Substance Abuse Services for Youth in Florida: A Guide for Families

Substance Abuse Services for Youth in Florida: A Guide for Families March 2009 Florida Certification Board/Southern Coast ATTC Monograph Series #4 Substance Abuse Services for Youth in Florida: A Guide for Families 1

Table of Contents Chapter One: Introduction...7 Purpose of this Publication...7 Chapter Two: Know Your Child...11 Talking to Your Child...11 Tips for Talking...11 What if My Child Doesn t Want Help?...12 Chapter Three: Taking the First Step...15 Getting Advice from Others...15 Getting an Assessment...15 Types of Assessments...16 Mental Health Problems...16 Where to Get an Assessment...18 Chapter Four: When Emergencies Happen...21 If your Child is Arrested...21 What if a Judge says Your Child Has a Problem?...22 What if the School says Your Child had Drugs?...22 Hospitalization...23 Chapter Five: Privacy of Information...25 Protecting Your Privacy...25 Mandated Reporting Requirements...25 Special Rules for Youth Seeking Alcohol/Drug Treatment...25 Protected Health Information...25 Chapter Six: Understanding Treatment...29 Types of Services...29 Finding Quality Care...30 What to Expect During Treatment...31 Signs that Treatment is Working...32 Maintaining Treatment Successes...33 Chapter Seven: Paying for Services...35 Payment Terminology...35 Paying for Services...38 Co-Payments...39 Locating Payment Assistance...39 Publicly-Funded Services...40 Documenting Eligibility...40 Chapter Eight: Your Rights and Responsibilities...43 Concerns about the Care Your Child is Receiving...44 Grievance Procedures...44 References...45 Appendices...47 Appendix A: Web Resources...48 Appendix B: Common Mental Health Disorders Among Children...50 Appendix C: Florida Department of Children and Families, Substance Abuse and Mental Health Program Offices...52 Appendix D: Florida Medicaid Area Offices...55

4 Substance Abuse Services for Youth in Florida: A Guide for Families Disclaimer: Please note that many people have reviewed this guide for accuracy at the time of publication. Remember, though, contact information, laws and agency policies can change at any time. It is always a good idea to request copies of current policies and rules from the agencies with whom you are working.

The system for children s substance abuse services can be complex and confusing. Navigating through it can be difficult, time consuming, and stressful. This guide can help. Dear Parent, If you learn your child is abusing drugs, you must act. Finding someone to treat your child s substance abuse problem is just as important taking care of his or her physical well-being. If your child has a broken bone, you go to an emergency room. But what if he or she is using or abusing alcohol or other drugs? Where do you go? A common complaint from parents is that they are frustrated in trying to obtain services from the systems that treat both substance abuse and mental health problems. This can be very complicated and confusing. This guidebook has been created to assist you in accessing substance abuse services for your child in Florida. The guidebook is a one-stop resource for parents. It is written for parents, but it is our hope that family members, community organizations, schools, and healthcare providers will also use the information. This guidebook maps all the different parts of the system (both public and private) and how they connect. We have included warning signs and symptoms of substance use; assessment and treatment options for substance abuse problems; and descriptions of different types of services providers and services that can help parents. Remember, you are providing important support for your child. Take care of yourself mentally and physically. Do not become frustrated; seek help. The resources in this guidebook have proven effective. Substance Abuse Services for Youth in Florida: A Guide for Families 5

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1 Chapter One: Introduction Rarely can we turn on the TV or read the headlines today without hearing about someone in trouble with alcohol or other drugs. Young people are particularly at risk for experimenting with them. Yet we know that alcohol and drug use interferes with important learning and growth that take place during the teenage years. Alcohol and drug abuse can affect a youth s ability to make good decisions. It can lead to health, school, developmental, legal, and family problems. The reasons youth use drugs are as different as the kids themselves. Some try alcohol and/or drugs to feel good, i.e., to be part of a group, to feel happier or be more at ease. Others may use drugs to cope with bad feelings, such as boredom, loneliness or sadness. They may be exposed to drugs by friends and may be curious about their effects. Sometimes drug use is happening in the family with an older brother or sister, or perhaps a parent. Drugs are more widely available to youth than most adults realize. For instance, the 2008 Florida Youth Substance Abuse Survey (of 91,471 Florida students in grades 6-12) showed 53.2% reported that they have used alcohol in their lifetime and 29.8% reported using it in the last 30 days. More than one in five (21.5%) Florida high school students reported one or more occasions of binge drinking (defined as the consumption of five or more drinks in a row) in the last two weeks. Marijuana use within the last thirty days was reported by 11.1%. Youth who use alcohol and other drugs often have a mental or emotional problem as well, which sometimes appears even before the drug use begins. Despite the widespread use of alcohol and other drugs by youth, most parents think not my kid. What would you do if you thought your child might be involved? Where would you go? What could you expect? Purpose of this Publication This guidebook is written to help you answer these questions. While there are no immediate, guaranteed solutions, there is much that you as a parent can do. Study after study has shown that parents are the most important influence in a teen s decision to use or not use drugs. Please note that whenever drugs are mentioned throughout this guidebook, it is important to remember that this includes alcohol, the most frequently used drug by teens. The time to act is now if you suspect or know that your child is using drugs. This guidebook will help you to: Identify some signs and symptoms of alcohol and drug use Learn tips for talking to your child Become familiar with places to go for help Understand what types of help is available Learn how you can be part of your child s care Understand you and your child s rights and responsibilities Review the most common payment methods The flow chart on the following pages will assist you in thinking through some of the action steps you will take in seeking help for your child and where to go in this publication to answer some of these important questions. Substance Abuse Services for Youth in Florida: A Guide for Families 7

A Quick Guide to Making Decisions Is Treatment Needed? Are you concerned that your child may be abusing alcohol or other drugs? YES Talk to your child. Ask questions that may help you to determine if you should be concerned. Are you still worried? YES Talk to others who know your child such as teachers, coaches, doctors, clergy and other parents. Do they agree that there may be a problem? NO Continue the positive things that you are doing. Remain watchful for signs or symptoms of a problem. Help your child to make healthy choices. NO Does the assessment recommend services other than substance abuse treatment, such as family counseling or mental health services? YES YES YES Get a professional assessment of your child s situation. (See page 18). Use the DCF Adolescent Substance Abuse Treatment Directory as a resource. Does the assessment recommend substance abuse treatment? NO If no services are recommended, continue positive parenting, seek healthy social support for yourself and your child and re-assess if negative changes create new concerns. YES Review the treatment recommendation as a family. Decide if you will seek treatment at this time. Decide as a family if you will enroll in these services. If the assessment agency has not provided specific information, call 211 to find services. Do you want to enroll your child in substance abuse treatment? (See page 29). YES 8 Substance Abuse Services for Youth in Florida: A Guide for Families

A Quick Guide to Making Decisions When Treatment is Necessary Do you know if your child is eligible to receive services at the agency you have identified treatment? YES If your child is eligible for services, do you know how much services cost and how you will pay for services? YES NO YES NO If you want to enroll your child in treatment, do you know where to find it? NO Call the agency or agencies you have selected and ask about your child s eligibility. Be prepared to answer questions about the treatment recommendation, where you live and your income. See the chart on pages 36 37 for ways to pay for treatment. YES YES Use the Adolescent Treatment Directory to find an agency in your area or call 211 to help you find appropriate services. treatment, do you know where to find it? YES If you know your child is eligible and you have a way to pay for services, call to see if a treatment slot is available. See the boxes below for what to do next. NO YES If a treatment slot is not available at this time, ask to be put on a wait list. Find out if there are services available to wait list clients. If so, enroll in those services. If the wait will be long, ask for a referral to an alternative appropriate agency or service. Continue to seek community and social support for your child and family. If a treatment slot is available, set up an appointment for an intake visit. Make sure you know what documentation and records you need to bring with you to this appointment. Substance Abuse Services for Youth in Florida: A Guide for Families 9

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2 Chapter Two: Know Your Child How will you know if your child is using alcohol or drugs? It may not be easy to tell, since changes in youth are expected as they approach the teen years. Knowing your child and the kinds of things that may indicate drug use will help. While none of these confirm your child is using, you may want to know what s causing them. Talking to Your Child The first step is often the hardest. Admitting to yourself that your child may be using alcohol or drugs can be frightening. The thought of talking to your child about potential drug use can be even scarier. Parents may also feel guilty or responsible. What s important to remember now is that there are many reasons why kids use drugs. It is never too early or too late to take action. Parents are the most important part of a child s life and your actions from this point on can make a difference. Always consider seeking professional advice for yourself. There is no need for you to confront this alone. Before you engage your child in a conversation, you ll need to prepare yourself. Go for a walk, sit where you can t be disturbed, and think. Reflect on the facts of the situation. Try to avoid negative feelings of anger and betrayal - as they won t be useful to you in this conversation and may result in your child tuning out. Organize your thoughts. Decide what you want to say. Tips for Talking First, learn what you can about alcohol and drugs. Many of the resources in Appendix A of this guidebook will direct you to places where this information is available for parents. Signs and Symptoms There may be sudden changes in the way your child acts, such as: Increased secrecy about activities Unusual outbursts of temper Withdrawal from the family Lying or stealing There may be changes in the way your child sounds or looks, such as: Slurred speech or lack of coordination Major weight loss or gain Different clothing, particularly those with drug messages There may be changes in your child s social or school activities, such as: Skipping school Drop in grades Loss of interest in previous activities Change in friends You may find things that may be related to alcohol or drug use, such as: Rolling papers, pipes, clips, etc. Lighter fluid, gasoline cans, etc., sometimes with paper bags or rags Bottles of eye drops (may be used to cover up blood shot eyes) Missing bottles of alcohol or prescription drugs from the home Find a time to talk with your child when you are calm and know what you want to say. Arrange for some privacy. Ensure there is enough uninterrupted time for the discussion. Tell your child what you have seen and how you feel about it. Be specific about what you have noticed that makes you think he or she may be using alcohol or other drugs. Explain why this concerns you. Try to find out what is going on and encourage your child to talk about alcohol or drugs. Convey your love and ensure your child that you will get help for him/ her and the family if needed. Substance Abuse Services for Youth in Florida: A Guide for Families 11

