HomeMy WebLinkAbout121514_ca07\ 615 Sheridan Street
(Joey Port Townsend, WA 98368
www. JeffersonCountyPublicHealth.org
is Health Consent Agenda
December 15, 2014
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
FROM: Jean Baldwin, Director Jefferson County Public Health
DATE: �� "tJ �� I S-1 �Lc (q-
SUBJECT: Jefferson County Mental Health (MH) and Chemical Dependency (CD)
Hargrove sales tax 8 -year Summary Report and Plan
STATEMENT OF ISSUE:
Jefferson County Public Health requests Board of Commissioners acceptance of this historical report that
summarizes the past 8 years of MH /CD committee work and BOCC allocations from this fund. The
documents can be viewed as foundational review on which to base further fund planning.
ANALYSIS /STRATEGIC GOALS /PRO'S and CON'S:
The BOCC has reviewed the Summary Report and Plan on July 7, 2014 and October 27, 2014. The Mental
Health and Chemical Dependency Committee has reviewed the Summary Report and Plan on September 2,
2014 and November 4, 2014. The purpose of the Chemical Dependency /Mental Health Program Fund is to
actively address, through treatment and intervention programs, the health, social, community, and economic
impacts Mental Illness and Chemical Dependency have on the citizens of Jefferson County. This report is a
summary of community services and tax spending allocated over the life of Hargorve fund. This is a
comprehensive history of a local funding system which was created by BOCC in 2005 for MH and CD
treatment. While this fund addresses some local treatment needs, the fund has not and will not be .able to
provide for all local treatment needs. It is understandable that all providers, contractors, committee
members and staff are passionate to provide the best services possible.
FISCAL IMPACT /COST BENEFIT ANALYSIS:
MH /CD fund has managed a 1 /10 of 1% sales tax since 2005. The BOCC appointed a process of committee
reviews; grant applications, service reports and costs. The Advisory committee makes allocation
recommendations to the BOCC each budget year. This small sales tax supports an average of $400,000 of
MH or CD treatment services a year in Jefferson County.
JCPH management request Board approval of the Hargrove sales tax 8 -year Summary Report and Plan as
final.
R HtE E _ SY2
Ptrilip orley, (Cou Administrator` 7 Date
Community Health Environmental Health
Developmental Disabilities Water Quality
360 -385 -9400 360 -385 -9444
360 -385 -9401 (f) Always working for a safer and healthier community (f) 360 -379 -4487
Report
Continuation Plan
JC Ordinance 08- 1003 -05
Jefferson County
Expanded Mental Health and Chemical Dependency
Treatment Fund
(Hargrove Sales Tax 1/10 of 1 %)
December 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 -11
Fiscal Plan:
Intent of Jefferson County Commissioners Page 11
Challenges Page 11 -12
Needs Page 12
Evaluation of Services Page 12 -13
Funding Planning Page 13 -15
Jefferson County Benefits Page 15
Report Summary Page 16 -18
0=11 I
A. Ordinance Page 19 -22
B. Hargrove Letter Page 23
C. Advisory Committee Members Page 24
D. Executive Summary Page 25 -35
E. Request for Funding Page 36 -42
F. Expanded Mental Health & Page 43 -45
Chemical Dependency Programs
Jefferson County Ordinance No. 08-1003-05. (Appendix A, adapted 2005.)
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, and outreach 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.
Coals of the State legislation were to:
1. Deduce 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, Deduce 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, the Jefferson County Board of County Commissioners (BoCC) adopted this tax
in order to provide enhanced mental health and substance abuse treatment services.
The BoCC established the Jefferson County Mental Health and Substance Abuse
Revised December 2014 Page 1
Advisory Committee to review community needs and local Requests for Proposals
(RFP) from vendors. Contracts have been negotiated yearly since 2006 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
residents who benefited from locally funded services may not have had state funded
services available during this time period.
The BoCC and the County Administrator 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 alone does not change local needs.
Local funding focuses on 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 of these local funds may change the health and safety of
residents 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, among others.
(See figure 1.) The cost impact throughout government is substantial in law
enforcement, courts, juvenile justice, the jail system, schools, public health, and
Medicaid.
Revised December 2014 Page 2
Selected outcomes to measure progress on each goal:
1. Reduce negative impacts of mental health and substance abuse on children and families Adverse Childhood Domesbc Violence ChIld Acuse and
Expenences (ACES;
2. Avoid buildrig more jails and prisons and prevent crime victims Youth laull.,ing llcohol and Drug Arrests r'iMfl Index
3, Reduce public assistance expenditures and unemooyment Pudic Asssiterice - Puoiic Assistance -
food treatment Unenroio,mentralq!
4. Reduce homelessness Homelessness Homeiissnessar�ong
— — ---- --- Students
$. Reduce phirsical-health care and emergency room costs, LkoholDrogoeaths rh?rgaflCr Room
H alcabons Visits
i--11;p1— —1-1—ry arli-�Ualrly —Omo for those suit substance abuse and menial health disorders �fvve ca q addre.-a goers 1-5 we shoutcce acreres&jg Boar 6
Figure 11
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 specific 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:
hftl2://www."effersoncountypublichealtL._orA,/Pdf/Community0utcomes.pd
ADVISORY COMMITTEE
The BoCC 2005 ordinance recommends having committee members from existing
committees that are knowledgeable of need and treatment services, The BoCC
appointed Mental Health & Substance Abuse Sales Tax Committee members to include
representatives from: Law and Justice Committee (2), Substance Abuse Committee (2),
Board of Health (2), 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 annually by
MH-SA tax. The complete community data is updated every two years to identify
changing community treatment needs. Data is at web page:
http://www.jeffersoncountypublichealth.or /i,ndex.php?oublications-data,-resources,
Quarterly program evaluation reports from each contracted agency are submitted with
bills for services to JCPH. Program evaluation data is compiled for the advisory
'Prepared by Jean Baldwin, JCPH Director, and Siri Kushner, Fund Contracted Evaluator. Sources and additional details available
upon request.
