Here we are in the middle of September and still no budget in sight. Just when you think things couldn’t get worse, they do. We have many staff members who are planning to retire and we now have a hiring freeze in place which means none of those jobs can be filled. No hiring, no promotions, no transfers. Yet despite all of this, our Department continues to churn out impressive accomplishments.
One of our major focuses is Health Care Reform (HCR). Things are moving very quickly. Even though many aspects of reform will not be implemented until 2014, the planning must begin now at the state level and among treatment providers if we hope to gain as much as we can from HCR.
The learning curve for our field is great. Issues that we need to address, among others, include:
Secretary Belshe has initiated a series of internal work groups and focused conversations involving all of the departments in CHHS, so that we can create for the incoming administration a summary of HCR preparation needed to work on and blue prints for recommended next steps. Workgroups in which our Executive Staff will be participating are:
These are exciting times for our field and the opportunities are great. Having worked in the AOD field for over 30 years, I see what were previously only dreams beginning to look possible with HCR.If you have thoughts and suggestions for topics you would like to see covered or for making FOCUS more helpful to you, please let us know. Your can reach Suzi Rupp, our PIO and Editor, at email@example.com.
September marks the 21st anniversary of the National Alcohol and Drug Addiction Recovery Month and California’s counties and providers are celebrating in a big way. Thousands of people in recovery are gathering in communities large and small for picnics, speeches, walk-a-thons, motorcycle and bike rallies, bowling tournaments, and information fairs.
The statewide celebration was launched September 1 on the steps of the State Capitol building in Sacramento with a tremendous kick-off event, “Recovery Happens 2010,” planned and presented by the California Association of Addiction Recovery Resources and sponsored by ADP.
ADP released a comprehensive announcement of statewide Recovery Month activities to all major media in California, alerting local press to events in their area. You’ll find a schedule of statewide events on ADP’s special Recovery Month webpage at www.adp.ca.gov/director/recovery_month.shtml
Join staff of the Department of Alcohol and Drug Programs, the ARC of California, and the California Fetal Alcohol Spectrum Disorders Task Force on September 9 at an information faire and rally on the west steps of the State Capitol. The 9th day of the 9th month is targeted each year to bring attention to the devastating effects of prenatal exposure to alcohol. For more information, see the featured story, “Those Critical Nine Months,” in this issue or visit the Women’s Page on ADP’s website www.adp.ca.gov/.
Save the date for SAMHSA’s Webinar discussing the implications of the Affordable Care Act on the behavioral health system. The passage of the Affordable Care Act has ensured that the role of behavioral health in the overall health care system will change.
Now, it is more important than ever to know how health care reform will affect you and your role, as well as the roles of states, behavioral health care providers, and consumers.
Participants will learn:
More information will soon be available on the SAMHSA website www.samhsa.gov
Hilton Hotel, Sacramento
One way to get prescription drugs out of medicine cabinets and away from those who misuse them is to give them back! ADP is supporting this year’s effort by the U.S. Drug Enforcement Administration and its partner organizations in the first National Prescription Drug Take-Back Day. Read more in the featured article in this issue.
Irvine Marriott, Irvine, California
The Department of Alcohol and Drug Programs’ Training Conference is set for Tuesday through Thursday, October 12-14, at the beautiful Radisson Hotel Sacramento. The deadline to reserve your hotel room at the discounted rate is Wednesday, September 11, 2010.
We have secured a block of rooms for Monday, October 11 through Wednesday, October 13 at a special discounted rate of $75 single occupancy, $95 double occupancy, $115 triple occupancy, and $135 quadruple occupancy (plus applicable local and state taxes).
After the September 11 cut-off date, rooms will be available on a first-come, first-served basis at the prevailing hotel room rate.
Make your reservation by calling the Radisson Hotel Sacramento directly at (916) 922-2020 or (888) 333-3333 and mention that you are attending the California Department of Alcohol and Drug Programs Training Conference. The hotel requires first night’s deposit or a credit card to guarantee room reservations. Please note: No-shows will be charged the contracted nightly rate (and tax) for the first night of the reservation.
