DEPARTMENT OF HUMAN SERVICES 2010

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1 SOMERSET COUNTY COMPREHENSIVE ALCOHOLISM & DRUG ABUSE SERVICES PLAN TREATMENT AND PREVENTION DEPARTMENT OF HUMAN SERVICES 2010

2 SOMERSET COUNTY COMPREHENSIVE ALCOHOLISM AND DRUG ABUSE SERVICES PLAN 2010 Approved By: 2009 SOMERSET COUNTY BOARD OF CHOSEN FREEHOLDERS Rick Fontana, Director Jack M. Ciattarelli, Deputy Director Robert Zaborowski Peter S. Palmer Patricia L. Walsh Prepared By: SOMERSET COUNTY DEPARTMENT OF HUMAN SERVICES Brenda Pateman, Alcoholism & Drug Abuse Coordinator Ronnie Weiner, Municipal Alliance Coordinator LOCAL ADVISORY COUNCIL ON ALCOHOLISM AND DRUG ABUSE Jack Bennett, Chairperson COUNTY ALLIANCE STEERING SUBCOMMITTEE William Veliky, Chairperson PROVIDERS ADVISORY COMMITTEE ON ALCOHOLISM AND DRUG ABUSE Sharon Lutz, Chairperson PREVENTION STEERING SUBCOMMITTEE Brenda Pateman and Ronnie Weiner, Co-Chairs

3 TABLE OF CONTENTS FORWARD/ACKNOWLEDGMENTS Page Number Local Advisory Council on Alcoholism and Drug Abuse i and Department of Human Services Board of Chosen Freeholders ii Acknowledgments iii CHAPTER I ATTICTION TREATMENT AND EDUCATION NEEDS AND PLAN FOR SERVICES I INTRODUCTION A. Background B. Planning Process II. NEEDS ASSESSMENT A. Assessing the Data B. Assessing the System C. Emerging Trends III. SERVICE GAPS AND BARRIERS A. Somerset County Service Gaps and Barriers B. Somerset County Service Gaps and Barriers for identified populations Women youth drivers under the influence criminal offenders persons with disabilities workforce (i.e., substance abuse on the job) persons with co-occurring disorders others, as identified by the county IV. PRIORITIES/ACTION PLANS A. County Funding Priorities and Strategies B. Population-Services Priority Needs C. Unfunded /Underfunded Priorities D. Data used to determine county funding priorities and strategies, and populationspecific priority needs E. County action plans to address identified population-needs F. System changes at State and County levels G. Strategies the County will invest in to address unmet needs H. Funding priorities that differ from those presented in the last planning cycle I. How new funding strategies better meet the priority needs or emerging trends of the county V. PLAN IMPLEMENTATION A. Authority B. County Request for Proposal timeline

4 VI. EVALUATION A. Process Evaluation B. Program Evaluation C. County Measurements & Programs Appendix I: FREEHOLDER RESOLUTION Appendix II: PLANNING ACTIVITIES A. County Spending Priority Grids B. Population-Specific Grids C. Simple Statements D. Focus Group Summary and Review of Treatment Resource Grids E. Planning Committee(s) Membership and Affiliation Appendix III: AGENCY DESCRIPTION A. Table of Organization B. LACADA Governance By-Laws Membership of LACADA C. PACADA Governance By-Laws Membership of PACADA D. Intoxicated Driver Resource Center E. County Council on Alcoholism and Drug Abuse Appendix IV: REQUEST FOR PROPOSALS Appendix V: Planning Data A Needs Assessment Questionnaire For CY B. Comparison of New Jersey Substance Abuse Management System (NJSAMS) between for Somerset County C. Changes in Target Population Demographics between 2007 & D. Somerset County Cases of HIV/AIDS and Perinatal HIV Exposure E. National Outcome Measures

