San Luis Obispo County Grand Jury
• 2017-2018
How Long Will the Need Go Unfulfilled?
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings and Recommendations 10 findings
F1
Available and affordable residential detox services are necessary for delivering comprehensive substance abuse treatment in San Luis Obispo County.
Related Recommendations (1)
R1
The County Health Agency’s Drug and Alcohol Services should resume its concentrated efforts to develop a residential detox service in the County to serve its Medi-Cal and less financially able citizens.
F2
The opening of the Haven provides needed detox services for County residents who are privately insured or can afford the high costs.
Related Recommendations (1)
R2
The Board of Supervisors should direct the Sheriff and the Health Agency to evaluate the feasibility of and approach to repurposing vacated buildings within the County Jail’s honor farm as a residential detox service. A final report on the feasibility and if indicated the specific steps 17 required to convert this housing to a substance-abuse residential and/or treatment facility should be completed by June 2018.
F3
There are no residential detox services available in the County for those with limited financial resources or insurance through Medi-Cal or Medicare.
Related Recommendations (1)
R3
The County Health Agency’s Drug and Alcohol Services should expand its County Jail programs, including individual and group counseling, to cover inmates who go through withdrawal protocols regardless of AB 109 status.
F4
The County Jail provides physical detox to newly admitted inmates but fails to provide the additional psychological and social treatments and supportive environment essential for the first phase of addiction treatment: detox-stabilization. 16
Related Recommendations (1)
R4
The County Jail should revise inmate classification and cell assignment to take into account the inmate’s substance abuse treatment needs and interest in such when determining cell placement.
F5
There are some arrestees currently booked in the County Jail who would be more effectively served by a diversion program, like Law Enforcement Assisted Diversion, and/or receiving treatment in a residential substance-abuse facility.
Related Recommendations (1)
R5
The County Jail should house inmates interested and/or involved in drug and alcohol services in such a way as to create groups of addiction-treatment participants (e.g., units or pods) that allow for efficient delivery of treatment services; this includes separation from other inmates who interfere or disrupt treatment participation.
F6
There is a lack of integration in how medical and drug/alcohol services are provided at the County Jail.
Related Recommendations (1)
R6
The County Health Agency and Sheriff should integrate the functions of the jail’s medical and drug and alcohol service providers by locating their offices in close proximity and requiring coordinated care for inmates with substance use disorders.
F7
The use of medication-assisted approaches for detox and addiction treatment at the County Jail is limited while other jurisdictions have been able to provide such treatments.
Related Recommendations (1)
R7
The County Health Agency should pilot the usage of medication-assisted treatments, i.e., Buprenorphine and Naltrexone, with a select population of opioid and alcohol addicts at the County Jail.
F8
Logistical and environmental challenges at the County Jail make delivery of drug and alcohol treatment services difficult and inefficient due to placement of inmates with substance use disorders.
Related Recommendations (1)
R8
The Board of Supervisors should evaluate the Law Enforcement Assisted Diversion program or a similar pre-booking substance abuse diversion for County implementation as a means of motivating and engaging young adult arrestees who are assessed to be primarily substance abusers and not criminally oriented. A written evaluation by the County Administrative Officer should be reviewed at a meeting of Board of Supervisors by June 2018. 18
F9
With the opening of the women’s jail, there is unused space in the honor farm which presents an opportunity for alternative program development.
Related Recommendations (1)
R9
The San Luis Obispo City Council should evaluate the Law Enforcement Assisted Diversion program or a similar pre-booking substance abuse diversion for City implementation as a means of motivating and engaging young adult arrestees who are assessed to be primarily substance abusers and not criminally oriented. A written evaluation by the City Manager should be reviewed at a meeting of the San Luis Obispo City Council, by June 2018.
F10
The homeless shelter has no clear plan as to how it will provide its long-anticipated detox beds/service.
Related Recommendations (1)
R10
The County Health Agency should direct its Drug and Alcohol Services to work with the board of the homeless shelter to develop a plan for operationalizing two detox beds in the yet-to- be-built Homeless Services Center, which could entail the DAS providing onsite outpatient detox services if other treatment options are not viable. This plan is to be developed prior to the opening of the center or by June 2018.
Conclusions 1
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CL1The Grand Jury completed an extensive investigation into the history, need, and future plans for residential detox services in San Luis Obispo County. This need has been apparent since 1982 4 Outpatient—less than nine hours of service per week for adults, less than six for youth 5 Intensive Outpatient—nine or more hours of service per week for adults, more than six for youth 15 2016-2017 Report on Detox Services when the detox unit at General Hospital closed its doors. The addition of the Haven last year reduces the need for those who can afford or have private insurance to cover the high costs. For those less fortunate, the county jail remains as a de facto detox facility and it is not an option for most residents in need. Addicts admitted to the jail experience services that are less than optimal. Jail staff and service providers have identified areas for improvement. Though medicines are used for short-term withdrawal management, the standard medication assisted treatments for opioid addiction are rarely employed at the jail. And, some substance-abusing inmates are considered as simply misplaced in the jail setting. As an alternative, a police-led, pre-booking diversion program (LEAD) was identified as a way to better serve some lower-level drug and alcohol offenders, including residential treatment when needed. Coincidentally, space for alternative programs or repurposing has become available on the grounds of the jail with the relocation of female honor-farm participants to the new women’s jail. For the County’s homeless whose addiction rates run very high, the long-planned detox beds at the soon-to-be-completed Homeless Services Center remain possible but appear to lack a clear plan. And lastly, the Grand Jury notes the likely positive impact that the County’s DMC-ODC Implementation Plan will have on detoxification services, if that plan comes to fruition.