Applicant: Monroe County, Florida, governed by a Board of County Commissioners.

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Phebe Marsh
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2 Monroe County Drug Court/JAG 2015/Local Project Abstract (Attachment 1) Applicant: Monroe County, Florida, governed by a Board of County Commissioners. Project Title: Monroe County Drug Court Medical Director Initiative. Project Goal: To continue to build the capacity within the Monroe County Drug Court to address the needs of clients presenting with mental health and/or prescription drug abuse issues. Allocating funds for the Medical Director Initiative for a forth year will significantly improve the effectiveness of drug treatment and case management activities conducted for drug court clients presenting with prescription drug abuse and/or mental health issues. This initiative will also increase the likelihood of recovery success, in addition to diverting clients from continuing criminal involvement. The allocation of 2012, 2013, and 2014 JAG funds, allowed the Drug Court Program participants and their employees to reap benefits of working with the Medical Director who has the expertise to address such issues. This initiative responds to the The Florida s Prescription Drug Diversion and Abuse Roadmap , released April 4, 2012, by Florida Attorney General Pam Bondi, which recognizes the need for existing drug courts to address prescription drug abuse issues. With a Medical Director, the Monroe County Drug Court will continue to provide professional medical/psychiatric assistance for clients with prescription drug abuse and/or mental health issues. Strategies: Continue to contract with a local Psychiatrist, proficient in the field of addiction, to act as the Drug Court Medical Director who will work with clients detoxifying and/or presenting with symptoms of mental health disorders to diagnose; explore alternative medications; make psychotropic medication recommendations to treating physicians when appropriate; and make recommendations to the court. The Monroe County Drug Court Criminal Court Services Coordinator, Jane Muir-Isherwood will work with the Trial Court Administrator, Holly Elomina, continuing to ensure that all aspects are fully implemented in an efficient manner, in compliance with the Monroe County purchasing policies, which required two or more written price quotes for the purchasing level of ten to twenty-five thousand dollars. Performance measures/outcomes: Monroe County Drug Court Program will contract with a local psychiatrist, proficient in the field of addiction to act as the Drug Court Medical Director to provide the services as described. The Drug Court Medical Director will provide about of sixty-four hours of services during the grant year. Medical Director Service hours will be tracked/monitored weekly and reported quarterly. Approximately 25 Monroe County Drug Court Program participants will receive medical services (many requiring multiple hours of service) to reduce their prescription drug abuse and/or to more comprehensively treat their mental health disorders that led to their involvement in the drug court/criminal justice system. Participant numbers will be tracked/monitored weekly and reported quarterly. Project Identifiers for this proposed project are: (1) Drug Courts, (2) Drug Offenders, (3) Prescription Drugs, (4) Substance Abuse Treatment, and (5) Mental Health.

