Department of Human Services/Oregon Health Authority Addictions and Mental Health Division (AMH) November 25, 2009

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1 Disclaimer High Level Briefing on Addiction Treatment System Prepared for the Alcohol and Drug Policy Commission This paper reflects only the highest level briefing information about the addiction treatment system and is not meant to serve as a comprehensive or detailed report. All of the information in this report can be explored in much more detail to provide additional context for decision-making and developing recommendations regarding the treatment system. This report does not discuss the strengths or challenges associated with the addictions workforce which deserves discussion in the treatment subcommittee. It also does not provide information about the strategic vision for addiction services under development with leadership from AMH. Who Needs Addiction Treatment in Oregon? Age Group Estimate abuse and/or dependency People served in public system 12 to 17 19, ,844 29% 18 to 25 81, ,088 16% , ,112 23% Percent of need met Regional variations in prevalence are captured in the National Survey on Drug Use and Health and are available upon request. Who Accesses Addiction Treatment in Oregon? 57,044 4 people received treatment during fiscal year All publicly funded clients, driving under the influence clients, and methadone maintenance clients are part of the count. Unless otherwise noted, all treatment data reported in this paper relate to fiscal year Estimates are based on the annual National Survey of Drug Use and Health (2007). 2 Ibid. 3 Ibid. 4 All client data presented in this report comes from the Client Process Monitoring System (CPMS), a treatment episode data system managed by the Addictions and Mental Health Division. Page 1 of 7

2 Gender 65% were male and 35% female. According to the national survey, males are more likely to need treatment than females. Race / Ethnicity The racial/ethnic composition was: 78% White/Caucasian; 9% Hispanic/Latino; 5% Native American; 4% African American; 1% Other race; 1% Asian; <1% Pacific Islander; and <1% Unknown. For treatment completion, Hispanic/Latino and Asian have the highest successful completion rates while African American and Native American have the lowest successful completion rates. Employment Status 51% of clients who reported they were eligible to work reported some type of work at enrollment (full time, part time or irregular work). Education Average grade level was 11 and 59% reported 12 grades completed indicating completion of high school. For clients age 18+, 34% of non-duii clients had reported completing less than 12 grades and only 22% of DUII clients reported completing less than 12 grades, indicating they had not completed high school. Criminal Involvement More than 60% were referred to treatment by the criminal justice system. Health Insurance 58% of those entering treatment reported no insurance coverage. 20% reported OHP as their primary insurance coverage and the remainder had other public or private insurance. Homelessness 7% reported as being homeless at enrollment. Geographic Distribution Treatment clients came from all counties in the state. Regional residential programs account for regional variations (see maps provided). Primary Drug Nearly 60% had a primary addiction to alcohol, followed by marijuana (17%), amphetamine/methamphetamine (14%), heroin (5%), other opiates (3%), and other drugs (1%). Page 2 of 7

3 What Kinds of Services do People Access? Addiction services and supports provided with public funds fall into the following categories: Outpatient (regular, intensive, case management and medication assisted treatment) Residential (adolescent and adult, including specialized services for parenting women and men) Detoxification (social and inpatient/hospital) Housing Supports (Oxford, rental assistance) Service Type Count of unique person served by level of care Total Episodes of care Percent of unique person by level of care Adult Residential 5,133 5,528 93% Youth Residential % Outpatient Non-DUII Clients 26,236 28,815 91% Outpatient DUII clients 19,368 20,569 94% Methadone 5,621 6,283 89% Detox service 3,662 4,978 74% Child with parent % When Do People Access Treatment and How Long Do They Stay? Oregon does not have a statewide, centralized waitlist management system. A manually designed residential waitlist process was developed in early 2008 by the AMH Program and Policy Development Unit and routinely shows about 800 people waiting for residential treatment monthly. Some of these people are on multiple waitlists, so this count does not reflect the actual number of unduplicated people waiting for beds. Generally, people seek treatment in response to a life crisis or precipitating event (DUII or other arrest, trouble at work, child welfare system involvement, or other negative life event). Length of stay in treatment varies by service type as shown in the chart below. Average length of stay for Page 3 of 7

4 successful completers (residential and outpatient services) was 158 days compared to 96 days for unsuccessful completers Average Length of Stay (LOS) in Days by Treatment Status Days Unsuccessful completion LOS Successful completion LOS 0 Methadone Outpatient Intensive Outpatient Residential Where Do People Access Treatment? Every Oregon County has capacity to provide alcohol and drug assessments and outpatient services. Residential and detoxification services are located in various regions throughout the state (see maps for regional adolescent and adult residential services). There are roughly 320 alcohol and drug treatment programs approved by AMH statewide. Services are provided through: Community Mental Health Programs Tribes Fully capitated health plans (FCHP-OHP) Nonprofit organizations How Are Services Delivered? By statute, DHS, AMH is the state entity responsible for administering and regulating the alcohol and drug treatment system. AMH conducts quality assurance and quality improvement activities and delivers technical Page 4 of 7

5 assistance throughout the treatment provider system focused on compliance with administrative rules and service quality improvement. Oregon Administrative Rules (OAR): AMH promulgates administrative rules that form the minimum standards for delivering addiction treatment. Statute dictates all alcohol and drug residential programs, regardless of funding source must be licensed by AMH. Outpatient programs receiving public funds must also be approved by AMH. AMH is currently finalizing the rule development process for an integrated addictions, mental health, and gambling services rule. American Society of Addiction Medicine (ASAM), Patient Placement Criteria for the Treatment of Substance-Related Disorders: Administrative rules governing addiction treatment incorporate this criteria, used by the entire provider system as a standardized method for placing individuals in the appropriate level of care and making continued stay / discharge decisions. Evidence-based Practices (EBP): Oregon leads the country in the adoption and implementation of evidence-based practices. Over 54% of AMH funding supports EBP according to the most recent EBP survey. (See map provided for the top five EBP implemented throughout the state.) New Initiatives: Oregon is one of NIATx five states participating in NIATx 200, a clinical trial designed to evaluate the cost effectiveness of field-tested process improvement strategies for addiction treatment providers. (See fact sheet provided.) Intensive Treatment and Recovery Services (ITRS) is an initiative funded by the 2007 Legislature expanding treatment capacity for parents with alcohol and drug problems. (See fact sheet provided.) ITRS has been extremely successful in the following areas: Accountability for services and outcomes o AMH has implemented performance-based contracting for Page 5 of 7

6 Collaboration between state and local child welfare and addiction services providers The following information is provided to facilitate a basic understanding of system financing and flow of resources supporting the addiction treatment system. This topic will be explored in more detail by the Structure Subcommittee. AMH Counties State & Tribal Services Regional Programs Prevention/Intervention Treatment OHP FCHP P Maintenance The following diagram represents budgeted service categories for both alcohol and drug prevention and treatment based on the Legislatively Authorized Budget for AMH. Page 6 of 7

7 Alcohol and Drug Treatment and Prevention LAB SE LA01-Local Admin, $64,325 Non-Service Element Contracts, $3,756,430 SE 60-Special Projects, $5,930,374 SE 71-Youth A&D Residential Treatment, $6,523,572 SE 70-Prevention Services, $10,091,738 SE 61-Residential Treatment, $29,959,202 SE 67-Residential Capacity Services, $8,453,400 SE 62-Dependent Residential, $1,854,052 SE 66-Continuum of Care, $37,578,811 Total Alcohol and Drug Budget by Service Element/Category Oregon Health Plan (outpatient only) $67,151,456 LA 01 Local Admin 64,325 SE 60 Special Projects 5,930,374 SE 61 Adult Residential Treatment 29,959,202 SE 62 Dependent Residential 1,854,052 SE 66 Continuum of Care 37,578,811 SE 67 Residential Capacity Services 8,453,400 SE 70 Prevention Services 10,091,738 SE 71 Youth A&D Residential Treatment 6,523,572 Non-Service Element Contracts 3,756,430 Total $171,363,360 Page 7 of 7