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JEFFERSON COUNTY PUBLIC HEALTH 615 Sheridan Street o Port Townsend o Washington o 96368 July 3, M4 JEFFERSON COUNTY BOARD OF COUNTY COMMISSIONERS AGENDA REQUEST TO: Board of County Commissioners Philip Morley, County Administrator FROM: Jean Ballwin, Director JCPH Anna McEnery, Developmental Disabilities Coordinator DATE: JVLy TH J•ofM SUBJECT: Agenda Item — Jefferson County Mental Health and Substance Abuse Fund (Hargrove Sales Tax 1/10 of 1%) STATEMENT OF ISSUE. Jefferson County Public Health, representing the BDCC in management of the 1/10 of 1%Sales Tax for Mental Health and Chemical Dependenry sales tax fund is presenting a plan proposal and continuation plan for lefferson CountyB CC polity review. ANALYSIS/STRATEGIC GOALS/PRO'S and CONS: This report and continuation plan presents draft proposals and considerations, including histories, needs, funding plans, benents assessments. FISCAL IMPACT/COST BENEFIT ANALYSIS' The benefits of continuing this plan are increased treatment in various settings jails, schools, homes, treatment agencies, and four courts; increased awareness of need; fair allocation of funds; continued awareness of community needs, available services, and youth needs. The Hargrove Sales Tax 1/10 of 1%and this plan will help the SDCC set policy direction for the next 6 vears. RECOMMENDATION• JCPH management request approval of the continuation of the Metal Health and Substance Abuse plan. REVIEWED g, ! A L Pam- 7/3/,OS Philip Morley ounry dministrator Date COMMUNITY HEALTH PUBLIC HEALTH ENVI RON MENTAL HEALTH DEVELOPMENTAL UALRY MAN:OOr3WI 3AR59CW DISABILITIES ALWAYS=O MR A&ANEA IW MAIN: 1360011385994i xx 66al38sa01 NNUTIIIER CDIMMONRY ASX(3601319J181 Jefferson County Mental Health and Substance Abuse Fund (Hargrove Sales Tax 1110 of 1 %) Report Continuation Plan JC Ordinance 08-1003-05 07/2014 Table of Contents Report: Jefferson County Ordinance No. 08-1003-05 Page 1 Purpose Legislative and Local Page 1-2 Local Needs and Local Funding Page 2-3 Advisory Committee Page 3 Design & Evaluation Page 3-4 Program Elements Page 4-5 Administration & Authority Page 5 Program/Funding Page 6-7 Fiscal Plan: intent of Jefferson County Commissioners Page 8 Challenges Page 9-10 Needs Page 10 Evaluation of Services Page 10 Funding Planning Page 11-13 Jefferson County Benefits Page 13 Appendix: A. Ordinance Page 14-17 B. Hargrove Letter Page 18 C. Advisory Committee Members Page 19 D. Executive Summary Page 20-30 E. Request for Funding Page 31-37 F. Chronic and Justice System Programs Page 38-41 Expanded Mental Health & Substance Abuse Treatment Funds ORDINANCE Jefferson County Ordinance No. 08-1003-05. (Appendix A, adopted 2005.) PURPOSE Legislative: The purpose of this ordinance was to use the Jefferson County Legislative Authority to authorize sales tax use not to exceed 1/10 of 1%, in order to provide monies for new or expanded local substance abuse and/or mental health treatment services. See 2013 letter from Senator Jim Hargrove regarding RCW intent for Counties to improve local treatment, prevention programs. (Appendix B.) In the 2005 legislative session Senator Hargrove passed the Omnibus Mental Health and Substance Abuse Reform Act SB 5763 to expand substance abuse and mental health treatment. The bill allows local governments to increase a sales tax to improve local services. Goals of the State legislation were to: 1. Reduce negative impacts of mental health and substance abuse on children and families 2. Prevent crime and victims; avoid building more jails and prisons 3. Reduce public assistance expenditures and unemployment 4. Reduce homelessness 5. Reduce physical -health care and emergency room costs 6. Improve recovery and quality of life for those with substance abuse and mental health disorders Local: In 2005 Jefferson County Board of County Commissioners (BoCC) adopted this tax. The BoCC established the Jefferson County Mental Health and Substance Abuse Sales Page 1 Tax Advisory Committee to review community needs and local Requests for Proposals (RFP) from vendors in order to provide enhanced mental health and substance abuse treatment services. Contracts have been negotiated yearly since 2005 based on the Committee recommendations. This fund was able to provide an average of $400,000 a year for treatment services in Jefferson County from 2006, through the worst recession in recent history. The people who received this treatment may not have had state funded services available during this time period. The BoCC and the County Administrator have administered the fund. They have the authority and approval to exercise all lawful powers necessary and appropriate for the contracting, statements of work, and maintenance operations. In 2009 the County Administrator appointed Jefferson County Public Health (JCPH) to do the contracting, fiscal management, County budgets, and committee staff work for the BoCC. State Funding does not change local needs, Local Funding changes local needs! The impacts of substance abuse and mental health disorders on Jefferson County are significant and are recognized as likely the most costly problems facing the government and community of Jefferson County in 2005 and today. Lack of treatment services are seen in many Jefferson County settings; emergency services, hospital, courts, jails, public health, businesses, homes, schools, shelters, and non -profits. The available State funds are wholly inadequate to meet local needs. The community impact is recognized in the health and safely of citizens and families suffering through substance abuse and mental illness cycles in their homes. The true community impacts of the untreated diseases are difficult to measure but are seen by accidents on the roadway, health care ER utilization rates, teen substance abuse arrests, child abuse rates, unemployment rates, and other impacts. The cost impact throughout government is substantial in courts, juvenile justice, the jail system, the schools, Public Health, and Medicaid. Page 2 {loam of"WA gitift U109t of 1%L,oglabdon: Selected outcomes to measure progress on each goal: 1. Reduce negative impacts of mental health and substance abuse on children and Gmities Adverse Childheud Experiences (ACES) Domesticweience Child Abuse and Neglect 2. Avoid burring more farts and pnsons and prevent came victims Youth Bullying Alcohol and Drug Arrests Crime index 3. Reduce public assistance experrdihrres and unemployment PublicAsssitance- Public Public Assistance- treatment Unemployment rate blamelessness Homelessness among 4- Reduce homelessness Students AlcnholiDrugDeaais AlcohoUthug Emergency Room s. Reduce physka"ealth care and emargencY room costs HospitaluaWns Visits 6. Improve recovery and quality of life for those with substance abuse and menial heats dsotders ff we can address goats 1-5, we should he addressing goal 6 Figure 1 State funded Mental Health and Chemical Dependency (MHICD) services are very limited and most individuals receiving these services must be in crisis or have Medicaid eligibility. Individuals must meet the proper criteria or they may not receive services. The rationed nature of these services creates more disparity throughout the County. See community impact and outcome data needs at: http:llwww Iefersoncountypublichealth.org/pdf/Community0utcomes,pdf ADVISORY COMMITTEE The BoCC appointed Mental Health & Substance Abuse Sales Tax Committee members to include two members of the Law and Justice Committee, two from the Substance Abuse Committee, two from the Board of Health, and the Chair of the BoCC, who is a member of the MH Regional Support Network. Members are to have no fiduciary interest in the contracted vendors. The Chair from the BoCC actively recruits member replacements. (Appendix C.) DESIGN & EVALUATION Committee members prioritize community treatment needs after reviewing Jefferson County community data. Community data or review of local needs is funded by MH-SA tax yearly. The community data is updated every two years to identify changing community needs. Data is at web page: http:llwww jeffersoncountypublichealth.orglindex.php?publicato-_ns-data-resources. Quarterly program reports are submitted with bills for services to JCPH. Program evaluation data is compiled for the advisory committee to review yearly. (Appendix D.) Program evaluation, measurements, and ongoing outcomes are standardized for each vendor. Evaluation data helps the committee see local services being completed. Page 3 The committee puts out a Request for Proposal (RFP), and contracting agencies submit their application and budget to the committee for review, funding allocations, and recommendations (Appendix E). After review of applications, evaluation data, program review, and monthly billing, the committee recommends programs and allocations for approval by the BoCC. No County staff time or funding is spent on oversight of the contractors; all are WA licensed vendors with external oversight of other programs. Service data is collected and shared with the public and committee. Contracts and monthly reports allow further oversight and audits. PROGRAM ELEMENTS The contractors are required to implement comprehensive County -wide services available to all citizens; without discrimination or income barriers. Mental Health/ Substance Abuse County funds are the payer of last resort; agencies need to serve clients with other funds first. The County Administrator may ask for proof of billing denials in yearend reviews or fiscal audits. The County believed that the programs or services that are to be implemented should be evidence based, research based, or a promising innovative practice. This fund creates a collaborative plan to supplement state funds with local funds and is building a significant service network for Jefferson County citizens. 