FORMAL INTERVENTION SERVICES FOR JUNEAU Quarterly Report April 1 June 30, 2014 Program Description NCADD received a CBJ SSAB block grant in FY13-14 to continue to provide ongoing intervention services. A modified Johnson Institute intervention model continues to be the selected approach and is the most effective protocol, both clinically and in terms of cost. Our target population for intervention services is the 29% of Juneau residents who are heavy drinkers or drug users, and their families and other concerned individuals. Annual target numbers include 60-70 families (about 100 individual family members) and 75 substance abusers, 50 of whom will enter treatment. 200-250 intervention inquiries are expected annually. Treatment for addictive diseases is rarely sought by patients voluntarily because of the strong denial component which characterizes addiction. Therefore, most recoveries must start with an intervention - a controlled, compassionate confrontation - usually done by family or significant others, with a trained interventionist facilitating the process. NCADD provides these interventions, with funding assistance from the CBJ SSAB block grant program. We receive inquiries almost every week from people worried about a significant other s substance abuse problem, both locally and elsewhere in the state. We schedule at least 50 interventions a year, and provide integrated behavioral health, outpatient treatment, individual and family counseling, as well as continuing care. The way a typical intervention works is that a significant other (spouse, friend, employer, etc.) will telephone NCADD with a request for assistance for someone in trouble with alcohol or drugs. These telephone calls are fielded 24 hours a day, 7 days a week, and are answered either by the executive director or one of our counselors. An initial appointment is set up and suitable intervention participants are chosen who receive a series of trainings on addiction and on the intervention process. The patient is also seen by one of our counselors, if necessary, to determine the appropriate level of care. Most patients agree to be assessed, either by NCADD or another behavioral health provider. The intervention itself is then conducted, either at NCADD s offices or somewhere else convenient for the group. A treatment bed date will have been secured by NCADD staff by this time, and the patient either agrees to go to treatment, or refuses. However, all is not lost if the patient refuses. It is said that no intervention is ever a failure; once intervened on, a patient will never be able to engage in addictive behaviors again without remembering the impact this behavior has on all the important people in the patient s life. Concerned significant others always gain from interventions as well by coming to a new understanding of addictive diseases and learning healthy coping behaviors for themselves. Finally, NCADD will offer a series of continuing care groups, which provide support for patients after they return from inpatient treatment. A public outreach component to this program includes advertising of NCADD s intervention services, and at least one public presentation that describes the disease concept of addiction in general, and the intervention process in particular, will be scheduled. We look for speakers
who will engage as wide an audience as possible. NCADD staff also provides presentations on addiction and interventions as requested to various community groups such as clergy, employers, physicians, etc. Summary of Progress FY14 Quarter 4 A significant change at the agency has been the hiring of a full time master's level clinician during Quarter 1 in FY14. Because we have a higher level of expertise who is on staff full time our capacity has increased. We are able to provide more services to more consumers. New Developments: During Quarter 1 of FY14 we spent agency resources and focus toward developing a drug and alcohol treatment program. This program is primarily based on a best practice evidenced based curriculum, the Matrix Model. In combination with motivational interviewing techniques, this curriculum is delivered in no less than 9 hours a week to patients who meet ASAM levels 1 to 2.1. In Quarter 2 on October 3 rd we implemented our first group therapy session within our outpatient treatment program which remains unnamed at this time (though we are in the process of coming up with a name for direct services at NCADD to help distinguish these services from other services and programs we provide). By the end of Quarter 3 we learned that a majority of our patients needs meet a higher level of care and we decided to end our 0.5 program and begin transitioning patients and taking new patients into a higher level of care, ASAM level 2.1. This level of care is at least 9 hours of group therapy and one hour of individual therapy for each patient each week for 16 weeks. We recently hired another casual status clinician to help us deliver these services and we began implementing our Level 2.1 intensive outpatient treatment the first week of May. We have had 2-3 patients enrolled in this level of care and approximately 9-13 patients on average enrolled in the Level 1 program. Continuing care services: In past quarters due to shortage of staff we were unable to provide a comprehensive therapeutic model of continuing care for individuals returning to Juneau after completing residential substance abuse treatment. In Quarter 2 we developed and organized a continuing care program. We provide weekly group and individual therapy in our continuing care program and we have received referrals from providers mainly out of state such as from Sundown M. Ranch in Selah, Washington and Lakeside Milam in Kirkland, Washington. We currently have 4 patients in this program. Service Numbers In Quarter 4 we conducted 2 formal interventions this quarter. From the formal intervention process, 1client successfully entered treatment as a result. A total of 4 significant others participated. Another level of intervention includes the 29 integrated behavioral health we provided to individuals, and of those 25 individuals entered into some level of treatment that was recommended for them. We estimate that about half of those (12) complied with their treatment program as these chose NCADD as their provider, but many of them chose behavioral health providers outside of NCADD. We assisted in the coordination of care in getting them referred and ensuring they accessed those providers. We provided 1 public presentation this quarter on disease concept of addiction and interventions. 