Response from HCA

Disagree The jail programs and the work furlough Stages program are education programs only and not treatment programs. Not all offenders with substance abuse problems are eligible for these programs. Offenders must fill out a program screening form if they are interested in the Substance Abuse Program and have 30+days left. The Drug and Alcohol Abuse Education (DEUCE) program is only available to inmates in Quad 300 N. Hillmont Avenue « Ventura, CA * 93003 + (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

D of the 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 a major role in their addiction. Partially Concur Refer to response to Finding 17. The jail programs and the work furlough Stages program are education programs only and not treatment programs. Most PC 1000 Diversion Programs are considered education only. One Ventura County program offers prevention, education, and treatment. Partially Concur BHD/ADP concurs with the first two sentences, and disagrees with the last sentence (refer to Finding 17 response). The jail programs and the work furlough Stages program are education programs only and not treatment programs. Concur Concur Co:icur Concur Concur Partially Concur Throughout the report the Grand Jury refers to the Oversight Committee. This is erroneous. The Implementation Committee evolved into the Operations Committee. An Oversight Committee was never formed. Final policy oversight rests with the Board of Supervisors. Concur Concur Unable to Comment Unable to Comment Concur 300 N. Hillmont Avenue + Ventura, CA = 93003 + (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

F-46 Concur Concur Concur Concur Partially Concur Probation and Parole are responsible for supervision. BHD/ADP and the treatment providers are responsible for case management. Concur Unable to Comment Concur Concur Concur Partially Concur The MOA was drafted, but never submitted. Concur Concur Concur Concur Partially Concur BHD/ADP agrees with all except the last sentence. On a first violation persons are usually referred back to treatment, which may be more intensive. N. Hilimont Avenue + Ventura, CA * 93003 + (805) 652-6737 = FAX: (805) 652-6160 www.vchca.org/bh

