Single assessment for needs to speed treatment and save tax dollars

The delivery of alcohol, drug addiction and mental health services is changing in Montgomery County to speed patient entry into treatment and to save tax dollars.

The goal: treatment on demand.

The Montgomery County Family and Children First Council, in 2007, identified substance abuse as a county-wide issue.

More than 43,000 people ages 12 and older needed services for alcohol and drug abuse in 2008. Of those, about 5,106, or 12 percent, received assessment in the public system, with just 3,055 making it to their first appointment. About 1,000 completed their treatment.

A year ago, the Montgomery County Alcohol & Drug Abuse Task Force, a year ago, made recommendations to improve entry into the system. On Wednesday, committee members working to implement the recommendations gave a progress report.

“Our singular focus is our clients,” said Helen Jones Kelley, executive director of the Alcohol, Drug Addiction & Mental Health Services (ADAMHS) Board of Montgomery County.

Since 1997, the sole entry into mental health, alcohol or drug addiction services in the county was through an assessment at Samaritan CrisisCare. That meant people in need of services were evaluated both at a hospital, in jail, through the courts, a treatment center or homeless shelter and had a second assessment through CrisisCare. In the future, wherever the patient enters the system— at a hospital, through law enforcement, etc. — a universal assessment will be done at the door, that information will be shared across the network of service providers and the person will be connected directly to services.

“Every time we do an assessment, it costs money, so we should only be doing one,” Andrea Hoff, director of community engagement and special services for the ADAMHS board said.

A single assessment costs $97.90, Hoff said. CrisisCare conducts anywhere from 550-600 assessments per month.

The task force’s most urgent recommendation was the development of a sophisticated electronic system for collecting and exchanging data, Montgomery County Commissioner Dan Foley said. A universal assessment couldn’t work without a data sharing plan.

“For a long time we used to hide behind HIPPA. Now, we are using HIPPA as a guide,” said Jones Kelley, adding all privacy laws and accreditation regulations are being followed. Initially, only “information release forms” will be shared electronically.

“By July 1, there will be no wrong door into our system,” Jones Kelley said. “Certainly, waiting time for services will be significantly reduced.”

Closing the gap between assessment and entry into a treatment program is expected to reduce the number of people who lose the motivation to work on their addiction in that interim period, Jones Kelley said. CrisisCare, during the past year, has worked to reduce the time it takes to get a treatment appointment from seven days to three. The agency also has hired a case manager to work with high risk clients while they wait for services.

“While I think it’s a great accomplishment, it’s an accomplishment dealing with how the system works today,” Jones Kelley said. “Our goal is to change the system and eliminate the gap.”

Also as part of information sharing, the county’s adult drug court, and its counterpart in juvenile court are now linked together and sharing information via JusticeWeb, to identify youth whose family members are or have been involved in the criminal justice system.

“We’re trying to make sure treatment plans meet the needs of the entire family,” Hoff said.

Individuals with drug addiction issues may be sent to a drug court in lieu of a traditional justice system case processing. Drug courts keep individuals in intensive treatment, while supervising them closely.

The task force also recommended establishing sobering centers, instead of using high-level care emergency rooms or the jail, for individuals who don’t need medical supervision to get sober.

“Having a central detox facility was cost-prohibited,” Hoff said. “Frankly, we don’t have the means to make that happen.”

ADAMHS continues to look for a licensed treatment facility that could provide the service.

The task force committees issued their final report Wednesday, but the work is far from done. It now falls to ADAMHS to move the recommendations forward, including creation of prevention plan.

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