After presenting the facts as you see them, ask your child for his/her response to the information you ve presented. Listen. Hear what your child is saying. You can show your attentiveness by simply repeating or reflecting what your child has said or by saying it back in your own words. This will make sure that you truly understand what s/he is trying to tell you. Listen! Be prepared for your child to deny using alcohol or drugs. Even if your child admits it, s/he may not think there is a problem. Discuss what the rules are in your family about drug or alcohol use and that you will enforce these. You can also share that there will be a continuing conversation about this and that you may want to talk to a professional. Leave the door open for the child to talk to you at any time in the future. The resources in Appendix A also include websites that have information about teenage drug use and give additional tips about how to talk to your child. What if My Child Doesn t Want Help? Chances are your child will not think or admit s/he needs help. The question for you as a parent becomes: How can you get your child the help once you believe s/he needs it? You must be firm about the importance of an assessment and/or recommended treatment. Substance abuse professionals who work with youth are prepared to counsel kids who may not yet recognize a problem. You may want to contact a substance abuse program and get some advice on what you can say and do before you speak with your child. Sometimes a young person may continue to refuse to attend or participate in substance abuse services. Under a Florida law called the Marchman Act (Chapter 397, Florida Statutes) there are some special circumstances when a youth can be taken involuntarily for assessment and/or treatment. The special circumstances include the requirements that the youth is substance impaired as evidenced by: 1. has lost the power of self-control with respect to substance use; and either 2. (a) has harmed, threatened to or attempted to harm him or herself or others, o r (b) needs substance abuse services but is so impaired by the use of substances that he/she cannot recognize the need or make a rational decision to get services; however, refusal to get services does not necessarily show evidence of a lack of judgment. The process used to enforce the Marchman Act varies in each county. In some counties, the family contacts an agency that provides substance abuse services for assistance in filing a Petition for Involuntary Assessment and Stabilization with the court. In the other counties, the probate office at the courthouse is the first point of contact. Once a petition for assessment has been filed, the Court will determine if your child needs to be immediately picked up for assessment without a hearing (an Ex Parte order), or will set a hearing date and time. If a hearing is conducted, all parties will have the opportunity to advise the judge of the need for the assessment and the resources available to complete it. 12 Substance Abuse Services for Youth in Florida: A Guide for Families

If the judge finds that there is enough evidence to meet the requirements for involuntary assessment, your child will be ordered to attend an appointment with a substance abuse counselor in an outpatient office-type setting. The judge could also direct your child to be placed into a secure facility such as a Juvenile Addictions Receiving Facility (if one is available in your area). During your child s stay in this safe and secure environment, s/he will receive a physical exam, in detailed substance abuse assessment, and supportive counseling every day. The assessment is usually completed within seventy-two (72) hours. The goal of the assessment is to provide you and your child a recommendation for treatment and a referral for followup care. In most cases, the counselor can make an appointment with a treatment provider during the assessment, and can answer questions regarding his or her recommendations. The counselor s duty is to ensure that your child is placed in the least-restrictive setting to receive care. This may be an outpatient program, daytreatment setting, or a residential facility. Finally, the counselor will determine if the youth is willing to enter the program on a voluntary basis, or if another Marchman Act court hearing will be necessary to ensure your child follows through with the recommended treatment. Based upon the results of the assessment and the determination that the youth will not voluntarily enter treatment, a Marchman Act Petition for Involuntary Treatment can be filed by the parent or a designated representative of the treatment facility (or the counselor) who completed the assessment. A court hearing will be held, and everyone involved in the case will have a chance to discuss the findings of the assessment and the appropriate treatment program. The judge will then make a determination whether your child should be court ordered to attend treatment. Key Terms Assessment: A professional review of a child s and family s needs that is done when they first seek services from a provider. The assessment of the child includes a review of physical and mental health, substance use history, developmental history, school history and performance, family situation, and behavior in the community. Diagnosis: The identification and labeling of a disorder or disease based on its signs and symptoms. Treatment: A set of activities carried out by properly trained and certified professionals that can help to reduce or eliminate the abusive use of alcohol and drugs. Marchman Act: A law under the Florida Statutes (Chapter 397) that enables family members to obtain help for a loved one who is unwilling to seek substance abuse services voluntarily. The Marchman Act court process is not a criminal proceeding but is designed to ensure your child understands the seriousness of his or her need for treatment and complies with the court order. If your child fails to obey the Order for Treatment, an Order to Show Cause as to why he or she has not followed the court order is filed with the court and s/he can be held responsible under the law. The court s order can be reviewed and renewed within sixty (60) days in order to make certain your child completes the program. Substance Abuse Services for Youth in Florida: A Guide for Families 13

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3 Chapter Three: Taking the First Step Getting Advice from Others You may want to talk to other people who can offer support and information on where to get help. There are various resources available to you at this point. Sometimes it is helpful to talk to other families who have had the same experience. This may be someone you know. Knowing that you are not alone and how others have sought help can be very encouraging. Many communities have self help groups for families such as Alanon and Narcanon. You can check your phone book for listings of these or Alcoholics Anonymous or Narcotic Anonymous hotlines for meeting locations and times. You may want to talk to your child s doctor. A doctor can also examine your child and perhaps order a drug test that can screen for the recent presence of certain drugs in the urine. The doctor may also be able to recommend a substance abuse professional or program where you can take your child for an assessment. Consider talking to your child s school counselor. School counselors often know if there are specialists in the school system that can help decide if a referral for a substance abuse or mental health assessment is needed. School counselors also often know where you can take your child for assessment and treatment within the community. Some schools have services that take place in the school for youth who may have a substance or mental health problem. You can ask your child s school counselor if there are services like this in your child s school. You may want to call your local office of the Florida Department of Children and Families (DCF) Substance Abuse Office. They will be able to tell you about publicly funded facilities or how to access private care. Getting an Assessment When you or others decide that your child may need help, the next step is getting your child an assessment. The assessment provides explanations of your child s problems as well as recommendations for strategies to treat them. During an assessment, the substance abuse professional will talk with your child and the family, and sometimes others (i.e., probation officers or teachers) in order to collect current and background information. This should include asking if your child has any specific cultural or physical needs that should be considered. The substance abuse professional doing the assessment may want your child to complete other tests or questionnaires. All information will be used to determine if your child is having any problems that need treatment. The initial assessment usually takes from one to two hours. The substance abuse professional will make recommendations to you and your child once the assessment is completed. These recommendations may include the need for further assessment and/ or treatment and the places where treatment may be available. Substance Abuse Services for Youth in Florida: A Guide for Families 15

Types of Assessments Some of the most common types of assessments for a substance abuse and/or co-existing mental health problem, and the type of professional who typically provides them are described in the following table. Type of Assessment Psychosocial Medical Psychiatric Who Does It Substance Abuse Professional (Bachelor or Master degree) Mental Health Professional (Bachelor, Master or Doctoral degree) Social Worker (Bachelor of Social Work, Master of Social Work or Licensed Clinical Social Worker) Physician (Medical Doctor-MD) Physician Assistant (PA) Advanced Registered Nurse Practitioner (ARNP) Psychiatrist (MD) Purpose Collects current information and background information in order to determine the need for substance abuse and mental health treatment Determines the need for medical assistance to withdraw from alcohol or drugs; conducts a routine medical exam Assesses mental and emotional problems; provides a diagnosis and treatment recommendations, including any medications Sometimes an assessment will include a urine drug screen. A urine sample can be tested to detect if certain drugs are present in the urine. Not all drugs can be detected in urine and each drug can only be detected for a certain period of time. Urine drug testing does not tell how often the drug has been used. Blood testing for alcohol and other drugs is rarely performed. It occurs most often in cases of arrests for driving under the influence or in hospitals in emergency situations. Mental Health Problems Young people can have mental, emotional, and behavioral problems. Mental health disorders, sometimes called emotional disorders, are medical conditions that can disrupt a child s mood, thinking, feelings, and ability to interact with and relate to others in his or her life. For the majority of children, a change in mood, feelings, and behavior is a natural part of child development. However, when these changes begin to impact a child s ability to function on a daily basis, a mental health disorder may be the cause of these changes. If this is the case, the child may need mental healthcare. If you suspect that your child has a mental health issue, it may be hard to know when to seek help. If you observe some of the following symptoms, it may be time to talk to your child s doctor about your child s symptoms: Extreme anxiety or worry Constant hyperactivity 16 Substance Abuse Services for Youth in Florida: A Guide for Families

Appearing distracted when others try to interact with him or her Constant nightmares Frequent anger, aggression, or disobedience Constant temper tantrums that cannot be explained Significant changes in eating or sleeping habits Significant change in performance at school Inability to handle daily stresses or problems Constant complaining about physical problems (for example, stomachaches or headaches) Acting withdrawn or depressed Self-injurious behaviors Drug or alcohol use may also be a sign of other mental health issues. Some children use substances as a way to control mental health symptoms a form of self-medicating without the use of (and sometimes the stigma of) prescription medications. If you think that your child may have a problem with drugs or alcohol, you may need to think about other mental health issues as well. Trying to figure out if a mental health problem is affecting your child is not easy and requires the expertise of a doctor, such as a psychiatrist or a pediatrician, or a mental health professional. These professionals can evaluate the child and determine if he or she has a mental health issue. Specially designed interview and assessment tools are used to evaluate a person for mental health disorders. The person conducting the assessment bases the diagnosis on the person s report of symptoms, and his or her observation of the person s attitudes and behavior. The physician or mental health professional then determines if the person s symptoms and degree of disability point to a diagnosis of a specific disorder. If a mental health problem is identified, it too should be treated. Experts agree that both substance abuse and mental health should be addressed at the same time. Not doing so is likely to result in treatment failure. The substance abuse professional may refer your child to a psychiatrist for evaluation. Parental permission is required TIP If your child s behavior concerns you, write down how he or she acts each day specific signs or symptoms, how often they happen, in what context they happen, when you first noticed them, and any other concerns you have. This will be a big help when you talk to your child s doctor or mental health specialist. It is also a good habit to get into for the future. If your child is diagnosed with a mental health disorder, your records can be very helpful in charting his or her symptoms and response to treatment over time. Substance Abuse Services for Youth in Florida: A Guide for Families 17

in most cases in order for your child to receive medication for mental or behavior problems. A description of common mental disorders among children and adolescents can be found in Appendix B. Where to Get an Assessment Substance abuse assessment and treatment services are offered primarily in two types of systems: publicly funded services, which families must qualify for, and services covered by a family s private insurance. There are programs that are mostly funded by state and public dollars. Because these programs receive public funding, they cannot deny services to individuals solely based on a person s inability to pay. You may want to contact your local publicly funded substance abuse program or community mental health center if you have limited income or financial resources. There are several ways you can access information about where to go for an assessment. Dial 211 for information and referral provided by Florida Alliance of Information and Referral Services which provides assistance to approximately 75% of Florida s population. Look in the Yellow Pages of your local telephone book which will list alcohol and drug treatment programs. Call the Florida Department of Children and Families Substance Abuse and Mental Health Office that serves your county. See listing in Appendix C. Obtain a copy of Florida s best source of information for publicly funded adolescent substance abuse programs - the Directory of DCF Funded Adolescent Substance Abuse Treatment Programs in Florida 2008. This Directory was developed to assist parents, families, Access the directory at: www.fadaa.org professionals, and individuals in locating services for Florida youth. Any of the providers listed in this directory, by county, will be happy to answer your questions about the various services they provide. Privately funded services can be obtained from both agencies and individuals, with families paying a fee. Since privately funded services do not receive public funding, they are more costly to the people who receive them. If you have insurance, it may pay for some of the costs, depending upon your policy. For details about payment options, please see Chapter Seven, Paying for Services. 18 Substance Abuse Services for Youth in Florida: A Guide for Families

