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Think Prevention


									City of Detroit                                                                           Annual Report 2007-2008

Special population HealtH ServiceS DiviSion
A Division o f t he De t r oi t Depar tmen t o f H eal t h and Wellne s s P r omo t ion

                                           Think Prevention


                             Bureau of
                             Laboratory Services

                                  Bureau of Substance Abuse Prevention
                                     Treatment and Recovery (BSAPTR)



The SPHSD wishes to acknowledge with thanks the contributions of Keisha Houston to this report.

Table of Contents

Letter from the DHWP Director & the SPHSD General Manager                         5

Report Overview                                                                   6

Chapter 1: SPHSD Prevention Framework                                             7

Chapter 2: Bureau of Substance Abuse Prevention, Treatment & Recovery (BSAPTR)   10
           Section 1: BSAPTR Prevention Services                                 10
           Section 2: BSAPTR Treatment Services                                  23
           Section 3: BSAPTR Recovery Oriented System of Care (ROSC) Update      32
           Section 4: Partnership for a Drug Free Detroit                        33
           Section 5: Youth Division                                             39
           Section 6: Systems Transformation                                     42
           Section 7: Spotlight on BSAPTR Special Projects                       44
           Section 8: Community Impact Stories                                   45
           Section 9: BSAPTR 2007 – 2008 Treatment Expenditures                  48

Chapter 3: HIV/AIDS Programs                                                     50

Chapter 4: Communicable Diseases                                                 56

Chapter 5: Pharmacy Services                                                     57

Chapter 6: Bureau of Laboratory Services                                         58

    Calvin R. Trent, PhD, MEd, MA                                        Kanzoni N. Asabigi, PhD, MD, MPH,
                                                                         MBA, CPH
    Dr. Calvin R. Trent holds a BA in psychology and an MEd from         Dr. Kanzoni Asabigi is certified in Public Health and a Diplomate
    Wayne State University and a PhD in clinical psychology from         of the American Board of Quality Assurance and Utilization
    the University of Detroit-Mercy, where his dissertation research     Review Physicians. He is currently the General Manager for the
    examined the relationship of substance abuse treatment and           Division of Special Population Health Services at the Department
    psychosocial development among black and white adult males.          of Health and Wellness Promotion, City of Detroit. The division
    Dr. Trent was appointed in March 2009 as Director and Public         includes, the Bureau of Substance Abuse Prevention, Treatment
    Health Officer for the City of Detroit Department of Health and      & Recovery, HIV/AIDS Programs, Bureau of Laboratory Services,
    Wellness Promotion. For the previous twelve years Dr. Trent          Communicable Diseases and Pharmacy.
    had served in the Health Department as General Manager of
    the Special Population Health Services Division, and before          Prior to joining the DHWP, he served as Vice President of Health
    that as Director of the Bureau of Substance Abuse Prevention,        Care Services, Ultimed HMO of Michigan. He is Board Certified
    Treatment and Recovery.                                              in Public Health and Health Care Quality Improvement. He
                                                                         received his PhD (Community Health), from Walden University
    Dr. Trent participates on many citywide committees. In addition      in 2009, MD in 1985 from the University of Bucharest Medical
    to being the Co-Chair of the Partnership for a Drug Free Detroit,    School, Romania. He earned his Master of Public Health (MPH)
    he is a member of the Wayne County Department of Community           at the University of Michigan in 1989, and Masters of Business
    Justice Advisory committee; the Governor’s Hepatitis C Task
                                                                         Administration (MBA) from the University of South Florida in
    Force and has served on the U.S. Attorney General’s Violence
    Reduction Task Force for the Detroit region.                         2000, specializing in Health Care Administration.

    His prior experience includes being the Principal Investigator of    His publications have appeared in The Journal of AIDS Education
    two Substance Abuse and Mental Health Service Administration-        and Prevention, The Cortlandt Forum, and the Journal for Health
    Targeted Capacity Expansion (SAMHSA-TEC) grants: one                 Care Executives. His recent book is titled “From Africa to Europe
    designing/implementing an integrated treatment system for            to America” ( He coauthored: Chronic Marijuana
    HIV/AIDS and substance abuse needs, and the other increasing         Use in Detroit – A Systemic View. His areas of interest include
    treatment options for women who need to take their children to       improving the delivery of Quality Health Care Services – especially
    treatment with them. Dr. Trent was also the Principal Investigator   behavioral medicine (substance abuse and mental health), and
    of the Detroit Recovery Project and the Detroit Youth-Building       improving the use of alternate managed care delivery systems to
    Communities Support Program of the Youth Development                 contain rising medical care costs.
    Institute (YDI) – both funded by SAMHSA.
                                                                         His recent focus deals with substance abuse prevention and
    Dr. Trent is the recipient of numerous awards including the 2005
    White House Special Recognition Award by the Office of Drug          treatment delivery systems and outcomes and transitioning
    Control Policy and the 2006 Civic & Humanitarian Award by            those systems into a Recovery Oriented System of Care. The
    Michigan’s Governor Jennifer M. Granholm.                            prevention initiatives include strategies for changing community
                                                                         norms regarding marijuana use.

November 2009

Dear Citizens, Leaders, and Stakeholders:
It is with great delight that we present the first combined report of the various programs within the Department of Health and Wellness
Promotion, Special Population Health Services Division (SPHSD) covering the period of October 1, 2007 through September 30, 2008.
The SPHSD comprises the following programs: The Bureau of Substance Abuse Prevention, Treatment, and Recovery (BSAPTR),
Communicable Diseases, HIV/AIDS Programs, Pharmacy Services, and the Bureau of Laboratory Services. The recent merger of
these programs under one division has resulted in enhanced collaborations and efficiencies in the delivery of services to vulnerable
populations in the City of Detroit.
The BSAPTR continues to be a pioneer in Recovery Support Services. BSAPTR’s Recovery Oriented System of Care (ROSC) made
significant improvements in the process of transforming the delivery of substance abuse services. Two major events occurred in
FY 2008: 1) the Michigan Department of Community Health Office of Drug Control Policy (ODCP) formulated a policy on Recovery
Support Services for Coordinating Agencies and 2) the BSAPTR began formulating procedures for implementation and reimbursement
of Recovery Support Services in the service area. These events and the collaboration and support of the provider network helped to
make improvements in the delivery system for the citizens of Detroit.
There have been improvements in the rate of transmission of the HIV virus among intravenous drug users in the City of Detroit.
The incidence of HIV transmission among intravenous drug users had shown a slight decline since 1992, but made a precipitous
drop in 2005, and has continued in that direction since that time. This decline is attributed, in part, to the Health Department’s
support of needle exchange programs. The two licensed programs, Community Health Alliance Group (CHAG) and Latino Family
Services have been aggressive in devising innovative ways of reaching the city’s injecting drug using population. We applaud their
service! The proportion of new HIV infections among 13-24 year-old African American males is a major concern for the HIV/AIDS
programs. Although the numbers are currently low, the disproportionate percentage increase in the incidence rate in this age group
has prompted the programs to readjust their prevention messages. The predominant mode of HIV transmission has been male-to-
male sex. Thus, every effort is being made to reach this population with prevention messages since the transmission of the HIV
virus is 100% preventable.
The Communicable Diseases (CD) section is ever vigilant in its surveillance of reportable disease occurrence in the City of Detroit.
CD monitors and reports on disease trends, ensuring that potential disease outbreaks are effectively monitored in order to safeguard
the community against these threats, while also maintaining effective communication with the citizens of Detroit. They are always in
touch with hospitals and other medical service delivery organizations, collecting data and providing technical assistance. As examples
of their service, they monitor and investigate food poisonings and dog bites.
The pharmacy is a safety net for the indigent and low-income population in Detroit. Prescription drugs are provided free of charge or
at a very low cost to patients ($1 – $6 per prescription). This is possible because of the Health Department’s collaborations with the
pharmaceutical industry. The formulary is reviewed annually to add new medications that are being provided by drug manufacturers.
The Bureau of Laboratory Services has achieved “Center of Excellence” designation as a result of its quality and performance. The
laboratory is a regional and reference lab, and is capable and designated to analyze samples in the event of a Bioterrorism incident.
The lab analyzes samples from the beaches to make sure that they are safe for city residents. It also analyzes the water to ensure that
it is safe to drink. In addition, the lab performs chemical and microbiological tests for various programs within the Health Department
and other medical clinics and drug treatment programs.
It is our hope that you will find this report useful in helping you to understand what services are offered through the Health Department’s
Special Population Health Services Division, and how you might utilize some of these services should the need arise.

Best Regards,

Calvin R Trent, PhD, MEd.                               Kanzoni Asabigi, PhD, MD, MPH, MBA, CPH
Director and Public Health Officer, DHWP                General Manager, SPHSD

Report Overview

Chapter 1: The SPHSD Prevention Framework
Presents the SPHSD comprehensive prevention approach to tackling the myriad challenges of substance abuse, HIV/AIDS, and
communicable diseases within the City of Detroit at the individual, family, and community levels. The focus is on developing effective
primary, secondary, and tertiary prevention strategies that work at multiple levels to reach the greatest number of people and help
prevent health and safety challenges, before they occur.

Chapter 2: The Bureau of Substance Abuse Prevention, Treatment & Recovery (BSAPTR)
Highlights the various prevention, treatment, and recovery services, as well as special projects, offered by the BSAPTR to assist the
citizens of Detroit tackle the substance abuse challenge. This multi-pronged approach is the only way to achieve long-term success
and not only help those suffering with addiction, but to build a viable, safe, and healthy City of Detroit. Stories of community members
who are making an impact also are shared.

Chapter 3: HIV/AIDS Programs
Details the variety of services within HIV/AIDS programs that address prevention, care, counseling, testing & referral, training,
education, and community support efforts. It also presents HIV/AIDS prevalence and testing data for the City of Detroit.

Chapter 4: Communicable Diseases
Outlines the programs and services deployed within Communicable Diseases to ensure the health and safety of the public through the
coordination and delivery of communicable disease surveillance, prevention, and bioterrorism activities for the City of Detroit.

Chapter 5: Pharmacy Services
Details the activities, initiatives, and accomplishments of the Pharmacy Services unit as it provides cost-effective prescription drugs
and devices with consultation for the uninsured or underinsured citizens within the City of Detroit.

Chapter 6: Bureau of Laboratory Services
Highlights the Bureau of Laboratory Services, which has been designated as a “Center of Excellence” as a result of its quality and
performance as it provides investigations diagnosis and confirms testing for infectious and non-infectious diseases as well as other
agents that may pose a threat to the public health of the community.

Chapter 1: The SPHSD Focus on Prevention
Today’s communities face many risks, including drug abuse, communicable diseases, and HIV/AIDS, to name only a few. Responding
to health related risks before they become problems is essential and a focus of the Special Population Health Services Division
(SPHSD) of the City of Detroit Department of Health Wellness and Promotion (DWHP).
Through its programs and initiatives, the SPHSD influences organizational practices and policy, in order to promote the emotional,
psychological, and physical well being of City of Detroit residents with particular emphasis on individuals, families, and communities
at risk. Focusing on strategies that work at multiple levels will reach the greatest number of people and can help prevent substance
abuse issues, before they occur.
From the SPHSD perspective, the use of all illicit drugs and the inappropriate use of legal drugs are considered substance abuse.
Substance abuse does not exist in a vacuum and has serious consequences in the families, schools, workplace, and communities of
the City of Detroit. Through the years, prevention strategy has expanded as agencies like ours strive to work at the cutting edge of
holistically analyzing the problem and bridging the gap between research and practice, as we actively work to build evidence-based
practices to our process of building and restoring communities.
The only way that prevention activities can be successful is if they are implemented as part of a broad network of care and support.
Within the SPHSD, our prevention activities involve professional organizations, public health professionals, community leaders, health care
practitioners (physicians, nurses, and allied health professionals), universities, and individuals working in a number of ways to maintain
and improve the health of communities in the City of Detroit. Only by acting in partnership and coalition can we achieve new outcomes.
We are pleased to offer our 2007 – 2008 annual report, Think Prevention, which focuses on the work of the five areas which comprise
the SPHSD: the Bureau of Substance Abuse Prevention Treatment and Recovery (BSAPTR), HIV/AIDS Programs, Communicable
Diseases, Pharmacy Services, and the Bureau of Laboratory Services. Across each of these areas, we put a focus on prevention. In
this report, we offer our framework of prevention, descriptions of our major programs, and key outcomes of our work. We hope you
will find this report informative and helpful.

  A Focus on Prevention
Through all of the efforts at the SPHSD, we focus on prevention. This approach requires a new way of doing business by expanding
prevention efforts to focus on organizational practices and policy change, reaching out to new partners, and taking a comprehensive
approach to understanding and addressing the underlying determinants of addiction and related diseases like HIV/AIDS. Prevention,
along with early intervention and treatment, are critical components of the continuum of care and support provided in the various
areas of the SPHSD.
The prevention efforts of the SDHP address all forms of drug abuse, alone or in combination, including the underage use of legal drugs
(e.g., tobacco or alcohol); the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained substances
(e.g., inhalants), prescription medications, or over-the-counter drugs. Our efforts focus on addressing the drug abuse problem in the
local community, targeting modifiable risk factors, and strengthening identified protective factors. As such, we tailor our prevention
programs to address risks that align to particular demographic characteristics, such as age, gender, ethnicity, and sexual practices,
to achieve better health outcomes in the City of Detroit.

People who avoid deviant activities, live as engaged citizens, and regularly engage in physical examinations and health screening
are less likely to fall victim to substance abuse, and more broadly, disease and disability. At the end of the day, the effectiveness of
prevention programs largely depend on the extent to which individuals are educated and empowered to take personal responsibility
for their own health by avoiding health risks such as tobacco use, substance abuse (misuse of alcohol and drugs), and unsafe sex.
Risk factors can influence drug abuse in several ways. The more risks a person is exposed to, the more likely the person will abuse
drugs. Some risk factors may be more powerful than others at certain stages in development, such as peer pressure during the
teenage years; just as some protective factors, such as a strong parent-child bond, can have a greater impact on reducing risks during
adolescence. An important goal of prevention is to change the balance between risk and protective factors so that protective factors
outweigh risk factors. In our efforts across each of the five areas of the SPHSD, we focus our efforts on prevention, reducing risk
factors, and increasing protective practices at the individual, family, community, organizational, and policy levels.