5 CHAPTER II ADDICTION PREVENTION NEEDS PLAN I. COUNTY BASED RECOMMENDATIONS FOR PRIORITIZING DIVISION OF ADDICTION SERVICES PREVENTION FUNDS II. MUNICIPAL SPECIFIC PRIORITIES III. IV. PREVENTION RESOURCE INVENTORY: COUNTY ATOD PREVENTION RESOURCES COUNTY ALLIANCE ACTIVITIES A. Mission Statement B. Freeholder Resolution C. Membership of County Alliance Steering Subcommittee D. Table of Organization E. Progress Report and Activities Municipal Alliance Program Summaries Municipal Alliance Committees and Chairpersons Somerset County Alliance Funding Formula County Fiscal Summary for DCA County Alliance Monitoring Process a. Forms b. County Alliance Training Plan V. COUNTY WIDE NEEDS AND RESOURCE ASSESSMENT Appendix I: AGENCY DESCRIPTION a. CASS b. By-Laws Appendix II: Legislation/Citizen Action Appendix III: Needs Assessment Secondary Data Resources Appendix IV: Prevention Program Providers in Somerset County Appendix V: Acronyms

6 FORWARD The members of the Somerset County Local Advisory Council on Alcoholism and Drug Abuse and the County Alliance Steering Subcommittee are pleased to present the Somerset County Comprehensive Alcoholism and Drug Abuse Services Plan for This document represents much effort on the part of many individuals and organizations in Somerset County to develop a comprehensive plan that will serve as a guideline for future planning and funding decisions. The development of this plan was the result of several meetings of the PACADA, LACADA, CASS, and the Prevention and Treatment Unification Steering Subcommittee. The Local Advisory Council on Alcoholism and Drug Abuse reviewed the Plan on September 9, At that time, the LACADA finalized the Somerset County Alcoholism and Drug Abuse Services Planning and funding recommendations for 2010 to be recommended to the Somerset County Board of Chosen Freeholders for their adoption. We are especially grateful to the many professionals, consumers, and informed citizens who participated in the process. This comprehensive Plan could not have been completed without the time and effort expended by all of those who participated. Special mention is given to PACADA and LACADA members for their help in facilitating the planning process. Mildred A. Gaupp Human Services Director Jack Bennett, Chairman Local Advisory Council on Alcoholism & Drug Abuse Brenda Pateman Alcoholism and Drug Abuse Coordinator i

7 The Somerset County Board of Chosen Freeholders was pleased to pass Resolutions R and R on November 4, 2009 approving this Comprehensive Alcoholism and Drug Abuse Services Plan and the County Prevention Chapters for submission to the New Jersey State Department of Human Services, Division of Addiction Services and the Governor s Council on Alcoholism and Drug Abuse. Copies of these Resolutions appear in Appendix I of both chapters of this Plan. This Plan is in compliance with the New Jersey Division of Addiction Services (DAS) and the Governor s Council on Alcoholism and Drug Abuse (GCADA) guidelines. In addition to satisfying DAS and GCADA requirements, it represents a significant step and illustration of our efforts to improve the coordination of alcoholism and drug abuse treatment and prevention services. The Plan will also serve as a significant management tool for both present and future decision-making. We look forward to continuing our partnership with the New Jersey Division of Addiction Services and the Governor s Council on Alcoholism and Drug Abuse. We wish to acknowledge the outstanding work that has gone into the development of this Plan by members of the County Department of Human Services, members of the Providers Advisory Committee on Alcoholism and Drug Abuse (PACADA), Local Advisory Council on Alcoholism and Drug Abuse (LACADA) members, County Alliance Steering Subcommittee (CASS) members and the Prevention and Treatment Unification Steering Subcommittee members SOMERSET COUNTY BOARD OF CHOSEN FREEHOLDERS: Rick Fontana, Director Jack M. Ciattarelli, Deputy Director Robert Zaborowski Peter S. Palmer Patricia L. Walsh ii

8 ACKNOWLEDGMENTS The efforts and contributions of the members of the Local Advisory Council on Alcoholism and Drug Abuse (LACADA), the Providers Advisory Committee on Alcoholism and Drug Abuse (PACADA), the County Alliance Steering Subcommittee (CASS) and the Planning Steering Subcommittee are gratefully acknowledged. Each committee meets regularly during the year and dedicates time, energy, and expertise to the planning of quality alcoholism and drug abuse treatment and prevention services. The members are listed in Chapter I, Appendix II, III and IV and Chapter II, Section IV, Appendix I of this Plan. In addition, special thanks must be extended to the following members of the Somerset County Department of Human Services Staff: Juanna James, Administrative Assistant I Samantha Tomaro, Administrative Assistant II Karen Kruzel, Executive Secretary iii

