I Countyexecutiveoffice John F. Johnston

through F-11 The CountyCIerk concurs.

Offheeightfacilities visifed, six are undercontractwith fhe eounr, whereas, VCMCandMagnoliaHeallh Center aperateddirectlyby the CountyofVentura. are Ofthe 8 facilities visitedby the GrandJury, only VCMC is operatedby the County. Althoughthe County the other7 facilities, they operatedby independent owns are physician contractors. 1

If a non-violent drug offender chooses not to participate in Prop 36 treatment, another treatment option is available under the Penal Code. In the pre-plea diversion statute and program (c,Diversion"), a defendant may plead guilty to a non-vialent drug usage offense and receive a "deferred entry ofjudgment" in order to obtain drug treatment. According to the statute, "The period during which deferred entry ofjudgment is granted shall be for less than 18 months no nor longerthanthree years." The courtsclosely monitor the defendant's progress, and the criminal charge or chargesmay be dismissed ifthe defendant successfully completes treatment. HallofJustice, 800South Victoria Ave., Ventura, CA 93009 www.ventura.org./vcda/ (80S) 684-2500 Fax (805) 654-3850 & The Honorable Bruce A. CIark August 16, 2004 Diversiondoes not require a choicetonever participate in Prop 36 treatment. Diversion eligible defendantsoften are still eligible for Prop 36 treatment even afterthey fail to successfully complete Diversion.

Disagree I Thejail programs and the work furlough Stages program are education programs only and nottreatmentprograms. Not all offenderswith substance abuse problems are efigible for these programs. Offenders must fiil out a program screening form ifthey are interested in the Substance Abuse Program and have 30+days left. The Drug and Alcohol Abuse Education (DEUCE) program is onlyavailable to inmates in Quad 300N. HillmontAvenue,Ventura,CA. 93003. (805) 652-6737 FM: (805) 652-6160 " wvw.vchca.orgfbh I I Page4 D ofthe Todd Road jail facility. Most of the offenders have experienced trauma in their lifetime and need more than education to deal with these underlying factors that play major role in their addiction. a

Partially Concur Referto response to Finding 17. Thejail programs and the work furlough Stages program are education programs only and nottreatment programs. Most PC 1000 Diversion Programs are considered education only. One Ventura Gounty program offers prevention, education, and treatment.

The Ventura County District Attorney's OFFice, along with CFS, caunty law enforcementagencies and the Ventnra Coun HealthCare Agency have developed Safe Harborto helpchild victimsofsexual andphysicalabuseand severe neglect; and

The location ofthe Safe Harbor site in Ventura is injeopardy due to high cost of therental spaceandcurrentcountywidebudgetproblems; I with both findings and commend the Grand Jury for achiowledging the value ofthe concur SafeHarborprogram in helpingchildvictims ofabuseandneglect andtheirnonoffendingfamily members access vital criminal justice, medical and counscling services. I must also state my e HallofJustice, 800SouthVictoriaAve.,Ventura, CA 93009 www.ventura.org.Jvcda/ (805) 654-2500 Fax(80S) 654-3850 I I TheHonorableBruce A. Clark I June 10, 2004 I PageTwo slxong support and concurrence with the Grand Jury's recognitionthat the Safe Harbor program facesfmancialjeopardydue to its highrentcostforits Venturafacilityandlocal budgetcuts. Responseto Recommendation: In referencetothe GrandJuryReport'srecommendation:

Parfially Concur Throughoutthe report the Grand Jury refers to the Oversight Committee. This is The Implementation Committee evolved into the erroneous. hn Operations Committee. OversightCommittee was never formed. Final policy oversight rests with the Board of Supervisors.

Concur 300 N. HillmontAvenue Ventura, CA,93003. (sos) 652-673T. FAX: (805) 652-6160 * www.vchca.orglbh I I

Parfialfy Concur Probation and Parole are responsiblefor supervision. BHDFADP and the treatment providers responsible for management. are case

Partally Concur The MOA drafted, but submitted. was never

Concur F44 Concur F45 Concur

Concur F-46 PartaUy Concur BHD/ADP agrees with all except the last sentence. On a first violation persons afe usually referred back to treatment, which may be more intensive. N. HillmontAvenue,Ventura,CA.93003 (805) 652-6737, FAX: (805) 652-6160 " www.vchca.org/bh I I F-4T Concur I F-4S Concur I F-49 Cancur F-50 Concur F-S1 Concur F-52 Concur F-53 Concur F-54 Unable fo Gommenf F-55 Unable to Comment I F-56 Concur F-57 Unable to Comment F-58 Concur F-59 Concur F-60 Concur F-61 Disagree Providers recognize that some clients experiencing co-occurring mental health and substanGe abuse disorders cannot benefitfrom treatmentuntil they have received psychiatrictreatment and stabilized are on medications. Just clientwith acute medical condition cannot as a an benefitfrom substance abuse treatmentintil their medical condition is stabilized. Protocols have been developed for referring clientsfor psychiatric Clients with co-occurring dual disorders hive services. or different treatment needs than clients having only alcohol other drug an or use disorder. The mostfrequently used treatment models include sequential treatment of each disorder, parallel treatmentof each disorder, 300 N. HillmontAvenue Ventura, CA. 93003. (805) 652-6737. FAX: (sos) ssz-siso - www.vchca.org/bh I I and integrated treatmentof both disorders. Several possible retationships exist between alcohoi and drug and psychiatric symptoms and use disorders. Alcohol and drug induce, diminish use can worsen, or psychiatric symptoms, complicatng the diagnostic process. (Center for Substance Abuse Treatment, "Assessment and Treatment of Patients with Coexisting mental lllness and Alcohol and Other Drug Abuse" Treatment Improvement Protocol Series 9.) F-62 Concur F-63 Disagree BHD/ADP is unaware of any staffthat made this statement. F-64 Disagree "Unamenable" is not behavioral health term. a F-65 Partially Concur The reference should be to memberof the Operations Committee not a Oversight Committee. r~eferto Finding 25 response. F-66 Unable to Comment I F-67 Disagree BHD/ADP is unaware of any staffthat made this statement. F-68 Unable to Comment F-69 Unable to Gomment I F-70 Unable to Commenf F-71 Partially Concur BHD/ADP concurs with the first sentence. Referto the response to

PartaUy Concur BHD/ADP agrees with all except the last sentence. On a first violation persons afe usually referred back to treatment, which may be more intensive. N. HillmontAvenue,Ventura,CA.93003 (805) 652-6737, FAX: (805) 652-6160 " www.vchca.org/bh I I

regarding working with clients with mental health and substance abuse disorders. BHD/ADP disagrees with generalizing mentally ill clients long-term criminals. The Diagnostic and Statistical as 300 N. HillmontAvenue Ventura, CA. 93003,(805) 652-6737. FAX: (805) 652-6160 - www.vchca.org/bh I I Manual (DSM IV) differentiates between persons with mental disorders and persons with persanalitydisorders. The remainderof this finding appears to be referring to individuais with Antisocial Personali Disorder. There is also a difference between individuals being unable to engage in treatment and those unwilling to participate.

Disagree BHD/ADP is unaware of any staffthat made this statement.

Disagree "Unamenable" is not behavioral health term. a

Partially Concur The reference should be to memberof the Operations Committee not a Oversight Committee. r~eferto Finding 25 response.

Disagree BHD/ADP is unaware of any staffthat made this statement.

Partially Concur BHD/ADP concurs with the first sentence. Referto the response to Finding 61 regarding working with clients with mental health and substance abuse disorders. BHD/ADP disagrees with generalizing mentally ill clients long-term criminals. The Diagnostic and Statistical as 300 N. HillmontAvenue Ventura, CA. 93003,(805) 652-6737. FAX: (805) 652-6160 - www.vchca.org/bh I I Manual (DSM IV) differentiates between persons with mental disorders and persons with persanalitydisorders. The remainderof this finding appears to be referring to individuais with Antisocial Personali Disorder. There is also a difference between individuals being unable to engage in treatment and those unwilling to participate. F72 Partially Concur I It originally understood that Proposition 36 for non-violentdrug was was offenders. However, the law has been interpreted to mean thatthe offender was not committng a violent offence at the time of the arrest. In fact, individuals with violent criminal histories and gang involvement are being referred to Proposition 36 by the criminal justice system. This is one of the Oaws in the law. Treatment providers have safety and concerns, have done goodjob in averting potentiallyviolent situations. a I

Partially Concur I It originally understood that Proposition 36 for non-violentdrug was was offenders. However, the law has been interpreted to mean thatthe offender was not committng a violent offence at the time of the arrest. In fact, individuals with violent criminal histories and gang involvement are being referred to Proposition 36 by the criminal justice system. This is one of the Oaws in the law. Treatment providers have safety and concerns, have done goodjob in averting potentiallyviolent situations. a I F-73 Concur

Concur F74 Parfially Concur This may have been true prior to the high court decision filed 8/8f03. Penal code 1210.1 subdivisioR (b) sets forth five categories of defendants who are ineligible for Prop. 36; #5 states "have twice failed drug treatment condition of probation and been found notto be amenableto drug as a treatment"- This high court decision includes defendant's who do not show up for assessment, treatment, or probation. Since the decision, the judge has been diligent in deeming defendants ineligible.

Parfially Concur This may have been true prior to the high court decision filed 8/8f03. Penal code 1210.1 subdivisioR (b) sets forth five categories of defendants who are ineligible for Prop. 36; #5 states "have twice failed drug treatment condition of probation and been found notto be amenableto drug as a treatment"- This high court decision includes defendant's who do not show up for assessment, treatment, or probation. Since the decision, the judge has been diligent in deeming defendants ineligible. F-75 Concur F-76 Parlially Concur The Court determines strikes, when a defendant strikes out, and when a defendant unamenable. is F-77 Parfially Concur The protocol states, "Clients who are resistant to treatment and refuse to pay program fees may be determined to be non-compliantn* Clients can not be deemed non-complaintfor not paying their program fees alone. Title 9 also differentiates between the inability to pay and the refusal to pay.

Parlially Concur The Court determines strikes, when a defendant strikes out, and when a defendant unamenable. is

Parfially Concur The protocol states, "Clients who are resistant to treatment and refuse to pay program fees may be determined to be non-compliantn* Clients can not be deemed non-complaintfor not paying their program fees alone. Title 9 also differentiates between the inability to pay and the refusal to pay. F78 Concur

Concur F-79 Concur 300 N. HillmontAvenue,Ventura,CA-93003. (805) 652-6737. FAX: (805) 652-6160 v,vt/w.vchca.orgfbh I I Page g F-80 PartiallyConcur An Operations Committee exists, not Oversight Committee. Referto an response to Finding 25.

Concur 300 N. HillmontAvenue,Ventura,CA-93003. (805) 652-6737. FAX: (805) 652-6160 v,vt/w.vchca.orgfbh I I Page g

PartiallyConcur An Operations Committee exists, not Oversight Committee. Referto an response to Finding 25. F81 Ursable to Gomment

Ursable to Gomment F-82 Parfially Concur Refer to response to Finding 61. BHD/ADP does not referto mentally ill clients being unamenable to treatment. It is importantto place clients as in the right treatment. Otherthen MART, and the Juvenile Adelante Court, Ventura County does not have designated mental health court. a F-83 Concur F-84 Concur F-85 Unable to Gamment F-86 Parfially Concur Prop. 36 eligible drug offenderswith misdemeanorcharges who optoait of treatment usually sentenced to 90 days in jail. Every dollar irivestsd in are treatment yields return of$7 saved (Department ofAlcohol and Drug a Programs, CALDATA Report). According to the Justice Policy Institute, Ventura County taxpayers spent $5.8 million in 1999 to imprison drug offenders, ofwhich nearly two-thirds ($3.1 million) spent prisoners was on sentenced for low-level drug possession charges. I F-87 Unable to Comment F-88 Goncur

Parfially Concur Refer to response to Finding 61. BHD/ADP does not referto mentally ill clients being unamenable to treatment. It is importantto place clients as in the right treatment. Otherthen MART, and the Juvenile Adelante Court, Ventura County does not have designated mental health court. a

Parfially Concur Prop. 36 eligible drug offenderswith misdemeanorcharges who optoait of treatment usually sentenced to 90 days in jail. Every dollar irivestsd in are treatment yields return of$7 saved (Department ofAlcohol and Drug a Programs, CALDATA Report). According to the Justice Policy Institute, Ventura County taxpayers spent $5.8 million in 1999 to imprison drug offenders, ofwhich nearly two-thirds ($3.1 million) spent prisoners was on sentenced for low-level drug possession charges. I

Concur F-90 Concur F-91 Goncur F-92 Partially Concur The Implementation Committee evolved into the Operations Committee notthe Oversight Committee (refer to the responsefor Finding 25). A representative from the CEO office the original chairperson ofthe s was Implementation Committee and meeting minutes published during were 300 N. HillmontAvenue Ventura, CA 93003.(805) 652-6737. FAX: (805) 652-6160 - " www.vchca.org/bh this time. When he stepped down in October 2001, the Committee voted a representative from the Public Defenders ofOce the chairperson. as new When the second chairperson stepped down in August 2002, the Committee nominated and unanimouslyvoted in representativefrom the a Lead Agency (BHDFADP) the chair. as F-93 Concur F-94 Partially Concur This is an Operations Committee not an OversightCommittee (refer to response for Finding 25). Numerous reminders of meetings and invitations have been extended to the Sheriffs Department and law enforcement council to attend the Operations Committee meetings, and statewide Making It Work Conferences. F-95 Partially Concur This is Operations Committee not OversightCommittee (refer to an an response for Finding 25). I F-96 PartiaUy Concur This is an Operations Committee not an O erstght Committee (refer tc response for Finding 25). F-97 Concur F-98 ConGur I F-99 Concur F-100 Concur F-101 Concur F-l02 Parfially Concvr Clients who do not contact the assessment centerwithin 5 days to schedule an assessment appointment are non-complied. During the first year, there were times when assessment appointments were booked out for three weeks. This was remedied by the second year and is no longer the case. Additional staff were hired and adjustments were made to the scheduling of appointments. The assessment calendaris closely 300 N. HillmontAvenue Ventura, CA. 93003. (805) 652-6737. FAX: (805) 652-6160 * vNININ.vchca.org/bh 1 I monitored to ensure timely appointments. Clients usually entertreatment the weekthey assessed. same are F-103 ConGur F-104 Concur F-105 Goncur F-106 Disagree I BHDFADP reviewed various types ofthe ASI, including self-administered formats. As of 10 Focus Counties selected to participate in the one statewide evaluation of the Substance Abuse and Crime Prevention Act of 2000 (SACPA), UCLA who is conducting the evaluation, did not want us to use self-administered ASI's as the reliability and validity were not as good. F-107 Parfially Concur The last sentence is incorrect. Proposition 36 mental health services are funded through the Substance Abuse TreatmentTrust Fund (SATTF) allocation, and not SAMHSA grant. a F-108 Concur F-109 Concur F-110 Concur F-111 Gancur F-112 Concur F-113 Goncur F-114 Parfially Goncur 500% of the Prop. 36 clients in Ventura County have not had any prior drug treatment. It is unknown whetherthey previouslyoffered were an opportunityfor treatment. F-115 ParfiallyConcur Refer to response for Finding 102. N. HillmontAvenue,Ventura, CA 93003. (805) 652-6737. FAX: (805) 652-6160 " www.vchca.org/bh I I F-116 Concur F-117 Unable to Comment F-118 Unable to Comment F-119 Unable to Comment F-120 Unable to Comment This broad generalization that does not apfly to all people. Research is a has shown the different stages of mothration and stages of change that clients go through. F-121 Disagree BHDFADP recognizes the importance of holding clients accountable through continual communication. Staff trained to check out and are verify information provided by clients. F-122 Concur F-123 Parfially ConGvr Probation and Parole supervise, BHD/ADP case manages. F-124 Concur As stated the Second Year Report, 2580 initial assessments had been in conducted since the inception ofthe program. F-125 Parfially Concur Treatment providers submit CADDS, PSR and DATAR forms each month. A GADDS form is completed every time there is a change in a client's status (new enrollment, re-enrallment, transfer to another program, discharge), Therefore, a CADDS form is not completed on every client every month. Providers also submit units of service (outpatient programs) bed days (residential praviders) for each client monthly basis. or on a Residential providers submit progress reports (treatment level reviews) each month. Outpatientproviders report clients the first 30 days and on then submit progress reports every 90 days. Out patient providers submit attendance group logs on a daily basis to the assessment center. Drug test results from the lab come daily to the assessment center and are then 300 N. HillmontAvenue,Ventura,CA. 93003.(805) 652-6737, FAX: (805) 652-6160 www.vchca.orgibh I faxed to the various outpatienttreatment providers. F-126 Partally Concur With the removal of the firewall September2003, there in are no requirements for assessment center case managers to meet with clients face to face, the treatment providers contact probation officers as now directly instead afgoing through the assessmentcenter. I F-127 Parfially Concur Site visits of both residential and outpatient providers conducted. are F-128 Concur F-129 Concur F-130 Partially Goncur Positive lab results are placed in client charts. A record of all of a client's drug tests is printed and placed in the client's chart. Electronic submission of drug testing resultsfrom the lab and connected to the CMS database is projected to be completed by the end ofthe first quarterthis year. We are waiting for outside vendor to complete work needed to implement. F-131 Concur It is the responsibilityofthe treatment praviders to noti the assessment centerof c)ient compliance and non-compliance. F-132 Concur I F-133 ParfiallyConcur A report is generated each month showing the numberof negative drug tests and positive tests by drug. F-134 Concur F-135 Partially Concvr BHDFADP has not been given full access to the criminaljustice data system and the DistrictAttorney's representative and representative's from Probation continue to not agree with providing information from their areas. Should BHDFADPbe given access and should agreed upon soon. niiiriont Avenue `Ventura, CA-93003.(805) 652-5737, FAX: c805) 652-6160 www.vchca.orgfbh I Q reporting from each area be provided, BHD/ADP has sufficientstaffto analysis, report and provide information. A Statistician is not needed. F-136 Concur F-137 Concur F-138 Concur F-139 Concur F-140 Concur F-141 Concur F-142 Concur F-143 Concur F-144 Concur F-145 Concur F-146 Concur F-147 Concur F-148 Concur F-149 Disagree According to the American Socie ofAddiction Medicine (ASAM) placement criteria not all clients need the same length of treatmentand treatment plans should be individualized based on the needs ofthe client. The initial referral of 30 days is used checks and balances to as a insure that clients are progressing and getting the treatmentthey need, and not being kept iQ treatmentjust to keep a bed filled. Residential providers must submit treatment level reviewform based ASAM placement a on criteria on each client every 30 days. F-150 Concur F-151 Unable to Comment F-152 Concur 300 N. HillmontAvenue Ventura, CA 93003. (805) 652-6?37. FAX: (805) 652-6160 - " iNwrN.vchca.org/bh F-153 Unable fo Gomment F-154 Unable to Comment F-155 Concur F-156 Disagree BHDFADP contracts require drug-free workplace and this is enforced. F-157 Disagree BHDFADP contract monitoring and quality controls and increased can are whenever necessary. F-158 Concur F-159 Concur F-160 Concur F-161 Concur F-162 Concur F-163 Concur F-164 Concur F-165 Unable fo Comment F-166 Partially Concur Referto response for FJnding 135. F-167 Cancur F-168 Concvr F-169 Concur F-170 Parfially Concur Protocols, including the satisfactory completion protocol originally were developed by the Implementation Committee. Some ofthe original 300 N. HiilmontAvenue Ventura, CA, 93003. (805) 652-6737. FAX: (805) 652-6160 * v,ww.vchca.org/bh I ! protocols based compromises with criminaljustice, and research were on and evidenced based clinical practices. There would be chaos without standardized protocols. Treatment providers ware not part ofthe Implementation Gommittee, buttaco representatives part ofthe are now Operatians Committee. As the program has evolved from implementation, certain changes have been made and representatives from treatment programs have been involved in these changes. Treatment providers review and update treatment plans with clienls and submit progress reports every 90 days on each client. One treatment provider developed card for each clientto record individual a score progress. The Addiction Severity Index (ASI) and drug testing are administered atthe time ofdischarge. Clients testing positive not are discharged, but remain in treatment. Ghanges and decisions based are sound clinical, ethical, and Iegal decisions. Provider contracts on were adjusted to units of service order to better meet the needs of individual in clients. I BHDFADP has agreed to not inciude the treatment providers the in Operations Committee. F-171 Concur The Assessment Center liaison to the dedicated court has objected to offenders referred to Proposition 36 to avail. BHDFADP is concemed no when cases involving drug dealers and gang members are pled down and these individuals have to be referred to treatment. Similar to the referral to mentally ill treatment, BHDIADP would like to be involved in the assessment and appropriateness of clients prior to their being sentenced to Prop. 36 treatment. Also, referto response for Finding 72. BHDIADP has proposed strictertreatment protocols for the first 30 days of treatment to try and determine those who serious about treatment from those are who not. BHDJADP hopes that the other partners in criminaljustice are will also reviewtheir protocois to keep these people out oftreatment. F-lT2 Concur F-173 Coneur F-174 Concur F-175 Concur F-176 Goncur F-177 Disagree 300 N. HillmontAvenue ,Ventura, CA 93003. (805) 652-6737 FAX: (805) 652-6160 " " www.vchca.org/bh I Underthe sub-heading "Violatton CriteriafProtocol"of the Non- Compliance Policy it states, "The Case Managersubmits violationlnon- compliance report with the CourUProbation within hNo business days of latest incident, utilizing the Non-compliance Form". A specific protocof is then iisted for each violation. F-178 Concur F-179 Unabfe to Comment. F-180 Partially Concur The formula the State used to calculate each county's allocation for 2001- 2004 based 50% county population, 25 % drug arrests, and 250% was on treatment load. The formula that used Tfll04 is based case was on on 50% population, 40% caseload, and 10% drug arrests. F-181 Concur F-182 Disagree The numberof treatment completions tracked monthly and provided in are report distributed to the BHDJADP Directors, Operations Committee, a and ADP Advisory Board. A copy of this report was gi fen to the Grand Jury several times. As of the end of May 2004, 628 cJents had satisfactorily completed treatment. Clients can requestto llave their expunged (removed from theircourt record) after completing cases treatment, paying all fines and fees, and complying with all terms oftheir probation. As of the end of May, 65 clients have had theircharges expunged. BHD/ADP does not have accessto recidism information unless the offenders pick up ancther Prop. 36 related case. F-183 Unable to Comment F-184 Disagree Treatment providers ask for voiunteers who want to speak about their experience in treatment at the Board af Supervisors. These volunteers are not given a script or told what to say. Providers are not aware of what the clients are going to say. Various Board members even ask the clients questions. Volunteers also sign of confidentiality. Treatment a waiver providers and BHDIADP unsolicited Ietters monthlyfrom clients, receives family and employers thanking us for the treatment experience that changed client's lives. N. HillmontAvenue Ventura, CA. 93003-(805) 652-6737. FAX: (805) 652-6160 - www.vchca.orglbh I I F-185 Concvr BHD/ADP has repeatedly been denied to this information. access F-186 Concur F-18T Concur F-188 Concur F-189 Concur F-190 CanGur F-191 Disagree I The standards and protocols specifically quantified in the Non- are Compliance Protocols. Treatment providers also provide the specifics to clients. F-192 Goneur F-193 Disagree BHDIADP quoted Senate Bill 223 (SB 223) which states, testing "--, is primarily used treatment iual" as a F-194 Concur F-195 Disagree There longer Drug Court in Ventura County. Comparing drug test is no a results of Prop. 36 clients with Drug Court participants not valid is a comparison. There are several differences between Drug Court participants and Proposition 36 offenders. Drug Court was very exclusive in what offenders were allowed to participate, the caseloads were smaller, and offenders motivated. Proposition 36 the other hand, is were more on I much inclusive letting who shouldn't be considered more even in some eligible (i.e. drug dealers, gang members, driving underthe inOuence), the caseloads much larger, and the offenlers have are more severe addictions, lengthiercriminal histories, and lower motivation. Drug Court only administered random testing which is easier for clients to use drugs alcohof in between tests regular drug testing done 2 to 3 times or versus perweek. N. HillmontAvenue,Ventura, CA. 93003. (805) 652-6737 FAX: (805) 652-6160 " wvtrw.vchca.org/bh I ! F-196 Concur F-197 Concur F-198 Unable fo Commenf F-189 Concur Drug Testing provided part oftreatment is treatmenttool. Drug as a a Testing by Probation-can be used toof of compliance with the law. as a BHD/ADP would encourage a greater amount of drug testing and oversight by Probatian of ciients participating Prop. 36 in F-200 Padially Concur Working drafts of prcposed protocof changes submitted for review to were the Operations Committee not the Oversight Committee. Referto response to Finding 25. Since marijuana can stay in the body for 30 days or nore, a separate protocof was developed during the first year. If nanogram counts do not reduce or go up, clients are non-complied. F-201 Parfially Concur This is an Operations Committee and not an Oversight Committee. Refer I to responseto Finding 25. Two major oulpatient trealment providefs dratte6 the drug testing protocof for 2004-2005. Combined these t,wo providers provide treatmentto over 500 Proposition 36 clients per year. These providers also drafted the attendance protocol, which is same new restrictive than the original protocol, and which the specific details more not mentioned in the Grand Jury report. are F-202 Parfially Goncur This is an Operations Committee and not an Oversight Committee. Refer to response to Finding 25. BHD/ADP recognized that a consensus was not going to be achieved, and that the protocols clinical 1 new were a decision, and therefore should be incorporated without the approval of the Operations Committee. F-203 Partially Concur This is Operations Committee and not Oversight Committee. Refer an an to responseto Finding 25. Previous copies of the proposed protocol changes were working drafts. The additional sentence regarding clients placed on a residential waiting list had been discussed throughoutthe 300 N. HilimontAvenue Ventura, CA. 93003, (805) 652-6737. FAX: (805) 652-6160 * www.vchca.org/bh Operations meetings and placed the final format. was on F-204 Partally Concur This is Operations Committee and not Oversight Committee. Refer an an to response to Finding 25. F-205 Goncur F-206 Parfially Concvr This why treatment providers requested that drug testing protocol is a new be developed to give them discretion in testing. Also, if clients test more positive at graduation, they are not completed and must remain in treatment. F-207 Concur F-208 Disagree Refer to the response to Finding 201. F-209 Partially Concur The drug testng protocol thatwent into effect July 1,2004 drafted bl was i two treatment providers and was based on clinical decisions ratherthan financia! business decision. The state only allocates certa)n amount of a funding for drug testing (refer to Senate Bill 223). The original law does not allowfunds to be used fordrug testing. Since the Proposition 36 lead agency does not receive funding from the County General Fund, there is where else to obtain additional drug testing funding. Afterthe first no year, the Assessment Center quit drug testing every client at assessment in order to allow more funding to go to the treatment providers and the increasing loads. case F-210 Disagree BHDFADP has proposed protocof with higher accountabilities I a in the first 30 days oftreatment. F-211 Concur F-212 PartiallyConcur The type oftesting changed from the firstyearto the seeond year. During the first year on site amino assaytests (dipsticks) were used. Because of 300 N. HillmontAvenue Ventura,CA. 93003. (805) 652-6?37, FAX: (805) 652-6160 - www.vchca.orglbh I r the error rate and false negatives that can occur with on-site tests, all urine specimens were sent to a lab beginning in the second year. On site testing is conducted with pregnant clients and at discharge, and the specimen is also sentto the lab. This is the same lab that Probation USOS. F-213 Partially Concur The table is showing lab tests only and does not include on-site amino assay (dipstick) tests at $7.00 pertest. The table also does not include the cost of supplies. F-214 Concur F-215 Unable to Comment BHD/ADP has asked Probation for data and reports, and they have commented that they did not keep this information. Probation has not been able to provide UCLA with information they have requested. F-216 Partially Concur Various different statstics kept by BHDFA)P. Clients revolving in are are and out oftreatment. They non-compliea and returned to the court. A are warrant will be issued for clientwho has losttouc-i with the treatment a provider. Some clients may be arrested right away and others may take longer. An analogy of being "on the tarmacn was given to explain pending clients that in holding pattern betNeen assessment, treatment, and are a the court. BHD/ADP does not know when client is in jail to a as access the VCIJIS jail has been denied. After 30 days of contactwith screen no a client, treatment providers are required to close the CADDS and discharge the client. Oversightof clients while the Community in is a function of the Probation department. I F-217 PartiallyConcur The generalized statementthat drug tests average three to fourtests per client per month, or less than one test perweek is incorrect. Clients are referred to different levels of treatment (Level 1, Level 11, or Level 111) which have different drug testing protocols at different phases the treatment in process. Since the beginning, a Matrix to show the phases of testing in the different treatment levels created, and shows testtng being was more done in tte beginning oftreatment and fewer tests at the end. F-218 Disagree 300 N. HillmontAvenue,Ventura,CA. 93003. (805) 652-6737. FAX: (805) 652-6160 www.vchca.orgfbh Page22 Same client counts reported ta the State duplicates (i.e. CADDS) and are some are unduplicated. Referto response to Findings 180, 216, and 217. F-219 Disagree The BHDFADP and Probation numbers cannot be compared they as are tracked differently. This is an incorrectway of figuring drug tests. Refer to response to Findings 216, 217, and 218. F-220 Concur This is why BHDFADP have been trying to get electronicsubmission'of drug results from the lab for over a year and a haif. Plans have also been made to connect providersto the BHDFADP computerdatabase. F-221 Disagree The 210% positive rate is not extremely high when compared to similar programs. According to the Matrix Institute on Addictions, ane of their program "success" completion measures is 70% urine samples drug free. This would be a 300% positive rate. The Grand Jury report mentoned Probation positive rates at 31% in Finding 222. Federal programs may have lower positive rates, but they are also very expensive programs to and Prop. 36 has not allocated enough funds to this type of run, run program. Other programs can have lower positive rates because they test on a random basis and not regularly. It is easierfor persons to use when they only tested randomly month. are once a F-222 Concur F-223 Goncur Ventura County provider's believe in the importance of client's taking personal responsibilityfor theirfinancial involvement in treatment, and therefore, use a sliding scale based on each individual's ability to pay. Title 9 differentiates between the inability to pay and the refusal to pay far treatment. F-224 Disagree Using this type of device would cost than the allocation of $175,274. more $3500 per month x 12 months = $42,000 x 8 sites = $336,000 plus the castof sending positive tests to the lab for confirmation F-225 Disagree 300 N. HillmontAvenue,Ventura,CA,93003. (805) 652-6737, FAX: (805) 652-6160 www.vchca.org/bh I I Hairfollicle testing would not be practical for this type of program. Proposition 36 treatment providers need immediate results. They need a narrow and most recentwindow of detection, rather than 90 days. At the expense of this type oftesting, fewertests would be run, and there would be the problem of overlapping tests. Hairfollicle testing works betterwith custody cases. F-226 Parfially Concur Mandated clients often have higher long-term recovery rates than voluntaryclients do, because it harder forthem to drop outoftreatment. is F-227 Concur F-228 Concur F-229 Concur The Grand Jury did not mention the high recidivism rate of parolees in California reported by the Little Hoover Commission. as F-2JO Concur. F-231 Concur F-232 Goncur F-233 Concur F-234 Concur F-235 Concur F-236 Concur F-237 Concur F-238 Unable to Comment F-239 Concur 300 N. HillmontAvenue Ventura, CA, 93003.(805) 652-6737. FAX: (805) 652-6160 * www.vchca.orgfbh I I F-240 Partafly Concur This is why the Standing Order was changed in May 2004 to allow BHDFADP to release the Pre-sentence Probation Report to treatment providers. Probation had opposed releasing the report without having the order changed. F-241 Concur F-242 Concur F-243 Unable to Comment F-244 Vnable to Comment F-245 Concur F-246 Concur F-247 Concur F-248 Partially Concur Drug offendefswho engage in predatory JIIegal acts thatvictimize others (assault, robbery, burglary, theft, forgery, fraud, embezzlement, i`nd dealing in stolen property) noteligible for Proposition 36. are F-249 Concur F-250 Concur F-251 Concur Other counties report all drug tests to the Court or Probation, however, the tests not sanctionable. are F-252 Concur F-253 Partially Concur BHDFADP follows the instructions given by the Court. For each non- compliance submitted the most recent information is recorded. Usually the entire record requested for contested hearing. is a F-254 Concur 300 N. HJIImontAvenue Ventura, CA. 93003. (805) 652-6737. FAX: (805) 652-6160 - viww.vchca.orglbh I I F-255 Goncur F-256 Parfially Concur In his letterthe District Attorney does not mention that his office take can up to a year to file charges, that it can take law enforcement officers several months to arrest non-complied clients on warrants, and the number of cases that are pled down. According to the Probation Pre- sentence Reports beta~een November2001 and Kune 23,2004, 70 DUI pled down and the offenders made eligible for Prop. 36. cases were were The Grand Jury failed to referenee the Public Defender's response to the District Attorney letter pointing out the and misinterpretations. s errors Refer to Findingl4 that states, "41,trials and plea bargairis result in can a convtction the drug charge only, making the defendanteligible for Prop on 36 probation" F-257 Parfially Concur Priorto Prop. 36 offenders revolved and out ofjail without treatment. in With Prop. 36 they are eld accountable and referred back to courtwhen they not compliant. are F-258 Goncur These crimes are not supposed to be eligible for Proposition 36. It is very disruptive to treatment when these cises, especiallythose involving sales, pled down and these individuals aliowed into Prop. 36. Having are are drug dealers in treatment seriouslyjeopardizes the safety and recovery process of other clients. F-259 Partially Concur Clients non-complied when they show to assessment and when are no they show to treatment. no F-260 Concur 1 F-261 Disagree Referto response to Findlngs 256 and 258, A random review of Probation Pre-sentence Reports submitted to BHDFADP between November2001 and June 23,2004, revealed that 70 DUI pled cases were down and the offenders made eligible for Prop. 36. At least were one involved Jnjurywith accident, and another involved driving an some one into a garage at a high speed and almost striking children. Other counties, such Santa Barbara County, charge offenders with DUI as S. N. HiilmontAvenue Ventura, CA. 93003. (805) 652-6/3T. FAX: (805) 652-6160 - www.vchca.org/bh I I F-262 Partially Concur As stated previously, Operations Committee exists, not Oversight an an Committee. Refer to the response for Finding 25. The BHDFADP chair of the Operations Committee voted into the position and the third was is chairperson. Refer to the response for Finding 92. F-263 Concur F-264 Parfially Concur Standards and outcomes are measured according to best practice guidelines. BHDFADP reserves the right to make necessary clinical decisions based the welfare of clients. BHD/ADP believe in quality on improvement. Prop. 36 distributes quarterly client satisfaction surveys to clients in all County and contracted treatment programs. F-265 Parfially Concur Standards and criteria have been developed collaboration with in treatment providers and the Operations Committee. F-266 Parfiaily Concur Underth6 drug testing protocof that became effective 7fl104, new treatment pro4iisrs given the discretion to increase decrease the were or frequency of testing based the individual needs of clients. on F-267 Partially Concur The new attendance protocof that went into effect 7/lf04, was the first change implementation, and developed in collaborationwith since was treatment providers and the Operations Committee. F-268 Parfialfy Goncur BHDIADP has not neglected to track information, BHDFADP cannottrack information we are not given access to thatthe other agencies have readily available (i.e. VISIONNCIJIS). The Operations Committee sub- committee has not been able to come to an agreement or prioritze what information should be reported. BHD/ADP has collected and submitted all mandated information to the State, and often Focus Counties as one submits information weeklyto UCLA. F-269 Parfiafly Concur 300 N. HIIlmontAvenue Ventura, CA. 93003,(805) 652-6737. FAX: (805) 652-6160 - www.vchca.orgfbh I I T As the Lead Agency it BHDJADP's responsibilityto submit all reports to is the State of California. in compiling reports, written information and replies gathered from the various members of the Operations are Committee. F-270 Concur F-271 Disagree The Grand Jury given the statistical reports given to the was same OperationsCommitteeand the ADP Advisory Board. Referto responses to Findings 216 and 273. F-272 Disagree As stated in Finding 279, 900% of assessed clients show up to treatment. Refer to responses to Findings 216 and 217. F-273 Disagree Referto response in Finding 271. F-274 Disagree F-275 Concur F-276 Vnable to commtnt. F-277 Concur F-278 Concur F-279 Concur F-280 Disagree The Probation Agency supplied the 1044 client countthat is documented the Second Year Report, which represents the numberof clients in on forma! probation. Offenders are sentenced to 36 months or 3 years of probation. Consideririg 44% (592) of the 1345 clients assessed the first year, and 420% (519) ofthe 1235 clients assessed the second year, gives total of 1111 that formai probation. The BHDIADP number of a were on 1111 does notfigure clients completing probation having their in or probation revoked. These numbers are very close. Also, referto responses to findings 215 and 219. N. HillmontAvenue Ventura, CA 93003. (805) 652-6737, FAX: (805) 652-6160 - " www.vchca.orgfbh F-281 Concur This is why the State contracted with CSU at Bakersfield to help define data reporting elements, and develop manual for the Lead a users Agencies. Training conducted in September2003. Refer to was response to Finding 218. F-282 Disagree Not all clients who are eligible for services are referred to Prop. 36. Some offenders"opt out" obtain other charges making them ineligiblefor or Prop. 36. F-283 Disagree As stated before the 1044 client count represents the numberof clients on formal probation. Offenders receive 36 months or 3 years of probation. It is erroneous to use this numberto calculate drug tests per month. The Grand Jury attempted to apply simple mathematical calculations to a complex program with many factors involved. Refer to responsesfor Findings 213, 217, 219, 273, and 280. F-284 Partially Concur Referto responses to Findings 216, 217 and 219. F-285 Partiaffy Goncur The Grand Kury received un-audited version of the demographic report an that contained faultyformula. The 108% and has been a was in error corrected to represent 100%. The table does not include clients entering priorto 711/03, those opting out, or those that have been non-complied. F-286 Concur F-287 Disagree 769 represents unduplicated clients. This number does not include new clients that started treatment priorto TJIJ03 or that returned to treatment. Refer to response to Finding 216. F-288 Disagree The 460-500 client count represented the numberof clients with the two largestoutpatient providers. It does not include clients in treatment at 300N. HillmontAvenue Ventura, CA, 93003. (805) 652-6737. FAX: (805) 652-5160 " www.vchca.org/bh I other locations, out af county or in residential treatment. Refer to response to Findings 216 and 287. F-289 Concur Refer to response to Findings 216, 287, and 288. F-290 Concur Referto response to Finding 215. F-291 Concur The applies to clients missing from treatment. same F-292 Concur Referto response to Finding 216.

