Substance Abuse Prevention and Treatment Plan FINAL DRAFT Block Grant Application

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1 Step 1: Assess the strengths and needs of the service system to address the specific populations. The S.C. Department of Alcohol and Other Drug Abuse Services (DAODAS) is the Single State Authority (SSA) for the Substance Abuse Prevention and Treatment Block Grant (SAPT BG), which is administered by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) and Center for Substance Abuse Prevention (CSAP). DAODAS oversees the state s public substance abuse system, which is made up of 33 county alcohol and drug abuse authorities that have incorporated themselves as Behavioral Health Services Association of South Carolina Inc. (BHSA). The 33 county authorities have offices in each of the state s 46 counties, thereby ensuring the availability of core substance abuse services to all South Carolina residents. These services include prevention, acute treatment, inpatient and outpatient services, the Alcohol and Drug Safety Action Program (ADSAP) for DUI offenders, adolescent services, women s treatment services, and recovery supports. Each of these services is driven by evidence based practices and monitored by DAODAS for quality assurance. Each county authority is licensed by the S.C. Department of Health and Environmental Control and accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) or the Joint Commission. Licensing and credentialing of substance abuse counselors is regulated by the State statute. This includes the requirement for certification of treatment counselors by the S.C. Association of Alcoholism and Drug Abuse Counselors (SCAADAC) and of prevention professionals by the S.C. Association of Prevention Professionals and Advocates (SCAPPA). There are no financial intermediaries between DAODAS and the county authorities, nor are there separate child and adult systems. DAODAS and the leadership of BHSA have a strong relationship and work closely to optimize the efficiency and effectiveness of services. DAODAS reviews and approves the county authorities strategic plans, which aid in the allocation of the SAPT BG, alcohol taxes earmarked for the county authorities, and other available funding through sub grants, discretionary grants, and subcontracts. The county authorities develop their plans with input from local surveys, focus groups, advisory councils, and/or political entities that oversee them (either county governments or specially appointed commissions). Thus, strategic planning starts at the local level; issues then are addressed through joint DAODAS-BHSA committees and approved by the BHSA membership; and plans are finalized by approval of the Single State Authority s Director. DAODAS county authorities have been providing Medicaid services since 1993, and the department continues to foster a treatment environment that ensures quality services. In FY 2012, the S.C. Department of Health and Human Services (South Carolina s Medicaid agency) and DAODAS partnered in moving South Carolina s public substance abuse system to a managed care model that was implemented in February This process highlights the SSA s efforts to begin constructing a framework that will encompass the changes produced by implementation of the federal Affordable Step 1: Assess the strengths and needs of the service system to address the specific populations. Page 1

2 Care Act (ACA) in FY The political environment in South Carolina is ambivalent regarding the ACA and what it will look like in South Carolina. On November 15, 2012, per the recommendation of the South Carolina Health Planning Committee that was convened by Gubernatorial Executive Order, South Carolina informed the federal government that it will not be establishing its own health exchange. Other matters regarding the ACA at the state level have not been decided. Due to changes in the healthcare environment, DAODAS recognizes the importance of building a framework for improving quality of care through introduction of electronic health records (EHRs) and fostering system-wide changes in direct treatment service quality. BHSA has purchased an EHR system, and its implementation is targeted to begin in This will aid in increasing efficiency of paperwork in direct services and free front-line counselors and staff to provide patient-centered treatment. Also, this system will foster quality data collection and will allow seamless communication between South Carolina and other EHR systems, where prudent and valuable. Another initiative to improve quality of services involves a state-wide training on the models of Modified Interpersonal Group Psychotherapy and Rational Behavior Training, led by Jeff Georgi, senior clinician with the Private Diagnostic Clinic at Duke University Medical Center. In conjunction with learning these models, participants are also being directly challenged to transcend the traditional monolithic vision of addiction treatment, to develop a deeper understanding of the disease of addiction, and to apply the latest scientific knowledge to direct practice. This training prepares participants to fully engage in a Recovery-Oriented System of Care (ROSC), a paradigm shift in the provision of intervention and treatment services. Prevention Services in South Carolina: Each county alcohol and drug abuse authority provides basic evidence-based prevention programs and strategies. Other specific prevention efforts that may not be available in every county include: Community Action for a Safer Tomorrow (CAST) Project (targeting underage drinking and alcohol-related car crashes) Preventing Underage Drinking Preventing Underage Use of Tobacco Retailer and Server Education Programs DAODAS will spend a minimum of 20% set aside from the SAPT BG to ensure that primary prevention services are available throughout the state s 46 counties to serve approximately 365,000 citizens. DAODAS will fund a wide range of substance abuse primary prevention programs and services throughout South Carolina. All county authorities will be required to develop and submit to DAODAS a Primary Prevention Management Plan that incorporates a minimum of one goal and objective for each of the six CSAP-established primary prevention strategy areas. Step 1: Assess the strengths and needs of the service system to address the specific populations. Page 2

