COUNTY OF SAN MATEO

Inter-Departmental Correspondence

Health Services Agency

 

DATE:

March 5, 2002

BOARD MEETING DATE:

March 19, 2002

 

TO:

Honorable Board of Supervisors

FROM:

Margaret Taylor, Director of Health Services Agency

Maureen Borland, Director of Human Services Agency

SUBJECT:

Contract with Department of Health and Human Services (DHHS) Center for Substance Abuse Treatment (CSAT) for brief physician intervention and case management

 

Recommendation

    1. Adopt a resolution to authorize acceptance of a three-year grant award from the Federal Department of Health and Human Services

    2. Adopt a Salary Ordinance Amendment adding two Social Worker (unclassified) positions one Community Program Specialist (unclassified) position and one Epidemiologist (unclassified) position to provide case management and project direction as specified in the grant application.

    3. Approve an Appropriation Transfer Request (ATR) recognizing new revenue and associated expenses in the amount of $64,500 for FY 2001-02

 

Background

In response to a Federal grant funding announcement, the Health Services Agency's Substance Abuse Policy Group submitted an application for a three-year grant to provide substance abuse treatment in primary care settings through brief physician intervention and case management. There is a considerable body of research that has shown the effectiveness of brief physician interventions for alcohol related problems in primary care settings. These studies have found that primary care clinicians can help patients decrease alcohol consumption and its harmful consequences through office-based interventions that take only 10 or 15 minutes. The grant-funded project would pilot use of this approach to assess, intervene, and refer substance abusers seen in the County's Willow, Fair Oaks, and Belle Haven clinics.

Many patients come into primary care settings with alcohol and other drug (AOD) abuse problems. This is an opportunity for assessment, intervention, and referral. However, physicians and other medical personnel in primary care settings such as public clinics may not be adequately trained to identify AOD problems, or to intervene when they do identify them. Consequently, there may be no intervention or referral. These patients have high utilization costs because of frequent clinic and emergency room visits, as well as under-utilization of appropriate AOD and mental health services.

 

Discussion

The Health Services Agency received notification of grant award in the amount of $751,500 for the period of three years. The grant project will train physicians and nurse practitioners at the clinics in substance abuse identification and in a brief intervention model, which will be adapted to meet local needs. The project will include collaborative involvement of the Health Services Agency, Human Services Agency, Alcohol and Drug Treatment Providers, and community physicians in Hospital and Clinics.

The project director will be Dr. Scott Morrow, the County Public Health Officer. A 50% FTE Community Program Specialist will act as project coordinator/clinical supervisor. A 50% Epidemiologist will provide analytic support. Two bilingual, bicultural Social Workers will provide on-site case management for the project. The grant application included contracted services through Barry Rosen, M.D. for training of health clinicians and a project evaluation component. The contract(s) for these services will be submitted separately.

Evaluation of the three-year pilot project will be conducted to assess effectiveness of the brief intervention model with the target population through use of the Addiction Severity Index (ASI), California Alcohol and Drug Data System (CADDS) and CSAT's Government Programs Reporting Act (GPRA) tool. The primary analytic and statistical strategies will focus on confirmation of implementation of the brief intervention approach, numbers of patients diagnosed with substance abuse problems through this approach, and utilization of case management services.

 

Vision Alignment

The contract with the State Department of Health Services keeps the commitment of ensuring basic health and safety for all and goal number 8: Help vulnerable people - the aged, disabled, mentally ill, at-risk youth and others - achieve a better quality of life. The contract contributes to these commitments and goals because the project goal is to identify and assist vulnerable people who would otherwise not be helped with their alcohol and other drug problems.

 

Fiscal Impact

The grant is for three federal fiscal years and spans from county FY 01-02 through FY 04-05. Funding for FY 2001 - 02 is $64,500, FY 2002 - 03 is $254,000, FY 2003 - 04 is $247,000, and FY 2004-05 is $186,000. There is no required County match and there is no additional Net County Cost associated with the grant. An MOU will be prepared between Health Services (Public Health Division) and Human Services (Alcohol and Drug Program) to account for and transfer the costs of the positions.