regarding working with clients with mental health and substance abuse disorders. BHD/ADP disagrees with generalizing mentally ill clients as long-term criminals. The Diagnostic and Statistical 300 N. Hillmont Avenue - Ventura, CA * 93003 + (805) 652-6737 + FAX: (805) 652-6160 www.vchca.org/bh F-72 F-73 F-74 F-75 F-76 F-77 F-78 F-79 Manual (DSM IV) differentiates between persons with mental disorders and persons with personality disorders. The remainder of this finding appears to be referring to individuals with Antisocial Personality Disorder. There is also a difference between individuals being unable to engage in treatment and those unwilling to participate. Partially Concur It was originally understood that Proposition 36 was for non-violent drug offenders. However, the law has been interpreted to mean that the offender was not committing 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 flaws in the law. Treatment providers have safety concerns, and have done a good job in averting potentially violent situations. Concur Partially Concur This may have been true prior to the high court decision filed 8/8/03. Penal code 1210.1 subdivision (b) sets forth five categories of defendants who are ineligible for Prop. 36; #5 states “have twice failed drug treatment as a condition of probation and been found not to be amenable to drug 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. Concur Partially Concur The Court determines strikes, when a defendant strikes out, and whena defendant is unamenable. Partially Concur The protocol states, “Clients who are resistant to treatment and refuse to pay program fees may be determined to be non-compliant”. Clients can not be deemed non-compiaint for not paying their program fees alone. Title 9 also differentiates between the inability to pay and the refusal to pay. Concur Concur 300 N. Hillmont Avenue * Ventura, CA = 93003 + (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh F-80 F-81 F-82 F-83 F-84 F-85 F-86 F-87 F-88 F-89 F-90 F-91 F-92 Partially Concur An Operations Committee exists, not an Oversight Committee. Refer to response to Finding 25. Unable to Comment Partially Concur Refer to response to Finding 61. BHD/ADP does not refer to mentally ill clients as being unamenable to treatment. It is important to place clients in the right treatment. Other then MART, and the Juvenile Adelante Court, Ventura County does not have a designated mental health court. Concur Concur Unable to Comment Partially Concur Prop. 36 eligible drug offenders with misdemeanor charges who opt out of treatment are usually sentenced to 90 days in jail. Every dollar invest 3d in treatment yields a return of $7 saved (Department of Alcohol and Drug Programs, CALDATA Report). According to the Justice Policy Institute, Ventura County taxpayers spent $5.8 million in 1999 to imprison drug offenders, of which nearly two-thirds ($3.7 million) was spent on prisoners sentenced for low-level drug possession charges. Unable to Comment Concur Concur Concur Concur Partially Concur The Implementation Committee evolved into the Operations Committee not the Oversight Committee (refer to the response for Finding 25). A representative from the CEO's office was the original chairperson of the implementation Committee and meeting minutes were published during 300 N. Hillmont Avenue * Ventura, CA + 93003 » (805) 652-6737 « FAX: (805) 652-6160 www.vchea.org/bh F-93 F.94 F-95 F-96 F-97 F-98 F-99 F-100 F-101 F-102 this time. When he stepped down in October 2001, the Committee voted a representative from the Public Defenders office as the new chairperson. When the second chairperson stepped down in August 2002, the Committee nominated and unanimously voted in a representative from the Lead Agency (BHD/ADP) as the chair. Concur Partially Concur This is an Operations Committee not an Oversight Committee (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 an Operations Committee not an Oversight Committee (refer to response for Finding 25). Partially Concur This is an Operations Committee not an Oversight Committee (refer to response for Finding 25). Concur Concur Concur Concur Concur Partially Concur Clients who do not contact the assessment center within 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 calendar is closely 300 N. Hillmont Avenue » Ventura, CA » 93003 + (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh F-103 F-104 F-105 F-106 F-107 F-108 F-109 F-110 F-111 F-112 F-113 F-114 F-115 monitored to ensure timely appointments. Clients usually enter treatment the same week they are assessed. Concur Concur Concur Disagree BHD/ADP reviewed various types of the ASI, including self-administered formats. As one of 10 Focus Counties selected to participate in the 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. Partially Concur The last sentence is incorrect. Proposition 36 mental health services are funded through the Substance Abuse Treatment Trust Fund (SATTF) allocation, and not a SAMHSA grant. Concur Concur Concur Concur Concur Concur Partially Concur 50% of the Prop. 36 clients in Ventura County have not had any prior drug treatment. It is unknown whether they were previously offered an opportunity for treatment. Partially Concur Refer to response for Finding 102. N. Hillmont Avenue + Ventura, CA » 93003 + (805) 652-6737 - FAX: (805) 652-6160 www.vchca.org/bh F-116 F-117 F-118 F-119 F-120 F-14121 F-122 F-123 F-124 F-125 Concur Unable to Comment Unable to Comment Unable to Comment Unable to Comment This is a broad generalization that does not apply to all people. Research has shown the different stages of motivation and stages of change that clients go through. Disagree BHD/ADP recognizes the importance of holding clients accountable through continual communication. Staff are trained to check out and verify information provided by clients. Concur Partially Concur Probation and Parole supervise, BHD/ADP case manages. Concur As stated in the Second Year Report, 2580 initial assessments had been conducted since the inception of the program. Partially Concur Treatment providers submit CADDS, PSR and DATAR forms each month. A CADDS form is completed every time there is a change in a client's status (new enrollment, re-enrollment, 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) or bed days (residential providers) for each client on a monthly basis. Residential providers submit progress reports (treatment level reviews) each month. Outpatient providers report on clients the first 30 days and 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. Hillmont Avenue ¢ Ventura, CA « 93003 = (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh F-126 F-127 F-128 F-129 F-130 F-131 F-132 F-133 F-134 F-135 faxed to the various outpatient treatment providers. Partially Concur With the removal of the firewall in September 2003, there are no requirements for assessment center case managers to meet with clients face to face, as the treatment providers now contact probation officers directly instead of going through the assessment center. Partially Concur Site visits of both residential and outpatient providers are conducted. Concur Concur Partially Concur 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 results from the lab and connected to the CMS database is projected to be completed by the end of the first quarter this year. We are waiting for outside vendor to complete work needed to implement. Concur It is the responsibility of the treatment providers to notify the assessment center of client compliance and non-compliance. Concur Partially Concur A report is generated each month showing the number of negative drug tests and positive tests by drug. Concur Partially Concur BHD/ADP has not been given full access to the criminal justice data system and the District Attorney's representative and representative's from Probation continue to not agree with providing information from their areas. Should BHD/ADPbe given access and should agreed upon 300 N. Hillmont Avenue » Ventura, CA » 93003 + (805) 652-6737 * FAX: (805) 652-6160 www.vchca.org/bh F-136 F-137 F-138 F-139 F-140 F-144 F-142 F-143 F-144 F-145 F-146 F-147 F-148 F-149 F-150 F-154 F-152 reporting from each area be provided, BHD/ADP has sufficient staff to analysis, report and provide information. A Statistician is not needed. Concur Concur Concur Concur Concur Concur Concur Concur Concur Concur Concur Concur Concur Disagree According to the American Society of Addiction Medicine (ASAM) placement criteria not all clients need the same length of treatment and treatment plans should be individualized based on the needs of the client. The initial referral of 30 days is used as a checks and balances to insure that clients are progressing and getting the treatment they need, and not being kept in treatment just to keep a bed filled. Residential providers must submit a treatment level review form based on ASAM placement criteria on each client every 30 days. Concur Unable to Comment Concur 300 N. Hillmont Avenue = Ventura, CA » 93003 « (805) 652-6737 = FAX: (805) 652-6160 www.vchca.org/bh F-153 Unable to Comment F-154 Unable to Comment F-155 Concur F-156 Disagree BHD/ADP contracts require drug-free workplace and this is enforced. F-157 Disagree BHD/ADP contract monitoring and quality controls can and are increased 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 to Comment F-166 Partially Concur Refer to response for Finding 135. F-167 Concur F-168 Concur F-169 Concur F-170 Partially Concur Protocols, including the satisfactory completion protocol were originally developed by the Implementation Committee. Some of the original 300 N. Hillmont Avenue +» Ventura, CA + 93003 « (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh F-171 F-172 F-173 F-174 F-175 F-176 F-177 protocols were based on compromises with criminal justice, and research and evidenced based clinical practices. There would be chaos without standardized protocols. Treatment providers were not part of the Implementation Committee, but two representatives are now part of the Operations 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 clients and submit progress reports every 90 days on each client. One treatment provider developed a score card for each client to record individual progress. The Addiction Severity Index (ASI) and drug testing are administered at the time of discharge. Clients testing positive are not discharged, but