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H. TREATMENT: Planned services occurring in a designated time-frame, facilitated by trained staff, treatment includes diagnostic evaluation and assessment, counseling, and other activities designed to influence the behavior of individuals toward identified goals and objectives.
1. Challenge: Direct services programs for individuals from multicultural groups with alcohol and other drug problems are a major cap in all service delivery systems in the County. Recent immigrants, monolingual individuals, and particularly those who are undocumented, not only have few service options available, but their eligibility and payer status may be nonexistent. Residential programs may be reluctant to take them because of inability to obtain General Assistance benefits due to undocumented status. As a result of such issues, many of these individuals avail themselves of emergency room services when problems have become very severe and warrant services late in the continuum. Spanish-speaking services are very limited, and a multicultural approach is virtually nonexistent for smaller groups such as Chinese, Tongan/Pacific Islanders, and others. Some groups, due to their small size, present very real economy-of-scale problems for program planners.
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Goals/Recommendations: |
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a. |
Develop core programs for larger, more concentrated populations of ethnic and immigrant groups, i.e., Latino, Black, Chinese, and Filipino. (H, SS; Long-Term)
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b. |
Assure that all services are provided in Spanish as well as in English. (H, SS; Long-Term)
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c. |
Provide mandatory and ongoing cultural awareness training for all alcohol and drug program workers. (H, SS; Short-Term)
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d. |
Work with the community colleges to develop affordable training, for specific cultural groups to prepare them to work in alcohol and drug programs, and other programs, throughout the County. (H, E; Long-Term)
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e. |
Collaborate with other Bay Area counties in developing regional programs for smaller groups where economy-of-scale issues preclude special programming at the local level. (H; Long-Tenn)
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2. Challenge: Services for women, homeless women, pregnant women, women with children, and alcohol- and drug-exposed infants are not perceived as being sufficiently available in the County, notwithstandincy significant allocations of special programming funded by the County Alcohol and Drug Program. The etiology of alcohol and other drug, problems in women, issue s related to incest and battering in the home, the complexity of perinatal services and their associated collaborative needs, the reluctance of women to access treatment and recovery programs if it means giving up their children, and the lower income potential for women, combine to intensify the enormity of this perceived service gap. Lack of Spanish language capability in existing programs, and lack of medical care for alcohol- and drug-using, women contribute to these problems.
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Goals/Recommendations: |
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a. |
Coordinate with the medical community to facilitate medical (obstetrical) appointments for women with alcohol and other drug problems. (H, SS; Short-Term)
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b. |
Provide services for women, including Latinas, in the new women's jail, similar to the CASE program available to men in jail. (H, SS, CJ; Short-Term)
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c. |
Provide codependency services to wives of men in the men's jail. (H, SS, CJ; Short-Term)
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d. |
Provide program content - - and not simply child care - - for small children of women entering programs with children. (H, SS; Long-Term)
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e. |
Provide, in all programs serving women, activities that address the problems that women have in the areas of parenting, training, life and job skills, and affordable housing. (H, SS, E; Long-Term)
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3. Challenge: Individuals who have alcohol and/or other drug problems in combination with mental health problems do not have adequate services, and in some instances are not reached by the services that are provided. There is a perceived gap in communication among workers in mental health programs and alcohol and drug programs, and a perceived lack of training among workers regarding each other's respective field. Budget reductions in the mental health system have contributed to this problem, which is particularly acute in the jail, homeless, and Spanish-speaking communities.
