1. From State Down: Improving How We Do Business Suzan Swanton, LCSW-C Executive Director Maryland State Drug and Alcohol Council www.maryland-sdaac.org

2. State Council: Members Sec., DHMH Sec, DPSCS Sec., DJS Sec., DHR Sec., DBM Sec., GOC Superintendent, MSDE Exec. Dir., GOCCP State Senator State Delegate District Court Judge Circuit Court Judge 7 members of public Dir., ADAA Dir., MHA Dir, DPP Asst. Sec. for Treatment, DPSCS

3. Purpose Develop comprehensive, coordinated and collaborative approach to use of State resources Coordinate delivery of prevention, intervention and treatment resources Promote collaboration and coordination of programs with LDAACs

4. Duties Strategic Plan Recommend systemic improvements Identify promising practices Recommend coordination and collaboration strategies Allocation Formula

5. Local Councils Health Officer Regional Dir, DJS Regional Dir., DPP States Attorney Public Defender Chief, Police/Sheriff Pres, local Bd. of Ed. County Exec., etc. Rep, County Council Adm. Judge, Cir. Ct. Adm. Judge, Dist. Ct. 1 consumer 2 providers Prevention provider Ind. Knowledgeable Warden, local detention center

6. What is best practice ? Gold Standard Multiple randomized clinical trials Second Tier Consensus reviews of available science Third Tier Expert opinion based on clinical observation (Drake, et al. 2001. Implementing evidence based practices in routine mental health service settings. Psychiatric Services, 52, 179 – 182)

7. Best Practice: Government Level Blueprint for the States: Policies to Improve the Way States Organize and Deliver Alcohol and Drug Prevention and Treatment Join Together Inc. – Boston Universitys School of Public Health www.jointogether.org

8. Why do we need to improve how we do business? 13% of States budget spent on the consequences of drugs and alcohol < 4% spent on treatment and prevention 96% spent on avoidable consequences

9. And more reasons… 70% - State child welfare budgets spent on AOD related problems 77% - State criminal justice budgets 25% - State Health budgets

10. Six Recomendations Leadership Structure Resources Measurement and Accountability Legislation Sustain State Focus and Attention

11. LEADERSHIP Continuous leadership from State executive, legislative and judicial branches State Plan Governor: hold State agencies accountable Legislative Leaders know and educate on cost and consequences Chief Judges – know and educate

12. STRUCTURE State Council with appropriate agencies Cabinet Level –Single State Agency Encourage Collaboration among providers

13. RESOURCES Funding Secure and Retain Skilled Professionals

14. MEASUREMENT AND ACCOUNTABILITY Create a unified data Track progress Annual reports that track the costs and consequences of AOD problems Pay more to providers that achieve better results

15. LEGISLATION Formal Review process Legislation reflects current understanding of disease? Legislation inhibits recovery and re-entry? Best practices in reducing underage drinking ? Balance between alcohol availability and public safety and health ?

16. SUSTAIN STATE FOCUS AND ATTENTION Permanent and highly visible board Local organizations that monitor and report local problems and progress Providers and State work together to incorporate best practices into state standards