remain in treatment. Changes and decisions are based on sound Clinical, ethical, and legal decisions. Provider contracts were adjusted to units of service in order to better meet the needs of individual clients. BHD/ADP has agreed to not include the treatment providers in the Operations Committee. Concur The Assessment Center liaison fo the dedicated court has objected to offenders referred to Proposition 36 to no avail. BHD/ADP is concerned 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 if! treatment, BHD/ADP would like to be involved in the assessment and appropriateness of clients prior to their being sentenced to Prop. 36 treatment. Also, refer to response for Finding 72. BHD/ADP has proposed stricter treatment protocols for the first 30 days of treatment to try and determine those who are serious about treatment from those who are not. BHD/ADP hopes that the other partners in criminal justice will also review their protocols to keep these people out of treatment. Concur Concur Concur Concur Concur Disagree 300 N. Hillmont Avenue + Ventura, CA + 93003 + (805) 652-6737 +» FAX: (805) 652-6160 www.vchca.org/bh F-178 F-179 F-180 F-181 F-182 F-183 F-184 Under the sub-heading “Violation Criteria/Protocol” of the Non- Compliance Policy it states, “The Case Manager submits violation/non- compliance report with the Court/Probation within two business days of latest incident, utilizing the Non-compliance Form”. A specific protocol is then listed for each violation. Concur Unable to Comment. Partially Concur The formula the State used to calculate each county's allocation for 2001- 2004 was based on 50% county population, 25 % drug arrests, and 25% treatment case load. The formula that was used on 7/1/04 is based on 50% population, 40% caseload, and 10% drug arrests. Concur Disagree The number of treatment completions are tracked monthly and provided in a report distributed to the BHD/ADP Directors, Operations Committee, and ADP Advisory Board. A copy of this report was gi en to the Grand Jury several times. As of the end of May 2004, 628 c.ients had satisfactorily completed treatment. Clients can request tu have their cases expunged (removed from their court record) after completing treatment, paying all fines and fees, and complying with all terms of their probation. As of the end of May, 65 clients have had their charges expunged. BHD/ADP does not have access to recidivism information unless the offenders pick up another Prop. 36 related case. Unable to Comment Disagree Treatment providers ask for volunteers who want to speak about their experience in treatment at the Board of 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 a waiver of confidentiality. Treatment providers and BHD/ADP receives unsolicited letters monthly from clients, family and employers thanking us for the treatment experience that changed client's lives. N. Hillmont Avenue * Ventura, CA « 93003 * (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh F-185 F-186 F-187 F-188 F-189 F-190 F-191 F-192 F-193 F-194 F-195 Concur BHD/ADP has repeatedly been denied access to this information. Concur Concur Concur Concur Concur Disagree The standards and protocols are specifically quantified in the Non- Compliance Protocols. Treatment providers also provide the specifics to clients. Concur Disagree BHD/ADP quoted Senate Bill 223 (SB 223) which states, “... testing is primarily used as a treatment qwol’”. Concur Disagree There is no longer a Drug Court in Ventura County. Comparing drug test results of Prop. 36 clients with Drug Court participants is not a valid 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 were more motivated. Proposition 36 on the other hand, is much more inclusive even letting in some who shouldn't be considered eligible (i.e. drug dealers, gang members, driving under the influence), the caseloads are much larger, and the offenders have more severe addictions, lengthier criminal histories, and lower motivation. Drug Court only administered random testing which is easier for clients to use drugs or alcohol in between tests versus regular drug testing done 2 to 3 times per week. N. Hillmont Avenue - Ventura, CA * 93003 « (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh F-196 F-197 F-198 F-199 F-200 F-201 F-202 F-203 Concur Concur Unable to Comment Concur Drug Testing provided as a part of treatment is a treatment tool. Drug Testing — by Probation — can be used as a tool of compliance with the law. BHD/ADP would encourage a greater amount of drug testing and oversight by Probation of clients participating in Prop. Partially Concur Working drafts of proposed protocol changes were submitted for review to the Operations Committee not the Oversight Committee. Refer to response to Finding 25. Since marijuana can stay in the body for 30 days or more, a separate protocol was developed during the first year. If nanogram counts do not reduce or go up, clients are non-complied. Partially Concur . This is an Operations Committee and not an Oversight Committee. Refer fo response to Finding 25. Two major outpatient treatment providers dratted the drug testing protoco! for 2004-2005. Combined these two providers provide treatment to over 500 Proposition 36 clients per year. These same providers also drafted the new attendance protocol, which is more restrictive than the original protocol, and which the specific details are not mentioned in the Grand Jury report. Partially Concur 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 new protocols were a clinical : decision, and therefore should be incorporated without the approval of the Operations Committee. Partially Concur This is an Operations Committee and not an Oversight Committee. Refer to response to 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 throughout the 300 N. Hillmont Avenue « Ventura, CA + 93003 + (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh F-204 F-205 F-206 F-207 F-208 F-209 F-210 F-211 F-212 Operations meetings and was placed on the final format. Partially Concur This is an Operations Committee and not an Oversight Committee. Refer to response to Finding 25. Concur Partially Concur This is why treatment providers requested that a new drug testing protocol be developed to give them more discretion in testing. Also, if clients test positive at graduation, they are not completed and must remain in treatment. Concur Disagree Refer to the response to Finding 201. Partially Concur The drug testing protocol that went into effect July 1, 2004 was drafted by two treatment providers and was based on Clinical decisions rather than a financial business decision. The state only allocates a certain amount of funding for drug testing (refer to Senate Bill 223). The original law does not allow funds to be used for drug testing. Since the Proposition 36 lead agency does not receive funding from the County General Fund, there is no where else fo obtain additional drug testing funding. After the first 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 case loads. Disagree BHD/ADP has proposed a protocol with higher accountabilities in the first 30 days of treatment. Concur Partially Concur The type of testing changed from the first year to the second year. During the first year on site amino assay tests (dipsticks) were used. Because of 300 N. Hillmont Avenue + Ventura, CA * 93003 - (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh F-213 F-214 F-215 F-216 F-217 F-218 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 sent to the lab. This is the same lab that Probation uses. Partially Concur The table is showing lab tests only and does not include on-site amino assay (dipstick) tests at $7.00 per test. The table also does not include the cost of supplies. Concur 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. Partially Concur Various different statistics are kept by BHD/A DP. Clients are revolving in and out of treatment. They are non-compliea and returned to the court. A warrant will be issued for a client who has lost toucii with the treatment provider. Some clients may be arrested right away and others may take longer. An analogy of being “on the tarmac” was given to explain pending clients that are in a holding pattern between assessment, treatment, and the court. BHD/ADP does not know when a client is in jail as access to the VCIJIS jail screen has been denied. After 30 days of no contact with a client, treatment providers are required to close the CADDS and discharge the client. Oversight of clients while in the Community is a function of the Probation department. Partially Concur The generalized statement that drug tests average three to four tests per client per month, or jess than one test per week is incorrect. Clients are referred to different levels of treatment (Level 1, Level Il, or Level lil) which have different drug testing protocols at different phases in the treatment process. Since the beginning, a Matrix to show the phases of testing in the different treatment levels was created, and shows more testing being done in the beginning of treatment and fewer tests at the end. Disagree 300 N. Hillmont Avenue « Ventura, CA + 93003 + (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh F-219 F-220 F-221 F-222 F-223 F-224 F-225 Some client counts reported to the State are duplicates (i.e. CADDS) and some are unduplicated. Refer to response to Findings 180, 216, and 217. Disagree The BHD/ADP and Probation numbers cannot be compared as they are tracked differently. This is an incorrect way of figuring drug tests. Refer to response to Findings 216, 217, and 218. Concur This is why BHD/ADP have been trying to get electronic submission of drug results from the lab for over a year and a half. Plans have also been made to connect providers to the BHD/ADP computer database. Disagree The 21% positive rate is not extremely high when compared to similar programs. According to the Matrix Institute on Addictions, one of their program “success” completion measures is 70% urine samples drug free. This would be a 30% positive rate. The Grand Jury report mentioned Probation positive rates at 31% in Finding 222. Federal programs may have lower positive rates, but they are also very expensive programs to run, and Prop. 36 has not allocated enough funds to run this type of program. Other programs can have lower positive rates because they test on a random basis and not regularly. It is easier for persons to