1) Provided information on interventions/ NCADD services and education to group of community clinicians at NCADD on 5-22-2014 (5 clinicians) The following table summarizes activities this quarter. ACTIVITIES THIS REPORTING PERIOD 2
Goal: Provide substance abuse intervention services to greater Juneau area Objectives Activities Maintain 24/7 intervention helpline; calls referred to staff cell phones after hours. 250 calls/year. Provide family intervention training as requested to 60-70 families (approximately 100 family members) annually. Provide professional for 50 patients who need interventions annually. Conduct 50 formal interventions per year. Provide family counseling for all intervention participants (100 family members annually). Arrange for treatment for 50 diagnosed substance abusers; 40 will enter treatment. Offer continuing care curriculum Design followup survey for clients to measure treatment success. Design/modify media ads for prevention and intervention services. Provide public presentations on addiction and on interventions. Activity: Calls referred to staff cell phones after working hours to provider 24-hour coverage. Measure: 5 calls per week estimated. Activity this quarter: 8 calls logged Activity: Employ techniques including written study materials, videos, suggested scripts and group coaching. Measure: 1 training every 1-2 weeks on average Activity this quarter: 3 family members, 2 trainings Activity: Administer multiaxial assessment tools employing DSM-IV, ASAM criteria (SASSI, AUDIT, SBIRT, etc.) prior to intervention to determine appropriate level of treatment. Measure: 1 assessment per week on average Activity this quarter: 29 patients received an integrated behavioral health assessment Activity: Schedule venue, participants, treatment bed, and facilitate formal intervention for patient with significant others presenting rehearsed statements. Measure: 50 interventions/year (roughly 1/week) Activity this quarter: 2 interventions completed Activity: 1-on 1 or group counseling, referrals as appropriate. Measure: 100 family members per year Activity this quarter: 3 family members Activity: Contact treatment provider, arrange for bed date and travel as appropriate, obtain releases. Measure: at least 40 patients into treatment Activity this quarter: 2 interventions, 1 entered treatment Activity: Design/modify existing continuing care curricula to offer clients returning from treatment. Measure: 10 clients to complete continuing care per year. Activity this quarter: 4 referrals, 4 clients participating Activity: Design a followup telephone survey to determine treatment success 6 months and one year post-treatment Measure: none yet established Activity this quarter: deemed infeasible at end of FY13, however we recognize the importance of this and will continue to strategize how we can be effective in this area and produce follow up data. The executive director has already begun collecting performance measures/survey questionnaires and is developing a draft and will be ready to begin this for FY15. Our set of first survey questions was mailed out on July 11 th to past patients to obtain feedback and data. We mailed 59 surveys out. Activity: Modify existing or design new media ads for intervention services or presentations (print, radio, TV). Measure: none established Activity this quarter: TV recovery ads on KATH-TV, along with prevention/intervention print ads in Capital City Weekly Activity: Plan events, engage speakers and venues, provide media coverage, and report on attendance and other statistics. Measure: At least 2 events per year, attendance measure not established. Activity this quarter: Community presentations: 1 presentation, 6 attendees (we provided a majority of this activity in Qtrs 1,2, and 3.) 3
Activity 1 st qtr 2 nd qtr 3 rd qtr 4 th qtr TOTAL GOAL Crisis calls logged 35 15 12 8 258 250 Assessments- adult 33 17 26 29 79 50 Assessments schools Intervention training family 68 37 6 3 114 100 members Formal Interventions 17 6 3 2 28 50 Adult Counseling family 2 2 2 3 9 100 members School Counseling individual School Group counseling - # of groups School Group counseling -# of students School counseling- parent counseling Successful referrals to treatment 10 3 from interventions 15 from 1 from intervention and 25 from 1 from intervention and 25 from 80 40 Public presentations 4 5 6 1 16 2 events per year Number of public presentation attendees School Presentations Number of school presentation attendees 58 251 299 6 614 Note: Shaded areas indicate services that were offered up until the end of FY13 in the Juneau School District through funding NCADD received as a subcontract with JSD under the Tobacco Prevention Control Program. This funding changed its goal for FY14 from funding direct services to funding policy and systems change activities only. NCADD no longer delivers direct services in the JSD. Though we would like to however we would need more funding to hire staff to deliver the services as we do not have the capacity and loss two counselors as a result of the cut in funding. 4