3 Continuum of Care in South Carolina in an ASAM Level Framework: Many county authorities provide intensive and specialized levels of care, such as intensive outpatient services (nine or more hours per week), day treatment, detoxification, adolescent inpatient treatment, and/or other residential services. Those county agencies that do not offer the non-core services are required by the DAODAS Block Grant Governing Terms to refer their clients to appropriate higher levels of care. The county authorities provide the following services (although not all services are available in every county): ASAM Level 0.5 Intervention Services: Alcohol and Drug Safety Action Program (ADSAP [state DUI program]) Screening, Brief Intervention, and Referral to Treatment (SBIRT) Offender-Based Intervention (OBI) ASAM Level I Outpatient Services: The Bridge Program Gambling Addiction Services Educational Individual and Group Counseling Youth and Adolescent Services (YAS) Intensive Family Services ASAM Level II: Intensive Outpatient Services: Intensive Outpatient Groups Day Treatment ASAM Level III: Inpatient Services: Detoxification Services (Social and Medical) Halfway Housing Inpatient Treatment Residential Treatment Step 1: Assess the strengths and needs of the service system to address the specific populations. Page 3

4 Other Behavioral Health Services in South Carolina: S.C. Department of Mental Health: Earle E. Morris Jr. Alcohol and Drug Addiction Treatment Center ( Morris Village ) is licensed by the State of South Carolina and accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF). Morris Village has 96 operational beds and provides inpatient treatment for adults affected by alcohol and/or other drug abuse or addiction, and when indicated addiction accompanied by psychiatric illness. William S. Hall Psychiatric Institute is licensed by the State of South Carolina for 89 beds as a specialized hospital, with a separately licensed 37-bed residential treatment facility for children and adolescents. The Institute provides inpatient psychiatric services and residential treatment for adolescents. As part of its inpatient psychiatric services, Hall Institute includes an 18-bed dual-diagnosis unit for adolescents with substance abuse disorders. S.C. Vocational Rehabilitation Department: Holmesview Center in Greenville and Palmetto Center in Florence are two voluntary residential treatment centers for clients who need inpatient therapy for the chronic abuse of alcohol and/or other drugs. Both facilities provide a full range of vocational and treatment services for people whose employment is prevented or jeopardized by substance abuse or dependence. Referred to the centers by their vocational rehabilitation counselors, these clients receive follow-up services once they return to their communities. Collaboration With State and Community Partners: State Prevention Partnerships: South Carolina is working toward a collaborative substance abuse prevention system that ensures the use of evidence-based programs, policies, and practices, as well as emphasizes cultural competency and demonstrates accountability among partners. In 2000, CSAP awarded South Carolina a State Incentive Grant (SIG), called the Governor s Cooperative Agreement for Prevention (G-CAP), which sparked formation of the Governor s Council on Substance Abuse Prevention and Treatment, involving 13 state agencies committed to the prevention of substance abuse and addiction. The various agencies on the Governor s Council many of which are cabinet-level agencies like DAODAS are committed to taking prevention to the next level over the next several years. At the Governor s request, cabinet member Robert C. Toomey, Director of DAODAS, serves as co-chair of the Council. The group has met quarterly since 2000, but its workgroups meet on a monthly to bi-monthly basis. The Council s varied membership of state agencies and community and youth service organizations provides an ideal mix of perspectives to effectively guide substance abuse prevention services in Step 1: Assess the strengths and needs of the service system to address the specific populations. Page 4