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4 Chapter Four: When Emergencies Happen Emergencies and crisis situations happen and sometimes cannot be avoided. Crisis situations are filled with high levels of stress, anxiety, and fear. Your best bet is to remain calm and realize your child needs your help and support. Your Child s Situation Your child is showing severe, out of control behavior. Your child may be a threat to self or others. You are frightened. There has been a major change in your child s behavior. Your child seems unable to function without help. You feel unable to cope with the situation or help your child. There has been a mild to moderate change in your child s behavior. You are worried, but not alarmed. When to Get Help Immediately (emergency) 48-72 hours (urgent) Soon (a routine evaluation) Where to Get Help Call 911 Hospital Emergency Room Mental Health Crisis Stabilization Units 1 Police Call 211 Pediatrician or other physician Substance Abuse or Mental Health provider or agency Community Organization (call your local DCF office as shown in Appendix C for the number) Pediatrician or other physician Substance Abuse or Mental Health provider or agency School Family or friend Community Organization (call your local DCF office as shown in Appendix C for the number) 1 Crisis Stabilization Services These services are residential acute care services that are provided on a 24-hour, 7-day a week basis. The services involve brief, intensive residential treatment to meet the needs of individuals who are experiencing acute crises and who, in the absence of a suitable, alternative, would need inpatient psychiatric hospitalization. Each county in Florida either has such a facility, usually called a Crisis Stabilization Unit (CSU), or contracts with a facility to serve people from that respective county. Several counties may contract with a facility to provide this service. If your Child is Arrested Many youth who are involved with alcohol or drugs come to the attention of the juvenile justice system since the use of these substances are illegal. The juvenile justice system includes a range of services provided under the Florida Department of Juvenile Justice to youth who break the law. There are different points of contact a youth may have within the juvenile justice system where a potential substance abuse or mental health problem may be identified. When a minor is taken into custody by a police officer for a law violation, the officer will determine whether the child can be released to the family pending further action on the charges or if the child needs to be screened for Substance Abuse Services for Youth in Florida: A Guide for Families 21

detention. Detention screening is done in a Juvenile Assessment Center or by a Department of Juvenile Justice on-call screener. A child may be detained in a residential Department of Juvenile Justice Detention facility or placed on home detention. A Juvenile Probation Officer (JPO) will be notified of the law violation and will then conduct an intake interview with the child and family to gather information and develop a plan to address the offense. The Juvenile Probation Officer s assessment and plan to address the offense is then sent as a recommendation to the State s Attorney s Office, who makes the final decision. The plan takes into consideration things like previous arrests, the nature of the offense, and the risk the child presents to the community. The recommendation may be to place the child in a program and divert them from the juvenile court system or file a petition for the child to appear in court. Youth who appear in court for a delinquent offense may be court ordered to attend a diversion program, placed on probation, and/or committed to a residential commitment program. All youth who are arrested for a law violation in Florida are screened for potential alcohol, drug and/or mental health problems. The substance abuse and mental health screening occurs after the arrest and may be done in a Juvenile Assessment Center or by an on-call detention screener. Screening may also be done when youth are placed in a detention center or by a Juvenile Probation Officer during the intake interview. This screening for substance abuse and mental health occurs as part of an instrument called the Positive Action Change Tool. A referral for a full assessment will be made if any screening indicates a potential substance abuse or mental health problem. What if a Judge says Your Child Has a Problem? An assessment that confirms a substance abuse and/or mental health problem will make recommendations for the type of services and may include a specific program where these services are available. Recommendations for treatment may be given to the Juvenile Judge who will hear your child s case. Based on these, the judge may court order your child to attend a particular program. If a judge commits your child to the Department of Juvenile Justice, the Department will decide where your child will be sent. Youth being considered for commitment to a Department of Juvenile Justice residential facility must receive a comprehensive evaluation, which includes mental health and substance abuse, prior to placement. The residential commitment facility should address any identified needs for substance abuse or mental health services. What if the School says Your Child had Drugs? Schools in Florida have a zero tolerance policy regarding the possession of alcohol and drugs at school. Youth found to have alcohol, tobacco or drugs at school may be expelled, suspended or referred to an alternative program, depending upon the policy in that school district. Should this happen to your child, it is important to ask the school any questions that you have about the incident. Find out what options there are for your child s continued education or how to get help. Ask about an appeals process if you disagree with the decisions that are made about your child. You can also contact the Florida Department of Education Office of Safe Schools at (850) 245-0416 for more information. 22 Substance Abuse Services for Youth in Florida: A Guide for Families

Hospitalization Emergency situations involving alcohol or drugs usually occurs in medical emergency situations, i.e., an overdose. Call 911 if you suspect that your child has overdosed. If you know what your child has taken or find bottles or pills, take these with you to the emergency room. The emergency room will medically evaluate your child. Once your child s immediate condition has been stabilized, the hospital may admit your child to the hospital for further observation, transfer your child directly to a substance abuse facility, or release your child to the family with follow-up recommendations. Keeping Track of Information You will likely interact with many people while seeking assistance for your child. Even though you may have others who coordinate specific aspects of your child s care, you are the primary coordinator of all your child s services. Keeping careful records will help you as well as all of your child s providers. Having information readily available will allow you to quickly provide a complete and accurate picture of your child to physicians, counselors, teachers, and others. It is well worth the effort. Here are some tips for getting organized: Keep all originals in a safe place in your home file and place only copies in your notebook. Fasten all records securely in a three-ring notebook. This will keep the pages from getting separated and out of order should the notebook fall. If the notebook becomes too big, transfer items not needed into your home files. Clean out the home files as needed. Keep a log or summary of the records contained in the notebook. If you have many records, separate them in a way that makes sense to you. Consider filing them in sections based on type of records or filing them in chronological order. You might have separate files for school reports, medical assessments, and treatment plans. For example, you might want to organize your folders this way: Birth certificate Immunization records Doctors reports Specialists reports Legal documents School tests and assessments Reports for any prior care for substance abuse or mental health problems Write any personal notes on a copy of the record or a blank sheet of paper. Keep a phone log with the name of the person you spoke with, date of the call and summary of conversation. This will help you keep track of important events, conversations and future appointments. If your child is on any medications, keep a list of medications including dosage changes, start date, and discontinue date. Be sure to note any adverse reactions. Do not rely on memory. Substance Abuse Services for Youth in Florida: A Guide for Families 23

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5 Chapter Five: Privacy of Information Protecting Your Privacy Your child has a right to confidentiality throughout the entire process of referral, assessment and treatment. Confidentiality means that personal information obtained during the process of seeking or receiving substance abuse services cannot be shared without the written permission of the person receiving services. Permission to release information must be in writing and be specific about who can receive information, the type of information to be shared and how the information will be used. There are a few situations where information can be released without the person s consent. Even then there are often restrictions on how much and what type of information can be given or how it can be used. Confidentiality and its limitations should be explained to your child during the initial contact with a service provider. Mandated Reporting Requirements One of the exceptions to confidentiality occurs when a professional is told or suspects that a child has been abused or neglected. The professional in this situation is required by law to report this suspicion to Child Protective Services. Child Protective Services will then be responsible for following up on the report. Special Rules for Youth Seeking Alcohol/Drug Treatment Florida law gives minors the right to seek and receive substance abuse prevention and treatment services without parental consent (meaning, on their own). For this reason, your child will be asked to sign consent forms in order for information to be shared about their treatment. This includes information that will be shared with parents and family members. Protected Health Information The federal government has a law called the Health Insurance Portability and Accountability Act of 1996 (HIPAA) which requires that personal health information be private. Your child s personal health information will be kept in records at the office or agency where you get services. This information cannot be given to others without written permission from the child if he or she is 18 years or older. Your written permission is needed if you are the guardian of a child younger than 18 years. When you first go to the professional or agency for help, they will ask you to sign a form giving permission for the agency to use or share your information. The form says you give permission for the personal health information to be shared with others for two purposes: 1) to get help from another professional who is needed; or, 2) in order for the office to send a bill to your insurance company, or to the Medicaid or Healthy Kids plan. Substance Abuse Services for Youth in Florida: A Guide for Families 25

Other reasons that the personal health information could be given to others include: To study what works, in order to improve services (for research). In this case, your child s name would not be shown. Only summaries would be published. Because a judge or court asked for the information. To protect public health, for example, if your child had a disease that others could get. For government agencies to review the work of this office, to insure that they are doing a good job and spending money wisely. When there is concern about abuse or neglect of a child. Your family s personal health information cannot be given to employers. It cannot be used or shared for sales calls or advertising. It is important that you give the health professional or agency all the information they need to help your child. They may ask you to sign a form giving permission for them to get old records so they can see your child s past medical history. If you think your privacy is not respected, you may file a complaint. Contact the Department of Health Inspector General at 850-245-4141. You can learn more about your rights at: www.hhs.gov/ocr/hipaa. This is a web site for the federal government. State rights to privacy may be stricter. Privacy is an expectation and a right. Here are your rights under the law: You can expect to have both written information and conversations kept private and confidential. You have the right to be told what the office s policies are about privacy and keeping personal health information confidential. This information should be in writing. You have the right to get a copy of your child s medical record or personal health information. You have the right to review it and to correct it if it is wrong or incomplete. You have the right to know who has used or shared your personal health information, and for what purpose. Generally the purposes will be for treatment, payment, or for office operations. You can ask to be called or have mail sent to another place other than your home. You can ask that information not be shared if it is not required for it to be used or shared. 26 Substance Abuse Services for Youth in Florida: A Guide for Families

