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Sacramento County's Alcohol and Other Drug Treatment Initiative

—Toni Moore, L.C.S.W., M.P.A.

California's Sacramento County Department of Health and Human Services (DHHS) has embarked on a

major shift in the provision of substance abuse treatment services. In 1993, substance abuse-related problems were saturating the department's child welfare, mental health, public health, adult protective services, and primary health care case loads. Yet the capacity of the substance abuse treatment system could meet less than a quarter of the demand for services. Former Sacramento County DHHS Director Robert Caulk set out to tackle these problems with the Alcohol and Other Drug Treatment Initiative (AODTI). The AODTI vision—to incorporate substance abuse treatment services as an integral part of the entire health and human services system—is changing the way public services in Sacramento County respond to clients with substance abuse-related problems. AODTI's approach embodies:

An acute awareness of the impact of substance abuse on multiple service systems, including child welfare, public health, law enforcement, and criminal justice

The need for a proactive response to the underfunding of substance abuse services, which cannot meet the community's burgeoning demand for help.

AODTI's goal is to provide treatment on demand to the chemically dependent and their families. Every worker in DHHS is trained to identify substance abuse-related problems and is given the tools to begin addressing those problems with their clients. Workers who carry a client case load are certified to use the Substance Abuse Subtle Screening Inventory (SASSI) and to assess a client's level of functioning in multiple domains. Case workers apply these new skills to refer clients to appropriate levels of substance abuse care at new community-based and departmental group treatment services. Social workers, probation officers, nurses, and welfare assistance workers provide education and facilitate pretreatment groups.

Positive Results of Training

To date, over 1,500 workers from DHHS, other county agencies, and community-based organizations have participated in the training. Comments from staff have been overwhelmingly positive. Evaluation of DHHS training shows that the workers have gained significant knowledge of and confidence in dealing with substance-abusing clients. DHHS' treatment capacity has expanded to over 400 weekly group treatment slots, with child welfare, social workers, substance abuse counselors, and public health nurses often co-facilitating groups. Groups vary in their structure and content and include information and education for clients and their family members. The pretreatment groups focus on engaging clients who are at early stages of recovery (precontemplation, contemplation, and preparation phases) and may not yet be ready to take action to fully engage with treatment processes.

DHHS is developing a computerized requisition system. All substance abuse treatment slots contracted with a network of community-based treatment providers and DHHS group services will be maintained in a relational database. The system will allow county "gatekeepers" to monitor availability and, eventually, directly requisition a treatment slot for a client. The county's management of the contracted treatment capacity will ensure more immediate access to substance abuse and specialized services for DHHS' clients.

Development of the training curriculum and evaluation was made possible through a grant from the Annie E. Casey Foundation, funding from the State of California Department of Alcohol and Drug Programs, and the Sac-ramento County Department of Health and Human Services. Further infor-mation about AODTI can be obtained from Guy Howard Klopp at 916-874-9907.

Ms. Moore has 20 years of experience in child welfare and social services. She is the Administrator of the Sacramento County, California, Department of Health and Human Services Alcohol and Drug Bureau. Prior to her current alcohol and drug abuse program activity, she had an extensive background in child welfare services.

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