use when they are only tested randomly once a month. Concur Concur Ventura County provider's believe in the importance of client's taking personal responsibility for their financial 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 for treatment. Disagree Using this type of device would cost more than the allocation of $175,274. $3500 per month x 12 months = $42,000 x 8 sites = $336,000 plus the cost of sending positive tests to the lab for confirmation Disagree 300 N. Hillmont Avenue » Ventura, CA - 93003 » (805) 652-6737 + FAX: (805) 652-6160 www.vchca.org/bh F-226 F-227 F-228 F-229 F-230 F-231 F-232 F-233 F-234 F-235 F-236 . F-237 F-238 F-239 Hair follicle testing would not be practical for this type of program. Proposition 36 treatment providers need immediate results. They need a narrow and most recent window of detection, rather than 90 days. At the expense Of this type of testing, fewer tests would be run, and there would be the problem of overlapping tests. Hair follicle testing works better with custody cases. Partially Concur Mandated clients often have higher long-term recovery rates than voluntary clients do, because it is harder for them to drop out of treatment. Concur Concur Concur The Grand Jury did not mention the high recidivism rate of parolees in California as reported by the Little Hoover Commission. Concur. Concur Concur Concur Concur Concur Concur Concur Unable to Comment Concur 300 N. Hillmont Avenue + Ventura, CA « 93003 - (805) 652-6737 - FAX; (805) 652-6160 www.vchca.org/oh F-240 F-241 F-242 F-243 F-244 F-245 F-246 F-247 F-248 F-249 F-250 F-251 F-252 F-253 F-254 Partially Concur This is why the Standing Order was changed in May 2004 to allow BHD/ADP to release the Pre-sentence Probation Report to treatment providers. Probation had opposed releasing the report without having the order changed. Concur Concur Unable to Comment Unable to Comment Concur Concur Concur Partially Concur Drug offenders who engage in predatory illegal acts that victimize others (assault, robbery, burglary, theft, forgery, fraud, embezzlement, «nd dealing in stolen property) are not eligible for Proposition 36. Concur Concur Concur Other counties report all drug tests to the Court or Probation, however, the tests are not sanctionable. Concur Partially Concur BHD/ADP follows the instructions given by the Court. For each non- compliance submitted the most recent information is recorded. Usually the entire record is requested for a contested hearing. Concur 300 N. Hillmont Avenue + Ventura, CA * 93003 + (805) 652-6737 + FAX: (805) 652-6160 www.vchca.org/bh F-255 F-256 F-257 F-258 F-259 F-260 F-261 Concur Partially Concur In his letter the District Attorney does not mention that his office can take 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 between November 2001 and June 23,2004, 70 DUI cases were pled down and the offenders were made eligible for Prop. 36. The Grand Jury failed to reference the Public Defender’s response to the District Attorney's letter pointing out the errors and misinterpretations. Refer to Finding14 that states, ”...trials and plea bargains can result in a conviction on the drug charge only, making the defendant eligible for Prop 36 probation”. Partially Concur Prior to Prop. 36 offenders revolved in and out of jail without treatment. With Prop. 36 they are held accountable and referred back to court when they are not compliant. Concur These crimes are not supposed to be eligible for Proposition 36. It is very disruptive to treatment when these cases, especially those involving sales, are pled down and these individuals are aliowed into Prop. 36. Having drug dealers in treatment seriously jeopardizes the safety and recovery process of other clients. Partially Concur Clients are non-complied when they no show to assessment and when they no show to treatment. Concur Disagree Refer to response to Findings 256 and 258, A random review of Probation Pre-sentence Reports submitted to BHD/ADP between November 2001 and June 23,2004, revealed that 70 DUI cases were pled down and the offenders were made eligible for Prop. 36. At least one involved an injury with accident, and another involved some one driving into a garage at a high speed and almost striking children. Other counties, such as Santa Barbara County, charge offenders with DUI's. N. Hillmont Avenue « Ventura, CA + 93003 + (805) 652-6737 + FAX: (805) 652-6160 www.vchca.org/bh F-262 F-263 F-264 F-265 F-266 F-267 F-268 F-269 Partially Concur As stated previously, an Operations Committee exists, not an Oversight Committee. Refer to the response for Finding 25. The BHD/ADP chair of the Operations Committee was voted into the position and is the third chairperson. Refer to the response for Finding 92. Concur Partially Concur Standards and outcomes are measured according to best practice guidelines. BHD/ADP reserves the right to make necessary clinical decisions based on the welfare of clients. BHD/ADP believe in quality improvement. Prop. 36 distributes quarterly client satisfaction surveys fo clients in all County and contracted treatment programs. Partially Concur Standards and criteria have been developed in collaboration with treatment providers and the Operations Committee. Partially Concur Under the new drug testing protocol that became effective 7/1/04, treatment providers were given the discretion to increase or decrease the frequency of testing based on the individual needs of clients. Partially Concur The new attendance protocol that went into effect 7/1/04, was the first change since implementation, and was developed in collaboration with treatment providers and the Operations Committee. Partially Concur BHD/ADP has not neglected to track information, BHD/ADP cannot track information we are not given access to that the other agencies have readily available (i.e. VISION/VCIJIS). The Operations Committee sub- committee has not been able to come to an agreement or prioritize what information should be reported. BHD/ADP has collected and submitted all mandated information to the State, and as one of ten Focus Counties submits information weekly to UCLA. Partially Concur 300 N. Hilimont Avenue - Ventura, CA = 93003 « (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh F-270 F-271 F-272 F-273 F-274 F-275 F-276 F-277 F-278 F-279 F-280 As the Lead Agency it is BHD/ADP'’s responsibility to submit all reports to the State of California. In compiling reports, written information and replies are gathered from the various members of the Operations Committee. Concur Disagree The Grand Jury was given the same statistical reports given to the Operations Committee and the ADP Advisory Board. Refer to responses to Findings 216 and 273. Disagree As stated in Finding 279, 90% of assessed clients show up to treatment. Refer to responses to Findings 216 and 217. Disagree Refer to response in Finding 271. Disagree Concur Unable to comment. Concur Concur Concur Disagree The Probation Agency supplied the 1044 client count that is documented in the Second Year Report, which represents the number of clients on formal probation. Offenders are sentenced to 36 months or 3 years of probation. Considering 44% (592) of the 1345 clients assessed the first year, and 42% (519) of the 1235 clients assessed the second year, gives a total of 1111 that were on formal probation. The BHD/ADP number of 1111 does not figure in clients completing probation or having their probation revoked. These numbers are very close. Also, refer to responses to findings 215 and 219. N. Hillmont Avenue + Ventura, CA » 93003 « (805) 652-6737 * FAX: (805) 652-6160 www.vchca.org/bh F-281 F-282 F-283 F-284 F-285 F-286 F-287 F-288 Concur This is why the State contracted with CSU at Bakersfield to help define data reporting elements, and develop a users manual for the Lead Agencies. Training was conducted in September 2003. Refer to response to Finding 218. Disagree Not all clients who are eligible for services are referred to Prop. 36. Some offenders “opt out” or obtain other charges making them ineligible for Prop. 36. Disagree As stated before the 1044 client count represents the number of clients on formal probation. Offenders receive 36 months or 3 years of probation. It is erroneous to use this number to calculate drug tests per month. The Grand Jury attempted to apply simple mathematical calculations to a complex program with many factors involved. Refer to responses for Findings 213, 217, 219, 273, and 280. Partially Concur Refer to responses to Findings 216, 217 and 219. Partially Concur The Grand Jury received an un-audited version of the demographic report that contained a faulty formula. The 108% was in error and has been corrected to represent 100%. The table does not include clients entering prior to 7/1/03, those opting out, or those that have been non-complied. Concur Disagree 769 represents unduplicated new clients. This number does not include clients that started treatment prior to 7/1/03 or that returned to treatment. Refer to response to Finding 216. Disagree The 460-500 client count represented the number of clients with the two largest outpatient providers. It does not include clients in treatment at 300 N. Hillmont Avenue + Ventura, CA + 93003 - (805) 652-6737 » FAX: (805) 652-6160 h www.vchca.org/b F-289 F-290 F-291 F-292 F-293 F-294 F-295 F-296 F-297 other locations, out of county or in residential treatment. Refer to response to Findings 216 and 287. Concur Refer to response to Findings 216, 287, and 288. Concur Refer to response to Finding 215. Concur The same applies to clients missing from treatment. Concur Refer to response to Finding 216. Concur Refer to response to Finding 215. Partially Concur Refer to responses to Findings 219 and 273. Disagree Duplicated and unduplicated numbers cannot be compared in this manner. The non-compliance number is a duplicated number (clients are usually non-complied more than once), where as the monthly estimated number of clients in treatment per Jevel 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 44% of the assessed clients were on formal probation, and 42% for FY2002-2003. FY2003-2004 32% of the clients assessed were on formal probation, 62% on conditional release, and 6% on parole. Also, refer to response to Finding 219. Disagree Refer to response to Finding 219, 273, and 283. N. Hillmont Avenue * Ventura, CA » 93003 » (805) 652-6737 » FAX: (805) 652-6160 www.ychca.org/bh

