Issues Raised in the Survey

Waiting lists. Provider waiting lists are an important indicator of the extent of need for increased substance abuse recovery services. Providers express waiting lists either in terms of a number of months for a waiting client to be served, or in terms of the number of clients waiting to be served. Most providers surveyed stated that their waiting lists were about 3 months long (the range was from 2 to 4 months). When expressed as the number of clients waiting, the figures ranged from a high of about 170 per month for detox to between 40 to 80 per month for different outpatient and residential programs. One program indicated that they get about 6 calls per day for residential treatment space.

Residential services. Related to the above issue of waiting lists, many respondents in the key informant survey stated with no prompting that there was a great need for more residential beds to serve all clients. This is a strongly perceived need of the county AOD service system.

One of the most important issues in providing residential services is the barriers to opening new facilities. More than one provider in the county, has experienced neighborhood and local government opposition to the siting of a substance abuse program in their community. Without the required permits, new facilities cannot open. This means that opening new facilities requires a strong, sustained commitment on the part of both the County and the contractor.

Medical detox. A need identified by several providers was for a medically supervised detox program. The existing detox services provider is basically a social model or "drug-free" program. Psychiatric medications are allowed to be used in the detox protocol, if clients have already had them prescribed. Yet, people with serious medical problems must be excluded.

Relapse prevention and aftercare. Another need identified by some providers was for services to help prevent clients from relapsing after they had completed recovery. One provider stated that they receive about 3 calls per month requesting services to help prevent relapse, such as support groups and individual counseling.

Services for women and women with children. Several respondents identified the need for more AOD recovery services for women, and especially for women with children. Especially emphasized were additional residential facilities, and more detox services.

Latino services. Another need that was strongly identified by many respondents was for additional bilingual/bicultural services for the county's large Latino population. There is only one 6-bed residential facility for the Spanish-speaking population, and that facility is for women. There is no other bilingual/bicultural program to refer people to in the county. The closest residential facilities are in Watsonville and Sacramento. There are no services specifically targeting Hispanic men; however, the county ADP has responded to this gap in services by issuing an RFP for a men's Latino residential facility and for a non-residential program.

African Americans. Although existing programs serve African Americans, the waiting lists show there is not sufficient capacity. Many African Americans in San Mateo County, live in East Palo Alto, which has high crime, high incidence of drug abuse, and ongoing economic problems. Although there are services in East Palo Alto, several respondents expressed the view that there is considerable unmet need for AOD services to African Americans.

Asian/Pacific Islander services. County AOD recovery providers indicated that do not have staff who are bilingual and bicultural in the Asian/Pacific Islander cultures that are represented in the county, such as Filipino (Tagalog), Chinese, Samoan, and Tongan. They feel that these cultural groups are not well-served, that programs are unable to access these cultural groups, and that recovery programming should be specifically identified with, or designed for the Asian/Pacific Islander population.

Non-U.S. citizens. A newly-identified group that has not been specifically addressed to date is program participants who are not citizens of the U.S. This does not refer only to illegal aliens. There are a number of individuals who are not citizens, but who are in the U.S. legally for a variety of reasons, and who may or may not be recipients of county ADP services. Concern has been expressed that this group may be falling through the cracks.

Dual and triple diagnosis. Providers indicate that they are serving dual diagnosis clients, but no programs are specifically designed for this population. For example, Project 90 has agreed to reserve 5 beds for dual diagnosis clients, but state that they average around 7-8 such clients at any particular time. Palm Avenue Detox states that they frequently work with dually-diagnosed clients, and clients who take psychiatric medications are permitted to use them during detox, unlike the traditional social model detox. This is an excellent step forward.

HIV/AIDS. The county AIDS program provides on-site anonymous testing, HIV education, and counseling at recovery programs through a contracted staff person, but respondents indicated that there are unresolved programmatic issues in serving HIV positive clients and persons with AIDS. One issue is the need for flexibility in program structure to incorporate specific medical needs. For example, if a recovery program is highly structured and clients are asked to leave if they do not participate in the structure, this creates a problem for HIV/AIDS clients who may physically be unable to meet some of the program obligations. Such clients may need to rest at certain times when they are expected to participate in activities, or otherwise be physically unable to perform expected tasks. Similarly, clients' needs for medication and medical attention may conflict with other program policies and procedures.

Gay and lesbian. One AOD provider stated that they see a large number of gay and lesbian individuals and couples, and that there was a need for additional services for this population.

Homeless. The detox provider estimated that about 60% of clients in detox are homeless.

Seniors. Pyramid Alternatives has been providing programming for senior adults for several years, but feels that, with sufficient funds, they could expand the program by as much as four times. They receive far more requests for service than they can provide.

Children and youth. Some providers feel that services for children in families in which substance abuse is a problem are an area of very great need. These children are often referred by the schools for a variety of problems identified by school personnel. Additionally, they may be identified by Child Protective Services, which is currently receiving about 400 reports per month.