SUBSTANCE ABUSE PREVENTION TREATMENT BLOCK GRANT FY2010 STATE

SUBSTANCE ABUSE PREVENTION TREATMENT BLOCK GRANT FY2010 STATE EXPENDITURE PERIOD 7/1/07 – 6/30/08 GOAL # 1. The State shall expend block grant funds to maintain a continuum of substance abuse treatment services that meet these needs for the services identified by the State. Describe the continuum of block grant-funded treatment services available in the State (See 42 U.S.C.300x-21(b) and 45 C.F.R. 96.122(f)(g)). FY 2007 (Compliance): The Bureau funded a full continuum of treatment services through 43 providers across the state. These services targeted adults, adolescents, pregnant women and women with dependent children with providers representing a combination of freestanding alcohol and drug abuse treatment facilities, community mental health agencies, and other behavioral health organizations. The Continuum of Care provided for the treatment of adults and adolescents with a primary or secondary alcohol and other drug abuse or dependency diagnoses. Services were provided on an as-needed basis and as applicable for each service recipient. Service recipients were able to transfer between the levels provided in the continuum to meet individual treatment needs; however, a service recipient can only be admitted to and receive services in one level of care at a time. Services were only provided in a level of care for which the provider submitted a written program plan, was approved by the State, and for which the provider had obtained the appropriate Alcohol and Drug Treatment Facility license. Listed below is a brief description of the continuum of services provided in Tennessee. Adult Continuum of Care • • • • • • • Screening/Assessment/Referral services were provided to 877 adults statewide Outpatient ASAM Level I services were provided to 2065 adults statewide Intensive Outpatient ASAM Level II.1 services were provided to 2344 adults statewide Partial Hospitalization Services ASAM Level II.5 were provided to 91 adults statewide Clinically Managed Detoxification Services ASAM Level III.2-D were provided to 950 adults statewide Medically Monitored Detoxification Services ASAM Level III.7-D 1317 adults statewide Medically Managed Detoxification Services ASAM Level IV (note: state funded) were provided to 345 adults statewide • • • • Clinically Managed Low Intensity Residential Rehabilitation ASAM Level III.1 were provided to 1165 adults statewide Clinically Managed Medium Intensity Residential Rehabilitation ASAM Level III.3 were provided to 1393 adults statewide Clinically Managed High Intensity Residential Rehabilitation ASAM Level III.5 were provided to 2910 adults statewide Medically Monitored Inpatient ASAM Level III.7 were provided to 1567 adults statewide Using state funds, the Division also funded Level IV-D Inpatient Medically Managed Detoxification services in four locations across the state. The Bureau was able to purchase alcohol and drug addiction inpatient medically managed detoxification services from acute care general licensed hospitals or acute care psychiatric hospital inpatient units on an as-needed basis. Adolescent Services Adolescent Outpatient involves organized non-residential services delivered in appropriately licensed facilities by designated addiction treatment personnel or addiction credentialed clinicians. According to a pre-determined schedule, Adolescent Outpatient services include professionally directed evaluation, treatment and recovery services for addicted adolescents. Adolescent Outpatient treatment provides a variety of programming opportunities. It may include a defined program that combines assessment, education, therapeutic and continuing care elements (e.g., a series of weekly outpatient services or organized school intervention programs). Services are provided in regularly scheduled sessions of usually fewer than nine (9) contact hours each week. These services are performed under a defined set of policies and procedures. For FY 2007, Adolescent Outpatient Services were provided to 505 youth statewide. Adolescent Day and Evening is a structured treatment program which operates three (3) or more hours per day (exclusive of school activities), a minimum of four (4) days a week for after school and evening programs and five (5) days a week for day programs, in order to provide an intensive community-based, multidisciplinary, on-going treatment program designed to assist the client to modify problem behavior and acquire the skills necessary to live as independently as possible and/or minimize his/her deterioration in the family or community setting. For FY 2007, Adolescent Day Treatment Services were provided to 613 youth statewide. Adolescent Residential includes provision of assessment, individual therapy, group therapy, family therapy or any combination of such counseling services. Adolescent Residential is designed to restore the severely dysfunctional alcohol and/or drug dependent person to levels of functioning appropriate to that individual. Adolescent Residential shall be provided in an appropriately licensed facility. An essential aspect of Adolescent Residential is the ongoing structured use of therapy to achieve the goal of rehabilitation. Adolescent Residential includes a minimum of five (5) counseling contacts per week and a minimum of five (5) lectures or seminars per week. Adolescent Residential also includes the essential service of education. Education is defined as a service separate and distinct from residential treatment, but provided to youth by the residential program. Education shall include, but not be limited to, the educational instruction required by the Tennessee Department of Education and may be provided directly by the Grantee, by affiliate agreement, by subcontract, or any combination of these methods. For FY 2007, Adolescent Residential Services were provided to 433 youth statewide. Women’s Intensive Outpatient Services Women’s Intensive Outpatient services were provided to 370 women statewide with a primary or secondary alcohol and/or drug abuse or dependency diagnosis or tertiary alcohol or other drug codependency. Services were designed to remove barriers to the woman’s participation in treatment and to be supportive of her recovery. Services included child-care, outreach, advocacy, case management, transportation, and aftercare services. Therapeutic interventions were also available to the children as needed. Pregnant Women’s Services Pregnant/Post Partum Women’s services were provided to 260 women statewide through Intensive Outpatient and 63 Residential treatment services. Women must have a primary or secondary alcohol and/or other drug abuse or dependency diagnosis and be either pregnant or three months or less post partum. Residential services provided the mother’s children age 5 or younger to reside with her. Services were designed to remove barriers to the woman’s participation in treatment and to be supportive of her recovery. Women’s Wrap-Around Services Women’s Wrap-Around services were also provided statewide. These services were provided to 242 women in treatment to improve retention and outcomes and included childcare, child-maintenance, case management, transportation, and supportive housing. State regulations and policy and procedures pertinent to alcohol and drug abuse treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety, and Environmental Protection, Chapter 24 Alcohol and Drug Treatment, Part 1-8 and Division Administrative Program Requirements and Scopes of Services. FOOTNOTE: Effective May 7, 2009, the Tennessee General Assembly transferred all state regulations and policy and procedures relevant to alcohol and drug abuse treatment to Title 33 Mental Health and Developmental Disabilities. FY 2009 (Progress): For the SFY 2008-2009 period, the Division continued to fund a full continuum of treatment services across the state. These services targeted adults, adolescents, pregnant women and women with dependent children. Services were provided through contracts with 42 providers representing a combination of freestanding alcohol and drug abuse treatment facilities, community mental health agencies, and other behavioral health organizations. Services listed below are ongoing from prior years, and the current network of providers will assure a continuum of treatment services regionally across the state. Should a vacancy in the provider network occur, those services will be replaced within the region where it occurred through a competitive contract process and demonstration of need. Adult Continuum of Care Adolescent services Adolescent Outpatient Adolescent Day/Evening Adolescent Residential Rehabilitation Women’s Intensive Outpatient Pregnant/Post Partum Women‘s Women’s Wrap-around The Division continues to have a strong emphasis for providers to use evidencebased and best practices leading to successful outcomes. Each funded organization must provide information in the yearly Program Plan detailing the evidence-based or best practice models utilized by the agency. FY 2010 (Intended Use): For SFY 2010 (July 1, 2009 – June 30, 2010), the Division intends to continue to fund the full continuum of care services throughout Tennessee, assuring regional access to the services for adults aged 19 and over with a primary or secondary alcohol and/or other drug abuse or dependency diagnosis. Additionally, adolescent residential and intensive outpatient, women’s intensive outpatient, pregnant women’s, and women’s wrap-around services will be provided. Estimates are based on the data of number persons served for continuum of care, adolescents, pregnant/post partum women and women's wrap-around services from previous years. Adult Continuum of Care •Screening/Assessment/Referral services will be provided to an estimated 800 adults statewide. •Outpatient ASAM level I services will be provided to an estimated 1,800 adults statewide. •Intensive Outpatient ASAM level II.1 services will be provided to an estimated 1,900 adults statewide. •Partial Hospitalization ASAM level II.5 will be provided to an estimated 100 adults statewide. •Clinically Managed Detox ASAM level III-2D will be provided to an estimated 850 adults statewide. •Medically Monitored Detox ASAM level III-7D will be provided to an estimated 1,250 adults statewide. •Medically Managed Detox ASAM level IV-D will be provided to an estimated 300 consumers statewide. (Note: state funded) •Clinically Managed Low Intensity Residential Rehab ASAM level III.1 will be provided to an estimated 1,100 adults statewide. •Clinically Managed Medium Intensity Residential Rehab ASAM level III.3 will be provided to an estimated 1,100 adults statewide. •Clinically Managed High Intensity Residential Rehab ASAM level III.5 will be provided to an estimated 2,000 adults statewide. •Medically Monitored Inpatient ASAM level III.7 will be provided to an estimated 1,000 adults statewide. Adolescent services will be provided to youth age 12 to 18 with a primary or secondary alcohol and/or drug diagnosis across the state as follows: •Adolescent Outpatient will be provided to an estimated 500 youth statewide •Adolescent Day/Evening Treatment will be provided to an estimated 650 youth statewide. •Adolescent Residential Rehabilitation will be provided to an estimated 440 youth statewide. Women’s Intensive Outpatient services will be provided to an estimated 350 women with a primary or secondary alcohol and/or other drug abuse or dependency diagnosis or tertiary alcohol or other drug codependency statewide. Services are designed to remove barriers to the woman’s participation in treatment and to be supportive of their recovery. Services include child-care, outreach, advocacy, case management, transportation, and aftercare services. Therapeutic interventions are also available to the children. Pregnant/Post Partum Women‘s services will be provided to an estimated 250 women through Intensive Outpatient statewide and an estimated 60 women through Residential Rehabilitation statewide. Women must have a primary or secondary alcohol and/or other drug abuse or dependency diagnosis and be either pregnant or three months or less post partum. Residential services provide for the mother’s children age 5 and younger to reside with her. Services are designed to remove barriers to the woman’s participation in treatment and to be supportive of their recovery. Services include child-care, outreach, advocacy, case management, transportation, and aftercare services. Additionally, primary medically care for women, referral for prenatal care, primary pediatric care including immunizations, and therapeutic interventions for women are also provided or arranged for the service recipients. Therapeutic interventions are also available to the children. Women’s Wrap-around services will be provided to an estimated 230 women statewide. These services are provided to women in treatment to improve retention and outcomes and include child-care, child-maintenance, case management, transportation, and supportive housing. In August 2009, the Division intends to fund five (5) Medically Monitored Crisis Detoxification centers serving approximately 1,500 individuals across the state. These services will have the capacity to admit consumers needing this level of care on a twenty-four/seven day a week (24/7) basis. The average length of stay will be under 72 hours, with the expectation that the consumer be transferred to a lower level of care when appropriate. Following the priority populations of pregnant IVDU, pregnant women, and IVDU consumers, individuals in the crisis detox center will be placed as fourth on the priority list for admission. It is anticipated that this will reduce inappropriate admissions to the state’s Regional Mental Health Institutes (state-funded psychiatric hospitals) and provide a more appropriate level of service to those consumers needing care. The expectation is that consumers leaving the Medically Monitored Crisis Detoxification centers will be admitted to an appropriate level of care (based on ASAM criteria) in a funded treatment center. The Division’s new data management system, TN-WITS, will track the consumer’s movement throughout all the levels of care needed for successful treatment outcomes. In October, the Division intends to issue an Announcement of Funding for CoOccurring Enhanced Services. This service will allow for consumers with a cooccurring disorder of substance use and psychiatric disorders (primary diagnosis of substance use disorder) to be treated in an integrated, evidence-based practice model. Programs with a specific track for women and/or individuals involved in the criminal justice system will be given special consideration. It is anticipated that $1.9 million in state funding will be used for this service, which will also include training for agencies to become co-occurring capable, and for those with this funding, to be co-occurring enhanced. It is expected that all Division-funded treatment agencies be, at a minimum, co-occurring capable by the end of the state’s fiscal year. In addition to the Co-occurring Enhanced Services, all Division contracted agencies will be required to provide Co-occurring Capable Services, as identified in the ASAM criteria. The Division will provide training and technical assistance to ensure that all contracted agencies have the ability and capability of delivering this level of service. While all Division staff members are knowledgeable of Cooccurring delivery of services, a staff member will be dedicated to the oversight of the co-occurring services. The Division, with its’ Access to Recovery (ATR) grant, work to integrate block grant and ATR services for consumers. Many of the block grant funded agencies are also ATR providers. The Division encourages the agencies to determine recovery support services needed for a consumer’s success, and assist the consumer in obtaining the necessary services. Often a consumer is receiving clinical treatment services as well as recovery support services. Additionally, it is expected that each block grant provider address how they will enhance treatment services by assisting the consumer in obtaining appropriate recovery support services. The Division works with over 90 ATR providers, many of whom are also block grant agencies, to support the consumer’s recovery with a wide array of recovery support services. While the funding and reporting remain separate, the consumer experiences a seamless transition for treatment and recovery support services identified through the assessment process. Using TNWITS, providers have easy access for integrating the two grants and tracking those consumers. GOAL # 2. An agreement to spend not less than 20 percent on primary prevention programs for individuals who do not require treatment for substance abuse, specifying the activities proposed for each of the six strategies or by the Institute of Medicine Model of Universal, Selective, or Indicated as defined below: (See 42 U.S.C.300x-22(a)(1) and 45 C.F.R. 96.124(b)(1)). Institute of Medicine Classification: Universal Selective and Indicated: • Universal: Activities targeted to the general public or a whole population group that has not been identified on the basis of individual risk. o Universal Direct. Row 1—Interventions directly serve an identifiable group of participants but who have not been identified on the basis of individual risk (e.g., school curriculum, after school program, parenting class). This also could include interventions involving interpersonal and ongoing/repeated contact (e.g., coalitions) o Universal Indirect. Row 2—Interventions support population-based programs and environmental strategies (e.g., establishing ATOD policies, modifying ATOD advertising practices). This also could include interventions involving programs and policies implemented by coalitions. • Selective: Activities targeted to individuals or a subgroup of the population whose risk of developing a disorder is significantly higher than average. • Indicated: Activities targeted to individuals in high-risk environments, identified as having minimal but detectable signs or symptoms foreshadowing disorder or having biological markers indicating predisposition for disorder but not yet meeting diagnostic levels. (Adapted from The Institute of Medicine Model of Prevention) FY 2007 Compliance: The Bureau of Alcohol and Drug Abuse Services (BADAS) met the primary prevention objectives identified in the FY 2007 SAPT Block Grant Application. Prevention programs services were funded above the 20% requirement and all six of the Center for Substance Abuse Prevention (CSAP) strategies was utilized in service delivery. Services were primarily focused on the target population of individuals under the age of 18, however, most persons served were between the ages of 6- 16. Prevention services were delivered according to contract requirements and were regularly monitored. Technical assistance was provided by state staff to ensure compliance. During SFY 2007 a total of 13,242 persons were served through the Prevention Services provided with SAPT Block Grant funding. The total number of persons served is inclusive of all persons served through universal, selective, and indicated strategies. Listed below is the total number of persons served per program area: • • • • • Community Prevention Initiative- 4,334 persons served. Deaf and Hard of Hearing- 278 Faith Initiative- 1,306 Intensive Focus- 6,917 Teen Institutes- 407 Information Dissemination: This CSAP strategy was primarily accomplished through contracting with the Tennessee Association of Alcohol, Drug, and other Addiction Services (TAADAS) to operate the Statewide Clearinghouse. The Clearinghouse makes available accurate information on alcohol, tobacco, other drugs of abuse (ATOD), problem gambling and HIV/ AIDS. Additionally, the Clearinghouse operates a toll free telephone information and referral service and disseminates ATOD specific information and reference materials. TAADAS is also the State designated affiliate for the Partnership for a Drug Free America, and as such works with radio and television stations in the major media markets across the state to maximize air time donated for the purpose of providing ATOD specific media messages. In 2007, the Clearinghouse distributed 175,813 pieces of literature and loaned 1,995 video tapes. In addition, they had approximately 352,303 website visitors. In addition to the Clearinghouse, information was disseminated through other contracted agencies including the Intensive Focus programs, Community Prevention Initiative programs, the Teen Institutes, as well as the Faith Based Initiatives. Prevention Education: Prevention Education is an important component of Tennessee’s comprehensive prevention program. Prevention education was delivered through all 26 providers that contracted with the Bureau to provide Intensive Focus services. Intensive Focus program by definition are structure, intensive programs, with a minimum of 10-12 group sessions, targeting youth up to 18 years of age who may be at risk for developing alcohol, tobacco, or other drug use problems. In general, Intensive Focus programs provide services to selective populations and the primary focus is reducing risk factors and increasing protective factors. Intensive Focus programs are required to be age-specific, developmentally appropriate and culturally sensitive. In addition, programming must strengthen personal commitments against drug use and increase social competence in the areas of communication skills, peer relationships, autonomy and assertiveness. For SFY 2007, 6,917 youth participated in the Intensive Focus Programs. The Bureau also provided prevention education through the newly funded, Comprehensive Alcohol Tobacco and other Drug Program that began in SFY 0607. This program was funded with a recurring state appropriation and served 358 kids. The program achieved its stated goals of increasing participants’ knowledge about alcohol and other drugs; improving communication skills, identifying and resisting peer and media pressure; and improving decision making skills. Alternatives: This CSAP strategy was primarily accomplished through the Intensive Focus program as each Intensive Focus provider is required to provide at least one alternative activity each time a group is offered in order to meet program requirements. Agencies participate in a variety of alternative activities ranging from community service projects to ropes courses. Block Grant funds were also used to facilitate three statewide Teen Institutes. Students who participated in the Teen Institutes spent one week on a college campus with fellow youth leaders. During the week, the youth participated in drug-free activities that promoted an ATOD free lifestyle. For SFY 2007, 407 youth participated in the Teen Institutes. Environmental: The Bureau of Alcohol and Drug Abuse Services in collaboration with the Department of Agriculture conducted compliance checks for establishments selling tobacco or tobacco products to minors. In addition, the Tennessee Department of Health, Bureau of Alcohol and Drug Abuse Services staff worked closely with the staff of the Division of Health Promotions, Tobacco Prevention Programs and their control initiatives that include health promotion and tobacco education, smoking cessation, and youth advocacy. Additionally, an Underage Drinking Advisory Council was appointed to address the issue, including policy, of underage drinking in Tennessee. The Director of Prevention was a member of this council. The Bureau has also worked with Community Anti-Drug Coalitions Across Tennessee to address underage drinking at the local level, including environmental strategies, through town hall meetings and sharing of information. A partnership is also in place between the Tennessee Independent Colleges and Universities Association and the Bureau to support policies for reducing college binge drinking. Community Based Processes: Agencies that contract with the Bureau to provide prevention services have a unique perspective that when shared allows the community to be more responsive to the needs of young people. Thus, as representatives of the primary prevention programs became involved in the SPF-SIG funded community anti-drug coalitions there was an increased understanding of the needs of the youth that resided in that community. Additionally, the Tennessee Teen Institute teaches youth the Strategic Prevention Framework and requires community youth teams to write a Community Action Plan that will be put into place upon returning from their camp experience. As a result of the action plans many youth have had a positive impact on their community. Also, the implementation of the Community Prevention Initiative set forth a policy in Tennessee of approaching alcohol and drug abuse prevention in Tennessee. The Community Prevention Initiative utilized current prevention research and accepted programming models, established a method for assessing communities, and designed programs and performance evaluations. The Community Prevention Initiative increased the scope, efficiency, and effectiveness