HomeMy WebLinkAbout08 1003 05i r?46
C <_k___ C
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 } ORDINANCE NO. 08-1003-05
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, 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
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
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, 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 new 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.
Section 2: Applicability 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 Dependencv/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
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.
f�? r
J�APRR(J�VED AND ADOPTED this �-_ day of �fC�tC �:�-�� _ 2005.
,
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
JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
ORDINANCE NO. 08-1003-05
Tax Increase 1/10 of 1 %
Expanded Mental Health & Substance Abuse Treatment &
Therapeutic Courts Funds
07/01/06
Table of Contents
Jefferson County Ordinance No. 08-1003-05
Purpose
Statement of Needs
Program Creation and Authority
Program Design & Evaluation
Program Elements
Administration & Authority
Program Funding
Evaluation
Termination
Attachments
A. Jefferson County Ordinance No. 08-1003-05
B. Jefferson County Substance Abuse Advisory Board Letter Dated September 5, 2005
C. CODTr (Co -Occurring Disorder Integrated Treatment Program) Budget Narrative
D. Definitions
PA
Expanded Mental Health & Substance Abuse Treatment
And
Therapeutic Courts Funds
ORDINANCE
Jefferson County Ordinance No. 08-1003-05. (See Attachment A)
PURPOSE of Expanded Mental Health & Substance Abuse Treatment & Therapeutic
Courts Funds (MH/SA Fund)
The purpose of this ordinance is to use 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
1/10 of 1% to provide monies to be used for the purpose of providing new or expanded substance
abuse or mental health treatment services and for the operation of a new or expanded therapeutic
court.
In the 2005 legislative session Senator Hargrove introduced the Omnibus Mental Health and
Substance Abuse Reform Act SB 5763 which focused on the expansion of substance abuse and
mental health treatment (co-occurring disorders). The bill passed with strong bi-partisan support.
The goals of the legislation were to:
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
To meet these goals the legislation provides a funding mechanism to expand or provide new
mental health and substance abuse treatment by authorizing counties to impose a sales and use
tax in the amount of 1/10 of one percent (10 cents per $100).
STATEMENT OF NEEDS
The impact of substance abuse and mental health disorders on Jefferson County is significant and
it is clearly recognized as the most costly issue facing Jefferson County Government today
because it affects all systems. The impact is across the board from emergency services, police,
courts, jails, public health, mental health, business, child abuse, domestic violence, public
assistance, schools, environment, housing, crime, substance abuse services, shelters, non -profits,
insurance rates, landlords, property values and more. It is all pervasive.
The available state funds are inadequate to meet these needs. In the county there is a daily lack
of access to treatment. These disorders contribute to continued problems within the schools, a
majority of calls to law enforcement for the city and county, and for many of the Jefferson
County Prosecutor's cases. The impact is substantial in the courts, Juvenile Justice, the jail
system, the schools, Public Health, employers and agencies.
The community impact is recognized in the health community and economic impact of citizens
and families suffering through substance abuse and mental illness cycles. The true community
impacts of the untreated diseases are difficult to measure and are indicated by accidents on the
roadway; health care ER utilization rates; teen substance abuse arrests; unemployment rates and
other impacts.
Some impacts are silent and devastating like: the impact on schools shown by data that Olympic
Educational Service District, Take Time Resources specialists found when serving 76 children
that self referred from 4-5`h grade. Other data is public and familiar like the treatment rate of
publicly funding treatment with methamphetamines These silent and visible behaviors impact
our community negatively and pervasively.
Mental Health services are very limited and most individuals receiving these services must be in
crisis or have Medicaid eligibility. If the individual does not meet the proper criteria they most
likely will not receive the service. The impact of the rationed nature of these services is that
underserved populations end up in hospital emergency rooms, jail or being involved with law
enforcement or other emergency services.
PROGRAM CREATION AND AUTHORITY
By adopting this 1/10th cent sales tax Jefferson County has increased taxing authority to create
and enhance mental health and substance abuse treatment services to decrease the fiscal and
emotional impact of these diseases on the community and the legal system. The vendor
contractors of these programs must implement comprehensive county -wide services available to
all citizens without discrimination due to lack of income, if they can serve clients with any other
available funding stream this "Mental Health/Substance Abuse Fund" becomes the payment of
last resort. The County Administrator may ask for proof of billing denials in year end reviews.
The fund and contracting will be administered by the Board of County Commissioners/County
Administrator, who shall have the authority, along with the approval of Jefferson County
Commissioners, to exercise all lawful powers necessary and appropriate for the contracting,
statements of work and maintenance, operations.
Community impact data and community needs will be identified by a group working with
Jefferson County Public Health Data Steering Committee. This data will help identify needs and
measurements on an ongoing basis. This is a moving target and we need a system that is
flexible, innovative and responsive to community needs.
The director of each subcontracting agency shall submit a yearly operating plan, budget and an
annual report to the County Commissioners for review and approval. This plan and budget
format will be approved by the County. Program evaluation is also the responsibility of the
contracting agency and will be requested by the Board of County Commissioners yearly and
reviewed by the advisory group.
The Board of County Commissioners will appoint a Mental Health/Substance Abuse Advisory
Committee to review the community need, program recommendations and evaluation
information and make recommendations to the Board of County Commissioners. Members will
be from existing boards and have no fiduciary interests in the contracts: two members of Law
and Justice, two from the Substance Abuse Committee; two from the Board of Health and a
Commissioner who will represent the Board of County Commissioners and the Mental Health
Regional Support Network and serve as Chairman.
PROGRAM DESIGN & EVALUATION
The County believes that the programs or services that are to be implemented are informed by
"evidence based", "research based", "emergency best practice", or "promising practice" as
defined in the legislation and the group encourages innovative approaches to local problems
where there are no applicable models. A collaborative plan to supplement services for citizens is
the best way to build a service network for Jefferson County. Services will be contracted through
Interlocal agreements or contract between the County and private not-for-profit agencies or other
government entities in Jefferson County.
The County believes in the development of a "Drug Addiction Co -Occurring Mental Health
Disorders (COD) model targeted on supporting Jefferson County crisis services and therapeutic
jurisprudence needs. The model will include multiple levels of mental health and substance
abuse services for adults and adolescents.
PROGRAM ELEMENTS
Contracts shall establish/or provide access to programs for the following services, based on the
priorities of the Law and Justice subcommittee and other standing committees.
• Treatment for individuals with co-occurring disorders
• Therapeutic court and case management staff to coordinate Drug & Mental Health
court referrals and dependency needs of families in courts
Expanded Mental Health/Substance Abuse treatment for populations not served
by other public funds
• Substance abuse assessment and Mental Health assessment, counseling, and
medication management in the jail
Additional funds could be available to contract with other vendors providing family, child
counseling or substance abuse treatment. Services could be provided by additional vendors to
provide care to family members coping with mental illness or substance abuse in a spouse, parent
or child:
• Family support in some schools providing mental health services to students
• Substance abuse interventions in the schools
• Ongoing Home Visits to families by Infant Mental Health & Public Health Nurses
for young families or Nurse Family Partnership visitation
• Other licensed treatment providers and addiction specialists who are successful
with county population and may need to bill for services
The program services and areas included in the model above could include the following
components:
• Family Dependency Court
• Juvenile Drug Court
• Crisis Services including; Evaluation and Treatment Unit, Sub -acute and Acute
Detoxification, and Residential Treatment (Inpatient)
• Expanded Outpatient Treatment providing services to Adults and Adolescents
who have Addition an Psychiatric Disorders (COD)
• Case Expediters/Facilitators; these positions would be designed to assist patients
with access to services, eligibility, and placement.
• Systems Collaboration with all identified stakeholders including: mental health,
crisis services, law enforcement, courts, jail, DCFS, CSO, Shelters, VA, alcohol
and drug services, hospitals, emergency services, corrections, public health, and
other to be determined.
• Program and Project Evaluation — This component of the model would provide
ongoing evaluation of programs and services. It would include accountability,
outcomes, planning, efficiency, effectiveness and cost offsets.
• Substance Abuse & Mental Health assessments within three working days for
referrals from the Juvenile Justice; Public Health; and Jefferson General Hospital
Emergency room.
ADMINISTRATION & AUTHORITY
The County Administrator shall submit an operating plan, budget and an annual report to the
Board of County Commissioners for review and approval.
PROGRAM FUNDING
Money received from tax imposed under this ordinance shall be used solely for the purpose of
providing new or expanded drug, alcohol abuse & mental health treatment service and for the
operation of new and expanded therapeutic court programs.
Moneys collected cannot be used to supplant existing funds for these purposes. This local
funding provides a unique opportunity to enhance services to community members in need of
mental health and substance abuse services that are presently not able to receive those services.
Because it is funding locally collected and locally distributed it would also provide an
opportunity to solve local problems innovatively, in other words, free from the constraints of
other levels of state and federal government. A percentage will be set aside annually for reserve
and match funding.
Mental Health/Substance Abuse enhancement programs and any participating municipality,
agency, department or special districts may solicit additional funds through grants, to supplement
program funding or bill any available insurance or Medicaid resources that become available.
The purpose of this partnership is to expand existing funds to serve more people.
Receipts anticipated for this tax can best be estimated by taking the actual collections the County
is experiencing on a similar tax that was imposed last year for the E911 dispatch services. We
have 12 months of actual collections from this tax which is imposed on the same taxable items.
In the first 12 months this tax has produced $389,668.77, or an average of $32,472.40 per month.
Receipts have ranged from $41,719.44 in November 2005 to $25,257.33 in March 2006. These
receipts are noted below:
Month of Receipt
June
July
August
September
October
November
December
January
February
March
April
May
Amount Received
$26,860.47
$30,266.38
$36,995.77
$34,513.70
$35,607.00
$41,719.44
$30,807.59
$29,244.01
$37,087.04
$25,257.53
$25,862.79
$35,447.05
Priority Funding Identified for First Two (2) Years:
The "Expanded Mental Health & Substance Abuse Treatment & Therapeutic Courts Funds" are
estimated to receive $360,000 during the first year the tax is imposed. The tax has been
imposed, according to the State, effective April 1'`. This means, based on past experience with
the State Department of Revenue, receipts should be received by the County in June. This was
confirmed by the Department of Revenue on June 7`h. The following programs/activities are
recommended to be implemented early on in the program within the anticipated funds to be
received during the first year.
Co -Occurring Disorder Integrated Treatment Program (CODIT): is envisioned as a
combined project of Jefferson Mental Health Services and Safe Harbor/Beacon of Hope.
The program is explained in detail as Attachment `B' and a budget is incorporated as
Attachment `C' and is envisioned as a treatment based program for individuals with co-
occurring disorders and those unable to find treatment through existing mental health or
substance abuse programs.
$167,608
Substance Abuse Assessment and Mental Health Assessment Counseling and
Medication Management: for clients unable to find treatment and for those in jail. This
service will be provided under the auspices of the Sheriffs office.
$33,196
Therapeutic Court and Case Management Staff to Coordinate Drug & Mental
Health Court Referrals and Dependency Needs of Families in Courts: to assist in
determining this service, a separate Ad Hoc Committee will be formed including
representatives from all offices who will be involved (i.e. Juvenile Services, Courts,
Health Department, Drug Court, etc.) The group should examine similar Courts in
Washington State and the nation to find the model that is best suited for Jefferson
County.
$33,196
20% Reserve and Cash Fund Reserve: will ensure that 20% of receipts will be set
aside and held in reserve to address any revenue shortfalls or provide grant matching
opportunities.
$72,000
10% for Baseline Studies, Community Assessments and Community Evaluation:
this service will be handled by the Department of Health. To provide ongoing systematic
collection of data and analysis of local needs through the use of Behavioral Risk Factor
Surveillance Surveys (BRFSS), youth data analysis and other community evaluations and
existing local data. This information will supply the Board of County Commissioners
and their designees with identification of the needs to prioritize and determine how
mental health/chemical dependency funds should be focused.
$36,000
5% Billing, Program Evaluation and Administration: this service will be provided by
the County Administrator's office or a department designated by the County
Administrator.
$18,000
Additionally, the State passed a bill this year (Engrossed Second Substitute Senate Bill 6239)
that will provide grants of up to $100,000 to those counties who pass/adopt this sales tax. The
grant applications will be available in 2007 and if funded by the State will be available for three
years, 2008, 2009 and 2010.
It is recommended that the sales tax imposed by the Board of County Commissioners be utilized
in this fashion to expand and implement new mental health and substance abuse services as well
as the Therapeutic Family Court. The impacts of untreated mental health and substance abuse
are great — to our economy and the quality of life in our community. Research by DASA has
shown that treatment works for behavioral health diseases at the same level as treatment for other
chronic diseases, such as diabetes.
The County believes that the programs or services that are to be implemented are informed by
"evidence based", "researched based", "emerging best practice", or "promising practice" as
defined in the legislation and innovative approaches to local problems where there are no
applicable models, are encouraged.
EVALUATION
Needs: Residents of Jefferson County asked to pay additional taxes, deserve documentation of
the needs and benefits of the use of those tax dollars. First, it is critical that an assessment of the
current status of the community needs be measured to establish a baseline set of data so change
can be measured. The Mental Health/Substance Abuse Services Advisory Board will be asked to
establish treatment evaluation criteria.
Evaluation of Impact: There is no data system that provides integration of substance abuse and
mental health data for those receiving services that are not publicly funded. The lack of adequate
baseline data will require that during the first year, specific data sets be established including
population unable to access services; sources of information are identified; data collection be
initiated; and analysis and establishment of baseline measures are created. It is expected that
these measures will include data regarding the impacts of behavioral health needs within law
enforcement, education, and health care. The collection of baseline data will enable the Board of
County Commissioners to utilize the information in establishing outcome measures in order to
measure the impacts of the program design. The program will contract with the Public Health
Department to execute these functions.
CONTRACT TERMINATION RULES
The following rules will be incorporated into all contracts/interlocal agreements:
Any party may terminate contract agreements for any reason upon 30 days prior written
notification to the other party. If these agreements are so terminated, the parties shall be
liable only for performance rendered or costs incurred in accordance with the terms of
this Agreement prior to the effective date of termination.
If for any cause, any contracting party does not fulfill in a timely and proper manner its
obligations under these contract agreements, or if either party violates any of these terms
and conditions, the aggrieved party will give the other party written notice of such failure
or violation. The responsible party will be given the opportunity to correct the violation
or failure within 15 working days. If the violation or failure is not corrected this
Agreement may be terminated immediately by written notice of the aggrieved party to the
other.
STATE OF WASHINGTON
County of Jefferson
Aitu�l„,,e„t A
In the Matter of Imposing a Sales and Use Tax- }
Providing for the Administration and Collection Thereof }
For Providing New or Expanded Chemical Dependency } ORDINANCE NO. 08-1003-05
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 501/o 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, HN 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
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 nerapeutic Court Programs as provided in Ch. 82 14.460
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
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
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 new 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.
Section 2: Applicability 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
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
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
Jef eicon 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 S. 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.
{,,RBRO�VED AND ADOPTED this _ day of 2005.
,J "
ATTEST:
Julie Matthes, CMC
Deputy Clerk of the Board
Approved as to Form:
Prosecuting Attorney
JEFFERSON COUNTY
BOARD OF COMMISSIONERS
Page 4 of 4
September 5, 2005
The Honorable Board of County Commissioners
Jefferson County Courthouse
Port Townsend, Washington 98368
Dear Commissioners,
f chwtm 0
The Jefferson County Substance Abuse Advisory Board is very excited that an opportunity to
positively address an aspect of Jefferson County's serious substance abuse disorder problem
has occurred.
We have reviewed E2SSB 5763 and the possibilities to improve the lives of Jefferson County
individuals with co-occurring substance abuse and mental disorders through enhancement of
our existing Treatment Court into a full Therapeutic Court as defined by the Bill, and to expand
the efforts being made by Safe Harbor/Beacon of Hope and Jefferson Mental Health Services
so that a true and thorough evidenced based treatment program for co-occurring disorders
(CODIT) can be implemented.
We have also reviewed the Proposals for 1) enhancement of existing Treatment Court to a
Therapeutic Court, and 2) a "Co-occurring Disorder Integrated Treatment' program (CODIT),
that have been developed at the behest of the community to address these issues
We urge you to take advantange of this unique opportunity by:
• Approving a 1/10"of one percent sales and use tax; and
• Implementing the tax by Commissioner action, immediately; and
• Directing implementation of the development of the Proposal attached, so that
lives (as well as money) can be saved.
We strongly believe that lives literally will be saved by immediate passage of this tax and
implementation of this proposal. We also believe that taxpayer money will be saved. The cost
to county citizens as well as tourists will be negligible (one penny for every ten
dollars spent), but the reduction in cost to the citizens who are paying for health,
law and justice and other systems struggling With these disorders, through
property taxes, could be significant.
Please, say yes!
Sin
Laurie Strong, Chair
Jefferson County Substance Abuse Advisory Board
Attachment: Proposal
Pat Townsend, WA 98368
MO) 395 -UW
E2SSB 5763 Sales and Use Tax & Mental and Substance Abuse Disorder Treatment
Background.
In the 2005 Washington State legislative session State Senator Jim Hargrove introduced Senate Bill 5763,
proposing omnibus treatment of mental and substance abuse disorders. The bill that ultimately passed,
E2SSB5763, makes significant changes to both chemical dependency and mental health involuntary treatment
acts as well as changes to the community mental health act. The focus of the bill is to address treatment of mental
and substance abuse disorders in order to improve services and effectiveness and reduce costs to society_ The bill
also identifies the importance of EB/BP (Evidence Based/Best Practice) programs for cost and treatment
effectiveness and incentivizes their use. Additionally implicit is the recognition that mental illness and substance
abuse, especially when co-occurring, have a negative impact not only on the individuals with these disorders, but
on our communitjes and citizens, economically as well as personally.
The significant and negative impact of substance abuse and mental illness on Jefferson County is clearly evident
in the Health Department's "Healthy Jefferson" survey outcomes, and in the Jefferson County Substance Abuse
Advisory Board's recent White Paper. The urgency of this issue is exacerbated by recent changes in mental
health treatment funding which restricts treatment access for individuals who do not have Medicaid coupons. In
Jefferson County, availability of"Stateonly (non Medicaid)" funds is so limited as to essentially preclude service
for non -Medicaid funded individuals except for crisis contacts. Additionally, chinges in allowable use of federal
funds precludes co-occurring disorder treatment. For individuals in Jefferson County who suffer from co-
occuring mental illness and chemical dependence—many of whom represent a significant drain on social service
and law and justice budgets—the possibility of treatment and recovery is now foreclosed.
The Hargrove Bill recognizes the urgency and seriousness of these problems. It states that:
• Integrated treatment of co-occurring mental illness and substance abuse disorder is more effective than
treatment provided separately;
• Identification and treatment of these disorders is crucial;
• Drug and mental health courts (Therapeutic Courts) are important and often pivotal components in
identification and treatment access;
• The present state system does not provide for, nor is it conducive toward, integrated services;
• New money and incentives are necessary to promote integrated treatment for co-occurring disorders.
To address these facts, Section 804 (re: RCW 82.14) of the bill specifically provides for the development of
funding for therapeutic courts and treatment programs through a 1/10"' of one percent sales and use tax imposed
by a county's taxing authority. This proposal urges the initiation of that I/I a of one percent sales tax in
Jefferson County as soon as possible in order to meet the county's exigent need.
Through discussion with the Law and Justice Committee, Health Department personnel, Substance Abuse
Advisory Board members, and mental health and substance abuse treatment staff, two needs congruent with SB
5763 criteria were identified. They are:
1. Administrative and evaluation assistance to the county's Therapeutic Courts;
2. Development of an evidence based co-occurring disorder integrated treatment program (CODIT).
The following proposal has been researched, developed and is respectfully submitted by Laurie Strong, Executive
Director of Jefferson Mental Health Services, and Ford Kessler, CEO of Safe Harbor/Beacon of Hope. This
Senate Bill represents a unique and important opportunity for Jefferson County and its government to move
beyond concern into action, to uphold the Prevention and Healthy Jefferson principles it avows, and to literally
put its money where the problem is at a time when the need is particularly urgent.
Strong, LCSW
Kessler, BA, NCACI, CDP, DVC
Hargrove/SB 5763 & CODIT BOCC Proposal — 9/12/05 continued
PROPOSAL
PROPOSAL I: Fund enhanced Tberapeutic Court implementation and evaluation functions by direct contract
with Safe Harbor/Beacon of Hope.
• Background: the existing Jeffersn County Treatment Court activities are facilitated to a great degree by Ford
Kessler, of Safe Harbor/Beacon of Hope; treatment costs are covered through ADATSA and CJTA funding,
however facilitation and evaluation of outcomes is unfunded and thus limited to available good will.
Jefferson County has exceeded its targeted use of this court because of high incidence and great need.
Inclusion of mental health and dependency issues in a Therapeutic Court setting requires expanded personnel.
• Criteria: enhanced implementation should rest on experience within the existing system and treatment needs;
on collaboration capability with agencies and entities interacting with a Therapeutic Court, and with an entity
with existing license, knowledge and capability to receive state "drug court" funds, and ability to contract
with Jefferson County.
• Plan: Through direct contract with Safe Harbor/Beacon of Hope, expand existing and successful Treatment
Court, fledgling "Mental Health Court," and SB5763 criteria -included dependency actions to Therapeutic
Court status and fund facilitation of implementation and evaluation functions:
PROPOSAL H: Fund development and implementation of an Evidence Based Co -Occurring Disorder Integrated
Treatment program (CODIT) through direct contract with Jefferson Mental Health Services.
Background: The importance of ensuring positive outcomes is driven by both economic and socially
conscious needs. Effective treatment saves lives, and costs less. The Behavioral Health industry has been
pursuing identification and implementation of Evidence Based Best Practices to increase effectiveness.
SAMHSA (the Federal Substance Abuse and Mental Health Services Administration) and its Center for Mental
Health Services (CMHS) have identified six Evidence Based Practice projects to address serious mental illness.
They are:
I . "Co-occurring Disorders: Integrated Dual Diagnosis Treatment"
2 "Family Psychoeducation,"
3. "Medication Management Approaches in Psychiatry" (use of medication algorithms; Jefferson
Mental Health Services has an existing medication algorithm protocol, " 3MAP"),
4. "Illness Management and Recovery,"
5. "Supported Employment" and
6. "Assertive Community Treatment"
The State of Washington has identified an array of `Best Practices", including, for adults:
• Integrated Mental Health and Chemical Dependency Services, (Safe Harbor/Beacon of Hope & Jefferson
Mental Health Services currently co -provide a dual diagnosis group)
• Vocational Services,
• Family Psychoeducation, and
• Medication Management.
A review of manualized* programs (*a criteria for being designated EB/BP) in both the substance abuse and mental
health treatment disciplines was accomplished. The SAMSHA "Co-occurring Disorders: Integrated Dual
Diagnosis Treatment" project includes an Implementation Manual, and appeared to be the most apt project to
meet Jefferson County's flexibility needs and anal nature. Using this acquired manual, and other reviewed
material, a "Co-occurring Disorder Integrated Treatment Program"—CODIT—for Jefferson County was
formulated. (See Synopsis below for program details.)
Criteria: Implementation of any new program should be based on]) evident need, 2) effective-
ness, 3) available funding, and 4) implementation ability.
Page 2 of 7
Hargrove/SB 5763 8 CODIT BOCC Proposal — 9/12105 continued
1) National incidence of co-occuring disorders is equal to Jefferson County's: approximately 50% of the
severely mentally ill are also chemically dependent; 3T/o of alcohol and 53% of drug abusers have a
serious mental illness. Jefferson County Law Enforcement, Justice System and social service leaders
identify people with these disorders as significant users of their systems, and those with co-occurring
disorders as particularly difficult. Without specialized treatment, these individuals rotate serially through
the law and justice, substance abuse, and mental health systems; lives are lost_
2) Research and experience is clear that serial or even concurrent interventions, if any occur at all for this
population, are ineffective. Current Medicaid system rules essentially preclude integrated treatment. This
Bill makes it possible to initiate and fund a treatment strategy that has survived research and evaluation
and is known to be effective (is an Evidenced Based Best Practice),
3) A 1/10" of one percent sales/use tax is projected to reap approximately $250,000 to $300,000 in Jefferson
County annually once it is in place_ This is an adequate amount to fund Proposal I plus this proposal for a
Co-occurring Disorder Integrated Treatment program. No other funding sources exist for the two
proposed programs; reduction in prior funding and changes in regulations have further eroded treatment
and service options, although some direct costs for aspects of the treatment program may be recoverable.
4) Jefferson Mental Health Services (JMHS) is the only licensed community mental health center in
Jefferson County, and the only entity with experience in addressing severe mental illness and meeting
complex program requirements. JMHS currently uses a number of "Best Practices" in its service menu,
including a medication algorith program, and is experienced in both vocdtional and housing access
requirements. JMHS works collaboratively with West End Outreach, who reach West County consumers,
and with Safe Harbor/Beacon of Hope in collaborative efforts on behalf of mutual consumers.
o JMHS is a 501 (c) 3 non-profit entity with contractual relationships with State and Federal
governments, School Districts, and historically with County government;
o JMHS holds current licenses with the DSHS Mental Health Division necessary for evaluation and
treatment services and meets administrative and clinical audit criteria;
o Safe Harbor/Beacon of Hope holds current state Dividison of Alcohol and Substance Abuse
certification for chemical dependency services, and through a Memorandum of Understanding will
provide authorization for offsite chemical dependency services for this program.
o JMHS is financially audited by an outside CPA firm annually in accordance with governmental
auditing standards ("Yellow -book audit");
o JMHS, and Safe Harbor/Beacon of Hope, have mututal understandings for existing collaborations,
and are able, through a CODIT Program -specific MOU, to enhance CODIT program funding through
third party billing as available;
o JMHS is familiar with the practices and protocols required by this Evidence Based program.