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

Disagree “Unamenable’ is not a behavioral health term.

Partially Concur The reference should be to a member of the Operations Committee not Oversight Committee. Refer to Finding 25 response.

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

Partially Concur BHD/ADP concurs with the first sentence. Refer to the response to Finding 61 regarding working with clients with mental health and substance abuse disorders. BHD/ADP disagrees with generalizing mentally ill clients as long-term criminals. The Diagnostic and Statistical 300 N. Hillmont Avenue - Ventura, CA * 93003 + (805) 652-6737 + FAX: (805) 652-6160 www.vchca.org/bh

F-79 Manual (DSM IV) differentiates between persons with mental disorders and persons with personality disorders. The remainder of this finding appears to be referring to individuals with Antisocial Personality Disorder. There is also a difference between individuals being unable to engage in treatment and those unwilling to participate. Partially Concur It was originally understood that Proposition 36 was for non-violent drug offenders. However, the law has been interpreted to mean that the offender was not committing 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 flaws in the law. Treatment providers have safety concerns, and have done a good job in averting potentially violent situations. Concur Partially Concur This may have been true prior to the high court decision filed 8/8/03. Penal code 1210.1 subdivision (b) sets forth five categories of defendants who are ineligible for Prop. 36; #5 states “have twice failed drug treatment as a condition of probation and been found not to be amenable to drug 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. Concur Partially Concur The Court determines strikes, when a defendant strikes out, and whena defendant is unamenable. Partially Concur The protocol states, “Clients who are resistant to treatment and refuse to pay program fees may be determined to be non-compliant”. Clients can not be deemed non-compiaint for not paying their program fees alone. Title 9 also differentiates between the inability to pay and the refusal to pay. Concur Concur 300 N. Hillmont Avenue * Ventura, CA = 93003 + (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

Partially Concur An Operations Committee exists, not an Oversight Committee. Refer to response to Finding 25. Unable to Comment Partially Concur Refer to response to Finding 61. BHD/ADP does not refer to mentally ill clients as being unamenable to treatment. It is important to place clients in the right treatment. Other then MART, and the Juvenile Adelante Court, Ventura County does not have a designated mental health court. Concur Concur Unable to Comment Partially Concur Prop. 36 eligible drug offenders with misdemeanor charges who opt out of treatment are usually sentenced to 90 days in jail. Every dollar invest 3d in treatment yields a return of $7 saved (Department of Alcohol and Drug Programs, CALDATA Report). According to the Justice Policy Institute, Ventura County taxpayers spent $5.8 million in 1999 to imprison drug offenders, of which nearly two-thirds ($3.7 million) was spent on prisoners sentenced for low-level drug possession charges. Unable to Comment Concur Concur Concur Concur Partially Concur The Implementation Committee evolved into the Operations Committee not the Oversight Committee (refer to the response for Finding 25). A representative from the CEO's office was the original chairperson of the implementation Committee and meeting minutes were published during 300 N. Hillmont Avenue * Ventura, CA + 93003 » (805) 652-6737 « FAX: (805) 652-6160 www.vchea.org/bh

F-102 this time. When he stepped down in October 2001, the Committee voted a representative from the Public Defenders office as the new chairperson. When the second chairperson stepped down in August 2002, the Committee nominated and unanimously voted in a representative from the Lead Agency (BHD/ADP) as the chair. Concur Partially Concur This is an Operations Committee not an Oversight Committee (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 an Operations Committee not an Oversight Committee (refer to response for Finding 25). Partially Concur This is an Operations Committee not an Oversight Committee (refer to response for Finding 25). Concur Concur Concur Concur Concur Partially Concur Clients who do not contact the assessment center within 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 calendar is closely 300 N. Hillmont Avenue » Ventura, CA » 93003 + (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

monitored to ensure timely appointments. Clients usually enter treatment the same week they are assessed. Concur Concur Concur Disagree BHD/ADP reviewed various types of the ASI, including self-administered formats. As one of 10 Focus Counties selected to participate in the 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. Partially Concur The last sentence is incorrect. Proposition 36 mental health services are funded through the Substance Abuse Treatment Trust Fund (SATTF) allocation, and not a SAMHSA grant. Concur Concur Concur Concur Concur Concur Partially Concur 50% of the Prop. 36 clients in Ventura County have not had any prior drug treatment. It is unknown whether they were previously offered an opportunity for treatment. Partially Concur Refer to response for Finding 102. N. Hillmont Avenue + Ventura, CA » 93003 + (805) 652-6737 - FAX: (805) 652-6160 www.vchca.org/bh