    Three Levels of Prevention Services
As indicated in Exhibit 1, the centerpiece of our philosophy at the SDHP is a three-tiered focus on prevention. Our efforts to enhance
prevention must happen at these three levels to maintain and improve the health of the Detroit community: (1) Primary Prevention, (2)
Secondary Prevention, and (3) Tertiary Prevention.
At the top of the pyramid is a focus on primary prevention. Primary prevention aims at ensuring that disease (e.g., substance abuse,
HIV/AIDS, etc.) never occurs by focusing on awareness, education, and deterrence of gateway drug use, and other deleterious
activities. The focus is on the entire population (national, state, city, community, school, etc.) in an effort to prevent or delay the abuse
of alcohol, tobacco, and other drugs, as well as engagement in other risky behaviors. Our primary prevention efforts are designed
to reduce both the incidence and prevalence of the presence of disease by providing as many people as possible with the type of
information necessary to deter drug use and abuse from ever occurring.
Secondary prevention, also called “screening,” refers to measures that detect disease before it is symptomatic. The goal of secondary
prevention is to identify and detect disease in its earliest stages, before noticeable symptoms develop and when it is most responsive
to treatment. Some identifiers that may be used as a trigger for secondary prevention services include among others, unemployment,
chronic depression, falling grades among students, known problem consumption or conduct disorders, alienation from parents,
school, and positive peer groups, etc. Early intervention is essential in substance abuse treatment to stop progression of the disease,
eliminate usage, and prevent the emergence of substance abuse outcomes.
Tertiary prevention efforts focus on people already affected by disease and attempt to reduce resultant disability and restore functionality.
The goal at this level is to address the negative impact of an already established health disorder (e.g., communicable disease) by
restoring function and ameliorating the harmful effects of the disease through treatment and rehabilitation. More specifically, at this
level, we work to prevent damage and pain from disease, slow down the progress of disease, prevent disease from causing other
problems or complications, give people better care, and attempt to help persons restore health in such a way that they are able to
continue and resume their normal quality of life.

Exhibit 1: Special Population Health Services Division Focus on Prevention

Chapter 2: The Bureau of Substance Abuse Prevention,
           Treatment & Recovery (BSAPTR)
     Section 1: BSAPTR Prevention Services
The Bureau of Substance Abuse Prevention, Treatment, and Recovery’s (BSAPTR) prevention services are tailored to address risks
specific to population characteristics in terms of age, gender, and ethnicity, in an effort to maximize their effectiveness. In these
programs, we educate community members about the risks of drug abuse, alone or in combination, including the underage use of
legal drugs (e.g. tobacco or alcohol); the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained
prescription medications, or over-the-counter drugs.
Programs funded with substance abuse prevention dollars implement programs in support of federal and state defined strategies.
These principles are applied through the utilization of 34 prevention providers:
     Environmental – Activities working with other individuals, to establish or change written and unwritten community standards,
     codes and attitudes, thereby influencing alcohol and other drug use among the general population. Typically the environmental
     strategy focuses on changing the shared environment through three interrelated factors: norms, availability, and regulations.
     Environmental approaches seek to create communities and societies that are more conducive to bringing about and maintaining
     desired behavior changes. Effective environmental strategies will focus on entire populations, enhance prevention messages
     directed at individuals, and have potential for long-term change.
     Community- Based Process – This strategy provides ongoing networking activities and technical assistance to community
     groups or agencies. It encompasses neighborhood-based grassroots empowerment models using action planning and collaborative
     systems planning. This strategy works to enhance the ability of the community to more effectively provide prevention and treatment
     services for alcohol, tobacco and other drug abuse disorders.
     Problem Identification & Referral – Aims at identification of those who have engaged in illegal/age-inappropriate use of tobacco
     or alcohol and those individuals who have indulged in the first use of illicit drugs in order to assess if their behavior can be reversed
     through education. This strategy does not include any diagnostic or problem assessment activity (although individuals may be
     identified for whom referral to treatment might be appropriate).
     Alternatives – This strategy provides participation in positive activities that exclude alcohol and other drugs. The purpose is to
     meet the needs filled by alcohol and other drugs with healthy activities and to discourage the use of alcohol and drugs through
     these activities.
     Education – This is two-way communication that is distinguished from disseminating information by the fact that it is based on an
     interaction between the educator and the participant. These activities generally are curriculum based or have at minimum, goals
     and objectives that aim to affect knowledge, concepts, principles, critical life and/or social skills, including decision making, refusal
     skills, and critical analysis. Note: Only recurring events can be counted as Educational Strategy, one-time events cannot be
     considered Education Strategy.
     Information Dissemination – Provides knowledge and increases awareness of the nature and extent of alcohol and other drug
     use, abuse and addiction as well as their effects on individuals, families, and communities. It also provides knowledge and
     increases awareness of available prevention and treatment programs and services. It is characterized by one-way communication
     from the source to the audience, with limited contact between the two.

The total prevention expenditures for fiscal year 2007 – 2008 totaled $4,319,306. The sources of funding for that year were state
allocation and local funding. As depicted in Figure 1, 46% of those funds were spent on “Education”, as this strategy of engaging
youth and raising their awareness of the harmful effects of substance use and abuse continues to be the most effective approach to
changing attitudes and behavior.

                                   Figure 1: Detroit Prevention Expenditures (FY 2007 – 2008)

                                                               Figure 1
                                        Detroit Prevention Expenditures (FY 2007 – 2008)

Prevention programming during 2007 – 2008 saw close to 100,000 participants attending multiple trainings, events, and activities
sponsored by the 34 different agencies throughout Detroit providing prevention services. Approximately 17,000 citizens participated
in at least one event or program. The BASPTR has established a goal of doubling the number of citizens receiving substance
abuse prevention services within the next two years.

Prevention Program Highlight: Take the LEAD
During 2008, BSAPTR was awarded a grant from the U.S. Department of Education to pilot random student drug testing at Finney
High School. The overall program goal of the School – Based Student Drug Testing Program is to deter young people from drug use,
while simultaneously identifying those who have initiated drug use for early intervention, and those with a dependence on drugs for
treatment. The working title for the project is Take The L.E.A.D – (equipping high school students with the critical tools necessary for
success in Leadership, Education, Achievement and a Drug-Free Lifestyle).
Take The LEAD will provide random drug testing, prevention services, and intervention services as a means of changing the social
norms regarding the use of illegal substances and preparing students for a world where 80% of all employers and 100% of college
and professional athletic programs test for drug use. In addition, Take The LEAD will offer student assistance services, community
referrals, health screenings, counseling services, college readiness programs, and tutorial services to address the overall needs
of students.
Initial project activities (July 2008 – January 2009) focused on acquiring approval for the school-based random drug testing policy
from The Detroit Public School Board, the hiring and training of key staff members, building trust and communication with school
personnel, and coalition building with key community leaders and organizations.
An evidence based-tool, the PRIDE Survey, was administered to capture baseline data in February 2009. The PRIDE Survey is
designed to identify the levels of risk and protective factors that predict problem behaviors such as alcohol, marijuana and other drug
use, poor school achievement, and delinquency. In addition to measuring risk and protective factors, the PRIDE Survey also measures
the actual prevalence of drug use, violence and other antisocial behaviors among the students surveyed.
Preliminary outcome data indicated that approximately 24% of the target population surveyed reported alcohol use in the past month,
and 20% of the target population surveyed reported marijuana use in the past month. The data also indicated that students who
reported drug use, also use alcohol occasionally and marijuana more frequently. Survey data also illustrates that ninth graders tend
to use alcohol more frequently than 10th – 12th graders. Marijuana use was consistent among the 9th – 12th graders that completed
the survey.
The program was successfully launched with presentations from Keith McKenzie, former Green Bay Packer and Super Bowl winner,
as well as Reggie Reg, a popular DJ on 102.7FM.

Students Attending the Take The LEAD Rally at Finney High School      Thomas Stallworth, Keith McKenzie, and Chetrice Gillom at the Take the
                                                                      LEAD Rally

Prevention Program Highlight: Cheer, Chant, and Jump for Life 2008
In 2008, the 3rd Annual Cheer, Chant and Jump for Life (CCJ) competition and drug awareness campaign were held at the Detroit
International Academy High School. This year’s event was a huge success thanks to dedicated volunteers, sponsors, schools, coaches,
and all of the highly energetic cheerleaders, dancers, and steppers. The event, which was held at the Detroit International Academy
High School, attracted over 600 spectators who witnessed 10 dynamic teams share their knowledge of alcohol and tobacco through
the performance of cheer, dance, and step routines. SunShyne and Dr. Darrius, DJ’s from WJLB FM98 served as MC’s for CCJ 2008.
CCJ educated 146 youth athletes on how tobacco and alcohol companies target youth. As a result of participating in CCJ, youth
athletes are able to:
     Recognize general marketing tactics used to make products seem more appealing to young people.
     Identify marketing ploys used by alcohol and tobacco marketing companies to increase sales in the youth markets.
     Better understand how specific products, like alco-pops and flavored cigarettes, are aimed at kids.
     Explore the ethics of marketing and selling products that cause disease and death.
     Improve decision-making skills about alcohol and tobacco use.
     Share information about alcohol and tobacco with peers and the community.
1st, 2nd and 3rd place winners walked away with a cash prize of $1,000, $500, and $250 to aid in future drug awareness activities
within their school. First Place: King High School; Second Place: Detroit Broncos; and Third Place: Spain Elementary/Middle School.

Dr. Calvin Trent, Mr. Thomas Stallworth, Dr. Kanzoni Asabigi & Mrs. Minou Carey   1st Place 2008 CCJ Winners: Martin Luther King Jr. High School

Students at the 2008 Cheer, Chant, Jump for Life Competition & Rally

Prevention Program Highlight: The Detroit Reentry Initiative Project
The Detroit Reentry Initiative Project is a “Prevention Intervention” focusing on the prevention and reduction of substance
abuse, and the transmission and spread of HIV/AIDS and Hepatitis C among minority released prisoners in the City of
Detroit. The services offered through this program include: comprehensive case management; HIV/AIDS/Hepatitis C counseling
(individual, family, group); HIV/AIDS/Hepatitis C prevention-based educational activities; referrals for support services and community
resources (housing, job readiness, job placement, etc.); office and conference space for project staff, key stakeholders and partnering
programs; a room for group meetings; a lounge and library for clients to review substance abuse and communicable disease prevention
information; and monthly Citizen Circle meetings. Program development has incorporated building a platform for sustainability including
cultural competency, investigation of available funding for program continuation, the utilization of social marketing techniques and the
implementation of prevention strategies recognized as “best practices”.
    The risk reduction programs showed strong positive results in the numbers of clients receiving HIV counseling, entering substance
    abuse treatment, having sex with only one partner, and not sharing injection needles (Figures 2 – 4).
    Further, the HIV/HCV prevention program reduced the likelihood of unsafe anal sex among participants by 60%.

     Figure 2: Returning Citizens Prevention: Counseling & Treatment

      Figure 3: Returning Citizens Prevention: Sexual Risk Reduction

     Figure 4: Returning Citizens Prevention: Injection Risk Reduction

Prevention Program Highlight: Prevention Roundtable
The Prevention Roundtable convenes members of the Prevention
Provider Network for the purpose of reporting, updating,
collaborating, and strengthening BSAPTR prevention efforts.
During these meetings, prevention providers are updated on
contractual requirements and other pertinent information as it
relates to the prevention department.

Other BSAPTR 2007 – 2008 Prevention Data
The following data elements provide information regarding BSAPTR
prevention for FY 2007 – 2008. The data covers information on
tobacco prevention, alcohol prevention, and Center for Disease
Control and Prevention (CDC) youth risk behavior surveillance
survey (YRBSS) local and statewide findings.

                                                                              Members of the BSAPTR Prevention Provider Network at a Roundtable Meeting
Tobacco Prevention
   Tobacco use remains the number one cause of preventable health issues in Detroit. This is a critical issue for the City, as Figure
   5 depicts higher rates of smoking in Detroit when compared to statewide rates.
   On average, smokers die 13 to 14 years earlier than nonsmokers. Cigarette smoking increases the length of time that people live
   with a disability by about 2 years.
   Annually, cigarette smoking costs more than $193 billion, based on lost productivity (more than $97 billion) and health care
   expenditures (more than $96 billion). Further, health care costs associated with exposure to secondhand smoke average $10
   billion annually. Figure 6 presents healthcare costs per capita for Detroit vs. Michigan citizens. In alignment with elevated smoking
   rates in Detroit, healthcare costs also are elevated for Detroiters compared to statewide figures.
   Current trends show that tobacco use will cause more than 8 million deaths worldwide annually by 2030. In the United States,
   although cigarette smoking is the leading preventable cause of death in the United States, it is responsible for about one in
   five deaths annually, or about 438,000 deaths per year. An estimated 38,000 of these deaths are the result of secondhand
   smoke exposure.
   BSAPTR is working to develop new innovative methods of making cessation service available to the public and preventing the
   initiation of smoking among youth.

                                     Figure 5: Detroit vs. Michigan Cigarette Smoking Rates

                                 Source: Michigan Department of Community Health, Michigan Behavioral Risk Factor Survey &
                                 Local Health Department Estimates; 2005

                             Figure 6: Detroit vs. Michigan Cigarette Health-Related Costs per Capita

                                Source: Michigan Department of Community Health, Division for Vital Records and Health Statistics and
                                Centers for Disease Control and Prevention; Smoking Attributable Morbidity, Mortality and Economic
                                Costs (SAMMEC), 2005.