2005-14 contracts were established to provide access to programs, based on the following priorities of the Board of County Commissioners- 6 Treatment for individuals with co-occurring MH/CD disorders 0 Therapeutic court: coordinate Alcohol/Drug & Mental Health court referrals and family dependency needs in courts o Expanded Mental Health/Substance Abuse treatment for populations not served by other public funds Page 4 Substance abuse and mental health assessment, counseling, referral in the jail Community based treatment for families, children coping with mental illness or substance abuse in a spouse, parent, child, or themselves • Mental health services to students on school campuses Home visits to families providing treatment services Program and Project Evaluation provides ongoing evaluation of programs and services. Program accountability and effectiveness are measured against local needs and outcomes ADMINISTRATION & AUTHORITY The County Administrator submits a budget and an annual report to the Board of County Commissioners for review and approval. Tax collection and allocations: Money received from tax imposed under this ordinance has been used solely for the purpose of providing drug/alcohol abuse & mental health treatment. In 2009 and 2010, the BOCC reviewed and stated tax moneys collected cannot be used to supplant state changes in funding. Jefferson County and other early adopters of the sales tax received an additional $100,000 yearly from the Engrossed Second Substitute Senate Bill 6239. Funds were designated for methamphetamine treatment and were allocated by the Methamphetamine Action Committee. Jefferson County Mental Health (JCMH) and Safe Harbor were the only two providers in 2008, 2009, and 2010 to receive the total of $300,000 in funds. In 2005-2007, Jefferson County had a surplus in the fund balance. The BoCC changed the reserve fund balance required from 20% to 10%. An early fund balance was allocated over four years through the recession to providers. Page 5 Z Z D LL Q w a O n C)n 0 0 C O C) 0 O cz CJ 0 0 C:) CD 0 0 0 6 ' 11 C C) c0 O 0 -t C)O � Ln CD P- O 000 0 O O Cf7 Lr) rV Cl) LeiO h th O CD CO r N H Nttl 67 Cl)(D c� co tg Gq 3 r a O 0 C7 0 0 C7 0 0 O C`14 0 C) 0 V L0000 p 00 00 p PLD00 r- to K p N MO 0O V 0 A h to 40 r 3 C O N to L '� N 4s r m CO M co N N N V a C7 O O O O 041) 0 0 to 0 0 vs to� � N cli f— a 00 to O N W 0 Cr) 0 CO i ~ m N (D v' N C)� to N ri N M N C7 C.D p CD a0 {C.) r M -;f CO r r W Ch CD Cl) 6% N Gq � V Q � O o 0 0 0 0 0 0 M o o h T h d d' CO c � 0 0 4 CD to CD 117 tf'! th a+ r O b} M to N 0 a I-- 6) -,I, Cn 0 O N o O O vf) o LO M to N O t) r h o O to 0 O R 00 N Lr) LO O M r W _O�® N a C0°i? C Cl LO t0[') o�p ti O N O C) N cD mCD rf N a Z ] fi d u) m- z Ji E a to E CL 'C F v E h tll 00 C V "lE rt _ � -0 �' <cn C: �U � w" F— L o O CID m y x m 0 2 9 2 CL U v 'J i. _ D `� N W X Tlu m � A o � e� w F w g a) N m O p N O d U) cc' LL LL L) ty3 W LU h ►� (n '�^ CID w I— The original Mental Health & Substance Abuse Sales Tax Committee allocated the fund at: 40% adult CQDIT, MH and substance abuse, 15% youth MH and substance abuse, 10% jail treatment nurse, 10%Q community assessment and program evaluation, 5% billing and administration, 10% therapeutic court, and 10% reserve. It was found the adult chronic services needed more funding so this formula has not been followed. The following graph shows 2014 budget allocations: 2014 Fund Budget Jumping Nurse Family Mental Juvenile Jail RN Courts (MH Substance Mental Mouse Partnership Health - Court & Abuse Health Schools (Topside) Therapeutic) Treatment Treatment Early s: Chronic & Justice System Programs: intervention: $6 t,740 $292,000 Community Treatment Sites Figure 3 Page 7 FISCAL PLAN INTENT of JEFFERSON COUNTY COMMISIONERS Expand and fund treatment throughout the County for all populations, in accessible sites. Decrease the impact of substance abuse and mental illness on the overall health and economic well-being of citizens. Fairly distribute funds to areas of the population of highest need and where improved outcomes may be possible. 2014 Fund by Vendor Juvenile Court, $16,000 , 4% Figure 4 Page 8 CHALLENGES There is not enough funding to fully fund prevention and treatment services throughout the County. Difficult choices are necessary by the BoCC to guide the advisory board with funding priorities. Looking at the graph "2014 Fund Budget" (figure 3) treatment dollars could easily be absorbed by providers serving urgent needs only. Changes with the implementation of the Affordable Care Act impact treatment of substance abuse and mental illness. Some State financed care will remain unchanged; other changes are coming to the Division of Behavioral Health at Washington State and the local communities and will be watched by the County. • If services created are not producing change or serving enough people, the County may stop the funding. Consistent funding must exist for the management of the fund: 6% yearly is required for fiscal management of the fund, contracts management, and vendor billing time. Additional staff time with vendors, meetings, and planning is an additional 2.5% for staff time. The committee in 2013 moved this management funding out of the treatment dollars. This 2.5% increase has not been in the fund before the 2015 budget cycle. Assessment of community needs, vendor monitoring of reported services, and process evaluation of the services has consistently taken 15 hours a month of contractor time. The process evaluations have lead to increase of funding for some vendors, elimination, service changes, and better overall access to care. Continual data updates especially Healthy Youth surveys keep the community needs analysis current. This funding has been consistent at 5% of the fund. Acute chronic illnesses are more expensive to treat so funding will always be a dilemma. Some treatment services are focused on treatments that prevent an ongoing life cycle problem, in the home, school and everyday settings. Costs per client are illustrated below: Page 9 Treatment Setting Average Per Month: Number Amount Billed to Served Fund % of Total Fund* Cost per Customer Served Services Funded Entirely by This $ Jumping Mouse 176 $24,000 7% $136 no Nurse Family Partnership 54 $25,900 8% $480 no Mental Health - Schools 167 $65,000 19% $389 yes Juvenile Court (Topside) 12 $15,080 4% $1,257 yes Jail RN 268 $32,995 10% $123 no Substance Abuse Treatment 8 $93,000 28%n $11,625 no Mental Health Treatment 28 $80,204 23.9% $2,864 no Total 713 $336,179 100% $471 __t_ $4.034,148 $5,658 rigure a NEEDS + Residents of Jefferson County asked to pay additional taxes want documentation of the benefits and tracking of those tax dollars. Assessment of current community needs have to be maintained to prioritize services within the fund. Maintain baseline data, so change can be measured. The Mental Health/Substance Abuse Sales Tax Committee attends meetings, listens to vendors' updates, and reads reports to monitor treatment effectiveness, as a group they have established a level of expertise. Leadership of this fund must remain visionary and provide long range planning and be not reactive. EVALUATION OF SERVICES Vendors are filling quarterly reports of services outputs. There is no data system that provides integration of substance abuse and mental health services at a patient level. The collection of service data has enabled the Committee and BoCC to utilize the information to see some impacts of the local programs. Page 10 FUNDING PLANNING Contracts for this fund in 2014-15 will be allocated for two years. Two year applications are being requested. 2013 BoCC action stopped agencies from using MH/CD County tax funds for match, without prior authorization of their match formula and allocation use from the Jefferson County Administrator and County fiscal team. The match may not be used by the vendor without that written permission. Programs are asked for a few changes over the years, for instance Jefferson Mental Health was asked to include in their co-occurring (CODIT) disorder contract allocation the time for the treatment in the Mental Health Court. The committee asks that services in the MH court be included in the CODIT hours, data shows many of the same clients. Safe Harbor will also include Mental Health Court in their hours billed under CODIT and Drug Court. Three of the Courts serving MH, CD, and dependency hearings are sharing a case manager. Planning funding to change community outcomes requires a diversity of service approaches and service vendors. The 2013 spending graph below suggests some of this diversity in sites and approaches to treatment. Page 1 1 131 Fund - 2013 Treatment Services Green _ Community Treatment Sites, Red = Chronic & Justice System lily 8% Court e), 4% # Billed to gyred I Fund Jumping Mouse I L 176 1 24,000 NFp 54 25,900 Mental Hep-Ah - Schools 29 65,000 259 1 114,900 Figure f Figure 7 Page 12 131 Fund 2013 Treatment Services Cost per Customer Served Green = Community Treatment Sites, Red = Chronic & Justice System Programs $14,000 _-_... i $12,000 $10,000 $8,000 $6,000 $4,000 $2,000 $0 Jumping Nurse Family Mental Juvenile Court Jail RN Substance Mental Mouse Partnership Health - (Topside) Abuse Health Schools Treatment Treatment Figure 7 JEFFERSON COUNTY BENEFITS • Increased treatment is available for citizens today with Mental Health (MH) or Chemical Dependency (CD) needs in various settings: jail, schools, homes, treatment agencies, and four courts. • A trained, educated, passionate advisory board is more aware of needs for CD and MH treatments and willing to make difficult choices. • Adoption by JC increased the treatment money available by an average of $400,000 a year since 2006. • RFP process is transparent and challenging for committee to allocate funds. • Increased awareness of local community needs, available services, and specific risks for some populations. Healthy Youth Survey assessment helps determine needs for youth. • Six years of community data has provided process evaluation of purchased services. Page 13 Appendix A. Jefferson County Ordinance No. 08-1003-05 ca: Pip �K/3)c5 STATE OF WASI County of Jeff_____ In the Matter of Imposing a Sales and Use Tax; } Providing for the Administration and Collection Thereof } For Providing New or Expanded Chemical Dependency } or Mental Health Treatment Services and } for the Operation of New or Expanded Therapeutic } Court Programs as Provided in Ch. 82.14.460 RCW. } ORDINANCE NO.08-1003-05 WHEREAS, substance use disorders are a serious and treatable health problem known to impact directly or indirectly as many as 60% of Americans and mental illness is a serious and treatable health problem known to directly occur in more than 19 million Americans, the most serious and chronic conditions occurring in 3 to 5% of the population; and WHEREAS, approximately 50% of individuals with severe mental disorders are also substance abuse disordered, and approximately 37% of alcohol abusers and 53% of drug abusers are also affected by serious mental illness; and WHEREAS, individuals with co-occurring disorders (dually diagnosed mental illness and substance abuse disorders) are at high risk for negative outcomes, including hospitalization, overdose, violence, legal problems, homelessness, victimization, HIV infection, and hepatitis; and WHEREAS, community children and youth are impacted by mental disorders, substance use disorders and co-occurring disorders both as the children of, and as individuals with, mental illness and/or substance abuse disorders, often with resulting negative impact on their health, ability