Substance Abuse Services for Youth in Florida: A Guide for Families 27

6 28 Substance Abuse Services for Youth in Florida: A Guide for Families

6 Chapter Six: Understanding Treatment There are many successful treatments for substance abuse and dependence. Treatment includes drug or alcohol rehabilitation, which provides strategies for coping with the desire to use alcohol or drugs, teaches ways to avoid drugs, and prevents a return to use (called relapse), and helps the person to deal with relapse if it occurs. Treatment also allows the person s body to get over any physical dependence to the substance. There are many different methods that are used to provide counseling for your child and your family. Individual, group, and family counseling are suggested forms of treatment. Depending on your child s situation, he or she may need different levels of care. Treatment for substance abuse may also include additional services such as education, peer support, and continuing care. Medications may be prescribed by a psychiatrist, who will continue to monitor your child while they are on them to assess their effects. Within Florida, a child 13 years old or older can receive mental health and substance abuse assessment services or individual and counseling, or other forms of verbal counseling from qualified agencies and professionals without parental consent. Types of Services Placement in a particular type of treatment is based on the results of the assessment. These placements are often guided by nationally recognized guidelines. If your child has any special cultural or physical needs, these should be considered in the placement recommendation. An array of services is usually available. Medical services involve a range of care depending upon individual needs: Detoxification centers provide medical withdrawal from addicting drugs in a residential or outpatient setting. Crisis stabilization units provide assessment and stabilization of a mental or emotional crisis, including suicide risk. Routine medical care offers nursing assessments, physical exams and prescribes medications to treat physical conditions, if indicated. Psychiatric services provide assessment, diagnosis, and prescribe and monitor medications for mental conditions, if indicated. Outpatient services consist of individual, group or family counseling in an office setting once or twice a week. Some programs are more Types of Counseling Services Individual counseling takes place one-on-one with just the counselor and the client. Group counseling is where a small group of youth meet regularly to talk, interact, and discuss problems with each other and the counselor. This setting gives youth a chance to talk about problems and get feedback from others who are experiencing similar problems. Family counseling is used to treat family problems and address the impact that an alcohol, drug or mental health problem has on the family. The counselor considers the family, not the individual, as the unit of treatment and emphasizes relationships and communication patterns between people as the focus of work to be done in treatment. Substance Abuse Services for Youth in Florida: A Guide for Families 29

intensive outpatient programs that provide individual, group or family counseling and educational services several hours per week. In some cases, outpatient counseling services are conducted in the home. Residential services are programs that are staff supervised twenty-four hours a day, seven days a week, and offer a variety of counseling, educational, recreational, case management, and support services. Residential programs can be short term (one month), intermediate (three to six months) or long term (more than six months). Peer support services are typically offered as self help groups. The most widely available support groups for people receiving treatment for substance abuse are 12 step groups such as Alcoholics Anonymous or Narcotics Anonymous. For family members, peer support groups are usually Al-Anon or Alateen. Case management services are activities that are handled by a counselor or case manager that link your child or family to other services that are needed. Some examples might be scheduling an appointment with a psychiatrist or an employment counselor. Educational services help you and your child learn more about your child s specific problems as well as new skills. When a child develops a substance abuse problem or a mental health issue, the child, parents, and other family members need specific information about what is happening the diagnosis, the meaning of specific symptoms, what is known about the causes, effects, and implications of the problems. It includes information on how to recognize signs of relapse, so that the child can get necessary treatment before it happens. It also involves teaching coping strategies and problem-solving skills to parents and other family members to help them deal more effectively with the child. Continuing care or aftercare services focus on maintaining changes made while in treatment. These may include going to continuing care groups, participating in peer support groups, or relapse prevention counseling. When parents, families, professionals, and adolescents are seeking treatment for substance abuse or substance dependence it can be challenging to determine if outpatient treatment is sufficient or if more intensive treatment is needed. When more intensive care is needed outside of the home, treatment choices may be limited and may not be available in all counties due to higher operational costs. Distance to treatment and cost for treatment can create challenges that influence treatment choices. Finding Quality Care Programs that hold themselves out to the public as substance abuse prevention and treatment services in Florida must be licensed by the Florida Department of Children and Families. This applies to programs that are publicly and privately funded. Licensure means that a program must meet various health, safety, and client care standards. Programs that are licensed are reviewed by the Department of Children and Families to ensure they meet these standards. In addition to licensing, programs may choose to be accredited by a national accreditation organization. Accreditation involves additional standards of care 30 Substance Abuse Services for Youth in Florida: A Guide for Families

and adds another layer to the assurance of quality services within a program. Programs that receive accreditation are reviewed by the accrediting body to ensure they meet those accreditation standards. Programs are required to post their license within each program area. Programs that are also accredited also post notices of their accreditation within their facilities. In addition, many programs cite licensure and accreditation status on their brochure or program information materials. Substance abuse counselors who work in licensed programs may choose to obtain licensure under the Department of Health (in areas listed below) as individuals or certification as addiction professionals. If the substance abuse counselor is not individually licensed or certified, the standards require that they be clinically supervised by someone who is either licensed under the Department of Health or certified as an addiction professional. Individuals in independent private practice who provide substance abuse and mental health services must be licensed individually. An individual must meet certain education, experience and competency requirements in order to be licensed. Individuals in Florida who provide these services are licensed by the Florida Department of Heath, Division of Medical Quality Assurance. Examples of the types of licenses held by individuals who treat mental heath and substance abuse problems include: Physician Psychiatrist Psychologist Mental Health Counselor Social Worker Marriage and Family Counselor TIP: There are some questions you may want to ask before your child enrolls in a program. Some things to consider are: Is the program and/or individual counselor licensed or certified? Do the program and/or individual have experience with youth who have substance abuse or mental health problems? What are the costs and what is my financial responsibility? What types of counseling will be provided for my child? How will the family be included in the treatment? What kind of information will I be given and how often? What are the major program rules/expectations? How are violations handled? Does the program offer medications as part of treatment, if appropriate? What happens when my child s treatment is complete? What success have you achieved in treating youth? What are your measurable program outcomes? What to Expect During Treatment A plan of care, or treatment plan, is developed when your child begins a program. You and your child will participate with the counselor and other treatment team members in the development of this plan. The plan will identify what problems will be addressed, what services will be applied to these problems, and what the expected result is for each problem. The plan will also specify how often and for how long your child will participate in services. The recommended length of treatment will depend upon the complexity of the problems being addressed and the level of care. Substance Abuse Services for Youth in Florida: A Guide for Families 31

Your child will be expected to follow this treatment plan and review it periodically with the counselor, making agreed upon changes when necessary. This includes attending and participating in counseling and other activities as scheduled. There may be other expectations for your child s behavior, such as coming to counseling sessions sober and not being in possession of drugs, including alcohol. You and your child should be informed about these expectations at the beginning of treatment. If your child does not attend treatment regularly, it will not work. It is widely accepted that families are a critical part of a child s treatment. Programs and individuals who work with youth know this and involve families in the treatment process in a number of ways. Families in most cases will be expected to arrange for transportation for their child to and from appointments. In some cases, families will be asked to attend activities specifically designed for families. You will want to ask in what ways you will be involved in your child s care. The following are examples of the types of activities that may be expected for family members: Communication: Families should expect to be in regular contact with treatment providers to receive information about their child s progress. Families need to know the kind of information that will be shared with them, consistent with confidentiality regulations. Counselors often want to hear your observations as well as anything that could impact on your child s treatment. Family Counseling: Some programs provide family counseling where parents and their child meet with counselors to improve communications and relationships within your individual family. Family Visitation: Residential programs usually offer times during the week when families can visit their child at the program. Your child may be allowed to come home for periods of time, depending on treatment progress and the length of the program. If there is another family member in the home that also has a problem with alcohol or drugs, including a parent, this will have a significant impact on your child s substance abuse treatment. Discuss this immediately with your child s counselor if this is happening in your family. Signs that Treatment is Working There are various signs that your child is getting better. In general, the things that led you to suspect that your child was involved with drugs and/or alcohol to begin with will start to disappear. You may also notice changes for the better in your child s attitude and appearance. Your child s attendance and grades in school may improve. Your child may start getting along better with other family members at home. You may request a meeting with your child s counselor or program to get their view of your child s progress. The counselor can share information, within the boundaries of your child s confidentiality. While there are many signs that treatment is working, only your child knows for sure whether or not they have truly made changes and will work to maintain them once treatment is over. 32 Substance Abuse Services for Youth in Florida: A Guide for Families

Maintaining Treatment Successes All of the available information based on years of studies indicates that treatment works. It especially works while the person is active in treatment. Most youth do complete the treatment program. However, it is hard to maintain changes for most people once treatment is completed. Old temptations will still be there and it is not unusual for youth and adults to stumble and return to using substances to relapse. Relapse is not unusual and because of this, substance abuse professionals develop a plan to prevent relapses with your child. This plan includes what to do if a relapse occurs. Usually this involves re-contacting a substance abuse professional or program as early in the relapse as possible. A relapse may result in a return to medical services, counseling, continuing care or self help groups, depending on the extent and nature of the relapse. Continuation in some type of support or aftercare services after completing the primary course of treatment is also important to help prevent relapse and maintain treatment gains. Family healing and the rebuilding of trust is a delicate process. If your child has completed treatment, he or she has worked hard to begin making the needed changes in their life. As your child continues to show the ability to maintain these changes, they will slowly begin to regain your trust. It is important to remember that many of the painful things that occurred in the past were related to your child s alcohol and drug use. Although the past doesn t go away, it is helpful to stay focused on the present and to allow your child to be the person they are now and are becoming. Substance Abuse Services for Youth in Florida: A Guide for Families 33

