Download Intervention | Treatment | Aftercare Services 2007

Pierce County
Strategic Plan for
Substance Abuse
Prevention | Intervention | Treatment | Aftercare
Services
2007
In collaboration with
Washington State Department of Social and Health Services
Division of Alcohol and Substance Abuse
and
Washington State Department of Community, Trade and Economic Development
Community Mobilization Against Substance Abuse and Violence
Pierce County
PART I
Initial Networking and
Community Assessment
2007
Description of Recruitment Efforts
A full spectrum of key stakeholders with relevant interest in the substance abuse continuum of
care in Pierce County was recruited to participate in our strategic planning process.
Members of the Pierce County Chemical Dependency Advisory Board, who represent the
county ethnically, culturally, and geographically, and who have expertise in the area of chemical
dependency, were asked to join the process.
The individuals and representatives from a diverse range of community based organizations
and partnering systems who were identified and enlisted to participate in our strategic planning
represent various sectors of the community, including, but not limited to, ethnic, racial, tribal,
faith based, and Gay, Lesbian, Bisexual, Transgender, and Questioning communities, and the
fields of health care, public health, social services, government, community mobilization,
shelters and housing, aging and long term care services, education, women’s programs,
military, law enforcement, juvenile justice, mental health care, and children and youth programs.
Representatives of the following organizations were invited:
Associated Ministries
Catholic Community Services
City of Tacoma, Human Rights and Human Services Department
Community Health Care
Clover Park Technical College
Girl Scouts of America
Greater Lakes Mental Healthcare
Martin Luther King , Jr. Housing Development Association
Metropolitan Development Council
MultiCare Health System
My Service Mind
National Guard
Network Tacoma
Pierce County AIDS Foundation
Pierce County Community Services Department
Pierce County Juvenile Court
Pierce County Human Services Department, Chemical Dependency Advisory Board Members
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Pierce County Human Services Department, Secure Detox Unit
Pierce County Human Services Department, Aging and Long Term Care
Pierce County Human Services Department, Mental Health Division
Pierce County Regional Support Network
Pierce County Sheriff
Puget Sound Educational Service District
Puyallup Tribal Health Authority
Safe Streets of Tacoma
Salvation Army
Shared Housing
South Puget Intertribal Planning Agency
Tacoma-Pierce County DUI Task Force
Tacoma-Pierce County Health Department
Tacoma Public School District
Tacoma Rescue Mission
United States Army
University of Washington, Parent-Child Assistance Program, Tacoma
Washington State Department of Social and Health Services, Region 5, Community Services
Division
Washington State Department of Social and Health Services, Region 5, Division of Alcohol and
Substance Abuse
Washington State Department of Social and Health Services, Region 5, Division of Children and
Family Services
YWCA
Community Participation in the Assessment Process
Community Work Group
The key stakeholders recruited from various sectors of the community fulfilled a crucial role in
our strategic planning process by actively participating in a regularly held community work group
which was convened over a six month period and which brought together these community
representatives to review and analyze data, to identify and discuss trends, needs, gaps, and
resources, and to develop recommendations and strategies.
In meeting sessions focusing on prevention, community work group members reviewed and
discussed results of the Healthy Youth Survey and our Pierce County community survey,
prioritized our county risk factors, and recommended target populations and prevention
strategies.
Community work group members also reviewed and discussed data during meeting sessions
examining intervention, treatment, and aftercare issues and services, with the purpose of
identifying trends, needs, and gaps, in order to generate data driven problem statements to lead
to the creation of strategies and recommendations.
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Community Survey
Community involvement and input also was solicited through a community survey we designed
specifically for the Six Year Strategic Plan process. The survey posed questions seeking
respondents’ views on various needs, issues, and services pertaining to the prevention,
intervention, treatment, and aftercare continuum in Pierce County, and included several
sections providing space for open-ended answers. The survey was made available to the public
using the Survey Monkey on-line service. The link to the survey was posted on our Chemical
Dependency Division section of our Pierce County Human Services Department’s Website, and
was disseminated widely through our list serves and those of scores of community meeting and
work groups. In addition, hard copies were made available. Response to the survey was
impressive, with 355 completed surveys submitted.
Data Sources
Key electronic data reports accompany this document.
The sources of data and community information and perception the community work group
reviewed and discussed during the meeting sessions focusing on prevention include:
The Healthy Youth Survey Trend Data
County Community Survey on Survey Monkey
School District 8th Grade Data
Pierce County Profile
The major data reports and sources the community work group utilized for information, and local
community perception, regarding intervention, treatment, and aftercare issues and services
include, but are not limited to, the following:
TARGET Reports, including roll up reports, M reports, performance reports, and the Treatment
Analyzer
Sixth Annual Statewide Patient Satisfaction Survey, August 2006, Washington State
Department of Social and Health Services, Division of Alcohol and Substance Abuse
County Community Survey on Survey Monkey
Household Survey, Pierce County, Washington State Department of Social and Health
Services, Division of Alcohol and Substance Abuse
Pierce County Co-occurring Disorders Core Group Questionnaire
Baseline Community Program and Resource Inventory
Prevention GAP Analysis:
The following graph outlines Pierce County district level 8th grade data including 30 day alcohol use,
risk factor data and 4th graders failing the WASL. It was hoped that this data could provide a means
for identifying the segments of the county with the most needs. However, the use of the data is very
limited because of the small “n” in about half of the school districts.
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2004 School District 8th Grade Data
30 Day
Alcohol use
Academic
Failure
Freshmen
who leave
school
Low
commitment
to school
4 grade
WASL
Poor
family
mgt.
Parental
attitudes
favorable
To use
Favorable
attitudes
toward anti
social bx
Bethel
19.8
48.8
16.61
38.9
60.8
38.4
31.8
47.5
Cloverpark
16.5
54.5
34.05
34.6
68.07
34.5
33.3
47.5
Eatonville*
12.4
39.4
32.41
35.6
54.72
23.1
16.9
29.2
Fife*
16.9
53
10.86
37.9
52
33
29.1
50
Franklin Pierce
23
52.1
22.37
31.7
60.59
39.8
30.9
57.2
Orting*
15
49.3
44.13
51.9
73.53
42.5
40
56.3
Peninsula*
14.7
39.1
10.13
39.8
40.61
40.6
26.2
44.5
Puyallup
15.9
43
21.54
38.1
53.97
34.2
22.7
43.2
Tacoma
21.1
47.3
49.4
37.7
59.91
39.5
30.7
53.7
University Place*
12.6
45.8
16.89
35
43.38
34.7
19.4
45.6
White River*
15.5
52.9
37.47
36.6
54.1
66.7
50
50
Pierce County
17.6
47
29.81
37.7
56.97
36.9
28.3
48.5
State Average
20.88
th
54.78
* N too small for reliable data
Data Report
Prevention
The prevention data report is a collection of data extracted from the Pierce County profile, Pierce
County Healthy Youth Survey (HYS) data and a community survey specifically created for the
Pierce County strategic plan on the Survey Monkey to obtain public perception data. The data is
divided by “county profile,” “public perception” from results of the community survey and “youth
perception” from HYS data. The public and youth perception data is broken up by risk factor
data and perception of use. The public perception survey (Survey Monkey data) also includes
recommendations for target populations and programs and activities.
