Kern County Methamphetamine Strategic Plan October, 2010 EXECUTIVE SUMMARY On September 14, 2009, Dr. Dixie King of Transforming Local Communities, Inc., presented to the Kern County Board of Supervisors the findings of the Impact of Methamphetamine in Kern County: A Preliminary Study. Findings from the study showed, among other disturbing facts, that up to 39% of all felony prosecutions in Kern County include methamphetamine offenses; approximately 37% of emergency room patients at Kern Medical Center have used methamphetamine; over 50% of substance abuse treatment admissions in Kern County are for methamphetamine; and over one-third of Adult Probation cases and nearly 30% of Juvenile Probation cases involve methamphetamine. These figures have ramifications for every county department, as well as for the courts. As a result of this presentation, the Kern County Board of Supervisors charged Kern County Mental Health with the task of developing a strategic plan to address methamphetamine use in Kern County. Supervisor Ray Watson (District IV), Chairman of the Board, convened the Kern County Methamphetamine Reduction Task Force to assist in the effort. The Task Force, which is comprised of county agencies, businesses, community-based organizations, the faith-based community, criminal justice agencies, and the community-at-large, met throughout the Winter and Spring of 2010. Members adopted a mission statement and guiding principles, listened to nationally-recognized experts in the field of substance abuse prevention and intervention, and developed a county-wide plan with four major foci: (1) Support for Business to Address Alcohol and Other Drug (AOD) Use; (4) Effective Criminal Justice Programs; (3) Family Wellbeing and Family Management; and (4) Prevention and Treatment for Youth. Task Force members identified factors in each of these four areas that contribute to promoting or sustaining methamphetamine and other substance use, developed goals and objectives to reduce risk and promote protective factors, and identified strategies for achieving these goals and objectives. Strategies fell under three main categories: activities currently underway; strategies possible within existing partnerships and using existing resources; and strategies that will require an infusion of new funding from outside the county. The Task Force then formalized these strategies through the development of a logic model. This report provides a narrative explanation of the process used by the Task Force to develop the strategic plan, and a Logic Model for each of the four areas of concern. The logic model detailing goals, objectives and strategies in the area of Support for Business to Address AOD Use is located in Section 3 of this binder; Section 4 contains the logic model for Effective Criminal Justice Programs; Section 5 the logic model for Family Wellbeing/Family Management; and Section 6 the logic model for Prevention and Treatment for Youth. Section 7 of the binder contains commitments made by each agency and business represented on the Task Force toward implementing the Strategic Plan. Sections 8 through 11 contain a synopsis of the data provided by the nationally recognized consultants who presented cutting edge data to the Task Force members prior to beginning the strategic planning process, and Section 12 contains the original Methamphetamine Impact Study.
Strategic Plan to Reduce and Prevent Methamphetamine Use in Kern County Overview and Methodology PLAN NARRATIVE Submitted for Approval to the Kern County Board of Supervisors by the Kern County Mental Health Department October, 2010 On September 14, 2009, Dr. Dixie King of Transforming Local Communities, Inc., presented to the Kern County Board of Supervisors the findings of the Impact of Methamphetamine in Kern County: A Preliminary Study (Meth Impact Study). The study, conducted under the auspices of the Kern County Mental Health Department 1 over an 18-month period, included data from existing data sets (e.g., the Criminal Justice Information System-CJIS, Mental Health System of Care records), information from interviews with county department heads, public opinion poll data, and case studies conducted in the West Kern communities of Taft and Wasco (the original target of the federal grant under which the study was funded). It also included data from a snapshot study conducted in May 2008 during which line staff from nearly a dozen county agencies completed a five-item survey for every encounter with a client in order to document whether methamphetamine use was a factor in the case. Findings from the study suggested that methamphetamine is significantly impacting agency case loads in Kern County; for example: Up to 39% of all felony prosecutions in Kern County include methamphetamine offenses; Approximately 37% of emergency room patients at Kern Medical Center have used methamphetamine; Over 50% of substance abuse treatment admissions in Kern County are for methamphetamine-related disorders; Approximately 37% of Adult Probation cases involved methamphetamine, as did 29% of Juvenile Probation cases; During the month of May 2008, approximately 36% of all Sheriff s Office calls/encounters in outlying areas and 33% of calls/encounters in metropolitan Bakersfield involved individuals who were either using methamphetamine or suspected of methamphetamine involvement. Over one-quarter of social worker encounters involved individuals who were either using methamphetamine or suspected of methamphetamine involvement. 1 This project was funded by the U.S. Department of Health & Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment under the Methamphetamine Targeted Capacity Expansion grant program (Federal grantee ID # TCE HTI1730).