734 Substance Abuse Services for Youth in Florida: A Guide for Families

7 Chapter Seven: Paying for Services Once you know that your child needs treatment, you may be concerned about how you can pay for the services that are needed. You might think that you would need to pay for services yourself or have private health insurance to cover the cost of care. This is not the case. In Florida, there are many different types of insurance and subsidy programs that can help you afford the care that your child needs. In addition, many programs offer sliding scale payment, which means that cost depends on how much you can afford to pay. Florida s publicly funded treatment programs cannot turn anyone away due to an inability to pay. Since there are limited slots in these public programs, there may be a waiting period for your child to enter treatment. Payment Terminology Depending on the severity of your child s problems and your own financial situation, you may need to use a combination of programs in order to pay for care. It is important to be familiar with the key terms below. Medicaid is a state and federally funded program that provides health care coverage for certain low-income individuals who meet requirements related to age, disability or condition of pregnancy. In Florida, the Agency for Health Care Administration (AHCA) develops and carries out policies related to the Medicaid program. The Florida Department of Children and Families determines eligibility for low-income children and family programs and the institutional care program. Managed Care is the process by which Medicaid controls the costs of its services. Medicaid has three types of managed care: 1. Medicaid HMOs (health maintenance organizations) are private managed care insurance companies that have contracts with the state of Florida to provide health care for eligible recipients. 2. MediPass is a state administered primary care case management program that provides health care for eligible recipients. 3. Provider Service Network (PSN) is operated by health care providers who offer integrated systems of health care to eligible recipients. Only a limited number of Florida counties have PSNs. Florida Healthy Kids is a program that helps thousands of uninsured children in the state of Florida gain access to affordable, quality health care. Healthy Kids combines local, state, federal and family funds to pay premiums to commercial health plans who assume the insurance risk. The program is one of four components of the Florida KidCare program and covers children ages five through eighteen who are uninsured and not eligible for Medicaid or the Children s Medical Services Network. Healthy Kids is unique because it is designed to provide affordable access to health insurance coverage for working families for whom the payment of the full premium would be out of reach. Private Health Insurance is usually obtained through an employer, but is also available for purchase on an individual basis. Your insurance policy is essentially a contract between you and the insurance company. The contract can be renewable yearly or monthly. The type and amount of health care costs that will be covered by the health plan are specified in advance in the member contract or an evidence of coverage guidebook. The chart on the following pages compares three of the primary public health and social programs that provide substance abuse services in Florida. Substance Abuse Services for Youth in Florida: A Guide for Families 35

Payors for Children s Substance Abuse Treatment Comparison Chart Questions Medicaid Florida Department of Children and Families (DCF), Substance Abuse Office Who is eligible? Eligibility is determined by the Department of Children and Families (DCF) or the Social Security Administration. Individuals with family incomes that are less than 250% of the federal poverty level. Fees are assessed based on sliding scale the higher the income, the more the client is responsible to pay. DCF determines Medicaid eligibility for: Low income families with children Children only Pregnant women Non-citizens with medical emergencies Aged and/or disabled individuals not currently receiving Supplemental Security Income (SSI). Social Security Administration determines eligibility for anyone who is: aged (age 65 or older); blind; or disabled. What are the income limits? (What if I own a house/car?) Eligibility is determined by the Department of Children and Families or the Social Security Administration. Income limits are set by these two entities and vary with eligibility group. Family income determinations include salary/hourly wage and benefits such as Supplemental Security Income (SSI)*, disability, retirement, TANF**, etc. for the client s household and for most state supported services, based on the Federal Poverty Level guidelines. Please see these websites for details. Department of Children and Families, Office of Economic Self Sufficiency http://www.dcf.state.fl.us/ess/ Social Security Administration: http://www.ssa.gov/ * Supplemental Security Income (SSI) is a federal program that makes monthly payments to people with low income who are age 65 or older or are blind or have a disability. ** Temporary Assistance for Needy Families (TANF) is a federal program that provides states with funds that replace the former welfare systems. TANF funds are provided directly to needy families, used to promote work and education, promote family planning, or be used to encourage two parent families. What does it cost to get substance abuse assessment and treatment services? Rates are dependent on the type of assessment and treatment that the recipient is receiving. Some providers have a nominal co-pay of $3 (or less) per day. State statutes governing substance abuse require a share of cost from the consumer, based on the family s ability to pay. Providers under contract with DCF are required to develop a Sliding Fee Scale in accordance with the Federal Poverty Level. Services can cost as little as a few dollars from the client per service. The state absorbs the majority of the costs for a wide range of services. 36 Substance Abuse Services for Youth in Florida: A Guide for Families Florida Healthy Kids Uninsured children ages 5 through 18; other programs under Florida KidCare are available for children from birth through age 18 as well. Subsidized coverage for children up to 200% Federal Poverty Levels Non-subsidized coverage for those over 200% FPL There is a monthly premium payment for overall coverage (most families pay $15 or $20 per month for coverage). $5 office co-payment for outpatient services

Do I have to be a legal resident to be eligible for services? Where can I go to apply for benefits under this payor? How long does it take to be able to receive services? What types of services are available as benefits? (related to substance abuse issues) What if we have health insurance... will this affect our services? How and where do I/my child go to receive these services? Yes. Again, eligibility is determined by the Department of Children and Family. http://www.myflorida.com/accessflorida/ This will vary depending upon the number of providers in their area, and the availability of appointments within each provider. Outpatient Substance Abuse services: individual/family therapy assessments group counseling, treatment planning; peer recovery support aftercare services methadone or buprenorphine administration Medicaid is the last payor to be used. Therefore, if you have 3rd party insurance the provider must bill your primary insurance first. Once payment or denial of payment is determined the provider can submit reimbursement from the Agency for any unpaid services. The Agency will determine if the claim is eligible for reimbursement based on: the service provided, the payment made by the primary insurer and the amount that Medicaid reimburses for that service. There are several agencies that provide these services. Please contact your local AHCA office for information (listings of the Medicaid offices can be found in Appendix D). State funding is allocated to local communities based on population; therefore, most areas of the state have additional requirements of residency due to local match funds. Because state resources are limited, providers have designated service areas for individuals and families residing in specific communities. Exceptions can be granted depending on circumstances of the client/family. To be eligible for subsidized coverage, a child must be a US Citizen or qualified non-citizen The local DCF Substance Abuse and Mental Health Program Offices maintain a list of contracted service providers and can provide a list of options. Many communities have a central intake process, an agency that determines eligibility and provides an assessment of service needs. Families can apply online at www.floridakidcare.org or call 1-888-540-KIDS and request an application be mailed to them. The more intensive services generally have longer wait times due to limited capacity (residential treatment) few days to a few weeks (some as long as a month). Interim services such as case management and counseling services are available until a bed becomes available. Less intensive services (outpatient) can be same day or same week. Applications take 6-8 weeks to process; coverage starts the first of the month following approval AND receipt of the first month s premium payment. A child may also be required to see a primary care physician first for a referral for specialty services. The department purchases a wide range of prevention, detoxification, treatment, and support services for individuals and families affected by substance abuse. Inpatient Services: 7 days per contract year for medical detoxification; 30 days residential services Outpatient Services: 40 visits per contract year. Families with health insurance have a greater number of options. They can go anywhere the insurance is accepted. The department has limited resources, and in most cases, only purchases a portion of a provider s service capacity. Yes, a child has to be uninsured to be enrolled in and eligible for the Healthy Kids program. Any provider that is licensed by the department has been thoroughly reviewed and is continuously monitored. For state or federally supported programs, the local SAMH Program Office (see Appendix C) or 211 can direct individuals to the most appropriate agency. Child must use designated providers within their managed care plan s network; the managed care plans vary by county. Substance Abuse Services for Youth in Florida: A Guide for Families 37

Access to Services Getting access to substance abuse treatment services can seem complicated at first, but the process is easier if you remember a few key points: Some agencies require a referral from a professional such as a doctor or mental health counselor in order to admit someone to treatment. Some agencies have their own referral coordinators or screeners. The agency that performs an assessment may be able to make a formal referral for treatment. Not all agencies take all forms of payment. Make sure the agency accepts your method of payment. Some insurance providers or subsidy programs require preauthorization for services. Make sure you complete this step before setting an appointment for services. Paying for Services There are generally three ways to pay for substance abuse or mental health services for children: Self-Pay If you have no insurance and are not eligible or enrolled in a subsidy or public entitlement program such as Medicaid, you may need to pay for care out of your own pocket. Many programs allow payment on a sliding scale, based on your income and ability to pay. Programs funded by the Florida Department of Children and Family Services or other government bodies generally are not allowed to refuse service based on inability to pay. However, private providers and programs do not have such restrictions. Private Insurance If you have private health insurance with coverage for your family, this insurance may cover some or all of the care your child needs. However, many medical insurance plans have limited coverage for substance abuse and mental health services, also known as behavioral healthcare. You should refer to your policy documents or call your insurance carrier s member service representative to confirm your coverage. Use of private insurance may also require approval in advance. This is referred to as prior authorization. For some plans, prior authorization can come from your child s primary physician, while others have a separate authorization for mental health services. Prior authorization may limit payment to a certain amount of visits or a specific period of time. Government Subsidy or Entitlement You may be eligible for Medicaid or Healthy Kids. Generally, children in families with low incomes, children who have a permanent medical condition, and pregnant women can enroll in Medicaid. Children cannot be older than twenty years of age. They must be citizens or qualified non-citizens. If your family is receiving Temporary Cash Assistance or can qualify to receive this assistance, you can enroll in Medicaid. 38 Substance Abuse Services for Youth in Florida: A Guide for Families

If there are two people in your family and you have $28,000 a year or less in income, you can enroll in Healthy Kids. Families of three people with $35,200 or less income also qualify for Healthy Kids. If there are four people in your family and you make $34,400 or less, you can enroll. Families in Medipass get mental health services through a pre-paid mental health plan. Call your area Medicaid office and ask how to get mental health services (see Appendix E for the phone number). To learn more or to apply for Medicaid or Healthy Kids, call Florida KidCare at: (888) 540-5437. You can also print out an application at: http://www.doh.state. fl.us/alternatesites/kidcare/printapp.html#howto Co-Payments The health professional or agency where your child gets services may charge you a small fee even if you have health insurance or Medicaid/Healthy Kids. This co-pay is paid directly to the office where you get services. There are some rules about co-pays for families enrolled in Medicaid. There is no co-pay for a child twenty years of age or younger. There are no co-pays if you are enrolled in a Medicaid HMO or a prepaid mental health plan. For someone older than twenty years of age who pays for substance abuse services, the fee is $2 for each visit. If you are a Medicaid/Healthy Kids recipient, you cannot be refused service because you don t have the money for co-pay at the time of service. Instead you will receive a bill in the mail. If you think you have been charged unfairly, you can file a complaint at http:// ahca.myflorida.com/contact/billingcomplaintform.pdf. Or call your local Medicaid office (see Appendix D for the number in your county). Locating Payment Assistance The Florida Department of Children and Families, Substance Abuse Program offers funding through contracted agencies to help families with low incomes that don t have health insurance, Medicaid or Healthy Kids. Appendix C of this guidebook provides the contact information for the regional and circuit offices of the Department of Children and Families. Locate the office that serves your county and contact this office to get information about their contracted service provider agencies in your area. There are several other places you can go to get information about services in your area: Dial 211 on your phone. Go on line to the web site: www.floridahealthfinder.gov and click on Medical Help Resources. There is information on this website about health services for people who need help with the cost of medical care. Go to the web site http://www.fachc.org/. Click on Find a Health Center. Then click on your county, and click on the state map to get information about the health center near you. Community health centers get funds from the federal government to provide Substance Abuse Services for Youth in Florida: A Guide for Families 39

