County May Try To Kick The Substance Abuse Treatment Center Habit



July 3, 2014

Everyone except drug dealers agrees that getting people off of drugs is a good idea, but some county commissioners and county administrators are questioning whether a county-funded 30-day residential program is the best and most efficient way to address the county’s substance abuse problem.


Guilford County is in a highly select group of North Carolina counties in this regard because it offers a long-term residential treatment center funded entirely with county money.  The Guilford County Substance Abuse Treatment Center stays at capacity, but recently some commissioners and others in county government have been pointing out that the treatment center is expensive, and they are openly questioning whether the center is the best use of county funds.  Last year, the center cost Guilford County about $2.4 million to run.


Guilford County is spending more per capita on mental health care than nearly every other county in the state and the center is one of the big ticket items adding to that cost.


 The residential clinic, like the rest of Guilford County’s mental health services, is administered by Sandhills Center, a mental health management association based in West End, NC.  Sandhills oversees mental health services for Guilford County and eight other North Carolina counties.


Guilford County’s residential treatment center on 5209 W. Wendover Ave. in High Point has 56 beds and is operated by Daymark Recovery Services.  The treatment center uses what’s known in the trade as a “high-intensity group-living model,” offering a daily schedule of services in a group environment for a minimum of 30 days.  It treats only Guilford County residents who have a diagnosed substance abuse disorder.  After a client has completed treatment at the center, he or she is usually referred to a provider of outpatient care.


The website for the treatment center clearly states the cost to clients: “Guilford County rate is $00.00.  In the residential program there are no fees charged by Daymark Recovery Services.”


Though there’s no charge for those being treated, the county spends about $2.4 million a year to provide the service, one that’s rarely offered by other counties in the state.


At a recent budget session where the issue came up, Commissioner Jeff Phillips and other commissioners said they want to explore whether this is the best way for the county to spend taxpayer money.


“It merits some serious evaluation,” Phillips said.


Phillips has worked extensively with the homeless population through community outreach efforts he’s been involved with, including NightWatch Ministry, which is funded by the Salvation Army.  In that capacity, he has worked with those who have drug and alcohol problems.


Phillips said that, even without the center, there are places that substance abusers can seek help.


“There are other private options in Guilford County,” Phillips said.


Commissioner Hank Henning said that Guilford County has mandated services that it’s required by law to provide and it has non-mandated ones as well – the category where the county has a choice and can save money.  Henning said the clinic is costly and non-mandated and he said it’s something the commissioners need to revisit.


“I’m not saying I’ve made up my mind,” Henning said, “but we really need to look at these non-mandated services.  We’re strapped for money.”


Henning said Guilford County should research how Mecklenburg County, Wake County and others handle substance abuse treatment.


“What do their citizens do?” Henning said.  “We’re not the only ones with a substance abuse problem.”


Commissioner Alan Branson also said he has some major questions about the viability of the treatment center, especially given the cost.


“What I’m trying to figure out is if we’re the only county in the state that does it,” Branson said.  “Some talk like, if we are, then maybe it’s a star in our crown, but I may have to beg to differ.  It’s one of those age old things – sooner or later people are going to have to figure out that government and the county can’t take on every problem.”


Sandhills Chief Executive Officer Victoria Whitt spoke with Guilford County commissioners recently about the substance abuse clinic and other issues related to mental health services in Guilford County.  Whitt said the success rate of a 30-day residential treatment center is higher than those with shorter stays.  However, the longer term means that the program isn’t eligible for Medicaid funding.  Medicaid will only fund a 14-day program of that type, but not ones where stays are longer.  Whitt said that’s one reason there are a lot of 14-day providers across the state.


Whitt told the commissioners at a budget work session recently, “I would also understand if you wanted to rethink the model.”


Phillips said his experience and his research leads him to question if a 30-day model is really much more effective than a 14-day model.


