- Report Published -
|2007 Annual Report and Comprehensive Interagency State Plan for Substance Abuse Services|
|Substance Abuse Services Council|
|This report is provided to the Governor and the General Assembly in compliance with Code of Virginia § 2.2-2696, which establishes the Substance Abuse Services Council to make recommendations to the Governor, the General Assembly and the State Board of the Department of Mental Health, Mental Retardation and Substance Abuse Services on broad policies and goals related to the coordination of public and private efforts to control substance abuse. A previous report required by Code of Virginia § 2.2-2697, an overview of treatment programs for persons with substance use disorders provided by state agencies, has already been published and is available at http://leg2.state.va.us/dls/h&sdocs.nsf/By+Year/RD2052007/$file/RD205.pdf. The thirty Council members include representatives of key state agencies, public and private provider organizations, consumer and advocacy organizations, and members of the General Assembly. Its chair and several of its members are appointed by the Governor for terms of three years. Staff support is provided by the Department of Mental Health, Mental Retardation and Substance Abuse Services. This year’s report focuses on four issues:|
The impact of maternal substance use on infant mortality;
Services to people with HIV or AIDS seeking treatment for substance use disorders;
Support to the Council; and
The Substance Abuse Council’s Vision for Substance Abuse Services Across the Commonwealth: A Template for Transformation
Two other documents are also included as Appendices:
Survey of Agencies 2007, which is included in compliance with Code of Virginia § 2.2-2696.F. This survey is conducted approximately every two years, and presents the results of a survey of state agencies regarding activities and services related to use and abuse of alcohol, tobacco and other drugs.
A report on the Council’s work with the Virginia Commission on Alcohol Safety Action Programs, as directed by the report and recommendations that resulted from Governor Warner’s Task Force to Combat Driving Under the Influence of Drugs and Alcohol. This document describes the progress made training providers in appropriate assessment of persons charged with driving under the influence, so that the interventions in which they participate will be clinically appropriate.
The Impact of Maternal Substance Use on Infant Mortality
The infant mortality rate (IMR) is measured by the number of live birth babies that die during the first year of life and is used to measure the health and well being of populations across and within countries. Virginia’s IMR has been higher than the national average for all but one of the last 22 years. In 2004 and 2005, Virginia’s IMR was 7.4 infant deaths per 1,000 live births. The Governor’s Health Reform Commission proposes to lower this rate to 7.0 by the end of FY 2009. In examining strategies to achieve this goal, the impact of substance use on pregnant women is significant. Although the Code of Virginia §54.1-2403.1 establishes medical screening for substance use as a component of prenatal care, no standardized protocol is in place, resulting in confusion and uneven compliance among health care providers. The Council is requesting that the General Assembly designate DMHMRSAS as the lead agency to establish a protocol and that general funds be appropriated to provide technical assistance to this endeavor.
1. In order to implement Code of Virginia §54.1-2403.1, the Council recommends that the General Assembly require the Department of Mental Health, Mental Retardation and Substance Abuse Services (DMHMRSAS) to convene a leadership team with representatives from the Department of Health, the Department of Social Services, the Department of Health Professions and other appropriate agencies to develop a universal statewide screening protocol for risks related to substance abuse, mental illness and domestic violence.
2. The Council recommends that the General Assembly should make a one-time appropriation from the general fund in the amount of $40,000 to develop and implement a protocol.
Because access to treatment for substance use disorders is crucial to good pregnancy outcomes when the mother is using alcohol or other drugs, and because there are many barriers to access, the Department of Mental Health, Mental Retardation and Substance Abuse Services has, for many years, provided access to treatment and care management funded largely with funds from the federal Substance Abuse Prevention and Treatment Block Grant, which provides more than half of the funds currently available for community treatment for substance use disorders ($42,939,145 in FY 08). Among these activities is a care management model, Project LINK, currently available in only eight sites in the state, that provides supports that improve access to treatment. In 2005, Project LINK served 2,891 women and 757 dependent children. Of the 161 babies born to these women, 75 percent achieved a healthy birth weight. The Council is, therefore, requesting funds to expand Project LINK.
3. The Council recommends that the General Assembly appropriate ongoing funding from the general fund to support increased access to treatment for pregnant women and women with dependent children through case management using the Project LINK model.
Additional funding for the expansion of Project LINK
Increase funding for existing 8 sites ($25,000 GF x 8 sites) = $200,000
Additional funding for 4 new single sites ($125,000 GF x 4 sites) = 500,000
Additional funding for 4 new collaborative sites ($150,000 GF x 4 sites) 600,000
Total to communities $1,300,000
Project LINK Coordinator for DMHMRSAS $100,000
Project LINK evaluation 35,000
Training funds across systems 100,000
Social marketing campaign 100,000
Administrative services total $335,000
Total Request $1,635,000
HIV/AIDS EARLY INTERVENTION SERVICES FOR PEOPLE SEEKING TREATMENT FOR SUBSTANCE USE DISORDERS
The Council recently learned that funds from the federal Substance Abuse Prevention and Treatment Block (SAPT) Grant, which the federal government required the Department of Mental Health, Mental Retardation and Substance Abuse Services to utilize for the specific purpose of supporting early intervention services to persons with HIV or AIDS seeking treatment for substance use disorders are no longer available for this purpose. The authorizing legislation for this grant requires states with AIDS case rates equal to or exceeding 10 per 100,000 population to expend five percent of the grant award ($2,146,957 in FY 08) to support these activities. Because injection drug use is a significant risk factor in the spread of HIV, integrating early intervention into treatment for substance use disorders is a sound public health strategy. When the legislation went into effect in 1995, Virginia’s case rate was 12.1. Virginia’s current case rate is 8.5 per 100,000. Federal code prohibits the Department of Mental Health, Mental Retardation and Substance Abuse Services from using these funds for this purpose now that the rate has declined. When the federal legislation authorizing the SAPT Block Grant was drafted in 1992, a diagnosis of HIV progressed quickly to AIDS and death soon followed. Considerable medical advances in the treatment of HIV, however, means that people infected with HIV often live productive lives for many years before developing AIDS. Nevertheless, infection with HIV seriously compromises quality of life and productivity.
Many communities in Virginia continue to have HIV or AIDS case rates that equal or exceed 10 per 100,000, and removal of these funds will cause these early intervention activities to cease. Community services boards do not have other funds to support these services. Therefore, the Council has requested that the General Assembly provide general funds to support these services.
4. The Council recommends that the General Assembly appropriate $1,666,236 annually to the Department of Mental Health, Mental Retardation and Substance Abuse Services to be allocated by DMHMRSAS to replace the federal funding that will be prohibited from use to support early intervention services for people with HIV or AIDS who are seeking treatment for substance use disorders.
SUSTAINING THE SUBSTANCE ABUSE SERVICES COUNCIL
Finally, the Code of Virginia 2.2-2696.E. & G. requires the Department of Mental Health, Mental Retardation and Substance Abuse Services to provide staff and other support to the Council, including reimbursement to members for their participation. The Council meets four times per year, and makes an effort to meet at various public locations throughout the Commonwealth to enhance member understanding of regional issues and provide opportunities for public input. Currently these costs are paid for using a portion of a five percent allowance from the Commonwealth’s Substance Abuse Prevention and Treatment (SAPT) Block Grant, which supports all of the administrative costs of the Office of Substance Abuse Services. However, the funding from the SAPT Block Grant has remained static for several years, and no increases are anticipated. As the costs of operating the Office have increased due to general raises granted to all state employees (which are not covered by general funds, but by the SAPT Block Grant) and other operating expenses, the funds available to support the Council are increasingly limited. Since the Council is a state mandate, the Council believes that state funds should support its operation.
5. The Council recommends that the General Assembly appropriate $100,000 in general funds annually to provide staff to and support the operation of the Substance Abuse Services Council. This amount covers staff salary and benefits, travel and accommodations for Council members and staff, costs associated with public hearings the Council may conduct, and publication and distribution of the Council’s reports.
SUBSTANCE USE SERVICES IN A TRANSFORMED SYSTEM
The Department of Mental Health, Mental Retardation and Substance Abuse Services has embarked upon a plan to transform its service system, focusing on the cornerstone human values of self-determination, empowerment and recovery, and implemented by improving accountability, access, and quality of services, developing partnerships, enhancing coordination, managing funding, and using resources efficiently. The Council, in its advisory role to the Governor, the General Assembly, and the Board of the Department, seeks to emphasize some key components of the transformation plan, as well as to augment it. This resulting white paper is the Council’s interpretation of transformation for the prevention and treatment of substance use disorders in Virginia’s public systems of care. This document promotes the values of self-determination, empowerment and recovery implemented through accountability, access, quality of services, partnerships, coordination, funding, and efficient use of resources, and concludes with a vision statement for the system of care. It is the Council’s intent to promote the use of this document as a compass in the development of policy and services for persons with substance use disorders in the Commonwealth.