County Profile
(Compares Counties Like Us)
Academic failure is 2.3 times worse than other counties like us
Low neighborhood attachment (prisoners) Pierce=plus 1.13
A lot more poverty in Pierce County: Pierce has more TANF & unemployment
More arrests for violent crimes +.71
Less arrests for drug law violations -1.02
Sexually transmitted disease cases +.86
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Survey Monkey
(Public Perception)
Based on 300 Community Surveys
The list is based on risk and protective factors and is broken down by how strongly people feel
these issues are in Pierce County. The number at the end of each item corresponds with the
HYS data and where the youth rank these issues and vice versa under the HYS “youth
perception.”
1. Friends who engage in the problem behavior (11)
2. Availability of drugs (4)
3. Family conflict ( )
4. Low commitment to school (3)
5. Poor family management (6)
6. Early initiation of the problem behavior (8)
7. Favorable attitudes toward the problem behavior (10)
8. Family history of substance abuse ()
9. Early academic failure (2 )
10. Lack of community organization/ low neighborhood attachment ()
11. Alienation/rebelliousness (5)
12. Community laws & norms favorable toward drug use (1)
13. Parental attitudes favorable to drug use
Survey Monkey
(Public Perception)
This list identifies what substances are the biggest issues in Pierce County. The question on the
survey asked respondents to identify the top two priorities:
1.
2.
3.
4.
5.
6.
7.
Alcohol 39%
Methamphetamine 37%
Marijuana 8%
Tobacco 8%
Inhalants 4%
Ecstacy 2%
Prescription Drugs 2%
Survey Monkey
(Public Perception)
This list identifies the populations Survey Monkey respondents believe should be targeted for
prevention programs. The list outlines the top four.
Target Population:
1. 6th-9th Graders 87%
2. Parents 72%
3. High School 70%
4. 4th-6th graders 66%
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Survey Monkey
(Public Perception)
This list identifies the categories/activities the Survey Monkey respondents think should be
targeted for prevention programs. The list outlines the top four.
Activities/Strategies
1. School based substance abuse education 64%
2. Mentoring programs 59%
3. Peer to peer prevention education 54%
4. School Prevention Teams 52%
Healthy Youth Survey
(Youth Perception)
The number preceding each item corresponds with the “public perception” respondents and
where the public rank risk/protective factors compared to where youth rate these items
*The number indicated at the end of each item is based on a combined average of the grades
1. (12) Laws & norms favorable to drug use 46.5
2. (9) Academic failure 44.75
3. (4) Low commitment to school 42.25
4. (2) Perceived availability 38.0
5. (11) Favorable attitudes/Antisocial behavior 31.6
6. (5) Poor family management 31.0
7. ( ) Early initiation of drugs 29.6
8. (6) Early initiation of the problem behavior
9. ( ) Perception of harm
10. (7) Favorable attitudes toward drug use
11. (1) Friends use of drugs
12. Intention to use
Healthy Youth Survey
(Combined average 30 day use)
This list takes HYS data and averages 6th, 8th, 10th and 12th grade 30 day usage. By averaging
the data we can assume that 18.5% of youth between 6th-12th grades have tried alcohol in the
last 30 days and so on.
1.
2.
3.
4.
30 Day alcohol use 18.45
30 Day marijuana use 9.5
30 Day cigarette use 8.75
30 Day illegal drug use 4.1
Comments on – and Explanation of Trends in – Healthy Youth Survey Data
*Six year trend analysis of Risk Factor data is attached to this document as Attachment I (Pierce
County Trend Data).
Analysis of Prevention Trend Data:
Tobacco continues its downward trend over the past 4 years for all grades.
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Chew tobacco had been declining over the last 4 years. However there was a 2% increase in the
12th grade in 2004.
30 day alcohol use shows a steady decline in the 10th and 12th grades. However, 6th and 8th
grades have leveled off.
Marijuana has shown a steady decrease in all grades during the past six years.
Methamphetamine Use is in decline for the past two years. Between 2% to 3% reported use.
Ecstasy use is in small decline in all grades during the past two years.
Youth that seriously considered Suicide continues to climb.
surpassed all grades during the past two years.
6th graders reached 21% and
Laws & Norms Favorable to Drug Use continues to decline. Approximately a 10% decrease over
the past six years.
Perceived Availability of Drugs has been in decline for the past six years. The only exception is a
10% increase in the 10th grade during the past two years.
Academic Failure continues to climb in all grades. Between 40% & 50% of youth report they are
failing.
Low Commitment to School continues an upward climb. Generally between 35% and 50% of
students report a low commitment to school.
Favorable Attitudes Toward Drug Use continues to decline over the past six years.
Perceived Risk of Use has show a small decline over the past two years in all grades.
Early Initiation of Drugs has shown a steady decline in all grades over the past six years.
Early Initiation of Problem Behavior has held steady at between 30% & 40% for the past six
years.
Favorable Attitudes/Antisocial Behavior has increased in the 12th grade over the past four years.
However, it is showing a slight decrease in the 8th & 10th grades during the same period of time.
Friends Who Use Drugs has show a steady decline over the past six years in 8th, 10th, & 12th
grades. (No stats on 6th graders).
Intentions to Use has held steady during the past two years. However, 8th graders report a 17%
higher intention to use that the 10th & 12th graders.
Poor Family Management shows a slight improvement. However 40% of youth are reporting poor
Family Management.
Assessment of Intervention, Treatment, and Aftercare Service Needs
During many meeting sessions examining intervention, treatment, and aftercare issues and
services, community work group members reviewed, analyzed, and discussed Pierce County
client outpatient treatment data and other relevant data; identified trends, needs, and gaps;
generated data driven problem statements; and developed recommendations and strategies.
Admissions Data Trends
Overall outpatient treatment admissions in Pierce County grew dramatically over the past several
years. A review of TARGET Treatment Analyzer data of admissions levels over time shows
2,388 clients admitted during the period January 2006 through June 2006, compared to 1,550
clients admitted during January 2000 through June 2000, reflecting an increase of 54%.
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Assessment of Service Needs for Selected Populations
A DASA REQUIRED SECTION
Persons with Disabilities
By far the disability most frequently identified by adult clients in Pierce County over the past
three years is mental health, with mobility and unidentified “other” as the next prevalent choices,
although these are approximately half the numbers of mental health levels.
Mental Health
According to recent TARGET data:
•
Mental health is the most frequently identified disability of adults admitted into outpatient
treatment, with those in need of mental health services at the time of admission at 15%
for all but one program.
•
The level of mental health identified as a disability by adults entering Opiate Substitution
Treatment is the highest, at 30% to 50%.
•
The rate of mental health identified as a disability by women admitted into pregnant,
postpartum, and parenting women’s outpatient treatment is 15% to 20%. Although they
have the highest level receiving mental health services at admit, they also have the
highest rate, at 30%, in need of mental health services at the time of admission.
