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HomeMy WebLinkAbout078 05 C.l'.: 'Tr J2.Q><=v'\LL-~..' ;;l -,?{) - (6- I, l4-ct J, r ,,,- A-<ks ~5 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. 78-05 WHEREAS, the Board of Commissioners did adopt Ordinance 08-1003-05 on October 3rd, 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 RESOL VED, that the Board of Commissioners hereby . states that its intent was to. implement the Sales Tax qS soon as possible, and thc;lt, 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 .l9- day of lJp('pmnpY' , 2005. . ., , \ \,,~. ATTEST: d~tLt.{7(~~, C/YI C , Julie Matthes, CMC Deputy Clerk of the Board 1/:., JEFFERSON COUNTY ~OF COMMISSIONERS ",' , 1 . Z / ..,- ~---_.,.. PhilJo . son, Chainnall ;/' /~/~ //1.1 l(t:,~~~~A1~El~ Davi(rSullivan, Member ~~ at Rodgers, Member - e : tea 77, 6,3k 5 6V, 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 Dependency/Mental Health Program Fund. There is hereby created the Chemical Dependency/Mental Health Program Fund. Monies collected pursuant to this ordinance shall be deposited in this fund by the Jefferson County Treasurer. The fund balance may be invested by the Treasurer and any interest earned shall be deposited in this fund as well. Page 3 of 4 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. UED AND ADOPTED this`— day of ��� , 2005. 4, 3 JEFFERSON COUNTY • BOARD OF COMMISSIONERS •� "' 1 i Phil Jo on, Chair ATTEST: Lei" Julie Matthes, CMC Deputy Clerk of the Board Approved as to Form: Prosecuting Attorney 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. ,s 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, 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 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. 81 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, changes 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. • JMHS is a 501 (c) 3 non -profit entity with contractual relationships with State and Federal governments, School Districts, and historically with County government; • 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. • JMHS is financially audited by an outside CPA firm annually in accordance with governmental auditing standards ( "Yellow -book audit"); • 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; • 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 • Mood Disorders • 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 • Identification Set • Secondary Funding if any • Reason for referral • Documentation of reason for referral • 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 — 9/12105 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 rents 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 futy 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 Full 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 ckenPs stage of recovery dients 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 kfe 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 Fandy Psydnoeducabon Illness Management Intensive Case Management 4 Time - Unlimited Services No time limits ascribed to services; intensity modified Intensive Cane Management according to each clients reeds • CognitivelBehavioral 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 need 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 • Roil 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 corxrseling principles Teaching how to manage cues 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 spedfically opportunity addresses both mental health and Access is openly available substance abuse problems readily available/oftered clients 9 Family Psychoeducation on Psychoeducation includes: Family Psydaeducabon Curriculum Dural 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 11 Pharmacological Treaknent Evaluation access, includes Medication evaluation Psychiatric medication evaluation • Psychiatric rneducations 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 legal disorders W Focus on increasing adherence • JMAP inclusion (medication algorithm program) • Avoid benzodiazepines and o0uer addictive 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 heath 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.Nhiwvwidons Explicit strategic plan and interventions. Ow9oing individualized review and TX Strategic plan and pmgrarn to On -going overt dint review of goals reached, planning • Merntify non - responders responsaWHespo nse to treatment Strategic response pans • Provide secondary Tilrated 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 $1,5351day CODIT Budget Narrative 2 kp Dctober, 2005 e ,�C� "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 (RASA). 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.