Discussion Notes

A brief recap of the issues discussed on the January 17, 2008 conference call…

• Budget Hearings have already begun on the changes (mostly reductions) proposed by the Governor for the current fiscal year’s budget, as well as for the budget year (’08-09). The Legislature has 45 days (from Jan. 10) to act on the Governor’s declaration of a “fiscal emergency,” and to send the Administration its proposal.  We will sign on to a letter from CADA (the Coalition of Alcohol & Drug Associations), objecting particularly to the cuts in Prop. 36 and Drug Medi-Cal (the latter of which will amount to a 20% reduction due to the loss of federal funds).  Regarding the SACPA reductions, the public safety issue needs to be emphasized.  The Administration’s plan to early release 22,000 prisoners, a high percentage of whom have AOD problems, means that most of these offenders will be coming back to our communities in need of AOD treatment, at the same time that funds are being cut to the very programs that will provide this treatment.  There is also concern about the “paper” transfer of funds from CDCR to ADP (mostly PSN $), simply to protect our MOE, funds which are then given right back to CDCR.  What’s to keep the Administration from doing the same thing with any of the hundreds of millions of dollars in CDCR’s budget for in-custody or parolee treatment?  We think this sets a bad precedent, and ultimately none of that money gets into our community-based treatment system.
  
  
• Alcohol Tax Proposal – We have been encouraged by some members to become more proactive in advocating for an increase in the alcohol tax, given the continued erosion of funding for AOD and its impact on the ability of our system of care to sustain adequate services.  Because alcohol taxes have not even kept pace with inflation, the state is essentially subsidizing the alcohol industry.  There was some discussion about the difficulty of accomplishing this through legislation, given the huge amounts of campaign money that the alcohol industry gives to lawmakers.  Every year at least one bill is introduced to increase alcohol taxes, only to die young in committee.  The initiative process is a possibility, and recent polling (which CADPAAC helped support) indicates an overwhelming voter support for nickel-a-drink or similar proposals.  But we need to be prepared to invest large sums of money into a campaign, since the industry will spend millions to defend the status quo against such an initiative.
  
  
• SB 1000 (Harman) – This CADPAAC-opposed bill, to change current statutes regarding a treatment facility’s application for ADP licensure, would have required an application to include “a certification by the applicant that the facility complies with local zoning ordinances,” and would have required ADP to verify this certification before approving the application.  6-bed-and-under facilities were not exempted.  The measure died this week in Senate Health Committee, but we can expect to see more bills like this introduced to restrict the location or operation of treatment programs.
  
  
• Zito Confirmation Letter – The Executive Committee approved the “kinder, gentler” version of the letter, as revised by D.J., but the language regarding CADPAAC’s priorities and our expectations of the Director’s leadership and advocacy in these areas is still very straightforward.
  
  
• Final Review of Quarterly Agenda – There were some minor revisions, including a decision to not repeat the Prop. 36 “grudge match” when it comes to the NORA presentation, and adding a couple of items to the Issues Discussion (NIATx Follow-up, and Women’s Treatment Standards).  Lily Alvarez said that the state’s Women’s Treatment Workgroup has just completed its proposal on Core Competencies for women’s treatment, which the administrators should review for consideration at the meeting.
  
  
• Proposed Prop. 36 Fact Sheet – I have augmented this informational document that was initiated by Dennis Koch to “tell our story” about Prop. 36.  There was some discussion about the order of the bullet points, and whether the data about prison overcrowding should be given more priority.  The document will be reviewed by the Criminal Justice Committee at next week’s meeting.
  
  
• Strategic Plans – There is a need to update our goals, objectives, and action plans to better reflect current issues that are being addressed by the various Issue Committees and by the association at large.  D.J. will review the action plans that were developed in 2006 and incorporate the relevant issues into our 2008 goals.
  
  
• Prisoner Early Release Proposal – The newspaper article regarding the Administration’s plan for early release of non-violent, low-level offenders was discussed, as it relates to the counties’ ability to provide AOD treatment services to this population when they return to their communities

A brief recap of the issues discussed on the January 31, 2008 conference call…

• NPI Submissions – Marjorie McKisson and her staff joined the call to respond to some county concerns about ADP’s start date of Feb. 1 for NPI submissions. CADPAAC had requested at our meeting last week that ADP consider moving back the start date to have it coincide with the DMH start date.  Marjorie said that only one county had contacted the Department to indicate that the Feb. 1 date was a problem for them, and ADP is working with that county to resolve the issue.  ADP staff participated in a Short-Doyle Medi-Cal conference call yesterday, and said basically that counties needing an extension can request one.
  
  
• Budget Hearings were held yesterday in both the Assembly and the Senate, dealing with the changes (mostly reductions) proposed by the Governor in health and human services, both for the current fiscal year as well as for the budget year (’08-09). As expected, there was a great deal of hand-wringing by a number of committee members, especially over the human impacts of a loss of services at the local level, but there was also a general acknowledgement that something has to be done to reduce the state’s budget deficit, and everyone is going to have to share the pain.  Senator Ducheny, Chair of the Senate Budget Committee, was particularly concerned about the cuts to Prop. 36, and wondered aloud how much more it would cost the state to incarcerate drug offenders who recidivate due to the inability to access treatment services.  She asked the Department to provide data regarding the number of clients statewide who would likely be unable to access services due to the budget reductions. Her comments were along the lines of, “if it’s going to cost us 3 times more to incarcerate these people than to provide them treatment, then it doesn’t make any sense to cut Prop. 36 funds…etc.”  Our point, exactly!  In our testimony, we also emphasized the public safety issue, especially if the Administration’s early release proposal goes forward.  Since a high percentage of these inmates have AOD problems, to send them back to their communities at the same time that funds are being cut to the very programs that provide treatment will mean that many of these offenders will be released untreated, resulting in high rates of recidivism as well as potential public safety concerns. In addition to opposing the cuts in Prop. 36, we also objected to the Drug Medi-Cal reductions, which will amount to a 20% reduction due to the loss of federal funds.  One interesting proposal came from the Legislative Analyst, who recommended that money currently allocated to the California Meth Initiative, for which there is no outcome data demonstrating effectiveness, be redirected into Prop. 36, which has been proven to be cost-effective.
  
  
• Alcohol Tax Proposal – Senator Ducheny has expressed great interest in reviving the alcohol tax proposal, and has met with the Campaign for New Drug Policies about this, since they conducted the polling on this issue as background for a possible youth treatment initiative.  Dave Fratello shared a summary of the polling data with Senator Ducheny, with a strong caveat that revenues from any tax increase on alcohol must be dedicated to AOD treatment.  There is, for good reason, a concern on our part that, if the Legislature were to pass an alcohol tax increase, the funds would be targeted to help reduce the state’s deficit, and could end up being diverted into other programs having nothing to do with AOD.
  
  
• Updated Bill List – Assemblyman Beall, on behalf of the Select Committee on AOD Abuse that he chairs, has introduced AB 1983, which requires the multi-agency juvenile justice coordinating council in each county to include the county AOD Administrator.  The Assemblyman has indicated that he plans to introduce at least a couple more AOD-related bills this year.  On the negative side, we can expect to see some bills introduced to restrict the siting and/or operation of community-based treatment programs and sober living homes.  AB 337 (Dymally), which would have equalized the criminal penalties for the possession of crack and powder cocaine, was defeated by the Assembly, which, in an occasionally-used maneuver, immediately expunged the vote.  Such an action ensures that the vote on such a controversial bill cannot be used by challengers in upcoming elections.  But just in case you’re curious, the vote was 37-33 (four short of the number needed for passage), with all Republicans voting “No,” five Democrats voting “No” (Arambula, Feuer, Levine, Lieu, Wolk), and five Democrats not voting (Galgiani, Karnette, Nava, Ruskin, Soto).
  
  
• Zito Confirmation Hearing – Renee Zito was confirmed yesterday by the Senate Rules Committee on a 5 – 0 vote.  Since this hearing took place at exactly the same time as the Senate and Assembly Budget hearings, I was unable to attend.  But D.J. watched it on television, and reported that the process was short and sweet.  Congrats to Renee!
  
  
• Proposed Prop. 36 Fact Sheet – We are going to try and finalize this document within the next couple of weeks so that we can begin distributing it to legislators and others.  There were some good comments about expanding the introductory description of Prop. 36, and deleting the reference to deportation as a possible explanation for “no-shows” (there is no indication from any county that this is an issue).  Also, there was a request that, once the document is approved, we have someone translate it into Spanish.
  
  
• Incarceration vs. Rehabilitation of Juvenile Offenders – This excellent study from the MacArthur Foundation presents compelling data indicating that (1) punitive responses to juvenile crime (e.g. the incarceration of juvenile offenders) are far more expensive and less effective than providing rehabilitative services in community settings; and (2) the public prefers, and is willing to pay more for rehabilitation than for incarceration of juvenile offenders.  This is an important study in light of the fact that NORA has provisions for adolescent AOD treatment.  On a related subject, more juvenile offenders are being released from state facilities and are coming back to their counties for services.  We have heard from several counties that some of the funds that accompany these youth are being used for AOD treatment, but that probation officers are doing the treatment using the Matrix model.  In other counties, Probation contracts with professional treatment providers to deliver these services.   
  
  
• Strategic Action Plans – The issue committees began working on these goals and objectives at least week’s Quarterly Meeting, and the committee chairs will present these drafts to the Executive Committee at the Feb. 14 meeting.
  
  
• Presentation by COJAC Housing Subcommittee – Cheryl Trenwith has received a request from the COJAC Housing Subcommittee to make a presentation at a future Quarterly Meeting regarding housing opportunities under the MHSA for clients with Co-Occurring Disorders.  Cheryl will follow up on this as a possibility for our May meeting.
  
  
• News re. the ADP-to-CDCR Pipeline – Rebecca Lira will become the next ADP Exec. to leave ADP for Corrections, where she will take over the Substance Abuse Service Coordination Agencies (SASCA).  Rebecca will certainly be missed at ADP but, on the plus side, there will be another executive-level person at CDCR who understands and supports AOD treatment.  Here’s an idea for a future Quarterly presentation: a Jett-Powers-Lira panel on the impacts of NORA on the Corrections system. It will be like old times

A brief recap of the issues discussed on the February 7, 2008 conference call…

• The President’s Budget Proposal provides funding for the SAPT Block Grant at about $1.779 billion (a $20 million increase), but makes deep cuts in both the Center for Substance Abuse Treatment budget ($63 million reduction) and the Center for Substance Abuse Prevention ($36 million reduction).  According to budget documents, the $20 million increase in the Block Grant would be used to support “supplemental performance awards” for the top 20% of Block Grant recipients that “demonstrate superior performance in preventing and treating substance abuse.”  The Safe & Drug-Free Schools grant program is proposed to be decreased by almost $195 million, approximately two-thirds of its current budget.  This is a program that, in previous budget proposals from this Administration, has been slated for deep reductions and even for elimination, but has always been restored due to its great bi-partisan popularity among many members of Congress.

• Proposition 36 Funding – Some counties have reported that they have not received their SACPA allocations which were anticipated by the end of January.  In checking with the Department, I learned that ADP, responding to the Governor’s proposed current-year reductions, has held off on issuing payment to many counties due to fears that counties could potentially spend more this year than they will end up receiving.  However, the “situation” has apparently been resolved, and checks should go out within the next couple of weeks.

• Review of Corrections Re-entry Webinar – The webinar was hosted by CDCR (the Department-formerly-known-as ADP), and featured presentations by Secretary Tilton and Deputy Secretary Kathy Jett, among others.  It was clear from the presentations that state funds will only be available for in-custody programs or services for parolees.  Once individuals are released from parole into the community, they become the counties’ responsibility. We need to find out how much money is allocated for AOD treatment in the re-entry facilities.  Kathy stated that the department wants to partner with counties and community-based providers to provide the in-custody treatment.  But there is some concern about language in the proposal specifying that re-entry staff will be trained in the “new therapeutic model.”  Does this mean that CDCR staff, rather than treatment professionals, would be providing direct treatment services?

• Proposition 36 Fact Sheet – The revised version met with approval, and with an encouragement to begin distributing it, under the CADPAAC logo, as soon as possible.  It will also be posted on the CADPAAC website.

• LHC “Roadmap to a Better System” – Mark Martin with the Little Hoover Commission has asked for another round of comments as he prepares to finalize the new report.  The draft report addresses four central problems with the current system (isolation of AOD from other health systems; lack of strong state leadership; gap between research and implementation of best practices; inadequate and limited funding streams), and provides recommendations for improvement.  Our hope is that Jim Beall and other lawmakers will utilize this report as a basis for legislation to address the issues raised.

• COD Screening Tool – We discussed the Co-Occurring Disorders Screening Instrument that was developed by the COJAC Subcommittee, and is already being used in some counties.  ADP will sponsor and conduct a scientific study, expected to take two years, designed to establish the validity of this tool.  All but two of the questions have already been validated.

• CA Endowment Application for NIATx Action Campaign – On a conference call with ATTC earlier this week, we agreed that UCLA/ATTC would be the primary co-applicant for the grant, and that CADPAAC would collaborate with them on implementing the NIATx model in participating counties.

• Probation Staff & AOD Treatment – We have heard from some counties that juvenile probation funds are being used for AOD treatment administered by probation officers using the Matrix model.  This practice may be a response to frustration over the unavailability of treatment or long wait times for treatment.  However, the counselor's handbook for the Matrix model gives the following description of who is best qualified to deliver the services: “a counselor with several years experience working with groups and individuals...experience with cognitive-behavioral and motivational approaches and has a familiarity with the neurobiology of addiction.”  It also states appropriate counselor supervision to ensure fidelity to the Matrix treatment approach.  If Probation would be willing to share some of the juvenile justice funds with AOD, there would be more treatment capacity and availability.  In fact, some counties report that, in their juvenile halls, probation does contract with trained AOD staff to provide treatment because they find it more cost-effective.  The first thing we need to do is find out how extensive is the practice of probation staff-provided treatment, and whether this is being used for in-custody or outpatient treatment.  D.J. will prepare a county survey designed to get this information.  If probation officers are using Matrix only for motivational interviewing, that is probably acceptable, as long as they see the value in having AOD staff provide the treatment.  If probation is doing the treatment, however, this is a problem that needs to be addressed.  No other health care system would tolerate having its services delivered by anyone other than trained professionals in the field.  If this is happening in AOD, then we should have a discussion with the Probation Officers Association to see how, together, we can properly address the problem of providing timely access to AOD services for adolescents in the juvenile justice system.     

• CCISC Change Agent Conference – Information was sent to administrators regarding this upcoming conference hosted by Drs. Minkoff and Cline, and featuring presentations on co-occurring disorders and related issues.  The CCISC Model refers to a “Comprehensive, Continuous, Integrated System of Care.”

Please feel free to contact me if you have any questions or would like more information on these or other issues.
  
Next Thursday (Valentine’s Day) is our Executive Committee meeting in Sacramento.  Our next conference call will be Thursday, Feb. 21.

A brief recap of the issues discussed on the February 21, 2008 conference call:

• LAO Analysis of State Budget - Our new best friend, the Legislative Analyst, in their most recent analysis of the Administration's Budget proposal, singled out drug treatment programs - Prop. 36 and Drug Courts in particular - as services which should not be cut, because they save the state so much money in other systems, i.e. Corrections, Child Welfare, Foster Care. The LAO also recommended that the Legislature redirect advertising funds from the California Meth Initiative, and a portion of proceeds from state and federal narcotic asset forfeitures, into AOD treatment programs to offset the cuts proposed for the budget year. They call upon the Legislature to fund Prop. 36 at $120 million SGF, and all drug court programs at $31 million SGF in 2008-09.
  
  
• Governor's Executive Order on the Budget - The Governor has ordered all agencies and departments to take action immediately to reduce non-essential programs, including contracts for media and outreach campaigns. We assume that continuation of the California Meth Initiative will be jeopardized by this Order, but CADPAAC would support the LAO's proposal to redirect these funds into treatment services, or otherwise use the savings to offset reductions in treatment. We will send a letter to Secretary Belshe and Director Zito, urging them to give thoughtful consideration to sustaining programs that are the most cost-effective and actually save the state money, rather than just automatically spreading the reductions equally across all programs.
  
  
• Student Aid Letter - There was consensus that CADPAAC should sign on to this letter to Congress, calling for repeal of the federal law that delays or denies financial aid eligibility for college students with drug convictions.
  
  
• New Legislation - Feb. 22 is the deadline for introducing new legislation this year, and we expect to see several new bills relating to alcohol and other drug issues. CADPAAC is supporting two bills already introduced by Assemblyman Beall - AB 1823, which includes County AOD Administrators on local Juvenile Justice Coordinating Councils; and AB 1877, which is the reintroduction of his AOD/Mental Health parity bill. We also understand that Assemblyman Beall plans to introduce legislation raising the alcohol tax. There was consensus that CADPAAC should support AB 1961 by Assemblyman Swanson, a bill that allows for dismissal of a drug offense conviction if the offender has served a prison term, successfully completed parole, and has never been convicted of a serious or violent felony. Assemblyman Huffman from San Rafael has given us notice - and asked for our input - regarding a bill that he plans to introduce dealing with the clustering of 6-bed-and-under recovery facilities. He has been approached by cities in his district complaining about the proliferation of these facilities in some neighborhoods. I explained to his office that our system of care needs more of these recovery/SLE programs, and that localities should learn to accommodate them as long as they are being "good neighbors." The language of his bill will need to be very carefully crafted, and absolutely free of any stigmatizing or negative rhetoric, if they expect CADPAAC to not oppose it.
  
  
• Corrections Reform Update - CDCR's progress - or lack thereof - in implementing the AB 900 re-entry programs has come under intense criticism from the Legislature. AB 900 contained $7.4 billion in bond money to add 53,000 beds to prison and jail systems, with 32,000 of these beds tied to drug treatment and other rehab programs. CDCR, which had initially estimated they would begin construction of the re-entry facilities last July, still has not asked for the money to be released. Moreover, they have downsized their initial projections for the first phase of this project, from 7,484 beds at 10 prisons to 1,000 beds at just one institution. Even the staunchest supporters of AB 900 are now complaining that implementation of the bill has been complicated by the Governor's proposal to release 22,000 low-risk inmates in the final 20 months of their terms, which runs counter to the AB 900 goal of putting short-term inmates into community-based re-entry facilities. In a recent report, the California Rehabilitation Oversight Board cited the Corrections system for no comprehensive and integrated plan, a lack of progress in assessing inmates for their risks and needs when they enter prison, and an inability to get the re-entry facilities sited.
  
  
• NIATx Process and County Contracts - A paper has been distributed regarding the implementation of the NIATx process improvement components in county contracts with AOD providers. Some counties - i.e. Sonoma and Santa Clara - report that they are already requiring these components in their contracting process. CADPAAC is also encouraging all administrators to participate in the NIATx summit in Los Angeles on March 20-21. The presentations will be valuable and designed especially for county administrators.
  
  
• SACPA Expenditures - ADP has released a matrix showing total county funds available and total county expenditures for Prop. 36 for every year since its inception. The data is very encouraging, and shows that counties have been successfully spending all of their SACPA funds. With regard to OTP, there are a few counties that have not invoiced for all of their allocation by the Jan. 31 deadline. Unlike Prop. 36 funds, the OTP money does not stay with the county if unspent, but will go back to ADP for redistribution to counties that are fully spending.
  
  
• AOD Treatment and Criminal Justice - Counties will be surveyed in an attempt to find out how extensive is the practice of probation staff or other criminal justice staff providing AOD treatment. If we find out that this practice is widespread among counties, then we can determine how best to address the problem. CADPAAC's position is that AOD treatment should be provided by adequately-trained AOD staff, and not by those who have the ability to use treatment information against the clients.
  
  
• 2008 CADPAAC Awards - Our annual awards banquet is quickly approaching (May 28), so administrators can start giving some thought to what programs or individuals in their counties should be honored for their work in the field. We will send out nomination forms early next month.
  
  
• Adolescent Treatment Services - Bob Garner reported that the Youth Committee is working with ADP on a statewide survey of counties to find out what AOD treatment services are available for youth throughout the state, where those services are provided and by whom, how much money is being spent on youth treatment, etc. They hope to have this information compiled and available by our September Quarterly Meeting. There was a brief discussion about the availability of EPSDT funds for adolescent AOD treatment. I have attached to this e-mail a copy of the ACL on this subject that came from DMH several years ago, as well as a recent paper prepared by the COJAC Funding Subcommittee, chaired by Mary Hale (remember her?)

A brief recap of the issues discussed on the March 6, 2008 conference call:

• Legislative/Budget Update - With wide differences between Republicans and Democrats on how to address the state's fiscal crisis, we could be in for a long, drawn-out budget process this year. Senate President Perata has already told Democrat legislators they should plan to TiVo their party's National Convention in September, because they probably won't be attending. On the federal level, HR 1424 (Ramstad-Kennedy), the mental health/AOD insurance parity bill that we strongly support, has passed the House of Representatives on a 268-148 vote, setting the stage for a compromise with a Senate bill that has the backing of business and insurance groups. With regard to state legislation, some law enforcement groups have expressed concern about AB 1983, saying that adding the AOD Administrator to the Juvenile Justice Coordinating Council in each county could disrupt the balance on these councils. There is already provision for an AOD program provider but, unlike the Mental Health Director, the provider cannot speak for the publicly-funded system of care. The AOD Administrator would be more appropriate as the counterpart to Mental Health, law enforcement, etc. AB 2124 would allow counties to put up local funds as a match for federal money to provide AOD brief screening and intervention services to Medi-Cal recipients. However, we believe the match should more appropriately come from the State, but California has not yet amended its State Plan to add screening and brief intervention as Medi-Cal benefits. Administrators were also asked to look at SB 1738, a bill by Senate President-Elect Darrell Steinberg that seeks to establish a pilot program to provide supplemental services, including AOD treatment, to Medi-Cal beneficiaries who are frequent users of health care. Finally, new legislation has been introduced (AB 259) that would make it a misdemeanor to sell the hallucinogen "salvia divinorum" to minors. Consistent with CADPAAC's position on other legislation of this type, we will not oppose the bill if funding is included for treatment.
  
  
• The Select Committee on Alcohol and Drug Abuse met this morning at the Capitol, with presentations on LAO-recommended policy changes for parolee services, NORA, optimizing federal funds for AOD, and alcohol tax increases as a long-term revenue source for AOD prevention and treatment. Materials from these presentations are available on Assemblyman Beall's website.
  
  
• Health & Safety Statutes Relating to AOD - The "job description" for County AOD Administrators is actually spelled out in state law, including a requirement that administrators attend each Quarterly Meeting unless they have a waiver from the state. These codes, along with all the H&S Code statutes dealing with AOD, will be available on CADPAAC's website for administrators to refer to when (as has happened in some counties) your travel to CADPAAC meetings is challenged by other county officials.
  
  
• National Drug Control Strategy - The President's Strategery for 2008 is weighted heavily toward supply reduction, but there is increased funding available for Drug Courts, as well as a focus on reducing adolescent drug use, particularly with regard to the problem of prescription drug abuse.
  
  
• Quarterly Meeting Presentations - Dr. Rick Rawson has strongly recommended a report by his colleague, Dr. Rachel Gonzales, on the Nature & Trends of Prescription and Over-the-Counter Drug Misuse Among Youth, as a possibility for a future presentation to CADPAAC. This will be referred to the Youth Committee for their recommendation. We have also received a request from the California Association of Alcohol & Drug Educators (CAADE) to do a brief presentation on their educational programs for AOD counselors. The consensus was that, to avoid favoritism, we not approve such a request from one counselor certifying organization without providing opportunities for all of the other organizations to present their programs as well. This might lend itself to a panel presentation at some future meeting, but the preference seemed to be for getting all their information in writing rather than an in-person presentation. There was a request for an Issues Discussion item on the Quarterly agenda dealing with the impacts that the current counselor regulations are having at the local level. Also on the agenda for this meeting will be a presentation by Tom Powers, the new Director of DARS (Division of Addiction Recovery Services) at CDCR. Finally, there was some discussion about having a regular slot on the agenda for administrator development, when counties can present effective programs, innovations, etc. that are working well at the local level, so we can learn from each other. I will send out an e-mail request asking you for recommendations on topics or subject areas for these presentations.
  
  
• A new PEW Center Report indicates that, for the first time, more than 1 in 100 American adults are behind bars. Since a high percentage of these are for drug offenses, this report will serve as further impetus for corrections reform, as well as a strong argument for initiatives like NORA.
  
  
• Boilerplate Language for County NNA Contracts - Our Fiscal Workgroup representatives have reviewed the boilerplate, and reported that they pushed for stronger guarantees of confidentiality with regard to CalOMS. But they believe that the Department has moved as far as it is going to on this issue and suggest that, unless there are ongoing concerns about confidentiality provisions, we should tell ADP to go ahead and finalize the contract language for counties to sign.
  
  
• Association Goals - D.J. has put together a good-looking Powerpoint document outlining CADPAAC's goals and objectives in various issue areas. This still needs input from a couple of committees, but should be finalized and available by the Quarterly Meeting.

A brief recap of the issues discussed on the April 3, 2008 conference call:

• Legislative/Budget Update - Assemblyman Swanson"s bill (AB 1961), which would allow for the dismissal of a nonviolent drug offense conviction for which the offender has served a prison term and successfully completed parole, passed the Assembly Public Safety Committee. The Assemblyman has also introduced another bill (AB 1996) that would remove the limitation excluding drug-related felons from the Food Stamp Program. In addition to these two bills, CADPAAC is supporting AB 2297 (Saldana), which will require the BOE to calculate the amount of revenue that will be collected from the Board's decision to classify and appropriately tax flavored malt beverages (a.k.a. "alcopops) as distilled spirits. Intent language in the bill specifies that proceeds should go to ADP for programs to help prevent underage drinking, and to establish new youth alcohol prevention and recovery centers. AB 2389 (Benoit), which would have required CalWORKs recipients to undergo random drug testing as a condition of continued eligibility, failed to pass the Assembly Human Services Committee. With regard to Assemblyman Beall's legislative package, CADPAAC sponsors or supports most of his bills, but has concerns about AB 2124, particularly because of the precedent set by having counties provide local funds as a match for federal dollars. There is also concern about the state not covering SBIRT benefits in its Medi-Cal plan (except for trauma and emergency room services). The Maternal, Child & Adolescent Health (MCAH) directors are concerned about AB 2129, because they fear it could end up dictating a model program for the AOD screening and treatment of women that all counties would be forced to adopt. (The bill in its current form does not dictate a model program.) On the budget front, the Assembly Budget Subcommittee 1 on Health & Human Services voted yesterday to reject the Governor's proposed 10% cuts to Prop. 36, Drug Court programs, and Women's Treatment services. They upheld the proposed reductions to the CA Meth Initiative, and left open the D/MC issues. There was consensus on the call that CADPAAC needs to address with the budget committees the problems with Drug Medi-Cal. Compared with other Medi-Cal systems, AOD has never had a developed program. D/MC rates/benefits are so low and so narrowly-proscribed as to make it very difficult to do best practices and evidence-based treatment.
  
  
• CADPAAC Motions - I broke the news to the COMP folks that CADPAAC has rejected any additions to the checklist on the County Certification of Need form that must be completed by county administrators when they receive applications for new NTP programs. However, they were encouraged that we have asked ADP to issue an ACL apprising administrators of their responsibility to exercise due diligence in accordance with the protocols. We need to make sure that the Department follows up on this request, and ask them to allow CADPAAC to review the ACL before it is issued.
  
  
• Prop. 36 Fact Sheet - I added a proposed section dealing with how to respond to the false claim made by some SACPA opponents that Prop. 36 treatment has "a 75% failure rate." We need to be more aggressive in countering this false claim whenever it is raised, and ask UCLA to weigh in on the issue, because it involves a warped interpretation of their data. We should also emphasize that engagement and retention of clients is more difficult due to the lack of resources and funding reductions.
  
  
• Parolee Data - We reviewed data from CDCR regarding the number of parolees who are sent back to prison on technical violations. Although the number of these cases over which the Department has discretion (about 22,000) is not as high as formerly thought, it is still enough to close a prison if these offenders were given treatment to help their reentry and reduce recidivism.
  
  
• County Policies Regarding AOD Counselors - A question was raised about what counties have policies to address the issue of counselors who cannot pass the certification test within the 5-year window from registration. Most counties responded that these counselors would probably have to be terminated from employment. Bob Garner said he would provide information regarding Santa Clara County's policies.
  
  
• NIATx Survey Results - The straw poll survey taken at last week's meeting indicates that 34 counties are either NIATx trained or plan to be trained within 6 months. We have passed this information on to the UCLA/ATTC folks, and they will be working with us and the Action Campaign to set up learning collaboratives in those counties that are prepared and willing to assist their neighbors. There was mention of the fact that, in some counties, Mental Health is using MHSA funds to pay for NIATx training for both MH and AOD staff.
  
  
• Little Hoover Commission Report - There was general consensus that we do not need to respond as an association, although some counties or individual administrators may want to send comments to the LHC. We do need, however, to ask ADP to respond to the recommendations made by the Commission, specifically where it calls upon the Department to implement certain practices or changes.
  
  
• DUI Programs - A question was raised about the advisability of implementing a 30-month drinking driver program. This idea was discouraged, mainly because it would cost more to provide the service than the program would make, and by law DUI programs have to be self-supporting. If some clients need a more intensive program, perhaps it would be more advisable to have them in outpatient treatment simultaneous with their DUI program.

A brief recap of the issues discussed on the April 17, 2008 conference call:

• Legislative/Budget Update - AB 1823 (Beall), requiring the participation of the AOD Administrator on each county's Juvenile Justice Coordinating Council, passed the Assembly on a 56-14 vote, and has now gone to the Senate. Its first stop there will be the Public Safety Committee. CADPAAC's two other sponsored bills, both authored by Assemblyman Beall - AB 1887 (insurance parity), and AB 2088 (cabinet-level Secretary of Addiction Prevention & Recovery Services) - have passed the Assembly Health Committee, but are likely to end up on the Appropriations Suspense File. AB 2337 (Beall), the mandated reporter bill, has been targeted by Appropriations staff as having a state cost due to the assumption that more child abusers will end up in prison. This is probably a false assumption, since it appears that most counties already require AOD counselors to report suspected child abuse or neglect, but the bill would provide legal protections for these counselors. Assemblyman Plescia has introduced a bill, AB 2613, that is strongly opposed by the Prevention community because it would allow for the furnishing of alcoholic beverage tastings at grocery stores and other retail outlets authorized to sell these products. Although amendments to the bill will limit the number of tastings an individual can have at any one outlet, the prospect of drinkers going "Safeway-hopping" on a Friday night raises some disturbing scenarios. AB 2903 (Huffman) is now being opposed by some of the provider groups because it could result in more local restrictions on treatment facilities that have multiple components. The author is willing, however, to take amendments that would narrow the focus of the bill. Finally, there was consensus that CADPAAC should support AB 2151 (Jones), because it would give local governments more say in the issuance and transfer of liquor store licenses within their communities, although there is some question as to whether current CUP processes already give local governments the authority to curb the over-concentration of alcohol outlets. A copy of this bill is attached.
  
  
• Review of Senate Budget Subcommittee Hearing - The agenda and vote outcomes were reviewed. The subcommittee members agreed with their Assembly counterparts in rejecting proposed cuts to Prop. 36, Drug Courts, and Perinatal programs, which means these issues should not have to go to Budget Conference Committee. They also voted to reject ADP's request for a redirection of federal funds and positions to enhance a specialized AOD treatment system for women, as well as the Department's request for a redirection of SAPT contract dollars to fund a feasibility study for a Local Assistance Tracking and Accountability System (LATAS). They did, however, approve ADP's request for a redirection of federal funds and positions to address expanded federal planning and reporting requirements for the SAPT Block Grant. They also approved funding and positions to maintain and expand the Access to Recovery program. The subcommittee opted to eliminate the $10 million FY '08-09 allocation for the California Meth Initiative, although it is unclear whether they intend to redirect these dollars into treatment services. The Drug Medi-Cal and the licensing fee issues were left open. There was a lot of public testimony in opposition to the proposed D/MC rate cuts, and the program licensing fee issue was discussed for informational purposes only. The subcommittee asked the Department if any treatment programs have closed due to licensing fees, to which ADP answered they did not know of any such closures. However, we have heard from some counties that providers have decided not to open programs due to the new fees, and some county-run programs may have to close for the same reason. I plan to send out a brief survey to see which counties are aware of program closures. We also need to review the licensing fee budget information from the Department to understand the fiscal impact on direct treatment services.
  
  
• CADPAAC Representatives for NORA Advisory Committee - CADPAAC has been asked for two additional reps. on this workgroup, one of whom will be Bill Manov from Santa Cruz. We still need a rep. from either a Small or MBA county, and the chairs of those committees will begin looking for volunteers.
  
  
• Review of Drug Court Conference - Gino reported that the conference was helpful, although there was a lot of vocalized opposition to and misinformation about NORA, without an opportunity for open dialogue regarding the pros/cons of the initiative. This was unfortunate for county staff who attended the conference, knowing that treatment is in support of NORA, but not given specific reasons why some Drug Court leaders are opposed.
  
  
• Corrections/Reentry Issues - There was some discussion regarding the announced retirement of Secretary Tilton and the appointment of Inspector General Cates, and what this might mean for the in-custody AOD treatment and reentry programs. CDCR is moving toward meeting the benchmarks identified in their prison reform proposals, but the Department has met with criticism from the Legislature that their progress is too slow.
  
  
• Little Hoover Commission Presentation - There was general agreement that we should ask the LHC staff to make a presentation to CADPAAC on Thursday of the May Quarterly, where their recommendations can then be addressed in the Like-Size Committee discussions and the Issues Discussion. If LHC is unable to do this, then a meeting with Executive Committee would be a back-up option.
  
  
• Criminal Justice/AOD Surveys - There were only a handful of counties that reported AOD services being delivered or overseen by law enforcement (i.e. probation, sheriffs). Rather than focusing our association efforts specifically on this problem, the recommendation was made that we go to Assemblyman Beall with a legislative proposal to require that any provider of publicly-funded AOD services in California be licensed or certified by ADP.
  
  
• Funding Matrix - Gino said that the revisions proposed at our last Quarterly Meeting have been made, and the revised matrix will be sent to all administrators.
  
  
• Beer Tax - There was some discussion about Assemblyman Beall's proposal to significantly raise the taxes on beer. I have attached a recent newspaper article regarding this proposal, which has not yet been introduced as legislation.
  
  
• Housing Workgroup - In recent discussions with ADP and Deborah Parker regarding land use & fair housing issues, the Department has agreed to take the lead in addressing these issues by convening a Housing Workgroup. They want a representative from each like-size county on this workgroup, so our committee chairs will put out the request for volunteers.
  
  
• Medical Marijuana - A question was raised regarding county policies around medical marijuana. I have attached a copy of Santa Clara County's policy, which has been helpful to many other counties.

A brief recap of the issues discussed on the April 24, 2008 conference call:

• Legislative/Budget Update - AB 1823 (Beall), requiring the participation of the AOD Administrator on each county's Multiagency Juvenile Justice Coordinating Council, has been scheduled for a hearing next week in the Senate Public Safety Committee. We don't yet know whether Assemblyman Beall is willing to take amendments proposed by the Chief Probation Officers, but we have responded to the proposal with our own alternative amendments, should that become necessary. Assemblyman DeSaulnier has reintroduced the AOD Counselor Licensing bill, now AB 239, which would provide for the licensure and regulation of private practice AOD counselors by the BBSE. Its provisions would not apply to staff in county, county-contracted, or government programs. The integral facilities legislation, AB 2903 (Huffman), has ended up on the Assembly Appropriations Suspense file. Appropriations staff put a rather hefty price tag on the bill, estimating that it would result in the loss of many 6-bed & under programs (due to increased local government restrictions), with resulting fiscal impacts on the foster care system. Assemblyman Calderon has introduced AB 2914 to impose an 8% tax on "gross receipts" (no pun intended) of the adult entertainment industry. The money collected would be used to ameliorate the "secondary effects" of adult entertainment venues, such as public health impacts, drug abuse, and mental illness. Anyone interested in testifying on this bill, or in simply being entertained by the testimony, can come to the Assembly Revenue & Taxation Committee hearing on May 5. Finally, it was just a matter of time before legislation was needed to mandate treatment for problem gambling. Senator Florez has met that need by introducing SB 1616, which authorizes the Office of Problem Gambling in ADP to establish a treatment plan for providing "comprehensive care to problem gamblers and their families."
  
  
• Federal AOD Legislation - There was some discussion about the need for CADPAAC to be more aware of legislation at the federal level that could impact our programs. We have not included such legislation on our bill matrix, but occasionally we do take positions as an association on Congressional bills, i.e. support for HR 1424 on insurance parity. The consensus was that, since information and news bulletins from the Legal Action Center and SAAS are regularly sent to the association, this is probably sufficient to keep us updated on federal AOD issues.
  
  
• CMS Medicaid Rule Changes - The Center for Medicaid Services has proposed several rules changes in Medicaid regulations that would shift more financial burdens to the states and reduce access to health care, including a reduction of targeted case management and other rehabilitation services that would negatively affect AOD programs. CADPAAC will go on record in support of legislation, the "Medicaid Safety Net Protection Act," to place a one-year moratorium on these regulation changes. We have subsequently learned that the House of Representatives passed this legislation on a bi-partisan 349-62 vote, and the Senate will now act on this bill or on its own version of the legislation.
  
  
• Marin Services for Women has sent letters to some counties asking to contract with the counties for services, and using Director Zito's name as an endorsement. D.J. will follow up on this and report back to the association.
  
  
• Redirection of Unspent OTP Funds - ADP has issued documentation showing what counties are subject to OTP allocation reductions because they have not spent 90% of the FY '06-07 allocation, and has listed several criteria to determine how counties would be subject to the redirection of these funds. This action is consistent with CADPAAC's principle that OTP funds should be recaptured from counties that are not spending and redirected to counties that will spend the funds. However, there was some discussion about the method by which counties are deemed eligible to receive redirected funds. The Department determined that eligible counties are those that have spent 70% or more of their FY '07-08 OTP allocation by the end of the second quarter, but then extended to April 1 the date by which these counties could submit invoices for the second quarter. CADPAAC's question is, since the cutoff date for 3rd quarter invoices is April 30, why not extend the date just a little further to include 3rd quarter invoices in order to make more counties eligible, since counties would be expected to have spent approximately 75% of their funds by the end of the 3rd quarter anyway?
  
  
• ADP Prop. 36 Conference - The theme of this year's conference will be "Building Bridges Between Treatment and Criminal Justice," and will focus heavily on presentations by counties that have innovative programs, high success rates, etc., in order that counties can learn from each other.
  
  
• Housing Workgroup - The Licensing & Certification Division of ADP wants to convene this workgroup as soon as possible, but we still need CADPAAC reps. from MBA and Small County Committees.
  
  
• Little Hoover Commission Presentation - Mark Martin and perhaps other Commission staff will be able to come to our May Quarterly meeting and discuss with the Like-Size Committees the implementation of their recommendations for the AOD system of care.
  
  
• NIATx Recommendations - Thanks to Gino's excellent organization skills (and no thanks to my poor memory), we were able to recall the recommendations that were made by the Medium Counties Committee at the last Quarterly, including recommendations that (1) L.A. County provide technical assistance to other counties in implementing NIATx processes; (2) we seek to increase the level of administrators' involvement in NIATx trainings; and (3) NIATx staff be available at each of our Quarterly Meetings to assist in implementation.
  
  
• Counselor Credentialing Workgroup - Connie is feeling lonely as the only CADPAAC rep. on this workgroup, so we need to recruit reps. from the other Like-Size Committees, especially now that counselor credentialing has become a "hot topic" again. Connie will send us information regarding the next meeting of this workgroup.
  
  
• CATES Trainings - The registration numbers for next month's trainings are running lower than expected, so we encourage everyone to again send out information to your staff and providers.

A brief recap of the issues discussed on the May 1, 2008 conference call:

• Legislative/Budget Update - We had some discussion about the allocation letters recently sent out by ADP, which reflect the 10% reduction in most programs. Although the legislative budget subcommittees have rejected cuts to Prop. 36, Drug Courts, and Perinatal programs, the Department has to stick with the Administration's proposals until the budget is finalized. We will know more about what the Governor intends to do after he issues the May Revise in less than 2 weeks (the 14th). Most of the bills we are following are currently in Appropriations Suspense files, so we won't know for a couple of weeks whether they are going forward. One exception is our sponsored bill, AB 1823 (Beall), which has been approved by the Senate Public Safety Committee and didn't have to go to Appropriations, so it's now before the full Senate. We had a long meeting this week in Assemblyman Huffman's office regarding AB 2903, his bill to give local governments more control over treatment facilities with integral licenses for 6-bed-&-under homes. We offered amendments to make this a bill that would strengthen ADP's licensing process, but the author seems intent on keeping it a local government bill. The fair housing advocates are adamantly opposed to the measure, so it appears that we are at a stalemate for now.
  
  
• CMS Medicaid Rule Changes - The full House has passed H.R. 5613, legislation to delay implementation of seven Medicaid regulations (including those on targeted case management and the rehabilitation services option) for one year. Even though the bi-partisan 349-62 House vote is sufficient to withstand a Presidential veto, the bill still has to get through the Senate. Senate Majority Leader Reid has moved to fast-track H.R. 5613 in an attempt to bypass any committee action and move the legislation straight to the floor for a vote. However, a number of Senate Republicans have expressed opposition. The Democratic leadership is now working to determine whether to move H.R. 5613 as a stand-alone bill or attempt to attach the measure to a bill likely to move through the Senate, such as the spending bill for war funding in Iraq and Afghanistan.
  
  
• Corrections Reform - Senate Democrats have sent a letter to Governor Schwarzenegger expressing concern over the fact that, one year after the passage of AB 900 to lessen the serious overcrowding problems in California's prisons, CDCR still has not constructed any new rehabilitation or reentry beds. Political reporter and newspaper columnist Dan Walters, in a recent column, said that "spending $40,000-plus per year to keep a drug addict in prison is ludicrous." He noted that the Governor is on the right path in suggesting the release of low-security inmates, especially those with drug problems, into treatment programs. If we transferred into the AOD treatment system all of the money currently being spent to keep drug addicts in prison, we could easily pay for NORA (my words, not Dan's). On a related note, it was mentioned on the call that the Public Defenders Association has formally endorsed NORA.
  
  
• NNA Contract Boilerplate Language - A few counties are still concerned that the language doesn't go far enough to protect confidentiality, and may want to express that in formal communication with ADP. We need to caution these counties not to speak for CADPAAC, since the association has already decided to approve the contract boilerplate for this year, so as not to hold up allocations to the counties, with the understanding that we would continue working with the Department on stronger language in the future. At least one county is considering an attestation that would be sent to ADP along with CalOMS data, attesting to the fact that the Department agrees to comply with all the provisions of 42 CFR. Individual counties are free to do what they want, of course, as long as they don't claim to speak for the association.
  
  
• OAC & COD - Dr. David Pating, with the MHSA Oversight Commission, has been very vocal about making sure that all counties include in their plans provisions for addressing co-occurring disorders. We had some discussion about inviting Dr. Pating to meet with our Executive Committee, and everyone seemed to think this is a good idea.
  
  
• Redirection of Unspent OTP Funds - I made one last appeal to the Department to extend to April 30 the date for counties to send in OTP invoices (through the 3rd Quarter), so that more counties can be eligible for redirected funds. However, OCJC is unwilling to budge on its policy of considering invoices only through the end of the 2nd Quarter, even though they did allow counties until April 1 to submit those invoices. Their position is that to extend the date any further would not allow the Department or counties sufficient time to get out and spend the money. The problem here has been somewhat aggravated by some gaps in communication, an issue that we should address with the Department at our Executive Committee meeting next week.
  
  
• Housing Workgroup - We are still soliciting CADPAAC reps. for this workgroup, and ADP would like to proceed with the first meeting as soon as possible. It looks like we may have an MBA volunteer, but we still need someone from the Small Counties Committee.
  
  
• Joint Meeting with CMHDA - I had a brief conversation with Pat Ryan this week, and we agreed that, given the importance of several issues in common facing both of our associations, it's time we had another joint meeting. We will work on putting something together within the next couple of months.
  
  
• Finally, Small and MBA Counties, Take Heart! Governor Schwarzenegger wants to help you, and provide more opportunities for people "from little towns." In a recent speech he said that it's good for lawmakers "from those little towns" to go out in the world and see worldly things like "an airport," "a highway that maybe has 10 lanes" or even "a highway on top of a highway." So the next time you come to a CADPAAC meeting in the big city, maybe you can get Bob Garner to take you out to see a real airport or freeway.