The Radisson Hotel Sacramento is conveniently located just five minutes from the California State Capitol and a short drive from many local attractions. Guests enjoy the convenience of complimentary Internet access, an on-site fitness center, and outdoor pool and spa.
The conference planning committee has lined up an outstanding array of keynote speakers and workshop presenters. They carefully selected diverse and relevant workshops to help prepare our field for health care reform, an issue at the top of everyone’s agenda this year. Among your many workshop choices, you can learn how to work effectively with veterans; establish and implement Screening, Brief Intervention, and Referral to Treatment (SBIRT); empower and engage immigrant parents in substance abuse prevention; address substance use and abuse in older adults; or how to use the Dual Diagnosis Capability in Addiction Treatment to assess co-occurring disorders treatment capability.
Don’t miss this opportunity to advance your knowledge and earn continuing education units. Act now to save money on room costs. Hope to see you at the conference!
Get more information at http://www.cce.csus.edu/conferences/adp/10/details.htm
Whooping Cough Epidemic
On June 23, the California Department of Public Health (CDPH) issued a warning about whooping cough (pertussis) as follows: “Whooping cough is now an epidemic in California…children should be vaccinated against the disease and parents, family members, and caregivers of infants need a booster shot” [See: http://www.cdph.ca.gov/Pages/NR10-041.aspx].
This current epidemic of whooping cough brings added responsibility for all AOD program directors and staff to be knowledgeable about whooping cough immunization and actions to assist clients to seek medical evaluation and treatment when necessary.
Whooping cough is a highly contagious disease and unimmunized or under-immunized infants are particularly at risk. Please review the critical information listed below and share with your AOD treatment and recovery services providers.
During this serious epidemic, we recommend sharing information, staying up-to-date on whooping cough-related recommendations from the CDPH, and maintaining communication with your local health department activities. Links to in-depth public health information on whooping cough are included below. Your actions will help keep clients and the AOD workforce healthy during this epidemic.
Who is recommended to receive the vaccination against whooping cough? Per the CDPH:
How can whooping cough be prevented?
Actions that we recommend AOD providers take:
What level of preparedness should be in place in an AOD program to respond to an epidemic like this one we are experiencing with whooping cough?
The California Department of Public Health website on whooping cough:
The CDPH June 23, 2010 press release on whooping cough:
Center for Disease Control and Prevention webpage on whooping cough is:
Department of Alcohol and Drug Programs
When alcohol and substance users enter treatment programs, they have costly, difficult to treat conditions. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an early intervention approach to modify risky behaviors before they exacerbate. In 2003, California was selected as one of seven states to receive funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) for a national SBIRT demonstration project. Under a 5-year cooperative agreement, the California Department of Alcohol and Drug Programs (ADP) received a $17.4 million ($3.5 million annually for five years) federal grant to demonstrate the viability and efficacy of integrating routine SBIRT services in various healthcare settings, including trauma centers, emergency departments, and primary health clinics. The California SBIRT (CASBIRT) grant is currently managed by San Diego County Alcohol and Drug Services and administered by the San Diego State University Research Foundation. In 2008, ADP expanded the grant by contracting with Los Angeles County to provide SBIRT services to short-term detainees upon their release from the Los Angeles County or city jails. This demonstration project is a collaborative partnership between the Los Angeles County Department of Public Health, and the County Sheriff’s and City Police Departments.
San Diego CASBIRT targets the general population during visits to primary care medical settings. CASBIRT improves long-term individual health outcomes and the health and safety of the community-at-large by identifying and addressing problems before they become societal issues. It also reduces healthcare costs resulting from fewer accidents and visits to trauma and emergency rooms. Los Angeles CASBIRT targets short-term detainees (released within 96 hours of arrest) as they are released from holding. Non-dependent but at-risk users are identified and then given an on-the-spot motivational intervention to reduce their consumption and, if needed, are referred to community services.