of programs for children, youth, and families by integrating service systems within the community. The Bureau also furthered the community based process work through SPF-SIG. The 15 SPF-SIG countywide coalitions that make up Cohort 1 either developed or had already completed a comprehensive assessment of community conditions associated with substance use as well as a capacity evaluation of their community’s readiness for addressing identified issues. Using the data and understanding gleaned from these reports, coalitions engaged in a culturally sensitive strategic planning process that embraced input from all sectors of their respective communities. This effort resulted in the development of plans for the implementation and evaluation of evidenced-based environmental strategies that effectively decrease youth access and consumption of alcohol. Problem Identification and Referral: Agencies that contracted with the Bureau to provide Intensive Focus services were contractually required to screen for appropriateness in their prevention programs. If the agency makes a decision that the individual’s behavior cannot be reversed through education then no further services are provided through the prevention program. The Tennessee Alcohol and Drug Prevention Outcome Longitudinal Evaluation (TADPOLE) serves as the evaluation instrument for primary prevention programs. This evaluation serves to provide feedback to each individual program in order to assess the effectiveness of the prevention strategies utilized, thus allowing the program to make needed changes. During 2007, the Bureau hosted a Service to Science Academy which provided program participants with the education, tools, and a limited amount of follow up technical assistance that will advance programs along a continuum of evidence effectiveness. Key content includes a working knowledge of evaluation planning and implementation and rating criteria for SAMHSA’s National Registry of Effective Programs and Practices. Two programs, the Tennessee Teen Institute and the ASK (Alcoholism, Screening, and Knowledge) Program, which is an Intensive Focus program, were chosen to receive a mini Science to Service grant. FY 2009 (Progress): The Division of Alcohol and Drug Abuse Services is on target to achieve the goals and objectives outlined in the 2009 Block Grant Application. Prevention block grant funding provided a variety of prevention services across the State of Tennessee including services targeted toward selective, indicated, and universal populations as well as each of the six CSAP strategies. Listed below are the programs offered during SFY 2009 and their progress in performing the activities for the CSAP six strategies. The Intensive Focus Prevention Program (IFPP) targeted youth who may be at risk for developing alcohol, tobacco, or other drug use problems. Most IFPPs are utilizing several of the CSAP Strategies including information dissemination, education, alternatives, and problem identification and referral. The Community Prevention Initiative (CPI) target population is at risk young people between the ages of 8 -16 as well as their families who are at risk for becoming involved in alcohol and drug abuse.. CPI programs are utilizing the following CSAP Strategies: information dissemination, education, problem identification and referral, and community based strategies. The Deaf and Hard of Hearing Program targets deaf and hard of hearing youth, children of deaf parents, as well as parents of deaf youth. These populations have been found to be at increased risk for developing substance abuse problems due to their inability to interact in meaningful ways with the hearing world. The Deaf and Hard of Hearing program is utilizing the following CSAP Strategies: information dissemination, community based processes, education, problem identification, and alternative activities. The Faith Initiative target population is children under the age of 18. The Faith Initiative is utilizing the following CSAP Strategies: Information Dissemination, Community Based Processes, Alternative Activities, and Education. The Tennessee Statewide Clearinghouse for Alcohol and Drug Information and Referral uses a variety of methods for information distribution including a library, toll-free information and referral hotline, and an internet website. The primary CSAP strategy used by the Clearinghouse is information dissemination. The Tennessee Teen Institute is an annual five day residential event that was held in June 2009 in three locations across Tennessee. Activities are designed to develop leadership, communication, and planning skills that will enable participants to develop initiatives for helping other teens avoid substance abuse in their communities. The Teen Institute utilizes the following CSAP Strategies: Information Dissemination, Education and Environmental. The Comprehensive Alcohol, Tobacco and other Drug Program are teaching youth using the SMART (Skills Mastery and Resistance Training) Moves Curriculum. This curriculum teaches youth drug resistance skills by increasing self-awareness, decision-making, and interpersonal skills. The Comprehensive Alcohol, Tobacco and other Drug Program is utilizes the following CSAP Strategies: Information Dissemination and Education. The Annual SYNAR Survey, as well as enforcement of the Prevention of Youth Access to Tobacco Act of 1994, is conducted in collaboration with the Tennessee Department of Agriculture. Synar was implemented statewide and targeted all youth under the age of 18. There were 3,296 compliance checks completed for the SFY 2009 Synar. The CSAP strategy used by Synar is Environmental. Nurses for Newborns goal is to improve pregnancy outcomes, ensure the health, growth and development of at-risk infants, and reduction of the use and misuse of tobacco, alcohol and other substances through in-home visitation services. Nurses for Newborns utilizes the CSAP strategies of Information Dissemination, Prevention Education, and Problem Identification and Referral. The Big Brother Big Sisters of Middle Tennessee’s (BBBSMT) mission is to help children reach their potential through professionally supported, one-to one relationships with measurable impact. The program has been shown to have positive effects including, increased self-confidence, improved school performance, and better interpersonal relationships with their families. Little Brothers and Sisters are also less likely to begin using illegal drugs, consume alcohol, skip school and classes, or engage in acts of violence. Big Brothers Big Sisters of Middle Tennessee utilized the CSAP strategy of Alternative Activity. The School-Based Mental Health/ Substance Abuse Liaison (SBMHL) program is in nine schools across Tennessee and provides: consultation with classroom teachers to assist them in structuring the classroom to enhance learning, training and education to school staff about a variety of mental health/substance abuse prevention topics, liaison services between the school and specific children’s families to promote school/family partnerships on behalf of the child’s education plan, and information and support for the schools in navigating the mental health/substance abuse system. SBMHL utilizes the CSAP strategy of information dissemination, prevention education, and problem identification and referral. The Higher Education Prevention Initiative targets college students at 22 institutions of higher education located throughout Tennessee. This college campus prevention initiative was designed to promote healthy and safe campus communities devoid of alcohol and other drug abuse and misuse and related violence. The Higher Education Prevention Initiative utilized the CSAP strategies of Information Dissemination, Prevention Education, Problem Identification and Referral. FY 2010 (Intended Use): In SFY 2010 (July 1, 2009 – June 30, 2010), the State intends to use prevention block grant funds to provide prevention services to a) selective and indicated populations identified as high need in the 2008 Substance Abuse Prevention and Treatment Needs Assessment and b) universal populations through community based processes and environmental strategies. The State has released four Announcements of Funding for services to be provided during SFY 2010 in the following categories: Tennessee Prevention Network, Community Anti-Drug Coalition, Higher Education Initiative, and Teen Institute. The Tennessee Prevention Network will provide selective and indicated evidence-based primary prevention services to individuals determined to be at increased risk of abusing alcohol and drugs. The following Selective Populations were identified as those most at risk of developing substance abuse problems in Tennessee: high school dropouts, foster care children, juvenile offenders, and children of substance abusing parents. The following Indicated Populations were identified as high risk for developing substance abuse problems in Tennessee: adolescents (ages fifteen to eighteen (15-18) years) engaged in binge drinking and excessive alcohol use and associated problems; young adults (ages eighteen to twenty-four (18-24) years) engaged in binge drinking and associated problems; adolescents (ages fifteen to eighteen (15-18) years) who have a high rate/excessive use of alcohol and/or drugs; youth ages ten to sixteen (10-16) years who are using inhalants; adolescents (ages fifteen to eighteen (15-18) years) who are abusing prescription drugs; or adolescents (ages fifteen to eighteen (15-18) years) who have co-occurring disorders and associated problems. 50 proposals were submitted in response to the Tennessee Prevention Network Announcement of Funding and each was scored by a panel of three reviewers. Funded proposals at minimum had to meet the following criteria: 1) Meet the criteria for being evidence based: a) Inclusion on a federal registry of evidence-based interventions; b) Reported (with positive effects on the primary targeted outcome) in peerreviewed journals; or c) Documented effectiveness supported by other sources of information and the consensus judgment of informed experts, as described in the following set of guidelines, all of which must be met: a. The intervention is based on a theory of change that is documented in a clear logic or conceptual model; and b. The intervention is similar in content and structure to interventions that appear in registries and/ or peer-reviewed literature; and c. The intervention is supported by documentation that it has been effectively implemented in the past, and multiple times, in a manner attentive to scientific standards of evidence and with results that show a consistent pattern of credible and positive effects. 2) Focus on providing primary prevention services. In addition, the State worked to ensure there was an equitable distribution of funding across the seven State Planning Areas by distributing the funding based on the population within each area. After thorough review, the State decided to enter into a contract with 32 prevention providers. The Tennessee Prevention Network has three overarching goals: To delay the onset of substance use, abuse, and dependence; to reduce illegal use of substances; and to reduce the prevalence of negative consequences associated with substances. Services provided through Tennessee Prevention Network Programs include the following: counseling, education activities (didactic and experimental), mentoring, referral activities, tutoring, service learning, student assistance programs, and alternative activities. It is estimated that during SFY 2010, 10,728 persons will be served through the Tennessee Prevention Network The Community Anti-Drug Coalitions will conduct environmental strategies within their communities. Environmental Strategies are those that focus on changing the community environment by targeting community conditions, standards, institutions, structures, systems and policies that tend to support social and health consequences of substance abuse in a community. Specifically, environmental strategies seek to: 1) limit access to substances, 2) change the culture and contexts within which decisions about substance use are made, and/or 3) reduce the prevalence of negative consequences associated with substances. Fifteen proposals were submitted for the Community Anti-Drug Coalition Announcement of Funding and each was scored by a panel of three reviewers. Funded proposals at minimum had to meet the following criteria: 1) Be evidence based, according to the State criteria (see criteria in Tennessee Prevention Network) 2) Focus on the coordination and implementation of prevention Environmental Strategies, utilizing the coalitions’ relationship with the various sector members within its community. 3) Have the capacity to increase a community's ability to effectively: i. Assess and prioritize need; ii. Build community prevention capacity; iii. Organize and strategically plan; iv. Coordinate the implementation of strategies collaboratively across community sectors; and v. Evaluate the effectiveness of the strategies implemented. After thorough review, the State decided to enter into a contract with 15 Community Anti-Drug Coalitions located in the following counties: Davidson, Fentress, Franklin, Hamblen, Hamilton, Humphreys, Jackson, McMinn, Madison, Maury, Roane, Rutherford, Scott, Sumner, and Washington. Community AntiDrug Coalitions will work to meet the following goals: Coordinate the implementation of substance abuse prevention environmental strategies within the Grantee’s community; Develop a highly effective substance abuse prevention system in their County; Prevent the onset and reduce the progression of substance abuse in their County; Reduce substance abuse-related problems in their community; and Build community level prevention capacity and infrastructure to prevent the onset and reduce the progression of substance abuse in their County. It is estimated that during SFY 2010, 1,935,629 persons will be served through the 15 Community Anti-Drug Coalitions. The Higher Education Initiative will deliver environmental management strategies that focus on changing the campus environment by stressing the prevention of high-risk behavior through changes to the environment in which students make decisions about their alcohol and other drug use. Specifically, environmental management strategies seek to: 1) limit access to substances, 2) change the culture and contexts within which decisions about substance use are made, and/or 3) reduce the prevalence of negative consequences associated with substances. One proposal was submitted for the Higher Education Initiative Announcement of Funding and the proposal was scored by a panel of 3reviewers. The funded proposal had to, at minimum, meet the following criteria: 1) Be evidence based, according to the State criteria (see criteria in Tennessee Prevention Network); and 2) Target coordination of the following environmental management strategies across partnering campuses: i. Offer alcohol-free social, extracurricular, and public service options on campus; ii. Create a health-promoting normative environment on campus; iii. Restrict the marketing and promotion of alcohol beverages on campus; iv. Limit alcohol availability on campus; v. Increase enforcement of laws and policies on campus; and vi. Develop and strengthen a campus-wide task force that includes a broad spectrum of faculty, staff, and students. After thorough review the State decided to enter into a contract with the Tennessee Independent Colleges and Universities Association for the services of CHASCo (Coalition for Health and Safe Campus Communities). CHASCo will do the work of this initiative through a consortium of public and private educational institutions. There are currently 22 institutions of higher education in the State of Tennessee that are members of CHASCo. These institutions are located in all grand divisions of the State. The goals of the Higher Education Initiation is to support Tennessee public and private colleges and universities in their efforts to promote a healthy and safe campus community devoid of alcohol and other drug abuse and misuse and related violence. It is estimated that during SFY 2010, approximately 260,000 persons will be served through the Higher Education Initiative. The Tennessee Teen Institute will provide selective and indicated evidence-based primary prevention services to individuals determined to be at increased risk of abusing alcohol and drugs. The following Selective Populations were identified as those most at risk of developing substance abuse problems in Tennessee: high school dropouts, foster care children, juvenile offenders, and children of substance abusing parents. The following Indicated Populations were identified as high risk for developing substance abuse problems in Tennessee: adolescents (ages fifteen to eighteen (15-18) years) engaged in binge drinking and excessive alcohol use and associated problems; young adults (ages eighteen to twenty-four (18-24) years) engaged in binge drinking and associated problems; adolescents (ages fifteen to eighteen (15-18) years) who have a high rate/excessive use of alcohol and/or drugs; individuals ages ten to sixteen (10-16) years who are using inhalants; adolescents (ages fifteen to eighteen (15-18) years) who are abusing prescription drug; or adolescents (ages fifteen to eighteen (15-18) years) who have co-occurring disorders and associated problems. The Teen Institute must, at minimum, meet the following criteria: 1) Be evidence based, according to the State criteria (see criteria in Tennessee Prevention Network); and 2) Focus on Primary Prevention Programs defined by the Substance Abuse Prevention and Treatment (SAPT) Block Grant, including but not limited to “those directed at individuals who have not been determined to require treatment for substance abuse.” Funding is specifically targeted for programs that seek to: (1) delay the onset of substance use, abuse, and dependence; (2) reduce illegal use of substances, and/or (3) reduce the prevalence of negative consequences associated with substances. The Tennessee Teen Institute Program (TIP) is a peer prevention program designed to provide teen participants with the skills, education, and information necessary to develop and implement alcohol and drug abuse prevention programs in their own communities. The comprehensive program includes a one week camp and at least one opportunity after the camp for participants to come together. TIP activities train, mobilize, and empower youth to prevent the illegal use of alcohol, tobacco, and other drugs and self destructive behaviors in themselves and their peers. The annual event includes activities designed to develop leadership, communication, and planning skills that will enable participants to develop initiatives for helping other teens avoid substance abuse in their communities. Approximately 300 youth will be directly served through the Teen Institute. Their will be equal representation from each of the three grand regions in the State. However, many more persons are served as a result of the programs and activities put into place through the actions plans developed during the one week Teen Institute. An Announcement of Funding process has been initiated to decide which agency will deliver this statewide program during FY 2010. The Division also plan to contract with three additional programs during SFY 2010. A description of these programs follows: The Comprehensive Alcohol, Tobacco and other Drug Program use SMART (Skills Mastery and Resistance Training) Moves Curriculum, which is a health and life skills program that teaches youth to resist the pressures of drugs and alcohol, and premature sexual activity. SMART Moves also teaches youth pro-social and resiliency skills, while increasing their self-awareness, decision-making, and interpersonal skills. In addition, SMART Moves is a nationally-acclaimed comprehensive prevention program proven to have a positive impact in youth’s choices to participate in tobacco, drug, or alcohol use. This year-round program encourages collaborations among Club staff, youth, parents and representatives from other community organizations. The program’s components include: SMART Kids, for children ages 6-9; Start SMART, for youth ages 10-12; Stay SMART, for youth ages 13-15; and SMART Parents, for parents of Club members participating in SMART Moves. The Comprehensive Alcohol, Tobacco and other Drug Program is a state funded program that will utilize the following CSAP Strategies: Information Dissemination and Education. It is estimated that 350 children, in State Planning Area-2 (East Tennessee), will be served by this program. The School-Based Mental Health/ Substance Abuse Liaison (SBMHL) service provides professionals with a background in social work and psychology to schools with the goal of promoting school success. Specific activities of the SBMHL include: consultation with classroom teachers to assist them in structuring the classroom to enhance learning, training and education to school staff about a variety of substance abuse/mental health prevention topics; providing liaison services between the school and specific children’s families to promote school/family partnerships on behalf of the child’s education plan; and providing information and support for the schools in navigating the substance abuse/mental health system. SBMHL utilizes the CSAP strategies of information dissemination, prevention education, and problem identification and referral. Services will be provided in all grand divisions of the State. It is estimated that 5,000 youth will be served in SFY 2010. SYNAR -The Division of Alcohol and Drug Abuse Services, in collaboration with the Department of Agriculture, address the issue of underage tobacco access through Synar. The Tennessee Department of Agriculture is responsible for coordinating and implementing both the Synar survey and tobacco enforcement programs. Tobacco compliance checks are completed statewide in establishments that sell tobacco products and are accessible to minors to ensure that tobacco products are not being sold to minors. Approximately 3,000 compliance checks will be completed in SFY 2010. Synar is implemented statewide and targets all youth under the age of 18. Attachment A: Prevention Answer the following questions about the current year status of policies, procedures, and legislation in your State. Most of the questions are related to Healthy People 2010 (http://www.healthypeople.gov/) objectives. References to these objectives are provided for each applicable question. To respond, check the appropriate box or enter numbers on the blanks provided. After you have completed your answers, copy the attachment and submit it with your application. 1. Does your State conduct sobriety checkpoints on major and minor thoroughfares on a periodic basis? (HP 26-25) Yes No Unknown 2. Does your State conduct or fund prevention/education activities aimed at preschool children? (HP 26-9) Yes No Unknown 3. Does your State alcohol and drug agency conduct or fund prevention/education activities in every school district aimed at youth grades K-12? (HP 26-9) SAPT BLOCK GRANT Yes No Unknown OTHER STATE FUNDS Yes No Unknown DRUG FREE SCHOOLS Yes No Unknown 4. Does your State have laws making it illegal to consume alcoholic beverages on the campuses of State colleges and universities? (HP 26-11) Yes No Unknown 5. Does your State conduct prevention/education activities aimed at college students that include: (HP 26-11c) Education bureau? Yes No Unknown Dissemination of materials? Media campaigns? Product pricing strategies? Policy to limit access? Yes Yes Yes Yes No No No No Unknown Unknown Unknown Unknown 6. Does your State now have laws that provide for administrative suspension or revocation of drivers’ licenses for those determined to have been driving under the influence of intoxicants? (HP 26-24) Yes No Unknown 7. Has the State enacted and enforced new policies in the last year to reduce access to alcoholic beverages by minors such as (HP 26-11c, 12, 23): Restrictions at recreational and entertainment events at which youth made up a majority of participants/consumers? Yes New product pricing? Yes No Unknown No Unknown New taxes on alcoholic beverages? Yes No Unknown New laws or enforcement of penalties and license revocation for sale of alcoholic beverages to minors? Yes No Unknown Parental responsibility laws for a child’s possession and use of alcoholic beverages? Yes No Unknown 8. Does your State provide training and assistance activities for parents regarding alcohol, tobacco, and other drug use by minors? Yes No Unknown 9. What is the average age of first use for the following? (HP 26-9 and 27-4, if available) Age 0-5 Age 6-11 Age 12-14 Age 15-18 Cigarettes Alcohol Marijuana 10. What is your State’s present legal alcohol concentration tolerance level for: (HP 2625) Motor vehicle drivers age 21 and older? Motor vehicle drivers under age 21? .08 .02 11. How many communities in your State have comprehensive, community-wide coalitions for alcohol and other drug abuse prevention (HP 26-3)? ___44___ 12. Has your State enacted statutes to restrict promotion of alcoholic beverages and tobacco that are focused principally on young audiences, (HP 26-11 and 26-16)? Yes No Unknown GOAL # 3. An agreement to expend not less than an amount equal to the amount expended by the State for FY 1994 to establish new programs or expand the capacity of existing programs to make available treatment services designed for pregnant women and women with dependent children; and, directly or through arrangements with other public or nonprofit entities, to make available prenatal care to women receiving such treatment services, and, while the women are receiving services, child care (See 42 U.S.C. 300x22(b)(1)(C) and 45 C.F.R. 96.124(c)(e)). FY 2007 (Compliance): The State expended not less than an amount equal to the amount expended by the State for FY 94 for women’s services. Treatment providers were required to establish relationships with other public or not-for-profit entities to make available provision of primary medical, prenatal, perinatal, neonatal care including immunization, child care, therapeutic care ( may address sexual abuse, physical abuse, parenting skills, etc. ), case management, and transportation for women who are receiving treatment services and their children. The State required that interim services be provided within the 48-hour time frame and that all contract agencies have policy and procedures documenting this contract requirement. Additionally, agencies were required to publicize the availability of treatment services to pregnant women. All treatment contracted agencies had policies and procedures in place regarding priority populations. Priority was given for treatment as follows: Pregnant injecting drug abusers Pregnant substance abusers Injecting drug users (IVDU’s) All others These requirements were monitored for compliance by the Department of Health, Office of Internal Audit and the Bureau contract compliance monitors. The Bureau of Alcohol and Drug Abuse Services continued to maintain service capacity for women with dependent children and pregnant and post-partum women through 16 programs offered by 11 providers statewide. In 2007, 676 women were served in the Women’s Intensive Outpatient and Pregnant Residential and Pregnant Intensive Outpatient programs. State regulations and policy and procedures pertinent to alcohol and drug abuse treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety, and Environmental Protection, Chapter 24 Alcohol and Drug Treatment, Part 1-8 and Division Administrative Program Requirements and Scopes of Services. FOOTNOTE: Effective May 7, 2009, the Tennessee General Assembly transferred all state regulations and policy and procedures relevant to alcohol and drug abuse treatment to Title 33 Mental Health and Developmental Disabilities. • FY 2009 (Progress): The Division of Alcohol and Drug Services has continued service provision to pregnant women and women with dependent children through the contracted network of 11 providers. The providers are required to continue or establish relationships with other public or not-for-profit entities to make available provision of primary medical, prenatal, perinatal, neonatal care including immunization , child care, therapeutic care (may address sexual abuse, physical abuse, parenting skills, etc.), case management, and transportation for women who are receiving treatment services and their children. Service utilization is monitored monthly to assure required levels of services to this population. During 2009, there has continued to be a focus on best practices and evidencebased practices through trainings, program planning, and voluntary accreditation. Agencies are also encouraged to begin addressing co-occurring disorders with the expectation that they will become co-occurring capable per ASAM guidelines. To date, services have not been expanded as new funds have not become available. However, during 2009, one provider in sub-State Planning Area (SPA) 7 discontinued services to the community. In an effort to provide minimal disruption to consumers, another licensed treatment provider was identified in SPA 7, a contract was executed and the provider began providing services to pregnant women and women with dependent children as quickly as possible The University of Memphis, Institute for Substance Abuse Treatment Evaluation Consumer Outcomes Evaluation Project monitored consumer outcomes for all treatment providers. FY 2010 (Intended Use): It is planned in SFY 2010 (July 1, 2009 – June 30, 2010) to provide services to pregnant women and women with dependent children through contracts with licensed providers who continue to meet all contractual requirements. Providers will be required to continue or seek new relationships with other public or notfor-profit entities to make available the provision of primary medical, prenatal, perinatal, neonatal care including immunization, child care, therapeutic care ( may address sexual abuse, physical abuse, parenting skills, etc.), case management, and transportation for women who are receiving treatment services and their children. Should a vacancy in the provider network occur, those services will be replaced within the region where it occurred through a competitive contract process or a transfer of funds based on a demonstration of need. If new funds become available, services will be expanded through a competitive contract process. It is the intention of the Division to reallocate State funds to provide co-occurring enhanced services for women during FY 2010. Agencies are contractually obligated to address co-occurring disorders in their programs and meet the ASAM guidelines for being considered co-occurring capable. The Division will provide training and technical assistance to agencies to ensure compliance. Women’s Intensive Outpatient services will be provided statewide to an estimated 350 women with a primary or secondary alcohol and/or other drug abuse or dependency diagnosis or tertiary alcohol or other drug codependency. Services are designed to remove barriers to the woman’s participation in treatment and to be supportive of their recovery. Services include child-care, advocacy, case management, transportation and aftercare services. Therapeutic interventions are also available to the children. Pregnant/Post Partum Women’s services will be provided statewide to an estimated 250 women through Intensive Outpatient statewide and an estimated 60 women through Residential Rehabilitation. Women must have a primary or secondary alcohol and/or other drug abuse or dependency diagnosis and be either pregnant or three months or less post partum. Residential services allow for the women’s children age 5 and younger to reside with them. Services are designed to remove barriers to the woman’s participation in treatment and to be supportive of their recovery. Services include child-care, outreach, advocacy, case management, transportation, and aftercare services. Therapeutic interventions are also available to the children. With the implementation of TN WITS, the Division will be able to use real-time data to better monitor the programs. The Access to Recovery Program plans to collaborate with the State Opioid Treatment Authority to develop methadone treatment and recovery support services for pregnant women abusing methadone. The OTP brought to the Division’s attention that there needed to be recovery support services and methadone treatment for pregnant women across the state. Pregnant women receiving methadone treatment are at a serious health risk of miscarrying or premature delivery, often resulting in infant mortality. Best medical practices dictate that pregnant women should not be detoxified from methadone during pregnancy. Statistics show that pregnant women are unable to maintain methadone assisted treatment because they can not afford it. ATTACHMENT B: Programs for Pregnant Women and Women with Dependent Children (See 42 U.S.C. 300x-22(b); 45 C.F.R. 96.124(c)(3); and 45 C.F.R. 96.122(f)(1)(viii)) For the fiscal year three years prior (FY 2007) to the fiscal year for which the State is applying for funds: Refer back to your Substance Abuse Entity Inventory (Form 6). Identify those projects serving pregnant women and women with dependent children and the types of services provided in FY 2007. In a narrative of up to two pages, describe these funded projects. Title XIX, Part B, Subpart II, of the PHS Act required the State to expend at least 5 percent of the FY 1993 and FY 1994 block grants to increase (relative to FY 1992 and FY 1993, respectively) the availability of treatment services designed for pregnant women and women with dependent children. In the case of a grant for any subsequent fiscal year, the State will expend for such services for such women not less than an amount equal to the amount expended by the State for fiscal year 1994. In up to four pages, answer the following questions: 1. Identify the name, location (include sub-State planning area), Inventory of Substance Abuse Treatment Services (I-SATS) ID number (formerly the National Facility Register (NFR) number), level of care (refer to definitions in Section II.4), capacity, and amount of funds made available to each program designed to meet the needs of pregnant women and women with dependent children. What did the State do to ensure compliance with 42 U.S.C. 300x-22(b)(1)(C) in spending FY 2007 Block Grant and/or State funds? 2. 3. 4. What special methods did the State use to monitor the adequacy of efforts to meet the special needs of pregnant women and women with dependent children? What sources of data did the State use in estimating treatment capacity and utilization by pregnant women and women with dependent children? 5. What did the State do with FY 2007 Block Grant and/or State funds to establish new programs or expand the capacity of existing programs for pregnant women and women with dependent children? 1. Identify the name, location (include sub-State planning area), Inventory of Substance Abuse Treatment Services (I-SATS) ID number (formerly the National Facility Register (NFR) number), level of care (refer to definitions in Section II.4), capacity, and amount of funds made available to each program designed to meet the needs of pregnant women and women with dependent children. Tennessee has a number of funded services and programs for women, including programs designed for pregnant women and women with dependent children. These services and programs are spread across Tennessee’s seven regions so as to be accessible to the targeted population. The following list includes all FY 07 services to women who abuse drugs and/or alcohol. Pregnant Substance Abuse Providers: Frontier Health- Johnson City, Tennessee, SPA-1, I-SATS ID # TN301353, Pregnant Intensive Outpatient, 1,285 Intensive Outpatient Treatment Sessions, Funding-$94,230 Florence Crittenton Agency- Knoxville, Tennessee, SPA-2, I-SATS ID # TN100706, Pregnant Intensive Outpatient, 3,820 Intensive Outpatient Treatment Sessions, Funding-$280,000 Lloyd C. Elam Mental Health Center at Meharry Medical College, Nashville, Tennessee, SPA-4, I-SATS ID # TN100086, Residential Rehabilitation (7 beds), 2,190 bed days , Funding-$500,000 Midtown Mental Health Center, Memphis, Tennessee, SPA-7, I-SATS ID # TN901509, Residential Rehabilitation (4 beds), 2,019 bed days, Pregnant Intensive, Funding, 2,045 Intensive Outpatient Treatment Sessions, PIO$150,000 PRR-$375,000 Women’s Intensive Outpatient Providers: Frontier Health- Johnson City, Tennessee, SPA-1, I-SATS ID # TN301353, Women’s Intensive Outpatient, 2,998 Intensive Outpatient Treatment Sessions Funding-$219,870 Child and Family Tennessee, Knoxville, Tennessee, SPA-2, I-SATS ID # TN901137,,Women’s Intensive Outpatient, 2,304 Intensive Outpatient Treatment Sessions , Funding-$169,000 Helen Ross McNabb Center, Knoxville, Tennessee, SPA-2, I-SATS ID # TN1000052, Women’s Intensive Outpatient, 2,969 Intensive Outpatient Treatment Sessions, Funding-$289,200 Parkwest(Peninsula) Medical Center, Knoxville, Tennessee, SPA-2, I-SATS, ID # TN301544, Women’s Intensive Outpatient, 1,160 Intensive Outpatient Treatment Sessions , Funding-$85,200 Renewal House, Nashville, Tennessee, SPA-4, I-SATS ID # TN100459,,Women’s Intensive Outpatient, 820 Intensive Outpatient Treatment Sessions, Funding-$60,000 Volunteer Behavioral Health Care System, Murfreesboro, Tennessee, SPA5, I-SATS ID # TN301403, Women’s Intensive Outpatient, 1,105 Intensive Outpatient Treatment Sessions,, Funding-$80,900 Serenity Recovery Center, Memphis, Tennessee, SPA-7, I-SATS ID # TN750245, Women’s Intensive Outpatient, 559 Intensive Outpatient Sessions, , Funding-$41,000 Women’s Wraparound and Supportive Services Programs: Child and Family Tennessee, Knoxville, Tennessee, SPA-2, I-SATS ID # TN901137, Provision of Wrap-Around Services, Funding-$55,500 Helen Ross McNabb Center, Knoxville, Tennessee, SPA-2, I-SATS ID # TN1000052, Provision of Wrap-Around Services, Funding-$55,500 Council for Alcohol and Drug Abuse Services, Inc., Chattanooga, Tennessee, SPA-3, I-SATS ID # TN301361, Provision of Wrap-Around Funding-$200,000 Renewal House, Nashville, Tennessee, SPA-4, I-SATS ID # TN100459, Provision of Wrap –Around Services Funding-$255,000 Other programs: Sister’s Program at Lloyd C. Elam Mental Health Center at Meharry Medical College, Nashville, Tennessee, SPA-4, I-SATS ID # TN100086, Outreach and Support, Funding-$531,000 2. What did the State do to ensure compliance with 42 U.S.C. 300x-22(b)(1)(C) in spending FY 2007 Block Grant and/or State funds? Contracted provider submitted data to the Department of Health, Bureau of Alcohol and Drug Abuse Services, specifying each female admission by primary and secondary diagnosis including whether they have dependent children and/or are pregnant. This information was then used to track SAPT Block Grant funding spent by the agencies for women’s alcohol and drug abuse activities. 3. What special methods did the State use to monitor the adequacy of efforts to meet the special needs of pregnant women and women with dependent children? As a part of the Bureau’s annual Independent Peer Review process, on-site and off-site monitoring of women’s programs were conducted to ensure the quality of services provided adhered to required program standards of operation. Bureau staff also reviewed program plans submitted annually and provided technical assistance as needed. 4. What sources of data did the State use in estimating treatment capacity and utilization by pregnant women and women with dependent children? The Bureau of Alcohol and Drug Abuse Services has referenced agency service utilization data that is submitted to the Alcohol and Drug Management Information System (ADMIS) system. Waiting lists were also referenced, as well as agency data reports specifying gender and, if female, determining if she has dependent children. 5. What did the State do with FY 2007 Block Grant and/or State funds to establish new programs or expand the capacity of existing programs for pregnant women and women with dependent children? Due to financial constraints, the Bureau of Alcohol and Drug Abuse Services did not expand any women’s programming in the FY 2007 time period. GOAL # 4. An agreement to provide treatment to intravenous drug abusers that fulfills the 90 percent capacity reporting, 14-120 day performance requirement, interim services, outreach activities and monitoring requirements (See 42 U.S.C. 300x-23 and 45 C.F.R. 96.126). FY 2007 (Compliance): The State designated Intravenous Drug Users (IVDU’s) as receiving priority placement in alcohol and drug abuse treatment programs. As part of the Alcohol and Drug Abuse contract, alcohol and drug abuse agencies were required to comply with the ninety percent (90%) capacity reporting, 14-120 day performance requirement, interim services, and outreach services. Interim services were mandatory while IVDUs were on a waiting list seeking treatment services. The following services were provided: • • • • • • • HIV Counseling and Education TB Counseling and Education Risks of needle sharing Risks of HIV, TB, and other STD transmission Steps to ensure HIV and TB Referral for HIV/AIDS and TB treatment For pregnant women, counseling on the effects of drugs and alcohol on the fetus and referral for prenatal care. The State monitored the compliance of contracted providers. Compliance was determined through independent peer review, on-site and off-site and using data from the Bureau’s management information system (MIS). When deficits were discovered, the Bureau required the agency to submit a Corrective Action Plan (CAP). The CAP was reviewed by Bureau staff and negotiated with the agency until the CAP could be approved by the Bureau. Ninety (90) days following the approval of the CAP, Bureau staff conducted an on-site and off-site review of the findings to ensure compliance with the CAP. If the CAP was not fully and appropriately implemented, agency staff met with the Assistant Commissioner to develop a plan of compliance. State regulations and policy and procedures pertinent to alcohol and drug abuse treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety, and Environmental Protection, Chapter 24 Alcohol and Drug Treatment, Part 1-8 and Division Administrative Program Requirements and Scopes of Services. FOOTNOTE: Effective May 7, 2009, the Tennessee General Assembly transferred all state regulations and policy and procedures relevant to alcohol and drug abuse treatment to Title 33 Mental Health and Developmental Disabilities. FY 2009 (Progress): The State continues service provision to IVDUs as a priority population to comply with the 90% capacity reporting, 14-120 day performance requirement, and the provision of interim and outreach services. These requirements are in each provider’s contract and are monitored by the Division through on-site and off-site activities. Interim and outreach services include: • • • • • • • • HIV Counseling and Education TB Counseling and Education TB Counseling and Education Risks of needle sharing Risks of HIV, TB and other STD transmission Steps to ensure HIV and TB Referral for HIV/AIDS and TB treatment For pregnant women, counseling on the effects of drugs and alcohol on the fetus and referral for prenatal care These services continue to be implemented and are provided on a statewide basis. The State anticipates that the estimated number of individuals served will be surpassed. FY 2010 (Intended Use): It is planned in FY 2010 to continue service provision for IVDUs as a priority population and to comply with the 90% capacity reporting, 14-120 performance requirement, and the provision of interim and outreach services. These requirements are in each provider’s contract. The State will regularly review quarterly reports submitted by providers and provide on-going technical assistance to assure the requirements are properly adhered to. The State will monitor the compliance of contracted providers. Compliance will be determined through independent peer review, on-site and off-site, and using data from the quarterly reports. When deficits are discovered, the Division will require the agency to submit a Corrective Action Plan (CAP). The CAP will be reviewed by Bureau staff and negotiated with the agency until the CAP can be approved by the Bureau. Ninety (90) days following the approval of the CAP, Bureau staff will conduct an on-site and off-site review of the findings to ensure compliance with the CAP. If the CAP is not fully and appropriately implemented, agency staff will meet with the Assistant Commissioner to develop a plan of compliance. Interim and outreach services include: • • • • • • HIV Counseling and Education TB Counseling and Education Risks of needle sharing Risks of HIV, TB and other STD transmission Steps to ensure HIV and TB Rapid HIV testing • • • Referral for HIV/AIDS and TB treatment Referral for HIV/ADIS and TB treatment For pregnant women, counseling on the effects of drugs and alcohol on the fetus and referral for prenatal care. ATTACHMENT C: Programs for Intravenous Drug Users (IVDUs) (See 42 U.S.C. 300x-23; 45 C.F.R. 96.126; and 45 C.F.R. 96.122(f)(1)(ix)) For the fiscal year three years prior (FY 2007) to the fiscal year for which the State is applying for funds: 1. 2. How did the State define IVDUs in need of treatment services? 42 U.S.C. 300x-23(a)(1) requires that any program receiving amounts from the grant to provide treatment for intravenous drug abuse notify the State when the program has reached 90 percent of its capacity. Describe how the State ensured that this was done. Please provide a list of all such programs that notified the State during FY 2007 and include the program’s I-SATS ID number (See 45 C.F.R. 96.126(a)). 42 U.S.C. 300x-23(a)(2)(A)(B) requires that an individual who requests and is in need of treatment for intravenous drug abuse is admitted to a program of such treatment within 14-120 days. Describe how the State ensured that such programs were in compliance with the 14-120 day performance requirement (See 45 C.F.R. 96.126(b)). 42 U.S.C. 300x-23(b) requires any program receiving amounts from the grant to provide treatment for intravenous drug abuse to carry out activities to encourage individuals in need of such treatment to undergo treatment. Describe how the State ensured that outreach activities directed toward IVDUs was accomplished (See 45 C.F.R. 96.126(e)). 3. 4. 1. The State has defined IVDUs in need of treatment services as follows: Any individual seeking treatment with injection drug use (IV/IM) as their primary route of administration. 2. The Bureau of Alcohol and Drug Abuse Services contracts require agencies to notify the Bureau when a program reaches 90% capacity. Providers must have policy and procedures for this notification and these are monitored as part of the Bureau’s annual on-site monitoring visits. The Bureau’s providers continuously operate at or near capacity. However, IVDUs have priority admission status and are thus generally able to be admitted within the 14 day requirement. If an agency reaches 90% capacity and notifies the Bureau, individual case follow up is conducted as needed to each provider to assure consumers receive needed services according to priority admission criteria. Individual alternatives are discussed for each consumer and referrals to other available local or regional resources made, when applicable, within the 14 day requirement. The priority admission criteria are: Pregnant injecting drug abusers Pregnant substance abusers Injecting drug users (IVDU’s) All others 3. The Bureau of Alcohol and Drug Abuse Services contracts require each agency to comply with the 14-120 day requirement. If a treatment program with the capacity to admit cannot be located, interim services are provided. These services may include education groups, regular check-in phone call, case management, admission into a recovery support service, HIV testing and prevention education, and encouragement to attend 12-step meetings. As part of the Independent Peer Review Process, alcohol and drug abuse contract agencies are monitored for compliance with this requirement. 4. All funded treatment providers, as part of contract requirements, are involved with IV/IM drug abuse outreach activities which include, but are not limited to, community education, speakers bureaus, consultation and education, and media campaigns. The HIV Early Intervention Services (HIV/EIS) Programs funded by the Bureau are designed to reach into the community via intensive outreach and refer individuals and families regarding appropriate treatment and care for IV/IM drug abusers. The HIV/EIS programs are also equipped and contractually required to provide oral rapid HIV testing, counseling, and referral services. These programs are community-based and focus on specific populations who are at high risk for drug abuse. ATTACHMENT D: Program Compliance Monitoring (See 45 C.F.R. 96.122(f)(3)(vii)) The Interim Final Rule (45 C.F.R. Part 96) requires effective strategies for monitoring programs’ compliance with the following sections of Title XIX, Part B, Subpart II of the PHS Act: 42 U.S.C. 300x-23(a); 42 U.S.C. 300x-24(a); and 42 U.S.C. 300x-27(b). For the fiscal year two years prior (FY 2008) to the fiscal year for which the State is applying for funds: In up to three pages provide the following: • • A description of the strategies developed by the State for monitoring compliance with each of the sections identified below; and A description of the problems identified and corrective actions taken: 1. 2. 3. Notification of Reaching Capacity 42 U.S.C. 300x-23(a) (See 45 C.F.R. 96.126(f) and 45 C.F.R. 96.122(f)(3)(vii)); Tuberculosis Services 42 U.S.C. 300x-24(a) (See 45 C.F.R. 96.127(b) and 45 C.F.R. 96.122(f)(3)(vii)); and Treatment Services for Pregnant Women 42 U.S.C. 300x-27(b) (See 45 C.F.R. 96.131(f) and 45 C.F.R. 96.122(f)(3)(vii)). 