RD242 - Annual Report and Plan of the Substance Abuse Services Council


Executive Summary:
This year’s report is presented in two sections, with related appendices. Part One emphasizes the public health aspects of substance use disorders. In that vein, the Council recommends improved funding for prevention and treatment services. Prevention and treatment both fall on the same continuum of activities. The Institute of Medicine has adopted a paradigm of prevention that recognizes three ranges of prevention strategies. The Institute starts with universal strategies focused on the broad needs of the total population. Then, it narrows its sights to address selective strategies focused on populations with specific risk factors. Finally, the Institute identifies indicated strategies for populations with specific identified needs but not yet requiring treatment. This paradigm is increasingly used in designing prevention strategies for a broad range of diseases, and is being applied to substance use disorders as well.

Substance use disorders present the same challenges as other chronic disorders, comparable to asthma, diabetes and hypertension. Effective treatment, therefore, must address disease management over a period of time. Advances in treatment, supported by research and evaluation, have significantly expanded knowledge about effective treatment approaches, including specific counseling strategies and the use of medication. Meanwhile, nearly the entire criminal justice population needs treatment for substance abuse. Innovative community strategies, such as drug courts, can help divert and redirect many nonviolent offenders needing treatment from long-term involvement with the criminal justice system.

While Virginia’s agencies clearly recognize the validity of these modalities, their ability to apply this knowledge is hampered by lack of funding. Currently, no General Funds are appropriated for the specific purpose of supporting prevention programs. Publicly funded support for treatment is stagnant at both the federal and state level. Medicaid reimbursement for substance abuse treatment is very limited in Virginia, and private insurance policies are very restrictive, as well. The result is that community capacity is shrinking, and services for some populations, including adolescents, are extremely limited.

Part Two provides the Council’s response to Virginia Code § 2.2-2697 (Review of state agency substance abuse treatment programs), enacted in 2003. This legislation requires the Council to report on the capacity of state agencies that provide treatment for substance use disorders to provide outcome information. To address this requirement, the Council surveyed its membership and identified the three agencies actually providing treatment services: the Department of Corrections, the Department of Juvenile Justice Services, and the Department of Mental Health, Mental Retardation and Substance Abuse Services. It is difficult to compare these agencies, for each provides treatment for substance use disorders under very different circumstances and varies considerably in their capacity to collect outcome information.

Furthermore, the Council cautions that strict analysis of outcome measures do not tell the whole story about the success of treatment. Given the chronic nature of substance use disorders, evaluation of services should encompass an array of conditions that are not limited to measuring outcome post-treatment.

The report concludes by identifying five recommendations for consideration:

1. Expand Medicaid funding.

The Council recommends that the General Assembly appropriate $6.1 million to provide General Fund match for Medicaid to fund the full range of treatment for substance use disorders for all eligible populations. This funding would produce a total of $12.2 million in new funds available for community-based substance abuse treatment. In addition, the Council recommends that the Department of Medical Assistance Services collaborate with the Department of Mental Health, Mental Retardation and Substance Abuse Services as well as public and private providers of treatment for substance use disorders to draft regulations for the State Medical Assistance Plan.

2. Appropriate funds designated for prevention services.

The Council recommends that the General Assembly increase the user fees on tobacco products by $.01 and appropriate the resulting revenue to the Department of Mental Health, Mental Retardation and Substance Abuse Services for allocation to the community services boards, specifying that these funds shall support only evidence-based prevention practices.

3. Expand capacity to treat adolescents.

The Council supports the initiatives of the Department of Mental Health, Mental Retardation and Substance Abuse Services requesting a total of $1.7 million to provide 16 bed residential unit and services for youth at the Commonwealth Center for Adolescents, Virginia’s public mental health facility for youth.

4. Support the development and funding of drug courts.

The Council supports the initiatives of the Supreme Court of Virginia and recommends that the General Assembly fully fund the budget request of the Court to a. Provide formula funding to ten drug courts that currently do not receive state funding at a cost of $1,726,795 in each year of the biennium for a total cost of $3,353,590;
b. Increase the statewide funding formula for drug courts by 3% at an annual cost of $88,560 in each year of the biennium, and a total cost of $177,120; and
c. Fully fund existing drug courts according to the statewide formula at an annual cost of $449,175 in each year of the biennium, and a total cost of $898,350.

In addition, the Council supports request of the Department of Mental Health, Mental Retardation and Substance Abuse Services for $2,625,000 to support expanded treatment capacity for drug court participants.

Finally, the Council recommends support in the amount of $600,000 for the second year of the biennium to fully fund two family drug courts that are losing federal grant funds in 2007.

5. Develop and implement a statewide strategy for evaluation of treatment programs funded with public dollars.

a. Require state agencies providing treatment for substance use disorders to report on the short and long term results of treatment.
b. Require state agencies providing treatment for substance use disorders to adopt the National Outcome Measures (NOMS) when appropriate. To the degree possible, data definitions and coding conventions should be consistent with those set forth in the NOMS.
c. Require all state agencies to share data for the purposes of evaluation while also assuring careful, secure maintenance of the data to protect confidentiality and privacy in accordance with agency requirements and state and federal law.
d. Provide funding to invest in research and evaluation of cost-effective treatment policies and programs for substance use disorders, including funding to support the required sharing, maintenance and analysis of interagency data.
e. Given the limitations on the agencies’ current capacities to report outcomes, modify the language of § 2.2-2697-B as summarized below:

B. Beginning in 2006, the Comprehensive Interagency State Plan shall include the following analysis for each agency-administered substance abuse treatment program: (i) the amount of funding expended under the program for the prior fiscal year; (ii) the number of individuals served by the program using that funding; {strike the following language shown in brackets} "[(iii) the extent to which program objectives have been accomplished as reflected by an evaluation of outcome measures; (iv) identifying the most effective substance abuse treatment, based on a combination of per person cost and success in meeting program objectives; (v) how effectiveness could be improved; (vi) an estimate of the cost effectiveness of these programs, and (vii) recommendations on the funding of programs based on these analysis]" {and replace it with the following new language} "(iii) the extent to which agency programs are employing evidence based practices; and (iv) recommendations on the funding of programs based on these analyses."