Partially Concur The Implementation Committee evolved into the Operations Committee notthe Oversight Committee (refer to the responsefor Finding 25). A representative from the CEO office the original chairperson ofthe s was Implementation Committee and meeting minutes published during were 300 N. HillmontAvenue Ventura, CA 93003.(805) 652-6737. FAX: (805) 652-6160 - " www.vchca.org/bh this time. When he stepped down in October 2001, the Committee voted a representative from the Public Defenders ofOce the chairperson. as new When the second chairperson stepped down in August 2002, the Committee nominated and unanimouslyvoted in representativefrom the a Lead Agency (BHDFADP) the chair. as

Partially Concur This is an Operations Committee not an OversightCommittee (refer to response for Finding 25). Numerous reminders of meetings and invitations have been extended to the Sheriffs Department and law enforcement council to attend the Operations Committee meetings, and statewide Making It Work Conferences.

Partially Concur This is Operations Committee not OversightCommittee (refer to an an response for Finding 25). I

PartiaUy Concur This is an Operations Committee not an O erstght Committee (refer tc response for Finding 25).

Concur F-l02 Parfially Concvr Clients who do not contact the assessment centerwithin 5 days to schedule an assessment appointment are non-complied. During the first year, there were times when assessment appointments were booked out for three weeks. This was remedied by the second year and is no longer the case. Additional staff were hired and adjustments were made to the scheduling of appointments. The assessment calendaris closely 300 N. HillmontAvenue Ventura, CA. 93003. (805) 652-6737. FAX: (805) 652-6160 * vNININ.vchca.org/bh 1 I monitored to ensure timely appointments. Clients usually entertreatment the weekthey assessed. same are

Disagree I BHDFADP reviewed various types ofthe ASI, including self-administered formats. As of 10 Focus Counties selected to participate in the one statewide evaluation of the Substance Abuse and Crime Prevention Act of 2000 (SACPA), UCLA who is conducting the evaluation, did not want us to use self-administered ASI's as the reliability and validity were not as good.

Parfially Concur The last sentence is incorrect. Proposition 36 mental health services are funded through the Substance Abuse TreatmentTrust Fund (SATTF) allocation, and not SAMHSA grant. a

Parfially Goncur 500% of the Prop. 36 clients in Ventura County have not had any prior drug treatment. It is unknown whetherthey previouslyoffered were an opportunityfor treatment.

ParfiallyConcur Refer to response for Finding 102. N. HillmontAvenue,Ventura, CA 93003. (805) 652-6737. FAX: (805) 652-6160 " www.vchca.org/bh I I

Unable to Comment This broad generalization that does not apfly to all people. Research is a has shown the different stages of mothration and stages of change that clients go through.

Disagree BHDFADP recognizes the importance of holding clients accountable through continual communication. Staff trained to check out and are verify information provided by clients.

Parfially ConGvr Probation and Parole supervise, BHD/ADP case manages.

Concur As stated the Second Year Report, 2580 initial assessments had been in conducted since the inception ofthe program.

Parfially Concur Treatment providers submit CADDS, PSR and DATAR forms each month. A GADDS form is completed every time there is a change in a client's status (new enrollment, re-enrallment, transfer to another program, discharge), Therefore, a CADDS form is not completed on every client every month. Providers also submit units of service (outpatient programs) bed days (residential praviders) for each client monthly basis. or on a Residential providers submit progress reports (treatment level reviews) each month. Outpatientproviders report clients the first 30 days and on then submit progress reports every 90 days. Out patient providers submit attendance group logs on a daily basis to the assessment center. Drug test results from the lab come daily to the assessment center and are then 300 N. HillmontAvenue,Ventura,CA. 93003.(805) 652-6737, FAX: (805) 652-6160 www.vchca.orgibh I faxed to the various outpatienttreatment providers.

Partally Concur With the removal of the firewall September2003, there in are no requirements for assessment center case managers to meet with clients face to face, the treatment providers contact probation officers as now directly instead afgoing through the assessmentcenter. I

Parfially Concur Site visits of both residential and outpatient providers conducted. are

Partially Goncur Positive lab results are placed in client charts. A record of all of a client's drug tests is printed and placed in the client's chart. Electronic submission of drug testing resultsfrom the lab and connected to the CMS database is projected to be completed by the end ofthe first quarterthis year. We are waiting for outside vendor to complete work needed to implement.

Concur It is the responsibilityofthe treatment praviders to noti the assessment centerof c)ient compliance and non-compliance.

ParfiallyConcur A report is generated each month showing the numberof negative drug tests and positive tests by drug.

Partially Concvr BHDFADP has not been given full access to the criminaljustice data system and the DistrictAttorney's representative and representative's from Probation continue to not agree with providing information from their areas. Should BHDFADPbe given access and should agreed upon soon. niiiriont Avenue `Ventura, CA-93003.(805) 652-5737, FAX: c805) 652-6160 www.vchca.orgfbh I Q reporting from each area be provided, BHD/ADP has sufficientstaffto analysis, report and provide information. A Statistician is not needed.

Disagree According to the American Socie ofAddiction Medicine (ASAM) placement criteria not all clients need the same length of treatmentand treatment plans should be individualized based on the needs ofthe client. The initial referral of 30 days is used checks and balances to as a insure that clients are progressing and getting the treatmentthey need, and not being kept iQ treatmentjust to keep a bed filled. Residential providers must submit treatment level reviewform based ASAM placement a on criteria on each client every 30 days.

Concur 300 N. HillmontAvenue Ventura, CA 93003. (805) 652-6?37. FAX: (805) 652-6160 - " iNwrN.vchca.org/bh

Disagree BHDFADP contracts require drug-free workplace and this is enforced.

Disagree BHDFADP contract monitoring and quality controls and increased can are whenever necessary.

BHD/ADP officials rep6rted to the lury that the office of the District Attomey has no statisticsto prove that any rise in crimecan be attributedto Prop 36 clients; however, the office ofthe District Attorney continues to state these beliefs along with the assertion that the substantiating statistics will eventually be collected when BHDJADPreleases the Prop 36 fundsrequired to hire a statistician. Property 9.3 percent in Ventura County in 2003. An 11-week study conducted by crimes rose the District Attomey in 2004 counted how many defendants appearing in Prop 36 court during that time period had suffered one or more prior convictions for thefi. This study revealed that at least 46.7 percent of defendants appearing in Prop 36 court during this period had previously been convicted of at least one theft offense. This tells us that nearly one-half of the Prop 36 defendants are convicted thieves, a significant statistic when one considers that most property theft crimes go unsolved. We know that molt ofthese individuals are unemployed, still using drugs while Prop 36 probation, and payini for their drug by selling drugs stealing and on use or I then selling property. Succinctly, unemployed drug users either deal or steal to support their habit. Statistical information pravided by ADP in July 2004 indicates that 58 percent of defendants enrolled in Prop 36 unemployed and another 11 percent employed just part-time. were were Most defendants enrolled in Prop 36 illegal drugs in violation of probation while the use on program. The protocol implemented by ADP recognizes and accepts this. In fact, the protocol does not mandate a treatment provider report a defendant for illegal drug use even if the defendant uses drugs every day for the first 30 daysoftreatment. Thereafter, a defendant can get caught using drugs up to 11 additional times before the protocol calls for the defendant to be terminated from the program. The terminated defendant can then re-enroll in the program upon the next arrest for a Prop 36 eligible offense. It is important to note that each use andlor possession ofdrugs by a defendant while on Prop 36 probation is actually an independent crime in addition to being a violation of the terrns of probation; however, the programhas made no attemptto keep a numerical count ofthese crimes. The following statistics have been collected by the District Attomey with regard to non-drug related offenses by defendants while Prop 36 probation. In period ofjust three months and on a fourdays (April S to July 9, 2004), 40 defendants were terminated from the Prop 36 program due I I I The Honorable Bruce A. Clark August 16, 2004 to their commission of non-Prop 36 criminal acts while under Prop 36 supervision. The new offenses included commercial burglary, possession of weapons, petty theft with priors, battery against elder dependantadult, spousal battery with injury, breaking/removingvehicle parts, an or interfering with police, forgery, vandalism, false identification to police, driving under the influence causing injury, vehicle theft, contempt of court, disorderly conduct and making criminal threats. As explained above, defendants Prop 36 probation often drugs dozens of times before on use grant of Prop 36 probation terminated. Many of those individuals subsequently even one is begin a new grant ofProp 36 probation after a prior grant is terminated. The District Attomey is allocated none of the more than $2.7 million received annually by ADP to run the Prop 36 program, despite the fact that the District Attomey devotes a deputy district attomey full-time to Prop 36 court. Prop 36 is not saving resources of the District Attorney. Defendants who are placed on Prop 36 probation often tax the resources of the criminal justice system in the traditional contesting their preliminary hearings and jury trials before manner, cases in eventually seeking placement in the Prop 36 program, even after contesting their guilt to a jury and being found guilty. Thus, the Office of the District Attomey is without the resources to adequatelycompile the statistics theprogram should havebeen compiling since July 2001. BHD/ADP has accumulated a tremendous surplus (over $1 million) of funds in managing the program. Parf of this money should be used to compile useful statistics for county policy makers. For example, BHD/ADP reports that 35 persons completed treatment in 2001/2002 and 245 persons completed treatment in 2002/2003. One of a number of studies that should be conducted to evaluate the success of the program would be to determine how many of those persons have been re-arrested since completion of treatment and for what charges. A study should be done to determine how many and what types of crimes were committed by all defendants while on Prop 36 probation. It should be reported how many defendants have received two, three, four or more grants of Prop 36 probation and how many "completed treatment"and how many ccsuccessfully completedtreatment."

Parfially Concur Protocols, including the satisfactory completion protocol originally were developed by the Implementation Committee. Some ofthe original 300 N. HiilmontAvenue Ventura, CA, 93003. (805) 652-6737. FAX: (805) 652-6160 * v,ww.vchca.org/bh I ! protocols based compromises with criminaljustice, and research were on and evidenced based clinical practices. There would be chaos without standardized protocols. Treatment providers ware not part ofthe Implementation Gommittee, buttaco representatives part ofthe are now Operatians Committee. As the program has evolved from implementation, certain changes have been made and representatives from treatment programs have been involved in these changes. Treatment providers review and update treatment plans with clienls and submit progress reports every 90 days on each client. One treatment provider developed card for each clientto record individual a score progress. The Addiction Severity Index (ASI) and drug testing are administered atthe time ofdischarge. Clients testing positive not are discharged, but remain in treatment. Ghanges and decisions based are sound clinical, ethical, and Iegal decisions. Provider contracts on were adjusted to units of service order to better meet the needs of individual in clients. I BHDFADP has agreed to not inciude the treatment providers the in Operations Committee.

Concur The Assessment Center liaison to the dedicated court has objected to offenders referred to Proposition 36 to avail. BHDFADP is concemed no when cases involving drug dealers and gang members are pled down and these individuals have to be referred to treatment. Similar to the referral to mentally ill treatment, BHDIADP would like to be involved in the assessment and appropriateness of clients prior to their being sentenced to Prop. 36 treatment. Also, referto response for Finding 72. BHDIADP has proposed strictertreatment protocols for the first 30 days of treatment to try and determine those who serious about treatment from those are who not. BHDJADP hopes that the other partners in criminaljustice are will also reviewtheir protocois to keep these people out oftreatment. F-lT2 Concur

Disagree 300 N. HillmontAvenue ,Ventura, CA 93003. (805) 652-6737 FAX: (805) 652-6160 " " www.vchca.org/bh I Underthe sub-heading "Violatton CriteriafProtocol"of the Non- Compliance Policy it states, "The Case Managersubmits violationlnon- compliance report with the CourUProbation within hNo business days of latest incident, utilizing the Non-compliance Form". A specific protocof is then iisted for each violation.

Partially Concur The formula the State used to calculate each county's allocation for 2001- 2004 based 50% county population, 25 % drug arrests, and 250% was on treatment load. The formula that used Tfll04 is based case was on on 50% population, 40% caseload, and 10% drug arrests.

Disagree The numberof treatment completions tracked monthly and provided in are report distributed to the BHDJADP Directors, Operations Committee, a and ADP Advisory Board. A copy of this report was gi fen to the Grand Jury several times. As of the end of May 2004, 628 cJents had satisfactorily completed treatment. Clients can requestto llave their expunged (removed from theircourt record) after completing cases treatment, paying all fines and fees, and complying with all terms oftheir probation. As of the end of May, 65 clients have had theircharges expunged. BHD/ADP does not have accessto recidism information unless the offenders pick up ancther Prop. 36 related case.

A senior BHD/ADP official was asked to comment on the fact that, with the exception of BHDFADP, everyone the Jury has asked about Prop 36 expresses disappointment in the lack of success. It was stated that, "You have to be careful who you ask." This was followed by, the "District Attomey and Probation are mostly interested in publi safety," and they have though those concems even concems are not backed up by data. Claims of should be viewed with caution unless supported by verifiable data that success indicates a defendant has met minimum objective standards. The law dictates that successful completion oftreatment has not been attained unless "--- there is reasonable cause to believe that the defendant will not abuse controlled substances the future." (Penal Code section 121O(c)) in I I The HonorableBruce A. Clark August 16, 2004 To date, administrators ofthe program have largely ignored this statutory guideline, blumng the line between mere completion of a treatment program and successful completion. Failure to implement mandatory requirements for random drugtesting and impose requirement minimum a that a defendant be proven drug free for a significant period prior to completion oftreatment is evidence that there has been no serious attempt to be guided by the law in awarding a I designation of "successful completion." Policy makers should demand clear definition from a program administrators of what gives administrators `creasonable cause to believe that the defendantwillnot abuse controlledsubstances in the future"before accepting a claim of SUCCOSS. The failweto collectmeaningful data and yet claim success is unacceptable. At the outset ofthe implementation of Prop 36, BHDJADP committed to collecting statistical data. In its second yearreport, submittedto the Board ofSupervisors on October 16, 2003, BHDJADP statedthat it has been working with computer consultant regarding the collection of data September a since 2001. To date, data collection system exists for tracking the criminality of Prop 36 no defendants while enrolled in the program or after a participant's ccsuccessful completion." BHDIADP has had sole controf of the budget for the program and has accumulated a huge surplus offunds (over $1 million at the end of year 2), but has failed to devote any resources to collecting data that meaningfully reflects the impact Prop 36 has had public safety. The on District Attomey has made repeated requests that BHD/ADP spend portion of the Prop 36 a fundingto track data so thatpolicy makers can make informed evaluationsand decisions. I Resoonse to Recommendations: In reference to the Grand Jury Report's recommendation:

Disagree Treatment providers ask for voiunteers who want to speak about their experience in treatment at the Board af Supervisors. These volunteers are not given a script or told what to say. Providers are not aware of what the clients are going to say. Various Board members even ask the clients questions. Volunteers also sign of confidentiality. Treatment a waiver providers and BHDIADP unsolicited Ietters monthlyfrom clients, receives family and employers thanking us for the treatment experience that changed client's lives. N. HillmontAvenue Ventura, CA. 93003-(805) 652-6737. FAX: (805) 652-6160 - www.vchca.orglbh I I

Concvr BHD/ADP has repeatedly been denied to this information. access

Concur Drug Testing provided part oftreatment is treatmenttool. Drug as a a Testing by Probation-can be used toof of compliance with the law. as a BHD/ADP would encourage a greater amount of drug testing and oversight by Probatian of ciients participating Prop. 36 in

Disagree I The standards and protocols specifically quantified in the Non- are Compliance Protocols. Treatment providers also provide the specifics to clients.

Disagree BHDIADP quoted Senate Bill 223 (SB 223) which states, testing "--, is primarily used treatment iual" as a

Disagree There longer Drug Court in Ventura County. Comparing drug test is no a results of Prop. 36 clients with Drug Court participants not valid is a comparison. There are several differences between Drug Court participants and Proposition 36 offenders. Drug Court was very exclusive in what offenders were allowed to participate, the caseloads were smaller, and offenders motivated. Proposition 36 the other hand, is were more on I much inclusive letting who shouldn't be considered more even in some eligible (i.e. drug dealers, gang members, driving underthe inOuence), the caseloads much larger, and the offenlers have are more severe addictions, lengthiercriminal histories, and lower motivation. Drug Court only administered random testing which is easier for clients to use drugs alcohof in between tests regular drug testing done 2 to 3 times or versus perweek. N. HillmontAvenue,Ventura, CA. 93003. (805) 652-6737 FAX: (805) 652-6160 " wvtrw.vchca.org/bh I !

Padially Concur Working drafts of prcposed protocof changes submitted for review to were the Operations Committee not the Oversight Committee. Referto response to Finding 25. Since marijuana can stay in the body for 30 days or nore, a separate protocof was developed during the first year. If nanogram counts do not reduce or go up, clients are non-complied.

Parfially Concur This is an Operations Committee and not an Oversight Committee. Refer I to responseto Finding 25. Two major oulpatient trealment providefs dratte6 the drug testing protocof for 2004-2005. Combined these t,wo providers provide treatmentto over 500 Proposition 36 clients per year. These providers also drafted the attendance protocol, which is same new restrictive than the original protocol, and which the specific details more not mentioned in the Grand Jury report. are

Parfially Goncur This is an Operations Committee and not an Oversight Committee. Refer to response to Finding 25. BHD/ADP recognized that a consensus was not going to be achieved, and that the protocols clinical 1 new were a decision, and therefore should be incorporated without the approval of the Operations Committee.

Partially Concur This is Operations Committee and not Oversight Committee. Refer an an to responseto Finding 25. Previous copies of the proposed protocol changes were working drafts. The additional sentence regarding clients placed on a residential waiting list had been discussed throughoutthe 300 N. HilimontAvenue Ventura, CA. 93003, (805) 652-6737. FAX: (805) 652-6160 * www.vchca.org/bh Operations meetings and placed the final format. was on

Partally Concur This is Operations Committee and not Oversight Committee. Refer an an to response to Finding 25.

Parfially Concvr This why treatment providers requested that drug testing protocol is a new be developed to give them discretion in testing. Also, if clients test more positive at graduation, they are not completed and must remain in treatment.

Disagree Refer to the response to Finding 201.

Partially Concur The drug testng protocol thatwent into effect July 1,2004 drafted bl was i two treatment providers and was based on clinical decisions ratherthan financia! business decision. The state only allocates certa)n amount of a funding for drug testing (refer to Senate Bill 223). The original law does not allowfunds to be used fordrug testing. Since the Proposition 36 lead agency does not receive funding from the County General Fund, there is where else to obtain additional drug testing funding. Afterthe first no year, the Assessment Center quit drug testing every client at assessment in order to allow more funding to go to the treatment providers and the increasing loads. case

Disagree BHDFADP has proposed protocof with higher accountabilities I a in the first 30 days oftreatment.

PartiallyConcur The type oftesting changed from the firstyearto the seeond year. During the first year on site amino assaytests (dipsticks) were used. Because of 300 N. HillmontAvenue Ventura,CA. 93003. (805) 652-6?37, FAX: (805) 652-6160 - www.vchca.orglbh I r the error rate and false negatives that can occur with on-site tests, all urine specimens were sent to a lab beginning in the second year. On site testing is conducted with pregnant clients and at discharge, and the specimen is also sentto the lab. This is the same lab that Probation USOS.

Partially Concur The table is showing lab tests only and does not include on-site amino assay (dipstick) tests at $7.00 pertest. The table also does not include the cost of supplies.

Unable to Comment BHD/ADP has asked Probation for data and reports, and they have commented that they did not keep this information. Probation has not been able to provide UCLA with information they have requested. 1

Partially Concur Various different statstics kept by BHDFA)P. Clients revolving in are are and out oftreatment. They non-compliea and returned to the court. A are warrant will be issued for clientwho has losttouc-i with the treatment a provider. Some clients may be arrested right away and others may take longer. An analogy of being "on the tarmacn was given to explain pending clients that in holding pattern betNeen assessment, treatment, and are a the court. BHD/ADP does not know when client is in jail to a as access the VCIJIS jail has been denied. After 30 days of contactwith screen no a client, treatment providers are required to close the CADDS and discharge the client. Oversightof clients while the Community in is a function of the Probation department. I F-217 PartiallyConcur The generalized statementthat drug tests average three to fourtests per client per month, or less than one test perweek is incorrect. Clients are referred to different levels of treatment (Level 1, Level 11, or Level 111) which have different drug testing protocols at different phases the treatment in process. Since the beginning, a Matrix to show the phases of testing in the different treatment levels created, and shows testtng being was more done in tte beginning oftreatment and fewer tests at the end.

Disagree 300 N. HillmontAvenue,Ventura,CA. 93003. (805) 652-6737. FAX: (805) 652-6160 www.vchca.orgfbh Page22 Same client counts reported ta the State duplicates (i.e. CADDS) and are some are unduplicated. Referto response to Findings 180, 216, and 217.

Disagree The BHDFADP and Probation numbers cannot be compared they as are tracked differently. This is an incorrectway of figuring drug tests. Refer to response to Findings 216, 217, and 218.

Concur This is why BHDFADP have been trying to get electronicsubmission'of drug results from the lab for over a year and a haif. Plans have also been made to connect providersto the BHDFADP computerdatabase.

Disagree The 210% positive rate is not extremely high when compared to similar programs. According to the Matrix Institute on Addictions, ane of their program "success" completion measures is 70% urine samples drug free. This would be a 300% positive rate. The Grand Jury report mentoned Probation positive rates at 31% in Finding 222. Federal programs may have lower positive rates, but they are also very expensive programs to and Prop. 36 has not allocated enough funds to this type of run, run program. Other programs can have lower positive rates because they test on a random basis and not regularly. It is easierfor persons to use when they only tested randomly month. are once a

Goncur Ventura County provider's believe in the importance of client's taking personal responsibilityfor theirfinancial involvement in treatment, and therefore, use a sliding scale based on each individual's ability to pay. Title 9 differentiates between the inability to pay and the refusal to pay far treatment.

Disagree Using this type of device would cost than the allocation of $175,274. more $3500 per month x 12 months = $42,000 x 8 sites = $336,000 plus the castof sending positive tests to the lab for confirmation

Disagree 300 N. HillmontAvenue,Ventura,CA,93003. (805) 652-6737, FAX: (805) 652-6160 www.vchca.org/bh I I Hairfollicle testing would not be practical for this type of program. Proposition 36 treatment providers need immediate results. They need a narrow and most recentwindow of detection, rather than 90 days. At the expense of this type oftesting, fewertests would be run, and there would be the problem of overlapping tests. Hairfollicle testing works betterwith custody cases.

Parfially Concur Mandated clients often have higher long-term recovery rates than voluntaryclients do, because it harder forthem to drop outoftreatment. is

Concur The Grand Jury did not mention the high recidivism rate of parolees in California reported by the Little Hoover Commission. as

Concur 300 N. HillmontAvenue Ventura, CA, 93003.(805) 652-6737. FAX: (805) 652-6160 * www.vchca.orgfbh I I

Partafly Concur This is why the Standing Order was changed in May 2004 to allow BHDFADP to release the Pre-sentence Probation Report to treatment providers. Probation had opposed releasing the report without having the order changed.