medical care. Most do not have drug and alcohol or mental health counselors, but they may refer you to another office. If you get lost in the system and don t know where to go, you can call (850) 488-3560, the State Medicaid Administrator. Or call the Medicaid hotline at (888) 419-3456. Publicly-Funded Services Services must be offered based on the ability to pay in all publicly funded programs. This is determined by a sliding fee scale based on income and the number of dependents. Many publiclyfunded programs can also accept some types of insurance payments for services, depending upon what services are covered by your policy and whether the provider is enrolled with your insurance carrier. Publicly-funded programs also accept Medicaid and Healthy Kids payments. TIP: Know Before You Go In order to minimize confusion about payment and avoid unnecessary delays, it is important to know the following things before you go for your appointment: What forms of payment does the provider take? Documenting Eligibility You may need to bring proof of income (check stub, tax return) and insurance cards, including Medicaid, to your first appointment with a service provider. It is the responsibility of the provider of services to discuss with you your resources and determine any costs you will be responsible for during the initial contact. Services cannot be denied in a publicly funded program solely based on an inability to pay. If you will need Medicaid or Healthy Kids to pay for behavioral healthcare services for your child and have not already enrolled in these services, you may be able to apply for them through the service provider. Documenting eligibility for these services requires proof of parent s income, a birth certificate and social security number for the child. If you already have Medicaid, you can go directly to a professional who is a Medicaid provider without getting permission first, if the professional is in a community agency (not a hospital). If it is an emergency, you can go directly to the hospital for help without permission. What will you be expected to pay up front? Do you have Medicaid or Kid Care coverage? If not, are you eligible for these programs? If you have private insurance, is the service covered? Is prior authorization required? Have you completed the pre-authorization process? Does the provider offer a sliding fee scale? What documentation do you need to verify your income or eligibility for services? If you are enrolled in Healthy Kids, you can go directly to a professional in the community (not a hospital) without permission first. If it is an emergency, you can go directly to the hospital for help without permission first. It is important for you as a parent to know that, regardless of your method of payment, your child is entitled to the same care offered to other clients at the service provider you choose. If a provider accepts Medicaid or Healthy Kids, 40 Substance Abuse Services for Youth in Florida: A Guide for Families

they are required to certify that families using this form of payment will not be denied specific services or given different services than those using private insurance or self pay. Private agencies or individual practitioners may choose whether or not to accept insurance or Medicaid as a form of payment for their services. If they do not accept third party reimbursement, they may still be willing to offer you a sliding fee scale or payment plan. Do not confuse cost of care with quality of care. Many publicly-funded providers or private providers who accept Medicaid offer excellent, high-quality care for children with substance abuse and mental health problems. By the same token, not all private providers who charge high fees provide the same level of care for their clients. As a consumer, you must make an informed decision about the provider you will choose for your child, with payment as a secondary consideration. Florida s system of care ensures that quality substance abuse and mental health services are available to all children and families, regardless of their financial circumstances. Substance Abuse Services for Youth in Florida: A Guide for Families 41

842 Substance Abuse Services for Youth in Florida: A Guide for Families

8 Chapter Eight: Your Rights and Responsibilities Your child has rights as a person receiving substance abuse and/or mental health services. Upon entry into treatment, the service provider will provide written materials that fully explain your child s and your rights, as well as your responsibilities as a consumer of services. Your child s right to confidentiality is fundamental, as described earlier in this guidebook. Also included are the following rights: To be treated with dignity To have unbiased access to treatment, regardless of your religion, race, ethnicity, gender, age, sexual orientation, HIV status, previous departures from treatment, number or relapses or use of physician prescribed medications To be treated in the least restrictive and most appropriate service To quality services To communication, within program limitations To possess personal clothing and effects To education, in the case of minors To confidentiality of client records, except in exceptional circumstances To be represented by legal counsel in involuntary proceedings To file a petition regarding the cause and legality of an involuntary commitment You also have a right to information from the service provider. You have the right to a prompt and reasonable answer to a question or a request, and to know the name, the job, and the qualifications of the people providing services. You also have the right to know the details about what services are needed as part of the treatment plan, if there are choices for services, what support services are available to help your child, what are the costs, and what are the intended outcomes of these services. You and your child have responsibilities in your child s treatment and recovery: To provide the service provider, to the best or your knowledge, accurate and complete information about present issues, medications, and other matters relating to your child s current situation To inform the service provider whether or not you understand the recommended course of action and what is expected of you and your child To follow the treatment plan recommended by the service provider To keep appointments and, when you and/or your child is unable to do so for any reason and notify the service provider or facility To be responsible for assuring that the financial obligations of the services are fulfilled as promptly as possible To follow the service facility rules and regulations affecting your child s care and conduct Substance Abuse Services for Youth in Florida: A Guide for Families 43

Concerns about the Care Your Child is Receiving If you have concerns or doubts about the treatment or other care your child is receiving, the best thing for you to do is to talk with the person (or persons) most closely involved with your child s care. Most likely this will be your child s counselor or treatment team. Explain what you have seen or heard that causes your concerns. Ask about what can be done and if any changes in the treatment should occur. If you have any specific requests, ask for these directly. If you have expectations that aren t being met or are having difficulty communicating with the counselor, this would be a good time to address these issues.. If you are not satisfied with the outcome of this discussion, take your concerns to the next level. Speak to program supervisors or administrators. Express your concerns and tell them what actions you have taken to this point to resolve them. If you are still dissatisfied with your child s counselor, explain why. In most cases, any issues you may have can be successfully resolved informally at this point. Grievance Procedures You and your child have the right to express a grievance if you are unhappy about the services you receive or if you believe there has been a violation of his or her rights through the grievance procedure of the health care provider or health care facility which served him or her and to the appropriate state licensing agency. Programs that are licensed by the Florida Department of Children and Families are required to have grievance procedures that must be explained to you and your child at the time of admission. These procedures include the steps that can be taken to file a grievance. The grievance procedures must be posted within each facility along with grievance forms. Licensed programs are also required to post the phone number of the Florida Abuse Hotline (800-96-abuse), the Human Rights Advocacy Committee (800-342-0825) and the Advocacy Center for Persons with Disabilities (800-324-0823) in each facility. For Medicaid consumers in managed care plans like an HMO or EPO or Prepaid Health Plan, you may contact the Subscriber Assistance Program sap@ ahca.myflorida.com or call (888) 419-3456 or (850) 921-4548. You may also file a grievance with your local Medicaid office. Look in Appendix E for the phone number in your county. Or go on line at http://www.ahca.myflorida. com/medicaid/areas/index.shtml. Every written complaint is looked at by the Inspector General of the Agency for Health Care Administration. You will receive a written response. If you have a traditional health plan coverage through insurance, you may contact the Florida Department of Financial Services (formerly called the Florida Department of Insurance) Consumer Assistance or Help Line at (800) 342-2762. 44 Substance Abuse Services for Youth in Florida: A Guide for Families

References 1. Center for Substance Abuse Treatment (nd). A Quick Guide to Finding Effective Alcohol and Drug Addiction Treatment. Rockville, MD: SAMHSA. Retrieved from http://csat.samhsa.gov/faqs.aspx 2. Confidentiality of Alcohol and Drug Abuse Patient Records (2002). 42 CFR 1, Part 2. 3. Florida Department of Children and Families (2008). 2008 Youth Substance Abuse Survey: State Report. Tallahassee, FL: Author. 4. Florida Department of Children and Families, Substance Abuse Program Office (2005, December). Chapter 65D-30, Florida Administrative Code, Substance Abuse Services. Tallahassee, FL: Author. 5. Florida Department of Juvenile Justice (2006, August). Mental Health and Substance Abuse Services Manual. Retrieved from http://www.djj.state.fl.us/manuals/approvedmanuals/mhsas/. 6. Florida Department of Juvenile Justice (nd). Overview of the Delinquency Process. Retrieved from http://www.djj.state.fl.us/parents. 7. Florida Statutes, Title XXIX, Public Health Code, Chapter 397, Substance Abuse Services, 2008. 8. Health Information Portability and Accountability Act (HIPAA), Pub. L. 104-191 (1996). 9. National Youth Anti-Drug Media Campaign (nd). Signs and Symptoms of Teen Drinking and Drug Use. Washington, DC: Office of National Drug Control Policy. Retrieved from http://www.theantidrug.com/ei/signs_symptoms.asp. 10. Office of National Drug Control Policy (2004). Suspect Your Teen Is Using Drug or Drinking? A Brief Guide to Action for Parents. Washington, DC. Retrieved from http://www.theantidrug.com/pdfs/ei/parents_brochure.pdf. 11. National Youth Network (nd). Teenage Substance Abuse - Symptoms and Treatment. Retrieved from http://www.nationalyouth.com/substanceabuse.html. 12. Rhode Island Department of Mental Health (2008, February). Rhode Island Parents Guide to Children s Mental Health. Retrieved from www.childrensmentalhealthguideri.org. 13. Substance Abuse and Mental Health Services Administration (nd). When Your Child Needs Substance Abuse Treatment. In Family Guide: Keeping Youth Mentally Healthy and Drug-Free. Retrieved from http://family.samhsa.gov/get/treatment.aspx. Substance Abuse Services for Youth in Florida: A Guide for Families 45

46 Substance Abuse Services for Youth in Florida: A Guide for Families

Appendices Substance Abuse Services for Youth in Florida: A Guide for Families 47

