resolution no. search...resolution no. 140-2006 of the board of supervisors of the county of el...

RESOLUTION No. 140-2006

OF THE BOARD OF SUPERVISORS OF THE COUNTY OF EL DORADO

Substance Abuse and Crime Prevention Act of 2000 County Plan for Fiscal Year 2006-2007

WHEREAS, the citizens of California passed Proposition 36, the Substance Abuse and Crime Prevention Act of 2000, and each County is responsible for implementing said Act; and

WHEREAS, the El Dorado County Board of Supervisors through Resolution No. 008-2001 passed and adopted on the 23'd of January, 2001, designated the El Dorado County Public Health Department as Lead Agency, assured compliance with the provisions of the Act, and also assured that a trust fund had been established and that all funds would be received into that trust fund; and

WHEREAS, §9515, Title 9, California Code of Regulations requires the completion and approval of an annual County Plan with regard to said Substance Abuse and Crime Prevention Act;

NOW, THEREFORE, BE IT RESOLVED, that the Board of Supervisors of the County of El Dorado hereby approves the Substance Abuse and Crime Prevention Act of 2000 County Plan FY 2006-2007, completed pursuant to §9515, Title 9, California Code of Regulations, by the El Dorado County Public Health Department.

PASSED AND ADOPTED by the Board of Supervisors of the County of El Dorado at a regular meeting of said Board, held on the 16 day of MAY , 2006, by the following vote of said Board:

Ayes:DUPRAY,BAUMANN,SWEENEY,SANTIAGO

ATTEST CINDY KECK

I CERTIFY THAT:

NONE PAINE

THE FOREGOING INSTRUMENT IS A CORRECT COPY OF THE ORIGINAL ON FILE IN THIS OFFICE

Date ---------ATTEST: Cindy Keck, Clerk of the Board of Supervisors

of the County of El Dorado, State of California.

Deputy Clerk

Plan Questions

El Dorado County Proposition 36 FY 06/07 County Plan

Pubhc: Health Department, Alcohol and Drug Programs Division

1. Is the county board of supervisors approval, or are the written board of supervisors delegation (by a written resolution, delegation of approval authority or order) and the county lead agency plan approval attached? [ref: §9515 (b )(3 )]

D Yes C8] No (expected date of approval): ·M9y 1ij1 ~OQij

2. Check the county agencies and other entities involved in developing the county plan. (Check all that apply) [ref. §9515(b)(2)]. If one or more of the required agencies or entities did not participate, please explain in Part Ill, Plan Description, Item 1.

REQUIRED C8] County alcohol and other drug agency C8] Court C8] Parole Authority C8] Probation Department

OPTIONAL (Check all that apply) D County Executive Office D County Mental Health D County Office of Education C8] County Public Health D County Social Services C8] District Attorney D Police Department C8] Public Defender D Sheriff D Other (specify) .

3. Check the impacted community parties that collaborated in the development of this county plan. [ref: §9515(b )(2)]

REQUIRED C8] Providers of drug treatment services in the community C8] Representatives of drug treatment associations in the community

OPTIONAL (Check all that apply) D Clients/Client groups D Colleges and Universities D Local Business Representatives D Non-Profit Organizations D Youth Organizations D Other ( specify)

Department of Alcohol and Drug Programs 1

4. How was community input collected? [ref: §9515(b)(2)]

D Community meetings ~ County advisory groups D Focus groups D Other method(s) (explain briefly)•

5. If there are federally recognized American Indian tribe(s) located within your county, did they provide input to the development of this county plan? [ref: §9515(b)(2)]

~ Yes - (required if such tribes are located in your county) D No federally recognized American Indian tribe(s) in the county

6. During this fiscal year, how often did entities and impacted community parties meet to develop this county plan? [ref: §9515(b )(2)(A)]

~ 1-4 times D 5 or more times

7. Specify how often entities and impacted community parties will meet during the implementation of this plan to continue ongoing coordination of services and activities. [ref: §9515(b)(2)(A) and 9520(a)]

~ Every three months (minimum required) D 5-8 times D 9 or more times

8. What services will be available to SACPA clients under this county plan? [ref: §9515(b)(2)(B); and Penal Code §1210.1(c) and §3063.1(c)]

REQUIRED ~ Drug treatment ~ Family counseling ~ Literacy training ~ Vocational training

OPTIONAL D Mental health D Other ( specify) ·

9. Identify the entity(s) responsible for determining a SACPA offender's level of need for, and placement in, drug treatment. [ref: §9515(b)(2)(C)]

~ County alcohol and other drug agency ~ Drug treatment provider(s) D Probation department D Other (specify) · ·


10. Identify the entity(s) responsible for assessing a SACPA offender's level of need for and placement in additional services supplemental to treatment. [ref: §9515(b )(2)(C)]

!Z1 County alcohol and other drug agency !ZI Drug treatment provider(s) !ZI Probation department !Z1 Other (specify) §uperiQr ¢q!Jrt§

11. What assessment tools will be used in your county for SACPA clients? [ref: §9515(b )(2)(C)]

!ZI ASI (Addiction Severity Index) !Z1 ASAM PPC (American Society of Addiction Medicine Patient Placement Criteria) !Z1 Other (specify) Mq~Wi~g A$(

12. Will drug testing be required for SACPA clients in your county? [ref: §9515(b)(3)(A)]

!ZI Yes D No

13. Is drug testing, when paid for with federal Substance Abuse Prevention and Treatment (SAPT) block grant funds, used for non-punitive treatment purposes?

!ZI Yes D No

14. Are drug testing results (positive and/or negative) used in conjunction with other program performance indicators (e.g., attendance, participation, employment, domestic relations, etc.) to make adjustments in the client's treatment program?

!ZI Yes D No

15. Other than the Substance Abuse Treatment and Testing Accountability (SATTA) Program, what sources of funds, if any, will be used to pay for drug testing? [ref: §9530(i)]

(Check all that apply. Do not include federal SAPT block grant funds provided under the state SA TTA program.) D Client fees D Additional funds budgeted by the county D Other (specify): ·

16. Has there been a change in the Lead Agency designation? (Check one)

D Yes !ZI No


Narrative Questions

1. Collaborative Process. Describe the collaborative process used during the current fiscal year to plan services. Describe how county entities, community parties, and others participated in the development of this plan. If one or more of the required agencies or entities did not participate in the collaborative process (Part II, Plan Questions, Item 2 and 3), explain why. [ref: §9515(b)(2)(A)]

In El Dorado County, Proposition 36 services are planned and delivered through the collaborative efforts of the following agencies:

• Public Health Department (lead agency), • Courts, • Probation Department, • District Attorney, • Public Defender, • Parole, • Board of Prison Terms, and • Contracted Treatment Providers.

In addition, the Public Health Department's Proposition 36 Project Coordinator confers periodically with the Chairman of the Shingle Springs Rancheria (Miwok Tribe) to obtain input concerning tribal treatment needs and strategies.

The Public Health Department convenes Proposition 36 meetings at least quarterly, and usually bi-monthly. These meetings provide an opportunity for the various Proposition 36 stakeholder groups to discuss implementation issues, plan service delivery approaches, refine operating procedures, and review funding issues. Individual, ad hoc meetings between the Public Health Department and contracted treatment providers are common, as are meetings between Public Health and Probation Department staff.

Our approach to collaboration emphasizes frequent, open communication among all participating agencies. Besides the formal meetings mentioned above, we also encourage the various Proposition 36 stakeholders to participate in development of written policies and procedures and to review drafts of the county's SACPA plan.

