1. Placer County: Integration of Services for Justice Involved Clients Presented by: Amy Ellis, MFT ASOC Substance Use and Mental Health Manager

2. Historical look at integration  1997: Placer County started it’s first Adult and Juvenile Drug Courts  1998: Integrated funding placed multiple probation officers at Children’s mental health services and one probation officer at Adult Services.  2000: Probation officers co-located in HHS received training in EBPs and motivational enhancement  2005- today: All probation officers receive training in Motivational Interviewing and other EBP.  2011: AB109 begins to increase discussions across disciplines about who to integrate more effectively  2012: HHS was given funding for 3 FTE treatment staff co- located at probation, and additional funding for contracted treatment in-custody and in the community.  2013: Veteran’s Court began  2015: Probation PREP center opened adding additional educational and vocational services PLACER COUNTY INTEGRATION Despite a long tradition of integrated practices, some silos still exist, integration is a continuous work in progress.

3. Over the last 4 years…. Consultants TRAINING, TRAINING, TRAINING Meetings and more meetings Transparency Combined rituals…. PLACER COUNTY INTEGRATION

4. Integration Enhanced  HHS staff co-located at probation  Leadership and staff integrated in both Substance Use Services AND Mental Health  Emphasis on decreasing barriers and cross system knowledge at both policy AND direct service level.  Series of cross discipline “sub-committees” to increase efficiencies (e.g. use of assessments)  “Pioneer” direct service staff becoming members of cross discipline teams.  Single MH and SUD assessment taking criminogenic needs into consideration. PLACER COUNTY INTEGRATION

5. CO-LOCATED HHS STAFF  3 FTE approved  PROVIDE:  Assessments to pre and post sentence  Linkage to MH and Substance Service  Case Management to Employment, Housing, Medical, Education, Vocational, and other services based on need.  Crisis Management  In-Custody linkage to community care FY11-12FY12-13FY13-14FY14-15 Total since program start Total unduplicated # Served 235366 432 1110 PLACER COUNTY INTEGRATION

6. AB109 System Entry Process PLACER COUNTY INTEGRATION

7. SCREENING/ASSESSMENT TOOLS Short tools to screen SUD/MH/Change factors:  Criminogenic Cognition Scale (CCS)  The Drug Abuse Screening Test (DAST 20)  Alcohol Use Disorders Identification Test (AUDIT)  RCQ Change Questionnaire  MH Screener  Mood Disorder Scale (MDQ) 2- 3 hour in-depth assessment (screened to need)  Biopsychosocial Assessment FY11-12FY12-13FY13-14FY14-15 Total since program start Out of custody only # referred 92148195 233 545 # screened/assessed 77140156 196 422 PLACER COUNTY INTEGRATION

8. Treatment versus Educational Programming  Treatment:  Typical services include: Detox, Residential, Outpatient  Providers are certified and/or licensed by the CA Department of Health Care Services (DHCS).  Must comply with regulations and standards defined by the state and county (e.g. group size, education levels of staff, documentation standards, etc.).  Educational Programming:  Larger class sizes,  Generally do not have set regulations and standards  May utilize an evidence based practice.  Examples: Domestic Violence, Parenting, Theft Class, etc.  DUI and PC1000 are unique, they have regulatory oversight/monitoring *Both MODALITIES are important parts of the “treatment continuum” and allow for an individualize plan for different needs. PLACER COUNTY INTEGRATION

9. Treatment Modalities  Detox / Residential  Transitional Housing combined with outclient treatment  Outclient Treatment  Educational Programming/Classes  Mental Health PLAER COUNTY TREATMENT FY11-12FY12-13FY13-14 FY14-15 Total since program start Total Placed in treatment (in/out of custody combined) 12211300 315 838 Detox 0713 6 26 Residential 82850 62 148 Out Patient SUDS 44851 60 163 Transitional Housing 637 51 131 Mental Health 112339 35 108 In Custody Treatment NA137220 205 562

10. Detox/Residential PLACER COUNTY TREATMENT Defined: 24/7 facility where treatment is received Typical Lengths of stay: Detox 7-10 days; Residential: 45-60 Days Research: Short term stays to stabilize followed by outpatient treatment in community Locations: Auburn, Grass Valley, Sacramento, Nevada City, Coloma, and Woodland Approx. # can be served annually : 50

11. Detox/Residential PROVIDERCONTRACTEDCAPACITY-UNITS Centerpoint-Residential$45,000.0011.1 CoRR-Residential/detox$68,000.0016.8 Progress House-Residential$82,500.0020.4 TOTALS$195,500.0048.3 FY13-14 Outcomes : Served in FY 13-14 13 Detox ; 50 Residential: 63 total 50% Completed their program 56% Continued their treatment to Outpatient PLACER COUNTY TREATMENT Units of treatment descriptors Cost per unit Residential: 45 days=1 unit $4,050.00 FY 14-15 Outcomes : Served in FY 14-15 6 Detox ; 62 Residential: 68 total 44% Completed their program 32% Continued their treatment to Outpatient

12. Transitional Housing: always combined with outpatient treatment Defined: 24/7 sober living where treatment is NOT received on site. Typical Lengths of stay: 30-90 days Locations: Roseville, Grass Valley, Nevada City, Tahoe Truckee, Placerville Success: Early outcomes support high success rates Approx. # can be served annually : 81.5 (at 60 day stay) Availability: Limited availability in Roseville/Auburn. Can take up to 4 weeks to place. PLACER COUNTY TREATMENT