3 Monroe County Drug Court/JAG 2015/Local Program Narrative (Attachment 2) Program Narrative The Monroe County Drug Court Program located in Monroe County, Florida has been in continuous operation since Our circuit operates a Juvenile, Dependency, and Adult Diversion Drug Court, with sites in Key West, Marathon, and Plantation Key. Monroe County is the southernmost county in the continental United States. It consists of the Florida Keys, a string of islands connected by U.S. Highway 1, extending 150 miles southwest of Miami and the surrounding waters. There are 42 bridges linking the Florida Keys. Drug Courts reduce drug seeking behaviors by treating the underlying addiction of the nonviolent offender, thereby offering a greater chance of breaking the cycle of drug abuse, crime, and incarceration. Drug Court program participants are closely supervised by a judge who is supported by a team of agency representatives operating outside their traditional roles. The team includes a drug court coordinator, case manager, substance abuse treatment counselors, prosecuting attorneys, defense attorneys, juvenile probation officers, school representatives, employees of Department of Children & Families, Guardian Ad Litem, community based care workers, law enforcement officers, and adult probation officers. Eligible participants for the drug court program are identified and assessed early, and then placed into a treatment program. During their time in treatment, offenders are given random drug screening tests, and are required to appear frequently in front of a judge for progress evaluations. Drug court participants may be rewarded for remaining abstinent and attending meetings. Following successful completion of the drug court s treatment program, the court may, set aside or reduce their sentence, dismiss the original charge, or a combination of these. However, participants may also be sanctioned for violating the program s regulations by being removed from the program and given their original sentence. In some drug courts, participants are also provided ancillary services, such as mental health treatment, family therapy, and job training to increase their probability for success (Casebolt, R., Huddleston III, C.S., Marlowe, D.B. (2008). Painting the Current Picture: A National Report Card on Drug Courts and Other Problem-Solving Court Programs in the United States. National Drug Court Institute, 2(1). It is estimated that every $1 spent on drug courts results in costs savings of anywhere from $1.74 to $6.32 per participant (Florida Office of the State Courts Administrator, Office of Court Improvement. (2010). Drug Courts in Florida: Frequently Asked Questions and Quick Facts.). On average, drug courts cost $4,333 per client, but they save $4,705 for taxpayers and $4,395 for potential victims (National Drug Court Institute. (2009). Research Findings). But even these costs are minimal compared to the costs of incarceration, which are, on average, $19,469 per inmate per year (Florida Department of Corrections. (2010) Annual Report: FY Retrieved from: A 2005 Government Accountability Office report showed lower percentages of drug court program participants were rearrested or reconvicted. Drug court program participants also 1

4 Monroe County Drug Court/JAG 2015/Local generally had longer times to first arrest or conviction than comparison group members. When comparing the results of treatment through drug courts, and results from standard punishment, it becomes apparent that drug courts are highly effective in reducing crime and consequently taxpayer expense (Rossman, Shelli B. etc. (2011). The Multi-State Adult Drug Court Evaluation. U.S. Department of Justice). The Monroe County Drug Court Program is applying for a fourth year of JAG funding for The Medical Director Initiative program, under the purpose area of Drug treatment and enforcement programs. The program activities include: 1. Contracting with a local Psychiatrist, proficient in the field of addiction to act as the Drug Court Medical Director, who will provide a total of sixty-three and nine hundred and seventy-five thousandth hours of psychiatric services to Adult Division, Family Treatment, and Juvenile Drug Court Program participants per funded calendar year. 2. The Medical Director will make professional and qualified decisions regarding clients presenting with prescription drug abuse and dependence issues. 3. The Medical Director will communicate with the treating physicians, assisting in the diagnosis and prescribing of psychotropic medication to our clients who are detoxifying and/or present with symptoms of mental health disorders. 4. The Medical Director will work with the clients to explore alternative medications and make recommendations to the court as a qualified professional. 5. Approximately 25 Monroe County Drug Court participants will receive medical services (many requiring multiple hours of service) to reduce their prescription drug abuse and/or to more comprehensively treat their mental health disorders that led to their involvement in the drug court/criminal justice system. Following a lengthy Request for Proposal, selection, and contract approval process beginning in July of 2012, under the supervision of the Monroe County Attorney s Office, the Medical Director initiated the provision of services for the Drug Court program in January In the first grant year The Medical Director provided fifty hours of service of which he attended ten staff sessions with the Drug Court clinical team, conducted ninety-four case reviews, performed fifty-three assessment sessions with thirty-eight clients, attended five groups with fifty clients, and educated the team with regards to best practice treatment techniques. In the second grant year, the Medical Director provided thirty-eight and a half hours of service of which he attended eleven staff sessions with the Drug Court clinical team, conducted two hundred and eleven case reviews, performed sixty assessment sessions with fifty-four clients, and was instrumental in researching best practices for ETG/Alcohol testing and developing the ETG/Alcohol testing protocol. In the first two quarters of the 2014 grant, the Medical Director provided forty-seven hours of service of which he attended six staff sessions with the Drug Court clinical team, conducted eighty-two case reviews, and performed twenty-eight assessment sessions with twenty-eight clients. Due to the late allocation of funds and the lengthy Medical Director hiring process in the first year of this initiative, we were unable to draw down all the allocated funds in the first two years, but we are now fiscally on track in our third year of funding. 2