1. Notification of Reaching Capacity All contracted substance abuse treatment providers in Tennessee’s publicly funded system of care continuously operate at or near capacity. Requirements remain in place to assure that consumers receive treatment services with reasonable promptness (i.e., within 14 calendar days) and waiting lists are kept to a minimum. In FY 2010, the Division will implement a new web-based data reporting system to assist providers with meeting this requirement. This electronic program, still in development, will include a screening/waiting list component which, in conjunction with program monitor reviews of both waiting list capacity and policy and procedures, will enhance the Division’s ability to ensure that waiting lists are kept to a minimum and that all persons seeking treatment services will receive said services with reasonable promptness. Further requirements are in place to assure that if a consumer cannot be admitted with reasonable promptness, appropriate referrals are made to programs with capacity, to admit, or consumers are placed on waiting lists. Requirements remain in place for IVDU’s and pregnant women to receive interim services if they must be placed on a waiting list due to lack of capacity. The Division continues to provide a statewide toll free number to assist agencies and consumers in locating available treatment services. Each provider’s contract continues to specify that they must notify the Division when they reach 90% of their capacity to admit. For fiscal years 2006-2007, these contract requirements were monitored by the Department of Health, Office of Internal Audit and the Bureau, which were responsible for monitoring the above requirements for compliance. During the 2008 transition from the Department of Health to the Department of Mental Health and Developmental Disabilities, Division of Fiscal Services began to monitor for compliance with contract requirements in conjunction with the Division of A & D program monitors. This monitoring was accomplished through on-site visits to providers. All compliance deficiencies identified through monitoring visits were addressed through the agency’s submission of a corrective action plan which was reviewed and approved by the Division. The Division also conducted follow-up visits to verify successful implementation of the corrective action. While compliance with these requirements was high among providers, some deficiencies were noted in regards to appropriately maintaining waiting lists and assuring the provision of interim services and absence of provider policy and procedures confirming same. Individual agencies with these deficiencies submitted corrective action plans and received follow-up visits from the Division verifying corrections. Also, these concerns were addressed systemically through Division advisory committees, training, and technical assistance to all providers. 2. Tuberculosis Services The Division worked with the Tennessee Department of Health TB Control Officer to assure that substance abuse consumers receive appropriate prevention, identification, and treatment services for tuberculosis. As a result of this collaboration, all contracted treatment provider, direct care personnel are required to be screened for active TB symptoms and tested for latent TB annually. All contracted treatment providers newly hired, direct care personnel are required to be screened for active TB symptoms and to participate in a twostep skin test to test for latent TB, at hire, and annually each year of employment, with the provider, thereafter. All service recipients are required to be screened for active TB symptoms and tested for latent TB prior to each admission. Additionally, requirements are in place to assure the provision of surveillance programs to protect consumers, employees, and visitors; the maintenance of infection control procedures; the reporting cases of disease; and the provision of testing/screening, counseling, case management, and TB treatment for consumers. For fiscal years 2006-2007, these contract requirements were monitored by the Department of Health, Office of Internal Audit and the Bureau, which were responsible for monitoring the above requirements for compliance. During the 2008 transition from the Department of Health to the Department of Mental Health and Developmental Disabilities, Division of Fiscal Services began to monitor for compliance with contract requirements in conjunction with the Division of A & D program monitors. This monitoring was accomplished through on-site visits to providers. All compliance deficiencies identified through monitoring visits were addressed through the agency’s submission of a corrective action plan which was reviewed and approved by the Division. The Division also conducted follow-up visits to verify successful implementation of the corrective action. While compliance with these requirements among providers was high, some deficiencies were noted in regards to assuring all consumers, especially outpatient consumers, receive TB testing. Individual providers with these deficiencies submitted corrective action plans and received follow-up visits by the Division to verify implementation of corrections. Also, these concerns were addressed systemically by the Division through advisory committees, trainings, and technical assistance to all providers. 3. Treatment Services for Pregnant Women The Division funds pregnant women treatment services regionally across the state. Services provided to pregnant women included primary medical and pediatric care, case management, transportation, substance abuse treatment, and other therapeutic interventions. Pregnant women receive the highest admission priority for all Division funded providers. In FY 2010, the Division will begin implementing a new web-based data reporting system to assist providers with meeting this requirement. The web-based data reporting system, which is under development, will automatically place pregnant women, in need of treatment services, at the top of the waiting list. Requirements remain in place to assure that programs publicize the availability of services to pregnant women and to assure timely placement in a treatment program. In the event that a program has insufficient capacity to admit a pregnant woman, the agency will notify the Division. The Division will locate a facility with the capacity to admit the pregnant woman for treatment services. If the Division is unsuccessful in placing the pregnant woman at another treatment facility, the originating program must place the pregnant woman on their waiting list, with the highest priority admission and provide interim services within 48 hours. For fiscal years 2006-2007, these contract requirements were monitored by the Department of Health, Office of Internal Audit and the Bureau, which were responsible for monitoring the above requirements for compliance. During the 2008 transition from the Department of Health to the Department of Mental Health and Developmental Disabilities, Division of Fiscal Services began to monitor for compliance with contract requirements in conjunction with the Division of A & D program monitors. This monitoring was accomplished through on-site visits to providers. All compliance deficiencies identified through monitoring visits were addressed through the agencies’ submission of a corrective action plan which was reviewed and approved by the Division. The Division also conducted follow-up visits to verify successful implementation of the corrective action. While compliance with these requirements among providers was high, some deficiencies were noted in regards to assuring appropriate placement on the waiting lists, provision of interim services, publicizing of treatment for pregnant women, Division notification of agency inability to provide services to pregnant women seeking treatment (so that the Division may attempt to place the pregnant woman at a facility with capacity), and the absence of provider policies and procedures confirming same. Individual providers with these deficiencies submitted corrective action plans and received follow-up visits by the Division to verify implementation of corrections. These concerns were also addressed systemically by the Division through advisory committees, trainings, and technical assistance to all providers. GOAL # 5. An agreement, directly or through arrangements with other public or nonprofit private entities, to routinely make available tuberculosis services to each individual receiving treatment for substance abuse and to monitor such service delivery (See 42 U.S.C. 300x-24(a) and 45 C.F.R. 96.127). FY 2007 (Compliance): The State ensured that this requirement was met by maintaining appropriate language in the contract and monitoring specific TB protocols developed by the Department of Health for usage by contractors. Local Health Departments and/or private physicians continued to provide TB services as consumer needs were identified. The Bureau maintained contact with the Department of Health TB Control Office regarding TB protocols. TB services are made available on a statewide basis with the contracted agencies for alcohol and drug abuse services deciding how best to provide TB services to consumers. Alcohol and Drug Abuse programs provide TB services directly or through an established relationship with the local/regional health departments for testing and follow-up services, or either a referral was made to a private physician for completion of required TB testing. The States’ licensure standards for alcohol and drug abuse treatment programs require all consumers to be tested. It is also mandatory that all staff members be tested, as well. If a consumer refuses a test for TB (either the Mantoux or Chest X-ray), the individual is referred to the Health Department for education, screening, evaluation, and if indicated, timely treatment. The above information was developed in conjunction with the Tennessee Department of health, TB Control Officer. A joint letter from the State TB Control Office, the State Director of Facility Licensure, and the SSA Director of Treatment Services is sent yearly to all contracted providers emphasizing the importance of continuing to aggressively screen all A&D consumer for TB infection and disease and the procedures for accomplishing this evaluation. Contract agencies have developed a plan of action on how they intend to integrate this requirement into the agency’s policies and procedures manual. The TB requirements are addressed through the contract language and treatment agencies are monitored by the State to evaluate compliance with the TB requirements. State regulations and policy and procedures pertinent to alcohol and drug abuse treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety and Environmental protection, Chapter 24 Alcohol and Drug Treatment, Part 1-8. Additional policy and procedures can be found in the Administrative and Program Requirements and Scopes of Services. FOOTNOTE: Effective May 7, 2009, the Tennessee General Assembly transferred all state regulations and policy and procedures relevant to alcohol and drug abuse treatment to Title 33 Mental Health and Developmental Disabilities. FY 2009 (Progress): The State continues to maintain contract requirements and compliance for providers that all alcohol and drug treatment consumers be tested for TB and receive TB services following State TB protocols. The Division, in consultation with the Department of Mental Health and Developmental Disabilities Medical Director, will continue to work collaboratively with the Tennessee Department of Health TB Control Office regarding TB protocols. The TB testing requirements was developed in conjunction with the Tennessee Department of Health, TB Control Officer. A joint letter from the State TB Control Office, the State Director of Facility Licensure, and the SSA Director of Treatment Services is sent yearly to all contracted providers emphasizing the importance of continuing to aggressively screen all A&D consumer for TB infection and disease and the procedures for accomplishing this evaluation. Infectious disease education, including tuberculosis, is part of the treatment experience. As previously stated, all consumers entering treatment are tested for TB. If a person tests positive, the information is immediately reported to the local Health Department and treatment services begin. If a person has active TB, the person must receive TB treatment before returning to the alcohol and drug abuse treatment center. All state reporting requirements are met, and federal and state confidentiality regulations are strictly adhered to. During the agency monitoring process, the Division reviews the agency’s polices and procedures, and also reviews the consumer’s record to determine if the individual was properly tested. Employee records are also reviewed to determine compliance with the TB requirements. FY 2010 (Intended Use): For SFY 2010 (July 1, 2009 – June 30, 2010), the Division has implemented a new screening and testing protocol for TB. Working with the Department of Health TB Control Office, new policies, procedures, and forms were developed following practices outlined by the Centers for Disease Control. The new policy and procedures are listed below. Policy: 2.1 Testing and medical evaluation to determine the presence or absence of active TB disease or LTBI in employees and volunteers of alcohol and drug treatment programs and recipients of alcohol and drug treatment services must conform to current guidelines of the Tuberculosis Elimination Program of the Tennessee Department of Health. Alcohol and drug treatment facilities must provide baseline screening of all new employees and new volunteers for symptoms of active TB disease and appropriate testing for LTBI prior to employment or provision of volunteer services. Alcohol and drug treatment facilities must ensure that all employees and volunteers who provide direct care services are screened annually for symptoms of active TB disease and appropriately tested for LTBI. Alcohol and drug treatment facilities must counsel all employees and volunteers annually regarding the symptoms and signs of active TB disease. Any alcohol or drug treatment program employee or volunteer with symptoms suggestive of active TB disease must be referred immediately for appropriate medical evaluation and cleared by a licensed medical provider prior to return to work in the facility or provision of direct care services. Any alcohol or drug treatment program employee or volunteer reported by a health care provider to the health department as having suspected or confirmed active TB disease must be excluded from the facility and provision of direct care services until the employee or volunteer is determined to be non-infectious by the State TB Control Officer of the Tennessee Department of Health. All alcohol and drug treatment facilities must screen all prospective service recipients for symptoms suggestive of active TB disease prior to each admission for alcohol and drug treatment services. Prospective service recipients presenting with symptoms suggestive of active TB disease must be referred immediately for appropriate medical evaluation and cleared by a licensed medical provider prior 2.2 2.3 2.4 2.5 2.6 2.7 2.8 to admission for alcohol and drug treatment services. 2.9 Any service recipient reported by a health care provider to the health department as having suspected or confirmed active TB disease must be excluded from services until the service recipient is determined to be non-infectious by the State TB Control Officer of the Tennessee Department of Health. Prospective recipients of all alcohol and drug treatment services who present without symptoms of active TB, and have no documentation of a previously positive TB skin test (TST), and have no documentation of testing for LTBI within the past six (6) months must be appropriately tested for LTBI within five (5) business days of initiation of alcohol and drug treatment services. Alcohol and drug treatment facilities must counsel all service recipients about the symptoms and signs of active TB disease during each admission for alcohol and drug treatment services. All alcohol and drug treatment facilities must provide case management activities to ensure that employees, volunteers, and service recipients diagnosed with LTBI receive appropriate medical evaluation, counseling about the risk of LTBI progressing to active TB disease, and LTBI treatment if such treatment is recommended to and accepted by the employee, volunteer, or service recipient. Testing for LTBI may be done on-site or by referral to a licensed medical provider. All TB screening and testing records of employees, volunteers, and service recipients are considered personal medical information protected by HIPAA and must be archived accordingly. 2.10 2.11 2.12 2.13 2.14 3. Procedure/Responsibility: General Procedures: 3.1 The Division of Alcohol and Drug Abuse Services must annually provide the Office of Licensure and A&D contracted agencies with the “TB Symptom Screening Tool.” The Division of Alcohol and Drug Abuse Services must offer training on administration of the “TB Symptom Screening Tool” at least annually. 3.2 3.3 Only trained alcohol and drug treatment personnel or medical personnel are permitted to administer the “TB Symptom Screening Tool” to program employees, volunteers, or service recipients. A copy of the completed “TB Symptom Screening Tool” with the results of the screening must be maintained in the file of the employee, volunteer, or service recipient, as applicable. Testing for LTBI may be conducted using either the standard Mantoux method of the TST or by an interferon-gama release blood assay (IGRA) according to guidelines established by the federal Centers for Disease Control and Prevention (CDC). 3.4 3.5 Specific Procedures: Employees and Volunteers 3.6 All new employees and volunteers must be screened with the “TB Symptom Screening Tool” prior to beginning employment or providing volunteer services, and appropriately tested for LTBI within three (3) business days of beginning employment or providing volunteer services. a. A new employee or volunteer with symptoms of active TB as documented on the “TB Symptom Screening Tool” should be referred immediately to a licensed medical provider for evaluation, and shall not report to work until written clearance is provided by the licensed medical provider. b. A new employee or volunteer without symptoms of active TB and without documentation of a previously positive TST should be tested within three (3) business days for latent TB infection (LTBI) utilizing the two-step Mantoux method. 1) An employee or volunteer with a positive initial TST (consistent with CDC guidelines) should be referred either to his/her medical provider or to the local health department for further evaluation of LTBI, including a chest radiograph. 2) An employee or volunteer with a negative initial TST should be re-tested within seven to fourteen (7-14) days of the initial test, unless the new employee or volunteer provides documentation of a negative TST within the past twelve (12) months. 3) An employee or volunteer with a negative second TST should receive education about signs and symptoms of active TB. 4) An employee or volunteer with a positive second TST should be referred to either his/ her medical provider or to the local health department for further evaluation of LTBI, including a chest radiograph. 5) A single interferon-gama release blood assay (IGRA) may be substituted for the two- step Mantoux TST; any employee or volunteer with a positive IGRA result should be referred to his/her medical provider or to the local health department for further evalua- tion of LTBI, including a chest radiograph. c. A new employee or volunteer without symptoms of active TB and presenting documentation of a previously positive TST result in millimeters (mm) should not be tested with either the TST or an IGRA, but rather referred within five (5) business days of beginning employment or volunteer services to his/her medical provider or to the local health department for further evaluation of LTBI, including a chest radiograph. d. All new employees and volunteers should receive education about signs and symptoms of active TB disease within three (3) business days of beginning employment. 3.7 All employees or volunteers providing direct care services must be screened annually for symptoms of active TB disease and appropriately tested with follow-up as described under item 3.6 above, except that TB skin testing of previously TST-negative employees and volunteers should be performed by the one-step Mantoux method. Documentation of all TB symptom screening and TB skin testing for LTBI must be treated as personal medical information and archived according to HIPAA guidelines. 3.8 Specific Procedures: Service Recipients 3.9 All recipients of alcohol and drug treatment services must be screened with the “TB Symptom Screening Tool” prior to enrollment in an alcohol and drug treatment program, and be appropriately tested for LTBI within five (5) business days of receiving alcohol and drug treatment services. a. A prospective recipient of alcohol and drug treatment services with symptoms of active TB as documented on the “TB Symptom Screening Tool” should be referred immediately to a licensed medical provider for evaluation, and shall not be admitted into an alcohol and drug treatment program until written clearance is provided by the medical provider. b. A prospective service recipient of alcohol and drug treatment services without symptoms of active TB and without documentation in millimeters (mm) of a previously positive TST, or without documentation of a negative TST within the past twelve (12) months, must be tested within five (5) business days for latent TB infection (LTBI) utilizing the one-step Mantoux method. 1) A service recipient with a positive TST (consistent with CDC criteria) should be referred within five (5) business days to a licensed medical provider or the local health department for further evaluation of LTBI, including a chest radiograph. 