9 SOMERSET COUNTY COMPREHENSIVE ALCOHOLISM & DRUG ABUSE SERVICES PLAN CHAPTER I ADDICTION TREATMENT AND EDUCATION NEEDS AND PLAN FOR SERVICES DEPARTMENT OF HUMAN SERVICES 2010

10 I. INTRODUCTION A. BACKGROUND: The Plan is prepared to assure compliance with State requirements and to establish a rational, coordinated avenue for contracting with the Department of Human Services, Division of Addiction Services and the Governor s Council on Alcoholism and Drug Abuse, and establish an objective basis for the allocation of P.L. 1989, Chapter 51 Funds. The Plan serves as a mechanism to identify existing services and gaps in services, as well as to address the needs of identified populations and facilitate the process of planning, implementing and monitoring alcoholism and drug abuse services. The Plan will be used as a blueprint for development and implementation of alcoholism and drug abuse service delivery throughout Somerset County in a client-centered, recovery-oriented system of care across the full continuum of care (prevention, early intervention, treatment and recovery supports). It will serve to educate the public; establish priorities; identify gaps in treatment services and assist the Board of Chosen Freeholders to continue to provide quality care to those in need. The Plan will be revised yearly through County alcoholism and drug abuse coordination and municipal alliance coordination efforts in accordance with the guidelines set forth by the Division of Addiction Services and the Governor s Council on Alcoholism and Drug Abuse and based upon input from the PACADA, LACADA, CASS and the Prevention and Treatment Unification Steering Subcommittee as approved by the Board of Chosen Freeholders. It is Somerset County s vision to meet the legislative intent of Chapter 51 to provide as much of a substance abuse treatment continuum of care to the county residents within certain mandated identified populations and others at the local level, as the finite amount of funding will allow. Clients can be served in their own locality so family involvement and follow-up treatment can be accessed easily. It is also important to note that there is a need for local implementation of substance abuse treatment as Somerset County, although a perceived wealthy county, has pockets of poverty and if New Jersey only funded hot spots it is a grave concern that persons with alcoholism and/or drug addiction would not receive the needed services in Somerset County. For every county resident provided service for substance abuse (1,726 residents in 2008) it is estimated that $4-$7 per person is saved by the New Jersey taxpayer for every dollar spent on treatment. As a result of restoring residents to better functioning, ancillary services may not be needed and thus substance abuse treatment provides an estimated savings of approximately ($7,223, $12,641,216.00). Of this savings the grant with the Division of Addiction Service ($509,999 in 2010) through the AEREF Ch 51 legislation, saves Somerset County and taxpayers an estimated $2,039, $3,569,993. It should also be noted that the AEREF funds (alcohol tax dollars) are allocated according to a funding formula and that the funds have been capped since 1990 at $11 million to be allocated to all 21 counties. 1

11 It is the hope that the following goals will be met between the years : 1) Detoxification services are provided at approximately 395 days of service to approximately 79 Somerset County Adult residents 2) Inpatient Rehabilitation Services are provided at approximately 391 days of service to approximately 78 Somerset County Adult residents 3) Education/Early Intervention Services will provide approximately 1,013 education hours of education and/or assessments as requested 4) Early Intervention/Outpatient Services will be provided to a minimum of 8 adolescents and their families 5) Intensive Outpatient Services will be provided to a minimum of 30 adolescents and their families 6) Intensive Outpatient Services will be provided to a minimum of 48 adult residents 7) 150 Intensive outpatient service days will be provided to 50 adult clients with cooccurring disorders and 8) 480 Halfway House bed days will be provided to 4-6 Somerset County women and 1,730 bed days to adult women from throughout New Jersey. In considering the National Outcomes Measures (NOMs) it is the hope that the following will occur: Overall, adolescents would demonstrate better outcomes for abstinence from drugs and alcohol at discharge and women would demonstrate better outcomes for abstinence from drugs and being employed at discharge. It is important to note that there was positive change in providing County residents with substance abuse treatment as demonstrated by the NOMS between 2006 and For CY , as demonstrated in the NOMs, there will be an increase in clients not using alcohol at discharge, an increase in clients not using drugs at discharge, and increase of clients being employed at discharge, clients decreased percent of arrest in past 30 days and decreased client s homelessness will demonstrate positive change for all levels of care (it is understood that employment, arrest and homelessness can be directly effected by the economy). It has been the history of the Somerset County Freeholders to augment these services through the non-profit purchase of services grants. The Non-Profit Purchase of Service RFP process seeks additional services that would otherwise not be provided and thus there would be an increased unmet demand/need for treatment to Somerset County residents. The additional funds in 2009 from the Somerset County Non Profit Purchase of Service, Somerset County Alliance Grants, Somerset United Way, Somerset County Community Development Block Grant, Somerset County Office of Youth Services, the Somerset County Mental Health Center and other Division of Addiction Services totaling approximately an additional $1,242,455 were utilized to augment the Chapter 51 dollars to provide the substance abuse continuum of care needed by local residents. The Substance Abuse and Mental Health Service Administration reports that every year less than 10% of the individuals in need of treatment receive it. This low rate of treatment is due to three factors: finances, readiness to quit and 2

12 service delivery. The purpose of the Network for the Improvement of Addiction Treatment (NIATx) is to improve access to and retention in addiction treatment, while making process improvement part of the culture of managing and delivering treatment (DAS, 2009). Nationally fewer than one in four people addicted to alcohol or drugs receive treatment and as many as half of those who do successfully access treatment leave their treatment program before its full benefit can be realized. For some people the issue is finances; for others, the issue is readiness. However, NIATx has found that often the real issue keeping patient from treatment is the way that services are delivered (DAS, 09). NIATx aims to improve access to and retention in addiction treatment and helps agencies transform their organizational cultures through process improvement. NIATx recognizes the following needs: to get more people into treatment using existing resources, to remove organizational barriers that limit treatment access, to reduce the field s high rates of premature drop-out from treatment, and to support and improve the service delivery infrastructure (DAS, 2009). The four aims of NIATx is 1) Reduce waiting times between first request for service and first treatment session 2) Reduce the number of patients who do not keep an appointment (no-shows) 3) Increase admissions to treatment and 4) Increase continuation from the first through the fourth treatment sessions (DAS, 2009) 3

13 Somerset County s Logic Model for CY10-12: Area Prevention Early Intervention Treatment LOGIC MODEL Goal Need Assessment Objective Strategy Outcome Maintain Municipal Alliances that currently exist in all municipalities Continue to provide the EIP to county adolescents Continued improvement of quality at county treatment providers. The Community CSAP Domain was the identified #1 priority for Somerset County The Individual/Peer CSAP Domain was identified as the #2 priority for Somerset County According to the National Outcomes Measures (NOMs) between 7/07-6/30/08 the following successful completion of treatment for Somerset County residents was indicated for each level of care: Outpatient-53.5%, Intensive Outpatient- Increase community awareness of substance abuse problems. Yr 1-Local Alliances to perform a baseline for each of their communities Yr-2 Identify areas of impact Yr3-Indicate change to baseline between years 1-3 Decrease early first use and antisocial behavior amongst at risk adolescents Yr1-Identify baseline of early first use and antisocial behavior Yr2-Identify areas of impact Yr3-Indicate change to baseline between years 1-3 Increase positive NOMs outcome measures as it pertains to increasing client s successful treatment completion. This includes looking at retention rate and follow-up at the next level of care; including decreasing wait times for clients entering treatment and decreasing treatment no shows. All 21 municipalities are active as Municipal Alliances for the prevention of alcohol and drug abuse Increase referrals to the Catholic Charities Substance Abuse Early Intervention Program Incorporate the NIATx Model of Process Improvement into Somerset County treatment provider s quality improvement processes. To maintain a network coalition of community leaders, private citizens, and representatives from public and private human services agencies who are dedicated to a comprehensive and coordinated effort to promote and support drug and alcohol prevention and education programs and related activities with an emphasis on all ages along the developmental life span. The age of onset in Somerset County youth will be increased by 10% Maximize client s ability to benefit from treatment and be successful in their recovery as defined by the client. 4

14 Area LOGIC MODEL Goal Need Assessment Objective Strategy Outcome 18.6%, Halfway House- 35.5%, Long-term residential-52.2%, Shortterm residential-71.7%, Hospital Based Detox- 89.3%, Opioid- Methadone Outpatient- 14.6% and the levels of stay were reported as follows: Outpatient treatment-175 days, Intensive Outpatient-137 days, Halfway House-145 days, Long-term residential-171 days, Short-term residential-30 days, Hospital Base detox-11 days and Opioid-Methadone Outpatient-573 days. Yr 1-Develop a Task Force with Somerset County providers to explore feasibility of implementing the Network for Improvement of Addiction Treatment (NIATx) model of process improvement Yr2-Examine how NIATx model of process improvement interfaces with current quality improvement processes that exist at Somerset County provider agencies Yr3-Develop a baseline of the core areas of the NIATx model as it pertains to Somerset County provider agencies. Recovery Support Increase recovery support activity in Somerset County There were reported to be 286 self help groups in Somerset County Increase number of Somerset County client reports of recovery support activity Yr1-develop provider questionnaire to send to clients asking about the client s recovery support activity Yr2-Develop baseline of reported recovery supports utilized by Somerset County clients Yr3-identify an increase in client s reported engagement in recovery support activity Identify any gaps in recovery supports as reported by the clients who have received services in Somerset County There will be a reported increase in the self help groups/recovery support reported in Somerset County especially where gaps exist. 5

15 The county supports a client-centered, recovery oriented system of care across the full continuum of care. This is apparent through the following: Prevention: Through the Municipal Alliances each municipality, made up of dedicated volunteers and including individuals in recovery, supports the recovery-oriented systems of care approach. Much is done at the local level to enhance communities and individuals with recovery from and prevention of substance abuse. Prevention approaches that teach social skills and generic personal self-management skills have been found to reduce substance abuse as much as 44% for up to six years (Botvin et al, 94, 95 cited in DAS, 2009). Recovery management check-ups can significantly decrease relapse and readmission (Dennis, Scott and Funk, 03 cited in DAS, 2009) Early Intervention: Early and brief interventions were found to be effective, up to four years later, in reducing alcohol use, days of hospitalization, and emergency department visits (Fleming et al., 02 cited in DAS, 2009). Heavy drinkers were twice as likely to moderate their drinking 6 to 12 months after receiving a brief intervention compared with heavy drinkers who did not receive an intervention (Wilk, Jensen and Havighurst, 97 cited in DAS, 2009). Treatment: Treatment will incorporate person-centered and self-directed approaches to care that builds on the strength and resilience of individuals, families and communities to sustain personal responsibility, health, wellness and recovery from alcohol and drug problems. Our providers will focus on sustained recovery management using chronic care models instead of treating individuals with relatively short, acute care interventions. The guiding principles of our providers will include the following: 1) There are many paths to recovery 2) Recovery is self-directed and empowering 3) Recovery involves a personal recognition of the need for change and transformation 4) Recovery is holistic 5) Recovery has cultural dimensions 6) Recovery exists on a continuum of improved health and wellness 7) Recovery emerges from hope and gratitude 8) Recovery involves a process of healing and self re-definition 9) Recovery involves addressing discrimination and transcending shame and stigma 10) Recovery is supported by peers and allies 11) Recovery involves (re) joining and (re) building a life in a community and 12) Recovery is a reality (Central East Addiction Technology Transfer Center, 2009). Studies have found that chronic care approaches, including self-management, family supports, and integrated services improve recovery outcomes (Lorig et al., 01; Jason, Davis, Ferrari and Bishop, 01; Weisner et al., 01; Friedman et al., 01 cited in DAS, 2009). Long-term recovery outcome is enhanced by individual choice and commitment (Laudet and White, 08, cited in DAS, 2009). By increasing a person s involvement in self-help groups, treatment programs decrease subsequent health care costs and offer a cost-effective approach to promoting recovery (Humphrey and Moos, 01). Individuals with co-occurring substance abuse/medical problems randomized to integrated care had significantly lower total medical costs than those in independent care (Parthasarathy, Mertens, Moore and Weisner, 03 cited in DAS, 2009). Integrated and collaborative care has been shown to optimize recovery outcomes and improve cost-effectiveness (Smith, Meyers and Miller, 01; Humphrey and Moos, 01 cited in DAS, 2009). Community-based treatment costs less to operate and results in higher levels of service satisfaction than those provided in acute settings (Hoult, 86 cited in DAS, 2009). 6

16 Recovery Supports: Although mutual support groups do not provide formal treatment, they are one part of a recovery-oriented systems-of-care approach to substance abuse recovery. By providing social, emotional, and informational support for persons throughout the recovery process, mutual support groups help individuals take responsibility for their alcohol and drug problems and for sustained health, wellness and recovery. The most widely available mutual support groups are 12-step groups, such as Alcoholics Anonymous (AA), but other mutual support groups such as Women for Sobriety (WFS), SMART Recovery (Self-Management and Recovery Training) and Secular Organizations for Sobriety/Save Our Selves (SOD) are also available. Abstinence rates increase with greater group participation. Persons who attend mutual support groups have also been found to have lower levels of alcohol-and drug-related problems. Present more than one choice when making referrals and encourage clients to attend several meetings before making any judgments about the groups. Clients should be encouraged to attend different groups until they find one in which they feel comfortable. Initiate the first conversation between a client and a support group contact person. Having a mutual aid support group member speak to a client by phone during the office visit may increase the likelihood that the client will attend the support groups meeting. Refer family members or others who may be affected by the client s substance use. Their involvement may encourage participation by providing social support. Once clients are attending a group they are comfortable with, the provider should actively encourage the client s support group experiences by scheduling followup visits to talk about their experiences and providing positive feedback. Clients should be asked about details-how many meetings are they attending, do they have a sponsor, are they abstinent. Gentle positive encouragement will likely increase participation. Providers should watch for signs of impending relapse, such as reluctance to discuss group participation or periods of extreme stress. By offering knowledgeable advice and informed referrals and taking an ongoing, active interest in clients support group experiences, providers can make a difference in their client s recovery. (SAMHSA, 09). Recovery-Oriented Systems of Care will include: 1) Recovery-oriented systems of care will be person centered. Individuals will have a menu of stageappropriate choices that fit their needs throughout the recovery process. Choices can include spiritual supports that fit the individual s recovery needs 2) Recovery-oriented systems of care will acknowledge the important role that families and other allies can play. Family and others will be incorporated, when appropriate, in recovery planning and support process. Systems need to address the treatment, recovery and other social support needs of the families and other allies 3) Recovery oriented systems of care will be individualized, comprehensive, stage appropriate and flexible. Systems will adapt to the needs of the individuals, rather than requiring individuals to adapt to them. Services will be designed to support recovery across the lifespan. The approach to substance use disorders will change from an acute-based model to one that manages chronic disorders over time 4) Systems of care will be nested in the community for the purpose of enhancing the availability and support capacities of families, intimate social networks, community-based institutions and other people in recovery 5) Recovery-oriented systems of care will offer a continuum of care, including pretreatment, treatment, continuing care and support throughout recovery. Individuals will have a full range of services from which to choose at any point in the recovery process 6) Recovery-oriented systems of 7

