RD72 - 2013 Biennial Report on Substance Abuse Services
Title 37.2 of the Code of Virginia establishes the Virginia Department Behavioral Health and Developmental Services (DBHDS) as the state authority for alcoholism and drug abuse services. DBHDS works to ensure efficient, accountable and effective services available for citizens with substance use disorders. The department is responsible for the administration, planning and regulation of services for substance use disorders in the Commonwealth.
This biennial report is submitted in accordance with § 37.2-310 Subsection 4 which requires DBHDS:
"4. To report biennially to the General Assembly on the comprehensive interagency state plan for substance abuse services and the Department's activities in administering, planning, and regulating substance abuse services and specifically on the extent to which the Department's duties as specified in this title have been performed."
This report provides epidemiological information about the extent to which substance use disorders affect the residents of the commonwealth, information about services provided and the individuals who received these services, and reports on major activities of the department on their behalf.
Nature, Scope and Degree of Substance Abuse in Virginia
Epidemiological information about the numbers of residents using, abusing and dependent on alcohol and other drugs in Virginia is derived from the National Survey on Drug Use and Health (NSDUH), conducted annually under the auspices of the federal Substance Abuse and Mental Health Services Administration (SAMHSA). NSDUH data, collected from individuals age 12 and older, can be analyzed regionally and by age groups. Another source of information is the Office of the Chief Medical Examiner at the Virginia Department of Health (OCME) which reports drug-caused deaths on an annual basis.
Over half (54.6%) of Virginians drink alcohol, and nearly half of these (23.21% of all Virginians) engaged in binge drinking (drinking five or more drinks in one occasion) in the month prior to the survey. This increases to 44.56% for those 18-25. Nearly seven percent (6.92%) of Virginians meet the criteria for abuse or dependence on alcohol (see Appendix C for definitions), and this rises to 16.27% for those 18-25. The proportion needing but not receiving treatment for alcohol use is 6.42% for the general population, rising to 15.32% in the 18-25 age group.
Illicit drugs include legal drugs that are used illicitly as well as drugs that are illegal. While fewer than eight percent (7.98%) of Virginians age 12 and older used illegal drugs in the month prior to the survey, that figure rises to 9.45 % for those 12-17 and 21.02% for those 18-25. In the past year, 9.98% Virginians used marijuana but, following the same pattern, 12.88% of those between 12-17 and 28.92% of those 18-25 used this drug. The rate of nonmedical use of pain relievers in the past year is 4.6% for the Commonwealth, higher than the national rate of 4.57%. Age data indicate that this is a significant problem among youth in Virginia, with 5.95% of those 12-17 and 11.39% of those 18-25 reporting nonmedical use of pain relievers in the past year. The proportion of Virginians needing but not receiving treatment for illegal drug use is slightly less (2.18%) than the national rate of 2.40%, but the rate among those 12-17 is 4.25%, climbing to 6.74% for young adults ages 18-25. ( http://www.samhsa.gov/data/NSDUH/2k11State/NSDUHsae2011/NSDUHsaeStateTabs2011.htm#Tab104)
The Office of the Chief Medical Examiner’s 2011 Annual Report indicated 818 people died due to drug/poison caused deaths, an increase of 18.2% since 2010. Prescription drugs accounted for 61.74% of these deaths while 17.48% were caused by illegal (street) drugs. Per capita rates of drug caused deaths were higher (9.6 per 100,000) than motor vehicle crashes (9.4 per 100,000) in the Commonwealth in 2011. One-third of all drug-caused deaths in the Commonwealth happened in the western part of the state, but the prevalence of prescription drug deaths has risen dramatically in other regions of the state as well, specifically in the northern and central regions. ( http://www.vdh.state.va.us/medExam/documents/2013/pdf/Annual%20Report%202011.pdf)
Characteristics of the Public Service System
Public community-based substance abuse services are provided through the 40 community services boards (CSBs) established in Title 37.2 of the Code of Virginia. CSBs provide services either directly or through contracts with other services providers. In State Fiscal Year 2012 (the most recent data available), the CSB system provided clinical substance abuse services to 36,743 individuals at a total cost of $106,561,525. Sources of funding include federal grants ($43,956,776), state general funds ($46,629,700), local government ($38,889,682) and fees and third party payors ($2,875,071). Two-thirds of those served are male and over one-third (38.1%) are between the ages of 26-40. Sixty percent are White, nearly one-third (28.89%) are Black, slightly more than six percent represent other groups, and two percent identified themselves as multi-racial. Over one-third (36.69%) are referred by the criminal justice system. Alcohol is the primary drug for which most individuals are seeking treatment (40.42%), followed by marijuana (22.87%), closely followed by opiates (21.85%).
