D B H D S Virginia Department of Behavioral Health and Developmental Services Creating Opportunities for People with Substance Use Disorders a presentation to the Substance Abuse Services Council September 16, 2011 Mellie Randall Manager Planning and Grants Management, Office of Behavioral Health Services

Page 2 DBHDS Virginia Department of Behavioral Health and Developmental Services Overview of Substance Use in Virginia NSDUH ( ) – Annual survey of Virginians age 12+ –22.9% participated in binge drinking (5+ drinks on one occasion) in the month prior. –7.5% used illicit drugs in the month prior. –9.84% used marijuana in the year prior. –4.89% used pain relievers for a nonmedical use in the year prior. –Among those years of age, 26.42% used alcohol in the month prior.

Page 3 DBHDS Virginia Department of Behavioral Health and Developmental Services Need for Treatment in Virginia NSDUH ( ) Virginians age 12+ –9.16% (574,883) met clinical criteria for abuse or dependence of illicit drugs or alcohol in the year prior. –7.23% (453,756) needed but did not receive treatment for alcohol use in the year prior. –2.45 (153,762) needed but did not receive treatment for illicit drug use in the year prior JLARC (2008): $613 million (2006$) expended due to untreated SA in Virginia (mostly CJS)

Page 4 DBHDS Virginia Department of Behavioral Health and Developmental Services Drug Caused Deaths by Region OCME ( )

Page 5 DBHDS Virginia Department of Behavioral Health and Developmental Services DBHDS Overview Directly operates 16 facilities to serve those who are most impaired  9 Mental Health Facilities (mentally ill and/or co- occurring SUD)  5 Training Facilities (intellectually impaired)  1 Medical Facility  1 Facility for Sexually Violent Predators Increasing emphasis on providing services in the community Contractual relationship with 40 community services boards

Page 6 DBHDS Virginia Department of Behavioral Health and Developmental Services Community Services Boards Established in 1968 by General Assembly to provide MH, SA and DD services to localities Every city/county required to be a member of a CSB Only codified mandated service is emergency and, “where resources are available”, case management

Page 7 DBHDS Virginia Department of Behavioral Health and Developmental Services CSB Prevention Services Entirely funded by federal SAPT BG (20% set-aside), local funds or other grants (No GF) Must meet SAPT BG criteria (evidence-based programs/practices, strategies, target populations) Six categories of federal strategies: 1.Information Dissemination 2.Education 3.Alternatives 4.Problem Identification 5.Community Based Process 6.Environmental Over 700,000 individuals participated in CSB prevention programs in 2010

Page 8 DBHDS Virginia Department of Behavioral Health and Developmental Services CSB SA Services Who Gets Treatment? N=38,661 in 2010 (July 2009-June 2010) Race: 60.3% White 29.88% Black/African-American Gender: 65% male 35% female Age:  17 or younger: 9.43%  :  23-59: 75.83%  59+: 1.77%

Page 9 DBHDS Virginia Department of Behavioral Health and Developmental Services CSB SA Treatment What Services are Provided? Nearly all CSBs provide outpatient services. About half provide case management, but fewer than 1/3 of SA CSB clients received service. About half provide medication assisted treatment. System wide, there are about 100 community-based detoxification beds. All CSBs must provide priority access to pregnant women and people who use drugs intravenously. All CSBs must provide certain supports for pregnant women and women with dependent children. Eight specialized sites for pregnant women (specialized case management with local health and social services).

Page 10 DBHDS Virginia Department of Behavioral Health and Developmental Services CSB SA Services How are Services Paid For? Federal:$42,867,676 State: $46,678,876 Local:$38,310,365 Fees & Other: $ 5,947,730 $133,804,647 FY 2010

Page 11 DBHDS Virginia Department of Behavioral Health and Developmental Services Substance-Use Disorder Report Goal – To provide the Governor with recommendations that will improve access to SUD services for Virginians with focus on prevention and treatment with special attention to persons involved in the criminal justice system. Two-stage process –Public and private providers –State agencies: DOC, DCJS, DBHDS, VDH, DHP, DJJ DMAS, DRS, DSS

Page 12 DBHDS Virginia Department of Behavioral Health and Developmental Services SUD Service Gaps Identified Multiple studies: OIG in 06 & 08, JLARC in 08 All communities surveyed by DBHDS in spring to determine availability of & gaps in services Gaps consistently identified: –Lack of access to adequate capacity of the array of services necessary to support recovery. –Results in inability to match the duration and intensity of service to the extent of abuse or dependence. –Limited use of evidence-based services

Page 13 DBHDS Virginia Department of Behavioral Health and Developmental Services Proposals to Expand Capacity to Assure Timely Access to SUD Services Enhance case management capacity Develop capacity to serve adolescents Expand Project Link for pregnant women Expand peer-run support services Enhance uniform screening and assessment Implement a structured systems improvement practice model such as NIATx

Page 14 DBHDS Virginia Department of Behavioral Health and Developmental Services Proposals to Fill Gaps in SUD Service Array Expand intensive outpatient services Expand capacity of community-based residential medical detoxification Expand access to medication assisted treatment Develop residential treatment capacity for pregnant women in SW Virginia

Page 15 DBHDS Virginia Department of Behavioral Health and Developmental Services Proposals for Services/Supports to Sustain Recovery Oriented System Expand DRS SA vocational counselor project Establish capacity for supported living services Create multi-agency SUD work force development capacity