to learn, home life and safety, social behavior, and emotional development; with concomitant impacts on education, juvenile justice, child and family, health, and mental health service systems; and WHEREAS, services for individuals with co-occurring disorders cost nearly twice as much as for clients with single disorders; and non-integrated parallel methods of treatment have proven to be ineffective; and WHEREAS, treatment for individuals with co-occurring substance use and mental illness requires specialized care to meet the unique and often opposing needs of both disorders; and WHEREAS, the Jefferson County Substance Abuse Advisory Board, upon review of local, state and national data and information, identified the health, social, community, and economic impact of alcohol and other drugs on Jefferson County and its citizens, and the impact of mental disorders, substance use disorders and co-occurring disorders, as a major public health and public safety problem in their October 2004 White Paper to the Jefferson County Board of County Commissioners and to the citizens of Jefferson County, and Page 14 Ordinance No. 08-1003-05; Imposing a Sales & Use Tax for Providing a New or Expanded Chemical Dependency or Mental Health Treatment Services and for the operation of New or Expanded Therapeutic Court Programs as provided in Ch. 82.14.460 RCW WHEREAS, the impact of substance use disorders on the Jefferson County law and justice system is significant, accounting for more than 2/3 of law enforcement calls in the City and County and half of the Jefferson County Prosecutor's cases; and WHEREAS, Law and Justice system response to individuals with mental disorders, substance use disorders and co-occurring disorders represents a significant and costly problem throughout Washington State, so much so that the 2005 Washington State Legislature passed E2SSB 5763, an act relating to the creation of the omnibus treatment of mental and substance abuse disorders, in the belief that identification and integrated evidence -based treatment of mental disorders, substance use disorders and co-occurring disorders is critical to successful outcomes and recovery; and WHEREAS, Jefferson County citizens, through their property taxes, are paying for the cost of mental disorders, substance use disorders and co-occurring disorders through funding of courts, jails, emergency medical technicians, schools, hospitals and law enforcement personnel; and WHEREAS, sales and use taxes are funding sources that affect citizens who do not own property in Jefferson County, and apply as well to visitors to Jefferson County, and, thus, would expand the potential revenue stream to address mental disorders, substance use disorders and co- occurring disorder treatment; and WHEREAS, therapeutic courts and integrated mental disorders, substance use disorders and co-occurring treatment programs utilizing evidence based best practices have been shown to have positive outcomes, thus decreasing negative social, health and fiscal impacts on individuals and communities; and WHEREAS, recognizing the health, social, community and economic impact of mental disorders, substance use disorders and co-occurring disorders on Jefferson County citizens as significant and negative, and desiring to achieve the goal of successful outcomes and recovery for individuals with mental disorders, substance use disorders and co-occurring disorders; and WHEREAS, Jefferson County has an aging population and older people consistently underutilize both mental health and substance abuse services, and therefore suffer a disproportionate degree of harm from these conditions, and need special services and efforts to utilize services effectively; and WHEREAS, the Board of County Commissioners recognize that successful outcomes and recovery for some citizens will be a prerequisite for becoming employable and entering the workforce, and make it possible for employers to retain valuable experienced employees; and Page 2 of 4 Page 15 Ordinance No. 08-1003-05; imposing a Sales & Use 'Fax for Providing a New or Expanded Chemical Dependency or Mental Health Treatment Services and for the Operation of New or Expanded Therapeutic Court programs as provided in Ch. 82.14.460 RCW WHEREAS, RCW 82.14.460 (2) authorizes the County Legislative Authority to authorize, fix and impose a sales and use tax in addition to other taxes authorized by law with a rate not to exceed one -tenth of one percent; and RCW 82.14.460 (3) provides that monies collected shall be used solely for the purpose of providing new or expanded chemical dependency or mental health treatment services and for the operation of new or expanded therapeutic court programs. WHEREAS, RCW 82.14.460 (3) provides that if Jefferson County authorizes the tax as provided, the County may include a riew and expanded therapeutic court for dependency or mental health treatment proceedings as a component of its existing Drug Court program, effective July 1, 2005. NOW, THEREFORE, BE IT ORDAINED, by the Board of County Commissioners of Jefferson County, Washington, that: Section 1: Tax Imposed. There is hereby imposed by this ordinance a one tenth of one percent sales and use tax, as the case may be, upon every taxable event, as defined in Chapter 82.08 and 82.12 RCW, occurring within Jefferson County. The tax shall be imposed upon and collected from those persons from whom the state sales or use tax is collected pursuant to Chapters 82.08 and 82.12 RCW. This tax shall be in addition to any other sales and use tax imposed by the State of Washington and/or Jefferson County. Secdou 2: Ayolicability of Tax, The rate of tax imposed by this ordinance shall be applied to the selling price in the case of a sales tax or the value of the article used in the case of a use tax. Section 4. Administration and Collection. The tax imposed by this ordinance shall be administered and collected in accordance with Chapter 82.14.050. The Chairman of the Board of County Commissioners is hereby authorized to and directed to execute and contracts with the Washington State Department of Revenue that may be necessary to provide for the administration or collection of the tax. Section 5: Establishment of Chemical Dependency/Mental Health -program Fund. There is hereby created the Chemical Dependency/Mental Health Program Fund. Monies collected pursuant to this ordinance shall be deposited in this fund by the Jefferson County Treasurer. The fund balance may be invested by the Treasurer and any interest earned shall be deposited in this fund as well. Page 3 of 4 Page.16 Ordinance No. 08-1003-05; Imposing a Sales & Use Tax for Providing a New or Expanded Chemical Dependency or Mental Health Treatment Services and for the Operation of New or Expanded Therapeutic Court Programs as provided in Ch. 82,14.460 RCW Section 6. Use of funds. Monies deposited in such fund shall only be used solely for purposes as authorized by the laws of the State of Washington, including, providing new or expanded chemical dependency or mental health treatment services and for the operation of new or expanded therapeutic court programs. Monies collected under this section shall not be used to supplant existing funding for these programs. Section 7. Administration of Fund. The Fund shall be administered by the Board of County Commissioners through the County Administrator. The County Administrator, with the help of the Jefferson County Law and Justice Council, the Substance Abuse Services Advisory Board, and Jefferson County Public Health, is hereby directed to prepare a six -year spending plan and an annual budget. Section 8. Effective Date. This ordinance shall take effect July 1, 2005, however, the creation of a therapeutic court as provided under Ch. 26.12 RCW, as a component of the County's existing Drug Court program will not become effective until July 1, 2006. Section 9. Severability. If any provision of this ordinance or its application to any person or circumstance is held invalid, the remainder of this ordinance or the application of the provisions to other persons or circumstances in not affected. }1 VED AND ADOPTED this —day of "C {� , 2005. a° - of SSE 1 ATTEST: Julie Matthes, CMC Deputy Clerk of the Board Approved as to Form: Prosecuting Attorney JEFFERSON COUNTY BOARD OF COMMISSIONERS Phil Jo on, Chair Page 4 of 4 Member Page 17 Appendix B. Hargrove Letter oiympia Address: 1'( ) bOx 40424 042-1 December 5, 2013 Washington State Senate Senator Jim Hargrove 24th Legislative District Dear County Legislative Authorities and Department of Social and Health Services: Tc1crhlnnr: _i m t' -$L `048 l l? k'rcc' 1 9410 �G') ('000 In 2oo8, I sponsored legislation allowing counties to impose a .i of one percent sales tax to fund chemical dependency and mental health treatment programs. Since being enacted into law, two-thirds of the counties have implemented this tax. Most counties are using some, if not all, of this revenue to fund mental health treatment programs, including prevention and outreach programs. 1 recently learned that there may be some confusion about whether "mental health treatment programs" was intended to mean that this could be used to fund mental health prevention and outreach programs. As the sponsor of the 2oo8 legislation, I am writing to clarify that mental health treatment programs was intended to mean the full continuum of treatment. This includes prevention and outreach programs specifically targeted towards individuals who show signs or high risk factors associated with mental health or chemical dependency disorders. Additionally, the statute states the revenues uses are "included but not limited to," indicating that counties have some flexibility on the specific type of mental health treatment that is provided. The relevant portion of the statute, RCW 82.14.460(3), states: (3) Moneys collected under this section must be used solely for the purpose of providing for the operation or delivery of chemical dependency or mental hea h treatment programs and services and for the operation or delivery of therapeutic court programs and services. For the purposes of this section, "programs and servi " inclu s but ' not limited to, treatment services, case management, and housing that are a component of a coordinated chemical dependency or mental health treatment program or service. (Emphasis added) The underlined phrase above, "mental health treatment programs and services" was intended to include programs in the entire continuum of mental health treatment, including prevention and outreach programs that are specifically targeted towards individuals who show signs or high risk factors associated with mental health or chemical dependency disorders. Additionally, the further definition of "programs and services" to include not be limited to treatment services suggests that counties are provided with some level of flexibility in which type of programs are funded. This clarification applies to chemical dependency programs as well as mental health. I hope this alleviates any confusion on the intent of RCW 82.14.460(3). If there is any additional needed clarification, please contact my office. Sincerely, Senator "Sim Hargrove Page 18 Appendix C. Advisory Committee Members 12 U� H N L r � z q r o C N c N en ;d so m cq n N w � r � N N r N I r+1 � [� H N N x A f3+ 's7 .Mr N N N H N ti N N F ® N N C7 Sri p1 ra ri N N 4 U O W 00 N W Ifi V � � , W C Lo m x N � 12 m m a o Q c wj5 ea O W o 0 Q o c U rod C, ~ 0 �}m a m A2 E O O O R. Z ;qqd L r- N N O [� <O H N N u 7 U C �ti N N N � Cp ❑ `� f� O E Z v] N L, N M ❑ ° o u 4 ti � F N G+ 4 N M m C O b C4 rya �• r OD 41 W focV Q � �D N N N C �' n ❑ VJ +A N H N N V LL W � O N Fr O .a N M Qy O 6 O W rh .a Uf d ro W) N m U e'1 M d W OQ. a m .y v Appendix D. Executive Summary Jerson County 1/14th of 1% Sales Tax for Mental Health & Substance Abuse Evaluation Report - Executive Summary 2013 BACKGROUND: In 2005, Washington State legislation sponsored by Senator Hargrove was enacted which authorized Counties to impose a one tenth of one percent local sales tax to fund new mental health, chemical dependency, and therapeutic court services. Commissioners in all counties had the option of inaugurating the tax as they saw fit, and could do so without a vote of the people. Goals of the Washington State legislation: 1. Reduce negative impacts of mental health and substance abuse on children and families 2. Avoid building more jails and prisons and prevent crime victims 3. Reduce public assistance expenditures and unemployment 4. Reduce homelessness 5. Reduce physical -health care and emergency room costs 6. Improve recovery and quality of life for those with substance abuse and mental health disorders Jefferson County was one of the first Washington counties to approve the tax, done so by the Board of County Commissioners in Ordinance No. 08-1003-05, signed October 3, 2005. A seven member Mental Health and Chemical Dependency Oversight Committee was formed and is comprised of 2 members from: Law & Justice Council; Substance Abuse Advisory Committee; Board of Health, and 1 County Commissioner. FUND HISTORY: On average, revenue since 2008 has been about $400,000 annually, dropping during the recession and showing recovery in 2013. A one-time funding allocation from the State related to methamphetamine prevention allowed annual expenses to exceeded the tax revenue for several years. The proportion of actual exnsnse by program area is detailed by year on the right. REVENUE EXPENSES 2008* $ 440,873 $ 406,992 2009 $ 379,448 $ 394,722 2010 $ 354,812 $ 431,973 2011 $ 366,278 $ 454,468 2012 $ 360,082 $ 423,525 2013 $ 404,816 $ 355,197 THERAPEUTIC ASSESSMENT/ ADULT CODIT YOUTH CODIT JAIL NURSE COURTS EVALUATION ADMIN 60% 2% 9% 5% 11% 7% 63% 16% 6% 0.4% 10% 5% 67% 13% 6% 2% 8% 4% 59% 17% 8% 4% 8% 4% 59% 20% 8% 4% 6% 4% 55% 24% 9% 4% 3% 5% *5% was put into a reserve fund FUND EVALUATION: Evaluation services are provided under contract by Kitsap Public Health District (KPHD). Each vendor contracted under the allocation categories above submits monthly evaluation reports to KPHD for review. KPHD has provided quarterly, semi-annual, and annual Evaluation Reports to the Oversight Committee. The Report includes numerous elements to track who is being served (age, gender, zipcode of residence, mental health status, substance use) and how many and what kinds of referrals and services are received. Page 20 Jefferson County 1/10th of 1% Sales Tax for Mental Huth & Substance Abuse Evaluation Report - Executive Summary 2013 EVALUATION HIGHLIGHTS 2013: AtotaI of 822 unduplicated individuals were served in 2013 by agencies receiving one tenth of one percent funds. This might include individuals served by more than one agency however it does not include any adults served in in drug court. On average, a total of 312 individuals were served each month in 2013 by agencies receiving one tenth of one percent funds. Individuals Served by Category and Vendor: Av # per Unduplicated # Month Safe Harbor 117 16 Adult JMH CODIT 28 11 CODIT NFP* 54 40 SBHC 167 96 Youth JumpingMouse** 176 113 CODIT Topside 12 6 Jail, RN 268 30 Total 822 312 *NFP reported number of families multiplied by 2 The next two pages include 2013 highlights by vendor and the **Includes children and caregivers served subsequent pages include a one -page 2013 evaluation report for each vendor. JEFFERSON COUNTY JAIL Description: Registered Nurse provides assessment for substance use and mental health for all consenting individuals booked into Jefferson County Jail. Highlights: Served 268 unduplicated individuals. On average each month, served 30 individuals. The majority are age 25 to 44, two-thirds are male. Three in 10 report a zipcode of residence in Port Townsend, another 3 in 10 report East County, and another 3 in 10 report non -Jefferson zipcodes. Over three-quarters have been in jail previously, 39% in the previous 90 days. On average each month, the nurse spent 48 hours conducting assessments. Mental health diagnosis is known for just over half of individuals, anxiety is most common. Self - reported past 30 day substance use is known for 85% of individuals, alcohol and tobacco are most common. JEFFERSON MENTAL HEALTH: CODIT PROGRAM Description: Direct individual and group services to clients with both substance abuse/dependence and mental health disorders. Highlights: Served 28 unduplicated individuals. On average each month, served 11 individuals. The majority served are age 25 to 44, two-thirds are male. Sixty-two percent report a zipcode of residence in Port Townsend. On average each month, the program provided 151 hours of support groups, 132 hours of CODIT groups, and 10 hours of individual services. Most common mental health diagnoses are Bipolar, PTSD and Schizophrenia. Most common self -reported past 30 day substance used was tobacco. JUMPING MOUSE CHILDREN'S CENTER Description: Services to traumatized children who have been directly impacted by a parent's substance abuse and/or mental illness; services also provided to the children's caregivers. Highlights: Served 73 unduplicated children and 103 unduplicated caregivers. On average each month, served 43 children and 70 caregivers. Forty-two percent of children are age 0 to 6, 36% age 7-9 and 22% age 10-12; 53% are male. Seventy-three percent of children have a zipcode in Port Townsend. On average each month, the program provided 219 hours of child sessions and 128 hours of caregiver sessions. Most common mental health diagnoses are generalized anxiety and PTSD. Sixty-two percent of children have been exposed to family substance use; 65% are directly impacted by drug/alcohol use; and 38% had a mother who used drugs/alcohol during pregnancy. Page 21 lofferson county 1/loot of 1% Sales Tax for Mental Health & Substonce Abuse Evaluation Report - Executive Summary 2013 JEFFERSON COUNTY PUBLIC HEALTH: NURSE FAMILY PARTNERSHIP Description: Public Health Nurse serves low-income first-time pregnant mothers with social/health indicators that increase the risk for poor outcomes for mother and infant. Highlights: Served 27 unduplicated families. On average each month, served 20 individuals. The majority are age 18 to 24. Half of clients report a zipcode in East Jefferson and another 38% in Port Townsend. On average each month, the program provided 26 hours of completed visits. Most common mental health diagnoses are anxiety and depression. Most common self -reported past 30 day substance used was tobacco. JEFFERSON MENTAL HEALTH: SCHOOL BASED HEALTH CENTERS Description: Three mental health professionals provide direct service onsite at school to students in the Port Townsend, Chimacum, and Quilcene School Districts. Highlights: From January -December 2013, the SBHC's served 167 unduplicated individuals. On average each month, served 96 individuals. For Fall 2013 only byschool district: PORT TOWNSEND: Served 28 unduplicated individuals with an average of 4 visits each. The majority were in 6- 8th and 10th grades; over half were females. Most received individual therapy, 40% of visits lasted 30 minutes. Most common visit reasons were: family problems, court diversion, grief, relationships, and school. CHIMACUM: Served 22 unduplicated individuals with an average of 6 visits each. The majority were in 9th grade; 69% were females although 40% of visits were missing gender data. Most received individual therapy, groups were also offered. About a third of visits were less than 30 minutes, another third 30 minutes and another quarter were 60 minutes. Most common visit reasons were: family problems, relationships, future, stress, and depression. QUILCENE: Served 17 unduplicated individuals with an average of 6 visits each. The majority were in 6-8th and lath grades; over half were females. Most received individual therapy, groups were also offered. Forty-five percent of visits lasted 30 minutes, another 31% were under 30 minutes. Most common visit reasons were: family problems, anxiety, relationships, anger management, and court diversion. SAFE HARBOR AND BEACON OF HOPE Description: Full-time chemical dependency counselor for the CODIT program, Relapse Prevention Education groups at the Jail, Drug and Alcohol Intake/Assessments, participation in District, Family Therapeutic, Topside, and Drug Court. Data only submitted for Drug/Alcohol Intake/Assessments and Relapse Prevention. Highlights: Served 117 unduplicated individuals. On average each month, served 16 individuals. The majority served were age 25 to 44, 57% were male. Fifty-three percent reported a zipcode of residence in Port Townsend, another 32% in East Jefferson. On average each month, most individuals completing intake were on a wait list until submitting all required paperwork to complete an assessment and enroll in the program. Relapse Prevention Education Groups served 114 unduplicated individuals. On average each month, served 10 individuals and provided 9 hours of groups. TOPSIDE: YOUTH THERAPEUTIC COURT Description: Alternative therapeutic court intervention for youth involved in the juvenile justice system. Assists in fostering a direct relationship between the Court, the parents, and the youth. Highlights: Served 12 unduplicated individuals. On average each month, served 6 individuals. The majority served were male. Over three-quarters reported a zipcode of residence in Port Townsend. On average each month, over half had improvement in the attitudes/behavior, chemical dependency, family functioning, and mental health domains. Most common mental health diagnoses were ADHD, Bipolar, Depression, and PTSD. Most common self -reported past 30 day substances used were marijuana and alcohol. Page 22 Jefferson County 1 /1 Oth of 1% for Mental Health & Substance Abuse Evaluation Data: Jefferson County Jail 12013 unduplicated individuals served: 268 Program Description: One registered nurse assesses a majority of subjects booked into jail $W000 1110th 1% Funding for substance abuse and/or withdrawal and mental health conditions. Nurse actively $40.000 recruits substance abuse inmates for participation in Relapse Prevention Education {RPE) $30,000 and co -facilitates two weekly RPE classes. Nurse provides assessment, early intervention, $20,000 and follow-up for inmates suffering from substance dependencies and/or mental health $10.000 issues, including education and public health interventions. Nurse makes frequent referrals $ to Jefferson Mental Health and the Jail Medical Provider, coordinates the continuum of care o 4 Q with Safe Harbor and Drug Court, and assists with placement of inmates into inpatient and N N N N N outpatient treatment programs. Individuals served by IMOth of 1%funds: 50 42 40 30 ! 31 29 30 • ! • � • 30 20 10 0 VQf C s 5 a > �' > Q N t�L Q ' y Q Z n M c N N a o 2013 N N N Total Individuals served by 1110th of 1%funds by zip cone of residence. aae aroup, and gender: 1001A --- Non-JC zip code South JC: 98376,20 50°/% ■ East JC 98358.39,25, i 65 0%/0 > > > > i% n 4) > > y O o m ¢ ■ PT: 98368 m o Q N LL 4 Q 0 Z 0 M N N N 2013 First time assessments and % resulting in enrollment: % Enrolled —•—Assessments completed T97 100% 40 • • 30 20 • ! 10 0 50% O G N N N N 2013 N 100%/a s5+ 50%UW1 I I U45-65 0% ■ 25-44 >>> C 9 4 a t m y, m s> V> a 0 0¢ N ii 2 Q g' 4 Q c(U O Z p m a 18-24 N N N N 2013 N 100% ■ Female 50% ■ Male 0%/% _ QQ 2 4 w m a m c 3 m� U o ar Q N� LL g Q��� Qa Z❑ M. N N N N 2013 cov Referrals to community services/agencies provided to clients (average # per month): Total Dental Hospital MH output Medical Public Hath 2009AV 38 2 2 5 28 1 2010AV 52 3 2 16 29 1 2011 AV 37 0 1 16 20 0 2012AV 42 <1 1 18 22 c1 Apr-Dec2013A 41 0 1 14 26 0 -+— total visits Total individual visits: ...•—individuals served 100 ♦ 49 • 26 o eQ- N LL ¢ -'� Q Z M 2013 N N N N Mental Health Diagnoses ■13iPolar (average # individuals): ■D stn mi %individuals with unknown MH status Y Y a 2009: Ink; 2010: 41%/%; 2011: 41%/0; 2012: 35°/%. 2013: 46%/% mAnxiety 15 10 Depression 5 PTSD 0 Other 2009AV 2010AV 2011 AV 2013AV 2013 Annual Report Previously in # days ago JC jail: adlmo. <90d >90d 2009AV 65%/% 2010AV 75% 2011 AV 74°/% 2012AV 76°/% 44% 56% 2013AV 77°/% 39°1% 61 °/% rotal hours for individual visits: 80 54 52 60 39 ♦ as 40 ♦ 20 0 ¢ Q a W 0 C Q b N O N N N 2013 O N Self Reported Past 30 Day Substance Use At Admission (average # individuals): ■Alcohol %/% individuals with unknown sub use: 2009: ink; 2010: 20%/%; 2011: 12°/%; 2012: 141%; 2013: 15%/% sMarijuana 30 1 241 Tobacco 10 ■ Meth 0 2009AV 2010AV 2011 AV 2013AV: * Other Page 23 February 4, 2014, revised March 26, 2014 Jefferson County 1 /1 Dth of I % for Mental Health & Substance Abuse Evaluation Data: Jefferson Mental Health Services, CODIT 12013 unduplicated individuals served: Program `no data sent by deadline $160,000 1110th 1% Funding Program Description: Our CODIT program, run in concert with Safe Harbor, provides $120.000 direct individual and group services to clients with both Substance $B0,000 Abuse/Dependence and Mental Health Disorders. These services, along with $40.000 access to medical specialists, a case manager and peer counselor, experienced in serving this population, provide a broad spectrum of treatment possibilities not O 4 r otherwise available in this county. N N N N N N Individuals served by 1110th of 4% funds: First time assessments and % resulting in enrollment: % Enrolled --0-- Assessments completed 30 22 100% 10 • 16 20 • 14 0 i 11 5 • • 10 • • 2 < U]Z 0cq N N N N 2013 N N N N N 2013 N served by 1110th of 1% funds by zip code 100% total individuals ss+ Df residence, age group, and gender: 50% 45-64 ° 100% Non-JC zip ■ 25-44 codes 0% Z. Q O O r N LL M ^-f d V) Z P $outh JG: N N N N 2013 N ■ 0 17 98376.20 50 % 100% ■ East X: ■ female 98358,39,25 50% ■male ,65 0% rn o d N ti g Q g' Q Z fl rd, ■ PT: 98368 a 0 /° ¢ Q Q Q m rt n '� c �° m y o iu C O r TO p q1 4 N i.L '2 Q ' d CO ❑ re, N N N N 2013 N N N N 2013 N Referrals to community serviceslagencies provided to clients (average # per month)*: Total CD-Inpt DSHS Education Employmt Medicai Quitline 2009AV 18 1 2 1 1 3 not recorded 2010AV 38 2 6 1 2 4 11 2011AV 44 2 4 4 3 5 13 Jan-Jun2012AV*• 47 2 3 6 10 2 13 Total services provided (duplicated counts) Seen individually —o—CODIT Groups Support Groups 150 • 65 50 g " # 25 0 o N LL d < U) ..Q Z o vQ, N N N 0 2013 N Mental Health Diagnoses •BiPolar ■Anxiety (average # individuals): Major Depression ■ Panic Disorder PTSD Schizophrenia 10 Other 8 6 4 2 0 —T , 2009AV 2010AV 2011AV 2012AV 2013AV Other 7 7 15 *No longer collecting in 2013 7 —No data submitted for July -Dec Total hours for services: --I-- Seen individually CODIT Groups Support Groups 300 • 200 • � 151 • . 1 100 32 010 c 7 O 4r a Nu_ d g'' Q w O Z p m N N N 2013 N Self Reported Past 30 Day Substance Use (average # individuals): 20 ■Alcohel ■ Marijuana Tobacco ■ Me1h Other 10 0 - 2009AV 2010AV 2011AV 2012AV 2013AV 2013 Annual Report February b. 2014, revised March 26, 201 4 Jefferson County 1/10th of 1T for Mental Health & Substance Abuse Evaluation Data: Jumping Mouse Children's Center 2013 unduplicated individuals served: 73 2013 unduplicated caregivers served: 103 Program Description: This funding provides services to traumatized children whose care is $30,000 Moth 1% Funding otherwise uncompensated, specifically to those who have been directly impacted by a parent's $20,0013 ..WOOOOO substance abuse and/or mental illness. With these funds, we are reaching some of the most at-risl members of our community, preventing substance abuse and mental health problems before the $1o,o00 begin. Data reporting changed in 2012 to reflect eligible clients similar to reporting by Nli Note that in $- N n 2011, 1 /10th of 1 % funds were exhausted by July, by Aug in 2012, and by Nov in 2013. N N Individuals served: Note: 1110th of 1% funds 10 clients --iii caregivers eligible children 80 111 70 60 31 1 40 11—M ■ 43 40 i 20 34 NLL M N 2013 C11 Average: Jan -July 2011 Jan -Aug 2012 %of eligible clients covered by 1110th funds 32% 24% First time assessments and % resulting in enrollment: % Enrolled —Assessments completed 25 - — 100% 20 10 15 10 R 50% 5 • a 0% a '� u N LL Q -� Q Z ❑ �. O N O C`+ 2013 N cost per eligible client not covered by insurance 72% 66% Jan -Dec 2013 �20% 1 71% Total individuals served by 1110th of 1% funds by zip code of residence, age group, and gender: Unknown 100% i . 110tl% ■ female Non-JC zip code ■ 10 to 12 ' 1 50% South JC: 50% 50% ■male 7 to 9 98376,20 ® East JC, 0 to 6 0% tan 96358,30,25,65 n 1 98366 -Aug 2012AV 2013AV 0% � �--.._ --� 0% - Jan -Aug 2012AV Apr -Dec 2013AV Jan -Aug 2012AV 2013AV Total services provided (duplicated counts). 2011 not comparable; only included ten 1/10th funded clients. —.*—CHILD SESSIONS 200 �— PARENT SESSIONS 150 124 ♦ 146 100 50 32 ■ 55 ■ I z LL M Q ry ' Q cJ Z ❑ M � N N Mental Health Diagnoses of Children ■ADHD (average # individuals): +Adjualiment Disorder 2011 not comparable; only included ten 1/10th ■Generalized Anxiety funded clients rAttachment Disorder 10 Major Depression PTS D 5 Other Other 2011 acute stress, sexual 0 _ abuse, neglect, mood disorder, Jan -Aug 2012AV 2013AV bereavement, parent/child problem Total hours for services. 2011 data not comparable; only included ten 1/101h clients. --*—CHILD SESSIONS (1.5 hrs av) 300 --Ill— PARENT SESSIONS 186 20© Islil • 219 s4 ■ 128 100 ■ 0� > N � LL Q '� 5 '�f Q a Z ❑ M N N Exposed to Substance Use ■Jan -Aug 2012AV (average % of child clients): 02013AV ° 61 % 62% 69% 65% 50% 30% 38% 0% family environment child impacted by mom used drugs/alcohol substance use druglalcohol use during pregnancy 2013 Annual Report Page 25 Fetrroary 4. 2014, revised March 26, 20 i 4 Jefferson County l /1 Oth of 1 %a for Mental Health L Substance Abuse Evaluation Data. Nurse Family Partnership, 2013 unduplicated families served: 27 Jefferson County Public health $50 000 n 1114th 1 /o Funding 0,000 Program Description: Serves low-income first time pregnant mothers with social/health $$40,000 indicators that will increase the risk of poor outcomes for mother and infant, The majority of ,000 participants either have a recent personal history of substance use and/or mental illness or $$2420,000 these risks currently or historically in the immediate family environment. Nurse treats the mother using behavior change theory and motivational interviewing for quitting substances, $ Q preventing relapse, treating mental illness, and N N N N addressing intergenerational patterns within the family system. NFP is an evidence based prevention program and JCPH collects extensive data to be confident in the quality and fidelity of services thus assuring the community that our families will have similar positive, long term outcomes as seen in the research trials. Individuals served: 1110th of 1 % funds 11 % of the NFP budget, the cost for 2 individuals 30 16 17 21 20 0 0 • 20 10 �^ . a�ti�117, ,�� bo W�&a ©�^�P, IN 2013 Total individuals served by wium or ro Tunas uy zap Vuua yr residence, age group, and gender: (age & gerderof all persons atappts) 100°/ 50% 0% 2013 Non-JC zip code South JC: 98376,20 First time assessments and % resulting in enrollment: % Enrolled —*—Assessments completed 6 — � 100% 4 2 250% 0 10% 4,k a ,e SSA P� � t boy o0 A�QJ 2013 y 100% fi5+ 50% 45-64 r 25-44 0 %inn ■ 18-24 7s* F°A`r®Q� �� c�O, 0��, ■ 2 t0 17 ¢� ti� ti� ryfl y 2013 ■ infant <2 140% afemale ■ East JC: 54 98358.39,25 ■ male ,65 0% ■P7:98368 G�,�JQQ��,a'1.YJoa�Iflrp4¢Q`p��o'� Oa �O ry0 2013 Referrals to community services/agencies provided to clients (average # per month): Total Child Care DSHS Dental Housing Medical MH Outpt Quitline 2010(Jul-Dec) 8 1 0 1 0 3 0 0 2011 12 1 1 0 1 2 1 <1 2012 13 <1 1 1 <1 2 1 0 2013 13 0 <1 2 <1 3 1 <1 Total services provided (duplicated counts): — l NFP Attempted visit -- NFP Completed visit 45 23 27 30 18 90 • 21 15 a ♦ 7 006 Gle �4J 'Qc �� �$ 40 7J�¢ '� ��� yak d" -.l oil i�9s N 'o 2013 Mental Health Diagnoses of Pregnant/Post-partum Clients ■ADHD (average # individuals): ,Anxiety Major Depression 10 ■ Panic Disorder 5 �, -PTSD 0 Other July-Dee2010 2011AV 2012AV 2013AV 2013 Annual Report Total hours for services: Transp Other 0 1 1 3 1 8 1 4 --$— NFP Attempted visit --a— NFP Completed visit 45 31 32 30 20 0 5 26 15 q41 d} + qP 2013 Self Reported Past 30 Day Substance Use of Pregnant/Post-partum Clients ■Alcohol (a 4 rage # individuals): ■ Marijuana Tobacco 2 ■ Meth a other July-Dec2010 2011AV 2012AV 2013AV Page 26 February 4, 2014, revised March 26. 2014 £LOZ zLoz 4LOZ OLOZ 60oz r—r— ON p C 0m 'D 6% N3 C V fR 4 N Vi � U a U O O O C O 0 O C C Q) � C O N + O s Q) U a � a0 Q) Q O L CL O 0 O O p ^ Q7 > o O T F N O Q7 O O U E t Q N O a) i aai v Q c £ a a a 0 o C Ti3 C :i C C 0 (D _F v O ') a iJ v O Q) N 2 D (D H O 1 - 0 0 d 2•- Q. N 0 > C CL O O ^C, .� I-- Q] o E 1 3 �Oe, {� 0ZQ o `O�! CD m N n r a l] � C3 a � a E 'n R a u 0 cn � Cs n n N "t .- 0, _ N 10 C 7 Il 10 b O n N AL Z O 'N 0 iV _= a '.a E o a y ,`ro (D N �a N C,) V U-) N N V U CO [V f, q a7 Q N E N O C 4 O 0 _ O N N C ID E Q? m •Gi N O. � U d [i n N C7 V N n N 11 In 10 0 n -- N m uj ri O T 0 N _A O Q� o Qi OC 0 0 0 �O d N C m V N V d �a 7 M N U- qF iem C L c CN O w tb 4 ■ ■ ■ ■ ■ ■ ■ U Om WQ Q A o ,'IV oi`y ryo n dh O\ ho p n0 ryo Cm �J roC JR o � � a 0 c a ■ r 0 mQn p � �ry O '4 ryo o ^ �\'�' ryo Q 0 O n0 ryo c� �J me a o a' 00 O 4 91 n "3 � o0 `a 5 C W r N 00 � E � v E .. � a o 3 L O u at D m LfSd Ln OLAO� S] W r W a 6 p 'S G ta N Sri 7 m �N azT a ■ ■ y o Z �my � N Z n © t ~ �o w - m , N O In O LD 0 1D 0 ID N N IL ID a n`5 ■ D) ryo m E o ao 0 m s o w U Oj ryo rr^\^ O u 0 3■ m0 e �J N'mac OOv, z °m U U ymQ J 7 Q o 0 0 N r ntlj ryo 4V ■ - r Q' °c d Ary O p\ryo Z \ry A� 7 AO n O ■ n0 C5, 0 L ry D U Cm � ■ Sroc �ei ry Q ®R y � t!7 O n� i0 �ryQ R � ■ 0 R^S 1Q D? O c 2 o Ary Ory0 e tiA Lo cp A h ■ ,y L AO� O\ryo 0 ■ ry z cm S k4 m �ro $ N Z ry Q� O �mQ O d u7 Q Jefferson County 1 /1©th of 1% for Mental Health & Substance Abuse Evaluation Data: Safe Harbor and Beacon of Hope, Inc. 2013 unduplicated individuals served: 117 Intake Support 1 2013 unduplicated individuals served in Relapse Prevention Education: 114 Note: Funding and program description in next rows represent all 1 /I Oth 1 % funded Safe Harbor programs. Program Description: Full time Chemical Dependency Counselor provided for the CODIT $150,000 111Oth 1 % Funding program to provide assessments, treatment, individuals, treatment planning, staffing's, and $100,000 reviews. Two Relapse Prevention Education groups per week at Jefferson County Jail facilitated by CDP/CDPT from Safe Harbor. Drug and Alcohol assessments for individuals in the community $50,000 as well as individuals currently incarcerated at Jefferson County Jail. Participation in District, Family Therapeutic, Topside (youth) and Drug Court. Data entry into the WA State Division of $ Behavioral Health and Recovery database of all assessments, admits, treatment participation H N N N N N (including groups, individuals, urinalysis), and discharges. Data entry is required by the State to be in compliance with state contracts. A portion of the funds are also used for CODIT program office supplies. Treatment for Jefferson County residents with no other means of payment. Assessments completed: 30 - 16 17 15 20 �• • 16 10 J {C)A�P4J 2013 Monthly average number of individuals by referral source*: Drug Law Family! MH tx Court DSHS Court Jail Enf Medical Friend 2011AV 1 5 2 1 2 0 0 1 2012AV 1 2 3 1 3 <1 <1 1 Total individuals served by 1I10th of 1%funds by zip code of residence, age group, and gender: 100°/a 50% 0% okop1Nl?-p��JPQ 23, ���AP��e0`oy�o, I esTs Tur l*Vwl1 viltri a. Non-JC zip code South Jc: 98376.20 r Fast X- 98358,39,25 '65 a PT 99368 —.*--total # UA's # individuals tested 60 40 40 25 ! • 30 20 ! L 10 0 , 13 14 -- --�� , S�Nl N mr�rm ilr{p'='O d' N y d vy z o 0ti 0 N 2013 Annual Report Assessment disposition: 100% — Lost to fallow -up ■ Referred to other 50% ■Client refused services a Wait list, no service 0% ■ Wait list, some service July -Dec 2011AV 2012AV 2013AV aEnrolled 2010 Social *no longer collected in 2013 Self Services Other 2 1 2 1 1 2 100% 65+ 5D% 45-64 0%I'll] 1411 . 25-44 0 3 J �c v eat ♦ aq �m o� Q� a e° J ary,Lp��rypryP ) F PQ ,o P�° pyo,.3P ■ 18-24 2013 ■ 0-17 100 % [ afemale 50% -I ■male 0% '33, "Z AV' 01boa (Zmo �pd Oe �0 do ryo� 2013 Relapse Prevention Grouns at Jefferson Countv Jail, --*---monthly participation --*--individuals participating 40 27 31 • • 21 20 1g 19 ♦ • 20 g� •• ♦ ♦ 10 0 c a g p tL `� '9 d 2 u> o M N N N 2013 N Total hours for groups 20 15 to 12 a 10 a � • 9 5 a o N v_ � a � � f7Z in N N N 2013 Page 29 CD N Jefferson County 1 /1 Oth of 1 %a for Mental Health & Substance Abuse Evaluation Data: Topside, Youth Therapeutic Court 12013 unduplicated individuals served: 12 Program Description: $20,000 1110th 1% Funding The Topside Program is an alternative therapeutic court intervention for youth involved in the $15,000 juvenile justice system. A youth referred to this program is one who has been identified as a moderate/high risk youth with significant risk factors in two or more of the following domains: $10,000 Chemical dependency; mental health, school, and/or family functioning. The theory is that $5,000 providing a treatment court setting for referred youth will assist in fostering a direct $_ relationship between the Court, the parents and the youth and better motivate them to fully Q engage in evidence -based interventions N N N N and other programs in an effort to reduce identified risk factors while supporting the strengths of the youth and family. Data reporting began in August 2010. Individuals served by 1110th of 1%funds: 10 5 5 5 • • • fi dc' @G��oNNPOArygs P 2013 )tal individuals served by 1110th of 1 /o tunas oy zip Coolie or res 140°A Non-JG zip code 50% South JC', 98376.20 O 1 • East JC G�ooA�o4Qo^�eJ 98358,39,25,65 O° ■ PT, 98368 Pa3 2013 Ni ,ember of individuals served (undupucatea) ana to wrtn vu-aay i Attitudes/Behavior 12 8 d 4 • • 0 Z@�r^O1'S3r° ���1 P � CP` OQs�ypJ O 1� rya 2013 `© 100% 50% 0% e s % 90-day improvement f# served 12 Family Functioning 100% 8 50% 4 • • • • • • o .,.. 0 y r'p i roy. aa� v�2013 L P %a 90-day improvement + # served Mental Health Diagnoses (average # individuals): ■ADHD ■BiPolar ■ Depression ■ Pann Disorder 4 ■PTSD 2 — VLE.& Aug- 2011AV 2012AV 2013AV Dec2010 First time assessments and % resulting in enrollment: % Enrolled --e--Assessments completed 8 100% 4 • 38050% 2 • • �^�^ ���� Sao �a� �•� ��aj��� )'�� ���,� Q�ao� ���, n �0u ry0 ,1Q ,y0 2013 :nee ana 100% ■ female 50% ■male 0% vO 2013 aomam: Chemical De endenC Feb 2013, changed from 12 P y Dru arAlcoholrMental Health. 100% 8 4 • • 50% 1 r� ,R o Oa `f' ra 2013 % 90-day improvement --*—# served 12 Mental Health Mental Health new Feb 2013, previausly Sl. choo 'e e Ot's �je �ar1'AA 4 'k� 2013 ti 100% 50% 0 PI % 90-day improvement t# served Self Reported Past 30 Day Substance Use (average # individuals): ■Alcohol ■Marijuana 4 1 Tobacco ■ Meth 21 0 Aug-Dec2010 2011AV 2012AV 2013AV Referrals to community servicestagencies provided to clients (average # per month)*: jpI CD CD I MH Dove inpatient outpatient louse Aug -Dec 2010 4 1 1 <1 1 Jan -Dec 2011 5 1 4 0 <1 Jan -Dec 2012 7 1 5 1 0 not collected in 2013 Page 30 February 4, 2014, revised March 26, 2014 2013 Annual Report Appendix E. Request for Funding REQUEST FOR PROPOSALS INTENSIVE MENTAL HEALTH & SUBSTANCE ABUSE ASSESSMENT AND TREATMENT FOR YOUTH SERVICES IN PORT TOWNSEND, CHIMACUM AND QUILCENE SCHOOL DISTRICTS NOTICE IS HEREBY GIVEN that the Jefferson Board of County Commissioners is announcing the availability of funds to provide outpatient treatment for school aged youth who may have chemical dependency or mental health problems. This is a 12- month term contract to provide clinical and care management services in Port Townsend, Chimacum and Quilcene High Schools. The anticipated total amount available in 2015 will be based on revenue projections. Funds for different projects may be divided between agencies. This is not a request to renew contracts. The County encourages proposals from new and first-time applicants. Renewal of a contract will be at the sole discretion of the County Commissioners and will generally be contingent upon, in part, contract compliance, proven effectiveness of services as demonstrated by internal and community based evaluation mechanisms, and the stability of funding. Funding for this program comes from the Jefferson County 1 /10t" of 1 percent sales tax collected for mental health and substance abuse programs. These funds are not guaranteed to continue at the same rates. Award of this contract does not guarantee future contracts will be awarded. The Jefferson County Board of County Commissioners is accepting proposals from agencies and firms specializing in effective treatment of mental health and substance abuse for school aged youth. The resulting contract(s) are let out by the Jefferson County Board of County Commissioners and will be signed by the successful bidder(s). The contracts and billing are reviewed for the Board of County Commissioners with oversight by Jefferson County Public Health (JCPH). Applications are prioritized by the Jefferson County Mental Health/Substance Abuse Sales Tax Advisory Committee. Eight (8) copies of proposals must be received no later than 4.30 p.m. on August 22, 2014. Applications are to be no longer than six pages except for attachments. Late or incomplete responses will not be accepted. Electronic mail or facsimile proposals will not be acce tted. The proposals should be sent or delivered to: Anna Mc Enery Jefferson County Public Health 615 Sheridan Street Port Townsend, WA 98368 Questions regarding the project scope and contents of the Request for Proposals should be directed to Anna Me Enery 360-385-9410, amcenery@co.jefferson.wa.us. Page 31 1. introduction ............................................................................................................................ 2 A. Project Description must serve citizens in the entire county ............................. 2 B. Qualifications................................................................................................................... 2 II. Project Management............................................................................................................ 2 111. Budget.............................................................................................................. 4 IV. Evaluation Criteria............................................................................................................... 5 V. Proposal Contents................................................................................................................ 5 VI. Selection Process and Schedule...................................................................... .......... 6 A. Selection Process........................................................................................................... 6 B. Preliminary schedule (subject to change)............................................................... 6 INTENSIVE MENTAL HEALTH & SUBSTANCE ABUSE ASSESSMENT AND TREATMENT FOR YOUTH I. Introduction A. Description: Project Description & application that benefit youth geographically throughout East Jefferson County are preferred. Project must be a documented evidence based, or proven practice. B. qualifications Services are only provided by Licensed Mental Health agency and/or Substance Abuse treatment agency with state accreditation and professional licensed staff. All staff identified in application providing services paid for by these funds must pass background checks; County can request proof of background checks. Staff must have extensive experience treating Youth, and participate in scheduled quarterly meetings with all school based clinic staff. The entity or agency submitting a proposal must provide proof (Certificates of Insurance) of professional malpractice insurance for the mental health care professional(s) licensed by the State of Washington who will perform services pursuant to the contract. All licensed treatment providers must have clinical supervision. ll. Project Management A description of your proposed project for 2015-16 must be provided. A brief resume for each person listed, as providing services should be included in the proposal, an organization chart should be included in the proposal. Please note: It is mandatory that you identify the actual persons who will be performinq the work, and notify Jefferson County in a timely manner of any staffing changes during the period of the contract. JCPH reserves the right to disqualify the consultant awarded this project if that consultant assigns staff to the contract that are not listed in the proposal without the prior notification of qualifications to JCPH: Page 32 Services: 1. Mental Health services with students and their families throughout the school year. 2. Work closely with school based clinic staff as a team; meet with students in SBC sites. Work closely with employees of the school including: principals, teachers, counselors. 3. Work coilaboratively with School based clinic staff, mental health and substance abuse treatment agencies for outreach, referrals, and follow up. 4. Provide licensed therapist to each site consistently, this will be the same therapist except for personal leave. Exceptions may only be made with the written approval of JCPH. 5. MH therapist will be in school buildings usually in SBC site; providing MH treatment, the same times and days agreed to in the contract consistently. Times of schedules can't be changed without prior notifications to Jefferson Co Public Health and the School Districts. 6. Each application will identify by building, a set number of hours per week they are open to see students. 7. Provide crisis interventions for individuals and schools. 8. Provide on -going individual therapy. 9. Work with youth to provide support services and referral to mental health or other treatment programs. 10. Parents or guardians of youth may be contacted as necessary following state and federal privacy laws as needed. 11. Consult with and advise school staff regarding children with mental health issues following state and federal privacy laws. 12. Provide bi-weekly clinical supervision for staff, and psychiatric consultation as needed. Documentation of supervision maybe requested. 13. Ensure Mental Health Professional (MHP) staff adheres to appropriate school protocol, post hours of MH services in each school building office and counselors office. 14. Maintain a secure and confidential records system guaranteeing HIPPA. 15. Bill where appropriate. Billing & Reporting: 1. Report monthly on client utilization, referrals, outcomes, and required reporting, using Access database, see Attachment 1. 2. Maintain a secure and confidential records system guaranteeing HIPPA. 3. Collect and prepare data for internal and external evaluation purposes and reporting. 4. CONTRACTOR shall submit monthly invoices with back-up documentation to JCPH, 615 Sheridan St., Port Townsend, WA 98368, Attn: Finance Department, for payment of work completed to date. 5. Bill other revenues sources whenever possible in order to utilize these funds for the clinical and care management of Jefferson County citizens with no other revenue sources. 6. Invoices must be submitted by the 2"d Monday of the month for the previous month's expenses. The County will review such invoices, and upon approval thereof, payment will be made to the Contractor in the amount approved. Page 33 7. Failure to submit timely invoices may result in a denial of reimbursement invoices submitted after three months will not be honored with outprior approval. 8 Contractor shall provide necessary backup documentation for all invoices including actual timesheets and statements. Any indirect charges require the submittal of an indirect cost methodology and rate using OMB Circular's A-87 and A-122. Management: 1. Provide funding for continuing professional education. 2. Provide adequate space for staff and client services, as well as waiting room, group room and private therapy areas. 3. Provide clerical, billing and general office support. Provide agency oversight regarding record keeping, data collection, legal and ethical issues and standards of care. III. Budget The projected amount available for these treatment services will be based on tax revenue projections for 2015. The proposed budget for services should include a detailed breakdown by each subtask included in your proposed scope of work that indicates: 1) the hours assigned to specific individuals by school and that person's hourly rate; and 2) the breakdown of hard costs associated with completion of the task. The budget should include the following assumptions: Provide a detailed budget spreadsheet, which covers both the requested local MHICD funds and any other funds required to support the services. The spreadsheet should have the following line items as necessary: Budget Item JCMHICD Funds Requested Other Funds Salaries $ $ Benefits $ $ Indirects $ $ Professional Services $ $ Incentives $ $ Other: (Please specify) Professional Insurance $ $ Other: (Please speci ) $ $ Other: (Please speci $ $ Page 34 Detailed budget for the project period includes: The amount of Mental Health/Substance Abuse Local Sales Tax funds requested and list hours available in each school Other Funds: The amount, by source, of other financial or in -kind support. Provide a budget justification for your detailed budget. Details by cateaorY: Personnel costs: should be explained by listing each staff member who will be supported from funds; name, position title, and percent full time equivalency. Indirects: Any indirect or overhead cost charged to the project (Circulars A-87 and A-1 22 guidelines must be followed and an approved methodology must be submitted if you will be billing for indirect or overhead costs) Professional Services: Professional and consultant services rendered by persons who are members of a particular profession or possess a special skill, when reasonable and necessary in relation to the services rendered. Incentives: Costs incurred for materials and supplies necessary to carry out the services provided. Supplies: Only supplies used in the actual performance may be charged as direct costs. Other: All costs that do not fit into any other category should be entered into this category. Provide an explanation of each cost. In some cases, grantee rent, utilities and insurance fall under this category if they are not included in an approved indirect cost rate. IV. Evaluation Criteria Approach to Scope of Work The Committee will be evaluating the proposed applicant's ability to accomplish the requirements of the scope of work, plus any original ideas or approaches proposed that would enhance the project. All proposals submitted by prior recipients must be new proposals. The Committee will not reward points for prior year re -submittals. • Budget The Committee allocates possible budgets to agencies based on the ability to achieve the stated goals of the project, within budget proposed. V. Proposal Contents All proposals shall be limited to six pages, not including the cover letter or resumes or indirect cost methodology. The proposals, at minimum, shall include: A description of the proposed team, including a description of the agency and each staff member and their qualifications to complete the assigned work. Page 35 A proposed scope of work, including detailed sub -tasks and deliverables. Include documentation for the evidence -based or proven practice you propose to use. • A detailed budget and schedule that includes dollar amounts for each task listed in the proposed scope of work. • Resumes for each person assigned work on the project, except for clerical or administrative support. VI. Selection Process and Schedule A. Selection Process The Committee will consist of representatives of Jefferson County Mental Health/Substance Abuse Sales Tax Advisory Committee and Jefferson Board of County Commissioners. Anna Mc Enery, of Jefferson County Public Health, will manage the selection process. She will be the primary contact between Jefferson County and the vendors submitting proposals for this project once the application process is completed. The Committee will evaluate all written proposals; they may request interviews for clarification of applications only. The selection committee retains the right to reject any and all submissions and to, if needed, begin anew with another RFP. Furthermore, the Committee is authorized to waive any minor variances or deficiencies in the submission or submissions of the persons or entities that Jefferson County Public Health chooses to contract with. B. Preliminary Schedule (subject to change) July 8 2014 RFP is released August 22 2014 RFPs are to be received by Jefferson County Public Health September 2 2014 Committee will review applications October 7 2014 Committee or Vendors answer questions for clarification if needed October 7 2014. Committee creates funding spreadsheet October 7 2014 Vendors selected and recommended to BoCC January 1 2015 Contract in place for services beginning January 1, 2015 Page 36 c 3 E � a� roa� v c cn C in m U) c a S6 N .�+ T N 'y M C ti N c 0 �co-S ❑ m N E❑ CF © O o U) -� w Enm CD ❑ C O] c6 En� U m .0 L �a d 'C = 7 d O d Q d❑ a O a� tlf fil E O ❑ U L L O M N O Z C L O 0 0 0 0 0 U O itl c N ❑ ❑ ❑ ❑ ❑ ❑ N. ❑ ❑ ❑ ❑ ❑ R.S. 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CD "O .� rn 0 m o 0 N 4Y O_ ®1 -p U a .. 7 E N � a L C 2 N U m O 'EL v ma c�c o m E.� °'to U a�'� L p. m(DL=- ay m in m m U z3 m rn E w m N z ° o Rq ❑2 o 2 O U ❑ ❑ ❑ ❑ ❑ ❑ ❑ U ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 0 .0 U V V) I] ❑ ❑ ❑ ❑ ❑ ❑ 0 0 ❑ 0 ❑ ❑ 0 u ❑ 2 9�w 12 Appendix F. Chronic and Justice System Programs Chronic & Justice System Programs 2014 Mental Health -Substance Abuse Budget for Direct Services $65,000 $33,000 $32,000 $30,000 Jumping Mouse Nurse Family Mental Health - Juvenile Court Partnership Schools (Topside) Jail RN Courts (MH & Substance Mental Health Therapeutic) Abuse Treatment Treatment jt#$6,,740f� 5chvo!r: Chronic & Justice System Programs: $65'000 9292.000 Community Treatment Sites A. Co -Occurring Disorder Treatment Program-(CODIT GRP) Since the 1990s, the field of co-occurring disorders treatment has continued to grow, but before the 1990's, treatment for substance abuse was delivered in a separate facility from treatment for mental health disorders, and care was delivered using fundamentally different therapeutic methods. "The U.S. Department of Health and Human Services estimates that severe psychiatric disorders like schizophrenia, bipolar disorder and schizoaffective disorder affect up to 5 percent of Americans, and that as many as one in five Americans struggles with mental illness at some level. Within that group, approximately 7 million also suffer from drug or alcohol addiction. Integrated treatment for co-occurring disorders is the key to protecting this group from the poverty, illness, isolation, incarceration and homelessness that often affect Dual Diagnosis individuals." (Dual Diagnosis.org) Page 38 The 11101h of 1 % tax finances the Co-occurring disorder treatment program or CODIT program that serves residents of East Jefferson County. A Chemical Dependency Counselor from Safe Harbor and a Mental Health Professional from Jefferson Mental Health (JMH) diagnosed CODIT clients eligible for the program, as having both a mental health disorder and a substance abuse problem. According to the RFP from Safe Harbor and JMH, they "follow a harm reduction model with a multi disciplinary approach to service delivery model. An integrated, individualized treatment plan is presented; it includes case management, outreach, education, access to housing and employment supports and counseling to address co-occurring disorders. Services are provided using a long term approach to treatment, hope and optimism is in the forefront". Coordination with Law Enforcement, Mental Health, Prosecuting Attorney and Drug Court is provided. B. Therapeutic Courts -(Mental Health, Drug, Juvenile & Family) The first drug court, (therapeutic court) emerged in Miami, Florida in 1989. Over the last 25 years, research has told us these pioneering courts can successfully deal with the public health dilemma of unlawful behavior and substance abuse. Therapeutic courts are a second chance for nonviolent offenders. They have the opportunity to avoid jail time but also the chance to recover, by defeating their addiction to drugs/alcohol with "rehab like" sentencing. According to Belenko's, (1998:2) research, "drug courts provide closer, more comprehensive supervision and much more frequent drug testing and monitoring during the program, than other forms of community supervision. More importantly, drug use and criminal behavior are substantially reduced while offenders are participating in drug court". There are multiple reasons why these courts exist including keeping non-violent offenders out of prisons/jails, giving offenders the chance to give back to the community, giving juveniles an opportunity to get their life on track, keeping families together. These findings mirror the experience of the Jefferson County therapeutic courts. The 1 i101h of 1 % tax finances the following Therapeutic Courts: • Topside-( for moderate to high risk juvenile offending youth affected by Substance Abuse, Chemical Dependency, and Mental Health issues) • Family Therapeutic Court -(Substance abuse issues are a part of parenting difficulty) • Mental Health Court -(For clients with mental health and substance abuse problems) • (Drug Court staffing is mostly funded by State funding) The Jefferson County Prosecuting Attorney shared that two recent graduates from Drug Court had quite a few felonies and misdemeanors between them; one of the graduates just finished paying $73,000 in back child support. He went on to say that before Drug Court the graduates cost to the County was $80,010 and now it's only $3,600, but more importantly Therapeutic Courts are giving offenders a second chance to get their lives back. A local Judge that participates in Mental Health Court said that because a client with severe mental health issues is in the Court, the County has saved $10,000 a year. She has known of this client for 20 years and his personal success is a testament to Mental Health Court. Page 39 Coordination with Law Enforcement, Mental Health, Prosecuting Attorney, Safe Harbor, Child Protective Services, Guardian ad Litems, various Attorneys and Community Action is provided. An additional benefit of coordination is that many people participating in the Therapeutic Courts have case management and are finding housing. C. JAIL RN Since 2008, the Jefferson County Jail has employed a Jail RN, (Correctional Nurse) part time at the Jail. The 1 /10th of 1 % tax funds this position five days a week, four hours each day. Kitsap and Claliam Counties are looking at Jefferson's Jail RN program as a model to duplicate. According to the 2014 Request for Proposal from the Jefferson County Jail, the Jail RN "is often the first line of intervention for substance abuse and acute mental health emergencies in the County". A Jail RN report in April of 2014 stated 47% of their inmates have mental health issues and the other 53% have substance abuse issues. She stated, "It's sad to see people with mental health/treatment issues in Jail, but there are no other services for them." The RN's presence in the Jail has helped the Guards learn about mental illness to better handle daily problems. The Jefferson County Jail RN co -facilitates Relapse Prevention Education classes & four active weekly AA meetings. These meetings/classes provide critical intervention for inmates in the early stages of recovery. The Jefferson County Jail RN assesses inmates suffering from substance abuse and/or withdrawal, mania, anorexia, mood disorders, self harm or other conditions yet to be identified; also reviews inmate's medication histories to ensure they have access to their psychotropic medications, guaranteeing continuity of care between medical and psychiatric providers and staff. The end result is a decreased need for emergency room services and hospitalizations. COMMUNITY TREATMENT SITES Early Intervention The 1/10th of 1 tax funds directed to early intensive interventions will be seen progressively improving community problems. Early intervention is services or programs of treatment started in pregnancy or birth or early in the onset of a problem. Intervening early with these children and their families is crucial to reducing and preventing mental illness and substance abuse. A. Nurse Family Partnership National evidence based home visiting program Nurse Family Partnership (NFP) provides early intervention seeing moms at 26 weeks of pregnancy until the child's second birthday. Jefferson County Public Health has provided the NFP program for 15 years continuing to see positive community outcomes. NFP nurses are working daily with high risk families involved in the justice system, drugs and alcohol and mental health problems. NFP —is based on the highest quality research that supports short and long-term outcomes for TWO generations of a family (mother and child). NFP is a prevention and treatment program that -targets --,high risk pregnant women, has the intensity and duration needed for lasting positive change, and starts early in pregnancy for better birth outcomes (prevent pre - term birthstlow birth wt/substance affected infants). NFP has a rigorous quality assurance Page 40 component so that communities can be confident that investing in families will lead to improved outcomes. B. Jumping Mouse Treatment According to the 2014 Request for Proposal from Jumping Mouse,"their agency is an in- depth, intensive, prevention program serving at -risk youth and their families as a 501(c) (3) nonprofit in Jefferson County". They went on to say, "since 1999, Jumping Mouse has been committed to systemic change by addressing the issues of substance abuse, family violence, and mental illness in families at the root cause. Our program halts unhealthy patterns through an integrated approach - long -term therapy for traumatized children, along with individualized education and support for their parents or other caregivers". Their RFP shared some statistics about the children currently at Jumping Mouse, 82% are from low-income families; 58% are in single -parent homes; • 75% have been exposed to domestic violence; • 63% were exposed to drugs prenatally andlor in the home; • 42 % are in foster, kinship or adoptive care; and • Almost a third have experienced homelessness. When necessary Jumping Mouse provides many services at a reduced fee or at no cost. The 1110`h of 1% tax funds help to make Jumping Mouse accessible to all children in need. As one grandfather stated, "[Jumping Mouse] is a powerful source of guidance for our next generation. We're sad that we didn't have these insights for our first generation of offspring. It would have made a big difference." Jumping Mouse builds resilience and hope. C. School Based Clinics The 11101h of 1% tax finances staff of Jefferson Mental Health, (JMHS) to provide mental health services for fourth grade through High School in a natural environment, the school based clinic. According to the 2014 Request for Proposal from JMHS, "the school health clinics have proven to be a beneficial way to access mental health services for students in need and to provide for preventative care. The JMHS mental health therapists work in collaboration with school staff to develop goals and objectives for the school based health clinic for the school year'. The mental health therapists provide services for youth through short-term counseling, supportive counseling and referrals for youth and their families. Treatment issues including depression, stress management, anger management, relationship issues, social skills and family issues will be available. Therapists can also provide services for families & school employees, when needed collaborate with substance abuse treatment providers. Providing mental health intervention and prevention services in the schools of East Jefferson County, is an important asset to the community. Page 41