Alcohol Prevention
     Consistent with State of Michigan objectives, BSAPTR has established the reduction of alcohol related crashes and fatalities as a
     key prevention priority.
     The number of alcohol-related motor vehicle crashes is higher in Detroit compared to Wayne County (Figure 7).
     Between 2004 and 2008, the number of alcohol-related crashes in Detroit has decreased by 27%.
     In 2004, Detroit had 3.2 times the number of alcohol-related vehicle crashes than Wayne County. In 2008 the difference in the
     number of alcohol-related crashes between Detroit and Wayne County increased to 3.7 times higher for Detroit.
     The number of alcohol-related motor vehicle fatality crashes is also higher in Detroit compared to Wayne County (Figure 8).
     Between 2004 and 2008, the number of alcohol-related fatal crashes in Detroit has decreased by 20%.
     In 2004, Detroit had 6.3 times the number of alcohol-related vehicle crashes than Wayne County. In 2008 the difference in the
     number of alcohol-related crashes between Detroit and Wayne County decreased to 5.5 times higher for Detroit.
     Among the top 10 intersections for traffic crashes in Detroit, the intersection of Conner and Gratiot has the highest percentage for
     traffic crashes (2004-2008) related to alcohol (7.8%) (Figure 9).
     The percentage of traffic crashes related to alcohol that occurred at Conner and Gratiot is 42% higher than the intersection of
     Conant and Davison, and 53% higher than the 7 Mile and Gratiot intersection.
     Three of the top ten intersections are within zip code 48228. The streets of Greenfield, Plymouth, Gratiot and 7 Mile Rd E. are key
     “hot spots” for alcohol related crashes.
     Extra caution is required when traveling near these intersections, particularly during weekend, evening and early morning hours.

                          Figure 7: Alcohol-Related Vehicle Crashes

Source: Southeast Michigan Council of Governments (SEMCOG): Detroit

                          Figure 8: Alcohol-Related Vehicle Crashes

Source: Southeast Michigan Council of Governments (SEMCOG): Detroit

Figure 9: Top 10 Detroit Crash Intersections Ranked by Alcohol Involvement, 2004-2008 Five Year Total*

 Intersection Location                                    Detroit Rank   % Involve Alcohol         Five year Total (2004-2008)
 Davison St W @ Linwood St                                1              2.0%                      252
 7 Mile Rd E @ Van Dyke St                                2              4.0%                      198
 Conner St @ Gratiot Ave                                  3              7.8%                      193
 Livernois Ave @ McNichols Rd W                           4              2.2%                      181
 Greenfield @ Warren Ave W                                5              4.9%                      183
 7 Mile Rd E @ Gratiot Ave                                6              5.1%                      175
 Davison St W @ Dexter Ave                                7              4.1%                      171
 Evergreen Rd @ Plymouth Rd                               8              4.7%                      169
 Conant St @ Davison St E                                 9              5.5%                      163
 Greenfield Rd @ Plymouth Rd                              10             4.4%                      159
* All crashes occurring within 250 feet of the intersection
Source: Southeast Michigan Council of Governments (SEMCOG): Detroit

Center for Disease Control Youth Risk Behavior Surveillance Survey (YRBSS) Data
Unintentional Injuries & Violence
     Preventing substance use and abuse is important not just to reduce the risk of addiction, but also the potential associated risks for
     school truancy, youth violence and personal injury.
     Data from the Youth Risk Behavior Surveillance Survey (YRBSS) was used to estimate the percentage of high school students in
     Detroit public schools who engage in certain health risk factors associated with substance abuse (i.e. violence, suicide, drunk
     driving & sexual behavior).
     For Detroit the percentages for “students who did not go to school because they felt unsafe”, “carried a weapon to school”,
     “considered suicide”, and “been in physical fights “have remained relatively the same over time (Figure 10).
     In comparing the health risk behavior prevalence illustrated in the above table, analysis shows that there are no statistical
     differences between the health risk behavior prevalence’s for 2005 and 2007, nor for 2003 and 2007 prevalence’s.
     While there was no increase in Youth Unintentional Injuries between 2003-07 Detroit students are at greater risk for the following
     activities: “not going to school because they felt unsafe” (p <0.01), “carried a weapon to school” (p=0.03), “been in a physical
     fight” (p<0.01), “medically treated after a physical fight” (p=0.04), and “been in a physical fight on school property (p<0.01)
     compared to Michigan rates. On the other hand, Detroit students are at less risk for “considering attempting suicide” (p=0.01)
     (Figure 11).
     Compared to the U.S., students in Detroit are at equal risk for “carrying a weapon”, greater risk for “physical fights” and “not going
     to school because they felt unsafe”, and less risk for “seriously considering attempting suicide”.
     Due to the potential severity of consequences of injury and death associated youth violence and the strong correlation with the use
     of substances, the Bureau of Substance Abuse Prevention, Treatment and Recovery has identified the “Reduction of Intended and
     Untended Injuries” as a key priority for the future.

            Figure 10: YRBSS Detroit: Youth Unintentional Injuries and Violence

   Source: CDC Youth Risk Behavior Surveillance Survey

Figure 11: 2007 YRBSS Detroit vs. Michigan: Youth Unintentional Injuries and Violence

 Source: CDC Youth Risk Behavior Surveillance Survey

Alcohol-Related Unintentional Injuries
     Reducing the number of alcohol related automobile accidents, injuries and fatalities is a key objective for the Detroit Health Department
     and the State.
     For Detroit the percentages of students who “rode in a car with someone who had been drinking”, and “drove when they had been
     drinking”, statistically remained relatively the same over time (Figure 12).
     Citizens and parents need to encourage responsible decisions and behavior associated with the consumption of alcohol. Youth need
     instruction on how to manage situations and avoid riding with drivers who have been drinking.
     Compared with the State, Detroit students are statistically at equal risk for “riding in a car with someone who had been drinking
     alcohol” (p=0.10). On the other hand, Detroit students are at less risk for “driving when they had been drinking” (p<0.01) (Figure 13).
     Compared to the U.S., students in Detroit are at equal risk for “riding in a car with someone who had been drinking alcohol”.

                               Figure 12: YRBSS Detroit: Alcohol-Related Youth Unintentional Injuries

                              Source: CDC Youth Risk Behavior Surveillance Survey

                   Figure 13: 2007 YRBSS Detroit vs. Michigan: Alcohol-Related Youth Unintentional Injuries

                        Source: CDC Youth Risk Behavior Surveillance Survey

Sexual Behaviors
   The percentage of Detroit students who had sexual intercourse after using drugs/alcohol decreased 19% from 2003 to 2007
   (Figure 14).
   Trend data for Detroit students who were “sexually active and used drugs/alcohol before intercourse” did not show statistical
   differences over time.
   The percentage for Michigan students who had sexual intercourse after using drugs/alcohol was 72% higher than Detroit students
   (Figure 15).
   Michigan high school students are statistically at greater risk for sexual intercourse after drug/alcohol use (p<0.01) when compared
   to Detroit youth.

               Figure 14: YRBSS Detroit: Youth Sexual Behaviors

              Source: CDC Youth Risk Behavior Surveillance Survey

     Figure 15: 2007 YRBSS Detroit vs. Michigan: Youth Sexual Behaviors

            Source: CDC Youth Risk Behavior Surveillance Survey

  Section 2: BSAPTR Treatment Services
The Bureau of Substance Abuse Prevention Treatment and Recovery (BSAPTR) is committed to providing high quality treatment
services for individuals who have developed an unhealthy dependency on legal or illegal substances. BSAPTR treatment focuses
on detoxification/ stabilization and rehabilitation/relapse prevention. Many of these efforts flow through the “treatment on demand
initiative.” Treatment on demand is a multidimensional concept embracing domains of affordability, acceptability, accommodation,
availability (no wait lists), service diversity, and competitive stance in the treatment process. The BSAPTR provides treatment
services through a network of 45 treatment providers. The Bureau utilizes extensive resources to provide comprehensive services
that are specifically tailored to individual needs. Treatment services that are available to clients include Detoxification Services,
Outpatient Drug-Free Services, Intensive Outpatient Services, Outpatient with Medication Services, Residential Services, and
Methadone maintenance.

Access to Treatment
The BSAPTR is responsible for assuring the availability and
operation of an access line for the City of Detroit residents who
are seeking substance abuse services. In April 2007, the BSAPTR
launched a “Call Center” which is a telephonic access line that
is available to screen clients 24 hours a day, seven days a week,
including holidays. The telephone access line connects Detroit
residents to treatment providers. They dial an “800” number
that is advertised all over the community (1-800-467-2452-
24 hours/7 days). Residents who call the hotline number are
screened for service eligibility and once the client is determined
to be qualified for services, the telephone agent electronically
refers the client to a treatment provider based on their modality.
Eligible clients are able to go immediately to treatment without
having to be put on a waiting list. The “Call Center” gives people
easy access to substance abuse treatment services that can
make a helpful impact on people’s lives.                             Raheem Anderson at the BSAPTR Treatment Call Center

The BSAPTR also has a “Walk-In Center” for those potential
clients who want to have a face to face screening. To receive this service, the potential client will need to come to the Herman Kiefer
Health Complex, 1151 Taylor St., Room 110A during normal business hours for a screening and referral to determine eligibility for
substance abuse treatment services.
Figure 1 comparatively depicts the total number of treatment referrals made in FY 2006 – 2007 and FY 2007 – 2008. During 2006
– 2007, there were 44,330 referrals made, compared to 34,569 in 2007-2008.

                               Figure 1: Total Number of 24-Hour Treatment Access Line Referrals

Co-occurring Enhancement Integration
On October 1, 2007, the BSAPTR began the work of building new capacity to integrate treatment services within the catchment area.
One of our providers, Professional Psychology and Psychiatric Services (PPPS) identified a psychological/psychiatric tool that would
assist the agency in formulating a DSM-IV diagnostic impression on individuals that are currently enrolled into City of Detroit Bureau
of Substance Abuse funded projects. The tool that is being utilized is the Mini International Neuropsychiatric Interview/Evaluation. A
team of Psychiatrists and Psychologists from the University of South Florida, Tampa and Hospital de la Salpetriere, Paris developed the
instrument. The instrument is not intended to be used in place of a full Psychological/Psychiatric workup, but can be used to assist in
data gathering, symptom identification, and provisional diagnostic formulation.
PPPS began providing onsite evaluations (utilizing the aforementioned instrument), to the Methadone providing centers. PPPS was
successful in engaging the actively admitted clients at the centers. The response to the project by the clients has been favorable.
It was identified that a large percent of the individuals evaluated presented (at the time of evaluation) with an active mental health
issue that was diagnosable. This information was then added to the open client record in CareNet. Those clients that were in need of
immediate mental health counseling services were referred to a project that could support their clinical need and/or to a provider of
the clients’ Qualified Health Plan (QHP)/Health Maintenance Organization (HMO) for service provision.
The second phase of the project was a replication of the first, except the targeted organizations were the residential treatment centers
that are contracted providers with the Bureau. The project was equally embraced, with similar results. PPPS is at the onset of the third
and final phase of the project. This phase will enable PPPS to evaluate clients that are receiving services at centers contracted with
the Bureau for outpatient counseling services. PPPS proposes to engage the clients during the scheduled group therapy time blocks
to ensure the least amount of disruption of counseling programming.
As of July 31, 2008, 929 Block Grant recipients had been evaluated, and 940 Medicaid recipients had been evaluated, for a total of
1,869 evaluations. PPPS will continue to contact each center and schedule a time to complete the evaluation instrument on any new
admissions through the program year. It is PPPS’ goal, to provide this service to all methadone and residential treatment programs
that are in need of becoming co-occurring capable. This new capacity will further assist the client population in receiving treatment
services that meet the totality of their needs, and reduce the probability of a client re-admission into treatment due to a mental health/
substance use issue.

BSAPTR 2007 – 2008 Treatment Data
The following data elements provide information regarding BSAPTR treatment admissions for FY 2007 – 2008. The data covers
information on admission rates, demographics, primary and secondary drug usage, correctional status, employment status, homeless
status, health status and treatment outcomes.
Treatment Admissions
     The number of unduplicated clients in Detroit treatment facilities increased annually between FY 2005 and 2007 (Figure 2).
     During FY 2008, the number of unduplicated treatment clients in Detroit facilities decreased 6.5% compared to FY 2007.
     The rate of admissions during 2008 decreased by 5.4%, from 2007, but was still 32% higher than in 2005, and 11% higher than
     in 2006 (Figure 3).

Figure 2: Number of Unduplicated Clients in Detroit Treatment Facilities

              Source: MDCH Substance Abuse Annual & Legislative Reports

          Figure 3: Age-Adjusted Treatment Admission Rates

          * 2000 U.S. Census Detroit population was used for the standard population

Client Admission Demographics
     The substance abuse treatment population in Detroit has been growing steadily older over the past four years (Figure 4).
     The rate of client treatment admissions in Detroit are highest among those between the ages of 45-54.
     Between FY 2005 and 2008 admission rates continually increased for those between 55-64 years.
     Among those between 55-64 years old, the admission rates during fiscal year 2008 was 116% higher compared to FY 2005, 65%
     higher than FY 2006, and 12% higher than FY 2007.

                                   Figure 4: Age-Specific Treatment Admission Rates (per 100,000) +

                   ± Rates are based upon the population in Detroit according to 2000 U.S. Census (N=951,270)
                   Source: MDCH Treatment Episodes Data Set (TEDS)

     Between FY 2005-2008 males averaged 65% of treatment admissions (Figure 5).

                                                    Figure 5: Treatment Admissions by Gender

                                              Source: MDCH Treatment Episodes Data Set (TEDS)

Marital Status
   Between FY 2005 and 2008 more than 80% of clients admitted into treatment had never been married or were divorced (Figure 6).

                                                Figure 6: Marital Status at Admission

                                   Never           Married/            Widowed         Divorced   Separated
                                  Married         Cohabitating

                                Source: MDCH Treatment Episodes Data Set (TEDS)

   The percentage of treatment admissions having less than a 12th grade education is increasing. In FY 2008 the percentage of
   treatment admissions with less than a 12th grade education was 13% higher than those with high school education, and 2 times
   higher than clients with education beyond high school (Figure 7).