5 South Carolina and to spread its impact into key agencies. Currently, the Council fulfills the following roles: serves as an advisory body to Governor Nikki Haley on substance abuse prevention and treatment; tracks substance abuse funding streams and seeks to identify opportunities to coordinate, leverage, or redirect funding; promotes effective prevention strategies and processes and encourages their implementation in key organizations; addresses important issues through standing or ad hoc committees (Underage Drinking Action Group, Methamphetamine Action Group); advocates for prevention and treatment and their increased funding; oversees major initiatives (e.g., SPF SIG, federal treatment grants); and informs Council members of ATOD information and important agency developments. The Governor s Council has proven to be an effectively diverse group in terms of its concern for the state s various populations, its state and local perspectives, and its cross-agency input. Even so, cultural diversity is an issue of constant attention. The Council currently oversees the State Epidemiological Outcomes Workgroup (SEOW) and will continue translating its findings and recommendations into actionable policies. The Council will also continue to regularly produce a document tracking changes in key indicators as identified in the state strategic plan for prevention and assess agencies contributions toward achieving outcomes identified in the strategic plan. Additionally, the Council through its Evidence-Based Programs, Policies, and Practices workgroup will continue monitoring selection and implementation of culturally appropriate evidence-based policies and practices throughout South Carolina. South Carolina partners have worked together to develop a state prevention strategic plan based on the work of the SEOW. The plan includes goals and objectives that will result in key stakeholders leveraging resources to work together as a state to implement a prevention strategic plan in accordance with the Strategic Prevention Framework s six guiding principles and five steps to achieve positive outcomes for the state. Prevention funding for the public substance abuse system is required in legislation and has a historical basis. The amount of funds currently allocated to each county to provide primary prevention services is based on population and specific need factors, although there is a base amount to ensure that prevention services are provided in each county throughout the state. The SSA will be actively looking to enhance this structure over the next several years to support a more data-driven process for allocating funds to address service needs/gaps. While South Carolina certainly touts a highly effective prevention system, there is acknowledgement of areas in which further work to develop a plan for the state will enhance our ability to create a more comprehensive and effective substance abuse prevention system. Such areas include: addressing the issue of underserved counties based on needs-assessment data; the Step 1: Assess the strengths and needs of the service system to address the specific populations. Page 5

6 development of capacity through training and technical assistance; and the ability to offer more indepth support to help counties build productive community-level epidemiological workgroups. Joint Council on Children and Adolescents: DAODAS and the S.C. Department of Mental Health (DMH) jointly proposed and formed South Carolina s Joint Council on Children and Adolescents in collaboration with the state Departments of Juvenile Justice, Health and Human Services, Education, and Social Services; Behavioral Health Services Association of South Carolina Inc.; South Carolina Primary Health Care Association; South Carolina Commission for Minority Affairs; Faces and Voices of Recovery South Carolina; National Alliance on Mental Illness South Carolina; South Carolina Federation of Families; and parent advocates. The Joint Council s current goals are to: ensure that children and adolescents are provided with proper services no matter where they enter the system; introduce use of a common evidence-based tool to screen and refer clients seamlessly to appropriate facilities; provide cross-training to substance abuse, mental health, and social service professionals; ensure services provided are culturally competent and, as appropriate, adhere to SAMHSA s Guiding Principles of Family-Driven Care; and ensure that behavioral health services across the state adhere to a trauma-informed standard. Statewide Trauma-Informed Care Initiative: In collaboration with multiple state agencies, DAODAS has spearheaded an effort to increase the provision of Trauma-Informed Care. The Trauma-Informed Care Initiative s main purpose is to promote an organizational culture change toward reflecting the five core principles of safety, trustworthiness, choice, collaboration, and empowerment in all services delivered. Trauma is pervasive and touches many aspects of life, as between 55% and 90% of individuals have experienced at least one traumatic event in their lifetimes. Many individuals who have experienced trauma have mental health and/or substance abuse problems, suicidal ideations, Post-Traumatic Stress Disorder, depression, and other interpersonal struggles not always connected to the trauma. Along with offering evidence-based trauma models, the behavioral health system is looking to alter the workplace environment and culture for clients and staff in a way that reduces trauma. DAODAS has also requested and received technical assistance on Trauma-Informed Care and has already engaged in planning that stems from this assistance. The Trauma-Informed Care Subcommittee of the Joint Council on Children and Adolescents has been involved in collaboration and strategic planning with a number of community and state organizations to implement trauma-informed services within those organizations. Front-line to administrative staff will be trained to handle the daily client population with a trauma-informed understanding and skill set. DAODAS will continue to be a leader in this paradigm shift on a statewide level and promote trauma-informed training and implementation in the behavioral health system. Step 1: Assess the strengths and needs of the service system to address the specific populations. Page 6

7 Veterans Policy Academy: In August 2008, South Carolina joined nine other states and federal groups in Bethesda, Md., for a SAMHSA-sponsored summit dedicated to assisting veterans and their families in returning to civilian life by identifying and providing needed services in a variety of areas. Composed of more than 50 organizations including military, legislative, veterans group, state agency, and non-profit representatives Team South Carolina has developed an Action Plan of six priority areas to identify and coordinate existing services and improve the integration of those services. DAODAS/DMH Collaborations: The S.C. Department of Mental Health (DMH) and DAODAS have a longstanding relationship at the state and community levels, as the two departments serve similar populations. DMH and DAODAS continue to work toward multiple collaborations in efforts to more consistently serve South Carolinians. Below are examples of these collaborations: Merged two separate adolescent grants funded by SAMHSA that aimed to improve the infrastructure of services provided to children and adolescents. In conjunction with DMH, DAODAS and the S.C. Vocational Rehabilitation Department partnered on a SAMHSA grant to improve the infrastructure for services provided to adults with co-occurring substance use disorders and mental illness. Historically, DMH has provided Peer Support Specialist training to persons in recovery in order to institute peer-support services among the providers of substance abuse services. Currently, DAODAS has launched a substance-specific peer support training through its work with Faces and Voices of Recovery South Carolina (FAVOR SC). The challenge in this collaboration continues to be aligning value systems, approaches, and perspectives, as well as improving communication at all levels of service delivery. DAODAS and DMH are increasingly providing care to a similar client base. DAODAS recognizes the importance of decreasing gaps in services and increasing the warm hand-off to partnering behavioral health providers such as DMH. DAODAS is committed to nurturing its established relationship with DMH to provide consistent treatment for our target populations. The strongest point of collaboration is evident in the institution of recovery-support services in the behavioral health system. Through the Recovery-Oriented System of Care initiative, DAODAS has developed a peer-support training management system that aligns with DMH s peer-support programming. DAODAS intends to work closely with DMH to ready Peer Support Specialists in caring for co-occurring populations. DAODAS/DHHS Collaboration: DAODAS and the Department of Health and Human Services (DHHS) have collaborated on the provision of substance use disorder (SUD) services to Medicaid beneficiaries. Last summer, DHHS launched a project to provide Screening, Brief Intervention, and Referral to Treatment (SBIRT) Step 1: Assess the strengths and needs of the service system to address the specific populations. Page 7