F-125 Concur Unable to Comment Unable to Comment Unable to Comment Unable to Comment This is a broad generalization that does not apply to all people. Research has shown the different stages of motivation and stages of change that clients go through. Disagree BHD/ADP recognizes the importance of holding clients accountable through continual communication. Staff are trained to check out and verify information provided by clients. Concur Partially Concur Probation and Parole supervise, BHD/ADP case manages. Concur As stated in the Second Year Report, 2580 initial assessments had been conducted since the inception of the program. Partially Concur Treatment providers submit CADDS, PSR and DATAR forms each month. A CADDS form is completed every time there is a change in a client's status (new enrollment, re-enrollment, 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) or bed days (residential providers) for each client on a monthly basis. Residential providers submit progress reports (treatment level reviews) each month. Outpatient providers report on clients the first 30 days and 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. Hillmont Avenue ¢ Ventura, CA « 93003 = (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

F-135 faxed to the various outpatient treatment providers. Partially Concur With the removal of the firewall in September 2003, there are no requirements for assessment center case managers to meet with clients face to face, as the treatment providers now contact probation officers directly instead of going through the assessment center. Partially Concur Site visits of both residential and outpatient providers are conducted. Concur Concur Partially Concur 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 results from the lab and connected to the CMS database is projected to be completed by the end of the first quarter this year. We are waiting for outside vendor to complete work needed to implement. Concur It is the responsibility of the treatment providers to notify the assessment center of client compliance and non-compliance. Concur Partially Concur A report is generated each month showing the number of negative drug tests and positive tests by drug. Concur Partially Concur BHD/ADP has not been given full access to the criminal justice data system and the District Attorney's representative and representative's from Probation continue to not agree with providing information from their areas. Should BHD/ADPbe given access and should agreed upon 300 N. Hillmont Avenue » Ventura, CA » 93003 + (805) 652-6737 * FAX: (805) 652-6160 www.vchca.org/bh

reporting from each area be provided, BHD/ADP has sufficient staff to analysis, report and provide information. A Statistician is not needed. Concur Concur Concur Concur Concur Concur Concur Concur Concur Concur Concur Concur Concur Disagree According to the American Society of Addiction Medicine (ASAM) placement criteria not all clients need the same length of treatment and treatment plans should be individualized based on the needs of the client. The initial referral of 30 days is used as a checks and balances to insure that clients are progressing and getting the treatment they need, and not being kept in treatment just to keep a bed filled. Residential providers must submit a treatment level review form based on ASAM placement criteria on each client every 30 days. Concur Unable to Comment Concur 300 N. Hillmont Avenue = Ventura, CA » 93003 « (805) 652-6737 = FAX: (805) 652-6160 www.vchca.org/bh

Disagree BHD/ADP contracts require drug-free workplace and this is enforced.

Disagree BHD/ADP contract monitoring and quality controls can and are increased whenever necessary.

Partially Concur Refer to response for Finding 135.

Partially Concur Protocols, including the satisfactory completion protocol were originally developed by the Implementation Committee. Some of the original 300 N. Hillmont Avenue +» Ventura, CA + 93003 « (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

protocols were based on compromises with criminal justice, and research and evidenced based clinical practices. There would be chaos without standardized protocols. Treatment providers were not part of the Implementation Committee, but two representatives are now part of the Operations 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 clients and submit progress reports every 90 days on each client. One treatment provider developed a score card for each client to record individual progress. The Addiction Severity Index (ASI) and drug testing are administered at the time of discharge. Clients testing positive are not discharged, but remain in treatment. Changes and decisions are based on sound Clinical, ethical, and legal decisions. Provider contracts were adjusted to units of service in order to better meet the needs of individual clients. BHD/ADP has agreed to not include the treatment providers in the Operations Committee. Concur The Assessment Center liaison fo the dedicated court has objected to offenders referred to Proposition 36 to no avail. BHD/ADP is concerned 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 if! treatment, BHD/ADP would like to be involved in the assessment and appropriateness of clients prior to their being sentenced to Prop. 36 treatment. Also, refer to response for Finding 72. BHD/ADP has proposed stricter treatment protocols for the first 30 days of treatment to try and determine those who are serious about treatment from those who are not. BHD/ADP hopes that the other partners in criminal justice will also review their protocols to keep these people out of treatment. Concur Concur Concur Concur Concur Disagree 300 N. Hillmont Avenue + Ventura, CA + 93003 + (805) 652-6737 +» FAX: (805) 652-6160 www.vchca.org/bh

Under the sub-heading “Violation Criteria/Protocol” of the Non- Compliance Policy it states, “The Case Manager submits violation/non- compliance report with the Court/Probation within two business days of latest incident, utilizing the Non-compliance Form”. A specific protocol is then listed for each violation. Concur Unable to Comment. Partially Concur The formula the State used to calculate each county's allocation for 2001- 2004 was based on 50% county population, 25 % drug arrests, and 25% treatment case load. The formula that was used on 7/1/04 is based on 50% population, 40% caseload, and 10% drug arrests. Concur Disagree The number of treatment completions are tracked monthly and provided in a report distributed to the BHD/ADP Directors, Operations Committee, and ADP Advisory Board. A copy of this report was gi en to the Grand Jury several times. As of the end of May 2004, 628 c.ients had satisfactorily completed treatment. Clients can request tu have their cases expunged (removed from their court record) after completing treatment, paying all fines and fees, and complying with all terms of their probation. As of the end of May, 65 clients have had their charges expunged. BHD/ADP does not have access to recidivism information unless the offenders pick up another Prop. 36 related case. Unable to Comment Disagree Treatment providers ask for volunteers who want to speak about their experience in treatment at the Board of 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 a waiver of confidentiality. Treatment providers and BHD/ADP receives unsolicited letters monthly from clients, family and employers thanking us for the treatment experience that changed client's lives. N. Hillmont Avenue * Ventura, CA « 93003 * (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

Concur BHD/ADP has repeatedly been denied access to this information. Concur Concur Concur Concur Concur Disagree The standards and protocols are specifically quantified in the Non- Compliance Protocols. Treatment providers also provide the specifics to clients. Concur Disagree BHD/ADP quoted Senate Bill 223 (SB 223) which states, “... testing is primarily used as a treatment qwol’”. Concur Disagree There is no longer a Drug Court in Ventura County. Comparing drug test results of Prop. 36 clients with Drug Court participants is not a valid 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 were more motivated. Proposition 36 on the other hand, is much more inclusive even letting in some who shouldn't be considered eligible (i.e. drug dealers, gang members, driving under the influence), the caseloads are much larger, and the offenders have more severe addictions, lengthier criminal histories, and lower motivation. Drug Court only administered random testing which is easier for clients to use drugs or alcohol in between tests versus regular drug testing done 2 to 3 times per week. N. Hillmont Avenue - Ventura, CA * 93003 « (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

F-203 Concur Concur Unable to Comment Concur Drug Testing provided as a part of treatment is a treatment tool. Drug Testing — by Probation — can be used as a tool of compliance with the law. BHD/ADP would encourage a greater amount of drug testing and oversight by Probation of clients participating in Prop. Partially Concur Working drafts of proposed protocol changes were submitted for review to the Operations Committee not the Oversight Committee. Refer to response to Finding 25. Since marijuana can stay in the body for 30 days or more, a separate protocol was developed during the first year. If nanogram counts do not reduce or go up, clients are non-complied. Partially Concur . This is an Operations Committee and not an Oversight Committee. Refer fo response to Finding 25. Two major outpatient treatment providers dratted the drug testing protoco! for 2004-2005. Combined these two providers provide treatment to over 500 Proposition 36 clients per year. These same providers also drafted the new attendance protocol, which is more restrictive than the original protocol, and which the specific details are not mentioned in the Grand Jury report. Partially Concur 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 new protocols were a clinical : decision, and therefore should be incorporated without the approval of the Operations Committee. Partially Concur This is an Operations Committee and not an Oversight Committee. Refer to response to 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 throughout the 300 N. Hillmont Avenue « Ventura, CA + 93003 + (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

Operations meetings and was placed on the final format. Partially Concur This is an Operations Committee and not an Oversight Committee. Refer to response to Finding 25. Concur Partially Concur This is why treatment providers requested that a new drug testing protocol be developed to give them more discretion in testing. Also, if clients test positive at graduation, they are not completed and must remain in treatment. Concur Disagree Refer to the response to Finding 201. Partially Concur The drug testing protocol that went into effect July 1, 2004 was drafted by two treatment providers and was based on Clinical decisions rather than a financial business decision. The state only allocates a certain amount of funding for drug testing (refer to Senate Bill 223). The original law does not allow funds to be used for drug testing. Since the Proposition 36 lead agency does not receive funding from the County General Fund, there is no where else fo obtain additional drug testing funding. After the first 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 case loads. Disagree BHD/ADP has proposed a protocol with higher accountabilities in the first 30 days of treatment. Concur Partially Concur The type of testing changed from the first year to the second year. During the first year on site amino assay tests (dipsticks) were used. Because of 300 N. Hillmont Avenue + Ventura, CA * 93003 - (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

F-218 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 sent to the lab. This is the same lab that Probation uses. Partially Concur The table is showing lab tests only and does not include on-site amino assay (dipstick) tests at $7.00 per test. The table also does not include the cost of supplies. Concur 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. Partially Concur Various different statistics are kept by BHD/A DP. Clients are revolving in and out of treatment. They are non-compliea and returned to the court. A warrant will be issued for a client who has lost toucii with the treatment provider. Some clients may be arrested right away and others may take longer. An analogy of being “on the tarmac” was given to explain pending clients that are in a holding pattern between assessment, treatment, and the court. BHD/ADP does not know when a client is in jail as access to the VCIJIS jail screen has been denied. After 30 days of no contact with a client, treatment providers are required to close the CADDS and discharge the client. Oversight of clients while in the Community is a function of the Probation department. Partially Concur The generalized statement that drug tests average three to four tests per client per month, or jess than one test per week is incorrect. Clients are referred to different levels of treatment (Level 1, Level Il, or Level lil) which have different drug testing protocols at different phases in the treatment process. Since the beginning, a Matrix to show the phases of testing in the different treatment levels was created, and shows more testing being done in the beginning of treatment and fewer tests at the end. Disagree 300 N. Hillmont Avenue « Ventura, CA + 93003 + (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

Some client counts reported to the State are duplicates (i.e. CADDS) and some are unduplicated. Refer to response to Findings 180, 216, and 217. Disagree The BHD/ADP and Probation numbers cannot be compared as they are tracked differently. This is an incorrect way of figuring drug tests. Refer to response to Findings 216, 217, and 218. Concur This is why BHD/ADP have been trying to get electronic submission of drug results from the lab for over a year and a half. Plans have also been made to connect providers to the BHD/ADP computer database. Disagree The 21% positive rate is not extremely high when compared to similar programs. According to the Matrix Institute on Addictions, one of their program “success” completion measures is 70% urine samples drug free. This would be a 30% positive rate. The Grand Jury report mentioned Probation positive rates at 31% in Finding 222. Federal programs may have lower positive rates, but they are also very expensive programs to run, and Prop. 36 has not allocated enough funds to run this type of program. Other programs can have lower positive rates because they test on a random basis and not regularly. It is easier for persons to use when they are only tested randomly once a month. Concur Concur Ventura County provider's believe in the importance of client's taking personal responsibility for their financial 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 for treatment. Disagree Using this type of device would cost more than the allocation of $175,274. $3500 per month x 12 months = $42,000 x 8 sites = $336,000 plus the cost of sending positive tests to the lab for confirmation Disagree 300 N. Hillmont Avenue » Ventura, CA - 93003 » (805) 652-6737 + FAX: (805) 652-6160 www.vchca.org/bh

F-239 Hair follicle testing would not be practical for this type of program. Proposition 36 treatment providers need immediate results. They need a narrow and most recent window of detection, rather than 90 days. At the expense Of this type of testing, fewer tests would be run, and there would be the problem of overlapping tests. Hair follicle testing works better with custody cases. Partially Concur Mandated clients often have higher long-term recovery rates than voluntary clients do, because it is harder for them to drop out of treatment. Concur Concur Concur The Grand Jury did not mention the high recidivism rate of parolees in California as reported by the Little Hoover Commission. Concur. Concur Concur Concur Concur Concur Concur Concur Unable to Comment Concur 300 N. Hillmont Avenue + Ventura, CA « 93003 - (805) 652-6737 - FAX; (805) 652-6160 www.vchca.org/oh

Partially Concur This is why the Standing Order was changed in May 2004 to allow BHD/ADP to release the Pre-sentence Probation Report to treatment providers. Probation had opposed releasing the report without having the order changed. Concur Concur Unable to Comment Unable to Comment Concur Concur Concur Partially Concur Drug offenders who engage in predatory illegal acts that victimize others (assault, robbery, burglary, theft, forgery, fraud, embezzlement, «nd dealing in stolen property) are not eligible for Proposition 36. Concur Concur Concur Other counties report all drug tests to the Court or Probation, however, the tests are not sanctionable. Concur Partially Concur BHD/ADP follows the instructions given by the Court. For each non- compliance submitted the most recent information is recorded. Usually the entire record is requested for a contested hearing. Concur 300 N. Hillmont Avenue + Ventura, CA * 93003 + (805) 652-6737 + FAX: (805) 652-6160 www.vchca.org/bh