                                 Figure 7: Treatment Admissions by Educational Attainment

                                     Source: MDCH Treatment Episodes Data Set (TEDS)

Substance Use at Admission
     Alcohol, crack, heroin, and marijuana are the main primary substances abused by treatment clients (Figure 8).
     The percentage of treatment clients admitted into treatment for alcohol abuse has been increasing and in 2008 was 18% higher
     than 2005, 22% higher than 2006 and 16% higher than 2007.
     The percentage of treatment clients admitted into treatment for crack abuse has been decreasing and in 2008 was 6.2% lower
     than 2005, 26% lower than 2006, and 14% lower than 2007.
     Treatment admissions for heroin use have been consistent, averaging 30% of the admission population for the last four years.
     Treatment admissions for marijuana use have also been relatively static, averaging 14% between 2005 and 2008.
     In 2008, 87% of the secondary substances used among clients admitted into treatment were alcohol (37%), crack (29%), and
     marijuana (21%) (Figure 9).

                                      Figure 8: Treatment Admissions by Primary Substance

                                         Source: MDCH Treatment Episodes Data Set (TEDS)

                                 Figure 9: 2008 Treatment Admissions by Secondary Substance

                                       Source: MDCH Treatment Episodes Data Set (TEDS)

Correctional Status, Employment Status & Homeless Status
   The majority of the treatment patients with a correctional status at the time of admission were on probation (FY 2007 & 2008)
   (Figure 10)
   Unemployed clients admitted into treatment averaged 71% of the admission population (2005-2008) (Figure 11).
   During FY 2005, 23% of the treatment admissions were homeless. This decreased by 14% in 2006. In 2007, the percentage of
   homeless clients at admission increased by 17%, and by 43% in 2008 (Figure 12).
   Increases in the percentage of homeless clients admitted into treatment is attributed to initiatives of Project Helping Hands. This
   program was initiated in 2006 to increase substance abuse treatment within the homeless population.

                                       Figure 10: Treatment Admission Correctional Status

                                                           FY 2007              FY 2008

                                  Source: MDCH Treatment Episodes Data Set (TEDS)

                                       Figure 11: Treatment Admission Employment Status

                                  Source: MDCH Treatment Episodes Data Set (TEDS)

                                          Figure 12: Treatment Admission Homeless Status

                                      Source: MDCH Treatment Episodes Data Set (TEDS)

Health Status & Drug-Related Emergency Department Visits
     Figure 13 depicts the top nine medical conditions among substance abuse clients. High blood pressure accounts for nearly 40%
     of the medical problems among clients in substance abuse treatment with a medical condition (2006-2008).
     The percentage of drug-related emergency department visits involving cocaine is decreasing while visits involving marijuana are
     increasing (2006-2008) (Figure 14).

                            Figure 13: Top Nine Medical Conditions among Substance Abuse Clients

                                 Source: CareNet Data Set

                                      Figure 14: Drug-Related Emergency Department Visits

                       Source: Drug Abuse Warning Network Data Set (DAWN)

Discharge Outcome Measure
  In 2008, 8,179 clients were discharged from Detroit treatment centers. Among those discharged, the percentage of clients reporting
  drug use decreased 86%, unemployment increased 1.4%, homelessness decreased 45%, and reported arrests decreased 20% at
  the time of discharge.

                                      Figure 15: 2008 Substance Abuse Treatment Outcomes








                                          Source: MDCH Treatment Episodes Data Set (TEDS)

     Section 3: Moving Forward with a Recovery Oriented System of Care
Detroit’s substance abuse treatment system is widely recognized as one of the premier Recovery Oriented Systems of Care (ROSC) in
the nation. With the Detroit Recovery Project and Targeted Populations Services (both recovery support service providers) as means to
engage and continue building the recovery community in Detroit, the city’s treatment system has a strong offering of recovery support
services and a strong link to Detroit’s vital recovery community.
While we have made great strides in cultivating a recovery oriented community and in making recovery support services available to
clients who are leaving treatment, as well as to those who seek recovery support services without first going to treatment, our efforts
to create a fully integrated Recovery Oriented System of Care are still at a relatively early stage. As we move forward we aim to create
a system of care where acute treatment services are seen as a part of a larger recovery oriented framework. As a fully integrated
Recovery Oriented System of Care, we hope to provide services that are client-centered and that involve peer-based recovery coaching
and support from the earliest stages of service engagement.
The Network for the Improvement of Addiction Treatment/Great Lakes Addiction Technology Transfer Center (NIATx/GLATTC) ROSC
Collaborative is one way that we are moving this effort forward. The collaborative was convened in early 2009 as part of a national
initiative that was launched in 5 cities across the country, funded by the Center for Substance Abuse Treatment, to assist local
providers in making process improvement changes. Broadly, the initiative aims to foster the collaboration of local payer/providers
with NIATx, a renowned substance abuse treatment consultation group based at the University of Wisconsin, and regional Addiction
Technology Transfer Centers (ATTC’s). Participants in the national initiative are implementing rapid cycle changes, based on simple
data gathering and evaluation techniques – or the “Plan, Do, Study, Act” model – to make changes that will increase access to and
extend retention in services. BSAPTR (in partnership with the GLATTC based in Chicago) is the only of these to focus on making
organizational process changes that will facilitate the adoption of a Recovery Oriented System of Care. Thus far, change projects
include the more systematic completion of “recovery plans” for clients in residential treatment settings, and the greater cooperation
and collaboration of recovery and peer support providers with clinicians offering services in residential settings. As the BSAPTR
maintains its focus on developing a more comprehensive recovery oriented system of care, the NIATx/ATTC learning collaboration may
prove to be an especially helpful development.
We plan to continue focusing on intensive interdisciplinary training of providers in the conceptual foundations and practical implications
of doing Recovery Management and of being a part of a Recovery Oriented System of Care.

BSAPTR Staff - Cornelius Wilson, Dr. Luke Bergmann, and Michael Johnson   BSAPTR Staff - Leslie Boney and Erin Elliott

  Section 4: Partnership for a Drug Free Detroit
The Partnership for a Drug Free Detroit is a collaborative initiative of the Mayor’s Office and Detroit City Council, the Department
of Health and Wellness Promotion (DHWP), and the Bureau of Substance Abuse Prevention, Treatment & Recovery (BSAPTR). The
BSAPTR highlights the Partnership for a Drug Free Detroit as the community coalition health outreach body that creates, promotes
and hosts activities and events throughout the different communities in the City of Detroit. These activities support healthy living for all
persons including youth and adults in conjunction with collaborative representatives and agencies creating a seamless continuum of
care through health outreach services. Outreach is delivered to the community through free health prevention, treatment and recovery
services from the Department of Health and Wellness Promotion that include: the AIDS Surveillance - HIV/AIDS Prevention Program;
Bureau of Substance Abuse Prevention, Treatment & Recovery; Nutrition Division/WIC; Emergency Preparedness; Project Hope;
Sexually Transmitted Disease (STD) Intervention; and other City of Detroit prevention, treatment and recovery providers.

The City of Detroit, in its Renaissance, will be a safe and drug free community for youth and families in the new millennium. The
Partnership for a Drug-Free Detroit, a comprehensive coalition of stakeholders committed to making Detroit a drug-free community,
has a primary purpose of reducing substance abuse (alcohol, tobacco, and other drugs) in the city of Detroit. We serve as a catalyst for
members of the community (community-based organizations, businesses, parents, youth, government, substance abuse prevention
and treatment providers, civic groups, faith-based organizations and community activists) to actively participate in changing attitudes,
making healthy choices, and fostering an environment which promotes healthy living.

The goals of the Partnership are as follows:
   To coordinate with state and national alcohol, tobacco, and other drug (ATOD) prevention groups.
   To significantly involve the recovery community to enhance prevention efforts.
   To develop a cadre of pre high school and high school youth that will be trained as substance abuse/use prevention peer educators.
   To submit grants and proposals to federal and state agencies that will increase funding of prevention and intervention programs in
   the City of Detroit.
   To establish community norms and limitations on substance abuse.
   To reduce the alcohol consumption in Detroit by 50%.

In 2008, on behalf of the citizens of Michigan, the Michigan Department of Community Health and the Office of Drug Control Policy,
Governor Jennifer M. Granholm honored, recognized, and commended the Partnership for a Drug Free Detroit for its response to
the Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking by hosting a town hall meeting. Governor Granholm
thanked the Partnership for a Drug Free Detroit for showing passion and commitment to ensuring the youth in the State of Michigan
are well educated on the dangers of underage drinking.

2007/2008 Annual Outreach Events
The Partnership for a Drug Free Detroit collaborates, sponsors and supports outreach activities within the Detroit community on an
annual basis. The Partnership staff and volunteers (Detroit citizens, health professionals, legislators and community leaders) join
together and render services in the community, offering prevention, treatment and recovery information to adults, children, individuals
and families, and anyone that freely accepts it at each community based activity. Community volunteers from churches, community
organizations, courts, police departments, prevention-treatment-recovery providers, schools, churches, etc., both youth and adults,
help the Partnership with All activities and events. Many contribute their time through the following subcommittees:
   Advocacy Committee                                        Speakers Bureau
   Faith Based Initiative                                    Volunteer Committee
   Recovery Committees

The monthly coalition meeting held at the Coleman Young Municipal Center continues to be the most well attended session held by
the Partnership. Therefore, efforts are made to continue to offer additional topics that provide highlights for community interaction.
This high level of participation by volunteers in the City of Detroit make health outreach activities possible by the Partnership for a
Drug Free Detroit.
Programs and services provided by the Partnership are tailored to serve our citywide population. Incentives offered through DHWP
departments are a good draw for Partnership events, including free blood pressure checks, lead tests, substance abuse assessments,
and HIV/AIDS tests. The Partnership provides community health outreach services in the DHWP Community Reinvestment Strategy
(CRS) identified in areas across the City of Detroit in Figure 1.

                                                               Figure 1

               DHWP Community Reinvestment Strategy Areas

2007 Outreach Initiatives by DHWP Cluster

CRS Area #1:
The Partnership for a Drug Free Detroit held its Takin’ it to
the Streets initiative at the Neighborhood Service Organization
(NSO). Four hundred (400) persons attended; thirty (30) were
tested for HIV/AIDS; and twenty-four (24) were referred for
treatment. All participants received literature on substance
abuse treatment and prevention.

CRS Area #3:
The Partnership for a Drug Free Detroit held its Takin’ it to
the Streets initiative at the Mack Alive site (Mack Avenue and
Bewick St.). Two hundred and thirty-six (236) persons attended;
twenty were tested for HIV/AIDS; eight (8) were referred for
treatment and three (3) receive homeless services.
Three hundred (300) community members attended the monthly
                                                                     Takin’ it to the Streets, Northend (Owen & Oakland) October 19, 2007
Finney Youth Initiative (FYI) meeting; 72 parents. Three hundred
and fifty (350) people attended the combined Holiday Parent
Teacher Conference and Open House.

CRS Area # 4:
The Partnership for a Drug Free Detroit held its Takin’ it to the Streets initiative at the New Bethel Baptist Church in the Linwood and
Philadelphia area. Two hundred fifty-two (252) persons attended; twenty-six (26) were tested for HIV/AIDS; eight (8) were referred
for treatment; two (2) received homeless services. All participants received literature on substance abuse treatment and prevention.
Three thousand (3,000) people attend the Ecumenical Faith Based Conference sponsored by the BSAPTR in partnership with the
Council of Baptists Pastors (COBAP).

CRS Area #10:
In July 2007, the Partnership for a Drug Free Detroit held its Takin’ it to the Streets initiative in the Brightmoor Area (Fenkell
and Lahser). Three hundred fifty (353) persons attended; nineteen (19) were tested for HIV/AIDS, nineteen (19) were referred for
treatment. All participants received literature on substance abuse treatment and prevention.
In October 2007, the Partnership for a Drug Free Detroit held its Takin’ it to the Streets initiative in the North End Area (Owen and
Oakland St.). One hundred and forty-two (142) persons attended; twelve (12) were tested for HIV/AIDS, three (3) were referred for
treatment; and one (1) received homeless services. All participants received literature on substance abuse treatment and prevention.

During the 2007 – 2008 service period, many areas of the City of Detroit received free health outreach services at the
various events noted below through collaborative efforts:
   Monthly Coalition Meetings (January thru October) (Northend Area 4)
   Faith Base Conference (Before Easter March or April) (Hamtramck Area 4)
   Takin’ it to the Streets Outreach (April thru October) (NDNI, West & East Areas 1, 2, 3, 4, 6, 7, 9, 10)
   Youth Development Institute Cheer, Chant & Jump City-wide Cheerleader Competition (May) (Northend Areas 4, 10)
   Safe & Sober March & Rally (May) (Osborn – Eastern District Area 3)
   Pancake Breakfast - Homeless (June) (Northend Area 1)
   Youth Development Institute Summer Interns (June thru July) (Northend Area 1)
   Youth Buddies for Business Summer Program (June thru August) (Eastern District Area 3)
   Recovery Activities (September) (Eastern District Area 3)
   Youth Halloween Event (October) (Eastern District Area 3)
   Thanksgiving Dinner (November) (Eastern District Area 3)
   Finney Youth Initiative Holiday Parent-Teacher Conference & Open House (December) (Eastern District Area 3)
   Christmas Dinner (December) (Northend District, Highland Park Area 1)
   Other Activities Roy Ayers Dinner (Northend District Area 1)

2007 & 2008 Faith Based City Wide Conference
The Partnership for a Drug Free Detroit hosted the Citywide Revival and Faith Based Substance Abuse Conference in collaboration
with the Council of Baptist Pastors of Detroit and Vicinity. This collaborative effort was held to bring the Spirit of Recovery to all
citizens, opening the doors to bring the disease of addiction out in the open allowing everyone to realize that this is indeed a health
problem that needs attention. The Department of Health and Wellness Promotion departments and City of Detroit providers were
available with resources and information for health resources to help with healing physically, spiritually, and mentally.
This Spirit filled conference was held on April 2-5, 2007 at Tabernacle Missionary Baptist Church where 3,000 adults and youth
attended four (4) days of workshops in the morning and evening revival services. On March 17-20, 2008 The Partnership for a
Drug Free Detroit collaborated again with the Council of Baptist Pastors of Detroit & Vicinity and hosted The City Wide Faith Based
Substance Conference at Corinthian Baptist Church. This conference was held with revival sessions only in the evening with moving
speakers and revival preaching in the evening, promoting a healthy life style. The DHWP brought resources and information on a daily
basis and administered free tests.

