Monthly Meeting Minutes March 17, p.m.

Transcription

1 Monthly Meeting Minutes March 17, p.m. MEMBERS PRESENT Kevin McConnell Edi Patrick MEMBERS ABSENT John Lloyd Marvin Mars Trey Dunia John Abrahams Don Cobb STAFF PRESENT Gino Giannavola, AODS Maureen Donaghue, AODS Angela Avery, AODS Kelly Elder, Prevention PROVIDERS & GUESTS Lindsey Condron, Sonoma State Nursing Tanya Sarcos, SRTP Catherine Siegel, District 1 Rose Bjornstrom, Sonoma State Nursing Cynthia Del Castillo, SRJC Jeff Avery, Member of the public Cheryle Stanley, WRS Michael Spielman, DAAC Jenna McAdam, Athena House Called to order at 5:05 pm, by Edi Patrick I. Introductions II. III. III. Public Comment Catherine Siegel is here as a potential Advisory Board member from District 1. Action Items Minutes: The Advisory Board is unprepared to address the approval of the minutes delayed until next month due to lack of a quorum. SACPA/OTP (Prop 36) Update Welcome to our new prospective board member. AODS received the JAG allocation approval letter we are allocated an additional $7,000 because some counties did not apply for the funding; our total allocation is $602, The OTP Steering Committee met yesterday to discuss the wind down of the program. State Proposition 36 funding has been eliminated in the governor s budget. The Court, Probation, lawyers and treatment providers must determine how to deal with 1210 Court cases. JAG funding will patchwork our program through the end of June. There is much to determine: 1210 Court termination date, Training Sessions for all Court staff, Public Page 1 of 7

2 Defender and District Attorney joint training, Probation s Role, Protocols for Court, and the impact on Adult Detention facilities. Stakeholders need a common understanding of what is treatment completion. The committee discussed treatment episodes that last longer than the funding, what options will be available for the clients? The committee s general direction is to get as many clients as possible into the pipeline ASAP; with the understanding that some will go over into month following our target close date. The OTP program may be open through July. AODS has prepared a board item to allow us to accept the JAG award it is scheduled for March 30 th. Contract amendments will go out thereafter. As of March 15 th, we have 52 clients in OTP treatment, and 35 on the waitlist. There are some folks in outpatient services that may be moved to modalities that are more appropriate. The end of April is the estimated end of referrals to treatment. The dedicated 1210 Court is also closing in April Court cases will be disbursed into the other Courts. There will be a lack of continuity of representation. Probation will also disburse their caseload. The Steering Committee is working out protocols and training plans for the OTP stakeholders. The State has a $20 billion deficit this year; it is unlikely the legislature or the governor will restore OTP funding. AODS has planned a focus group with treatment providers to determine what they can do to deal directly with the Courts. We need to determine how to fit clients into the system without funding. There will be no slots the OTP clients will have to go on the waitlist. It may be proposed to the Courts that only 12 step and probation testing are available. There are limited options Medi-Cal clients can get into DAAC or CHD Outpatient. CMSP does not cover AOD treatment, with the exception of a small pilot program in Sonoma Valley for outpatient. AODS will give a menu of options to the judge. Health insurance parity does not kick in for a while. The public comment period on the regulations goes until May, after which the Feds must complete their processes. It will probably be one year before there is a parity impact in treatment. Treatment providers must gear up for taking health insurance clients. Clients without health insurance can be funded through the block grant. Pregnant and HIV clients receive preference in the block grant. There will be no OTP program to do assessments the Courts will refer to treatment, then an assessment will be done at the provider; who will decide where to send the client for the correct modality? When we had funding, SACPA/OTP served about 700 people per year, with about 450 in treatment at any given time. These clients will recycle through the Court system and could eventually end up in jail. At the OTP Steering Committee, the Public Defender discussed a new law regarding jail credits. Because of this law, people are opting to stay in jail as opposed to opting for treatment. The offender s records are not dismissed. The only way to get records dismissed under Proposition 36 is to successfully complete appropriate treatment. The 12-Step programs, in conjunction with Drug Testing, may not qualify as appropriate Page 2 of 7

3 treatment. Offender motivation to opt for treatment could be impacted if the record is not expunged, why go to treatment? The Sheriff is included in the OTP program discussions. There is no immediate plan to open another mod in jail the Sheriff will review the situation in 6-month increments. It will cost the County $1 million to open a unit in the jail. 12 Step is not equal to treatment. Providers will have to make decisions. There will be limited options clients can wait in line for Turning Point Orenda Program (TPOP), there are some catholic charities beds available, and DAAC may have one community bed. Clients who are eligible can get treatment through Medi-Cal; others may be able to access treatment by private pay. The system will give what we can and hope for the best. The whole system is in jeopardy this year. OTP clients have been in holding groups assessed for modality but referred to non-appropriate treatment. AODS can analyze the data. The prediction is that the outcomes will not be good. The bulk of the impact will hit after 1210 Court is closed in April and after OTP program closes end of June or July. Probation will have no oversight over offenders charged with misdemeanors. If these clients are assigned to treatment but do not show up, the provider will not know and probation will not know. Without treatment, there may be more violations of probation and new charges, which could bring additional jail time. Eventually the crime level could escalate. IV. Prevention Division Report Advisory Board members were given a copy of a letter in support of AB 1694, the alcohol tax while we cannot lobby, we can discuss the proposed regulations with Advisory Boards and Coalitions, and educate about the impacts of increased cost on underage drinking. The Advisory Board was asked if they would like to submit a letter encouraging the health committee to support legislation that aims to prevent underage access to alcohol. Coalition members have taken a position recognizing the value of research that shows increased tax reduces alcohol use. The Advisory Board could not take action without a quorum. Because letters needed to be submitted by March 18 to impact the committee meeting on the 23 rd, the Advisory Board decided it would be best to an electronic version to Advisory Board members to determine if they wish to submit individual letters. Seniors/Aging Adults Michael Spielman is the chair of the age appropriate treatment committee. There are no new funds available to provide treatment, but the committee plans to do cross training to ensure that every treatment provider has at least one person on staff that is trained in gerontology issues. They are working with AODS on delivery of 3-hour gerontology 101 training to be provided by DAAC and the Council on Aging. Michael distributed a Save the Date flier on DAAC s Understanding Addiction conference scheduled in September. Dr. Frederic Blow, who wrote the Substance Abuse and Mental Health Services Administration s (SAMHSA) Tip 26, the gold standard for aging adult treatment issues, will be the speaker. He only does two presentations per year, we were Page 3 of 7

4 lucky to get him. Edi Patrick noted that DAAC s conference generally have excellent programs covering a variety of issues. In addition to the treatment subcommittee chaired by Michael Spielman, there is a Provider education subcommittee working on use and misuse of alcohol and prescription drugs among aging adults. They are working on developing a pilot program to implement screening protocols in a hospital setting. A doctor at Palm Drive hospital has expressed interest. The group is also looking to change social norms about drinking in the aging adult population. They hope to frame the issue of substance abuse prevention as one part of healthy aging. Members who are residents of Oakmont have suggested that we pilot a community norm change strategy with the Oakmont community. Substance abuse is rapidly increasing in this population; we will be unable to meet demand if we do not curtail the problem. V. AODS Division Report 2010/2011 Budget The County CAO reported a $47.5 million shortfall for FY 10/11. Budget hearings are scheduled for June 14 th to 18 th. The AODS board item on the Reorganization and the RFQs for Detox, ATP and BASN has been delayed until March 30. If the board approves, we will engage in the RFQ process for community partners to provide services. The AODS reduction plan has changed since our last meeting. We were instructed to reduce $1.9 million in County General Funds, to include Maintenance of Effort (MOEs) for two other divisions, but that has been cut to $1.2 million.). However, when discussed with the CAO, a decision was made to exclude the MOE dollar reduction in AODS. Our current reductions include Detox, ATP and BASN contracting out, reductions in administrative positions and the Reorganization. All other reduction options are off the table including Starting Point and TASC counselors. There are no provider reductions If the Board of Supervisors rejects our reduction plan on March 30 or in June, we will need to propose a new reduction plan. The revised plan would keep administrative reductions, but would have to go to provider contracts to make the necessary reductions. It is anticipated that there could be quite a bit of discussion over the proposed transfers of services. Public Health is also going to board to transfer services. These plans are in line with the County s strategic plan, the upstream plan and the Bennett study. Providers are urged to go to board meetings to express their opinions about the proposed reductions. The AODS proposed reductions are client neutral, but there are implications for County employees. We hope to get some sense of direction on March 30 th. If the board rejects our proposed reductions, there is no place else to go but contracts. Public Health is proposing HIV services reductions the HIV commission is speaking at the Beilenson hearing. The Advisory Board members can choose to speak to the Board of Page 4 of 7

5 Supervisors on the AODS reductions. The AODS proposed reduction plan is the least detrimental in terms of the core values adopted by the Advisory Board last year. The reduction plan includes a clause that current program staff are interviewed by the contractor as part of the process. If existing staff moves to the final selection process they would be given the first right of refusal. Kevin McConnell asked if there is a current analysis of transfer of Orenda Center Outpatient and Residential programs. From DAAC s point of view, the transfer went well. DAAC hired four former Orenda Center staff members to run their TPOP program. Kelly Elder suggested that it may be compelling if staff who were vocally against last year s transfer (who have been hired by providers and are happy) speak towards the success of the transfer in the public comment portion of the board meeting. The public reaction to the March 30 th board meeting will determine the level of resistance to our proposals between now and June. It will be important to have board members understand our strategy to reduce the negative impacts of budget reductions on clients. Budget hearings are June 14 th to 18 th, but reductions will not be effective until July 13 th, requiring bridge funding from July 1 st to the July 13 th effective date. The DHS reorganization is also scheduled to be heard by the board on March 30 th. The DHS reorganization is uncontroversial, with the exception of the Mental Health/AODS division name. We are asking for the name to be Mental Health/AODS instead of Behavioral Health. The reorganization plan is to keep programs separate for one year then plan for integration, especially for co-occurring programs. The County new CAO has made many good changes in the 7 weeks she has been on board and involved with the budget process. At the Board meeting, three board members commented on how pleased they were to see department heads closely aligned with CAO in this budget process VI. Roundtable Discussion Kelly Elder: As part of the proposed DHS reorganization, a proposal to transfer HIV care services from County run Programs to the primary care clinic system will be considered. The proposed plan is designed to minimize the impacts of budget cuts on clients. The new system of care will provide the same level of services at more locations throughout the County. 550 clients will be transferred from the County run HIV Center for Prevention and Care to community clinics. Some of the staff of the Center is expected to transfer to the community clinic programs. July 1 st is the target change date. Maureen: Please note that the front of the building was decorated for St. Patrick s Day, and note Gino s green shirt. The date for our RFQ and reorganization board item has been moved to March 30 th. We have moved our first public meeting for prospective applicants for the Page 5 of 7

6 RFQs for Detox, ATP and BASN to March 31 st, 9am-11am in this room. We have ed a broad swath of potentially interested parties. We need two reviewers of the RFQ applications. One of the reviews is scheduled for May 4 th and one is scheduled for May 5 th. Kevin McConnell volunteered to be a reviewer for the BASN RFQ. Maureen will contact him. There is a possibility that Edi may be a reviewer for the Detox RFQ, if she cannot, we will ask Trey if he can be backup. Jenna McAdam: Athena house is doing business as usual and anxiety as usual. They had a shakedown around non-smoking. Their license renewal has not been received. This is the first year that they have not gotten the license in the mail in timely manner. Cheryle Stanley: WRS had been non-smoking for 11 years. They do random smoking test regularly - all have been negative for the last few weeks. WRS had a recent site visit from the state they passed with flying colors. On the day of the site visit, there was heavy rain and the roof leaked it was marked on the review. WRS is celebrating their 35 th anniversary in May. Catherine Siegel: I think this is an interesting process. Michael Spielman: DAAC has been in process for a Federal stimulus grant to put a new roof on Professional Drive. It has been an amazing process, even down to the bid packages. In end, they will have a new roof, which they could not afford any other way. DAAC has also applied for a Federal earmark grant with the hopes of expanding the adolescent program. The plan is to start in the next school year in South Petaluma. We are negotiating with the feds over details. Turning Point is operating at full capacity, 133 beds full out of 134. We expect the facility to stay full with JAG clients through end of the year. The perinatal program is also at full capacity with 36 women with children. There are 20 women on the wait list, of which 3 are pregnant. The grant from St. Josephs ends on July 1 st ; we will have to reduce capacity to 28 women. Clients not served by perinatal can be served in outpatient if they have Medi-Cal, but there is no transportation or childcare available. The perinatal program is full with 36 clients. DAAC could replicate the services by adding an afternoon session that would serve an additional 36 clients if resources were available. The estimated cost would be $250k to $300k per year for staffing. A discussion ensued about TASC beds there are 50 to 60 clients on the waitlist in total. About 20 of them are ready without a slot available, but the others must finish the court process. We recently placed 4 or 5 at Casa Calmecac. They have had issues in keeping facility full, in part because of immigration issues. TASC counselors have worked hard to fill the beds. Female TASC clients are waiting Page 6 of 7

7 about 3 weeks for beds. Athena house has empty beds waiting for adjudication. DAAC would like more females, to keep the ratio of men and women in line. TASC is down two counselors the remaining counselors are maxed out. There is no funding for extra help. TASC Counselors are having problems keeping up with the caseload. Tanya Sarcos: NTP renewals are generally done in April. We have not received anything from ADP yet. Tanya will check her renewal date and let us know. Kevin McConnell: Welcome to Catherine. Meeting Adjourned at 6:35 pm. Next Meeting: April 21, 2010 Orenda Center conference room # Neotomas Avenue Santa Rosa, CA Page 7 of 7