2) A single interferon-gama release blood assay (IGRA) may be substituted for the one-step mantoux TST; any service recipient with a positive IGRA result should be referred within five (5) business days to a licensed medical provider or to the local health department for further evaluation of LTBI, including a chest radiograph. c. A service recipient without symptoms of active TB and presenting documentation in millimeters (mm) of a previously positive TST should not be tested with either the TST or an IGRA, but referred within five (5) business days to a licensed medical provider or to the local health department for further evaluation of LTBI, including a chest radiograph. d. All new recipients of residential alcohol and drug treatment services must receive education about signs and symptoms of active TB disease within three (3) business days of beginning alcohol and drug treatment services, regardless of receipt of such services within the past year. 3.10 Documentation of all TB symptom screening and TB skin testing for LTBI of service recipients must be treated as personal medical information and archived according to HIPAA guidelines. Division staff will be training on the use of the protocols and will train contracted treatment providers. The new protocol will be required to be used during FY 2010. Regular monitoring of staff charts and consumers records will be conducted to ensure the appropriate implementation of the policy. The Division plans to continue providing technical assistance and training to providers on an as-needed basis. GOAL # 6. An agreement, by designated States, to provide treatment for persons with substance abuse problems with an emphasis on making available within existing programs early intervention services for HIV in areas of the State that have the greatest need for such services and to monitor such service delivery (See 42 U.S.C. 300x-24(b) and 45 C.F.R. 96.128). FY 2007 (Compliance) The Bureau ensured that Early Intervention Services (EIS) for HIV/AIDS were made available to all clients with substance abuse problems in state supported alcohol and drug abuse programs. These services were ongoing from previous years and were targeted to persons at risk for contracting and/or transmitting HIV with a focus on persons with substance abuse/addiction disorders. This was accomplished by trained HIV/AIDS counselors and also via liaison agreements with either the eight regional HIV/AIDS EIS programs or the local Health Departments. Contract agency policies and procedures were in place that mandated annual staff development activities. All educational sessions, referrals, screening and testing were documented to ensure monitoring of this requirement. The Bureau maintained contact with the Department of Health, HIV/AIDS Office as needed to ensure that Early Intervention Services (EIS) continued to be developed and made available to all consumers with substance abuse problems in the state supported alcohol and drug abuse programs. This was accomplished by trained HIV/AIDS counselors and also via liaison agreements with either the eight regional HIV/AIDS Early Intervention Services programs or the local Health Department. Contract agency policies and procedures are in place that mandate annual staff development activities. All educational sessions, referrals, screening and testing are documented to ensure monitoring of this requirement. According to the Department of Health’s HIV/AIDS Office sub-State Planning Area 4 (Davidson) and sub-State Planning Area 7 (Shelby) were the most critical areas of need. Services were offered in each of these areas. The Bureau monitored contractor’s compliance with this requirement. The Bureau initiated a pilot project with three agencies to conduct rapid HIV testing for the A&D population. These three agencies exceeded the goals of 45,000 outreach to individual, adults and youths, 750 short term counseling and 150 education activities for groups. The HIV EIS provided outreach to 83,184 adults, provided 2,248 short term counseling sessions, provided 660 education activities for groups, provided 148 trainings to Alcohol and Drug Providers and provided 1,511 Oral Rapid Tests to individuals. The additional 5 agencies conducted 85,896 outreach to adults, 2767 short term counseling sessions, 720 education activities for groups and provided 23 trainings to Alcohol and Drug Abuse Providers. They did not participate in the initial pilot rapid testing. During 2007 all HIV EIS contracted providers received training and technical assistance in implementing or continuing Rapid Testing. The eight HIV EIS providers as of July 1, 2007 were implementing the Rapid Testing to the target population. This was the first year implementing the rapid test. The HIV EIS providers are required to expend no less than 5% of their budgets for purchasing the rapid test kits. According to the Department of Health’s HIV/AIDS Office sub-State Planning Area 4 (Davidson) and sub-State Planning Area 7 (Shelby) are the most critical areas of need. The focus of the HIV EIS program in Tennessee rests with alcohol and drug abuse treatment clients, especially those with a history of IV drug use, formerly incarcerated individuals, and other high-risk persons. Outreach efforts are concentrated in communities that are disproportionally impacted by HIV, as evidenced by the results indicated by the annual needs assessment conducted through the HIV Regional Community Planning Groups. Strategies appropriate to the populations served are employed including age-appropriateness and cultural sensitivity. Language and literacy concerns are also addressed. Services are provided with attention to the strengths, needs, abilities, and preferences of those served. The Stages of Change behavioral model for HIV Prevention education activities is utilized, as well as Comprehensive Risk Counseling Services program recommended by the Centers of Disease Control. Rapid testing was incorporated into the agencies services. All early intervention programs provided quarterly reports to assist the Bureau in monitoring. The providers met and exceeded program requirements. . The providers actively marketed their programs and services, using public service announcements, outdoor advertising,, college and, health fairs, literature distribution, and regular outreach to the community. State regulations and policy and procedures pertinent to alcohol and drug abuse treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety and Environmental protection, Chapter 24 Alcohol and Drug Treatment, Part 1-8. Additional policy and procedures can be found in the Administrative and Program Requirements and Scopes of Services. FOOTNOTE: Effective May 7, 2009, the Tennessee General Assembly transferred all state regulations and policy and procedures relevant to alcohol and drug abuse treatment to Title 33 Mental Health and Developmental Disabilities. FY 2009 (Progress): The Division of Alcohol and Drug Abuse Services continues to fund eight agencies regionally that provide HIV/AIDS Early Intervention Services (HIV EIS)and activities as specified by SAPT Block Grant requirements. These services are ongoing and are targeted to persons at risk for contracting and/ or transmitting HIV with a focus on persons with substance abuse/addiction disorders. The Division continues to monitor these agencies on-site and off-site to confirm compliance. The Division continues to ensure Early Intervention Services are carried out and conducted according to annual program plans submitted by the agencies providing the service. The Division will continue to meet regularly with these agencies to discuss service delivery and related issues regarding HIV/AIDS outreach and early intervention services. The Division met with the providers in December 2008, and Division program staff have meet individually with all eight HIV EIS providers at their agency for updates and continued technical assistance. The next scheduled meeting is scheduled for October 2009. The Division’s HIV EIS Coordinator serves on several committees, attends the quarterly statewide HIV meeting, and works collaboratively with Meharry Medical Center (Elam) and the Metro Department of Health efforts. The Division will continue to maintain contact with the Department of Health’s HIV/AIDS Office regarding early intervention services. In March 2009, one of the Division’s long-time providers in sub-State Planning Area (SPA) 7 decided to cease providing services to the community. Although this was a tremendous lost to SPA-7, the Division located another licensed provider within a 5 miles radius of the previous provider. The new agency is providing quality service in the area, and is on target to surpass the region’s goals, as well as meeting the Division’s and agency’s goals, for the program. All early intervention programs continue to provide quarterly reports to assist the Division in monitoring. The providers continue to meet and exceed program requirements. All HIV EIS agencies are providing Rapid Testing services. The providers actively market their programs and services, using public service announcements, outdoor advertising, college and, health fairs, literature distribution, and regular outreach to the community. The providers continue to look for new strategies to engage consumers and reduce barriers to treatment access. FY 2010 (Intended Use): For SFY 2010 (July 1, 2009 – June 30, 2010), the State plans to continue funding eight agencies regionally to provide HIV/AIDS Early Intervention services and activities. These services will target persons at risk for contracting and/or transmitting HIV with a focus on persons with substance abuse/addiction disorders. We will continue monitoring the HIV EIS programs for improved program compliance and quality improvement and provide technical assistance to all contracted providers and how to best report their vast accomplishments and the changing trends and needs of this high risk population across the State of Tennessee. Rapid Testing will continue to be the primary instrument used for counseling and testing for high risk populations. Division staff will meet two (2) times (at a minimum) with HIV EIS providers throughout FY 2010 to ensure program compliance and to provide training and technical assistance. The Division will continue to maintain contact with the Department of Health’s HIV/AIDS Office regarding early intervention services. With the on-going success that the State has experienced for many years with the HIV EIS providers, the Division does not anticipate any difficulties in the program compliance and expects the agencies to continue to exceed the minimum contractual requirements. The following minimum levels of services continue to be required: • • • • Outreach services to 108,750 individuals statewide Short-term counseling to 1,812 individuals or families statewide Educational activities for 362 groups statewide HIV oral rapid testing for 3,998 individuals statewide ATTACHMENT E: Tuberculosis (TB) and Early Intervention Services for HIV (See 45 C.F.R. 96.122(f)(1)(x)) For the fiscal year three years prior (FY 2007) to the fiscal year for which the State is applying for funds: Provide a description of the State’s procedures and activities and the total funds expended for tuberculosis services. If a “designated State,” provide funds expended for early intervention services for HIV. Please refer to the FY 2007 Uniform Application, Section III.4, FY 2007 Intended Use Plan (Form 11), and Appendix A, List of HIV Designated States, to confirm applicable percentage and required amount of SAPT Block Grant funds expended for early intervention services for HIV. Examples of procedures include, but are not limited to: • development of procedures (and any subsequent amendments), for tuberculosis services and, if a designated State, early intervention services for HIV, e.g., Qualified Services Organization Agreements (QSOA) and Memoranda of Understanding (MOU); the role of the Single State Agency (SSA) for substance abuse prevention and treatment; and the role of the Single State Agency for public health and communicable diseases. • • Examples of activities include, but are not limited to: • • • • the type and amount of training made available to providers to ensure that tuberculosis services are routinely made available to each individual receiving treatment for substance abuse; the number and geographic locations (include sub-State planning area) of projects delivering early intervention services for HIV; the linkages between IVDU outreach (See 42 U.S.C. 300x-23(b) and 45 C.F.R. 96.126(e)) and the projects delivering early intervention services for HIV; and technical assistance. The Division has worked with the Tennessee Department of Health TB Control Officer to assure that substance abuse consumers receive appropriate prevention, identification, and treatment services for tuberculosis. As a result of this collaboration, all contracted treatment providers, direct care personnel are required to be screened for active TB symptoms and tested for latent TB annually. All newly hired contracted treatment providers, direct care personnel are required to be screened for active TB symptoms and to participate in a twostep skin test to test for latent TB, prior to employment. All service recipients are required to be screened for active TB symptoms and tested for latent TB prior to each admission. Additionally, requirements remain in place assuring the provision of surveillance programs to protect consumers, employees, and visitors; the maintenance of infection control procedures; the reporting cases of disease; and the provision of testing/screening, counseling, case management, and TB treatment for consumers. The TB screening policies and protocols have been developed with the State’s TB Control Office and follow the Centers for Disease Control recommended policies and practices. For fiscal year 2007, these contract requirements distributed to providers through the Administrative Program Requirements were monitored by the Department of Health, Office of Internal Audit and the Bureau of Alcohol and Drug Abuse Services. This monitoring was accomplished through on-site visits to providers. All compliance deficiencies identified through monitoring visits were addressed through the agency’s submission of a corrective action plan which was reviewed and approved by the Division. The Division also conducted follow-up visits to verify successful implementation of the corrective action. While compliance with these requirements among providers was high, some deficiencies were noted in regards to assuring all consumers, especially outpatient consumers, receive TB testing. Individual providers with these deficiencies submitted corrective action plans and received follow-up visits by the Division to verify implementation of corrections. Also, these concerns were addressed systemically by the Division through advisory committees, trainings, and technical assistance to all providers. Treatment agencies are also required to comply with the obligations under the Health Insurance Portability and Accountability Act of 1996 (HIPPA) and its accompanying regulations. Agencies are also required to have written policies and procedures for communicable disease control, including HIV/AIDS and Hepatitis B. Every employee is required to sign a document that they have reviewed and understand the policies. There are eight programs statewide that offer HIV early intervention services in geograhical areas with the greatest need (high HIV/AIDS rates): • One program in Sullivan County, SPA-1, Northeast Tennessee • One program in Knox County, SPA-2, East Tennessee • One program in Hamilton County, SPA-3, Southeast Tennessee • One program in Davidson County, SPA-4, Davidson County, the metropolitan area of Nashville. • One program in Sumner County, SPA-5, Mid-Cumberland area • One program in Tipton County, SPA- 6, West Tennessee • Two programs in Shelby County, SPA-7, Shelby County and the city of Memphis, the largest county in Tennessee. These programs are geographically distributed so that any person that needs the service can receive it with a little delay. Each treatment agency is required to provide outreach to the IVDU population. The agency must also have a working relationship with the HIV programs in their area and must document that relationship to be compliant with their contract. All eight HIV Early Intervention programs are offering Rapid Testing to consumers. The total funds expended or obligated for early intervention services for HIV are as follows: FY 07 $1,516,100 (obligated) FY 08 $1,482,254 (obligated) FY 09 $1,482,290 (obligated) GOAL # 7. An agreement to continue to provide for and encourage the development of group homes for recovering substance abusers through the operation of a revolving loan fund (See 42 U.S.C. 300x-25). Effective FY 2001, the States may choose to maintain such a fund. If a State chooses to participate, reporting is required. FY 2007 (Compliance): (Reporting REQUIRED if State chose to participate) For FY 2007, funding was available, but there were not any requests for loans. FY 2009 (Progress): (Reporting REQUIRED if State chose to participate) There have not been any requests made for loans. FY 2010 (Intended Use): (State participation is OPTIONAL) Due to budget constraints, the State chose not to offer the Group Home Loan Program. ATTACHMENT F: Group Home Entities and Programs (See 42 U.S.C. 300x-25) If the State has chosen in FY 2007 to participate and continue to provide for and encourage the development of group homes for recovering substance abusers through the operation of a revolving loan fund, then Attachment F must be completed. Provide a list of all entities that have received loans from the revolving fund during FY 2007 to establish group homes for recovering substance abusers. In a narrative of up to two pages, describe the following: • • • • • • • • the number and amount of loans made available during the applicable fiscal years; the amount available in the fund throughout the fiscal year; the source of funds used to establish and maintain the revolving fund; the loan requirements, application procedures, the number of loans made, the number of repayments, and any repayment problems encountered; the private, nonprofit entity selected to manage the fund; any written agreement that may exist between the State and the managing entity; how the State monitors fund and loan operations; and any changes from previous years’ operations. An $8,000 revolving loan fund to encourage the establishment and development of group homes for recovering alcohol and drug abusers was provided. The established process of providing $4,000 loans for homes that provide appropriate supportive living experience for recovering alcohol and drug clients will be maintained. The source of the revolving fund is state funds. An application is required that includes documentation of chartered not-for-profit status. Contracts are executed as applications are approved. The mechanism for funding group homes has been in effect since it became a SAPT Block Grant requirement. In FY 2007, no requests for loans were received by the State. GOAL # 8. An agreement to continue to have in effect a State law that makes it unlawful for any manufacturer, retailer, or distributor of tobacco products to sell or distribute any such product to any individual under the age of 18; and, to enforce such laws in a manner that can reasonably be expected to reduce the extent to which tobacco products are available to individuals under age 18 (See 42 U.S.C. 300x-26, 45 C.F.R. 96.130 and 45 C.F.R. 96.122(d)). • • Is the State’s FY 2010 Annual Synar Report included with the FY No X 2010 uniform application? Yes If No, please indicate when the State plans to submit the report: December 31, 2009 mm/dd/2009 Note: The statutory due date is December 31, 2009. The 98th General Assembly of the State of Tennessee passed the Prevention of Youth Access to Tobacco Act of 1994 with the intention of reducing the accessibility of tobacco products to minors. The act requires appropriate signs to be posted at the point of sale for tobacco products, informing the public that it is illegal to sell tobacco products or smoking paraphernalia to persons under the age of 18 years and that proof of age may be required. Violations of the act may result in monetary penalties and community service sanctions. The Act placed the Tennessee Department of Agriculture in charge of enforcing the law. The Department of Agriculture has the responsibility to inspect all retail food stores for sanitation requirements, as well as compliance with the State’s weights and measures law. Therefore, the monitoring of compliance of the tobacco law will be determined during routine inspections of these facilities. While it is estimated that the majority of tobacco products are purchased at grocery and convenience stores, other locations where tobacco products may be offered for sale include food service establishments (restaurants) and similar facilities. The inspection of food service establishments is conducted by the Tennessee Department of Health, Division of General Environmental Health which includes monitoring compliance with unannounced visits. The Tennessee Department of Agriculture remains, by law, the agency responsible to enforce the present statutes that make it unlawful for any manufacturer, retailer, or distributor of tobacco products to sell or distribute any such product to an individual under the age of 18 years. This department is also the lead enforcement agency. Tennessee’s weighted retailer violation rate for Federal Fiscal year 2009 was 13.1 percent. The agreement between the Department of Mental Health and Developmental Disabilities and the Department of Agriculture will continue to be executed. Tennessee will conduct activities to enforce the laws that prohibit the sale of tobacco products to minors. Tennessee’s Annual Synar Report is not included with the FY 2010 uniform application. The State will submit the Synar report by December 31, 2009. GOAL # 9. An agreement to ensure that each pregnant woman be given preference in admission to treatment facilities; and, when the facility has insufficient capacity, to ensure that the pregnant woman be referred to the State, which will refer the woman to a facility that does have capacity to admit the woman, or if no such facility has the capacity to admit the woman, will make available interim services within 48 hours, including a referral for prenatal care (See 42 U.S.C. 300x-27 and 45 C.F.R. 96.131). FY 2007 (Compliance): The State ensured that priority preference for admission to treatment facilities for pregnant women was follows: Pregnant Injecting Drug Abusers Pregnant Substance Abusers Injecting Drug Abusers All others The Bureau’s Administrative and Program Requirements and agency contracts ensured that when a facility had insufficient capacity to treat a pregnant woman substance abuser and the facility could not locate and refer the consumer to another facility that did have capacity, the agency would report this information to the Director of Treatment Services who would locate an agency with capacity or assure that interim services were provided through an agency. These interim services were as follows: Referrals for prenatal care Counseling on the effects of alcohol and drug use on the fetus Risks of needle sharing Risks of transmission of HIV/AIDS to sexual partners and infants Steps to be taken to ensure that HIV transmission did not occur Referral for HIV/AIDS and TB services, as needed For all programs treating women, it was required that they have policy and procedures which addressed services to pregnant women as follows: Assurances that the program publicizes the availability of services to pregnant women and those pregnant women receive preference for admission. Methods for publicizing services include, but are not limited to: street outreach programs, ongoing public service announcements (radio/tv), internet, regular advertisements in local/regional print media, posters in targeted areas and frequent notification to the network of community based organizations, health care providers and social services agencies. State regulations and policy and procedures pertinent to alcohol and drug abuse treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety, and Environmental Protection, Chapter 24 Alcohol and Drug Treatment, Part 1-8. Additional polity and procedures can be found in the Administrative and Program Requirements and Scope of Services. FOOTNOTE: Effective May 7, 2009, the Tennessee General Assembly transferred all state regulations and policy and procedures relevant to alcohol and drug abuse treatment to Title 33 Mental Health and Developmental Disabilities. FY 2009 (Progress): Pregnant women continue to receive priority admission with contracted alcohol and drug treatment providers as specified in the Division’s contract requirements. The requirements have also been emphasized during site visits and Division meetings. Compliance continues to be monitored through on-site and off-site reviews. Program monitoring results indicate that pregnant women are receiving priority admissions and, if needed, interim services within 48 hours, including a referral for prenatal care. This is monitored through a review of their policies and procedures. The number of pregnant women served through the specific pregnant women’s programs may be slightly lower than the projected number of 300 because one provider in sub-State Planning Area (SPA) 7 discontinued services to the community. In an effort to provide minimal disruption to consumers, another licensed treatment provider was identified in SPA 7, a contract was executed and the provider began providing services to pregnant women and women with dependent children as quickly as possible FY 2010 (Intended Use): For SFY 2010 (July 1, 2009 – June 30, 2010), the Division will continue to ensure that priority admission and interim services are provided to pregnant women and will continue to include requirements in all treatment providers contracts, emphasizing such at scheduled provider meetings and during site visits. These services are ongoing from prior years and are available on a statewide basis. The Division will utilize the TN-WITS system to aid in managing waiting lists and capacity and to monitor compliance of contractual obligations.. The Division provided technical assistance to assure these requirements are met. It is estimated that approximately 300 pregnant women will be served during the state fiscal year. TN-WITS will assist in waiting list management and capacity for block grant consumers went into operation on July 1, 2009. The Division is currently working with the TN-WITS vendor to complete the development of the waiting list module. This will be operable by December 1, 2009. In the interim, agencies are required to continue to keep the waiting list through a paper format or in the agencies computerized system. ATTACHMENT G: Capacity Management and Waiting List Systems (See 45 C.F.R. 96.122(f)(3)(vi)) For the fiscal year two years prior (FY 2008) to the fiscal year for which the State is applying for funds: In up to five pages, provide a description of the State’s procedures and activities undertaken, and the total amount of funds expended (or obligated if expenditure data is not available), to comply with the requirement to develop capacity management and waiting list systems for intravenous drug users and pregnant women (See 45 C.F.R. 96.126(c) and 45 C.F.R. 96.131(c), respectively). This report should include information regarding the utilization of these systems. Examples of procedures may include, but not be limited to: • • • • development of procedures (and any subsequent amendments) to reasonably implement a capacity management and waiting list system; the role of the Single State Agency (SSA) for substance abuse prevention and treatment; the role of intermediaries (county or regional entity), if applicable, and substance abuse treatment providers; and the use of technology, e.g., toll-free telephone numbers, automated reporting systems, etc. Examples of activities may include, but not be limited to: • • • how interim services are