8 services to pregnant women being seen by selected Medical Home Network primary healthcare providers. The goal is to expand this service to all pregnant Medicaid beneficiaries later in Again, DAODAS continues to collaborate with DHHS on efforts to move the public substance abuse treatment system to a managed care model. DAODAS also partners with DHHS Birth Outcomes Initiative (BOI), which includes DMH, S.C. Hospital Association, S.C. Department of Health and Environmental Control, S.C. Office of Research and Statistics, the University of South Carolina s Institute on Families in Society, and the S.C. March of Dimes. Launched in July 2011, the BOI seeks to improve birth outcomes for newborns who are Medicaid beneficiaries. DAODAS, in conjunction with the BOI, is working to reduce the length of stay in neonatal intensive care units for infants exposed to opioids during pregnancy, as well as creating a link for referral to local behavioral health services for the mothers. DAODAS/DJJ Collaboration: DAODAS continues to nurture its nationally-recognized Bridge program to successfully transition Department of Juvenile Justice clients with substance abuse issues to their communities after release from incarceration. The Bridge program also refers clients to adolescent treatment services when appropriate. DAODAS/SCDC Collaboration: The S.C. Department of Corrections (SCDC) and DAODAS are in the process of developing a program similar to The Bridge for young adult offenders (ages 18-25) who have substance abuse issues. SCDC has also been active on the Recovery-Oriented System of Care strategic planning committees, and DAODAS is currently involved in the early stages of a planning grant in conjunction with SCDC to increase support services for adults leaving the corrections system. Services projected to be strengthened include Peer Support Specialists, housing opportunities, case management, employment, and substance abuse referral and treatment. DAODAS/DSS Collaboration: Through the Partners in Achieving Independence through Recovery and Self-Sufficiency Strategies (PAIRS) program, DAODAS is helping the Department of Social Services (DSS) achieve its goals of strengthening family units through the development of Family Care Centers and the Family Care Center model offered to mothers at risk of losing custody of their children to DSS. This model would allow mothers to engage in treatment services in a residential setting with their children on site. Both mother and child would receive therapeutic intervention and transitional services. Recovery-Oriented System of Care: DAODAS, in partnership with FAVOR SC, BHSA, DMH, and many other key stakeholders, has developed a strategic plan to establish a Recovery-Oriented System of Care (ROSC) across the state. DAODAS received excellent technical assistance from CSAT and has worked with the Southeast Addiction Technology Transfer Center to draft a comprehensive strategic plan, with implementation Step 1: Assess the strengths and needs of the service system to address the specific populations. Page 8

9 anticipated during Our planning to date is in consonance with Emerging Framework Recovery Oriented Systems of Care by Shannon Taitt (CSAT), Jack Stein (CSAT), and Melanie Whitter (Abt Associates Inc.) that was briefed during the 2008 SAAS National Conference and the NIATx Summit in Orlando ROSC is a paradigm shift in the provision of intervention and treatment services in South Carolina, as it focuses on prevention and intervention before a traditional treatment episode, as well as recovery support after the end of a treatment episode. The ultimate goal is to lengthen the period between relapses, to reduce the number of relapses, and to get relapsing clients back into treatment services before they require detoxification or inpatient services. Key areas of emphasis will be to: expand SBIRT services, both hospital ER and primary health settings; increase the utilization of Peer Support Specialists; operationalize plans for Community Recovery Centers, in collaboration with FAVOR SC; and provide proven treatment modalities and additional recovery support tools, such as medication-assisted treatment and temporary housing assistance. There is a great need to ensure that care coordination and recovery supports are provided throughout the continuum of care. DAODAS, DMH, and the recovering community have worked with the S.C. Primary Health Care Association to develop a long-range strategy on care coordination and recovery support provision. Our initial concept is to use the Colorado Patient Navigator Training Program (see figure below) to produce a cross-trained workforce of Patient Navigators (Recovery Support Coaches and/or Peer Support Specialists) that will support a client in every stage of the client/patient process: Link to healthcare system Health screening and brief intervention Diagnostic process/assessment Treatment/management Maintenance, recovery support, and end-of-life Step 1: Assess the strengths and needs of the service system to address the specific populations. Page 9

10 Our current concept is to develop Level One and Level Two Patient Navigators (Peer Support Specialists and/or Recovery Coaches) who will initially specialize in mental health and substance use disorder clients, but over time will cross-train to support co-occurring clients and all behavioral health clients, with specialization in special populations such as the homeless, individuals with HIV/AIDS, women and children, and returning veterans. In the future, we envision a force that also includes generalists who can provide navigation and peer-support services to any client, regardless of their health needs. Service to Diverse Racial and Ethnic Groups: One of DAODAS core principles is to serve the residents of South Carolina regardless of their race or ethnic background. DAODAS also understands the importance of cultural competence and offers training to all employees in its system on how best to serve individuals who are seeking help for substance abuse issues. DAODAS local providers strive to practice in accordance with ROSC principles that suggest encouraging the individual to chart their own journey in treatment. Each individual s cultural, racial, and ethnic attributes are naturally attended to in that process. Step 1: Assess the strengths and needs of the service system to address the specific populations. Page 10