This afternoon, the Palm Beach County Commission will get its first opportunity to review the extensive report issued by an outside consultant, charged with examining the state of affairs of the treatment service delivery model as well as where resources must be assigned to overcome deficiencies.
As reported by the Palm Beach Post, the report (which can be found here) found a multitude of positive strengths to the existing response, as well as many challenges that remain and which need to be addressed.
The Report found the following to be the strengths of the existing system:
- Palm Beach County Administration’s interest in developing solutions and working collaboratively with community partners;
- Commitment on many levels by a diverse group of stakeholders to solve the complex community challenges related to opioid use and abuse;
- Resources from the legislature to fund the State Attorney’s initiative to focus on the treatment industry and sober homes;
- Suboxone pilot project supported by the community through existing dollars;
- The Criminal Justice Commission is bringing the Law Enforcement community together to focus on the challenge;
- Research on Medication Assisted Treatment will expand continuum to include outpatient options;
- Drug Court has robust outcomes;
- Drug
Court has committed treatment providers that allow access to services, including psychiatric, with assessments conducted on-site at Drug Court; - A group of committed treatment providers are interested in creating a peer review protocol to monitor treatment services;
- The State Attorney’s Office has worked with the Sober Homes Task Force, the Heroin Task Force and the Grand Jury to identify legislative changes to impact the system;
- The Heroin Task Force has robust involvement and commitment- representatives from diverse organizations are at the table;
- The State Attorney’s Sober Home Task Force enforcement initiatives have resulted in the arrests of several “bad actors” in the substance use treatment industry;
- The Palm Beach County Substance Awareness Coalition is working to create materials to assist families in accessing services;
- The Palm Beach County Substance Awareness Coalition is engaging the Palm Beach County School system through prevention curriculum;
- Prevention services are provided at Palm Beach County schools through DATA (Drug Abuse Treatment Association), a contracted SEFBHN provider;
- Individuals with lived experience, people in recovery, peer specialists and family members are engaged in the process;
- Numerous materials have been reviewed, including the National League of Cities/National Association of Counties and the National Governor’s Association to support evidence-based practices;
- The Medical Examiner is a partner in using data to focus on solutions;
- The Medical Examiner’s office is creating an application to track data about overdoses, suicides and deaths;
- The Florida Department of Health in Palm Beach County is an engaged partner and is supportive of the initiative, particularly regarding the co-morbidity of HIV, HepC and other communicable diseases;
- The Palm Beach County Sheriff’s Office is integrally involved and has engaged social workers as partners in their community policing efforts;
- Judge Shepherd had staff trained to administer Naloxone at Drug Court when necessary;
- The Healthcare District is expanding their resources to support people with substance use issues; and
- A support system and phone number has been created to assist when people change or lose their sober home accommodations.
Similarly, the Report found many existing challenges to the system,most of which has also been addressed in the Sober Home Task Force Report as well as the Grand Jury Report, and include:
- Need more treatment beds for uninsured and underinsured;
- Length of stay in residential does not meet the needs (LOS based on insurance);
- Need sober housing for teens;
- Need training for Emergency Room doctors, nurses and techs about how to work with individuals who are abusing substances;
- Palm Beach County citizens cannot access treatment services in Palm Beach County due to the influx of out of state participants;
- Florida based insurance (i.e., Florida Blue) pays less for in-state treatment so treatment centers prefer to fill beds with out-of-state people;
- Only two (2) of the twenty-five (25) (Boynton Beach and Delray Beach) local law enforcement agencies in Palm Beach County use Naloxone in the community;
- The Community needs to be further engaged in carrying and utilizing Naloxone;
- Families do not know where to turn to get legitimate help for access to treatment;
- There is a lack of safe, stable, and affordable housing options in the community (people are homeless or end up in unstable housing situations);
- There are not enough residential beds to support discharge from the hospital;
- Marketing practices of some for-profit treatment centers may put clients at risk;
- Need local support for clean needle exchange programs;
- Limited services are available in Belle Glade;
- Need additional funding for enhanced urinalysis testing in Drug Court;
- Number of substance related deaths has recently increased significantly;
- Emergency room toxicology screenings should be updated and improved to assist the Medical Examiner in their autopsy review;
- Medical Examiner lacks capacity to meet the increased volume of overdose deaths;
- Rebuild publicly supported substance abuse crisis response and treatment services to restore capacity lost over the past 10 years (as much as 60%) due to the closure of the Sheriff’s Office Substance Abuse and Awareness Program (SAAP) which included the Drug Farm and CARP (Between March 2015 and March 2016, there were a total of 60 individuals incarcerated from Drug Court who were waiting for a community residential treatment bed. They were incarcerated for an average of 11.6 days at a cost of $135 per day, for a total cost of $93,825);
- In order to meet the need, nonprofits need the resources to build services to insure immediate access to treatment for individuals abusing substances;
- Not all for-profit treatment providers are accountable to clinical standards through monitoring and evaluation; and
- The community needs to build capacity to provide Medication Assisted Treatment • Out of state individuals come to Palm Beach County for treatment and if they are not successful they do not always return to their home state
The Report also found some barriers that must be addressed and overcome if we are to progress in making headway against the issues at hand, such as:
- Florida is 49th out of 50 states in mental health per capita funding;
- There are funding, legal and political barriers to creating a needle exchange program;
- The number of treatment facilities outpaces the capacity for DCF program specialists to monitor those facilities;
- Marketing practices have interfered with the system’s ability to treat individuals;
- Out of state clients come to West Palm and utilize local beds that could support the internal needs of Palm Beach County;
- The current laws and rules need to be changed to address the current challenges (i.e., marketing practices);
- Once the laws change, the illegal practices change so the system needs to be vigilant.
Leading the fight on behalf of public health is County Commissioner Melissa McKinlay, whose professional experience in government and her personal experience with the loss of a loved one (the children of one of her staff) has energized her to place this public health priority as one of her main missions.
“The opioid epidemic is complex requiring a coordinated community response,” the report states, but also found, as did the Palm Beach Sober Home Task Force, that the current response is uncoordinated, underfunded and under-staffed.
In response, and during today’s County Commission meeting, the County will determine whether to hire a senior-level administrative staffer to oversee coordination of efforts; create two new positions with the Medical Examiner’s Office; and use $1 million of reserves to be applied to a range of treatment programs.
“We are not anxious to tap into reserves for this or for any other purpose,” Deputy County Administrator Jon Van Arnam said. “But in this instance, the need is so great that, from a staff perspective, we feel this is justified.”