ALAMEDA COUNTY SUBSTANCE USE DISORDER (SUD) SERVICES

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1 ALAMEDA COUNTY SUBSTANCE USE DISORDER (SUD) SERVICES Current Configuration and Vision for the Future Presentation to Board of Supervisors Health Committee March 23,

2 Presentation Overview Demographic data on substance use disorder clients Continuum of substance abuse services Major sources of funding for substance use disorder (SUD) services Historical patterns in funding and service utilization Guiding principles for strategic planning Challenges, opportunities and next steps 2

3 2014 SUD Clients in Alameda County Summarized by Age < 18: 503 7% 18-25: % 26-40: 2,260 30% 41-54: 2,579 34% 55-59: 710 9% 60+: 604 8% Total Clients 7,476 3

4 2014 SUD Clients in Alameda County Summarized by Gender Female: 2,876 Male: 4,600 4

5 2014 SUD Clients in Alameda County Summarized by Race/Ethnicity African American: 2,884 39% Caucasian: 2,367 32% Latino: 1,432 19% Asian/Pacific Islander: 308 4% Native American: 89 1% Other/Unknown: 396 5% Total Clients 7,476 5

6 2014 SUD Admissions Summarized by Type of Drug Used Heroin: 27% Alcohol: 24% Methamphetamines: 17% Cocaine: 12% Marijuana: 11% Other opiates and synthetics: 4% Oxycodone/OxyContin: 2% *Other 3% *Club Drugs, Benzodiazepine, PCP, Hallucinogens, Barbiturates, etc. 6

7 Detoxification Services Social Model Detox 1,527 clients the detox center, and 2,274 clients the sobering center in 2014 Provider: Horizon Services-Cherry Hill Narcotic Program Detox 211 clients served in 2014 Providers: Bay Area Addiction Research and Treatment (BAART) Berkeley Addiction Treatment Services (BATS) Humanistic Alternatives to Addiction Research and Treatment (HAART) West Oakland Health Council (WOHC) 7

8 Residential Treatment General 721 clients in 2014 Providers: Bonita House Carnales Unidos Reformando Adictos (CURA) Horizon Services (Chrysalis, Cronin) Latino Commission New Bridge Options Recovery Services 8

9 Residential Treatment (cont d) Perinatal 149 clients in 2014 Providers: Bi-Bett East Bay Community Recovery Program (EBCRP) Magnolia Women s Recovery Program 9

10 Recovery Residences 113 clients in 2014 Providers: Options Recovery Services CURA Second Chance 10

11 Intensive Outpatient Treatment 112 clients FY09-10 Providers: Alameda Health System West Oakland Health Center (WOHC) 11

12 Outpatient Treatment 3637 total clients seen for outpatient in 2014 Providers Alameda Health System Alameda Family Services Asian Community Mental Health Outpatient Youth Axis Community Health Bi-Bett EORC City of Fremont Outpatient Horizon Outpatient Project Eden Youth Latino Commission General and Perinatal New Bridge Outpatient Youth 12

13 Outpatient Treatment (cont d) Options Recovery Services St. Mary s Center Second Change General and Perinatal Senior Support Program West Oakland Health Center (WOHC) East and West Oakland Programs 13

14 Methadone Maintenance Narcotic Treatment Programs 2,418 clients in 2014 Providers: BAART BATS HAART Lifeline Treatment Services Successful Alternatives for Addiction and Counseling Services (SAACS) WOHC 14

15 HIV Early Intervention, CalWORKS HIV Early Intervention Providers: Alameda County Public Health Bay Area Consortium for Quality Health Care East Bay Community Recovery Project (EBCRP) CalWORKS Programs Providers: Alameda Health System Second Chance 15

16 Primary Prevention Substance Use (SU) Primary Prevention activities are designed for the general public, not clients in SU disorder treatment In calendar year 2014, SU Primary Prevention providers reached out to 7,651 youth and their families and 1,029 older adults in the general public BHCS Primary Prevention strategies include: - Education - Alternative activities to substance abuse - Problem identification and referral - Community outreach - Environmental interventions to reduce the promotion of and access to addictive substances 16

17 Primary Prevention Providers Axis Community Health EMQ Families First Filipino Advocates for Justice Horizon Services Institute for the Advanced Study of Black Family Life and Culture Native American Health Center New Bridge Foundation Senior Support Program of the Tri-Valley St. Mary s Center 17

18 Major Sources of Funding MediCal/Drug MediCal (DMC) Approximately $10.98 Million in FY14/15 Realigned Match, Realigned Reserve, FFP Medi-Cal, and County Offset Non-NNA Expected funding growth through: improvements in the economy that led to growth of the behavioral health subaccount for realigned match expanded DMC benefits passed by CA Legislature expansion of the covered population with increased federal match through health care reform anticipated further expansion of benefits, costs and federal match likely through DMC Waiver 18

