RD254 - 2014 Substance Abuse Services Council Response to Code of Virginia § 2.2-2697
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 $146,953,897 for FY 2013.
- This overall figure is an approximate sum of the following revenue components:
Federal: $ 42,709,125
State: $ 46,629,700
Local: $ 40,155,891
Consumer fees or third-party payers: $ 14,437,296
Other: $ 3,021,885
- A total of 34,382 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.
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.
There are a number of factors that negatively impact the ability to report valid results on these metrics. House Joint Resolution 683 and Senate Joint Resolution 395 from the 2007 General Assembly directed the Joint Legislative Audit and Review Commission (JLARC) to study the impact of substance abuse on the state and localities. In the resulting report, Mitigating the Costs of Substance Abuse in Virginia, JLARC staff concluded the following regarding evaluation and outcome measures:
Based on a review of the research literature and interviews with staff at numerous State agencies, it appears that robust evaluations of substance abuse services must include participants’ outcomes after they have completed treatment. Yet, obtaining this information can be very challenging because substance abuse has a variety of effects that are captured by numerous agencies whose information systems are not intended to perform an evaluation function.
To support systems change, outcomes must be considered as part of an organized and committed quality improvement initiative at both the state and provider levels. DBHDS has developed a quality improvement process for CSBs and state facilities focused on intensity of engagement and retention in services.
DBHDS has developed a strategic plan ("Creating Opportunities for People in Need of Substance Abuse Services: An Interagency Approach to Strategic Resource Development" [*1], http://www.dbhds.virginia.gov/library/document-library/omh-sa-interagencysareport.pdf) proposing enhancing access to a consistent array of substance abuse services across Virginia by expanding statewide capacity and filling identified gaps in the array of substance abuse service modalities.
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:
Substance Abuse Services Expenditures: $1,104,531
Total Division Expenditures: $80,054,196
In FY 2013, 86% of the 439 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 VOICES, A Program of Self-discovery and Empowerment (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 $6,656,651 for FY 2013 with community corrections expending approximately $2,639,651and institutions expending approximately $4,017,000. As of June 2014, 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 evidence based 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 and related security posts 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.
[*1] Virginia Department of Behavioral Health and Developmental Services, et al. "Creating Opportunities for People in Need of Substance Abuse Services: An Interagency Approach to Strategic Resource Development." Report to Governor Robert F. McDonnell. 2011.