Revised December 2014 Page 3
committee for annual review. (Appendix D,) Program evaluation, measurements, and
ongoing outcomes are standardized for each vendor. Evaluation data helps the
committee see local services being completed and opportunities for improvement.
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. The recommendations are discussed, possibly modified,
adopted by the BoCC, and subsequently added to the upcoming year County budget.
Contracted vendor agencies are all 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 BoCC 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 residents.
In 2005-14 contracts were established to provide access to programs, based on the
following priorities of the BoCC:
0 Treatment for individuals with co-occurring MH/CD disorders
Therapeutic court: coordinate Alcohol/Drug & Mental Health court referrals
and family dependency needs in courts
Revised December 2014 Page 4
a Expanded Mental Health/Substance Abuse treatment for populations not
served by other public funds
a 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
o Mental health services to students on school campuses
0 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 BOCC for
review and approval.
Tax collection and allocations:
Money received from the 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
Methamphetarnine Action Committee. Jefferson Mental Health Services (.JMHS) 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.
Revised December 2014 Page 5
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Starting in 2006, the Mental Health & Substance Abuse Sales Tax Committee allocated
the fund at: 40% adult Co-occurring Disorders, MH and substance abuse treatment,
15% youth, 10% jail treatment nurse, 10% community assessment and program
evaluation, 5% billing and administration, 10% therapeutic court, and 10% reserve. it
was found that adult chronic services needed more funding so this formula was
discontinued.
Treatment funding can be categorized broadly as early intervention, schools, and'
chronic treatment & justice system programs. The following graphs shows the 2014
fund budget by category and next by service provider.
Jumping Nurse Family Mental Juvenile Jail RN Courts (MH Substance Mental
Mouse Partnership Health - Court & Abuse Health
Schools (Topside) Therapeutic) Treatment Treat-me-
Early Schools:
Interventiow -+� 4F— $65,000 Chronic Treatment & Justice System 10
$61,740 Programs:
$292,000
Community Treatment Sites
Figure 3
Page 7
2014 Fund by Vendor, $ Budgeted and Percent of Total
Legend: '.4, wa -k, ;HERMON
fO((
OMONVA
Figure 4
Revised December 2014 Page 8
Costs per client from the JC MH/CD fund is not possible to do since most of
these programs have other sources of funds. The only two programs that are
exclusively funded by the MH/CD fund are illustrated below.
Treatment Setting
if
If i11111111f ff 11M I I %
Unduplicated Amount of
Number Billed to Total
Served Fund Fund
R"
MH/CD Fund
Cost per
Individual
Served
Services
Funded
Entirely
by This
Mental Health - Schools
167 $65,000 19%
$389
yes
Jail RN
268 $32,995 10%
$123
yes
Figure 5
Reviewing benefit/cost analysis of services is a goal. It is complicated to review with the
weaving of several funding sources. Funds can be fees, State or Federal funding, or
insurance. The Washington State Institute for Public Policy (WSIPP) does extensive
analysis of publicly funded programs and looks at total costs/benefits of programs using
national and state data. Rand Corporation, Universities, National Institute of Health, and
other research bodies normalize program costs so they can be used to compare
outcomes. This is not a perfect science but the figure below illustrates how the process
of cost analysis is completed by WSIPP for Jefferson County programs,
Revised December 2014 Page 9
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Other local treatment programs have not been required to evaluate the cost of services
per person. All their program costs would be a prohibitive research project since there
are many fenders. All that can be reviewed is the cost per year from this fund and the
number of persons served. Costs for services cannot always be compared between
services since intensive services last a longer time, have more visits and may only be
available for a small percent of the general population. For example, an average of
10%-20% of Jefferson county births qualify for Nurse Family Partnership services,
based on risk and need, The nurse can only carry a caseload of 25. Juvenile justice
drug court and Jumping Mouse are similar in that therapeutic case loads are small.
INTENT of JEFFERSON COUNTY COMMISIONERS
0 Expand and fund treatment throughout the County for all populations, in
accessible sites.
0 Decrease the impact of substance abuse and mental illness on the overall health
and economic well-being of residents.
• Fairly distribute funds to areas of the population of highest need and where
improved outcomes may be possible.
CHALLENGES
• There is not enough funding to fully fund prevention and treatment services
throughout the County. Difficult choices are necessary for the advisory board to
make recommendations to the BoCC establishing funding priorities. Treatment
dollars could easily be absorbed by providers serving urgent needs only.
• If services created are not producing change or serving enough people, the
County may stop the funding.
Changes with the implementation of the Affordable Care Act (ACA) will impact
payment for treatment of substance abuse and mental illness. Some State
financed care will remain unchanged; other changes are coming to the Division
of Behavioral Health within Washington State. The BoCC, JMHS, and Safe
Harbor, and other community providers, are monitoring these changes,
* Consistent funding must exist for the management of the fund. In 2013 the
committee moved these three services out of the treatment allocation dollars.
Page 11
6% yearly is required for fiscal management of the fund, contracts management,
and vendor billing time. This team also coordinates the committee reports of
current tax revenue, spending, total contract changes throughout the year, and
has one interface with the County budget system.
Additional staff time with meetings and planning is an additional 2.5% for staff
time.
Assessment of County wide needs and program evaluations of the services have
consistently taken 10-15 hours a month of contractor time. The process
evaluation has led to increase of funding for some vendors, elimination and
service changes. Continual data updates allow the community and advisory
committee to know current community treatment needs. This funding has been
consistent at 5% of the fund.
Acute and chronic illnesses are more expensive and intensive to treat. Some
treatment services are focused on treatments that prevent an ongoing life cycle
problem, in the home, school and everyday settings. The split in priorities and
funding is always a problem; there is not enough money to provide all needed
services. The Jefferson County BoCC choose to invest some of the fund in both
models of services.
it 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 has 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 effectiiveness;
as a group they have established a level of expertise.
0 Leadership of this fund must remain visionary and provide long range planning
and be not reactive.
EVALUATION OF SERVICES
Vendors are providing quarterly reports of service outputs. There is no data system that
provides integration of substance abuse and mental health services at a patient level.
Revised December 2014 Page 12
The collection of service data has enabled the Committee and BoCC to utilize the
information to see some impacts of the local programs.
Contracts for this fund in 2015 will be allocated for one year. Two-year applications
were requested but unknown changes in the funding from the Healthcare Authority and
the Division of Behavioral Health make it difficult to know what existing programs may
need in 2016. 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.
Contracts change each year based on the committee's recommendations, service
needs, or input from vendors. For instance Jefferson Mental Health Services was asked
to include in their co-occurring (CODIT) disorder contract, staff time for treatment in
Mental Health Court. The committee asks that services in the MH court be included in
the CODIT hours since current staff say they have many of the same clients. The
Courts are managed as follows:
Juvenile Court — Juvenile Drug Court (Topside)
Superior Court — Family Therapeutic Court, Drug Court
District Court — Mental Health Court
Family Therapeutic, Drug, and Mental Health Court all share case management
services since 2013. (See Appendix F)
Revised December 2014 Page 13
Planning funding to change community outcomes requires a diversity of service
rlhes and service vendors. The 2013 spending chart (Figure 6) depicts some of
CI PP, 1-1 n
this diversity in
sites and
approaches to
treatment.
Services
shaded green
represent
early
intervention
schools',
community
treatment is
seen in gray',
red represent
treatment and
justice system
interventions. Figure 6
The number of individuals served and cost per individual differs by program (Figure 7 and 8).
7
.e
Revised December 2014 Page 14
IVIH/CD Fund 2013 Treatment Services
unduplicated Number of Individuals Served
Green = Early Intervention
Gray = Community Treatment Sites
Red Chronic & Justice System Programs
300
250
200
150
M
0
Jumping
Nurse Farn,ily Mental HealthJuvenile Court Jail RN Substance Mental Health
Mouse
Partnership - Schools (Topside) Abuse Treatment
Treatment (CODIT)
(intakes +
Relapse Prev.)
7
.e
Revised December 2014 Page 14
Figure 8 Cost indicates JC MHICD fund allocation only
• Increased treatment is available for residents today with Mental Health (MH)
and/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 CID
and MH treatments and willing to make difficult choices.
• Adoption by Jefferson County increased the treatment money available by an
average of $400,000 per year since 2006.
• RFP process is transparent and challenging for the 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.
Revised December 2014 Page 15
MH/CD Fund 2013 Treatment Services
Cost per Customer Served by
Green = Early Intervention
Gray= Community Treatment Sites
Red = Chronic & Justice System Programs
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
. . . .........
Jumping Nurse Family Mental HealthJuvenile Court Jail RN
Substance Mental Health
Mouse Partnership - Schools (Topside)
Abuse Treatment
Treatment
(Intakes +
Relapse Prev.)
Figure 8 Cost indicates JC MHICD fund allocation only
• Increased treatment is available for residents today with Mental Health (MH)
and/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 CID
and MH treatments and willing to make difficult choices.
• Adoption by Jefferson County increased the treatment money available by an
average of $400,000 per year since 2006.
• RFP process is transparent and challenging for the 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.
Revised December 2014 Page 15
UJIF-MIUM 2=1 RE Tal, Ii rim
iittee I
Future contract goals are to provide access to Mental Health and Substance Abuse
treatment, based on a continuation of priorities of the Board of County Commissioners:
• Treatment for individuals with co-occurring MH/SA disorders
• Substance abuse and mental health assessment, counseling, referral in the
jail
• Therapeutic Court: coordinate alcohol/drug & mental health referrals and
family dependency needs in courts
• Community based treatment for families and children coping with mental
illness or substance abuse in a spouse, parent, child, or themselves in
community settings
• Mental health services to students on school campuses
• Early intervention home visits to pregnant families providing treatment
services
• Expanded Mental Health/Substance Abuse treatment for populations not
served by other public funds.
Service foals and uidelines
This fund creates a collaborative plan to supplement state funds with local
funds and is building a significant service network for Jefferson County
citizens
• The County believes that the programs or services that are to be
implemented should be evidence based, research based, or a promising
innovative practice.
• The contractors are required to implement comprehensive County-wide
services available to all citizens; without discrimination or income barriers.
• There is not enough funding to fully fund prevention and treatment
needs throughout the County.
• Mental Health/Substance Abuse County funds are the payer of last resort;
agencies need to serve clients with other funds first.
• Vendor reports are to be filled so services can be tracked throughout the
year.
Revised December 2014 Page 15
Additional staff time (problem solving, technical assistance, and
reviewing/signing off on monthly invoices to assure contract compliance) with
vendors, writing and managing contracts, producing and oversight of yearly
RFP, staffing MH-SA Committee meetings (speaking with the chair to
write/review the agenda, taking minutes, coordination of vendor presentations
and sending out mailings) and reviewing evaluation reports is estimated to be
2.5% of the fund. (This 2.5% increase has not been in the fund before the
2015 budget cycle).
The fund must be accountable to citizens through fiscal management and
service delivery. Both must be available for citizen review in a concise and
clear format.
Consistent funding must exist for the management of the tax fund by
providing three unique functions within the infrastructure. These functions are
not reviewed by the committee in the yearly allocation of the fund.
1. 6% yearly is required for fiscal' management of the fund, vendor billing,
County Budget process (amendments, projections, and updates to
committee), maintaining state and federal compliance for auditing
accountability, monthly financial status, and allocation balances. Financial
assistance and guidelines to vendors as needed. Track billings and
invoice submittal and offer guidance as needed. Web management in
JCPH!,
2. Additional staff time with vendors, contracts management, committee
members, meetings, and reviewing reports is estimated to be 2.5% of the
fund. (This 2.5% increase has not been in the fund before the 2,015 budget
cycle).
3. Program Evaluation provides ongoing evaluation of funded programs and
services. Changing community needs are also monitored to see, if
programs are making a difference and if needs are changing. Yearly
updates of these reports are posted at
h:ttp://www,meffersoncountypublichealth.or /index.php?publications-data-
resources. A structured format has provided the committee and BoCC
tracking reviews. Average costs for this have been 5% and will continue.
In 2014, problems were found in reporting and billing. The current design of
the fund systems provides a consistent way to monitor services, without
addiling additional monitoring steps.
Revised December 2014 Page 17
MH-SA local funds will change community outcomes only if a diversity of service
approaches and vendors remain available. The 2014 Report shows this diversity in sites
and approaches to treatment; and the taxes are going to treatment.
Acute and chronic illnesses, are expensive to treat. No treatment program is able to
meet the needs of all citizens. A variety of programs must exist to serve people in
different times of their life.
Some treatment services are focused on interventions, which prevent a lifelong ongoing
problem starting in the home, school, and everyday settings.
The Hargrove MH-SA advisory committee is a skilled and knowledgeable working group
that provides great service to the community and the County Commissioners.
Any future changes to fund management will be after the committee provides advice
and recommendations.
Revised December 2014 Page 18
Appendix
Jeffersion County Ordinance No. 08-1003-05
PA //C
-dN
STATE OF WASHINGTON
County of Jefferson
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,
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, borne 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
WHERE,4S, 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 19
Ordinance No. 08-IL03-05; Imposing a Sales &.Use Tax for Providing a New or Expanded Chemical Dependency or McnW
Health Treatment Services and for the Operation of New or Expanded Therapeutic Court Program 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
E2SSB5763, 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 20
Ordinance No. 1 8-10 3-05; 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, RCW 82-14.460 (2) authorizes the County Legislative Authority to
authorize, fix and impose a Wes 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
F�_' - 0
WHEREAS, RCW 82.14.460 (3) provides that if Jefferson County authorizes the tax as
provided, the County may include a new and expanded therapeutic court for dependency or mental
health treatment proceedings as a component of existing Drug Court program, effective July 1,
2005.
NOW, THEREFORE, BE IT ORDAINED, by the Board of County Commissioners of
Jefferson County, Washington, that:
S!Nljon 1: Tax IMRosed.
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.
SLctian-
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 ofthe article used in the case of a use tax.
Section 4. Administration and Colleeflon.
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 Departrnent of Revenue that may be necessary to provide for
the administration or collection of the tax.
Section 5• Establishment of Chemical Dependency/Mental Healtb 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 21
ordinance No. 08-1003-05 Imposing a Sales 8t Use Tax for Providing a New or Expanded Chemical Dependency or Mental
Health TTeatrnmt Services and for the Operation of New or Expanded Therapeutic Court Programs as provided in Ch. 92-14460
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.
'4o VD AND ARTRq ADOPTED this G4
dayof 2005.
rQ
ATTEi T:
CoL
Julie Matthes, CMC
Deputy Clerk of the Board
Approved as to Form:
Prosecuting Attorney
JEFFERSON COUNTY
BOARD OF COAO&SSIONERS
Page 4 of 4
Page 22
Appendix B.
Hargrove Letter
otympia Addre,"is:
I'() Box 40424
jjjpjj. %\'N OM04 042-1
December 5, 2013
Xbti
V5 Mm
Senator Jim Hargrove
2'4th Legislative District
Dear County Legislative Authorities and Department of Social and Health Services:
Tckphonv,
_S6 646
'6111 900 502 0910
In 2008, 1 sponsored legislation allowing counties to impose a.i of one percent sales tax to fund chemical
Aependency 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.
I, 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 outrecich, 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 health treatment Dromms-md. services and for the operation or
delivery of therapeutic court programs and services. For the purposes of this section, "pEggrams and
se !s" includes, but is, Lt limited to, treatment services, case management, and housing that area
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 82.14.46o(3). If there is any additional needed
clarification, please contact my office.
Sincerely,
Senatur,hin, Hargrove
Page 23
Appendix C.
Advisory Committee Members
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Appendix D.
Executive Summary
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 d000 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,
J. Reduce public assistance expenditures and unemployment
4. Reduce homelessness
G. Reduce physical-health care and emergency room costs
6, Improve recovery and quality of life for those with substance abuse and menta,l 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. 08-10O3-O5 signed October 3, 20D5.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 I 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
empsnseby program area is detailed by year on the right.
EXPENSES
$ 406,992
$ ]94,7Z2
$ 431,973
$ 454'468
$ 423'625
$ 355'l97
REVENUE
2008*
$
440,873
2009
$
379,448
2010
g
354,812
2011
$
906,278
2012
$
360,082
2013
g
404,816
EXPENSES
$ 406,992
$ ]94,7Z2
$ 431,973
$ 454'468
$ 423'625
$ 355'l97
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, sem�-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 25
THERAPEUTIC
ASSESSMENT/
ADULTCODIT
YOUTH CODIT
iAIL NURSE
COURTS
EVALUATION
ADMIN
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, sem�-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 25
EVALUATION HIGHLIGHTS 2013:
A total of82Z unduplicated individuals were served in2O13
by agencies receiving one tenth of one percent funds.
This might include individuals served by more than one
agency however h does not include any adults served in
An drug court.
0m average, atota:lof312 individuals were served each
month, |n2U13by agencies receiving one tenth cfone
percent funds,
*NFP reported number of families multiplied by 2
The next two pages include 2O13highlights by vendoandThe "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
lO report East County, and, another 3 in1O report non-Jefferson zipcodes. Over three-quarters have been lnjaii|
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: CODITpROGRAM
Description: Direct individual and group services to clients with both substance abuse/dependence and mental
health disorders.
Highlights: Served 28 unduplicated inclividuaK On average each month, served 11 individuals. The majority
served are age 25tu44\tvvethirds are male. Sixty-two percent report adpcodemf residence in Port Townsend,
Dn average each month, the program provided 151 hours of support groups, 132 hours ofCOD)T groups, and 1D
hours of individual services. Most common mental health diagnoses are Bipolar, PTSD and Schizophrenia, Most
common self-reported past 9N 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.
H|gh1iUhts;Semed73undupAcatedchi|drenand103undop|icatedcapegivnrs.8navemQeeachmomth,sen/ed
49 children and 78 caregivers, Forty-two percent of children are age Dto6,]G% age 7'9 and 22$t age 1O-12;
530/, are male. Seventy-three percent of children have a zipcocle 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 26
Adult Safe Harbor
117
16
NFP*
54
40
SBHC
167
96
Youth
JumpingivIouse"
176
113
CODIT
Topside
12
6
Jail, RN
268
30
*NFP reported number of families multiplied by 2
The next two pages include 2O13highlights by vendoandThe "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
lO report East County, and, another 3 in1O report non-Jefferson zipcodes. Over three-quarters have been lnjaii|
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: CODITpROGRAM
Description: Direct individual and group services to clients with both substance abuse/dependence and mental
health disorders.
Highlights: Served 28 unduplicated inclividuaK On average each month, served 11 individuals. The majority
served are age 25tu44\tvvethirds are male. Sixty-two percent report adpcodemf residence in Port Townsend,
Dn average each month, the program provided 151 hours of support groups, 132 hours ofCOD)T groups, and 1D
hours of individual services. Most common mental health diagnoses are Bipolar, PTSD and Schizophrenia, Most
common self-reported past 9N 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.
H|gh1iUhts;Semed73undupAcatedchi|drenand103undop|icatedcapegivnrs.8navemQeeachmomth,sen/ed
49 children and 78 caregivers, Forty-two percent of children are age Dto6,]G% age 7'9 and 22$t age 1O-12;
530/, are male. Seventy-three percent of children have a zipcocle 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 26
_ '~
JEFFERSON COUNTY PWBUC HEALTH: NURSE FAMILY PARTNERSHIP
Description: Public Health Nurse serves low-income first-time pregnant mothers with suciaVheahhind|catons
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 Z6 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, Chimecum, and QuQcene School Districts.
Highlights: From January-December 2013, the SBHC's served 167 unduplicated individuals. On average each
month, served 86 individuals. For Fall 2023 only by school district:
pORTTOVVN5END: 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.
[H|M4CUK«:Sem/ed 22 unduplicated individuals with an average of6 visits each, The majority were in 9th: grade;
6996 were females although 4O%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.
QN;LC[NE: Served 17 unduplicated individuals with an average of 6 visits each. The majority were in 6-8th and
Iltbgmdes; 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'OFNOPE
Description: Full-time chemical dependency counselor for the COMT program, Relapse Prevention Education
groups at the Jail, Drug and Alcohol Intake/Assessments, participation in District, Family Therapeutic, Topside,
and Drug Court. Data only submittedfor DruglAlcohol IntokelAssessments and Relopse 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
Tpvvnsend,anotbex32%inEast]efersoo.OnaveraQeeechmootkmustindividua|ocompletimg/ntskeweneno
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. Om average each month, served 1O
individuals an,d provided 9 hours ofgroups.
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 IZumdmp|icated individuals. Onaverage each month, served G 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 clagnoses were ADHD, Bipolar, Depression, and PTSD.
most common self-reported past 30 day substances used were marijuana and alcohol.
Page 27
gram Description: One registered nurse assesses a majority of subjects booked into jail
substance abuse and/or withdrawal and mental health conditions. Nurse actively
wits substance abuse inmates for participation in Relapse Prevention Education [RPE)
I co-facilitates two weekly RPE classes. Nurse provides assessment, early intervention,
i follow-up for inmates suffering from substance dependencies and/or mental health
es, including education and public health interventions. Nurse makes frequent referrals
efferson Mental Health and! the Jail Medical Provider, coordinates the continuum of care
i Safe Harbor and Drug Court, and assists with placement of inmates into inpatient and
patient treatment programs.
tal individuals served by 1110th of 1% funds Dy Zip COCIe OT
;idence, age group, and gender:
100%
50%
01/
Non-JG zip
code
South JQ
98376.20
0 East JIC:
98358,39,25,
65
> > > > w PT 98368
< < Z 6, 6 0
CA
0
C-4 c4v 04 N 2013
$50,000 1110th 1% Funding
$40,000
$30,000
$20,000
$10,000
'0 0, 0 CN n
100%
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Other
2009AV
2,01 OAV
2011 AV
65
50%
.45-65
0%
025-44
M 7E t >
o 0 L n < 2 ow 0 Zo Do six
a 18-24
C04 CR C"' P, 2013
100%
M Female
50%
m Male
0%
> > > > > >
gg < < 0 a 9
Z 0
L
0 0 C)
C 2013 4 C4 N C4 N
-ferrals to community serviceslagencies provided to clients (average # per month): Previously in # days ago
[-Total Dental Hospital MH output Medical Public Hath I IJC Jail, ad/mo. <90d >9(
09AV 38 2 2 51 28 1 2009AV 65%
110AV 52 3 2 16 29 1 2010AV 75%
MAV 37 0 1 16 20 0 2011 AV 74%
112AV 42 <1 1 18 22 <1 2012AV 76% 44% 56'
)rDec2013 1 41 0 1 14 26 0 2013AV 77% 39% 611
vff
ON/
k
4
717",S,
V"
17
W7,
71
2013 Annual Repoli
Self Reported Past 30 Day Substance Use At
Admission (average # individuals): INAlcohol
% individuals with unknown sub use:
2009; ink; 2010: 20%; 2011: 12%12012. 14%. 2013: 15% a Marijuana
Febtuary 4, 2014, revis'6,79tTcIT7-6, 2014
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20
m Math
Other
2009AV
2,01 OAV
2011 AV
2013AV:
Febtuary 4, 2014, revis'6,79tTcIT7-6, 2014
970:
'no data sent by deadline
Program Description: Our CODII program, run in concert with Safe Harbor, provides
direct individual and group services to clients with both Substance
Abuse/Dependence and Mental Health Disorders. These services, along with
access to medical specialists, a case manager and peer counselor, experienced in
serving this population, provide a broad spectrum of treatment possibilities not
otherwise available in this county.
$160,000 1110th 1% Funding
$120,000
$80,000
$40,000
0 0
0 a a n 0 C,
N C' CN CN N "
Total individuals served by 1110th of 1% funds by zip code
100%
50%
0%
ana aenuer:
Non-JC zip
codes
South JC:
98376,20
0 East JC -
86358,39,25
,65
> > >
m < Z 0 0 Q C W o 0 0) OPT: 98368
o 0 0 0 0
N N N N 2013
100%
n fernale
50% -
%-MEM ® male
0
CL o 0
0 — — —
N0 0 0 N n 2013
r4 N cv
ils to community services /agencies provided to clients (average # per month)*:
Total CD-lnpt
DSHS
Education
Employrnt
Medical
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
312Av** 47 2
3
6
10
2
13
Other
7
7
15 *No longer collecting in 2013
7 **No data submitted for July-Dec
Mental Health Diagnoses m BiPcIar
ImAnxiety
(average # individ'uals):
Major Depression
BlPanicDisorder
PTSD
Schizophrenia
10
Other
4
2
0
2009AV 201 OAV
2011AV
2012AV
2013AV
2013 Annual Report February 4, 201A. revjQ&CrcfiY6, ?0 14
from Description: This funding provides services to traumatized children whose care is $30000 1110th 1% Funding
,rwis,e uncompensated, specifically to those who have been directly impacted by a parent's $20,000 ■.00040
tance abuse and/or mental illness. With these funds, we are reaching some of the most af-risl,
nbers of our community, preventing substance abuse and mental health problems before the $jo,000
in, reporting changed in 2012 to reflect eligible clients similar to reporting by NFP. Note that in $_
o
1, 1 /10th of 1% funds were exhausted by July, by Aug in 2012, and by Nov in 2013.
)rage:
n-July 2011 32% 72%
n-Aug 2012 24% 71%
m-Dec 2013 2U%
l,21 inrlividaials served! by 1 110th of I% funds by zip code of residence, age giroup, and gender:
100%
50%
10%
Jan-Aug 2012AV2013AV
mUnknown
Non-JC zip code
,,A South AC:
913376,20
• East JC.,
98358,39 , 25,66
• PT: 98368
100%
50%
0%
Jan,Aug 2012AV Apr -Dec 2013AV
VO to 12
o7 to 9
0 to 6
ofernale
0 male
Exposed to Substance Use Rjan-Aug 2012AV
(average % of child clients): m 2013AV
100% 1 61% 62% 69% 65%
751/77,77 �77/�=
0% 1—
family environment child impacted by mom used drugs /aloe
substance use druglalcohol use during pregnancy
2013 Annual Report February 4.?Oo4, revXeCMC 96.20x4
Ja
Jefferson County Public Health
Progrclirin, Description: Serves low-income first time pregnant mothers with social /health
indicators that will increase the risk of poor outcomes for mother and infant. The majority of
participants either have a recent personal history of substance use and/or mental illness or
these risks currently or historically in the immediate family environment. Nurse treats the
mother using behavior change theory and motivational interviewing for quitting substances,
preventing relapse, treating mental illness, and
$50,000 1110th 1% Funding
$40,000
$30,000
$20,000
$10,000
$-
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.
Total individuals served by 1110th of 1% funds by zip code of
residence, age group, and gender: (age & gender of all persons at appts)
100%
50%
0%
C,� N
0
Pc' 4q
S\ 2013
Non-JC zip
code
South JC'
98376,20
• East JC:
98358,39,25
k5
• PT: 98368
100% 5+
50% rm 7,; 45-6
m25-44
®18.24
ID 1110 102 to 17
,ep Ip
70 , 2013 8 infant <2
100%
50%
0%
em,
2013
Referrals to community servicesilagencies provided to clients (average # per month):
Total
Child Care DSHS Dental
Housing
Medical
MH O,utpt Quitline
2010(Jul-Dec)
8
1 0 1
0
3
0 0
2011
12
1 1 C)
1
2
1 <1
2012
13
<1 1 1
<1
2
1 0
2013
13
0 <1 2
<1
3
1 <1
Transp Other
3
8
4
mfernaie
amale
Mental Health Diagnoses of mADHD
PregnanVPost-partum Clients NAnx�ety
(average # individuals):
Mafor Depression
10 'a Panic Disorder
5 d PTSD
0 Other
July-DeC2010 2011AV 2012AV 2013AV
2013 Annual Report
sen Reported Past 30 Day Substance Use
of pregnant/Post -partum Clients
0 Alcohol
{average # individuals):
4
m Marijuana
2
Tobacco
Iff Meth
N Other
July-Dec2010 20I1AV 2012AV
2013AV
Febrt a,y 4,2014, relmij, 20T4
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�pmnDescNp#cm:FuU�nneChem�a| Dependency Counselor provided for the {�OD�
]rcm to provide assessments, treatment, individuals, treatment planning, staffing's, and w100,000
a~ws' Two Relapse Prevention
Education groups per week ot Jefferson County Jail facilitated
~np/ �Dp� f mm So he Ho±o,' Drug and Alcohol assessments for individuals |n the community
$50,000
t�du�Je��nom{�ou�yJmO Ror0dpo�ion�mDbthcf
/eUosindividuo|s�un�nt�innor�exo . ' �
d�Thenzpeohc^Tupside(youth)ondDmg��ou�.Dn+mentryinhotheYwA3tateD�isiomof
ovioral Health and Recovery database of all assessments, admits, treatment participation
|oding groups, individuals, oMnm|ysis).and
'harges. Data entry is required by the State to be in compliance with state contracts. A portion of the funds are also used for
nrr nrnrirnm office supplies, Treatment for Jefferson County residents with no other means of payment,
nthly average her of individuals by referral source*:
Drug aw Family/
MH tx Court DSHS Court Jail Enf Mediral Friend
tal individuals served by 1110th of 1% funds by zip code of
100%
501/0
nm
-' m^
2013
code
• East »C:
98358,39,25
• PT 98368
100%
a female
50% wmale
ot'ON'.e '-o ov u++�e"�
2013 Annual Report
Youth Therapeutic Court I
Prpguamn0emcrip0ion: m20,00 1w0th1% Funding
The Topside Prograrn is on alternative therapeutic court intervention for youth involved in the
$m000
�
juvanijuytioeqm+em.Ayo�hn�ax program '
moderate/high risk youth with significant risk factors in two or more of the foliowing domains: »10,000
Chemical dependency; mentai health, school, and/or family functioning. The theory is that vu000
providing q treatment court setting for referred youth will assist |n fostering odirect m_
.
relationship between the Coud � motivate
engage im evidence-based interventions
and other programs imomeffort to reduce identified risk factors while supporting the strengths of the youth and family. Data
reporting began in August 2O10.
Total individuals served by1n0thcf1% funds by zip code of residence and
`om��"�umuno
2Ul3 Annual xePo� �^~m,^mw,�.�6��.�:��/"
Appendix E.
Request for Funding
I Ice
Ilia-,
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, Chimacurn 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 1110th 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 pgges except for attachments. Late or
incomplete responses will not be accepted. Electronic mail or facsimile proposals will
not be accepted. 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 Mc Enery 360-385-9410, amcenery@co.jefferson-wa.us,
1
Page 36
I. Introduction .............................. – ................................................ --' .................................. -2
A. Project Description must serve citizens in the entire county ........................... 2
B. Qualifications ....................... ............................................................................................ 2
Il. Project Management.– ........................................................................................................ 2
Ill. Budget ......................................... - ........... I .......... I ................................................. ............. 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.
II. Project Management
A description of your proposed project for 2015-16 must be provided. A brief r6sum6 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 mandat—, that %ing identify the actual persons who will 12g_performinq
the work and notify Jefferson County in a timely manner of any staffing changes during
he e d of the contract. t ' JCP H reserves the righ t
to
disgu
aliy the consultant ultant
a
w
arded
ir r 0 e ct if that c on consultant ass/ n s r ta ff to the contract that are not listed in the
ro os a I without the ri or notification of qualifications to JC PH
2
Page 37
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 collaboratively 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 2nd 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,
3
Page 38
7. Failure to sub it timely invoices may result in a denial of reimbursement.
Invoices submitted after three months will not be honored with out prior
apmo—val-
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.
