Program B: Prevention and Treatment

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Program B: Prevention and Treatment

Program Authorization: Act 353 of 1952; Acts 33 & 121 of 1958; Act 786 of 1978; Act 20 of 1979; Act 899 of 1984; Act 1 of First Extraordinary Session of 1988; and Act 159 of 1989

PROGRAM DESCRIPTION

The mission of the Prevention and Treatment Program is to provide services and technical expertise in the prevention and treatment of alcohol, tobacco, and illicit drug abuse; distribute information and implement strategies in the community to promote the continued freedom from chemical dependency and other addictions; and access, diagnose and treat those individuals affected by alcohol, other drug abuse and addiction, and problem and compulsive gambling.

The goal of the Prevention and Treatment Program is to provide "state-of-the art" prevention programs on a statewide basis and provide the most responsive, effective, and efficient continuum of treatment services to the citizens of Louisiana.

OBJECTIVES AND PERFORMANCE INDICATORS

1. In FY 1998-99, Prevention and Treatment Program will increase the number of patient days for nonmedical detoxification services by 1,282 to meet the demands of drug testing legislation.

1 This does not include two medical detoxification programs as OADA does not pay for the full cost of operating both programs. At First Step Detox, OADA contracts for professional services at a cost of $39,552. Included in the T.O. of OADA is the cost of five funded civil service positions at a cost of $87,950. The total number of patient days for FY 1996-97 was 4,134. At Lallie Kemp Hospital, OADA contracted to purchase ten beds at a cost of $109,000. The total patient days for FY 1996-97 was 1,506.

2 This is a new indicator. Data will begin in FY 1999-2000.

2. In FY 1998-99, the Prevention and Treatment Program, through its Primary Inpatient (Adult) activity, will increase the number of inpatient days available by 14,582 to meet the demand for drug testing legislation and continue to provide intensive, comprehensive, accessible, and coordinated inpatient residential treatment services to persons with alcohol and drug related disorders and those identified as at high risk of developing such problem and aid them in restoring and/or maintaining a productive life.

1 This is a new indicator. Data collection will begin FY 1998-99.

2 Previous years data included adolescent inpatient figures and Capital Area Human Services District.

3. In FY 1998-99, the Prevention and Treatment will increase primary inpatient adolescent beds by 26 beds.

1 This data was previously included/combined with Primary Inpatient (Adult) in Act 18.

2 This is a new indicator. Data collection will begin FY 1998-99.

3 This total is representative of going to a per diem of $100 per day.

4 This total is representative of going to a per diem of $100 per day.

5 This was a new program. Start-up costs were involved. It was transferred from the Medicaid program to the Block Grant.

4. In FY 1998-99, the Prevention and Treatment Program, through its Community-Based Adults activity, will increase by 5% the number of clients successfully completing the program, and reduce by 5% those experiencing additional involvement with the criminal justice system.

1 This data includes the Pre-Release (Blue Waters), Community-Based Adolescents, and Capital Area Human Service District.

5. In FY 1998-99, the Prevention and Treatment Program, through its Community-Based Adolescent activity, will increase the number of beds by 30, increase inpatient day by 100% and increase admissions by 100%.

1 Information is not yet available. Tracking for these indicators will begin for FY 1998-99.

2 This data was included/combined with Community-Based Adults figures.

6. In FY 1998-99, the Prevention and Treatment Program, through the Outpatient activity will increase by 5% the percentage of those completing treatment: to increase the number of persons who are discharged and employed by 5%: to increase the percentages of those clients who have no re-involvement with the criminal justice system, by 5%: to maintain the current level of discharges involved with self-help groups.

1 This is an new indicator. Data collection will begin in FY 1998-99.

2 This information includes/combines outpatient and case-management figures.

7. In FY 1998-99, the Prevention and Treatment Program will have 86% of its clients successfully complete the treatment program in the Pre-Release (Blue Waters Program) and will redesign the program to assure efficient and quality operations.

Explanatory Note: OADA provides treatment only.

1 This is a new indicator. Data collection will begin in FY 1998-99.

2 This data was included/combined with the Community-Based Adult program.

8. By September 30, 1998, the Prevention and Treatment Program will establish 9 new drug court treatment programs.

1 Data to be collected from judicial districts.

9. In FY 1998-99, the Prevention and Treatment Programs, will put into operation, in each region, a comprehensive array of prevention and treatment services that will meet the needs of 2,572 problem and compulsive gamblers.

1 Data obtained from a report to the Legislature by the Louisiana Compulsive Gambling Study Committee, March 18, 1996.

2 This is a program, prior data is not available.

3 Information is not yet available. Tracking will begin in FY 1998-99.

4 Projected.

10. In FY 1998-99, the Prevention and Treatment Program, through its Primary Prevention activity, will provide 54 prevention services programs and enroll 6,536 participants. 1

1 This objective is targeting face to face alternative programs (i.e., after school tutorials).

2 This is a new indicator. Data collection and tracking will begin in FY 1998-99.

3 Act 18 figures includes all prevention activities except mass media campaigns.

4 These figures do not include the Capital Area Human Services District or state-operated programs, but are for contract programs only. There has been a slight increase in contracts.

11. In FY 1998-99, the Prevention and Treatment Program, through its Synar/Tobacco activity, will reduce by 9% the sale of tobacco products to youths under the age of eighteen.

1 Synar/Tobacco activity was included in "Prevention Services" in Act 18.

2 No official list of tobacco vendors. Vendors must apply for a tobacco permit effective October 1, 1997. A database of tobacco vendors will be tentatively completed in July, 1998, and an update of the list will be ongoing.

3 Unconsummated compliance checks (UCC's) are conducted by youth (minors) volunteers. No actual tobacco purchase - a check is considered a "sale" if the clerk agreed to sell to the minor; a "no sale", if a clerk refuses to sell to the minor. UCC's are used for education, not enforcement.

4 Federal requirements were set at a baseline of 75% for the first year, 60% for FFY 1998, 45% for FFY 1999, and 33% for FFY 2000.

5 Considered in compliance because federal guidelines were met.

RESOURCE ALLOCATION FOR THE PROGRAM

SOURCE OF FUNDING

The Office of Alcohol and Drug Abuse Prevention and Treatment Program is funded from general fund, interagency transfers, fees and self-generated revenue, statutory dedications, and federal funds. Interagency transfer means of financing represents Title XIX reimbursement for services provided to Medicaid eligible patients received from the Department of Health and Hospitals, Medical Vendor Payments Program. Fees and self-generated revenues include fees from patients for services provided based on a sliding fee scale, DWI fees paid for prevention and treatment services provided to DWI offenders, reimbursement for meals provided to employees and visitors at inpatient treatment facilities, and co-payments on urine drug screens. Statutory Dedications means of financing are available in accordance with Act 1215 of 1995 and Act 585 of 1997. Act 1215 established the Compulsive and Problem Gaming Fund. Act 585 increased the fund amounts to $500,000 each from Lottery, River Boat Gambling and Video Poker (Per R.S. 39:32B.(8), see table below for a listing of expenditures out of each statutory dedication fund). Federal funds include Title XVIII for services provided to Medicare eligible patients, funds provided by the Bureau of Prisons, and the following grants: Office of Alcohol and Drug Abuse Block Grant, "Target Cities" grant, Needs Assessment grants, Shelter Plus grant, and Women with Dependent Children grant.

ANALYSIS OF RECOMMENDATION

GENERAL FUND	TOTAL	T.O.	DESCRIPTION

$12,332,467	$41,316,792	459	ACT 18 FISCAL YEAR 1997-1998

			BA-7 TRANSACTIONS:
$0	$532,419	0	Carryforward of federal funds for supplies, services, acquisitions and major repairs
$0	$0	23	Transfer of positions from Capital Area Human Services District for operation of the substance abuse residential unit at East LA State Hospital
$0	$920,789	0	Federal Grant to conduct studies for treatment needs assessment
$0	$360,000	0	Allocation of unused Compulsive and Problem Gaming Fund monies for improved services
$0	$1,497,000	0	Increase in Substance Abuse Prevention and Treatment Block Grant for increased services

$12,332,467	$44,627,000	482	EXISTING OPERATING BUDGET - December 10, 1997

$0	($532,419)	0	Non-Recurring Carryforward of federal funds for supplies, services, acquisitions and major repairs
$132,198	$132,198	0	Equipment/Major Repairs Adjustments (Non-recurring: -$296,142; Replacement/New: +$428,340)
$264,728	$264,728	0	Annualization of 1997-98 Merit Pay Adjustment(s)
$0	$314,807	0	1998-99 Merit Pay Adjustment(s)
($235,393)	($235,393)	0	Attrition Adjustment(s)
($6,636)	($6,636)	0	Retirement Rate Adjustment(s)
($178,431)	($178,431)	0	Reductions from other line items to fully fund salaries
$0	($50,882)	0	Risk Management Adjustment
$0	$6,700	0	Funding for an increase in the number of participants in the Retiree's Group Insurance
$0	($167,317)	0	Expiration of target cities grant which funded New Orleans Target Cities Project - Substance Abuse Clinic
$0	($820,035)	0	Expiration of target cities grant which funded New Orleans Target Cities Project - Outpatient and Jail Based Programs
$0	($360,000)	0	Elimination of prior year funds that are not available in recommended year
$0	$1,050,000	0	Increase in annual allocation to Compulsive and Problem Gaming Fund from $150,000 to $500,000 each from Lottery, River Boat and Video Poker
$0	$0	(23)	Transfer operation of substance abuse unit currently located at East LA to Capital Area Human Services to move unit to Baton Rouge

$12,308,933	$44,044,320	459	TOTAL RECOMMENDED

($23,534)	($582,680)	(23)	DIFFERENCE (TOTAL RECOMMENDED AND EXISTING OPERATING BUDGET)

The total means of financing for this program is recommended at 98.7% of the existing operating budget. It represents 69% of the total request ($63,847,431) for this program. The major changes reflected in the analysis of recommendation include: full funding has been provided for all 459 recommended positions including a net decrease of $149,096 of general fund and a federal fund increase of $314,807 for merit increases and an adjustment to reflect an anticipated attrition factor of 3%; increase of $1,050,000 in statutory dedications per ACT 585 of 1997 which increased the annual allocation to Compulsive and Problem Gaming Fund from $150,000 to $500,000 from Lottery, Riverboat Gambling and Video Poker; reduction of $360,000 in statutory dedications for the elimination of a BA-7 which used prior year funds for improved services before Act 585 was approved; reduction of $50,882 of general fund for risk management premiums; net reduction of $400,221 ($532,419 reduction in federal fund and $132,198 net increase in general fund) for non-recurring expenses including acquisitions and major repairs; increase of $6,700 in general fund for an increase in the number of retirees; decrease of $987,352 in federal funds due to expiration of two New Orleans Target Cities Projects for substance abuse clinic and outpatient and jail based programs; and $6,636 general fund decrease for state employee retirement rate adjustment.

PROFESSIONAL SERVICES

$460,647		Contracts with physicians to provide medical services at a given facility to patients and provides medical consultation to staff of the specified facility. The medical services provided may vary from facility but primarily they include routine physicals of clients enrolled in the program.
$317,494		Primarily Psychiatric services to patients of Alcohol and Drug Abuse Clinics. Also provide formulation and authorization of Treatment plan, Medical Management and consultation to members of the staff of the clinics.
$122,448		Contracts with nurses and phlebotomists who assist staff with HIV/TB Counseling/Testing and phlebotomy services including Sexually Transmitted Disease (STD) education and Venereal Disease Research Laboratory for Syphilis (VDRLS). These providers will also do TB skin testing on IV drug user clients and HIV positive clients. These type of contracts will also provide direct observed therapy on-site when appropriate in collaboration with the Louisiana AIDS Program and the TB Control Program.
$6,474		Provide psychological testing, consultation and assessment on personality characteristics of alcohol and drug abuse clients.
$38,000		Interpreting service for hearing impaired clients. In compliance with the ADA Act of 1990, OADA is required to provide treatment outcome.
$182,985		Other service contracts for dietitian, consulting, computer and software specialist, counselors, training and other non-medical services

$1,128,048		TOTAL PROFESSIONAL SERVICES

OTHER CHARGES

$2,588,688		Outpatient treatment services provides an array of services to substance abusing individuals and their families at the community level that is least restrictive, less costly to access than formalized inpatient treatment services. These services are designed to bring the addictive process to remission and to support individual and family growth to sustain recovery. Standardized core services this component include: Individual, family, group and couples counseling; intensive day treatment, medical services, educational services; drug screens; case management and aftercare services to both children/youth and adults statewide.
$3,576,906		Residential treatment services provides a therapeutic environment for citizens diagnosed with substance abuse disorders (chemical dependency, addiction, etc.) who are due to the severity of the disorder, cannot achieve recovery in a less restrictive environment. Services are provided to both adolescents and adults, including specialized programming to addicted pregnant women, women with dependent children. These services are either short-term (standard 28 day program or long-term (3-6 months) for the more chronic individuals).
$2,757,160		Halfway house services provides a structured, community-based supportive living environment for both adult and adolescent males and females, after completing a formalized primary care treatment program. This component of care allows the client/patient an opportunity to continue to work toward recovery, as reflected by his/her individualized treatment plans; provides individuals and group counseling; 12 Steps AA/NA meetings and other self-help support group and personal growth services in a safe, drug-free setting that is supportive, and peer generated, while reintegrating into the community. The length of stay ranges from (2-6) months during which time the resident is either employed, seeking employment or enrolled in vocational/educational activities.
$885,618		Acute care detox services provides medical or medically supervised support services to persons undergoing detoxification after a prolonged period of alcohol and/or drug abuse where the forward motion of the addictive process can be halted and the individual can begin the screening and assessment for the development of an appropriate treatment plan. Services included are aftercare planning and referrals to appropriate component in the continuum of care. Each program has a specific number of inpatient beds assigned based on population. Services provided during the inpatient stay may include, in addition to the supervision of the detoxification process, group, individual and family counseling; introduction to and participation in self-help groups, and other information meeting and referral groups. These contractual programs provide over 36,000 patient days per year.
$3,017,038		Prevention Services the most cost effective approach for achieving success in the war against drugs in to lessen the demand for the substance. The aim of prevention contracts is to create a social environment in which substance abuse is unacceptable. Focus is on those at highest risk, which includes youth in high crime and drug abuse areas, school dropouts and those experiencing difficulty in school, parents of those children, young adults and pregnant women. This task can be accomplished by assembling the resources of all the citizens of this state in a sustained and well-organized effort to alter the attitudes and behavior that encourage substance abuse. Prevention contracts are required for awareness and education to the effects of alcohol, tobacco, and other drugs of abuse, within the youth and general population of the State of Louisiana.
$1,650,936		The New Orleans Target cities Demonstration Project is a $11.5 million cooperative agreement between the Office of Alcohol and Drug Abuse (OADA) and the funding agency, the Center for Substance Abuse Treatment (CAST). The award is for five (5) years and covers three areas: System improvement, treatment and Criminal Justice Linkage. System improvement includes coordination of public and privately funded substance abuse treatment providers, creation Units (CIU'S) with a standardized objective assessment protocol, an automated management information system that allows for patient treatment matching, a unified unduplicated waiting list, treatment slot management and patient tracking across treatment system. The New Orleans Substance Abuse Treatment System will receive funds to enhance and expand treatment services. This project improves the linkages between the substance abuse treatment community and the criminal justice system.
$1,318,235		The State Demand and Need Assessment Grant is a cooperative agreement between the Office of Alcohol Drug Abuse (OADA) and funding agency, the Center for Substance Abuse Treatment (CAST). The award is for three (3) years, September 1997 through September 2000, with the objective of assessing the demand and need for substance abuse prevention services at the State and substate level ($224,978 Prevention and $1,093,257 Treatment).
$527,653		The Shelter Plus Grant represents a unique partnership between two major collaborative efforts underway in the City of New Orleans: UNITY for the Homeless and the New Orleans Target Cities Project. By proposing Shelter Plus Care sponsor-based renewal assistance for the homeless substance abusing population, the project seeks to address in a comprehensive manner the continuum of care needs of a significant segment of the city's homeless population
$2,381,427		Included in Other Contracted Services are SYNAR (Tobacco enforcement), bloodwork, Management Information Services contracts and HIV, Phlebotomy, Urine Screen, Gambling, Conference Co-Sponsorship, matching Grants Funds, Statewide Training and Employment contracts.
$695,902		This grant is funded by the Substance Abuse and Mental Health Services Administration to provide residential treatment services for women and their dependent children. This is a demonstration grant in region three (3) at the present time. The award is for five (5) years from September 1995 through September 2000.

$19,399,563		TOTAL OTHER CHARGES

		Interagency Transfers:
$1,151,650		Capital Area Human Services District for operating expenses of the Capital Area Recovery Program to be located in Baton Rouge
$284,150		Central Louisiana State Hospital for operating expenses of the Red River Treatment Center inpatient facility with payments made via monthly billing of actual cost incurred including utilities, dietary services, maintenance, etc.
$47,500		Central Louisiana State Hospital for operating expenses of the Alexandria/Pineville Outpatient Clinic
$3,000		Northwest Louisiana Development Center for supplies provided to Pines Treatment Center and the Alcohol and Drug Unit
$621,320		Southeast Louisiana Hospital for operating expenses of the Fountainbleau Treatment Center and the Alcohol and Drug Unit
$3,106,809		Capital Area Human Services District to perform community-based functions related to the care, diagnosis, training, treatment and education of alcohol and drug abusers and prevention of alcohol and drug abuse
$16,090		DSS/Office of the Secretary for printing of letterhead, envelopes and manuals for statewide use
$41,163		DSS/ Office of the Secretary for normal office supplies for use in all office facilities statewide
$6,725		DSS/ Office of the Secretary for medical supplies needed in the clinics including E.G. gloves, mask, syringes, etc.

$5,278,407		TOTAL INTERAGENCY TRANSFERS

ACQUISITIONS AND MAJOR REPAIRS

$409,800		Recommended level of funding for the replacement and repairs of obsolete inoperable or damaged equipment and buildings

$409,800		TOTAL ACQUISITIONS AND MAJOR REPAIRS

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