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Strategic Plan - Santa Barbara County

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					Table of Contents

Vision, Mission & Values....................................................................... 2

Introduction ........................................................................................ 3

Strategic Issue #1: Comprehensive Service System ................................. 4

Strategic Issue #2: Access ................................................................... 12

Strategic Issue #3: Coordination......................................................... 16

Strategic Issue #4: Prevention ............................................................. 21

Strategic Issue #5: Advocacy............................................................... 27

Strategic Issue #6: Funding................................................................. 30

Strategic Issue #7: Administration ...................................................... 34

Appendix A: Strategic Planning Steering Committee ............................ 40

Appendix B: Definitions & Acronyms .................................................. 41

Alcohol & Drug Program Contracted Provider List ........Inside Back Cover




                                                                                                          1
Introduction

                     I
                         n Santa Barbara County, it is the role of the Alcohol and Drug Program (ADP), a
                         division within Alcohol, Drug and Mental Health Services (ADMHS) to provide
                         leadership, coordination and oversight of alcohol and drug prevention, early interven-
                     tion, treatment and recovery support services. Roughly six million dollars are distributed
                     by ADP annually to over twenty-five community-based organizations (CBO’s) throughout
                     the county who provide direct services to clients and communities. In 2000, over 4,300
                     individuals received treatment services and another 2,000 participated in prevention
                     activities through Santa Barbara County’s publicly funded alcohol and drug system.
                     In early 1990, ADP went through an extensive planning process to develop the Master
                     Plan. The intent of this process was to establish a five year plan that would outline and
                     prioritize alcohol and drug services. Then again in 1998, having just merged with Mental
                     Health, ADP went through a two day prioritizing process, the SEARCH Conference, with
                     several community stakeholders. Five broad issues were established and used to prioritize
                     services for the next funding cycle in 1999. From this process came the commitment to
                     establish a regionally standardized service system. With the endorsement of the Advisory
                     Board on Alcohol and Drug Problems, ADP then proceeded to develop regional Youth &
                     Family Treatment Centers, treatment and housing for pregnant and parenting women,
                     detoxification programs, and the integration of treatment court programs into the adult
                     treatment system. In addition, and in partnership with local law enforcement, ADP began
                     the process of mapping alcohol and other drug-related police contacts or events by
                     neighborhoods in an effort to begin the critical process of establishing prevention-
                     oriented community coalitions to address local problems.
                                            Two years later, the administration of ADMHS, continuing to
                                            struggle with the implementation of the merger of ADP and the
                                            Mental Health Services (MHS), was pressured by the local alcohol
                                            and drug recovery community and Providers to demonstrate
                                            greater support for the management of the Alcohol and Drug
                                            Program. In addition, members of the recovery community
                                            questioned the absence of broader county attention regarding
                                            alcohol and drug issues to the Santa Barbara County Board of
                                            Supervisors. In response, ADP was charged with developing a plan
Town Hall Meeting in Santa Maria.           that would outline how the Department would give greater visibil-
Over 400 people attended town hall          ity to alcohol and drug issues and provide the Board of Supervisors
meetings throughout Santa Barbara County.   with a framework for prioritizing needed services.

                     In February 2001, a project charter was developed and fifteen representatives of key
                     stakeholder groups were invited to serve as the Strategic Planning Steering Committee.
                     ADP, committed to ensuring broad community representation, sought out representatives
                     from a variety of stakeholder groups. The Steering Committee involved members of
                     community-based organizations, County departments, advocates from the recovery
                     community, the Chair of the Advisory Board on Alcohol and Drug Problems, a member of
                     the Mental Health Commission, and a Program Manager from Adult Mental Health. ADP
                     staffed the Steering Committee and the Work Group, charged with preparing the actual
                     draft document.
                     As part of the planning process, the Steering Committee sponsored Town Hall Meetings
                     in the South County (Santa Barbara), Mid-County (Lompoc) and North County (Santa
                     Maria). With over 400 people in attendance, the Town Hall Meetings far surpassed
                     expectations and appeared to reflect broad community interest in the development of


                                                                                                                  3
               appropriate strategies to address alcohol and other drug-related problems. Information
               on community need gathered from these meetings was incorporated into the strategic
               plan that follows.
               Now that the plan has been completed, the next challenge is its implementation. Because
               alcohol and other drug problems impact all segments of the community, it will take broad
               community involvement and acceptance of the plan to be realized. A key component of
               the implementation of this plan will be an annual evaluation. ADP has committed to
               establishing a regular reporting process for the Advisory Board on Alcohol and Other
               Drug Problems. In addition, the Strategic Plan Steering Committee structure will be
               maintained and while it’s membership will undoubtedly change over time, it will meet on
               an annual basis through June 2007 for status reports and to assist in revising and
               updating the plan.
               We hope the readers of this planning document will appreciate the thoughtfulness by all
               of the participants in this planning process and the broad commitment to the develop-
               ment of a dynamic and responsive alcohol and other drug service system within the
               County of Santa Barbara. ADP and the Steering Committee wishes to acknowledge the
               support provided by our facilitators, Laura Mancuso, a consultant to the Department,
               and Dennis Pankratz, generously loaned to this process by the Probation Department.


    Introduction of Strategic Issues

               A
                       lcohol and drug problems affect a significant number of individuals, families and
                       communities in Santa Barbara County and throughout the nation. Lack of
                       effective prevention programs and untreated substance abuse contribute to
               impaired job performance, school failure, illness, accidents, automobile crashes, injuries,
               family violence, poverty, homelessness, and crime; however, its role in these problems is
               often not adequately addressed. Untreated alcoholism and addiction leads to a “revolving
               door” syndrome in the criminal justice, mental health, and social service systems that
               creates unnecessary human suffering and a costly burden to taxpayers. A need exists to
               increase the community’s awareness of the significance of alcoholism and addiction in
               community life and the value of preventing alcohol and substance abuse problems.
               A critical element of this educational process was finding consensus within the Steering
               Committee on the significant issues facing the Alcohol and Drug Program, and in a
               broader sense, the County’s response to alcohol and other drug problems as a whole.
               After a series of issue presentations and healthy discussion, the Steering Committee
               identified seven inter-related strategic issues:
                            •   Comprehensive Service System
                            •   Access
                            •   Coordination
                            •   Prevention
                            •   Advocacy
                            •   Funding
                            •   Administration
               The following sections will present each of the seven strategic issues, goals, objectives and
               action steps.


4
1 Strategic Issue: Comprehensive Service System

      I
         n order to effectively address alcohol and drug abuse in our communities, a comprehensive
         service system is needed—one that provides services to a diverse population with a wide
         variety of needs for different types and intensities of prevention, intervention, treatment,
      recovery support and advocacy services.
      There are several significant challenges to developing a comprehensive service system. First, the
      need for services far exceeds the amount of available resources. The number of county residents
      requiring treatment for alcohol and other drug-related problems is estimated to be 40,000, with
      roughly 33,400 individuals needing services provided through the publicly funded County system.
      Additionally, the number of county residents experiencing secondhand substance abuse (defined
      loosely as those community residents, co-workers and family members impacted by the misuse,
      abuse or addiction of alcohol and other drugs by significant others) is estimated to be 100,000.

              Determining the Need for Alcohol & Drug Services
              in Santa Barbara County1

          •   Total county population (Census 2000)                                            399,437

          •   Estimated number of residents in need of treatment services (10%)                  40,000

          •   Estimated number of residents experiencing second hand substance abuse           100,000
              (1:2.5 ratio)

          Santa Barbara County Residents Needing Treatment: 40,000

          •   Estimated number of residents covered by Medi-Cal (10%)                             4,000

          •   Estimated number of residents having no medical insurance (24%)                     9,600

          •   Estimated number of residents having medical insurance but no substance
              abuse treatment benefit (75% of the 66% of insured people)                         19,800

          •   Estimated number of residents needing the publicly funded
              Alcohol & Drug Program System (84% of those in need of treatment)                  33,400

          •   Number of residents receiving treatment through the publicly funded
              Alcohol & Drug Program System in fiscal year 00-01 (10%)                            3,219
                                                                          1
                                                                              Community Recovery Network, 2001
      Second, resources are limited. The average cost of treatment estimated by the Physicians for
      National Drug Policy is $3,150 per person. Last year, the average cost per person receiving treat-
      ment through Santa Barbara County’s Alcohol & Drug Program system was $2,907. If ADP were
      able to serve the roughly 33,400 people in need, the cost would equal over $97 million dollars.
      With roughly $6 million dollars available for treatment annually, the need far outweighs the
      available resources.
      In addition to treatment services, the need for prevention, early intervention and recovery support
      is also great. Research suggests that for every $1.00 invested in treatment, there is a commensu-
      rate savings of $7.00 in public and private expenses (CALDATA Study, 1994). However, for every
      $1.00 spent on prevention, up to $5.00 is saved on treatment (NIDA, “Preventing Drug Use
      Among Children and Adolescents”). Yet prevention dollars represent only 3% of ADP’s total


                                                                                                                 5
    annual budget (County Budget, FY 2000). Similar statements could be made regarding interven-
    tion and recovery support services, yet the benefit of these programs is underestimated. The
    demand and urgency of much needed treatment services often outweigh the positive effects and
    value of prevention, early intervention and recovery support services.
    Further, most of the funding managed by the Alcohol & Drug Program comes from the state or
    federal government. Much of this funding is accompanied by mandates and restrictions on the
    type of service that may be purchased which sometimes limits services to persons of certain ages,
    gender, health status, location, or other characteristic. However, these mandates also protect
    many services offered to historically under-served populations. The availability of these funds may
    also stimulate the expansion of the local service system by providing funding to address
    longstanding or emerging problem areas. Issues such as treatment and housing for pregnant and
    parenting women, early intervention for county residents at risk for HIV, mentoring and treatment
    services for youth, and prevention services designed to address underage drinking have been
    developed as a result of categorical funding.
    Another significant challenge is the need for coordination between the various agencies serving
    county residents with alcohol and other drug–related (AOD) problems. Different agencies,
    whether they are public or private, establish their own unique requirements in order for
    individuals and their families to participate in services.
    Thus, adoption of any service system model needs to take into consideration funding availability
    and service requirements along with an analysis of the strengths, gaps and needs within the
    existing system. To accomplish this, this plan proposes a core services continuum for each region
    of the county. This core services continuum is based upon an adaptation of the Level of Services
    model adopted by the American Society of Addiction Medicine. This proposed core services
    continuum provides ADP with a blueprint for developing a comprehensive service system that
    takes into account Santa Barbara County’s existing service structure and unique needs.

      The ingredients of the proposed comprehensive service system:

        Level 1:        Prevention
        Level 2:        Early Intervention
        Level 3:        Outpatient Services
        Level 4:        Intensive Outpatient & Partial Residential
        Level 5:        Residential/Inpatient Services
        Level 6:        Intensive Inpatient Services
        Level 7:        Ancillary & Recovery Support Services


    While ADP has established a solid foundation of services within this continuum, there are gaps in
    terms of the availability of services in some regions, the number of county residents that can be
    served within this continuum, and in the populations served within the current structure. For
    example, ADP currently funds detoxification services within the Santa Maria and Santa Barbara
    areas however these services are limited both in scope and comprehensiveness. Additionally, while
    detoxification services are available to adult males and females, these services are virtually nonex-
    istent for adolescents or the frail elderly and are severely limited for people with a dual diagnosis
    of concurrent substance abuse and psychiatric disorders. One could go through this list and find
    unmet need within each modality. Nonetheless, it serves the useful purpose of providing each
    region of the county with a broad framework from which to build.