Recommendations
Based on their analyses and discussions of needs and trends, members of the community work
group developed the following recommendations, which were approved by the Pierce County
Chemical Dependency Advisory Board:
•
Link clients with mental health needs to appropriate mental health services
•
Emphasize mental health training for Chemical Dependency Professionals (CDPs)
•
Award extra points during the Request For Proposals process to applicants that
use the full Global Assessment of Individual Needs (GAIN)
•
Monitor the state’s use of GAIN-Short Screen (SS) and full GAIN information
•
Explore dual chemical dependency and mental health training and certification of
clinicians at the state Department of Health level
Co-occurring Disorders Projects
To enhance services to clients in our county with co-occurring chemical dependency and mental
health disorders, the Pierce County Chemical Dependency Division will explore initiating new
projects and will continue the following special projects:
A Group Care Enhancement Project, begun on January 1, 2007 at Western State Hospital,
provides an outstationed CDP, who is employed by Reflections Recovery and Learning Center,
a contracted outpatient chemical dependency treatment provider, to work with patients with cooccurring chemical dependency and psychiatric disorders to determine level of care, provide
chemical dependency treatment, and facilitate subsequent chemical dependency outpatient
treatment in the community.
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Pierce County and King County planned and operate the Bi-County Co-Occurring Residential
Treatment Center, a co-occurring disorders residential treatment facility for Criminal Justice
Treatment Account (CJTA) clients, located in Kent, Washington. Pierce County has had an
exceptional treatment completion rate for those entering the facility, with continued success
when they return to their outpatient care provider. Currently all 6 Pierce County contracted beds
are occupied and a waiting list has been started.
Within the Pierce County Human Services Department, staff of the Chemical Dependency
Division and the Mental Health Division collaborated on the Secure Detox pilot, writing the
proposal and designing the services, and continue to work together, developing a stronger
integration of the two systems and enhanced services to clients.
A Pierce County Chemical Dependency Division staff member who was trained to administer
and use the full GAIN and the GAIN–Short Screen (SS) became a short screen trainer and has
provided multiple GAIN-SS trainings to, among others, outpatient chemical dependency
treatment providers, inpatient chemical dependency treatment facilities, and audience members
at the Washington Institute’s Training for Co-occurring Disorders Among Older Adults.
Youth
According to TARGET Treatment Analyzer data of Pierce County youth outpatient treatment,
the average number of annual admissions for the period January 2003 through June 2006 is
436 youth. Recent TARGET data indicate a decrease in youth admits, although currently the
number is increasing.
TARGET data for youth in publicly funded outpatient chemical dependency treatment in Pierce
County appear fairly constant over the last few years. Analysis revealed several significant
trends:
•
Youth admissions decreased.
•
Marijuana continues to be the primary substance used, followed by alcohol, for females
and males, across ethnic groups.
•
Methamphetamine is claimed as their primary substance by very few youth, and those
are white and mostly female.
•
The overall youth treatment completion rate in Pierce County is 40% to 45%, with
Hispanics as a group having a higher rate, and African Americans as a group having the
lowest rate.
•
African American youth as a group experience the lowest treatment completion rate.
Recommendations
Based on their analyses and discussions of needs and trends, members of the community work
group developed the following recommendations, which were approved by the Pierce County
Chemical Dependency Advisory Board:
•
Develop integrated approaches to working with youth, who often have multiple,
complex needs
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•
Collaborate with other systems that serve youth
•
Link youth to specialized programs and community agencies working with youth,
particularly those at-risk, (such as several City of Tacoma programs and the
Tacoma Urban League’s Male to Male Mentoring Program), that provide support
for children and adolescents
•
Promote training of CDPs to strengthen skills in working with youth
•
Recruit counselors and other experienced staff from relevant types of youth
programs who have expertise in working with youth
•
Emphasize culturally sensitive and competent treatment services, and continue
specialized programs for ethnic minority populations, particularly for African
American youth
•
Research payment system changes to cover services that currently are unallowed
Youth Projects
To strengthen services to youth in our county, the Pierce County Chemical Dependency Division
will explore launching new projects and will continue the following special projects:
Juvenile Drug Court Services contracted and operated by Pierce County Juvenile Court
Specialized services to ethnic minority youth, particularly African American, who are involved, or at
risk of becoming involved, in the juvenile justice system, contracted and operated by Community
Counseling Institute, a youth outpatient chemical dependency treatment agency. In Pierce County,
and across Washington State, disproportionate confinement of minority youth in the Juvenile
Rehabilitation Administration (JRA) is a serious problem. Currently 44% of the young people
confined in Washington State’s JRA are from minority communities, in contrast to Washington’s
juvenile population, in which minority youth account for 24% of youth in the state. In addition,
Pierce County Chemical Dependency Division staff, along with staff from Department of
Corrections, JRA, outpatient chemical dependency treatment providers, and other interested
stakeholders, participate in a monthly community meeting addressing disproportionate minority
contact and disparity in juvenile sentencing, to reduce the number of minority youth being
contacted or confined by the justice system.
A youth work group of youth chemical dependency outpatient treatment providers, educational
service district representatives, school prevention/interventionists, prevention service providers,
youth mental health professionals, and other interested stakeholders, organized to improve and
develop a more successful service continuum for Pierce County adolescents, encompassing
prevention, intervention, treatment, and aftercare services.
A youth outreach program at Mary Bridge Hospital in Tacoma, contracted and operated by the
Metropolitan Development Council, a chemical dependency treatment agency, that provides
CDPs who are available to youth and their families to perform screening, brief intervention, and
referral to prevention and treatment services in Pierce County.
Pregnant, Postpartum, and Parenting Women
The level of admissions into the specialized pregnant, postpartum, and parenting women’s
outpatient treatment program in Pierce County fluctuated between January 2000 through June
2006. Several years during this time period, the total number of women admitted annually was
approximately 240, according to TARGET Treatment Analyzer data.
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Significant trends include the following:
•
The rate of mental health identified as a disability by women admitted into pregnant,
postpartum, and parenting women’s outpatient treatment is 15% to 20%. Although they
have the highest level receiving mental health services at admit, they also have the
highest rate, at 30%, in need of mental health services at the time of admission.
•
Methamphetamine is the primary substance, at a rate of 35% to 40%, used by females
before entering pregnant, postpartum, and parenting women’s outpatient treatment, with
alcohol as the second highest.
Parents With Children
Outpatient treatment admissions in Pierce County of parents with children increased steadily
and significantly over the past several years. An examination of TARGET Treatment Analyzer
data of admissions levels over time shows 849 parents with children admitted during the period
January 2006 through June 2006, compared to 560 parents with children admitted during the
period January 2000 through June 2000, an increase of 52%.
TANF/WorkFirst Families
The Pierce County Chemical Dependency Division continues to work with treatment providers,
Department of Social and Health Services (DSHS) Region 5 representatives, and Community
Services Offices (CSO) staff to facilitate referrals, assessments, and treatment for adult
TANF/WorkFirst parents with substance abuse and dependency issues. Three (3) TANF
Outstationed CDPs, who are employees of Pierce County Alliance, a contracted chemical
dependency outpatient treatment agency, work at the CSOs in Pierce County.
DCFS Families
Two (2) CDPs employed by the Pierce County Chemical Dependency Division have been
outstationed at the DSHS Region 5 Division of Children and Family Services (DCFS) for nearly
a year. They have worked with contracted chemical dependency outpatient treatment agencies
and DCFS representatives to develop and implement protocols and procedures for expanded
assessments for individuals referred by DCFS. They work collaboratively with DCFS social
workers to facilitate referrals, which has resulted in more DCFS clients being referred, showing
up for their assessments scheduled by the CDPs, and entering treatment.
Meetings between DCFS and Pierce County Chemical Dependency Division staff are held to
monitor the success of the outstationed CDP positions and to improve the service delivery
system. The CDPs provide trainings on substance abuse topics requested by DCFS staff, and
are available for case consultations and family meetings. They work to strengthen relationships
and communication to improve referral, assessment, and treatment processes for DCFS clients.
Elderly
According to TARGET client demographics reports and the Treatment Analyzer, the number of
Pierce County elders, 65 years of age and above, admitted into outpatient treatment has risen
since a few years ago, and during the period January 2006 through December 2006, 9 elderly
individuals were admitted into outpatient treatment.
During the same time frame, the level of elderly individuals assessed for chemical dependency
grew dramatically. In the year 2003, 4 elderly individuals were assessed, compared to the year
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2005, during which 25 elders received assessments.
To increase services to elderly individuals in our county, the Pierce County Chemical
Dependency Division will continue to contract for a Group Care Enhancement Project for
disabled and elderly individuals, operated by Reflections Recovery and Learning Center, a
contracted chemical dependency outpatient treatment agency. A CDP employed by the agency
works with eligible disabled and elderly individuals to determine level of care, provide chemical
dependency treatment, and facilitate linkages to services in the community.
Gay, Lesbian, Bisexual, Transgender, and Questioning Persons
Over the past four years, the number of clients identifying as Gay, Lesbian, Bisexual,
Transgender, and Questioning (GLBTQ) admitted into outpatient treatment in Pierce County
ranged between 34 and 56 persons each year, according to the TARGET Treatment Analyzer.
During the period January 2002 through June 2002, the admissions level totaled 38 GLBTQ
individuals, while the January 2006 through June 2006 admissions level included 49 GLBTQ
clients. Each year, from January 2002 through June 2006, GLBTQ clients represented
approximately 2% of outpatient treatment admissions in Pierce County.
By contract, our contract agencies are required to provide culturally sensitive and competent
services to clients, which includes individuals in the GLBTQ communities.
IV Drug Users
Admissions into outpatient treatment in Pierce County of individuals who ever injected rose
between January 2002 and June 2006. The level of injecting drug users admitted during the
period January 2000 through December 2000 numbered 770, compared to a total during
January 2005 through December 2005 of 1,075, which is the highest figure for Pierce County
recorded in the TARGET Treatment Analyzer, and represents approximately 23% of the overall
outpatient treatment admissions during this period.
Intravenous Method of Use
• Over the past three years, intravenous method of use of their primary substance by
individuals entering opiate substitution outpatient treatment has remained constant at
60% to 90%.
•
During the same period, intravenous method of use of their primary substance has
increased slightly for females and males, predominantly white, admitted into adult (at a
rate of 8%) and ADATSA (at a rate of 15%) outpatient treatment.
Our contract agencies who work with IV drug users address their clients’ health concerns,
including needle use and heightened medical issues such as abscesses and infections.
Adult Data Trends
TARGET data for adults in publicly funded outpatient chemical dependency treatment in Pierce
County appear fairly constant over the last three years. Analysis revealed several key trends:
Primary Substance
Alcohol
•
Although remaining the primary substance used by both females and males prior to
admission into adult and ADATSA outpatient treatment (along with methamphetamine
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for ADATSA females), the rate, in numbers and percentages (20% to 30%), of alcohol as
the primary substance of use has decreased somewhat, although dropping only slightly
for Hispanics and Native Americans, who exhibit the steadiest, highest use.
Methamphetamine
•
Methamphetamine is the primary substance, at a rate of 35% to 40%, used by females
before entering pregnant, postpartum, and parenting women’s outpatient treatment, with
alcohol as the second highest.
•
Methamphetamine has increased over the past three years as a primary substance used
by both males and females, predominantly white, prior to admission into adult or
ADATSA outpatient treatment.
Marijuana
•
Marijuana is the third highest primary substance of use by individuals, especially males,
prior to admit into adult outpatient treatment, and by females entering pregnant,
postpartum, and parenting women’s outpatient treatment, and is the highest secondary
substance of use for both females and males prior to admission into these and ADATSA
outpatient treatment programs.
Cocaine
•
Cocaine as the primary substance of use prior to entering outpatient treatment is at 10%
to 12%, except for ADATSA clients, for whom cocaine is the third highest primary
substance of use prior to admit, at a rate of 15% to 18%. Cocaine appears to be the
primary substance used by African Americans, both females and males.
Heroin
•
Heroin remains the primary substance of use of individuals prior to entering opiate
substitution outpatient treatment, at a rate of 60% to 90%, and is used at a higher rate by
persons, predominantly white males, entering ADATSA outpatient treatment compared
to adult outpatient treatment.
Prescribed Opiate Substitution Drugs
•
A new trend is an increase in prescribed opiate substitution drugs as the primary
substance of use by a percentage of individuals entering opiate substitution outpatient
treatment.
Trends Across Ethnic Groups
•
Whites, both males and females, have shown increased use of methamphetamine as a
primary substance prior to admission into adult and ADATSA outpatient treatment.
•
Of those who inject their primary substance, the highest percentage has been whites.
•
For African-Americans, both females and males, cocaine has appeared to be the
primary substance of use.
•
Hispanics, both males and females, have exhibited a steady, fairly high use of alcohol as
the primary substance of use.
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•
Native Americans, both males and females, also have shown a steady, fairly high use of
alcohol as the primary substance of use.
•
Asian-Pacific Islanders have displayed an increase in the use of marijuana and
methamphetamine.
Treatment Completion Trends
•
In adult, ADATSA, and pregnant, postpartum, and parenting women’s outpatient
treatment over the last three years, completion rates have been highest for those who
indicated at admission a primary substance of alcohol, marijuana, or methamphetamine.
•
Those with cocaine as their primary substance have shown the lowest treatment
completion rates.
•
Hispanics and Native Americans have tended to demonstrate high treatment completion
levels.
•
African Americans have experienced lower treatment completion rates.
Recommendations
Based on their analyses and discussions of needs and trends, members of the community work
group developed the following recommendations, which were approved by the Pierce County
Chemical Dependency Advisory Board:
•
Utilize proven methodologies to effectively address stimulant use, particularly
cocaine and methamphetamine
•
Adopt proactive approaches to prevent methamphetamine use
•
Emphasize culturally sensitive and competent treatment services, and continue
specialized programs for ethnic minority populations, particularly African
Americans, who experience a low treatment completion rate
•
Link ethnic minority clients, particularly African Americans, to appropriate
community connections and supports
•
Facilitate the entry of ethnic minority individuals, particularly African Americans,
into the chemical dependency treatment field as a career choice
Treatment Expansion Assessment of Expanded Services for SSI, GA-U, TANF,
and Youth
A DASA REQUIRED SECTION
Treatment expansion funds awarded to Pierce County for the 2005-2007 biennium are being
fully expended and have allowed the Pierce County Chemical Dependency Division to
significantly increase capacity to provide outpatient chemical dependency treatment services to
eligible TANF, SSI, GA-U, and youth clients. A review of TARGET data for the year 2006
indicates the level of adults served reached approximately 75% of our projected goal, and the
number of youth served was at 80% of our goal.
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Pierce County
PART II
Mobilization and Capacity
Building
2007
Persons and Organizations Involved in the Planning Process 1
A DASA REQUIRED SECTION
A broad range of individuals took part in our strategic planning process, representing various
organizations and sectors of the community, including, but not limited to, ethnic, racial, and Gay,
Lesbian, Bisexual, Transgender, and Questioning communities, and the fields of health care,
public health, social services, government, community mobilization, education, women’s
programs, juvenile justice, mental health care, and children and youth programs.
Although of differing backgrounds, experiences, and perspectives, these key stakeholders share
a strong interest in the substance abuse continuum of care in Pierce County. They actively
participated in a regularly held community work group, convened over a six month period, which
brought them together to review and analyze data, to identify and discuss trends and service
needs, gaps, and resources, and to develop recommendations and strategies.
The following participated in our strategic planning process:
City of Tacoma, Human Rights and Human Services Department: Debbie Bergthold
Community Health Care: David Flentge, Chief Executive Officer
Clover Park Technical College: Chandra Miller-Starks
Girl Scouts of America: Gloria Morehouse, Outreach Coordinator
Greater Lakes Mental Healthcare: Joseph Rinehart, AERS Clinical Manager
Metropolitan Development Council, Chemical Abuse Resources and Education: Colin
DeForrest
MultiCare Health System, Underage Drinking and Trauma Prevention: Carolynn Morris,
Coordinator
Pierce County Juvenile Court: Robert Womack
Pierce County Human Services Department, Chemical Dependency Advisory Board
Members: Yvonne Barker, Dolores Behr, Marguerite Brown, Kelly Leasure, Emily Happy
Miller, Bill Oltman, Rebecca Roger, and Amar Sapalo
Pierce County Human Services Department, Secure Detox Unit: Robert Hamilton, Direct
Services Supervisor
Pierce County Human Services Department, Mental Health Division/Regional Support
Network: Mark Nelson, Children’s Care Manager
Puget Sound Educational Service District, School Family Community Partnerships:
Frausto, Director
1
Liz
This is very similar to the Community Mobilization requirement for this section.
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Puget Sound Educational Service District: Kelli Hoekstra, Program Manager
Safe Streets of Tacoma: Michelle Galaz, Program Development Manager
Tacoma-Pierce County DUI Task Force: Gloria Averill, Coordinator
Tacoma-Pierce County Health Department, Prevention Priorities: Dan Pritchard
Tacoma Public School District: Kathleen Dommer
University of Washington, Parent-Child Assistance Program, Tacoma:
Clinical Director
Julie Youngblood,
Washington State Department of Social and Health Services, Region 5, Division of Alcohol
and Substance Abuse: Miae Christofferson, Prevention Manager, and Earl Long, Regional
Administrator
Washington State Department of Social and Health Services, Region 5, Division of Children
and Family Services: Robert Palmer, Child Protective Services Program Manager
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Pierce County
PART III
Planning and
Goal Formation
2007
Goals and Expanded Services: The Treatment Expansion Population
A DASA REQUIRED SECTION
Pierce County anticipates achieving increased client service levels with treatment expansion
funding, and several activities are in place to accomplish our goals. To expand and enhance
services to eligible youth and SSI, GA-U, and TANF adults in our county, the Pierce County
Chemical Dependency Division will explore new initiatives and continue successful projects,
such as the following:
SSI and GA-U Adults
A Group Care Enhancement Project for disabled and elderly individuals, contracted and
operated by Reflections Recovery and Learning Center, a chemical dependency outpatient
treatment agency, that provides a CDP who works with eligible disabled and elderly individuals
to determine level of care, provide chemical dependency treatment, and facilitate linkages to
services in the community.
A CDP position with the Metropolitan Development Council, a contracted chemical dependency
outpatient treatment agency, for the Housing First Project, which serves eligible homeless
individuals.
TANF Adults
Work with treatment providers, DSHS Region 5 representatives, and CSO staff to facilitate
referrals, assessments, and treatment for adult TANF/WorkFirst parents with substance abuse
and dependency issues. Three (3) TANF Outstationed CDPs, who are employees of Pierce
County Alliance, a contracted chemical dependency outpatient treatment agency, work at the
CSOs in Pierce County.
Youth
A youth work group of youth chemical dependency outpatient treatment providers, educational
service district representatives, school prevention/interventionists, prevention service providers,
youth mental health professionals, and other interested stakeholders, organized to increase
client access and develop a more successful service continuum for Pierce County adolescents,
encompassing prevention, intervention, treatment, and aftercare services.
A youth outreach program at Mary Bridge Hospital in Tacoma, contracted and operated by
Metropolitan Development Council, a chemical dependency treatment agency, that provides
CDPs who are available to youth and their families to perform screening, brief intervention, and
referral to prevention and treatment services in Pierce County.
The CDPs outstationed at DSHS Region 5 DCFS work to facilitate chemical dependency
referrals, assessments, and treatment not only for adults referred by DCFS, but also for youth
with substance abuse and dependency issues.
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Requirements Specific to the Criminal Justice Section
A DASA REQUIRED SECTION
Pierce County Criminal Justice Treatment Account Plan
The Pierce County CJTA program will continue the stand-alone outpatient chemical
dependency treatment program that leverages the in-place procedures of those programs
already working directly with the court and the offender population, i.e., Breaking the Cycle
(BTC) and drug court programs. This would entail the court-ordering of all potential clients to the
BTC program which initiates the court reporting process. Every person so ordered would
receive a comprehensive chemical dependency assessment according to ASAM criteria and
DASA standards. Based on the assessed needs of the individual, he or she will be directed to
the dedicated treatment program proposed, or, where appropriate, to alternative services or
ancillary services, such as inpatient treatment, detox, child care, and transportation.
A major component of this proposal is the provision of a stand-alone treatment capacity that can
serve the population with a dedicated outpatient treatment service. This would incorporate
thrice-weekly group treatment sessions, monthly individual counseling sessions with a chemical
dependency counselor, and up to five random urinalyses per month.
Another key aspect of these services is the means for the court to intensively monitor the
offenders while they are in a pre-trial status. Under court order to the BTC pre-trial program, the
offenders will have near-daily contact with the CJTA counselors who will monitor the entrants’
progress and compliance with program requirements and provide status reports and related
treatment recommendations to the court. At sentencing, the judge would have a clear indication
of the individual’s demonstrated attitudes toward treatment and additional considerations that
may relate to the individual’s final sentencing or conditions of sentence.
As previously indicated, the program will also be an excellent source for additional candidates
for the drug court program. Persons, who were not previously identified as drug court
candidates could be further monitored over the course of CJTA treatment and, based on their
progress, are recognized as strong candidates for rehabilitation. If they otherwise meet drug
court criteria, they could then be referred to the drug court for possible enrollment. Having
already demonstrated positive steps towards recovery, these persons would be excellent
candidates for longer retention in the drug court program and with better prospects for a positive
outcome, i.e., successful graduation.
The total treatment capacity would be up to a maximum of 1400 clients during the 2007-09
biennium. PCA anticipates that an average of two or more additional persons per month could be
referred to the drug court program. This would, in turn, open up slots for additional CJTA clients.
The estimated numbers of offenders with an addiction problem against whom charges are filed by
a prosecuting attorney in Washington State are 4,888 a year.
The estimated numbers of persons with a substance abuse problem that, if not treated would result
in addiction, against whom charges are filed by a prosecuting attorney in Washington State are
1833 a year (15% of 12,219 of total offenders for non-traffic misdemeanors and felony filings).
Estimated number of nonviolent offenders for a drug court/ CJTA program are 1,300.
The county’s role in the judicial system in the delivery of PITA services is to provide specialized
inpatient services for co-occurring CJTA clients and others who are judiciously supervised through
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our Bicorp program. In addition, we hope to continue ATR services and offer those ancillary
services such as housing, medical, transportation, etc. to clients, supporting them in their recovery.
We have the ability to provide a best practice parenting curriculum to parents who have either
attended treatment or who have an adolescent in treatment. If any clients involved in the judicial
system are chronically homeless we can provide housing through the Housing First Project and
offer other social services to them if wanted.
The residential need for offenders is being met at this time. Through CJTA funding, Innovated
funding, and county general fund. The number of clients assessed as needing residential
treatment is 70 a year and at this time we have been able to provide treatment on demand.
Panel members when contacted by the Treatment Provider agreed, since there were no significant
changes in this plan, the original signature page would still suffice.
Pierce County 2007-2009 Innovated CJTA Plan
Pierce County and King County partnered in March, 2006 and opened the doors to the Co-ed
Chemical Dependency Co-occurring Disorders Residential Treatment Program for Pierce
County and King County CJTA clients. This project is innovated, regional, and a best practice,
exceeding the requirements of the Legislative intent. The program serves individuals with an
addiction or a substance abuse problem, against whom a prosecuting attorney in Washington
State has filed charges, or who are non-violent offenders within a drug court program as defined
in RCW 70.96A.055 and RCW 2.28.170. Individuals using this service have a co-occurring
substance and mental disorder, an emergent medical condition and or a history of multiple
admissions and subsequent premature discharges from other residential treatment programs.
Complex and very challenging clients, who are chemically addicted, criminally involved and
mentally ill need a more intensive, higher skill level of treatment professionals and more
intensive integrated treatment to succeed in gaining recovery. It is believed that these very
challenging clients can benefit from an integrated residential treatment approach that
emphasizes addiction rehabilitation and mental health symptom stabilization. This program
combines continued abstinence from alcohol and drugs after detoxification, stabilization of
significant health issues and complex medication regimens, rehabilitation addiction treatment,
and mental health treatment or treatment linkages in a safe and medically/psychiatric monitored
environment. Individualized treatment is an essential part of the program, as is a review of
provisional diagnoses, review of current and past medication regimens, addictions treatment
and mental health symptom stabilization.
Pierce and King County contract this service out to Pioneer Human services. Staffing for this
integrated co-occurring treatment program, where in addition to the presenting substance abuse
issues, both mental health and medical issues may present, require sufficient and qualified staff
to safely provide and maintain a therapeutic environment. Higher staff to patient ratio and dually
qualified staff assure services are delivered to maintain both patient and staff safety, which
Pioneer has done successfully.
In addition, managing medications, securing pharmacy services and services to assist in
managing medications are necessary. The contract requires accommodations to provide for
medication management and storage, and for the delivery of complex medication regimens.
Additional use of medical staff including contracted staff, and the qualifications of medical staff
are increased to accommodate a client population that could present challenges needing a
higher level of medical expertise.
Psychiatric evaluations and psychiatric medication
management, the two primary services that the psychiatrist performs, are done with increased
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frequency. The psychiatrist providing on-call availability is certified in Addictions, able to
prescribe buprenorphine, and provides on-site services.
Residential chemical dependency treatment programs are encouraged to provide opiate
substitute treatment (OST) dosing for clients currently receiving treatment. In many cases this
is not a realistic option due to lack of proximity to an OST program, funding to allow for this
service, and transporting doses out of Pierce County. If this should change then Pierce will
provide opiate substitution services to those clients needing it when they are receiving treatment
at the COD residential facility.
Linkages to ongoing outpatient mental health services and the provision of mental health
services as part of the stabilization process remains a key component of the program. Linkages
to Pierce County funded RSN mental health providers have been established. Cost for
outpatient mental health services are borne by the King County RSN or the Pierce County RSN
for those eligible for enrollment in the RSN. For clients not eligible for RSN services, mental
health services can be provided by ATR funding if appropriate and available.
Capacity – list the number of offenders to be served by each Fiscal Year (FY 07 and FY 09):
FY 07 – 30 clients (based on an average stay of 60 days at the FY 06 rate of $232.48)
FY 09 – 30 clients (based on an average stay of 60 days at the FY 06 rate of $232.48)
Because of limited funding for this project Pierce County will continue to serve primarily
Medicaid clients. If funding is increased the number of clients served will also increase.
Goals and objectives:
1.
To develop stability in the client’s basic life conditions;
2.
To provide clear assessments and evaluations of any provisional diagnoses, diagnoses,
or ongoing medical conditions including an integrated, comprehensive treatment plan for
recovery;
3.
To engage the client in necessary chemical dependency treatment, necessary mental
health treatment, necessary medical treatment, and meaningful activities and adjunctive
services that keep the client engaged in services, while in both residential treatment and
outpatient treatment;
4.
To assist the client with enrollment for entitlements and other available funding for
treatment and support services in the community.
5.
Ensure that all residential staff are trained and utilizing the GAIN.
Outcomes and monitoring activities include:
1.
Engagement and retention in treatment monitored through census logs and tracking of
clients through to discharge;
2.
Linkage to ongoing treatment and support services monitored through required reports
and review of client case files;
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3.
Placement in transitional or semi-permanent/permanent housing monitored through
required reports and review of client case files;
4.
Decreased substance abuse monitored through required reports and review of client
case files; and
5.
Increased involvement in meaningful substance-free activities as identified by the client
monitored through required reports and review of client case files.
In addition to the clinical goals, Pierce County will maximize resources by utilizing Title XIX,
Medicaid funding. The facility size of 16 beds meets federal exclusion criteria.
Pierce County uses both a drug court and CJTA outpatient treatment model. This model allows
us to treat clients with referrals coming from outpatient treatment providers, RSN agencies,
Secure Detox and Crisis Triage.
Prevention Goals 2
A DASA REQUIRED SECTION
Prevention goals by program, goal and objective:
Orting-Mentoring: Big Bros/Big Sis
Goal: Decrease the risk associated with favorable attitudes towards the problem behavior
Objective: Decrease attitudes that support the use of alcohol and other substances in middle
school students in Orting
Orting-Tutoring
Goal: Decrease the risk associated with academic failure beginning in late elementary school
Objective: Improve academic performance among elementary school students in Orting
Parent Involvement Coordinator Program: Guiding Good Choices, Love and Logic, Family
Night Out, Strengthening Families
Goal: Decrease the risk associated with family management problem
Objective: Improve attitudes about family management skills (i.e., use of different forms of
punishment and monitoring approaches) with parents/caregivers in Pierce County
POD Project: Great Body Shop, Life Skills Training, Too Good for Drugs
Goal: Decrease the risk associated with favorable attitudes toward the problem behavior
Objective: Decrease attitudes that support the use of alcohol and other substances with youth
(under age 18) in Pierce County
Samoan Family Support Services-Strengthening Multi-Ethnic Families
Goal: Decrease the risk associated with family management problems
Objective: Improve attitudes about family management skills (i.e., use of different forms of
punishment and discipline and monitoring approaches) in adults within adults in the Samoan
community
2
This is very similar to the Community Mobilization requirement for this section.
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Samoan Family Support Services- Tutoring
Goals: Decrease the risk associated with academic failure beginning late elementary
Objective: Improve academic performance in elementary school students in South Tacoma
Samoan Family Support Services- Life Skills Training
Goal: Decrease the risk associated with favorable attitudes toward the problem behavior
Objective: Decrease attitudes that support the use of alcohol and other substances with youth
(under age) in the Samoan community.
Foundations for Multicultural Solution: Guiding Good Choices
Goal: Decrease the risk associated with family management problems
Objective: Increase use of Family Management Skills (i.e., discipline strategies, techniques for
setting limits, approaches to monitoring youth behaviors.
Foundations-Tutoring
Goal: Decrease the risk associated with academic failure beginning late elementary
Objective: Improve academic performance in elementary school students in East Tacoma
ICSC-Life Skills Training Program
Goal: Decrease the risk associated with favorable attitudes toward the problem behavior
Objective: Decrease attitudes that support the use of alcohol and other substances with youth
(under age) in the SE Asian Community
ICSC-Strengthening Multi-ethnic Families
Goal: Decrease the risk with family management problems
Objective: Improve attitudes about family management skills (i.e., use of different forms of
punishment and discipline and monitoring approaches) in adults within adults in the SE Asian
Community
LEEAP-Sheriff
Goal: Decrease the risk associated with favorable attitudes toward the problem behavior
Objective: Decrease attitudes that support the use of alcohol and other substances in youth
(under 18) in South Pierce Co.
List of Priority Risk and Protective Factors
The following lists were developed as a result of the recommendations of the Pierce County
Prevention strategic planning work group. Data was extracted from the Pierce County Healthy
Youth Survey data and a community survey specifically created for the Pierce County strategic
plan on the Survey Monkey to obtain public perception data. The data was presented to the
internal and external work groups. The external groups met on several occasions, explored and
analyzed the data, reviewed current programs and community needs, and made
recommendations for risk/protective factors, programs, activities and target populations.
In no particular order:
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Risk Factor
Protective Factor
Academic Failure
Bonding to School
Skills
Poor Family Management
Bonding to Family
Skills
Healthy Beliefs/Clear Standards
Favorable Attitudes Toward ATOD
Skills
Friends who Use
Skills
Community Law and Norms
Favorable to Drug Use
Bonding to Community
Perceived Availability
Skills
Health Beliefs/Clear Standards
Community Disorganization
Bonding to Community
Goals: Increases or Decreases in Risk/Protective Factors
See Prevention Goals.
Objectives, Identifying Target Population
This list identifies the specific population recommendations brought forward from the strategic
planning work group and identified as the programs in Pierce County needing prevention
services.
K-3rd Grade Students in Pierce County schools
4th-6th Grade
Hard to reach, geographically isolated, ethnic minorities and under served populations
Family/Parent Programs
School ATOD Education
Dates for Accomplishing Goals
The Pierce County Prevention Program plans to extend the current provider contracts for the
first half of the 2007-09 biennium. This, of course, will depend on program performance. We
anticipate issuing an RFP in January 2008 for prevention services based on the risk factors and
target population that are establish in this document. Our target date for accomplishing our
current goals will be June 30, 2008. However, our target date for accomplishing our goals for
the second half of the biennium will be established in May of 2008.
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Prevention Programs: Descriptions and Implementation Plans
A DASA REQUIRED SECTION
It is the intention of the Pierce County Prevention Program to extend our contracts with current
providers, who are in contract compliance, to cover the period of July 1, 2007 to June 30, 2008.
Based on the contents of our strategic plan, we are planning to issue a Prevention RFP for the
July 1, 2008 to June 30, 2009 time period. Based on conducting contract extensions for 2007 to
2008, the following providers and services would be funded:
Foundation for Multicultural Solutions.
Guiding Good Choices
Tutoring
Indochinese Cultural Services Center
Life Skill Training
Strengthening Multi-Ethnic Families
Orting School District.
Mentoring
Tutoring
Pierce County Sheriff’s Department.
Mentoring
Samoan Family Support Services
Guiding Good Choices
Life Skills Training
Tutoring
Sumner School District.
Guiding Good Choices
Strengthening Families
Great Body Shop
Life Skills Training
To Good For Drugs
Underage Drinking Initiative
Parent Involvement Coordinators
School Prevention Teams
County Wide Youth Conference
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Pierce County
PART IV
Evaluation
2007
Evaluation: Monitoring Substance Abuse Services
Purpose
The purpose of this section will be to outline a series of evaluation activities designed to monitor
the access, utilization and outcomes of substance abuse services. To ensure efficiency and
some degree of standardization with other counties, the activities outlined here will use readily
available tools and data. Access, utilization and outcomes are three critical concepts for all
publicly funded health services and all three must be monitored for several reasons. First, in
times of tight budgets all public programs are under scrutiny and must be able to demonstrate
that they function according to plan and produce desired results. Second, programs are typically
designed to serve certain target populations, and it must be demonstrated that members of
those populations are indeed being served. Finally, a focus on access, utilization and outcomes
will allow areas in need of improvement to be readily identified.
Introduction: Ongoing Program Monitoring
Monitoring is the process of documenting aspects of a program’s performance that indicate
whether the program is functioning as expected, or meeting appropriate standards. The scope
of programming monitoring can vary: almost any facet could be monitored, from budgetary
decision making to contract and program implementation to impacts on participants, but we will
opt for a more limited and focused approach. For county purposes, the emphasis will be on
access, utilization and outcomes of substance abuse services.
