2008 Program Review and Evaluation

Service Descriptions

The substance abuse and addictions treatment delivery system is designed to provide a network of services for community intervention, early intervention, treatment and recovery support of individuals with a wide range of alcohol and other substance abuse/addiction problems.

Treatment and recovery support involves a complex interaction of medical, psychological, and other therapies administered by trained addictions counselors, peer counselors and other health care professionals. The system offers a broad range of treatments to address the needs of alcohol and other drug abusers and to afford opportunities for individuals to contribute to their own recovery.

In response to the national trend toward strategies that insure better access to services, more standardization, and the use of best practice protocols, DASA requires treatment providers to utilize the American Society of Addiction Medicine (ASAM) Placement Criteria.

This approach requires frequent reassessment of need and client matching. Over 140 community-based providers offer comprehensive services that include early intervention, treatment, case management, HIV counseling and testing, and continuing care. All treatment services are provided through licensed facilities, which are governed by physical safety and clinical requirements.

The population of Illinois is diverse and many specialty services are offered. Examples of these specialty services include specifically-designed services for women with children, and for DCFS, TANF, and criminal justice clients.

The Treatment Continuum

Level I (Outpatient)

Non-residential substance abuse treatment consists of face-to-face clinical services for adults or adolescents. The frequency and intensity of such treatment shall depend on patient need but consists of a planned regimen of regularly scheduled sessions that average less than nine hours per week.

Level II (Intensive Outpatient)

Non-residential substance abuse treatment consisting of face-to-face clinical services for adults or adolescents. The frequency and intensity of such treatment shall depend on patient need but consists of a planned regimen of scheduled sessions for a minimum of nine hours per week.

Level III.2 (Detoxification)

Detoxification is the process of withdrawing a person from a specific psychoactive substance in a safe and effective manner.

Case Management

Substance abuse case management services are activities designed to augment clinical services for an admitted patient. Substance abuse case management provides coordination or arrangement of ancillary services designed to support a specific patient's substance abuse treatment with the goal of improving clinical outcomes.

Early Intervention Services related to HIV

This service refers to HIV counseling and testing services.

Recovery Homes

Recovery homes are licensed facilities and possess an alcohol and drug-free housing component whose rules, peer-led groups, staff activities and/or structured operations are directed toward maintenance of sobriety for persons in early recovery from substance abuse, or those individuals who recently have completed substance abuse treatment at another licensed facility.

Level III.3

Residential Extended Aftercare (Halfway House) Halfway houses provide residential transitional living opportunities to clients in need of additional services, usually following residential rehabilitation. Services are designed to support the clients' productive return to the community. In its admission for services, substance abuse treatment services give priority to the following clients:

  • Pregnant women who are injecting drug users.
  • Pregnant and post-partum women.
  • Injecting drug abusers who are at risk for HIV and known HIV-infected persons.
  • Persons eligible for Temporary Assistance to Needy Families (TANF).
  • Illinois Department of Children and Family Services referrals.
  • Other women and children.
  • Department of Corrections (DOC) releasees who completed a prison treatment program.
  • Treatment Alternatives for Special Clients (TASC) referrals.

Level III.5 (formerly Inpatient/Residential)

Residential substance abuse treatment consisting of clinical services for adults or adolescents. The frequency and intensity of such treatment depends on patient need but consists, except in residential extended care (as defined in Administrative Rule 2060; Title 77 Illinois Administrative Code) of a planned regimen of clinical services for a minimum of twenty-five hours per week. Inpatient care, with the exception of residential extended care (as defined in Administrative Rule 2060) which requires staff that are on duty and awake twenty-four hours per day seven days a week.

Family Impact

Substance abuse and other addictive problems are considered diseases or illnesses that require a collaborative effort with the family, community, schools and peer groups to secure prevention. IDHS' Division of Alcoholism and Substance Abuse (DASA) works to strengthen and promote binding stability by combining these applications:

  • Recognizing and using natural support systems to encourage caring for individuals by family members.
  • Encouraging meaningful family participation in decisions affecting them, irrespective of the degree to which the family is determined dysfunctional.
  • Urging sensitivity to cultural traditions, values and practices of families from diverse racial, ethnic and religious backgrounds in all programs.
  • Addressing family concerns with understanding and respect.
  • Helping families identify and use existing community resources.
  • Offering services at community-based agencies when feasible.
  • Providing basic needs like food, clothing, shelter and medical care by linking appropriate resources.
  • Promoting sound preventive mental and physical health measures to alleviate alcoholism and other drug dependency.
  • Focusing its services to target family members of all ages.
  • Offering adequate protection by reporting to appropriate authorities physically abused family members of all ages including persons who may be neglected.

Need and Populations Served

Administrative responsibilities for addictions intervention and treatment fall under the Division of Alcoholism and Substance Abuse. DASA is the designated lead agency for all substance abuse and addiction-related prevention, intervention, and treatment issues for the State of Illinois. It is charged with the planning, systems development, funding, monitoring, and licensing of a statewide system of prevention, community intervention, intervention, and treatment services.

The 2003 Illinois Household Survey, Need for Treatment estimated that 1,560,844 Illinois residents aged 16 and above were in need of some level of alcohol or drug abuse or addiction treatment in 2003. It is estimated that in Illinois 35 percent of those in need may have no insurance or other means of paying for services. Applying this percentage to the potential treatment population, we arrive at a total publicly supported treatment population of 1,014,549. DASA serves primarily indigent, uninsured or under-insured patients with Medicaid and contract funds. Patient income eligibility criteria determine the appropriateness of contract dollar utilization for treatment reimbursement. Changes in private insurance coverage have decreased the availability and adequacy of coverage for treatment services and more adults and more youth will require publicly supported services in the future.

Performance Measures

?Performance Measures SFY08 SFY09 SFY10
Description Actual Estimated Projected
Number of overdoses reported by Chicago Core Hospitals related to opoids (heroin/fentanyl) addiction. 4,546 4,319 4,800
Number of individuals treated in the Methadone Program. 5,210 5,210 6,000
Number of discharges from Alcohol & Drug treatment programs classified as positive. 53,419 48,000 48,500
Percent of positive discharges from Alcohol & Drug treatment programs. 59.7% 60% 61%
Number of unduplicated patients served.* 84,167 60,000 70,000
Persons receiving alcohol & substance abuse treatment as a percent of the estimated number of persons in need of alcohol & substance abuse treatment. 5.00% 5.33% 5.33%
Persons receiving alcohol & substance abuse treatment as a percent of the desired treatment capacity. 41.1% 37.5% 41%

*This performance measure is in the process of changing from patients served during the State Fiscal Year (SFY) to patients admitted during the SFY. 84,167 is the number of individuals served during the FY 2008, 60,000 is the number of individuals estimated to be admitted during SFY 2009. In addition, this performance measure was impacted by the Governor's line item veto of SFY 2009 which resulted in a significant reduction in General Revenue funding for Addiction Treatment Services from July through December of FY 2009.

STRATEGIC GOALS, OBJECTIVES, AND ACCOMPLISHMENTS SFY 08

Priority - Health

Collaborate with human service agencies to improve the health and well-being of individuals and families and provide effective treatment to individuals in need.

Strategic Goal/Initiative 28

Decrease drug related overdose occurrences/deaths in Cook County.

Objective(s)

By June 30, 2008, increase overdose prevention education for abusers, non-EMT emergency responders, hospital ER staff, and the general public.

By June 30, 2008, work with other state agencies to develop standards and protocols to increase monitoring of Pain Management Clinics and ''Pain Doctors.''

Accomplishment(s)

DASA sponsored overdose training and outreach through a number of state funded methadone providers in 2006 and 2007. Efforts are underway to pass legislation that will expand education and prevention efforts to the general public, drug users and their families/significant others.

DASA has worked with the IDHS Pharmacy Division regarding the use and misuse of prescription pain relievers. DASA is cosponsoring training for physicians prescribing opiod pain relievers with the Substance Abuse and Mental Health Administration, the State Medical Society and the Illinois Society on Addiction Medicine.

Strategic Goal/Initiative 30

Improve effectiveness of treatment for persons with co-existing disorders (chronic mental illness and addiction) by stabilizing needs of food and shelter.

Objective(s)

Through June 30, 2008, continue key recovery support services for 40 persons with co-existing disorders through the Federal Chicago Collaborative to End Chronic Homeless Project.

Accomplishment(s)

The Chicago Collaborative to End Chronic Homelessness Project, now known as the ARCH Program, met the goal to service 40 persons with co-existing disorders through June 30, 2008. Approximately 53 persons were housed, and continued to receive support services related to their addictions, mental health, medical, employment and educational needs.

Strategic Goal/Initiative 31

Improve treatment outcomes for DASA customers by reducing time waiting for treatment initiation/date of first service and/or continued recovery support services.

Objective(s)

By June 30, 2008, decrease client no-show rate from 50 percent to 30 percent.

Status: The FY 08 rate for against staff advice/noshow discharges was 38.75 percent.

By June 30, 2008, decrease the time from first contact to first treatment session among 10 pilot sites from 30 days to not more than 5 days.

Status: There was a 10.3 percent reduction in time from date of first service to date of second service.

Accomplishment(s)

The Substance Abuse and Mental Health Services Administration transitioned the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) to a Performance Partnership Grant in 2004. DASA received a competitive award in 2007 supporting assessment, review and change of provider and state procedures impeding client access to care and treatment/recovery outcomes. Funded providers and DASA staff have received training in process improvement and change leadership.

After starting with the Mt. Vernon, Illinois addiction treatment network, process improvement support has become available statewide, either through State or Peer Led improvement networks.

STRATEGIC GOALS AND OBJECTIVES SFY 09 - 11

DASA works in conjunction with the Advisory Council Committee on Planning and Budget each year to develop goals and objectives related to these three focus areas. The Goals and Objectives for 2009 and 2010 (Illinois State Substance Abuse Plan 2003-2009) are as follows:

Priority III - Health

Collaborate with human service agencies to improve the health and well-being of individuals and families and provide effective treatment to individuals in need.

Strategic Goal/Initiative 28

Decrease drug related overdose occurrences/deaths in Cook County.

Objective(s)

By June 30, 2009, maintain emergency room heroin overdose events in Cook County at the FY 08 level of 4546.

By June 30, 2010, decrease by 10 percent the emergency room heroin overdose events in Cook County.

By June 30, 2010, decrease by 50 percent the number of overdose deaths reported by Chicago Core Hospitals (into Drug Abuse Warning Network - DAWN) related to opoids (heroin/fetanyl) from 346 to 173.

Strategic Goal/Initiative 29

Expand coverage for the opiate treatment program to reduce waiting lists.

Objective(s)

By June 30, 2011, increase treatment capacity in Opiate Maintenance Treatment (methadone programs) by 160 people from 5210 to 5370.

Strategic Goal/Initiative 30

Improve effectiveness of treatment for persons with co-existing disorders (chronic mental illness and addiction) by stabilizing needs of food and shelter.

Objective(s)

Through June 30, 2009, continue key recovery support services for 60 persons with co-existing disorders through the Federal Chicago Collaborative to End Chronic Homeless Project.

Strategic Goal/Initiative 31

Improve treatment outcomes for DASA customers by reducing time waiting for treatment initiation/date of first service and/or continued recovery support services.

Objective(s)

By June 30, 2009, increase by 5 percent the number of positive discharges from Alcohol and Drug treatment programs from the FY 08 percent of 59.7 percent (53,412) to 64.7 percent (57,852) for FY 09.

Strategic Goal/Initiative 32

Increase capacity of DASA programs.

Objective(s)

By June 30, 2011, work with medical provider staff to increase access to needed medication via state pharmacy.

By June 30, 2011, work with pharmaceutical companies and medical providers to implement an indigent pharmacy program to serve 600 patients.

July 1, 2010, through June 30, 2011, work with the DMH to implement ''Integrated Recovery Management Services for Co-occurring Disorders'' for 25 unduplicated patients.

Strategic Goal/Initiative 33

Increase capacity of DASA programs

Objective(s)

By June, 2010, submit budget initiative which adequately addresses capacity issues of DASA methadone and recovery support programs.

FUTURE PRIORITY INITIATIVES/ GOALS/OBJECTIVES

Below are priority initiatives/goals/objectives not yet entered into the IDHS Strategic Plan.

Strategic Goal/Initiative

Improve Treatment Outcomes through development of a Recovery-Oriented System of Care to include professional and peer based services that reflects the current thinking and practice emerging from substance abuse researchers. Recovery support will include all aspects of community involvement (jobs, social reintegration, relapse prevention) to support a sustained recovery during and post treatment.

Objective(s)
  • DASA will establish three pilot recovery centers in culturally diverse communities

Strategic Goal/Initiative

Increase Accountability and Efficiency in Service Delivery and Provider Contracting

Objective(s)
  • Develop Data-Driven Performance-Based Contracts through a system of well managed data that can provide DASA and the provider organizations an objective view of organizational activity.
  • Develop a Web portal for DASA providers to access current data.
  • Develop individualized DASA performance-based contracts.
  • Publish individual DASA provider performance reports.