Alcohol and Other Drug Treatment Initiative

Subject of Investigation

A pilot program in operation within the Sacramento County Department of Health and Human Services.

This program, called the "Alcohol and Other Drug Abuse Treatment Initiative," has been funded through a grant from the private Annie E. Casey Foundation.

Reason for Investigation

The Department of Health and Human Services informed the 1995-1996 Grand Jury of this program and the Jury accepted the Department's invitation to review the Initiative and observe its training component.

Procedures

The Grand Jury observed a three-day training session for group counselors. The Jury also reviewed related program documentation.

Findings

The Initiative is innovative as an administrative concept. The department-wide systems approach to alcohol and drug abuse is new. There is no new treatment methodology under test, nor is there a new insight into the addict's personality or pathology under scrutiny. Widely accepted and practiced group treatment procedures are the planned therapy mode. Twelve step programs, groups using cognitive and supportive approaches, and referral to detoxification and
medical practitioners when needed are specifically named in the Initiative documentation.

Historically, every novel method of treatment for alcohol and drug addiction is embraced enthusiastically and with high expectations of success. Unfortunately, careful scientific supervision and five year or longer follow-up reveal huge recidivism rates.

Such considerations have not discouraged the Department and are not cited to criticize the effort. The Initiative founders hope to use old treatments in a new context. In a carefully thought- out plan, the Department proposes to study more than recidivism. The letter from the Annie E. Casey Foundation, announcing the award of $200,000 over two years, lists other outcomes

The Department agrees, by accepting the money, to evaluate these suggested results:

· Reduce alcohol and drug use

· Reduce child abuse and neglect

· Lower incidence of perinatal substance abuse

· Reduce numbers of children in out-of-home care

· Improve school attendance by children of affected parents

The Department's recognition of the enormity of substance abuse in Sacramento County and, particularly, in its client population is reflected in the goals of the Initiative. These goals are realistic and attainable. Moreover, they are measurable by statistical analysis.

The plan intends to equip all front-line employees in the Department to recognize drug and alcohol abuse problems in its clients, to intervene effectively and, finally, to offer group counseling to those clients under court order to attend and those who voluntarily seek treatment. These groups will be conducted only by licensed and properly trained workers.

The Department of Health and Human Services began to evolve this Initiative in 1994. The Department hired a well-qualified and committed project coordinator. Advisory boards are in place. Training by contract experts has taken place on all three designated levels of training. Budget documents suggest that front line staff will spend 10 percent of their time in service to this plan. Planned automation services are running into performance problems due to software unavailability and insufficient funds, among several reasons. An evaluation plan exists. Several training and facilitator's manuals are in manuscript form and near print.

Several hundred employees are trained in one or more of the designated three levels of training. Over six hundred client slots in various organized therapy groups exist now. A formal plan for the next two years is written.

Despite an impressive start, several roadblocks slowed the progress of the Initiative. Unexpected slow referral

patterns and slow origination of new problem-oriented groups developed. Funds to begin the review process were withheld. Computer assistance, needed to follow clients and track results is not available.

The most recent funding request to the Annie E. Casey Foundation focuses more precisely on creating a system for alcohol and drug treatment by front-line workers, with an orientation focusing on children and family.

The Department has received inquiries from Sacramento County education, law enforcement, and probation agencies for advice on creating similar initiatives. Not just a departmental but a county-wide effort in drug and alcohol intervention is on the horizon. No plan of this breadth and scope exists anywhere else in the United States.

Recommendations

The Grand Jury recommends that:

· The Sacramento County Department of Health and Human Services continue to implement, train its personnel for, and evaluate the Alcohol and Other Drug Treatment Initiative

· The Department advise and join agencies like the school districts and law enforcement and probation departments to explore a county wide alcohol and other drug treatment initiative as a cost effective way to impact many county service problems

· The Department find money-from its own budget or by grant application -to fund evaluation of the results of the Alcohol and Other Drug Treatment Initiative

· The Department find money-from its own budget or by grant application -to purchase a computer system with appropriate hardware and software to track the clients, oversee their referral and study results

Response Required

The Penal Code requires responses to the recommendations contained in this report be submitted to the Presiding Judge of the Sacramento County Superior and Municipal Courts by September 30, 1996, from:

Sacramento County Board of Supervisors