Appendix A: Web Resources Finding a Program The Florida Department of Children and Families Adolescent Substance Abuse Treatment Programs Directory 2008 provides a list of adolescent treatment facilities in Florida. http://www.fadaa.org/services/resource_center/documents/dcf_directory.pdf The Florida Alliance of Information and Referral Services, Inc. (FLAIRS) is a statewide association of agencies and individuals committed to the provision of quality information, referral and hotline services. http://www.flairs.org Substance Abuse and Mental Health Services Administration Treatment Facility Locator is a web based searchable directory of drug and alcohol treatment programs which shows the location of facilities around the country that treat alcoholism, alcohol abuse and drug abuse problems. http://findtreatment.samhsa.gov/ Florida Alcohol and Drug Abuse Association (FADAA) is a non-profit, membership organization which represents more than 100 community-based substance abuse treatment and prevention agencies and over 1000 individual members throughout Florida. http://www.fadaa.org The Florida Council for Community Mental Health (FCCMH) is a statewide association of 70 community-based mental health and substance abuse agencies. The associations membership includes a number of agencies that specialize in substance abuse services and children s services, as well as hospital-based programs. http://www.fccmh.org/ Florida Association of Community Health Centers, Inc. (FACHC) has been the leading state advocate for community-based health care programs. To find a community health care center in your area go to the website below and click on the Find a Health Center link. http://www.fachc.org/ Information TheAntiDrug.com was created by the National Youth Anti-Drug Media Campaign to equip parents and other adult caregivers with the tools they need to raise drug-free kids. Working with the nation s leading experts in the fields of parenting and substance abuse prevention, TheAntiDrug.com serves as a drug prevention information center, and a supportive community for parents to interact and learn from each other. http://www.theantidrug.com or http://www.aantidroga.com in Spanish The Family Guide is designed for parents and other adults involved in the lives of 7- to 18-yearolds, the Family Guide Web site emphasizes the importance of family, promotes mental health, and helps prevent underage use of alcohol, tobacco, and illegal drugs. http://family.samhsa.gov/ National Institute on Drug Abuse (NIDA). NIDA s mission is to lead the Nation in bringing the power of science to bear on drug abuse and addiction. This site has excellent resources available for parents and youth. http://www.nida.nih.gov National Institute on Alcohol Abuse and Alcoholism s Underage Drinking Research Initiative. This initiative advances scientific research that has helped to shed light on several important aspects of underage drinking, particularly related to effective prevention and treatment options. http://www.niaaa.nih.gov/aboutniaaa/niaaasponsoredprograms/underage.htm The National Institute of Mental Health (NIMH) is the largest scientific organization in the world dedicated to research focused on the understanding, treatment, and prevention of mental disorders and the promotion of mental health. http://nimh.nih.gov/ 48 Substance Abuse Services for Youth in Florida: A Guide for Families

National Alliance on Mental Illness (NAMI) is the nation s largest grassroots organization for people with mental illness and their families. http://nami.org Office of National Drug Policy is a component of the Executive Office of the President that was established by the Anti-Drug Abuse Act of 1988. The principal purpose of ONDCP is to establish policies, priorities, and objectives for the Nation s drug control program. The website of this Office provides information about treatment, drug facts, and much more. http://www.whitehousedrugpolicy.gov/drugfact/index.html Partnership for a Drug Free America is a nonprofit organization that unites parents, renowned scientists and communications professionals to help families raise healthy children. The Partnership motivates and equips parents to prevent their children from using drugs and alcohol, and to find help and treatment for family and friends in trouble. http://www.drugfreeamerica.org/parents_caregivers. Drug Guide found at http://www.drugfree.org/portal/drug_guide/ The Partnership for a Drug Free America also hosts an online guide A Parent s Guide to the Teen Brain a digital, science-based resource for parents that explains adolescent brain processes and offers tips for communicating and helping teens make good decisions. It can be found at: http://www.drugfree.org/teenbrain The Substance Abuse and Mental Health Services Administration (SAMHSA) is a federal agency within the Department of Health and Human Services focused on recovery for people with or at risk for mental or substance use disorders. SAMHSA provides A Family Guide To Keeping Youth Mentally Healthy & Drug Free which is a public education website. http://family.samhsa.gov/ Stop Underage Drinking is a website, supported by multiple federal agencies, that supports the Start Talking Before They Start Drinking Campaign in their efforts to combat underage drinking and to educate parents, youth, and others on the issue of alcohol abuse. http://www.stopalcoholabuse.gov/multimedia/starttalking.aspx The Southern Coast Addiction Technology Transfer Center has many publications that address the treatment of adolescent s with substance use disorders. http://attcnetwork.org/southerncoast Community Anti-Drug Coalitions of America (CADCA) works to strengthen the capacity of community coalitions in their effort to create and maintain safe, healthy and drug-free communities. http://www.cadca.org Substance Abuse Services for Youth in Florida: A Guide for Families 49

Appendix B: Common Mental Health Disorders among Children and Adolescents at a Glance Disorder Anxiety Disorders Severe Depression Bipolar Disorder Attention Deficit/ Hyperactivity Disorder (ADHD) Description Young people who experience excessive fear, worry, or uneasiness may have an anxiety disorder. Many people once believed that severe depression did not occur in childhood. Today, experts agree that severe depression can occur at any age. Children and adolescents who demonstrate exaggerated mood swings that range from extreme highs (excitedness or manic phases) to extreme lows (depression) may have bipolar disorder (sometimes called manic depression). Young people with attention-deficit/ hyperactivity disorder are unable to focus their attention and are often impulsive and easily distracted. Symptoms Anxiety disorders are among the most common of childhood disorders. Anxiety disorders include: Phobias, which are unrealistic and overwhelming fears of objects or situations. Generalized anxiety disorder, which causes children to demonstrate a pattern of excessive, unrealistic worry that cannot be attributed to any recent experience. Panic disorder, which causes terrifying panic attacks that include physical symptoms, such as a rapid heartbeat and dizziness. Obsessive-compulsive disorder, which causes children to become trapped in a pattern of repeated thoughts and behaviors, such as counting or hand washing. Post-traumatic stress disorder, which causes a pattern of flashbacks and other symptoms and occurs in children who have experienced a psychologically distressing event, such as abuse, being a victim or witness of violence, or exposure to other types of trauma such as wars or natural disasters. The disorder is marked by changes in: Emotions - Children often feel sad, cry, or feel worthless. Motivation - Children lose interest in play activities, or schoolwork declines. Physical well-being - Children may experience changes in appetite or sleeping patterns and may have vague physical complaints. Thoughts - Children believe they are ugly, unable to do anything right, or that the world or life is hopeless. It also is important for parents and caregivers to be aware that some children and adolescents with depression may not value their lives, which can put them at risk for suicide. Periods of moderate mood occur in between the extreme highs and lows. During manic phases, children or adolescents may talk nonstop, need very little sleep, and show unusually poor judgment. At the low end of the mood swing, children experience severe depression. Bipolar mood swings can recur throughout life. Adults with bipolar disorder (about one in 100) often experienced their first symptoms during their teenage years Most children with this disorder have great difficulty remaining still, taking turns, and keeping quiet. Symptoms must be evident in at least two settings, such as home and school, in order for attention-deficit/hyperactivity disorder to be diagnosed. 50 Substance Abuse Services for Youth in Florida: A Guide for Families

Learning Disorders Conduct Disorder Eating Disorders Autism Schizophrenia Substance Use Disorder Difficulties that make it harder for children and adolescents to receive or express information could be a sign of learning disorders. Young people with conduct disorder usually have little concern for others and repeatedly violate the basic rights of others and the rules of society. Children or adolescents who are intensely afraid of gaining weight and do not believe that they are underweight may have eating disorders. Children with autism, also called autistic disorder, have problems interacting and communicating with others. Young people with schizophrenia have psychotic periods that may involve hallucinations, withdrawal from others, and loss of contact with reality. Young people with substance use disorders have compulsive and repetitive use of a substance that may result in tolerance to the effect of the drug and have experienced significant impairment or distress as a result of substance use. Learning disorders can show up as problems with spoken and written language, coordination, attention, or self-control. Conduct disorder causes children and adolescents to act out their feelings or impulses in destructive ways. The offenses these children and adolescents commit often grow more serious over time. Such offenses may include lying, theft, aggression, truancy, the setting of fires, and vandalism. Eating disorders can be life threatening. Young people with anorexia nervosa, for example, have difficulty maintaining a minimum healthy body weight. Youngsters with bulimia nervosa feel compelled to binge (eat huge amounts of food in one sitting). After a binge, in order to prevent weight gain, they rid their bodies of the food by vomiting, abusing laxatives, taking enemas, or exercising obsessively. Autism appears before the third birthday, causing children to act inappropriately, often repeating behaviors over long periods of time. For example, some children bang their heads, rock, or spin objects. Symptoms of autism range from mild to severe. Children with autism may have a very limited awareness of others and are at increased risk for other mental disorders. Symptoms include delusional or disordered thoughts and an inability to experience pleasure. Diagnosis is made on the occurrence of three (3) or more occasions during a 12 month period: Tolerance Withdrawal Taking drug in larger amounts or a longer time than intended Persistent efforts (and failures) to cut down or control use Considerable time spent in obtaining, using and recovering from effects of use Important activities are given up to drug use Continued use despite negative effects. Taken from SAMHSA Fact Sheet: Children s Mental Health Facts Children and Adolescents with Mental, Emotional, and Behavioral Disorders. This can be retrieved from www.mentalhealth.samhsa.gov/publications/allpubs/ca-0006/default.asp Substance Abuse Services for Youth in Florida: A Guide for Families 51

Appendix C: Florida Department of Children and Families, Substance Abuse and Mental Health Program Offices STATE HEADQUARTERS NORTHEAST 1317 Winewood Blvd. Assistant Secretary for Substance Abuse and Mental Health (Bldg. 1, Suite 207) Mental Health (Bldg 6, 2nd Floor) Substance Abuse (Bldg. 6, 3rd Floor) Tallahassee, FL 32399-0700 NORTHWEST Mental Health (MH) Program Office (850) 413-9610 Substance Abuse (SA) Program Office (850) 921-8461 REGIONAL/CIRCUIT OFFICES SUNCOAST CENTRAL NORTHWEST REGION (Circuit 1, 2, and 14) 1317 Winewood Boulevard, B-1, Room 203B Tallahassee, FL 32399-0700 Office number: (850) 413-7975 SOUTHEAST CIRCUIT 1 (Escambia, Santa Rosa, Okaloosa, and Walton) Circuit Administrator Office 160 Governmental Center, Suite 611 Pensacola, FL 32502-5734 Office number: (850) 595-8210 SA & MH PROGRAM SUPERVISOR Office number: (850) 595-8366 CIRCUIT 2 (Gadsden, Leon, Jefferson, Liberty, Wakulla, and Franklin) and CIRCUIT 14 (Holmes, Jackson, Washington, Bay, Calhoun, and Gulf) 2639 North Monroe Street, Tallahassee, FL 32399-2949 CIRCUIT ADMINISTRATOR Office number:(850) 488-0567 SA & MH PROGRAM SUPERVISOR Office number: (850) 488-2419 ext. #1068 SOUTHERN NORTHEAST REGION (Circuit 3, 4, 7, and 8) 5920 Arlington Expressway Jacksonville, FL 32211 Regional Director Office numbers: (904) 723-5364 and (904) 723-2023 CIRCUIT 3 (Madison, Hamilton, Columbia, Suwannee, Lafayette, Taylor, and Dixie) and CIRCUIT 8 (Baker, Union, Bradford, Gilchrist, Alachua, and Levy) 1621 N.E. Waldo Rd. Gainesville, FL 32609 Circuit Administrator Office number:(352) 955-5010 SA & MH PROGRAM SUPERVISOR Office number: (352) 955-5053 CIRCUIT 4 (Nassau, Duval, and Clay) 5920 Arlington Expressway Jacksonville, FL 32211 CIRCUIT ADMINISTRATOR Office numbers: (904) 723-5364 and (904) 723-2023 SA & MH PROGRAM SUPERVISOR Office number: (904) 723-2014 CIRCUIT 7 (St. John s, Putnam, Flagler, and Volusia) 210 North Palmetto Avenue, Daytona Beach, FL 32114-3284 CIRCUIT ADMINISTRATOR Office numbers: (386) 238-4750 or (386) 947-4017 SA & MH PROGRAM SUPERVISOR Office number: (386) 254-3744 52 Substance Abuse Services for Youth in Florida: A Guide for Families