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Goals/Recommendations: |
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a. |
Encourage greater participation in the monthly multiple diagnosis trainings provided in the Department of Health Services for County Alcohol and Drug, Program staff, County Mental Health Services staff, and contract provider staff. (H, SS; Short-Term and Ongoing,)
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b. |
Ensure that the County Alcohol and Drug Program provides inservice training for Division of Mental Health staff on alcohol and other drug problems, alcohol and drug counseling, and access to alcohol and drug programs, once annually. (H, SS; Short-Term and Ongoing)
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c. |
Ensure that the County Division of Mental Health provides inservice training for the Alcohol and Drug Program on chronic mental illness, psychiatric medications, and access to mental health programs, once annually. (H, SS; Short-Term and Ongoing)
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d. |
Ensure that the Division of Mental Health has policies and procedures for coordinating services with alcohol and drug programs for multiple diagnosis clients, particularly in the areas of psychiatric medication, crisis/relapse prevention, and methadone. (H, SS; Short-Term)
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e. |
Ensure that the Division of Mental Health creates a system of Alert Plans for identifying multiple diagnosis (and other) clients who relapse and are seen in the County's emergency services, i.e., Jail Psychiatric Services, San Mateo County General Hospital Emergency Room, and Psychiatric Emergency Services. (H; Short-Term)
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f. |
Ensure that the County Alcohol and Drug, Program has policies and procedures for coordinating services with Mental Health on mutual clients/program participants, especially in the areas of admissions to programs and medications. (H; Short-Term)
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g. |
Develop collaboration between the Alcohol and Drug Program, the Mental Health Division, and Criminal Justice to create a "fast track" for admitting problem clients to services to improve the quality of care. (H, SS, CJ; Short-Term)
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h. |
Develop and fund a residential program for multiple diagnosis clients that provides board and care, balanced meals, physical activity, and sessions regarding living in society, and that makes A.A. and N.A. meetings available in house and in the community. (H, SS; Long-Term)
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4. Challenge: Services for individuals with physical disabilities, including the visually impaired, deaf, and hard-of-hearing, are lacking. The problems exist not only at the level of accessible physical facilities, but also extend to attitudinal accessibility. Because of the size of the populations involved, economy-of-scale issues may have significant impact on any one county's ability to implement programs. Cross training of alcohol and drug program workers and disability program workers is an additional need.
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Goals/Recommendations: |
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a. |
Collaborate with other Bay Area counties to fund a regional residential program for, and run by, the deaf and hard-of-hearing. (H, SS; Short-Term)
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b. |
Provide ongoing funding for interpreters for support groups, and provide basic training on American Sign Language to alcohol and drug program workers. (H, SS; Short-Term and Ongoing)
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c. |
Develop and implement an ongoing cross training program for disability program workers and alcohol and drug program workers. (H, SS; Short-Term and Ongoing)
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5. Challenge,: Eighty percent of the older adult caseload in San Mateo County has alcohol or drug, problems in the lives of the older adults or their significant others. Residential programs are not licensed for an older adult population and, in fact, no programs are available specifically for the older adult who might wish to access recovery. Nevertheless, the older adult frequently has severe medical problems associated with alcohol and other drug use, may need detoxification services, and has no residential or nonresidential program available.
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Goals/Recommendations: |
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a. |
Provide training on alcohol and other drug problems to agencies that serve the older adult, and training on issues affecting the older adult to workers in alcohol and drug programs. (H, SS; (Short-Term and Ongoing)
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b. |
Work with nonresidential program providers to develop special programs to meet the needs of the older adult. (H, SS; Short-Term)
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c. |
Develop and fund a residential program capacity for older adults, perhaps as part of a collaborative regional project. (H, SS; Long-Term)
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6. Challenge: The criminal justice system is on overload as a direct result of the effects of alcohol and other drug problems, including DUI's (especially multiple offenders), public inebriety, and domestic violence cases where alcohol use is nearly always involved. Law enforcement, court, and jail costs, and the numbers of crimes committed where alcohol and drug use is the central force, cause officials in the criminal justice system to be very concerned about addressing the alcohol and drug problems in individuals, and not just the law enforcement/criminal justice problems. Potential referrals for services from the criminal justice system include arrestees, persons released from custody and awaiting trial, incarcerated individuals, probationers and parolees. Sentencing individuals to treatment programs and to attend A.A./N.A. meetings is thought by many to be inconsistent with the voluntary nature of such approaches. The entire matter of mandatory program referral vis-a-vis the motivational level of the individual referred is a very complicated issue, with outcome research on coerced program participation less than compelling. Additionally, services must be affordable, i.e., sliding scales that really slide, if they are to be accessed by criminal justice clients. Although the services that are available are Generally well thought of, it is clear that many more services are needed.
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Goals/Recommendations: |
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a. |
Develop and fund a central reception and booking center for DUI'S, public inebriates, and other offenses where alcohol and drug use is the major underlying problem, where intake, assessment, and referral can be handled under minimum security conditions. (H, SS, CJ; Short-Term) (Priority)
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b. |
Create a centrally located multi-service day center, available to the courts, where clients may be referred for a variety of health and human services needs. (H, SS, CJ; Long,-Term)
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c. |
Increase the number of counselors located in the jails, including Spanish speaking counselors. (H, SS, CJ; Long-Term)
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d. |
Provide services directly in the new women's facility. (H, SS, CJ; Short-Term)
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e. |
Address violence in jail and conflict resolution skills development in on-site-jail programming. (H, SS, CJ; Short-Term and Ongoing)
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f. |
Assure the continuation of education, treatment, and recovery alternatives for first offense drug-related arrests. (CJ; Short-Term) (Priority)
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7. Challenge.: There are not adequate services available to reach the numbers of adolescents and youth experiencing problems with alcohol, drugs, and depression. Of particular concern are the residential program needs of non-English-speaking youth, and the small numbers in some groups, a fact that makes specialized services difficult to implement for economy-of-scale reasons. Family services, in general, are not adequately available, and yet the disintegration and breakdown of families highlights the need to aggressively address families as units, rather than treating individuals within families as separate units.
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Goals/Recommendations: |
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a. |
Develop and implement more family counseling programs where work with youth can address the broad problems of alcohol and drug use and teenage depression. (H, SS; Long-Term)
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b. |
Encourage statewide and regional collaborations to create residential program options for youth from multicultural groups. (H, SS; Long-Term)
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8. Challenge,: The Master Plan process is designed to foster greater coordination and collaboration among programs, services, and activities serving the community. In many instances San Mateo County community representatives acknowledge the need for greater communication, cooperation, coordination, and collaboration. However, the community is also concerned that policy makers be aware that collaboration is not a substitute for dollars. Clearly, as all commentary clearly points out, resources to address alcohol and other drug problems - - as well as those available to address many other health and human services problems - - are simply not available in sufficient enough quantity or quality to do the job. It is a gross oversimplification to imply that collaboration by itself will solve the problem.
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Goals/Recommendations: |
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a. |
Create more forums for dialogue and communication among agencies, organizations, groups, and individuals, with particular emphasis on information sharing between mental health program staff and alcohol and drug, program staff, including County staff and not-for-profit service provider agencies. (H, SS; Short-Term and Ongoing)
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b. |
Write more grants on an interdepartmental basis, as was done with the IPSAT (Interagency Perinatal Substance Abuse Team) project. (H, SS, E, CJ; Short-Term and Ongoing)
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c. |
Acknowledge, when creating collaborative formats, that there are profound differences between administrative collaboration and line staff collaboration; between official and unofficial collaboration. (H, SS, E, CJ; Short-Term and Ongoing)
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9. Challenge: The lack of space available and the waiting lists in existing, programs highlight the fact that the community in general is underserved. While a list of programmatic direct service needs would be endless, following are some of the areas that received special attention during the focus group process.
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Goals/Recommendations: |
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a. |
Develop a program capacity for the Coastside region of the County, acknowledging the different needs of rural and isolated communities, the high numbers of new immigrants (including the undocumented), and the lack of Spanish speaking services in the area. (H, SS; Short-Term)
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b. |
Increase detoxification program capacity. (H, SS, CJ; Long-Term)
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c. |
Review the needs of people with the antibody to Human Immunodeficiency Virus (HIV), including the bed capacity in alcohol and drug residential programs. (H, SS; Short-Term)
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d. |
Review access issues with regard to mid-income individuals, who often are not poor enough for public programs but cannot afford to pay for private (hospital based) programs. (H, SS; Short-Term)
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