12th and 13th Annual Pancake Breakfast
The Partnership for a Drug Free Detroit held the 12th Annual Pancake Breakfast at Cass Park on June 9, 2007. This annual event is
held to offer services to the homeless during the summer months. Homeless individuals gather in the Cass Park area near downtown
Detroit on a continuous basis and the DHWP offered free tests and services. Prevention, treatment and recovery providers also were
on hand to assist. Free unlimited pancakes, sausage and juice and care packages were available for everyone in the community that
attended. One thousand (1,000) participants attended. On June 7, 2008 the 13th Annual Pancake Breakfast was held at Cass Park,
offering free services to the homeless and everyone that attended. One thousand five hundred (1,500) persons attended.

12th and 13th Annual Safe & Sober March & Rally
In 2007, the Partnership for a Drug Free Detroit hosted the 12th Annual Safe & Sober March and Rally at Palmer Park on May 25,
2007. This event is held yearly as a Kick-off event for a Safe & Sober Summer for Detroit, Michigan. Games, rides, refreshments,
high school bands, entertainers and speakers come out to enjoy the day offering free resources from community organizations,
the DHWP, and other prevention, treatment and recovery providers. Two thousand (2,000) persons attended. In 2008, the 13th
Annual Safe & Sober March & Rally was held on May 23, 2008 on the grounds of Osborn High School. One thousand eight hundred
(1,800) persons attended.

Pancake Breakfast at Cass Park June 7, 2008                           Safe & Sober March & Rally at Palmer Park (Woodward & 7 Mile Rd)
                                                                      May 25, 2007

Reverend Denice Nixon, Manager, Partnership for a Drug Free Detroit   BSAPTR Staff - Jeanine McIntosh (Operations Manager) and Nikita Womack

BSAPTR Special Projects
BSAPTR Special Projects were developed to create a continuum of care for substance abuse prevention, treatment and recovery
throughout the City of Detroit. The special project activities involve community organizations, faith based community, schools, law
enforcement, courts, social workers, local & state legislators and officials (Figure 2).

                                                                 Figure 2

   The Council of Baptist Pastors is a faith-based organization that includes 300+ Baptist pastors in the City of Detroit and surrounding
   areas. Activities and programs are planned to enhance substance abuse, HIV/AIDS intervention in the faith-based community.
   The Finney High School (FYI) project is a large collaborative with community partners, Detroit Public School staff, St. John
   Hospital, Empowerment Zone Coalition, NCADD, parents, Detroit Police Department, BSAPTR, City of Detroit Safety Program
   and others. This group meets to change the mindset of students, parents, staff and the community toward educational goals
   and positive interaction. Meetings are held on a monthly basis. A grant has been recently received for random drug testing to be
   implemented at Finney High School and serve as a model for Detroit Public Schools.
   Homeless Action Network of Detroit (HAND) interacts with current issues in the homeless community to address underlying
   substance problems, homelessness and other related issues to the homeless. HAND coordinates funding grants for providers that
   support this community. BSAPTR and other providers serve on the committee to assist coordination and include substance abuse
   and mental health needs for the homeless population in the City of Detroit. “Every Person Counts” will be implemented again this
   year to count the homeless. It is expected that numbers will decrease because of the work of Project Helping Hands (a BSAPTR
   project in collaboration with NSO). Collaboration with HAND Advocacy Committee events on a regular basis is vital to assist with
   speaking to the homeless population and assisting in offering needed advice and support for upcoming activities. Involvement with
   the HUD/City of Detroit 10 year plan for homelessness and SOAR program are also a part of this collaboration.
   Project FAIR (Families Achieving Independence through Recovery) The major goal of this project is to keep families together
   by providing integrated substance abuse services through a continuum of care that includes assessment, treatment, supportive
   services and aftercare services. Project FAIR aims to reduce the number of days a child spends in care and increase the number of
   children who successfully remain with or are reunified with their families. Project FAIR is a collaborative effort between the State of
   Michigan Department of Human Services (DHS) Child Protective Services, Foster Care and the City of Detroit Bureau of Substance
   Abuse, Prevention, Treatment and Recovery.
   Project Fresh Start is a collaborative effort initiated by the Wayne County Sheriff’s Department, Wayne County Prosecutor’s office,
   Detroit Police Department, Detroit Law Department, 36th District Court and the City’s Bureau of Substance Abuse Prevention,
   Treatment and Recovery. Project Fresh Start affects street level drug sells by interdicting street prostitution. The program serves
   as an alternative to jail time. Prostitutes have the choice to go into drug treatment. If they choose not to, they go to jail for 90 days
   or more according to their tickets and ruling by Judge L. Lloyd. The project began on April 5, 2004. Female clients are referred
   to specific Women Specialty Treatment programs throughout the City of Detroit. Monthly meetings are held at 36th District Court
   for confidential case management, project maintenance, evaluation, and planning continued intervention and progress of clients.
   Needs and future area sweeps around the City of Detroit are reviewed. Graduation rates show that almost half of the clients
   are graduating from the program. More data collection within the divisions outlined will identify outcome information regarding
   individual clients and show further success rates, including employment, training, housing, family interaction, etc.

     The Southeastern Michigan HIV/AIDS Council (SEMHAC) is an HIV/AIDS community planning body whose mission is to
     strengthen a coordinated regional response to the HIV/AIDS epidemic by involving persons infected with and/or affected by
     the virus. Local and state human service representatives, community organizations, affected and infected HIV/AIDS client
     representatives and professional staff are members of SEMHAC. Activities and reports are planned and discussed and valuable
     information disseminated for intervention and program implementation.

SEMHAC Staff Members

Dr. Kanzoni Asabigi, SPHSD General Manager and Nikita Womack       BSAPTR Staff - Reverend Diana Cross (Partnership) and Tracey King

  Section 5: Youth Division
The Youth Division of the Bureau of Substance Abuse Prevention, Treatment, and Recovery (BSAPTR) coordinates and executes
the events and activities for three youth programs, the Successful Alliance for Educating Talented Youth (SAFETY), Dreaming While
Achieving (DWA), and the Strong Teens Excelling in Prevention Services (STEPS) Programs. Program descriptions, highlights, and
student showcases are presented in the following sections.

Successful Alliance for Educating Talented Youth (SAFETY) Program
Successful Alliance for Educating Talented Youth (SAFETY) is a 3 component program that provides crisis management and case
management services through our Assessment Center (ages 10-17), After-School enrichment programming (ages 14-18) and a Summer
Internship Program to Detroit Public School students (ages 14-18). We partner with the Detroit Public Schools, Alkebu-Lan Village and
Title I Competitors. The SAFETY After-School and Summer Programs are funded by the Department of Health and Wellness Promotion’s
Bureau of Substance Abuse, Prevention, Treatment and Recovery and the Michigan Juvenile Accountability Block Grant (JABG).
Programs are available at Finney High School, Southeastern High School, Westside Academy and Fredrick Douglas Academy. During
the summer, we served 54 youth in our 6-week prevention internship program that includes prevention workshops, resume writing,
interviewing skills and our annual award-winning cookout event.
SAFETY 2007 – 2008 Program Highlights
   In November, the students in our SAFETY After School Program at Finney High School began the Cultural Enrichment Program
   at Alkebu-Lan Village. This is a program that was established for the students from Finney High School to participate in to help
   mentor and promote character building for our students. The students are offered opportunities to learn anger management
   through sessions, discipline and self-control through the Martial Arts program, entrepreneurship and skill development through
   the Recording Studio and Business training, and an environment to have fun in a clean and safe place. The students are provided
   with a delicious and healthy hot meal. Transportation to the Village every Wednesday and Friday evening is provided also.
   The Finney High School FYI (Finney Youth Initiative) Committee participated in an Open House, Parent Teacher Conference, and
   Teacher Appreciation Dinner in December. The was an event organized in partnership with the FYI Committee and Finney High
   School Staff to encourage parent and community participation and awareness. Finney High School is preparing to implement a
   Student Random Drug Test Program (SRDT); this event was also purposed to further share information on the plans of the SRDT
   Program. This was a very successful event with more than 250 students, parents, and community leaders participating.
   In January, our Hot Spot Program welcomed a guest speaker to share information on the subject of Financial Planning. Ms. Kim
   Sherobbi offered her services free of charge to share information with our Teen Hot Spot youth because of her passion regarding
   the importance of having good financial planning and understanding how the manage your money. The students received her
   information very well, asking many questions and gaining a better understanding of the importance of financial planning.
   The Bureau of Substance Abuse sponsored a Citywide Revival Faith Based Substance Abuse Ecumenical Conference in March. The
   program was hosted at the Corinthian Baptist Church on Caniff. Transportation was provided by the Bureau, and all of our After School
   Programs were able to participate, Fredrick Douglas, Westside Academy, Southeastern High School, and Finney High School.
   March 21st was the date of the Recreation department Youth Service Unit departure for our “Great Debaters” Southwest Cultural
   College Tour. Ten students from our ABC Hot Spot participated and 7 from our after school program. A total of 31 students from all
   three programs participated. We visited 7 Universities in Texas and Louisiana, Wiley College, East Texas Baptist University, Prairie
   View A&M University, Texas Southern University, Southern University A&M, Dillard University, and Xavier University. This was a
   very educational Tour with zero incidents. The students also visited Six Flags over Arlington Texas after church services on Easter
   Sunday in Dallas Texas at Friendship West Baptist Church. The students also enjoyed having lunch on University campus site
   visits, which proved to be very cost efficient with a wide variety of food selection. It also offered the opportunity for the students
   to engage with the college students to get their input on College Life.
   Students in our After School Programs participated in a Public Hearing on Under Age Drinking at Finney High School in April. The
   STEPS Program students also participated. Some of the students from Finney High School presented a short skit on the affects of
   Alcohol entitled “Think, Don’t Drink”. The students were asked to participate in a question and answer segment and some shared
   some pretty personal information on how alcohol has affected their personal lives and families.

     Our STEPS Program Step Show and Prevention Swing occurred in May. All of our Program students were invited to come out and
     participate in the event. The performances were outstanding and the Program was without any incidents, well supervised, and a
     job well done.
     In June, three of our youth and two of our parents participated in a Faith Based After School Program Retreat in Port Huron Michigan
     at the Thomas Edison Inn. The students were asked to sit on a panel to share how After School Programs have influenced their
     lives. Our students spoke very well and offered excellent information on the benefits of After School Programs and suggestions
     on how to improve them. The parents also were a part of a separate panel where they shared information on how After School
     Programs have helped in offering opportunities that have benefited their children to do very well in life. The parents who attended
     have three children who have participated with the SAFETY Program for several years, and they have been very pleased at the
     support they have received and the progress they have made.
SAFETY Student Showcase – Jacob Durrah
The SAFETY Program would like to pay tribute to one of our outstanding young men, Jacob Durrah.
He is a dedicated, mature young man, and a ninth grade student from our Finney SAFETY After
School Program. He has participated consistently with the program. He worked very hard to maintain
and improve in his academics, taking advantage of the tutorial program that the SAFETY Program
offers. During our Summer Prevention Employment Program, Jacob excelled far above expectations.
His site placement supervisor was so impressed with Jacobs’ work ethic (always on time, ready
and available to work, making himself available at all times, etc.) that he requested to keep Jacob
throughout the school year. Efforts are in motion to keep Jacob employed throughout the school year.
This depends on whether the site placement center is able to put Jacob into their budget. We salute
Jacob Durrah for a job well done!

                                                                                                             Jacob Durrah
Dreaming While Achieving (DWA) Program
Dreaming While Achieving (DWA) provides computer-based vocational skills training for low-income Detroit youth between the ages
of 14-21. Aspects of the vocational training and employment program include, developing employability skills, career coaching, one-
on-one mentoring, and academic enrichment services. After completing the training program, youth are placed in a 6-week internship.
The program partners with organizations such as Spectrum Human Services, and the Department of Workforce Development. Annual
activities include: Inventor’s Quest, a Cultural College Tour, Scholarship Search Fest, College and Career Forums, Holiday Can Food Drives,
and an annual Entrepreneurship Contest. During the summer, we placed a total of 80 youth in internship opportunities in various fields of
study. Eligibility is based on family income. Funding is provided by the Michigan Department of Energy, Labor and Economic Growth and
the Department of Health and Wellness Promotion’s Bureau of Substance Abuse Prevention, Treatment and Recovery.
DWA 2007 – 2008 Program Highlights
     Participants had an opportunity to demonstrate their skills during summer employment opportunities. Various business and
     institutions hosted our young people for six (6) weeks during the months of July and August 2007/08, including:
              Collision Contractors, Alkebu-Lan Village, Connections for Deaf Citizens, St. John Riverview Hospital, Second
              Ebenezer Church, CDC (Vanguard), Focus Hope, Spectrum Human Services, Detroit City Council, the Art League
              of Michigan, City of Detroit Department of Health and Wellness Promotion, Detroit Recreation Department,
              Motown Museum, American Red Cross, Mayor’s Office of Community Affairs, Youth Development Commission,
              Arts and Scraps, Detroit School of the Arts, and Microworks.
     Five (5) DWA participants graduated high school and have pursued a post-secondary education. Institutions include Wayne State
     University, Michigan State University, Ashland Theological, and Wayne County Community College.
     Three (3) DWA participants obtained part-time, after school employment with Kentucky Fried Chicken, Petco, and St. John
     Riverview Hospital.

DWA Student Showcase – Latice Shaw
Latice Shaw joined the DWA Program in the spring of 2009. Latice had interest in several career
paths; however, she had no clear direction to obtain her goal. Through our program Latice has learned
to focus her interests and present herself in a more professional manner. Latice is currently pursuing
her dream of becoming a Pharmacist. “I found a home with DWA. The people really care and I believe
that my life has changed for the better” stated Latice when her mother was named DWA parent of
the year. Through hard work and dedication, our youth can achieve anything.

Strong Teens Excelling in Prevention Services (STEPS) Program
Strong Teens Excelling in Prevention Services (STEPS) provides violence prevention, as well as
Alcohol, Tobacco and Other Drugs (ATOD) prevention skills to youth ages 13-18 years old. STEPS’
partners include, Wayne County Community College, the 4-H Club, and Spectrum Human Services. In          Latice Shaw
the summer, 61 youth earned internships with local community businesses and agencies. STEPS is
funded by the Department of Health and Wellness Promotion’s Bureau of Substance Abuse Prevention,
Treatment and Recovery.
STEPS 2007 – 2008 Program Highlights
The following outcomes were observed for youth who participated in the STEPS Program:
   Academic achievement was improved by 61%
   School absenteeism was reduced by 21%
   Community & school discipline was reduced by 60%
   Knowledge of violence and drug use were increased by 57%
   Criminal bookings were reduced by up to 90%
   Knowledge of social issues like HIV-AIDS was increased by 47%
   Knowledge of self concept & values were increased by 52%
   Decision-making, problem solving, and social/interpersonal skills rose by 29%
   Cultural involvement & interaction increased by 17%
   Behavior, character, and responsibility improved by 10%
   Conflict Resolution and life-skills were increased by 40%
   Community service and volunteerism increased by 42%
STEPS Student Showcase – Daniel Pounds
A good example of someone that has acknowledged the services provided by STEPS is Daniel Pounds.
Since the age of 13 when he entered the STEPS program, he has improved socially, becoming a leader
amongst his peers. Daniel attends most of the community service activities and his positive attitude
filters throughout the program to other young people. Pounds is a shining example of what can be
accomplished despite the harsh reality of drugs and gang violence. In the face of peer pressures that
engulf our youth in many different ways, Daniel Pounds has excelled in the STEPS program and the
community. With a grade point average of 3.8, this 15-year old has shown noticeable changes in self-
esteem, assertiveness, and confidence.

                                                                                                         Daniel Pounds

     Section 6: Systems Transformation for Consumers with Co-occurring Mental and
                Substance Use Disorders
The Michigan Department of Community Health (MDCH) has placed a high priority on the development and implementation of a
welcoming, recovery oriented, and integrated system of care statewide. The vision for this system transformation is to:
     Create a welcoming “no wrong door” access and outreach system
     Seamlessly provide or link all services in a fluid manner
     Remove the burden on individuals/families served to navigate different systems
The Bureau of Substance Abuse Prevention, Treatment and
Recovery (BSAPTR), recognizes that many individuals and
families served in the Detroit Coordinating Agency (CA) have co-
occurring disorders. These persons present with co-occurring
psychiatric and substance disorders resulting in poor outcomes
and higher costs for treatment. To increase the awareness
among substance abuse clinicians, in 2005 the BSAPTR began
encouraging its network of treatment providers to develop
competencies in the field of mental health, and to obtain mental
health services certification in order to provide both substance
abuse and mental health services to clients. The Detroit CA has
modified its screening tool to better identify potential clients    BSAPTR Staff – Laeki Hester, Kathleen Givens, and Makini Kwnell
with both mental health and substance use disorders. Clients
are referred to providers in the network that have the capacity and ability to treat them. Since 2006, the BSAPTR has collaborated
with the Detroit – Wayne County Community Mental Health Agency and the State of Michigan’s Community Mental Health Boards
(MACMHB) to offer seminars and trainings to address this issue.
In February 2007, the BSAPTR began collaboration with four core partners to develop a system charter to address the needs of
the people and families we serve. These partners are Detroit-Wayne County Community Mental Health Agency, the Managers of
Comprehensive Provider Networks (MCPN’s) Gateway Community Health, Carelink, and the Southeast Michigan Community Alliance
(SEMCA). The partners have each adopted this project charter as an official policy statement, and disseminated it in official material
to its MI/SA provider network. The charter has as its goal, “… to create a collaborative culture where all of the subsystems, funding
streams and stakeholders join together in a partnership (not a merger) to own collective responsibility for individuals and families with
any combination of mental health and substance abuse needs that present in any setting, and to collaboratively prioritize our resources
to meet the needs of this population most effectively, and to create a framework for universal capability and mutual support.”
The partners have agreed to use the Comprehensive, Continuous, Integrated System of Care (CCISC) model for designing systems
change. It is recognized as a best practice model and is aligned with a statewide initiative supported and coordinated with the Michigan
Department of Community Health and Office of Drug Control Policy. The goal is to develop a multi-year quality improvement project
that will improve recovery orientation, recovery planning and management, cultural competency, access, engagement, and outcomes
for individuals and families with both mental health and substance use disorders. Consumers, family advocates and members of the
recovery community are empowered partners in this process at every level.
A Core Implementation Team (CIT), consisting of representatives from each of the system partners, meets regularly to oversee
and guide the transformation process. The CIT has identified a team of change agents or champions to assist in clinical practice
development. Technical assistance, training and consultation for the change agents are provided by consultants from Zia Partners
(Dr. Kenneth Minkoff and Dr. Christie A. Cline). Change agents are expected to help staff learn new attitudes, values, knowledge and
skills related to treatment of individuals with co-occurring disorders. They also are to help their agency, and the system as a whole to
reorganize and provide more welcoming, accessible, integrated, continuous, and comprehensive services to individuals and families
with co-occurring disorders. Over 135 change agents throughout the MI/SA provider network have been identified.

2007 – 2008 Accomplishments
     The Five Core Partners have established the infrastructure necessary to support the system transformation effort.
     A system-wide conference was conducted to announce the system transformation initiative. Over 400 representatives attended
     the conference from all of the system partners.

    Conducted the first of a series of trainings for the change agents in June 2008.
    A consensus charter document was developed with input from consumers, stakeholders, partner agencies, and providers regarding
    the overall system change process for integrated services.
    Distributed a system transformation letter to all network providers and stakeholders announcing the systems transformation
    project. This letter was signed by the CEO’s from each of the five core partners.
    Began the CQI process at each of the partners to improve the recognition of co-occurring disorders in their data system and
    established baseline data of the number of individuals served with co-occurring disorders.
    Conducted the first in a series of meetings to align this initiative with the implementation of other transformational practices such
    as supportive housing and supportive employment.
    Developed Co-occurring Grand Rounds, a learning series that began in December 2008.
    The Detroit Recovery Project (DRP) has impacted the criminal justice system by providing linkages needed to promote recovery
    for individuals with co-occurring disorders. One hundred seventy six (176) individuals in the Wayne County jail have participated in
    daily groups.

BSAPTR Staff - David McDaniel                                          BSAPTR Staff - Lola Holton and Johnnie Jones

BSAPTR Staff - Patti Garbacz and Peter Granaas                         BSAPTR Staff - Samy Ganesan and Armenta Young

     Section 7: Spotlight on BSAPTR Special Projects – Project FAIR & Project Helping Hands
The Bureau of Substance Abuse Prevention, Treatment, and Recovery (BSAPTR) has a panoply of programs that support Detroit
citizens as they deal with the myriad challenges of substance abuse. This year, we have chosen to showcase two special projects that
address the needs of some of the most vulnerable citizens in Detroit, the homeless population and families that are at-risk of losing
their children to the foster care system as a result of substance abuse. These programs have made significant strides this year, and
highlights are summarized below.

Project FAIR
Project FAIR (Families Achieving Independence through Recovery) is a collaborative effort between the Department of Human
Services (DHS)-Child Protective Services (CPS) and the City of Detroit’s Bureau of Substance Abuse Prevention, Treatment
and Recovery (BSAPTR). Project FAIR is not a discrete program or agency but rather an inter-agency practice model that helps
families that DHS-Child Protective Services workers have identified as low to moderate-risk for Foster Care involvement (based on
Child Protection/Community Partnership criteria) and that are struggling with substance abuse issues. The primary goal of the project
is to identify families with substance abuse issues that DHS-CPS may be compelled to separate and instead keep them intact by
providing integrated substance abuse services through a continuum of care that includes assessment, treatment, supportive services
and recovery services.
The program coordinates institutional practice and protocol so that in cases where issues of substance abuse are apparent to a DHS-
CPS worker, a referral to treatment through BSAPTR is made. Most importantly, if adult caregivers who are referred to Project FAIR
remain in good standing in substance abuse treatment they will maintain guardianship of their children through their involvement in
treatment. The specific aims of this project are to reduce the number of days children spend in state care and increase the number of
children who successfully remain with or are reunified with their families.
Recently, staff from BSAPTR and DHS who are involved in Project FAIR have given extremely well received presentations on their work
to audiences in Lansing and there is great excitement at the state level in Project FAIR as a model for coordinated services in other
Michigan communities.

Project Helping Hands
Project Helping Hands (HH) is a one-of-a-kind program devoted to outreach and the coordination of services for homeless people. In
operation for just over two years, HH has already made important strides in reducing chronic homelessness in Detroit, and has become
an important part of the plan to end homelessness in Detroit and Wayne County.
HH represents the work of a broad coalition coming together around a common goal. In anticipation of the 2006 Super Bowl, a
network of providers and community partners and stakeholders, including the Bureau of Substance Abuse, Prevention, Treatment
and Recovery (BSAPTR), Neighborhood Service Organization (NSO), Detroit Rescue Mission Ministries (DRMM), the Coalition on
Temporary Shelter (COTS), along with the Detroit Police Department (DPD), The National Football League (NFL), and the Detroit-
Wayne County Community Mental Health Agency, worked to establish a venue where homeless individuals could participate in the
festivities while also receiving outreach services. Over the course of the Super Bowl weekend this coalition of community partners
connected hundreds of homeless people to the services they needed.
With the success of this event the BSAPTR sought funding from DPD to create a mobile outreach initiative that would serve people who
are homeless and having frequent encounters with law enforcement. Almost immediately, outreach staff found that most individuals
had substance abuse and/or mental health concerns. This, in turn, encouraged the Detroit Wayne County Community Mental Health
Agency (D-WCCMHA) to fund what is currently known as Project Helping Hands.
Now operated jointly by BSAPTR and NSO, HH has provided services to over 2,500 individuals since its founding. More than 150
people have found permanent supportive housing. Over 500 people have been referred to substance abuse or mental health treatment
services. And the Mobile Outreach Team (MOT) is now widely seen as a critical resource for the community.

  Section 8: Community Impact Stories
Carolyn Anderson
“Grow where you are planted”, is the philosophy that has fueled Mrs. Carolyn Anderson’s passion to
help urban youth. She believes that with the proper guidance and the availability of healthy, positive
alternatives, all young people can thrive and develop into happy and productive adults that are drug-
free and engaged in their communities.
She is the founder and Executive Director of CLASS (Changing Lives and Staying Sober), a
community-based drug prevention program. CLASS began in 2003 as a subsidiary of True Love
Christian Ministries, and was created to provide at-risk youth and their families in the Northeast
Detroit community with skills to improve the quality of their lives while educating them about the
harmful effects of alcohol, tobacco, and other drugs.
Funding from the Bureau of Substance Abuse Prevention, Treatment, and Recovery (BSAPTR) allows
the program to provide free year-round after-school and summer drug prevention programs for youth         Carolyn Anderson
ages 5 – 18 years old. Since its inception, the program has successfully serviced over 1,000 youth.
The CLASS after-school program operates on Monday through Thursday from 4pm- 6pm, and a 5-week summer program operates
from 8am – 1pm, Monday through Thursday. The primary curriculum for the after-school and summer programs is Life Skills, a
research based curriculum that can be adapted to the urban environment as well as to various age groups. It is designed to address
personal and social issues, as well as drug awareness through the use of enrichment activities as a framework for successful drug
prevention education. Sample topics are self-esteem, positive attitudes, conflict resolution, violence prevention, dangers of tobacco,
myths of marijuana, and influences of media on drug use. CLASS complements this curriculum with academic enrichment activities
in reading and math, as well as recreational activities, such as drama and arts and crafts.
A recent independent evaluation of the program found that program participants displayed increased knowledge about the negative
effects of substance abuse, nutrition and wellness, as well as enhanced reading ability and self-confidence.
Mrs. Anderson believes that you have to impact change where you live, and cultivate a sense of community “ownership” among both
children and adults. She says, “We must come to believe that we are ultimately responsible for the health, safety, and well-being of
our own communities, nobody else”.
Mrs. Anderson realizes that the work of substance abuse prevention is never accomplished alone, and wishes to recognize her
collaborative partners, among which are the Detroit Department of Health and Wellness Promotion’s Bureau of Substance Abuse
Prevention, Treatment, and Recovery, New Detroit, Davenport University, Computech, Youth Development Commission, Detroit Area
Agency on Aging, and the Northeast Police District.

Johnnie Jones
“Always smiling, and always willing to help” is a common way that colleagues describe Mr. Johnnie
Jones. He serves as the Recipient Rights Specialist at the Bureau of Substance Abuse Prevention,
Treatment, and Recovery, and he meets his work everyday with a positive attitude. He believes that
no matter how good things are, they could be better, and no matter how bad they are, they could be
worse. When asked the familiar question “How are you doing today?”, his signature reply is “Never
less than wonderful”.
However, things were not always so positive in Mr. Jones’ life. He struggled with substance abuse
for 32 years before he was able to turn his life around. His pivotal turning point came after what he
describes as multiple failed treatment episodes, and ultimately experiencing a spiritual awakening at
the Detroit Rescue Mission Ministries (DRMM). He said to himself, “I can’t continue to live like this”.
The support he received in the recovery process from the DRMM sparked his desire to pursue work in
the area of substance abuse. He worked at the DRMM Christian Guidance Center for 12 years before          Johnnie Jones
coming to work at the BSAPTR in 2006.
Johnnie does not mind speaking about his past. He openly states, “I am not happy about what I did, but I am not ashamed to talk
about it because it made me who I am today. My experience in the abuse sub-culture helps me to serve others better, and relate to
their experiences, and help to ease them out of their situation by providing information and support”. He prides himself in working

hard to treat everyone with dignity and respect, and always strives to be the listening ear that so many dealing with substance abuse
desperately need.
Service to others is what fuels Johnnie. In addition to being the Recipients Rights Specialist, he also volunteers with the Detroit
Substance Abuse Advisory Council, the Detroit Recovery Project, and the Partnership for a Drug Free Detroit. He attends meetings and
offers suggestions, assists with referrals, and participates in health fairs by providing information on recipient rights and due process.
Mr. Jones is happy to now be living a satisfying, drug-free life, and states that, “first and foremost, I give God the glory for my
recovery”. Completing his college education is on Johnnie’s short list of future goals. He ultimately plans to attend law school to
become a lawyer, specializing in either criminal or business law.