2. Coordination of Services and Client Flow. Describe how involved entities coordinate multiple services as clients progress from referral through program completion. (referral, assessment, placement, court monitoring, probation supervision, case management, etc.). Describe specific roles and activities of court, probation, parole, county alcohol and drug treatment, and treatment providers. [ref: §9515(b)(2)(A)]

Probation and parole client flow begins with a referral from the Superior Courts to the Probation Department. Upon contact with the Probation Department, clients are scheduled for an assessment. Due to staffing constraints, assessments occur on every Monday by County Alcohol and Drug Program staff. If county staff is unavailable, then clients are referred to contracted Prop 36 treatment providers for their assessment. After the assessment is completed by county staff, the client is immediately referred to one of the contracted Prop 36 providers to set up an intake


appointment and begin their assessed level of treatment with appropriate ancillary services. Intake appointments occur within 5 business days of the original contact from the clients, but most often occur within 1-2 days of contact. Once the client has completed the intake with the treatment provider, this information is provided to the Probation Department or Parole, and County ADP (the same is true for clients who fail to make their appointment) and the client is actually placed in treatment. All clients begin treatment at the assessed level, but requests are received on an 'as required' basis should the treatment provider believe a level change is necessary. If a level change is requested, the County Referral Team (Probation and County ADP) examines the request and makes a decision based on factors outside of treatment such as budget, probation violations, etc. Clients receive urinalysis testing while in treatment from the treatment provider and probation department. Testing is used as a component of treatment.

Treatment providers submit monthly progress reports on clients to the Probation Department or Parole Agency and County ADP. These progress reports are then utilized by the dedicated Prop 36 treatment court team (Judge, District Attorney, Public Defender, Probation, County ADP/Treatment) to move clients along in a drug court fashion. This court is for Prop 36 clients only and is held on the first Thursday of every month.

Court monitoring and case management is done primarily by the County ADP, but also as a part of probation supervision. Case management includes determining the nature of services to be provided, routing the client to those services, monitoring the client's progress in treatment, managing the client's progress in treatment court, and ensuring the client's compliance with the treatment regime. Case management continues throughout the client's course of treatment and, if necessary, aftercare.

Specific Roles/activities are as follows:

• Court - dedicates court calendar for Prop 36 clients only. Held on first Thursday of every month in a quasi drug court model. Judge is an integral part of client interaction in courtroom.

• Probation - supervises the probation Prop 36 client caseload. Appears in Prop 36 court as a part of the treatment court team. Conducts urinalysis testing as a component of treatment and accountability.

• Parole - supervises the parole Prop 36 client caseload. Refers and monitors clients accordingly.

• County ADP - carries out case management and court monitoring of clients. Responsible for assessment and referral of clients to treatment. Ensures client flow is continually monitored and functioning within mandated guidelines.

• Treatment Providers - provide substance abuse treatment and ancillary service linkage to Prop 36 clients. Provide progress reports and sanction recommendations.


3. Drug Treatment and Additional Services Assessment Process. Describe the assessment process and tools that will be used to determine clients' level of need for both drug treatment and additional services. [ref: §9515(b )(3)(8)]

The County Alcohol and Drug Programs Division, in collaboration with the contracted treatment providers, designed the County Plan service levels to conform to the American Society of Addiction Medicine (ASAM) Patient Placement Criteria. The ASAM, ASI, or a county modified version of the Addiction Severity Index Lite (ASI-Lite) assessment tool, are the standard instruments used by both the Public Health Department and our contracted treatment providers to determine participants' level of care. The three service levels identified for El Dorado County parallel ASAM placement levels: I. Outpatient, II. Intensive Outpatient, and Ill. Clinically Managed Low and Medium Intensity Residential Services.

The Public Health Department and county-contracted treatment providers use these assessment instruments as part of a thorough bio-psycho-social evaluation, which determines the most appropriate treatment placement level for each participant. The assessment process also identifies any supplemental or ancillary services the participant may need.

Completed assessments are forwarded to the County Referral Team, which includes a designated Project Coordinator. The Project Coordinator reviews incoming assessments to confirm that placement level recommendations are appropriate and authorizes payment for the recommended services. The County Referral Team collectively determines the treatment provider to whom the participant will be referred for the recommended treatment.

4. Drug Treatment, Aftercare and Additional Services. Describe the types of treatment, aftercare, and additional services the county provides to clients after assessment. Describe the intensity and length of treatment and other services, and client flow among services. If services (e.g., residential, narcotic replacement therapy) are unavailable in the county, identify how services will be provided to clients whose assessments indicate the services are needed. [ref: §9515(b )(3 )(B )(D)(E)]

Core services are delivered through a treatment program that offers differing service levels appropriate to individual client needs. Following is a description of the required service levels.

1. Level I: Low intensity outpatient education and treatment services are those services or activities provided to adults who are willing to cooperate in their own treatment but need motivating and monitoring to sustain the recovery process. Level I services are appropriate for participants who are able to maintain abstinence or control their substance use and to pursue recovery goals with minimal support. Participants placed in this service level are in a supportive recovery environment or have the necessary coping skills to deal with a nonsupportive recovery environment. Services at this level shall exist for a minimum of 3 months, with 1-3 months of additional services available upon request from the treatment provider and subsequent approval by the County Referral Team.

Level I services shall include: one intake appointment, once weekly attendance at an outpatient group session and referral to ancillary services as needed. All ancillary services must be prior authorized by the County Referral Team to be eligible for payment.


1.1 Level I: Dual diagnosis seNices means outpatient group sessions for participants with cooccurring substance abuse and mental health diagnoses. For participants who can benefit from this specialized service, and with approval from the County Referral Team, dual diagnosis group sessions may be substituted for Level I core outpatient group sessions, but may not be offered in addition to core outpatient group sessions.

2. Level II: High intensity outpatient education and treatment seNices are those services provided to adults whose resistance to treatment is high enough to require a structured program, but not so high as to render outpatient treatment ineffective. This level of service may also be indicated for individuals whose addiction symptoms intensify while participating in low intensity outpatient services. Services at this level shall exist for a minimum of 6 months, with 1-3 months of additional services available upon request from the treatment provider and subsequent approval by the County Referral Team.

Level II services shall include: one intake appointment; once weekly attendance at group education for the first 6 weeks, for a maximum of 6 classes; once weekly attendance at an outpatient counseling group for the first 6 weeks, then twice weekly attendance at outpatient group counseling and referral to ancillary services as needed. All ancillary services must be prior authorized by the County Referral Team to be eligible for payment.

2.1 Level II: Dual diagnosis seNices means outpatient group sessions for participants with cooccurring substance abuse and mental health diagnoses. For participants who can benefit from this specialized service, and with approval from the County Referral Team, dual diagnosis group sessions may be substituted for Level II core outpatient group sessions, but may not be offered in addition to core outpatient group sessions.

*Clients receiving Level 1 or Level 2 services shall be held to the following participation protocol: a. Client is permitted three absences throughout the course of Level 1 treatment services. If

client exceeds three absences, treatment provider must send a drop form to Probation and the Project Coordinator.

b. Client is permitted eight absences throughout the course of Level 2 treatment services. If client exceeds eight absences, treatment provider must send a drop form to Probation and the Project Coordinator.

c. Clients receiving Level 1 or Level 2 treatment services who fail to show for three consecutive classes are to be dropped from the current program. Treatment provider must send a drop form to Probation and the Project Coordinator

3. Level Ill: residential treatment means delivery of services to adult males, females, and/or women with children in an inpatient setting for a maximum of 30 days. Participants placed at this level must have a demonstrated need for a highly structured living environment to achieve and maintain control of addiction symptoms. Residential treatment extending beyond 30 days may only be provided with prior approval from the County Referral Team. Such approval will only be granted if clear justification exists, has been documented in writing, and submitted to the County Referral Team for consideration. Perinatal residential services are limited to clients who meet the Drug Medi-Cal perinatal definition, or who have children age 12 or under with them at the residential facility.


Residential treatment shall include a minimum of 20 hours per week of group education on health and/or addiction topics; 5 hours per week of process group; 1 one-hour individual session at least once every other week, 5 hours per week of recreational activities, and 1 hour per week of family therapy for those clients with intact family systems. Residents shall be included in day-to-day housekeeping activities of the facility and privileges shall be earned for successful completion of program goals. Women's group and individual therapy programs shall be focused upon the unique needs of women in recovery.

4. Individual treatment sessions must be used for "crisis" services only with services focusing on alleviating crisis problems. When possible, such services must be preauthorized by the County Referral Team.

5. Aftercare consists of 12 step meetings as recommended by the treatment provider for a maximum of 6 months. Aftercare services must receive prior approval from the County Referral Team and shall not exceed 6 months in duration.

6. Participants are eligible for 12 months of treatment funding under Proposition 36 and as a result, can be re-referred based on treatment funding eligibility for modified periods of treatment services upon the request of any of the participating agencies of the El Dorado County Proposition 36 program, with subsequent approval from the County Referral Team.

The need for additional services is typically determined during the initial assessment process as described in #3. However, in participant cases where the need for supplemental services is identified during the course of treatment, rather than during the initial assessment, the provider submits a treatment plan change request to the Project Coordinator. The change request must explain the reason that supplemental services are needed and if an additional assessment is recommended. The Project Coordinator reviews the request for consistency and compatibility with the original assessment. The County Referral Team then approves or disapproves the request.

Ancillary/additional services supplement core treatment services, and must receive prior authorization from the County Referral Team to be eligible for payment. Allowable ancillary services are described below.

1. Family counseling means counseling with individual couples or groups which examines interpersonal and family relationships. Such counseling shall be provided by an existing community resource staffed with therapists licensed in accordance with sections 4980 through 4981 of the Business and Professions Code. Upon authorization for services, the identified participant and/or or family member(s) are eligible for 3 counseling sessions. The County Referral Team may authorize extensions up to a 15-session limit.

2. Vocational training means instruction and information presented in a group setting to increase opportunities for gainful employment. Such instruction shall be provided by an existing, already funded community resource such as the Job One program.

3. Literacy training means instruction and information presented in an individual or group setting to increase literacy skills and reading comprehension. Such instruction shall be provided by an existing, already funded community resource such as the Literacy Council.


4. Perinatal Services (other than residential) means supportive services in an agency setting or home visitation for pregnant or parenting women to support their recovery with specific interventions designed for the needs of women developing new life skills while in recovery. Interventions shall be provided by an existing community resource. Upon authorization for services, the identified participant is eligible for 3 service sessions with extensions possible up to a 15-session limit.

5. Transitional Housing means a supervised clean and sober living environment that provides no treatment program component. A clean and sober living environment shall meet the requirements of the California Association of Recovery Homes voluntary certification process. Transitional housing is only available to clients who are actively participating in Level 11 or Aftercare services, and must be pre-authorized by the County Referral Team. If approved, transitional housing may be provided for thirty days with extensions in 30 day increments available at the discretion of the County Referral Team. Clients residing in transitional housing must:

5.1 Be actively seeking permanent housing. 5.2 If not a high school graduate or in possession of a GED, be working toward a high school

diploma or GED. 5.3 If unemployed, begin an intensive job search within 72 hours of entering transitional housing. 5.4 Furnish proof of the above three activities to Probation upon request.

The transitional housing supervisor is responsible for informing clients of their obligation to participate in these activities, and the importance of providing Probation with acceptable verification substantiating compliance.

6. Detoxification may be offered as an ancillary service through a local treatment center.

The county-contracted treatment providers do not offer narcotic replacement therapy services due to low demand for such service in El Dorado County. Clients requiring such services are referred to a neighboring county that can accommodate their needs.

5. Quality of Treatment Services and Additional Services. Describe the criteria and tools the county will use to monitor services and assure clients receive the type and level of treatment services and additional services as determined by their assessment. [ref: §9515(b)(3)(C)]

The Project Coordinator reviews provider reports, treatment plans, and invoices as a means to monitor the quality of all services to be rendered. If any of these documents indicates a potential quality or contract compliance issue, the county initiates discussion of the issue at the next bimonthly SACPA Stakeholders meeting. In addition, the county's contract with treatment providers gives the county the ability to conduct on-site quality reviews at provider facilities at any time. In the event a potential quality issue cannot be satisfactorily evaluated and/or corrected during the bi-monthly meetings, or the issue is emergent, the county immediately conducts an on-site review. The mechanisms the county can use to address quality issues once they are substantiated include but are not limited to:


• Corrective action plans, • Termination of referrals to the provider, and • Termination of the provider's contract.

These quality monitoring and corrective action mechanisms are used for both substance abuse treatment services and ancillary services, such as family counseling, vocational training, and literacy training.

6. Plan Changes from FY 2005-06 County Plan. Identify any changes from the FY 2005-06 county plan to the FY 2006-07 county plan in the following areas.

a) Drug Treatment Services. Describe changes in drug treatment services from the previous plan year. (Include reasons for increases or decreases in costs, staffing, length of treatment, treatment options, treatment capacity, etc.)

i) We anticipate drug treatment services to be relatively the same for 06/07. There is a slight ,ehange in outpatient non-residential cost due to an inerease in yearly eost of service and the 06/07 allocation not commensurately tnc::rec:1~Jng'. This, i~ t,ru~ for res,igentic:1J s~rvtce as weJI. The $RI$ Jndicates these c::hc:1nge§.,

b) Criminal Justice Activities: Describe changes in criminal justice activities from the previous plan year. (Include reasons for increases or decreases in costs, staffing, level of probation supervision, court oversight activities, services provided, etc.)

i) 'criminaf justice act1v1ties wffl change, in that their wlfi be one dedicated eourt for aff Prop 36 participants in the Placerville area. lhis court will operate under a drug court model and be held 2 times per month. If legislation is passed that indicates drug court models should be used for the SACPA program, probation costs may increase as the drug court mod.~I would need to be implemented in South Lake Tahoe as well a Placerville. Currently, tw0 Probation Officers are funded with SACPA due to the demands of the drug court model in Placerville. The Probation Officer in South Lake Tahoe is currently funded by the Probation Department because there is no drug court system in place and thus the workload is not a;, great. C,a;,e manc:1g,~ment ~.;,t~ c:1re p~gnned tq mimic th,~ qven~JI c::hc:11;1ge tq c:1 grug c,ou~ mogel.

c) Client Referral Projections: Describe and explain the reasons for increases and decreases in the number of offenders referred to SACPA by both court/probation and parole.

iJ w~ an~cipate client r~ferral proJ~ctlons, to ~~ §r!Jl(l,§tr for O~/Q?. d) Client Treatment Projections: Describe and explain the reasons for increases and

decreases in the number of new clients admitted to treatment from the previous plan year.

iJ W~ sn1Lc::ipJ~t~ c!J~nJ tr~c:1tment prqJ~c::tiqn$ t9 ~~ th~ ssim~ t9r 69/TY(


7. Program Goals and Tracking. Describe the county's SACPA program goals and individual treatment goals for SACPA clients and how the county measures and tracks these goals. Include criteria the county considers, other than drug testing, when evaluating a client's progress toward meeting treatment goals. How does the county plan to track these goals?

SACPA Program Goals:

• Provide quality services to El Dorado County Prop 36 Participants • Ensure the provision of appropriate level of services • Maintain collaboration will all agencies connected to the program • Support recovery and treatment • Reduce the impacts of substance abuse in El Dorado County

Measurement tools include the following: Quarterly client satisfaction surveys, treatment completion rates, pre and post employment rates, educational attainment rates, and number of babies born drug free.

Individual Treatment Goals:

• Abstinence • Recovery • Employment/job skills • Education • Improved self-efficacy

All goals are measured and tracked by the Prop 36 Program Coordinator through case management. Treatment providers assist in individual treatment goals and work with the treatment court team to track and monitor the individual goals. Clients are always evaluated on a case by case routine, incorporating life domain aspects beyond just drug abstinence.


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