made available to individuals awaiting admission to treatment; the mechanism(s) utilized by programs for maintaining contact with individuals awaiting admission to treatment; and technical assistance. For FY 2008, compliance with capacity-management and waiting-list regulations was a cooperative effort involving the Division and the contract providers. There was not a system in place to track time that is specifically spent on activities to achieve compliance. Consequently, the Bureau is unable to determine the amount of funds expended to achieve compliance. The SAPT Block Grant Application requires that all alcohol and drug abuse programs treating IVDUs must notify the State when the program reaches 90% capacity. This requirement was written in all alcohol and drug abuse contracts. For those agencies that have reached 90% of their capacity and notified the Bureau, individual follow-up is conducted on an "as needed" basis. Alternatives are discussed for each individual case and referrals are then made to other available resources. The Bureau’s MIS system does provide the Bureau with the capability to improve data capturing for this population and generate timely management reports from each treatment agency client database. In the case where an agency has insufficient capacity to provide treatment services to a pregnant woman and the agency could not locate and refer the woman to another facility that did have capacity, the agency would report this information to the Director of Treatment Services who would locate an agency with capacity or assure that interim services were provided through an agency. The Bureau has been investigating a web-based system that would provide a picture of statewide waiting lists, service gaps and where consumers may be sent for services. The Bureau was awarded a grant through Research Institute Triangle to assist with the development of the web-based system. In November 2008, the Bureau entered into a contract with FEI.com for the Tennessee Webbased Information Technology System (TN-WITS). TN-WITS has been used by Tennessee Access to Recovery (ATR) providers since 2004. FEI.com was charged with enhancing the current system to include an E-Health Record, Addiction Severity Index (ASI) assessment, Capacity Management and Waiting List System Treatment Episode Data Sets (TEDS) collection for block grant requirements and financial management capabilities including invoice generation and reimbursement to providers. The total cost obligated for enhancement of the existing TN WITS system is $947,788 over a 3-year period. While TN WITS is being developed, the Bureau maintained a toll-free number, The Tennessee Redline, through a contracted provider who serves as the statewide A&D Clearinghouse to assist with providing information and referrals. The Bureau regularly provides technical assistance to treatment providers in regards to maintaining waiting list, capacity management, and providing interim services. Beginning July 1, 2009, the Division implemented TN-WITS. While we are currently using this system, the capacity management waiting list module remains under development. In order to ensure that the State remains HIPAA and C.F.R. 42 compliant, business rules are being developed. Upon completion of the waiting list module, all contracted agencies will have the ability to determine where services are available throughout the State, thereby increasing the likelihood that the consumer can be admitted for services in a timely manner. In the meantime, agencies will continue to collect waiting list information and follow the admission criteria established for the priority populations. The SAPT Block Grant Application requires that all alcohol and drug abuse programs treating IVDUs must notify the State when the program reaches 90% capacity. This requirement has been written in all alcohol and drug abuse contracts. For those agencies that have reached 90% of their capacity and have notified the Division, individual follow-up is conducted by the agency on an "as needed" basis. Alternatives are discussed for each individual case and referrals are then made to other available resources. The Division maintains a 24 hour a day/ 7 days a week toll-free hotline, The Tennessee Redline, through a contracted provider who serves as the statewide A&D Clearinghouse to assist with providing information and referrals. The Division regularly provides technical assistance to treatment providers in regards to maintaining waiting list, capacity management, and providing interim services. The Division also monitors the waiting list at regular intervals through the Division’s monitoring process. GOAL # 10. An agreement to improve the process in the State for referring individuals to the treatment modality that is most appropriate for the individual (See 42 U.S.C. 300x28(a) and 45 C.F.R. 96.132(a)). The Bureau continued to improve the process for referring individuals to the treatment modality that is most appropriate for them by supporting and implementing the following activities: • • • The Bureau’s Training Section provided courses on a regional basis, as well as hosting a statewide conference, directed to alcohol and drug abuse professionals and paraprofessionals. The Bureau continues to work with and encourage agencies to seek JCAHO or CARF accreditation. Within the service capabilities, alcohol and drug abuse providers offered a continuum of treatment services in each regional area. All funded treatment providers were required to sue the Addiction Severity Index (ASI) as the consumer assessment instrument and the American Society of Addiction Medicine Patient Placement Criteria for the Treatment of SubstanceRelated Disorders, Second Edition-Revised (ASAM PPC-2R)as the placement criteria ensuring that consumers are placed and maintained in the appropriate level of care to best meet the identified needs. State regulations and policy and procedures pertinent to alcohol and drug abuse treatment can be found in Tennessee Code Annotated, Title 68 Health Safety, and Environmental Protection, Chapter 24 Alcohol and Treatment, Part 1-8. Additional policies and procedures can be found in the Administrative and Program Requirements and Scopes of Services. FY 2009 (Progress): The Division continues to ensure that all funded treatment providers use the most current version of the ASI and ASAM PPC-2R to place consumers in the proper level of care. The Division continues to make these requirements part of each contract with every treatment provider, emphasizing such at scheduled provider meetings and during site visits. The services are ongoing from prior years and are available on a statewide basis. The Division also continues to monitor for compliance during onsite and off-site visits and to provide technical assistance and training to assure these requirements are met. Additionally, the Division has implemented TN-WITS, the Division’s new data collection and billing information system, which will ensure compliance with ASI and ASAM requirements. The Division has developed a business rule in TN-WITS that will not allow a provider to enroll or invoice for services until the ASI is completed. In addition, TN-WITS provide reminders to providers of when a ASAM Continued Stay assessment needs to be completed. Given that this is real-time data, Division staff can monitor compliance with these requirements on an as-needed basis (daily if necessary). FY 2010 (Intended Use): For SFY 2010 (July 1, 2009 – June 30, 2010), the Division will continue to ensure that consumers needing treatment services are properly assessed for services and placed in the appropriate level of care. The ASI instrument will continue to be required for each adult consumer seeking services. The ASAM-PPC-2 will be used for each adult consumer prior to admission to ensure the appropriate level of care. Additionally, the ASAM-PPC-2 will be used for continued stay criteria, with the expectation that consumers will move to lower levels of care as they progress through the treatment services. The Teen Addiction Severity Index (TASI) will be used for the assessment instruments for adolescents seeking treatment services. It is estimated that 11,000 individuals will receive a clinical assessment in SFY 2010. Additionally, the Division has implemented TN-WITS, the Division’s new data collection and billing information system, which will ensure compliance with ASI and ASAM requirements. The Division has developed a business rule in TN-WITS that will not allow a provider to enroll or invoice for services until the ASI is completed. Additionally, the TN-WITS will provide reminders for the agency to ensure that the ASAM-PPC-2 assessment will be used for each consumer prior to admission to ensure the appropriate level of care. Additionally, the ASAM-PPC-2 will be used for continued stay criteria, with the expectation that consumers will move to lower levels of care as they progress through the treatment services. Given that TN-WITS offers real-time data, Division staff will monitor compliance with these requirements on an as-needed basis (daily if necessary). The Division will ensure that the ASI and ASAM requirements will be included in all funded treatment providers contracts; Division staff will monitor compliance; and the estimated number of consumer to be assessed. GOAL # 11. An agreement to provide continuing education for the employees of facilities which provide prevention activities or treatment services (or both as the case may be) (See 42 U.S.C. 300x-28(b) and 45 C.F.R. 96.132(b)). FY 2007(Compliance): The Bureau of Alcohol and Drug Abuse Services continued to require continuing education and training of employees in funded facilities who provide prevention and treatment services. The Bureau continued to fund a alcohol and drug abuse training system in support of contractor’s continuing education and continued to improve training efforts and systems to compliment the shift to an evidencebased treatment and prevention system that is consistent with our statewide needs assessment findings. This training system was comprised of the following components: regional & priority training (in the form of prevention & treatment conferences) and the Clearinghouse. The regional training component employed the use of six Regional Training Coordinators (RTCs) strategically located throughout the state, who were responsible for sub-state and community needs. The RTCs implemented an annual needs assessment to determine prevention and treatment workforce needs. The seven hundred twenty regional training courses offered were based upon needs identified by the regional trainer needs assessment. Courses included but were not limited to topics such as motivational interviewing, pharmacology, alcohol & drug abuse clinical assessment and placement The priority training component involved the Bureau of Alcohol and Drug Abuse Services’ continued provision of two conferences; the Tennessee Advanced School on Addiction (TASA) and the Prevention Conference. TASA is a annual week-long training conference which provided alcohol and drug abuse prevention and treatment training activities for professionals, paraprofessionals, and other individuals employed in substance abuse treatment and prevention and other health-related areas. In FY 07, this weeklong training conference offered substance abuse prevention and treatment professionals up to 30 hours of Bureau sponsored training which included the following topics: chemical dependency, leadership, recovery, prevention, adolescent treatment, wellness, neurobiology and pharmacology, treatment planning for the criminal drug offender, adolescent inhalant use, clinical supervision, prescription drug use and addiction, drug courts, counseling skills, life skills, problem gambling, client engagement through story telling and listening, sustaining recovery, addiction and spirituality, national outcome measures, and gang related activity, The 2007 Prevention conference also offered prevention professionals Bureau sponsored training. The Statewide Clearinghouse component involved the continued provision of collateral materials to individuals, interested in prevention and treatment activities, and resources to assist trainers in curriculum development. FY 2009 (Progress): The Division of Alcohol and Drug Abuse Services continues to require continuing education and training of employees who provide block grant funded prevention and treatment services. The Division continues to fund a regional alcohol and drug abuse training system in support of provider’s continuing education. The Division conducted a statewide training needs assessment, the results of which the Division plans to use to improve training efforts and systems in an effort to compliment the shift to an evidence-based treatment and prevention system. The Regional Training Coordinators (RTCs) are on target to provide 120 hours of prevention and treatment training in all regions. Some of the courses that have been offered include co-occurring disorders, ASAM PPC-2R, Addiction Severity Index, substance abuse evidence-based treatment or prevention and mental health evidenced-based treatment. To further develop Tennessee’s workforce with evidence-based curriculum, the RTCs continued to provide a minimum of 6 contact hours of training that reflect topics from the National Registry of Evidence-based Programs and Practices (NREPP). In FY 2009, the Division did not host the 32nd annual week-long training conference, Tennessee Advanced School on Addiction (TASA). A change in leadership and subsequent change in process and vision altered program direction resulting in the restructuring of this priority training program. In lieu of TASA, the Division provided four, six hour courses which provided alcohol and drug abuse training activities for professionals, paraprofessionals, and other individuals employed in health-related areas. Training courses were offered in the following areas: Co-Occurring Disorders, Pharmacopsychosocial, Adult A&D Assessment, and Process Improvement Fundamentals. Also, the Division began offering online prevention courses. The following course series are available: AOD Foundation Series, Strategic Prevention Framework Series and Environmental Publication Series. In September 2008, the Division collaborated with the National Guard and area prevention providers to sponsor the Tennessee Prevention Congress Substance Abuse Prevention SUMMIT, an intensive training conference about effective, evidence-based prevention strategies, program/policy development, funding sources, evaluation and other topics that focused on the development of an effective prevention system for Tennessee. FY 2010 (Intended Use): In SFY 2010 (July 1, 2009 – June 30, 2010), the Division intends to continue to require continuing education and training for an estimated 2,000 employees who provide block grant prevention and treatment services. The Division will continue to fund a regional alcohol and drug abuse training system in support of provider’s continuing education. The Division intends to use its statewide training needs assessment to improve training efforts and systems to compliment the shift to an evidence-based treatment and prevention system. To further expand and enhance the training system, the Division intends to centralize all A&D training efforts. The Division will contract with an agency to provide statewide regional and specialized training. This agency will conduct the needs assessments in each region; provide 180 hours of prevention, treatment and recovery training designed to enhance participants’ knowledge, skills and development; and provide courses and workshops in co-occurring disorders, ASAM PPC-2R, Addiction Severity Index, substance abuse evidence-based treatment or prevention, or mental health evidenced-based treatment, recovery services and case management, medication assisted treatment, cultural competency, prevention and treatment of adolescent drug use, binge drinking, and prescription drug use. These courses are to be offered at least once during the state fiscal year 2009 - 2010 or more frequently as predicated by their regional needs. The Division intends to host a two and one half day training conference, Tennessee Workforce Development Conference (TWDC), which provides intensive alcohol and drug abuse training activities for professionals, paraprofessionals, and other individuals employed in substance abuse and mental health-related areas. This conference will include prevention, treatment, and recovery training courses and will allow attendees to receive up to twenty continuing education units (CEU’s). In SFY 2010, the Division intends to provide additional prevention and treatment training courses. These courses will include, but are not limited to, strategic planning, environmental prevention strategies, prevention ethics, facilitation management strategies, co-occurring capable and co-occurring enhanced treatment services and Teen Addiction Severity Index. The State also intends to partner with the Tennessee Primary Care Association to engage and train treatment, and primary care providers about the usefulness of SBIRT as a tool for early identification of substance abuse problems. In addition, community anti-drug coalitions will help identify community partners that should be part of a community SBIRT system. The coalition's unique ability to understand the providers and culture within the community make them an ideal partner for collaboration of this effort in local communities GOAL # 12. An agreement to coordinate prevention activities and treatment services with the provision of other appropriate services (See 42 U.S.C. 300x-28(c) and 45 C.F.R. 96.132(c)). FY 2007 (Compliance): The Bureau ensured continued coordination of prevention and treatment activities with the provision of other appropriate services by partnering with other state agencies, counties, cities, and communities, and working with County Health Councils as needed to help develop county health plans that identify alcohol and drug prevention and treatment issues, including steps for resolution. The SPF-SIG project played a key role in informing and influencing the future of the Bureau’s prevention system. Coordination with County Health Councils A collaborative effort continued between the Bureau of Alcohol & Drug Abuse Services and the Tennessee Department of Health, Bureau of Health Services in order to maintain ongoing involvement with the County Health Councils as they identified alcohol and drug abuse treatment and prevention needs for their county. Each of the ninety five (95) counties in Tennessee has a County Health Council. To develop and fund effective prevention programs and services under the auspices of the state’s Community Prevention Initiative, a collaborative effort existed between the Bureau of Alcohol & Drug Abuse Services and the Tennessee Department of Health, Bureau of Health Services Programs. Programs and services are funded at the community level in counties identified through the Community Diagnosis process as those most in need of services. Strategic Prevention Framework State Incentive Grant (SPF-SIG) The implementation of Tennessee Strategic Prevention Framework (SPF) State Incentive Grant (SIG) provides the framework and resources for state government and communities to effectively partner. Tennessee's SPF SIG's design used data-based problem solving within a systems change model. In addition, the Tennessee SPF-SIG built capacity in 30 county anti-drug coalitions and their statewide association, Community Anti-Drug Coalitions Across Tennessee (CADCAT), to support the prevention interventions of community based process and environmental change with help from the Epiteam, SPF Advisory Council, and the Pacific Institute for Research and Evaluation, Inc, (PIRE). Juvenile Justice & Teen Pregnancy In addition, the Bureau continued to address juvenile justice, teen pregnancy, suicide prevention and general health promotion through regular engagement with: the Tennessee Commission on Children and Youth (TCCY), the Tennessee Suicide Prevention Advisory Council, and the Tennessee Department of HealthOffice of Health/Health Promotion/Disease Control section. Coordination of Treatment Services The Division uses the Addiction Severity Index (ASI) as the assessment tool. The ASI is the basis for the development of a comprehensive treatment plan which includes appropriate services for health, social, correctional and criminal justice, educational, vocational rehabilitation and employment needs. Agencies are required to provide the identified ancillary services or refer to other community organizations. Additionally, the Tennessee Access to Recovery program provides ancillary services statewide. Division staff also participated on the Tennessee Adolescent Coordination of Treatment (T-ACT) Project. The goals of the T-ACT project were to: • Enhance cooperation between agencies and stakeholders, across all counties and regions of the State. • Incorporate evidence-based practices into clinical practice standards and staff training. • Improve network adequacy. • Increase family involvement and resources. FY 2009 (Progress): The Division is continuing to work with a variety of stakeholders to coordinate the delivery of prevention activities and treatment services. The Division’s work toward this goal has several areas of focus including collaboration among prevention and treatment service providers; agencies and Departments; and community partners. The Division is working to ensure that all service providers in the State are aware of other agencies that contract with the Division to provide services. The Division has asked the Tennessee Association of Alcohol, Drug and Other Addiction Services (TAADAS) to compile a directory that can be accessed online that will list all prevention, treatment, and recovery services providers regardless of source of funding. The directory should lead to better collaboration and coordination among prevention and treatment providers. Additionally, all providers have been encouraged to get involved in local community anti-drug coalitions as a way of better understanding the needs of the community they serve. In addition, TAADAS operates a 24 hour, seven day a week information and referral hotline that is available to all Tennesseans for prevention and treatment resources. The Division continues to foster better working relationships with many state agencies that participate in the SPF-SIG Advisory Council including the Department of Education, Department of Children’s Services, The Tennessee Commission on Children and Youth, and the Governor’s Office of Children’s Care Coordination. During 2009 we worked with these partners and continue to look for meaningful ways to collaborate. The Division regularly collaborates with a variety of community partners to ensure that services being offered best meet the needs of all Tennesseans. The Division regularly meets with the provider organizations in the State to discuss important issues including practice improvement and evaluation. The Division has a Treatment and Recovery Advisory Council that meets on a regular basis. In addition, the Office of Prevention Services began a Prevention Advisory Council in January of 2009. This Council has representation from all seven state planning area as well as other important partners including provider organizations and state agencies. The Tennessee Access to Recovery (ATR) program continues to be a national leader in treatment and recovery support services and regularly provides treatment and recovery support services to consumers throughout the State with a primary focus on the criminal justice system. FY 2010 (Intended Use): An agreement to coordinate prevention activities and treatment services with the provision of other appropriate services (See 42 U.S.C. 300x-28(c) and 45 C.F.R. 96.132(c)). In SFY 2010 (July 1, 2009 – June 30, 2010), the Office of Prevention as well as the Office of Addiction, Treatment and Recovery Services will maintain regular communication and planning in an effort to best coordinate prevention and treatment services. The Division works through a variety of stakeholder groups to ensure information is consistent and messages are delivered in a uniform manner. The Office of Prevention Services holds quarterly Tennessee Prevention Advisory Council meetings and gains information from a variety of providers, state agencies, as well as community groups. In addition, the Office of Addiction, Treatment and Recovery Services holds regular meetings of the Treatment and Recovery Advisory Committee, Faith Based Advisory Committee, Adolescent Advisory Committee, Women’s Advisory Committee, and Co-occurring Advisory Committee. In SFY 2010, Prevention and Treatment will contract with the Tennessee Association of Alcohol, Drug and Other Addiction Services (TAADAS) to provide workforce development training for contracted agencies. The development of a training curriculum as well as an annual workforce development conference will be done in collaboration with prevention and treatment contracted