Creating Opportunities for People in Need of Substance Abuse Services: An Interagency Approach to Strategic Resource Development. DBHDS prepared a strategic plan for substance abuse services and presented it in October 2011. This plan was the result of a two-stage, two-year process involving advocates and individuals receiving services, providers, and other key state agencies. The resulting plan, Creating Opportunities for People in Need of Substance Abuse Services: An Interagency Approach to Strategic Resource Development ( http://www.dbhds.virginia.gov/documents/omh-sa-InteragencySAReport.pdf) , indicates that nearly $54 million is needed to improve access to services, address gaps in the array of services and provide adequate support services to those in need of substance abuse treatment.
Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS-TACS). In 2012, DBHDS received competitive grant funding from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to participate in a federally-sponsored policy initiative focused on implementing recovery-oriented systems of care (ROSC) for people with both mental illness and substance use disorders. DBHDS used part of the $50,000 award to sponsor a statewide Recovery Forum in Roanoke on June 9-11, 2013. Approximately 110 persons representing all seven regions of the state and CSBs, state facilities, DBHDS staff, and the substance abuse and mental health peer and advocacy services communities participated. A steering committee has been organized to continue work on these goals and to plan a second Recovery Forum.
National Governors Association Prescription Drug Prevention Project. As abuse of prescription drugs continues to be a problem for the nation and in Virginia, the Commonwealth was competitively selected, along with six other states, to participate in the initial policy conference focusing on this topic sponsored by the National Governors’ Association (NGA). The Department of Health Professions (DHP) was the lead agency for the Virginia team, joined by the Secretary of Public Safety, Secretary of Health and Human Resources, the Superintendent of State Police and the Commissioner of DBHDS. The team attended two national meetings to receive technical assistance and participate in discussions led by experts to assist the team in developing a strategy for Virginia. The team developed four subgroups to focus on enforcement, disposal, monitoring, and training and education. The training and education subgroup was chaired by the DBHDS Director of the Office of Substance Abuse Services (OSAS). Each subgroup included a variety of expertise related to the subject matter. The team hosted a statewide meeting in March 2013 that was attended by over 100 participants and facilitated by staff from the NGA. Each subgroup presented its draft plan at the meeting and received comment. The team has since finalized its plan, which has been accepted by the Governor and forwarded to the NGA.
Juvenile Justice Behavioral Health Diversion Pilot. In the fall of 2012, Virginia was competitively selected to participate in a national policy academy co-sponsored by SAMHSA and the MacArthur Foundation to develop strategies for diverting youth with behavioral health issues from the juvenile justice system. DBHDS collaborated with the Department of Juvenile Justice (DJJ), the Office of Comprehensive Services (CSA), the 24th District Court Service Unit and Horizon Behavioral Health Services to develop a strategy to screen youth for behavioral health concerns whose parents were requesting petitions for Children in Need of Services or domestic violence issues. The team used the $25,000 award to implement the project. Those youth who qualified were referred to Horizon Behavioral Health Services for assessment and services. The result was a significant decrease in the number of petitions filed and accompanying increase in the numbers of children receiving appropriate behavioral health services.
Synar: Tobacco Law Compliance. As a condition for receiving the federal Substance Abuse Prevention and Treatment Block Grant (SAPT BG) states must (1) statutorily prohibit and enforce the sale of tobacco products to minors; (2) conduct random, unannounced inspections of tobacco retailers to ensure that they are complying with the law; and (3) annually report findings to the U.S. Department of Health and Human Services. Federal law requires a noncompliance rate of no more than 20%. Failure to comply with any part of the law can result in a loss of up to 40% of the total award, which would be a loss of $16 million for Virginia. DBHDS contracts with the Department of Alcoholic Beverage Control (ABC) to conduct these inspections using trained youth under the supervision of an ABC agent. Virginia achieved a compliance rate of 13.0% in 2011 and 13.5% in 2012. DBHDS also works closely with CSBs to develop and provide effective tobacco use prevention programming focused on youth.
Screening Women for Substance Use and Mental Health Disorders. DBHDS website includes information, including specific screening tools appropriate for different populations, to help professionals identify people who may need substance abuse services. These include tools for women, adolescents and other adults.
Medication Assisted Treatment. DBHDS is responsible for providing regulatory oversight and technical assistance to programs that utilize methadone in the treatment of opioid addiction. The number of these programs is growing significantly throughout the state.
Professional Development. To improve the quality of services offered in the community, DBHDS offered a variety of knowledge and skill building workshops on a regional level. These include training in providing services to adolescents, substance abuse screening for women seeking prenatal care, development of peer and recovery services, clinical supervision, training health care providers and other providers of addiction services. These events were funded by the federal Substance Abuse Prevention and Treatment Block Grant (SAPT BG). The largest of these events include:
Services to Adolescents Who Have Experienced Trauma. DBHDS sponsored two events to train counselors to provide treatment services to adolescents who have experienced trauma, such as witnessing or being the victim of a violent crime. Research indicates that a significant proportion of individuals with behavioral health problems have experienced serious traumatic events that have not been addressed. The longer these events remain unaddressed, the more emotional damage occurs, often leading to substance abuse, as well as depression, poor emotional control, and other serious behavioral issues. The training provided an opportunity to increase knowledge and skills in assessment and treatment practices designed to help adolescents who have experienced trauma. The 105 participants attending a two-day event learned about providing trauma-informed services for adolescents with co-occurring substance abuse and mental health problems.
Informing Parents and Caregivers about Adolescent Substance Abuse. DBHDS sponsored training to help parents and caregivers understand adolescent development, identify when an adolescent may be using drugs or alcohol, and learn how to get help. This three hour session provided information about the signs and symptoms of substance use, the treatment process, and strategies that family members can employ to take care of themselves during adolescent using episodes.
Virginia Summer Institute for Addiction Studies (VSIAS). Held in Williamsburg, VSIAS provides an opportunity for Virginia substance abuse professionals to learn from national experts through lectures and participatory workshops in an intensive learning environment. VSIAS is a collaborative effort of the Virginia Association of Drug and Alcohol Programs, the Virginia Association of Drug and Alcohol Counselors, and the Substance Abuse Certification Alliance of Virginia. DBHDS provided staff and financial resources for the institute. In 2011, 189 persons participated, and 366 persons participated in 2012.
Virginia Association of Medication Assisted Recovery Programs (VAMARP). This annual training event provides current information to professionals working with opiate-dependent individuals. DBHDS provided staff support and funding. In 2011, 225 persons participated, and 240 persons participated in 2012.
Prenatal Care Providers. In conjunction with the University of Virginia (UVA), the Department of Medical Assistance Services (DMAS), the Department of Health (VDH) and DBHDS received a grant from the U.S. Department of Health and Human Services to provide training in screening pregnant women for substance abuse, mental illness and domestic violence.
Clinical Supervision. DBHDS provided skill and knowledge training in clinical supervision to assure best practices and fidelity to treatment models. Approximately 91 new and experienced clinical supervisors from 21 community services boards, five state facilities, and several opiate treatment programs attended a five-day training and skill development program, “Clinical Supervision Workshop and Clinic,” in 2011. This training met the requirements of the Virginia Department of Health Professions (DHP) Board of Counseling and Board of Social Work for supervisors of candidates for either the professional counselor license (LPC) or clinical social worker license (LCSW).
Psychiatrists and Other Medical Staff. In collaboration with the University of Virginia (UVA) and the Virginia Association of Community Services Boards (VACSB), DBHDS provided training for psychiatrists and other health care providers who work with community services boards or state mental health facilities to improve their knowledge about treating people with addictions or co-occurring mental health disorders. DBHDS also collaborated with the Virginia Health Practitioners Monitoring Program (within the Department of Health Professions) to provide training about pain management for people who are recovering from addiction.
Creating Opportunities Goal to Further Develop Recovery and Peer Services. In collaboration with the Substance Abuse and Addiction Recovery Alliance of Virginia (SAARA), DBHDS provided funding from the federal Substance Abuse Prevention and Treatment (SAPT) and Community Mental Health Services (CMHS) block grants to present the third annual conference focused on peer and recovery support services for persons with substance use disorders and/or mental illness. Over 200 attendees, including peer providers, supervisors and clinical staff from the community services boards, and state agency staff, participated in the conference.
