Bullying in the Workplace,*

R02

The BOS should ensure that adequate personnel are designated to be responsible for tracking offenders from the Prop 36 Courtroom, through the treatment process, and back to the Prop 36 Judge, in order to determine rehabilitative outcomes. This recommendation has been implemented. Despite inadequate funding VCBHD still has kept reporting capability intact through existing personnel and the use of automation. The program utilizes a PC 1210 Case Management System with portals in the court as well as at VCBHD provider sites. There is a PC 1210 Referral System that tracks referrals from the courts to the provider sites. There is a California Outcome Measurement System which collects admission and discharge data on clients. Finally, each VCBHD provider site submits progress reports to the dedicated court. The actual supervision of the offenders through the process is maintained by Ventura County Probation Agency (VCPA) staff at an appropriate, although reduced, level. The above aside, it may not be possible to continue providing adequate staff as the Ventura Courts have indicated they will discontinue having a dedicated courtroom for the former Prop 36 Program. If this occurs, continuing in the above manner may no longer be feasible as additional staff would be required in order to have a presence in multiple courtrooms. (

R03

The BOS should ensure that some kind of statistical process be put in place to calculate success, recidivism, and failure rates of the County's Prop 36 program. This recommendation has been partially implemented in that service data is collected from the mechanisms described in the response to recommendation R-02 that allow VCBHD to track PC 1210 client admissions, completions and discharges over the course of their treatment. However, analysis of that data is not formalized into ongoing program reports by either VCPA or VCBHD, and an integrated mechanism across participating agencies does not exist to allow basic recidivism statistics to be determined. Given the lack of funding for the Program and the fact that at Ventura County, alternative existing programs are now being leveraged to treat former Prop 36 program clients, it is difficult to justify investing further in dedicated Prop 36 outcome reporting measures. Under the County's newly initiated program budgeting initiative, performance measures are kept for selected programs. The longer term plan is to have a performance measure for every County program. As departments fully implement program budgeting in the next fiscal year (FY 2012-13), County Executive Office staff will work with VCBHD and VCPA staff to leverage the program measures utilized for the alternative existing programs that now treat former Prop 36 Program clients. Ţ.... VENTURA COUNTY HEALTH CARE AGENCY <b>&</b> VENTUEA COUNTY MEMORANDJM Response to 2010-11 Grand Jury Report Report Title: <u>Under-Enrollment in Proposition</u> ° Report Date: June 10, 2011 Response by: Meloney Roy, LCSW Title; Behavioral Health Director <b>FINDINGS</b> I (we) agree with the findings numbered: N/A I (we) disagree wholly or partially with the findings numbered: FI-02, FI-03, FI-04 (Attach a statement specifying any portions of the findings that are disputed; include an explanation of the reasons therefore.) RECOMMENDATIONS Recommendations numbered N/A have been implemented. • (Attach a summary describing the implemented actions.) Recommendations numbered N/A have not yet been implemented, but will be implemented in • the future. (Attach a timeframe for the implementation.) Recommendations numbered R-02 and 03 require further analysis. . (Attach an explanation and the scope and parameters of an analysis or study, and a timeframe for the matter to be prepared for discussion by the officer or director of the agency or department being investigated or reviewed, including the governing body of the public agency when applicable. This timeframe shall not exceed six months from the date of publication of the grand jury report.) Recommendations numbered ______ will not be implemented because they are not warranted or are not reasonable. (Attach an explanation.) Signed: Mulney Koy Tate: July 22, 2011 Number of pages attached: 3 VCBHD appreciates the Grand Jury's continued interest in the challenges that face the Prop 36 Program, recently renamed PC 1210. As you are aware, the Substance Abuse and Crime Prevention Act (SACPA) was approved in 2000, to provide a cost effective alternative to incarceration for minor, non-violent drug offenders. VCBHD believes strongly that community-based treatment, which results in lower recidivism, is a fiscally responsible alternative to incarceration. FI-02 From the time un offender