agencies, DADAS staff, and TAADAS. An overarching goal of training during FY 2010 will be an understanding among agencies of the prevention and treatment array of services and strategies. One specific effort that will include both prevention and treatment providers as well as primary care providers is training around Screening, Brief Intervention, and Referral for Treatment (SBIRT). The Division is partnering with the Tennessee Primary Care Association to engage and train treatment, and primary care providers about the usefulness of SBIRT as a tool for early identification of substance abuse problems. In addition, community anti-drug coalitions have been asked to help identify community partners that should be part of a community SBIRT system. The coalition’s unique ability to understand the providers and culture within the community make them an ideal partner for collaboration of this effort in local communities. The Division also plans to continue to use the Addiction Severity Index (ASI) as the assessment tool. The ASI is the basis for the development of a comprehensive treatment plan which includes appropriate services for health, social, correctional and criminal justice, educational, vocational rehabilitation and employment needs. Agencies are required to provide the identified ancillary services or refer to other community organizations. Additionally, the Tennessee Access to Recovery program provides ancillary services statewide. With the implementation of TN-WITS, there is greater access to enrolling individuals into services identified through the assessment process. Referrals for individuals can easily be made through this system, and can more thoroughly be monitored by providers and the Division. In SFY 2010, through a Memorandum of Understanding with The Tennessee of Board of Probation and Parole has contacted the Division about partnering with them on their Joint Offender Management Project. This project targets at risk technical violators for placement in community treatment programs, diverting them from state prison. GOAL # 13. An agreement to submit an assessment of the need for both treatment and prevention in the State for authorized activities, both by locality and by the State in general (See 42 U.S.C. 300x-29 and 45 C.F.R. 96.133). FY 2007 (Compliance): For SYF 2007, the Bureau was unsuccessful identifying funds to update the treatment needs assessment. Therefore, the Bureau continued to utilize the 2002 – 2003 Family Studies to identify geographic areas of need and identify gaps in services. The studies included: •Tennessee Social Indicator Study: County Level Risk for Adolescent Substance abuse. D.J. Law, Ph.D; P.P. Kane, M.A.; D.L. Howard. Tennessee Department of Health, Bureau of Health Informatics, 2003. •2002 Tennessee Health AOD Needs Assessment Survey Statewide Results. Tennessee Department of Health and Community Health Research Group, The University of Tennessee, Knoxville, 2003. The Bureau also used the Tennessee Alcohol and Drug Prevention Outcome Longitudinal Evaluation (TADPOLE) as well as the Tennessee Outcomes for Alcohol and Drug Services (TOADS) to better understand and evaluate Tennessee’s prevention and treatment needs. State regulations and policy and procedures pertinent to alcohol and drug abuse treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety, and Environmental Protection, Chapter 24 Alcohol and Drug Treatment, Part 1-8. FOOTNOTE: Effective May 7, 2009, the Tennessee General Assembly transferred all state regulations and policy and procedures relevant to alcohol and drug abuse treatment to Title 33 Mental Health and Developmental Disabilities. FY 2009 (Progress): An initial draft of the 2008 Needs Assessment was available in late 2008. The Needs Assessment included a wealth of useful information including: • Summary of Priority Needs that discusses the continuum of needs between prevention and treatment, including the distinct parameters for public funding in each of these areas. Specific priorities are identified using research-based knowledge concerning risk, and specific data for Tennessee. Vulnerable populations are also identified as a practical and important basis for focusing services on need. • Profile of current Division services that discusses current resource allocation among treatment and prevention programs and their relation to needs. Analysis is focused on those program areas that require the greatest resources. The Needs assessment contains research evidence on links of need indicator to harm/consequences; problem magnitude to include prevalance (likelihood of transition to abuse/dependence); and Tennessee data on target populations, risk population size and trends. Judgments on risk, trend and harm indicators were weighted for a priority score. Listed below are the ranking of the Tennessee’s priority populations: Highest priority • Early use initiation, prescription drug use, dependent population Second priority group • Adolescent binge drinking, adolescent drug use Third priority group Inhalant use, Co-occurring disorders in adolescence Fourth priority group • Adolescent drug use, DUI Fifth priority group • Methamphetamine use The Needs Assessment also addresses the implications that the priority needs and service profiles indicate about improving the provision of substance abuse prevention and treatment services in Tennessee. The Needs Assessment was the basis of the Prevention Announcement of Funding that was released in April 2009. The Needs Assessment identified Selective and Indicated populations most at risk of developing substance abuse problems in Tennessee. Those include: high school dropouts, foster care children, juvenile offenders, and children of substance abusing parents. In addition, the following Indicated Populations were identified as high risk for developing substance abuse problems in Tennessee: adolescents (ages fifteen to eighteen (15-18) years) engaged in binge drinking and excessive alcohol use and associated problems; young adults (ages eighteen to twenty-four (18-24) years) engaged in binge drinking and associated problems; adolescents (ages fifteen to eighteen (15-18) years) who have a high rate/excessive use of alcohol and/or drugs; individuals ages ten to sixteen (10-16) years who are using inhalants; adolescents (ages fifteen to eighteen (15-18) years) who are abusing prescription drug; or adolescents (ages fifteen to eighteen (15-18) years) who have co-occurring disorders and associated problems. FY 2010 (Intended Use): For SYF 2010 (July 1, 2009 – June 30, 2010), the Division plans to utilize the 2008 Needs Assessment to make prevention and treatment funding allocation decisions. The Needs Assessment found that sufficient integrated co-occurring services are lacking. As a result, the Division’s Office of Addiction, Treatment and Recovery Services plan to release an Announcement of Funding for Intensive Outpatient Co-occurring Enhanced Treatment Services. The Division intends to contract with seven providers across the State to deliver these services, one in each State Planning Area. Agencies that submit proposals that have specific tracks for women and the Criminal Justice system will be given special priority. These areas were identified in the Needs Assessment in the “high need” category. The Needs Assessment indicates an overuse of residential services. To gather more information about this, the Division meets frequently with the Tennessee Department of Children’s Services. It was determined that less adolescent services were needed and that more intensive outpatient services would better serve individuals in the community Funds will be decreased for adolescent residential services by 10% and increasing adolescent outpatient services by 10%. This change will increase the number of adolescents served by an additional 9.7%. Division staff has been invited to participate, and regularly participate, in monthly meetings of the Department of Children’s Services Mental Health and Substance Abuse subcommittee. During FY 2010, the Division intends to further the work done in the 2008 Needs Assessment by collaborating with local providers to identify how the agencies are addressing the priority needs that were identified in the 2008 Needs Assessment and better understand where gaps in services within local communities exist. After the community process is complete, an addendum to the 2008 Needs Assessment will be released. GOAL # 14. An agreement to ensure that no program funded through the Block Grant will use funds to provide individuals with hypodermic needles or syringes so that such individuals may use illegal drugs (See 42 U.S.C. 300x-31(a)(1)(F) and 45 C.F.R. 96.135(a)(6)). FY 2007 (Compliance): The Bureau continued to ensure that the prohibition of the use of Block Grant funds for the purchase of needles and syringes was included in the contract with funded agencies and was monitored for compliance as part of the independent peer review process. State regulations and policy and procedures pertinent to alcohol and drug abuse treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety, and Environmental protection, Chapter 24 Alcohol and Drug Treatment, Part 1-8; Division Administrative Program Requirements and Scope of Services; Department of Finance and Administrative Policy 22; and Office of Management and Budget Circular 133.. FOOTNOTE: Effective May 7, 2009, the Tennessee General Assembly transferred all state regulations and policy and procedures relevant to alcohol and drug abuse treatment to Title 33 Mental Health and Developmental Disabilities. FY 2009 (Progress): The Division continues to maintain contract language that prohibits the use of Block Grant funds for the purchase of needles and syringes. This prohibition language remains a part of all provider contracts. The Department of Mental Health and Developmental Disabilities (TDMHDD), Division of Fiscal Services and Division of Alcohol and Drug Abuse Services continue to monitor agency compliance with this contract requirement through on-site reviews and off-site processes. FY 2010 (Intended Use): In SFY 2010 (July 1, 2009 – June 30, 2010), the Division intends to continue to maintain contract language that prohibits the use of Block Grant funds for the purchase of needles and syringes. The prohibition language will remain a part of all provider contracts that are negotiated annually. The TDMHDD’s Division of Fiscal Services and the Division of Alcohol and Drug Abuse Services intend to continue monitoring agency compliance with this contract requirement through on-site reviews and off-site processes. GOAL # 15. An agreement to assess and improve, through independent peer review, the quality and appropriateness of treatment services delivered by providers that receive funds from the block grant (See 42 U.S.C. 300x-53(a) and 45 C.F.R. 96.136). FY 2007 (Compliance): The Bureau met this requirement by the maintenance of a formal process and procedure conducted by the Department of Health, Office of Internal Audit (OIA), ensuring that the quality and appropriateness of treatment and prevention services was delivered. In addition, the Bureau utilized the two newly hired Program Monitors to complement and strengthen the existing process. These Monitors worked closely with OIA Auditors in conducting joint site visits. Program Monitors performed onsite contract monitoring reviews dealing with programmatic compliance, while the Department of Health, Office of Internal Audit, continued to have responsibility for the financial and fiscal reviews. Monitors and Auditors also collaborated on the identification of findings and the publication of the Monitoring Report. State regulations and policy and procedures pertinent to alcohol and drug abuse treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety, and Environmental protection, Chapter 24 Alcohol and Drug Treatment, Part 18l; Division Administrative Program Requirements and Scope of Services; Department of Finance and Administrative Policy 22; and Office of Management and Budget Circular 133. FOOTNOTE: Effective May 7, 2009, the Tennessee General Assembly transferred all state regulations and policy and procedures relevant to alcohol and drug abuse treatment to Title 33 Mental Health and Developmental Disabilities. FY 2009 (Progress): The Division continues to meet this requirement through the maintenance of a formal process and procedure conducted by the Department of Mental Health and Developmental Disabilities, Division of Fiscal Services (DFS), ensuring that the quality and appropriateness of treatment and prevention services was delivered. In addition, the Division utilized Program Monitors to complement and strengthen the existing process. Once the licensing process merger was complete, these Monitors began working closely with DFS Auditors in conducting site visits. Program Monitors performed on-site contract monitoring reviews dealing with programmatic compliance, while the DFS, had responsibility for the financial and fiscal reviews. Monitors and Auditors also collaborated on the identification of findings and the publication of the Monitoring Report. The monitoring process continues to include: (1) all A&D contracted agencies statewide; (2) both a fiscal and programmatic review; and (3) site visit scheduling, discrepancy reporting requirements and the continued need to conduct risk assessments. Therefore, the State continues to meet this requirement by the maintenance of a formal process and procedure ensuring that the quality and appropriateness of treatment and prevention services is delivered. State regulations and policy and procedures pertinent to alcohol and drug abuse treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety, and Environmental protection, Chapter 24 Alcohol and Drug Treatment, Part 18l; Division Administrative Program Requirements and Scope of Services; Department of Finance and Administrative Policy 22; and Office of Management and Budget Circular 133. FY 2010 (Intended Use): In SFY 2010 (July 1 2009 – June 30, 2010), the State intends to continue to maintain its established formal process and procedure for ensuring that the quality and appropriateness of treatment and prevention services is delivered through monitoring contracted agencies for compliance. The monitoring process will include (1) all Division contracted agencies statewide; (2) both a fiscal and programmatic review; (3) site visit scheduling, (4) discrepancy reporting requirements; and (5) continued need to conduct risk assessments. ATTACHMENT H: Independent Peer Review (See 45 C.F.R. 96.122(f)(3)(v)) In up to three pages provide a description of the State’s procedures and activities undertaken to comply with the requirement to conduct independent peer review during FY 2008 (See 42 U.S.C. 300x-53(a)(1) and 45 C.F.R. 96.136). Examples of procedures may include, but not be limited to: • the role of the Single State Agency (SSA) for substance abuse prevention activities and treatment services in the development of operational procedures implementing independent peer review; the role of the State Medical Director for Substance Abuse Services in the development of such procedures; the role of the independent peer reviewers; and the role of the entity(ies) reviewed. • • • Examples of activities may include, but not be limited to: • • • the number of entities reviewed during the applicable fiscal year; technical assistance made available to the entity(ies) reviewed; and technical assistance made available to the reviewers, if applicable. The Division’s evaluation of funded providers consisted of several processes. First, it should be noted that the Division contracted with prevention agencies and state-licensed treatment agencies. In order to obtain a license, alcohol and drug abuse treatment agencies were required to comply with life safety requirements, environmental standards, and program rules which established a basic level of service quality. Annual licensure visits included announced and unannounced (as necessary) on-site visits for treatment and prevention programs. Beyond the licensure requirements for funded agencies, the Division evaluated programs through the Administrative Program Guidelines and Grant Contract Scopes of Services compliance with requirements regarding: •the organization and structure of programs; •the services (including level and quantity) to be provided; •the intended recipients; • the personnel qualifications; and •the contract/provider requirements. The Division evaluated 44 agencies for compliance with these requirements through: •ongoing analysis of automated and manually submitted program data regarding services delivered, and •on-site visits conducted by fiscal auditors from the Tennessee Department of Mental Health, Division of Fiscal Services who review a representative sample of treatment, prevention, and training agencies. A&D Division Program Monitors were available to assist fiscal auditors in conducting on-site visits. Program Monitors focused on the review of programmatic compliance while fiscal auditors conducted the financial reviews of A & D agencies. GOAL # 16. An agreement to ensure that the State has in effect a system to protect patient records from inappropriate disclosure (See 42 U.S.C. 300x-53(b), 45 C.F.R. 96.132(e), and 42 C.F.R. Part 2). FY 2007 (Compliance): The Bureau ensured that a system was maintained to protect consumer's from inappropriate disclosure of consumer records, and that agencies were made aware of confidentiality requirements through education, training, meetings, and agency forums. All State alcohol and drug abuse contracts contained language assuring that the Grantee shall maintain strict confidentiality of patient medical records and other similar records in accordance with state and federal guidelines (42CFR Part 2, Confidentiality of Alcohol and Drug Abuse Patient Records). In particular, the contractor was required to notify each client of their confidentiality rights as described in 42 CFR. The contractor was also required to provide employee education on confidentiality requirements for alcohol and drug abuse clients and records and the consequences of the violation for inappropriate disclosure of client records and information. Contract compliance was monitored through on-site reviews by program monitors. State regulations and policy and procedures pertinent to alcohol and drug abuse prevention and treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety, and Environmental Protection, Chapter 24 Alcohol and Drug Treatment, Part 1-8. Additional policy and procedures can be found in the Administrative and Program Requirements and Scope of Services; Department of Finance and Administrative Policy 22; and Office of Management and Budget Circular 133. FOOTNOTE: Effective May 7, 2009, the Tennessee General Assembly transferred all state regulations and policy and procedures relevant to alcohol and drug abuse prevention and treatment to Title 33 Mental Health and Developmental Disabilities. FY 2009 (Progress): Contract language requiring compliance with state and federal confidentiality guidelines for patient medical records continues to be maintained. The language continues to be included in all of our provider contracts. Education, training, and technical assistance, concerning the above guidelines, continue to be provided to agencies through the Division. Contract compliance continues to be verified through the Division’s on-site monitoring process. FY 2010 (Intended Use): In SFY 2010 (July 1, 2009 – June 30, 2010), the Division intends to continue to require all contacted agencies to comply with state and federal confidentiality guidelines for patient medical records. Language will be included in all contracts requiring compliance with these guidelines. Education and technical assistance, concerning the above guidelines, will be provided to agencies by the Division, as needed. Contract compliance will continue to be verified through the Division’s on-site monitoring process. GOAL #17. An agreement to ensure that the State has in effect a system to comply with services provided by non-governmental organizations (See 42 U.S.C. 300x-65 and 42 C.F.R. part 54 (See 42 C.F.R. 54.8(b) and 54.8(c)(4), Charitable Choice Provisions; Final Rule (68 FR 189, pp. 56430-56449, September 30, 2003). FY 2007 (Compliance): The Bureau continued to implement activities that ensured that all provisions and regulations for Charitable Choice were met (e.g., inclusion of language in provider contracts, provider notification of regulations & use of model note). The Bureau maintained contractual requirements to assure compliance with Charitable Choice regulations, including the use of the model notice. Compliance was monitored through the on-site review process. State regulations and policy and procedures pertinent to alcohol and drug abuse prevention and treatment can be found in Tennessee Code Annotated, Title 68 Health, Safety, and Environmental Protection, Chapter 24 Alcohol and Drug Treatment, Part 1-8. Additional policy and procedures can be found in the Administrative and Program Requirements and Scope of Services Department of Finance and Administrative Policy 22; and Office of Management and Budget Circular 133... FOOTNOTE: Effective May 7, 2009, the Tennessee General Assembly transferred all state regulations and policy and procedures relevant to alcohol and drug abuse prevention and treatment to Title 33 Mental Health and Developmental Disabilities. FY 2009 (Progress): The Division continues to assure compliance with Charitable Choice regulations, including use of the model notice, through contract requirements for all block grant providers. Education and technical assistance on the regulation continues to be provided to agencies by the Division. The Division continues to monitor compliance through the on-site review process. FY 2010 (Intended Use): In SFY 2010 (July 1, 2009 – June 30, 2010), the Division intends to continue to ensure contracted agency compliance with Charitable Choice regulations including the use of the model notice. The Division also intends to continue to require religious organizations to give notice to all potential beneficiaries. This requirement will continue to be included in all provider contracts. Education and technical assistance will continue to be provided to these agencies by the Division, as needed. Compliance will continue to be monitored through the Division’s on-site review process. Under Charitable Choice, States, local governments, and religious organizations, each as SAMHSA grant recipients, must: (1) ensure that religious organizations that are providers provide notice of their right to alternative services to all potential and actual program beneficiaries (services recipients); (2) ensure that religious organizations that are providers refer program beneficiaries to alternative services; and (3) fund and/or provide alternative services. The term “alternative services” means services determined by the State to be accessible and comparable and provided within a reasonable period of time from another substance abuse provider (“alternative provider”) to which the program beneficiary (“services recipient”) has no religious objection. The purpose of Attachment I is to document how your State is complying with these provisions. Attachment I: Charitable Choice For the fiscal year prior (FY 2009) to the fiscal year for which the State is applying for funds check the appropriate box(es) that describe the State’s procedures and activities undertaken to comply with the provisions. Notice to Program Beneficiaries – Check all that apply: X Used model notice provided in final regulations. Used notice developed by State (please attach a copy in Appendix A). X State has disseminated notice to religious organizations that are providers. X State requires these religious organizations to give notice to all potential beneficiaries. Referrals to Alternative Services – Check all that apply: State has developed specific referral system for this requirement. State has incorporated this requirement into existing referral system(s). X SAMHSA’s Treatment Facility Locator is used to help identify providers. Other networks and information systems are used to help identify providers. State maintains record of referrals made by religious organizations that are providers. X 0 Enter total number of referrals necessitated by religious objection to other substance abuse providers (“alternative providers”), as defined above, made in previous fiscal year. Provide total only; no information on specific referrals required. Planning This item addresses compliance of the State’s planning procedures with several statutory requirements. It requires completion of narratives and a checklist. These are the statutory requirements: • 42 U.S.C. 300x-29, 45 C.F. R. 96.133 and 45 C.F.R. 96.122(g)(13) require the State to submit a Statewide assessment of need for both treatment and prevention. In a narrative of up to three pages, describe how your State carries out sub-State area planning and determines which areas have the highest incidence, prevalence, and greatest need. Include a definition of your State’s sub-State planning areas. Identify what data is collected, how it is collected and how it is used in making these decisions. If there is a State, regional or local advisory council, describe their composition and their role in the planning process. Describe the monitoring process the State will use to assure that funded programs serve communities with the highest prevalence and need. Describe the State’s Epidemiological Outcomes Workgroup’s composition and contribution to the planning process for primary prevention and treatment planning. States are encouraged to utilize the epidemiological analyses and profiles to establish substance abuse prevention and treatment goals at the State level. Describe how your State evaluates activities related to ongoing substance abuse prevention efforts, such as programs, policies and practices, and how this data is used for planning. For the prevention assessment, States should focus on the SEOW process. Provide a summary of how data/data indicators were chosen, as well as, key date construct and indicators for understanding State-level substance use patterns and related consequences and mechanisms for tracking data and reporting significant changes should be outlined. • 42 U.S.C. 300x-51 and 45 C.F. R. 96.123(a)(13) require the State to make the State plan public in such a manner as to facilitate public comment from any person during the development of the plan. In a narrative of up to two pages, describe the process your State used to facilitate public comment in developing the State’s plan and its FY 2010 application for SAPT Block Grant funds. The Division will carry out the planning process utilizing two methods. First, the Tennessee Health AOD Needs Assessment Survey is used to determine the prevalence of alcohol and other drug use, abuse, dependence and need for treatment of Tennessee adults in households by region or sub-State area. This survey identified geographic areas of need and gaps in treatment and prevention services. The survey consisted of sociodemographic and background characteristics; health and well-being of adults in Tennessee; health care coverage and access; alcohol, tobacco and other drug use; self-reported substance addiction; alcohol and drug-related life problems; need for treatment; treatment history; and treatment gap estimates. The Tennessee Alcohol and Drug Prevention Outcome Longitudinal Evaluation (TADPOLE) was also used to establish priorities to be addressed in Prevention Services. Second, the Tennessee Department of Mental Health and Developmental Disabilities (TDMHDD) has a revised system of advisory councils which consists of the TDMHDD Statewide Planning and Policy Council and seven Regional Planning and Policy Councils. The Councils consists of members representing mental health, alcohol and drug and developmental disabilities. The revised system increased representation from the alcohol and drug community into the Councils, which was one of the major goals of revising the Council structure. Tennessee's block grant sub-State planning areas are the same as the regional planning and policy council’s areas. The purpose of the TDMHDD Statewide Planning and Policy Council is to assist in planning a comprehensive array of high quality prevention, early intervention, treatment, and habilitation services and supports; and to advise TDMHDD on policy, budget requests, and developing and evaluating services and supports.(T.C.A. §33-1-401). Additional responsibilities of the Statewide Planning and Policy Council are: •To advise the Commissioner on the plans and policies to be followed in the service system and the operation of the TDMHDD programs and facilities; •To recommend to the General Assembly legislation and appropriations for such programs and facilities; •To advocate for and publicize the recommendations; •To publicize generally the situation and needs of persons with mental illness, serious emotional disturbance, alcohol and other drug use disorders, or developmental disability and their families •To provide, with the Commissioner, an annual report to the Governor on the service system, including TDMHDD programs, services, supports and facilities. Copies of this report may be provided to the General Assembly with recommendations for legislation. Other reports are provided to the Governor and General Assembly as needed; •Identification of common areas of concern to be addressed by the service areas; •Needs of service recipients who are children or elderly; and service recipients with a combination of mental illness, serious emotional disturbance, developmental disabilities, or alcohol or drug abuse or dependence; •Evaluation of annual needs assessment, service and budget proposals; •Reconciliation of policy issues among the service areas; and •Annual review of the adequacy of Title 33 to support the service systems (T.C.A. §33-1-402), and annual review of the Mental Health and SAPT Block grants. The purpose of the Regional Planning and Policy Councils is to provide citizen participation in policy planning and serve as a representative for the service recipients and their families; service recipient advocates for children, adults, and the elderly, service providers, agencies; and other affected persons and organizations (T.C.A. §33-2-203). The responsibilities of the Regional Planning and Policy Councils are: •To advise the TDMHDD Statewide Planning and Policy Council on the Department’s Three Year Plan which is based on an assessment of the public need for mental health, developmental disability and alcohol and drug services and supports, the desirable array of prevention, early intervention, treatment, and services and supports for service recipients and their families, conduct annual needs assessment by region, and other matters as the Commissioner or the TDMHDD Statewide Planning and Policy Council may request; and •To provide information and advice to TDMHDD on policy, formulation of budget requests, and development and evaluation of services and supports. (TCA§33-2202) The Tennessee Prevention Advisory Council (TNPAC) was reinstituted in January 2009 after being terminated in 2006. The SPF-SIG Advisory Council was the catalyst for bringing this important group back together. The original TNPAC included only provider agencies and while these agencies were a crucial component of the Prevention System, the council did not include other state agencies that shared the goal of substance abuse prevention in Tennessee or community anti-drug coalitions. The SPF-SIG Advisory Council began in 2004 and assisted the Division in formalizing existing and building new linkages amongst a network of State agencies, public and private. The SPF-SIG Advisory Council also paved the way to integrate grassroots efforts into the statewide infrastructure for evidence-based prevention programming. Thus, when the new TNPAC was formed this year, the preferred structure included a combination of the former TNPAC structure along with the state agency collaboration that was a crucial part of the SPF-SIG Advisory Council structure, as well as the inclusion of coalitions. TNPAC has built on the racial, ethnic, faith and socioeconomic diversity already represented in the current prevention system and will continue to recruit subcommittee members that are reflective of the population of the State. The composition of TNPAC is as follows: • Ten individuals that represent State and Federal Agencies; • Five Statewide Organization Members; • Ten Regional Field Representatives; • One Youth Representative, and • The Director of Prevention Services. In addition, the Council includes an alternate from each of the ten regions as well as an alternate Youth Representative. TNPAC has five Standing Committees: • Assessment and Evaluation Committee • Policy and Strategic Planning Committee • Professional Development Committee • Membership Committee • Youth Committee The Assessment and Evaluation Committee has been tasked with two roles, to house the Evidence-Based Practices Workgroup (EBPW) and the State Epidemiological and Outcomes Workgroup (SEOW). The EBPW is tasked with operationalizing the definition of Evidence Based Practice in Tennessee as well as serving as a panel of experts that will make determinations about whether interventions are evidence based, including reviewing and approving all proposed community-level strategies prior to their implementation plan being approved by the State. The SEOW is tasked with promoting data driven decision making in the prevention system by bringing systematic data-driven thinking to guide effective and efficient use of prevention resources. One of their main focuses will be expanding and improving the AOD data mart for behavioral health and related issues through the SPF-SIG project. The Policy and Strategic Planning Committee sets priorities and goals for the Tennessee Prevention System as well as assists with strategic planning. The Professional Development Committee advises the Office of Prevention Services regarding the professional development needs of prevention providers and offers advice regarding prevention certification and credentialing. The Membership Committee nominates members for the Prevention Advisory Council as well as all Standing Committees. The Youth Committee is comprised of youth that represent the makeup of the state economically, socially, regionally, and culturally; and ensures the TNPAC is provided with a youth perspective. Beginning in State Fiscal Year 2010, all agencies that contract with the Division to provide prevention services will be contractually obligated to be a member of a Standing Committee. State Process Used to Facilitate Public Comment on State Plan and Application Submittal TDMHDD has implemented a revised system of advisory councils that integrates representation from the alcohol and drug community in the Statewide TDMHDD Planning and Policy Council and the seven Regional Planning and Policy Councils. To facilitate public comment, the block grant application will be posted on the TDMHDD website, and e-mailed to the members of the TDMHDD Planning and Policy Council for their review and comment. Chairs of the Regional Councils will send the application to their membership, or direct them to the Department’s website for review and comment. Comments will be directed to Division staff for consideration. OVERALL NARRATIVE: The State should address as many of these questions as possible and may provide other relevant information if so desired. Responses to questions that are already provided in other sections of the application (e.g., planning, needs assessment) should be referenced whenever possible. State Performance Management and Leadership Describe the Single State Agency’s capacity and capability to make data driven decisions based on performance measures. Describe any potential barriers and necessary changes that would enhance the SSA’s leadership role in this capacity. Describe the types of regular and ad hoc reports generated by the State and identify to whom they are distributed and how. If the State sets benchmarks, performance targets or quantified objectives, what methods are used by the State in setting these values? What actions does the State take as a result of analyzing performance management data? If the SSA has a regular training program for State and provider staff that collect and report client information, describe the training program, its participants and frequency. Do workforce development plans address NOMs implementation and performance-based management practices? Does the State require providers to supply information about the intensity or number of services received? The Tennessee Division of Alcohol and Drug Abuse Services initiated its Practice Improvement Program during the 2008-2009 fiscal year. The goal of the program is to improve the overall health of Tennessee residents by providing the SSA with the data and information it needs to make quality-based funding decisions. It has two primary objectives: (1) to identify services which successfully achieve consumer-centered outcomes and (2) to provide maximum available state support to sustain and expand those services. The Practice Improvement Program is implemented through six continuous activities that are both closely linked and mutually reinforcing. 1)Needs Assessment 2)Strategic and Annual Operating Plans 3)Performance Contracts 4)Service Evaluation 5)Education and Training 6)Program Policies and Guidance Needs Assessment The most recent comprehensive needs assessment conducted for the State of Tennessee was more than ten years ago, a period during which significant developments have occurred both in the use and variety of substances and in their treatment. In May 2008, DADAS contracted with The EMT Group (“Evaluation-Management-Training”) based in Folsom, California to develop a comprehensive assessment of the need for substance abuse treatment and recovery services based on a thorough review of the literature and extensive interviews with key in-state and external informants. Scheduled for completion in November 2008, the new needs assessment will identify and prioritize alcohol and drug use indicators as well as selected mental health indicators. It will include a “gap” analysis that will compare identified service needs with what is currently being provided. This analysis is at the center of a useful analysis for the state because it links the assessment directly to action. The 2008 Needs Assessment will provide essential information to staff throughout the Department of Mental Health and Developmental Disabilities as they begin planning and prioritizing for the 2009- 2010 contract cycle, a period in which we expect significant system change to continue, based on significant budgetary constraints. The 2008 Needs Assessment will: •provide empirical evidence of need (surveillance and emerging needs); •help DADAS, MHDD and local decision-makers set service priorities; •guide decisions on policy, programs and practice; •guide decisions on resource allocation; •link to the TN-WITS data system; and, •include procedures to sustain and improve future needs assessments. Strategic and Annual Operating Plans Utilizing the 2008 Needs Assessment as a foundation document, DADAS will create two plans: a Strategic Plan and an Operating Plan. The Strategic Plan will be a three- to five-year plan that incorporates the risk indicators and gaps identified by the needs assessment with the results of interviews which DADAS staff are now conducting directly with community alcohol, drug abuse and mental health agency leaders. These interviews move beyond service needs to identify environmental trends that are expected to impact on the delivery of services in various areas of addictions, in Tennessee and nationally. Long-term goals will be set forth both for the division and for Tennessee’s alcohol and drug service delivery system, as a whole. The 2009-2010 Operating Plan will identify the highest priorities for services, service supports and administrative support that are needed to move Tennessee’s addictions service system to its next developmental level. Not only will the plan provide a blueprint for the year’s actions for DADAS staff, it will also highlight the ways in which 2009-2010 performance contracts with providers will be used to achieve consumer-centered outcomes among highest priority clients and service needs. Performance Contracts System stability and continuous quality improvement dictate that changes to the existing service system be approached thoughtfully, transparently, methodically and with the participation of all relevant stakeholders. We have introduced the concept of performance contracting at a series of provider and statewide meetings over the past several months, as well as during individual meetings between providers and the Division director. On July 28, 2008, a meeting of statewide stakeholders was convened to discuss the Practice Improvement Program and the role of performance contracting in the overall effort to improve services quality. Participants raised questions, identified potential strengths and challenges to a Practice Improvement approach and suggested recommendations designed to strengthen division strategies in implementing PIP. For example, it is critically important that the State of Tennessee participate in the National Outcome Measures (NOMS) program and that providers achieve agreed-upon levels of service and outcomes. For the coming contract year, DADAS will work directly with each individual contract agency to identify and set performance benchmarks that are appropriate to local need, level of funding and type of service intervention, such as the use of evidence-based practices. Those expectations will be incorporated into performance contracts and monitored monthly to ensure that highest priority client needs are met. Any shortfall in achieving benchmarks will be noted by contract specialists and discussed with individual agencies. If necessary, benchmarks will be adjusted. Underperformance will be addressed through a Corrective Action Plan, which will also be monitored by contract specialists to ensure benchmarks are subsequently met. Failure to meet contracted benchmarks can ultimately result in funding reductions. A second example of high-priority performance contracting relates to the recent reduction in Regional Mental Health Institute (RMHI) beds throughout the state, combined with what appears to be some level of unnecessary use of RMHIs by individuals with primary alcohol and drug abuse issues, will necessitate that contract agencies work more closely with Tennessee’s crisis service providers. Consequently, we expect that developing crisis service capacity and skillsincluding social detoxification services-among both alcohol and drug service and mental health service agencies will be a performance contract priority for the 2009-2010 period. Agency contracts will vary according to assessment of need, funding levels, capacity, type of services delivered, use of evidence-based practices and past performance (e.g., evaluation results and program monitoring visits (see below). Benchmarks are currently being developed in collaboration with provider agencies through the Practice Improvement Task Force and will be inaugurated in the FY 2009-2010 contract cycle. DADAS hopes to build in contract incentives to encourage providers to move as swiftly as possible toward achievement of desired consumer outcomes. Service Evaluation Tennessee’s Division of Alcohol and Drug Abuse Services has a long history of evaluating the delivery of its contract services. The University of Memphis Institute for Substance Abuse Research and Evaluation (I-SARE) conducts annual Program Evaluations for each agency with whom DADAS contracts for treatment (Tennessee Outcomes for Alcohol and Drug Services/ “TOADS”), recovery support and prevention services (Tennessee Alcohol and Drug Prevention Outcomes Longitudinal Evaluation/“TADPOLE”). Earlier this year, a thorough assessment of the research and evaluation methods used for this purpose was undertaken by the Division director, the MHDD Director of Research and EMT’s Director of Research. Several key recommendations to strengthen evaluation activities were subsequently adopted, including: a)greater sample randomization; b)addition of supplemental interviews with significant others; and c)increased expected percentage of clients who consent to participate in the evaluation. These changes significantly strengthen the results of I-SARE evaluation activities, which result in: 1) an annual report to the Division aggregating the results of all contract agency evaluation outcomes, and 2) annual individual agency outcome reports, permitting each agency to assess their level of achievement on selected performance targets, that are or will be incorporated into contracts. DADAS and providers jointly use these evaluation results to assess adequacy of performance during the prior period and to set future target benchmarks. Examples of performance target categories assessed include: •stability of residential services •achievement of abstinence •decreases in involvement with community law enforcement •increase in employment stability •completion of treatment •enrollment in basic education curriculum •etc. DADAS staff also conduct Program Monitoring visits to contract agencies, which are identified as at High, Medium or Low Risk. Those agencies identified as at High Risk are automatically scheduled for an annual on-site program monitoring visit, as quickly as possible. Identification as a High Risk may not be “for cause.” For example, all agencies receiving more than $1M in DADAS contract funds qualify for an annual visit on that basis alone. Alternately, an agency may be deemed to be at High Risk based on performance related concerns—e.g., client accusations of malfeasance or inappropriate behaviors. In such cases, the agency is visited virtually immediately. Agencies at Medium Risk may be visited annually or every two years, with Low Risk agencies most likely to be visited every two years. Any agency which does not comply with rules, regulations and guidelines must develop and achieve a Corrective Action Plan to ensure that the shortcoming is corrected within a reasonable period of time. The most recent program monitoring plan identifies the need to monitor a total of 262 contracts covering 1539 services in a total of 58 contracting entities in the coming two years. Results of all program evaluation and program monitoring visits are reported to and reviewed by all treatment and prevention contract specialists, to ensure that findings are appropriately reflected in DADAS/provider agency performance contracts. Education and Training (see also previous section on Education and Training) Targeted needs assessments are conducted annually by Regional Training Coordinators and integrated with the results of the 2008 Needs Assessment, results of Program Evaluations and results of Program Monitoring visits. Taken together, this information will provide clear direction for the approximately 120 training events on treatment and prevention that are offered through DADAS each year. Program Policies and Practices DADAS Administrative Program Guidelines have been completely revised in the past six months to provide clear direction to DADAS contract agencies in the expenditure of public funds designed to achieve the highest possible level of agency performance and outcomes. In addition, rules which govern agency licensure are perceived as a joint effort, undertaken in partnership between TDMHDD and contract agencies, for the overall improvement of services and supports. Each year, rules applicable to all programs and services are reviewed and consideration given to revising them on the basis of need indentified through needs assessment, performance contracting, service evaluation and education and training activities. Summary The Practice Improvement Program will be fully supported by the Tennessee WITS Web-Based Information Technology (TN-WITS) system. Prior to the current year, TN-WITS has been utilized exclusively by the Access to Recovery (ATR) Program to provide information on ATR treatment and recovery support services offered by 100 provider agencies throughout the State. Providers and state personnel alike have found TN-WITS to be accurate, timely, comprehensive and relatively easy to use. At the same time, state information and division personnel have had long-standing concerns that the existing information system, ADMIS, has reached the end of its useful life. As an Excel based system, ADMIS’ clear limitations prompted DADAS to explore the possibility of using TN-WITS for all treatment and prevention related activities, including service recording, billing and reporting. The expansion of TN-WITS is in its final stages of approval by Tennessee finance and administrative authorities. Upon approval, we expect to begin the expansion of TN-WITS immediately, with full implementation within six months that will provide comprehensive data support for all Practice Improvement Program activities. TN-WITS will be used to review all contract agency program and fiscal performance on a monthly basis. Contract specialists are responsible to assess achievement of all treatment and prevention goals and objectives activities, utilizing TN-WITS and the other sources of data noted above. PIP builds upon data and information gathered at every contact with every contract agency, with the submission of every report and with the completion and evaluation of each contract’s performance. Workforce is developed on the basis of their strongest and greatest needs. Administrative guidelines are revised to support agencies in achieving their objectives. DADAS is committed to rewarding those agencies who meet or exceed expectations. Corrective Action Plans are developed for those who do not, with the objective of guiding them to higher performance. Ultimately, the PIP helps Tennessee make the wisest possible use of limited public funds to improve the overall health of all its citizens.