Transcript DCHS Substance Use Disorders Statewide Conference August

The California
DUI Treatment System
A Presentation for the
California Behavioral Health
Directors Association
SAPT+ Committee
March 26 2015
1
Your Presenters
Bob Dorris
Retired, The High Road Program
CADTP Board of Directors
CADTP Counselor Certification Board
[email protected]
Teri Kerns
OHS
CADTP Board of Directors
Strategic Highway Safety Plan
DHCS DUI Advisory Group
[email protected]
Craig French
Barbara Aday-Garcia
OHS San Marcos
CADTP Board of Directors
[email protected]
Twin Palms Recovery Center
CADTP Board of Directors
DHCS DUI Advisory Group
[email protected]
2
Todays Objectives

DUI Programs - The History and
Current Story

Program Fees

Evaluation of Effectiveness

Client Services

Is the DUI Program Treatment

Standard Assessments

Collaboration
3
History

In 1978 the California Legislature mandated development of programs that
would be designed to reduce the high level of recidivism of individuals
arrested and convicted of driving-under-the-influence [DUI], endangering
public safety by individuals consuming alcohol and drugs and driving on
California streets and highways.

The legislature passed Senate Bill 38 creating a post-conviction program and
assigned the Department of Alcohol and Drug Programs responsibility for
developing regulations based on state law, i.e. §11836 – §11837 of the
California Health and Safety Code, and §23161 – §23181 of the California
Vehicle Code.

The initial focus of the legislature was on alcohol related offenses. Over the
past thirty-six (36) years, program services have evolved to focus on any type
of DUI offense, i.e. alcohol, licit [prescription] and/or illegal drugs.
4
The DUI System Today

DUI programs are licensed by the Department of Health Care Services to
provide a less intensive level of outpatient alcohol and other drug treatment
services focused on improving public health and safety by reducing and/or
eliminating additional DUI offenses.

These services consist of education classes (prevention); individual and group
counseling sessions (intervention); and in some counties individual client
involvement in self-help programs to facilitate ongoing recovery from the
abuse of alcohol and drugs.

Consistent with state regulations DUI treatment is provided by alcohol and
other drug counselors certified under Chapter 8, Division 4, Title 9,
California Code of Regulations.
5
The DUI System Today

DUI treatment programs collaborate with the Courts and the Department of
Motor Vehicles to ensure client compliance with summary or formal
probation requirements and prepare clients to regain their to drivers license
by successfully completing their DUI treatment program.

While program services are focused on refraining from operating an
automobile [or any mode of transportation] while under-the-influence, DUI
services also provide clients with a new understanding of their individual
responsibility to themselves, their families, and their community, and a
healthy new approach to their use of alcohol and drugs.
6
DUI Program Fees
7
Myth vs. Fact
Myth:
“DUI program providers are allowed to charge exorbitant fees and make
huge profits”.
Fact:
DUI program fees are approved and controlled by the
Department of Health Care Services and by law are
limited to earning a maximum 10% profit/surplus of
total DUI revenue
8
Fee Structure
DUI treatment program fees are regulated under §9878 – Chapter 3, Division 4,
Title 9, California Code of Regulations. In part these regulations state:

The program fee shall be set at a level sufficient to cover the cost of program services,
including each participant's share of personnel and operating expenses incurred by the
program in providing program services.

The licensee shall charge only the program fee and any additional fees that have been
approved by the Department pursuant to this section of regulation. The licensee shall
not increase program fees unless a request has been submitted to the county alcohol
and drug program administrator and approved by the Department.

