Funding and Outcomes Report for Prop 26
'9
Comnultee Ayenda IX-ne: Apri! 13, 2006
Agenda ffeti) Nn.4
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"^ounty of Santa Clara
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Office of the County Executive
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Children and Family Services, Public Safety & Justice
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CSFC-CEOl 041306
Prepared hy; Quycn Nguyen
Program Manager 11
DATE:
April 13,2006
TO:
Supervisor Blanca Alvarado, Chairperson
Supervisor James T. Beall, Jr., Vice-Chaii-person
Public Safety & Justice Committee
EBOM:
Sandra Y. Nathan
Deputy County Executive
SUBJECT: Report back on referrals regarding the overall funding and outcomes of the Prop
36 and Drug Treatment Court programs.
RECOMMENDED ACTION
Accept a report back on referrals regarding the overall funding and outcomes of the Prop 36
and Drug Treatment Court programs made by the Board on November 1,2005.
FISCAL IMPLICATIONS
There is no implication to General Fund upon acceptance of this Report.
REASONS FOR RECOMMENDATION
Board of Supervisors: Donald F. Gage. Blanca Alvarado. Pete McHugh. Jim Beall. Liz Kniss
County Executive: Peter Kutras Jr.
1
Committee Agenda Date: April 13,2006
Agenda Item No.4
The true cost of a program consists of the expenditures, which would have been
expended in their next best use, if not used for these programs. For SACPA,in FY 05,
the unbudgeted General Fund expenditures were $7,927,727. For Drug Treatment
Court, the unbudgeted General Fund expenditures were $1,445,914 from the Probation
Department.
• Prop 36 clients generally do not contribute to the increased jail population as they are
released fairly quickly. However, there are a number of Prop 36 clients who stay in jail
for significant jail days due to serving sentences for multiple charges.
• Treatment works for the clients who completed treatment. Similar outcomes were
observed for Prop 36 clients versus non-Prop 36 clients.
• Similar outcomes were observed for methamphetamine users as compared to
non-methamphetamine users.
• There are 3 possible areas suggested for further discussion on improving efficiency:(a)
reduce the amount of re-assessments and/or uncompleted assessments,(b) target
probation supervision resources by level of risks, and (3)resources supported for
programs based on outcomes not on availability of resources.
; BACKGROUND
The Report back is attached in Attachment A.
Responses to questions posed by the Board of Supervisors and data from CJIC, Probation
department. District Attorney's Office, Public Defender office. Pretrial Services, Public Health
department. Mental Health Department, and Department of Alcohol and Drug Services are in
Attachment B.
The referenced research-based evaluations from the UCLA and DADS’ Research Institute are
in Attachment C. Other referenced articles and/or reports are available upon requests.
ATTACHMENTS
• Attachment A- Report back on referral for the Drug Treatment Court and Prop 36
Programs
Board of Supervisors: Donald F. Gage, Blanca Alvarado. Pete McHugh,Jim Beall, Liz Kniss
CounV Executive: Peter Kutras Jr.
3
■
County of Santa Clara
Office of the County Executive
Cmn'iiy Cjiivornmeiil Cenicr. liiisi Winy:
-'/() Vv'ost Hcdiling Slrcel. 1 1 Flo01
n Jose, Califurni;! 95 \ 10
. -08! 290-.S 10?
Date:
March 30, 2006
TO:
Supervisor Blanca Alvarado, Chairperson
Supervisor James T. Beall, Jr., Vice-Chairperson
Public Safety & Justice Committee
FROM:
Sandra Nathan, Deputy County Executive
SUBJECT:
Response on Refeiral for the Drug Treatment Court/ Prop 36 Program
RECOMMENDED ACTION
Accept a report back on Drug Treatment Court/Prop 36 Eunding and Outcomes as directed by
both the Public Safety and Justice and Health and Hospital Committees.
FISCAL IMPLICATIONS
There is no General Fund impact associated with the acceptance of this report.
REASONS FOR RECOMMENDATION
On October 13, 2005, in considering the revised SACPA Annual Plan, the Public Safety and
Justice Committee requested a report back on the overall effectiveness of the SACPA Program
and the impact of methamphetamine abuse on SACPA clients and the jail population.
At the November 1, 2005 meeting, the Board of Supervisors directed the Office of Budget and
Analysis to return to Public Safety and Justice Committee (PSJC) with a report showing total
Drug Treatment Court (DTC) funding from General Fund and Grant funds. The Board also
directed the County Executive’s Office to report back to PSJC with outcomes from DTC at the
same time SACPA outcomes will be presented.
In particular, the Board asked for the following information:
■
Outline of costs/ reimbursement funded through drug court
■
Whether drug court services contribute to an increased jail population.
■
Whether or not treatment services have the desired effects.
■
Drug court services outcomes as compared to SACPA services
Board of Supervisors: Donald F. Gage, Blanca Alvarado, Pete McFlugh, James T. Beall Jr., Liz Kniss
County Executive: Peter Kutras, Jr.
SACPA program: The General Fund budget for SACPA in FY 05 included a one-time
bridge, in the amount of $473,333, for the lease at the Assessment Center, one Justice System
Clerk and a part-time extra help receptionist cost for the Assessment Center.
Drug Treatment Court program: The General Fund budget for the Adult Drug Treatment
Court(DTC) was $238,41 1. Several grants were used to support DTC such as the Drug Court
Partnership at Probation ($183,500), and at DADS,and the Comprehensive Drug Court
Implementation grants(CDCl)for both drug treatment court and dependency treatment couil.
A portion of the total in Adult Treatment Court included the budget for the Mental Health
Treatment Court program. It consists of a team from the Mental Health department. Adult
Custody Services, District Attorney’s office. Public Defender’s office. Probation department,
and the courts. It is designed to serve about 400 clients who are mentally ill and dual
diagnosed. The General Fund budget specifically for the Mental Health Court included 2.50
FTE ($212,601).
Dependency Drug Treatment Court program; Funded through a grant by First-5 for the
Healthy Pregnancy and Early Parenting initiative to the Public Heath Department for services
by a public health nurse (1.0 PTE)and public health nutritionist. Two additional Rehab
Counselors and Marriage and Pamily Therapist (assigned in DADS budget) are also part of
the team. The General Pund budget for DDTC was an additional $972,738 in DADS for staff
and treatment contracts. A portion of this resource is also used to support Dnjg Treatment
Court. The grant is due to end on June 30, 2006.
Table 2-Drug Court/ Prop 36 Services Budget: All Costs outlines the departmental actual
operational costs that were not budgeted but were absorbed by various departments in PY 05.
Table 2
Dept of Alcohol and
SACPA
$5,193,502
DTC
DDTC
Unable to determine
Sub-TOTAL
Unknown
$5,193,502
from report^
Drus Services
Probation Dept
$2,684,877(SATTF)
$1,445,914
N/A
$4,130,791
Probation Dept
$10,894(SATTA)
N/A
N/A
$10,894
$ 22,500(SATTA)
N/A
N/A
$22,500
$15,954
N/A
N/A
$15,954
$7,927,727
$1,445,914
Unknown
$9,373,641
Pretrial Services
ISD (CJIC)
TOTAL
UNBUDGETED GF
COSTS
2 Per comments from D.VDS, some SACPA clients may also be identified as DTC. The courts are reportedly
particularly interested in not only what funding stream may pay for a client but what legal constraints the chent may
fall under. To accommodate the courts, some clients are listed under multiple categories. To produce this table
DADS indicated that it must rely on the provider sites indicating the clients Referral Source/Categorical Funding at
the time of admission into their program. .-\s a result the number of admissions is greater than it should be for the
fiscal year.
Response on referral for Drug 'freatment Court / Prop 36 Program Submitted to Public Safet\- and justice Committee (April 13, 2006 meeting)
Page 3
Brown Act notification, etc), providing liaison to State, UCLA (Focus group), other counties
and County departments, coordinating and shepherding the annual plan through the local and
state's review/approval process, providing oversight of program budget, and managing the
Trust Fund.
Moreover, not available for inclusion in Table-2 are the additional expenses, above the costs
of traditional adjudication, from the criminal justice agencies in the implementation of DTC
or Prop 36 program. For example, both the District Attorney's Office and the Office of the
Public Defender are obligated to staff these types of cases even if the drug courts or Prop 36
did not exist. Nevertheless, the collaborative Prop 36 courts (or DTC)are known to impose
additional obligations that did not exist with traditional case processing.
For example, in Prop 36 courts, review hearings for each offender have typically been
scheduled from every 2 weeks, or 3 weeks or 4 weeks depending on a particular court. Added
to the workload burden to both the courts and criminal justice departments is the scheduling
of regular reviews for lower risk probationers and court probation cases, and the longer
probation terms for court probation cases (up to 3 years).
As such, the Office of the Public Defender has indicated that the high volume (11,743 drug
case files) and mandatory court appearances have a significant impact on staffing resources.
For example, attorneys are in court 8 out of 10 ten half-day sessions (cases range from 10 to
120) a week. In 2 of the Prop 36/ drug courts at Terraine St, attorneys are in court up to 9
sessions per week^. Likewise, paralegals (interview for eligibility, processing case files, etc),
investigators (locate, interview and subpoena witness), and clerical .staff(run calendars for
attorneys, notify clients, etc) are heavily impacted as w'ell.
Statewide data: In the Spring of 2005, the County Alcohol and Drug Program Administrators
Association of California (CADPAAC),in collaboration with the Chief Probation Officers of
California(CPOC)conducted a prop 36 Unmet Needs Surveys. Of the forty-eight counties
responded, seventeen reported using additional funds beyond their SACPA allocation to
support the Prop 36 program.^
County General
Funds
Other
SAPT (Block
Grant)
Sub-Total
Treatment
$7,246,340
$880,975
$5,391,710
$13,519,025
Ancillary Services
$1,216,940
$2,500
$10,000
$1,229,440
Criminal Justice
$2,258,565
$0
$3,444,900
$5,703,465
$10,721,845
$883,475
$8,846,610
$20,451,930
TOTAL
Mandator}- court appearances are not tracked per case in the drug courts. However, the PDO indicated that tl-us
data can be tabulated manually if requested.
' SACPA Proposition 36 Unmet Needs Survey results. Collaborative survey presented by C,A.-\RR and CADP.-VVC.
Response on referral for Drug 'I'reatment Court / Prop 36 I’rogram Submitted to Public Safet}' and justice Committee (.April 13, 2006 meeting)
Page 5
On the same dale, there were also 202 additional "Prop .36-ers” in custody. 01'the 202
inmates, 3.3 (or 16%)inmates were released and 169 (or 847r) inmates remained in custody.
As Table- 4 indicated, once granted Prop 36. the inmates were released fairly quickly.
#
Table 4- “Prop36-ers” Inmates(Feb 14, 2006)
released
Disposition
Total days in jail
since booking
inmate
DEJ arantcd in current cases, no other cases
4
Released
Data not available
Current case pending, pre-plea
4
Relea,sed-SORP
Data not available
Current ca.ses pending, pre-plea, conditional release
2
Released
23 days
P36 granted in new cases
13
Released
Data not available
P36 granted in new cases, conditional relea.se
9
Released
5.5 days
T(9TAL
32
Of the 169 (or 83.8% of total) “Prop 36-er” inmates in custody, 2 inmates (or 1 % of total)
were waiting for a bed space and the other 167 inmates remained in custody for other reasons
not related to the processing of Prop 36 cases.
Table 5- “Prop36-ers” Inmates(Feb 14, 2006) remained in custody
#
Percent to total
inmate
cases (202)
Waiting for a bed space
7
1 .0
Pending cases only
13
6.4
Disqualified from P36 on current cases
0.5
Un-amenable for P36 on current cases, nothing else pending
2
1.0
Probation denied in current P36 cases
3
1 .5
Refused P36 on current cases, no other cases pending
9
4.5
28
13.9
49
24.3
62
30.7
169
83.8%
Ineligible for P36 on current case due to either strike prior, or non-P36 charges in
some cases
Remained in custody on other pending cases, Violation of Probation findings, or
parole holds
Remained in custody in serving other sentences, or parole violations
TOTAL
While data regarding the impact ofjail sanctions on the jail population is not available, one
certain thing is that both programs(DTC and Prop 36) have the potential to increase or
decrease the jail population. With the Courts’ support, the County could further discuss the
outcomes of DTC to highlight its successes.
Response on reterral for Drug 1 Veatment (^ourt / Prop 36 Program -
Submitted to Public Safetv and justice (.ommittce (April 13, 2006 meeting)
l^agc /
further categorized under the following reasons, which may or may not include three drugrelated violations;
Table 7: Prop 36 Unsuccessful Probation Terminations(FY 05)
Reason
Percent
1%
Early Terininaiion
Probation to Terminate On Release- VOP
34%
Probation to Terminate On Release- Original Conditions Ordered
Reinstated & Terminated - No Further Penalty
]%
17%
4%
Probation Revoked - No Further Penalty
Probation Revoked - County Jail
31%
Probation Revoked - Prison
12%
100%
However, there is no data to support the correlation between these unsuccessful probation
clients and whether or not they have had three drug-related probation violations found. For
example, a client may have three drug-related violations and continue on probation as active
in Prop 36 that are not counted as unsuccessful. Conversely, clients may have three drugrelated violations or have been found un-amenable to treatment, removed from SACPA and
continue on probation as a non-Prop 36 client that is not counted as unsuccessful.
The count of ] 2"‘* and 3'^'* drug-related probation violations, as an outcome indicator, may be
misleading. For the purpose of this report, 60 dockets were randomly selected for analysis.
10
#of
Table 8- Types of dockets
Results
dockets
Probation violations filed
13
Petition not found
Non-drug Probation violations admitted with no further penalty
Probation violation modified with no finding
20
Clients re-referred to treatment
4
Clients remain active in Prop36
Clients remain active in Prop 36
Client remain active in Prop 36
Client remain active in Prop 36
Arraigned on probation violation with no finding
2
Drug-related probation violation found: 3'*' VOP
Drug-related probation violation found: 2"“* VOP first and P' VOP
I
1
second
Drug -related probation violation found: ]"' VOP three times
Client remain active in Prop 36
Drug-related probation violation found: P' VOP two times
2
No probation violations.
16
TOTAL
Clients remain active in Prop 36
Clients remain active in Prop 36
60
The results indicate that 20 probation violations were found where the client was either re
referred to treatment or continued on probation with no further penalty. These violations were
There is a great variation due to judicial discretions on whether or not violations of probation are found. A
violation may or mav not be found when probation submits a petition, and may or may not be found when probation
does not submit a petition.
Response on referral for Drug 't reatment Court / Urop 36 Urogram Submitted to Public Safew and justice Committee (.\pril 13,2006 meeting)
Page 9
month follow-up period for SACPA's first year offenders, examine 12-month outcomes among
SACPA second-year offenders, and describe SACPA’s fiscal impact.
Overall effectiveness of the SACPA Program and the impact of methamphetamine (meth)
abuse on SACPA clients and the jail population.
A report prepared by DADS’s Research Institute indicates that 64% of Prop 36 clients selfidentified meth as their primary drug of choice and meth users utilized more outpatient
treatment days than non-meth users (average of 123 days compared to 106 days respectively).
The report noted that meth users are predominantly male (67%); however, a larger percentage
of female used meth (34%)than in the non-meth (27%)group.
The report also indicated that treatment outcomes for meth users are comparable to non-meth
users (Rice, 2006). Likewise, the UCLA report indicated that meth users were similar to the
overall SACPA population in their rate of treatment completion (Longshore, 2005).
According to the state’s Alcohol and Drug Programs, the effectiveness of treatment generally
increases when the program draws on a variety of components. Because of the inability of
many meth users to recognize problems related to their drug use, techniques that promote
change in patients’ thinking, expectation, and behaviors are emphasized. Treatment often is
provided in intensive outpatient programs. Therapies may be combined with techniques to
strengthen coping skills for stress and with medications, as needed. The clinical challenges
related to paranoia, psychosis, agitation, and severe carving usually require knowledge and
12
skills beyond those involved in traditional alcohol treatment.
Other descriptive research findings suggest that there are more male-female similarities in
substance-use behaviors than differences; however, significant differences do exist that may
have implications for prevention and treatment strategies. For example, weight loss and
desire for more energy, more likely in females than males, suggest a different focus than do
those more distinguishing (but not significant) for males of working more and better sex.
Gender differences also pointed to distinct relationships between users and their networks.
Females’ access to meth by their spouses/boyfriends may indicate an already established and
more deeply integrated structure of family and drug use as compared to male users’ network
of “friends”. These gender differences suggest ways of specializing strategies in diirg
education and intervention to different client subgroups. In addition, intervention strategies
should include educating practitioners about symptoms/problems of meth users to facilitate
13
identification and provision resources for treatment.
Meth is highly addictive, and users can develop a tolerance quickly, needing larger amounts to
get high. In some cases, users forego food and sleep and take more meth every few hours for
days,'binging' until they run out of the drug or become too disorganized to continue. Chronic
'- California Department of Alcohol and Drug Programs, Publication No (ADP) 02—3639, Meth: What’s Cooking
in four Neighborhood?
Brechta, M., O’Briena, A., Mayrhauserb, C., & Anglin, D., Methamphetamine use behaviors andgender differences.
Integrated Substance Abuse Programs, UCDV and the Department of Anthropolog)-, California State Universm- of
Northndge, 2003.
Response on referral for I3rug I'rcatmcnt Court / Prop 36 Program Submitted to Public Safety and )usticc Committee (April 13, 2006 meeting)
Page 11
Genei'al bunds structural deficits.
Improving program elTicieney to alJovv us to operate
reasonably w ithin our budget and not posing additional public safety risks are a challenge that
retjuires careful consideration and support from the Board in setting levels of services, as well
as cooperation from all stakeholders in the Prop 36 Steering Committee.
To initiate this consideration, preliminary data indicates that there are several areas along the
Prop 36 process that warrant attention and discussion especially when additional independent
studies on cost-effectiveness become available in April 2006 and later part of 2008.
Area I. As.sessment Oow^ process can be improved to reduce the amount of
uncompleted and/or re-assessments. Assessment improvement could be achieved
by either (1) not performing an assessment on in-custody clients until a release
date has been set, or (2) fully implementing the phone as.sessment for all incustody clients.
In Santa Clara County, a majority of clients are ordered to have an assessment before
sentencing. This process w'as designed so that the judges could lend his or her authority byconfirming the clients’ treatment plan at sentencing hearing. How’ever. as some clients w’ho
were assessed while in-custody are subsequently found to be unavailable for Prop 36 (due to
holds or other pending cases in other courts), the timing of the referrals could render
unnecessary workload for both the courts and assessment center staff.
f
During the first six months of FY 06, of the 1,454 people referred iTom the court and parole, a
total of 2.566 people w'ere assessed resulting in 1,637 new clients in County treatment'-'’.
Since data is compiled using three databa.ses across tw’o .separate systems, it is unclear w'hether
any of these data points represent a subset of the other. The FY 05 Prop 36 Annual Report
intends to provide clarity to this mystery by matching clients across databa.ses to draw
conclusions on number of dropout, repeat clients, and recommendations for improved
efficiency.
New clients are the clients newly admitted in a reporting period due to a new eligible offense regardless of prior
treatment expenences. Per UCL.\ study (Longshore, 2005), 55.7% of Counnfs SACP.A clients had one or more prior
treatment admissions compared to 53.8% statewide.
Response on referral for Drug 'I'reatment Court / Prop 36 Program Submitted to Public SafeU' and justice Committee (.April 13, 2006 meeting)
Page 13
Clinical Assessment
Table
(July 1 through Dec 31,2005)
(T0TAL= 3,223)
10-
Details on
clinical
uii-completed
assessments
refused, prefer jail lime, failed to comply
171
slaffing-related issues, time constraint
183
Un-
131
out-of-county, private provider
legal issues, parole hold, un-amenable
jail issue, not in custody, INS hold
assessment still valid, already in treatment
com pleted
(1 ,209)
38%
Com pleted
[2,014) 62%
100
64
37
unknown reasons & other
97
426
referred and no response
TOTAL
1,209
A different way to illustrate assessment data is by location where the assessments were
conducted and by the number of people.
By location: Asses.sments are performed both mostly face-to-face and via phone for incustody clients, and mostly via phone (Gateway model) and some by appointments for out-of
custody clients. Among the assessments conducted in jail, 45% (or 619 assessments)
remained uncompleted as compared to 32% (or 590 assessments) uncompleted among the outof-custody assessments.
By people: Since 20% of people had more than one assessment, the number of people with
one completed assessment may also be a subset of something else. For example, there were
1683 clients that had only one completed assessment; but that does not mean that they did not
have an uncompleted assessment. Likewise, there were two clients that had five uncompleted
assessments but they could have also had a completed assessment. So the completed and
uncompleted assessment numbers are independent of each other for each person.
Table JJ
STATUS OF ASSESSMENTS BY
STATUS OF ASSESSMENTS BY PEOPLE
LOCATION
In-custody
Completed
Oiit-of-
TOTAL
People
People
People
People
People
w/ 1
w/2
w/3
w/ 4
w/ 5
766 (.5.5%)
custody
1.248(68%)
2,014
1,683
142
16
619(45%)
590(32%.)
1,209
924
120
10
1,385 (100%)
1,838(100%)
3,223
0
0
assessments
Un-completed
2
assessments
1’OTAL
Area 2: Assign probation supervision and drug testing seiwdces according to
clients’ level of public safety risks so that supervision resources are more focused
on high to medium risk offenders. This could be achieved by either (1) having a
dedicated Prop 36 court(.s), and/or (2) continually re-seeking agreements among
the current judges and other stakeholders on supervision protocols and process.
There is a widely accepted body of published research findings on evidenced-based
supervision practices that have emerged over the last several years. This literature offers
Response on referral for Drug Treatment Court / Prop 36 Program -
Submitted to Public .Safew and Justice Committee (.\pn) 13, 2006 meeting)
Page 15
clients to the more frequent high-risk court calendars (or low-risk clients to a less frequent
calendar) requires much collaboration and coordination among partners.
Area 3: Similar to the state' attempts in setting an appropriation level for Prop 36
programs using cost-benefits information, the County may want to address the
Prop 36 general fund's contribution based on the program's outcome or
performance.
Although the intent of Prop 36 program’s outcomes was to;(1) Preserve jail and prison cells
for serious and violent offenders; (2) Enhance public safety by reducing drug-related crime;
and (3) Improve public health by reducing drug abuse through proven and effective treatment
strategies, the state’s ADP has yet developed or issued standard definitions of treatment
success, information on treatment goal and objectives, as well as overall program outcomes.
As it is frustrating, the lack of standardization also allows the counties opportunities to align
Prop 36 program’s outcomes with local priorities, values and principles, evidenced-based
practices as well as regional realities and limitations. More than ever, and especially in the
current time of scare resources, funding support for Prop 36 program should be based on
19
outcome performance, not solely on funding availability.
Nevertheless, as counties are now being requested to submit outcome objectives for the FY07
Annual Plan, DADS has proposed the following SACPA program’s treatment goals and
objectives of which the standards are based on results from local SACPA outcome studies and
other local studies.
and effective
To provide SACPA clients with access to appropriate
20
treatment based on assessment of individual needs.
Objectives:
■
■
90% of completed SACPA assessments will be admitted to the
appropriate level of care.
80% of clients referred to outpatient who complete
Orientation/Intake will stay in treatment four treatment sessions
or more.
■
90% of clients referred to residential treatment will remain in
treatment for 9 days or more.
To reduce or eliminate client substance abuse.
’’ Wlule a nimimum amount of funding is necessary to maintain an efficient operation, funding level by itself is not a
solution to operate a program efficiently.
21)
Starting januarv 06, treatment data has been collected for the California Outcomes Monitonng System (CALOMS)
at admission and at discharge for alcohol, drug, family/social, psychiatric, medical, legal, and employment
functioning. This replaces the former outcomes monitoring system employing measures of psychosocial and
substance abuse functioning. These measures wiD provide core treatment data for outcome assessment of SACP.V
clients.
Response on referral for Drug Treatment Court / I’rop 36 Program Submitted to Public Safetv and justice Committee (.\pril 13,2006 meeting)
Page 17
ATTACHMENT AA- Summary of fiscal reports from Departments
■
Page 1; SACPA- All Fund
-
Page 2: SATTA- All Fund
■
Page 3: Dependency Drug Treatment Court- All Fund
■
Page 4: Adult Drug Treatment Court- All Fund
■
Page 5: All Drug Court Services- All Fund
■
Page 6: All Drug Court Services- Grant/Trust Fund
■
Page?: All Drug Court Services-General Fund
)
SUBSTANCE ABUSE TESTINCrTREATMENT AC
)
Stability(sattai services budget - aii Fund
Pre-Trial
Total SATTA Budget
Probation
(All Fund)
FY05
FY05 Actual
Approved
FY06
FY05
Approved
Approved
FY06
FY05
Approved
Approved
FY05 Actual
FY06
FY05 Actual
Approved
ADMINISTRATION:
Supplies and Others
Subtotal
0
0
0
187,347
191.275
139,494
187.347
191,275
139,494
0
0
0
187,347
191,275
139,494
187,347
191,275
139,494
107,500
5,000
107,500
140,235
0
0
0
107,500
107,500
140,235
4,201
5,000
0
0
0
5,000
4,201
5,000
112,500
111,701
145,235
0
0
0
112,500
111,701
145,235
TREATMENT:
Community Worker (2.0 FTE)
Others (mileage, office expenses, phones)
Subtotal
CRIMINAL;
0
0
0
65,500
72,466
80,616
65,500
72,466
80,616
Subtotal
0
0
0
65,500
72,466
80,616
65,500
72,466 i
80,616
TOTAL FTE
2.0
2.0
2.0
1.0
1.0
1.0
3.0
3.0
3.0
TOTAL EXPENDITURES
112,500
111,701
145,235
252,847
263,741
220,110
365,347
375,442
365,345
Probation Community Worker (1.0 FTE)
Attachment AA
2 of 7
ADULT TREATMENT COURT ocRVICES BUDGET ■ All Fund
Total Adult Treatment Court
Public Health
Mental Health
DADS
Probation
Sen/ices Budget
(All Fund)
FY05
FY05
pros
FY05
FY05
FY06
FY05
FY05
P^06
FY05
FY05
FY06
FY05
FY05
FY06
Approved
Actual
Approved
Approved
Actual
Approved
Approved
Actual
Approved
Approved
Actual
Approved
Approved
Actual
Approved
ADMINISTRATION:
Public Health Nurse III (0-2 FTE)
Program Evaluation
Supplies and Others
24,951
24.951
27.377
0
0
0
0
0
0
0
0
0
24,951
24,951
27.377
0
0
0
0
0
0
70.000
58,814
36,667
0
0
0
70,000
58,814
36,667
0
Subtotal
24,951
0
0
0
0
0
141,992
140,106
136,994
32,500
26,255
25,000
174,492
166,361
161,994
24,951
27,377
0
0
0
211,992
198,920
173,661
32,500
26,255
25,000
269,443
250,126
226,038
101,637
109.433
TREATMENT:
Marriage Family Therapist i i (1.0 PTE)
Marriage Family Therapist II (0.5 FTE)
Marriage Family Therapist I (1.0 FTE)
Psychiatric Social Worker II (1.0 FTE)
Rehab Counselor ^ OS III (ILEBG)
0
0
0
0
0
0
104,476
101,637
109,433
0
0
0
104,476 :
0
0
0
51.258
47.629
55.296
0
0
0
0
0
0
51.258
47,629
55,296
0
0
0
90,345
96,299
101,317
0
0
0
0
0
0
90,345
96.299
101,317
0
0
0
86,625
42,217
93,504
0
0
0
0
0
0
66.625
42,217
93,504
0
0
0
0
0
0
128.759
131.355
0
0
0
0
128,759
131,355
Salary Savings
Court Expenses
0
0
0
0
0
0
0
0
0
(15.627)
0
0
0
0
0
0
216,458
180.689
165,633
0
0
0
216,458
180,689
165.633
Drug Testing
0
0
0
0
0
0
553.146
541,802
550.276
0
0
0
553,146
550,276
Treatment Contracted Services
0
0
0
0
0
0
1.743.506
1,634.060
1.683.450
0
0
0
1,743,508 I
541,802 i
1,634,080 i
1,603,450
Psychiatrlc/Lab & Meds
Supplies and Others
Others (mileage, office expenses, phones)
0
0
0
0
0
0
114,308
137,872
78.770
0
0
0
137,872 i
76,770
0
0
0
0
0
0
59,695
30.828
11,554
0
0
0
114,308
59,695
30,828
11.554
0
0
0
0
5.155
0
0
0
0
0
0
0
0
Subtotal
0
0
0
191,300
243,498
2,920,350
2,758,263
2,599,116
0
0
0
3,132,951
0
151,000
151,000
159,930
151.00Q
151.000
159,930
151,000
159.930
(15,627)
212,601
0
(6,619)
0
0
(6,619)
0
5,155
2,949,563 I
I
2,842,614
I
TREATMENT:
Probation Community Worker (1.8 FTE)
Subtotal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
151,000
151,000
159,930
151,000
TOTAL FTE
0,2
0.2
0.2
2.5
2.5
2.5
3.0
3,0
1.0
1.8
1.8
1.8
7.5
TOTAL EXPENDITURES
24,951
24,951
27,377
212,601
191,300
243,498
3,132,342
2,957,183
2,772,777
183,500
177,255
184,930
3.553,394
7.5 ;
5.5
3,350,689 ; 3,228.582
Attachment AA
4 of 7
)
)
)
)
)
Substance Abuse
Substance Abuse and Crime
Testing/Treatment Accountability
Prevention Act(SACPA)
(SATTA)
Dependency Drug Treatment
Court(DDTC)
Adult Drug Treatment Court
FY05
FY05
FY06
FY05
FY05
FY06
FY05
FY05
FY06
FY05
Approved
Actual
Approved
Approved
Actual
Approved
Approved
Actual
Approved
Approved
FY06
FY05 Actual
Approved
ADMINISTRATION:
Sr. Health Care Prog Analyst (1.0 FTE)
Health Care Program Analyst (1.0 FTE)
Health Care Program Analyst (1.0 FTE)
Health Care Program Analyst (0.5 FTE)
Public Health Nurse III (0.20 FTE)
Ql Coordinator A&D Services (1.0 FTE)
Health Services Rep.(1.0 FTE)
Justice Systems Clerk (1.0 FTE)
Office Specialist III (1.0 FTE)
Program Evaluation
Supplies and Others
0
32,589
120,003
0
0
0
0
0
0
0
0
0
85,306
83,250
90,716
107,275
0
0
0
0
0
0
0
0
0
77,678
0
0
0
0
0
0
0
0
0
0
50,268
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100,596
99,003
110,316
0
0
0
0
0
0
0
0!
0
63,636
43,256
69,840
0
0
0
0
0
0
0
0
0
63,720
68,804
70,092
0
0
0
0
0
0
0
0
0
62,100
73,301
68,208
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
70,000
58,814
36,667
24,951 !
0
24,951 I
27,377
T
Subtotal
48,653
40,753
48,653
187,347
191,275
139,494
24,627
18,672
36,209
174,492
166.361 !
161,994
557,531
526,100
594,387
187,347
191,275
139,494
24,627
18.672
36,209
269,443
250,126 \
226,038
TREATMENT:
Community Worker (2.0 FTE)
Health Care Program Manager II (1.0 FTE)
Marriage Family Therapist II (1.0 FTE)
Marriage Family Therapist l-U (1.0 FTE) half-year
Psychiatric Social Worker I (1.0 FTE)
Public Health Nurse II (1.0 FTE)
Public Health Nutritionist (0.5 FTE)
Rehab Counselor (3.0 FTE)
Rehab Counselor (0.5 FTE)
Rehab Counselor-U (1.0 FTE)/half-year
Rehab Counselor -r OS III (LLEBG)
Court Expenses
Drug Testing
Mentor and Legal Services
0
0
0
107,500
107,500
140,235
0
0
0
0
0
116,160
117,674
127,172
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
104,476
101,637
84,117
0
0
0 i
0
0
0
0
0
0
0
22,146
0
51,738
0
88,668
97,479
101,496
0
0
0
0
0
0
0
0
0
0
0
0
0
116,160
116,160
127,452
0 i
0
0
0
0
0
0
0
42,036
42,036
49,353
0I
0
0
270,772
266,228
301,716
0
0
0
0
0
0
0 !
£1.-
0
0 II
0
0
°4-
0
0
1
I
T
Treatment Contracted Services
Psychiatric/Lab & Meds
Supplies and Others
Subtotal
0
44,132
0
44,132
0
0
0
0
0
0
0
0
0
0
0
0
22,416
9,709
47,190
0
0
0
0
0
0
0
0
0
128,759
131,355
0
0
0
0
0
0
0
19,317
22,667
63,635
216.458
180,689
165,633
0
0
0
0
0
0
0
0
0
553,146
541,802
550,276
0
0
0
0
0
0
23,156
8,649
24.000
0
0 i
0
2,733,141
2,538,817
2,675,425
0
0
0
51,000
0
78.030
1,505,097
1 ,397.584 !
1.435.325
100,000
63,846
100,000
0
0
0
2,333
0
7,441
114,308
137,872 I
78,770
0
0
0
5,000
4.201
5.000
12,800
0
62,090
59,695
30,828
3,352,873
3,134,044
3,349,941
112,500
111,701
145,235
311.364
510.929
2.681,939
2.521.767 i
2.325.675
0
199,221
I
11,554
CRIMINAL;
Supervising Probation Officer (1.0 FTE)
Deputy Probation Officer ll/lll (6.0 FTE)
Probation Community Worker (1.8 FTE)
Probation Community Worker (1,0 FTE)
127,368
134,188
136,836
0
0
0
0
0
0
0
0 i
860,722
854,551
938,652
0
0
0
0
0
0
0
0“T
0
0
0
T
151,000
151,000 i
0
159,930
69.702
63,970
79,488
65,500
72,466
80,616
0
0
0
0
0
0
Subtotal
1,057,792
1,052,709
1,154,976
65,500
72,466
80,616
0
0
0
151.000
151.000
159.930
TOTAL FTE
22.0
22.0
21.5
3.0
3.0
3.0
3.5
3.5
3.5
5.0
5.0
3.0
TOTAL EXPENDITURES
4,968,196
4,712,853
5,099,304
L
L
365,347
375,442
i
365,345
:
335,991
217,893
L
547,138
L
3,102,382 ] 2,§22~893~
2,711,643
Attachment AA
6 of 7
)
ATTACHMENT B- Reponses from departments
a. Information Services Department- CJIC
b. Probation Department
c. Office of the District Attorney Office
d. Office of the Public Defender
e.
Office of Pretrial Services
f Public Health Department
g. Mental Health Department
h. Department of Alcohol and Drug Services
Prop 36 CPU/Machine Costs
Based on Accounting Period 12, Fiscal Year 2005
Job#
Program/Report Name
Run Frequency
Cost
C28002886
Prop36 State & PSJC reports
annual & semiannual
C28003570
Prop36 Calendars
tape storage
CJSM608
Prop36 Notices
weekly
$1,433
CJSM749
Prop36 Eligible Parolees rpt
weekly
$808
CJSM889
Prop36 Statistics
monthly & quarterly
$841
Total
$12,753
$129
$15,964
SACPA
One supervising probation officer, eight probation officers, one probation community worker and one
justice systems clerk are funded by SACPA and m.ake-up the R.ecovery Services Unit(RSU). This unit
assesses and supervises P36 clients and supports P36 court calendars. Two community workers, one in
the RSU and one in general supervision, and the justice systems clerk, who supports both the Department
of Alcohol and Drug Services and probation as a receptionist, are funded with a one-time FY06 general
fund allocation. One other probation community worker funded by SATTA is assigned to general
supervision. Additionally, 15% of each general supervision caseload is made up of active P36 clients.
A common misperception is that probation would have received all ofthese SACPA cases prior to P36.
The reality is that as a result of the legislation, some clients are now granted probation that never would
have been prior to P36. These cases are primarily misdemeanor under the influence cases that used to
statutorily mandate a jail sentence. More often than not, these cases would not have resulted in a grant of
formal probation, but rather would have been granted court probation or a straight jail commitment would
have been imposed. Other cases include some felonies that would have been sentenced or violated with
probation to terminate upon release and some that would have been sentenced or violated to state prison.
In light of the court review process, P36 cases generate a high volume of drug test results and program
compliance to track and report to the court. This current process significantly impacts probation officer
staff and clerical support.
The legislation has created a system that brings more clients into the formal system and retains them
longer. As a result ofP36, probation spends general fund dollars that were not spent prior to P36.
Examples post-P36 general fund dollars:
1. Probation created a modified AMT caseload with one general fund probation officer, supervising
an average of 490 P36 clients. Managing this caseload, that includes programming and testing,
would not be possible without the SATTA funded probation community worker.
2. The RSU support staff is augmented with a general fund justice systems clerk. This unit is still so
backlogged administratively that probation is looking for a funding source to add another support
staff person.
The Probation Department is committed to providing services to the Drug Courts and collaborating with
partners to ensure treatment is available to drug court clients. We are looking forward to working with
our partners in assessing our overall operational efficiency during FY07.
Probati
)
l artment
Costs associated with various L.
I
I
ourt Services vi/ith NO BUDGET
Substance Abuse
Substance Abuse and Crime
Prevention Act(SACPA)
I
Adult Drug Treatment Court
jTesting/Treatment Accountability
1
Services
pros
FY05
FY05
% Time ! Approved
Category
FY06
FY05
i
1
0!
0
58%
58%
:
Subtotal !
1
SUBTOTAL FTE!
I
Actual
FY06
: Approved
0 i
1
0I
36,280 i
76.389
0
0 ;
0
0 'T
0 ;
0
0
0 ,
0
0 ' I
0
0;
0
0
0 '■
0
0.0 i
0.0
80.069 i
545,437 :
41,929 !
78,177 i
487,093 I
121,878 I
0
0 i
625,506 i
529,022 \
200,055 IT
0
36,280 !
9.0 i
9.0 !
9.0 j i
3.0 :
3.0
3.0 : !
0,0 !
20,849 i !
0 i
0
0 I i
0 I
0
0
0 i
0
0 : -
0 I
0
0
T
Substance Abuse Unit:
(SATTA)
FY05
~~T
100%
Criminal
Criminal
FY05
Approved :
I
±
Criminal
i
; !
Approved I ! Approved | Actual i Approved
Actual
Drug Treatment Court:
Probation Community Wor1<er - DCP (1.2 FTE)
Supervising Probation Officer (1.0 FTE)
Deputy Probation Officer ll/lll (8.0 FTE)
FY06
FY05
76,389 : '
I
Criminal
Supervising Probation Officer (1.0 FTE)
Deputy Probation Officer ll/lll (1.0 FTE) - MHDTC
Probation Community Worker • (1.0 FTE)
Deputy Probation Officer ll/lll (5.0 FTE)
Criminal
15%
100%
I
Criminal
95%
Criminal
15%
i
8,268
21,151 !
123,660 i
114,359
66,451
66,451
86,558
91,253
Subtotal 1
297,819
280,330
SUBTOTAL FTE I
8.0
121,908 ! i
65,425
0
0
0
297,407
0
0
0 i
8.0
0.0
0,0
89,225 !
8.0 i
!
0.0
0 i
0
0
0
0
0
0.0
0.0 I
0.0
I
Supervision Units:
Supervising Probation Officer (1.0 FTE) - SUP I
Deputy Probation Officer l/ll/lll (11.0 FTE) - SUP I
Criminal
15%
■
17,907
2,172
17,652
0
0
0
0
0
0
Criminal
'l5%
1
191,881
187,273
187,201
0
0
0
0 i
0
0
Supervising Probation Officer (1.0 FTE) - SUP IV
Criminal
15%
21,151 i
18,245
2 T053
0
0 I
0
0
0
0
Deputy Probation Officer l/ll/ni'(13.o'FTE) - SUP IV
Criminal
15%
235,597 i
187,973
187,201
0
0
0
0
0
0
Supervising Probation Officer (1.0 FTE) - SUP V
Crirninai
15%
21,151
11,778
17,652 :
0
0
0
0
0
0
Deputy Probation Officer l/ll/lll (9.0 FTE) - SUP V
Criminal
15%
169,776
157,750
151,572 :
0
0
0
0
0
0
r
1
Supervising Probation Officer (1.0 FTE) - SUP VI
Deputy Probation Officer l/ll/lll (1.0 FTE) - SUP VI - AMT
Criminal
Deputy Probation Officer I/ll/ill (3.0 FTE) • SUP VI - AMT
Criminal
Criminal
Deputy Probation Officer l/ll/lll (6.0 FTE) - North County
Criminal
!
15%
21,354
20,509
21,053
0 !
0
0 . !
0
0 !
0
100%
95,400
90,648
94^20
0 :
0
0
0
0!’
0
T
7,898
7,358
’ 5,i6"i
0 '
0
197,856
47.0
157,581
195,053
0
0
0 ■
0
47.0
46.0
0 ;
0.0 !
0
SUBTOTAL FTE
0.0
0.0
0.0
0.0 :
0.0
Subtotal
979,970
841,288
897,557
0 ;
0
0
0
64.0
64.0
63.0
3.0 •
3.0 !
1,903,295
1,650,640
1,395,019
0 I
909,000
I
2,432,222■ -tT 2',304,020
0 !
2%
27%
TOTAL FTE'
TOTAL EXPENDITURES w/o Admin 0/H
Admin Overhead Dept ICRP applied to F^U_
70%
781,582 \
781,582
TOTAL EXPENDITURES with Admin 0/H
2,684,877
3.0
1
0
0 ,
0
:
0.0
36,280 !
76,389 ; !
0
0
36,280
76,389
0 I
0
0
0
0.0 ,
0,0
0
...I. ....
i
i
I
I-
I
0
T
i
!
I
-
DATA SOURCE:
.'Z
' J"
J
Estimate % allocation usage for FY05 is based upon number of caseloads for various units from SHARKS printout dated 04/05/05,
Same % allocation rate is used for FY06 estimates, "j
|
]
i
1
'FY05 Salaries & Benefits budgeted are based upon BRASS report printed 0l7l 1/OSlor'FYOS'PosC^nts!
'FY05 actual Salaries _& Benefito are_based_upon SAP report_ZHR_PAYRPT from Accounting Period 1 thru 12 of FY05.
FYOS Salaries & Benefits budgeted are_based upon PeopleSoft/BRAS S report printed 09/16/05 for FY06 PosCounts.
Admin Overhead Dept ICRP applied to RSU for FYOe is estimated at 74.20%.
Probation_FY05_Expenditure Budget Details_REV.xls
I
"
1-
4-
"
Other Costs
3/20/2006 = = 2:39 PM
Probation _^,pa^tme^t
Expenditures Details - Non General Fund Only
Substance Abuse
Substance Abuse and Crime
Adult Drug Treatment Court
Prevention Act(SACPA)
i
Services
FY05
FY05
FY06
Category
Approved
Actual
Approved
FY06
FY05 j FY05
j Approved
Testing/Treatment Accountability
(SATTA)
Actual
Approved
FY05 i
Approved I
FY05 j
FY06
Actual : Approved
Recovery Services Unit:
Criminal
Supervising Probation Officer (1.0 FTE)
Criminal
Deputy Probation Officer ll/lll (8.0 FTE)
(
Criminal
Probation Community Worker (1.0 FTE)
Administration
Justice Systems Cler1< I (1,0 FTE)
Administration
Supplies and Others
Criminal
Probation Community Worker - SATTA (1,0 FTE)
Administration
Supplies and Others - SATTA
Subtotal
127,368
860,722
134,188 ;
136,836
0
0
0 i
854,551 i
938,652
0
0
0 i
69,702
63,970”i
79,488
0
0
0
63,720
18,653
68,804 !
70,092
0
0
18,653
18,653 i
0
0
0 I!
0
0 ;
0 i
0
0
0
1,140,165
0 i
0 I
£1
1,140,165 I 1,243.721
0j
0i
0 1
0
0
0
0
0
0
0
0
0
0!
0
0
65,500
80,616
65,500
0
0i
0
187,347
187,347
139.494
0
0
0
252,847 i
252,847
220,110
159,930
0:
0
0
0 i
0
0
0
Drug Treatment Court:
Probation Community Wori<er - DCP (1.8 FTE)
Supplies and Others ^DCP
Criminal
0
0 ;
0
151,000
151,000
Administration
0
0!
0
32,500
26,255
0 I
0
0
183,500
177,255
184,930
0
0
3.0
3.0
3.0
1.0
1.0
Subtotal
j
25,000 :
i
TOTAL FTE
11.0
11.0
11.0 I
1.0
I'-'
TOTAL EXPENDITURES
Probr
j|^Y05_Expenditure Budget Details_REV.xls
1,140,165
1,140,165
1,243,721
Grant
183,500
1
St Fund
)
177,255
184,930
252,847 I
252,847 i
220,110
1
3/20/20C
)
2:39 PM
County of Santa Clara
OHicc' of tlK^ District Attoinc'v
m
7t
Ttr
)iintv (iovc'rniiu'iii C.i'int'r. \Vi-si
. o \V(->bi i-ifiidin}* Sirrri
Siin Jose. Calilorniii OSI 1()
(40«) 2<)<>740()
\A'w\v.,sanirKinra-<ta.or,L;
G<'or>5<' W. Kennedy
Disirici Ailonu^y
DATE:
March 2], 2006
TO;
Sandra Nathan
Deputy County Executive
FROM:
George Doorley
Administrative Services Manager Iff
SUBJECT
District Attorney Resources Supporting Prop. 36 and DEJ
The District Attorney’s Office does not use any outside funds to support the efforts in
implementing Proposition 36 or Delayed Entry of Judgment(DEJ).
Deputy District Attorneys screen each narcotics case for eligibility for either Prop. 36
and/or DEJ. This screening is done at the time of issuing and is part ofthe regular duties
ofthe issuing attorney.
The majority of narcotics cases are heard in the Terraine Street Courthouse. One Deputy
District Attorney is assigned to each ofthe courtrooms. Each attorney is responsible for
handing every case heard in their assigned court, whether or not the defendant is on Prop.
36 probation or DEJ. Reviews for Prop. 36 and violations of probation are part of the
attorney’s regular court assignment.
6 ODS
March 20, 2006
Page 2
Traditional punitive sanctions resulted in increased incarceration of addicts who inevitably failed
probation or were transported directly to state prison for their offenses at high cost to taxpayers.
Treatment models avoid these costs, as well as the costs ofjury trials. However, other costs are
incurred because the treatment model requires court monitoring of defendants by means of court
appearances. Court appearances are used to review the progress of clients in treatment and to
use a combination of sanctions and more intensive treatment modalities when addicts inevitably
stumble in their efforts toward recovery. These court obligations require the presence of
attorneys, with attendant paralegal and clerical support. The increased number of court
appearances and probation violation appearances tax PDO/ADO resources. As noted above, the
PDO/ADO has tracked numbers of opened drug cases, but not tracked the number of
appearances per case in the drug courts. This could be accomplished manually if necessary.
It is also important to note that the services provided by the PDO/ADO to defendants charged
with drug offenses are not limited to those provided in the drug courts located at the Terrame
Street Courthouse. Felony cases that settle by way of dismissal or plea bargain remain at
Terraine Street. Those that do not settle are transferred to the Hall of Justice for preliminary
hearing and trial where the PDO has trial attorneys assigned to represent those drug clients who
choose to go to trial. SACPA ineligible misdemeanants and felons are prosecuted in the Hall of
Justice misdemeanor departments and are only transferred for review to Terraine Street if the
case is resolved for a SACPA eligible offense.
Provision of services and corresponding impact on the PDO/ADO:
Because each drug court processes an enormous number of cases each and every day of the work
week, the impact on staffing resources is significant. The PDO/ADO assigns attorneys to cover
arraignment, plea, early settlement (known as FAR which stands for Felony Advance
Resolution) and status/review calendars in each drug court. Attorneys assigned to drug court are
in court eight out of ten half day sessions a week, generally on calendars ranging anywhere from
10 to 120 cases. In two of the Terraine Street courts, attorneys are in court as many as nine
sessions per week. Mandatory court appearances leave attorneys with little time to meet with
clients or their families outside the courtroom, return phone calls, investigate and prepare cases
for settlement and/or trial, or follow up with clients in treatment to ensure compliance with court
ordered requirements for successful completion of SACPA and/or probation.
Apart from the effect on attorney staff, the tremendous volume of cases in drug court impacts our
paralegal, investigator and clerical staff as well. PDO/ADO paralegals conduct intake interviews
with every defendant who requests a court appointed attorney to determine eligibility for
PDO/ADO services - each interview takes Vi hour to complete. Some of these defendants are
out of custody, but many are in custody. In custody defendants carmot be interviewed at the
same rate as out of custody defendants because paralegals working in the jail are impacted by
Department of Correction (DOC) schedules for inmate head counts, feeding, pill call, security
lockdowns and periodic staff shortages.
Paralegals also assist attorneys both in and out of the courtroom in processing as many 80 -100
case files for clients appearing in each department on any given day. Additionally when a drug
court client is charged under Three Strikes Law, a PDO/ADO paralegal is assigned to prepare a
2
A
»
>
>0
Office of t
(C Defender
Expenditures Deu
'General Fund Only
1
Terraine Street
Adult Drug Treatment Court
(Dept 64)
Drug Court
FY05 [
Approved!
FY05 Actual
Drug Court
FY06
Actual
I
as of
FY05
FY05 Actual;
I Approved
I
12/31/05
i
T
Actual
FY05
as of
12/31/05
Approved
ATTORNEY STAFF:
Attorney III(2 FTE)
Attorney IV (8 FTE)
Subiotal
FY05 Actual;
Outlying Courts
I
FY06
0!
0 !
I
0:
1,023,870 i
0!!
596.000 !
T
0 I
0;
0
0:
0 s
0 I
0
0
0 i ■
0!
0
0
0
1.023.870
0 I
409.54r['
0 I
0 i !
0 I
0
598,000 \ \
0 I
409,548
0! i
0
T
I
0
238.400
I
as of
^
12/31/05
328,264 !
0 i
0!
I i
FY06
(
Actual
FY05 I FY05 Actual
Actual
FY05
! i Approved !
0
0
0
0 I
0'
0
Paralegals (3.3 FTE)
89,320 j
231,630
Legal Clerks (4FTE)
0
144,648
TOTAL FTE
OJ 328,264
0 ! 1.638,192 I
0
0
21,243
7,494
49,649
0
101.662 I
79,404 I
n
0
11,672 !
0
0
0
0 !
0
0
0
0
0'
0
0
0
0 1
0!
0
IJ ■
0
0
0 :
0
0 I !
238,400
328,264 !
0
17B.76TV:
0 \
204.774 •
4,117 !
0
22~^30 I
119.200 I
47.373
0
46.326 j
^.415 ;
0
9,265 •
72,324
39,702
0
72,324 :
39',702
0
6,206
0
4,669
2,998
1,647
3.103 i ‘
0
11,165 :
t
0
0 ;
0
0
0 i
8,497 :
0'
0
0!
0
0 ' 1.966.456 ' 1.132.360
\
as of
0!
0 ;
0
0
0
0 ;
0
0
0
0
0
0 I
0
0
0
0\
0
1
0
j
0
6,206 I j
0 :
133,980
65,164
0 •
oi
0
^083 j i
0 ;
373.573
179,533
0 !
0
0
0
289,296
0
0
0
0 I
100,990
158,808 ! :
21,009 i i
0
0
0
5.764 j '
0
4,669
0 I!
0
10,492
0
0
0 ■
0
0
0
0
o|
0
0
0 I
0;
0
0
0:
0
0
0
0
0 i
0
0
0
0
0
OI
0
0
0
0
0
0
0 i
0
0
0
0
0
140,980
68.220
0
28.927
15.958 !
0
908.331
430.278
0
0
0
1.2
”1.2i
0.00
20.60
0.0
0,0
0.0
0
0
0
0
0.0
494.335
246.504 i
0
161.335
99,597
0
0
0
■i--
10.56
”10.56!
0 i
5.14
'5.14
0.00
3.70
'3.70
”20.60
I
TOTAL EXPENDITURES
I
I 12/31/05
I
11,165
86,352
8,497
178.760 1 i
953.600 ; ;
0 FT
0
TT
0 i
0i
Subiotal
r
0!
! FY06 Actual
FY05
Actual
i!
0
SUPPORT STAFF:
Record RetentiQn Staff(1
Reception (.22 FTE)
! 12/31/05
119,200 I
0 i
FY06 i
: Approved j
I I
as of
0
0 i
Actual
t
204.774
0 :
T
Investigators (1.2 FTE)
FY05 Actuali
12/31/05 I !
178.760
•^Substance Abuse and Crime
Prevention Act(SACPA)
FY06
as of
j Approved|
i
I
Total Adult Drug Court
I San Martin, Sunnyvale, Palo Alto
T
FY06
-L
I
Alternate Defender
1,518,205
842,504 i
0
590,883
i
0
337,99J_
J.. .
469,244
246.980
0
135,158 i !
233,701
0
2.874,787
1,562,638
I
’^Statistics for SACPA expenditures are not available.
'
’ ’
7
!
'
_"y/e_believe the above Hgures refect an accurate cost of me services provided by the Public PefenderTn" drug and drun trsat;;;;:^ r.^ irtl anmaTTi;. T information is based on ratio of case numbers in each category.'
**The Public Defender does not handle Dependency Drug Treatment Court.
”FTE for FY2006 is based on full fiscal year—expenditures are based on 6 months.
”AII criminal—the Public Defender does not provide treatment"
\~^
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id
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Please see the foJJoAviig attachments for FYOS/Oh budget and staffing information
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SATTA Expenditure Details
Z''
SATTA Funds
FY05
FY05
FY06
Approved
Actual
Approved
TREATMENT:
107,500
107,500
140,235
5,000
4,201
5,000
Subtotal
112,500
111,701
145,235
TOTAL FTE
2.0
2.0
2.0
TOTAL EXPENDITURES
112,500
111,701
145,235
Community Worker (2.0 FTE)
Supplies
‘estimate from a prior year time-study
County of Santa Clara
Public Health Department
3003 IVIooqDark Avenue
'’an Jose, California 95128
fel) 408.423.0701
(Fax)408.423.0702
February 14, 2006
Sandra Nathan
To:
Deputy County Executive
From;
Guadalupe S. Olivas, PhD
Director, Public Health Department
Subject:
Information Required for Board Referral on Services Provided to Drug Treatment
Court
The Public Health Department provides services to both the Dependency Drug Treatment Court
and the Adult Drug Treatment Court. The budgets for both services are attached.
Dependency Drug Treatment Court
The Healthy Pregnancy and Early Parenting(HPEP)initiative, a EIRST 5-supported home
visitation program that is slated to end on June 30, 2006. If not re-funded, this effort may cease
as part of the Board of Supervisors budget approval process for FY 07.
Approximately 100 clients are served annually. The clients are primarily mothers with open
cases in Drug Court. The intent of the program is to ensure full-term delivery of babies,
increasing the parenting skills of the mothers and provision of services for rehabilitation and
psychosocial counseling, as well as linkages to other community-based services/programs.
The grant funds 1.0 Public Health Nurse II, 0.5 Public Health Nutritionist, 2.0 Rehabilitation
Counselors, and 1.0 Marriage and Family Therapist. The Rehabilitation Counselors and the
Marriage and Family Therapist are located with the HPEP team in the Public Health Department,
but the codes are reflected in the Drug and Alcohol Department budget.
Adult Drug Treatment Court
The Public Health Nurse (PFfN)is an integral team member of the Adult Drug Treatment Court
(DTC)in Santa Clara County. This position serves as a nurse consultant to the court.
Twenty percent of a PHN III staff has been assigned to DTC since November 1998. The PHN
attends weekly DTC review meetings to identify appropriate referrals for clients who are
pregnant or parenting a child under 5 years of age. The majority of the DTC referrals for
pregnant and/or parenting women with children under age two have been to the PHD/ DADS
Healthy Pregnancy Early Parenting Program (HPEP).
The Public Health Department is a division of Santa Clara Valley Health & Hospital System.
}
^ealth Department
Pl
)
Expenditures details - Non General Fund Only
Substance Abuse and Crime
Dependency Drug Treatment Court
Prevention Act(SACPA)
(DDTC)
Adult Drug Treatment Court
FY05
FY05
FY06
FY05
FY05
FY06
FY05
FY05
FY06
Approved
Actual
Approved
Approved
Actual
Approved
Approved
Actual
Approved
ADMINISTRATION (Referrals):
Public Health Nurse I II (.20 FTE)
24,951
Subtotal
0
0
0
0
0
0
116,160
116,160
42,036
42,036
127,452
49.353
24.951
24,951
27,377
27,377
TREATMENT;
Public Health Nurse II (1.0 FTE)
Public Health Nutritionist (.5 FTE)
0
0
0
158,196
158,196
176,805
TOTAL FTE
0.0
0.0
0.0
1.5
1.5
1.5
TOTAL EXPENDITURES
0
0
0
158,196
158,196
176,805
0
0.20
24,951
0
0.20
0
0
0.20
27,377
Program: Superior Court of California, County of Santa Clara Mental Health
Treatment Court
The program was established in 1999 to serve defendants who have co-occumng mental
illness and substance abuse problems. They are at risk for failing traditional treatment
and court models. Santa Clara was the first county in California to operate a Mental
Health Treatment Court. The Court emphasizes the need to both address the criminal
behavior and the mental illness in order to stabilize and reduce re-an est and incarceration
and to assist the individual in developing pro-social behavior and self-sufficiency to
reintegrate into seiv’ing the community. Referral sources for the program services are
Judges, Probation Officers, Public Defenders, District Attorneys, Pretrial Services, and
County Jail.
Target Population
The Court currently is serving 400 clients. There are 47 between the ages of 18-25; 105
between the ages of 26-35; 241 betw'een the ages of 36-55; and 7 between the ages of 56
and 71. All prospective participant’s offenses are reviewed on a case-by-case basis prior
to admission to the court. The average defendant graduates from the Mental Health
Treatment Court in 18 months.
Project Partners
Santa Clara County Mental Health Department, Adult Custody Mental Health, District
Attorney’s Office,Public Defenders Office, Department of Alcohol and Drug Services,
The Department of Public Health, Adult Probation Department, other Judges and Courts
may make referrals.
Through agreement and the cooperation with the San Jose Police Department and the
Santa Clara Sheriffs Department, service of bench warrants and arrest of Mental Health
Court participants who have absconded from treatment are given priority. This serves to
lower the risk that Mental Health Court clients will decompensate and pick-up new
criminal charges before the Mental Health Court team can intervene and assist the clients
return to stabilization and treatment. The Department of Corrections provides in-custody
treatment programs that accept dual diagnosed clients. These jail services prepare
defendants for admission into the Mental Health Court and demonstrate their motivation
to work on the co-occurring disorders that contribute to criminal behavior and non-
compliance with court orders in the community. The Judge has secured staff and funding
to provide limited case management services and psychiatric medication for those clients
who do not meet Mental Health Department medical necessity criteria. Those clients are
connected with the court based psychiatrist. .
The Mental Health Drug Treatment Court also sees clients from the Dependency Court
when individuals have both criminal and dependency charges. In these cases, treatment is
coordinated between the two courts.
This program has many positive social outcomes to report. While only 22 % of Mental
Health court graduates were employed upon entering the program, 38 % were employed
upon exiting the program. Eighty-three percent(83%)of graduates were homeless upon
entry and 68 % had obtained independent housing at exit, while the remaining 32 %
resided in some form of group living at time of discharge from the program.
The most important goal of the program relates to self-esteem and family reuninification.
gained more control over their
Eighty percent(80%)ofthe graduates felt that they hadand
lives and the ability to overcome obstacles to recovery 78 % were able to reunite with
their families. These outcomes reflect the success of this program linking the court with
treatment services.
Mental Heau,. Jepartment
Expenditures Details - General Funds
Adult Drug Treatment Coxixt
i FYOS Approved
FY05 Actual I FY06 Approved
TREATMENT:
Psychiatric Social Worker II (1.0 FTE)
Marriage Family Therapist I (1.0 FTE)
Marriage Family Therapist 11 (0.5 El E)
Salary Savings
Others (mileage, office expense, phones)
86,625 :
42,217 ;
93,504
90,345
51,258
96,299 j
101,317
47,629
55,296
(15,627)
0
0:
5,155
2.50 ;
2.50
(6,619)
0
I
TOTAL FTE:
TOTAL EXPENDITURESi
)
2,50
I
I
212,601
191,300
243,498
)
)
SObmitted to Sandra Nathan, Deputy County Executive
on January 13, 2006, by Robert Gamer, Director of
Department of Aicohoi & Dmg Services
I.
Introduction and Background:
This report is a combined response to two referrals from Supervisor Alvarado,
one involving funding from the Substance Abuse and Crime Prevention Act
(SACPA-Proposition 36) and the other a broader referral dealing with drug
courts in general. The general substance of both referrals was to obtain a
broader context within which all court-referred clients are treated. There was a
concern that by trying to deal with issues involving individual services or
funding sources the Board was unable to see the broader context and the
relationships between the individual parts and the process of setting broader
funding priorities and policies was made more difficult.
Section II of this report will contain a broad overview and discussion of the
major issues involved in the relationship between the court system and the
drug and alcohol treatment system. The purpose of this section is to give the
Board an understanding of the context within which issues of funding and
resource allocation take place. The detail supporting this discussion will be
found in Section III, which includes a source and application of all drug and
alcohol treatment funding as well as a description of the client population
served. This Section also contains a description of the treatment system.
Finally, Section IV contains a special report on the impact of the
methamphetamine problem on the substance abuse treatment system, as
requested in the original Board referrals.
II.
Major Issues:
This Section identiftes and discusses the major Issues related to the funding of
alcohol and drug treatment and utilization of those treatment services by the
criminal justice system. While each of these major issues could be broken into
sub-issues, the purpose here is to keep the discussion at a high level,
providing a basic understanding of the relationship between criminal justice
and treatment and helping the Board to make decisions on individual funding
and service items as they come forward. All of these individual items need to
be understood in the broader context of the relationship between criminal
justice and treatment. While there is no specific action required or even
recommended in this report, the Board will be addressing numerous issues
during the next budget cycle that will relate in some way to the issues
addressed in the report. It is likely that discussion about the issues in this
report will generate further discussion, and require further data analysis.
1 The vast majority of resources in the Department of Alcohol and Drug
Services(DADS)are allocated to adult treatment. About 72% of the
total resources made available to DADS, approximately $33 million,
directly support adult treatment. This allocation is in part historical and
in pari a reflection of State and Federal priorities. The drug and alcohol
field developed primarily as a response to drug-related crime, and initial
State and Federal responses focused on this relationship. The vast
majority of resources provided to fight drug and alcohol problems were
1
CHART #1
FY05 TOTAL DADS BUDGET:
$45,194,415
BALL OTHER SERVICES
□ ADULT TREATMENT
CHART #2
FY05 TOTAL ADULT TREATMENT
CLIENTS: 15,204
□ ALL OTHER CLIENTS
74%
11,278
□ REFERRED FROM
CRIMINAL JUSTICE
3
III.
Adult System of Care:
This section provides the detail that supports the discussion of major issues in
Section II. The first part is a description of the adult system of care (ASOC):
how clients gain access, the assessment process, development of treatment
plans, treatment, and quality improvement and accountability. The second
part is a series of three charts describing the source and application of funds
for adult services, the cost of providing each modality of care, and the cost to
serve criminal justice clients in each modality. The third part is a series of
three charts showing the number of clients served in the ASOC, by modality
and funding source, the number and percentage of those clients that are
referred by the criminal justice system.
The ASOC for substance abusing clients is administered as a managed
system of care. The Department controls both access to and utilization of the
treatment resources. The goal is to assure the most appropriate and efficient
use of the limited resources available in the community. This is accomplished
by requiring that every individual seeking access to dmg and alcohol treatment
receives an assessment. For this purpose, the Department administers a
validated assessment instrument adapted from the multidimensional,
biopsychosocial assessment developed by the American Society of Addiction
Medicine. The assessment gathers basic information about multiple
dimensions of the individual’s life, including substance use, and identifies the
appropriate level of care for treatment. This assessment process assures that
only individuals requiring treatment enter the treatment system, and that they
enter treatment at a level appropriate to meet their needs.
The primary point of access to adult substance abuse treatment is through the
GATEWAY program, a 1-800 number that links the caller with a brief
information, referral and screening process. The large majority of calls are for
general information about substance use and abuse and prevention, and
these are directed to information and education resources in the community.
Those callers identified as needing treatment are given an assessment over
the phone to determine the appropriate level of care. Once the level of care
has been determined the caller is given a welcome to treatment appointment
with the appropriate treatment provider.
Because of the large number of clients entering the ASOC with a referral from
the courts, special satellite assessment centers or other decentralized
assessment sites have been created. For example, within the Dependency
Drug Treatment Court the Department has assigned two full time staff to
perform assessments on clients immediately following the court referral. The
level of care and treatment referral is then considered when the overall plan is
developed for the client by the Dependency Court. A larger example is in the
SACRA (Substance Abuse and Crime Prevention Act - Proposition 36)
Assessment Center, which was established to provide assessments for the
high volume of SACPA clients referred by the Court.
5
Outpatient clients are also eligible to receive ancillary services such as
housing (Transitional Housing Units), medical and time limited psychiatric
services. In addition, they are eligible for vocational services, which include
training and job placement, career counseling, and referrals to GED, ESL and
literacy classes.
When a client has completed treatment, a Discharge Summary is completed to
summarize the client’s progress in treatment. It requires the counselor to do a
summary of all 6 ASAM dimensions (see above)related to a client’s substance
abuse and mental health Issues. Any dimension rated medium or high in the
Discharge Summary should include a plan related to how the client will
address that issue once the client leaves treatment.
Once in treatment, providers continually assess a client’s treatment needs and
treatment progress to determine if or when the client should be referred to a
different level of care. Clients move in either direction along the continuum, as
their treatment needs change.
Policies, procedures, processes, and forms are standardized across the
system. This strengthens cohesion among providers and facilitates smooth
transitions along the continuum of care for the clients.
DADS Quality Improvement(Ql) Division Is responsible for the overall
cohesion of the ASOC by providing intensive oversight and management of
the system’s daily operations. Ql monitors access, utilization, and service
quality for the system and provides training, technical assistance, and clinical
consultation for all providers.
Providers in the DADS ASOC must achieve certain performance measures as
designated by contract. The Ql Division conducts audits annually with all
providers in the system to ensure providers’ adherence to the Department’s
clinical standards. The audits are scheduled In advance and the Ql Division
provides coaching and information about how to succeed In the annual audit.
In the event a provider fails the audit, they are required to submit a formal
corrective action plan with timelines for achieving improvement. The Ql
Division follows up to verify that the provider’s corrective action plan has been
implemented and to determine its success.
7
)
)
)
health and H0S^AL_SYSJEM~ .i
„
,
_
DEPARTMENTOF A^C^l^NO DRUG SERVICES
FY 06 - SOURCE AND application "adult TREATMENT SERVICES _
Exp»n»e
FY06
Fund.Source
Drug Court Partnership(OCP)
This is a slate gran! from ADR. The C5ai9 Court Partnership grant supports Drug Treatment
Grant Period: Rented annually
Court(DTC)activities such as a Da>g Court Coordinator(DCC)for the Superior Court and
community workers In Probation for drug testing in addition to transitional housing unit beds for
clients in substance abuse treatment. This grant is revnewed annually.
Office of Justice Program • Dependency This is 3 federal grant and expires 8/31/06. This grant expands and enhances services for
Drug Treatment Court (OJP • DOTC)
clients in Oependertcy Drug Court, particularly during limes when they are preparing to transition
GrantPeriod: 9/1/04^8/31/06
out of DDTC program. Counseling and casement management services are provided by
425.175
Court reimb
Drug testing
THU (12)
124.990
Act (SACPA)
Prop 36, approved by voters in Nov 2000, requires specificied drug offenders to receive drug
treatment services in place of incaraceralion. Funds due to expire 6/30/06.
3.902.979
Board of Supervisors approved one-lime funds for FY06 SACPA services through 6/30/06.
1.074.813
GrantPeriod: 7/1/00-6/30/06
Substance Abuse and Crime Prevention
Admin OH
OP (20)
Case mgmt
contract provider Expires 8/31/06.
Substance Abuse and Crime Prevention
Admin OH
Act (SACPA). General Fund
Grant Period; FY06
Assessment
Admin OH
Evaluation
SB 223(Burton) are SAPT federal block grant funds for drug testing related to Prop 36, No
368.916
3.000
Bus
9.385
Probation SACPA budget $1,234,721
Probation SACPA lx budget $300,160
$ 19,000
95,000
80,000
132.000
40.000
Psych/Meds
37,000
Comm Wkrs
28,600
Pre-Tnai Svc $ 145,236
Probation
specified sunset dale on these funds.
15.000
Travel
9.916
DAOS
$ 256,456
Svc& Supplies 36,136
367.906
Res (15)
415.235
THU (40)
OP (20)
Res (4)
91.200
Data entry
39.015
DAOS
$1,097,554
Svc & Supplies 30,000
100.000
Pysch/Labs
1.496.096
OP (469)
723,335
Res (26)
455,994
THU (52)
Expires 5/31/06,
DCC
39,015
14.000
dual diagnosis clients. Rollover grant savings will be used to cover June 2006 expenditures.
Comments
Court reimbursement
$ 13.044
10.000
this grant support a Dual Diagnosis Drug Court and provides the assessment and treatment for
Substance Abuse Testing/Treatmeni
Accountability(SATTA)
110.600
Legal Svcs
Travel & tmg
Services Agency • Dual Diagnosis
(SAMHSA - DO)
GrantPeriod: 6/1/03-5/31/06
118.585
164,930
Mentors
Substance Abuse and Mental Health
431.600
5 11.060
220,110
Grant Period: None
Drinking Driving Program (OOP)Fees,
Diversion fees and CGF
County assesses a 6% admin fee of gross program revenue of drinking driver programs and
diversion programs to administer and monitor the program in accordance with Stale regulations.
Annual collections are rougly $180,000 annually.
Total for Adyll.Seryices
Total OADS byi^el
SAPT ’ Substance Abuse Prevention Treatment (Federal Block Grant)
MM - Meihadone_Maintenance
SGF - slate General Fund
_
CGF - County General Fund
'..,f?0Sidenti3[_
M/c"- Medi’-Cal
Jransitiooai Housing Units
ODTC ■ PepOTde'nCTllr^g T» CoVl'
CD
1/20/2006 3:37 PM
2
$180,000
214,992
Svc/suppiies 130,313
^32j.6^.321_
Acronym OescripUpn;
Admin
Assessment
'"_45,!.94,115.
OP • Oyipalierit
06 source and app • adult lx - RG.xls
525.305
Revenues are compose of
30%
OOP fees
4%
Diversion fees
66%
CGF
Total Admission By Modality For Adult System FY06
ASOC
Outpatient
Residential
Methadone
THU
DETOX
No Contract
Contract
No Contract
Contract
No Contract
323
13
314
4
2315
683
84
0
1601
0
0
249
26
1011
126
57
0
190
112
2
0
0
0
9
0
0
1169
0
0
430
0
838
44
0
0
0
0
0
0
0
209
0
0
30
4164
1071
141
0
DCP
DTC
DDTC
OOP
LLBG
TOTAL
1
53
84
2
1
7300
0
0
3360
0
0
325
0
2772
3017
1191
435
Outpatient
993
15
SAMSHA
CalWORKS
Continued
CDCI
SACRA
BASN
VHP
Contract
7168
Total
MEDICAL
Contract
No Contract
Contract
No Contract
243
43
99
21
Residential
0
0
20
58
1
168
43
Methadone
0
0
0
0
0
0
12
THU
0
0
0
24
2
212
51
2
24
0
214
4
DETOX
Total
0
0
0
20
0
3
243
43
119
123
4
436
1447
1
15204
These are new admissions to the system for the fiscal year.
)
)
)
)
)
Percent Criminal Justice Referral Admissions By Modality For Adult System FY05
MEDI-CAL
VHP
85.52%
98.50%
0.00%
63.16%
15.38%
N/A
0.00%
33.96%
9.99%
ASOC
Outpatient
Residential
Methadone
THU
DETOX
Total
65.19%
Outpatient
Residential
Methadone
DETOX
Total
CO
No Contract
100.00%
N/A
N/A
100.00%
100.00%
100.00%
100.00%
N/A
DCP
DTC
OJP
LLBG
TOTAL
100.00%
100.00%
100.00%
100.00%
100.00%
N/A
N/A
84.74%
90,65%
No Contract
Contract
100.00%
N/A
100.00%
100.00%
100.00%
0.00%
N/A
N/A
N/A
N/A
N/A
100.00%
N/A
100.00%
N/A
N/A
N/A
N/A
13.33%
100.00%
SAMSHA
CalWORKS
Continued
Contract
100.00%
100.00%
100.00%
100.00%
100.00%
Contract
100.00%
100.00%
46.90%
Contract
No Contract
Contract
No Contract
6.58%
2.33%
100,00%
100.00%
CDCI
SACRA
BASN
1 No Contract
100.00%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
100.00%
100.00%
100,00%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
2.77%
100.00%
N/A
61.65%
N/A
N/A
22.67%
100,00%
100.00%
74.18%
N/A
N/A
N/A
100.00%
100,00%
100.00%
N/A
N/A
N/A
100,00%
N/A
100,00%
6,58%
2.33%
100.00%
100,00%
100,00%
100.00%
IV.
Impact of Methamphetamine Use:
This section is a review of the client data showing the growing impact of
methamphetamine use on the treatment system. The impact of this drug is far
more significant in those clients referred by the criminal justice system, and
specifically, by SACPA. In FY05 48.4% of ail clients entering the adult system
of care reported methamphetamine as their primary drug of choice. During
that same period, 63.7% of SACPA clients identified methamphetamine as
their primary drug of choice.
15
Department of
I
)
I and Drug Services
Expenditures Details - General Fund Only
Substance Abuse and Crime
Dependency Drug Treatment
Prevention Act(SACPA)
Court(DDTC)
FY05
FY05
FY06
Approved
Actual
Approved
I
FY05
FY05
! Approved
I
Actual
Adult Drug Treatment Court
FY06
FY05
FY05
FY06
Approved
Approved
Actual
Approved
ADMINISTRATION;
I
T
Health Care Prog Analyst (1.0 FTE)
Health Care Program Analyst (1,0 FTE)
Ql Coordinator A&P Services (1,0 FTE)
Health Services Rep.(1.0 FTE)
Office Specialist III (1.0 FTE)
Health Program Analyst (.5 FTE)
Sr. Health Care Program Analyst (1.0)
Office Specialist III-U(1.0 FTE)
Health Care Program Analyst - U (1.0 FTE)
0
0
0
0!
0
0i I
0 i
0
0
0:
0
0!
0 i
0
0
0
0
01
0 i
0 ;
0i
0 i
0!
0'
0 1
0
0
0
0I
o;
0 i
0
0 i
0i
0
0
0
0
0 ;
0 i
0 ;
0 I
0
0
0
0
0
0:
0 :
0 i
0 i
0
0
0 I
0
0
0'
0 I
0 :
0 ;
0
0
0±
0
0 , I
0
0
0
0i
oi
0
0|
Program Evaluation
0
0!
Supplies and Others
0
0
Subtotal
0
59,040 ; I
109,993 j
0 I
0 i
0
i
0 :
0
0
0I i
0
0:
0 ,
I
0
0
0
o1
0
0
0!
0
0
0
0
0|
169,033
0 i
0
0 ; i
0 i
0
0
TREATMENT:
Health Care Program Manager II (1,0 FTE)
Psychiatric Social Worker I (1.0 FTE)
Marriage Family Therapist II (1.0 FTE)
Rehab Counselor (3.0 FTE)
Rehab Counselor (.5 FTE)
Rehab Counselor-U (1.0 FTE)
Sr, Office Specialist (1,0 FTE)
Psychiatric Social Worker II (1.0 FTE)
Rehab Counselor (1,0 FTE)
Rehab Counselor • U (1.0 FTE)/half yr
0
0i
0
0
0 I
0 ;
0
0
0
0
0 i
0
0
0
0 i
0
0
0
0
0:
0
0
0
0 ;
0
0
0
0
0
0
0
0
0I
0
0
0I
0
0 I
0
0
0
0
0
0
0
85,200
0I
0
0
0
0
0
73,764
0
0
0
110,316 !
100.572 i
0 I
0
0
0
0
0
0
0
0
0
0
0
67,188
64,419
0
0
0
100,596
111,811
0
0
0
77,664
96,816
0
0
0
0
0
Marriage Family Therapist II - U (1.0 FTE)/half yr^
0
0
0
0
0
Rehab Counselor + OSIII (LIEBG)
Marriage Family Therapist (1.0 FTE)
Supplies and Others
0
0
0
0
0
0
0
0
0
0
Treatment Contracted Services
0
Mentor and Legal Services
Court Expenses
Drug Testing
0
0
0
0
0 i
0 i
Psychiatric/Lab & Meds
0
0
Oj
0
0
0
0
0
0
0
0 i
0:
0
0
0
0
0
0
0
25,316
0
59,631
29,667
59,631
0
0
0
819,357
667,659
660,838
697,391
238,411
236,496
248,125
0 i
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0:
0
0
0 :
0
0
0
0 ;
0
0
0 I
0
Subtotal
0
0
904,557
972,738
963,551
1,041,674
238,411
236,496
273,441
TOTAL FTE
0.0
0.0
3.0
3.0
3.0
3.0
0.0
0.0
0.0
TOTAL EXPENDITURES
0
0
1,073,590
972,738
963,551
1,041,674
238,411
236,496
273,441
ATTACHMENT C
a.
Julie Rice, DADS Research Institute, Comparison ofSACPA
Methamphetamine Users andSACPA Non-Methamphetamine
Users- Fiscal year 2005. Report issued in Jan 2006.
b. Longshore, Doug, et al, UCLA Integrated Substance Abuse
Program, Evaluation ofthe Substance Abuse and Crime
Prevention Act- 2004 Report, prepared for the Department of
Alcohol and Drug Programs. Report issued on July 22,2005.
c. Wiley, Deane, et al, Assessment ofSanta Clara County SACPA
Client Outcomes. Report issued on Sept 2004.
2 of 7
oi/n/06
methamphetamine as
the primary or secondary drug of choice at time of admission to the
1
treatment provider.
Seventy-six percent(75.9%)of SACPA clients reported methamphetamine as either their
primary (63.7%)or secondary(12.3%)drug of choice.
Demographics
As shown in the tables below methamphetamine users in Santa Clara County are younger than
non-methamphetamine users. Methamphetamine users are predominantly male however a larger
percent of females use methamphetamines than in the non-methamphetamine group.
Methamphetamine
Non-Meth
Users
Users
Age
18-25
479
23.6%
108
16.7%
•
26-35
712
35.0%
173
26.8%
•
36-55
831
40.9%
346
53.6%
11
0.01%
18
2.8%
2033
100%
645
100%
682
33.5%
171
26.5%
1351
66.5%
474
73.5%
2033
100%
645
100%
•
•
Over 55
TOTAL
Gender
•
Female
•
Male
TOTAL
As shown in the Age by Gender table and Age by Gender graph, the percent offemales between
the ages of 18-35 using methamphetamines is greater than the percent of males in the same age
range. 'Phis indicates that the majority of women using methamphetamines are in their
childbearing years while women using other drugs are more likely to be over the age of 35.
Age by Gender
Non-Methamphetamine
Methamphetamine
Optimal
Childbearing Years
Users
Users
Male
Female
Male
Female
Yes(18-35)
No(Over 35)
776
57.4%
417
61.1%
216
45.6%
65
38.0%
575
42.6%
265
38.9%
258
54.4%
106
62.0%
Total
1351
100%
682
100%
474
100%
171
100%
)
These numbers vary slightly from data reported in the SACPA Statistical Summary for Annual FY05, which used
data from the clients Level of Care Placement screening.
4 of 7
01/11/06
Outcomes
Methamphetamine users tend to stay in outpatient treatment longer than non-methamphetamine
users.
Service Modality
Outpatient
Residential
Transitional Housing
Methamphetamine
Non-Meth
Users
Users
Average Length of Stay
122.7 days
51.0 days
93.7 days
Average Length of Stay
106.3 days
51.6 days
86.4 days
The following tables give the last discharge status from residential or outpatient treatment in
FY05.
Discharge Status From Last Treatment Episode
Outpatient
Methamphetamine Users
Residential
Satisfactory Treatment Discharge
872
58.7%
170
68.5%
Unsatisfactory Treatment Discharge
613
41.3%
78
31.5%
1485
100%
248
100%
TOTAL
Discharge Status From Last Treatment Episode
Outpatient
Non-Methamphetamine Users
Residential
Satisfactory Treatment Discharge
257
56.2%
46
63.9%
Unsatisfactory Treatment Discharge
200
43.8%
26
36.1%
457
100%
72
100%
TOTAL
oi/n/06
6of7
Employment Status Comparison
(Between First Admission & Last Discharge)
50.0%
40.0%
42.4%
35.1%
30.0%
20.0%
10.0%
0.0%
Better
Worse
Positive No
Change
Negative No
Change
■ Methamphetamine □ Non-Methamphetamine
Comparison of Frequency of Use at First Admission and at Last Discharge
The client’s primary substance frequency of use is examined at first admission and at last
discharge. Only clients with complete data on admission and discharge frequency of use were
used in the following analysis. Please note that 111 non-methamphetamine users and 180
methamphetamine users did not have complete records for frequency of use.
Frequency of Use at Admission
• No use prior month
• 1 -3 times in past month
• 1 -2 times per week
• 3-6 times per week
• Daily
TOTAL
Frequency of Use at Discharge
• No use prior month
• 1-3 times in past month
• 1 -2 times per week
• 3-6 times per week
• Daily
TOTAL
Methamphetamine
Non-Meth
Users
Users
1225
66.1%
308
74
4.0%
24
4.5%
196
10.6%
66
12.4%
129
7.0%
49
9.2%
229
12.4%
87
16.3%
1853
100%
534
100%
1319
66.7%
57.7%
71.2%
356
57
3.1%
25
4.7%
190
10.3%
66
12.4%
136
7.3%
43
8.1%
151
8.1%
44
8.2%
1853
100%
534
100%
Evaluation of the
Substance Abuse and
Crime Prevention Act
2004 Report
Prepared for the Department of Alcohol and Drug Programs
California Health and Human Services Agency
By Douglas Longshore, Ph.D., Darren Urada, Ph.D.,
Elizabeth Evans, Yih-lng Hser, Ph.D., Michael Prendergast, Ph.D., and
Angela Hawken
July 22, 2005
ISAP^
Integrated Sutetanee Abuse Pragrams
Overall, about one-quarter (24.9%) of offenders who agreed to participate in SACPA in
its second year completed treament (based on a 72.6% treatment entry rate among all
SACPA offenders and a 34.3% completion rate among offenders who entered treatment).
This rate is typical of drug users referred to treatment by criminal justice.
Half of SACPA outpatient drug-free clients (5].4%o) received at least 90 days of
treatment, as did 41.2%o of long-term residential clients. These rates are typical of drug
users referred to treatment by criminal justice. A period of 90 days is widely cited as the
minimum length of stay before treatment is likely to have a beneficial effect.
Treatment completion was lower for African Americans, Hispanics, and Native
Americans than for Whites and Asian/Pacific Islanders. These findings signal the
importance of assessing the possible disproportionate impact of limited treatment
capacity, assessment procedures, and treatment protocols across racial/ethnic groups.
Clients with no prior experience in treatment were as likely to complete treatment in
SACPA as clients who had been exposed to treatment before. This finding is notable
because clients with no prior treatment experience may find it difficult to conform to
unfamiliar requirements such as open acknowledgement of their drug problem and self
disclosure in groups.
Methamphetamine users were similar to the overall SACPA population in their rate of
treatment completion. Concern has been raised regarding clinical challenges, such as
severe mental health problems and poor engagement in treatment, arising from
methamphetamine use. Treatment providers in SACPA appear to have responded well to
these challenges.
Treatment completion was lower, and duration shorter,for heroin users than for users of
other drugs. Few heroin users in SACPA were placed in methadone detoxification or
maintenance,
Heroin users’ performance in treatment might improve if methadone
treatment were available to those who wish to receive it.
Offender outcomes
Outcomes during the initial 12-month follow-up—new arrests, drug use, a?jd
employment—were most favorable among first-year SACPA offenders who completed
treatment, compared to those who were referred to SACPA but did not enter treatment
and those who entered treatment but did not complete it. This comparison shows
outcomes in relation to offenders’ degree of participation in SACPA. Favorable
outcomes were substantial for employment and occurrence of new drug arrests. Drug use
outcomes were uneven. It will be important to see whether initial favorable outcomes are
sustained across a longer period.
Drug offenders eligible for SACPA in its first year (SACPA-era offenders) were more
likely to have a new drug arrest during the initial 12-month follow-up than a pre-SACPA
comparison group of similar offenders who would have been eligible for SACPA. All
IV
County of Santa Clara
Office of the Covinty Exectitive
"ounf)’ Government Center, East Wing
West Hedding Street
San Jose, California 95110
(408) 299-5105
Date:
September 27, 2005
From:
Quyen Nguyen, Program Manager
To:
Prop 36 Steering Committee Members
Cc:
Jail Population Task Force Members
Subject:
Evaluation of SACPA- 2004 UCLA Report
The third annual evaluation report of Prop 36 is recently released. Prepared by the independent UCLA
group for the Stale’s Alcohol and Drug Program, the report descnbes the Prop 36 “pipeline” in its third
year (July 1, 2003 to June 30, 2004). This Report can be downloaded at:
http://A\"ww.adp.ca.gov/SACPA/P36_Reports.shtml
Additionally, attached for your review are the parallel findings for Santa Clara County’s Prop 36 program.
Several of their findings are highlighted as follows:
Almost half of the clients(42%)completed treatment. The other 2 non-SACPA comparative
groups also had similar completion rate.
Among treatment completers, almost half of them (41.9%) had a new drug arrest during
the 12 months after offense, and half of them (50%)reported drug use in the past 30 days.
Among treatment completers, the average length of stay was 129 days in outpatient, or 55
days in residential. Statewide average for completion was 194 days in outpatient or 90
days in residential.
About two-third (76.8%)ofSACPA clients utilized outpatient treatment, and about onefifth (21.4%) utilized residential. Statewide, most clients(84.4%)utilized outpatient and
11.2% utilized residential.
To assess Prop 36 as a social policy, the UCLA report indicated that 37% of SACPA
eligible offenders had a new arrest in its first year as compared to 31% of new arrest from
a population of offenders arrested in 1997-98 who would have been eligible for SACPA.
If you have any question, please contact me at (408) 299-5138 or quven.nguven@ceo.sccgov.org.
Thank you
Board of Supervisors: Donald F. Gage, Blanca Alvarado, Pete McHugh,James T. Bc-.J], Jr., Liz Knis.s
Counn’ Executive: Peter Kutras,Jr.
r
Treatment Clients by Referral Source
(CADDS), 7/1/03- 6/30/04
60 -|
54.7
43.6
<w
a 40 %>
31.1
E
233
22.9
o
19.9
g 20 a.
2.5
2.0
0
SaotA Clara Couary
Slatfv*>de
(N = 6,410)
(N = 164^21)
!□ SACPA probation D SACPA parole B Crimioal justice non-SACPA B Noivcrimioal justice
\
Race/Ethnicity of SACPA Treatment Clients
(CADDS), 7/1/03 - 6/30/04
60 n
2
a>
44.8
443
c
V
£40 32.4
27.4
<
o.
U
<
^20 ^
173
o
14.4
a>
a>
5.6
CU
43
2.7
4.1
0.9
0
Sania Clara County
(N-2,122)
Stateside
(N - 36,773)
|o While B Hispapic » African Ajnerican B Asiatt/PaciSc Islander B Other ■ Nativt American |
Prop 36: UCLA Year 4 Report
2
Primary Drug Among SACPA Treatment Clients
(CADDS),7/1/03 - 6/30/04
80 -I
C
<i>
'V
fb-'
A
60
c>-
c
E
< 40 H
Cu
U
<
in
o
c 20 ^
N
<i>
L>
<0
9-
%>
Cl-
‘b*
s'>
is
\N’
0
Slairwide
Santa Clara Count>-
(N - 36,773)
(7V» 7,122)
|d Melhamphclamine B Cocaiot/crack M Marijuapa B Heroin D Alcabol ■ Olber|
Years Since First Use of Primary Drug
Among SACPA Treatment Clients
(CADDS),7/1/03 - 6/30/04
80 -1
“ 60
a>
B
a>
< 40 a.
O
<
26.9
00
»%v
20.0
o
20.3
18.4
18.1
5
= 20 «>
(J
o.
a
0
Santa Clara Cnwnty
{N - 2,112)
[□0-5B6-l0ail-ISB16-20B21+]
Prop 36: UCLA Year 4 Report
Stalrsvidr
8
4
Number of Prior Treatment Admissions
Among SACPA Treatment Clients
(CADDS), 7/1/03 - 6/30/04
60 n
c
c
£ 40
<
a.
U
<
20
o
<u
a.
S'
>
N*
0
Slalewide
Santa Clara County
(N =2,122)
□ 0
8 1
a 2
(N = 36,773)
04
Q3
■5
n 6
□ 7
B8
D94 I
SACPA Treatment Clients by Modality
(CADDS), 7/1/03 - 6/30/04
V)
lOO -1
c
a>
84.4
u
c
80
76.8
a>
E
c«
a>
60 '
<
a.
U
40 -
<
21.4
o
c
20
a>
u
a>
0
■
11.2
1.7
0.0
0.1
0.1
Santa Clara County (N = 2,122)
□) Outpatient
■Residential
> 30 days
Prop 36: UCLA Year 4 Report
□ Detox
O Residential
2.0
1-2
03
1.0
Statewide (N = 36,773)
□ Methadone detox
■ Methadone maintenance
< 30 days
6
Discharge Status by Referral Source
(CADDS), 7/1/02 - 6/30/03
60 n
l).4i
8.5
18.6
c 40
5
V.3i
O)
O
c
42^6
42.9
^ 20
37^5;
34A
.35.0
.30.0
0
SACPA
Criminal justice
Noo-crimina)
SACPA
Criminal jmtke
Non-criiranal
(N = 1,903)
non-SACPA
justice
(N = 1,950)
(N = 28,749)
non-SACPA
justice
(N = 77,866)
(N = 2,444)
(N =38,615)
Statewide
Santa Clara County
0 Made satisfactory progress
O Completed treatment
(
i
County Variation in Completion Rates
for SACPA Offenders
(CADDS)
60 -|
38
3
5 40
36
C
3
O
tj
O
V
i 20
21
10
8
9
7
1
1
0
BO-25
7/1/01 - 6/30/02
7/1/02 - 6/30/03
(N-54)
{N-56)
Q 26 - 50
□ 51-75
0 76+
Note: Analysis for each year excluded counties where no SACPA clients had a discharge on r^^ord.
Prop 36; UCLA Year 4 Report
8
Median Length of Stay in Treatment
Among Treatment Completers by Modality
Santa Clara County
(CADDS),7/1/02 - 6/30/03
(N = 2,539)
300 -|
270'
243*
S 240
I 210 168*
- 180 -
° 150
J 29126)25
■3 120 c
cs
73
90 -
TD
S
55
60 ■
49
20*20*20
30 -
4* 0
4
0
0
0
0
0
OutpAtiriit
KeskleDtix)
Detox
□ SACPA
(W = 81<i)
KeskkDtbl
MelhadoM detox
Methadooe
maiDtcnasce
< 30 days
> 30 tbyx
B Noo-criminai justke
(N = 682)
B CrimiDal juslke ood-SACTA
(N= ),04J)
19
* Finiiings may be unreliable because numbers were small (e g-, between 1 and 4),
County Variation in Median Length of Stay
Among Outpatient Treatment Completers
(CADDS), 7/1/02 - 6/30/03
(N = 55)
30 -|
25 22
W)
c 20 3
17
a
o
o
14
15 ^
a>
§10
2:
5 2
0
) - )00
)0) -200
20) - 300
30) - 400
Note; In three counties, the number of outpatient treatment completers was too low for a reliable
estimate of length of slay.
Prop 36: UCLA Year 4 Report
10
New Arrests During 12 Months After Offense
(DOJ SACPA Offenders), July 2001 - June 2002
(Statewide N ^ 29,969)
80 -|
u 60
a>
c
a>
o
w
40 -
o
c
a>
u
a>
ffu 20
10.9
8.5
5.7
3.1
2.5
1.5
0
New drug arrest
0 Referred but untrcaled
New property arrest
CD Entered but did not complete treatment 0 Completed treatment
(N = 5,176)
(N = 14,597)
<N = 10,196)
New vioJenl anest
New Arrests During 12 Months After Offense
(DOJ SACPA Offenders), July 2001 - June 2002
(Santa Clara County N = 2,037)
80 n
63.6
64.6
2 60
a>
73
a>
41.9
o
40
o
c:
u
u
0^ 20
15.0
11.9
7.0
0
3-7
m
New drug arrest
New property arrest
3.7
1.7
New violent arrest
Q Referred but untreated CD Entered but did not complete treatment S Completed treatment
(N ==568)
Prop 36: UCLA Year 4 Report
(N = 984)
(N =485)
12
New Misdemeanor Arrests During 12 Months After Offense
(DOJ SACPA Offenders), July 2001 - June 2002
(Statewide N = 29,969)
40
<a>
■o
c
,a>
20^
o
^
o
21J
20
13.7
c
a>
o
L.
a>
I
Cu
0
New drug arrest
B Referred but uDtrealed
(N = 10,196)
3.0
2.4
1.7
13
13
0.6
IjgggOHHim.'
New property anesl
New viofent arrest
O Entered but did not complete treatment S Completed treatment
(N = 5,176)
(N = 14,597)
27
New Misdemeanor Arrests During 12 Months After Offense
(DOJ SACPA Offenders), July 2001 - June 2002
(Santa Clara County N = 2,037)
40
36.4
30.7
VO
U
<U
T3
,a>
O
20
17.3
o
c:
u
Cu
3-2
2.7
2.5
l.S
1.6
0-4
Mim
0
New property arrest
New drug arrest
D Referred but untreated
(N - 568)
New violent arrest
HI Entered but did not complete treatment S Completed treatment
(N = 984)
<N = 485)
28
Prop 36: UCLA Year 4 Report
14
Days of Primary Drug Use in Past 30
(SACPA Offender Survey)
(Santa Clara County N = 27)
10 a
9
8
^ 7
■o
6
o
V.
5
<i>
-D
4
s
3
Z 3-
IS,
2-3
2 -
13
1.1
0.9
1
0.0
0
A55e5sedbut untreated
(N-8)
Coinp^tcd trtatmrnl
(N = 4)
Enterrd but (Sdnot comptetr treatment
(N=-)5)
SPosI
DPre
31
Any Work in Past 30 Days
(SACPA Offender Survey)
(Statewide N = 753)
80 a
C
a>
53.9
60
2,b
XJ
c
b
<u
42.2
40.8*
o
40 o
32.9
29.5
29.8
c
(U
o
a>
20 -
0
Assessedbut ontreated
Entered but did not ci>Dif)tete
(N«177)
treabDtBt
Con^ted tTrabnenl
(N-146)
(N - 421)
0Pre
BPosI
• Group (liffercnccs are statistically signiricanl, p = .04. Alt three pre-post differences are staSStically
significant, p <.0001.
Prop 36; UCLA Year 4 Report
16
During 12 Months After Offense
Santa Clara County
1.9
2.6
iiiiiiiiiiiinii
■ SACPA eligible ofTenders
(N = 7,167)
offenders
35
New Felony Arrests During 12 Months After Offense
Statewide
40
to
u
TD
C
20.8
o
^ 20
c
cj
u
a.
4.6
0.9
M
0
New dreg
(I
QJ Comparison offenders
(N = 136,429)
Htw property vmt
Drw viokni urot
■ SACPA eUgiblc offenders
(N = 133,866)
36
Prop 36: UCLA Year 4 Report
18
New Misdemeanor Arrests During 12 Months After Offense
Santa Clara County
20
C/5
(1>
T3
C
,a>
o
o
c
a>
u
Cu
3.1
2.4
IJ
1.1
0
Hew drog VTT3I
HI Comparison otTeoders
(N = 6,927)
He-*' propoiy anrst
Hor viotrnt arresi
■ SACPA eligible ofTenders
(IN = 7,167)
39
r
I
Prop 36: UCLA Year 4 Report
20
Santa Clara County SACPA Client Outcomes Report
Page ii
This report is based on an assessment of Santa Clara County SACPA client outcomes,
undertaken for the County's Alcohol and Drug Services Research Institute and submitted
by Speiglman Norris Associates in June 2004 (County of Santa Clara contract number
4400000925). Richard Speiglman and Jean Norris can be contacted at(510)238-8432 or
rspeiglman@earthlink.net.
Deane Wiley, Acting Director, ADSRI,served as Project Manager and guided the
execution of the study. Hung Nguyen of ADSRI prepared the data, which were then
further developed by Speiglman Norris Associates. Martha Beattie, former Director of
ADSRI, also participated in the project. ADSRI is located at 976 Lenzen Avenue, San
Jose, California 95126. Dr. Wiley can be contacted at Deane.Wiley@hhs.co.scl.ca.us.
Santa Clara County SACPA Client Outcomes Report
Page iv
Executive Summary
Background
Proposition 36, the Substance Abuse Crime Prevention Act, passed in November 2000,
mandates that adults in California convicted of possession or use of illegal drugs be
offered substance abuse treatment in lieu of incarceration. A large number of adults
arrested for drug use are thereby directed into community-based treatment. Using
secondary data, this report examines outcomes for Santa Clara County SACPA clients in
the period following treatment completion. This is accomplished by comparing how
client statuses compare from one year prior to SACPA treatment entry to one year after
discharge from treatment.
In Santa Clara County, the County Executive’s Office, the lead agency for SACPA
implementation, convened a Steering Committee to plan the implementation of the
program.
Determination of SACPA eligibility is made by Santa Clara County’s District
Attorney’s office. If upon arraignment the offender pleads guilty to the offense, a
conviction is recorded; otherwise, a trial is scheduled. Less than one percent of those
pleading or found guilty refuse treatment and receive traditional sentencing.
Understanding that pre-sentence assessments give judges the maximum amount of
information on which to base sentencing, those convicted are, before sentencing, referred
for assessment by both the County Department of Probation and the County Department
of Alcohol and Drug Services(DADS). Assessments took place in custody for almost
half of SACPA-eligible offenders during the first year of operation, upon which this
study is based. Once assessed, offenders are sentenced, placed under probation
supervision and referred for treatment. Three-quarters of the offenders referred from the
courts receive treatment in the DADS treatment system. About ten percent are referred
for private treatment or to another county; the remaining fifteen percent either were not
matched between court and treatment databases, or, in violation of the judge’s order, do
not connect with treatment at all. About 15% of the most needy clients receive
residential treatment followed by outpatient services after stabilization, while over half
start in outpatient treatment. Smaller proportions are referred to case management or
psychoeducational services.
Method
The study defines a 9-month selection window for new SACPA client treatment
authorizations, from October 1,2001, through June 30, 2002(N = 1190). Data included
information on client demographic characteristics; alcohol and drug use; criminal justice
status; utilization of health, mental health, and alcohol and drug treatment services; and
receipt of social welfare benefits. Data were generated from databases compiled or
administered by the Santa Clara County Department of Alcohol and Drug Services
(DADS), Department of Mental Health, Health and Hospital System, Criminal Justice
Information Control (CJIC), and Social Services Agency.
Whenever data from more than one information system are used, there will be some cases
for which no match is found when it should be. For SACPA clients in the DADS
Santa Clara County SACPA Client Outcomes Report
Page vi
a level of use and level of care no greater than the previous use. Overall, 39% of the
sample had at least one return to treatment.
• Within one year of discharge, the initial return to treatment for 18% of the study
population was because they experienced a relapse.
• Within one year of discharge, the initial return to treatment for 21% of the
population was a maintenance return to treatment.
• Both relapse and maintenance returns for SACPA clients are more than double the
rates for clients served by DADS prior to SACPA implementation. Some of this
difference may be the result of closer scrutiny of the SACPA population, all
members of which are under the close supervision of the court and,for some
offenders, more intensive probation supervision than was utilized prior to
SACPA. Also since maintenance return is defined as a return to treatment, within
one year of discharge, with a level of use and level of care no greater than the
previous use, this can indicate a positive decision to return before a relapse takes
place.
Drug-Related Re-Arrests and Re-Arrest Rates Decline Significantlyfollowing Treatment
• Most(59%)SACPA clients committed at least one drug-related crime in the year
prior to SACPA treatment entry that resulted in an arrest. This figure is not the
expected 100% arrested for several reasons:
o
offenses culminating in a SACPA conviction may have occurred over a
year earlier due to criminal justice delays in arrests, criminal filings, and
convictions;
o
the amount of time between assessment and treatment entry was
sometimes quite lengthy; and
o
only 90% of the treatment clients were matched with criminal justice data
due to non-matching identifying information in the two databases.
During the treatment period, 5% of clients are reported to have at least one
offense resulting in a new, drug-related arrest. Recall that the treatment period is
only 3.4 months and thus a lower number would be expected.
In the year after treatment 22% experience such an arrest.
The rate of new, drug-related misdemeanor or felony arrests declines from .78 per
person before to .06 during and then increases to .27 after treatment. The rate
refers to the total number of arrests per person occurring during those time
periods.
Similar findings are evident for drug-related convictions for new offenses
occurring during those periods.
The entire DADS treatment population in the years before the implementation of
SACPA also shows high rates of arrests and convictions. In Fiscal Year 2000, the
year
before SACPA was introduced, 44% of clients had one or more arrests in the
year before treatment, and this dropped to 19% in the year after treatment.
Interestingly, the proportion arrested during treatment, 5%,is identical to the
proportion of SACPA clients arrested during the SACPA treatment period.
Time in Jailfor Drug-Related Offenses Is Greatly Reducedfollowing Treatment
Prevalence and rate ofjail time for drug-related misdemeanor and felony offenses closely
track findings for arrests and convictions.
Santa Clara County SACPA Client Outcomes Report
Page viii
benefits^ such as Food Stamps or cash assistance. Hence, even as treatment proves
successful and employment is secured, benefit rates may increase rather than deerease.
Third, all four indicators are sensitive to larger economic trends and to changes in
program rules, such as time limits for receipt of CalWORKs and Food Stamps. Limited
to these administrative data, it is difficult to define what a successful outcome would be
in a relatively short-term follow-up.
• CalWORKs benefits were provided to 3% of SACPA treatment clients in the year
prior to treatment and to 3% in the year following treatment.
• Food Stamps were provided to 5% of clients in the year before treatment and to
8% following treatment discharge.
• The prevalence of General Assistance receipt increased from 3% before treatment
to 6% in the after-treatment year.
• Receipt of Medi-Cal eligibility was unchanged at 7% in the year prior to
treatment and the year following treatment.
• SACPA clients are more likely to receive General Assistance than DADS clients
prior to SACPA. For the remaining public benefits, SACPA clients start off at
lower utilization than clients prior to SACPA and over the study period increase
utilization. The increase may be evidence of greater improvement for SACPA
clients, who demonstrate greater access to and/or use of these benefits.
Use ofMental Health Services, an Indicator ofPsychological Distress or Serious Mental
Disorder, Is Virtually Unchangedfrom the Year Before to the Year after Treatment
A useful, though imperfect, measure of well-being is receipt of county mental health
services. In a general sense, one can infer positive mental health among SACPA clients
by lack of contact with the mental health system. On the other hand, for persons who had
not been receiving services that were needed, we might infer that mental health would
improve if regular engagement with the mental health system were initiated or resumed.
• The prevalence of receipt of mental health services was 13% in the year prior to
SACPA treatment and 12% in the year following treatment, virtually unchanged.
• SACPA clients display less service use than previous DADS clients.
Use ofEmergency Room Services Declinesfollowing Treatment, while Outpatient
Utilization Increases
Improved physical health is often an objective of treatment services. Lack of
hospitalizations and emergency room visits provide an indirect, if imperfect, measure of
physical health. While outpatient visits may indicate ill-health they may also reflect
appropriate use of preventive and routine medical care. Thus, although we would expect
reduced numbers of emergency room visits, and perhaps hospital stays, following
substance abuse treatment, outpatient service utilization might increase as former clients
integrate routine and preventive care into their lives.
• Prevalence of emergency room visits declined slightly from 16% in the year prior
to treatment to 15% in the year following treatment.
• Rate of emergency room visits parallels prevalence, changing slightly from 0.26
per person per year pre-treatment to 0.24 following treatment.
Santa Clara County SACPA Client Outcomes Report
Page X
Policy Implications
Together, the data on arrests, convictions, and jail days suggest that treatment serves to
decrease risk for arrest and conviction - and probably engagement in - criminal behavior,
both that involving drugs and other criminal activity. The major finding is that treatment
works, as intended in policy, and works at least as well for SACPA clients as for DADS
clients in general. The treatment period is associated with fewer arrests, convictions, and
jail days than would otherwise be expected. Use of expensive and possibly unnecessary
emergency services decreases, and outpatient utilization increases, probably due to
education received during treatment.
The finding that criminal activity decreases following treatment is especially salient in
light of the relatively poor results for SACPA clients in the brief period after assessment
and before entry into treatment. Thus, we would suggest, efforts should be continued to
focus on providing for more rapid entry to treatment.
Limitations on interpretation of SACPA findings.
There are three factors limiting interpretation of these findings that we wish to note.
First, as mentioned above, we experienced an imperfect match between DADS and CJIC
databases. Ten percent of the eases were not matehed at all, and it is possible that some
“matches” were mis-matched due to wrong identifying information in one or both
systems.
Second, we rely on administrative data that were not collected for the purpose of
monitoring the outcomes examined in this study. There are problems with both over- and
under-counting. As an example of under-counting, as a measure of relapse returns to
substance abuse treatment misses both individuals experiencing a relapse who do not
return to treatment and those who, having relapsed, secure treatment outside the DADS
system. There are similar limitations with the mental health, emergency room, outpatient
services, and hospital data. Arrests, convictions, and jail days are also imperfect
measures, given their reliance on observation and action by the criminal justice system
and a catchment area that does not extend beyond the County’s borders. Much of the
problem is presumed inconsequential, however, insofar as the same limitations apply to
all time periods of interest. An important exception is discussed below. Hence, while
few of the health, hospital, and eriminal justice figures can be taken to represent absolute
prevalence or rate of services utilization, or need for services, comparisons of prevalence
and rate across time remain useful.
Extreme eaution must be used in interpreting one aspect of the criminal justice measures.
There is not a one-to-one relationship between acts of criminality and arrests or
convictions for those acts. Most crime goes unreported and undiscovered, and, among
crimes discovered, many result in no arrest and/or no eonviction. By definition, all
members of the SACPA client group had, relatively reeently, experienced at least one
arrest and conviction that resulted in a SACPA sentence. Hence, we would expect a
decrease in the percent of SACPA clients experiencing arrest, conviction, and jail days,
even if nothing changed in the individual client's drug behavior during or after treatment.
However, while many SACPA clients may have been under the watchful eye of Court
Page ]
SACPA Client Outcomes Study
1. Background
In recent years there has been an intensification of the policy debate over how United
States society should respond to users of illicit psychoactive drugs. One of the most
closely watched and potentially influential developments has been the implementation of
Proposition 36, the Substance Abuse and Crime Prevention Act(SACPA), which passed
in November 2000. This ballot initiative mandates that adults in California convicted of
possession or use of illegal drugs be offered substance abuse treatment in lieu of
incarceration. A large number of adults arrested for drug use are being directed into
community-based treatment, probably surpassing the number of persons entering
treatment through drug court. Counties have considerable discretion in how they
structure their systems of care and client management procedures for handling SACPA
clients.
The stated intent of the drafters of the initiative is to provide treatment as an alternative to
prison, and to address substance abuse as a matter of public health rather than criminal
justice.^ Counties confront delicate questions of how to prioritize limited funding for this
on-going program. While implementation studies have been completed or initiated at the
Public Health Institute, RAND and UCLA, no outcome study results are anticipated in
the near future.
Though not providing outcome results, findings from a study by User and colleagues^ is
of interest for its description of the SACPA treatment population in their five-county
evaluation. Compared with non-SACPA clients, the authors write, SACPA patients are
“more likely to be men, first-time admissions, treated in outpatient drug-free programs,
employed full-time, and users of methamphetamine or marijuana”(p. 479). Longshore
and colleagues'*, evaluating SACPA implementation statewide, report similar findings
concerning gender, first-time admissions, treatment modality, and the primacy of
methamphetamine.
With the approaching deadline for re-funding SACPA, it is appropriate to examine the
efficacy of SACPA procedures and treatments as data become available. Process
measures and outcomes of interest should include treatment completion versus dropout.
^ Marlowe et al. term Proposition 36 post-adjudication “low-intensity, non-judicially managed diversionary
intervention”(p. 216). Marlowe, D.B., Elwork, A., Festinger, D.S., and McLellan, T. (2003). “Drug
policy by popular referendum: This, too, shall pass”. Journal of Substance Abuse Treatment. 25(3): 213221.
’User, Y-L, Teruya, C., Evans, E.A., Longshore, D., Grella, C., and Farabee, D.(2003). “Treating drugabusing offenders. Initial findings from a five-county study on the impact of California’s Proposition 36 on
the treatment system and patient outcomes”. Evaluation Review, 27(5): 479-505.
'* Longshore, D., Evans, E., Urada, D., Teruya, C., Hardy, M., Hser, Y-L, Prendertgast, M., and Ettner, S.
(2003). “Evaluation of the Substance Abuse and Crime Prevention Act 2002”. Report. “Implementation:
July 1, 2001 to June 30, 2002”. Los Angeles: Integrated Substance Abuse Programs, UCLA,July 7.
Santa Clara County SACPA Client Outcomes Report
Page 3
2. Project goals
The mode! for the SACPA study is an ADSR! examination of Department of Alcohol and
Drug Services(DADS)client outcomes over the FY 1997 - 1998 - FY 2000 - 2001
period, reported in “Outcome Evaluation ofthe Department ofAlcohol and Drug
Services Using Performance Jndictorsfrom Secondary Data”^ (hereinafter, the previous
ADSRI study). In that study, ADSRJ used several sources of administrative secondary
data to monitor client outcomes and infer DADS program success.
The primary project goal is to describe outcomes for SACPA clients in the first
year of SACPA implementation (July 2001 - June 2002).
The second goal is to compare SACPA client outcomes with those for the
entire DADS population in the year prior to SACPA implementation by
reporting similar evaluation data on selected client characteristics and
outcomes.
•
The third project goal is to assess the usefulness of various indicators and data
on client characteristics for multivariate modeling, and to generate preliminary
multivariate models intended to identify predictors of success for the treatment
system. Progress on this goal will be reported in a subsequent report.
The primary and secondary research questions are:
•
How do client outcomes compare before/during/after the SACPA client’s
treatment experience; that is, from one year prior to SACPA treatment entry,
through the period of treatment, to one year after discharge from treatment?
•
How does SACPA appear to be changing the characteristics of the DADS
treatment population overall?
Given the goals and research question, the population of interest is SACPA clients ofthe
Department of Alcohol and Drug Services, Santa Clara Valley Health and Hospital
System.
In Santa Clara County, the County Executive’s Office, the lead SACPA agency,
convened a Steering Committee to plan the implementation of the program.
Determination of SACPA eligibility is made by Santa Clara County’s District Attorney’s
office. If upon arraignment the offender pleads guilty to the offense, a conviction is
recorded; otherwise, a trial is scheduled. Less than one percent of those pleading or
found guilty refuse treatment and receive traditional sentencing. Those convicted are,
before sentencing, referred for assessment to both the Department of Probation and the
Department of Alcohol and Drug Services(DADS). While most counties assess postsentencing, the Steering Committee decided upon pre-sentence assessments in order to
^ Alcohol and Drug Services Research Institute, July 24,2003. Project Director: Martha C. Beattie, Ph.D.;
Project Manager: Hung Nguyen, M.S. Available at htlp://w\vw.sccdads.org/ under Evaluation and
Research Reports.
Santa Clara County SACPA Client Outcomes Report
Page 5
maintenance-only cases(N = 7) were excluded as unlikely to complete treatment in an
18-month treatment period, the maximum length of stay permitted within the evaluation
format. In total, 344 cases were excluded from analysis, some for more than one reason.
Project data. Data used for this project include information on client demographic
characteristics; alcohol and drug use; criminal justice status; utilization of health, mental
health, and alcohol and drug treatment services; and receipt of social welfare benefits.
Data were generated from data bases compiled or administered by the Santa Clara
County Department of Alcohol and Drug Services(DADS), Department of Mental
Health, Health and Hospital System, Criminal Justice Information Control (CJIC), and
Social Services Agency. Treatment records include information on participation in
detoxification, outpatient, and residential alcohol and drug services; mental health
services; and medical care episodes in the hospital emergency room, inpatient, and
ambulatory clinic care. Criminal justice records include arrest, conviction, and jail
incarceration data on drug-related and other offenses. Social services records provide
information on receipt of public assistance and other benefits, including CalWORKs,
General Assistance, Food Stamps, and Medi-Cal.
Data preparation. For comparability between this study and the previous work on
DADS clients, ADSRJ staff performed coding of arrests and convictions as “new” and
“drug-related” or “non-drug-related”, following the protocols used in the previous study.
Likewise, ADSRl staff coded episodes associated with hospitalizations, emergency room
use or outpatient medical or mental health care following similar or identical decision
rules as used in the DADS report.
ADSRl matched information across data systems with data on individuals assessed by
DADS for SACPA treatment referral. To accomplish this, ADSRl created unique
identifiers recognized across data systems for each assessment client. ADSRl then
selected individual cases meeting the SACPA study selection window criteria and
identified relevant data within each individual’s before, during, or after treatment
periods.(Study time periods are further described below). In addition, to enable
examination of client experience between assessment and before treatment, ADSRl
selected relevant data falling within periods called before and after assessment. After
ADSRl prepared the data, a file stripped of personal identifiers was provided to
Speiglman Norris Associates(SNA),for further analysis and report preparation.
Human subjects review. Because all personal identifiers were stripped from the
working data files provided to Speiglman Norris Associates, the Institutional Review
Board of the Santa Clara County Public Health Department declared the project exempt
from IRB review under federal regulations. Data from the multiple administrative data
sources were linked by ADSRl staff using a random numeric identifier for each case, and
SNA received data with only this fictitious case identifier.
Decision rulesfor identifying dates and defining before, during and after periods.
Periods of interest include:
Santa Clara County SACPA Client Outcomes Report
Page 7
been married. Although the group is racially heterogeneous, together, Latino/Hispanics
and Non-Latino Whites comprise 81.9% of the group, with Blacks/African Americans
accounting for another 8.4%. Mean years of education is 11.4; median, 12. Almost all
members of the group (89.9%)report English as their preferred language, with 7.6%
selecting Spanish.
In comparison, the treatment population in the year prior to SACPA’s introduction was
somewhat less likely to be male (67%), but on other demographic characteristics it is
quite similar.
Table 1. Demographics
Frequency
Percent
Female
295
24.8
Male
895
75.2
Total
1190
100.0
740
62.2
Gender
Marital status
Never married
Now married
149
12.5
Divorced/separated/widowed
290
24.4
Unknown
Total
Race/ethnicity
Latino/Hispanic
11
.9
1190
100.0
544
45.7
Non-Latino White
431
36.2
Black/African American
100
8.4
6.4
Asian/Pacific Islander
76
Native American
20
1.7
Other
19
1.6
Total
1190
100.0
Education
Mean
Median
Preferred language
English
Spanish
11.4 years
12.0 years
1070
89.9
91
7.6
Asian/Indo-Chinese
14
1.2
Other/unknown
15
1 .3
1190
100.0
Total
Page 9
Santa Clara County SACPA Client Outcomes Report
Figure 1. Time between Assessment and Treatment
(values greater than 4 displayed = 4.0)
400
o
c
Q>
3
CT
a>
4.00
Months
During Treatment Period. Table 3 provides summary statistics for the period of
time from first treatment contact under the SACPA authorization until discharge date,
operationalized as the last treatment contact under the same authorization. As is evident,
while mean and median length of time in treatment are each about 3.5 months, the range
of time in treatment-from 0 months(6.8% of cases with less than one full day in
treatment) to 10 months or more(2% of cases)- suggests great variety probably both in
the clinical and the legal role played by treatment.'^
13
If we distinguish between persons whose treatment followed an assessment within the study selection
window,from those whose treatment began before the selection window, we find noteworthy differences.
For cases in which treatment entry followed assessment(N = 1093), median length oftime in treatment is
3.3 months. For cases in which treatment entry preceded assessment(N = 96), median length oftime in
treatment is 4.8 months. Recall that the selection window avoided the earliest SACPA clients because their
characteristics, or course through SACPA, were thought likely to differ from later clients. Although the
number of persons with treatment beginning before the study selection window is small, their longer
duration of treatment suggests that their SACPA experiences may indeed differ.
Santa Clara County SACPA Client Outcomes Report
Page 11
return before a relapse takes place. Figure 2 depicts those outcomes: as measured by the
first return to treatment in the DADS system. Within one year of discharge, 1 8.0% of the
study population experienced a relapse, while 21.1% recorded a maintenance return to
treatment.
Table 4. Levels of Care
Level of care
Treatment Modality
Detoxification
Residential
Case management
Intensive outpatient
Motivational enhancement
2
Outpatient drug-free
Transitional housing
Psychiatric services
Aftercare
3
Psycho-education
Figure 2. Returns to Treatment
70.0%
60.0%
50.0%
40.0%
30.0%
21.1%
18.0%
20.0%
15'
lift!
»
m
iisjswwsa
w.
10.0%
11
0.0%
Relapse
Maintenance Return
Santa Clara County SACPA Client Outcomes Report
Page 13
The 59.2% figure for before treatment drug-related arrests is surprising. Certainly, before
a SACPA conviction, all SACPA treatment clients should share the criminal history
fact” of having experienced an arrest for at least one SACPA offense. In fact, since our
definition of“drug-related” arrest is broader than the set of offenses defined by law as
SACPA offenses (for example, drug sales are drug-related but are not SACPA offenses),
arrest rate findings depicted in Figure 4 could and might be expected to surpass 1.0.
(C
Figure 4. Arrest Rate for New Misdemeanor/Felony
Drug-related Offenses Before, During and After Treatment
0.90
0.78
0.70
0.60
'im
n
0.50
(0
Q)
< 0.40
0.27
0.30
|i
iS
0.20
0 nfi
0.10
0,00
Before treatment
During treatment
After treatment
However, given criminal justice delays in arrests, criminal filings, and convictions and
delays resulting from defense motions, it appears that some offenses, arrests, and
convictions may have been taken place prior to the one-year period before treatment
entry. Some of this delay may accumulate from the time between assessment and
treatment entry. Finally, administrative data mismatch between treatment clients and
criminal Justice participants explains some of the difference between 59.2 and the
expected 100 percent since 10% of the clients could not be matched to their criminal
Justice data.’’
Similar findings are evident for drug-related convictions for new offenses. With
conviction defined as a finding of guilt resulting from the arrest examined, by definition
conviction prevalence and rate must be no greater than corresponding arrest prevalence
and rate.
17
In this regard, it should be noted, conviction prevalence and rate may be further under-counted due to
procedural delays.
Santa Clara County SACPA Client Outcomes Report
Page 15
of SACPA clients have some jail time in Santa Clara County in the one-year period prior
to treatment. That proportion declines to 4.3% in the during-treatment period and rises to
20.3% in the year after treatment (Figure 7). From the before- to the during-treatment
period, the mean number ofjail days drops from 23.8 to 2.0 and rises to 12.2 days in the
after-treatment year (Figure 8).
Together, the data on arrests, convictions, and jail days suggest that treatment serves to
decrease risk for arrest and conviction - and probably engagement in - criminal behavior
involving drugs.
Figure 7. Percent of Clients with Any Misdemeanor/Felony
Jail Days for Drug-related Offense Before, During, and
After Treatment
70.0%
60.0%
-55^%
50.0%
40.0%
30.0%
-2Cr3%
20.0%
10.0%
0 0%
Before treatment
During treatment
After treatment
Figure 8. Mean Number of Misdemeanor/Felony Jail Days for Drug-Related
Offenses Before, During, and After Treatment
300
23.8
25.0
§
K
20.0
(/)
si
to
Q
15.0
I
11^6
re
10.0
i
5.0
>1
I!m
00
k*
3^
\U
Ir
s
Before treatment
2.0
iiigaiai
During treatment
After treatment
Santa Clara County SACPA Client Outcomes Report
Page 18
Figure 11. Percent of Clients with Any Misdemeanor/Felony Jail
Days for Drug-related Offenses Before and After Assessment
70.0%
60,0%
500%
40.0%
30.0%
20.0%
5.6%
100%
0.0%
Before assessment
After assessment
Figure 12. Mean Number of Misdemeanor/Felony Jail Days for
Drug-Related Offenses Before and After Assessment
30,0
25.0
25.0
20,0
(/>
re
Q
15.0
re
10.0
5.0
2.3
0.0
Before assessment
After assessment
Santa Clara County SACPA Client Outcomes Report
Page 19
4b. Care for oneself financially
Difficulty securing and keeping work may be one indicator of a problem with alcohol and
other drugs. Therefore, preparing for and gaining productive work is often a goal of
treatment. While our dataset lacks direct measures of employment and work-related
income, it does include information about receipt of four forms of public benefits.
CalWORXs and General Assistance provide cash and Food Stamps a quasi-cash form of
assistance for impoverished persons. Medi-Cal constitutes a health insurance program
for poor Californians.
Three important considerations need to be stated before we examine findings in this area.
First, initial treatment success may result in increased utilization of public benefits.
Whether because of abuse of alcohol or other drugs, because of lack of information, or
personal or familial disorganization, many individuals presumptively eligible for benefits
either do not acquire them or lose them because of failure to comply with paperwork and
other requirements. Upon treatment entry, counselors and case managers would may
urge eligible clients to apply for these benefits. Second, even for those finding work, low
wages from entry-level jobs may not eliminate eligibility for means-tested benefits, such
as Food Stamps or cash assistance. Hence, even as treatment proves successful and
employment is secured, benefit rates may increase rather than decrease. Third, all four
indicators are sensitive to larger economic trends and to changes in program rules, such
as time limits for receipt of CalWORKs and Food Stamps. Accordingly, limited to these
administrative data, it is difficult to define what a successful outcome would be in a
relatively short-term follow-up.
CalWORKs benefits were provided to 2.7% of SACPA treatment clients in the year prior
to treatment (see Figure 13). During treatment the prevalence dipped slightly, to 1.8%.
In the year following treatment 2.8% of clients received CalWORKs cash assistance.
Santa Clara Count)’ SACPA Client Outcomes Report
Page 21
The prevalence of General Assistance receipt remained level at 3.4% in the before- and
during-treatment periods and increased to 5.7% in the after-treatment year (see Figure
15).
Figure 15. Percent of Clients Receiving General Assistance
Benefits Before, During, and After Treatment
250%
!
20.0%
15.0%
-c.0%
5.7%
3.4%
3.4%
5.0%
Pig
m
.1
0.0%
Before treatment
During treatment
1
After treatment
Surprisingly, receipt of Medi-Cal eligibility dropped from 6.6% in the year prior to
treatment to 4.S% in the during-treatment period before increasing to 7.1% following
treatment (see Figure 16).
Figure 16. Percent of Clients Receiving Medi-Cal Benefits
Before, During, and After Treatment
25.0%
20.0%
15.0%
10.0%
6.6%
5.0%
as
ass
0.0%
Before treatment
During treatment
After treatment
Santa Clara County SACPA Client Outcomes Report
Page 23
Figure 18. Rate of Mental Health Service Episodes Opened
Before, During, and After Treatment
0.40
0.34
0,35
7
0.32
1^
0.30
0.25
1
0.20
0.15
m
m
leal
■M
msa; •
I
0.12
0.10
0.05
0.00
Before treatment
During treatment
After treatment
4d. Physical health
Improved physical health is often an objective of treatment services. Lack of
hospitalizations and emergency room visits provide an indirect, if imperfect, measure of
physical health. On the other hand, outpatient visits may indicate ill-health or may reflect
appropriate use of preventative and routine medical care. Thus, while we would expect
reduced numbers of emergency room visits and hospital stays following substance abuse
treatment, outpatient service utilization might increase as former clients integrate routine
and preventative care into their lives. Figures 19 through 25 display prevalence and rate
statistics for the three types of health and hospital service utilization.
As displayed in Figure 19, prevalence of emergency room visits declined from 16.3% in
the year prior to treatment to 7.6% during treatment and increased to 14.9% in the year
following treatment. Rate of emergency room visits has a parallel decline from before to
during treatment. Likewise, the after-treatment rate remains slightly lower than the
comparable before-treatment figure (Figure 20). Prevalence and rate of emergency room
visits during treatment is surprisingly large, given that median length of treatment is
substantially less than half of a year.
Santa Clara County SACPA Client Outcomes Report
Page 25
Figure 21. Percent of Clients with Inpatient Stays Before, During, and
After Treatment
25.0»A
I
I
)
20 0%
15 0%
'1
100%
5.0%
3.2%
1.7%
oo%
li
i
Before treatment
*
mm
During treatment
i
After treatment
Figure 22. Rate of Client Inpatient Stays Before, During, and After
Treatment
0.25
f
I
0.20
c
CL
c 0.10
0.05
0.05
0.04
0.02
0.00
Before treatment
During treatment
After treatment
When comparing before- to after-treatment periods, outpatient utilization increased in
prevalence and rate (Figures 23 and 24). In the year before treatment, 19.5% of SACPA
clients used outpatient services at Valley Medical Center ambulatory care sites.
Prevalence declined to 13.4% during treatment and increased to 23.5% in the year
following treatment. Before- to after-treatment rates show an even bigger increase, rising
from .31 visits per person-year before treatment to .68 visits per person-year following
treatment. Further analysis would be necessary to discover whether or not this increase
in rate is due to increased routine and preventative care.
Santa Clara County SACPA Client Outcomes Report
Page 27
that may be associated with substance abuse. Violent offenses and property crimes, for
example, may be part of a life pattern involving substance abuse. Therefore, we report on
prevalence and rate for all new misdemeanor and felony arrests, convictions associated
with those arrests, and associated jail days, whether drug- or non-drug-related.
Generally, the patterns in the figures that follow resemble those for drug-only arrests,
convictions, and Jail days, though on a larger scale.
The prevalence of total new arrests declines from 74.7% in the year before treatment to
13.5% in the during-treatment period and 42.6% after treatment (Figure 25). Arrest rates
follow, declining from 1.39 per person-year before treatment to .17 per person during the
treatment period and increasing to .69 per person-year following treatment (Figure 26).
Figure 25. Percent of Clients with New Drug- and/or NonDrug-Related Arrest for Misdemeanor/Felony Before, During
and After Treatment
90.0%
74.7%
80.0%
70.0%
''Am'
60.0%
IV;
50.0%
42.6%
40.0%
30 0%
ii
IIP
, If
20.0%
13.5%
t).0%
I
*
w
m
0.0%
Before treatment
During treatment
After treatment
Santa Clara County SACPA Client Outcomes Report
Page 29
Figure 28. Rate of Misdemeanor/Felony Drug- and/or Non-Drug-Related
Convictions for Arrests
Before, During and After Treatment
4
3.32
3.5
3
WM
U) 2.5
O
1.81
.2
2
>
c
o
O
1.5
m
i-r
1
■
0.41
m
ii
0.5
0
i)
j
*
tl
P*?!
Before treatment
During treatment
After treatment
The proportion of clients with days in jail for any misdemeanor or felony drops from
71.3% in the year before treatment entry to 10.3% during the treatment period and 36.5%
in the year following treatment (Figure 29). In the same three periods rate ofjail days
varies from 37.8 jail days per person-year before treatment to 5.8 days per person during
the treatment period to 25.7 days per person-year post-treatment (Figure 30).
Figure 29. Percent of Clients with Any Drug- and/or
Non-Drug-Related Misdemeanor/Felony Jail Days
Before, During, and After Treatment
80.0%
71.3%
70.0%
%
60.0%
id'
1“
50.0%
36.5%
40.0%
30.0%
ii
20.0%
10.3%
j
ise«
10.0%
i
I
0.0%
Before treatment
During treatment
After treatment
Santa Clara County SACPA Client Outcomes Report
Page 31
tends to decrease apparent differences between DADS and SACPA clients even though
the SACPA treatment was a new episode of care.
In the following, we compare SACPA client outcomes with DADS client outcomes from
the closest time period to this study, FY 2000 - 2001. The FY 2000- 2001 findings may
be found at www.sccdads.org. Evaluation and Research Reports, “Outcome Evaluation of
the Department ofA Icohol and Drug Services Using Performance Indictorsfrom
Secondary Data
• Both relapse and maintenance returns are more prevalent for SACPA as
contrasted with the DADS population generally. Some of this difference may be
the result of closer scrutiny of the SACPA population, all members of which are
under the close supervision of the court and, for some offenders, more intensive
probation supervision than was utilized prior to SACPA.'*
• Comparing before and after criminal justice measures available for both groups,
SACPA clients start off looking worse but also demonstrate more improvement,
compared to FY 2000- 2001 DADS clients. Some of the positive change
attributed to the SACPA population may be more overstated than that attributed to
the DADS population, however, in light of statistical tendencies for population
data to regress to the mean.(For more detail, see discussion under “limitations”
below.)
^— ..
• On three ofthe four financial stability indicators, SACPA clients start off at lower
utilization of public benefits and over the study period increase utilization. This
may be evidence of greater improvement for SACPA clients, who demonstrate
greater access to and/or use of these benefits.
• On the two mental health measures, SACPA clients display less service use,
compared to the DADS population. Utilization among both groups decreases
over time, less so for the SACPA than the DADS group
• For the physical health dimensions, greater variation is evident. SACPA clients
utilize hospital, emergency room, and outpatient services less than do DADS
clients overall. However, when comparing change in service use, SACPA clients’
use of outpatient and inpatient services increases at a faster rate compared to
members of the DADS population. Emergency room visits decline for SACPA
clients but increase for DADS clients in the FY 2000-2001 cohort.
While Santa Clara County SACPA clients may have more direct contact with the court than with
Probation, the point made by Marlowe et al.(2003)would appear relevant: Most probationers “fail to
comply with their release conditions for probation including drug testing, attendance at drug treatment, and
avoidance of criminal activity [references].” Intensive, supervised probation is associated with the worst
outcomes, precisely because supervision is closer. Marlowe et al.(2003), p. 214.
Santa Clara County SACPA Client Outcomes Report
Page 33
Finally, extreme caution must be used in interpreting one aspect of the criminal justice
measures. There is not a one-to-one relationship between acts of criminality and arrests
convictions for those acts. Most crime goes unreported and undiscovered, and, among
or
discovered, many result in no arrest and/or no conviction. By definition, however.
all members of the SACPA client group had, relatively recently, experienced at least one
crimes
arrest and conviction that resulted in a SACPA sentence. Hence, we would expect a
decrease in the percent of SACPA clients experiencing arrest, conviction, and jail days,
if nothing
changed in the individual client’s drug behavior during or after
19
even
treatment.
Some of these limitations will be addressed as we begin work on predictive models that
can control for a number of important variables.
9. Next steps
What next? In addition to the multivariate studies, next steps could include (1) a larger or
longer-term comparative study including the collection of prospective data for this or
newer SACPA cohorts, as well as data on the remainder, or a comparison subset of,
DADS clients, and (2)studies examining the SACPA cost savings attributable to DADS
treatment.
19
Prevalence could not increase beyond 100%,and statistics such as this tend to regress to the mean.
Hence, to demonstrate success for the SACPA treatment program, we would need to find prevalence and
rate figures lower than those projected through a sophisticated analytical process.
Comnultee Ayenda IX-ne: Apri! 13, 2006
Agenda ffeti) Nn.4
i'
(V
<
"^ounty of Santa Clara
0~f^
rOU/V
>■
</
O
Office of the County Executive
A-.
Children and Family Services, Public Safety & Justice
'<A
.sJlii£tLr(
CSFC-CEOl 041306
Prepared hy; Quycn Nguyen
Program Manager 11
DATE:
April 13,2006
TO:
Supervisor Blanca Alvarado, Chairperson
Supervisor James T. Beall, Jr., Vice-Chaii-person
Public Safety & Justice Committee
EBOM:
Sandra Y. Nathan
Deputy County Executive
SUBJECT: Report back on referrals regarding the overall funding and outcomes of the Prop
36 and Drug Treatment Court programs.
RECOMMENDED ACTION
Accept a report back on referrals regarding the overall funding and outcomes of the Prop 36
and Drug Treatment Court programs made by the Board on November 1,2005.
FISCAL IMPLICATIONS
There is no implication to General Fund upon acceptance of this Report.
REASONS FOR RECOMMENDATION
Board of Supervisors: Donald F. Gage. Blanca Alvarado. Pete McHugh. Jim Beall. Liz Kniss
County Executive: Peter Kutras Jr.
1
Committee Agenda Date: April 13,2006
Agenda Item No.4
The true cost of a program consists of the expenditures, which would have been
expended in their next best use, if not used for these programs. For SACPA,in FY 05,
the unbudgeted General Fund expenditures were $7,927,727. For Drug Treatment
Court, the unbudgeted General Fund expenditures were $1,445,914 from the Probation
Department.
• Prop 36 clients generally do not contribute to the increased jail population as they are
released fairly quickly. However, there are a number of Prop 36 clients who stay in jail
for significant jail days due to serving sentences for multiple charges.
• Treatment works for the clients who completed treatment. Similar outcomes were
observed for Prop 36 clients versus non-Prop 36 clients.
• Similar outcomes were observed for methamphetamine users as compared to
non-methamphetamine users.
• There are 3 possible areas suggested for further discussion on improving efficiency:(a)
reduce the amount of re-assessments and/or uncompleted assessments,(b) target
probation supervision resources by level of risks, and (3)resources supported for
programs based on outcomes not on availability of resources.
; BACKGROUND
The Report back is attached in Attachment A.
Responses to questions posed by the Board of Supervisors and data from CJIC, Probation
department. District Attorney's Office, Public Defender office. Pretrial Services, Public Health
department. Mental Health Department, and Department of Alcohol and Drug Services are in
Attachment B.
The referenced research-based evaluations from the UCLA and DADS’ Research Institute are
in Attachment C. Other referenced articles and/or reports are available upon requests.
ATTACHMENTS
• Attachment A- Report back on referral for the Drug Treatment Court and Prop 36
Programs
Board of Supervisors: Donald F. Gage, Blanca Alvarado. Pete McHugh,Jim Beall, Liz Kniss
CounV Executive: Peter Kutras Jr.
3
■
County of Santa Clara
Office of the County Executive
Cmn'iiy Cjiivornmeiil Cenicr. liiisi Winy:
-'/() Vv'ost Hcdiling Slrcel. 1 1 Flo01
n Jose, Califurni;! 95 \ 10
. -08! 290-.S 10?
Date:
March 30, 2006
TO:
Supervisor Blanca Alvarado, Chairperson
Supervisor James T. Beall, Jr., Vice-Chairperson
Public Safety & Justice Committee
FROM:
Sandra Nathan, Deputy County Executive
SUBJECT:
Response on Refeiral for the Drug Treatment Court/ Prop 36 Program
RECOMMENDED ACTION
Accept a report back on Drug Treatment Court/Prop 36 Eunding and Outcomes as directed by
both the Public Safety and Justice and Health and Hospital Committees.
FISCAL IMPLICATIONS
There is no General Fund impact associated with the acceptance of this report.
REASONS FOR RECOMMENDATION
On October 13, 2005, in considering the revised SACPA Annual Plan, the Public Safety and
Justice Committee requested a report back on the overall effectiveness of the SACPA Program
and the impact of methamphetamine abuse on SACPA clients and the jail population.
At the November 1, 2005 meeting, the Board of Supervisors directed the Office of Budget and
Analysis to return to Public Safety and Justice Committee (PSJC) with a report showing total
Drug Treatment Court (DTC) funding from General Fund and Grant funds. The Board also
directed the County Executive’s Office to report back to PSJC with outcomes from DTC at the
same time SACPA outcomes will be presented.
In particular, the Board asked for the following information:
■
Outline of costs/ reimbursement funded through drug court
■
Whether drug court services contribute to an increased jail population.
■
Whether or not treatment services have the desired effects.
■
Drug court services outcomes as compared to SACPA services
Board of Supervisors: Donald F. Gage, Blanca Alvarado, Pete McFlugh, James T. Beall Jr., Liz Kniss
County Executive: Peter Kutras, Jr.
SACPA program: The General Fund budget for SACPA in FY 05 included a one-time
bridge, in the amount of $473,333, for the lease at the Assessment Center, one Justice System
Clerk and a part-time extra help receptionist cost for the Assessment Center.
Drug Treatment Court program: The General Fund budget for the Adult Drug Treatment
Court(DTC) was $238,41 1. Several grants were used to support DTC such as the Drug Court
Partnership at Probation ($183,500), and at DADS,and the Comprehensive Drug Court
Implementation grants(CDCl)for both drug treatment court and dependency treatment couil.
A portion of the total in Adult Treatment Court included the budget for the Mental Health
Treatment Court program. It consists of a team from the Mental Health department. Adult
Custody Services, District Attorney’s office. Public Defender’s office. Probation department,
and the courts. It is designed to serve about 400 clients who are mentally ill and dual
diagnosed. The General Fund budget specifically for the Mental Health Court included 2.50
FTE ($212,601).
Dependency Drug Treatment Court program; Funded through a grant by First-5 for the
Healthy Pregnancy and Early Parenting initiative to the Public Heath Department for services
by a public health nurse (1.0 PTE)and public health nutritionist. Two additional Rehab
Counselors and Marriage and Pamily Therapist (assigned in DADS budget) are also part of
the team. The General Pund budget for DDTC was an additional $972,738 in DADS for staff
and treatment contracts. A portion of this resource is also used to support Dnjg Treatment
Court. The grant is due to end on June 30, 2006.
Table 2-Drug Court/ Prop 36 Services Budget: All Costs outlines the departmental actual
operational costs that were not budgeted but were absorbed by various departments in PY 05.
Table 2
Dept of Alcohol and
SACPA
$5,193,502
DTC
DDTC
Unable to determine
Sub-TOTAL
Unknown
$5,193,502
from report^
Drus Services
Probation Dept
$2,684,877(SATTF)
$1,445,914
N/A
$4,130,791
Probation Dept
$10,894(SATTA)
N/A
N/A
$10,894
$ 22,500(SATTA)
N/A
N/A
$22,500
$15,954
N/A
N/A
$15,954
$7,927,727
$1,445,914
Unknown
$9,373,641
Pretrial Services
ISD (CJIC)
TOTAL
UNBUDGETED GF
COSTS
2 Per comments from D.VDS, some SACPA clients may also be identified as DTC. The courts are reportedly
particularly interested in not only what funding stream may pay for a client but what legal constraints the chent may
fall under. To accommodate the courts, some clients are listed under multiple categories. To produce this table
DADS indicated that it must rely on the provider sites indicating the clients Referral Source/Categorical Funding at
the time of admission into their program. .-\s a result the number of admissions is greater than it should be for the
fiscal year.
Response on referral for Drug 'freatment Court / Prop 36 Program Submitted to Public Safet\- and justice Committee (April 13, 2006 meeting)
Page 3
Brown Act notification, etc), providing liaison to State, UCLA (Focus group), other counties
and County departments, coordinating and shepherding the annual plan through the local and
state's review/approval process, providing oversight of program budget, and managing the
Trust Fund.
Moreover, not available for inclusion in Table-2 are the additional expenses, above the costs
of traditional adjudication, from the criminal justice agencies in the implementation of DTC
or Prop 36 program. For example, both the District Attorney's Office and the Office of the
Public Defender are obligated to staff these types of cases even if the drug courts or Prop 36
did not exist. Nevertheless, the collaborative Prop 36 courts (or DTC)are known to impose
additional obligations that did not exist with traditional case processing.
For example, in Prop 36 courts, review hearings for each offender have typically been
scheduled from every 2 weeks, or 3 weeks or 4 weeks depending on a particular court. Added
to the workload burden to both the courts and criminal justice departments is the scheduling
of regular reviews for lower risk probationers and court probation cases, and the longer
probation terms for court probation cases (up to 3 years).
As such, the Office of the Public Defender has indicated that the high volume (11,743 drug
case files) and mandatory court appearances have a significant impact on staffing resources.
For example, attorneys are in court 8 out of 10 ten half-day sessions (cases range from 10 to
120) a week. In 2 of the Prop 36/ drug courts at Terraine St, attorneys are in court up to 9
sessions per week^. Likewise, paralegals (interview for eligibility, processing case files, etc),
investigators (locate, interview and subpoena witness), and clerical .staff(run calendars for
attorneys, notify clients, etc) are heavily impacted as w'ell.
Statewide data: In the Spring of 2005, the County Alcohol and Drug Program Administrators
Association of California (CADPAAC),in collaboration with the Chief Probation Officers of
California(CPOC)conducted a prop 36 Unmet Needs Surveys. Of the forty-eight counties
responded, seventeen reported using additional funds beyond their SACPA allocation to
support the Prop 36 program.^
County General
Funds
Other
SAPT (Block
Grant)
Sub-Total
Treatment
$7,246,340
$880,975
$5,391,710
$13,519,025
Ancillary Services
$1,216,940
$2,500
$10,000
$1,229,440
Criminal Justice
$2,258,565
$0
$3,444,900
$5,703,465
$10,721,845
$883,475
$8,846,610
$20,451,930
TOTAL
Mandator}- court appearances are not tracked per case in the drug courts. However, the PDO indicated that tl-us
data can be tabulated manually if requested.
' SACPA Proposition 36 Unmet Needs Survey results. Collaborative survey presented by C,A.-\RR and CADP.-VVC.
Response on referral for Drug 'I'reatment Court / Prop 36 I’rogram Submitted to Public Safet}' and justice Committee (.April 13, 2006 meeting)
Page 5
On the same dale, there were also 202 additional "Prop .36-ers” in custody. 01'the 202
inmates, 3.3 (or 16%)inmates were released and 169 (or 847r) inmates remained in custody.
As Table- 4 indicated, once granted Prop 36. the inmates were released fairly quickly.
#
Table 4- “Prop36-ers” Inmates(Feb 14, 2006)
released
Disposition
Total days in jail
since booking
inmate
DEJ arantcd in current cases, no other cases
4
Released
Data not available
Current case pending, pre-plea
4
Relea,sed-SORP
Data not available
Current ca.ses pending, pre-plea, conditional release
2
Released
23 days
P36 granted in new cases
13
Released
Data not available
P36 granted in new cases, conditional relea.se
9
Released
5.5 days
T(9TAL
32
Of the 169 (or 83.8% of total) “Prop 36-er” inmates in custody, 2 inmates (or 1 % of total)
were waiting for a bed space and the other 167 inmates remained in custody for other reasons
not related to the processing of Prop 36 cases.
Table 5- “Prop36-ers” Inmates(Feb 14, 2006) remained in custody
#
Percent to total
inmate
cases (202)
Waiting for a bed space
7
1 .0
Pending cases only
13
6.4
Disqualified from P36 on current cases
0.5
Un-amenable for P36 on current cases, nothing else pending
2
1.0
Probation denied in current P36 cases
3
1 .5
Refused P36 on current cases, no other cases pending
9
4.5
28
13.9
49
24.3
62
30.7
169
83.8%
Ineligible for P36 on current case due to either strike prior, or non-P36 charges in
some cases
Remained in custody on other pending cases, Violation of Probation findings, or
parole holds
Remained in custody in serving other sentences, or parole violations
TOTAL
While data regarding the impact ofjail sanctions on the jail population is not available, one
certain thing is that both programs(DTC and Prop 36) have the potential to increase or
decrease the jail population. With the Courts’ support, the County could further discuss the
outcomes of DTC to highlight its successes.
Response on reterral for Drug 1 Veatment (^ourt / Prop 36 Program -
Submitted to Public Safetv and justice (.ommittce (April 13, 2006 meeting)
l^agc /
further categorized under the following reasons, which may or may not include three drugrelated violations;
Table 7: Prop 36 Unsuccessful Probation Terminations(FY 05)
Reason
Percent
1%
Early Terininaiion
Probation to Terminate On Release- VOP
34%
Probation to Terminate On Release- Original Conditions Ordered
Reinstated & Terminated - No Further Penalty
]%
17%
4%
Probation Revoked - No Further Penalty
Probation Revoked - County Jail
31%
Probation Revoked - Prison
12%
100%
However, there is no data to support the correlation between these unsuccessful probation
clients and whether or not they have had three drug-related probation violations found. For
example, a client may have three drug-related violations and continue on probation as active
in Prop 36 that are not counted as unsuccessful. Conversely, clients may have three drugrelated violations or have been found un-amenable to treatment, removed from SACPA and
continue on probation as a non-Prop 36 client that is not counted as unsuccessful.
The count of ] 2"‘* and 3'^'* drug-related probation violations, as an outcome indicator, may be
misleading. For the purpose of this report, 60 dockets were randomly selected for analysis.
10
#of
Table 8- Types of dockets
Results
dockets
Probation violations filed
13
Petition not found
Non-drug Probation violations admitted with no further penalty
Probation violation modified with no finding
20
Clients re-referred to treatment
4
Clients remain active in Prop36
Clients remain active in Prop 36
Client remain active in Prop 36
Client remain active in Prop 36
Arraigned on probation violation with no finding
2
Drug-related probation violation found: 3'*' VOP
Drug-related probation violation found: 2"“* VOP first and P' VOP
I
1
second
Drug -related probation violation found: ]"' VOP three times
Client remain active in Prop 36
Drug-related probation violation found: P' VOP two times
2
No probation violations.
16
TOTAL
Clients remain active in Prop 36
Clients remain active in Prop 36
60
The results indicate that 20 probation violations were found where the client was either re
referred to treatment or continued on probation with no further penalty. These violations were
There is a great variation due to judicial discretions on whether or not violations of probation are found. A
violation may or mav not be found when probation submits a petition, and may or may not be found when probation
does not submit a petition.
Response on referral for Drug 't reatment Court / Urop 36 Urogram Submitted to Public Safew and justice Committee (.\pril 13,2006 meeting)
Page 9
month follow-up period for SACPA's first year offenders, examine 12-month outcomes among
SACPA second-year offenders, and describe SACPA’s fiscal impact.
Overall effectiveness of the SACPA Program and the impact of methamphetamine (meth)
abuse on SACPA clients and the jail population.
A report prepared by DADS’s Research Institute indicates that 64% of Prop 36 clients selfidentified meth as their primary drug of choice and meth users utilized more outpatient
treatment days than non-meth users (average of 123 days compared to 106 days respectively).
The report noted that meth users are predominantly male (67%); however, a larger percentage
of female used meth (34%)than in the non-meth (27%)group.
The report also indicated that treatment outcomes for meth users are comparable to non-meth
users (Rice, 2006). Likewise, the UCLA report indicated that meth users were similar to the
overall SACPA population in their rate of treatment completion (Longshore, 2005).
According to the state’s Alcohol and Drug Programs, the effectiveness of treatment generally
increases when the program draws on a variety of components. Because of the inability of
many meth users to recognize problems related to their drug use, techniques that promote
change in patients’ thinking, expectation, and behaviors are emphasized. Treatment often is
provided in intensive outpatient programs. Therapies may be combined with techniques to
strengthen coping skills for stress and with medications, as needed. The clinical challenges
related to paranoia, psychosis, agitation, and severe carving usually require knowledge and
12
skills beyond those involved in traditional alcohol treatment.
Other descriptive research findings suggest that there are more male-female similarities in
substance-use behaviors than differences; however, significant differences do exist that may
have implications for prevention and treatment strategies. For example, weight loss and
desire for more energy, more likely in females than males, suggest a different focus than do
those more distinguishing (but not significant) for males of working more and better sex.
Gender differences also pointed to distinct relationships between users and their networks.
Females’ access to meth by their spouses/boyfriends may indicate an already established and
more deeply integrated structure of family and drug use as compared to male users’ network
of “friends”. These gender differences suggest ways of specializing strategies in diirg
education and intervention to different client subgroups. In addition, intervention strategies
should include educating practitioners about symptoms/problems of meth users to facilitate
13
identification and provision resources for treatment.
Meth is highly addictive, and users can develop a tolerance quickly, needing larger amounts to
get high. In some cases, users forego food and sleep and take more meth every few hours for
days,'binging' until they run out of the drug or become too disorganized to continue. Chronic
'- California Department of Alcohol and Drug Programs, Publication No (ADP) 02—3639, Meth: What’s Cooking
in four Neighborhood?
Brechta, M., O’Briena, A., Mayrhauserb, C., & Anglin, D., Methamphetamine use behaviors andgender differences.
Integrated Substance Abuse Programs, UCDV and the Department of Anthropolog)-, California State Universm- of
Northndge, 2003.
Response on referral for I3rug I'rcatmcnt Court / Prop 36 Program Submitted to Public Safety and )usticc Committee (April 13, 2006 meeting)
Page 11
Genei'al bunds structural deficits.
Improving program elTicieney to alJovv us to operate
reasonably w ithin our budget and not posing additional public safety risks are a challenge that
retjuires careful consideration and support from the Board in setting levels of services, as well
as cooperation from all stakeholders in the Prop 36 Steering Committee.
To initiate this consideration, preliminary data indicates that there are several areas along the
Prop 36 process that warrant attention and discussion especially when additional independent
studies on cost-effectiveness become available in April 2006 and later part of 2008.
Area I. As.sessment Oow^ process can be improved to reduce the amount of
uncompleted and/or re-assessments. Assessment improvement could be achieved
by either (1) not performing an assessment on in-custody clients until a release
date has been set, or (2) fully implementing the phone as.sessment for all incustody clients.
In Santa Clara County, a majority of clients are ordered to have an assessment before
sentencing. This process w'as designed so that the judges could lend his or her authority byconfirming the clients’ treatment plan at sentencing hearing. How’ever. as some clients w’ho
were assessed while in-custody are subsequently found to be unavailable for Prop 36 (due to
holds or other pending cases in other courts), the timing of the referrals could render
unnecessary workload for both the courts and assessment center staff.
f
During the first six months of FY 06, of the 1,454 people referred iTom the court and parole, a
total of 2.566 people w'ere assessed resulting in 1,637 new clients in County treatment'-'’.
Since data is compiled using three databa.ses across tw’o .separate systems, it is unclear w'hether
any of these data points represent a subset of the other. The FY 05 Prop 36 Annual Report
intends to provide clarity to this mystery by matching clients across databa.ses to draw
conclusions on number of dropout, repeat clients, and recommendations for improved
efficiency.
New clients are the clients newly admitted in a reporting period due to a new eligible offense regardless of prior
treatment expenences. Per UCL.\ study (Longshore, 2005), 55.7% of Counnfs SACP.A clients had one or more prior
treatment admissions compared to 53.8% statewide.
Response on referral for Drug 'I'reatment Court / Prop 36 Program Submitted to Public SafeU' and justice Committee (.April 13, 2006 meeting)
Page 13
Clinical Assessment
Table
(July 1 through Dec 31,2005)
(T0TAL= 3,223)
10-
Details on
clinical
uii-completed
assessments
refused, prefer jail lime, failed to comply
171
slaffing-related issues, time constraint
183
Un-
131
out-of-county, private provider
legal issues, parole hold, un-amenable
jail issue, not in custody, INS hold
assessment still valid, already in treatment
com pleted
(1 ,209)
38%
Com pleted
[2,014) 62%
100
64
37
unknown reasons & other
97
426
referred and no response
TOTAL
1,209
A different way to illustrate assessment data is by location where the assessments were
conducted and by the number of people.
By location: Asses.sments are performed both mostly face-to-face and via phone for incustody clients, and mostly via phone (Gateway model) and some by appointments for out-of
custody clients. Among the assessments conducted in jail, 45% (or 619 assessments)
remained uncompleted as compared to 32% (or 590 assessments) uncompleted among the outof-custody assessments.
By people: Since 20% of people had more than one assessment, the number of people with
one completed assessment may also be a subset of something else. For example, there were
1683 clients that had only one completed assessment; but that does not mean that they did not
have an uncompleted assessment. Likewise, there were two clients that had five uncompleted
assessments but they could have also had a completed assessment. So the completed and
uncompleted assessment numbers are independent of each other for each person.
Table JJ
STATUS OF ASSESSMENTS BY
STATUS OF ASSESSMENTS BY PEOPLE
LOCATION
In-custody
Completed
Oiit-of-
TOTAL
People
People
People
People
People
w/ 1
w/2
w/3
w/ 4
w/ 5
766 (.5.5%)
custody
1.248(68%)
2,014
1,683
142
16
619(45%)
590(32%.)
1,209
924
120
10
1,385 (100%)
1,838(100%)
3,223
0
0
assessments
Un-completed
2
assessments
1’OTAL
Area 2: Assign probation supervision and drug testing seiwdces according to
clients’ level of public safety risks so that supervision resources are more focused
on high to medium risk offenders. This could be achieved by either (1) having a
dedicated Prop 36 court(.s), and/or (2) continually re-seeking agreements among
the current judges and other stakeholders on supervision protocols and process.
There is a widely accepted body of published research findings on evidenced-based
supervision practices that have emerged over the last several years. This literature offers
Response on referral for Drug Treatment Court / Prop 36 Program -
Submitted to Public .Safew and Justice Committee (.\pn) 13, 2006 meeting)
Page 15
clients to the more frequent high-risk court calendars (or low-risk clients to a less frequent
calendar) requires much collaboration and coordination among partners.
Area 3: Similar to the state' attempts in setting an appropriation level for Prop 36
programs using cost-benefits information, the County may want to address the
Prop 36 general fund's contribution based on the program's outcome or
performance.
Although the intent of Prop 36 program’s outcomes was to;(1) Preserve jail and prison cells
for serious and violent offenders; (2) Enhance public safety by reducing drug-related crime;
and (3) Improve public health by reducing drug abuse through proven and effective treatment
strategies, the state’s ADP has yet developed or issued standard definitions of treatment
success, information on treatment goal and objectives, as well as overall program outcomes.
As it is frustrating, the lack of standardization also allows the counties opportunities to align
Prop 36 program’s outcomes with local priorities, values and principles, evidenced-based
practices as well as regional realities and limitations. More than ever, and especially in the
current time of scare resources, funding support for Prop 36 program should be based on
19
outcome performance, not solely on funding availability.
Nevertheless, as counties are now being requested to submit outcome objectives for the FY07
Annual Plan, DADS has proposed the following SACPA program’s treatment goals and
objectives of which the standards are based on results from local SACPA outcome studies and
other local studies.
and effective
To provide SACPA clients with access to appropriate
20
treatment based on assessment of individual needs.
Objectives:
■
■
90% of completed SACPA assessments will be admitted to the
appropriate level of care.
80% of clients referred to outpatient who complete
Orientation/Intake will stay in treatment four treatment sessions
or more.
■
90% of clients referred to residential treatment will remain in
treatment for 9 days or more.
To reduce or eliminate client substance abuse.
’’ Wlule a nimimum amount of funding is necessary to maintain an efficient operation, funding level by itself is not a
solution to operate a program efficiently.
21)
Starting januarv 06, treatment data has been collected for the California Outcomes Monitonng System (CALOMS)
at admission and at discharge for alcohol, drug, family/social, psychiatric, medical, legal, and employment
functioning. This replaces the former outcomes monitoring system employing measures of psychosocial and
substance abuse functioning. These measures wiD provide core treatment data for outcome assessment of SACP.V
clients.
Response on referral for Drug Treatment Court / I’rop 36 Program Submitted to Public Safetv and justice Committee (.\pril 13,2006 meeting)
Page 17
ATTACHMENT AA- Summary of fiscal reports from Departments
■
Page 1; SACPA- All Fund
-
Page 2: SATTA- All Fund
■
Page 3: Dependency Drug Treatment Court- All Fund
■
Page 4: Adult Drug Treatment Court- All Fund
■
Page 5: All Drug Court Services- All Fund
■
Page 6: All Drug Court Services- Grant/Trust Fund
■
Page?: All Drug Court Services-General Fund
)
SUBSTANCE ABUSE TESTINCrTREATMENT AC
)
Stability(sattai services budget - aii Fund
Pre-Trial
Total SATTA Budget
Probation
(All Fund)
FY05
FY05 Actual
Approved
FY06
FY05
Approved
Approved
FY06
FY05
Approved
Approved
FY05 Actual
FY06
FY05 Actual
Approved
ADMINISTRATION:
Supplies and Others
Subtotal
0
0
0
187,347
191.275
139,494
187.347
191,275
139,494
0
0
0
187,347
191,275
139,494
187,347
191,275
139,494
107,500
5,000
107,500
140,235
0
0
0
107,500
107,500
140,235
4,201
5,000
0
0
0
5,000
4,201
5,000
112,500
111,701
145,235
0
0
0
112,500
111,701
145,235
TREATMENT:
Community Worker (2.0 FTE)
Others (mileage, office expenses, phones)
Subtotal
CRIMINAL;
0
0
0
65,500
72,466
80,616
65,500
72,466
80,616
Subtotal
0
0
0
65,500
72,466
80,616
65,500
72,466 i
80,616
TOTAL FTE
2.0
2.0
2.0
1.0
1.0
1.0
3.0
3.0
3.0
TOTAL EXPENDITURES
112,500
111,701
145,235
252,847
263,741
220,110
365,347
375,442
365,345
Probation Community Worker (1.0 FTE)
Attachment AA
2 of 7
ADULT TREATMENT COURT ocRVICES BUDGET ■ All Fund
Total Adult Treatment Court
Public Health
Mental Health
DADS
Probation
Sen/ices Budget
(All Fund)
FY05
FY05
pros
FY05
FY05
FY06
FY05
FY05
P^06
FY05
FY05
FY06
FY05
FY05
FY06
Approved
Actual
Approved
Approved
Actual
Approved
Approved
Actual
Approved
Approved
Actual
Approved
Approved
Actual
Approved
ADMINISTRATION:
Public Health Nurse III (0-2 FTE)
Program Evaluation
Supplies and Others
24,951
24.951
27.377
0
0
0
0
0
0
0
0
0
24,951
24,951
27.377
0
0
0
0
0
0
70.000
58,814
36,667
0
0
0
70,000
58,814
36,667
0
Subtotal
24,951
0
0
0
0
0
141,992
140,106
136,994
32,500
26,255
25,000
174,492
166,361
161,994
24,951
27,377
0
0
0
211,992
198,920
173,661
32,500
26,255
25,000
269,443
250,126
226,038
101,637
109.433
TREATMENT:
Marriage Family Therapist i i (1.0 PTE)
Marriage Family Therapist II (0.5 FTE)
Marriage Family Therapist I (1.0 FTE)
Psychiatric Social Worker II (1.0 FTE)
Rehab Counselor ^ OS III (ILEBG)
0
0
0
0
0
0
104,476
101,637
109,433
0
0
0
104,476 :
0
0
0
51.258
47.629
55.296
0
0
0
0
0
0
51.258
47,629
55,296
0
0
0
90,345
96,299
101,317
0
0
0
0
0
0
90,345
96.299
101,317
0
0
0
86,625
42,217
93,504
0
0
0
0
0
0
66.625
42,217
93,504
0
0
0
0
0
0
128.759
131.355
0
0
0
0
128,759
131,355
Salary Savings
Court Expenses
0
0
0
0
0
0
0
0
0
(15.627)
0
0
0
0
0
0
216,458
180.689
165,633
0
0
0
216,458
180,689
165.633
Drug Testing
0
0
0
0
0
0
553.146
541,802
550.276
0
0
0
553,146
550,276
Treatment Contracted Services
0
0
0
0
0
0
1.743.506
1,634.060
1.683.450
0
0
0
1,743,508 I
541,802 i
1,634,080 i
1,603,450
Psychiatrlc/Lab & Meds
Supplies and Others
Others (mileage, office expenses, phones)
0
0
0
0
0
0
114,308
137,872
78.770
0
0
0
137,872 i
76,770
0
0
0
0
0
0
59,695
30.828
11,554
0
0
0
114,308
59,695
30,828
11.554
0
0
0
0
5.155
0
0
0
0
0
0
0
0
Subtotal
0
0
0
191,300
243,498
2,920,350
2,758,263
2,599,116
0
0
0
3,132,951
0
151,000
151,000
159,930
151.00Q
151.000
159,930
151,000
159.930
(15,627)
212,601
0
(6,619)
0
0
(6,619)
0
5,155
2,949,563 I
I
2,842,614
I
TREATMENT:
Probation Community Worker (1.8 FTE)
Subtotal
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
151,000
151,000
159,930
151,000
TOTAL FTE
0,2
0.2
0.2
2.5
2.5
2.5
3.0
3,0
1.0
1.8
1.8
1.8
7.5
TOTAL EXPENDITURES
24,951
24,951
27,377
212,601
191,300
243,498
3,132,342
2,957,183
2,772,777
183,500
177,255
184,930
3.553,394
7.5 ;
5.5
3,350,689 ; 3,228.582
Attachment AA
4 of 7
)
)
)
)
)
Substance Abuse
Substance Abuse and Crime
Testing/Treatment Accountability
Prevention Act(SACPA)
(SATTA)
Dependency Drug Treatment
Court(DDTC)
Adult Drug Treatment Court
FY05
FY05
FY06
FY05
FY05
FY06
FY05
FY05
FY06
FY05
Approved
Actual
Approved
Approved
Actual
Approved
Approved
Actual
Approved
Approved
FY06
FY05 Actual
Approved
ADMINISTRATION:
Sr. Health Care Prog Analyst (1.0 FTE)
Health Care Program Analyst (1.0 FTE)
Health Care Program Analyst (1.0 FTE)
Health Care Program Analyst (0.5 FTE)
Public Health Nurse III (0.20 FTE)
Ql Coordinator A&D Services (1.0 FTE)
Health Services Rep.(1.0 FTE)
Justice Systems Clerk (1.0 FTE)
Office Specialist III (1.0 FTE)
Program Evaluation
Supplies and Others
0
32,589
120,003
0
0
0
0
0
0
0
0
0
85,306
83,250
90,716
107,275
0
0
0
0
0
0
0
0
0
77,678
0
0
0
0
0
0
0
0
0
0
50,268
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
100,596
99,003
110,316
0
0
0
0
0
0
0
0!
0
63,636
43,256
69,840
0
0
0
0
0
0
0
0
0
63,720
68,804
70,092
0
0
0
0
0
0
0
0
0
62,100
73,301
68,208
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
70,000
58,814
36,667
24,951 !
0
24,951 I
27,377
T
Subtotal
48,653
40,753
48,653
187,347
191,275
139,494
24,627
18,672
36,209
174,492
166.361 !
161,994
557,531
526,100
594,387
187,347
191,275
139,494
24,627
18.672
36,209
269,443
250,126 \
226,038
TREATMENT:
Community Worker (2.0 FTE)
Health Care Program Manager II (1.0 FTE)
Marriage Family Therapist II (1.0 FTE)
Marriage Family Therapist l-U (1.0 FTE) half-year
Psychiatric Social Worker I (1.0 FTE)
Public Health Nurse II (1.0 FTE)
Public Health Nutritionist (0.5 FTE)
Rehab Counselor (3.0 FTE)
Rehab Counselor (0.5 FTE)
Rehab Counselor-U (1.0 FTE)/half-year
Rehab Counselor -r OS III (LLEBG)
Court Expenses
Drug Testing
Mentor and Legal Services
0
0
0
107,500
107,500
140,235
0
0
0
0
0
116,160
117,674
127,172
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
104,476
101,637
84,117
0
0
0 i
0
0
0
0
0
0
0
22,146
0
51,738
0
88,668
97,479
101,496
0
0
0
0
0
0
0
0
0
0
0
0
0
116,160
116,160
127,452
0 i
0
0
0
0
0
0
0
42,036
42,036
49,353
0I
0
0
270,772
266,228
301,716
0
0
0
0
0
0
0 !
£1.-
0
0 II
0
0
°4-
0
0
1
I
T
Treatment Contracted Services
Psychiatric/Lab & Meds
Supplies and Others
Subtotal
0
44,132
0
44,132
0
0
0
0
0
0
0
0
0
0
0
0
22,416
9,709
47,190
0
0
0
0
0
0
0
0
0
128,759
131,355
0
0
0
0
0
0
0
19,317
22,667
63,635
216.458
180,689
165,633
0
0
0
0
0
0
0
0
0
553,146
541,802
550,276
0
0
0
0
0
0
23,156
8,649
24.000
0
0 i
0
2,733,141
2,538,817
2,675,425
0
0
0
51,000
0
78.030
1,505,097
1 ,397.584 !
1.435.325
100,000
63,846
100,000
0
0
0
2,333
0
7,441
114,308
137,872 I
78,770
0
0
0
5,000
4.201
5.000
12,800
0
62,090
59,695
30,828
3,352,873
3,134,044
3,349,941
112,500
111,701
145,235
311.364
510.929
2.681,939
2.521.767 i
2.325.675
0
199,221
I
11,554
CRIMINAL;
Supervising Probation Officer (1.0 FTE)
Deputy Probation Officer ll/lll (6.0 FTE)
Probation Community Worker (1.8 FTE)
Probation Community Worker (1,0 FTE)
127,368
134,188
136,836
0
0
0
0
0
0
0
0 i
860,722
854,551
938,652
0
0
0
0
0
0
0
0“T
0
0
0
T
151,000
151,000 i
0
159,930
69.702
63,970
79,488
65,500
72,466
80,616
0
0
0
0
0
0
Subtotal
1,057,792
1,052,709
1,154,976
65,500
72,466
80,616
0
0
0
151.000
151.000
159.930
TOTAL FTE
22.0
22.0
21.5
3.0
3.0
3.0
3.5
3.5
3.5
5.0
5.0
3.0
TOTAL EXPENDITURES
4,968,196
4,712,853
5,099,304
L
L
365,347
375,442
i
365,345
:
335,991
217,893
L
547,138
L
3,102,382 ] 2,§22~893~
2,711,643
Attachment AA
6 of 7
)
ATTACHMENT B- Reponses from departments
a. Information Services Department- CJIC
b. Probation Department
c. Office of the District Attorney Office
d. Office of the Public Defender
e.
Office of Pretrial Services
f Public Health Department
g. Mental Health Department
h. Department of Alcohol and Drug Services
Prop 36 CPU/Machine Costs
Based on Accounting Period 12, Fiscal Year 2005
Job#
Program/Report Name
Run Frequency
Cost
C28002886
Prop36 State & PSJC reports
annual & semiannual
C28003570
Prop36 Calendars
tape storage
CJSM608
Prop36 Notices
weekly
$1,433
CJSM749
Prop36 Eligible Parolees rpt
weekly
$808
CJSM889
Prop36 Statistics
monthly & quarterly
$841
Total
$12,753
$129
$15,964
SACPA
One supervising probation officer, eight probation officers, one probation community worker and one
justice systems clerk are funded by SACPA and m.ake-up the R.ecovery Services Unit(RSU). This unit
assesses and supervises P36 clients and supports P36 court calendars. Two community workers, one in
the RSU and one in general supervision, and the justice systems clerk, who supports both the Department
of Alcohol and Drug Services and probation as a receptionist, are funded with a one-time FY06 general
fund allocation. One other probation community worker funded by SATTA is assigned to general
supervision. Additionally, 15% of each general supervision caseload is made up of active P36 clients.
A common misperception is that probation would have received all ofthese SACPA cases prior to P36.
The reality is that as a result of the legislation, some clients are now granted probation that never would
have been prior to P36. These cases are primarily misdemeanor under the influence cases that used to
statutorily mandate a jail sentence. More often than not, these cases would not have resulted in a grant of
formal probation, but rather would have been granted court probation or a straight jail commitment would
have been imposed. Other cases include some felonies that would have been sentenced or violated with
probation to terminate upon release and some that would have been sentenced or violated to state prison.
In light of the court review process, P36 cases generate a high volume of drug test results and program
compliance to track and report to the court. This current process significantly impacts probation officer
staff and clerical support.
The legislation has created a system that brings more clients into the formal system and retains them
longer. As a result ofP36, probation spends general fund dollars that were not spent prior to P36.
Examples post-P36 general fund dollars:
1. Probation created a modified AMT caseload with one general fund probation officer, supervising
an average of 490 P36 clients. Managing this caseload, that includes programming and testing,
would not be possible without the SATTA funded probation community worker.
2. The RSU support staff is augmented with a general fund justice systems clerk. This unit is still so
backlogged administratively that probation is looking for a funding source to add another support
staff person.
The Probation Department is committed to providing services to the Drug Courts and collaborating with
partners to ensure treatment is available to drug court clients. We are looking forward to working with
our partners in assessing our overall operational efficiency during FY07.
Probati
)
l artment
Costs associated with various L.
I
I
ourt Services vi/ith NO BUDGET
Substance Abuse
Substance Abuse and Crime
Prevention Act(SACPA)
I
Adult Drug Treatment Court
jTesting/Treatment Accountability
1
Services
pros
FY05
FY05
% Time ! Approved
Category
FY06
FY05
i
1
0!
0
58%
58%
:
Subtotal !
1
SUBTOTAL FTE!
I
Actual
FY06
: Approved
0 i
1
0I
36,280 i
76.389
0
0 ;
0
0 'T
0 ;
0
0
0 ,
0
0 ' I
0
0;
0
0
0 '■
0
0.0 i
0.0
80.069 i
545,437 :
41,929 !
78,177 i
487,093 I
121,878 I
0
0 i
625,506 i
529,022 \
200,055 IT
0
36,280 !
9.0 i
9.0 !
9.0 j i
3.0 :
3.0
3.0 : !
0,0 !
20,849 i !
0 i
0
0 I i
0 I
0
0
0 i
0
0 : -
0 I
0
0
T
Substance Abuse Unit:
(SATTA)
FY05
~~T
100%
Criminal
Criminal
FY05
Approved :
I
±
Criminal
i
; !
Approved I ! Approved | Actual i Approved
Actual
Drug Treatment Court:
Probation Community Wor1<er - DCP (1.2 FTE)
Supervising Probation Officer (1.0 FTE)
Deputy Probation Officer ll/lll (8.0 FTE)
FY06
FY05
76,389 : '
I
Criminal
Supervising Probation Officer (1.0 FTE)
Deputy Probation Officer ll/lll (1.0 FTE) - MHDTC
Probation Community Worker • (1.0 FTE)
Deputy Probation Officer ll/lll (5.0 FTE)
Criminal
15%
100%
I
Criminal
95%
Criminal
15%
i
8,268
21,151 !
123,660 i
114,359
66,451
66,451
86,558
91,253
Subtotal 1
297,819
280,330
SUBTOTAL FTE I
8.0
121,908 ! i
65,425
0
0
0
297,407
0
0
0 i
8.0
0.0
0,0
89,225 !
8.0 i
!
0.0
0 i
0
0
0
0
0
0.0
0.0 I
0.0
I
Supervision Units:
Supervising Probation Officer (1.0 FTE) - SUP I
Deputy Probation Officer l/ll/lll (11.0 FTE) - SUP I
Criminal
15%
■
17,907
2,172
17,652
0
0
0
0
0
0
Criminal
'l5%
1
191,881
187,273
187,201
0
0
0
0 i
0
0
Supervising Probation Officer (1.0 FTE) - SUP IV
Criminal
15%
21,151 i
18,245
2 T053
0
0 I
0
0
0
0
Deputy Probation Officer l/ll/ni'(13.o'FTE) - SUP IV
Criminal
15%
235,597 i
187,973
187,201
0
0
0
0
0
0
Supervising Probation Officer (1.0 FTE) - SUP V
Crirninai
15%
21,151
11,778
17,652 :
0
0
0
0
0
0
Deputy Probation Officer l/ll/lll (9.0 FTE) - SUP V
Criminal
15%
169,776
157,750
151,572 :
0
0
0
0
0
0
r
1
Supervising Probation Officer (1.0 FTE) - SUP VI
Deputy Probation Officer l/ll/lll (1.0 FTE) - SUP VI - AMT
Criminal
Deputy Probation Officer I/ll/ill (3.0 FTE) • SUP VI - AMT
Criminal
Criminal
Deputy Probation Officer l/ll/lll (6.0 FTE) - North County
Criminal
!
15%
21,354
20,509
21,053
0 !
0
0 . !
0
0 !
0
100%
95,400
90,648
94^20
0 :
0
0
0
0!’
0
T
7,898
7,358
’ 5,i6"i
0 '
0
197,856
47.0
157,581
195,053
0
0
0 ■
0
47.0
46.0
0 ;
0.0 !
0
SUBTOTAL FTE
0.0
0.0
0.0
0.0 :
0.0
Subtotal
979,970
841,288
897,557
0 ;
0
0
0
64.0
64.0
63.0
3.0 •
3.0 !
1,903,295
1,650,640
1,395,019
0 I
909,000
I
2,432,222■ -tT 2',304,020
0 !
2%
27%
TOTAL FTE'
TOTAL EXPENDITURES w/o Admin 0/H
Admin Overhead Dept ICRP applied to F^U_
70%
781,582 \
781,582
TOTAL EXPENDITURES with Admin 0/H
2,684,877
3.0
1
0
0 ,
0
:
0.0
36,280 !
76,389 ; !
0
0
36,280
76,389
0 I
0
0
0
0.0 ,
0,0
0
...I. ....
i
i
I
I-
I
0
T
i
!
I
-
DATA SOURCE:
.'Z
' J"
J
Estimate % allocation usage for FY05 is based upon number of caseloads for various units from SHARKS printout dated 04/05/05,
Same % allocation rate is used for FY06 estimates, "j
|
]
i
1
'FY05 Salaries & Benefits budgeted are based upon BRASS report printed 0l7l 1/OSlor'FYOS'PosC^nts!
'FY05 actual Salaries _& Benefito are_based_upon SAP report_ZHR_PAYRPT from Accounting Period 1 thru 12 of FY05.
FYOS Salaries & Benefits budgeted are_based upon PeopleSoft/BRAS S report printed 09/16/05 for FY06 PosCounts.
Admin Overhead Dept ICRP applied to RSU for FYOe is estimated at 74.20%.
Probation_FY05_Expenditure Budget Details_REV.xls
I
"
1-
4-
"
Other Costs
3/20/2006 = = 2:39 PM
Probation _^,pa^tme^t
Expenditures Details - Non General Fund Only
Substance Abuse
Substance Abuse and Crime
Adult Drug Treatment Court
Prevention Act(SACPA)
i
Services
FY05
FY05
FY06
Category
Approved
Actual
Approved
FY06
FY05 j FY05
j Approved
Testing/Treatment Accountability
(SATTA)
Actual
Approved
FY05 i
Approved I
FY05 j
FY06
Actual : Approved
Recovery Services Unit:
Criminal
Supervising Probation Officer (1.0 FTE)
Criminal
Deputy Probation Officer ll/lll (8.0 FTE)
(
Criminal
Probation Community Worker (1.0 FTE)
Administration
Justice Systems Cler1< I (1,0 FTE)
Administration
Supplies and Others
Criminal
Probation Community Worker - SATTA (1,0 FTE)
Administration
Supplies and Others - SATTA
Subtotal
127,368
860,722
134,188 ;
136,836
0
0
0 i
854,551 i
938,652
0
0
0 i
69,702
63,970”i
79,488
0
0
0
63,720
18,653
68,804 !
70,092
0
0
18,653
18,653 i
0
0
0 I!
0
0 ;
0 i
0
0
0
1,140,165
0 i
0 I
£1
1,140,165 I 1,243.721
0j
0i
0 1
0
0
0
0
0
0
0
0
0
0!
0
0
65,500
80,616
65,500
0
0i
0
187,347
187,347
139.494
0
0
0
252,847 i
252,847
220,110
159,930
0:
0
0
0 i
0
0
0
Drug Treatment Court:
Probation Community Wori<er - DCP (1.8 FTE)
Supplies and Others ^DCP
Criminal
0
0 ;
0
151,000
151,000
Administration
0
0!
0
32,500
26,255
0 I
0
0
183,500
177,255
184,930
0
0
3.0
3.0
3.0
1.0
1.0
Subtotal
j
25,000 :
i
TOTAL FTE
11.0
11.0
11.0 I
1.0
I'-'
TOTAL EXPENDITURES
Probr
j|^Y05_Expenditure Budget Details_REV.xls
1,140,165
1,140,165
1,243,721
Grant
183,500
1
St Fund
)
177,255
184,930
252,847 I
252,847 i
220,110
1
3/20/20C
)
2:39 PM
County of Santa Clara
OHicc' of tlK^ District Attoinc'v
m
7t
Ttr
)iintv (iovc'rniiu'iii C.i'int'r. \Vi-si
. o \V(->bi i-ifiidin}* Sirrri
Siin Jose. Calilorniii OSI 1()
(40«) 2<)<>740()
\A'w\v.,sanirKinra-<ta.or,L;
G<'or>5<' W. Kennedy
Disirici Ailonu^y
DATE:
March 2], 2006
TO;
Sandra Nathan
Deputy County Executive
FROM:
George Doorley
Administrative Services Manager Iff
SUBJECT
District Attorney Resources Supporting Prop. 36 and DEJ
The District Attorney’s Office does not use any outside funds to support the efforts in
implementing Proposition 36 or Delayed Entry of Judgment(DEJ).
Deputy District Attorneys screen each narcotics case for eligibility for either Prop. 36
and/or DEJ. This screening is done at the time of issuing and is part ofthe regular duties
ofthe issuing attorney.
The majority of narcotics cases are heard in the Terraine Street Courthouse. One Deputy
District Attorney is assigned to each ofthe courtrooms. Each attorney is responsible for
handing every case heard in their assigned court, whether or not the defendant is on Prop.
36 probation or DEJ. Reviews for Prop. 36 and violations of probation are part of the
attorney’s regular court assignment.
6 ODS
March 20, 2006
Page 2
Traditional punitive sanctions resulted in increased incarceration of addicts who inevitably failed
probation or were transported directly to state prison for their offenses at high cost to taxpayers.
Treatment models avoid these costs, as well as the costs ofjury trials. However, other costs are
incurred because the treatment model requires court monitoring of defendants by means of court
appearances. Court appearances are used to review the progress of clients in treatment and to
use a combination of sanctions and more intensive treatment modalities when addicts inevitably
stumble in their efforts toward recovery. These court obligations require the presence of
attorneys, with attendant paralegal and clerical support. The increased number of court
appearances and probation violation appearances tax PDO/ADO resources. As noted above, the
PDO/ADO has tracked numbers of opened drug cases, but not tracked the number of
appearances per case in the drug courts. This could be accomplished manually if necessary.
It is also important to note that the services provided by the PDO/ADO to defendants charged
with drug offenses are not limited to those provided in the drug courts located at the Terrame
Street Courthouse. Felony cases that settle by way of dismissal or plea bargain remain at
Terraine Street. Those that do not settle are transferred to the Hall of Justice for preliminary
hearing and trial where the PDO has trial attorneys assigned to represent those drug clients who
choose to go to trial. SACPA ineligible misdemeanants and felons are prosecuted in the Hall of
Justice misdemeanor departments and are only transferred for review to Terraine Street if the
case is resolved for a SACPA eligible offense.
Provision of services and corresponding impact on the PDO/ADO:
Because each drug court processes an enormous number of cases each and every day of the work
week, the impact on staffing resources is significant. The PDO/ADO assigns attorneys to cover
arraignment, plea, early settlement (known as FAR which stands for Felony Advance
Resolution) and status/review calendars in each drug court. Attorneys assigned to drug court are
in court eight out of ten half day sessions a week, generally on calendars ranging anywhere from
10 to 120 cases. In two of the Terraine Street courts, attorneys are in court as many as nine
sessions per week. Mandatory court appearances leave attorneys with little time to meet with
clients or their families outside the courtroom, return phone calls, investigate and prepare cases
for settlement and/or trial, or follow up with clients in treatment to ensure compliance with court
ordered requirements for successful completion of SACPA and/or probation.
Apart from the effect on attorney staff, the tremendous volume of cases in drug court impacts our
paralegal, investigator and clerical staff as well. PDO/ADO paralegals conduct intake interviews
with every defendant who requests a court appointed attorney to determine eligibility for
PDO/ADO services - each interview takes Vi hour to complete. Some of these defendants are
out of custody, but many are in custody. In custody defendants carmot be interviewed at the
same rate as out of custody defendants because paralegals working in the jail are impacted by
Department of Correction (DOC) schedules for inmate head counts, feeding, pill call, security
lockdowns and periodic staff shortages.
Paralegals also assist attorneys both in and out of the courtroom in processing as many 80 -100
case files for clients appearing in each department on any given day. Additionally when a drug
court client is charged under Three Strikes Law, a PDO/ADO paralegal is assigned to prepare a
2
A
»
>
>0
Office of t
(C Defender
Expenditures Deu
'General Fund Only
1
Terraine Street
Adult Drug Treatment Court
(Dept 64)
Drug Court
FY05 [
Approved!
FY05 Actual
Drug Court
FY06
Actual
I
as of
FY05
FY05 Actual;
I Approved
I
12/31/05
i
T
Actual
FY05
as of
12/31/05
Approved
ATTORNEY STAFF:
Attorney III(2 FTE)
Attorney IV (8 FTE)
Subiotal
FY05 Actual;
Outlying Courts
I
FY06
0!
0 !
I
0:
1,023,870 i
0!!
596.000 !
T
0 I
0;
0
0:
0 s
0 I
0
0
0 i ■
0!
0
0
0
1.023.870
0 I
409.54r['
0 I
0 i !
0 I
0
598,000 \ \
0 I
409,548
0! i
0
T
I
0
238.400
I
as of
^
12/31/05
328,264 !
0 i
0!
I i
FY06
(
Actual
FY05 I FY05 Actual
Actual
FY05
! i Approved !
0
0
0
0 I
0'
0
Paralegals (3.3 FTE)
89,320 j
231,630
Legal Clerks (4FTE)
0
144,648
TOTAL FTE
OJ 328,264
0 ! 1.638,192 I
0
0
21,243
7,494
49,649
0
101.662 I
79,404 I
n
0
11,672 !
0
0
0
0 !
0
0
0
0
0'
0
0
0
0 1
0!
0
IJ ■
0
0
0 :
0
0 I !
238,400
328,264 !
0
17B.76TV:
0 \
204.774 •
4,117 !
0
22~^30 I
119.200 I
47.373
0
46.326 j
^.415 ;
0
9,265 •
72,324
39,702
0
72,324 :
39',702
0
6,206
0
4,669
2,998
1,647
3.103 i ‘
0
11,165 :
t
0
0 ;
0
0
0 i
8,497 :
0'
0
0!
0
0 ' 1.966.456 ' 1.132.360
\
as of
0!
0 ;
0
0
0
0 ;
0
0
0
0
0
0 I
0
0
0
0\
0
1
0
j
0
6,206 I j
0 :
133,980
65,164
0 •
oi
0
^083 j i
0 ;
373.573
179,533
0 !
0
0
0
289,296
0
0
0
0 I
100,990
158,808 ! :
21,009 i i
0
0
0
5.764 j '
0
4,669
0 I!
0
10,492
0
0
0 ■
0
0
0
0
o|
0
0
0 I
0;
0
0
0:
0
0
0
0
0 i
0
0
0
0
0
OI
0
0
0
0
0
0
0 i
0
0
0
0
0
140,980
68.220
0
28.927
15.958 !
0
908.331
430.278
0
0
0
1.2
”1.2i
0.00
20.60
0.0
0,0
0.0
0
0
0
0
0.0
494.335
246.504 i
0
161.335
99,597
0
0
0
■i--
10.56
”10.56!
0 i
5.14
'5.14
0.00
3.70
'3.70
”20.60
I
TOTAL EXPENDITURES
I
I 12/31/05
I
11,165
86,352
8,497
178.760 1 i
953.600 ; ;
0 FT
0
TT
0 i
0i
Subiotal
r
0!
! FY06 Actual
FY05
Actual
i!
0
SUPPORT STAFF:
Record RetentiQn Staff(1
Reception (.22 FTE)
! 12/31/05
119,200 I
0 i
FY06 i
: Approved j
I I
as of
0
0 i
Actual
t
204.774
0 :
T
Investigators (1.2 FTE)
FY05 Actuali
12/31/05 I !
178.760
•^Substance Abuse and Crime
Prevention Act(SACPA)
FY06
as of
j Approved|
i
I
Total Adult Drug Court
I San Martin, Sunnyvale, Palo Alto
T
FY06
-L
I
Alternate Defender
1,518,205
842,504 i
0
590,883
i
0
337,99J_
J.. .
469,244
246.980
0
135,158 i !
233,701
0
2.874,787
1,562,638
I
’^Statistics for SACPA expenditures are not available.
'
’ ’
7
!
'
_"y/e_believe the above Hgures refect an accurate cost of me services provided by the Public PefenderTn" drug and drun trsat;;;;:^ r.^ irtl anmaTTi;. T information is based on ratio of case numbers in each category.'
**The Public Defender does not handle Dependency Drug Treatment Court.
”FTE for FY2006 is based on full fiscal year—expenditures are based on 6 months.
”AII criminal—the Public Defender does not provide treatment"
\~^
I
ZL _
-L
i
t
•!
id
V
Please see the foJJoAviig attachments for FYOS/Oh budget and staffing information
V
t
)
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<
V
i
i
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t
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1■/■'
SATTA Expenditure Details
Z''
SATTA Funds
FY05
FY05
FY06
Approved
Actual
Approved
TREATMENT:
107,500
107,500
140,235
5,000
4,201
5,000
Subtotal
112,500
111,701
145,235
TOTAL FTE
2.0
2.0
2.0
TOTAL EXPENDITURES
112,500
111,701
145,235
Community Worker (2.0 FTE)
Supplies
‘estimate from a prior year time-study
County of Santa Clara
Public Health Department
3003 IVIooqDark Avenue
'’an Jose, California 95128
fel) 408.423.0701
(Fax)408.423.0702
February 14, 2006
Sandra Nathan
To:
Deputy County Executive
From;
Guadalupe S. Olivas, PhD
Director, Public Health Department
Subject:
Information Required for Board Referral on Services Provided to Drug Treatment
Court
The Public Health Department provides services to both the Dependency Drug Treatment Court
and the Adult Drug Treatment Court. The budgets for both services are attached.
Dependency Drug Treatment Court
The Healthy Pregnancy and Early Parenting(HPEP)initiative, a EIRST 5-supported home
visitation program that is slated to end on June 30, 2006. If not re-funded, this effort may cease
as part of the Board of Supervisors budget approval process for FY 07.
Approximately 100 clients are served annually. The clients are primarily mothers with open
cases in Drug Court. The intent of the program is to ensure full-term delivery of babies,
increasing the parenting skills of the mothers and provision of services for rehabilitation and
psychosocial counseling, as well as linkages to other community-based services/programs.
The grant funds 1.0 Public Health Nurse II, 0.5 Public Health Nutritionist, 2.0 Rehabilitation
Counselors, and 1.0 Marriage and Family Therapist. The Rehabilitation Counselors and the
Marriage and Family Therapist are located with the HPEP team in the Public Health Department,
but the codes are reflected in the Drug and Alcohol Department budget.
Adult Drug Treatment Court
The Public Health Nurse (PFfN)is an integral team member of the Adult Drug Treatment Court
(DTC)in Santa Clara County. This position serves as a nurse consultant to the court.
Twenty percent of a PHN III staff has been assigned to DTC since November 1998. The PHN
attends weekly DTC review meetings to identify appropriate referrals for clients who are
pregnant or parenting a child under 5 years of age. The majority of the DTC referrals for
pregnant and/or parenting women with children under age two have been to the PHD/ DADS
Healthy Pregnancy Early Parenting Program (HPEP).
The Public Health Department is a division of Santa Clara Valley Health & Hospital System.
}
^ealth Department
Pl
)
Expenditures details - Non General Fund Only
Substance Abuse and Crime
Dependency Drug Treatment Court
Prevention Act(SACPA)
(DDTC)
Adult Drug Treatment Court
FY05
FY05
FY06
FY05
FY05
FY06
FY05
FY05
FY06
Approved
Actual
Approved
Approved
Actual
Approved
Approved
Actual
Approved
ADMINISTRATION (Referrals):
Public Health Nurse I II (.20 FTE)
24,951
Subtotal
0
0
0
0
0
0
116,160
116,160
42,036
42,036
127,452
49.353
24.951
24,951
27,377
27,377
TREATMENT;
Public Health Nurse II (1.0 FTE)
Public Health Nutritionist (.5 FTE)
0
0
0
158,196
158,196
176,805
TOTAL FTE
0.0
0.0
0.0
1.5
1.5
1.5
TOTAL EXPENDITURES
0
0
0
158,196
158,196
176,805
0
0.20
24,951
0
0.20
0
0
0.20
27,377
Program: Superior Court of California, County of Santa Clara Mental Health
Treatment Court
The program was established in 1999 to serve defendants who have co-occumng mental
illness and substance abuse problems. They are at risk for failing traditional treatment
and court models. Santa Clara was the first county in California to operate a Mental
Health Treatment Court. The Court emphasizes the need to both address the criminal
behavior and the mental illness in order to stabilize and reduce re-an est and incarceration
and to assist the individual in developing pro-social behavior and self-sufficiency to
reintegrate into seiv’ing the community. Referral sources for the program services are
Judges, Probation Officers, Public Defenders, District Attorneys, Pretrial Services, and
County Jail.
Target Population
The Court currently is serving 400 clients. There are 47 between the ages of 18-25; 105
between the ages of 26-35; 241 betw'een the ages of 36-55; and 7 between the ages of 56
and 71. All prospective participant’s offenses are reviewed on a case-by-case basis prior
to admission to the court. The average defendant graduates from the Mental Health
Treatment Court in 18 months.
Project Partners
Santa Clara County Mental Health Department, Adult Custody Mental Health, District
Attorney’s Office,Public Defenders Office, Department of Alcohol and Drug Services,
The Department of Public Health, Adult Probation Department, other Judges and Courts
may make referrals.
Through agreement and the cooperation with the San Jose Police Department and the
Santa Clara Sheriffs Department, service of bench warrants and arrest of Mental Health
Court participants who have absconded from treatment are given priority. This serves to
lower the risk that Mental Health Court clients will decompensate and pick-up new
criminal charges before the Mental Health Court team can intervene and assist the clients
return to stabilization and treatment. The Department of Corrections provides in-custody
treatment programs that accept dual diagnosed clients. These jail services prepare
defendants for admission into the Mental Health Court and demonstrate their motivation
to work on the co-occurring disorders that contribute to criminal behavior and non-
compliance with court orders in the community. The Judge has secured staff and funding
to provide limited case management services and psychiatric medication for those clients
who do not meet Mental Health Department medical necessity criteria. Those clients are
connected with the court based psychiatrist. .
The Mental Health Drug Treatment Court also sees clients from the Dependency Court
when individuals have both criminal and dependency charges. In these cases, treatment is
coordinated between the two courts.
This program has many positive social outcomes to report. While only 22 % of Mental
Health court graduates were employed upon entering the program, 38 % were employed
upon exiting the program. Eighty-three percent(83%)of graduates were homeless upon
entry and 68 % had obtained independent housing at exit, while the remaining 32 %
resided in some form of group living at time of discharge from the program.
The most important goal of the program relates to self-esteem and family reuninification.
gained more control over their
Eighty percent(80%)ofthe graduates felt that they hadand
lives and the ability to overcome obstacles to recovery 78 % were able to reunite with
their families. These outcomes reflect the success of this program linking the court with
treatment services.
Mental Heau,. Jepartment
Expenditures Details - General Funds
Adult Drug Treatment Coxixt
i FYOS Approved
FY05 Actual I FY06 Approved
TREATMENT:
Psychiatric Social Worker II (1.0 FTE)
Marriage Family Therapist I (1.0 FTE)
Marriage Family Therapist 11 (0.5 El E)
Salary Savings
Others (mileage, office expense, phones)
86,625 :
42,217 ;
93,504
90,345
51,258
96,299 j
101,317
47,629
55,296
(15,627)
0
0:
5,155
2.50 ;
2.50
(6,619)
0
I
TOTAL FTE:
TOTAL EXPENDITURESi
)
2,50
I
I
212,601
191,300
243,498
)
)
SObmitted to Sandra Nathan, Deputy County Executive
on January 13, 2006, by Robert Gamer, Director of
Department of Aicohoi & Dmg Services
I.
Introduction and Background:
This report is a combined response to two referrals from Supervisor Alvarado,
one involving funding from the Substance Abuse and Crime Prevention Act
(SACPA-Proposition 36) and the other a broader referral dealing with drug
courts in general. The general substance of both referrals was to obtain a
broader context within which all court-referred clients are treated. There was a
concern that by trying to deal with issues involving individual services or
funding sources the Board was unable to see the broader context and the
relationships between the individual parts and the process of setting broader
funding priorities and policies was made more difficult.
Section II of this report will contain a broad overview and discussion of the
major issues involved in the relationship between the court system and the
drug and alcohol treatment system. The purpose of this section is to give the
Board an understanding of the context within which issues of funding and
resource allocation take place. The detail supporting this discussion will be
found in Section III, which includes a source and application of all drug and
alcohol treatment funding as well as a description of the client population
served. This Section also contains a description of the treatment system.
Finally, Section IV contains a special report on the impact of the
methamphetamine problem on the substance abuse treatment system, as
requested in the original Board referrals.
II.
Major Issues:
This Section identiftes and discusses the major Issues related to the funding of
alcohol and drug treatment and utilization of those treatment services by the
criminal justice system. While each of these major issues could be broken into
sub-issues, the purpose here is to keep the discussion at a high level,
providing a basic understanding of the relationship between criminal justice
and treatment and helping the Board to make decisions on individual funding
and service items as they come forward. All of these individual items need to
be understood in the broader context of the relationship between criminal
justice and treatment. While there is no specific action required or even
recommended in this report, the Board will be addressing numerous issues
during the next budget cycle that will relate in some way to the issues
addressed in the report. It is likely that discussion about the issues in this
report will generate further discussion, and require further data analysis.
1 The vast majority of resources in the Department of Alcohol and Drug
Services(DADS)are allocated to adult treatment. About 72% of the
total resources made available to DADS, approximately $33 million,
directly support adult treatment. This allocation is in part historical and
in pari a reflection of State and Federal priorities. The drug and alcohol
field developed primarily as a response to drug-related crime, and initial
State and Federal responses focused on this relationship. The vast
majority of resources provided to fight drug and alcohol problems were
1
CHART #1
FY05 TOTAL DADS BUDGET:
$45,194,415
BALL OTHER SERVICES
□ ADULT TREATMENT
CHART #2
FY05 TOTAL ADULT TREATMENT
CLIENTS: 15,204
□ ALL OTHER CLIENTS
74%
11,278
□ REFERRED FROM
CRIMINAL JUSTICE
3
III.
Adult System of Care:
This section provides the detail that supports the discussion of major issues in
Section II. The first part is a description of the adult system of care (ASOC):
how clients gain access, the assessment process, development of treatment
plans, treatment, and quality improvement and accountability. The second
part is a series of three charts describing the source and application of funds
for adult services, the cost of providing each modality of care, and the cost to
serve criminal justice clients in each modality. The third part is a series of
three charts showing the number of clients served in the ASOC, by modality
and funding source, the number and percentage of those clients that are
referred by the criminal justice system.
The ASOC for substance abusing clients is administered as a managed
system of care. The Department controls both access to and utilization of the
treatment resources. The goal is to assure the most appropriate and efficient
use of the limited resources available in the community. This is accomplished
by requiring that every individual seeking access to dmg and alcohol treatment
receives an assessment. For this purpose, the Department administers a
validated assessment instrument adapted from the multidimensional,
biopsychosocial assessment developed by the American Society of Addiction
Medicine. The assessment gathers basic information about multiple
dimensions of the individual’s life, including substance use, and identifies the
appropriate level of care for treatment. This assessment process assures that
only individuals requiring treatment enter the treatment system, and that they
enter treatment at a level appropriate to meet their needs.
The primary point of access to adult substance abuse treatment is through the
GATEWAY program, a 1-800 number that links the caller with a brief
information, referral and screening process. The large majority of calls are for
general information about substance use and abuse and prevention, and
these are directed to information and education resources in the community.
Those callers identified as needing treatment are given an assessment over
the phone to determine the appropriate level of care. Once the level of care
has been determined the caller is given a welcome to treatment appointment
with the appropriate treatment provider.
Because of the large number of clients entering the ASOC with a referral from
the courts, special satellite assessment centers or other decentralized
assessment sites have been created. For example, within the Dependency
Drug Treatment Court the Department has assigned two full time staff to
perform assessments on clients immediately following the court referral. The
level of care and treatment referral is then considered when the overall plan is
developed for the client by the Dependency Court. A larger example is in the
SACRA (Substance Abuse and Crime Prevention Act - Proposition 36)
Assessment Center, which was established to provide assessments for the
high volume of SACPA clients referred by the Court.
5
Outpatient clients are also eligible to receive ancillary services such as
housing (Transitional Housing Units), medical and time limited psychiatric
services. In addition, they are eligible for vocational services, which include
training and job placement, career counseling, and referrals to GED, ESL and
literacy classes.
When a client has completed treatment, a Discharge Summary is completed to
summarize the client’s progress in treatment. It requires the counselor to do a
summary of all 6 ASAM dimensions (see above)related to a client’s substance
abuse and mental health Issues. Any dimension rated medium or high in the
Discharge Summary should include a plan related to how the client will
address that issue once the client leaves treatment.
Once in treatment, providers continually assess a client’s treatment needs and
treatment progress to determine if or when the client should be referred to a
different level of care. Clients move in either direction along the continuum, as
their treatment needs change.
Policies, procedures, processes, and forms are standardized across the
system. This strengthens cohesion among providers and facilitates smooth
transitions along the continuum of care for the clients.
DADS Quality Improvement(Ql) Division Is responsible for the overall
cohesion of the ASOC by providing intensive oversight and management of
the system’s daily operations. Ql monitors access, utilization, and service
quality for the system and provides training, technical assistance, and clinical
consultation for all providers.
Providers in the DADS ASOC must achieve certain performance measures as
designated by contract. The Ql Division conducts audits annually with all
providers in the system to ensure providers’ adherence to the Department’s
clinical standards. The audits are scheduled In advance and the Ql Division
provides coaching and information about how to succeed In the annual audit.
In the event a provider fails the audit, they are required to submit a formal
corrective action plan with timelines for achieving improvement. The Ql
Division follows up to verify that the provider’s corrective action plan has been
implemented and to determine its success.
7
)
)
)
health and H0S^AL_SYSJEM~ .i
„
,
_
DEPARTMENTOF A^C^l^NO DRUG SERVICES
FY 06 - SOURCE AND application "adult TREATMENT SERVICES _
Exp»n»e
FY06
Fund.Source
Drug Court Partnership(OCP)
This is a slate gran! from ADR. The C5ai9 Court Partnership grant supports Drug Treatment
Grant Period: Rented annually
Court(DTC)activities such as a Da>g Court Coordinator(DCC)for the Superior Court and
community workers In Probation for drug testing in addition to transitional housing unit beds for
clients in substance abuse treatment. This grant is revnewed annually.
Office of Justice Program • Dependency This is 3 federal grant and expires 8/31/06. This grant expands and enhances services for
Drug Treatment Court (OJP • DOTC)
clients in Oependertcy Drug Court, particularly during limes when they are preparing to transition
GrantPeriod: 9/1/04^8/31/06
out of DDTC program. Counseling and casement management services are provided by
425.175
Court reimb
Drug testing
THU (12)
124.990
Act (SACPA)
Prop 36, approved by voters in Nov 2000, requires specificied drug offenders to receive drug
treatment services in place of incaraceralion. Funds due to expire 6/30/06.
3.902.979
Board of Supervisors approved one-lime funds for FY06 SACPA services through 6/30/06.
1.074.813
GrantPeriod: 7/1/00-6/30/06
Substance Abuse and Crime Prevention
Admin OH
OP (20)
Case mgmt
contract provider Expires 8/31/06.
Substance Abuse and Crime Prevention
Admin OH
Act (SACPA). General Fund
Grant Period; FY06
Assessment
Admin OH
Evaluation
SB 223(Burton) are SAPT federal block grant funds for drug testing related to Prop 36, No
368.916
3.000
Bus
9.385
Probation SACPA budget $1,234,721
Probation SACPA lx budget $300,160
$ 19,000
95,000
80,000
132.000
40.000
Psych/Meds
37,000
Comm Wkrs
28,600
Pre-Tnai Svc $ 145,236
Probation
specified sunset dale on these funds.
15.000
Travel
9.916
DAOS
$ 256,456
Svc& Supplies 36,136
367.906
Res (15)
415.235
THU (40)
OP (20)
Res (4)
91.200
Data entry
39.015
DAOS
$1,097,554
Svc & Supplies 30,000
100.000
Pysch/Labs
1.496.096
OP (469)
723,335
Res (26)
455,994
THU (52)
Expires 5/31/06,
DCC
39,015
14.000
dual diagnosis clients. Rollover grant savings will be used to cover June 2006 expenditures.
Comments
Court reimbursement
$ 13.044
10.000
this grant support a Dual Diagnosis Drug Court and provides the assessment and treatment for
Substance Abuse Testing/Treatmeni
Accountability(SATTA)
110.600
Legal Svcs
Travel & tmg
Services Agency • Dual Diagnosis
(SAMHSA - DO)
GrantPeriod: 6/1/03-5/31/06
118.585
164,930
Mentors
Substance Abuse and Mental Health
431.600
5 11.060
220,110
Grant Period: None
Drinking Driving Program (OOP)Fees,
Diversion fees and CGF
County assesses a 6% admin fee of gross program revenue of drinking driver programs and
diversion programs to administer and monitor the program in accordance with Stale regulations.
Annual collections are rougly $180,000 annually.
Total for Adyll.Seryices
Total OADS byi^el
SAPT ’ Substance Abuse Prevention Treatment (Federal Block Grant)
MM - Meihadone_Maintenance
SGF - slate General Fund
_
CGF - County General Fund
'..,f?0Sidenti3[_
M/c"- Medi’-Cal
Jransitiooai Housing Units
ODTC ■ PepOTde'nCTllr^g T» CoVl'
CD
1/20/2006 3:37 PM
2
$180,000
214,992
Svc/suppiies 130,313
^32j.6^.321_
Acronym OescripUpn;
Admin
Assessment
'"_45,!.94,115.
OP • Oyipalierit
06 source and app • adult lx - RG.xls
525.305
Revenues are compose of
30%
OOP fees
4%
Diversion fees
66%
CGF
Total Admission By Modality For Adult System FY06
ASOC
Outpatient
Residential
Methadone
THU
DETOX
No Contract
Contract
No Contract
Contract
No Contract
323
13
314
4
2315
683
84
0
1601
0
0
249
26
1011
126
57
0
190
112
2
0
0
0
9
0
0
1169
0
0
430
0
838
44
0
0
0
0
0
0
0
209
0
0
30
4164
1071
141
0
DCP
DTC
DDTC
OOP
LLBG
TOTAL
1
53
84
2
1
7300
0
0
3360
0
0
325
0
2772
3017
1191
435
Outpatient
993
15
SAMSHA
CalWORKS
Continued
CDCI
SACRA
BASN
VHP
Contract
7168
Total
MEDICAL
Contract
No Contract
Contract
No Contract
243
43
99
21
Residential
0
0
20
58
1
168
43
Methadone
0
0
0
0
0
0
12
THU
0
0
0
24
2
212
51
2
24
0
214
4
DETOX
Total
0
0
0
20
0
3
243
43
119
123
4
436
1447
1
15204
These are new admissions to the system for the fiscal year.
)
)
)
)
)
Percent Criminal Justice Referral Admissions By Modality For Adult System FY05
MEDI-CAL
VHP
85.52%
98.50%
0.00%
63.16%
15.38%
N/A
0.00%
33.96%
9.99%
ASOC
Outpatient
Residential
Methadone
THU
DETOX
Total
65.19%
Outpatient
Residential
Methadone
DETOX
Total
CO
No Contract
100.00%
N/A
N/A
100.00%
100.00%
100.00%
100.00%
N/A
DCP
DTC
OJP
LLBG
TOTAL
100.00%
100.00%
100.00%
100.00%
100.00%
N/A
N/A
84.74%
90,65%
No Contract
Contract
100.00%
N/A
100.00%
100.00%
100.00%
0.00%
N/A
N/A
N/A
N/A
N/A
100.00%
N/A
100.00%
N/A
N/A
N/A
N/A
13.33%
100.00%
SAMSHA
CalWORKS
Continued
Contract
100.00%
100.00%
100.00%
100.00%
100.00%
Contract
100.00%
100.00%
46.90%
Contract
No Contract
Contract
No Contract
6.58%
2.33%
100,00%
100.00%
CDCI
SACRA
BASN
1 No Contract
100.00%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
100.00%
100.00%
100,00%
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
2.77%
100.00%
N/A
61.65%
N/A
N/A
22.67%
100,00%
100.00%
74.18%
N/A
N/A
N/A
100.00%
100,00%
100.00%
N/A
N/A
N/A
100,00%
N/A
100,00%
6,58%
2.33%
100.00%
100,00%
100,00%
100.00%
IV.
Impact of Methamphetamine Use:
This section is a review of the client data showing the growing impact of
methamphetamine use on the treatment system. The impact of this drug is far
more significant in those clients referred by the criminal justice system, and
specifically, by SACPA. In FY05 48.4% of ail clients entering the adult system
of care reported methamphetamine as their primary drug of choice. During
that same period, 63.7% of SACPA clients identified methamphetamine as
their primary drug of choice.
15
Department of
I
)
I and Drug Services
Expenditures Details - General Fund Only
Substance Abuse and Crime
Dependency Drug Treatment
Prevention Act(SACPA)
Court(DDTC)
FY05
FY05
FY06
Approved
Actual
Approved
I
FY05
FY05
! Approved
I
Actual
Adult Drug Treatment Court
FY06
FY05
FY05
FY06
Approved
Approved
Actual
Approved
ADMINISTRATION;
I
T
Health Care Prog Analyst (1.0 FTE)
Health Care Program Analyst (1,0 FTE)
Ql Coordinator A&P Services (1,0 FTE)
Health Services Rep.(1.0 FTE)
Office Specialist III (1.0 FTE)
Health Program Analyst (.5 FTE)
Sr. Health Care Program Analyst (1.0)
Office Specialist III-U(1.0 FTE)
Health Care Program Analyst - U (1.0 FTE)
0
0
0
0!
0
0i I
0 i
0
0
0:
0
0!
0 i
0
0
0
0
01
0 i
0 ;
0i
0 i
0!
0'
0 1
0
0
0
0I
o;
0 i
0
0 i
0i
0
0
0
0
0 ;
0 i
0 ;
0 I
0
0
0
0
0
0:
0 :
0 i
0 i
0
0
0 I
0
0
0'
0 I
0 :
0 ;
0
0
0±
0
0 , I
0
0
0
0i
oi
0
0|
Program Evaluation
0
0!
Supplies and Others
0
0
Subtotal
0
59,040 ; I
109,993 j
0 I
0 i
0
i
0 :
0
0
0I i
0
0:
0 ,
I
0
0
0
o1
0
0
0!
0
0
0
0
0|
169,033
0 i
0
0 ; i
0 i
0
0
TREATMENT:
Health Care Program Manager II (1,0 FTE)
Psychiatric Social Worker I (1.0 FTE)
Marriage Family Therapist II (1.0 FTE)
Rehab Counselor (3.0 FTE)
Rehab Counselor (.5 FTE)
Rehab Counselor-U (1.0 FTE)
Sr, Office Specialist (1,0 FTE)
Psychiatric Social Worker II (1.0 FTE)
Rehab Counselor (1,0 FTE)
Rehab Counselor • U (1.0 FTE)/half yr
0
0i
0
0
0 I
0 ;
0
0
0
0
0 i
0
0
0
0 i
0
0
0
0
0:
0
0
0
0 ;
0
0
0
0
0
0
0
0
0I
0
0
0I
0
0 I
0
0
0
0
0
0
0
85,200
0I
0
0
0
0
0
73,764
0
0
0
110,316 !
100.572 i
0 I
0
0
0
0
0
0
0
0
0
0
0
67,188
64,419
0
0
0
100,596
111,811
0
0
0
77,664
96,816
0
0
0
0
0
Marriage Family Therapist II - U (1.0 FTE)/half yr^
0
0
0
0
0
Rehab Counselor + OSIII (LIEBG)
Marriage Family Therapist (1.0 FTE)
Supplies and Others
0
0
0
0
0
0
0
0
0
0
Treatment Contracted Services
0
Mentor and Legal Services
Court Expenses
Drug Testing
0
0
0
0
0 i
0 i
Psychiatric/Lab & Meds
0
0
Oj
0
0
0
0
0
0
0
0 i
0:
0
0
0
0
0
0
0
25,316
0
59,631
29,667
59,631
0
0
0
819,357
667,659
660,838
697,391
238,411
236,496
248,125
0 i
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0:
0
0
0 :
0
0
0
0 ;
0
0
0 I
0
Subtotal
0
0
904,557
972,738
963,551
1,041,674
238,411
236,496
273,441
TOTAL FTE
0.0
0.0
3.0
3.0
3.0
3.0
0.0
0.0
0.0
TOTAL EXPENDITURES
0
0
1,073,590
972,738
963,551
1,041,674
238,411
236,496
273,441
ATTACHMENT C
a.
Julie Rice, DADS Research Institute, Comparison ofSACPA
Methamphetamine Users andSACPA Non-Methamphetamine
Users- Fiscal year 2005. Report issued in Jan 2006.
b. Longshore, Doug, et al, UCLA Integrated Substance Abuse
Program, Evaluation ofthe Substance Abuse and Crime
Prevention Act- 2004 Report, prepared for the Department of
Alcohol and Drug Programs. Report issued on July 22,2005.
c. Wiley, Deane, et al, Assessment ofSanta Clara County SACPA
Client Outcomes. Report issued on Sept 2004.
2 of 7
oi/n/06
methamphetamine as
the primary or secondary drug of choice at time of admission to the
1
treatment provider.
Seventy-six percent(75.9%)of SACPA clients reported methamphetamine as either their
primary (63.7%)or secondary(12.3%)drug of choice.
Demographics
As shown in the tables below methamphetamine users in Santa Clara County are younger than
non-methamphetamine users. Methamphetamine users are predominantly male however a larger
percent of females use methamphetamines than in the non-methamphetamine group.
Methamphetamine
Non-Meth
Users
Users
Age
18-25
479
23.6%
108
16.7%
•
26-35
712
35.0%
173
26.8%
•
36-55
831
40.9%
346
53.6%
11
0.01%
18
2.8%
2033
100%
645
100%
682
33.5%
171
26.5%
1351
66.5%
474
73.5%
2033
100%
645
100%
•
•
Over 55
TOTAL
Gender
•
Female
•
Male
TOTAL
As shown in the Age by Gender table and Age by Gender graph, the percent offemales between
the ages of 18-35 using methamphetamines is greater than the percent of males in the same age
range. 'Phis indicates that the majority of women using methamphetamines are in their
childbearing years while women using other drugs are more likely to be over the age of 35.
Age by Gender
Non-Methamphetamine
Methamphetamine
Optimal
Childbearing Years
Users
Users
Male
Female
Male
Female
Yes(18-35)
No(Over 35)
776
57.4%
417
61.1%
216
45.6%
65
38.0%
575
42.6%
265
38.9%
258
54.4%
106
62.0%
Total
1351
100%
682
100%
474
100%
171
100%
)
These numbers vary slightly from data reported in the SACPA Statistical Summary for Annual FY05, which used
data from the clients Level of Care Placement screening.
4 of 7
01/11/06
Outcomes
Methamphetamine users tend to stay in outpatient treatment longer than non-methamphetamine
users.
Service Modality
Outpatient
Residential
Transitional Housing
Methamphetamine
Non-Meth
Users
Users
Average Length of Stay
122.7 days
51.0 days
93.7 days
Average Length of Stay
106.3 days
51.6 days
86.4 days
The following tables give the last discharge status from residential or outpatient treatment in
FY05.
Discharge Status From Last Treatment Episode
Outpatient
Methamphetamine Users
Residential
Satisfactory Treatment Discharge
872
58.7%
170
68.5%
Unsatisfactory Treatment Discharge
613
41.3%
78
31.5%
1485
100%
248
100%
TOTAL
Discharge Status From Last Treatment Episode
Outpatient
Non-Methamphetamine Users
Residential
Satisfactory Treatment Discharge
257
56.2%
46
63.9%
Unsatisfactory Treatment Discharge
200
43.8%
26
36.1%
457
100%
72
100%
TOTAL
oi/n/06
6of7
Employment Status Comparison
(Between First Admission & Last Discharge)
50.0%
40.0%
42.4%
35.1%
30.0%
20.0%
10.0%
0.0%
Better
Worse
Positive No
Change
Negative No
Change
■ Methamphetamine □ Non-Methamphetamine
Comparison of Frequency of Use at First Admission and at Last Discharge
The client’s primary substance frequency of use is examined at first admission and at last
discharge. Only clients with complete data on admission and discharge frequency of use were
used in the following analysis. Please note that 111 non-methamphetamine users and 180
methamphetamine users did not have complete records for frequency of use.
Frequency of Use at Admission
• No use prior month
• 1 -3 times in past month
• 1 -2 times per week
• 3-6 times per week
• Daily
TOTAL
Frequency of Use at Discharge
• No use prior month
• 1-3 times in past month
• 1 -2 times per week
• 3-6 times per week
• Daily
TOTAL
Methamphetamine
Non-Meth
Users
Users
1225
66.1%
308
74
4.0%
24
4.5%
196
10.6%
66
12.4%
129
7.0%
49
9.2%
229
12.4%
87
16.3%
1853
100%
534
100%
1319
66.7%
57.7%
71.2%
356
57
3.1%
25
4.7%
190
10.3%
66
12.4%
136
7.3%
43
8.1%
151
8.1%
44
8.2%
1853
100%
534
100%
Evaluation of the
Substance Abuse and
Crime Prevention Act
2004 Report
Prepared for the Department of Alcohol and Drug Programs
California Health and Human Services Agency
By Douglas Longshore, Ph.D., Darren Urada, Ph.D.,
Elizabeth Evans, Yih-lng Hser, Ph.D., Michael Prendergast, Ph.D., and
Angela Hawken
July 22, 2005
ISAP^
Integrated Sutetanee Abuse Pragrams
Overall, about one-quarter (24.9%) of offenders who agreed to participate in SACPA in
its second year completed treament (based on a 72.6% treatment entry rate among all
SACPA offenders and a 34.3% completion rate among offenders who entered treatment).
This rate is typical of drug users referred to treatment by criminal justice.
Half of SACPA outpatient drug-free clients (5].4%o) received at least 90 days of
treatment, as did 41.2%o of long-term residential clients. These rates are typical of drug
users referred to treatment by criminal justice. A period of 90 days is widely cited as the
minimum length of stay before treatment is likely to have a beneficial effect.
Treatment completion was lower for African Americans, Hispanics, and Native
Americans than for Whites and Asian/Pacific Islanders. These findings signal the
importance of assessing the possible disproportionate impact of limited treatment
capacity, assessment procedures, and treatment protocols across racial/ethnic groups.
Clients with no prior experience in treatment were as likely to complete treatment in
SACPA as clients who had been exposed to treatment before. This finding is notable
because clients with no prior treatment experience may find it difficult to conform to
unfamiliar requirements such as open acknowledgement of their drug problem and self
disclosure in groups.
Methamphetamine users were similar to the overall SACPA population in their rate of
treatment completion. Concern has been raised regarding clinical challenges, such as
severe mental health problems and poor engagement in treatment, arising from
methamphetamine use. Treatment providers in SACPA appear to have responded well to
these challenges.
Treatment completion was lower, and duration shorter,for heroin users than for users of
other drugs. Few heroin users in SACPA were placed in methadone detoxification or
maintenance,
Heroin users’ performance in treatment might improve if methadone
treatment were available to those who wish to receive it.
Offender outcomes
Outcomes during the initial 12-month follow-up—new arrests, drug use, a?jd
employment—were most favorable among first-year SACPA offenders who completed
treatment, compared to those who were referred to SACPA but did not enter treatment
and those who entered treatment but did not complete it. This comparison shows
outcomes in relation to offenders’ degree of participation in SACPA. Favorable
outcomes were substantial for employment and occurrence of new drug arrests. Drug use
outcomes were uneven. It will be important to see whether initial favorable outcomes are
sustained across a longer period.
Drug offenders eligible for SACPA in its first year (SACPA-era offenders) were more
likely to have a new drug arrest during the initial 12-month follow-up than a pre-SACPA
comparison group of similar offenders who would have been eligible for SACPA. All
IV
County of Santa Clara
Office of the Covinty Exectitive
"ounf)’ Government Center, East Wing
West Hedding Street
San Jose, California 95110
(408) 299-5105
Date:
September 27, 2005
From:
Quyen Nguyen, Program Manager
To:
Prop 36 Steering Committee Members
Cc:
Jail Population Task Force Members
Subject:
Evaluation of SACPA- 2004 UCLA Report
The third annual evaluation report of Prop 36 is recently released. Prepared by the independent UCLA
group for the Stale’s Alcohol and Drug Program, the report descnbes the Prop 36 “pipeline” in its third
year (July 1, 2003 to June 30, 2004). This Report can be downloaded at:
http://A\"ww.adp.ca.gov/SACPA/P36_Reports.shtml
Additionally, attached for your review are the parallel findings for Santa Clara County’s Prop 36 program.
Several of their findings are highlighted as follows:
Almost half of the clients(42%)completed treatment. The other 2 non-SACPA comparative
groups also had similar completion rate.
Among treatment completers, almost half of them (41.9%) had a new drug arrest during
the 12 months after offense, and half of them (50%)reported drug use in the past 30 days.
Among treatment completers, the average length of stay was 129 days in outpatient, or 55
days in residential. Statewide average for completion was 194 days in outpatient or 90
days in residential.
About two-third (76.8%)ofSACPA clients utilized outpatient treatment, and about onefifth (21.4%) utilized residential. Statewide, most clients(84.4%)utilized outpatient and
11.2% utilized residential.
To assess Prop 36 as a social policy, the UCLA report indicated that 37% of SACPA
eligible offenders had a new arrest in its first year as compared to 31% of new arrest from
a population of offenders arrested in 1997-98 who would have been eligible for SACPA.
If you have any question, please contact me at (408) 299-5138 or quven.nguven@ceo.sccgov.org.
Thank you
Board of Supervisors: Donald F. Gage, Blanca Alvarado, Pete McHugh,James T. Bc-.J], Jr., Liz Knis.s
Counn’ Executive: Peter Kutras,Jr.
r
Treatment Clients by Referral Source
(CADDS), 7/1/03- 6/30/04
60 -|
54.7
43.6
<w
a 40 %>
31.1
E
233
22.9
o
19.9
g 20 a.
2.5
2.0
0
SaotA Clara Couary
Slatfv*>de
(N = 6,410)
(N = 164^21)
!□ SACPA probation D SACPA parole B Crimioal justice non-SACPA B Noivcrimioal justice
\
Race/Ethnicity of SACPA Treatment Clients
(CADDS), 7/1/03 - 6/30/04
60 n
2
a>
44.8
443
c
V
£40 32.4
27.4
<
o.
U
<
^20 ^
173
o
14.4
a>
a>
5.6
CU
43
2.7
4.1
0.9
0
Sania Clara County
(N-2,122)
Stateside
(N - 36,773)
|o While B Hispapic » African Ajnerican B Asiatt/PaciSc Islander B Other ■ Nativt American |
Prop 36: UCLA Year 4 Report
2
Primary Drug Among SACPA Treatment Clients
(CADDS),7/1/03 - 6/30/04
80 -I
C
<i>
'V
fb-'
A
60
c>-
c
E
< 40 H
Cu
U
<
in
o
c 20 ^
N
<i>
L>
<0
9-
%>
Cl-
‘b*
s'>
is
\N’
0
Slairwide
Santa Clara Count>-
(N - 36,773)
(7V» 7,122)
|d Melhamphclamine B Cocaiot/crack M Marijuapa B Heroin D Alcabol ■ Olber|
Years Since First Use of Primary Drug
Among SACPA Treatment Clients
(CADDS),7/1/03 - 6/30/04
80 -1
“ 60
a>
B
a>
< 40 a.
O
<
26.9
00
»%v
20.0
o
20.3
18.4
18.1
5
= 20 «>
(J
o.
a
0
Santa Clara Cnwnty
{N - 2,112)
[□0-5B6-l0ail-ISB16-20B21+]
Prop 36: UCLA Year 4 Report
Stalrsvidr
8
4
Number of Prior Treatment Admissions
Among SACPA Treatment Clients
(CADDS), 7/1/03 - 6/30/04
60 n
c
c
£ 40
<
a.
U
<
20
o
<u
a.
S'
>
N*
0
Slalewide
Santa Clara County
(N =2,122)
□ 0
8 1
a 2
(N = 36,773)
04
Q3
■5
n 6
□ 7
B8
D94 I
SACPA Treatment Clients by Modality
(CADDS), 7/1/03 - 6/30/04
V)
lOO -1
c
a>
84.4
u
c
80
76.8
a>
E
c«
a>
60 '
<
a.
U
40 -
<
21.4
o
c
20
a>
u
a>
0
■
11.2
1.7
0.0
0.1
0.1
Santa Clara County (N = 2,122)
□) Outpatient
■Residential
> 30 days
Prop 36: UCLA Year 4 Report
□ Detox
O Residential
2.0
1-2
03
1.0
Statewide (N = 36,773)
□ Methadone detox
■ Methadone maintenance
< 30 days
6
Discharge Status by Referral Source
(CADDS), 7/1/02 - 6/30/03
60 n
l).4i
8.5
18.6
c 40
5
V.3i
O)
O
c
42^6
42.9
^ 20
37^5;
34A
.35.0
.30.0
0
SACPA
Criminal justice
Noo-crimina)
SACPA
Criminal jmtke
Non-criiranal
(N = 1,903)
non-SACPA
justice
(N = 1,950)
(N = 28,749)
non-SACPA
justice
(N = 77,866)
(N = 2,444)
(N =38,615)
Statewide
Santa Clara County
0 Made satisfactory progress
O Completed treatment
(
i
County Variation in Completion Rates
for SACPA Offenders
(CADDS)
60 -|
38
3
5 40
36
C
3
O
tj
O
V
i 20
21
10
8
9
7
1
1
0
BO-25
7/1/01 - 6/30/02
7/1/02 - 6/30/03
(N-54)
{N-56)
Q 26 - 50
□ 51-75
0 76+
Note: Analysis for each year excluded counties where no SACPA clients had a discharge on r^^ord.
Prop 36; UCLA Year 4 Report
8
Median Length of Stay in Treatment
Among Treatment Completers by Modality
Santa Clara County
(CADDS),7/1/02 - 6/30/03
(N = 2,539)
300 -|
270'
243*
S 240
I 210 168*
- 180 -
° 150
J 29126)25
■3 120 c
cs
73
90 -
TD
S
55
60 ■
49
20*20*20
30 -
4* 0
4
0
0
0
0
0
OutpAtiriit
KeskleDtix)
Detox
□ SACPA
(W = 81<i)
KeskkDtbl
MelhadoM detox
Methadooe
maiDtcnasce
< 30 days
> 30 tbyx
B Noo-criminai justke
(N = 682)
B CrimiDal juslke ood-SACTA
(N= ),04J)
19
* Finiiings may be unreliable because numbers were small (e g-, between 1 and 4),
County Variation in Median Length of Stay
Among Outpatient Treatment Completers
(CADDS), 7/1/02 - 6/30/03
(N = 55)
30 -|
25 22
W)
c 20 3
17
a
o
o
14
15 ^
a>
§10
2:
5 2
0
) - )00
)0) -200
20) - 300
30) - 400
Note; In three counties, the number of outpatient treatment completers was too low for a reliable
estimate of length of slay.
Prop 36: UCLA Year 4 Report
10
New Arrests During 12 Months After Offense
(DOJ SACPA Offenders), July 2001 - June 2002
(Statewide N ^ 29,969)
80 -|
u 60
a>
c
a>
o
w
40 -
o
c
a>
u
a>
ffu 20
10.9
8.5
5.7
3.1
2.5
1.5
0
New drug arrest
0 Referred but untrcaled
New property arrest
CD Entered but did not complete treatment 0 Completed treatment
(N = 5,176)
(N = 14,597)
<N = 10,196)
New vioJenl anest
New Arrests During 12 Months After Offense
(DOJ SACPA Offenders), July 2001 - June 2002
(Santa Clara County N = 2,037)
80 n
63.6
64.6
2 60
a>
73
a>
41.9
o
40
o
c:
u
u
0^ 20
15.0
11.9
7.0
0
3-7
m
New drug arrest
New property arrest
3.7
1.7
New violent arrest
Q Referred but untreated CD Entered but did not complete treatment S Completed treatment
(N ==568)
Prop 36: UCLA Year 4 Report
(N = 984)
(N =485)
12
New Misdemeanor Arrests During 12 Months After Offense
(DOJ SACPA Offenders), July 2001 - June 2002
(Statewide N = 29,969)
40
<a>
■o
c
,a>
20^
o
^
o
21J
20
13.7
c
a>
o
L.
a>
I
Cu
0
New drug arrest
B Referred but uDtrealed
(N = 10,196)
3.0
2.4
1.7
13
13
0.6
IjgggOHHim.'
New property anesl
New viofent arrest
O Entered but did not complete treatment S Completed treatment
(N = 5,176)
(N = 14,597)
27
New Misdemeanor Arrests During 12 Months After Offense
(DOJ SACPA Offenders), July 2001 - June 2002
(Santa Clara County N = 2,037)
40
36.4
30.7
VO
U
<U
T3
,a>
O
20
17.3
o
c:
u
Cu
3-2
2.7
2.5
l.S
1.6
0-4
Mim
0
New property arrest
New drug arrest
D Referred but untreated
(N - 568)
New violent arrest
HI Entered but did not complete treatment S Completed treatment
(N = 984)
<N = 485)
28
Prop 36: UCLA Year 4 Report
14
Days of Primary Drug Use in Past 30
(SACPA Offender Survey)
(Santa Clara County N = 27)
10 a
9
8
^ 7
■o
6
o
V.
5
<i>
-D
4
s
3
Z 3-
IS,
2-3
2 -
13
1.1
0.9
1
0.0
0
A55e5sedbut untreated
(N-8)
Coinp^tcd trtatmrnl
(N = 4)
Enterrd but (Sdnot comptetr treatment
(N=-)5)
SPosI
DPre
31
Any Work in Past 30 Days
(SACPA Offender Survey)
(Statewide N = 753)
80 a
C
a>
53.9
60
2,b
XJ
c
b
<u
42.2
40.8*
o
40 o
32.9
29.5
29.8
c
(U
o
a>
20 -
0
Assessedbut ontreated
Entered but did not ci>Dif)tete
(N«177)
treabDtBt
Con^ted tTrabnenl
(N-146)
(N - 421)
0Pre
BPosI
• Group (liffercnccs are statistically signiricanl, p = .04. Alt three pre-post differences are staSStically
significant, p <.0001.
Prop 36; UCLA Year 4 Report
16
During 12 Months After Offense
Santa Clara County
1.9
2.6
iiiiiiiiiiiinii
■ SACPA eligible ofTenders
(N = 7,167)
offenders
35
New Felony Arrests During 12 Months After Offense
Statewide
40
to
u
TD
C
20.8
o
^ 20
c
cj
u
a.
4.6
0.9
M
0
New dreg
(I
QJ Comparison offenders
(N = 136,429)
Htw property vmt
Drw viokni urot
■ SACPA eUgiblc offenders
(N = 133,866)
36
Prop 36: UCLA Year 4 Report
18
New Misdemeanor Arrests During 12 Months After Offense
Santa Clara County
20
C/5
(1>
T3
C
,a>
o
o
c
a>
u
Cu
3.1
2.4
IJ
1.1
0
Hew drog VTT3I
HI Comparison otTeoders
(N = 6,927)
He-*' propoiy anrst
Hor viotrnt arresi
■ SACPA eligible ofTenders
(IN = 7,167)
39
r
I
Prop 36: UCLA Year 4 Report
20
Santa Clara County SACPA Client Outcomes Report
Page ii
This report is based on an assessment of Santa Clara County SACPA client outcomes,
undertaken for the County's Alcohol and Drug Services Research Institute and submitted
by Speiglman Norris Associates in June 2004 (County of Santa Clara contract number
4400000925). Richard Speiglman and Jean Norris can be contacted at(510)238-8432 or
rspeiglman@earthlink.net.
Deane Wiley, Acting Director, ADSRI,served as Project Manager and guided the
execution of the study. Hung Nguyen of ADSRI prepared the data, which were then
further developed by Speiglman Norris Associates. Martha Beattie, former Director of
ADSRI, also participated in the project. ADSRI is located at 976 Lenzen Avenue, San
Jose, California 95126. Dr. Wiley can be contacted at Deane.Wiley@hhs.co.scl.ca.us.
Santa Clara County SACPA Client Outcomes Report
Page iv
Executive Summary
Background
Proposition 36, the Substance Abuse Crime Prevention Act, passed in November 2000,
mandates that adults in California convicted of possession or use of illegal drugs be
offered substance abuse treatment in lieu of incarceration. A large number of adults
arrested for drug use are thereby directed into community-based treatment. Using
secondary data, this report examines outcomes for Santa Clara County SACPA clients in
the period following treatment completion. This is accomplished by comparing how
client statuses compare from one year prior to SACPA treatment entry to one year after
discharge from treatment.
In Santa Clara County, the County Executive’s Office, the lead agency for SACPA
implementation, convened a Steering Committee to plan the implementation of the
program.
Determination of SACPA eligibility is made by Santa Clara County’s District
Attorney’s office. If upon arraignment the offender pleads guilty to the offense, a
conviction is recorded; otherwise, a trial is scheduled. Less than one percent of those
pleading or found guilty refuse treatment and receive traditional sentencing.
Understanding that pre-sentence assessments give judges the maximum amount of
information on which to base sentencing, those convicted are, before sentencing, referred
for assessment by both the County Department of Probation and the County Department
of Alcohol and Drug Services(DADS). Assessments took place in custody for almost
half of SACPA-eligible offenders during the first year of operation, upon which this
study is based. Once assessed, offenders are sentenced, placed under probation
supervision and referred for treatment. Three-quarters of the offenders referred from the
courts receive treatment in the DADS treatment system. About ten percent are referred
for private treatment or to another county; the remaining fifteen percent either were not
matched between court and treatment databases, or, in violation of the judge’s order, do
not connect with treatment at all. About 15% of the most needy clients receive
residential treatment followed by outpatient services after stabilization, while over half
start in outpatient treatment. Smaller proportions are referred to case management or
psychoeducational services.
Method
The study defines a 9-month selection window for new SACPA client treatment
authorizations, from October 1,2001, through June 30, 2002(N = 1190). Data included
information on client demographic characteristics; alcohol and drug use; criminal justice
status; utilization of health, mental health, and alcohol and drug treatment services; and
receipt of social welfare benefits. Data were generated from databases compiled or
administered by the Santa Clara County Department of Alcohol and Drug Services
(DADS), Department of Mental Health, Health and Hospital System, Criminal Justice
Information Control (CJIC), and Social Services Agency.
Whenever data from more than one information system are used, there will be some cases
for which no match is found when it should be. For SACPA clients in the DADS
Santa Clara County SACPA Client Outcomes Report
Page vi
a level of use and level of care no greater than the previous use. Overall, 39% of the
sample had at least one return to treatment.
• Within one year of discharge, the initial return to treatment for 18% of the study
population was because they experienced a relapse.
• Within one year of discharge, the initial return to treatment for 21% of the
population was a maintenance return to treatment.
• Both relapse and maintenance returns for SACPA clients are more than double the
rates for clients served by DADS prior to SACPA implementation. Some of this
difference may be the result of closer scrutiny of the SACPA population, all
members of which are under the close supervision of the court and,for some
offenders, more intensive probation supervision than was utilized prior to
SACPA. Also since maintenance return is defined as a return to treatment, within
one year of discharge, with a level of use and level of care no greater than the
previous use, this can indicate a positive decision to return before a relapse takes
place.
Drug-Related Re-Arrests and Re-Arrest Rates Decline Significantlyfollowing Treatment
• Most(59%)SACPA clients committed at least one drug-related crime in the year
prior to SACPA treatment entry that resulted in an arrest. This figure is not the
expected 100% arrested for several reasons:
o
offenses culminating in a SACPA conviction may have occurred over a
year earlier due to criminal justice delays in arrests, criminal filings, and
convictions;
o
the amount of time between assessment and treatment entry was
sometimes quite lengthy; and
o
only 90% of the treatment clients were matched with criminal justice data
due to non-matching identifying information in the two databases.
During the treatment period, 5% of clients are reported to have at least one
offense resulting in a new, drug-related arrest. Recall that the treatment period is
only 3.4 months and thus a lower number would be expected.
In the year after treatment 22% experience such an arrest.
The rate of new, drug-related misdemeanor or felony arrests declines from .78 per
person before to .06 during and then increases to .27 after treatment. The rate
refers to the total number of arrests per person occurring during those time
periods.
Similar findings are evident for drug-related convictions for new offenses
occurring during those periods.
The entire DADS treatment population in the years before the implementation of
SACPA also shows high rates of arrests and convictions. In Fiscal Year 2000, the
year
before SACPA was introduced, 44% of clients had one or more arrests in the
year before treatment, and this dropped to 19% in the year after treatment.
Interestingly, the proportion arrested during treatment, 5%,is identical to the
proportion of SACPA clients arrested during the SACPA treatment period.
Time in Jailfor Drug-Related Offenses Is Greatly Reducedfollowing Treatment
Prevalence and rate ofjail time for drug-related misdemeanor and felony offenses closely
track findings for arrests and convictions.
Santa Clara County SACPA Client Outcomes Report
Page viii
benefits^ such as Food Stamps or cash assistance. Hence, even as treatment proves
successful and employment is secured, benefit rates may increase rather than deerease.
Third, all four indicators are sensitive to larger economic trends and to changes in
program rules, such as time limits for receipt of CalWORKs and Food Stamps. Limited
to these administrative data, it is difficult to define what a successful outcome would be
in a relatively short-term follow-up.
• CalWORKs benefits were provided to 3% of SACPA treatment clients in the year
prior to treatment and to 3% in the year following treatment.
• Food Stamps were provided to 5% of clients in the year before treatment and to
8% following treatment discharge.
• The prevalence of General Assistance receipt increased from 3% before treatment
to 6% in the after-treatment year.
• Receipt of Medi-Cal eligibility was unchanged at 7% in the year prior to
treatment and the year following treatment.
• SACPA clients are more likely to receive General Assistance than DADS clients
prior to SACPA. For the remaining public benefits, SACPA clients start off at
lower utilization than clients prior to SACPA and over the study period increase
utilization. The increase may be evidence of greater improvement for SACPA
clients, who demonstrate greater access to and/or use of these benefits.
Use ofMental Health Services, an Indicator ofPsychological Distress or Serious Mental
Disorder, Is Virtually Unchangedfrom the Year Before to the Year after Treatment
A useful, though imperfect, measure of well-being is receipt of county mental health
services. In a general sense, one can infer positive mental health among SACPA clients
by lack of contact with the mental health system. On the other hand, for persons who had
not been receiving services that were needed, we might infer that mental health would
improve if regular engagement with the mental health system were initiated or resumed.
• The prevalence of receipt of mental health services was 13% in the year prior to
SACPA treatment and 12% in the year following treatment, virtually unchanged.
• SACPA clients display less service use than previous DADS clients.
Use ofEmergency Room Services Declinesfollowing Treatment, while Outpatient
Utilization Increases
Improved physical health is often an objective of treatment services. Lack of
hospitalizations and emergency room visits provide an indirect, if imperfect, measure of
physical health. While outpatient visits may indicate ill-health they may also reflect
appropriate use of preventive and routine medical care. Thus, although we would expect
reduced numbers of emergency room visits, and perhaps hospital stays, following
substance abuse treatment, outpatient service utilization might increase as former clients
integrate routine and preventive care into their lives.
• Prevalence of emergency room visits declined slightly from 16% in the year prior
to treatment to 15% in the year following treatment.
• Rate of emergency room visits parallels prevalence, changing slightly from 0.26
per person per year pre-treatment to 0.24 following treatment.
Santa Clara County SACPA Client Outcomes Report
Page X
Policy Implications
Together, the data on arrests, convictions, and jail days suggest that treatment serves to
decrease risk for arrest and conviction - and probably engagement in - criminal behavior,
both that involving drugs and other criminal activity. The major finding is that treatment
works, as intended in policy, and works at least as well for SACPA clients as for DADS
clients in general. The treatment period is associated with fewer arrests, convictions, and
jail days than would otherwise be expected. Use of expensive and possibly unnecessary
emergency services decreases, and outpatient utilization increases, probably due to
education received during treatment.
The finding that criminal activity decreases following treatment is especially salient in
light of the relatively poor results for SACPA clients in the brief period after assessment
and before entry into treatment. Thus, we would suggest, efforts should be continued to
focus on providing for more rapid entry to treatment.
Limitations on interpretation of SACPA findings.
There are three factors limiting interpretation of these findings that we wish to note.
First, as mentioned above, we experienced an imperfect match between DADS and CJIC
databases. Ten percent of the eases were not matehed at all, and it is possible that some
“matches” were mis-matched due to wrong identifying information in one or both
systems.
Second, we rely on administrative data that were not collected for the purpose of
monitoring the outcomes examined in this study. There are problems with both over- and
under-counting. As an example of under-counting, as a measure of relapse returns to
substance abuse treatment misses both individuals experiencing a relapse who do not
return to treatment and those who, having relapsed, secure treatment outside the DADS
system. There are similar limitations with the mental health, emergency room, outpatient
services, and hospital data. Arrests, convictions, and jail days are also imperfect
measures, given their reliance on observation and action by the criminal justice system
and a catchment area that does not extend beyond the County’s borders. Much of the
problem is presumed inconsequential, however, insofar as the same limitations apply to
all time periods of interest. An important exception is discussed below. Hence, while
few of the health, hospital, and eriminal justice figures can be taken to represent absolute
prevalence or rate of services utilization, or need for services, comparisons of prevalence
and rate across time remain useful.
Extreme eaution must be used in interpreting one aspect of the criminal justice measures.
There is not a one-to-one relationship between acts of criminality and arrests or
convictions for those acts. Most crime goes unreported and undiscovered, and, among
crimes discovered, many result in no arrest and/or no eonviction. By definition, all
members of the SACPA client group had, relatively reeently, experienced at least one
arrest and conviction that resulted in a SACPA sentence. Hence, we would expect a
decrease in the percent of SACPA clients experiencing arrest, conviction, and jail days,
even if nothing changed in the individual client's drug behavior during or after treatment.
However, while many SACPA clients may have been under the watchful eye of Court
Page ]
SACPA Client Outcomes Study
1. Background
In recent years there has been an intensification of the policy debate over how United
States society should respond to users of illicit psychoactive drugs. One of the most
closely watched and potentially influential developments has been the implementation of
Proposition 36, the Substance Abuse and Crime Prevention Act(SACPA), which passed
in November 2000. This ballot initiative mandates that adults in California convicted of
possession or use of illegal drugs be offered substance abuse treatment in lieu of
incarceration. A large number of adults arrested for drug use are being directed into
community-based treatment, probably surpassing the number of persons entering
treatment through drug court. Counties have considerable discretion in how they
structure their systems of care and client management procedures for handling SACPA
clients.
The stated intent of the drafters of the initiative is to provide treatment as an alternative to
prison, and to address substance abuse as a matter of public health rather than criminal
justice.^ Counties confront delicate questions of how to prioritize limited funding for this
on-going program. While implementation studies have been completed or initiated at the
Public Health Institute, RAND and UCLA, no outcome study results are anticipated in
the near future.
Though not providing outcome results, findings from a study by User and colleagues^ is
of interest for its description of the SACPA treatment population in their five-county
evaluation. Compared with non-SACPA clients, the authors write, SACPA patients are
“more likely to be men, first-time admissions, treated in outpatient drug-free programs,
employed full-time, and users of methamphetamine or marijuana”(p. 479). Longshore
and colleagues'*, evaluating SACPA implementation statewide, report similar findings
concerning gender, first-time admissions, treatment modality, and the primacy of
methamphetamine.
With the approaching deadline for re-funding SACPA, it is appropriate to examine the
efficacy of SACPA procedures and treatments as data become available. Process
measures and outcomes of interest should include treatment completion versus dropout.
^ Marlowe et al. term Proposition 36 post-adjudication “low-intensity, non-judicially managed diversionary
intervention”(p. 216). Marlowe, D.B., Elwork, A., Festinger, D.S., and McLellan, T. (2003). “Drug
policy by popular referendum: This, too, shall pass”. Journal of Substance Abuse Treatment. 25(3): 213221.
’User, Y-L, Teruya, C., Evans, E.A., Longshore, D., Grella, C., and Farabee, D.(2003). “Treating drugabusing offenders. Initial findings from a five-county study on the impact of California’s Proposition 36 on
the treatment system and patient outcomes”. Evaluation Review, 27(5): 479-505.
'* Longshore, D., Evans, E., Urada, D., Teruya, C., Hardy, M., Hser, Y-L, Prendertgast, M., and Ettner, S.
(2003). “Evaluation of the Substance Abuse and Crime Prevention Act 2002”. Report. “Implementation:
July 1, 2001 to June 30, 2002”. Los Angeles: Integrated Substance Abuse Programs, UCLA,July 7.
Santa Clara County SACPA Client Outcomes Report
Page 3
2. Project goals
The mode! for the SACPA study is an ADSR! examination of Department of Alcohol and
Drug Services(DADS)client outcomes over the FY 1997 - 1998 - FY 2000 - 2001
period, reported in “Outcome Evaluation ofthe Department ofAlcohol and Drug
Services Using Performance Jndictorsfrom Secondary Data”^ (hereinafter, the previous
ADSRI study). In that study, ADSRJ used several sources of administrative secondary
data to monitor client outcomes and infer DADS program success.
The primary project goal is to describe outcomes for SACPA clients in the first
year of SACPA implementation (July 2001 - June 2002).
The second goal is to compare SACPA client outcomes with those for the
entire DADS population in the year prior to SACPA implementation by
reporting similar evaluation data on selected client characteristics and
outcomes.
•
The third project goal is to assess the usefulness of various indicators and data
on client characteristics for multivariate modeling, and to generate preliminary
multivariate models intended to identify predictors of success for the treatment
system. Progress on this goal will be reported in a subsequent report.
The primary and secondary research questions are:
•
How do client outcomes compare before/during/after the SACPA client’s
treatment experience; that is, from one year prior to SACPA treatment entry,
through the period of treatment, to one year after discharge from treatment?
•
How does SACPA appear to be changing the characteristics of the DADS
treatment population overall?
Given the goals and research question, the population of interest is SACPA clients ofthe
Department of Alcohol and Drug Services, Santa Clara Valley Health and Hospital
System.
In Santa Clara County, the County Executive’s Office, the lead SACPA agency,
convened a Steering Committee to plan the implementation of the program.
Determination of SACPA eligibility is made by Santa Clara County’s District Attorney’s
office. If upon arraignment the offender pleads guilty to the offense, a conviction is
recorded; otherwise, a trial is scheduled. Less than one percent of those pleading or
found guilty refuse treatment and receive traditional sentencing. Those convicted are,
before sentencing, referred for assessment to both the Department of Probation and the
Department of Alcohol and Drug Services(DADS). While most counties assess postsentencing, the Steering Committee decided upon pre-sentence assessments in order to
^ Alcohol and Drug Services Research Institute, July 24,2003. Project Director: Martha C. Beattie, Ph.D.;
Project Manager: Hung Nguyen, M.S. Available at htlp://w\vw.sccdads.org/ under Evaluation and
Research Reports.
Santa Clara County SACPA Client Outcomes Report
Page 5
maintenance-only cases(N = 7) were excluded as unlikely to complete treatment in an
18-month treatment period, the maximum length of stay permitted within the evaluation
format. In total, 344 cases were excluded from analysis, some for more than one reason.
Project data. Data used for this project include information on client demographic
characteristics; alcohol and drug use; criminal justice status; utilization of health, mental
health, and alcohol and drug treatment services; and receipt of social welfare benefits.
Data were generated from data bases compiled or administered by the Santa Clara
County Department of Alcohol and Drug Services(DADS), Department of Mental
Health, Health and Hospital System, Criminal Justice Information Control (CJIC), and
Social Services Agency. Treatment records include information on participation in
detoxification, outpatient, and residential alcohol and drug services; mental health
services; and medical care episodes in the hospital emergency room, inpatient, and
ambulatory clinic care. Criminal justice records include arrest, conviction, and jail
incarceration data on drug-related and other offenses. Social services records provide
information on receipt of public assistance and other benefits, including CalWORKs,
General Assistance, Food Stamps, and Medi-Cal.
Data preparation. For comparability between this study and the previous work on
DADS clients, ADSRJ staff performed coding of arrests and convictions as “new” and
“drug-related” or “non-drug-related”, following the protocols used in the previous study.
Likewise, ADSRl staff coded episodes associated with hospitalizations, emergency room
use or outpatient medical or mental health care following similar or identical decision
rules as used in the DADS report.
ADSRl matched information across data systems with data on individuals assessed by
DADS for SACPA treatment referral. To accomplish this, ADSRl created unique
identifiers recognized across data systems for each assessment client. ADSRl then
selected individual cases meeting the SACPA study selection window criteria and
identified relevant data within each individual’s before, during, or after treatment
periods.(Study time periods are further described below). In addition, to enable
examination of client experience between assessment and before treatment, ADSRl
selected relevant data falling within periods called before and after assessment. After
ADSRl prepared the data, a file stripped of personal identifiers was provided to
Speiglman Norris Associates(SNA),for further analysis and report preparation.
Human subjects review. Because all personal identifiers were stripped from the
working data files provided to Speiglman Norris Associates, the Institutional Review
Board of the Santa Clara County Public Health Department declared the project exempt
from IRB review under federal regulations. Data from the multiple administrative data
sources were linked by ADSRl staff using a random numeric identifier for each case, and
SNA received data with only this fictitious case identifier.
Decision rulesfor identifying dates and defining before, during and after periods.
Periods of interest include:
Santa Clara County SACPA Client Outcomes Report
Page 7
been married. Although the group is racially heterogeneous, together, Latino/Hispanics
and Non-Latino Whites comprise 81.9% of the group, with Blacks/African Americans
accounting for another 8.4%. Mean years of education is 11.4; median, 12. Almost all
members of the group (89.9%)report English as their preferred language, with 7.6%
selecting Spanish.
In comparison, the treatment population in the year prior to SACPA’s introduction was
somewhat less likely to be male (67%), but on other demographic characteristics it is
quite similar.
Table 1. Demographics
Frequency
Percent
Female
295
24.8
Male
895
75.2
Total
1190
100.0
740
62.2
Gender
Marital status
Never married
Now married
149
12.5
Divorced/separated/widowed
290
24.4
Unknown
Total
Race/ethnicity
Latino/Hispanic
11
.9
1190
100.0
544
45.7
Non-Latino White
431
36.2
Black/African American
100
8.4
6.4
Asian/Pacific Islander
76
Native American
20
1.7
Other
19
1.6
Total
1190
100.0
Education
Mean
Median
Preferred language
English
Spanish
11.4 years
12.0 years
1070
89.9
91
7.6
Asian/Indo-Chinese
14
1.2
Other/unknown
15
1 .3
1190
100.0
Total
Page 9
Santa Clara County SACPA Client Outcomes Report
Figure 1. Time between Assessment and Treatment
(values greater than 4 displayed = 4.0)
400
o
c
Q>
3
CT
a>
4.00
Months
During Treatment Period. Table 3 provides summary statistics for the period of
time from first treatment contact under the SACPA authorization until discharge date,
operationalized as the last treatment contact under the same authorization. As is evident,
while mean and median length of time in treatment are each about 3.5 months, the range
of time in treatment-from 0 months(6.8% of cases with less than one full day in
treatment) to 10 months or more(2% of cases)- suggests great variety probably both in
the clinical and the legal role played by treatment.'^
13
If we distinguish between persons whose treatment followed an assessment within the study selection
window,from those whose treatment began before the selection window, we find noteworthy differences.
For cases in which treatment entry followed assessment(N = 1093), median length oftime in treatment is
3.3 months. For cases in which treatment entry preceded assessment(N = 96), median length oftime in
treatment is 4.8 months. Recall that the selection window avoided the earliest SACPA clients because their
characteristics, or course through SACPA, were thought likely to differ from later clients. Although the
number of persons with treatment beginning before the study selection window is small, their longer
duration of treatment suggests that their SACPA experiences may indeed differ.
Santa Clara County SACPA Client Outcomes Report
Page 11
return before a relapse takes place. Figure 2 depicts those outcomes: as measured by the
first return to treatment in the DADS system. Within one year of discharge, 1 8.0% of the
study population experienced a relapse, while 21.1% recorded a maintenance return to
treatment.
Table 4. Levels of Care
Level of care
Treatment Modality
Detoxification
Residential
Case management
Intensive outpatient
Motivational enhancement
2
Outpatient drug-free
Transitional housing
Psychiatric services
Aftercare
3
Psycho-education
Figure 2. Returns to Treatment
70.0%
60.0%
50.0%
40.0%
30.0%
21.1%
18.0%
20.0%
15'
lift!
»
m
iisjswwsa
w.
10.0%
11
0.0%
Relapse
Maintenance Return
Santa Clara County SACPA Client Outcomes Report
Page 13
The 59.2% figure for before treatment drug-related arrests is surprising. Certainly, before
a SACPA conviction, all SACPA treatment clients should share the criminal history
fact” of having experienced an arrest for at least one SACPA offense. In fact, since our
definition of“drug-related” arrest is broader than the set of offenses defined by law as
SACPA offenses (for example, drug sales are drug-related but are not SACPA offenses),
arrest rate findings depicted in Figure 4 could and might be expected to surpass 1.0.
(C
Figure 4. Arrest Rate for New Misdemeanor/Felony
Drug-related Offenses Before, During and After Treatment
0.90
0.78
0.70
0.60
'im
n
0.50
(0
Q)
< 0.40
0.27
0.30
|i
iS
0.20
0 nfi
0.10
0,00
Before treatment
During treatment
After treatment
However, given criminal justice delays in arrests, criminal filings, and convictions and
delays resulting from defense motions, it appears that some offenses, arrests, and
convictions may have been taken place prior to the one-year period before treatment
entry. Some of this delay may accumulate from the time between assessment and
treatment entry. Finally, administrative data mismatch between treatment clients and
criminal Justice participants explains some of the difference between 59.2 and the
expected 100 percent since 10% of the clients could not be matched to their criminal
Justice data.’’
Similar findings are evident for drug-related convictions for new offenses. With
conviction defined as a finding of guilt resulting from the arrest examined, by definition
conviction prevalence and rate must be no greater than corresponding arrest prevalence
and rate.
17
In this regard, it should be noted, conviction prevalence and rate may be further under-counted due to
procedural delays.
Santa Clara County SACPA Client Outcomes Report
Page 15
of SACPA clients have some jail time in Santa Clara County in the one-year period prior
to treatment. That proportion declines to 4.3% in the during-treatment period and rises to
20.3% in the year after treatment (Figure 7). From the before- to the during-treatment
period, the mean number ofjail days drops from 23.8 to 2.0 and rises to 12.2 days in the
after-treatment year (Figure 8).
Together, the data on arrests, convictions, and jail days suggest that treatment serves to
decrease risk for arrest and conviction - and probably engagement in - criminal behavior
involving drugs.
Figure 7. Percent of Clients with Any Misdemeanor/Felony
Jail Days for Drug-related Offense Before, During, and
After Treatment
70.0%
60.0%
-55^%
50.0%
40.0%
30.0%
-2Cr3%
20.0%
10.0%
0 0%
Before treatment
During treatment
After treatment
Figure 8. Mean Number of Misdemeanor/Felony Jail Days for Drug-Related
Offenses Before, During, and After Treatment
300
23.8
25.0
§
K
20.0
(/)
si
to
Q
15.0
I
11^6
re
10.0
i
5.0
>1
I!m
00
k*
3^
\U
Ir
s
Before treatment
2.0
iiigaiai
During treatment
After treatment
Santa Clara County SACPA Client Outcomes Report
Page 18
Figure 11. Percent of Clients with Any Misdemeanor/Felony Jail
Days for Drug-related Offenses Before and After Assessment
70.0%
60,0%
500%
40.0%
30.0%
20.0%
5.6%
100%
0.0%
Before assessment
After assessment
Figure 12. Mean Number of Misdemeanor/Felony Jail Days for
Drug-Related Offenses Before and After Assessment
30,0
25.0
25.0
20,0
(/>
re
Q
15.0
re
10.0
5.0
2.3
0.0
Before assessment
After assessment
Santa Clara County SACPA Client Outcomes Report
Page 19
4b. Care for oneself financially
Difficulty securing and keeping work may be one indicator of a problem with alcohol and
other drugs. Therefore, preparing for and gaining productive work is often a goal of
treatment. While our dataset lacks direct measures of employment and work-related
income, it does include information about receipt of four forms of public benefits.
CalWORXs and General Assistance provide cash and Food Stamps a quasi-cash form of
assistance for impoverished persons. Medi-Cal constitutes a health insurance program
for poor Californians.
Three important considerations need to be stated before we examine findings in this area.
First, initial treatment success may result in increased utilization of public benefits.
Whether because of abuse of alcohol or other drugs, because of lack of information, or
personal or familial disorganization, many individuals presumptively eligible for benefits
either do not acquire them or lose them because of failure to comply with paperwork and
other requirements. Upon treatment entry, counselors and case managers would may
urge eligible clients to apply for these benefits. Second, even for those finding work, low
wages from entry-level jobs may not eliminate eligibility for means-tested benefits, such
as Food Stamps or cash assistance. Hence, even as treatment proves successful and
employment is secured, benefit rates may increase rather than decrease. Third, all four
indicators are sensitive to larger economic trends and to changes in program rules, such
as time limits for receipt of CalWORKs and Food Stamps. Accordingly, limited to these
administrative data, it is difficult to define what a successful outcome would be in a
relatively short-term follow-up.
CalWORKs benefits were provided to 2.7% of SACPA treatment clients in the year prior
to treatment (see Figure 13). During treatment the prevalence dipped slightly, to 1.8%.
In the year following treatment 2.8% of clients received CalWORKs cash assistance.
Santa Clara Count)’ SACPA Client Outcomes Report
Page 21
The prevalence of General Assistance receipt remained level at 3.4% in the before- and
during-treatment periods and increased to 5.7% in the after-treatment year (see Figure
15).
Figure 15. Percent of Clients Receiving General Assistance
Benefits Before, During, and After Treatment
250%
!
20.0%
15.0%
-c.0%
5.7%
3.4%
3.4%
5.0%
Pig
m
.1
0.0%
Before treatment
During treatment
1
After treatment
Surprisingly, receipt of Medi-Cal eligibility dropped from 6.6% in the year prior to
treatment to 4.S% in the during-treatment period before increasing to 7.1% following
treatment (see Figure 16).
Figure 16. Percent of Clients Receiving Medi-Cal Benefits
Before, During, and After Treatment
25.0%
20.0%
15.0%
10.0%
6.6%
5.0%
as
ass
0.0%
Before treatment
During treatment
After treatment
Santa Clara County SACPA Client Outcomes Report
Page 23
Figure 18. Rate of Mental Health Service Episodes Opened
Before, During, and After Treatment
0.40
0.34
0,35
7
0.32
1^
0.30
0.25
1
0.20
0.15
m
m
leal
■M
msa; •
I
0.12
0.10
0.05
0.00
Before treatment
During treatment
After treatment
4d. Physical health
Improved physical health is often an objective of treatment services. Lack of
hospitalizations and emergency room visits provide an indirect, if imperfect, measure of
physical health. On the other hand, outpatient visits may indicate ill-health or may reflect
appropriate use of preventative and routine medical care. Thus, while we would expect
reduced numbers of emergency room visits and hospital stays following substance abuse
treatment, outpatient service utilization might increase as former clients integrate routine
and preventative care into their lives. Figures 19 through 25 display prevalence and rate
statistics for the three types of health and hospital service utilization.
As displayed in Figure 19, prevalence of emergency room visits declined from 16.3% in
the year prior to treatment to 7.6% during treatment and increased to 14.9% in the year
following treatment. Rate of emergency room visits has a parallel decline from before to
during treatment. Likewise, the after-treatment rate remains slightly lower than the
comparable before-treatment figure (Figure 20). Prevalence and rate of emergency room
visits during treatment is surprisingly large, given that median length of treatment is
substantially less than half of a year.
Santa Clara County SACPA Client Outcomes Report
Page 25
Figure 21. Percent of Clients with Inpatient Stays Before, During, and
After Treatment
25.0»A
I
I
)
20 0%
15 0%
'1
100%
5.0%
3.2%
1.7%
oo%
li
i
Before treatment
*
mm
During treatment
i
After treatment
Figure 22. Rate of Client Inpatient Stays Before, During, and After
Treatment
0.25
f
I
0.20
c
CL
c 0.10
0.05
0.05
0.04
0.02
0.00
Before treatment
During treatment
After treatment
When comparing before- to after-treatment periods, outpatient utilization increased in
prevalence and rate (Figures 23 and 24). In the year before treatment, 19.5% of SACPA
clients used outpatient services at Valley Medical Center ambulatory care sites.
Prevalence declined to 13.4% during treatment and increased to 23.5% in the year
following treatment. Before- to after-treatment rates show an even bigger increase, rising
from .31 visits per person-year before treatment to .68 visits per person-year following
treatment. Further analysis would be necessary to discover whether or not this increase
in rate is due to increased routine and preventative care.
Santa Clara County SACPA Client Outcomes Report
Page 27
that may be associated with substance abuse. Violent offenses and property crimes, for
example, may be part of a life pattern involving substance abuse. Therefore, we report on
prevalence and rate for all new misdemeanor and felony arrests, convictions associated
with those arrests, and associated jail days, whether drug- or non-drug-related.
Generally, the patterns in the figures that follow resemble those for drug-only arrests,
convictions, and Jail days, though on a larger scale.
The prevalence of total new arrests declines from 74.7% in the year before treatment to
13.5% in the during-treatment period and 42.6% after treatment (Figure 25). Arrest rates
follow, declining from 1.39 per person-year before treatment to .17 per person during the
treatment period and increasing to .69 per person-year following treatment (Figure 26).
Figure 25. Percent of Clients with New Drug- and/or NonDrug-Related Arrest for Misdemeanor/Felony Before, During
and After Treatment
90.0%
74.7%
80.0%
70.0%
''Am'
60.0%
IV;
50.0%
42.6%
40.0%
30 0%
ii
IIP
, If
20.0%
13.5%
t).0%
I
*
w
m
0.0%
Before treatment
During treatment
After treatment
Santa Clara County SACPA Client Outcomes Report
Page 29
Figure 28. Rate of Misdemeanor/Felony Drug- and/or Non-Drug-Related
Convictions for Arrests
Before, During and After Treatment
4
3.32
3.5
3
WM
U) 2.5
O
1.81
.2
2
>
c
o
O
1.5
m
i-r
1
■
0.41
m
ii
0.5
0
i)
j
*
tl
P*?!
Before treatment
During treatment
After treatment
The proportion of clients with days in jail for any misdemeanor or felony drops from
71.3% in the year before treatment entry to 10.3% during the treatment period and 36.5%
in the year following treatment (Figure 29). In the same three periods rate ofjail days
varies from 37.8 jail days per person-year before treatment to 5.8 days per person during
the treatment period to 25.7 days per person-year post-treatment (Figure 30).
Figure 29. Percent of Clients with Any Drug- and/or
Non-Drug-Related Misdemeanor/Felony Jail Days
Before, During, and After Treatment
80.0%
71.3%
70.0%
%
60.0%
id'
1“
50.0%
36.5%
40.0%
30.0%
ii
20.0%
10.3%
j
ise«
10.0%
i
I
0.0%
Before treatment
During treatment
After treatment
Santa Clara County SACPA Client Outcomes Report
Page 31
tends to decrease apparent differences between DADS and SACPA clients even though
the SACPA treatment was a new episode of care.
In the following, we compare SACPA client outcomes with DADS client outcomes from
the closest time period to this study, FY 2000 - 2001. The FY 2000- 2001 findings may
be found at www.sccdads.org. Evaluation and Research Reports, “Outcome Evaluation of
the Department ofA Icohol and Drug Services Using Performance Indictorsfrom
Secondary Data
• Both relapse and maintenance returns are more prevalent for SACPA as
contrasted with the DADS population generally. Some of this difference may be
the result of closer scrutiny of the SACPA population, all members of which are
under the close supervision of the court and, for some offenders, more intensive
probation supervision than was utilized prior to SACPA.'*
• Comparing before and after criminal justice measures available for both groups,
SACPA clients start off looking worse but also demonstrate more improvement,
compared to FY 2000- 2001 DADS clients. Some of the positive change
attributed to the SACPA population may be more overstated than that attributed to
the DADS population, however, in light of statistical tendencies for population
data to regress to the mean.(For more detail, see discussion under “limitations”
below.)
^— ..
• On three ofthe four financial stability indicators, SACPA clients start off at lower
utilization of public benefits and over the study period increase utilization. This
may be evidence of greater improvement for SACPA clients, who demonstrate
greater access to and/or use of these benefits.
• On the two mental health measures, SACPA clients display less service use,
compared to the DADS population. Utilization among both groups decreases
over time, less so for the SACPA than the DADS group
• For the physical health dimensions, greater variation is evident. SACPA clients
utilize hospital, emergency room, and outpatient services less than do DADS
clients overall. However, when comparing change in service use, SACPA clients’
use of outpatient and inpatient services increases at a faster rate compared to
members of the DADS population. Emergency room visits decline for SACPA
clients but increase for DADS clients in the FY 2000-2001 cohort.
While Santa Clara County SACPA clients may have more direct contact with the court than with
Probation, the point made by Marlowe et al.(2003)would appear relevant: Most probationers “fail to
comply with their release conditions for probation including drug testing, attendance at drug treatment, and
avoidance of criminal activity [references].” Intensive, supervised probation is associated with the worst
outcomes, precisely because supervision is closer. Marlowe et al.(2003), p. 214.
Santa Clara County SACPA Client Outcomes Report
Page 33
Finally, extreme caution must be used in interpreting one aspect of the criminal justice
measures. There is not a one-to-one relationship between acts of criminality and arrests
convictions for those acts. Most crime goes unreported and undiscovered, and, among
or
discovered, many result in no arrest and/or no conviction. By definition, however.
all members of the SACPA client group had, relatively recently, experienced at least one
crimes
arrest and conviction that resulted in a SACPA sentence. Hence, we would expect a
decrease in the percent of SACPA clients experiencing arrest, conviction, and jail days,
if nothing
changed in the individual client’s drug behavior during or after
19
even
treatment.
Some of these limitations will be addressed as we begin work on predictive models that
can control for a number of important variables.
9. Next steps
What next? In addition to the multivariate studies, next steps could include (1) a larger or
longer-term comparative study including the collection of prospective data for this or
newer SACPA cohorts, as well as data on the remainder, or a comparison subset of,
DADS clients, and (2)studies examining the SACPA cost savings attributable to DADS
treatment.
19
Prevalence could not increase beyond 100%,and statistics such as this tend to regress to the mean.
Hence, to demonstrate success for the SACPA treatment program, we would need to find prevalence and
rate figures lower than those projected through a sophisticated analytical process.
Document
Memoranda regarding the implementation of Proposition 36 on the following recommendations: 1) Adopt the resolution designating the Office of the County Executive as lead agency for implementation of Proposition 36, the Substance Abuse and Crime Prevention Act of 2000; 2) Adopt the resolution forming a steering committee to monitor implementation and provide guidance on policy issues pertaining to implementation of the Act
Collection
James T. Beall, Jr.
Content Type
Memoranda
Resource Type
Document
Date
04/13/2006
Creator
Sandra Nathan, Deputy County Executive
Language
English
Rights
No Copyright: http://rightsstatements.org/vocab/NoC-US/1.0/