This month, the CASBIRT grant comes to a close. The August 19th meeting of the Governor’s Prevention Advisory Council (GPAC) at ADP focused on CASBIRT efforts in the state and showcased the accomplishments of the CASBIRT grant. Representatives from the San Diego and Los Angeles projects presented lessons learned, integration of technology in the projects, and the importance of effective partnerships in the success of their efforts. Representatives from the University of California, Los Angeles, presented the statewide training initiative and project evaluation. ADP’s Chief Deputy Director Michael Cunningham and Tim Cermak, president of the California Society of Addiction Medicine facilitated a thoughtful and productive roundtable discussion to finalize SBIRT recommendations for the state.
ADP staff presented a slide show demonstrating an online SBIRT toolkit, which was developed by the GPAC subcommittee. The toolkit offers a wealth of information on SBIRT services including screening tools, information on motivational interviewing techniques, and information about SBI in specific settings. To access the toolkit, please visit http://www.adp.ca.gov/SBI/screening.shtml
The GPAC CASBIRT project subcommittee recommended that policy be changed regarding the Uniform Accident and Sickness Policy Provision Law (UPPL). UPPL had the direct effect of discouraging screening of trauma patients for alcohol and other drug problems, since a positive screen could lead to denial of coverage for those seeking medical attention. In September 2008, the Governor signed legislation to repeal UPPL, lifting a significant barrier to implementing SBIRT services.
The CASBIRT subcommittee also recommended that all state-funded healthcare and medical insurance include SBIRT services as a routine component of care for adult and adolescent patients in emergency department and trauma centers, in prenatal and student healthcare settings, and for the parents of patients in pediatric healthcare settings. SBIRT addresses substance use in patients in a variety of healthcare settings by screening and providing appropriate interventions, brief treatments, and referrals.
A third recommendation asking that SBIRT services be adopted as a standard of practice for early detection of, and intervention in, high-risk alcohol and other drug use at all university, college, and community college student health and counseling centers in California will be presented for consideration to the California Medical Associationat its annual meeting in October
The GPAC CASBIRT subcommittee will continue to meet periodically to develop policy recommendations on SBIRT services.
Fetal Alcohol Spectrum Disorders Awareness Day
Every year on the ninth day of the ninth month of the year, the Department of Alcohol and Drug Programs joins members of the California Fetal Alcohol Spectrum Disorders Task Force to recognize Fetal Alcohol Spectrum Disorders Awareness Day.
There is a reason that September 9 is the day chosen to focus attention on the severe consequences of prenatal exposure to alcohol—the ninth day of the ninth month helps focus attention on the fact that the nine months that a woman is pregnant is critical in the development of her child.
Fetal Alcohol Syndrome (FAS) is 100 percent preventable, but the disabilities caused by FAS are incurable. It is the leading cause of mental retardation in the United States and causes a number of physical disorders, such as kidney, heart, and muscular defects.
Unfortunately, many women are unaware that they are pregnant until many weeks—or months—into their pregnancy. Consequently, they don’t take precautions to protect their fetus. Significant brain development occurs throughout pregnancy and exposure to alcohol during this period causes memory, learning, attention, and sensory disorders, among a list of many other defects.
It is critically important to reach women before they get pregnant. If a mother-to-be refrains from drinking alcohol of any kind in any amount during her entire pregnancy, she can prevent her baby from being born with the debilitating consequences FAS.
Join ADP, the ARC of California, and the California Fetal Alcohol Spectrum Disorders Task Force on September 9 at an information faire on the west steps of the Capitol. Then help spread the word to women and men across the state about this critical issue.
What is FASD?
Fetal alcohol spectrum disorders (FASD) is a set of physical and mental birth defects that result when a woman drinks alcohol during her pregnancy. When a pregnant woman drinks beer, wine, or mixed drinks, so does her baby. Alcohol passes through the placenta right into the developing baby and the baby may suffer lifelong damage as a result. FASD is the number one cause of birth defects in the United States and is 100% preventable.
What is it like to live with FASD?
For more information, visit the Women’s Page on ADP’s website www.adp.ca.gov/
Underage drinking is a dangerous behavior and a growing concern in California. The Governor’s Prevention Advisory Council (GPAC), an advisory panel for the Department of Alcohol and Drug Programs (ADP) is addressing the issue with a goal of informing youth of the risks involved and, by doing so, preventing the behavior.
Depending on the amount of alcohol consumed, youth under the influence exhibit a long list of risky behaviors. Drinking alcohol harms brain development and contributes to suicide, unsafe sexual behavior, academic failure, and experimentation with other illegal substances and activities such as smoking marijuana. While adults generally consume larger amounts of alcohol than minors overall, minors are more prone to binge drinking.
Cities and counties throughout California are taking steps to curb underage drinking with ordinances that fine adults for allowing minors to consume alcohol in their homes. Called “social host ordinances,” these ordinances have passed in the cities of Oceanside, Carlsbad, Vista, Sacramento and also San Bernardino County to date.
On August 18, Gov. Arnold Schwarzenegger signed a bill (AB2486) into law that would allow adults to be held civilly liable if they knowingly serve alcohol to people under the legal drinking age who are subsequently injured or killed as a result of the intoxication.
The growing popularity of “alcopops” is a major contributing factor in underage drinking. Alcopops are sweetened alcoholic beverages usually sold in single bottles or cans. The packaging resembles that of sodas and soft drinks.
It’s becoming apparent that alcohol companies are marketing to teens. Advertising often depicts young people in a party setting. With teen drinking—especially binge drinking—on the rise, we need to redouble our efforts to reach our youth with prevention messages. And we need to put the alcohol on notice that we will not stand by and watch our children slip into alcoholism.
One way to get prescription drugs out of medicine cabinets and away from those who misuse them is to give them back! ADP is supporting this year’s effort by the U.S. Drug Enforcement Administration and its partner organizations in the first National Prescription Drug Take-Back Day scheduled for Saturday, September 25.
According to the 2008 National Survey on Drug Use and Health, more than six million Americans used a prescription medicine for non-medical purposes in the month prior to the date of the study. Prescription drugs are the second-most abused substances in the country after marijuana, the study says.
To minimize their diversion and misuse, prescription drugs no longer needed for medical purposes should be disposed of properly. One of the best ways to get rid of unused medications and make them unavailable for misuse is to dispose of them through a community take-back program. Take-back programs are organized by law enforcement professionals and community groups as a way to place prescription drugs in safe hands for disposal.
Take-back programs are a common-sense approach to the rapidly growing threat of prescription drug abuse. They reduce the chances these drugs will be used for non-medical purposes, and they can engage the entire community in a discussion about prescription drug diversion and abuse. Take-back programs are also an environmentally responsible alternative to dumping or flushing unused medicines down the toilet, practices that can leave traces of drugs in the water supply.
Several states, counties, and grassroots organizations, working with law enforcement officials and with the DEA’s approval, have already established drug take-back programs. Others are planning similar initiatives this year.
We encourage local communities to get involved and set up take-back programs of their own. Remember to involve local law enforcement officials from the very start of your planning, however, because law enforcement must be involved when a take-back program accepts controlled substances.
To start a drug take-back program in your community, contact law enforcement agencies and the DEA Special-Agent-in-Charge for your area. You can get more information from the following websites: For a directory of State Environmental Agencies, visit: http://www.epa.gov/epahome/state.htm. For a map and list of DEA Domestic Divisions, visit: http://www.justice.gov/dea/pubs/states/domestic.html
Heath Care Reform
ADP has been working with all levels of government to define the information technology standards and requirements to meet the 2014 deadline. We work with the Substance Abuse and Mental Health Services Administration as part of the block grant implementation to define new outcome reporting requirements.
We also continue to monitor the Health Information Technology Extension for Behavioral Health Services Act of 2010. The aim of the act is to make behavioral and mental health professionals, substance abuse professionals, psychiatric hospitals, behavioral and mental health clinics, and substance use treatment facilities eligible for Medicaid and Medicare incentive funds available for the meaningful use of EHRs. This bill is going through the first step in the legislative process. Typically, introduced bills and resolutions first go to committees that deliberate, investigate, and revise them before they go to general debate. On May 3, 2010, the bill was referred to the Subcommittee on Health.
ADP is also working with departments within the Health and Human Services Agency to address the technical and business requirements for Health Information Exchange and Technology. ADP has convened a Health Care Reform Information Technology committee comprised of the Department of Health Care Services, Department of Mental Health, Office of Health Information Integrity, Office of Systems Integration, and various counties and providers. The purposes of this committee are to ensure California information technology platforms are consistent with health care reform and to help us plan and prepare for changes ahead. If you are interested in joining this committee, please contact Theresa Lea at 916-323-7836 or firstname.lastname@example.org.
Prevention Services Branch
Evidence-Based Interventions, a New Paradigm for Selecting Prevention Strategies
The CPI Prevention Tactic, A Paradigm Shift in Selecting Evidence-based Approaches for Substance Abuse Prevention, explores the evolution of selecting strategies based upon evidence, and discusses how prevention providers can now review evidence in a more deliberate and comprehensive manner.
Of particular relevance to the prevention field, SAMHSA* has outlined a new standard for assessing evidence, which has been integrated into the National Registry of Evidence-based Programs and Practices (NREPP). In an effort to consider evidence related to the relevance and appropriateness of it with communities, resources, and capacity, NREPP has moved away from one-dimensional, categorical ratings of programs. Prevention providers will find that NREPP is a model for how to assess evidence and find interventions that are outcomes-driven, culturally relevant, and that have a greater likelihood of being sustained.
ADP, through the Community Prevention Initiative, will feature two companion documents that highlight the power of prevention. The first will discuss new evidence that supports the work of prevention and the outcomes that are achieved when prevention is prioritized.
Another publication will study the cost-effectiveness of prevention related to areas that are critically impacted by substance abuse and related harms including healthcare, schools, and community settings.
Campaign Against Alcoholic Energy Drinks
On July 29, 2010, a letter was sent to the U.S. Food and Drug Administration (FDA) asking for an investigation of the safety of these products.Senator Schumer’s office found ADP’s website on AEDs to be a valuable resource when conducting research for the letter to the FDA. You can find a copy of the letters to the FTC and FDA as well as other valuable information regarding AEDs at http://www.adp.ca.gov/youth/aed_index.shtml
If you are interested in browsing and/or borrowing materials from Lending Services, please refer to our website: http://www.adp.ca.gov/RC/rc_lib.shtml
CARE is a program of the California Department of Alcohol and Drug Programs funded by the federal Substance Abuse and Mental Health Services Administration
ADP’s California Access to Recovery Effort staff achieved a major accomplishment this summer with the rollout of an automated (paperless) payment system. The CARE program makes direct payments to more than 200 organizations to reimburse them for treatment and recovery support services provided to clients with CARE vouchers. Previously, CARE staff sent providers paper invoices at the end of the month to sign and return to ADP. CARE staff had to review and adjudicate each invoice and then send them to Accounting for processing. Providers often waited three months or more to receive payment. The new system has significantly reduced the time between provider billing and reimbursement, which encourages continued participation of providers, many of whom are small, grassroots organizations that experience considerable hardship when payments are delayed.
Implementation of the automated system took several years to accomplish and involved collaboration between ADP and the state Controllers Office, the Department of Technology Services, and CARE’s voucher system contractor, MAXIMUS.
CARE 3 Preparation and Training
The Licensing and Certification Division was very busy during the third quarter of fiscal year 2009-2010. From January through March, despite continued furloughs, LCD completed review of 23 new residential and outpatient program applications and 109 Drug Medi-Cal certification applications. In addition, our field analysts made more than 391 site visits.
Responding to Public Records Act requests contributes to this administration's commitment to transparency in state government. Of the 44 Public Record Act requests that ADP received during the third quarter, 28 were assigned to LCD. The division responded to 22 of those requests within the quarter.
In the third quarter, LCD completed 35 Drug Medi-Cal post-service post-payment reviews. During that same period, the Compliance Branch received 58 program complaints and 30 allegations of counselor misconduct. In response to recommendations from the Counselor Certification Advisory Committee, we implemented a toll-free telephone number (1-877-685-8333) for ease in filing reports. We mailed more than 2,000 notices to programs and County Administrators to inform them of the toll-free number, to encourage them to post it and remind them of their responsibility to report allegations of counselor misconduct. We believe the increased awareness and ease of reporting will improve safety.
Along with the announcement of the toll-free phone number, we reminded counties and providers that April 1, 2010, was an important date—the five-year anniversary of the counselor certification regulations. As of April 1, 2010, the Regulations became fully implemented, requiring at least 30 percent of counselors working in programs and facilities certified and/ or licensed by ADP to be certified or otherwise licensed (e.g., MFT, LCSW, etc.). The remaining 70 percent of counselors have to be registered with one of the nine counselor-certifying organizations (COs).
Now that the regulations have been fully implemented, it is time to review the status and look for possible improvements in the current system. There are nine COs, with the possibility of more becoming recognized. ADP is working to ensure individuals seeking to become counselors—and those already certified—receive the required education and training they need. Our intent is to provide increased assurances in the current system, while we continue to plan for the future.
After a great deal of work in all aspects of LCD, Daniel Steinhart has resigned his position as deputy director. Millicent Gomes, deputy director of OCJC and OARA, immediately stepped in as acting deputy director of the Licensing and Certification Division.
ADP’s Position on Alcohol and Drug Legislation
ADP also held an “oppose” position on AB 417 (Beall), which would have established a medication-assisted pilot program within Drug Medi-Cal for the purpose of evaluating buprenorphine for treating opioid dependence. ADP opposed the bill because the proposed pilot program is unnecessary—the efficacy of buprenorphine has already been tested and proven, and buprenorphine services are already available to narcotic treatment programs through the fee-for-service Medi-Cal program. The measure was held on the Senate Appropriations Suspense file.
Joint Constituent Committee Meeting
Native American Web Pages
Congratulations to the Office of Problem Gambling for receiving the People’s Choice Award for its “More Than Just Your Money” public awareness billboard presented in June at the 24th National Conference on Problem Gambling in Portland, Oregon.
Every year, this conference brings together leaders in prevention, education, treatment, responsible gaming, research and recovery to network and educate their peers on the latest developments in the problem gambling field. Physicians, licensed professional counselors, social workers, certified substance abuse counselors and gambling treatment counselors throughout the United States attended the conference and voted for the best print public awareness message.
The billboard, presented in English and Spanish and displayed throughout the state, is only one component of OPG’s public awareness campaign, which also includes radio messages. OPG’s public awareness messages can be seen at http://www.adp.ca.gov/OPG/index.shtml
Gathering of the Lodges
The ninth annual “Gathering of the Lodges – A Celebration of Recovery” took place Aug. 6 in Oakland, where ADP Director Renée Zito and OLEA Deputy Director Tina Chiginsky were on hand to celebrate sobriety and recovery among California’s Native Americans. A very vulnerable population, American Indian/Alaskan Natives rank third among ethnic groups in lifetime use of alcohol and rank highest in binge drinking and heavy drinking. Zito commended the tribes for their culturally specific methods – including sweat lodges, talking circles, drumming and song – for treating addictions.