Reverend Dr. Audry Turner
Reverend Dr. Audry Turner, an ordained minister and psychotherapist, knows all too well how exposure
to substance abuse early on can influence a young person’s life path. During junior high school, she
recalls a schoolyard guard who regularly supplied alcohol to her and other underage youth in her
neighborhood. These experiences coupled with a long family history of alcohol problems, started her
down the road of substance abuse. Reflecting on her family history and the associated episodes of
violence spurred Rev. Dr. Turner’s desire for change. Celebrating nearly 30 years of complete sobriety,
she credits God for her deliverance from alcohol addiction. She states that, “If God can change me, I
believe he can change anybody.”
Rev. Dr. Turner works closely with the Partnership for a Drug Free Detroit within the Department of
Health and Wellness Promotions’ Bureau of Substance Abuse Prevention Treatment and Recovery.
She serves as the event coordinator for the annual Faith-Based Substance Abuse Conference and
                                                                                                        Reverend Dr. Audry Turner
City-Wide Revival. This event is a collaborative effort between the Partnership and the Council of
Baptist Pastors of Detroit and Vicinity, Inc. Broadly, these two entities work together to partner with
other faith-based and community-based organizations to provide spiritual and mental health resources for substance abuse problems
to churches and the community at large.
The Faith-Based Substance Abuse Conference and City-Wide Revival occurs during Passion Week every year, and reaches
approximately 4,000 people. Their strategy is multi-pronged, tailoring activities and programming to reach youth, adults, churches,
and the community at large. Rev. Dr. Turner is especially pleased with the high level of youth participation in recent years, as this is
often the stage where substance abuse prevention can be most effective. In 2008, over 1,000 youth attended the City-Wide Revival
for special programs of singing, dancing, and step shows that included prevention messages for HIV and substance abuse.
Rev. Dr. Turner believes that often unresolved personal issues and traumatic experiences lead individuals down the road to self-
medicate, and continuously advocates for greater numbers and more visible counseling facilities within Detroit. She also works to
expand acceptance of counseling services among African Americans. Rev. Dr. Turner says, “You have to go to the pain in people’s
heart to get an understanding of why they are choosing to self-destruct. Without this level of intervention, you can’t help them affect
the type of change that will cause them to become productive citizens and be successful for the rest of their lives.”
Rev. Dr. Turner strives to be an integral part of the revival and restoration of the City of Detroit and its citizens. She states, “I have a
personal passion for this work due to my personal and family experience. I try to empathize with people, and my past has helped me
to develop that empathy. I want to see people free from the bondage of substance abuse. I want to help people see the opportunity for
hope. People have to know that the opportunity for change exists.”

Anthony Johnson
15-year old Anthony Johnson always wanted a place where he could feel comfortable, express himself, and meet positive new friends.
He found that place in the Youth Development Institute (YDI). His two brothers (ages 16 and 12) also participate in the program.
The YDI is a community-based, youth-oriented support program that identifies and addresses risk and protective factors associated
with substance abuse among youth. The goal of the program is to help develop confident, positive, and drug-free youth who ultimately
become productive adults. While in the program, youth are exposed to innovative academic enrichment activities, as well as fun
and engaging activities like video and music production, and visits to local museums. Participants also develop healthy mentoring
relationships with adult staff and engage in a research-based substance abuse prevention curriculum.

Anthony is in his second year of the program, and particularly enjoys his role in the performance
troupe. The troupe includes young people who sing, dance, act, step, and rap at various venues around
the city, per request. Often embedded in their performances are messages about drug prevention. A
recent performance included a theatrical sketch about the dangers of drugs and drug prevention at
a local church youth program.
The substance abuse prevention message he receives in the program seems to have positively
impacted Anthony’s choices thus far. He reported learning a great deal about drugs that he did not
previously know, such as the major impact that drugs can have on an individuals’ long-term physical
and mental health. He also learned that marijuana is a gateway drug, and feels that having this
knowledge will prevent him from trying drugs later in life.
Anthony loves to sing, and credits his participation in YDI with helping him to develop his talent. He           Anthony Johnson
has gained the confidence to perform in front of an audience. Anthony also loves math, and plans to
attend college to become an engineer while pursuing his singing as a hobby. When asked how the program has helped him overall,
Anthony stated, “I just like to be a part of it. I enjoy the program very much. It is positive, and I want to stay a part of it. It has enriched
my life”. This sentiment extends beyond Anthony to include his mother, Veronica Johnson. She said of YDI, “The program gives my
sons a positive environment. They have learned to volunteer and serve other people. It encourages a work ethic, lifts their self-esteem,
and teaches them about the dangers of drugs. It is a totally positive influence in their lives.”

     Section 9: BSAPTR 2007 – 2008 Treatment Expenditures
The BSAPTR received funding for the period of October 1, 2007 – September 30, 2008 from federal, state, and local sources. Medicaid
and Office of Drug Control Policy (ODCP) funding are two major revenue sources. ODCP processes federal and block grant funds, as
well as state appropriations. Medicaid funding consists of Per Eligible Per Month payments administered by the Detroit Department of
Health. Local revenue is provided from local (Detroit City Council) sources as match for grants or for special programs. The following
data comparatively depicts treatment expenditures from 2005 through 2008. Data is presented by service category in Figure 1, and
per client by service category in Figure 2.
     Expenditures for intensive outpatient and methadone treatment decreased between 2005 and 2008 while expenditures for
     residential and detoxification treatment increased.
     Between 2005 and 2008, intensive outpatient treatment expenditures decreased 78%, and expenditures for methadone treatment
     decreased by 19%.
     Residential treatment expenditures increased 49% 2005-2007, and expenditures for detoxification treatment increased 1.7 times
     between 2005 and 2007.
     Although methadone treatment expenditures have decreased 2005-2008, the cost per client has increased 2.1 times in 2008
     compared to 2005.
     The cost per treatment client in residential treatment decreased 12% between 2005 and 2008.
     Expenditures for residential treatment services have increased for both Medicaid and ODCP funding.
     Between fiscal years 2006 and 2008 expenditures for residential treatment increased 32% for Medicaid funding and 65% for ODCP.
     There has been a significant decrease in expenditures for intensive outpatient treatment for both Medicaid and ODCP funding.

                             Figure 1: Treatment Expenditures by Service Category (FY 2005 – 2008)

                                 Total expenditures include revenue from ODCP, Medicaid, Adult Benefit Waiver (ABW), and local funds.

                             Figure 2: Treatment Expenditures per Client by Service Category (FY 2005 – 2008)

                                  Total expenditures include revenue from ODCP, Medicaid, Adult Benefit Waiver (ABW), and local funds.

Medicaid Transit Advertising that Appears Throughout Detroit

Chapter 3: HIV/AIDS Programs
The Department of Health and Wellness Promotion HIV/AIDS Programs, which began in 1985, provides
a continuum of prevention, early intervention and care services aimed at educating populations
engaging in high-risk behaviors, assisting them in learning their status through FREE confidential
testing, and referring them to needed services. In addition, the HIV/AIDS Programs provide training
and education to the public and technical assistance to community-based organizations in the Detroit
area providing HIV/AIDS related services.
The HIV/AIDS Programs employ a staff of public health professionals trained in behavioral health,
health education, social work, substance abuse, community organization, and outreach. Currently, all
of the HIV/AIDS Programs activities are supported by state and federal grants.

The DHWP HIV/AIDS Programs consists of five (5) operational sections and other programs.                    Andrea Roberson, Director,
The following represents statistics and accomplishments for the identified sections:                        HIV/AIDS Programs

I. Ryan White Program
     DHWP received Part A formula and supplemental funds in the amount of $7,721,895 for FY 2007-08; and $7,389,088 for FY
     DHWP received an increase in Part A Minority AIDS Initiative funding in the amount of $644,567 for FY 2007-08; and was awarded
     $666,538 for FY 2008-2009.
     In 2007, Michigan Department of Community Health (MDCH) awarded DHWP $325,000 in funding to restart the Mobile Care Unit.
     The unit will offer HIV care, outreach, primary care, and health screening services to the Detroit eligible metropolitan area (EMA).
     In 2007, the Ryan White Part A program procured 21 providers to provide 37 contracts for HIV care and supportive services for
     16 service categories. In 2008, there were 23 providers. For FY 2007-08, 10 service contracts were awarded for Minority AIDS
     Initiative funding.
     One new service provider was added to the Ryan White list of contractors.
     Funding for Ryan White Part A FY 2007 has supported service to 7,532 clients, and provided 155,732 units of service, with an
     average cost per unit of $3,463.

II. Quality
     In FY 2007, 100% or 37 Part A programs received site visits to assure contract compliance and 100% or 37 programs received
     “In Compliance” status to Public Health Standards/Scope of Service Contract requirements. All 37 programs reported on quality
     committee progress of achievements.
     Year to date for FY 2008-09, 21 Part A programs surpassed 100% of their contracted goal of clients served, and 18 programs
     surpassed 100% of their contracted goal for units of service.

  In FY 2007-08, four quarterly Community Case Conferences; four Community Primary Care
  Network Meetings and four Quarterly Initiative Committee Meetings were conducted.
  Two programs were certified for the City of Detroit Needle Exchange Programs in FY 2007-2008.
  In one quarter (Oct. – Dec. 2007), one program reported 18,674 syringes exchanged, servicing
  238 clients (56 or 24% female; 182 or 76% male); 70 participants were referred for HIV counseling
  and testing services, and 10 participants were referred for drug treatment through the Bureau of
  Substance Abuse.
  In one quarter (Oct. – Dec. 2007), one program reported 2,147 syringes exchanged, servicing 111
  clients (47 or 42% female; 64 or 58% male)
                                                                                                       Dr. Renee McCoy, Director
                                                                                                       (2006-2009), HIV/AIDS Programs
III. Housing Opportunities for Persons with AIDS (HOPWA) Program
  The housing program is currently comprised of long-term housing & informational services and a
  special projects of national significance (SPNS) grant.
  $1.64 million dollars in HOPWA funding has supported over 170 clients and families in long-term housing during the 2007-2008
  FY. There are currently 158 clients being serviced.
  The SPNS Grant ($1.3 million) was extended to June 30, 2009.
  $1.979 million in HOPWA funding is projected for the 2008-09 FY. Increased funding will support long-term housing and will enable
  the program to contract for community residences (transitional housing).

IV. Business & Labor Response to AIDS (BRTA/LRTA) Projects
  DHWP was awarded $50,000 to increase HIV/AIDS awareness, testing, education, and decrease stigma in the city of Detroit by
  working with local merchants. DHWP is to provide $50,000 in matching funds.

V. Prevention Programs
  DHWP Counseling and Testing: In FY 2007,
  this unit provided 7,848 counseling and
  testing sessions (64% Males and 36%
  Females; 95% were African-American, 3%
  White, 1% Latino, 1% Other).
  Education and Training: In FY 2007, the
  Regional Training Unit provided 70 training
  sessions; In FY 2008 YTD, the Unit provided
  188 training sessions.                          HIV/AIDS Programs Staff

  In FY 2007, the Njdeka Program provided
  80 health education, risk reduction and outreach sessions to 1250 women.
  In FY 2007, the Jemadari Program provided 446 health education, risk reduction and outreach sessions to 4,619 men.
  Perinatal Program (Ryan White Part D): In FY 2007, this program provided prevention counseling to 244 pregnant women, tested
  185 pregnant women, and provided 189 HIV 101 presentations to 2,398 individuals.
  Wayne County Jail: In FY 2007, staff performed 114 counseling and testing sessions. In FY 2008, staff performed 41 counseling
  and testing sessions.
  36th District Court: In FY 2007, staff provided 116 HIV Awareness sessions to 495 individuals. In FY 2008, staff provided 115 HIV
  Awareness sessions to 504 individuals.
  Mobile Programs – Early Intervention Program (EIP) and Early Intervention Services (EIS):
       EIP Mobile Unit - In FY 2007, this unit provided 1,077 counseling and testing sessions. In FY 2008, EIP provided 1,023
       counseling and testing sessions.

           EIS Mobile Unit - In FY 2007, this unit provided 32 Persons Living With HIV/AIDS (PLWH/A) with primary care services;
           performed 591 health assessments; and provided 856 persons with HIV counseling, testing and referral services. In FY
           2008, EIS Mobile Unit provided 74 PLWH/A with primary care services; performed 532 health assessments; and provided
           293 persons with HIV counseling, testing and referral services.

VI. Other Accomplishments and Programs
     In October 2007, Dr. Renee McCoy was hired to lead the HIV/AIDS Programs unit.
     In 2007, HIV/AIDS Programs generated approximately $995 in funds from the Michigan AIDS Walk – City of Detroit.
     The Michigan Women & AIDS Committee (MWAC) has been reinvigorated. MWAC had its first annual Red Ribbon Awards Luncheon
     held on April 25, 2008 at the Northwest Activities Center. The establishment of the Joan Fields Memorial Fund was announced.
     In 2008, Dr. McCoy introduced the Beatitudes Project led by P.E.T. (Prevention, Education and Training) team staff. This program is
     a church HIV/AIDS readiness assessment program. The Faith Roundtable forum was introduced as a means to engage the faith-
     based community.
     In 2008, in an attempt to engage the LGBTQ Community, the Sexuality Roundtable was introduced.

Southeastern Michigan HIV/AIDS Council (SEMHAC)
This planning council is a group of individuals appointed by the CEO to plan and decide how to use Title I funds to deliver HIV services.
As a community planning body, its mission is to strengthen a coordinated regional response to the HIV/AIDS epidemic by involving
person infected with or affected by the virus. Jointly, the planning council:
           Assures services to women, infants, children and youth with HIV
           Carries out needs assessments
           Prepares a comprehensive plan
           Prioritizes and allocates HIV Title I funds

2007 – 2008 Accomplishments
     Conducted the annual SEMHAC Comprehensive Plan adherence assessment.
     Data analysis was completed and report written which summarized data obtained from the consumer Needs Assessment study.
     Planning Council orientation was provided to all new members appointed to the council.
     Media/Marketing and PWC participated in several community events (e.g., Balm in Gilead, Freedom Weekend (NAACP), Hotter
     than July, and World AIDS Day).
     Offered Leadership Training to all planning council members which included Meeting Facilitation, Roberts Rules of Order,
     Communications Skills, Cultural Competence and Sexual Harassment.
     HIV/AIDS 101 training was offered to and attended by planning council members.
     A press kit was developed that included a new logo and organizational identity to apply to stationary, business cards, brochures, etc.
     SEMHAC updated the inventory of support office equipment.
     Successfully fulfilled all other planning council responsibilities as set forth by the 2004 reauthorization of the Ryan White CARE Act (i.e.,
     membership and nominations process, assessment of the administrative mechanism, and prioritization and allocations process).
     Policies and procedures were drafted by SEMHAC staff for five administrative and/or programmatic areas.
     SEMHAC staff attended approximately seventy-seven hours of staff developmental training.