Concur Partially Concur In his letter the District Attorney does not mention that his office can take 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 between November 2001 and June 23,2004, 70 DUI cases were pled down and the offenders were made eligible for Prop. 36. The Grand Jury failed to reference the Public Defender’s response to the District Attorney's letter pointing out the errors and misinterpretations. Refer to Finding14 that states, ”...trials and plea bargains can result in a conviction on the drug charge only, making the defendant eligible for Prop 36 probation”. Partially Concur Prior to Prop. 36 offenders revolved in and out of jail without treatment. With Prop. 36 they are held accountable and referred back to court when they are not compliant. Concur These crimes are not supposed to be eligible for Proposition 36. It is very disruptive to treatment when these cases, especially those involving sales, are pled down and these individuals are aliowed into Prop. 36. Having drug dealers in treatment seriously jeopardizes the safety and recovery process of other clients. Partially Concur Clients are non-complied when they no show to assessment and when they no show to treatment. Concur Disagree Refer to response to Findings 256 and 258, A random review of Probation Pre-sentence Reports submitted to BHD/ADP between November 2001 and June 23,2004, revealed that 70 DUI cases were pled down and the offenders were made eligible for Prop. 36. At least one involved an injury with accident, and another involved some one driving into a garage at a high speed and almost striking children. Other counties, such as Santa Barbara County, charge offenders with DUI's. N. Hillmont Avenue « Ventura, CA + 93003 + (805) 652-6737 + FAX: (805) 652-6160 www.vchca.org/bh

F-269 Partially Concur As stated previously, an Operations Committee exists, not an Oversight Committee. Refer to the response for Finding 25. The BHD/ADP chair of the Operations Committee was voted into the position and is the third chairperson. Refer to the response for Finding 92. Concur Partially Concur Standards and outcomes are measured according to best practice guidelines. BHD/ADP reserves the right to make necessary clinical decisions based on the welfare of clients. BHD/ADP believe in quality improvement. Prop. 36 distributes quarterly client satisfaction surveys fo clients in all County and contracted treatment programs. Partially Concur Standards and criteria have been developed in collaboration with treatment providers and the Operations Committee. Partially Concur Under the new drug testing protocol that became effective 7/1/04, treatment providers were given the discretion to increase or decrease the frequency of testing based on the individual needs of clients. Partially Concur The new attendance protocol that went into effect 7/1/04, was the first change since implementation, and was developed in collaboration with treatment providers and the Operations Committee. Partially Concur BHD/ADP has not neglected to track information, BHD/ADP cannot track information we are not given access to that the other agencies have readily available (i.e. VISION/VCIJIS). The Operations Committee sub- committee has not been able to come to an agreement or prioritize what information should be reported. BHD/ADP has collected and submitted all mandated information to the State, and as one of ten Focus Counties submits information weekly to UCLA. Partially Concur 300 N. Hilimont Avenue - Ventura, CA = 93003 « (805) 652-6737 » FAX: (805) 652-6160 www.vchca.org/bh

As the Lead Agency it is BHD/ADP'’s responsibility to submit all reports to the State of California. In compiling reports, written information and replies are gathered from the various members of the Operations Committee. Concur Disagree The Grand Jury was given the same statistical reports given to the Operations Committee and the ADP Advisory Board. Refer to responses to Findings 216 and 273. Disagree As stated in Finding 279, 90% of assessed clients show up to treatment. Refer to responses to Findings 216 and 217. Disagree Refer to response in Finding 271. Disagree Concur Unable to comment. Concur Concur Concur Disagree The Probation Agency supplied the 1044 client count that is documented in the Second Year Report, which represents the number of clients on formal probation. Offenders are sentenced to 36 months or 3 years of probation. Considering 44% (592) of the 1345 clients assessed the first year, and 42% (519) of the 1235 clients assessed the second year, gives a total of 1111 that were on formal probation. The BHD/ADP number of 1111 does not figure in clients completing probation or having their probation revoked. These numbers are very close. Also, refer to responses to findings 215 and 219. N. Hillmont Avenue + Ventura, CA » 93003 « (805) 652-6737 * FAX: (805) 652-6160 www.vchca.org/bh

F-288 Concur This is why the State contracted with CSU at Bakersfield to help define data reporting elements, and develop a users manual for the Lead Agencies. Training was conducted in September 2003. Refer to response to Finding 218. Disagree Not all clients who are eligible for services are referred to Prop. 36. Some offenders “opt out” or obtain other charges making them ineligible for Prop. 36. Disagree As stated before the 1044 client count represents the number of clients on formal probation. Offenders receive 36 months or 3 years of probation. It is erroneous to use this number to calculate drug tests per month. The Grand Jury attempted to apply simple mathematical calculations to a complex program with many factors involved. Refer to responses for Findings 213, 217, 219, 273, and 280. Partially Concur Refer to responses to Findings 216, 217 and 219. Partially Concur The Grand Jury received an un-audited version of the demographic report that contained a faulty formula. The 108% was in error and has been corrected to represent 100%. The table does not include clients entering prior to 7/1/03, those opting out, or those that have been non-complied. Concur Disagree 769 represents unduplicated new clients. This number does not include clients that started treatment prior to 7/1/03 or that returned to treatment. Refer to response to Finding 216. Disagree The 460-500 client count represented the number of clients with the two largest outpatient providers. It does not include clients in treatment at 300 N. Hillmont Avenue + Ventura, CA + 93003 - (805) 652-6737 » FAX: (805) 652-6160 h www.vchca.org/b

other locations, out of county or in residential treatment. Refer to response to Findings 216 and 287. Concur Refer to response to Findings 216, 287, and 288. Concur Refer to response to Finding 215. Concur The same applies to clients missing from treatment. Concur Refer to response to Finding 216. Concur Refer to response to Finding 215. Partially Concur Refer to responses to Findings 219 and 273. Disagree Duplicated and unduplicated numbers cannot be compared in this manner. The non-compliance number is a duplicated number (clients are usually non-complied more than once), where as the monthly estimated number of clients in treatment per Jevel 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 44% of the assessed clients were on formal probation, and 42% for FY2002-2003. FY2003-2004 32% of the clients assessed were on formal probation, 62% on conditional release, and 6% on parole. Also, refer to response to Finding 219. Disagree Refer to response to Finding 219, 273, and 283. N. Hillmont Avenue * Ventura, CA » 93003 » (805) 652-6737 » FAX: (805) 652-6160 www.ychca.org/bh Recommendations: