RD267 - 2013 Substance Abuse Services Council Response to Code of Virginia § 2.2-2697


Executive Summary:
The 2004 Session of the General Assembly amended the Code of Virginia (§ 2.2-2697), directing the Substance Abuse Services Council to collect information about the impact and cost of substance abuse treatment provided by public agencies in the Commonwealth and to “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; (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 costs 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 analyses.” Publicly funded substance abuse treatment services in the Commonwealth of Virginia are provided by the following state agencies: the Department Behavioral Health and Developmental Services (DBHDS); the Department of Juvenile Justice (DJJ); and the Department of Corrections (DOC). Common goals of these programs include abstinence or reduction in alcohol or other drug usage and reduction in criminal behavior.

DEPARTMENT OF BEHAVIORAL HEALTH AND DEVELOPMENTAL SERVICES

DBHDS provides funding and oversight to 40 community services boards (CSBs) which provide publicly funded substance abuse treatment services to specific jurisdictions. The following information reflects these services.

- Revenues supporting treatment services totaled $145,730,942 for FY 2012.

- This overall figure is an approximate sum of the following revenue components:

Federal: $43,956,776
State: $46,629,700
Local: $38,889,682
Consumer fees or third party payers (e.g., insurance): $13,379,713
Other: $2,875,071

- A total of 36,743 individuals received substance abuse treatment services supported by this funding.

Over the last decade, CSBs have experienced level funding from federal and state sources resulting in stagnant capacity while knowledge of evidence-based treatment for substance use disorders has expanded. These services require more time and skill to successfully implement and often require the services of trained medical personnel as well as counseling staff trained in specific treatment models appropriate for the individual’s issues. Increasing evidence indicates that many individuals with substance use disorders are also experiencing mental health issues that interfere with recovery; unless the mental health issues are addressed, the individual is not likely to successfully achieve recovery from the substance use disorder. In addition, most individuals seeking services for their substance use disorder also have other life issues that present barriers to successful recovery, such as lack of transportation to treatment, lack of childcare while participating in treatment, unsafe housing, or serious health issues. Successful treatment programs require personnel and resources to help the individual address these problems. These added demands have increased costs, resulting in a gradual decline in the number of clients served each year and an average waiting time for individuals seeking to enter treatment of almost three weeks. Due to lack of adequate funding, CSBs are unable to provide the array of services needed to address these complex problems, with the consequence that individuals receive services that lack the intensity, duration or specific clinical approach needed to successfully address the substance use disorder, and they do not get the assistance they need to address barriers to treatment engagement. This results in less effective treatment services.

DEPARTMENT OF JUVENILE JUSTICE

The Department of Juvenile Justice (DJJ) provides substance abuse treatment services to residents meeting the appropriate criteria at each of its juvenile correctional centers (JCCs) with the exception of the Reception and Diagnostic Center (RDC). The following information reflects these services:

JCC Programs:

Substance Abuse Services Expenditures: $1,120,958
Total Division Expenditures: $75,363,056

In FY 2012, 88% of the 493 residents admitted to JCCs had a mandatory or recommended substance abuse treatment need.

DJJ institutions should continue to implement evidence-based programming: Cannabis Youth Treatment, individualized treatment plans for residents with co-occurring disorders, and Residential Substance Abuse Treatment (RSAT) program (gender-specific treatment programming for female residents). Re-entry systems and collaboration with community resources and families should continue to be strengthened to ensure smooth transition of residents to the community.

DEPARTMENT OF CORRECTIONS

The Department of Corrections (DOC) provides a tiered substance abuse services approach to address varying offender treatment needs based on the severity of the problem. VADOC is organized into two areas of field operations: Community Corrections and Institutions.

VADOC attempts to match the offender to appropriate treatment services based upon criminogenic factors and risk of recidivating.

Treatment services expenditures totaled $6,739,854 for FY 2012 with Community Corrections expending approximately $2,722,854 and Institutions expending approximately $4,017,000. As of June 30, 2013, there were approximately 57,165 offenders under active supervision in the community and an active institution population of 30,086. Screenings conducted on all offenders entering VADOC indicate that approximately 70% of the offender population may have a need for some level of substance abuse treatment.

VADOC continues to face a number of issues related to substance abuse services:

• Limited resources for clinical supervision to ensure program fidelity, provide technical assistance, and enhance outcomes;

• Limited staff resources for programming (i.e., in particular for the Matrix Program) as well as assessment and data collection activities;

• Limited availability of EBP treatment services in Community Corrections for offenders with substance abuse problems;

• Limited special resources for offenders with co-occurring mental disorders.

• Limited evaluation resources; and

• Sometimes a lack of optimal programming space in prisons.

The availability of additional resources would increase the number of offenders who could be provided with treatment as well as enhance the quality of the programs to provide better outcomes. In general, facilities must use existing limited staff resources to provide the program, and it has hindered the ability of VADOC to be able to provide the program to all offenders that may need it.

In general terms, successful outcomes of substance abuse treatment programs include a reduction in drug and alcohol use which can produce a decrease in criminal activities and, thereby, an increase in public safety. The Department-wide per capita cost of housing offenders was $25,498 in FY 2012. The cost avoidance and benefits to society that are achieved from offenders not returning or not coming into prison offsets treatment costs.