Partially Concur Drug offendefswho engage in predatory JIIegal acts thatvictimize others (assault, robbery, burglary, theft, forgery, fraud, embezzlement, i`nd dealing in stolen property) noteligible for Proposition 36. are

Concur Other counties report all drug tests to the Court or Probation, however, the tests not sanctionable. are

Partially Concur BHDFADP follows the instructions given by the Court. For each non- compliance submitted the most recent information is recorded. Usually the entire record requested for contested hearing. is a

Concur 300 N. HJIImontAvenue Ventura, CA. 93003. (805) 652-6737. FAX: (805) 652-6160 - viww.vchca.orglbh I I

Parfially Concur In his letterthe District Attorney does not mention that his office take can up to a year to file charges, that it can take law enforcement officers several months to arrest non-complied clients on warrants, and the number of cases that are pled down. According to the Probation Pre- sentence Reports beta~een November2001 and Kune 23,2004, 70 DUI pled down and the offenders made eligible for Prop. 36. cases were were The Grand Jury failed to referenee the Public Defender's response to the District Attorney letter pointing out the and misinterpretations. s errors Refer to Findingl4 that states, "41,trials and plea bargairis result in can a convtction the drug charge only, making the defendanteligible for Prop on 36 probation"

Parfially Concur Priorto Prop. 36 offenders revolved and out ofjail without treatment. in With Prop. 36 they are eld accountable and referred back to courtwhen they not compliant. are

Goncur These crimes are not supposed to be eligible for Proposition 36. It is very disruptive to treatment when these cises, especiallythose involving sales, pled down and these individuals aliowed into Prop. 36. Having are are drug dealers in treatment seriouslyjeopardizes the safety and recovery process of other clients.

Partially Concur Clients non-complied when they show to assessment and when are no they show to treatment. no

Disagree Referto response to Findlngs 256 and 258, A random review of Probation Pre-sentence Reports submitted to BHDFADP between November2001 and June 23,2004, revealed that 70 DUI pled cases were down and the offenders made eligible for Prop. 36. At least were one involved Jnjurywith accident, and another involved driving an some one into a garage at a high speed and almost striking children. Other counties, such Santa Barbara County, charge offenders with DUI as S. N. HiilmontAvenue Ventura, CA. 93003. (805) 652-6/3T. FAX: (805) 652-6160 - www.vchca.org/bh I I

Partially Concur As stated previously, Operations Committee exists, not Oversight an an Committee. Refer to the response for Finding 25. The BHDFADP chair of the Operations Committee voted into the position and the third was is chairperson. Refer to the response for Finding 92.

Parfially Concur Standards and outcomes are measured according to best practice guidelines. BHDFADP reserves the right to make necessary clinical decisions based the welfare of clients. BHD/ADP believe in quality on improvement. Prop. 36 distributes quarterly client satisfaction surveys to clients in all County and contracted treatment programs.

Parfially Concur Standards and criteria have been developed collaboration with in treatment providers and the Operations Committee.

Parfiaily Concur Underth6 drug testing protocof that became effective 7fl104, new treatment pro4iisrs given the discretion to increase decrease the were or frequency of testing based the individual needs of clients. on

Partially Concur The new attendance protocof that went into effect 7/lf04, was the first change implementation, and developed in collaborationwith since was treatment providers and the Operations Committee.

Parfialfy Goncur BHDIADP has not neglected to track information, BHDFADP cannottrack information we are not given access to thatthe other agencies have readily available (i.e. VISIONNCIJIS). The Operations Committee sub- committee has not been able to come to an agreement or prioritze what information should be reported. BHD/ADP has collected and submitted all mandated information to the State, and often Focus Counties as one submits information weeklyto UCLA.

Parfiafly Concur 300 N. HIIlmontAvenue Ventura, CA. 93003,(805) 652-6737. FAX: (805) 652-6160 - www.vchca.orgfbh I I T As the Lead Agency it BHDJADP's responsibilityto submit all reports to is the State of California. in compiling reports, written information and replies gathered from the various members of the Operations are Committee.

Disagree The Grand Jury given the statistical reports given to the was same OperationsCommitteeand the ADP Advisory Board. Referto responses to Findings 216 and 273.

Disagree As stated in Finding 279, 900% of assessed clients show up to treatment. Refer to responses to Findings 216 and 217.

Disagree Referto response in Finding 271.

Disagree The Probation Agency supplied the 1044 client countthat is documented the Second Year Report, which represents the numberof clients in on forma! probation. Offenders are sentenced to 36 months or 3 years of probation. Consideririg 44% (592) of the 1345 clients assessed the first year, and 420% (519) ofthe 1235 clients assessed the second year, gives total of 1111 that formai probation. The BHDIADP number of a were on 1111 does notfigure clients completing probation having their in or probation revoked. These numbers are very close. Also, referto responses to findings 215 and 219. N. HillmontAvenue Ventura, CA 93003. (805) 652-6737, FAX: (805) 652-6160 - " www.vchca.orgfbh

Concur This is why the State contracted with CSU at Bakersfield to help define data reporting elements, and develop manual for the Lead a users Agencies. Training conducted in September2003. Refer to was response to Finding 218.

Disagree Not all clients who are eligible for services are referred to Prop. 36. Some offenders"opt out" obtain other charges making them ineligiblefor or Prop. 36.

Disagree As stated before the 1044 client count represents the numberof clients on formal probation. Offenders receive 36 months or 3 years of probation. It is erroneous to use this numberto calculate drug tests per month. The Grand Jury attempted to apply simple mathematical calculations to a complex program with many factors involved. Refer to responsesfor Findings 213, 217, 219, 273, and 280.

Partially Concur Referto responses to Findings 216, 217 and 219.

Partiaffy Goncur The Grand Kury received un-audited version of the demographic report an that contained faultyformula. The 108% and has been a was in error corrected to represent 100%. The table does not include clients entering priorto 711/03, those opting out, or those that have been non-complied.

Disagree 769 represents unduplicated clients. This number does not include new clients that started treatment priorto TJIJ03 or that returned to treatment. Refer to response to Finding 216.

Disagree The 460-500 client count represented the numberof clients with the two largestoutpatient providers. It does not include clients in treatment at 300N. HillmontAvenue Ventura, CA, 93003. (805) 652-6737. FAX: (805) 652-5160 " www.vchca.org/bh I other locations, out af county or in residential treatment. Refer to response to Findings 216 and 287.

Concur Refer to response to Findings 216, 287, and 288.

Concur Referto response to Finding 215.

Concur The applies to clients missing from treatment. same

Concur Referto response to Finding 216. F293 Concur Referto response to Finding 215.

Concur Referto response to Finding 215. F-294 Partially Concur Referto responses to Findiriijs 219 and 273. F-295 Disagree Duplicated and unduplicated numbers cannot be compared this in The non-compliance number duplicated number (clients manner. is a are usually non-complied than once), where the monthly estimated more as number of clients in treatment per level is an unduplicated number. Refer to responses to Findings 219 and 273. F-296 Disagree The number of new assessments for clients on formal probation has been decreasing the last two years. FY 2001-2002 440% of the assessed clients were on formal probation, and 420% for FY2002-2003. FY2003-2004 320% ofthe clients assessed formal probation, 620% conditional were on on release, and 60% on parole. Also, referto response to Finding 219. F-297 Disagree Refer to response to Finding 219, 273, and 283. 300N. HillmontAvenue-Ventura,CA. 93003. (sos) ssz-s/3T. FAX: (805) 652-6160 v,ww.vchca.org/bh I

Partially Concur Referto responses to Findiriijs 219 and 273.

Disagree Duplicated and unduplicated numbers cannot be compared this in The non-compliance number duplicated number (clients manner. is a are usually non-complied than once), where the monthly estimated more as number of clients in treatment per level is an unduplicated number. Refer to responses to Findings 219 and 273.

Disagree The number of new assessments for clients on formal probation has been decreasing the last two years. FY 2001-2002 440% of the assessed clients were on formal probation, and 420% for FY2002-2003. FY2003-2004 320% ofthe clients assessed formal probation, 620% conditional were on on release, and 60% on parole. Also, referto response to Finding 219.

Disagree Refer to response to Finding 219, 273, and 283. 300N. HillmontAvenue-Ventura,CA. 93003. (sos) ssz-s/3T. FAX: (805) 652-6160 v,ww.vchca.org/bh I Recommendations: R-l BHDFADP believes that this recommendation be accommodated if: can a) The OversightCommittee officially designated by the Board of is Supervisors. BHDFADP would suggest that members of the Committee should be the Chief Probation Officer, The District Attorney, The Public Defender, the Judge from the Operations Committee, the Directorof Behavioral Health, representative a from the C.E.O.'s office and member ofthe Board of Supervisors. a b) Once the Oversight Committee is officially designated, MOU an should be created that defines the various roles of each agency in the operation of Prop. 36.