Ill. 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
MH/CID funds and any other funds required to support the services. The
spreadsheet should have the following line, items as necessary:
Budget Item
JCMH/CD
Funds
Requested
Other
Funds
Salaries
$
$
Benefits
$
$
Indirects
$
$
$
$
Professional Services
$
$
incentives
$
$
0#1eE Please specify) Professional Insurance
Other; Pleases ci
$
$
$
$
Other: (Please specify)
$
$
4
Page 39
• 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 category,
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-122 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 r6sumes 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,
5
Page 40
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.
R6sum6s 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
,July
RFP is released
ust 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
6
Page 41
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Appendix
Expanded Mental
..
Expanded Mental Health & I
C.'O'hemical Dependency ProgramL
The 1110 of 1% Tax finances the Co-occurring disorder treatment program (CODIT) that
serves residents of East Jefferson County. A Chemical Dependency Counselor from Safe
Harbor and a Mental Health Professional from Jefferson Mental Health Services (JMHS)
diagnose CODIT clients eligible for the program as having both a mental health disorder and
a substance abuse problem. Coordination with Law Enforcement, Mental Health services, the
Prosecuting Attorney, and Drug Court is provided.
Safe Harbor and JMHS follow a harm reduction model, with a multi-disciplinary approach to
service. Treatment plans include 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.
The US Department of Health and Human Services estimates 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." (www.dualdiagnosis.oEg
B., Therapeutic Courts (Mental Health, Drug, Juvenile & Family)
Therapeutic courts are a second chance for nonviolent offenders. The offenders not only
have the opportunity to avoid jail time, but also the chance to recover by defeating their
addiction to drugs/alcohol with "rehab-like" sentencing.
The 1 /10 of I % Tax finances the following Therapeutic Courts-
• Topside. Moderate to high-risk juvenile offending youth affected by substance abuse,
chemical dependency, and mental health issues
• Family Therapeutic Court: Substance abuse issues
• Mental Health Court: Mental health and substance abuse problems
• Drug Court: Drug abuse issues. Staffing was funded by State funding
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, and keeping families together. These
findings mirror the experience of the Jefferson County Therapeutic Courts,
Coordination with Law Enforcement, Mental Health Services, the 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.
Page 43
C. JAIL. ESN
Since 2008, the Jefferson County Jail has employed a part -time Jail RN (Correctional Nurse).
The 1 /10 of 1 % Tax funds this position five days a week, four hours a day. Kitsap and
Clallam Counties are looking at Jefferson's Jail RN program as a model to duplicate..
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 inmates have
mental health issues and the other 53% have substance abuse issues.
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, reviews inmate's medication histories to ensure they have access to their
psychotropic medications, and guarantees continuity of care between medical and psychiatric
providers and staff. The end result is a decreased need for emergency roam, services and
hospitalizations.
COMMUNITY ``""
Intervention Early
Early intervention is a variety of services or treatment programs that begin during pregnancy,
at birth, or early in childhood before the onset of a problem. Funds of the 1/10 of 1 % Tax that
are directed to intensive early interventions will progressively improve community problems.
Early intervention is crucial to reducing or preventing mental illness and substance abuse for
families and their children.
Nurse Family Partnership
rshi
Nurse - Family Partnership (NFP) is an evidence based nurse home visiting program that
fosters long term success for first time mothers and their babies. First time mothers who are
Medicaid eligible meet with specially trained nurses during their pregnancy and until their
child's second birthday. NFP is a prevention and treatment program that targets high risk
pregnant women and impacts two generations of a family, the mother and child. It is based
on the highest quality of research (best practice) and supports positive short and long -term
outcomes for families, including improved birth outcomes in the form of decreased pre -term
births, decreased low birth weight and substance- affected newborns, increased school
readiness.
Jefferson County Public Health has offered Nurse- Family Partnership to Jefferson County
families for 15 years and continues to see positive community outcomes. The nurse home
visitors support moms to have healthy pregnancies, healthy babies„ and to become
knowledgeable, nurturing, and responsible parents, while often working with families involved
in the community's criminal justice, mental health, and substance abuse systems or referring
them into those systems. NFP has a rigorous quality assurance component that can assure
community confidence that investment in families will lead to improved outcomes,
Jumping use Treatment
Jumping Mouse is an in- depth, intensive prevention program for at -risk youth and their
families in Jefferson County. Jumping Mouse addresses the issues of substance abuse,
family violence, and mental illness in families, and halts unhealthy patterns through an
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integrated approach of long-term therapy for traumatized children, along with individualized
education and support for their parents or caregivers.
In 2014, Jumping Mouse reported the following information about children currently receiving
their services:
• 82% are from low - income families;
0 58% are in single-parent homes;
0 75% have been exposed to domestic violence;
a 63% were exposed to drugs prenatally and/or in the home;
0 42 % are in foster, kinship or adoptive care; and
0 Almost 1/3 of clients have experienced homelessness.
Jumping Mouse provides many services at a reduced fee or at no cost. The 1/10 of 1% Tax
help to make Jumping Mouse accessible to all children in need,
C. School Based Clinics MH
The 1/10 of 1 % Tax finances staff at Jefferson Mental Health Services (JMHS) to provide
mental health services in a natural environment for students: the School Based Clinic,
Mental health therapists provide services for youth through short-term counseling, supportive
counseling, and referrals for youth and their families. Treatment is available for issues such
as depression, stress management, anger management, relationship issues, social skills,
and family issues. Providing mental health intervention and prevention services in the
schools of East Jefferson County is an important asset to the community. Counselors work in
combination with the Jefferson Healthcare and JCPH medical staff to improve health of JO
teens.
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