CENTRAL REGION (Circuit 5, 9, 10, 18, and 9) 400 W. Robinson St., Orlando, FL 32801 Regional Director Office number: (407) 245-0400 CIRCUIT 5 (Marion, Lake, Sumter, Citrus, and Hernando) 1601 West Gulf-Atlantic Highway, Wildwood, FL 34785-8158 CIRCUIT ADMINISTRATOR Office number: (352) 330-2177 SA & MH PROGRAM SUPERVISOR Office number: (352) 330-2162 CIRCUIT 9 (Orange and Osceola) 400 West Robinson Street Orlando, FL 32801 CIRCUIT ADMINISTRATOR Office number: (407) 245-0400 SA & MH PROGRAM SUPERVISOR Office number: (407) 245-0420 CIRCUIT 18 (Seminole and Brevard) 2694 South Orlando Drive Sanford, FL 32773 CIRCUIT ADMINISTRATOR Office number: (407) 302-1088 SA & MH PROGRAM SUPERVISOR Office number: (407) 245-0420 CIRCUIT 19 (Indian River, St. Lucie, Martin and Okeechobee) 337 N. U. S. Highway 1, Ft. Pierce, FL 34950 CIRCUIT ADMINISTRATOR Office numbers: (772) 467-4178 and (772) 467-4177 SA & MH PROGRAM SUPERVISOR Office number: (772) 467-3852 CIRCUIT 10 (Hardee, Highlands, and Polk) 4720 Old Highway 37, Lakeland, FL 33813-2030 CIRCUIT ADMINISTRATOR Office number: (863) 619-4112 SA & MH PROGRAM SUPERVISOR Office number: (863) 619-4171 SUNCOAST REGION (Circuit 6, 12, 13, and 20) 9393 North Florida Ave., Tampa, FL 33612 Regional Director Office numbers: (813) 558-5504 and (813) 558-5503 CIRCUIT 6 (Pasco and Pinellas) 11351 Ulmerton Rd., Largo, FL 33778 CIRCUIT ADMINISTRATOR Office numbers: (727) 588-6993 and (727) 518-3242 Regional SA/MH Director Office number: (813) 558-5700 CIRCUIT 12 (Manatee, Sarasota, and DeSoto) and CIRCUIT 13 (Hillsborough) 9393 North Florida Avenue Tampa, FL 33612 CIRCUIT ADMINISTRATOR Office number : (813) 558-5500 Regional SA/MH Director (All positions also cover Circuit 6) Office number: (813) 558-5700 CIRCUIT 20 (Charlotte, Glade, Hendry, Lee, and Collier) 2295 Victoria Avenue, Ft. Myers, FL 33901 CIRCUIT ADMINISTRATOR Office number : (239) 338-1211 SA & MH PROGRAM SUPERVISOR Office number: (239) 338-1262 Substance Abuse Services for Youth in Florida: A Guide for Families 53

SOUTHEAST REGION (Circuit 15 and 17) 201 W. Broward Blvd., Ft. Lauderdale, FL 33301 Regional Director Office numbers: (954) 267-2199 and (954) 267-2085 CIRCUIT 15 (Palm Beach) 111 South Sapodilla Avenue West Palm Beach, FL 33401 CIRCUIT ADMINISTRATOR Office number: (561) 837-5679 SA & MH PROGRAM SUPERVISOR Office number : (561) 650-6860 Children s Mental Health Coordinator Office number: (561) 650-6825 CIRCUIT 17 (Broward) 201 West Broward Blvd. Ft. Lauderdale, FL 33301 CIRCUIT ADMINISTRATOR Office numbers: (954) 267-2199 and (954) 267-2085 SA & MH PROGRAM SUPERVISOR Office number: (954) 713-3026 SOUTHERN REGION (Circuit 11 and 16) 401 N.W. 2nd Avenue, N1007, Miami, FL 33128 Regional Director Office number: (305) 377-5055 CIRCUIT 11 (Miami-Dade) and CIRCUIT 16 (Monroe) 401 NW 2nd Avenue, N1007 Miami, FL 33128 CIRCUIT ADMINISTRATOR Office numbers: (305) 349-1495 and (305) 349-1496 SA & MH PROGRAM SUPERVISOR Office number: (305) 377-5029 54 Substance Abuse Services for Youth in Florida: A Guide for Families

Appendix D: Florida Medicaid Area Offices Where to Go for Help Area 1 Counties: Escambia, Okaloosa, Santa Rosa, and Walton Delphine Metarko, Field Office Manager 160 Governmental Center, Room 510 Pensacola, FL 32502 Free call: (800) 303-2422 (850) 595-5700 Fax: (850) 595-5718 Area 2a Counties: Bay, Franklin, Gulf, Holmes, Jackson, and Washington Earnie Brewe, Field Office Manager 651 West 14th St., Ste. K Panama City, FL 32401 brewere@ahca.myflorida.com Bay County only (850) 872-7690 Fax: (850) 747-5456 Franklin, Gulf, Holmes, Jackson, and Washington Counties Toll Free (800) 226-7690 Fax: (850) 747-5456 Area 2b Counties: Calhoun, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor, and Wakulla Earnie Brewer, Field Office Manager 2727 Mahan Drive, MS #42 Bldg. 2, 3rd Floor Tallahassee, FL 32308 area2bmedicaidhel@ahca.myflorida.com Calhoun, Gadsden, Jefferson, Leon, Madison, and Wakulla Counties (850) 487-2272 Fax: (850) 921-0394 Taylor and Liberty Counties only Toll Free: (800) 248-2243 Fax: (850) 921-0394 Area 3a Counties: Alachua, Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy, Putnam, Suwannee, and Union Marilynn Schlott, Field Office Manager schlottm@ahca.myflorida.com 14101 N.W. Hwy. 441, Suite 600 Alachua, FL 32615-5669 Toll Free: (800) 803-3245 (386) 418-5350 Fax: (386) 418-5370 1 2a Area 4 Counties: Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia Lisa Broward, Field Office Manager Area4MedicaidHelp@ahca.myflorida.com Duval Regional Service Center 921 N. Davis St. Building A, Suite 160 Jacksonville, FL 32209-6806 Toll Free: (800) 273-5880 (904) 353-2100 Fax: (904) 353-2198 Area 5 Counties: Pasco and Pinellas Noreen Hemmen, Field Office Manager MedResource5@ahca.myflorida.com 525 Mirror Lake Drive N., Suite 510 St. Petersburg, FL 33701 Toll Free: (800) 299-4844 (727) 552-1191 Fax: (727) 552-1216 Area 6 Counties: Hardee, Highlands, Hillsborough, Manatee, and Polk Sue McPhee, Field Office Manager area6medicaid@ahca.myflorida.com 6800 N. Dale Mabry Hwy., Suite 220 Tampa, FL 33614 Toll Free: (800) 226-2316 (813) 871-7600 Fax: (813) 673-4592 Area 7 Counties: Orange, Osceola, Seminole, and Brevard Judy Jacobs, Acting Field Office Manager Area7MedicaidHelp@ahca.myflorida.com 400 W. Robinson St., Hurston South Tower, Suite S309 Orlando, FL 32801 Toll Free: (877) 254-1055 (407) 317-7851 2b 3a 5 3b 6 4 Area 9 Counties: Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie Mark Pickering, Field Office Manager Area09bnm@ahca.myflorida.com 1655 Palm Beach Lakes Blvd. Bldg. C, Suite 300 West Palm Beach, FL 33401 Toll Free: (800) 226-5082 (561) 616-5255 Fax: (561) 616-1545 Area 10 County: Broward Rafael Copa, Field Office Manager A10info@ahca.myflorida.com 1400 W. Commercial Blvd., Suite 110 Ft. Lauderdale, FL 33309 Toll Free: (866) 875-9131 (954) 202-3200 Fax: (954) 202-3220 8 Area 11 Counties: Miami-Dade and Monroe Rhea Gray. Acting Field Office Manager Area11MedicaidHelp@ahca.myflorida.com 8355 N.W. 53rd St. Koger Center 2nd Floor Manchester Bldg. Miami, FL 33166 Toll Free: (800) 953-0555 (305) 499-2000 Fax: (305) 499-2022 7 11 9 10 Area 3b Counties: Citrus, Hernando, Lake, Marion, and Sumter Marilynn Schlott, Field Office Manager schlottm@ahca.myflorida.com 2441 W. Silver Springs Blvd. Ocala, FL 34475 Toll Free: (877) 724-2358 (352) 732-1349 Fax: (352) 620-3076 Area 8 Counties: Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota Fran Nieves, Field Office Manager Regional Services Center 2295 Victoria Ave., Room 309 Ft. Myers, FL 33901 Toll Free: (800) 226-6735 (239) 338-2620 Fax: (239) 338-2642 Substance Abuse Services for Youth in Florida: A Guide for Families 55

This publication was produced by the Florida Certification Board/Southern Coast Addiction Technology Transfer Center under contract LD702, Florida Department of Children and Families, in concurrence with SAMHSA Grant #TI 17378, Adolescent Substance Abuse Treatment Coordination Grant. 56 Substance Abuse Services for Youth in Florida: A Guide for Families