17 care will be patterned after a partnership-consultant model that focuses more on collaboration and less on hierarchy. Systems will be designed so that individuals feel empowered to direct their own recovery. 7) Recovery-oriented systems of care will emphasize individual strengths, assets and resiliencies 8) Recoveryoriented systems of care will be culturally sensitive, competent and responsive. There will be recognition that beliefs and customs are diverse and can impact the outcomes of recovery efforts. In addition, the cultures of those who support the recovering individual affect the recovery process 9) Recovery-oriented systems of care will respect the spiritual, religious and/or secular beliefs of those they serve and provide linkages to an array of recovery options that are consistent with these beliefs 10) Recovery-oriented systems of care will include peer recovery support services. Individuals with personal experience in recovery will provide these valuable services 11) The voices and experiences of people in recovery and their family members will contribute to the design and implementation of recovery-oriented systems of care. People in recovery and their family members will contribute to the design and implementation of recovery-oriented systems of care. People in recovery will and their family members will be included among decision-makers and have oversight responsibilities for service provision. Recovering individuals and their family members will be prominently and authentically represented on advisory councils, boards, task forces and committees at the Federal, State and local levels 12) Recovery-oriented systems of care will coordinate and/or integrate efforts across service systems to achieve an integrated process that responds effectively to the individual s unique constellation of strengths, desires and needs 13) Recovery-oriented systems of care will ensure that concepts of recovery and wellness are foundational elements of curricula, certification, licensure, accreditation and testing mechanism. The workforce also requires continual training, at every level, to reinforce the tenets of recovery-oriented system of care 14) Recovery-oriented systems of care will provide ongoing monitoring and feedback with assertive outreach efforts to promote continual participation, re-motivation and re-engagement 15) Recovery oriented systems of care will be guided by recovery-based process and outcomes measures. These measures will be developed in collaboration with individuals in recovery. Outcome measures will reflect long-term global effects of the recovery process on the individual, family and community, not just remission of biomedical symptoms. Outcomes will be measureable and include benchmarks of qualityof-life changes 16) Recovery-oriented systems of care will be informed by research. Additional research on individuals in recovery, recovery venues and the process of recovery, including cultural and spiritual aspects, is essential. Research will be supplemented by the experiences of people in recovery 17) Recovery-oriented systems of care will be adequately financed to permit access to a full continuum of services, ranging from detoxification and treatment to continuing care and recovery support. In addition, funding will be sufficiently flexible to permit unbundling of services, enabling the establishment of a customized array of services that can evolve over time in support of an individual s recovery (CSAT, 2005). Individuals who participated in both treatment and recovery support groups had better long-term recovery outcomes than people who used either service alone (Florentine and Hillhouse, 00 cited in DAS 2009). Studies support the benefit of recovery coaches, mutual aid societies, and social and community supports in achieving long-term recover (Scott, Dennis and Foos, 05; Laudet, Savage and 8

18 Mahmood, 02 cited in Das, 2009). By increasing a person s involvement in selfhelp groups, treatment programs decrease subsequent health care costs and offer a cost-effective approach to promoting recovery (Humphrey and Moos, 01). There are eight (8) core strategies of Recovery Community Organizations (White and Taylor, 06 cited in DAS, 2009)) 1) Building strong grassroots organizations that develop leaders, offer opportunities for recovering people to express their collective voice and provide a forum for community service 2) Advocating for meaningful representation and voice for people in long-term recovery and their family members on issues that affect their lives 3) Assessing needs related to the adequacy and quality of local treatment and recovery support services 4) Educating the public, policymakers and service providers about the prevalence and multiple pathways of addiction recovery 5) Developing human and fiscal resources by expanding philanthropic and public support for addiction treatment, recovery support services and recovery advocacy and cultivating volunteerism within local communities of recovery 6) Advocating for policy changes at the local, state and federal levels that promote recovery and remove barriers to recovery 7) Celebrating recovery from addiction through public events that offer testimony of the transformative power of recovery and 8) Supporting research that illuminates effective strategies and the processes of long-term recovery. The New Jersey Department of Human Services, Division of Addiction Services Identifies that a Recovery-oriented system of care is: 1) Client centered and includes advocacy and stigma reduction, a partnership with consumers, a holistic approach on wellness, it integrates with primary care and mental health, it is a strengths-based approach to services, it offers a full continuum of care, and is available for prevention, intervention, treatment and recovery support. 2) A chronic care model and includes case management, has clinically driven lengths of stay and placement, is responsive to relapse, has flexible funding that follows the client and provides continuity of care 3) Provides recovery supports and includes supportive housing, college recovery housing, phone outreach, mentors and recovery support centers and 4) It provides recovery-oriented quality care that provides evidenced-based practices (pharmacological and psychosocial), there is credentialing and competency, it is outcomes focused and includes the NIATx process improvement. DAS further identifies recovery support services as: 1) Family services (including marriage education, parenting and child development services) 2) Child care 3) Employment services 4) Preemployment services 5) Employment coaching 6) Individual services coordination 7) Transportation to and from treatment, recovery support activities, employment, etc 8) Employment services and job training 9) HIV/AIDS services 10) Supportive transitional drug-free housing services 11) Other case management services 12) Continuing care 13) Relapse prevention 14) Recovery coaching 15) Self-help and support groups 16) Spiritual support 17) Other after care services 18) Substance abuse education 19) HIV/AIDS education 20) Other education services 21) Peer coaching or mentoring 22) Housing support 23) Alcohol-and drug-free social activities 24) Information and referral and 25) Other peer-to-peer recovery support services. 9

19 NA/AA can support and supplement addiction treatment as an aftercare resource ( Gossop, Stewart and Marsden, 09). Women were more likely than men to attend aftercare (Carter, et al., American Journal of Drug and Alcohol Abuse, 09). It is concluded that as cost-effective additions to primary treatment, AA and maintenance care services deserve greater attention in the treatment of substance use disorders. Researchers should also pay greater attention to patient diagnosis as an integral part of patient care (Floyd, Hoffmann and Karno, Substance Use and Misuse, 01). Post treatment more than pretreatment factors appear to be more decisive in predicting relapse risk (Miller, et al., The American Journal on Addictions, 99). Overall, the most important finding is that both women and men in recovery from addiction have an equal need of an aftercare service that continues to address the issues underlying their dependence and the lifestyle rehabilitation issues that are fundamental to long-term recover (Mumme, International Journal of the Addictions, 91). Our goals must be to portray addiction as problems with viable solutions; to present living role models; to counteract images that dehumanize, objectify and demonize people in recovery to enhance the variety and availability of treatment and self-help; and remove environmental barriers to recovery (White in Join Together, 11/2009). Through working with the Local Advisory Council on Alcoholism and Drug Abuse, the County Alliance Steering Subcommittee, the Providers Advisory Council on Alcoholism and Drug Abuse and other county governmental offices, Somerset County meets the legislative intent to provide a full continuum of care through alcohol tax (AEREF) and county government. The outcomes sought as previously stated are to improve impact according to the NOMS. 10

20 B. PLANNING PROCESS: The 2010 Alcoholism and Drug Abuse Services Plan is the result of coordinated efforts on the part of the Local Advisory Council on Alcoholism and Drug Abuse, the Providers Advisory Committee on Alcoholism and Drug Abuse, the County Alliance Steering Subcommittee and the Planning Steering Subcommittee. Brenda Pateman, Somerset County Alcoholism and Drug Abuse Coordinator and Ronnie Weiner, Municipal Alliance Coordinator facilitated these efforts. Input for the development of the Plan is encouraged through public meetings with service providers such as the Providers Advisory Committee on Alcoholism and Drug Abuse (PACADA), which is an advisory committee to LACADA, and the Planning Steering Subcommittee, which served to advise the LACADA and the CASS on prevention and treatment matters. These series of meetings provided a forum for an interchange of ideas and information with county and local agencies. LACADA members reviewed the recommendations of the providers and generated the priorities outlined in the Plan. In order to ensure quality planning, a comprehensive services delivery system and communication and cooperation with human services, mental health and other services systems, the County Alcoholism and Drug Abuse Coordinator works closely with other planning entities and professionals as shown below. Human Services Advisory Council (HSAC) - The County Coordinator gives a yearly report to the HSAC and serves on human services planning subcommittees as requested. Youth Services Commission (YSC) - The County Coordinator is a member of the YSC and serves on its Substance Abuse Subcommittee and Substance Abuse Planning Subcommittee addressing the substance abuse issues of youth in the county Mental Health Board (MHB) - The County Coordinator serves on a combined MHB/LACADA Co-Occurring Disorders Subcommittee addressing problems and issues pertaining to mentally ill persons and persons with co-occurring disorders. Office on Aging - The County Coordinator has attended meetings to assist in addressing the mental health and substance abuse needs of the senior population. United Way of Somerset County - The County Coordinator works closely with United Way representatives on several issues of mutual concern throughout the year. By interfacing with this network of agencies, the County is better able to maintain and deliver the highest quality of service to those Somerset County residents who are afflicted or affected by alcoholism, drug addiction, and alcohol and drug abuse. These interactions are instrumental in preventing unnecessary duplication of services, addressing service gaps, identifying service priorities, and allowing Somerset County to diversify the types of alcoholism/drug abuse services which it provides according to the needs of its population. 11

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