PLAN: Directly contract with Jefferson Mental Health Services to develop and implement CODIT including
outside evaluation to ensure fidelity to the model and attainment of goals and identified outcomes.
The CODIT ProZmm:
• Is an Evidenced Based Best Practice incorporating recovery -based philosophy
• BuildsAn flexibility in order to grow with need and available funding, and meet exingencies of a rural and
limited population.
• Includes a Multi -disciplinary Treatment Team that meets no less than weekly to review program clients, but
accesses component disciplines/members on-call based on client need, thus reducing expense and increasing
flexibility. (Not all disciplines will be needed all the time for every client.)
■ Training:
• Initial training in the model occurs at the same time for all team members.
• Training is also provided cross system collaborators, and subcontractors.
• All Training follows the EBP Implementation Resource Kit, Users Guide and components;
• Training subsequent to Initial Training is on-going and no less than annual;
■ Fidelity to the model is ensured through:
■ monitoring client outcomes (achievement of client recovery goals), and
Page 3 of 7
Hargrove/SB 5763 8 CODIT BOCC Proposal — 9/12105 continued
• use of"Fidelity Scales" for this best practice as developed by SAMSHA in the "Co-occurring
Disorders: Integrated Dual Diagnosis Treatment" Project;
Supplemental program funding is accessed through billable third party payers or sliding fee schedule, through
MOU between program agencies (Jefferson Mental Health Services and Safe Harbor/Beacon of Hope) utilizing their
existent billing processes.
A CODIT Program Budget is developed annually.
CODIT ACCESS:
Referral Sources: Therapeutic Courts, Substance Abuse Treatment system, Mental Health Treatment
system, community
Entry Criteria:
1. DSM IV Axis I Disorder of:'
o Schizophrenia and other Psychotic Disorders
o Mood Disorders
o Anxiety Disorders
2. DSM N Axis 11 Disorder of
o Substance—Related Disorders
Per diagnosis by a Mental Health Specialist and Substance Abuse Specialist
3. GAF (Level of Functioning) score within current protocol
Entry Process:
I) Referral received, includes
o Identification Set
o Secondary Funding if any
o Reason for referral
o Documentation of reason for referral
o Prospective'client's level of willingness to be enrolled
2) Referral reviewed by Multi -disciplinary Team at weekly meeting
3) Referral approved/denied (if denied, returned to referral source with reason for denial)
4) If referral approved, enrollment scheduled
a. Mental Health Assessment
b. Substance Use Assessment
c. Consolidated Treatment Plan developed and initiated
d. Administrative set (consent to treat, privacy notice, financial set, etc.)
CODIT OUTCOMES
• Outside evaluator identified program outcomes (such as reduction in hospitalization and law enforcement contacts)
• Fidelity Scale outcomes met
Upon approval, a program budget and implementation plan will be developed.
Page 4 of 7
Hargrove/SB 5763 & CODIT BOCC Proposal — 9/12/05 continued
CODIT
Safe Harbodt3eacon of Hope & Jefferson Mental Health
Port Townsend, Washington
An Evidence -Bared Practice as identified by SAMSHA
PROGRAM SYNOPSIS
Program Values
• Recovery - satisfying life circumstances across fife domains
• Inclusion - clients cannot be expelled from program for failure to succeed
• Respect - all program interactions and components are respectful to clients and across disciplines
Entry Criteria
• Age 13 or older
• Co-occurring DSM IV Axis I Mental Disorder and Axis II Substance Related Disorder
• Meets Level of Functioning and Acuity Level Criteria
• Approved for enrollment by CODIT Mufti -disciplinary Team
Program Requirements
Components
Attributes
Activities
1 Multidisciplinary Treatment
Combined Substance Abuse/Mental Health Team
Regularly scheduled tearn meetings
Team:
including residential and vocational components.
Includes all disciplines
• Case Manager(s)
Clients receive care from a fuly multidisciplinary
Case review and
• Substance abuse speciabsl(s)
team (vs. a series of single providers) with a strong
coordination
• Mental health speaalist(s)
emphasis on accessing a broad range of services
Program tradcinglreview
• PsyduatisUNurse
and excellent commumcation between disciplines.
• Residential specialist
Team Leader designated.
a Delivers services to dients
• Vocational specialist
Ful team receives cross -discipline training.
Cross system stakeholders also receive training.)
2 Stage -Wise Interventions:
Stages of recovery:
• Interventions are overtly consistent
Treatment is consistent with the
Engagement
with dent's stage of recovery
dienrs stage of recovery (MUSA)
Motivation
Documentation and format is
Action
consistent with stages of recovery
Relapse Prevention
awareness
3 Access to all program
Recognition that broad life domain deficits impede
Overt review of needs
services including:
recovery and that access to all aspects of service
Individualized treatment plan
MIlSA Treatment
improves prognosis.
Case Management to access treatment
Psychnatry
Housing
Follow-up to ensure treatment
Supported Employment
accessed
Fanly Psydhoeducalon
Ilness Management
Intensive Case Management
4 Time -Unlimited Services
No time limits ascribed to services; intensity modified
Intensive Cane Management
adxxxding to each clients reeds
• GognitivelBehavioral Mental Health &
Substance Abuse treatment
• Psychiatric evaluation, medication,
medication monitoring (JMAP)
• Family psychoeducation
• Vocational assistance
• Housing assistarrce
• Illness man t
Page 5 of 7
Hargrove/SB 5763 & COD1T BOCC Proposal — 9112/05 continued
Components
Attributes
Activities
5 Outreach
Has strategies, contacts, means to outreach
Therapeutic Court & liaison
Strategic plans to outreach
community for services on behalf of clients, such as
Team assessment
community where appropriate
legal aid, housing, medical care, safety, etc.
Individual treatment plan flexibility
• Ongoing meed identification
Outreach
• Case Management
• Cross system alliances
• Subcontracts in place
6 Motivational kfterventions
Motivational Interventions valued and used:
Interactions conform with this value
Team members trained in and
Express empathy
understand motivational
Develop discrepancy between goals and
interventions and use therm
continued (substance) use
• Avoid argumentation
• Rot with resistance
• Instill self and hope
7 Substance Abuse Counseling
Clients in 'action' stage, or 'relapse prevention'
Stage of recovery tracked and documented,
Team members understand basic
stage receive SA counseling that induces:
so counseling and intervention are timely
SA cornselirg principles
Teaching how to manage ares to use and
and on point
consequences of use
• Teaching relapse prevention strategies/skills
• Drug and alcohol refusal skills
Problem solving skills training to avoid high risk
situations
• Challenging clients beliefs about substance
abuse
Coping skills and social skills haining
8 Group Dual-Dx Treatment:
MHISA specialist team members provide group
Croup Treatment Schedule
Croup treatment that speafically
opportunity
addresses both mental health and
Access is openly available
substance abuse problems readily
available/oftered clients
9 Family Psychoeducation on
Psychoeducation includes:
Family Psychoeducation Curriculum
Dual Diagnosis
Education about Dual Diagnosis
Scheduled Sessions
Education, training, support offered
Mental Illness
Support Access
family members of clients
Substance uselabuse
Interactions
Consequences
Coping skills training
Collaboration with team
Support
10 Alcohol and Drug Self Help
Progrardteam facilitate access and encourage
Information available
Groups
attendance
Case Management
Clients in action or relapse
prevention stages attend
community self-help programs
11 Pharmacological Treaknent
Evaluation access, includes
Medication evaluation
Psychiatric medication evaluation
• Psychiatric rnedhcations prescribed despite
Medication monitoring
and provision to address mental
active substance use
Multidisciplinary bllow-uo
illness by prescriber trained in dual
• Close coordination with multi-discipfinary lean
disorders
W Focus on increasing adherence
• JMAP inclusion (medication algorithm program)
• Avoid benzodiazepines and other adductive
substances
• Use dozapine, naltrexone, disutfaam
Page 6 of 7
Hargrove/SB 5763 & CODIT BOCC Proposal — 9112105 continued
Components
Attributes
Activities
12 Health Promotion
Explicit program to promote dent health and reduce
Team tranjrg in health promotion,
Interventions
negative consecluences:
techniques in negative consequence
• Avoid infecbm diseases
reducton, and overt and documented
• Help ckrds avoid high-risk situations and
interventions
victimization
• Secure safe housing
• Encourage clients to pursue work, medical pre,
diet, exercise
13 Nw4esponder.Nhiwvwidom
Explicit strategic plan and interventions.
Ow9oing individualized review and TX
Strategic plan and pmgrarn to
On-going overt dint review of goals reached,
planning
• Identify non -responders
responsaWHespo nse to treatment
Strategic response plans
• Provide secondary
Titrated response strategies for intervention
Access to secondary interventions, e.g.
interventions
Secondaryhnaease intervention availability
Medication, long term residential, trauma
treatment, intensive family intervention,
intensive rmn
Wage 7 of 7
Jefferson County Community Network Q
Subcommittee of the Law & Justice Council Pt
Special Meeting on SB5763
August 11, 2005
Jefferson Mental Health Services
Attending: Laurie Strong, Ford Kessler, Jean Baldwin, Crad Verser, Mark Huth, Beth
Wihnart.
Recommendation to the Law & Justice Council
Given the requirement of the S135763, and the unique needs of Jefferson County, the
group recommends the following:
1. The BOCC go forward with the new sales tax, as provided for in the bill;
2. The proceeds be allocated to the following programs:
a. Expand the existing Therapeutic Court to include a Mental Health Court;
b. Expand the existing Therapeutic Court to include dependency cases (as
required). It is noted that a very small number of dependency cases are
filed each year.
c. Add a Program Assistant (probably part-time) to the Therapeutic Court
staff, to manage program evaluation and ease the current administrative
burden.
d. Fund a combined chemical dependency/mental health treatment_ program.
i. Intensive Case Management
ii. Evidence -based
iii. Estimate 25+ clients per year
iv. Clients are not necessarily court -involved
• 615 Sheridan • Castle Hill Center • Port Townsend, WA 98368
• 360/379-4495 • FAX 385-9401
A*ce k melni C
CODIT
Co -Occurring Disorder Integrated Treatment Program
A combined project of Jefferson Mental Health Services and Safe Harbor/Beacon of Hope
Budget — Year One
@ full enrollment of 40 clients
EXPENSE
Personnel:
1 FTE Case Manager II Provides outreach and assertive Case Management for
a caseload ranging from 25 to 40 clients; BA plus 4 years in MH Case Management
field, Registered, plus 1 or more years experience and/or training in CD Treatment.
Attends team meetings. Wages & Benefits: $38,960
.40 FTE CD Specialist II Provides S/A Education & Treatment —Individual and Group -
to clients in appropriate stages of readiness; family education; referral as necessary, some
case management. Certified, BA plus 4 years in CD Treatment, plus 1 or more years
experience and/or training in MH. Attends team meetings.
Wages & Benefits: 15,584
.40 FTE MH Specialist II Provides (billable) Mental Health Treatment to clients and
Family Psychoeducation. Some case management. Certified/licensed MA/MSW plus 5
post graduate years in treatment services to individuals with severe mental illness, plus 1 or
more years experience and/or training in CD field. Attends team meetings.
Wages & Benefits: 18,360
.20 Psychiatric Nurse Provides (billable) medication monitoring and assistance.
Licensed, 5 years experience in psychiatric nursing. CD experience preferred. Attends
team meetings. Wages & Benefits: 8,680
.15 Program/Clinical Supervisor Certified/Licensed MA/MSW with 7 or more years in
treatment services to individuals with severe mental illness, training and/or experience in
the CD field, and 4 or more years in program development and clinical supervision. Attends
team meetings, provides program management and supervision_
Wages & Benefits: 7,500
Total Wage & Benefits: $ 89,084
Personnel: Contract
Psychiatrist: Licensed with experience in treatment of mental illness and chemical
dependency. Provides evaluation and pharmocological treatment, including prescription of
psychiatric medications within protocol for dual disordered clients and medications known to
be effective in decreasing substance use. Works closely with team & client, attends weekly
team meeting. $105/hour.
Projected at 25 hours a month: $ 31,500
Evaluator: Research and evaluation firm (such as Maike & Associates) for first
year of project: identify, evaluate outcomes, fidelity scales, and produce report,
@ 11% of project total. $ 22,000
Housing and Vocational assistance are important components in establishing and
maintaining stability. The need for these services varies, and once accessed may
not need to be re -accessed for successful clients.
CODIT Budget Narrative 1 Odober, 2005
Housing Specialist: Experience and knowledge in accessing Residential Services,
including support and monitoring, for clients in need of appropriate housing. $ 8,400
Vocational Specialist: Experience and knowledge in evaluation of work skills and
needs, readiness to work, and employment development and support 9.000
Total Contract Personnel Costs: $ 70,900
Indirect Personnel costs: per JMHS Cost Allocation Plan/Federal: Accounting, bookkeeping,
payroll, contract managemen/administration costs: $ 10,950
Mileage & Transportation 500
Training 750
Total Indirect Personnel Costs $ 12,200
Total Personnel Costs: $ 172,184.
Other Costs
Communication
Dues/Licenses
Equipment, large furnishings
Equipment, rental
Facility rent
Facility repair/improvement
Facility maintenance
Furnishings, small
Insurance
Miscellaneous
Postage & Delivery
Printing & Reproduction
Program Expense
Supplies — Office
Supplies -:Other
Taxes
Utilities
Wraparound Funds
Reference Materials
Third party billables
Other. revenue (county)
CODIT cost per client:
Vs.
Total Other Costs:
Total Expenses:
REVENUE
$ 40,000
167.608
Total Revenue:
Year
$5,190/year
Psychiatric hospitalization cost: range of
2,710
954
J,530
238
3,000
954
212
160
4,500
350
200
450
9,600
1,166
1,250
1,100
2,500
6,000,
550
$ 35.424
207,608
$ 207,608
Day
$14.221day
$415.79 to $1,535/day
CODIT Budget Narrative 2 kp October,2005
"ATTACHMENT D"
DEFINITIONS
Fiduciary Interest:
Is a.) the right to compensation from an organization that receives public mental health/chemical
dependency funds; or b.) budgetary or policy-making authority for an organization listed as a vendor
for these services. A person who acts solely in an advisory capacity and receives no compensation
from a health, social service, or justice system organization, and who has no budgetary or policy-
making authority is deemed to have no fiduciary interest in the process.
Assessment:
The regular collection, analysis, and sharing of information about conditions, risks, and resources in
the County. Assessment analysis identifies & monitors trends in violence & behaviors that contribute
to injury or death. It also identifies environmental risk factors, community concerns, community
resources & assets. Assessment includes gathering statistical data as well as conducting epidemiologic
and other investigations and evaluations of emergencies and specific ongoing problems.
Administrative Costs:
Costs associated with contract processing; contract management; accounting; budgeting; auditing; and
organizational planning, consultation, and reporting.
Interim Services:
Costs incurred for services offered a person denied admission to a treatment program on the basis of
the lack of the capacity of the program. These services shall reduce the adverse health effects of
substance abuse, promote the health of the individual, and reduce the risk of transmission of disease.
Such services are provided until the individual is admitted to a treatment program. Services include
brief screening activities, the development of a service plan, individual or group contacts to assist the
person either directly or by way of referral in meeting his/her basic needs, updates to advise him/her of
treatment availability, and information to prepare him/her for treatment, counseling, education and
referral regarding HIV and tuberculosis.
Detoxification Services:
Costs incurred for care and treatment of patients while the patient recovers from the transitory effects
of acute or chronic intoxication or withdrawal from alcohol or other drags. Examples of Detox are:
1. Acute Detox: A method of withdrawing a patient from alcohol or other drugs where nursing
services and medications are routinely administered under physician supervision to
facilitate the patient's withdrawal, and
2. Sub -acute Detox: A method of withdrawing a patient from alcohol or other drugs utilizing
primarily social interaction between patients and staff within a supportive environment
designed to facilitate safety for patients during their recovery from the effects of withdrawal
from alcohol or other drugs.
Monitoring:
Costs incurred in diagnosis, placement and case monitoring of persons who apply for services and
other eligible clients as defined in contracts issued by the Division of Alcohol and Substance Abuse
(DASA). Does not include treatment costs, protective payee, or shelter costs for such clients.
Outpatient Treatment - General:
Cost incurred for services that provide non-domiciliary/non-residential chemical dependency
assessments and treatment to patients. Includes services to family and significant others of person in
treatment. Does not include services to family or significant others of a person not currently in
treatment. These expenses should be coded as family support services. Outpatient treatment services
must meet the criteria in the specific modality provisions set forth in WAC 388-805.
Outpatient Treatment - Youth:
Costs incurred for services that provide non-domiciliary/non-residential chemical dependency/abuse
assessment and treatment to youth and young adults ages 10 through 20. Includes services to family
members of persons in treatment. Does not include services to family members of a person not
currently in treatment. These expenses should be coded as family support services. Outpatient
treatment services must meet the criteria in the specific modality provisions set forth in WAC 388-805.
Case Management - General:
Costs incurred for clients assessed as needing treatment to provide case planning, case consultation and
referral services, and other support services for the purpose of engaging and retaining clients in
treatment or maintaining clients in treatment. Does not include treatment planning activities required in
WAC 388-805. Case management services are services provided by a Chemical Dependency
Professional (CDP), CDP Trainee, or person under the clinical supervision of a CDP who will assist
clients in gaining access to needed medical, social, educations, and other services. Does not include
direct treatment services in this sub -element.
Intensive Inpatient Residential Treatment Services:
Costs incurred for a concentrated program of chemical dependency treatment, individual and group
counseling, education, and related activities for alcoholics and addicts including room and board in a
twenty -four -hour -a -day supervised facility in accordance with WAC 388-805 or its successor.
STATE OF WASHINGTON
County of Jefferson
In the Matter of Clarification of the }
Commissioners intended Effective date for }
the .1 % Sales Tax under Ordinance 08-1003-05 } RESOLUTION NO. 7805
WHEREAS, the Board of Commissioners did adopt Ordinance 08-1003-05 on
October 3�d, 2005, in order to implement the Chemical Dependency/Mental Health Fund
pursuant to RCW 82.14.460; and
WHEREAS, the Board of Commissioners would like to clarify its intent regarding the
effective date for imposing the Sales Tax.
NOW, THEREFORE, BE IT RESOLVED, that the Board of Commissioners hereby
states that its intent was to implement the Sales Tax as soon as possible, and that, at this
time, the Board of Commissioners directs the County Treasurer to notify the State
immediately that the Sales Tax should be implemented no later than April 1, 2006, but
sooner if possible.
APPROVED this 12 day of T)prPmhp , 2005.
;. to
%u JEFFERSON COUNTY
'�' BO OF COMMISSIONERS
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r a ► Phil Jo son, Chairman
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ATTEST_ : David-'ullivan Member
Julie Matthes, CMC
Deputy Clerk of the Board at Rodgers, Member
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JEFFERSON COUNTY
GUEST LIST
HEARING: 1/10 of 1% Sales and Excise Tax for Operation of New or Expanded Therapeutic Court Programs
DATE: Monday, October 3, 2005 at 9 a.m.
PLACE: Commissioners' Chambers
NAME (Please Print)
STREET ADDRESS
CITY
Testimony?
YES NO MAYBE
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JEFFERSON COUNTY
GUEST LIST
HEARING: 1/10 of 1% Sales and Excise Tax for Operation of New or Expanded Therapeutic Court Programs
DATE: Monday, October 3, 2005 at 9 a.m.
PLACE: Commissioners' Chambers
NAME (Please Print)
STREET ADDRESS
CITY
Testimony?
YES NO MAYBE
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I JUMEON MfNTAI HfALTH ffR ME
Community Supported Outpatient Care for East Jefferson Courp.
Children, Adolescents, Adults and Older Adults -24 Hour Crisis
August 8, 2006
The Honorable Phil Johnson
Jefferson County Board of County Commissioners�
Jefferson County Courthouse
05
Port Townsend, WA 98368 tEF
" y
Dear Commissioner Johnson,
Thanks to SB 5763, an omnibus act addressing mental illness and substance abuse, every county
in Washington State has been given a unique opportunity to stand up and do something
substantive to reduce suffering, loss of life, and spiraling Law and Justice costs. The bill allows
1/10'' of one percent sales and use tax increase specifically to enhance therapeutic courts and
develop integrated programs for the treatment of people with co-occurring substance abuse
disorder and mental illness, with the clear understanding that by doing so, suffering and loss of
life will be reduced, and money will be saved.
Every Board of County Commissioners is faced with two choices:
1) decide to save lives and lower costs, or decide not to,
2) decide now through vote of the Commissioners, or delay the decision and risk the oppor-
tunity to save lives and lower costs; and at the least, suffer unnecessary interim losses.
If voted in, the cost to the purchasing Jefferson County taxpayer would be negligible, literally
pennies: 1 penny for every ten -dollar sales/use-taxed purchase.
Board of Directors
If denied, the financial cost to the Jefferson County taxpayer will continue to increase as police,
President
sheriff, prosecutor and court systems struggle with an increasing load and limited options; mental
Z. Jack Randall
health and substance abuse treatment providers will continue to struggle with crises and a
p gg h funding
Vice President
Quentin Goodrich)
system that militates against best practices and realistic support. Lives will be lost, wholly, or
through unnecessary diminished capacity.
g �' l� �'•
Secretary
W.C. Henry
Members
If affirmed, the substance abuse and mental health treatment agencies in Jefferson County, and
Doris Hardyman
both Superior and District Courts, would immediately move ahead to implement the plan and
Rex Whipple
program proposal that they believe will make a substantive difference and that is being presented
to you.
Mike Beers
Sandra Stewart
We, the Board of Directors of Jefferson Mental Health Services (JMHS), respectfully urge you to Laurie suo,9 toe Director
make that decision now, through Commissioner vote, and affirmatively choose to take advantage PO Box 565 1884 , L Park
of this unique opportunity. As you are well aware, substance abuse and mental illness are Port Townsend, WA 98368
repeatedly listed as significant health and economic problems in Jefferson County. At JMHS the Phone: 360-385-0321
60-379-55
seriousness, frustration and heartbreak of this health problem is evident daily. We are committed Fax: 800-659-0321
to continue our dual disorders work with Safe Harbor, even in the face of recent federal/state Email: general@jmhs.info
funding regulation that increases cost and denies mental heath system financial support. Here, www.jmhs.info
incredibly and at last, is a legislative action that will solve problems instead of increase them!
Please, say yes. ^ tl n
Jaa Randall, President Quentin Goodrich, Vice President
September 9, 2005
Board of County Commissioners
Jefferson County Court House
1820 Jefferson St.
Port Townsend, WA 98368
Dear Board of County Commissioners:
The Jefferson County Law and Justice Council has had recent presentations on the Senate
Bill 5763 that allows for the Board of County Commissioners (BOCC) to implement new
sales tax that allows and dedicates the resulting revenues to the local Mental Health and
Substance Abuse programs. The purpose would be to expand existing programs for
county clients that are involved in mental health and substance abuse issues. A
subcommittee of the Law and Justice Committee met to discuss the SB5763 and made its
recommendations to the Law and Justice Committee to support SB5763 and to forward
their recommendation on to the BOCC (see attached).
It was unanimously approved by the Law and Justice Council to support the
recommendations and to forward it on to the BOCC. We appreciate the BOCC's
consideration in this matter.
Respectfully submitted,
Bill Nesmith, Chair
Jefferson County Law and Justice Council
Jefferson County Community Network
Subcommittee of the Law & Justice Council
Special Meeting on SB5763
August 11, 2005
Jefferson Mental Health Services
Attending: Laurie Strong, Ford Kessler, Jean Baldwin, Crad Verser, Mark Huth, Beth
Wilmart.
Recommendation to the Law & Justice Council
Given the requirement of the SB5763, and the unique needs of Jefferson County, the
group recommends the following:
1. The BOCC go forward with the new sales tax, as provided for in the bill;
2. The proceeds be allocated to the following programs:
a. Expand the existing Therapeutic Court to include a Mental Health Court;
b. Expand the existing Therapeutic Court to include dependency cases (as
required). It is noted that a very small number of dependency cases are
filed each year.
c. Add a Program Assistant (probably part-time) to the Therapeutic Court
staff, to manage program evaluation and ease the current administrative
burden.
d. Fund a combined chemical dependency/mental health treatment program.
i. Intensive Case Management
ii. Evidence -based
iii. Estimate 25+ clients per year
iv. Clients are not necessarily court -involved
• 615 Sheridan • Castle Hill Center • Port Townsend, WA 98368 •
• 360/379-4495 • FAX 385-9401 9
September 9, 2005
Board of County Commissioners
Jefferson County Court House
1820 Jefferson St.
Port Townsend, WA 98268
Dear Board of County Commissioners (BOCC):
The Jefferson County Law and Justice Council received a letter dated August 8, 2005,
from the Domestic Violence Sexual Assault Program (see attached) requesting our
support for their letter to the Jefferson County Board of Commissioners (see attached).
In essence they are requesting that the full amount of the $6.00 increase for filing fees for
dissolutions, legal separations and declarations of invalidity of marriage be allocated by
the BOCC to the Domestic Violence Sexual Assault Program. While the funding will
not be significant, it will demonstrate that the County recognizes the serious problem of
domestic violence in our community and their support for the only community-based
victim services program in the County.
On August 25, 2005, the Jefferson County Law and Justice Council unanimously voted to
support their letter to the BOCC.
Respectfully submitted,
Bill Nesmith, Chair
Jefferson County Law and Justice Council
Rug 22 05 03:47p DVSR of Jefferson County 360 385 2338 p.3
Dome- tic Violence
Sexual .ASsault Program
Conridimtial and Caring
P.O. Box 743, Part Townsend, WA 98368
Phone: 385-5291 (24 hour)
August 8, 2005
Mr. Bill NeSmith, Chair
Law and Justice Council
915 Sheridan Street
Port Townsend, WA 98368
Dear Bill:
In the 2005 regular legislative session, this Washington State Legislature amended RCW
3618 by increasing the filing fees for dissolutions, legal separations, and declarations of
invalidity of marriage. RCW 36.18.016 (2)(b) directs that $6.00 of the $30.00 increase
be retained by the county for the purpose of supporting community-based services within
the county for victims of domestic violence, except for five percent of the six dollars,
which may be retained by the court for administrative purposes.
Prior to 2002, the County provided a substantial grant to the Domestic Violence Program
for the purpose of supporting services for victims of domestic violence. Due to a sharp
reduction in revenues, the County phased out that financial support with all support
ending in December, 2004. Since the Pro ;ram currently is receiving no County funding,
we are requesting that the Board of Count V Commissioners allocate the full amount of the
$6.00 to the Domestic Violence Program i ather than retaining a portion of the fee for
administrative purposes. This allocation will not replace the "lost funding," because
there just aren't that many family law case s filed each year in our county. However, it
will demonstrate that the County, as well t.s our state legislators, recognizes the serious
problem of domestic violence in our community and their support for the only
community-based victim services prograrr in the County.
As Chair of the DV/SA Program Board of Directors, I am asking the Law and Justice
Council to support the Program's request to the Board of County Commissioners for this
allocation of these funds.
Sincerely,
Mike Brasfield
Jefferson County Sheriff
Aug 22 05 03:47p DVSR of Jefferson County 360 385 2338 p•2
Domc:itic violence
Sexual Assault Program
Confidential and Caring
P.O. Box 743, Fort Townsend, WA 98368
Phone! :195-5291 (24 hour)
August 8, 2005
Board of County Commissioners
P.O. Box 1220
Port Townsend, WA 98368
Dear Sirs:
In the 2005 regular legislative session, the Washington State Legislature amended RCW
2618 by increasing the filing fees for dissolutions, legal separations, and declarations of
invalidity of marriage. RCW 36.18.016(2)(b) directs that $6.00 of the $30.00 increase be
retained by the County for the purpose of supporting community-based services within
the County for victims of domestic violen;,e, except for five percent of the six dollars,
which may be retained by the court for adbninistrative purposes.
Prior to 2002, the County provided a substantial grant to the Domestic Violence Program
for the purpose of supporting services for victims of domestic violence. Due to a sharp
reduction in revenues, the County phased out that financial support with all support
ending in December, 2004. Since the Program currently is receiving no County funding,
we are requesting that the Board of County Commissioners allocate the full amount of the
$6.00 to the Domestic Violence Program rather than retaining a portion of the fee for
administrative purposes. This allocation will not replace the "lost funding," because
there just aren't that many family law cases filed each year in our County. However, it
will demonstrate the County, as well as our state legislators, recognizes the serious
problem of domestic violence in our community and their support for the only
community-based victim services program in the County.
If you would like more information concerning this request, please contact me at 385-
5292 or (email) direct orAdvsajeffco org.
Sincerely,
Peggy Thompson
Executive Director
Jefferson County Commissioners
Court House
Port Townsend, WA
Dear Commissioners,
I encourage you to adopt an increase in our sales tax to fund services for co-
occurring disorders.
I work at Jefferson Mental Health Services. I constantly see the need for
more preemptive service for the mentally ill involved with drugs and alcohol. I
answer the phone for our crisis line. 911 calls me about these people. The police,
jail, emergency room, Community Action, landlords, parents, grandparents,
friends, neighbors, spouses and pastors call me about these people. Most everyone
knows someone whose marriage, business, education and life has been impacted
by mental illness compounded with drugs and alcohol. Look real close at the
suicide reports in our county. I wish we had more services to offer. With more
funds we would have more service.
It is difficult to raise taxes but our community must take care of its own.
This tax might cost each resident $10 a year. That is about two minutes in the
emergency room for a person who was not helped earlier in the decompensation
process. That is about three hours of a jail sentence for a person self medicating
illegally. Our money will give a better return if spent therapeutically.
If you have questions or need more information come by and visit us here at
JMHS. Or call me on the crisis line, because this is a community crisis we are
dealing with.
�et &Y4
Gary No k
Leslie Locke
From:
David Sullivan
Sent:
Friday, September 23, 2005 4:06 PM
To:
Leslie Locke
Subject:
FW: Sales Tax increase
>__________
>From: Stephen Willing[SMTP:ECOPLACE@OLYMPUS.NET]
>Sent: Friday, September 23, 2005 4:07:08 PM
>To: David Sullivan
>Subject: Sales Tax increase
>Auto forwarded by a Rule
Dear Mr. Sullivan,
I object to the proposed sales tax increase slated for mental health
issues and am asking you to withdraw your support of it. I am unable
to attend the public hearing on this matter so am sending you an
email instead.
As a managing partner of an overnight transient accommodation that
has been in continual operation since the 1930's our guests are
already paying to much tax for the privilege of staying in Jefferson
county. Our guests are astonished at the 10.3% sales tax they must
pay. Asking them to pay 10.4% while not seeming like much, is
turning into a burdensome amount. Perhaps the commissioners would do
well to check with a number of accommodations to see what their
occupancy rates were this past summer. I have heard from numerous
owners and operators that their numbers are down. Perhaps the sales
tax is part of the problem? Since overnight stays in Jefferson
County have been declining since the spring of 2001 for most
operations, it would be advisable to reconsider additional tax burden
impacts to one of the largest industries in the county.
In addition, I will seriously limit my spending in Jefferson County
should the tax rate increase. Out of county stores offer more of
what I need, and the internet/catalogs provide goods without as much
sales tax.
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Molli Hinkle, M.D.
HEARIM7Adult, Child &Adolescent Psychiatry
CORD P.O. Box 223 Port Townsend, WA 98368
360.821.9272
Jefferson County Board of Commissioners
1820 Jefferson Street
Port Townsend, WA 98368
Jefferson County Board of Commissioners,
I am writing to support the proposed ordinance that provides additional funding for chemical dependency
and mental health treatment services by imposing a 1/10th of 1% sales tax. I am sorry to miss the
rescheduled meeting on this issue, as I will be out of the State. I will not bore you with a regurgitation of the
facts, but would like to voice my strong support for this ordinance.
Dual diagnosis, the combination of mental health problems with substance abuse, is a complex issue that
requires a multi -system approach. A large portion of my clientele struggle with both addiction and mental
health problems. I have seen remarkable improvement when both of these issues are addressed, but
funding is needed to address them.
In dealing with dual -diagnosis clients, there are biological, psychological, and social issues at work. Clearly,
the treatment is complex, but the good news is that proper treatment can improve the outcome for these
clients. While proper treatment may appear expensive, it often prevents the clients from depending on other
more costly services.
Prevention, in this case, is without a doubt cheaper than the burden placed on the legal, education, and
public health systems that occurs when treatment is not available. It is in everyone's interest in Jefferson
County for this ordinance to be passed.
I have read the arguments and not only agree with the statements I have reviewed, but also strongly
advocate the adoption of Ordinance for the purposes of funding substance abuse and mental health
treatment.
Sincerely,
Molli Hinkle, M.D.
Adult Psychiatrist
Child and Adolescent Psychiatrist
Message �,C - UCC �
Leslie Locke
Page 1 of 1
From: Pat Rodgers
Sent: Thursday, September 29, 2005 5:46 PM HEARIN"(31' RECORD
To: Leslie Locke
Subject: FW: Public Hearing October 3, 2005, 9:00 am 1/10 of 1 % funds
From: Laurie Strong[SMTP:LAURIES@JMHS.INFO]
Sent: Thursday, September 29, 2005 5:48:30 PM
To: David Sullivan; Phil Johnson; Pat Rodgers
Subject: Public Hearing October 3, 2005, 9:00 am 1/10 of 1 % funds
Auto forwarded by a Rule
I have put together a budget for the CODIT proposal, which is attached.
I won't be in the office tomorrow (friday) but will certainly be at the hearing.
Thank you,
Laurie
Laurie Strong
Jefferson Mental Health Services
PO Box 565, Port Townsend, WA 98368
Phone: (360) 385-2893
Fax: (360) 385-3944
Im-
9/30/2005
CODIT
Co -Occurring Disorder Integrated Treatment Program
A combined project of Jefferson Mental Health Services and Safe Harbor/Beacon of Hope
Budget — Year One
@ full enrollment of 40 clients
EXPENSE
Personnel -
1 FTE Case Manager 11 Provides outreach and assertive Case Management for
a caseload ranging from 25 to 40 clients; BA plus 4 years in MH Case Management
field, Registered, plus 1 or more years experience and/or training in CD Treatment.
Attends team meetings. Wages & Benefits: $38,960
.40 FTE CD Specialist II Provides S/A Education & Treatment —Individual and Group -
to clients in appropriate stages of readiness; family education; referral as necessary, some
case management. Certified, BA plus 4 years in CD Treatment, plus 1 or more years
experience and/or training in MH. Attends team meetings.
Wages & Benefits: 15,584
.40 FTE MH Specialist II Provides (billable) Mental Health Treatment to clients and
Family Psychoeducation. Some case management. Certified/licensed MA/MSW plus 5
post graduate years in treatment services to individuals with severe mental illness, plus 1 or
more years experience and/or training in CD field. Attends team meetings.
Wages & Benefits: 18,360
.20 Psychiatric Nurse Provides (billable) medication monitoring and assistance.
Licensed, 5 years experience in psychiatric nursing. CD experience preferred. Attends
team meetings. Wages & Benefits: 8,680
.15 Program/Clinical Supervisor Certified/Licensed MA/MSW with 7 or more years in
treatment services to individuals with severe mental illness, training and/or experience in
the CD field, and 4 or more years in program development and clinical supervision. Attends
team meetings, provides program management and supervision.
Wages & Benefits: 7,500
Total Wage & Benefits: $ 89,084
Personnel: Contract
Psychiatrist: Licensed with experience in treatment of mental illness and chemical
dependency. Provides evaluation and pharmocological treatment, including prescription of
psychiatric medications within protocol for dual disordered clients and medications known to
be effective in decreasing substance use. Works closely with team & client, attends weekly
team meeting. $105/hour.
Projected at 25 hours a month: $ 31,500
Evaluator: Research and evaluation firm (such as Maike & Associates) for first
year of project: identify, evaluate outcomes, fidelity scales, and produce report,
@ 11 % of project total. $ 22,000
Housing and Vocational assistance are important components in establishing and
maintaining stability. The need for these services varies, and once accessed may
not need to be re -accessed for successful clients.
CODIT Budget Narrative 1 October, 2005
Housing Specialist: Experience and knowledge in accessing Residential Services,
including support and monitoring, for clients in need of appropriate housing. $ 8,400
Vocational Specialist: Experience and knowledge in evaluation of work skills and
needs, readiness to work, and employment development and support 9,000
Total Contract Personnel Costs: $ 70,900
Indirect Personnel costs: per JMHS Cost Allocation Plan/Federal: Accounting, bookkeeping,
payroll, contract managemen/administration costs: $ 10,950
Mileage & Transportation 500
Training 750
Total Indirect Personnel Costs $ 12,200
Total Personnel Costs:
Other Costs
Communication
Dues/Licenses
Equipment, large furnishings
Equipment, rental
Facility rent
Facility repair/improvement
Facility maintenance
Furnishings, small
Insurance
Miscellaneous
Postage & Delivery
Printing & Reproduction
Program Expense
Supplies — Office
Supplies — Other
Taxes
Utilities
Wraparound Funds
Reference Materials
Total Other Costs:
2,710
954
1,530
238
3,000
954
212
160
4,500
350
200
450
9,600
1,166
1,250
1,100
2,500
6,000
550
$ 172,184.
$ 35,424
Total Expenses: $ 207,608
REVENUE
Third party billables $ 40,000
Other revenue (county) 167,608
Total Revenue: $ 207,608
Year Day
CODIT cost per client: $5,190/year $14.22/day
Vs.
Psychiatric hospitalization cost: range of $415.79 to $1,535/day
CODIT Budget Narrative 2 October, 2005
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P hN1G
RE
COR
Sheila Lauder, 805 58th Street Port Townsend, Wa. 98368 D
before Commissioner Johnson, Commissioner Rodgers, and
Commissioner Sullivan, on October 3rd, 2006.
My name is Sheila Lauder and I serve as president of the board of the
Jefferson County Affiliate of NAMI (the National Alliance on Mental Illlness).
NAMI is a grassroots organisation formed in 1979 with a mission to offer
support, advocacy and education for the mentally ill, their families and
friends.
This is a special week for mental health. It's National Mental Illness
Awareness Week. Thursday is Bi -Polar Awareness Day. And on
Wednesday NAMI Jefferson County celebrates its first anniversary.
Today can become milestone for mental health in Jefferson County, if,
effective immediately, the Board Commissioners uses its authority and
acts on legislation that will enable funding for a pilot program in our
community to treat co-ocurring mental illness and alcohlic and substance
addiction.
This is from a NAMI member. It's the testimony of a Jefferson County
resident with a daughter, also a resident, who has a serious mental
disorder. Sadly there is a lot of stigma and ignorance surrounding mental
illness so in order to protect their privacy and anonymity I'm honored to
present this testimony today on their behalf.
"I am the mother of an adult daughter who has a brain disorder and has
abused substances in order to self -medicate. In other words, she falls into
the category of people who exhibit co-occurring disorders of mental
illness and chemical dependency.
It is important to my daughter and to me to tell you our personal story even
though now it is being made public. I checked with my daughter about the
possibility that she may be identified, despite our hope to keep this
testimony anonymous to protect her privacy. She gave me her blessing
and said that she knew it was important to get people the help they need,
and she would take the risk. She is both incredibly compassionate and
brave.
My daughter was cruelly struck down with bi-polar disorder 6 years ago
when she was in her mid 30s, financially successful in her career as a Los
Angeles fine artist, and happily married. She lost her husband, her career,
and the L.A. home she owned. She has had several involuntary
hospitalizations. She has attempted suicide. She and we, her parents, now
know that her past attempts to self medicate with alcohol and marijuana
instead interfered with her prescribed medications for her brain disorder,
which resulted in mental health relapses that became life threatening.
Her experience of self-medication, relapse and life destruction is echoed
by hundreds of our current neighbors and fellow citizens who want to be
healthy and want to stay healthy but don't know how. Her experience
could continue to be reflected in the generations to come. As our county
population grows' so shall the numbers of people needing this type of
help. We need this tax to give people who are so vulnerable, through no
fault of their own, some tools for success. We need to give a "hand up" to
those for whom the curse of misunderstanding and stigma is so prevalent.
It takes collaborative, coordinated, consistent and integrated efforts
between chemical dependency counselors and mental health
professionals to emotionally support these afflicted folks, to help them
have insights into their illness, to teach them how to recognize their
individual mental health needs, and to share techniques to resist the
temptation to blot out the horror and grief of an unrelenting and persistent
brain disorder through alcohol or drugs.
I want to end my testimony by assuring you that people do recover! I've
read about them in mental health newsletters and magazines. Even though
they had been afflicted with co-occurring disorders, they found out how to
be healthy, stay healthy and became productive and sometimes, even
famous, citizens. The knowledge is out there, we just need to make it
available here.
I respectfully hope that each of you will vote to enact the tax now because
you know it is an investment, that it is the right and prudent thing to do
both for now and for the future. Please do not jeopardize nor delay the
helpthat is available by putting this decision on the ballot.
Thank you for your attention and consideration,
A concerned and hopeful resident of Jefferson County'
Oct.3, 2005
Testimony before Jefferson County
Commissioners Phil Johnson, Pat Rodgers,
David Sullivan
From: Judy Tough, 424 Colman Dr., Port
Townsend, WA
Commissioner Johnson, Commissioner Rodgers,
and Commissioner Sullivan,
I am Judy Tough, a resident of Cape George,
serve as a Jefferson County representative on
the RSN Advisory Board and also am the vice-
president of the board of the Jefferson County
affiliate of NAMI - the National Alliance on
Mental Illness.
The combination of mental illness and substance
abuse is so common that many clinicians who
work with those with brain disorders now expect
to find it. Studies show that fully 50% of
persons with mental illness also have a
substance abuse problem. And more that half
the persons with a substance abuse diagnosis
also have a diagnosable mental illness.
Dual diagnosis means the condition is especially
complex and difficult to manage. Families with a
dually diagnosed member may experience twice
the problems of those whose family member has
only one disorder.
Increasingly, the psychiatric and drug counseling
communities agree that both disorders must be
integrated and treated at the same time. Early
studies show that when mental illness and
substance abuse are treated together, suicide
attempts and psychotic episodes decrease
rapidly. One tenth of one percent tax increase is
a small price to pay for saving lives and
providing an opportunity for people to become
productive and successful citizens.
This is an opportunity for Jefferson County to be
in the vanguard with other communities in the
nation who are applying successful model
programs for treating the complexity of co-
occurring disorders.
NAMI Jefferson County joins with the others
who speak in favor of enacting this small tax
that will generate a large amount of good and
alleviate a great amount of suffering. We would
respectfully urge you, the commissioners, to
enact this tax at once and not delay this unique
opportunity offered to you to make a difference
today. Thank you.