Interagency Relationships. DBHDS is represented on a number of state-level committees to ensure collaboration and improve access to services. These include:
Commission on the Virginia Alcohol Safety Action Program. Established as a legislative agency, the commission establishes and implements policy regarding operating standards and criteria for the 24 local agencies that provide services to individuals charged with driving under the influence of alcohol or other drugs. By statute (§ 18.2-271.2.A), DBHDS is represented on the commission.
Drug Treatment Court Statewide Advisory Committee. Established by the Supreme Court of Virginia, the committee focuses on evaluation of applications to establish local drug treatment courts. By statute (§ 18.2-254.1.F), DBHDS is represented on the committee.
Home Visiting Consortium and the Maternal, Infant and Early Childhood Home Visiting Grant. This collaboration of early childhood home visiting programs that serve families who are pregnant or who have children up to five years of age also serves as the advisory committee for a federal grant managed by the Virginia Department of Health (Maternal, Infant and Early Childhood Home Visiting grant). DBHDS provides access to technical assistance concerning behavioral health, including providing training.
Substance Abuse Services Council. Established by statute (§ 2.2-2696), this council, staffed by DBHDS/OSAS, consists of 29 members including two senators and four delegates, as well as representatives from provider and advocacy organizations, and state agencies. The purpose of the council is to advise the Governor and the General Assembly on policies concerning substance abuse. The council meets four times per year.
Strengthening Families Prevention Grants. DBHDS used funds from the federal Substance Abuse Prevention and Treatment Block Grant (SAPT BG) to support Strengthening Families in 16 communities. The program provides a weekly family meal as an opportunity for at-risk families to meet with a facilitator and improve communication and other skills necessary to parent in a healthy family. These programs are used to help families increase cohesion, a research-based strategy that helps protect children from substance abuse and other problems.
Strategic Prevention Framework State Infrastructure Grant. As a member of the Governor’s Office for Substance Abuse Prevention (GOSAP) Collaborative [currently the Virginia Office for Substance Abuse Prevention (VOSAP) Collaborative], DBHDS was a partner with 12 other state agencies in the Commonwealth’s application to the federal Substance Abuse and Mental Health Services Administration for funding to identify, study and implement a major prevention initiative for the state. SAMHSA awarded grant funds in the amount of $2,135,724 annually through 2015. These funds are being used to develop a statewide systematic approach to the prevention of underage alcohol use. This is the first time that these efforts have been based on epidemiologic data.
Prevention and Promotion Advisory Council (PPAC). This interagency council consists of 12 members and advises the State Board of DBHDS on matters related to prevention and promotions. Members are appointed by the board to receive and review information on prevention efforts. The council developed a white paper on how changes in federal government prevention policy will broaden programs and services to encompass all of behavioral health as opposed to the previous singular focus on substance abuse.
Suicide Prevention. DBHDS staff provided a training of trainers focusing on suicide prevention skills to 24 trainers, using the Applied Suicide Intervention Skills Training (ASIST) curriculum. Those trainers then trained 796 individuals. An additional 97 individuals also participated in an ASIST training. DBHDS staff chaired a workgroup that drafted a statewide suicide prevention strategic plan, currently in review.
Substance Abuse Prevention Specialist Training. DBHDS provided a five-day training to 14 CSB prevention staff to improve their knowledge and skill in developing and providing community-based prevention programs and services that are based on scientific research. A total of 53 individuals participated in the training during the biennium. This curriculum has recently been selected by SAMHSA for distribution to other states.
Prevention Supervisor Mentorship Program. DBHDS sponsored five experienced CSB supervisors to function as mentors to newly hired CSB prevention supervisors. These mentors have provided over 200 hours of consultation since July 2012.
Off-site Prevention Supervision Program. This program provides the necessary supervision to become designated as an Internationally Certified Prevention Specialist to individuals who do not have local access to the appropriately credentialed professional who can provide this type of assistance. To date, this program has been piloted with one site.
Other Prevention Training. DBHDS provided 360 scholarships for CSB prevention staff and community coalition members to attend training provided by the Virginia Foundation for Healthy Youth to improve knowledge and skill in general prevention knowledge and coalition building.