Fiscal Year 2004 Proposed Budget

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DEPARTMENT OF HUMAN SERVICES
SUBSTANCE ABUSE SERVICES

PROGRAM MISSION: To improve the bio-psychosocial functioning and prevent the continued deterioration and adverse social, legal, and medical consequences to individuals and the community resulting from alcohol and drug dependency. This is accomplished by serving those most in need (individuals with severe problems who lack resources for services elsewhere), providing a continuum of care and services to meet client needs, and utilizing private, nonprofit agencies in the delivery of services. The following services are provided:

• Outpatient Substance Abuse Services seek to eliminate clients' alcohol and/or drug use in order to improve functioning, increase self-sufficiency and prevent continued legal, social and medical consequences. These services include: assessment, individual and group therapy, alcohol and drug education courses, relapse prevention services, psychological evaluations, urinalysis, and introduction to community-based support groups. Most services are also available to individuals who speak Spanish. Substance abuse clients are referred primarily from the criminal justice system (Probation and Parole, ASAP, Juvenile and Domestic Relations Court) and from other programs in the Department of Human Services. A contract with the Alexandria Community Services Board provides for methadone treatment services for a limited number of narcotic-using adults.

• Case Management and Contractual Substance Abuse Treatment Services prevent the detrimental consequences of alcohol and drug dependency on individuals and society. They promote self-sufficiency through the elimination of drug use and improvement in functioning of seriously impaired chemically dependent individuals. Adults are evaluated by case management staff and placed in the appropriate level of treatment, provided by the private sector. The continuum of contractual treatment services includes social or medical detoxification, residential treatment (from two to nine months with varying levels of intensity), as well as transitional living placements to facilitate recovery from chemical dependency. Case management staff monitor client services at contract agencies and the individual's progress, referring for ancillary services as needed. The primary recipients of residential services are Arlington residents with severe and chronic substance abuse problems, who require more intensive treatment than is available in an outpatient setting and who do not have the financial resources to pay for residential treatment. Pregnant women, intravenous drug users, and HIV positive individuals are priority populations in programs receiving federal Substance Abuse Prevention and Treatment Block Grant funds.

• Prevention and Outreach Services are designed to increase the awareness of and sensitivity to the problems related to alcohol and drug use, mental illness and trauma by emphasizing the need for prevention, early intervention, and treatment to the community and other professionals. These services include education, information, counseling, consultation, crisis intervention and professional training in community-based locations.

• Detention Facility Jail Based Services provides assessment, early intervention, prevention, treatment, and case management services to program participants while they are incarcerated to prevent the continuation of bio-psychosocial deterioration and the criminal activities that accompany it. Consolidated Jail-based services include the ACT Program which serves to prevent and prepare individuals for recovery from alcohol and drug dependency. The Mental Health Jail Treatment Unit serves to prevent suicide, mental psychiatric hospitalization and disciplinary problems for inmates who are experiencing mental health, mental retardation or adjustment difficulties while incarcerated. These programs also facilitate appropriate placement in outpatient or residential aftercare settings upon the release of clients from the Detention Facility.

• Prevention Services was established by reallocating 1.0 FTE from Mental Health Services to Substance Services to provide community prevention and outreach.

SIGNIFICANT BUDGET HIGHLIGHTS:

• Because of state budget cuts affecting funding for mental health, mental retardation and substance abuse service programs, the Substance Abuse budget was reduced by $126,047. Of this amount, $41,047 was restored using LPACAP funds. The remaining $85,000 was for residential services.

• The FY 2003 adopted budget does not include a supplemental appropriation, fully supported with outside revenue, approved during FY 2003: Center for Substance Abuse Treatment (CSAT) ($374,250, 0.5 FTE). This grant continues in FY 2004 and is reflected at its projected funding and staffing level in the FY 2004 proposed budget.

• Nonprofits increased ($42,932) due to additional funding from CSAT funds of $114,944 less a reduction in state funds resulted in a loss of $85,000 in residential funds, and $12,988 for a 2% salary adjustment for Volunteers of America for the Residential Program Center.

• Inter-Departmental Credit was added to reflect the transfer of the Mental Health Jail Services that are funded by the Sheriff's Department to Substance Abuse Services.

• Fee increase reflects a 1% adjustment for inflationary growth. DHS staff and the Arlington Community Services Board are undergoing a comprehensive review of all mental health, mental retardation and substance abuse service client fees, and will be developing a new fee scale based on current service costs. The review will be completed by early February.

• State share decreased ($67,244) as a result of the Virginia Department of MHMRSAS budget cuts.

• Federal Grants increased ($126,339) due to the addition of the Center for Substance Abuse Treatment (CSAT) funds of $124,750 and increase of the federal allocation for HIV services of $1,589. FY 2004 funding for the CSAT grant represents the final three months of funding from a multi-year grant.

• LPACAP funds were used to offset state cuts for a 0.5 FTE Mental Health Therapist II to provide outpatient services ($33,547) and psychological and evaluation consultation services for Spanish speaking consumers ($7,500).

• FTE increase reflects the net effect of internal Divisional reorganization:

• Reallocation of 3.1 FTE Mental Health Therapist II from Substance Abuse to Homeless Services (1.0 FTE), Dual Diagnosis Services (1.5 FTE), and Medical Services (0.6 FTE);

• Reallocation of 3.0 FTEs from Mental Health Services for Mental Health Therapist II for Mental Health jail-based services (2.0 FTE), and reallocation of 1.0 FTE Mental Health Therapist III from Mental Health to provide prevention services.

• An additional 0.5 FTE Management Specialist I position to support the CSAT grant.

PERFORMANCE MEASURES:

Adult Outpatient Services Objective: To decrease alcohol and drug use and improve the bio-psychosocial functioning of clients in treatment as measured by 60 percent of clients demonstrating abstinence and improved functioning at the time of discharge.

• Alcohol and Drug Education services are offered only to clients enrolled in concurrent treatment services.

• Workload measure targets reflect accepted caseload standards and time-limited treatment services.

• Outcome measure target for "improved at discharge" reflects national norms.

• Outcome measure target for "abstaining at discharge" reflects internal standards.

• Target for client satisfaction reflects norms for 39 mental health and substance abuse outpatient sites in Virginia.

• Workload and outcome measures include specialized services provided to dually diagnosed clients (concurrent substance abuse and mental illness disorders) by substance abuse and mental health staff.

Contractual Substance Abuse Detoxification Services Objective: To provide alcohol and other drug detoxification services to clients in a monitored, safe environment, as evidenced by at least 75 percent of persons staying for three or more days.

• Of the 277 unduplicated consumers discharged in FY 2002 from the Residential Program Center (RPC) detox, 86 consumers went on to residential substance abuse treatment, 3 participated in treatment in the ACT program, 67 participated in outpatient substance abuse treatment and 19 received primary mental health treatment services.

Case Management and Contractual Substance Abuse Services Objective: To decrease substance abuse and improve the bio-psychosocial functioning of seriously impaired chemically dependent adults through the provision of case management, day treatment and residential services as evidenced by completion rates of 50 percent or more, depending upon the program.

• In FY 2002, nearly all adults in need of and requesting residential treatment, excluding detoxification, were placed in programs. There were a number of adults with psychiatric problems too severe to be treated in the existing treatment settings or individuals that initially requested services but failed to follow through with the placement.

• The Fairfax CSB Hope Center was closed in FY 2003 as the result of cuts in state funding.

• The regional residential program for Hispanic adults (Viviendo Saludable) will close as of September 2003 when the three-year US Department of Health and Human Services, Center for Substance Abuse Treatment demonstration funds end.

• Completion rates reflect clients who have achieved most or all of the goals of their treatment plan. The figures shown reflect outcome measures for clients who completed their treatment programs and are a subset of the number of clients in treatment. Completion rates for Demeter House reflect the discharge of women; children are not included in completion statistics. Overall, 58% of the clients placed in residential treatment successfully completed the program.

• In FY 2002, fifty-six percent of the clients who completed residential treatment moved into a transitional, supportive living environment and 58% of the clients who completed a residential treatment program went on to participate in ongoing outpatient aftercare treatment. The longer a person is engaged in treatment, the better the long-term recovery outcome.

• Workload measure targets reflect available funds. Outcome measure targets reflect internal standards (client progress).

ACT Program/Detention Facility Substance Abuse Services Objective: To provide jail-based substance abuse treatment services that prepare individuals for recovery from alcohol and drug dependency.

• Inmates are surveyed on their views of the Act Unit twice each year because of population turnover. The survey is a Likert scale with a 5 representing the highest rating.

• Workload measure targets reflect length of stay and available treatment slots. Outcome measures reflect internal standards for this service.

• The completion rate is the ratio of the number of individuals who had the opportunity to complete (i.e., the number of admissions less those who withdrew immediately from treatment, or were released/transferred prior to the end of treatment) or continue in treatment.

• The Act Unit measure for follow-up treatment placement reflects the number of Arlington residents who received additional treatment services in Arlington after discharge from the program. Arlington residents comprise an estimated 40% of the total jail population.

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