6
While there are many populations in need of alcohol and drug program services, several were
emphasized at the Town Hall Meetings. Information gathered through this process is consistent
with data from ADP treatment records.

Populations most urgently needing additional resources:




                          Youth                                            Elderly




          Families              Spanish Speaking                    Dually Diagnosed

While the above populations were identified, ADP knows there are other populations within
our county in need. As part of the strategic planning process, several additional populations
were identified.
In addition, the community Town Hall Meetings identified the need to promote a “family friendly”
service system. The impact of substance abuse on families is well known and promoting the
availability of family education and treatment has been recognized as unmet needs for several
years. While ADP successfully established three regional Youth and Family Treatment Centers in
1999 and has seen a 130% increase in county youth receiving treatment services last year, other
opportunities exist for promoting family involvement in the local service system. These opportuni-
ties include the development of a service system that is increasingly responsive to civil cases heard
in the Dependency Courts and the “bridging” of the family violence and alcohol and other drug
treatment systems.
The following Goals, Objectives and Actions Steps represent the direction in which ADP will strive
towards to address Strategic Issue #1: Comprehensive Service System.
Note: Prevention Services will be discussed separately under Strategic Issue #4: Prevention.


                                                                                                        7
    Santa Barbara County Alcohol & Drug Program Service System

                                                                       Alcohol & Drug Program
                                                                       Services:


                                                                       Level 1: Prevention
                                                                       • Community Coalitions

                                                                       • Public Policy Development

                                                                       • Youth Development & Leadership

                                                                       • GIS-based Data Collection

                                                                       • Alternative Activities

                                                                       Level 2: Early Intervention
                                                                       • Mentoring

                                                                       • School Based Counseling

      Santa Barbara County                                             • Standardized Assessments
                                                                       • DUI and Drug Diversion Programs


      Level 3: Outpatient Services                           Level 5: Residential/Inpatient
                                                              Services
      • Youth & Family Treatment
                                                             • Perinatal Transitional Programs
      • Adult Outpatient Treatment
                                                             • Residential Treatment
      • Multiple Diagnosis Services
                                                               (Under development)
      Level 4: Intensive Outpatient
                                                             Level 6: Intensive Inpatient
       & Supportive Housing
                                                              Services
      • Detox Services
                                                             • Limited availability through private sector
      • Perinatal Treatment
                                                             Level 7: Ancillary & Recovery
      • Treatment Courts
                                                              Support
      • Narcotic Treatment Programs
                                                             • TB/HIV/Hep C Testing
      • Sober Living Centers
                                                             • Case Management
       (Limited availability through
       private sector)                                       • Drug Testing

      Note: Some services may not be available countywide.




8
Strategic Issue 1. Comprehensive Service System



  Goal:

      To enhance the existing alcohol and other drug prevention, early intervention,
      treatment and recovery support system throughout Santa Barbara County.
                               Objective 1.1
                               Initiate a plan to expand culturally competent alcohol
                               and other drug services by June 30, 2004.

                                                      Action Steps
                               1. ADP staff will conduct a population and service analysis to
                                  determine utilization rates and need in comparison to county
                                  demographics.
                               2. ADP, with technical assistance from the State and local
                                  consultants, will survey Providers to determine current
                                  knowledge of culturally competent practices, including
                                  retention of under-served populations.
                               3. ADP staff, with technical assistance from the State, ADMHS
                                  and local consultants, will develop a training module on
                                  cultural competency.
                               4. ADP, with technical assistance from the State, ADMHS and
                                  local consultants, will establish standards for culturally
                                  competent alcohol and drug services that will be incorporated
                                  into ADP contracts.


                               Objective 1.2
                               Expand the number of treatment slots funded by
                               Medi-Cal by 15% by June 30, 2006.
                                                      Action Steps
                               1. ADP will work with its Providers to encourage a regular
                                  presence by DSS’s Medi-Cal outreach workers at ADP
                                  Provider sites.
                               2. ADP will identify specific populations in need of treatment
                                  services and provide technical assistance to ADP Providers on
                                  program design and standards for treatment services.
                               3. ADP will provide technical assistance on advocacy strategies
                                  to local service advocates interesting in expanding state match
                                  dollars for Drug Medi-Cal services.




                                                                                                    9
     Strategic Issue 1. Comprehensive Service System



       Goal:

                To enhance the existing alcohol and other drug prevention, early intervention,
                treatment and recovery support system throughout Santa Barbara County.
                                         Objective 1.3
                                         Expand the number of residential service beds by 100%
                                         for clients in treatment by June 30, 2005.

                                                                  Action Steps

                                         1. ADP staff will identify current residential services within each
                                            region of the county.
                                         2. ADP staff will identify and pursue financial resources to
                                            support residential services.
                                         3. ADP staff will promote partnerships between outpatient
                                            treatment Providers and residential service Providers.
                                         4. ADP staff will give priority to those communities lacking
                                            residential services.


                                         Objective 1.4
         ○
         ○




                                         Expand the number of slots and/or beds available for
         ○




                                         detox by 50% by June 30, 2003.
         ○
         ○
         ○




                                                                 Action Steps
         ○
         ○
         ○




                                         1. ADP staff, with assistance from local Providers, will establish
         ○




                                            standards for detox services.
         ○




                                         2. ADP staff will meet with local health facilities to establish
      Number of Detox Beds                  a protocol to address medical clearance and withdrawal
      Currently Available in                management for social model detox services.
      Santa Barbara County:
                                         3. ADP staff will identify current detox services available for
      Santa Barbara:   6                    possible expansion in each region of the county.
      Lompoc:          0                 4. ADP will prioritize the expansion of detox services in Lompoc,
                                            contingent upon funding.
      Santa Maria:     4


                                         Partnership Works! In Santa Barbara, the Alcohol & Drug
                                         Program funds Project Recovery to provide outpatient day
                                         treatment and detoxification services in partnership with
                                         the Santa Barbara Salvation Army, who provides overnight
                                         residential beds for persons undergoing detox.



10
Goal:

    To enhance the existing alcohol and other drug prevention, early intervention,
    treatment and recovery support system throughout Santa Barbara County.
                             Objective 1.5
                             Expand case management services for clients in
                             treatment by 20% by June 30, 2005.
                                                      Action Steps
                             1. ADP will convene a workgroup to review and develop case
                                management standards and apply the best practices identified
                                in CSAT’s TIP Series #27 for local special populations.
                             2. ADP will negotiate with its local treatment Providers to de-
                                velop, define and establish case management services without
                                compromising existing services and contingent upon the use of
                                our federal or state funding.


                             Objective 1.6
                             Increase the level of family participation in local
                             treatment services by 10% by June 30, 2005.
                                                      Action Steps
                             1. ADP will establish a baseline of family involvement in
                                treatment services through the use of local admissions data.
                             2. ADP will establish broad standards for family involvement in
                                concert with CSAP’s family services research.
                             3. ADP will provide technical assistance to local Providers in an
                                effort to increase skill level with family systems and family
                                recruitment.
                             4. ADP will incorporate family messages into it’s media campaign
                                to promote youth and parental participation in treatment.


                             Objective 1.7
                             Increase the number of clients who successfully
                             complete treatment and respond to the survey reporting
                             no relapse after one year to 60% by June 30, 2007.
                                                      Action Steps
                             1. ADP will consult with its existing evaluation consultant from
                                UCSB to establish an effective evaluation.
                             2. ADP in partnership with local Providers will design a recovery
                                support process to assist clients in attaining long term sobriety.


                                                                                                     11
     2 Strategic Issue: Access

           T
                   o impact alcohol and drug problems in a community, those that are affected by alcohol
                   and drug problems need to have access to a range of comprehensive services. Unlike
                   persons with other illnesses, people with alcohol and other drug problems are frequently
           reluctant to access services without assistance. There are many reasons for this and these are
           generally referred to as “barriers.” Barriers to seeking and receiving services need to be reduced or
           eliminated. These barriers include lack of ability to pay, waiting lists, limited hours of operation,
           lack of family support, transportation and child care needs, differences in culture and language,
           co-existing physical or mental disabilities, and the pervasive stigma associated with alcohol and
           drug problems.
           One of the first steps to accessing services is for an alcohol or drug problem to be identified.
           Many people with alcohol or drug problems come into contact with service providers and institu-
           tions, yet their alcohol and drug problem may not be identified and addressed so they can be
           referred to the services that they need. Each contact presents an opportunity for appropriate
           identification, assessment, and linkage to treatment.
           A need exists to increase the frequency with which individuals and families in need of services are
           identified as a result of problems in school or at work. Violence against children, women and the
           elderly, homelessness, eviction from housing, treatment for serious mental illness or physical
           health problems, intervention by health, social service and law enforcement agencies are opportu-
           nities to examine a person’s use of substances. Screening should occur in each of these settings to
           reliably identify individuals and families with alcohol, drug, and/or co-occurring physical/mental
           health problems (including those in crisis), provide them with immediate access to assessments,
           and link them with treatment. The County should be prepared to take advantage of new federal
           initiatives that may result in augmented federal funds for treatment services in adult and juvenile
           detention facilities as well as other initiatives that would improve access.
           Assessments performed by adequately trained persons are critical in making the linkage between
           the person in need and the available resources. Co-locating addictions assessment staff with other
           service agencies is a recognized and valued model; unfortunately, lack of funding and space
           limitations serve as barriers to this approach.
           The lack of crisis intervention services is particularly troublesome. There is an urgent need for
           24-hour crisis intervention services and locations in each region of the county where people who
           are in crisis and appear to be intoxicated can be screened, assessed, and temporarily housed. Law
           enforcement officers should be able to bring people to these locations, instead of jail, at any hour.
           Resources should be available at each location for crisis stabilization and detox. One person at
           the Santa Maria town hall meeting silenced the room with her story of having to seek arrest in
           order to access treatment. While “treatment on demand” is a laudable goal, access to treatment
           remains beyond the reach of many within the county.
           People must be aware of services in order to access them. Again, many of the town hall attendees,
           unless they had experienced the alcohol and drug system, were not familiar with the services
           provided through ADP and it’s Provider network. ADP often receives calls from individuals
           needing assistance in finding alcohol and drug treatment. While it is the role of the Division to
           provide this information, more needs to be done around educating residents. Public education
           strategies should be undertaken to ensure that people in all regions of the county are aware of
           available services.
           The following Goals, Objectives and Actions Steps represent the direction in which ADP will strive
           towards to address Strategic Issue #2: Access.



12
Strategic Issue 2. Access


  Goal:

           To increase the ability of persons affected by drug and alcohol issues to access
           services through multiple community doorways.
                                    Objective 2.1
                                    Increase in the number of admissions to and retention
                                    in treatment by 15% commensurate with the
                                    demographics and need of Santa Barbara County
                                    by June 30, 2007.
                                                            Action Steps
                                    1. ADP staff will develop a baseline evaluation of clients
                                       currently in treatment to determine the under-served
                                       populations, including families.
                                    2. ADP, with assistance from local Providers, will develop
                                       standards that address the barriers to treatment for clients,
                                       families, Providers and other agencies.
                                    3. ADP, with assistance from local Providers, will develop
                                       strategies, including cultural competency training, for Provid-
                                       ers and other agencies to aid in the reduction of barriers.


                                    Objective 2.2
    ○
    ○




                                    Increase the number of admissions to treatment for
    ○
    ○




                                    youth occurring from referrals by self, friends, schools
    ○




                                    or family by 12% by June 30, 2006.
    ○
    ○
    ○




                                                            Action Steps
    ○
    ○
    ○




                                    1. ADP will contract with a media consultant to design an
                                       annual campaign to:
  Youth Referrals to
   Treatment (2001)                      • reduce stigma associated to substance abuse and
                                         • promote youth and parental participation in treatment.
 Self:             7.2%
                                    2. ADP will encourage Providers to incorporate into treatment
 School:          32.8%                services a strength based approach.
 Family/Friend:    4.2%             3. ADP will establish formal standards for youth treatment.
 Justice System: 51.3%              4. ADP will assist ADP’s Youth & Family Treatment Center,
                                       Mentoring and School-Based Counseling Providers in
 Other:            4.5%                developing stronger linkages with local schools to enable
                                       youth and their families to better access treatment services.




                                                                                                         13
     Strategic Issue 2. Access



       Goal:

            To increase the ability of persons affected by drug and alcohol issues to access
            services through multiple community doorways.
                                     Objective 2.3
                                     Increase the number of admissions to treatment from
                                     County departments beginning June 30, 2005 by 6%
                                     through June 30, 2006.
                                                                      Action Steps
                                     1. ADP will research other communities for best practices
                                        around screening, assessment and referral protocols.
                                     2. ADP will establish a protocol for identifying, screening,
                                        assessment and referral for treatment services, including the
                                        development of a referral/resource guide.
                                     3. ADP will develop a screening and assessment tool for use by
                                        county agencies and ADP Providers and provide technical
                                        assistance on the use of the tool.
                                     4. ADMHS will explore joint funding for alcohol & drug
                                        assessment staff in Mental Health clinics.


                                     Objective 2.4
        ○
        ○




                                     Reduce the number of county residents experiencing
        ○




                                     substance abuse issues requiring hospitalization due to
        ○
        ○




                                     alcohol and other drug use by 5% by June 30, 2007.
        ○
        ○
        ○




                                                                     Action Steps
        ○




                                     1. Explore the feasibility of expanding detox services and crisis
                                        services in partnership with MHS and other agencies.
                                     2. Develop standards for detox services including crisis services.
                                     3. Identify opportunities to pilot a model detox and crisis center.



                                       Hospital Discharges for Alcohol & Drug Related Causes
                                                                Rate per 100,000 Population1
                                       Santa Barbara County:                       174.3
                                       California:                                 168.8
                                       Statewide Ranking:                          47th (out of 58 counties)
                                                                                                a high ranking indicates high risk

                                       1
                                        1996-1998 comparisons; three year average rates. Community Indicators of Alcohol and Drug
                                        Abuse Risk. California Department of Alcohol and Drug Programs; July, 2001.




14
Goal:

        To increase the ability of persons affected by drug and alcohol issues to access
        services through multiple community doorways.
                                            Objective 2.5
○
○




                                            Increase the community’s utilization of available
○




                                            prevention, early intervention, treatment, and recovery
○
○




                                            support services within Santa Barbara County by
○
○




                                            developing and implementing a marketing campaign
○
○




                                            by December 31, 2002.
○
○
○




                                                                   Action Steps
○
○
○




                                            1. ADP will work with a media consultant to help develop
○




                                               and implement a marketing campaign that will increase the
○
○




                                               publicity for alcohol and drug services through television,
○
○




                                               radio, newsprint and other appropriate methods in Santa
○




                                               Barbara County.
○
○
○




                                            2. ADP shall maintain a Resource Guide for agencies and
○
○




                                               individuals listing at a minimum the ADP contracted
○




                                               prevention, intervention and treatment services.
○
○
○




                                            3. ADP will work with the County to provide the Resource
○




                                               Guide in an electronic format to all County employees.
○
○
○




                                            4. ADP will revise its web site to include information
○




                                               regarding prevention, early intervention and treatment
○
○




                                               services within the county and will measure electronic
○
○




                                               access to this information.
○
○
○




                   County Alcohol & Drug Program Websites

                                                              www.sbadp.com

    For Teens:
    • Recognize the signs of alcoholism and
      drug abuse
                                                            • About SBADP               • Treatment
    • Resources and Teen Chat
                                                            • Education Resources         Resources
      (online Al-Anon Family Groups)
                                                            • Physical Effects          • Prevention
    For Parents:
    • Recognize the signs that your child                     of Drugs                  • Legal Resources
      may be using drugs                                    • Online Resources          • Directories
    • Helpful Links



                                                                                                             15
     3 Strategic Issue: Coordination

                   M
                              any of the people requiring alcohol and other drug services do not enter directly into
                              the local AOD services system. The number of people who access the treatment system
                              through a referral process has continually risen over the past four years, with roughly
                   62% being referred by the criminal justice system or another community source. There is a need to
                   better coordinate service delivery among the agencies and institutions outside of ADMHS, such as
                   other County departments, schools, and health care organizations. There are opportunities for
                   promoting the coordination of services at the client level and strengthening the bonds between
                   service providers.
                   Testimony offered by Town Hall Meeting attendees echoed the need for improved coordination
                   between county departments and county funded agencies. Participants spoke about having to
                   provide information on family histories to multiple interviewers, experience multiple assessments,
                   and endure multiple caseworkers. Various research has indicated that for every office a person in
                   need has to visit, attrition of up to 50% occurs. These departments and agencies often represent
                   the first opportunity for assisting residents requiring information, referral to alcohol and other
                   drug services or needing assistance with family problems related to alcohol and other drugs.
                   Given the challenges someone with a substance abuse problem has, greater effort should be made
                   to minimize these system redundancies.
                                                       The local alcohol and drug services system began to address this
                                                       issue during the most recent contracting process by requiring
                                                       partnerships or collaborations between applying agencies. This
                                                       initial task requires ongoing support and definition to further
                                                       reduce institutional barriers experienced by clients in need of
                                                       services. The most successful partnerships to date demonstrate a
                                                       commitment to focusing on the needs of the client, mutual problem
                                                       solving and frequent communication. Shared development of
                                                       protocols that address decision making regarding client issues,
                                                       co-location, staff development and funding reallocations further
                                                       advance the partnership process.
                                                       County residents experiencing problems related to substance abuse
                                                       and mental illness, referred to as dually diagnosed, are a particu-
                                                       larly challenging population. A wide range of disorders fall into the
     Clients with co-occurring mental illness and
                                                       term of dual diagnosis and anecdotal information suggests very few
     substance abuse problems are a particularly
     challenging population. The best strategy for     of county residents with dual diagnosis are served well. This is a
     serving these clients is to provide coordinated   nationally recognized problem that requires significant cooperation
     services at a single site.                        and planning by ADMHS and its service partners.

                   While contractors funded by ADP routinely serve clients with co-occurring mental health issues,
                   these clients frequently do not fall into the narrow range of people with severe mental illness that
                   the Mental Health divisions of ADMHS are mandated to serve. As a result, ADP-funded Providers
                   are unable to access Mental Health, leaving many of their clients at risk for escalation of their
                   mental illness.
                   On the other hand, the ADMHS-operated Mental Health clinics frequently serve the more severely
                   impaired clients with dual disorders. Clinical staff face understandable challenges in trying to
                   access local alcohol and drug services, especially if the treatment programs lack the knowledge
                   and training to address the needs of people with severe mental illness.
                   Research indicates that the best strategy for serving dually diagnosed county residents is to
                   provide coordinated and comprehensive services at a single site. Consideration should be given to


16
             promoting dual ADP/MH program certification for the Department’s clinics and contractors to
             insure the broadest level of access for clients. In addition, having ADP Providers establish a
             presence at the Mental Health clinics while also having Mental Health staff establish a presence at
             Alcohol & Drug Program-funded Provider sites would promote communication within the
             department’s service system. This mutuality of support moves the discussion to a client centered
             approach of “what can we do for each other” as opposed to the current “what can you do for
             me” mentality.
             ADP needs and issues should have greater visibility and prominence within the department and
             likewise, services to clients with both alcohol/drug and mental health problems must be better
             coordinated. A source of funding must be identified for serving the full spectrum of individuals
             with dual disorders.
             ADP should continue its partnership with the Public Health Department in the area of prevention
             of communicable diseases such as HIV, Sexually Transmitted Diseases (STD’s) and Hepatitis C.
             ADP and Public Health identified strategies to promote knowledge among contractor staff and
             clients, economized on data entry and lab work, and standardized the calculation of service rates.
             ADP should continue working with Public Health’s Tobacco Education program to advance
             tobacco cessation strategies within the AOD treatment arena as well as learn from their
             prevention approaches.
             Opportunities exist for improving alcohol and other drug services to parents involved in the Child
             Welfare system. Faced with the loss of custodial rights due to substance abuse related issues,
             parents are faced with the loss of public assistance due to the temporary loss of custody. Yet, they
                                             are often required to participate in treatment without personal
                                             resources. Changes in state law have abbreviated the period of
                                             time that such parents have for demonstrating they have devel-
                                             oped the skills and capacity for caring for their children. Depart-
                                             ment of Social Services and Alcohol & Drug Programs have
                                             recognized that substance abuse treatment services are critical to
                                             the success of these parents and are striving to develop appropri-
                                             ate strategies to implement these services.
                                              There is growing interest in exploring the relationship between
                                              alcohol and other drug use and family violence. There is a high
                                              correlation between addiction and child abuse, family violence
                                              and abuse of the elderly. ADP should continue its effort to create
                                              a “bridge” between those community agencies involved in the
                                              treatment of addictions and family violence. Examples of out-
                                              comes include the development of protocols that facilitate im-
Given the relationship between alcohol and    proved coordination, enhanced training and the development of
other drug use and family violence, there     promotional materials that market the availability of services
needs to be coordination between agencies     between these systems.
involved in the treatment of addictions and
those who deal with family violence.         The passage of Proposition 36 represented a monumental shift in
                                             public policy away from the unnecessary incarceration of low level
             drug offenders to required participation in a treatment program. Early indications suggest that
             the local implementation of this new initiative has been a success due to the significant coordina-
             tion between the criminal justice and treatment systems. Recent inclusion of the representatives of
             the local treatment provider community on the Proposition 36 Policy Council further demon-
             strates a commitment to coordination.
             A “Search Conference” was conducted in March of 1998 to identify strategic priorities for the
             County’s Alcohol and Drug Program. One of the primary recommendations was the continued


                                                                                                                    17
     support of alternative sentencing approaches for appropriate drug offenders. The expansion of
     the drug court model led to the development of a Juvenile Drug Court Project, the funding of
     the Mental Health Treatment Court and the continued consideration of a Dependency Court to
     address child welfare issues. These initiatives have occurred as a result of unprecedented
     cooperation between various county offices and the treatment provider community. This should
     be further encouraged.
     California legislation requires alcohol and other drug treatment programs to encourage client
     participation in vocational services. While CalWORKS continues to serve as an example of service
     coordination between ADMHS and DSS, additional opportunities exist. ADP should encourage
     greater coordination between the treatment agencies and the newly established Workforce
     Resource Center in Santa Maria and the vocational campus approach taken in Santa Barbara.
     The funding of employment counselors through Adult Drug Court and Proposition 36 is another
     example of promoting employment for those experiencing addictions.
     ADP should seek coordination with local law enforcement agencies and other public agencies to
     expand use of the GIS-based Alcohol Sensitive Information Planning System (ASIPS) mapping
     software to further the identification of problem areas within the county.
     The following Goals, Objectives and Actions Steps represent the direction in which ADP will strive
     towards to address Strategic Issue #3: Coordination.

            GIS-Based Mapping of Alcohol and Drug-Related
                     Calls for Service in Isla Vista




       GIS-Based mapping provides of graphic illustration of the extent of alcohol and drug-related mayhem in Isla
       Vista, particularly on Del Playa Street, home to many UCSB and Santa Barbara City College students.



18
Strategic Issue 3. Coordination


  Goal 1:

       To improve the coordination of AOD-client services between law enforcement,
   ○




       health and human service agencies and ADP-funded service Providers.
   ○
   ○
   ○




                               Objective 3.1
                               Increase the number of clients over the age of 18
                               employed at discharge from treatment by 10%
                               annually through June 30, 2007.
                                                       Action Steps
                               1. ADP will host a workshop between ADP Treatment Providers
                                  and Workforce Resource Center on employment issues and
                                  services for clients in treatment.
                               2. ADP will partner with Workforce Resource Center to establish
                                  technical assistance for ADP Treatment Providers.


                               Objective 3.2
                               Increase the collection of local alcohol and drug
                               problem data by June 30, 2005.
                                                       Action Steps
                               1. ADP will collect and analyze local alcohol and drug problem
                                  data to 1) evaluate trends, 2) evaluate success in reducing
                                  problems and 3) set priorities for future funding initiatives.
                               2. ADP will meet with the Sheriff ’s Department and Santa Maria
                                  Police Department to discuss GIS-based reporting of alcohol
                                  and other drug data.
                               3. ADP staff will develop a triannual Report Card on alcohol
                                  and other drug indicator data.
                               4. In concert with the Report Card, ADP staff will conduct a
                                  media campaign to release the Report Card and inform the
                                  community on the status of alcohol and drug problems in
                                  Santa Barbara County.




                                                                                                   19
 Strategic Issue 3. Coordination


     Goal 2:

         To improve the integration of service delivery by ADMHS for clients with
     ○




         dual diagnosis.
     ○
     ○
     ○




                                  Objective 3.3
                                  Increase the number of clients receiving both mental
                                  health services and alcohol and other drug services by
                                  10% by June 30, 2005.
                                                         Action Steps
                                  1. ADP and Mental Health staff will work in partnership with
                                     the Children’s and Adult Mental Health and ADP Treatment
                                     Providers to establish dual diagnosis (includes SED)
                                     treatment protocols and a plan for service delivery.
                                  2. ADP will work with the Children’s and Adult Treatment
                                     Providers and Mental Health Clinics to increase Medi-Cal
                                     claiming in each region of the county.
                                  3. ADP will participate in the coordination or development of
                                     regional workgroups to address ongoing operational issues
                                     related to serving clients with SMI, SED and substance abuse.


                                  Objective 3.4
                                  Increase the level of addictions knowledge and skills
                                  across county and Provider service systems by
                                  providing four workshops by June 30, 2004.
                                                         Action Steps
                                  1. ADP, with consultation by the County’s Employee University,
                                     Allan Hancock College and Santa Barbara City College, will
                                     conduct a survey of county employees interested in seeking
                                     addictions certification.
                                  2. ADP will consult with the County’s Employee University
                                     and Santa Barbara City College to establish an addictions
                                     certification program for interested county employees that
                                     takes into consideration the counselor standards
                                     documented in CSAT’s TIP Series # 21.
                                  3. ADP, contingent on available resources, will provide partial
                                     scholarships to Provider and ADP staff interested in seeking
                                     addictions certification.
                                  4. ADP, through its “Training Institute” and with assistance
                                     from the local medical community, will host a forum on
                                     addiction for County and Provider staff.



20
   4 Strategic Issue: Prevention

                 P
                        roblems associated with the misuse and abuse of alcohol and other drugs impact
                        individuals, families and communities throughout Santa Barbara County. Substance abuse
                        is one of eleven leading health indicators identified by the Federal Government, reflecting it
                 as one of the top public health concerns in the United States. At a local level, roughly 40% of
                 county residents are at risk of alcohol and/or other drug dependence while an estimated 10% or
                 40,000 are in need of treatment. According to statements echoed by concerned community
                 members at three regional Town Hall Meetings, alcohol and other drug problems are pervasive
                 and the need for services is great. Parents in Santa Maria, for example, voiced concern regarding
                 the ease with which youth have in accessing alcohol at retail stores. The California Healthy Kids
                 Survey confirms this concern, with 83% of 11th graders reporting that alcohol is easy or very easy
                 to obtain. More South Santa Barbara County adults drink regularly and binge drink than those
                 nationwide. Excessive drinking may be facilitated by the 1,061 liquor licenses in the county,
                 particularly in downtown Santa Barbara and Isla Vista where high concentrations of alcohol
                 outlets exist.
                                                                  The good news is that prevention works! For every
                                                                  $1 spent on prevention, $5 is saved in providing
                                                                  treatment services. For this reason, the inclusion of
                                                                  prevention as a core component within a compre-
                                                                  hensive service system is not only important, it is
                                                                  imperative. With an abundance of research proving
                                                                  that prevention policies and programs can make a
                                                                  significant impact on precluding and reducing
                                                                  problems, Santa Barbara County must review and
                                                                  reinvest in prevention. Currently, the Alcohol and
                                                                  Drug Program spends about 3% of it’s total budget
                                                                  on prevention services. While treatment dollars
At the Santa Maria Town Hall Meeting, parents voiced strong       recently increased as a result of Proposition 36, it is
concern about how easy it is for youth to buy alcohol at retail   time to consider a re-investment policy for effective
stores. Note the Notice of Suspension at this particular liquor   prevention programming.
store in Santa Maria.
                 Traditional prevention approaches have focused on changing individual behavior through
                 education by targeting those in high-risk populations or with identified risk factors. This
                 approach has had limited impact on community change: untargeted individuals are left
                 unaffected; changes are seen only at the individual level; significant financial resources are
                 required; and it leaves out the broader community environment in which individuals exist.
                 Conversely, an environmental approach focuses on changing the place, setting or location in
                 which alcohol or drug problems occur rather than changing the individual. Environmental
                 approaches prompt community change resulting in individual behavior changes. While prevention
                 programs are available, there is a need to expand this type of approach to incorporate a greater
                 balance between traditional and environmental approaches so that both the individual and the
                 community are able to benefit from the reduction of risks associated with the abuse of alcohol
                 and other drugs. Town Hall participants countywide articulated an interest in addressing the
                 environmental, social and community norms around alcohol and other drug use. The Alcohol and
                 Drug Program should support the development of local community coalitions to expand the
                 environmental policy based prevention approach.
                 Consumption of alcohol by minors continues to remain a strong community concern. Alcohol is
                 the number one drug used by young people. Participants at each of the Town Hall Meetings
                 expressed a desire to prioritize youth alcohol and drug problems, especially use and access. To
                 effectively do this, the Alcohol and Drug Program will need to partner and coordinate with the

                                                                                                                            21
     school system. The recent California Healthy Kids Survey shows that county youth are receiving a
     significant amount of information in school regarding the harmful effects of using alcohol and
     other drugs, yet the larger community environment remains conducive to youth access and use.
     The Alcohol and Drug Program will need to work more closely with school systems so that
     educational approaches are not undermined once youth leave the safety of school campuses into
     a larger community environment that may condone use.
     Having good alcohol and drug specific data is also necessary. The Fighting Back Project has
     collected various indicator data over the past decade for the South County. A similar approach
     should be conducted for the North County. The Santa Barbara School District conducts the
     California Healthy Kids Survey roughly every two years for 7th, 9th, and 11th graders. Kids Network
     releases their annual Kids Scorecard in which the status of a few alcohol and drug indicators is
     described. The Alcohol and Drug Program has partnered with UC Berkeley and local law
     enforcement to collect alcohol and drug specific police data, called ASIPS. The Alcohol/drug
     Sensitive Information Planning System is currently occurring with Santa Barbara and Lompoc
     Police Departments and the Isla Vista Foot Patrol division of the Santa Barbara County Sheriff’s
     Department. This data reports alcohol and other drug-related crime in police calls for service.
     Maps are used to show specific problem locations within communities.
     The Alcohol and Drug Program needs to expand this and other data collection that will assist
     local communities in understanding their specific alcohol and other drug problems so that various
     strategies, policies and programs can be promoted and utilized. This data is also imperative for
     measuring impact and outcomes. The Alcohol and Drug Program should also take a lead role in
     promoting community data around alcohol and drug problems so that communities are informed
     and can mobilize to effectively address their problems.
     While ADP lacks the resources to counter the pervasive promotion of alcoholic beverages that
     regardless of intent, impacts our youth, the investment of prevention funds towards media
     strategies to offset the barrage of alcohol industry promotions should be strongly considered.
     The following Goals, Objectives and Actions Steps represent the direction in which ADP will strive
     towards to address Strategic Issue #4: Prevention.


                                                                                    Map of
                                                                                    Santa Barbara
                                                                                    Alcohol Outlets
                                                                                    and AOD-
                                                                                    Related Crime
                                                                                    The Alcohol/drug
                                                                                    Sensitive Information
                                                                                    Planning System
                                                                                    (ASIPS) reports
                                                                                    alcohol and other
                                                                                    drug-related crime
                                                                                    in police calls for
                                                                                    service. This map
                                                                                    shows a high density
                                                                                    of alcohol licenses
                                                                                    and crime in the
                                                                                    lower State Street
                                                                                    area.



22
Strategic Issue 4. Prevention



  Goal:

          To foster community involvement to prevent and reduce alcohol and other
   ○




          drug problems throughout Santa Barbara County.
   ○
   ○
   ○




                                 Objective 4.1
                                 Increase the number of youth in prevention services
                                 who report abstinence from alcohol and other drugs
                                 by 3% annually through June 30, 2004.
                                                         Action Steps
                                 1. ADP staff will work with youth to develop a counter
                                    advertising campaign to de-glamorize the use of alcohol.
                                 2. ADP will continue to fund primary and secondary prevention
                                    projects that focus on reducing youth use of alcohol and
                                    other drugs through a variety of strategic initiatives including
                                    a youth development model, an environmental approach
                                    and/or programs which build character and promote
                                    resiliency in youth (e.g. mentoring).
                                 3. ADP staff will work with secondary prevention Providers
                                    (mentoring and school-based counseling) to enhance
                                    linkages with the Youth & Family Treatment Centers so
                                    that youth from AOD abusing families can become better
                                    engaged in treatment.
                                 4. ADP staff will standardize the collection of data on youth use
                                    by Providers in order to measure impact and evaluate change.
                                 5. ADP staff will work with schools, law enforcement and other
                                    youth serving agencies to develop organizational and/or
                                    community policies that support the reduction of youth
                                    alcohol and other drug use.


                                 Objective 4.2
   ○




                                 Reduce the ease of youth access to alcohol at retail
   ○
   ○




                                 stores by 20% by June 30, 2005.
   ○




  Retail Liquor Outlets                                  Action Steps
      Per 100,000                1. ADP staff will collect local data triannually on how and where
    Total Population                youth access alcohol.
 Santa Barbara                   2. ADP will support the development of “Policy Panels on Youth
 County:              260.0         Access” so that local communities can address the issue of
                                    youth access to alcohol.
 California:          198.3
                                 3. ADP will give priority to youth driven initiatives and
 Statewide Ranking:    27th
                                    community coalitions that reduce youth access to and use
                                    of alcohol.


                                                                                                       23
     Strategic Issue 4. Prevention



       Goal:

            To foster community involvement to prevent and reduce alcohol and other
        ○




            drug problems throughout Santa Barbara County.
        ○
        ○
        ○




                                    Objective 4.3
                                    Reduce the incidence of crashes, injuries and deaths
                                    associated with driving under the influence (DUI)
                                    by 5% by June 30, 2006.
                                                            Action Steps
                                    1. ADP staff will work with ADP Providers that conduct DUI
                                       offender programs to collect the “place of last drink”
                                       information.
                                    2. ADP staff will identify various prevention strategies to
                                       address DUI related problems identified through the survey.
                                    3. ADP staff will allocate funding to agencies that can effectively
                                       implement the above identified strategies.
                                    4. ADP will provide information to the community through the
                                       triannual Report Card on the incidence of DUI throughout the
                                       county.


                                    Objective 4.4
                                    Increase the public and ADP Provider’s knowledge on
                                    methamphetamine use and associated problems by
                                    June 30, 2003.
                                                            Action Steps
                                    1. ADP staff will conduct a countywide training with law
                                       enforcement, Probation Department, and prevention and
                                       treatment agencies in Santa Barbara County on the use,
                                       abuse, enforcement and environmental factors associated
                                       with methamphetamine.
                                    2. ADP will consider educational campaigns to increase
                                       awareness regarding the problem of methamphetamine
                                       manufacturing, sales and use.
                                    3. ADP will replicate the above training biannually on the most
                                       current “drug of choice” for the county.




24
Goal:

    To foster community involvement to prevent and reduce alcohol and other
○




    drug problems throughout Santa Barbara County.
○
○
○




                            Objective 4.5
                            Enhance public and provider knowledge of alcohol and
                            other drug problems by providing 650 person hours of
                            prevention training and 400 person hours of treatment
                            training annually through June 30, 2007.
                                                    Action Steps
                            1. ADP staff will provide at least four trainings a year on
                               prevention to community members and prevention Providers
                               and will integrate its treatment training with the ADMHS
                               training activities for Providers and staff.
                            2. ADP staff will provide technical assistance to ADP Providers,
                               schools, youth serving organizations, residents and community
                               coalitions on various approaches and/or tools available to
                               reduce alcohol and other drug problems.


                            Objective 4.6
                            Increase the total dollars allocated annually to
                            prevention from 3% of the total ADP budget to 10%
                            through June 30, 2007.
                                                    Action Steps
                            1. ADP will establish a re-investment process for prevention
                               programming.
                            2. ADP staff, in partnership with Providers, will identify, seek
                               and/or support appropriate grant opportunities to increase
                               prevention programming in the County.
                            3. ADP will support/share with the Providers, community
                               coalitions, and schools legislative information regarding
                               fiscal changes for prevention at the state and federal level.




                                             Prevention Works!
                                     For every $1 spent on prevention,
                                $5 is saved in providing treatment services.


                                                                                               25
     Strategic Issue 4. Prevention


        Goal:

                 To foster community involvement to prevent and reduce alcohol and other
                 drug problems throughout Santa Barbara County.
                                                      Objective 4.7
                                                      Increase the number of county residents participating
                                                      in alcohol and other drug prevention coalitions by
                                                      50% by June 30, 2004.

     “By connecting multiple sectors of                                        Action Steps
     the community in a comprehensive                 1. ADP staff will include coalition building in the menu of
     approach, community coalitions                      trainings offered through the Training Institute as a way
     are achieving real outcomes in                      to support the development and ongoing activities of
     substance abuse and violence                        community coalitions.
     reduction.”                                      2. ADP will hire a Community Developer to help build local
           —Community Anti Drug                          coalitions throughout the county that can effectively identify
            Coalitions of America                        and address community problems specific to alcohol and
                                                         other drugs.
                                                      3. ADP staff will share information and research regarding
                                                         community coalitions with all prevention Providers.


                  County-Funded Community Coalitions (FY 2002-03):
       Isla Vista Alcohol & Other Drug Council: The IV AOD Council is a broad-based community coalition that uses
       environmental management strategies to address legal, institutional, social and health issues in order to reduce alcohol
       and other drug problems in Isla Vista.
                                                                Seniors & Substance Abuse: The Seniors & Substance
                                                                Abuse committee consists of agency representatives from the
                                                                aging network of providers. Organized by the Central Coast
                                                                Commission for Senior Citizens, the committee focuses on
                                                                educating and training service provider staff from the aging
                                                                network and the medical community on the issue of
                                                                substance abuse among the elderly.
                                                                  Santa Maria Valley Policy Panel to Reduce Youth
                                                                  Access to Alcohol: Made up of concerned individuals,
                                                                  agencies, youth and law enforcement, the year-old Santa
                                                                  Maria Policy Panel has developed a comprehensive list of
                                                                  policy recommendations that will help to reduce easy
                                                                  access to alcohol by young people.
                                                                  Santa Barbara City Teen Coalition: This teen driven
       Carpinteria Policy Panel on Youth Access to                coalition focuses on assessing neighborhood alcohol
       Alcohol: The Carpinteria Policy Panel (pictured)           problems in Santa Barbara and making environmental
       is a newly established coalition of residents, youth,      changes to reduce problems and improve the community.
       agencies, parks and city staff, and law enforce-           The Teen Coalition also hosts the Teen Summit on Alcohol
       ment. Concerned about youth access and use of              & Drug Problems.
       alcohol, this coalition will develop a list of policy-
                                                                  Note: The Teen Cooperative and the Santa Barbara
       based recommendations that will reduce alcohol
                                                                  Community Alcohol Problem Prevention Project were
       problems for youth.
                                                                  ADP funded coalitions through June, 2002.



26
5 Strategic Issue: Advocacy

      A
              dvocacy is a significant gap in the current system of care. While there is strong and
              organized advocacy within our community for certain healthcare and mental health
              services, advocacy concerning alcohol and drug problems have been historically absent
      from the system of care and from systems planning. An exception has been in the criminal justice
      system, where local, state, and federal advocacy for drug treatment services has resulted in
      significant improvement of both funding for and access to services for persons involved in
      criminal behavior. The ongoing criminalization of addiction led addiction advocates to
      successfully organize the public towards the passage of Proposition 36, which further established
      treatment as a viable alternative to incarcerating low-level offenders.
      There is much that Santa Barbara County can do to increase advocacy efforts to the benefit of
      needed local services. County government and its employees have networks that may be able to
      influence statewide legislation; ADP can foster advocacy support among the recovery community
      and family members, and Providers can make advocacy information available to clients, their
      families and agency Boards of Directors. Much can be learned from the community advocates
      who have affiliated with Public Health to promote anti-tobacco strategies along with the Public
      Welfare system that led to the successful advocacy for treatment funding for the Welfare to Work
      population. Advocacy can also become an integral part of ADP’s prevention, outreach, training,
      educational, and marketing programming.
      Encouraging recovering persons and their family members to have a more formal voice in systems
      planning and policy can also reinforce potential local constituencies. Local recovery advocates
      should be encouraged to include in their agenda the targeting of problem alcohol outlets and
      other problem environments that contribute to public alcohol problems. Recovering persons and
      concerned family members should be involved in advocating for local community planning that
      results in healthy and safe environments that support recovery. The recovery community can also
      play a role in advocating for legislative changes that would create greater flexibility within the
      Medi-Cal addictions benefit model in the state.
      Strategies need to be developed and implemented to mobilize community resources in support of
      all community members affected by alcohol and drug issues. Advocates need to inform the
      general public, program administrators, and policy-makers about the primacy of alcohol and drug
      issues in our society. There is a need to coordinate advocacy efforts across the many involved
      community and government agencies to lobby state and federal legislative bodies for more
      funding and greater discretion to spend funds according to local needs.
      Administrators of County health, social services, and law enforcement departments and the
      County Board of Supervisors should acknowledge the significant impact of alcohol and drug
      problems on local service systems and demonstrate leadership in policy development in this area.
      One strategy for assisting in this endeavor would be to develop a tri-annual “report card” on
      alcohol and drug indicators for Santa Barbara County, including the amount of county general
      funds directly allocated to ADP for prevention and treatment services. More people need to know
      that prevention is effective, treatment works, and recovery is possible. The stigma associated with
      alcohol and drug problems and their treatment needs to be eliminated.
      The following Goals, Objectives and Actions Steps represent the direction in which ADP will strive
      towards to address Strategic Issue #5: Advocacy.




                                                                                                            27
     Strategic Issue 5. Advocacy


       Goal:

            To broaden the involvement of Santa Barbara County residents, organizations
        ○




            and institutions in advocating for policy change regarding alcohol and drug
        ○
        ○




            prevention, early intervention, treatment and recovery services.
        ○
        ○
        ○




                                    Objective 5.1
                                    Establish a biannual advocacy agenda and strategies
                                    for building a constituency regarding alcohol and
                                    drug legislative issues through June 30, 2007.
                                                            Action Steps
                                    1. ADP staff will monitor and report local, state or federal
                                       legislative initiatives to Providers and County departments.
                                    2. ADP will host an annual Policy Summit each September for
                                       Providers, County departments, advocacy groups, and other
                                       community stakeholders in order to establish advocacy
                                       priorities for the following 12-month period.
                                    3. ADP will seek to establish partnerships with stakeholders that
                                       will publicize and advance the annual legislative priorities.
                                    4. ADP staff will inform the County Legislative Committee and
                                       the Board of Supervisors on annual legislative priorities and
                                       other relative pending legislative initiatives.


                                    Objective 5.2
                                    Increase the number of agencies and coalitions
                                    involved in advocacy efforts around alcohol and
                                    other drug issues by June 30, 2004.
                                                            Action Steps
                                    1. ADP will conduct training for the community, community-
                                       based organizations, and Providers on advocacy through
                                       the “Training Institute”.
                                    2. ADP staff will incorporate advocacy messages into alcohol and
                                       other drug trainings conducted through the “Training Institute”.
                                    3. ADP staff will incorporate advocacy messages into public
                                       education efforts where appropriate.
                                    4. ADP staff will provide technical assistance to all Providers
                                       on incorporating advocacy information for clients and family
                                       members into their services.
                                    5. ADP staff will provide technical assistance to local recovery
                                       advocacy organizations and community coalitions on
                                       statewide networking, acquiring financial support, or other
                                       advocacy related issues.


28
Goal:

    To broaden the involvement of Santa Barbara County residents, organizations
○




    and institutions in advocating for policy change regarding alcohol and drug
○




    prevention, early intervention, treatment and recovery services.
○
○
○




                                     Objective 5.3
                                     Strengthen and support local advocacy efforts by
                                     providing recovering persons and/or their family
                                     members formal representation in systems planning
                                     and policy development by June 30, 2002.
                                                                 Action Steps
                                     1. ADP will request the representation of at least one person in
                                        recovery or family member on the ADP Advisory Board on
                                        Alcohol and other Drug Problems for each supervisory
                                        district.
                                     2. ADP will request the participation of at least one person in
                                        recovery on any planning and policy forum relating to alcohol
                                        and drug issues.




            Advocacy Works! In September of 2000, the recovery community organized a march and rally in Santa
            Barbara to call attention to inadequate detoxification services in South County. The event, attended by
            many local dignitaries and elected officials, resulted in the opening of a public detox program the following
            year. (Photo courtesy of CRN)


                                                                                                                            29
     6 Strategic Issue: Funding

           T
                  he total community need for alcohol and drug prevention and treatment far exceeds the
                  available resources. Mechanisms to access state and federal funds are complex. The
                  alcohol and drug service system is driven, to a large degree, by categorical funding
           designed to address populations that have been under-served in the past. This funding approach
           has also protected the local service system by ensuring that alcohol and other drug service funds
           are not diverted to other uses.
           The alcohol and other drug service system also suffers from the absence of local investment.
           Other county departments managing health and human service programs enjoy more significant
           county support and despite the broad impact created by alcohol and other drug problems locally,
           less than $100,000 in county general funds are allocated to ADP for alcohol and drug services
           each year. The local program has become increasingly dependent on the use of federal funds for
           local services, putting the program at risk in the event of a shift in federal priorities.
           The decision by the state in the mid-1990’s to restrict substance abuse treatment benefits under
           the Medi-Cal program is an example of how the local program can suffer when priorities shift
           outside the local level. The local treatment system experienced significant retrenchment and local
           community-based agencies continue to demonstrate concern when asked to build treatment
           services around Medi-Cal claiming. The local system is only just now beginning to rebuild its
           treatment system through careful reallocation of funds, promotion of Medi-Cal claiming, and use
           of new categorical funds.
           Additionally, the Medi-Cal program for alcohol and other drug treatment services lacks the
           flexibility enjoyed under the “rehabilitation model” by the Mental Health divisions of ADMHS,
           therefore lacking adequate reimbursement for services such as case management, residential care,
           and clinically appropriate individual counseling. An effort needs to be made to advocate for state
           approval of this model for the alcohol and other drug treatment system. Development of service
           relationships with other third-party health coverage plans and a commitment to seek client
           co-payment for services also needs to occur.
           During the Town Hall Meetings, residents expressed concern that due to the absence of adequate
           funding, access to services may only occur as a result of involvement with the criminal justice or
           the public welfare systems. While ADP supports the principle of voluntary participation, we have
           also supported alternative sentencing approaches by strengthening our relationship with the
           criminal justice system through the development of the drug court model. The recent passage
           of Proposition 36, which made available almost two million dollars a year for enhanced
           treatment services for county residents convicted of drug-related offenses, is another alternative
           sentencing approach.
           Additionally, the Sheriff’s Department provides significant funding for in-custody treatment
           and the Probation Department has moved into an active position as a local funder of treatment
           services by their aggressive effort to apply for grants. The Department of Social Services provides
           funding for adult welfare recipients through the CalWorks Project and Child Welfare also funds
           local treatment services. The Tobacco Settlement Advisory Committee under Public Health
           has also provided significant support to ADP through the investment of tobacco settlement funds
           for local treatment services. Attention should be given to improved coordination of these other
           funding agencies.
           Services funded by the County Alcohol & Drug Programs are largely delivered through contracts
           with community-based organizations (CBO’s). This is beneficial in that community-based
           organizations can leverage contract funds to obtain even more resources for alcohol and drug
           prevention and treatment through foundation grants, matching funds, client fees, and private


30
fund-raising as evidenced by the data in the graph shown below. This privatization model requires
significant administrative management as the expectations of mutual performance accountability
between the public and private sector continues to build.
All possible revenue sources need to be maximized for prevention and treatment services and
policy changes need to be explored that will improve our ability to be responsive to local needs. A
local policy that rewards the reduction of costs associated with alcohol and other drug problems
by reinvesting resources back into the local delivery system should be considered. ADP should
promote recognition of the relationship between funding mechanisms, and their restrictions, and
the County’s ability to respond to community needs. At the same time, the County must recognize
the limitations of certain revenue sources, in particular grants. While certainly these sources of
revenue have allowed the County to respond more quickly to local need, there is an inherent
problem with this type of funding, most notably time limits and matching requirements. Ongoing
annual updates to this strategic plan are critical to ensuring that attention to the absence of
community needs, not funding mechanisms, drive the design of our service system.
The following Goals, Objectives and Actions Steps represent the direction in which ADP will strive
towards to address Strategic Issue #6: Funding.



Funding Sources for Santa Barbara County
Alcohol and Drug Program Fiscal Year 2000-01




                                Local Revenue              Medi-Cal Revenue
                                     30%                         27%


                            State General Fund         Federal Block Grant
                                 11%                          32%




     Medi-Cal Revenue1:           $2,253,830
     Federal Block Grant:         $2,670,351
     State General Fund:             $947,191
     Local Revenue:               $2,470,053
     Total Funding:               $8,341,425
     1
      Federal and State Medi-Cal Revenue




                                                                                                      31
     Strategic Issue 6. Funding


       Goal:

            To develop administrative mechanisms that will enable Santa Barbara County to
        ○




            access, maximize and fairly allocate all available funding sources for ADP services,
        ○
        ○




            including federal, state and private dollars, to achieve the goals and objectives in
        ○
        ○




            this plan and meet local needs.
        ○
        ○
        ○




                                      Objective 6.3
                                      Refine and publish an allocation methodology for
                                      ADP funds attentive to local priorities and responsive
                                      to regional services needs by June 30, 2003.
                                                                Action Steps
                                      1. ADP staff, with consultation from local interests, will refine
                                         an allocation methodology for ADP funds.
                                      2. ADP staff will utilize this allocation methodology for future
                                         funding decisions.




                                      Objective 6.2
                                      Increase the amount of private, public, and
                                      foundation funds invested for prevention,
                                      intervention, treatment and/or recovery support
                                      services by 10% by June 30, 2005.
                                                              Action Steps
                                      1. ADP will continue to seek the support of other departments
                                         for local alcohol and other drug services as resources allow.
                                      2. ADP will establish a public speaking unit to support
                                         local foundation investment for local alcohol and other
                                         drug services.




32
Goal:

    To develop administrative mechanisms that will enable Santa Barbara County to
    access, maximize and fairly allocate all available funding sources for ADP services,
    including federal, state and private dollars, to achieve the goals and objectives in
    this plan and meet local needs.

                                             Objective 6.1
                                             Increase Medi-Cal, client fees and other third party
                                             revenue by 15% by June 30, 2006.
                                                                               Action Steps
                                             1. ADP staff will determine trends in Medi-Cal, Title IV-E,
                                                Healthy Families and other third party insurance
                                                claiming annually.
                                             2. ADP will promote partnerships between county departments
                                                and local treatment agencies to promote Medi-Cal, Title IV-E,
                                                Healthy Families and other third party insurance claiming.
                                             3. ADP will prioritize awarding of other ADP funds to those
                                                agencies serving large numbers of uninsured and also
                                                demonstrating improvement in Medi-Cal, Title IV-E,
                                                Health Families and other third party insurance claiming.



  Projected Increases in Medi-Cal, Client Fees, and Other Third Party Revenue

   Projected Annual                 $3,000,000
                                   $3,000,000
   Increases to Achieve
   a 15% Increase                   $2,500,000
                                   $2,500,000
   in Third Party Revenue
   by 2006
                                    $2,000,000
                                   $2,000,000



                                   $1,500,000
                                    $1,500,000




                                    $1,000,000
                                   $1,000,000



                                     $500,000
                                      $500,000




                                             $0
                                             $0
                                                   2000-01
                                                       2000-01    2001-02
                                                                     2000-02    2002-03
                                                                                  2002-03    2003-04
                                                                                                2003-04   2004-05
                                                                                                             2004-05    2005-06
                                                                                                                          2005-06
                      Other Third Party Revenue
                       Other Third Party Revenue     $658,655
                                                      $658,655     $678,415
                                                                    $678,415     $698,174
                                                                                 $698,174     $717,934
                                                                                               $717,934    $737,694
                                                                                                            $737,694     $757,453
                        Client Fees
                      Client fees                     $322,468
                                                     $322,468       $332,142
                                                                   $332,142      $341,816     $351,490
                                                                                               $351,490     $361,164
                                                                                                           $361,164      $370,838
                      Medi-Cal Revenue
                       Medi-Cal Revenue             $2,253,830
                                                   $2,253,830     $2,321,445
                                                                 $2,321,445    $2,389,060    $2,456,675
                                                                                            $2,456,675    $2,524,290
                                                                                                          $2,524,290   $2,591,905
                                                                                                                       $2,591,905




                                                                                                                                    33
      7 Strategic Issue: Administration

                T
                        he transfer of the Alcohol and Drug Program from Public Health to the Mental Health
                        Services Department, which then became the new Department of Alcohol, Drug and
                        Mental Health Services, occurred without benefit of any advance planning. The continued
                absence of a transition plan has hampered the incorporation of ADP into the new organization
                and contributed to an ineffective service structure. In addition, the financial problems experienced
                by ADMHS’s Divisions of Children’s, Adult and Forensic Services has further hampered the
                development of expanded dual diagnosis services, resulting in unrealistic expectations by some
                that ADP should serve as the primary resource. There has been little appreciation for ADP’s
                responsibility for meeting the needs of a service population that predated the movement into
                ADMHS and for meeting the needs of those county residents experiencing mental health issues
                that do not meet the department’s target population.
                                                      In January 2001, the Auditor Controllers Office was
                                                      contracted to evaluate and stabilize the department’s
     “ADP...seeks greater Provider and                fiscal services unit. An outcome of the Auditor Controller
                                                      Office’s involvement was the recognition of ADP’s complex
     consumer participation in discussions            administrative and fiscal responsibilities, leading to
     regarding performance outcomes,                  improved fiscal support. More importantly, the recent hire
     administrative process improvement,              of a new director for the department has contributed
     and service system design.”                      significantly to the enhanced role of ADP within the depart-
                                                      ment. The new director has clearly indicated his support for
                                                      ADP and re-engaged ADP management staff within the
                                                      policy setting level of the department.
                This enhanced level of support brings greater acknowledgment of the unique reporting and
                funding management mandates with which ADP is required to comply. The ongoing challenge
                then is to insure the development of departmental procedures that support the convergence of
                administrative procedures between ADP and Mental Health Divisions while allowing for the
                unique administrative needs of each. In addition, care should be taken to avoid imposing
                significantly new departmental costs on ADP that will diminish the resources available for
                local services.
                The use of contracted services by ADP continues to serve as the primary mechanism for the
                delivery of services. In recognition of this relationship, ADP has striven to develop positive
                relationships with local contractors to strengthen support for greater accountability within the
                local services system and to reach consensus on issues of service and policy development. The
                formation of ADP-hosted contractor forums allows the needs of Providers to be effectively
                communicated while also serving as mechanisms for developing appropriate service standards.
                ADP has established a service presence in the area of assessment in an effort to provide greater
                response to county-funded treatment projects. However, ADP is committed to the continuance
                of its relationship with CBO’s and seeks greater Provider and consumer participation in
                discussions regarding performance outcomes, administrative process improvement, and service
                system design.
                Payment processes should be simplified and accomplished electronically to expedite payment to
                Providers and insure continued delivery of client services. Payment reports should be easy to
                interpret and distributed in a timely manner to allow service Providers to promptly reconcile
                accounts. More frequent cost report schedules should be established to minimize problems at
                year-end. ADMHS should facilitate the development of standards for financial systems at the
                Provider level to insure the viability of the local service system.



34
             Multiple county departments contract with the same agencies for services, but use different
             contracting methods and monitoring processes. This creates an unnecessary administrative
             burden on community-based organizations that provide alcohol and drug services through
             contracts with multiple county agencies. There is a need to streamline administrative processes to
             reduce duplication and improve efficiency, especially in the areas of service definition, contract
             standards and the adoption of standard rates for services. ADP has promoted the development of
             standardized monitoring mechanisms across other county departments to address the duplicative
             service review and reporting processes currently in place.
                                               Cross training is needed among the many service systems that
                                               reach people with alcohol and drug problems. Training and skill
                                               building should insure that staff in each service “doorway” are
                                               competent to screen for alcohol and drug problems and link
                                               clients to needed treatment.
                                               ADMHS should consider the development of parity between
                                               ADP and Mental Health Divisions of ADMHS to address
                                               inequities in the staffing and salary structure within the
                                               department. In order to further advance integration, creation
                                               of a classification that maximizes the knowledge of prevention,
                                               treatment of addictions and mental illness should occur.
                                               Creation of ADP-based administrative intern positions should
                                               be considered to further develop local talent in the area of
                                               substance abuse program management. Attention should be
                                               given to the strengthening of ADP’s contracting process,
                                               especially in light of the need to respond quickly to shifts in
                                               funding, increased attention to contract monitoring and
                                               Provider accountability, and the implementation of Prop 36.
                                              Administrative processes for outcome measurement, quality
                                              assurance, and service standards need to be strengthened. A
                                              performance measure should be designed to enhance Provider
                                              accountability by addressing improved monitoring of ADP-
Cross training among service systems should   funded projects and establishing clear standards for Provider
insure that staff in each service “doorway”   compliance. As ADP assumes responsibility for additional
are competent to screen for alcohol and
                                              programs, its administrative capacity will need to be
drug problems.
                                              concurrently augmented.

The Department’s MIS implementation project should be finalized to insure that data needs are adequately
met. Implementation of the DUI module needs to be completed to support the development of a proposed
new prevention project that will target problem bars or restaurants that contribute to DUI offenses.
The following Goals, Objectives and Actions Steps represent the direction in which ADP will strive towards to
address Strategic Issue #7: Administration.




                                                                                                                  35
     Strategic Issue 7. Administration


       Goal:

            To develop effective and efficient administrative processes that are responsive to
        ○




            the Alcohol and Drug Program service system.
        ○
        ○
        ○




                                     Objective 7.1
                                     Increase integration of ADP administrative and direct
                                     services into ADMHS by preparing an integration plan
                                     by December 31, 2002.
                                                            Action Steps
                                     1. ADP staff will utilize the County’s Process Improvement
                                        Planning Model to identify opportunities for improved
                                        administrative integration between ADP and MHS.
                                     2. ADP staff will prepare a report identifying opportunities for
                                        improving the administration of the alcohol and other drug
                                        program.


                                     Objective 7.2
                                     Provide contract standards for alcohol and other
                                     drug services to other county departments by
                                     June 30, 2003.
                                                            Action Steps
                                     1. ADP will prepare draft standards defining services, modalities
                                        and rates for review by the Inter-Agency Policy Council.
                                     2. The Inter-Agency Policy Council will be encouraged to
                                        adopt such standards for use in contracting for similar
                                        AOD services.
                                     3. The Inter-Agency Policy Council will be encouraged to consult
                                        with ADP in the event of concerns related to the performance
                                        of CBO’S funded to conduct AOD services.



                                     Objective 7.3
                                     Improve and enhance data collection by finalizing
                                     implementation of ADP’s MIS data system by
                                     December 31, 2002.
                                                              Action Steps
                                     1. ADMHS will complete the ADP MIS project.
                                     2. ADMHS will complete the ADP MIS Provider Manual.



36
 Goal:

        To develop effective and efficient administrative processes that are responsive to
  ○




        the Alcohol and Drug Program service system.
  ○
  ○
  ○




                                       Objective 7.4
                                       Improve the financial viability of ADP Providers by
                                       reducing the amount of cost report paybacks or audit
                                       findings by 40% by June 30, 2007.
                                                               Action Steps
                                       1. ADMHS fiscal staff, assisted by a workgroup comprised of
                                          local service contractors and ADP program staff, will develop
      Cost Report                         standards for conducting financial monitoring site visits.
       Paybacks                        2. ADMHS fiscal staff will conduct biannual fiscal site reviews
                                          for ADP Providers identified through the annual cost report
FY 2000-01: $130,000                      preparation process.
                                       3. ADMHS fiscal staff will provide annual technical assistance to
GOAL
                                          ADP Providers identified through the annual cost report
FY 2006-07:     $78,000
                                          preparation process.
                                       4. ADP will make new fiscal year rate adjustments through the
                                          use of fiscal information provided by the cost report process.
                                       5. ADP will explore the feasibility of an advance payment option
                                          to ADP Providers to address reimbursement issues.




      Alcohol and Drug Program Expenditures for Administration and Services


         $8,000,000                                                        3%         ADP Service Staff

         $7,000,000       6%                          6%                              ADP Administrative
                                                                  10%                 Staff
         $6,000,000
                                11%         7%                  10%
         $5,000,000

         $4,000,000                                                                   ADP Provider
                                                                                      Services
         $3,000,000                                                      87%
                       94%                           94%
         $2,000,000             89%        93%                 90%
         $1,000,000

                $0
                      95-96    96-97      97-98     98-99     99-00     00-01




                                                                                                           37
     Strategic Issue 7. Administration


       Goal:

            To develop effective and efficient administrative processes that are responsive to
        ○




            the Alcohol and Drug Program service system.
        ○
        ○
        ○




                                     Objective 7.5
                                     Further integrate Alcohol, Drug and Mental Health
                                     Services by establishing a personnel classification with
                                     specialized alcohol and other drugs andmental health
                                     expertise by June 30, 2003.
                                                            Action Steps
                                     1. ADP, in conjunction with ADMHS Personnel, will establish
                                        an ADP services position classification that reflects the
                                        assessment duties conducted by ADP.
                                     2. ADP, in conjunction with ADMHS Personnel, will establish
                                        an integrated addictions and mental health position
                                        classification within the department.
                                     3. ADP, in conjunction with ADMHS Personnel, will define
                                        the criteria for establishing salary parity between ADP and
                                        Mental Health position classifications.
                                     4. ADP, in conjunction with ADMHS Personnel, will reclassify
                                        ADP staff positions as determined by parity criteria.


                                     Objective 7.6
                                     Improve Provider accountability by establishing
                                     standards for prevention and treatment services and
                                     monitoring activities by December 31, 2002.
                                                             Action Steps
                                     1. ADP, assisted by a work group comprised of local service
                                        contractors and ADP program staff, will develop standards
                                        for conducting prevention and treatment services closely tied,
                                        where appropriate, to State certification requirements.
                                     2. ADP will provide local Providers with a schedule for program
                                        monitoring visits.
                                     3. ADP will provide technical assistance to Providers found to be
                                        in non-compliance with program standards as appropriate.




38
Goal:

    To develop effective and efficient administrative processes that are responsive
    to the Alcohol and Drug Program service system.

                             Objective 7.7
                             Improve and enhance ADMHS and Provider knowledge
                             around the prevention, early intervention, treatment,
                             and recovery for mental health and substance abuse
                             issues by developing an ADMHS “Training Institute”
                             by June 30, 2004.
                                                    Action Steps
                             1. ADMHS staff will work to integrate and better coordinate all
                                trainings on substance abuse and mental health issues.
                             2. ADMHS staff will develop and distribute a training calendar
                                for staff and Providers.
                             3. ADMHS staff will establish a CEU process for CAADAC
                                and CAADC license holders and offer CEU’s at treatment
                                trainings.
                             4. ADP staff will work with ADP Providers to ensure that training
                                is incorporated into their staff development plan.




                           Dual Diagnosis Certificate Program!
                           “ADMHS and Community Based Organizations’ (CBO)
                           staff face the challenges of serving clients with
                           co-occurring alcohol, drug and mental health issues
                           on a daily basis. These staff require specific training
                           and support. As a result, the Department has entered
                           into a newly formed collaborative effort with Santa
                           Barbara City College and Allan Hancock Community
                           College to establish a Dual Diagnosis Certificate
                           Program to compliment their existing Alcohol and
                           Drug Certificate Programs.”
                                                                       — Al Rodriguez, Manager,
                                                                       Alcohol & Drug Programs




                                                                                                  39
     Appendix A:
     Strategic Planning Steering Committee
             Project Lead
                   Al Rodriguez, Manager, Alcohol & Drug Programs, ADMHS
             Project Facilitators
                   Laura L. Mancuso, Project Manager, ADMHS
                   Dennis Pankratz, Project Manager, Probation Department
             ADP Advisory Board
                   Anne Steiner, Chair
             Community-Based Organizations
                   Vida Makowski, Ph.D., Executive Director, Family Life Counseling
                   Frank Banales, Executive Director, Zona Seca
                   Penny Jenkins, Executive Director, Council on Alcoholism and Drug Abuse (CADA)
             Recovery Community
                   Alex Brumbaugh, Project Director, Community Recovery Network
                   Marina Ross, Chair, Program Task Force, Community Recovery Network
                   Deborah Marsh, Chair, Prevention Committee, Lompoc Valley Healthcare Council
             Mental Health Commission/Mental Health Association in Santa
             Barbara/National Alliance for the Mentally Ill
                   Ann Eldridge, Member, Mental Health Commission; Board Member, MHA in Santa
                   Barbara; President, NAMI in Santa Barbara
              Alcohol and Drug Program, ADMHS
                   Nancy Vasquez, Prevention Coordinator
                   Stan Speck, MA, MFT, Treatment Coordinator
                   Carol Nickell, Treatment Coordinator
             Mental Health Services, ADMHS
                   Tricia Hanna (replaced Sharon Westcott), Program Manager
             Department of Social Services
                   Edna Terrell, Deputy Director
             Probation Department
                   Dennis Pankratz (replaced Gene Hutton), Project Manager
             Public Health Department
                   Michele Mickiewicz, Project Manager
             Board of Supervisors District Offices
                   Danielle Casebolt, Administrative Assistant to the North County Supervisors Office




40
Appendix B:
Definitions and Acronyms


        T
                 hroughout this strategic plan, various terms and acronyms are used. Such terms are used
                 for two purposes: to simplify the document and to familiarize the reader with certain
                 terms used in the alcohol and drug field. These terms, while common to those who work
        in the field or related systems, may be unfamiliar to others. The list below is intended to provide
        clarity and understanding to the context in which the term was used.
        ADA means the federal Americans with Disabilities Act.
        ADMHS means the Department of Alcohol, Drug and Mental Health Services.
        ADP means the Division of Alcohol and Drug Programs.
        Addiction means a primary, chronic, neurobiological disease, the development and
        manifestations of which are influenced by genetic, psychosocial, and environmental factors.
        Addiction is characterized by continuous or periodic impaired control over use of the substance,
        preoccupation with its use, and continued use despite adverse consequences and distortions
        in thinking.
        Advisory Board means the Advisory Board on Alcohol and Drug Problems; a citizens group
        appointed by the Board of Supervisors.
        Ancillary (wraparound) services means services in addition to AOD abuse treatment that are
        provided to participants to improve retention in treatment and treatment outcomes.
        AOD means alcohol and other drug.
        AOD Abuse means the use of a psychoactive drug to such an extent that its effects seriously
        interfere with health or occupational and social functioning; abuse may or may not involve
        physiologic dependence or tolerance.
        AOD Dependency means a progressive process that includes 1) compulsion to acquire and use
        AOD’s and preoccupation with their acquisition and use, 2) loss of control over AOD use or
        AOD-induced behavior, 3) continued AOD use despite adverse consequences, 4) a tendency
        towards relapse following periods of abstinence, and 5) tolerance and withdrawal symptoms.
        ASAM means the American Society of Addiction Medicine.
        Assessment means an ongoing process through which a counselor collaborates with the client
        and others to gather and interpret information necessary for planning treatment and evaluating
        client progress.
        Asset-based development philosophy means a concept that promotes developmental asset
        building, social supports and services, and job skill and workforce opportunities to help reduce
        problem behaviors and produce positive long-term outcomes for participants.
        ASI means the Addiction Severity Index, an assessment tool to determine severity of alcohol and
        other drug abuse or dependency; a variation of the ASI is in use for adolescents.
        CADDS means California Alcohol and Drug Data System; refers to the client data collected
        through the ADP-funded treatment programs.
        CalWORKS means a collaborative program between DSS, ADP, and community providers to
        assess and treat alcohol and other drug, domestic violence and mental health issues which may
        impact welfare recipients ability to seek and maintain employment.


                                                                                                              41
     Case management means an ongoing process by which the program establishes linkages with
     other service systems and its providers, acts as liaison between the participants and those other
     systems, and coordinates referrals to ensure access to necessary services to assist participants and
     their families to address their special needs.
     Community assessment means the process by which a neighborhood group gathers and
     interprets information necessary to accurately identify a community’s need for assistance.
     CBO means Community Based Organization.
     Community coalition means a group of individuals who form an alliance to address alcohol and
     drug-related problems in their neighborhood or community.
     Community organizing means the process by which a coalition would involve the community to
     gain support for a policy initiative that would reduce alcohol and/or drug-related problems.
     Community development means the process by which a community learns, understands and
     experiences changing their community to address and reduce alcohol and other drug problems.
     Co-existing disorders means the co-existence of both a DSM IV-defined substance related
     disorder and an Axis II, III, IV, or V mental health disorder.
     Continuum of care means a full range of AOD services available to address the diverse needs of
     participants. A full continuum of care generally includes prevention, intervention, and treatment,
     with a variety of settings and services included within each category.
     Coordinated and/or integrated services means services offered in a manner that is collaborative
     and designed to work toward the same set of mutually understood goals. From a treatment
     service perspective, coordinated services support a structure that results in “whole person”
     treatment plans through use of ADP, MH or other county department resources. For administra-
     tive services, coordinated services indicate the development of departmental standards that take
     into account differences in philosophical and/or unique operational approaches while building on
     effective communication.
     CHDP means Child Health & Disability Prevention Program, a program within Santa Barbara
     County Public Health Department.
     CSAT-TIP means the Center for Substance Abuse Treatment, Treatment Improvement Protocols.
     CSAP means the Center for Substance Abuse Prevention.
     CSAT means the Center for Substance Abuse Treatment.
     Detoxification means acute abstinence syndrome requiring monitoring and management of
     withdrawal symptoms with consideration given to the attending medical issues.
     Diagnosis means a process of examination to determine the nature of a problem or set of
     problems, and the decision or opinion based on that examination.
     DSM IV means the Diagnostic and Statistical Manual of Mental Disorders IV.
     Dual diagnosis means a diagnosis that includes concurrent substance abuse disorder and a
     psychiatric disorder(s) (may also include a physical health disorder).
     DMC means Drug Medi-Cal, the alcohol and other drug benefit package available within the
     California Medi-Cal system that provides for alcohol and drug treatment services.
     DSS means Santa Barbara County Department of Social Services.




42
Environmental prevention means strategies that change the places, settings and occasions where
alcohol or drug use can be or is a problem.
Family means the nuclear family (parents, grandparents, siblings, stepparents, adoptive parents,
foster parents, or legal guardians), extended family (aunts, uncles, cousins), significant others,
mentors, or persons viewed as family members when a participant has no identifiable family.
Family treatment means treatment of a client’s immediate or extended family to coordinate the
treatment plans and goal of client in treatment.
GIS means Geographic Information System, which is a computerized mapping program.
HIV & STD’s means Human Immunodeficiency Virus and Sexually Transmitted Diseases.
High risk participants means participants at high risk for future alcohol and drug abuse.
Lead Agency means the agency designated by the Board of Supervisors to assume administrative
responsibility for SACPA or Prop 36.
Matching means a process of individualizing prevention or treatment resources to a community’s
or participants needs.
Medi-Cal means the California government program providing health/dental benefits to aged,
blind, disabled, refugees, pregnant women, children and/or families with children deprived of
some type of parental support. Benefits may be limited based on citizenship status.
MHS refers to the department of Mental Health Services. As of 1998, the department merged
with the Alcohol and Drug Program forming the new department of Alcohol, Drug and Mental
Health Services.
Mental Health Medi-Cal also is referred to as Short Doyle Medi-Cal.
Mental illness means a DSM-IV Axis I and/or Axis II diagnosis which may or may not involve
functional impairments.
Media campaign means a campaign designed to educate or influence the public through the use
of media, such as television, radio or newsprint.
MISC means Multi Integrated System of Care. MISC is a component within the Children’s Mental
Health program offered by Santa Barbara County Alcohol, Drug and Mental Health Services.
MISC represents a cooperative effort to bring together various agencies in regional locations to
provide multiple services.
Modality means a specific type of AOD approach (prevention, secondary prevention,
non-residential treatment, ancillary service, etc.).
Needs assessment means a process by which an individual or system examines existing resources
to determine what resources are needed or how to reallocate resource to achieve a desired goal.
Participants means the defined target population for prevention or treatment services
(interchangeable with customers or clients).
PH means Santa Barbara County Public Health Department.
Prevention is a proactive process intended to promote and protect health and reduce or eliminate
the need for remedial treatment of the physical, social, and emotional problems associated with
the consumption of alcoholic beverages and drugs. It addresses individuals, the environmental
settings in which they live, and the larger community.




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     Prop 36 means Proposition 36 or the Substance Abuse and Crime Prevention Act of 2000, the
     California citizen’s initiative designed to provide treatment as an alternative to incarceration for
     non-violent drug offenders, voted into law in November of 2000.
     Provider is defined as an agency that has a contract with the Alcohol and Drug Program for
     alcohol and other drug services, including prevention, early intervention, treatment or ancillary
     services.
     Recovery means the process of regaining a healthy balance in the lives of those directly or
     indirectly affected by substance use.”
     Recovery home means a residential facility licensed and certified by the State as having met
     standards for long-term residential care, generally through use of a social model approach.
     Services include personal recovery/treatment planning; educational sessions; social/recreational
     activities; individual and group sessions; and assistance in obtaining ancillary services
     RFP means Request For Proposals and is a process for soliciting grant applications from agencies
     that provide services.
     Resiliency is defined as healthy development despite risk. Resiliency based programs usually
     identify and promote the protective factors (or assets), both individually and environmentally,
     that move children toward healthy adult development.
     SACPA means the Substance Abuse and Crime Prevention Act of 2000. See Prop 36.
     Screening means the use of a brief and simple questionnaire to identify participants who may
     need alcohol and drug treatment by uncovering indicators of alcohol and drug problems.
     SED means Severely Emotionally Disturbed. This is defined as a child who exhibits at least one of
     the five following characteristics: 1) an inability to learn that can’t be explained by mental ability,
     2) an inability to build or maintain relationships, 3) inappropriate behavior or feelings under
     normal circumstances, 4) pervasive mood of unhappiness or depression, 5) tendency to develop
     physical symptoms or fears associated with personal or school problems. Defined by Santa
     Barbara County Education Office. Further definition of this can be found in Chapter 26.5 of the
     Government Code.
     SMI means Severe and persistent Mental Illness, a DSM-IV Axis I formal diagnosis which may
     include an Axis II diagnosis, and always includes functional impairments.
     Sober Living Center means a housing unit operated in association with an established organiza-
     tion or by an informal agreement that adopts an alcohol and drug free environment and other
     house rules designed to support abstinence and recovery. Residents agree in advance to certain
     rules designed to promote a recovery-oriented cooperative living environment. There are usually
     no services associated with a sober living center.
     Sobering services means a set of informal services designed to promote withdrawal from alcohol
     and other drugs in a non-medical or detoxification environment.
     State means the California Department of Alcohol and Drug Programs.
     Substance abuse means alcohol and other drug abuse.
     Title IV means the Safe and Drug Free Schools (SDFS) monies that are allocated to local schools
     from the Federal Government. SDFS dollars provide alcohol and other drug prevention, safety,
     sexual harassment and hate crime education and activities.
     Wraparound (ancillary) services means services in addition to alcohol and other drug
     abuse treatment that are provided to participants to improve retention in treatment and
     treatment outcome.

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