluation Process for Established Drug Treatment Courts. Drug treatment courts have evolved as a national model for adults and youths facing felony convictions for nonviolent crimes related to drug or alcohol abuse or dependence. They provide a closely supervised alternative to conviction and incarceration. Currently there are 27 drug treatment courts in Virginia. The process for establishing a drug treatment court involves making application to the Supreme Court of Virginia (SCV) and then, once approved, review and approval by the General Assembly. However, some members of the General Assembly are not confident that drug treatment courts are effective. In the 2011 Session of the General Assembly, six applications approved by the Supreme Court were presented to the General Assembly, but none were approved. This proposal would fund support for the development and implementation of a statewide evaluation of drug courts operating in the Commonwealth. In addition, pending the outcome, funds for existing drug treatment courts would be held harmless.
Note: The Substance Abuse Services Council wishes to note that the National Center on State Courts is currently under contract to conduct a two-year cost-benefit analysis of the state drug treatment court system; the Council supports expansion of this evaluation and also supports the adoption of drug treatment courts that are approved by the Supreme Court of Virginia.