HIV/AIDS 2007 – 2008 Data
The following data elements provide information regarding the prevalence of HIV/AIDS in Detroit and Southeast Michigan, as well as
SEMHAC HIV/AIDS testing data. Collectively, this information contextualizes the magnitude of the problem that HIV/AIDS Programs
and SEMHAC addressed during 2007-2008.

HIV/AIDS 2007-2008 Prevalence Data
   The prevalence rate for HIV/AIDS in Detroit is 2.1 times the rate for Southeast Michigan and 3.5 times the rate for the state of
   Michigan (Figure 1).
   In both Detroit and Southeast Michigan, African Americans have a higher prevalence of HIV/AIDS compared to other races, and
   males have a higher prevalence of HIV/AIDS than women.
   The prevalence for males in Detroit is nearly 2 times the rate for males in Southeast Michigan. The prevalence among females in
   Detroit is 2.5 times the rate for females in Southeast Michigan.
   Fifty-eight percent (58%) of the individuals diagnosed with HIV were between the ages of 30 and 49 years at the time of diagnosis.
   Looking across the years 1981 – 2007, data show that the prevalence rate for HIV/AIDS is increasing, while deaths and new
   diagnosed cases are decreasing, suggesting that people are living longer with the disease (Figure 2).

                                        Figure 1: 2008 HIV/AIDS Prevalence Rate (per 100,000)

                    Source: MDCH July 2008 Quarterly HIV/AIDS Analysis Report: Detroit

                       Figure 2: New Diagnoses, Deaths, and Prevalence of HIV/AIDS in Detroit by Year

                        Source: MDCH July 2008 Quarterly HIV/AIDS Analysis Report: Detroit

SEMHAC 2007-2008 HIV/AIDS Testing Data
     During 2007 - 2008 SEMHAC tested a total of 7,848 clients for HIV/AIDS (Figure 3).
     Among those tested for HIV/AIDS, 64% were males and 95% of the clients screened were African American. The majority of the
     clients tested were 25 years or older (64%), and approximately 27% (2,139) of the clients tested received an HIV/AIDS test for the
     first time.
     Among those clients tested during FY 2007-2008, 82% were heterosexual, 16% high-risk heterosexual, 14% had been diagnosed
     with an STD, 1% were men who have sex with men exclusively & 1% were men who have sex with both males and females.
     Among those clients screened for HIV/AIDS during FY 2007-2008, 62 clients tested positive (Figure 4), of which 87% were male
     (Figure 5).
     During 2007-2008, the majority of the clients who were found to be positive were 25 years or older (Figure 6).
     The percentage of clients who tested positive for HIV/AIDS was highest for men who have sex with men exclusively (31%), followed
     by heterosexuals (29%), men who have sex with both men and women (18%), and high-risk heterosexual (15%).
     A total of 114 clients were given a referral during FY 2008. The largest number of referrals were for Partner Counseling and
     Referral Services (PCRS), which is a prevention program where newly diagnosed HIV-infected clients are provided HIV education
     and are counseled on the importance of notifying their at-risk sex or injection needle-sharing partners so they may also receive
     HIV counseling and testing (Figure 7).

                                 Figure 3: Number of Clients Tested for HIV/AIDS (FY 2007-2008)

                             Figure 4: Number of Clients Tested Positive for HIV/AIDS (FY 2007-2008)

Figure 5: Clients Tested Positive for HIV/AIDS by Gender (FY 2007-2008)

 Figure 6: Clients Tested Positive for HIV/AIDS by Age (FY 2007-2008)

             Figure 7: SEMHAC Client Referrals (FY 2008)

Chapter 4: Communicable Diseases
The Communicable Disease section of the Special Population Health Services Division is responsible for ensuring the health and safety
of the public through the coordination and delivery of communicable disease surveillance, prevention, and bioterrorism activities for
the City of Detroit. It monitors, investigates, and when appropriate, ensures that close contacts of the nationally and state reportable
infectious diseases receive preventative treatment or post-exposure prophylaxis. We are also involved in outbreak investigations (i.e.
Anthrax, H1N1, SARS, etc). Additional activities include tuberculosis case investigations, control and treatment. This unit also works
with the Food Sanitation component of the Department of Health and Wellness Promotion to investigate food-borne disease outbreaks.

Why Do We Report Communicable Diseases?
 1. To identify outbreaks and epidemics.
 2. To enable preventive treatment and/or education to be provided.
 3. To help target prevention programs, identify care needs, and use scarce prevention
    resources efficiently.
 4. To evaluate the success of long-term control efforts.
 5. To facilitate epidemiologic investigation and/or research to uncover a preventable cause.
 6. To assist with national and international disease surveillance efforts.

2007 – 2008 Accomplishments                                                                                Dr. Angela Hines – Disease Control

     Communicable Disease provided disease-specific follow-up and/or interventions on 2,039
     reportable communicable diseases, excluding tuberculosis and sexually transmitted diseases,
     during 2008.
     This section of the SPHSD provided 3238 tuberculin skin tests during screening and investigation
     activities. In addition, 62 newly reported cases of tuberculosis received medical and diagnostic
     evaluation, medication, and clinical/public health follow-up during the year. Approximately
     30 tuberculosis cases continued to receive services as they complete their therapy from the
     previous year.
     The Tuberculosis Control component of Communicable Disease received accolades from our
     Centers for Disease Control and Prevention (CD) Project Officer on the following activities: 100%
     of reported TB cases are now placed on directly-observed therapy, providing information and
     education to clients to assist them in medication compliance, and accessing education and             Karlayne Hodges – Disease Control
     training to enhance quality assurance and staff competency.

Chapter 5: Pharmacy Services
The Pharmacy & Pharmacology section of the Special Population Health Services Division, as a “Quality Center” provides
pharmaceutical services to City of Detroit citizens in a cost effective manner. We provide prescription drugs and devices with
consultation for the uninsured or underinsured ($1 – $6 prescriptions).

Major Initiatives
   The Drug Expenditure Cost Reduction Initiative was fully implemented in 2004, and continues to be a major initiative in Pharmacy
   Services. The primary component of the initiative is the Caring Partners Program by AstraZeneca Pharmaceutical that provides
   free drugs through “Bulk Replacement.” (Drugs are replaced monthly after documentation of usage is reported to AstraZeneca).
   The major benefit of this program is that it gives the citizens of Detroit access to highly effective medications to control chronic
   disease and shorten acute diseases.
   The McKesson Automated Refill Manager was implemented to accept call-ins for refills by phone. Currently, sixty percent (60%) of
   all refills are called in. Thus, Detroit’s uninsured/underinsured population can save the time that was previously used to physically
   bring refills into the clinic.

2007 – 2008 Accomplishments
   During 2007 – 2008, 51,000 Prescriptions were dispensed to 30,000 uninsured /underinsured
   Detroit residents. These life saving drugs were available to prevent emergency room visits,
   hospitalizations, and days lost of work.
   Drug costs for prescriptions dispensed were reduced from $890,000 in 2006 –2007 to $588,462
   in 2007 – 2008, representing a 34% savings. This improvement in this vital service results in a
   significant reduced net tax cost for Detroit citizens.
   Pharmacy Services has begun to use the State of Michigan’s MiDEAL purchasing system. An
   increasing number of City of Detroit departments are signing on to this service, and are observing
   tremendous cost savings, helping to reduce the Net Tax Cost for Detroit’s citizens.

                                                                                                           Ronald Coleman – DHWP
                                                                                                           Pharmacy Administrator

Chapter 6: Bureau of Laboratory Services
The Detroit Department of Health and Wellness Promotion (DHWP) Laboratory provides investigations diagnosis and confirms testing
for infectious and non-infectious diseases as well as other agents that may pose a threat to the public health of the community. The
laboratory has achieved “Center of Excellence” status as a result of its quality and performance. It serves the City of Detroit, and is an
integral part of the Michigan Department of Community Health laboratory system, serving southeast Michigan as a regional laboratory.
It is the only public health laboratory in Michigan performing clinical, environmental, and public health testing.
The DHWP Laboratory is a Clinical Laboratory Improvement Amendments of 1998 (CLIA ’88) approved service facility qualified to
conduct moderate and high complexity testing [non-waived]. The laboratory is certified under CLIA to perform testing in the specialties
and subspecialties, of Chemistry, Hematology, Immunohematology, Toxicology (Blood Lead Analysis, Drugs of Abuse), Bacteriology,
Parasitology, Mycology, General Immunology, Syphilis Serology, and Urinalysis. In conjunction with the Michigan Department of
Community Health, the DHWP Laboratory serves as Reference Regional Laboratory for: Food, VD Screening, Syphilis Serology, HIV
and Bioterrorism (testing of specimens and coordination with local community Hospital laboratories as the Reference Laboratory for
the Detroit sub region). Our Environmental Lead Analysis Laboratory is certified by the American Industrial Hygiene Association (valid
until 2011). The DHWP Laboratory also is certified by the CDC Select Agent Program and the APHIS Agriculture Select Agent Program
authorized to possess, use and transfer select agents and toxins (valid until 2010).

Laboratory Sections
     Clinical Chemistry Lab Hepatitis Testing
     Clinical Microbiology/VD Detection/Emergency Preparedness Lab
     Hematology/VD Serology/Sickle Cell/LIS
     General Serology-HIV Lab/Water Testing/ Molecular Lab/Vendors Payments
     Services/Special Send-outs/Reference Lab/ [State of Michigan, others]
     Satellite Laboratory/Billing/Urinalysis/Client Service/Accession Lab w/Sendouts
     Toxicology/Lab Safety
          Drug-of-Abuse Testing                                                                             Dr. Aloysius Hanson, Director,
                                                                                                            Bureau of Laboratory Services
          Blood Lead Analysis
          Environmental Lead Analysis

Services (January – December 2008)
     Service Statistics: The total number of specimens/examinations was 580,896.
     Units of Services Provided: Primary Care, Family Planning/Prenatal, WIC, Medical, Substance Abuse.

    Service Delivery Areas: Communicable Disease/Environmental/Other Disease, HIV, STD Clinic, VD Serology, VD Screening, Lead
    Screen, Food-Borne Disease/Water, Sickle Cell, General Serology, Substance Abuse.

2007 – 2008 Accomplishments
    Certification/ Registration for the following tests were obtained during the period covering January - December 2008:
          Human Specimen Testing, CLIA ‘88
          Water Testing
          Select Agent Testing

    The Michigan Department of Consumer and Industry Services (MDCIS) conducted a Clinical Laboratory Improvement
    Amendments of 1998 (CLIA) survey on October 5, 2008. Based on the findings of the survey, our laboratory is in compliance
    with CLIA requirements and the Centers for Medicare & Medicaid Services (CMS) for the 2-year period from May 9,2009 through
    May 8, 2011, and we have received certification by CLIA No. 23D0036478.
    State of Michigan Department of Environmental Quality Environmental Science and Service Division certifies that the Detroit
    DHWP laboratories has been approved for the following parameters for the analysis of drinking water (Expiration Date- August
    11, 2010; Laboratory Number – 0005):
                             Total Coliform and E. coli
                             Fecal Coliform
                             Heterotrophic Plate Count

    Based on information provided to the CDS Select Agent Program and the APHIS Agriculture Select Agent Programs, the DHWP
    Laboratory is authorized to posses use, and transfer select agents and toxins under the conditions specified in the entity
    registration application, in accordance with 42 CFR part 73, 9 CFR part 121, and 7 CFR part 331(Registration #C20070125-
    0618; Effective Date: January 25, 2007; Expiration date: January 20, 2010).
    The DHWP Laboratory fulfilled the requirements of the American Industrial Hygiene Association (AIHA) Laboratory Quality
    Assurance Programs (LQAP), thereby conforming to the ISO/IEC 17025:2005 international standard - General Requirements
    for the Competence of Testing and Calibration Laboratories. Our laboratories have been accredited (Environmental Lead
    Accreditation Expires: January 1, 2011).

Laboratory Staff - Jolly Shah, Reepal Shah, Panil Patel, and Joy John   Laboratory Staff - Patricia Street and Yahtecia Wallace-Jackson

City of Detroit                      SPHSD Management Team
David Bing, Mayor                    Dr. Kanzoni Asabigi, General Manager, Special Population Health Services Division
                                     Andrea Roberson, MHSA, Director, HIV/AIDS Programs
Detroit City Council                 Ronald Coleman, R. Ph., Pharmacy Administrator
Kenneth V. Cockrel, Jr., President
                                     Dr. Melinda Dixon, Medical Director, Communicable Diseases
JoAnn Watson
                                     Jeanine McIntosh, MA, LPC, Operations Manager, BSAPTR
Sheila Cockrel
                                     Dr. Aloysius Hanson, Director, Bureau of Laboratory Services
Barbara Rose-Collins
Kwame Kenyatta                       Detroit Department of Health and Wellness Promotion
Alberta Tinsley-Talabi               Dr. Calvin Trent, Director and Health Officer
Martha Reeves                        William Ridella, MPH, MBA, Deputy Director
Brenda Jones                         Herman Kiefer Building
                                     1151 Taylor Street, Detroit, MI 48202
Janice Winfrey, City Clerk
                                     1.800.467.2452 (For Substance Abuse Treatment)

                                     Supported by State and Federal Funds and Wayne County Community
                                     Mental Health Agency

                                                                             WWG Research & Consulting Group
                                                                             P: (313) 610-7624 F: (734) 484-1096
                                                                             1118 Rue Willette Blvd.
                                                                             Ypsilanti, MI 48198

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