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Clearfield-Jefferson Drug and Alcohol Commission 2013 - 2014 ANNUAL REPORT TABLE OF CONTENTS PAGE I. SCA MISSION STATEMENT 2 II. SCA BACKGROUND 2 ORGANIZATIONAL CHART 5 III. MEMBERSHIP OF COMMISSION BOARD 6 IV. MAJOR ACCOMPLISHMENTS OF THE SCA 7 Administration 7 Prevention 9 Intervention 11 Case Management / Treatment 12 Hepatitis C Screening Initiative 15 Drug Free Communities Program 18 Medication Assisted Treatment Program 20 Recovery Support 22 V. SCA CASE MANAGEMENT SYSTEM 22 VI. CLIENT DEMOGRAPHICS 24 Total Clients Served by County and Gender 24, 26, 27 Average Age and Level of Care Recommended 24, 25 Primary Choice of Drugs 25, 26, 27 FISCAL INFORMATION 28 Total Revenue and Expenses 28-29 Chart of Total Revenue 30 Chart of Total Expenses 31 Funds Used for Treatment 31 Chart of Treatment Expenses by Funding Stream 1 32 (SCA, Cen-Clear and Community Guidance Center) (SCA) (SCA, Cen-Clear and Community Guidance Center) VII. Clearfield-Jefferson Drug and Alcohol Commission I. SCA Mission Statement With community service for drug, alcohol and tobacco addiction as our foundation, we are driven by goals determined by a needs assessment of the community to seek solutions, enhance the quality of life, and foster a sense of well-being in individuals. We are committed to the development of a comprehensive system of services for the prevention, intervention, and treatment of alcohol, tobacco and other drug problems. We believe that alcohol, tobacco and other drug problems affect the entire population and that an individual community’s involvement is essential to the development of an effective response. We strive to serve all people within our jurisdiction with respect, fairness and compassion, to assess the needs of each individual; and provide opportunities for them to become successful to recover from their addiction. Funding for substance abuse treatment is targeted toward the indigent or public client and we ensure that our services are cost-effective. We nurture public trust by holding ourselves to the highest standard of performance, ethics and confidentiality. Our exceptionally low overhead means that more money is directed to serving the community by further providing encouragement, education and the means of prevention. II. SCA Background The Clearfield-Jefferson Drug and Alcohol Commission is organized as an Independent Commission authorized by the Department of Drug and Alcohol Programs (DDAP) as the Local Authority for the alcohol and other drug systems in Clearfield and Jefferson Counties. The Commission is a non-profit corporation designated as the Single County Authority (SCA) to plan, coordinate and implement community alcohol and other drug prevention, gambling prevention, intervention, and treatment services in Clearfield and Jefferson counties. Clearfield and Jefferson counties are located in the northwestern portion of PA and covers approximately 1,803 square miles. Clearfield County is the third largest county in PA, in terms of square miles 2 Clearfield-Jefferson Drug and Alcohol Commission and Jefferson is roughly half the size of Clearfield County. The combined population of Clearfield and Jefferson Counties is 126,140 according to the U.S. Census, 2013. The administrative office of the Commission is located at 135 Midway Drive, Suite A, DuBois, PA 15801. The office is operational five days a week between the hours of 8:30 a.m. and 4:30 p.m. The phone number is (814) 371-9002 or 1-800-9002. The Commission’s website address is www.cjdac.org. A Board of Directors, made up of no fewer than eleven and no more than fifteen, representative of the population of the two-county area governs the Commission. Monthly public meetings are advertised on the Commission website and are held on the fourth Tuesday of each month at 6:30 p.m. The Board of Directors maintained eleven members in the 2013-2014 fiscal year. The makeup of the Board of Directors includes a Chairperson, 1st Vice-Chair, 2nd Vice-Chair and a Secretary/Treasurer. Each member serves a term of office for three years and may serve consecutive terms. The role of the Board of Directors is to manage the business affairs of the Commission. This includes entering into contracts on behalf of the Commission, to include the PA Department of Drug and Alcohol Programs. The Clearfield-Jefferson Drug and Alcohol Commission provides several in-house services. Services include the following: Administrative Unit: made up of the Executive Director, Deputy Director, Chief Fiscal Officer, Fiscal Technician and Administrative Assistant. The Administrative Unit is responsible for oversight, planning, and management of all day-to-day business affairs, and overall direction of the Commission. Prevention Unit: made up of two Prevention Specialists and one Prevention Supervisor. The Commission maintains a functional Prevention Unit and is responsible for the direct delivery of all drug and alcohol prevention services within Clearfield and Jefferson Counties. A third Prevention Specialist is designated as the Student Assistance Program Liaison. Through a shared partnership with Community Connections (MH/MR), the 3 Clearfield-Jefferson Drug and Alcohol Commission Student Assistance Program (SAP) covers 12 public and 1 parochial school districts. The Prevention Unit provides SAP maintenance meetings for districts and the Executive Director was approved as Lead Trainer during the 13-14 Fiscal Year. Clearfield-Jefferson Drug Free Communities Coalition: made up of one Prevention Supervisor (Coalition Coordinator) and one Prevention Specialist (Coalition Specialist). This unit is responsible for the