19 Major Sources of Funding (cont d) Federal Substance Abuse Prevention and Treatment (SAPT) block grant Approximately $9.16M FY14/15 Prevention 20% - Highest priorities are children and adolescents, then for medical testing and case management for HIV, TB and Hepatitis C Treatment 80% - Highest priorities are IV drug using pregnant women, then IV drug using non-pregnant women, then IV drug using men, then all others 19

20 Major Sources of Funding (cont d) County Funding Approximately $8.10M FY14/15 County General Funds, Measure A State Realigned Funding to Counties Approximately $5.04M in FY14/15 AB109, Drug Court, Non-Drug Medi-Cal, Perinatal Other Funding Approximately $1.17M FY14/15 Realigned MISP, Statham, DUI, Cal-WORKS, Alcohol and Drug Education, Other Misc. 20

21 Alameda County Trends in Funding of SUD Services 50,000,000 45,000,000 40,000,000 35,000,000 30,000,000 25,000,000 20,000,000 Annual Overall CGF/Measure A 15,000,000 10,000,000 5,000,000-09/10 10/11 11/12 12/13 13/14 14/15 21

22 Alameda County Trends in Utilization of SUD Treatment Services Total Unique Clients Seen 7,790 8,459 Total Admissions 11,869 13,711 Total Client Contacts 675, ,668 22

23 Alameda County Trends in Utilization of DMC-Covered Services 40,000 DMC Outpatient Utilization 20,000-09/10 10/11 11/12 12/13 13/14 14/15 Individual & Group Visits DMC NTP Utilization 900, , , , , , , , ,000-09/10 10/11 11/12 12/13 13/14 14/15 Doses & Counseling 23

24 Alameda County Trends in Funding of DMC-Supported Services 24

25 Growth Trends: Challenges and Opportunities National health care reform Dramatically expanded coverage for previously uninsured persons in poverty with addictions New models of integrated behavioral health with primary care and increased demand for SUD treatment services Increased federal funds leverage (FFP) Requirements for professionalized SUD providers skilled in evidence-based practices, DMC documentation, and billing DMC and other insurers 25

26 Growth Trends: Challenges and Opportunities Prison reform Increased county responsibility for services to promote jail diversion and decrease recidivism Recognition of high rate of substance use disorders among offenders Increased referrals to substance use disorder services by criminal justice departments 26

27 Growth trends: Challenges and Opportunities Drug Medi-Cal (DMC) Waiver Timeline: Likely to be approved by CMS in early April, opt in plan by Bay Area Counties submitted in July Primary purpose: Design and implement an organized delivery system for SUD services Increased flexibility in: provider contracting, covered services, rate setting Increased accountability for: Access to services, care management, quality management 27

28 Guiding Principles for Strategic Planning: Individualized Treatment 1. Recovery from severe alcohol and/or drug dependence is a long-term process comparable in many respects to management of diabetes or hypertension - In medical terms, chronic disease management is a more appropriate model than acute care 2. Persons requesting treatment should be provided with the most appropriate type and amount of treatment according to an assessment of their condition, need and motivation using American Society of Addiction Medicine (ASAM) Criteria 3. Clients in treatment should be regularly reassessed and the type and amount of treatment should be adjusted to address ongoing changes in the client s condition, need and motivation 4. Clients in treatment should receive skills training in how to manage their alcohol and/or drug dependence to prevent relapse 5. Clients with co-occurring physical and/or mental health conditions should be treated for those conditions with a well-coordinated, integrated approach. 28

29 Guiding Principles for Strategic Planning: Cost Effectiveness 1. Providing clients with the care that best addresses their condition, needs and motivation is more cost-efficient and effective 2. The cost of providing inappropriate, ineffective care will likely be experienced outside ACBHCS by: - the clients: physical health problems, lost productivity, emotional suffering, social disconnection, etc. - the clients family: physical & emotional abuse, poverty, trauma - other county departments: increased use of emergency rooms & other medical services, increased arrests & incarcerations, etc. - society: lost productivity, decreased tax revenues, increased expenditures in county services 3. Measuring, monitoring and managing service quality and outcomes should be conducted within the framework of a chronic disease management model rather than an acute care model, and within an integrated approach to co-occurring conditions. 29

30 Guiding Principles for Strategic Planning: Organized System of Care 1. A continuum of services to address the range of client treatment needs 2. Use of American Society of Addiction Medicine Criteria to screen and match clients to the level of care and treatment that best fits their needs 4. Well coordinated care between providers, including warm handoffs from one program to the next as clients needs change 5. Staff training and incentives to implement evidence-based treatments 6. Performance measures to monitor and improve service quality and treatment outcomes 7. Learning collaboratives and other initiatives to encourage ongoing quality improvement. 30

31 Planning for the Future: Next steps Develop implementation plan for DMC Waiver Design and implement call center for screening, referrals and care management of SUD residential services Establish recovery residence + outpatient level of care with partial repurposing of SAPT Block Grant funds Assist CBOs to build infrastructure for staff training, chart documentation to meet DMC requirements, billing, and sustainability Resource and build BHCS staff infrastructure to manage access and quality of an organized delivery system for SUD services 31

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