13. Transitional Housing: always combined with outpatient treatment FY 13-14 Outcomes : 37 served (average 87 day stay) 40% Employed, 60% Stable Housing, 20% Family Reunification (preliminary data) PLACER COUNTY TREATMENT PROVIDERCONTRACTEDCAPACITY-UNITS Progress House-transitional+ Outclient$82,500.0041.3 Recovery Now- transitional$9,500.007.3 Roseville Home Start- transitional$4,600.003.6 Victory Outreach- transitional$9,500.009.4 CoRR- transitional$20,000.0020.0 TOTAL$126,100.0081.6 Units of treatment descriptors Cost per unit Transitional: 60 days=1 unit $1,300.00 FY 14-15 Outcomes: 51 served, 131 served since program start *68 additional served expected in FY 15-16 due to increased capacity added from in-custody amounts

14. Outclient: (out of custody) Defined: 1-4x per week group treatment that occurs in the community. Typical Lengths of stay: 90 days- 1 year Locations: Roseville, Lincoln, Auburn, Grass Valley, Placerville, Tahoe Truckee Approximate Number able to be served annually : no limit for DMC eligible clients. In and out of Custody: About 165 (if all complete). PLACER COUNTY TREATMENT

15. Outclient Out of Custody Outcomes : Served 51 AB109 individuals 47% completed their program 32% Employed, 26% Stable Housing, 14% Family Reunification (preliminary data) PROVIDERCONTRACTED CAPACITY-UNITS PES- Outclient$25,000.0035.7 CORR-Outclient$51,000.0079.7 SMWG-Outclient$25,000.0035.7 Native Alliance- Outclient$10,000.0014.3 *TOTAL $111,000.00165.4 *PES and CORR dollar amounts include in- custody treatment Units of treatment descriptors Cost per unit Intensive Outpatient: 3 groups+ 1 ind per wk for 4 wks (one month unit)= 1 unit $650-795 PLACER COUNTY TREATMENT

16. Contracted In-Custody Treatment  Research: Best if followed by out of custody treatment. Outcomes:  Total Served: 220 (29.1% successful completed= 64)  16 (25% of those who successfully completed) connected to out of custody treatment  Anecdotal decrease in “incidents” in jail PLACER COUNTY TREATMENT

17. HHS In-Custody (not only AB109 funded) .5 FTE SUS staff (not AB109 funded ) responds to treatment requests.  Assessments/ Placements to treatment leveraging various fund streams.  Recent improved access to Co-Occurring (MH and Substance Use) Placer County care post release.  Coordination to non ASOC services: Physical Health, Vocation, Human Resources, etc.  Partner with SCOE, Probation and Sheriff to meet inmate needs. PLACER COUNTY TREATMENT

18. Additional Outcomes FY 15-16 *unique client counts combining all out of custody modalities *Percentages based on those who successfully completed treatment  90% Remained Sober  55% Secured Safe and Healthy Housing  43% Became Employed  27% Reunited with their family  8% Enrolled in School PLACER COUNTY TREATMENT

19. Current County Capacity  Dedicated AB109 funding but no dedicated beds  Transitional Housing at times has wait times of 4 weeks.  Residential at times has a wait time of up to 2 weeks.  Priority is given to IV drug users and pregnant women.  Outclient treatment always has capacity and is more accessible than ever due to the ACA.  Access to non criminal justice specific funding. To maximize available funding sources.  Screening Clinic is a free service that can be used by ANY Placer County resident to access treatment. PLACER COUNTY TREATMENT

20. FREE Screening Clinic RECOMMENDED TREATMENT LEVEL PROVIDED TO CLIENT AT TIME OF SCREENING  Auburn : Mon/Tues 1:00-2:00 pm 11522 B Ave, @ ASOC Welcome Center  Roseville: Thurs 4:30-5:30 pm 101 Cirby Hills Way @ ASOC For More Information Call 530-889-7240 Press 5 for AOD Services PLACER COUNTY TREATMENT Criminal Justice NOT just served by AB109 funds.

21. PLACER COUNTY TREATMENT

22. Enhanced Integrated Care (both by SUS team and other HHS teams)  Co-Occurring FSP  Turning Point  Mental Health treatment  Coordination with other disciplines (e.g. SCOE)  Connection to Housing, Education, Vocation, Medical, and other needs. PLACER COUNTY INTEGRATION

23. More Integrated Projects  Grant funded Collaborative Court Coordinator  Executive level collaborative Court committee.  Screening Clinic on-site at new PREP center  Ongoing training of probation and Educational programming staff related to best treatment practices  SAMSHA Health integration grant PLACER COUNTY INTEGRATION

24. Integration is a work in progress: Future Considerations  1115 Waiver: will enhance DMC substance use service continuum (full changes 2 years away).  More regulation for higher quality care  Increased access to services: Residential, Intensive Outpatient, Case Management, Medication Assisted Therapies  DMC funded services to satisfy requirements?  PC1000, Alternative Sentencing, prep center, etc.?  Further Integration of Health Services PLACER COUNTY INTEGRATION

25. Questions? PLACER COUNTY INTEGRATION