Question: What programs, outside of the schools, does the proposed budget fund in regards to addressing and preventing opioid addiction?(Councilman McPike)
Response:
Funded by proposed budget:
The proposed budget does not add new funding for opioid prevention and addiction; however, the programs and initiatives currently funded are described below.
Current Treatment/Intervention Programs:
Child and Family Behavioral Health Services (CFBHS) for Youth (under 18) with Opioid Use:
Services are provided in the community and/or are office based. Youth and families receive harm reductions tools such as NARCAN and Fentanyl test strips.
Community based outpatient substance use therapy includes substance use treatment practices that are trauma-informed and based on research and evidence, such as, Motivational Interviewing, Cognitive Behavioral Therapy, Trauma Focused-Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing, and elements of Multi Systemic Therapy. This includes weekly individual and/or family therapy sessions related to an individualized treatment plan created with the youth/family.
Clinical case management services assist families with children with opioid use challenges in accessing medical, psychiatric, social, educational, vocational, and other supports essential to meeting basic needs.
Medication Assisted Treatment (MAT) psychiatry services includes specialized psychiatric assessment and medication management for youth with opioid use. Youth MAT does not include withdrawal management.
High Fidelity Wraparound is a structured, evidence based, team-based collaborative planning process that develops and carries out individualized care plans for youth with reported opioid use challenges and their families. Youth may also be involved with child welfare or juvenile justice.
Peer Support via Family Support Partners (FSP) who engage the parent/guardian whose child is experiencing opioid use in individual or group services that support family voice and choice, increase family engagement in child’s substance use services, and build natural support with the goal of self-sufficiency. FSPs are professionals with personal experience navigating a child serving system with children in their care.
Independent Assessment Certification and Coordination Team (IACCT Assessment) provides assessment and recommendations when substance use residential treatment is a consideration for youth using opioids. Funding sources include Medicaid or funding from the Children’s Services Act.
Intensive Care Coordination (ICC) assists families with youth using opioids who are at risk of out-of-home placement and their professional and natural supports to find solutions, so youth remain in their community. If they are found by the IACCT assessment (see above) to meet criteria for a higher level of care, ICC services assist the family in finding an appropriate placement (i.e., group home or residential treatment).
Prevention Programs and Initiatives:
Parent Support and Prevention Approaches
The Opioid Workgroup[1], in partnership with the Alexandria City Public Schools, is developing a series of town hall meetings to facilitate community conversations in the hardest hit neighborhoods of the City as part of its strategic plan. These will launch in late March and continue through the spring. The OWG previously launched a social media campaign called “Think you know, think again,” aimed at providing short educational video clips regarding the dangers of counterfeit pills and fentanyl. Additional materials will be created to supplement the campaign in response to emerging trends at the local, state, and national levels. The city is also supporting parents and teens through Harm Reduction initiatives and access to Naloxone and Fentanyl Test Strips, including Narcan distribution in the Teen Wellness Center.
Youth Engagement in Prevention Efforts
Between October 2022 and December 2022, Substance Abuse Prevention Coalition of Alexandria (SAPCA) hosted listening tours at two middle schools and two high schools to incorporate youth expertise in prevention planning efforts. As a result of these visits, over 300 middle and high school students reviewed the latest youth substance use data trends, provided their reactions to this information, and shared strategies to prevent and reduce youth substance use in their community. The invaluable feedback shared by students will enhance SAPCA's efforts to prevent youth substance use, misuse, and abuse.
Reducing Access to Medication
In 2022, the City of Alexandria collected and safely disposed of 1,593 pounds of medication – 583 pounds stemming from two drug take back day events and the remaining 1,010 pounds resulting from the City’s three permanent medication drop-boxes. These permanent drop boxes provide year-round access to safe drug disposal for all Alexandria residents. Information about safe medication disposal at home is also available on the City’s website.
Additionally, DCHS continues to distribute locking medication boxes for safe medication storage. Through partnerships with ALIVE, the Alexandria Police Department, the Alexandria Sheriff’s Office, Alfred Street Baptist Church and several other community partners, DCHS distributed 1,776 locking medication boxes to Alexandria residents between May 1, 2021, and February 1, 2023.
DCHS Center for Adult Services Programming Addressing Opioid Addiction
Substance Use Disorder Outpatient Treatment Program (SUDOP)
The SUDOP provides outpatient individual and group psychotherapy and support services to individuals with substance use disorders and other co-occurring diagnoses. This service is provided to all individuals enrolled in the Medication Assisted Treatment (MAT) program. SUDOP subsumes other programs which frequently treat individuals with opiate use disorders, including:
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Recovery, Engagement, Action, and Learning (REAL) is a program which targets individuals involved in the criminal justice system who have demonstrated history of unsuccessful treatment and instability who would benefit from increased communication and coordination between the therapist, client, and probation officer. This service is often provided with individuals who are residents of the Friends of Guest House program.
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Alexandria Treatment Court (ATC) is another collaborative program between the Court, State probation, Alexandria Police, and the Department of Community and Human Services to provide substance use disorder treatment and other services for justice involved individuals. The Treatment Court involves a very high level of supervision and service to individuals with non-violent felony offenses who are diagnosed with moderate to severe substance use disorder.
Opioid Treatment Program (OTP) provides Medication Assisted Treatment (MAT) services to individuals with opiate dependence diagnoses. The program provides medically supervised administration of MAT medications (such as methadone and suboxone) in addition to outpatient therapy services by SUDOP therapy staff. An opioid intake coordinator provides fast-tracked admission to services and serves as the overdose outreach clinician by making outreach attempts to reported victims of overdose in Alexandria to engage in treatment services.
Detoxification and short-term residential treatment services are available to individuals requiring supervised or medical detoxification and withdrawal management from substances. Medical detoxification services are accessed through Emergency Services staff who evaluate and refer individuals, and the service is provided by Inova CATS program and paid for by regional funding. Detoxification services for less medically complex cases are provided at the Arlington Recovery Center (ARC) through a contract between Alexandria and Arlington County. The service is accessed via Alexandria City funded staff who evaluate, refer, and provide discharge planning. Inpatient treatment (up to 30 days) is also available through ARC. A 24-hour on call number to access these services is staffed by Alexandria funded therapists.
Jail Behavioral Health Team is a team of clinicians who provide mental health and substance use assessment and treatment services within the Alexandria Detention Center. This team coordinates with court, probation, families, and outpatient services to provide treatment within the jail and assist with transition and referral to community resources upon release. The program provides “release bags” to individuals leaving the jail which contain community treatment and resource information, Narcan (emergency opiate overdose reversal medication), and Fentanyl test strips. Services within the jail include the group and individual therapy throughout the jail, and the Men’s and Women’s Sober Living Units, which are 90-day intensive substance use treatment programs provided in a therapeutic community setting within the jail.
Opioid Coordinator is a clinician serving many functions in collaboration with other City agencies and other community partners to coordinate the response to the opioid epidemic with the support of the Opioid Workgroup1. The Opioid Coordinator also provides community education and outreach, data collection, and spearheads a number of collaborative plans with other agencies, including a program with the Alexandria Health Department to provide Narcan to local restaurants to distribute to customers; development with Arlington County of a 12-step meeting for youth; and a program in conjunction with Alexandria Emergency Medical Services (EMS) to provide recovery bags with treatment information and Narcan to overdose victims.
Other City programming not funded by the City, but working within the programs and services listed include:
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State Opioid Response (SOR) grant money funds aspects of the OTP program, including supplementing the number of Pharmacist hours; supplementing Nurse practitioner cost, and covering cost of backup medical Doctor; and funding for two Peer Support Specialist positions which are individuals with lived experience with substance use disorders who provide support and adjunct services to the clients of the OTP.
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High Intensity Drug Trafficking Area (HIDTA) is Federal Drug Enforcement Agency funding which pays for two clinical positions operating on the Jail Behavioral Health Team providing assessment, treatment, and release planning for individuals with substance use disorder, particularly focused on those with Opioid use Disorder.
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[1]The Opioid Workgroup (OWG) membership consists of Alexandria City Public Schools (ACPS), Alexandria Fire Department, Alexandria Health Department, Alexandria Police Department (APD), Alexandria Sheriff’s Office, Care First BlueCross BlueShield, Commonwealth Attorney’s Office, Department of Community and Human Services, Guest House, Inova Alexandria Hospital, Substance Abuse Prevention Coalition of Alexandria (SAPCA), and the Virginia Department of Corrections/Probation and Parole.