“Fourteen to 30 days is nominal when it comes to long-term substance abuse as I understand it,” Phillips said.  “I’m not suggesting I’m an expert, but my experience and the forums I’ve attended and what I’ve read indicate to me that a best-case scenario to see positive outcomes is long-term treatment of six to 18 months – not days.”


He said that suggests to him that the county needs to rethink the way it spends the money.


“I’m questioning whether this is the best use of about two and half million dollars of county funds,” Phillips said.  “We certainly have to be sensitive about the need for treatment but we also want to be smart about the way we spend taxpayer funds.  We don’t want to be doing it just to be doing it – we want to see positive outcomes.  So the questions are, A, should it be run a different way, and, B, should we be doing it at all?


According to reports provided by Sandhills, in the 2012-2013 fiscal year, the clinic served 556 patients and, in the first six months of fiscal 2013-2014, it served 340.


About 88 percent of clients completed the group living portion of the program and, once they leave, about 78 percent move into a follow-up treatment program within five business days of finishing the 30-day program.


Guilford County Manager Marty Lawing, when asked his opinion of the county running the clinic, said he was still assessing the situation and he hadn’t come to a conclusion.  Lawing said he was in the process of gathering more information about the way other counties handle substance abuse treatment and how they fund those services.


Anthony Ward, who was the director of Guilford County’s mental health services before those services were put under Sandhills, is now the chief operating officer for Sandhills.  Ward said in an email that counties in North Carolina have varying approaches to substance abuse treatment.


 “Across the State, counties have developed different programs to fit the needs of the local community,” he wrote.  “That’s the case for Guilford County as well.  The Guilford County Substance Abuse Treatment Center is a critical element in the community’s substance abuse continuum of services.  The funding and support from the Board of Commissioners ensures the availability of the Treatment Center services.”


He also stated that other counties do provide some funding for similar services.


“In Mecklenburg County, the Provider Services Organization (a Mecklenburg County department/service) offers a 40-bed residential treatment program that indicates the length of stay is based on the consumer’s needs.  Wake County Human Services contracts with UNC Healthcare for an addiction treatment center at Wakebrook.  This facility offers substance abuse residential treatment for men and women.  It is my understanding that these facilities receive county funding from their respective counties.”


While some commissioners and administrators want to reevaluate the county’s substance abuse treatment services, others say they’re opposed to the new attempt to revisit a matter that was decided years ago.  They say this is treading old ground and there’s no reason to second-guess the former board that established the 30-day residential drug treatment center.


Commissioner Carolyn Coleman said that reconsidering the clinic is a big mistake.  She said she remembers well the discussions among commissioners nearly a decade ago when the county began talking about establishing the clinic, and she added that the board thoroughly weighed the options and then came to the decision to establish the center after a long involved process.


“I was on the board at that time and we discussed it and discussed it,” she said.  “I would hope the board would stay true to its word.”


Wally Harrelson, the late former longtime public defender for Guilford County, was a big proponent of establishing the long-term treatment facility and, after lengthy discussions between Harrelson, the county commissioners and other advocates, the county opened the treatment center about seven years ago.


But the commissioners who came on to the board in recent years – four of them in the last two years – weren’t a part of those discussions and, as with many things established by a prior board dominated by a Democratic majority, the new Republican-run Board of Commissioners is revisiting those decisions.


Commissioner Kay Cashion said that shorter programs, such as 14-day stay centers, often don’t have addicts long enough to help them in any meaningful way, but that there is a greater success rate with 30-day programs.


Commissioner Ray Trapp said that, while it costs money to pay for care for those with substance abuse problems, it will cost much more for the county to pay for those users down the road.  Trapp said that doing away with these much needed services would be “penny wise and pound foolish.”


Trapp said, “We’re going to either pay for them on Wendover or pay for them later in other ways.”


A good number of substance abusers wind up in the county’s jails and emergency rooms, and they often rely on constant public assistance for survival.








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