The program shall establish and use a standardized payment schedule, approved by the
Department in accordance with this subsection, to determine each participant's
assessed program fee and schedule for payment of fees.
9
Myth vs. Fact
Myth
“DUI treatment service providers receive state and/or county funding to provide
services to clients.”
Fact
California’s DUI treatment system is one hundred percent (100%) self-funded by
program fees paid by the client.
From inception of the system in 1978, the State Legislature made it mandatory
that the system would be self-funded. That remains true today … there is no taxpayer money funding the system and its services.
The DUI Programs collect participant fees for providing program services plus
fees to reimburse the State and County for their monitoring and compliance
auditing services as required by state law.
10
Myth vs. Fact
Myth
“DUI Program Services are costly and a financial burden to the client.”
Fact
The actual cost of treatment services statewide ranges from a low of
$15.00/hour to $27.00 /hour of service, depending on the level of program
the client needs to complete, (shown below).
Per Hour for Average FOP = $17.52
Per Hour for Average MOP = $21.10
Source: A Descriptive Analysis of California DUI Programs
Sheldon Zhang, Project Director
San Diego State University
Department of Sociology
11
Evaluating the Effectiveness
12
Myth vs. Fact
Myth:
“There is little or no oversight of DUI program providers and the statewide DUI treatment
system”.
Fact:
The California Department of Health Care Services licenses all DUI treatment programs
and regulates the delivery of services as prescribed in Chapter 3, Division 4, Title 9,
California Code of Regulations, and provides analysts who conduct on-sight compliance
visits bi-annually.
In addition, the County Alcohol and Drug Administration of each county has
responsibility to monitor compliance of the DUI treatment programs within their county
on a consistent basis throughout any given year.
Source: A Descriptive Analysis of California DUI Programs
Sheldon X. Zhang, Project Director
Department of Sociology
San Diego State University
13
Evaluating the System

For 23 years the California Department of Motor Vehicles [DMV] has
conducted annual outcome studies on the effectiveness of the California DUI
system in reducing recidivism.

The DMV Annual DUI MIS Reports can be found at:
http://www.dmv.ca.gov/portal/dmv/detail/about/profile/rd/toc
14
Evaluating the DUI System
2014 DMV DUI MIS Report:
The 1-year recidivism rates for all first DUI offenders decreased to the lowest
level seen in the past 22 years. The DUI re-offense rate for first offenders
arrested in 2011 was 50.0% lower than the re-offense rate for first offenders
arrested in 1990
The 1-year re-offense rate for second DUI offenders also decreased about 50%
in the past 22 years, from 9.7% in 1990 to 4.9%
Subsequent 1-year crash rates among second DUI offenders have declined
from 4.0% in 1990 to 1.7% in 2011, a 57.5% relative decrease.
 The crash rate for first offenders has also declined; their 2011 rate is 52.8%
lower than their 1990 crash rate (see Figure 7 and Table 11a)
15
Evaluating the DUI Program
2014 DMV DUI MIS Report:
 Alcohol or drug reckless offenders assigned to a DUI program show a 17.2%
lower crash rate than those not assigned to the program.
 Alcohol or drug-reckless offenders assigned to a DUI program show a statistically
fewer number of DUI incidents in the 1 year following their assignment than those
who were not assigned
 Of the DUI offenders arrested in 2011 who enrolled in a DUI intervention program,
87.8% of first offenders and 41.1% of second offenders completed their program
assignment
 Among convicted DUI offenders arrested in 2011, 73.7% were first offenders and
26.3% were repeat offenders (one or more prior convictions within the previous 10
years). The proportion of repeat offenders has decreased considerably since
1989, when it stood at 37%,even though prior DUI convictions are counted over
10 years now, but only over 7 years in 1989
16
Evaluating the System
Source: A Descriptive Analysis of California DUI Programs
Final Report
Submitted to California Department of Alcohol and Drug Programs
Driving-Under-the-Influence Program Branch
Prepared by
Sheldon Zhang, Project Director
San Diego State University
17
Department of Sociology
California DUI Program Providers Survey,
2011
Presented to:
California Department of Alcohol and Drug Programs
By:
Sheldon X. Zhang, Project Director
Department of Sociology
San Diego State University
Email: [email protected]
This report describes the results of a survey of 136 Program Managers representing 125
Driving under the Influence (DUI) programs across the State of California.
18
Source: California DUI Program Providers Survey
Sheldon Zhang, Project Director
San Diego State University
Department of Sociology
Main Education Curriculum Components
Respondents mentioned a wide variety of
curriculum topics covered in their education,
including:
• Physiological and social effects of
alcohol and drugs,
• Addiction,
• Choices and consequences,
• Community resources,
• Alcohol and the family,
• Denial,
• The disease concept,
• DUI policies,
• Tools for living,
• Relapse prevention,
• Recovery.
19
Recommendations
D.1. DUI Program Providers
Short-term measures: (1) establish performance benchmarks; (2) increase transparency in program fees
and administrative fees; and (3) increase web presence for all DUI programs.
Long-term measures: (1) establish a mechanism for outcome assessment.
D.2. ADP Oversight (DHCS)
Short-term measures: (1) achieve greater consistency in curriculum development; (2) compile and
disseminate vital statistics for statewide DUI programs; (3) compile and publish DUI program fees; (4)
assemble and publish an online spreadsheet containing standard programmatic information for all DUI
programs.
Long-term measures: (1) establish a more rational fee review and approval procedure; (2) create a rating
system using monitoring results to encourage self-improvement through an open and transparent grading
system; (3) increase ADP oversight through an updated data tracking system; (4) realign programs that
are rarely used and have low completion rates; and (5) invest in research and evaluation of DUI program
services.
D.3. County Alcohol and Drug Services
Greater involvement from county alcohol and drug services is needed to mediate emerging or on-going
issues between DUI program providers and the state oversight agency.
Source: A Descriptive Analysis of California DUI Programs
Sheldon Zhang, Project Director
San Diego State University
Department of Sociology
20
Court Referral System
Strategic Highway Safety Plan
Challenge Area 1
Title 9 - § 9801.5. County Responsibilities
(b) The county alcohol and drug program administrator shall:
(8) Carry out liaison activities with the courts, the county probation
department, DUI programs, and interested parties at the county
level.
(9) Develop and insure the implementation of a court referral
system as described in Health and Safety Code Section 11837.2.
21
CADTP Best Practice Document
The best practice document was a
collaboration of DUI program
representatives who each took a
section and the committee agreed
upon content to ensure generic enough
for implementation.
The intent of this document is to
present a set of suggested best
practices for licensed DUI Treatment
Programs to follow in order to provide
quality services and regulatory
compliance, resulting in safer
communities and healthier individuals
at no cost to the tax-payer.
22
Client Services
23
DUI Program Services

The DUI programs primary goal is to assist participants to
explore their relationships with alcohol/drugs and the
inherent risks involved

The desired result is modified drinking and/or drug use in
high-risk situations such as driving

Our programs provide counseling and education to assist
in reducing the recidivism rate of DUI offenders
24
Myth vs. Fact
Myth:
DUI Programs are Education not Counseling
Fact:
All AOD Treatment Programs have an Educational Component and so do
DUI Treatment Programs

Orientation to DUI laws, Alcohol & Drug Impairment and the DUI Program

Patterns Of Consumption, Chemical Dependency And Assessment

Medical Aspects Of Alcohol And Other Drugs

Social Aspects Of Alcohol And Other Drugs

Addiction And The Family

Recovery, Resources And Options For Change
Instructors are certified counselors who must
have 2 years of experience providing Alcohol and
Other Drugs Education.
25
DUI Program Philosophy of Services
DUI Programs take a proactive stance in helping those with alcohol and/or
drug dependency problems make life-affirming changes.
DUI Programs recognize that substance use behavior exists along a
continuum, ranging from non pathological use at one end, to problematic or
substance abuse in the middle to chronic substance dependence on the other.
DUI services are designed to address this continuum of use through the
education, group and individual case management sessions.
26
DUI Program Levels
Wet Reckless Program:
Blood Alcohol Content under .08
 12 hours of education
3-month First Offender Program - 37.5 % education, 62.5% counseling
Blood Alcohol Content .08 and above




12 hours of education
10 hours of group counseling
3 individual sessions (face to face)
Eight additional hours of program services,
consisting of educational sessions, group
counseling sessions, or a combination of the two
27
DUI Program Levels
6-month First Offender Program 26.7% education, 73.3% counseling
Blood Alcohol Content .15 - .19




12 hours of education
28 hours of group counseling
Minimum of 4 individual sessions
Four additional hours of program services, consisting of
educational sessions, group counseling sessions, face-to-face
interviews or a combination of the three
9-month First Offender Program 19.1% education, 80.9% counseling
Blood Alcohol Content .20 and above




12 hours of education
44 hours of group
Minimum of 5 individual sessions
Four additional hours of program services, consisting
of educational sessions, group counseling sessions,
face-to-face interviews or a combination of the three
DUI Program Levels
18-month Multiple Offender Program 15.4% education, 84.6% counseling
2 or more DUI’s in a 10 year period
 The first 12 months of the 18 month program
 12 hours of education,
 52 hours of group counseling
 1 individual session every other week.
 The last 6 months of the 18-month program includes up to
6 hours of services.
 Each program and/or county determines how to
structure the last 6 months of service
29
DUI Program Levels
30-Month Multiple Offender Program 7.9% education, 92.1% counseling
3 or more DUI Offenses in a 10 year period
 1st 18 months = 12 hours of education, 78 hours of group counseling and
one face to face session every other week
 Last 12 months – DUI Program must continue to monitor compendium
of evidence, can credit some time towards last 12 months for residential
or in-patient AOD Treatment with court approval
Client must show a compendium of evidence, on a tri-monthly basis, of performance of
voluntary community service for one-half of the time served (not less than 120 hours and
not more than 300 hours, as determined by the court) demonstrating:
1. The prevention of driving-under-the-influence, promotion of safe driving,
and responsible attitude toward the use of chemicals of any kind.
2. Significant improvement in occupational performance (including efforts to
obtain gainful employment), physical and mental health, family relations,
and financial affairs and economic stability.
* Not available in all Counties in California
30
Myth vs. Fact
Myth: DUI Counselors are not Certified Alcohol & Other Drug Counselors
Fact: Title 9 California Code of Regulations - Staff Qualifications
DUI program staff who conduct educational sessions shall have a minimum of two
years of experience in providing alcohol and/or drug education and information to
persons with alcohol and/or other drug problems in a classroom setting or meet the
staff qualifications required in Section 9846(c) or Section 9846(f).
All DUI program staff who provide counseling services (as defined in Section
13005(a)(4)) shall be licensed, certified, or registered to obtain certification
pursuant to Chapter 8 (commencing with Section 13000) or meet the
qualifications required in subdivision (f).
DUI program staff who provide counseling services (as defined in Section
13005(a)(4)) shall comply with the code of conduct, pursuant to Section 13060,
developed by the organization by which they were certified or registered
31
Individual Counseling Sessions
Face to face sessions address the following questions,
1. “Discuss and identify problems which may be barriers to program completion,
including progress in group and other counseling sessions.”
2. “Evaluate the client’s need for referral to ancillary services.”
3. “Discuss and encourage client attendance in educational and counseling
sessions.”
4. “Monitor payment of fees.”
A formal substance abuse assessment is conducted within 60 days from
enrollment, discussed with the client and appropriate referrals are provided and
documented.
32
Objectives of individual and group counseling
1. To assist clients in recognizing and eliminating high risk behavior
associated with alcohol and drug use i.e. drinking and driving.
2. To provide clients with assessment and referral services to address
life management issues that impact healthy functioning and wellbeing.
3. To facilitate the reduction or elimination of alcohol or drug use as
appropriate.
4. To stimulate positive behavioral change resulting in increased wellbeing and functioning in major life areas.
Problem recognition
Taking responsibility
Self-regulation
Harm reduction
33
The DUI Client
34
A Preventable Tragedy
35
WHO IS THE “TYPICAL" DUI CLIENT?
 The California DUI client is as unique and diverse as the State’s
population
 The California DUI client runs the full spectrum of cultural, ethnic, and
educational background.
 The DUI offenses occur with no respect to age or gender
 California DUI clients are from every walk of life and income level, i.e.,
students, blue collar workers, white collar workers, agricultural
businesses , small business, manufacturing, unemployed, health care
professionals, retirees and politicians
 The DUI clients participating in our program mirror the communities
we live in
36
CALIFORNIA DEPARTMENT OF MOTOR VEHICLES ANNUAL REPORT OF THE
CALIFORNIA DUI MANAGEMENT INFORMATION SYSTEM
Client Profile
Race/Ethnicity
Percentage
% California
Population
White
39.9%
39%
Hispanic
45.9%
38.4%
Black
8.4%
6.6%
Other
8.95%
15.8%
Gender
Average Age
Male
Female
33.7 years
33 years
White
35.6 years
Hispanic
31.5 years
Percentage
of arrests
% California
Population
Black
35.7 years
Male
76.5%
49.7%
Other
31.9 years
Female
23.5%
50.3%
37
Myth vs. Fact
Myth:
All DUI Clients are Alcoholics or Addicts
Fact:
What we know as providers of DUI services is that our clientele run the
full spectrum regarding use/abuse of alcohol and drugs.
Some clients do not have a substance use disorder and others may
require additional services to address addictive behaviors.
38
Myth vs. Fact
Myth:
DUI Providers have a Singular Mission to Provide DUI Services Only
Fact:
DUI Programs are mandated by Regulations to “Evaluate the client’s
need for referral to ancillary services”
The referral to ancillary services are based upon the clients assessed
needs. i.e. an appropriate level of AOD Treatment, medical issues,
food bank, financial assistance, etc.
39
Napa
Referrals to Ancillary Services
FY 11-12
#
Services
# referrals
%
1 Napa County Alcohol and Drugs Services
12
12%
2 Tobacco cessation (Take charge)
30
30%
3 AA/NA (12 Step Programs
4 Clinic Ole- Behavioral services
25
25%
6
6%
5 HHS Mental health Services
6 Residential Treatment programs
5
5%
9
9%
7 Dental Services (Clinic Ole)
1
1%
8 Other*
11
11%
99
100%
Total Referrals
Napa
Referrals to Ancillary Services
Fiscal Year 12-13
* Job Connection,ParentCan, Goodwill, Meals on Wheels, CMSP, FS, IHSS,
#
Services
Total
%
1 Napa County ADP
10
8%
2 Tobacco cessation
30
24%
3 AA/NA (12 Step Programs
30
24%
4 CO- Behavioral services
5
4%
5 HHS Mental health Services
3
2%
6 Treatment programs
10
8%
7 Centro Legal la raza
20
16%
8 Carecen
15
12%
9 CO-Dental Services
1
1%
#
3
2%
127
100%
Other*
Total Referrals
*Other: Divorce lawyer, Domestic Violence Program, Care giver support
40
How Clients Fit into DHCS’S
Continuum of Care
DUI Programs are:
Prevention, Assessment , Early Intervention, and Treatment
Approximately 150,000 court ordered DUI participants per year are provided
support for positive changes in life style to facilitate reduction or elimination
of alcohol/drug problems by the DUI Program Providers.
This is accomplished through the AOD education, group and individual
counseling session , the assessment of their substance use/abuse and the
evaluation of the participant’s need for referral to ancillary services.
CADTP is in process of evaluating the types of assessments currently being
used in the DUI programs and initial findings are that DUI programs are using
different proven assessments used in the AOD treatment field.
41
Summary of DUI Services

Alcohol and drug outpatient treatment and education services

1st stage treatment program – primary gate keeper

Prevention specialists, education, assessment

Intervention

Continuum of care

Totally self-funded

Effective at reducing recidivism

Protect public safety
42
The Wheel of
Collaboration
43
44
A Successful Client
=
A Safer Community
45