San Mateo County System of Care Transformation

1
San Mateo County System of Care Transformation

• Santa Cruz County
• JANUS Conference
• September 10, 2008

2
San Mateo County Snapshot

• Population 733,496
• 14th most populated county in the State
• 20 cities and several unincorporated communities
• Consists of urban, suburban and rural areas
• (2006 quickfacts.census.gov)

3
San Mateo CountyPopulation by Race (2006)
4
SMC Alcohol and Other Drug Services (AOD)

• Mission To provide leadership and advocacy,
  support effective prevention approaches and
  quality addiction treatment services, and to
  educate the community about substance use and
  abuse and its related impacts on individuals,
  families, and communities.
• Annual budget of over 17 million
• 22 contracted community-based prevention and
  treatment providers.

5
AOD System Design

• AOD is not a direct treatment service provider
• AOD has 32 staff, including 8 Program Analysts
  and 11 Alcohol and Drug Assessor/Case Managers
• Treatment services are provided via contract with
  14 treatment providers to provide a full range of
  treatment modalities (OP, IOP, RTP, NRT, Detox)

6
(No Transcript)
7
Who We Serve Admissions by Race and Ethnicity
8
Who We ServeAge at Admission
9
Who We ServeAdmissions by Referral Source

• For FY 06/07
• Individual, includes self referral 40
• Criminal Justice 35
• Other Community Referral 9
• Juvenile Justice 8
• Child Welfare 5
• Alcohol/Drug Program 3

10
Total Admissions to Treatment by Modality
11
Our System Treatment Need

• Community Need for Treatment
• Approximately one out of every 12 San Mateo
  County residents (57,000 people) abuse alcohol or
  drugs, largely alcohol (65) and methamphetamine
  (43).
• It is estimated 20,000 that residents quality for
  publicly-funded
• In FY 06/07, San Mateo County served
• 3419 unduplicated clients
• 4663 duplicated clients (total treatment
  admissions)
• 6212 duplicated clients (including detox)
• excludes short term residential detox services.

12
Need for Systems Change Historical Context

• Clients inadequately and/or underserved by the
  system
• No established target populations for priority
  access to treatment (who you know access)
• Acute and episodic treatment of addiction
• One size fits all limited use of evidence based
  treatment and individually tailored,
  client-centered care
• Abstinence-based treatment (relapse discharge)
• Little coordination among service providers
• Only 1.5 of clients subsequently enrolled into a
  continuing care modality (aftercare / relapse
  prevention) within 30 days of discharge from
  their primary treatment episode.

13
Systems Change Initiated (2006) Development of
AOD Strategic Plan

• Key Principles
• Alcohol and drug addiction is a chronic,
  relapsing brain disease.
• Interventions are designed to break the cycle of
  familial addiction.
• Harm-reduction engages people not ready for
  treatment and can improve other health-related
  outcomes.
• Supports are comprehensive, continuous and
  integrated.
• Best practices are client and community centered,
  evidence-based, gender specific, ethically and
  culturally responsive.

14
Systems Change Initiated (2006) AOD Strategic
Plan Outcomes

• Client sobriety and recovery
• Children/youth living in safe, supportive and
  stable families
• Stable finances/housing/basic supports
• Children/youth in pro-social activity/asset
  development
• Increased involvement of clients and families

• Client wellness and recovery
• Timely access to help
• Elimination of ethnic disparities
• Safe and adequate housing and decreased
  homelessness
• Client employment, vocational training,
  education, and social and community activities
• Reduction in incarceration and involuntary
  treatment

15
Systems Change Initiated (2006) AOD Strategic
Plan

• Approved by County Board in November 2006
• Aligned with existing Board of Supervisors
  priorities
• Established three strategic directions
• Priority populations for treatment services
• System-wide improvements
• Capacity and resource development
• Results Board invested additional 1.5 M
  annually to support implementation

16
Systems Change Initiated (2006)Philosophical
Strategic Changes

• Established AOD and Mental Health Partnership to
  better serve clients with co-occurring disorders
  (COD)
• Adoption of Comprehensive, Continuous, integrated
  Systems of Care (CCISC) Model for Systems Change
  ZIA Partners
• The Systems Transformation Project Charter
  Document to improve service delivery to those
  with co-occurring disorders

17
System Design Change (2007)

• Behavioral Health and Recovery Services (BHRS) is
  created in October 2007 (integrates AOD and
  Mental Health)
• Change Agents for COD Systems Transformation
• RFP all AOD Treatment Services
• Required service of identified priority
  populations (85)
• Utilize evidence-based and best practice services
• Quality Improvement framework requirement

18
Changing Policies, Standards and Business
Practices (2008)

• New AOD Policies
• Medication, Narcotic Replacement, and Relapse
  Policies
• Welcoming Framework
• Establish Standards of Care, EBP required
• Quality Improvement Framework
• WRA Continuing Care Pilot
• COD Documentation (Medi-Cal charting and billing)

19
Women's Recovery Association Continuing Care Pilot

• Contract and Provider Details
• Pilot funded by County dollars
• Provider has full continuum of services
• Establishes annual case rate
• Eight (8) women to be served for one full year
• Provider has one year contract

• Program Highlights
• Client will utilize full continuum of care- from
  primary treatment to recovery management for one
  full year
• Provider to determine, with client, level of care
  and length of stay
• Client progress tracked weekly through weekly
  assessment tool
• Data on progress, client status, quality of life
  measures, and current risk is collected weekly.
• Pilot study includes evaluation plan with control
  group

20
Challenges to Implementing Change

• Federal and state funding policy
• Limited data and information system barriers
• Evaluation methods
• Implementing a chronic care model using EBP will
  result in serving fewer people annually, if done
  within the same resources
• Political and ethical impacts in reductions in
  number of people served.

21
Treatment Provider Concerns

• Limited new funding for AOD evidence based
  treatment and best practices lack of funding to
  implement practice with fidelity
• Pressure to improve outcomes show me
• Workforce development and staff turnover
  challenge

22
Whats Next?

• Continue Integration of services (BHRS)
• CCISC/Change Agents Access to Care
• Maximize available resources (HPSM, DMC, MAA)
• Continuing Care
• Use of Technology to Support Continuing Care
• AOD Care Managers
• Community Engagement / Voices of Recovery

23
Whats Next?

• Expand the use of practices shown by evidence to
  be effective, e.g.
• Teaching Pro-Social Skills to youth
• Continuing care and relapse prevention
• Culturally appropriate and gender specific
  treatment
• Integrated System of Care for people with
  Co-Occurring Disorders
• Continue treatment provider and staff trainings
  and technical assistance

24
Thank you!

• For more information, contact
• Clara Boyden
• SMC Behavioral Health and Recovery Services
• Alcohol and Other Drug Services
• cboyden_at_co.sanmateo.ca.us
• 650-802-5101