walks out of the Prop 36 Courtroom until treatment begins, many obstacles exist: long waiting lists for fewer affordable outpatient treatment centers; transportation difficulties; and heavy financial burdens on the enrollees. VCBHD agrees that challenges exist, in a large part due to the fact that this program is an unfunded mandate. Therefore, Ventura County is not unique in the challenges it faces in implementing PC 1210. Other like-sized counties across the State have seen even more significant decreases in referrals and enrollment. Although not ideal, waiting lists are used by multiple counties to balance resources and demands. VCBHD agrees that waiting lists are not preferable. We attempt to ensure that clients are able to access ٠ treatment timely by offering treatment at other VCBHD Alcohol and Drug (ADP) program sites. Should clients choose to remain on the waiting list, they are required to check in on a regular basis, attend interim "Getting Started" services at VCBHD ADP, and are subject to random drug testing. Although VCBHD has instituted client fees for PC 1210, those who qualify for Drug Medi-Cal receive ٠ services free of cost. Depending on income, clients may be eligible for a fee waiver. Of the clients who enroll under the self-pay (fee) option, at least 85% pay consistently. As is commonly done in the Mental Health field and with consideration of the clinical setting, clients are asked to contribute financially to treatment, as their means permit, to promote self-responsibility and commitment to recovery. VCBHD's Alcohol and Drug Programs offer a continuum of services, funded by local, state and federal ٠ resources. Our major sources of funding require that we utilize our resources to treat the most needy and at-risk priority populations, based on criteria such as type of drug use, pregnancy status etc. Court-mandated treatment for criminal offenders, who may or may not meet treatment priority criteria, must therefore be balanced in the context of available resources and the needs of Ventura County residents accessing our continuum of care. Quality is fundamental to positive treatment outcomes. As such, VCBHD has maintained key elements ŧ in our service delivery system to ensure that viable treatment opportunities exist for qualifying PC 1210 clients. VCBHD's services are individualized, evidence and outcome-based, physician directed within a multi-disciplinary team, and utilize sufficient levels of drug testing. FI-03 Most treatment programs are on an outpatient basis because they are less expensive, but they often lack consistency and continuity, thus contributing to a higher dropout rate. Ventura County PC 1210 completion rates are commensurate with State-wide California Outcome Measurement System data, which shows an increase in completion rates from FY 01-02 to 07-08 from 34% to 40%. To put the topic of completion rates into perspective, according to a National Institute on Drug Abuse ****** „Report, relapse rates for drug addiction are similar to those for other well-known medical illnesses such as Type 1 Diabetes, Hypertension and Asthma (Addiction Science: From Molecules to Managed Care McLellan et al., Journal of Addiction Medicine (JAMA), 2000). Due to the chronic nature of the illness, long-term, successful management of drug addiction is likely to involve multiple treatment episodes. Substance abuse addiction requires ongoing treatment and recovery is a continuous process (Inspector General's Special Review into In- Prison Substance Abuse Programs Managed by CDCR, 2007). Inpatient services provide an important acute intervention for some clients, but do not address the chronic and relapsing elements of their addiction. It is also important to note that the clients served in the program have a more chronic and persistent level of drug use than was originally anticipated. Statewide enrollments for Proposition 36 show that 57% of first- time treatment clients had been using drugs for more than ten years and that one in five had been using drugs for more than 20 years. Despite that reality, results of a cost-benefit analysis conducted by UCLA indicated that taxpayers saved $2.50 for every $1 spent on offenders who did not complete treatment and $4 for every $1 invested for offenders who did complete treatment (Evaluation of Proposition 36, Darren Urada, PhD et al UCLA 2008; SACPA Cost Analysis Report, Douglas Longshore, PhD et al., 2006) There is no categorical funding for residential treatment for clients participating in the PC 1210 program. However clients, if they meet criteria and are willing, are able to access residential treatment (including detoxification) through the processes utilized by other clients in our system. Recognizing the need for available male beds, VCBHD has increased the number of available male residential bed days by 129% since FY'06-07. Despite the above noted challenges, VCBHD will continue to review and adapt our programs with the goal of improved access and continuity of care. FI-04 If the offender has financial means, self-payment for an inpatient treatment facility is the best option. Presently, this enables those who are better off financially to have the best chance at rehabilitation. Prop 36 was designed to provide funds for successful treatment to all offenders who met the enrollment criteria, irrespective of financial means. It is unfortunate that state funding for Prop 36 was discontinued and that the program is now an unfunded mandate. To create the opportunity for any offender who desires treatment to access treatment, fees for the PC 1210 Program are based on "ability to pay". As was stated above, clients who meet criteria and are willing to commit to residential treatment are able to access it (including detoxification) through the processes utilized for any other client in our system. It is important to note that Ventura County has an established Adult Drug Court option, designed primarily for clients who are failing in PC 1210 and may be facing long-term incarceration. REC R-02 The BOS should ensure that adequate personnel are designated to be responsible for tracking offenders from the Prop 36 Courtroom, through in treatment process, and back to the Prop 36 Judge, in order to determine rehabilitative outcomes. Despite the lacking funding, many of the original elements related to tracking and treatment outcomes are still in place. Please see tracking mechanisms outlined below in response to REC R-03. REC R-03 The BOS should ensure that some kind of statistical process be put in place to calculate success, recidivism, and failure rates of the County's Prop 36 program. The following data elements are in place currently and allow us to track admission, completions, discharges, and other relevant outcome and performance measures. At this time, a data system, integrated with other agencies, does not exist through which recidivism data would be collected. Case Management System. Clients referred into PC 1210 are tracked via the proprietary Case Management System or CMS. The CMS portal exists inside the dedicated courtroom and allows the VCBHD treatment liaison to provide up to date status reports to the judge, public defender and probation as collected and ٠. entered by the VCBHD provider sites. PC 1210 Referral System. All clients referred through the Quick Start Assessment Center (located inside the Hall of Justice across from the PC 1210 courtroom) are tracked as referrals to the provider sites are made. California Outcome Measurement System. Each provider site collects both admission and discharge data ٠ on clients via the California Outcome Measurement System, as required by State ADP. Finally, each VCBHD provider site submits progress reports to the dedicated court. Response to 2010-2011 Grand Jury Report Form (Insert Fiscal Year) Report Title: <u>Under-enrollment in Proposition 36</u> Report Date: <u>July 12, 2011</u> Responding Agency/Dept. <u>Probation Agency</u> Response by: Patricia E. Olivares Title: Division Manager <b>FINDINGS</b> I (we) agree with the findings numbered: FI-02, FI-04 I (we) disagree wholly or partially with the findings numbered: F1-03 (Altach a statement specifying any portions of the findings that are disputed; include an explanation of the reasons therefore.) RECOMMENDATIONS Recommendations numbered R-02 have been implemented. (Attach a summary describing the implemented actions.) Recommendations numbered R-03 have not yet been ٠ implemented, but will be implemented in the future. (Attach a timeframe for the implementation.) Recommendations numbered ______require further analysis. * (Attach an explanation and the scope and parameters of an analysis or study, and a timeframe for the matter to be prepared for discussion by the officer or director of the agency or department being investigated or reviewed, including the governing body of the public agency when applicable. This timeframe shall not exceed six months from the date of publication of the grand jury report.) Recommendations numbered ___ _will not be implemented because they are not warranted or are not reasonable. (Attach an explanation.) Thisin E. Olivar Signed: _ Date: August 16, 2011 Number of pages attached: 3 Response to 2010-2011 Grand Jury Report Form (Insert Fiscal Year) Report Title: <u>Under-enrollment in Proposition 36</u> Report Date: July 12, 2011 Responding Agency/Dept. Probation Agency Response by: Patricia E. Olivares Title: <u>Division Manager</u> <b>FINDINGS</b> I (we) agree with the findings numbered: FI-02, F1-04 FI-02 From the time an offender walks out of the Prop 36 Courtroom until treatment begins, many obstacles exist: long waiting lists for fewer affordable outpatient treatment centers; transportation difficulties; and heavy financial burdens on the enrollees. Response: Long waits: Some offenders have waited up to 9 months or more (on "Getting Started" (GS) wait list). After court, a defendant immediately reports to the Quick Start Center for assessment (or within 72 hours of release if in custody). The offender is then assigned to a particular group based upon their geographic residence. The majority are placed on a waiting list ("Getting Started" meetings) as the groups are routinely full. These GS meetings take place twice monthly. Average wait is anywhere from 4 to 6 months. (NOTE: In some cases, the offenders contribute to this challenge by their own violations of the ADP protocols: If a defendant misses a GS meeting, they will be "bumped to the back of the line" per ADP policy. Missing a GS meeting usually results in a Treatment Reporting Form (Violation of Probation) filed by ADP with the Court. Transportation: The only program we are aware of that provides transportation is A New Start For Moms (ANSFM). This is reserved for moms and moms-to-be and is based upon space, and availability. Many offenders do not possess a California Driver's License, do not own or have access to a vehicle and often lack support systems. These obstacles can make it difficult for the offender to attend treatment. Therefore, most program/treatment sites are assigned based upon the residence of the offender in order to make transportation more feasible. Those offenders living in Santa Paula, Ojai and Fillmore must attend programs located in Oxnard or Ventura. Offenders residing in East County attend Simi Valley ADP. Financial Burdens: Offenders who request a stay on fines/fees are routinely granted a 90 day stay on those fines/fees at time of sentencing (or, upon their first request following sentencing). Beyond 90 days, they can request a financial evaluation and get the fines/fees further stayed or pay at a reduced scale as determined by their ability to pay. As to program/treatment costs, defendants are sometimes violated or disqualified (DQ) for inability (or unwillingness) to pay the treatment costs. However, when failure to pay is the only violation, the Court team does not automatically consider it to be a violation leading to a strike or DQ from Prop 36. The offenders in these cases are often granted an opportunity to work with ADP on setting up a financial plan or making application to General Relief. Should they fail to seek assistance or meet with treatment to devise a plan, then a penalty (i.e. strike or DQ) is imposed. In some rare instances, the Court has allowed offenders to seek treatment elsewhere as a means to provide treatment sooner and/or reduce their financial burden if the alternative program is offering them a better rate or sliding scale. FI-04 If the offender has financial means, self-payment for an inpatient treatment facility is the best option. Presently, this enables those who are better off financially to have the best chance at rehabilitation. Prop 36 was designed to [provide funds for successful treatment to all offenders who met the enrollment criteria, irrespective of financial means. Response: We agree offenders who are in need of inpatient treatment should receive these services. ADP was using Prop 36 funding for inpatient programs at Khepera House and Prototypes. It is uncertain whether ADP will be able to continue funding these programs after the loss of the Prop 36 funding. Offenders who do not have the financial means to pay for inpatient treatment can apply for General Relief and obtain approval for that funding. Alternatively, there are some free sober/residential homes such as Salvation Army, Teen Challenge and Rescue Mission. Additionally, there are other spiritually based recovery homes. I (we) disagree wholly or partially with the findings numbered: FI-03 (Attach a statement specifying any portions of the findings that are disputed; include an explanation of the reasons therefore.) FI-03 Most treatment programs are on an outpatient basis because they are less expensive, but they often lack consistency and continuity, thus contributing to a higher dropout rate. Response: We do not feel we are in a position to make an informed response to this finding. VCBH is responsible for assessing clients and referring them to treatment providers. RECOMMENDATIONS Recommendations numbered R-02 have been implemented. (Attach a summary describing the implemented actions.)