Drug Free Communities grant and the Sober Truth on Preventing Underage Drinking Act grant, received by the Commission from the Substance Abuse and Mental Health Services Administration. Treatment: The Clearfield-Jefferson Drug and Alcohol Commission contracts with twentyfour providers for all level of care treatment services within the two-county area. This includes three in-county out-patient providers, of which two are drug free and one is methadone maintenance. Case Management Unit: made up of two Case Managers and one Case Management Supervisor. This unit is responsible for all client related services in the SCA including Level of Care Assessments and Case Coordination services. Medication Assisted Treatment: made up of one Drug and Alcohol Program Specialist. This program is responsible for all client related services in the SCA that are related to medication (i.e. Methadone, Buprenorphine). This position is funded by Health Choices reinvestment funds. Hepatitis C Screening Program: made up of one Drug and Alcohol Prevention Program Specialist. This program is responsible for direct implementation of the Hepatitis C Screening Program maintained by the Commission. 4 Clearfield-Jefferson Drug and Alcohol Commission Recovery Support: The SCA continues to promote a Recovery Oriented System of Care (ROSC) philosophy in all aspects of SCA programming, both in-house and with contracted providers. A ROSC is a coordinated network of community-based services and supports that are person-centered and builds on the strengths and resilience of individuals, families and communities to achieve abstinence and improved health, wellness and quality of life for those with or at risk of alcohol and drug problems. Organizational Chart 5 Clearfield-Jefferson Drug and Alcohol Commission III. Membership of the Commission Board 2013-2014 Board of Directors Leanne G. Peters, Chair..............................................................................Clearfield County Debra Thomas, First Vice-Chair..............................................................Clearfield County Joseph Molitierno, Second Vice-Chair...................................................Jefferson County Rose Buterbaugh, Secretary-Treasurer...............................................Jefferson County Ruthanne Barbazzeni................................................................................ Clearfield County Sean Bresnahan............................................................................................Clearfield County Janice Foster...................................................................................................Jefferson County Jody Kulakowski...........................................................................................Jefferson County Cathy Sokloski...............................................................................................Clearfield County Tuesdae Stainbrook....................................................................................Clearfield County John Welsh......................................................................................................Jefferson County 2013-2014 Retired Board Members Rose Buterbaugh.........................................................................................................10 Years 2013-2014 Retired Staff Eileen McIntyre................... 25 Years...................................................................Clerk Typist Joseph Zbieg.........................32 Years........................................Student Assistance Liaison 6 Clearfield-Jefferson Drug and Alcohol Commission IV. Major Accomplishments Administration The Clearfield-Jefferson Drug and Alcohol Commission is the Single County Authority (SCA) for Clearfield and Jefferson Counties, located in northwestern Pennsylvania. The Administrative Unit of the SCA is responsible for the assessment of needs, planning, capacity building and implementation of all drug and alcohol prevention, intervention, treatment, case management and other specialized initiatives within the service area. There were several noteworthy accomplishments during the 2013 -2014 fiscal year: The Monitoring visit by the Department of Drug and Alcohol Services very well. The Case Management Unit was commended on its excellent charting and disposition of cases. The Commission received continued funding for the Restrictive Intermediate Punishment Grant through Jefferson County Probation and the PA Commission on Crime and Delinquency. In addition, the Commission continued to participate in the Right Turn grant through the Clearfield-Jefferson MH/MR program for incarcerated offenders. Finally, the Commission received continued funding for its Hepatitis C Screening Program. The Commission received Year 8 Funding for the Drug Free Communities Grant and Year 2 Funding for the STOP Act Grant. The Commission completed a Strengthening Families (10-14) grant for Clearfield County and was also able to provide another 7 week program with DDAP funds throughout the Fiscal Year. Administration collected one full year of information from the Case Management Unit and our Out-Patient Providers regarding all services delivered for individuals in Clearfield and Jefferson Counties. 7 Clearfield-Jefferson Drug and Alcohol Commission Administration participated in the County Plan requested by the Department of Public Welfare during the 13-14 year. Administration was able to work closely with County Commissioners to develop a plan to provide for substance abuse treatment services. The Commission, working with its partner, the Clearfield-Jefferson Heroin Task Force, Inc. was able to raise $8,150 for the Opioid Overdose Resuscitation Card. Funding was raised through the Small Games of Chance Act and local service and social clubs. The Commission received $89,651 for Gambling Prevention for 2013 - 2014 Fiscal Year. The Commission’s Executive Director continued the year as past Chair of the Greater DuBois Chamber of Commerce, the Secretary of the DuFAST Transit (local municipal transit agency), the Treasurer of the Behavioral Health Alliance of Rural Pennsylvania (BHARP is the executive board of the 23 county managed care region in north-central PA) and served as an alternate Regional Representative for PACDAA (PA County Drug and Alcohol Administrators Association). RAC (Rural Assistance Center) notified the Commission that the Hepatitis C Program was one of the programs featured in its Mental Health Toolkit that came out this year. Long time Student Assistance Program Liaison, Joseph Zbieg, retired in July 2013 after 32 years with the Commission. Long time Secretary, Eileen McIntyre retired after 25 years of service to the Commission at the end of June 2014. The SCA replaced the position of Fiscal Officer, after the resignation of the previous officer in February 2014. This is a key position in the agency. The Executive Director received the Lead Trainer designation for the Student Assistance Training Program during the 2013 - 2014 Fiscal Year. Four trainings were provided for 64 individuals. The PA Department of Education monitored the second training and the 8 Clearfield-Jefferson Drug and Alcohol Commission SCA received full re-credentialing with no findings. In addition the Executive Director condensed the SAP manual which has helped with printing costs. The Commission's new website, www.cjdac.org, became operational in March of 2014. The Commission hired a Solicitor, Patrick Lavelle, Esquire as it's very first attorney. The Director and Deputy Director worked throughout the year to better define their roles and separation of duties in an effort to increase efficiency in the agency. The Commission, Board of Directors updated by-laws and began the process of creating a 5 year Strategic Plan for the agency. Prevention The Commissions alcohol, tobacco, other drugs and gambling prevention efforts focus on providing awareness and knowledge on the nature and extent of alcohol, tobacco, drug use, abuse, addiction, and gambling, and its effects on individuals, families, and the overall community. The Commission’s prevention program plan seeks to reduce risk, and enhance protective factors associated with substance use within our local area. The Drug and Alcohol Commission’s staff provides information, education, and prevention services in a variety of settings throughout the two county area. The Commission works collaboratively with our area schools and local community groups in providing effective, evidence-based and state approved prevention programming with the goal of reducing the prevalence of substance abuse. Agency prevention programming, strategies, policies, practices and procedures are based on proven methodologies tailored to address the identified needs of the community and the risk and protective factors associated with substance use/abuse. Prevention programming is guided by six federal strategies: Information Dissemination, Education, Alternative Activities, Problem Identification and Referral, Community-Based Process, and Environmental. The Commission’s prevention plan includes evidence based programs which have shown through research and 9 Clearfield-Jefferson Drug and Alcohol Commission evaluation to be effective in the prevention or delay of substance use and abuse. The Commission is currently offering the Strengthening Families Program for Youth Ages 10-14; Toward No Drug Abuse, K-12; and the Too Good for Drugs and Violence High School Program for schools and the community. These programs are approved by the Substance Abuse and Mental Health Services Administration (SAMHSA)/ National Registry of Evidence Based Programs and practices. The prevention plan also includes a number of State Approved Programs that have been identified as being effective in preventing or delaying the use of substance use and abuse. Prevention services occur as a single service or as a group event. For the 2013-2014 fiscal years the number of events and the overall percentages across the six federal strategies are as follows: Strategy Number of Events Percentage 155 Single Service Events 31% 77 Group Events 25% Alternative Activities 17 Single Service Events 3% Problem ID and Referral 156 Single Service Events 32% Community-Based Process 38 Single Service Events 8% Environmental 3 Single Service Events 1% Information Dissemination Education The prevention staff continues to work toward a balanced approach in the delivery of services across all six of the federal strategies. Goals include the delivery of services according to best practice providing as much evidence based programming first, followed by state approved programming. Staff will continue the ongoing effort to assess the community needs, risk factors, and protective factors and adjust the prevention program plan accordingly. This past year staff has been heavily focused on the marketing of all prevention programs and services. We have targeted, and are providing more prevention programming to our elementary level students. We 10 Clearfield-Jefferson Drug and Alcohol Commission have continued to offer the Strengthening Families 10-14 Programs though the use of DDAP funds and other community supports. The Commission has continued with its Problem Gambling Initiative. Prevention staff continues to provide education and information to promote awareness of problem gambling at the community level. Prevention programming has targeted both problem youth gambling and problem senior gambling across the two county areas. Services include state approved prevention programs, consultation and technical support for youth, adult, and community groups regarding compulsive gambling. Intervention/Student Assistance Program The Student Assistance Program (SAP) entered its 29th year during the 2013-2014 fiscal year. Although much of the focus remained on core team meetings, maintenance meetings and assessments, the main focus of the year was acquainting a new SAP Liaison to replace long-time SAP Liaison, Joe Zbieg, with the process of SAP in the schools. In order to accomplish this goal, special meetings, including SAP Coordination, SAP Updates and Superintendent Breakfasts were attended during 2013-2014, in addition to providing SAP Screens for student referrals. Several school districts formed Elementary SAP (ESAP) Teams this year, and the SAP Liaison attempted to attend at least one meeting per month of the ESAP teams, in addition to the two meetings of the Secondary SAP Teams. The Commission continues to do a thorough job in meeting the maintenance obligations for each district. They are a top priority in our schools and the planning for those meetings ran smoothly this year. There were 52 assessments completed this year, with 32 of those assessments resulting in a recommendation for further services. The Executive Director was approved as a Lead Trainer for the SAP Program by the Commonwealth of PA Department of Education for the Clearfield-Jefferson Drug and Alcohol Commission. In addition, the SAP manual was revised with many outdated materials updated or removed. The size of the manual was also greatly reduced to make it more manageable and user 11 Clearfield-Jefferson Drug and Alcohol Commission friendly. Four SAP trainings were held during 2013-2014 School Year with 64 new SAP team members trained. Case Management The 2013-2014 fiscal year was one of consistency and growth in the Case Management Unit. For the first time in 3 years, the Case Management Unit retained the same staff for the entire fiscal year. Staff spent much of the year fine tuning the specific programs they work with and continuing to learn through trainings and experience. Collaboration with Jefferson County Probation continues through the Restrictive Intermediate Punishment Grant. Candidates for the program are at risk of being sentenced to state prison, and are diverted through a level of care assessment and court recommendations and sentencing that requires individuals to follow through with all the recommendations. Most participants attend inpatient, halfway house, intensive outpatient and outpatient. However, individuals also receive case coordination services from staff and attendance to treatment is monitored on a regular basis. The Case Management staff has developed a successful system for communicating with the probation officer and counselors as well as tracking the client’s needs to assist in success. The Right Turn/Second Chance grant experienced an influx of referrals in the 2013 – 2014 Fiscal Year and saw an increase in participation from probation officers and the court system. The goal of this program is to reduce the recidivism rate for clients with co-occurring disorders who are considered to be high risk for returning to jail. Participants of the Right Turn program are always provided with a drug and alcohol case manager as well as a mental health case manager. Participants are required to follow through with all drug and alcohol and mental health treatment as well as the case management services. Transportation is provided to assist individuals with attending treatment and case management appointments as well as physical health appointments and meetings with the probation officer. Help with housing needs such as rent and occasionally utility bills is also available to participants. A team consisting of the drug and alcohol Case Manager and Supervisor, the Right Turn Coordinator, probation and various mental health professionals meet regularly to discuss and monitor the clients’ progress. The 12 Clearfield-Jefferson Drug and Alcohol Commission team collaborates to make necessary changes to help the client succeed. This program was designed to work with 20 participants and has often worked with 25 to 30 at a time. The SCA continues to contract with all levels of care. 231 assessments were completed during the 2013-2014 fiscal year. A breakdown of the drugs of choice is as follows: Substance Number of Assessments Heroin 68 Other Opiates (i.e. pain medications and non-prescribed methadone, suboxone etc.) 63 Alcohol 37 THC (Marijuana) 35 None 8 Benzodiazepines 5 Cocaine 4 Other 4 Methamphetamines 2 Bath Salts 2 Other Synthetics 2 Other RX Medications 1 13 Clearfield-Jefferson Drug and Alcohol Commission Recommended Levels of Care Out-Patient 30 Intensive Out-Patient 32 Detox 29 Non-Hospital Residential 102 Halfway House 9 Hospital-Based Residential 1 Each year there are problems that interfere with clients and their treatment process. Lack of funding is a barrier to proper treatment. The SCA must manage funding in a manner that allows as many individuals as possible to attend a recommended level of care. With decreasing or flat funding and increasing numbers of individuals seeking treatment, it is difficult to offer each individual the appropriate amount of treatment services. Too often, this leads to relapse. New trends in Medicated Assisted Treatment (MAT) continue to arise. MAT continues to be requested by clients who work or have children and cannot attend inpatient treatment for 21 to 28 days. We have limited spots in our MAT program to meet these needs. A new trend in Medicated Assisted Treatment is non-hospital residential facilities providing Vivitrol and Revia while in care. These clients are sent home with prescriptions with the intent to continue on these medications locally. However; case managers have not been successful in finding local doctors to continue this treatment. Physical and Mental Health symptoms have served as a barrier to treatment. Clients experiencing active physical health and mental health symptoms are often not accepted into a regular inpatient facility. These services are difficult to provide due to funding issues. Treatment facilities have been very busy and bed availability is often another barrier to treatment. Often there is not a bed free for one to two weeks for individuals seeking treatment. Clients change their minds about inpatient treatment while they are waiting to be admitted. Individuals continue to use during this time and that can lead to physical health, mental health and legal problems and fatalities. 14 Clearfield-Jefferson Drug and Alcohol Commission The Clearfield and Jefferson county has been experiencing a lack of insurance certified counselors. Individuals seeking treatment who have private insurance currently only have one outpatient facility they can attend and that facility often has only one insurance certified employee. These individuals also have large deductibles and copayments which interfere with attending and completing treatment. The Case Management staff along with the rest of the state of PA has been dealing with its share of drug overdoses, particularly heroin overdoses. An Overdose Policy was created and implemented in the 2013 – 2014 Fiscal Year and staff has been working with local Emergency Rooms regarding services that the Commission provides. Hepatitis C Screening Program Many outreach activities took place during the 2013-2014 reporting period. The prevention unit worked to provide Hepatitis C materials at local community health fairs, local college campuses, and social services agencies. The Rural Health Outreach Coordinator distributed flyers to bars and local businesses, advertising the program, risk factors and how to receive free screenings. Many businesses displayed the flyers in the restrooms and on cork boards located near the entrance. The Rural Health Outreach Coordinator facilitated several Hepatitis Education classes which were offered to individuals involved with Clearfield County probation. These classes took place bi-monthly. The Rural Health Outreach Coordinator attempted to expand these classes into Jefferson County, however was not successful. The Rural Health Outreach Coordinator facilitated a Hepatitis C education class at the Clearfield County Jail for both the female and male inmates. Power Point presentations were conducted at the Heroin Task Force meeting and the Annual Hepatitis C Meeting in Harrisburg. The Rural Health Outreach Coordinator developed a new venue to advertise the program and risk factors. The Primitive Addictions Tattoo Shop received fliers, tee shirts, and educational brochures on Hepatitis C to distribute to their clientele during the fiscal year. 15 Clearfield-Jefferson Drug and Alcohol Commission Throughout the year, various forms of advertising was used to promote the screening project. Radio advertisements aired targeting those who were born between the years of 1945 and1965 (baby boomers). Other radio commercials targeted those who had already been tested or treated for the Hepatitis C virus and were still participating in particular high risk activities. Many patients who called in for testing stated that they were informed of the program through our radio efforts. In addition, a newspaper advertisement was approved by DDAP and was placed in the local newspaper also advertising the program. Tee-shirts were also distributed throughout the year with the QR code linking to one of several educational videos on Hepatitis C. They were given to contracted providers such as Cen-Clear, Community Guidance Center, Discovery House, Clearfield CYS, as well as patients who were screened, those who participated in the probation class, and community members that attended the Health and Provider Fairs. These shirts were a big hit with the 18-25 year old population. Several businesses were approved to wear the shirts during their hours of operation. A Face book page was set up for the HCV program and to date we have received 53 likes. The Face book page is used to share links regarding new updates on hepatitis c, treatment, and our screening days/locations. The Rural Health Outreach Coordinator also used godubois.com, pennswoods.net, and gantdaily.com to advertise the program. These free announcements are updated monthly on each site. The Commission has been receiving an average or 58 hits per site each month. Many of the patients who seek a free Hepatitis C Screen are referred by contracted providers (Cen-Clear, Community Guidance, and Discovery House), a primary care physician or an organization such as Adagio Health. A few patients used google.com to find HCV screening sites in their area, and was directed to our program. Others are self referrals and call in after hearing the radio advertisements. The Rural Health Outreach Coordinator worked in conjunction with the Heroin Task Force and took part in the development of an Opioid Overdose Resuscitation Campaign. The Rural Health Outreach Coordinator participated with a committee of the Task Force go create brochures, rack cards and pocket cards with step by step instructions on what to do in the event that someone is 16 Clearfield-Jefferson Drug and Alcohol Commission in the company of an individual overdosing from an opioid. The instructions were provided by the American Anesthesiology Association. Message Board Pavilions will be erected in any municipality that wishes to have one with the first erected in DuBois on the City Walkway. The committee also surveyed local ambulance companies, in an effort to determine how many overdoses are occurring in Clearfield and Jefferson Counties. The Rural Health Outreach Coordinator also conducted level of care assessments and made referrals to appropriate rehabs and/or providers as needed throughout the 2013 – 2014 Fiscal Year. In addition, the Commission provided 3 locations throughout the year for screenings and once a month there was a night screening held from 4-6pm. Screenings were provided at Cen-Clear in Clearfield, Cen-Clear in Punxsutawney, The Community Guidance Center in DuBois and the Discovery House in Clearfield. The Discovery House was the first Friday of every month and walk ins were accepted. Extra testing days were also set up in the month of May due to Hepatitis Awareness month. Eighty-two patients were screened in 2013 2014 and 59 of those patients were substance abusers. Twenty-four patients tested positive and of those 21 (87%) were substance abusers. Nine followed through with the PCR blood test and 5 were confirmed to have Active HCV. Four of the 5 followed through with a follow up appointment with Dr. Stainbrook and are seeking treatment. The largest barrier faced this fiscal year was the inability to have an impact on positive patients completing their PCR lab work. Of the twenty four positives, 11 did not follow through with the PCR testing. We had 24 positives and 11 of those positives did not follow through with the PCR testing. Two of the 11 were incarcerated and do not have the ability to complete the screening until release. In the new fiscal year the Commission will look at incentivizing the process in the hopes that more patients will follow through with PCR testing. The vast majority of the patients that did not complete the PCR were from the Discovery House and transportation was a barrier. 17 Clearfield-Jefferson Drug and Alcohol Commission The Commission began using the OraQuick Rapid HCV Antibody Tests, which are single-use immunoassay tests that use a finger stick whole blood specimen. Results are complete in 20 minutes and patients receive post counseling and lab orders immediately if warranted. Screening Period July 1, 2013 - June 30, 2014 Rate Number of People Screened 82 N/A Number of Substance Abusers 59 71% Number of Positive Screens 23 28% Risk Factor other than Substance Abuse (SA) 24 29% Number of Positive Screens (SA) 21 91% Number of PCR Tests 9 39% Number Negative/Undetected 4 44% Number Confirmed Active 5 55% Number Followed through with HCV TX 4 80% Drug Free Communities The Clearfield-Jefferson Drug and Alcohol Commission was awarded the Drug Free Communities Grant first in August 2006 and was awarded it again in August 2011 by the National Office on Drug Control Policy and the Substance Abuse and Mental Health Services Administration through the Office of Health and Human Services. Through this grant, the Clearfield-Jefferson Drug Free Communities Coalition was funded. The Coalition was created to assess Alcohol, Tobacco, and Other Drug (ATOD) trends in the bi-county area, build resource capacity in our communities, and plan, implement and evaluate prevention strategies to address the trends. The Pennsylvania Youth Survey is a tool utilized by the Coalition and the Commission in helping to determine priority risk and protective factors. 18 Clearfield-Jefferson Drug and Alcohol Commission A Hot Air Balloon Fundraiser was scheduled for the first time this year. Unfortunately the weather did not cooperate but a rain date will be scheduled for future plans. The Coalition also continued to sponsor the bi-annual Superintendents Breakfast. This is an important event for both the Coalition and the Commission. The breakfast meeting allows the opportunity to foster relationships with our area school districts as well as highlight the services available to the schools. The Drug Free Communities Grant provides the Coalition the ability to offer opportunities to the community, schools and organizations in addition to what the SCA can provide. The following are some of those opportunities: In 2012 the Commission applied for the federal STOP Act grant to allow the Coalition to expand its work to the 18-20 year old populations at local college campuses. This grant is for $50,000.00 a year for 4 years. At the end of the 2013- 2014 Fiscal Year the Commission was in the second year of the grant. The Coalition was able to provide Distracted Driving Simulators to many students over the past year. It is important that the Coalition encourages neighborhood support for these events so that they become ingrained in the community for guaranteed sustainability and success in future years. Several drug-free alternative youth events were of great success as a result of a coalition’s collaboration with community officials and school personnel. We provided technical assistance and support to various school sports tournaments, prom activities and anti-drug celebrations. In 2013 the PA Youth Survey (PAYS) was conducted by schools in Clearfield and Jefferson counties. This data was released in a timely fashion and has been reviewed by the Coalition’s Data Committee and new priority risk and protective factors have been identified. This will direct the 2014 - 2015 objectives, strategies and action plans. 19 Clearfield-Jefferson Drug and Alcohol Commission Medication Assisted Treatment During the 2013-2014 Fiscal Year the Single County Authority's (SCA) Medication Assisted Treatment Program (MAT) has provided ongoing monitoring and Case Management services for previous patients that have continued to participate in MAT, along with increasing the number of patients the program could assist. The SCA worked with two primary physicians during the year, who are certified in prescribing Buprenorphine and are able to serve both Clearfield and Jefferson Counties. The SCA also works with four pharmacies in close proximity of the physicians' offices. The physicians and the pharmacies continue to work in collaboration with the SCA to provide individualized care for each patient. In addition two drug and alcohol out-patient facilities are able to provide treatment services to our MAT patients. Together we have become a collaborative Treatment Team. As a Treatment Team we are able to collectively provide information to individualize treatment plans, provide appropriate support, and recovery services to the patient. Due to the ongoing efforts of our collaborative Treatment Team, the MAT program is demonstrating that it is under the national average for illicit and non-prescribed drugs found and also for prescribed drugs that are not found. According to Ameritox Laboratories, who collected data for the program, the Commission’s MAT program exhibits an 11% rate of fewer people using illegal drug, showing medications not prescribed, and taking their medications as prescribed. Eleven percent is under the national average, and Ameritox contributes our rate to the tight controls that are required by the CJDAC’s MAT. During the 13-14 Fiscal Year, the SCA served a total of 24 Buprenorphine clients participating in the MAT program. Of those twenty-four clients, nine were discharged for noncompliance, fourteen continued to participate beyond the end of the fiscal year, one left the program against advice, one was accepted into the program however changed their mind before beginning MAT, one was discharged in order to seek out pain management, and one was referred to another level of care due to doctor denial for MAT. 20 Clearfield-Jefferson Drug and Alcohol Commission By utilizing ongoing Case Management Services the CJDAC has been able to engage appropriate patients into different levels of outpatient services; outpatient and intensive outpatient services. By combining the two components of treatment, medication and outpatient services, a positive impact is evidenced and individuals have been able to obtain employment and support themselves, further their education and build a career, rebuild relationships, resolve legal issues, lessen medical issues, and maintain a sober lifestyle. The SCA continues to see a decrease in residential treatment funds used with the availability of MAT for appropriate individuals. The SCA seeks additional physicians and pharmacies willing to participate in the MAT program in an effort to assist clients in closer proximity to their place of residence in hopes to decrease the client’s burden of transportation. Transportation continues to be a barrier for some clients. Transportation affects their ability to participate in MAT by attending appointments regularly, responding to medication counts, random drug screens, and drug and alcohol therapy. Other barriers are clients who are employed, but do not have medical insurance to remain in MAT, and clients who are not eligible for medical assistance. The cost of the monthly medical appointments and prescriptions make it difficult for the client to develop the appropriate tools to support their recovery efforts. Furthermore, it is becoming difficult to locate service providers who are able to provide outpatient drug and alcohol therapy to clients who have private insurance. Another barrier includes clients who have Mental Health diagnoses and need medication refills after discharge from detox or rehab programs or those who are in MAT and need to see a psychiatrist for an evaluation. There are limited options and availability of Psychiatrists who can see clients within a reasonable amount of time. Also noted have been clients who have medical issues and are in pain management or their doctors discontinue prescribing opiates for pain management; examples of this are back and 21 Clearfield-Jefferson Drug and Alcohol Commission neck deterioration or previous injuries that require pain management. The CJDAC is not a pain management program. On a final note clients whose employment is through Marcellus Shale are not fully able to participate in IOP drug and alcohol therapy if needed. This is a hindrance to their treatment in MAT to gain the appropriate amount of drug and alcohol therapy to assist them in their recovery efforts and maintain sobriety long term. Recovery Support The SCA continued to work on creating an all inclusive Recovery Oriented System of Care during the 2013 - 2014 Fiscal Year. This included the following: The SCA continued to work with each Out-Patient County Provider regarding the Certified Recovery Specialist Program. Cen-Clear was able to begin billing CCBHO for services during the fiscal year and the Community Guidance Center received a one year extension (June 30, 2015) to spend reinvestment funds that were allocated in the 2012-2013 Fiscal Year. The SCA, in conjunction with the Clearfield-Jefferson Heroin Task Force, Inc. raised $8,150.00 towards the printing and distribution of an Opioid Overdose Resuscitation Card developed by the American Anesthesiology Association. A male Oxford House was opened in Punxsutawney, PA as the result of Reinvestment funds from Community Care Behavioral Health. Although the house had a slow start, by the end of the fiscal year, it began to see more stability. An environmental scan was completed in Clearfield County regarding the placement of a second female home. V. SCA Case Management System Case Management is designed to assist a client with the skills necessary to achieve and maintain self-sufficiency and recovery from substance abuse disorders. The Case Management Unit provides the following functions: Level of Care Assessments, Intensive Case Management, Case 22 Clearfield-Jefferson Drug and Alcohol Commission Coordination. All Case Managers are trained to provide all of the functions offered by the Unit. The following are the essential tasks performed by each Case Manager, drug and alcohol level of care assessment, recommendation and referral for treatment, documentation of client progress in treatment and addressing non-treatment needs. All services are free and adhere to all federal and state confidentiality laws. Referrals are accepted from any source and can be made in person or by telephone. Once the referral is initiated, the Case Management Unit completes a screening to identify any emergent care needs such as Detoxification, Suicidal/Homicidal Ideations, Medical Complications, and/or Prenatal/Perinatal issues. After emergent care needs have been appropriately addressed, a Level of Care Assessment is scheduled to determine appropriate treatment and non-treatment needs. In addition, the SCA does contract with The Clearfield-Jefferson Community Mental Health Center and Cen-Clear Child Services to complete Level of Care Assessments and Case Coordination Evaluation. Clients seeking outpatient services primarily utilize this access point. With the exception of outpatient and detoxification, clients may not access funding for residential levels of care without a level of care assessment completed by the SCA. During the 2013-2014 Fiscal Year the following limitations existed for assessments and funding: Clients who did not complete the recommended levels of care at all levels were not eligible for funding for a minimum of thirty days following discharge. The SCA limited the number of Out-Patient assessments that an individual could receive at the provider level to one at each facility. Clients were eligible for multiple treatment episodes at the discretion of the SCA and based on available funding. Clients were eligible to participate in two detoxification stays without prior approval by a case manager. Cases that exceed the two detoxification stays were reviewed on an individual basis, as needed. 23 Clearfield-Jefferson Drug and Alcohol Commission Individuals with private insurance and high deductibles were eligible to apply for SCA funding provided they met the income eligibility criteria. This was dependent upon the availability of funds and was only available with SCA authorization. VI. Client Demographics Clearfield-Jefferson Drug and Alcohol Commission County Clearfield Co = 17 Jefferson Co = 33 Out of County = 0 125 93 12 Male = 1 Female = 2 Transgender = 3 141 89 0 Gender Month Average Age July 2013 31.76 August 2013 27.15 September 2013 28.80 October 2013 33.42 November 2013 30.62 December 2013 28.72 January 2014 29.91 February 2014 30.18 March 2014 30.30 April 2014 27.04 May 2014 31.00 June 2014 30.10 Overall Average Age of Clients 29.91 24 Clearfield-Jefferson Drug and Alcohol Commission 25 Clearfield-Jefferson Drug and Alcohol Commission Cen-Clear, Inc. County Clearfield Co = 17 Jefferson Co = 33 Out of County = 0 201 167 5 Male = 1 Female = 2 Transgeneder = 3 238 135 0 Gender 26 Clearfield-Jefferson Drug and Alcohol Commission Community Guidance Center County Clearfield Co = 17 Jefferson Co = 33 Out of County = 0 160 58 6 Male = 1 Female = 2 Transgeneder = 3 133 90 0 Gender Age 27 Clearfield-Jefferson Drug and Alcohol Commission VII. Fiscal Information 2013 - 2014 Revenues SCA State Revenues 478,146 Federal Block Grant Prevention 122,787 Federal Block Grant Treatment 306,689 Race Horse Development (Prevention) 89,651 Gaming Treatment Act 2010-01 22,411 Act 152 168,453 Behavioral Health Special Initiative 143,180 Human Services Development Funds 19,052 DUI Fines 63,491 Strengthening Families 7,711 Drug Free Communities Grant 99,324 PCCD Jefferson County 90,712 Right Turn Federal Grant 100,139 Stop Act Grant 31,806 Reinvestment Buprenorphine 55,234 Reinvestment Recovery Specialist 39,994 Other Income 28,595 TOTAL $ 1,867,375 28 Clearfield-Jefferson Drug and Alcohol Commission 2013-2014 Expenses Administration 117,858 Prevention 281,478 Drug Free Communities 129,960 Strengthening Families 10,851 Hepatitis C 112,409 Race Horse Development (Prevention) Case Management 86,032 177,913 Gaming Treatment Act 2010-01 22,411 Human Service Development Funds 19,052 Out-Patient Services 281,184 Intensive Out-Patient Services 6,120 Detox 46,249 Non-Hospital Residential 209,745 Halfway House 6,768 PCCD Jefferson County 90,712 Right Turn Federal Grant 100,139 Stop Act Grant 49,689 Reinvestment Buprenorphine 55,234 Reinvestment Recovery Specialist 39,994 TOTAL 1,868,722 29 Clearfield-Jefferson Drug and Alcohol Commission 30 Clearfield-Jefferson Drug and Alcohol Commission Funds used for Treatment 2013-2014 Federal Block Grant Act 152 BHSI HSDF State Act 2010-01 DUI Other D&A $300,843.00 $151,608.00 $109,278.00 $ 16,071.00 $ 22,411.00 $ 344.00 $ 80,970.00 $681,525.00 31 Clearfield-Jefferson Drug and Alcohol Commission 32 Clearfield-Jefferson Drug and Alcohol Commission 33 Clearfield-Jefferson Drug and Alcohol Commission 34 Clearfield-Jefferson Drug and Alcohol Commission 35