Program monitoring is typically thought of as a form of evaluation. However, evaluations are
often designed to determine the precise impact of a program on participants, communities or
service systems. This type of evaluation is both expensive and time consuming. What is being
proposed here is different: we outline a series of monitoring activities whose primary goal is to
assist those who administer programs, to see that programs are being run efficiently, serving
targeted subgroups and to allow for future planning. Our purpose is to provide as much useful
information as possible to enhance the ability of those responsible to administer these important
programs. The importance of program monitoring cannot be overstated. Some questions that
should be answered by monitoring activities outlined below include: 1) is the program
functioning as expected? 2) are perceived needs being met, for all important subgroups of
clients?, and 3) is performance information being made available to all county constituents?
Effective program monitoring can only be accomplished when 3 conditions exist: 1) within each
service domain, the most relevant and pertinent issues have been identified, 2) data analysis
tools that address those issues are available and can be used in a cost-effective manner, and 3)
a mechanism exists to disseminate performance information to all the relevant parties. Much of
the performance information outlined below can be acquired from the DASA Treatment Analyzer
(TA), which is currently available to all county and state staff. The reports that can be run with
the DASA-TA can include data for the entire county as well as data for individual agencies.
Thus, monitoring is possible at both the county and agency levels.
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This proposal will address how the county will provide the monitoring needed to meet the three
conditions outlined above. In short, it will show how the county will monitor access, utilization
and outcomes of substance abuse services.
Monitoring Substance Abuse Services
Monitoring Treatment
Access
For our purposes, access to services will be defined as admissions to treatment, assessment or
detoxification services. The judgment of county and state staff will be used to determine
whether access is at appropriate levels for the county as a whole or for individual groups of
clients. Key questions regarding access include:
• For all clients: Are treatment admissions increasing or decreasing over time?
• For important subgroups of clients:
− Are admissions for important subgroups increasing or decreasing over time?
− Are admissions for important subgroups at expected levels?
Utilization
Utilization refers to how much of the service is being received. It will be measured by examining
length of stay and retention statistics. Key questions regarding utilization include:
• For all clients in OP:
− On average, how long are clients remaining in OP?
− What percent are remaining in TX for at least 90 days?
• For important subgroups of clients in OP:
− On average, how long are important subgroups of clients remaining in OP?
− What percent are being retained for at least 90 days?
− For opiate substitution clients, what percentage are retained at 3, 6, 9 and 12 months
following admission?
• For opiate substitution clients:
− What percent of clients are retained in treatment at 3, 6, 9 and 12 months?
− Do retention rates vary by the age, ethnicity or gender of the clients?
Outcomes
Outcomes include both the immediate results of the service, as well as more distant, postdischarge measures. Key questions regarding outcomes include:
• For all clients in OP:
− What is the overall completion rate for all clients? Does that rate vary depending on
client characteristics?
− What percent of clients were arrested after discharge? Did the arrest rate for
completers differ from non-completers?
− What percent of clients became employed after discharge? Did the employment rate
and wages for completers differ from non-completers?
• For all clients assessed:
− What percent of assessed clients enter treatment? Is that rate increasing over time?
• For all clients receiving detoxification services:
− What percent of those receiving detox completed their stay?
− What proportion of clients entered treatment after receiving detox?
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The table below lists domains and monitoring issues, and links those to the appropriate DASATA report.
Evaluation Table: A Summary of Monitoring Activities
Service Domain
Program Monitoring Issue
DASA-TA Report
Access
Trend in Overall Admissions
OP Admissions: contains data on OS admissions as
well.
Trend in Subgroup Admissions
OP Admissions: filters exist which allow users to
specify the population for this report in over 60 ways.
Trends in Admissions for each
Expansion Subpopulation and
Progress Toward Goals
TX Expansion: reports provide county data as well as
data on the performance of individual agencies.
Length of Stay in Outpatient
Treatment
OP Completion: median lengths of stay broken out by
completion status, race, age and other characteristics.
90 Day Retention: Outpatient
OP Retention: provides retention percentages for up
to 180 days following admission.
Retention in Opiate Substitution
OS Retention: 3, 6, 9 & 12 month retention data.
Outpatient Completion
OP Completion: can be filtered to include only CJTAfunded clients.
Arrests
Felony Arrest
Employment
Employment Outcomes
Detox Completion
An ad hoc query is necessary to calculate the detox
completion rate.
Detox Recipients Entering
Treatment
Detox to Treatment
Assessed Clients Entering
Treatment
Assessment Results
Utilization
Outcomes
Monitoring Prevention Activities
An important source of data for assessing the need for various prevention activities is the
Healthy Youth Survey, administered every two years at schools in every Washington State
county. While the Department of Health (DOH) has published some results of the survey on the
web, until recently there has been no readily available tool that counties can use to analyze their
own data. However, recently the Office of Superintendent of Public Instruction (OSPI) has
contracted with Looking Glass Analytics to develop a website that will allow users to analyze
data for their counties. In particular, this site will provide data on trends over time in important
measures of both risk and protective factors for substance abuse. This site is scheduled to be
online and available to counties by summer of 2007.
1.
Prevention provider, where applicable, will participate in entering information into the
PBPS. This shall include: Enrollment information, Attendance and Pre/Post surveys.
2.
Non-profit agency prevention providers will be required to attend a monthly provider
meeting and a county-wide Prevention Network meeting to inform the community of their
activities.
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3.
Site visits will be done on an annual basis to review non-profit agency provider progress
and contract compliance.
4.
School Prevention Teams will continue to choose between conducting pre/post surveys
or reporting on environmental changes within their schools.
5.
Prevention providers that work with schools will be required to obtain a release of
building level HYS results to the county. This HYS data will assist the county in analysis
of changes within the school.
Monitoring Prevention Programs for Fidelity
A DASA REQUIRED SECTION
Pierce County prevention providers conducting best practice curriculums will be trained and
certified in the curriculum they conduct. This will ensure that facilitators can identify and
understand the theory behind the program.
The facilitators will follow the curriculum in the way that it is designed. Facilitators are
responsible for providing the curriculum, workbooks and additional material where appropriate.
Technical assistance will be available upon request.
Additionally, a checklist outlining the fidelity requirements (see Attachment II Fidelity Checklist
document) will be completed on the individuals conducting best practices curriculums.
The Program Fidelity checklist may be completed by the school principal or their designee, or a
county staff person.
Plan to Gather Prevention Services Data
A DASA REQUIRED SECTION
The county will require all prevention providers to participate by entering data into the PBPS
where applicable: Enrollment, attendance and pre/post survey data will be entered into the
PBPS. School prevention teams will continue to be entered into the CBC Report.
The CBC will be submitted on a quarterly basis.
All providers that work with schools will be expected to obtain a release to the county for HYS
building level data. This release of data will go back as far as possible to enable the county to
develop a baseline for progress.
The county will continue to participate on the DASA Prevention MIS Advisory Committee to
assist with PBPS systems development/improvement. This participation will hopefully lead to
improvements in our data gathering efforts.
Pierce County will continue to participate on the Prevention Evaluation Work Group. This work
group often discusses way to improve our data gathering capacity.
H:\CD\Strategic Plan\CD 6 Year Strategic Plan\Strategic Plan Final
PIERCE COUNTY
A Strategic Plan for Substance Abuse Prevention | Intervention | Treatment | Aftercare Support Services ●
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