5 Analysis of Need Monroe County Drug Court/JAG 2015/Local The number of referrals to Drug Court with prescription drug arrests are on the increase state wide. According to the Monroe County Sheriff s office from April 2011 to April 2012 there were approximately 150 arrests for possession of a controlled substance without a prescription. This number does not include other criminal activities associated with prescription drug abuse. The Court and clinical staff hands are tied with regards to being qualified to assess the necessity of medication for our clients. The Florida s Prescription Drug Diversion and Abuse Roadmap , released April 4, 2012, by Florida Attorney General Pam Bondi recognizes the strength of existing drug courts and places them front-and-center in the multi-faceted fight against prescription drug abuse. The Roadmap recommends two important strategies: 1. Florida must expand drug courts across the state to admit more non-violent prescription drug offenders. Expanding Drug Courts increase overall savings to the state s budget as fewer offenders would be sentenced to costly prison time. Expansion of Drug Courts also decreases crime rates overall by effectively shortening a non-violent offender s emerging criminal history by intervening earlier with effective drug treatment consisting, in part, of swift and certain sanctions (Office of Program Policy Analysis & Government Accountability. (2010). Without Changes, Expansion Drug Courts Unlikely to Realize Expected Cost Savings. Tallahassee, FL.). 2. Florida must ensure reliable screening processes are established to capture those offenders whose crimes are grounded in prescription drug abuse, and who would benefit from a comprehensive treatment program. Monroe County s Drug Court proposal for JAG funding is directly responsive to the Attorney General s recommendations. A contractual agreement with a Medical Director will expand the capacity and expertise of our Drug Court Program to address participants with prescription drug abuse issues. A strong nexus exists between crime and drug abuse. If mental health and prescription drug abuse issues are left untreated, users will typically engage in repeated drug theft, shoplifting, prescription fraud, burglary, and a myriad of other criminal activities. Law enforcement is reporting that prescription drug abuse is fueling increases in property crimes, as criminals seek to acquire powerful pain medications by breaking into pharmacies and homes in order to both consume and sell pills on the black market (Goodnough, Abby. (2010). A Wave of Addiction and Crime, with the Medicine Cabinet to Blame. The New York Times, September 23, Retrieved from: Our focus on treating prescription drug addiction in the criminal justice system reflects the scientific understanding that addiction is a result of brain changes caused by repeated drug use. The United States makes up roughly 5 percent of the world s population, but consumes 80 percent of its opioids, as well as 99 percent of the world s hydrocodone (Avila, Jim. (2011). 3

6 Monroe County Drug Court/JAG 2015/Local Prescription Painkiller Use at Record High for Americans. ABC World News, April 20, Retrieved from: It is unclear how much of this consumption is legitimate and how much is diverted for abuse. Drug courts remain the most effective means we have for reducing diverted prescription drug demand by addicts in our criminal justice system. Anticipated Coordination Efforts Contracting the services of a Medical Director has improved the Drug Court Program team s performance outcome by increasing the program s effectiveness and comprehensiveness, reducing recidivism, increasing participant success rates, and reducing costs to law enforcement and the criminal justice system. In the first grant year The Medical Director provided fifty hours of service of which he attended ten staff sessions with the Drug Court clinical team, conducted ninety-four case reviews, performed fifty-three assessment sessions with thirty-eight clients, attended five groups with fifty clients, and educated the team with regards to best practice treatment techniques. In the second grant year, the Medical Director provided thirty-eight and a half hours of service of which he attended eleven staff sessions with the Drug Court clinical team, conducted two hundred and eleven case reviews, performed sixty assessment sessions with fifty-four clients, and was instrumental in researching best practices for ETG/Alcohol testing and developing the ETG/Alcohol testing protocol. In the first two quarters of the 2014 grant, the Medical Director provided forty-seven hours of service of which he attended six staff sessions with the Drug Court clinical team, conducted eighty-two case reviews, and performed twenty-eight assessment sessions with twenty-eight clients. Due to the late allocation of funds and the lengthy Medical Director hiring process in the first year of this initiative, we were unable to draw down all the allocated funds in the first two years, but we are now fiscally on track in our third year of funding. The team includes the drug court judge, criminal court services coordinator, drug court coordinator, case manager, substance abuse treatment counselors, prosecution attorneys, defense attorneys, juvenile probation officers, school representatives, employees of Department of Children & Families, Guardian Ad Litem, community based care workers, law enforcement officers, and adult probation officers. 4