Of the randomly-selected substance abuse clients interviewed in West Kern, seven of eight had begun their meth-using careers as teenagers, and four had used methamphetamine for the first time when they were under 15 years of age. As a result of this presentation, the Board of Supervisors directed Dr. James Waterman, Mental Health Director, to return with a plan to strategically address the problem of methamphetamine use in Kern County. Ultimately, the Kern County Mental Health Department (KCMH) proposed a strategic planning process that would be led by Lily Alvarez, the KCMH Substance Abuse Administrator, and that would include the involvement of representatives from a broad spectrum of county interests and constituencies. Planning was proposed to take place over approximately eight sessions between January and April 2010, and would include three sessions devoted to presentations by nationally recognized experts in the field of substance abuse prevention and intervention, as well as a fourth session presented by Dr. King examining best practices from other communities around the country. The remaining sessions would be devoted to customizing a plan for Kern County that incorporated evidence-based practices wherever possible. The methodology was accepted by the Board, and Supervisor Watson convened the planning group.. Dr. King was contracted to facilitate the planning process and to deliver a written strategic plan. Selection of the Task Force In determining the membership of the planning group, renamed the Methamphetamine Reduction Task Force, the Mental Health Department (KCMH) sought to be inclusive of individuals representing the broad geographic regions and unique interests of Kern County residents, while ensuring that the number of participants was limited to allow for a short-term planning process. KCMH developed a list of approximately 20 key participants whose involvement was considered to be critical for the adoption and implementation of a county-wide initiative (e.g., Kern County District Attorney, Kern County Public Defender, Probation, the courts, Mental Health, Public Health, Department of Human Services, law enforcement, treatment providers). KCMH also included representatives from groups and constituencies whose involvement would be crucial in implementing nationally recognized best practices (e.g., educational institutions, businesses, family resource centers, youth-serving organizations and the faith-based community). A decision was made to focus on county-wide planning rather than to attempt to address the needs of individual communities, in that communities in Kern County serve diverse populations and have very different sets of needs. It was agreed, however, that the Plan would include support for outlying communities to develop local methamphetamine reduction plans. KCMH was careful to ensure that membership in the Task Force remained as balanced and representative as possible, so that no one constituency could drive the process in a particular direction. In the end, the voting membership of the Task Force grew to 30 (Section 1 of this binder provides a comprehensive list of members). Every effort was made to involve the general public in the planning process. The Board of Supervisors opened the Board Chambers for the presentations by nationally 2 P age
recognized experts, and promoted these sessions through local media. When the Task Force began the primary work of building the strategic plan, the general public was again invited to participate in the meetings, and although they could not vote, Task Force members were encouraged to incorporate information and perspectives from as many different individuals and groups as possible. Expert Consultation In an effort to ensure that all Task Force members had access to the most up-to-date information about best practices in the field of substance abuse reduction, three of the first four sessions were devoted to presentations by nationally recognized experts. Dr. David Hawkins, University of Washington, is the author of the seminal work done to develop a risk factor framework for adolescent substance abuse. Dr. Richard Rawson, University of California, Los Angeles, presented on the properties of methamphetamine, how it impacts the brain, national and international use trends, and implications for treatment efficacy. Joel Phillips, prevention expert and consultant to the State Attorney General s Office and the Departments of Alcohol and Drug Programs and Education addressed the issues related to under-age drinking and the nexus between alcohol and other drug abuse, as well as environmental factors that mitigate toward or against experimentation. A fourth session, facilitated by Dr. King, focused on nationally recognized models currently in use in other communities, including the Montana Project (a media campaign), The San Diego Strike Force, and Drug Court. These presentations, accompanied by printed materials and other information resources, provided Task Force members with a common language and a common framework from which to examine the problem of methamphetamine use in Kern County. They also helped members to distinguish between approaches to prevention that may be politically popular but that research has shown to be ineffective in reducing adolescent experimentation, and evidence-based or best practices which research has shown to be effective in preventing or reducing drug use among specific populations. Development of a Mission Statement and Guiding Principles The first undertaking of the Task Force was the creation of a mission statement and guiding principles. In order to expedite this process, Dr. King asked Task Force members to provide a written list of elements that should be included in a mission statement, and three principles that they felt were critical to promoting and sustaining their work. Between meetings she drew from these responses to develop four draft mission statements. Members then selected by consensus and refined the mission statement that they felt best represented their work: The mission of the Kern County Methamphetamine Reduction Task Force is to create a road map to reduce methamphetamine use and its impact in Kern County. 3 P age
Using the same procedure, the Task Force adopted the following Guiding Principles: 1. Our approach will be broad and multi-faceted. 2. Our recommendations will be data-driven, community-focused, and culturally sensitive. 3. We will work to understand each other s programs, mandates, priorities and resources in order to make realistic recommendations to the Board of Supervisors. 4. We understand that each member of the Task Force represents a unique perspective, and while we may not always come to agreement, we will always show respect for each others points of view. 5. We will ensure that community voices are incorporated into our strategic planning process. 6. We will incorporate assessment, monitoring and evaluation into our recommendations in order to ensure that we are able to measure the degree to which we are successful. 7. We will give priority to approaches that have been demonstrated to be effective. 8. We will support the right of individual communities within Kern County to create and implement their own strategic plans, based on local needs, resources, and priorities. The Task Force agreed to vote on issues by consensus. Selection of a Theoretical Framework During the first planning session, the Task Force re-examined the information presented by the expert consultants in order to determine a theoretical approach or framework to use in structuring the strategic plan. Contextual issues the Task Force considered in selecting a model included: Easy access to methamphetamine in Kern County; Lack of coordination between agencies in addressing the issue; Inadequate agency resources; and Limited funding to promote multi-disciplinary efforts on the part of agencies, businesses, service organizations, and the community at large. The Task Force examined four approaches or models for addressing methamphetamine that included risk and resiliency approaches to youth substance abuse, the Institutes of Medicine (IOM) model that focuses on both prevention and treatment, the San Diego Strike Force Model, and a comprehensive, systems-wide approach that includes prevention, intervention, treatment, and interdiction. After some deliberation, the Task Force agreed to use the IOM model, which is recommended by the Substance Abuse & Mental Health Administration, a division of the U.S. Department of Health & Human Services. A benefit of this approach is that it incorporates intervention and treatment, as well as prevention, and targets all ages and all segments of the community. According to "Drug Abuse Prevention: What Works", National Institute of Drug Abuse, 1997, p. 10-15): The IOM model divides the continuum of care into three parts: prevention, treatment, and maintenance. The 4 P age
prevention category is divided into three classifications--universal, selective and indicated prevention interventions. Universal prevention strategies address the entire population (national, local community, school, neighborhood) with messages and programs aimed at preventing or delaying the abuse of alcohol, tobacco, and other drugs. An example of a universal strategy might be a public media campaign, or a drug prevention curriculum delivered to all middle school students. Selective or selected prevention strategies target subsets of the total population that are deemed to be at risk for substance abuse by virtue of their membership in a particular population segment. Selective prevention targets the entire subgroup regardless of the degree of risk of any individual within the group. An example of a selective strategy might be to target the parents of adolescents using an evidencebased parenting curriculum, or to introduce mandatory testing to employees in jobs that place them at high risk for substance use due to long hours or shift work. Indicated strategies are designed to prevent the onset of substance abuse in individuals who do not meet criteria for addiction, but who are showing early danger signs, such as excessive consumption of alcohol or the use of other gateway drugs. The mission of indicated prevention is to identify individuals who are exhibiting early signs of substance abuse and other problem behaviors associated with substance abuse and to target them with special programs. Indicated prevention programs address risk factors associated with the individual, such as conduct disorders, and alienation from parents, school, and positive peer groups. The aim of indicated prevention programs is not only the reduction in first-time substance abuse, but also reduction in the length of time the signs continue, delay of onset of substance abuse, and/or reduction in the severity of substance abuse. Development of the Strategic Plan Based on the findings of the Methamphetamine Impact Study and on their perspectives both as representatives of a constituency and as residents of the community, members generated a list of factors contributing to the problem of methamphetamine use in Kern County. They then grouped and prioritized these needs, which fell into four key areas: Support for Business to Address AOD Use, Effective Criminal Justice Programs, Family Well-being/Family Management, and Prevention and Treatment for Youth. The Task Force broke into groups under each major identified issue that met for an additional nine sessions in order to complete a draft strategic plan. The Plan included a goal for each targeted population (universal, selected, indicated); recommended strategies or objectives aimed at each population group, anticipated outcomes, and partners needed to coordinate or implement the recommended strategies. Strategies identified fell into three categories: (1) programs, strategies and/or resources currently available; (2) strategies possible within existing resources or with new partnerships; and (3) strategies requiring new funding streams (e.g., grants). 5 P age
Representatives from each agency, business, institution, and organization listed as a partner under each set of strategies took the draft plan back to their respective stakeholder groups for review and approval. It was agreed that the plan as it is written is a starting point only and that, if implemented, will require the involvement of many other partner agencies and groups. In addition, the Task Force recognizes that in order to successfully address methamphetamine and other drug use in the long term, it will be necessary to support individual communities throughout Kern County in undertaking a similar strategic planning process that addresses the unique needs of the residents of those communities. Major Objectives in the Four Target Areas (1) Support for Business to Address AOD Use Concerns in the area of business regarding the impact of methamphetamine use included reduced labor force availability; increased liability for businesses; equipment and property loss; lost time on the job, injuries, lost productivity; fear of stigma or employment consequences on the willingness of employees to seek assistance (e.g., Employee Assistance Programs); cost of pre-employment screening/monitoring; and negligent hiring/testing practices. Strategies targeting all businesses (universal): Develop training for local businesses in the identification of meth paraphernalia and meth use; Educate businesses regarding the benefits of drug-free workplace policies and provide support for the development of such policies; and Launch a social marketing campaign to promote a drug-free workforce. Strategies targeting businesses that test employees and/or prospective employees (selected): Identify and provide best practice guidelines for businesses using shift work ; and Develop an AOD resource directory for businesses. Strategies targeting business that regularly fire employees for AOD abuse (indicated): Increase Employee Assistance Program capacity among local employers; Training local businesses in risk and liability management related to AOD; Promote the use of random drug testing. (2) Effective Criminal Justice Programs Factors contributing to the problem in the area of Effective Criminal Justice Programs were identified as inadequate availability of treatment for Prop 36 offenders, especially in outlying communities; lack of consequences under current system for non-compliant 6 P age
offenders in Prop 36; inadequate length of treatment for offenders, given what we know about recovery from methamphetamine; absence of re-entry programs; inadequate services for co-occurring disorders; lack of a PDO prevention/intervention unit; and easy access to meth. Strategies targeting the community-at-large (universal): Develop a media campaign to increase awareness and encourage reporting through a variety a venues (call center hotlines, web reporting, etc.); Conduct town hall meetings to raise local awareness and gain local support; and Increase the number of Neighborhood Watch sites operating in the county. Strategies targeting truant and/or unsupervised youth, children of parents with a history of incarceration and/or AOD use (selected): Develop evidence-based mentoring programs for both youth and families; Maintain the Truancy Reduction Program in Kern County. Strategies targeting offenders with AOD-related issues and their families (indicated): Maintain and increase Prop 36 treatment programs; Establish Prop 36 treatment in rural communities that don t have programs; Establish a traditional Adult Drug Court for offenders able to participate in outpatient treatment programs; Expand the hours for drug testing in outlying communities for people who are employed; Develop a Mental Health Court for mentally ill/drug addicted defendants; Offer transportation and childcare for offenders to attend treatment; and Expand existing re-entry programs for parolees with a history of substance abuse to incorporate evidence-based practices. (3) Family Wellbeing/Family Management The Task Force identified factors that compromise family well-being and/or good family management practices. These included multi-generational substance abuse; lack of or inadequate parenting skills; lack of stable environment for kids; lack of appropriate monitoring and supervision for kids; increased number of single-parent families; and lack of parental involvement at school. Strategies targeting all families (universal): Public education campaign to increase awareness of risk and protective factors. Strategies targeting non-substance abusing teen parents, parents of foster children, homeless parents, parents with a family history of AOD abuse (selected): Develop capacity of Family Resource Centers, CBOs, DHS, medical providers, and the faith-based community to increase social networking opportunities and build knowledge about AOD abuse; 7 P age
Develop support networks for families through family mentoring; Increase perinatal screening for AOD; and Expand the Nurse Family Partnership program for teen parents. Strategies targeting families with drug-exposed infants, parents who fail drug tests and are not in treatment, families with minors receiving DUIs, parents of students in court and community schools (indicated): Develop a Family Drug Court model to address the needs of AOD offenders and their children involved in Dependency Court; Expand the Family Decision-making Meeting model; and Expand Differential Response. (4) Prevention and Treatment for Youth The Task Force identified the following contributing factors in the area of Prevention and Treatment for Youth: the inability of schools to implement programs shown to be effective in preventing alcohol, tobacco and other drug use (ATOD); lack of intervention programs for youth at high risk for ATOD; counter-productive zero-tolerance policies in schools; lack of support services for students with AOD problems; and not enough treatment centers for adolescents. Strategies targeting all K-12 schools (universal): Launch a social marketing campaign to address youth AOD use; Promote revision of zero-tolerance policies and increase awareness of effective school and community-based interventions to address the problem behavior; Increase the number of school sites trained in Student Assistance Team (SAT) identification and referral process. Strategies targeting children whose families use; children who are truant; children in foster care or group homes; pregnant & parenting teens; children who are experimenting (selected): Increase capacity of Student Assistance Teams to properly screen for AOD use and to provide Brief Intervention and referral services, as needed; Increase ability of CBOs to partner with schools to deliver evidence-based AOD interventions for credit in after school and alternative education settings; and Expand capacity to deliver evidence-based mentoring in school and community. Strategies targeted at youth already addicted to AOD (indicated): Expand prevention, intervention, and treatment programs in local schools; Establish an evidence-based Adolescent Drug Court in Kern County; and Expand the availability of residential treatment for adolescents in Kern County. Strategies for carrying out each of the objectives listed above are included in the logic models found in Sections 3, 4, 5, and 6 of this binder. 8 P age