7 Monroe County Drug Court/JAG 2015/Local Budget and Budget Narrative (Attachment 3) Budget Category Quantity Name Price Contract Enter into a Contract for an additional year with a local Psychiatrist, proficient in the field of addictions, to act as Drug Court Medical Director. The Medical Director will provide a total of sixty-four hours of psychiatric services, at the rate of two hundred dollars an hour to the Adult Diversion, Family Treatment, and Juvenile Drug Court Program participants for the grant calendar year. $12, The Medical Director will make professional and qualified decisions regarding clients presenting with prescription drug abuse issues. The Medical Director will work with the clients and their to physicians to explore alternative medications and make recommendations to the court as a qualified professional. The Medical Director will provide case management, education, and training to the Drug Court staff. Travel/Mileage Expense $ TOTAL PROJECT $12, Federal Request COSTS $12, Non-Federal Amount $5.00 Budget Narrative The Justice Department has allocated $12, to Monroe County, Florida as part of the 2015 JAG Local Solicitation. The Monroe County Drug Court Program is applying for the total amount. The JAG funds will provide a Medical Director for the Monroe County s Drug Court Program. This funding will provide Medical Director Services for a fourth year. Without this grant funding there is no budget for this service and the service will not be provided. These federal funds will not be used to replace or supplant any nonfederal funds as none were appropriated for this purpose. Monroe County Drug Court has contracted with a provider in compliance with Monroe County s purchasing policies.

8 Monroe County Drug Court/JAG 2015/Local Review Narrative (Attachment 4) Governing Body Review This Fiscal year 2015 JAG application for Monroe County is scheduled to be presented to the governing body, the Board of County Commissioners, by June 30, 2015, as part of the official agenda for the regular, monthly (July) meeting of the BOCC. The application will be reviewed by the Monroe County Board of Commissioners at the publicly noticed Commission meeting scheduled on July 15, The application will thus be made public to the citizens and neighborhood or community organizations and they will have an opportunity to comment on its worthiness at the July 2015 Commission meeting. (The Monroe County Drug Court Program was unable to present this application to the Board of County Commissioners at an earlier date due to the short turn-around time between our awareness of the JAG announcement and the application submission due date.)

9 Monroe County Drug Court/JAG 2015/Local Applicant Disclosure of No Pending Applications (Attachment 5) Monroe County does not have pending applications submitted within the last 12 months for federally funded grants or subgrants (including cooperative agreements) that include requests for funding to support the same project being proposed under this solicitation that will cover the identical cost items outlined in the budget narrative and worksheet in the application under this solicitation.

ORGANIZATION OF AMERICAN STATES

ORGANIZATION OF AMERICAN STATES INTER-AMERICAN DRUG ABUSE CONTROL COMMISSION FORTY-FOURTH REGULAR SESSION November 19-21, 2008 Santiago, Chile OEA/Ser.L/XIV.2.44 CICAD/doc.1703/08 20 November 2008 Original: