Klickitat County Intervention Treatment Aftercare

Klickitat County

Intervention  Treatment  Aftercare

Six-Year Strategic Plan

2007-2013

First Revision June 1, 2007

Developed by The Klickitat County Substance Abuse Advisory Board In Partnership with Klickitat County Health Department, Skamania Klickitat Community Network, And committed citizens of Klickitat County

To meet Strategic Planning requirements set forth by The Division of Alcohol and Substance Abuse

1 Table of Contents

Strategic Plan Overview 3 Klickitat County P-I-T-A Goals 4 Initial Networking and Community Assessment 6 Mobilization and Capacity Building to Address the Needs 10 Klickitat County Intervention, Treatment, and Aftercare 11 Goals and Strategies Strategic Plan Evaluation 25 Annual Activity Timelines 2007-8 Annual Activity Timeline 26 2008-9 Annual Activity Timeline 27 2009-11 Biannual Activity Timeline 28 2011-13 Biannual Activity Timeline 29 Supporting Data Prevention and Intervention 30 Treatment 35 Treatment Expansion Section 47 Criminal Justice Section 51 Exhibit Exhibit A: SAAB Logic Model 60 Exhibit B: PITA Community Questionnaire 61 Exhibit C: PITA Community Questionnaire Dissemination Plan 63 Exhibit D: PITA Community Questionnaire Results and 65 Responses

2 Strategic Plan Overview

Efforts to develop a six-year strategic plan for prevention, intervention, treatment, and aftercare services in Klickitat County were initiated by strategic planning requirements set forth by the Division of Alcohol and Substance Abuse (DASA) in cooperation with Community Mobilization Against Substance Abuse (CMASA). The strategic plan is necessary to meet RCW 70.96A.320 and RCW 70.96A.350.

In addition to meeting these state and federal funding requirements, the six-year strategic plan provides a structured format for discussing the long term service needs and goals of Klickitat County in the areas of substance abuse prevention, intervention, treatment and aftercare. Planning efforts were led in partnership by Deidre Duffy, the county’s Prevention Coordinator and staff person to the county’s CMASA Board, and Lindsay Miller, County Coordinator for Chemical Dependency Programs and staff person to the Substance Abuse Advisory Board (SAAB). Various factions of the community, including several advisory and governing boards, community groups, and unaffiliated community members were included in the strategic planning process between June, 2006 and June, 2007.

The Skamania Klickitat Community Network (SKCN) worked to develop the goals and strategies outlined in the prevention portion of the strategic plan. This is a combined membership board constituting members from both Family Policy Council and CMASA Boards. Members meet monthly to discuss prevention issues including topics around parenting supports, after school programs, violence prevention, and community bonding. The SKCN board meetings held in December, 2006 and March, 2007 were dedicated solely to strategic planning efforts for prevention services.

The Substance Abuse Advisory Board (SAAB) played a key role in development of the intervention, treatment, and aftercare portions of the strategic plan. The SAAB is comprised of ten Board Members representing public health and healthcare, corrections, social services, the recovery community, parents, and the faith community, among other interests. Their mission is to “assist in the development, implementation, and evaluation of Klickitat County chemical dependency programs” (Exhibit A).

The resultant six-year strategic plan illustrates the collaborative planning efforts of committed individuals in Klickitat County. It identifies specific needs in the areas of intervention, treatment, and aftercare for substance abuse issues in the county, and outlines supporting data demonstrating the significance of the identified needs. In addition, the plan outlines targeted goals, outcomes, strategies, and evaluation indicators for providing high quality chemical dependency services in Klickitat County over the next six years.

The Klickitat County PITA Strategic Plan is intended to be a working document, one that is periodically updated to accurately reflect the service needs and goals of our

3 community. Through the strategic planning process, four goals for prevention and fourteen goals for intervention, treatment, and aftercare services were identified as priority.

Klickitat County P-I-T-A Goals Preventi on Goals (please see the Prevention Section for details): 1. Increase community awareness about substance abuse in order to reduce community laws and norms favorable to substance abuse. 2. Increase communication between parents, community, schools and church in order to improve neighborhood attachment. 3. Increase opportunities for pro-social involvement for youth to improve bonding to school. 4. Increase opportunities for youth to bond with their families while increasing family management skills. Intervention Goals 1. Build collaborative relationships between schools, intervention programs, treatment providers, and community based services. 2. Develop additional intervention services across the county to complete the service array. Treatment Goals 3. Change the community perception that treatment is not affordable. 4. Reduce transportation related barriers to treatment. 5. Increase access to timely chemical dependency assessments. 6. Develop and implement a family component to county-funded chemical dependency treatment. 7. Improve coordination and availability of chemical dependency related crisis services for people in our county. 8. Support positive workforce development in the chemical dependency field both locally and statewide Youth Specific Treatment Goals 9. Increase youth treatment completion rate to a rate consistent with the statewide average. Treatment Expansion Goals 10. Increase outreach and engagement for aged, blind, disabled, people receiving TANF, SSI, GUA, or GAX assistance and are in need of chemical dependency treatment.

4 Criminal Justice Treatment Goals 11. Improve access to treatment for criminal justice involved clients. Aftercare Goals 12. Decrease community acceptance of substance abuse in our community. 13. Increase community resources to help people in recovery develop supportive social networks. 14. Develop clean and sober housing in our community.

5 Initial Networking and Community Assessment

To start the planning process, a service assessment across the prevention, intervention, treatment and aftercare continuum was initiated through the development and dissemination of a community survey by the Substance Abuse Advisory Board in September, 2006. This community survey, called the PITA Community Questionnaire, was developed through a series of meetings by the Substance Abuse Advisory Board. The purpose of the questionnaire (Exhibit B) was to gather a wide range of community perspectives to determine the greatest needs in each of the four service categories (prevention, intervention, treatment, and aftercare). From a list of possible risk factors, barriers, and unmet needs, survey respondents were asked to identify which factors most contribute to substance abuse in Klickitat County. Questions specific to the needs of youth, parents, persons with disabilities, and the elderly were included in the questionnaire. The questionnaire was translated into Spanish, developed to accommodate a fifth grade reading level, and was available both on the web and in paper format.

To circulate the questionnaire, the SAAB developed a dissemination plan (Exhibit C) that utilized the community connections of each Board member. Target audiences identified in the DASA strategic planning guidelines were assigned to Board members depending on their community ties, and over 350 paper copies of the questionnaire were circulated. Members of the Community Mobilization Against Substance Abuse (CMASA) and Family Policy (FPC) council boards were also involved in distributing the survey. Articles about the survey were printed in the two local newspapers. They included contact information and a link to the online survey website. Email list serves also distributed the link to the survey. In addition, surveys were left in a wide variety of public locations, such as the Health Department and WorkSource offices. Some service providers, such as probation officers and chemical dependency professionals, also included the surveys in their client’s required paperwork.

A total of 281 surveys were completed, either online or by hand, representing the opinions and input of nearly every targeted group. The results were lacking respondents in the categories of gay/lesbian/bisexual/bi-gendered and pregnant women. Approximately 68% of the respondents were female, and about 66% were between the ages of 36 and 65. About 18% of the respondents were between the ages of 21 and 35, about 5% were under 21, and 11% were over 65. The reported zip codes of the questionnaire respondents ranged across the entire county.

Out of about 50 possible risk factors included in the survey, 11 priority needs were identified (Exhibit D) and served as the basis for the strategic plan. The questionnaire results showed that, under the Prevention heading, respondents felt the following risk factors contributed most to substance abuse:  Drugs and alcohol are easy for youth to get (77.7%)  Our families lack parenting skills (68.7%)  Parents are not involved in their child’s schooling (73.7%)

6  Our youth experiment with drugs and alcohol at a young age (75.4%)

Under the Intervention heading, the survey showed that:  A lack of affordable counseling for youth, individuals, and families (48.1%) and  The lack of mentoring programs for youth (47.4%) most contributed to substance abuse.

With respect to Treatment barriers, respondents felt that:  People can’t afford to pay for treatment (53.2%) and  A lack of transportation makes it hard for people to attend treatment (49.8%).

Under the Aftercare heading, the greatest factors contributing to substance abuse in this county were:  There is high acceptance of substance abuse in our county (48.7%)  It is hard for people in recovery to make new friends who don’t use (48.7%)  We lack clean and sober housing resources in our county (449%)

In addition, the survey results drew over 150 individually written responses to the question “What do you think the County should do about substance abuse?” The responses ranged in content and opinion from Provide residential treatment and aftercare programs right here in Klickitat County. Provide early education to our children. Make the community more aware & enlist their help towards prevention activities - Provide more alcohol and drug-free activities for our children to “Education!” to “Just keep trying to reach the people that need and want help.” For a complete list of the survey responses, please see Exhibit D. The PITA Community Questionnaire results were analyzed and used as the basis for the PITA Strategic Planning efforts. Targeted goals were drawn from the top risk factors in each category, and anecdotal data were taken into consideration when identifying needs.

In addition to the information gathered on the PITA Community Questionnaire, community information was also solicited through various community meetings:

Youth Advisory Boards The prevention specialist/CM coordinator, tobacco prevention specialist, and a CM board member conducted a series of focus groups with youth advisory boards in two high schools (White Salmon and Lyle) in order to get more youth input. Over 35 students participated. They came from a variety of social circles. Identified Needs—The students involved discussed many contributors to substance abuse and strategies to eliminate the problems. The youth identified the following as contributors to substance abuse: pain due to relationship (family and peer) problems, lack of low cost, community-based (non-school) activities, lack of transportation to activities, poor school spirit, not enough parental involvement, too

7 few school counselors and poor communication about opportunities. They also discussed parental acceptance of substance abuse as a problem. Identified Resources—One school’s youth felt that they had received a lot of information about drugs in school. The sports programs were seen as an asset for those who are interested in sports. Teachers who cared about kids were also identified as a resource. Some said that the internet, especially myspace, was a valuable tool for communication.

The Network Café In order to get the perspective of parents and their needs, the Skamania Klickitat Community Network (SKCN) hosted a network café discussion meeting. The SKCN is a coalition of CMASA board members, Family Policy Council members and anyone interested in substance abuse prevention. This coalition is being mentored through support of a Drug Free Community Mentoring grant. 32 people attended the hour and a half discussion circle about how to best support parents. Many concerns about lack of parenting skills and involvement had been expressed in other surveys and planning retreats. We had four circles (school focused, community focused, spiritual community focused, and agency focused). We asked: what should we keep doing? stop doing? and start doing? Parents were recruited from the recovery, low income, and Hispanic communities. We also recruited parents of younger children. Personal interviews were conducted with parents of special needs children. Identified Needs—The need for better communication was identified as a need for parents. Schools, agencies, churches, and the community at large all need to work towards communicating more clearly with parents and each other. There is a need for a greater amount of respect and acceptance of parents and youth of all types. Stereotyping needs to lessen. The need for more parenting classes was also identified. Identified Resources—School newsletters, parent- teacher conferences, mandatory parental involvement in disciplinary actions, after- school programs, community councils, faith based youth groups, art shows, prevention information, community resources directory, gorgekids.net, and interagency connections were all seen as community resources.

Horizon - poverty reduction discussion circles Five communities in Klickitat County (White Salmon, Glenwood, Trout Lake, Klickitat, and Goldendale) held a series of discussion circles as part of the Horizon poverty reduction project. 290 people participated in five 2 hour facilitated meetings in which belief systems about poverty, community needs and resources and ideas about action plans was discussed. According the 2000 census Klickitat County has a 17% poverty level. People in poverty and minority groups were strongly recruited to be part of the discussion circles. The results of these discussions were included in our assessment. Identified Needs—All five communities identified poor communication between the community and government/agencies/schools and lack of community bonding as major contributors to the continuation of poverty. Some communities expressed the need for affordable housing, transportation, and skilled leadership. Identified Resources— People who care, the natural beauty of our area, schools, libraries, the mix of newcomers and old-timers and living in a small town were all seen as resources.

8 2005 Service Provider survey 51 service providers responded to a needs assessment survey conducted in 2005. When asked “what is the most significant social/public health problem or issue affecting citizens in our community?” an overwhelming majority rated substance abuse as the biggest problem. Community attachment/social isolation, child abuse and neglect, domestic violence, and low commitment to school followed significantly behind. Youth violence was the least concern. Poverty and unemployment were seen as key contributors to problems. Mental health services, parenting classes and support groups, and after-school programs were seen as the biggest need. Lack of funding was seen as the biggest barrier to offering services to meet these needs. Lack of awareness and fear were seen as the biggest barriers to people accessing services. Domestic violence, substance abuse, and parenting programs were identified as resources as well as bilingual services and increased program funding. However, all of these were identified as insufficient.

9 Mobilization and Capacity Building to Address the Needs

The strategic planning process for intervention, treatment, and aftercare services took place over several community meetings between February and May, 2007. The Substance Abuse Advisory Board provided a forum for strategic planning, and regular SAAB meetings during this time were devoted to the strategic planning process. The Board has representation from parents, community members, and professionals dedicated to improving treatment services. Its members reflect the perspectives of the healthcare, social service, criminal justice, faith based, and recovery communities. The Board has representatives from two minority groups, and over half of its members are people in recovery. In addition to the regularly scheduled SAAB meetings, strategic planning activities occurred in dedicated community meetings. The SAAB hosted a Strategic Planning Retreat in February, 2007 and invitations were sent out to a variety of community participants to elicit feedback to the strategic plan. The meeting was advertised in the local papers, and notices were sent out by email to county employees and community list serves. In addition, formal invitations were mailed to each of the County Commissioners, the Prosecuting Attorney, the Sheriff’s office, Prevention Intervention specialists, school counselors and administrators, the supervisor of the Children’s Administration office, representatives from the Police Action League, representatives from the Hispanic community, and selected healthcare professionals. A group of ten people attended the full day planning retreat, analyzed pertinent data, and developed goals and strategies for the treatment portion of the strategic plan. In May, we held a second meeting dedicated to strategic planning for intervention services. In an effort to include the input from school staff, a special invitation was made to school counselors and prevention specialists working. The two hour meeting provided time to identify current intervention resources, gaps in services, and specific goals for the intervention portion of our local service array. The first version of the strategic plan will be submitted for review by DASA officials, County officials, and the Substance Abuse Advisory Board. Additions and revisions to the plan will be made biennially at a minimum, and should accurately reflect the continuously changing needs of our community.

10 Klickitat County Intervention, Treatment, and Aftercare Goals and Strategies INTERVENTION: GOAL #1 Build collaborative relationships between schools, intervention programs, treatment providers, and community based services. OBJECTIVE: School staff, Prevention Specialists, and CD treatment providers work in coordination to provide a seamless continuum of care for youth at risk for substance abuse. Available Problem Statement Strategy Who/By When Target Indicator Resources Our current prevention, Treatment provider will DHS staff currently DHS staff to provide in- Community utilization of intervention, and offer regular offers onsite service or onsite trainings intervention and treatment treatment services for communication and outreach to schools, and presentations to at services evidenced by an youth could be better outreach to schools, CA and CSO offices least 4 community increase in school and coordinated. Referrals counselors, teachers, and partners per year community-based referrals across systems are rare community agencies Positive relationshipsbeginning October, 2007 to treatment and and communication (onsite consultation, in- with schools in intervention services. between agencies is service trainings on Goldendale sometimes lacking. chemical dependency and the services available) Develop an informational DHS resources for Treatment provider with School personnel working Target Population brochure and presentation printing county assistance as knowledge of treatment outlining intervention and needed by beginning of resources and referral treatment services County support with 2007 school year. process. Prevention, available to distribute to layout and material intervention, and community partners and development Presentations made to treatment providers school personnel. schools and community School staff members partners Build personal relationshipsYouth Treatment County to facilitate Quarterly meetings held Indicators of Success between treatment, specialist attends quarterly meetings with beginning September, Health Youth Survey prevention, and JAG meetings provider, PIs and school 2007. data intervention providers regularly. personnel for feedback Increase in number of through regular meetings and ideas on ways to school and community- and interaction. improve services. based referrals to Offer youth treatment Currently offering Provider to determine If deemed appropriate, on- treatment services on-site at schools on-site assessments need for on-site services site services are made as appropriate. as requested. through communication available beginning with school and September, 2008. intervention staff 11 12 INTERVENTION: GOAL #2 Develop additional intervention services across the county to complete the service array. OBJECTIVE: Intervention service array effectively meets the community’s needs and offers a wide variety of useful services. Problem Statement Strategy Available Resources Who/By When Target Indicator When analyzing Use prevention and Girls’ Circle training, Prevention Specialist, Boys’ Groups offered in available intervention intervention funds to knowledge, and County Coordinator to work at least 4 services, several gaps develop and support a successful with Intervention staff and schools/communities by were identified, boys social group implementation treatment provider as Fall 2008 especially mentoring program modeled after needed to develop program programs and social the Girls’ Circle training by 2008. groups for boys. currently implemented in the county. Enhance existing and/or Community Prevention Specialist, Effective mentoring Target Population develop new resources motivation around County Coordinator to resources and system in for mentorship programs developing mentoring collaborate with appropriate place by Spring 2009 Prevention, in the county through resources. community partners to intervention, and partnerships with school Possible mentor develop mentoring treatment providers and prevention staff and resources through resources. Collaborative School staff other community Americorps meetings to begin process County officials, general resources such as Existing Big Brother should start in the spring of public Americorps. Big Sisters program 2008. Continue efforts to Current DISEY County to facilitate ongoing Regular DISEY classes Indicators of Success provide effective program in place discussion and adjustment are offered and well Resource analysis alternative to suspension Well utilized by to program to best fit the utilized by the demonstrates a well program for youth in treatment and JJ needs of the community. community. developed intervention Klickitat County. Partnership between service array. DHS and tobacco prevention Develop youth support Strong Families Begin discussions of possible Youth Support Groups groups county wide for resources available partnerships and resources up and running by children of addicts Family member through community January 2009. support of the idea meetings to be held in 2008. Existing Youth Advisory Board

13 TREATMENT: GOAL #4 ReduceTREATMENT: transportation GOAL related #3 barriers to treatment OBJECTIVE:Change the community Transportation perception is not a barrierthat treatment to receiving is nottreatment affordable. ProblemOBJECTIVE: Statement The communityStrategy is aware of financialAvailable resources Resources availableWho/By Whento pay for treatment.Target Indicator Problem Statement Strategy Available Resources Who/By When Target Indicator Community perceives Assess the need of DHS DHS to track transport Needs reported to SAAB lackPeople of perceivetransportation that astransportationDevelop and implement assistance. a TARGETSAAB, SKCN, data DV task needsEducation of clients committee in treatment Communityby December Education 2007 Plan aoutpatient barrier to treatment treatment in community education force, CMASA atheaded time ofby assessmentcounty staff and to developed by January 2008 the community is not plan promoting MAT, Local media reportinclude to representatives SAAB December and implemented by March affordable. “Treatment is affordable!”County resources 2007from county 2008 Communicateto include all available with Mt MtFaith Adams community Transport Countydepartments, Coordinator SAAB, to faith Status reports to SAAB Adamsmodes ofto mediacoordinate and SAAB arrangecommunity, meeting treatment with Mt on collaborative Target Population grouppresentation. times and/or Funding for Adamsprovider, Transport media, andand/or transport solutions April other community groups General public capacity building through transportation SAAB in January 2008 2008 Ensure that County County treatment Treatment provider to Implementation reports by People in treatment additional contracts/ treatment provider provider ensure message is provider OrganizationsTarget Population grant writing, especially forpromotes youth to“Treatment attend is Available funding for delivered starting July 07 groupsaffordable!” message treatment SAAB to provide feedbackIndependent verification Advocatebeginning atwith a county initial MtChange Adams process Transport SAABand additional to write lettersmonitoring to Letters written by SAAB General public levelclient for contact a fixed and route all SAABparticipation appropriateas necessary recipients twice twice yearly beginning People in need of tx publiccommunications transportation Funding for yearly November 2007 Agency referrants systemDevelop to and be administerdeveloped transportationSurvey experience SAAB to develop Completed survey report at community perception perception survey in least every two years survey Web based collection August 2007 and Explore the possibility of Lawmode enforcement Countyimplement Coordinator perception to Status report to SAAB Indicators of Success alternate and/or mobile resources collaboratesurvey by October with existing 2007 on possible mobile SAAB Community# of people Perceptionin treatment locations in Funding for transport providers, treatment solutions by surveytreatment. response to treatment transportation treatment providers, and September, 2008 ClientCommunity barriers perception to need in rural communitiesWilling treatment other community partners treatmentsurvey provider through meetings beginning July 2008 Dependency Health Funding DHS to develop handout or First contact survey for Services to regularly DHS staff monitoring tool to ensure DHS clients inform clients of existing Mt Adams that all clients receive transportation resources transport related information and assistance available by July 2007

14 TREATMENT: GOAL #5 Increase access to timely assessments. OBJECTIVE: Average wait time for completed assessment less than 2 weeks Problem Statement Strategy Available Resources Who/By When Target Indicator Currently experiencing Track average wait time TARGET and intake DHS staff to provide wait Status report to SAAB by six week wait time for for assessments and data time report by August, August 2007 assessment report data back to SAAB.County Coordinator 2007 appointments.

Facilitate discussion with DHS DHS and County Implementation plan to Target Population Dependency Health SAAB Coordinator to develop address assessment wait Dependency Health Services and/or initiate County Coordinator assessment wait time time in place by December Services, referring contractual language Youth Treatment action place as needed 2007 if deemed necessary agencies additions to address Coordination Grant assessment wait time issues if deemed necessary by wait time report.

Indicators of Success Client wait time between first contact and completed assessment is less than two weeks

15 TREATMENT: GOAL #6 Develop and implement a family component to county-funded chemical dependency treatment. OBJECTIVE: Youth, parents, and family members of those participating in treatment will be involved in family support and treatment groups to strengthen recovery skills. Problem Statement Strategy Available Resources Who/By When Target Indicator There currently exists Complete an EBPs for family DHS staff to work with Plan developed no family component to implementation plan to component programs County Coordinator to CD treatment in our include research of Successful projects develop plan by June county. existing evidence based through CWCMH in 2008 family programs, Yakima documented local need, Willing DHS staff projected costs and Target Population utilization, possible Dependency Health community partners to Services, County include in program, and officials, families action plans for participating in implementation and treatment monitoring Secure funding for family DASA funds County Coordinator to Funding proposal complete component programs County funds develop funding proposal by June, 2008 Indicators of Success based on submitted implementation plan Family treatment component is available Implement family DHS staff and DHS to implement new Program up and running by and well utilized as component programming community partners program by July 1, 2008 July 1, 2008. evidenced in the according to plan TARGET reporting Provide family support DHS staff and/or DHS, county, and/or Support groups up and system groups for parents, community partners community partners running by July, 2009 Increase in treatment grandparents, and family develop curriculum and completion for youth members of addicts to guidelines for support and parents in follow family component groups by June, 2009 treatment of treatment

TREATMENT: GOAL #7

16 Improve coordination and availability of chemical dependency related crisis services in our county. OBJECTIVE: Chemical dependency related crises in our county are responded to in a coordinated, collaborative, and effective manner. Problem Statement Strategy Available Resources Who/By When Target Indicator Crisis response services Encourage collaborative Existing Behavioral County Coordinator to Crisis coordination plan for CD related calls are discussions and planning Health Crisis work with other developed by July, 2009. often disjointed, under- across all crisis response Coordination grant community partners funded, or nonexistent. systems to include law through Klickitat invested in crisis service Plan implementation by enforcement, health care, Valley Health Services improvement, schedule January, 2010 CD treatment, and began discussion community meetings, and transportation to develop process. help develop coordination Target Population a county wide crisis plan by July, 2009. Law enforcement response plan for Health services behavioral health crises. CD treatment providers County officials Secure adequate funding Services are currently County Coordinator to Funding to be secured for Transportation to support after hours CD available, but are work with provider and 07-09 biennium. providers on call crisis services in funded using mental DASA to develop feasible Clients at risk for ER Klickitat County health dollars. funding plan for 07-09 involvement Estimated 80% of biennium. crisis calls to MH Indicators of Success center are CD related. Reduction in number of chemical dependency related crisis events in the county as measured by Health Provider and law enforcement data and DASA TA documented ER visits.

17 TREATMENT: GOAL #8 Support positive workforce development in the chemical dependency field both locally and statewide. OBJECTIVE: Qualified chemical dependency professionals are available and committed to providing quality services in our county and across the state. Problem Statement Strategy Available Resources Who/By When Target Indicator In Klickitat County and Advocate for the fair SAAB has local SAAB to write a letter or Letters and/or activities across the state we find compensation of qualified advisory power participate in other completed annually or in a shortage of qualified CDPs across the state advocacy activities to response to legislative CDPs. Certification and locally by writing build support for developments requirements are letters, participating in increased compensation lengthy, and lobbying activities, and to CDPs locally and compensation following spreading awareness statewide certification is low in throughout the comparison to other community. professions. Develop a funding Creative minds, local CC to develop proposal Proposal developed and proposal to include grant support for workforce by May 2008 submitted to appropriate Target Population or county dollars to development reviewers County officials, support local citizens in treatment providers, obtaining their CDP state leaders and certification legislators

Indicators of Success Decrease in local CDP attrition rates

Increase in CDP wages

18 YOUTH TREATMENT: GOAL #9 Increase the youth treatment completion rate to a rate consistent with the statewide average. OBJECTIVE: Youth treatment completion rate will increase from 26% to 45% over the next six years . Problem Statement Strategy Available Resources Who/By When Target Indicator Our county’s current Provide Youth Treatment DHS staff committed DHS staff to select two Biannual youth treatment youth treatment Specialists will attend to providing quality youth specific trainings specific trainings attended completion rate of 26% additional trainings youth services per year for targeted staffby targeted DHS staff is well below the state specific to providing County funding and County Coordinator to beginning in 07-09 average of 42%. effective youth services community priority forallocate adequate funding biennium. youth treatment to pay for these trainings

Target Population Dependency Health Services, youth and Incorporate family Increased youth treatment families in treatment component into youth completion rate Indicators of Success treatment model (see Treatment Goal #4) Youth treatment completion rate reported in DASA Treatment Analyzer Develop and implement DHS staff committed DHS to develop proposal Support groups up and an aftercare or relapse to providing quality and implementation plan running by July, 2008. Monitor incremental prevention support group youth services by April, 2008 improvement, with an for youth completing County funding and expected increase in treatment. community priority for completion rate of 5- youth treatment 7% per biennium.

19 TREATMENT EXPANSION: GOAL #10 Increase outreach and engagement for aged, blind, disabled, people receiving TANF, SSI, GAU, and/or GAX assistance in need of CD treatment. OBJECTIVE: People qualifying for Treatment Expansion funding are aware of financial resources and know how to access chemical dependency treatment. Problem Statement Strategy Available Resources Who/By When Target Indicator We need to increase Increase collaboration Funding for position Collaboration between Improved utilization of outreach and and effectiveness of available Coordinator, treatment outstationed staff person’s engagement of outstationed counselor Desire to maintain provider, and DSHS staff to time and staff perception Treatment Expansion positions at DSHS offices and improve positionbrainstorm and implement of the position clients. in Goldendale and White Successful CA position improvements by Salmon outstation September ‘07 Increase collaboration ESD 112 and county County staff, treatment Collaboration plan with KC Developmental willing to partner provider staff, ESD 112 developed by December, Disabilities provider (ESD staff to meet by Dec ’08 to 2008 112) develop collaboration plan Increase collaboration DV staff, county DV staff, county staff, Collaboration plan Target Population with domestic violence staff, treatment treatment provider to meet developed by January, People who qualify for resources (DVR) provider and develop collab. plan 2008 Treatment Expansion Increase outreach, Behavioral Health Treatment provider staff Collaboration plan funds collaboration and Crisis Coord. Grant, and County Coordinator to developed by March, 2008 Referral agencies communication to ER and KVHS, Skyline facilitate collaborative Health Services, hospital, treatment discussions with Indicators of Success especially detox services provider staff appropriate healthcare Increase in numbers of in East end of the county providers beginning Feb ‘08 Treatment Expansion to facilitate smooth clients served referrals and treatment admissions Provide training and Large network of in County Coordinator, Trainings and information referral information to home care treatment provider staff, provided to in home care Senior Services In Home providers, strong Senior Services staff to providers Care Providers senior services meet July ‘07

20 CRIMINAL JUSTICE TREATMENT: GOAL #11 Improve access to treatment for criminal justice involved clients. OBJECTIVE: People involved in the criminal justice system have access to chemical dependency treatment. Problem Statement Strategy Available Resources Who/By When Target Indicator We need to increase Encourage faith based, Existing faith based County Coordinator will Groups available in jail for access to treatment for 12-step, and other groups (SAFE, invite group reps to a people who want to Criminal Justice support group presence Freedom Now) SAAB meeting & ask how participate by January involved clients in local jail. Supportive law we can support them 2008. enforcement November, 2007 AA/NA contacts Facilitate collaboration DHS Set up necessary Resource plan in place by Target Population between Sheriff’s Supportive law meetings to develop January, 2008 Criminal Justice Department, jail, and enforcement treatment resource plan involved clients Chemical Dependency Crisis coordination for jail services by Jail services as needed in treatment provider to grant September, 2007 place by July, 2008 assess unmet inmate needs and develop a plan as needed Request additional CJTA State funds available County Coordinator Additional funds awarded funds for 07-09 and for 07-09 biennium Indicators of Success subsequent biennia More criminal justice involved clients entering treatment Continue participation in Program is up and CC to allocate funds, Adequate utilization of the regional CJTA running and was well renew contracts, audit service by Klickitat County Innovative project for the utilized by Klickitat facilities, and monitor clients. Pathways Co-occurring County in the 05-07 services on an ongoing mental health and biennium. basis. chemical dependency inpatient program in Sunnyside.

21 AFTERCARE: GOAL #12 Decrease community acceptance of substance abuse in our community. OBJECTIVE: Substance abuse is not an accepted norm in our community. Problem Statement Strategy Available Resources Who/By When Target Indicator Substance abuse is Develop and implement a SAAB SAAB/Beginning of 07/09 Survey developed by April, accepted in our community wide survey SKCN biennium 2008 community to measure the level of Prevention strategies Survey disseminated and community acceptance of for measurement results analyzed by June, substance abuse. Survey expert 2008

Provide positive drug and Existing resources Create plan for county County supported activity alcohol free community (transitional housing, supported activities by plan developed by March, events for youth and community events, March 2008 2008 families community ed, parks Support biannual and rec., SKCN, etc) community events Drug and alcohol free Schools beginning June 2008 events take place on a biannual basis beginning June 2008 Develop and disseminate SAAB, Prevention SAAB to lead campaign Social marketing/campaign Target Population a media/word of mouth staff, materials, and efforts following plan developed January General public campaign built upon the knowledge, SKCN completion of community 2009 People in need of tx results of the survey. Local media, survey Businesses Use questions, Community groups SAAB to develop media Social marketing campaign Youth and Families community discussions, Faith based groups, campaign by January plan implemented February and individual Schools 2009 2009-February 2011 connections to develop community relationships Indicators of Success Utilize AA and Meth MAT has hired, SAAB to get the word out Community speakers are Community perception Action Team public qualified speakers in to the public that being utilized at least survey speakers to present at recovery speakers are available quarterly at engagements community events, to AA has community and facilitate connections throughout the county by groups, schools, etc. relations coord and February 2008 volunteer speakers

22 AFTERCARE: GOAL #13 Increase community resources to help people in recovery develop supportive social networks. OBJECTIVE: People in recovery have resources to help them build a clean and sober social network. Problem Statement Strategy Available Resources Who/By When Target Indicator It is hard for people in Provide positive drug and recovery to find friends alcohol free community who don’t use. events for youth and families (see related strategy for Aftercare Goal #1) Help with the development Gorge Family Resource County Coordinator Communication system is in of a coordinated Guide, SKCN Parent to partner with place and the community communication system to Coordinator, Klick Co prevention, knows about it by January, disseminate information onwebsite, Klickmeth parenting, and 2010 Target Population community events, website partner staff General public services and resources People in recovery Develop peer to peer Peer to peer model for Partnership between Peer to peer services added Referral agencies coaching resources for mental health services, county and provider to the local service array by Treatment providers people in recovery Liquor tax funds, best staff Services should July 2009 Corrections, DSHS practice peer models be available July 2009 Develop recovery resource Bunny Nadler and MAT MAT, SAAB, County Resource rooms exist in center in each major already looking into staff each community by June Indicators of Success county community logistics for starting Resource room in GD 2010 # of new recovery resource room in GD. by Sept ’08. Other support resources Liquor Tax dollars might communities by June supplement efforts. 2010 Ensure utilization of local Strong and active AA Adult probation, % of clients in treatment AA resources, community community locally prosecutor, judges, who participate in 12-step events, and hotline by Adult probation and treatment provider, program requiring participation for treatment provider ongoing and already Criminal Justice and CD support participation in in place treatment clients AA

AFTERCARE: GOAL #14

23 Develop clean and sober housing in our community. OBJECTIVE: Clean and sober housing resources exist for people in recovery in Klickitat County.. Problem Statement Strategy Available Resources Who/By When Target Indicator We lack clean and soberIncrease collaboration Work already done on SAAB, Continuum of Care Housing plan in place to housing resources in and support for the long term housing housing group include specific housing our community. Continuum of Care plan, bid in to the resources for people in housing group working to state to receive recovery per housing develop homeless and housing funds, strong committee’s timelines for transitional housing community support plan completion and resources in the county. for efforts, treatment implementation The group hopes to be representative on awarded housing funds housing committee Target Population directly from the state to General public continue efforts to People in recovery develop housing Community resources. organizations County Officials

Indicators of Success # of clean housing resources

24 Strategic Plan Evaluation

The Klickitat County six-year strategic plan will be evaluated and revised at least biannually, with the first revision to occur before June 1, 2009. In addition to the required biannual updates, we will revise the plan as needed to accommodate the shifting priorities and needs of our communities.

To monitor progress made on the plan, we will use the following Activity Timelines to track strategies that have been completed over the next six year. These Activity Timelines are intended to be used as a tool for holding our community accountable to the goals that have been set forth in this plan. As goals and strategies contained in the strategic plan change, as they are expected to do over the next six years, the corresponding Activity Timeline will be updated. The Activity Timelines will be tracked on a quarterly basis by our Substance Abuse Advisory Board to monitor the progress made with respect to each strategy and goal.

In addition, each goal set forth in the strategic plan has corresponding “Indicators of Success” identified for qualitative monitoring of each goal. Each strategy, in turn, is associated with an intermediate target indicator to monitor both the effectiveness of the strategy, and whether or not each strategy has been completed. Strategies include clear timelines and identify people responsible for the follow through of each strategy.

25 26 27 28 29 Supporting Data: Prevention and Intervention

Are OUR children using alcohol?

…while driving? …recently? Percent of students who report drinking and driving OR riding with a driver who had been drinking Percent of students who report having a drink in the past month driving 26% 24% 25% riding 16%

42% 9% 8% 34% 23% 9%

Grade 8 Grade 10 Grade 12 Grade 6 Grade 8 Grade 10 Grade 12

…frequently?

Percent of students who report drinking on 3 or more days in the past month

How do students who drank during the past month get their alcohol? 19% 15% 10% 2%

I got it at a Grade 6 Grade 8 Grade 10 Grade 12 party 19% I got it at home with permission 13% …heavily? I got it some other way 17%

I took it from home without permission I bought it 9% from a store 23% 19% 2% 14% 0%

I got it from Grade 6 Grade 8 Grade 10 Grade 12 I gave money friends to someone 16% to get it for me Percent of students who report drinking heavily 24% (5 or more drinks in a row) at least once Survey results are generated from in the past two weeks student responses to the statewide 2004 Healthy Youth Survey. To find out more about the Healthy Youth 30 Survey, please visit http://www3.doh.wa.gov/HYS How strong are the barriers to drinking in our community? Percent of students who feel that their Percent of students who think they parents* think it is only "a little bit wrong" or will get caught by parents* or police "not wrong at all" for their teen to drink alcohol if they drink alcohol regularly parents 59% police 50% 49% 37% 28% 23% 25% 13% 13% 14% 2% 0%

Grade 6 Grade 8 Grade 10 Grade 12 Grade 6 Grade 8 Grade 10 Grade 12

Percent of students who think it is easy to get alcohol when they want

66% 73% 39% 30%

Grade 6 Grade 8 Grade 10 Grade 12

*Questions about parental attitudes were included at the discretion of the school districts. Results may not reflect a representative sample of all

Is there real harm in underage drinking?

Alcohol use among youth is strongly correlated with:

 Violence  Sexual activity  School failure  Illicit drug use  Driving safety "What parents may not realize is that children say that parental disapproval of underage drinking is the key reason they have chosen not to drink." Charles Curie, SAMHSA Administrator 31 Are our children using illegal drugs? Percent of students who report using an illegal drug Percent of students who report being drunk or in the past month high at school in the past year

18% 19% 5% 6% 6% 8% 0% 0%

Percent of students who report that it is sort Percent of students who report it would be of easy or very easy to get marijuana sort of easy or easy to get hard drugs

54% 52%

30% 23% 24% 11% 8% 12%

Percent of students who report that kids smoking marijuana would be caught by the police Percent of students who report that their parents would think it was wrong or very wrong to smoke marijuana

89% 90% 91%

62% 38% 0% 29% 21% Grade 6 Grade 8 Grade 10 Grade 12 Grade 6 Grade 8 Grade 10 Grade 12

32 33 34 35 Supporting Data: Treatment

Is Treatment Affordable? 53% of respondents on the PITA Community Questionnaire felt that “People can’t afford to pay for treatment” This was the highest rated barrier to treatment Related comments include: “We need more $ for providing treatment for people with low income.” “If they could make what they have more affordable and have more groups or classes it would help.” “I have known people who have gotten some help, but not enough because they couldn’t afford it. It also made them struggle to pay their bills.” d e t t i

Monthlym Household Income for Admissions 7/05-12/06 d A

s t n e i l C

Who currently qualifies forMonthly funding Household assistance Income in our county? Pregnant and Parenting Any youth who needs women treatment IV drug users People receiving assistance People on a state medical through SSI or TANF coupon People who are unemployed People over the age of 62 due to a disability People who have a mental or People who have used in the physical disability last 90 days and have no Parent who meet income income guidelines through DSHS People in the criminal justice Youth in foster care system

36 37 Transportation in Klickitat County 50% of respondents to the PITA Community Questionnaire felt that “Transportation makes it hard for people to attend treatment.” This was the second highest rated barrier to treatment Related comments include: “Have outpatient treatment available in rural areas because of the lack of transportation for most families.”

Available Transportation Resources in Klickitat County Provides free priority transportation for seniors and other people who have a medical coupon across Klickitat County People who don’t have a medical coupon can also be transported for a small fare They have 4 buses in White Salmon and 3 in Goldendale Reservations should be made 48+ hours in advance, and sometimes they fill up 5-6 days ahead of time White Salmon services complete an average of 60-70 pickups each day Mt. Adams Example fares for non-Medicaid riders: Wishram to Goldendale: $5.00 round trip Transportation In town destination (Goldendale or White Salmon): $1.00 White Salmon to Dallesport: $6.00 round trip White Salmon to Lyle: $3.00 round trip Goldendale to White Salmon: $10.00 round trip Just out of town (2-3 miles) pickups: $2.00 Weekly trips to The Dalles and Hood River are offered Daily local route with additional pickups/drop-offs as needed Volunteer drivers available when vans are full

Available in the White Salmon area only Example fares for one way trip: Lyle to White Salmon: $18.00 Taxi Service Goldendale to White Salmon: $50.00 In town destination White Salmon: $7.00

Other considerations when assessing transportation needs: Average gas price in Washington is $3.31 Average car gets about 18 miles/gallon That’s about 18 cents/mile According to admissions data for adults entering treatment between July 2005 and December 2006: 53% of clients do NOT have a valid driver’s license 45% of clients do NOT have access to a vehicle

38 Past Year Changes and State and County Comparisons

Past Year Change2 Trends in Outpatient3 Admissions County State Overall Admissions 25.60% 5.80% Youth4 300.00% 2.55% Female 5.88% 9.42% Pregnant and Parenting Women5 undefinedXX 5.86% Parents with Children6 33.33% 4.28% Gay, Lesbian, Transgender7 undefinedXX 25.40% IV Drug Use (Ever)8 7.69% 6.88% IV Drug Use (past 30 days)9 -66.66% 0.49% CJTA-funded Admission10 -84.21% 13.44% CJ Referrals11 40.00% -1.03% Opiate Substitution Admission n/a -8.68% Primary Drug Alcohol 5.00% 4.57% Cocaine undefinedXX -1.97% Heroin undefinedXX 2.11% Methamphetamine 14.28% 12.49% Marijuana 73.68% 3.50% Trends in Detox Admissions Detox Admissions n/a -5.43% Percent Completed n/a 65.95% Past year completion, not a change in score

PROGRESS TOWARD GOAL IN 2006 Treatment Expansion: Progress Toward Goals County State All Adults 103.41% 81.03% Aged 0.00% 65.61% Blind/Disabled 114.34% 70.33% TANF 96.43% 86.26% GA-U 103.80% 114.37% Youth 179.10% 91.25%

1 Defined using the Facility County field in TARGET. Private pay funded admissions are excluded. Admissions whose contract type is DOC-Community are included. 2 [(Admissions: Jan-June 06-Admissions Jan-June 05)/Admissions Jan-June 05]* 100. 3 Includes Intensive Outpatient, Outpatient, MICA Outpatient. 4 Under 18 years of age at admission. 5 Identified using the contract type field in TARGET. Value of Pregnant/Parenting. 6 Identified using two fields from TARGET. The first field indicates the client’s children (under 18) that are living with them and the second indicates other children living with the client. If the client has either their own or other children living with them they are counted as parents with children for this analysis. 7 Identified using the sexual orientation field in TARGET. 8 Identified using the needle use field in TARGET. 9 Identified using the used needle recently field or the method_ID field in TARGET. 10 Identified using the contract type field in TARGET. Values of 1) Criminal Justice or 2) Criminal Justice - Innovations. 11 Identified using the entry referral field in TARGET. Values of 1) Court/Probation, 2) Department of Corrections, 3) Diversion, 4) Police or 5) JRA. 12 Expansion subpopulations were identified using several fields from the TARGET database, including Public Assistance Type, Contract Type and Disability.

39 Outpatient2 Admissions by Primary Drug3

Comparison of Admissions Over Time Primary Drug Jan-Jun 2006 Change in Compared to...4 Alcohol Cocaine Heroin Methamphetamine Marijuana Other All Admissions

Jan-Jun 2005 undefinedXX undefinedXX 5.00% 14.28% 73.68% 50.00% 25.60% Jan-Jun 2003 undefinedXX undefinedXX 250.00% 0.00% 500.00% 560.00% 368.18% Jan-Jun 2000 -23.63% -100.00% 0.00% 200.00% 94.11% 200.00% 22.61%

Admissions by Primary Drug Alcohol Cocaine Heroin Marijuana Meth Other Admits % Admits % Admits % Admits % Admits % Admits % Total

Jan 2000-Jun 2000 55 65.5% 2 2.4% 1 1.2% 17 20.2% 8 9.5% 1 1.2% 84 Jul 2000-Dec 2000 58 58.0% 0 0.0% 1 1.0% 17 17.0% 22 22.0% 2 2.0% 100 Jan 2001-Jun 2001 38 48.1% 0 0.0% 0 0.0% 16 20.3% 24 30.4% 1 1.3% 79 Jul 2001-Dec 2001 33 70.2% 0 0.0% 0 0.0% 3 6.4% 9 19.1% 2 4.3% 47 Jan 2002-Jun 2002 25 44.6% 1 1.8% 0 0.0% 13 23.2% 16 28.6% 1 1.8% 56 Jul 2002-Dec 2002 21 48.8% 0 0.0% 2 4.7% 11 25.6% 7 16.3% 2 4.7% 43 Jan 2003-Jun 2003 12 54.5% 0 0.0% 1 4.5% 5 22.7% 4 18.2% 0 0.0% 22 Jul 2003-Dec 2003 23 34.3% 0 0.0% 4 6.0% 15 22.4% 24 35.8% 1 1.5% 67 Jan 2004-Jun 2004 41 50.6% 2 2.5% 2 2.5% 17 21.0% 17 21.0% 2 2.5% 81 Jul 2004-Dec 2004 36 50.0% 0 0.0% 0 0.0% 17 23.6% 14 19.4% 5 6.9% 72 Jan 2005-Jun 2005 40 48.8% 0 0.0% 0 0.0% 19 23.2% 21 25.6% 2 2.4% 82 Jul 2005-Dec 2005 56 41.8% 1 0.7% 0 0.0% 33 24.6% 38 28.4% 6 4.5% 134 Jan 2006-Jun 2006 42 40.8% 0 0.0% 1 1.0% 33 32.0% 24 23.3% 3 2.9% 103

1 County is defined using the Facility County field in TARGET. Private pay funded admissions are excluded. Contract type = ‘DOC-Community’ are included. 2 Includes Intensive Outpatient, Outpatient, MICA Outpatient 3 Identified using the Substance_ID variable in TARGET

40 4 [(Admissions:Jan-Jun 06 – Admissions: Previous Period)/Admissions: Previous Period] * 100.

41 Overall Outpatient2 Admissions

Comparison of Admissions Over Time Jan-Jun 2006 Change in Compared to... All Admissions5

Jan-Jun 2005 25.60% Jan-Jun 2003 368.18% Jan-Jun 2000 22.61%

Admissions4 Jan 2000-Jun 2000 84 Jul 2000-Dec 2000 100 Jan 2001-Jun 2001 79 Jul 2001-Dec 2001 47 Jan 2002-Jun 2002 56 Jul 2002-Dec 2002 43 Jan 2003-Jun 2003 22 Jul 2003-Dec 2003 67 Jan 2004-Jun 2004 81 Jul 2004-Dec 2004 72 Jan 2005-Jun 2005 82 Jul 2005-Dec 2005 134 Jan 2006-Jun 2006 103

1 Defined using the Facility County field in TARGET. Private pay funded admissions are excluded. Contract type = ‘DOC-Community’ are included. 2 Includes Intensive Outpatient, Outpatient, MICA Outpatient. 3 [(Admissions:Jan-Jun06 – Admissions:Previous Period)/Admissions:Previous Period)] * 100. 4 Counts of admissions for a six month period.

42 Youth2 Outpatient3 Admissions

Comparison of Admissions Over Time Jan-Jun 2006 Change in Youth Change in Compared to... Admissions5 All Admissions5

Jan-Jun 2005 300.00% 25.60% Jan-Jun 2003 500.00% 368.18% Jan-Jun 2000 140.00% 22.61%

Youth Yes No Admits %6 Admits % Total

Jan 2000-Jun 2000 5 6.0% 79 94.0% 84 Jul 2000-Dec 2000 7 7.0% 93 93.0% 100 Jan 2001-Jun 2001 6 7.6% 73 92.4% 79 Jul 2001-Dec 2001 2 4.3% 45 95.7% 47 Jan 2002-Jun 2002 2 3.6% 54 96.4% 56 Jul 2002-Dec 2002 4 9.3% 39 90.7% 43 Jan 2003-Jun 2003 2 9.1% 20 90.9% 22 Jul 2003-Dec 2003 7 10.4% 60 89.6% 67 Jan 2004-Jun 2004 8 9.9% 73 90.1% 81 Jul 2004-Dec 2004 4 5.6% 68 94.4% 72 Jan 2005-Jun 2005 3 3.7% 79 96.3% 82 Jul 2005-Dec 2005 10 7.5% 124 92.5% 134 Jan 2006-Jun 2006 12 11.7% 91 88.3% 103

1 County is defined using the Facility County field in TARGET. Private pay funded admissions are excluded. Contract type = ‘DOC-Community’ are included. 2 Under 18 years of age at admission. 3 Includes Intensive Outpatient, Outpatient, MICA Outpatient. 4 (Number of Admissions to Youth/Total Outpatient Admissions) * 100. This line shows the trend in Youth admissions relative to overall admissions. It is included on the graph because of the additional information it provides. For example, it is possible for the total number of Youth admissions to be falling over time and still represent an increasing percentage of overall admissions. 5 [(Admissions:Jan-Jun 06 – Admissions: Previous Period)/Admissions: Previous Period] * 100. 6 (N/Total)*100. Figures in this column represent the percent of all admissions for youth during a given period of time.

43 44 Parent with Kids2 Outpatient3 Admissions

Comparison of Admissions Over Time Jan-Jun 2006 Change in Parent with Kids Change in Compared to... Admissions5 All Admissions5

Jan-Jun 2005 33.33% 25.60% Jan-Jun 2003 633.33% 368.18% Jan-Jun 2000 -16.98% 22.61%

Parent with Kids Yes No Admits %6 Admits % Total

1 County is defined using the Facility County field in TARGET. Private pay funded admissions are excluded. Contract type = ‘DOC-Community’ are included. 2 Identified using two fields from TARGET. The first field indicates the client’s children (under 18) that are living with them and the second indicates other children living with the client. If the client has either their own or other children living with them they are counted as parents with children for this analysis. 3 Includes Intensive Outpatient, Outpatient, MICA Outpatient. 4 (Number of Admissions to Parents with children/Total Outpatient Admissions) * 100. This line shows the trend in admissions for parents with children relative to overall admissions. It is included on the graph because of the additional information it provides. For example, it is possible for the total number of PPW admissions to be falling over time and still represent an increasing percentage of overall admissions.

45 5 [(Admissions:Jan-Jun 06 – Admissions: Previous Period)/Admissions: Previous Period] * 100. 6 (N/Total)*100. Figures in this column represent the percent of all admissions for parents with children in the home during a given period of time.

Gay, Lesbian or Transgender2 Outpatient3 Admissions

Comparison of Admissions Over Time Change in Gay, Lesbian or Jan-Jun 2006 Transgender Change in Compared to... Admissions5 All Admissions5

Jan-Jun 2005 undefinedXX 25.60% Jan-Jun 2003 undefinedXX 368.18% Jan-Jun 2000 undefinedXX 22.61%

Gay, Lesbian or Transgender Yes No Admits %6 Admits % Total

1 County is defined using the Facility County field in TARGET. Private pay funded admissions are excluded. Contract type = ‘DOC-Community’ are included. 2 Identified using the sexual orientation field in TARGET. 3 Includes Intensive Outpatient, Outpatient, MICA Outpatient. 4 (Number of Admissions to gay, lesbian and transgender clients/Total Outpatient Admissions) * 100. This line shows the trend in gay, lesbian and transgender admissions relative to overall admissions. It is included on the graph because of the additional information it provides. For example, it is possible for the total number of gay, lesbian and transgender admissions to be falling over time and still represent an increasing percentage of overall admissions.

46 5 [(Admissions:Jan-Jun 06 – Admissions: Previous Period)/Admissions: Previous Period] * 100. 6 (N/Total)*100. Figures in this column represent the percent of all admissions for gay, lesbian and transgender clients during a given period of time.

IV Drug User (Ever)2 Outpatient3 Admissions

Comparison of Admissions Over Time Jan-Jun 2006 Change in IV Drug User (Ever) Change in Compared to... Admissions5 All Admissions5

Jan-Jun 2005 7.69% 25.60% Jan-Jun 2003 366.66% 368.18% Jan-Jun 2000 16.66% 22.61%

IV Drug User (Ever) Yes No Admits %6 Admits % Total

1 County is defined using the Facility County field in TARGET. Private pay funded admissions are excluded. Contract type = ‘DOC-Community’ are included. 2 Identified using the needle use field in TARGET. 3 Includes Intensive Outpatient, Outpatient, MICA Outpatient. 4 (Number of Admissions to IV Drug Users/Total Outpatient Admissions) * 100. This line shows the trend in IV Drug Use admissions relative to overall admissions. It is included on the graph because of the additional information it provides. For example, it is possible for the total number of IV Drug Use admissions to be falling over time and still represent an increasing percentage of overall admissions.

47 5 [(Admissions:Jan-Jun 06 – Admissions: Previous Period)/Admissions: Previous Period] * 100. 6 (N/Total)*100. Figures in this column represent the percent of all admissions for clients that every used needles to inject drugs. IV Drug User (30 days)2 Outpatient3 Admissions

Comparison of Admissions Over Time Change in IV Drug User (30 Jan-Jun 2006 days) Change in Compared to... Admissions5 All Admissions5

Jan-Jun 2005 -66.66% 25.60% Jan-Jun 2003 undefinedXX 368.18% Jan-Jun 2000 -91.66% 22.61%

IV Drug User (30 days) Yes No Admits %6 Admits % Total

1 County is defined using the Facility County field in TARGET. Private pay funded admissions are excluded. Contract type = ‘DOC-Community’ are included. 2 Identified using the used needle recently field or the method_ID field in TARGET. 3 Includes Intensive Outpatient, Outpatient, MICA Outpatient. 4 (Number of Admissions to IV Drug Users/Total Outpatient Admissions) * 100. This line shows the trend in IV Drug Use admissions relative to overall admissions. It is included on the graph because of the additional information it provides. For example, it is possible for the total number of IV Drug Use admissions to be falling over time and still represent an increasing percentage of overall admissions.

48 5 [(Admissions:Jan-Jun 06 – Admissions: Previous Period)/Admissions: Previous Period] * 100. 6 (N/Total)*100. Figures in this column represent the percent of all admissions for recent IV drug users during a given period of time.

DASA-TA Percent of Treatment Admissions Outpatient Admissions

Month of Admission between July 2005 and April 2007

By ER Visits

Footnote: Based on records where the following conditions are met: - Governing County is Equal to Klickitat - AND - - DOC and private pay included - Note: Data in the system is updated monthly and numbers for the most recent months may change slightly over time.

Run Date: 05/30/2007 TARGET data available through 4/2007

49 Treatment Expansion Section

Initial Networking and Community Assessment: During the networking and assessment phase of the strategic planning process, efforts were made to specifically identify the needs of Treatment Expansion eligible clients. Target populations including the elderly, disabled, low income, unemployed, and youth were asked to complete the PITA Community Questionnaire to provide specific feedback on the needs for these populations. Over 30 seniors completed the questionnaire, along with several representatives from the other target populations. In addition, discussions surrounding the service needs of Treatment Expansion clients were had at the Strategic Planning Retreat and subsequent Substance Abuse Advisory Meetings. During the meetings, planning participants reviewed Treatment Expansion data, and developed strategies accordingly. Through the assessment process, we noted that Treatment Expansion efforts in our County have been very successful. We have consistently met or exceeded the target number of Treatment Clients to be served throughout the 2005-2007 biennium, and continue to serve additional clients using Treatment Expansion dollars. Specific efforts made include the designation of a Youth Specialist CDPT to provide services to youth in the community, at schools, and at the office. This strategy has been immensely effective to increase our services to youth over the last two years. In addition, outreach efforts have been successfully made in the Children’s Administration offices in both White Salmon and Goldendale, where outstationed CDPs are utilized to provide consultation, outreach and referral services, and assessments in urgent cases.

Strategic Planning Narrative: Please see the following Treatment Expansion Goal #1 and Youth Treatment Goal #1 in table format for details describing our County’s plan to expand services to clients who qualify for Treatment Expansion.

50 YOUTH TREATMENT: GOAL #9 Increase the youth treatment completion rate to a rate consistent with the statewide average. OBJECTIVE: Youth treatment completion rate will increase from 26% to 45% over the next six years . Problem Statement Strategy Available Resources Who/By When Target Indicator Our county’s current Provide Youth Treatment DHS staff committed DHS staff to select two Biannual youth treatment youth treatment Specialists will attend to providing quality youth specific trainings specific trainings attended completion rate of 26% additional trainings youth services per year for targeted staffby targeted DHS staff is well below the state specific to providing County funding and County Coordinator to beginning in 07-09 average of 42%. effective youth services community priority forallocate adequate funding biennium. youth treatment to pay for these trainings

Target Population Dependency Health Services, youth and Incorporate family Increased youth treatment families in treatment component into youth completion rate Indicators of Success treatment model (see Treatment Goal #4) Youth treatment completion rate reported in DASA Treatment Analyzer Develop and implement DHS staff committed DHS to develop proposal Support groups up and an aftercare or relapse to providing quality and implementation plan running by July, 2008. Monitor incremental prevention support group youth services by April, 2008 improvement, with an for youth completing County funding and expected increase in treatment. community priority for completion rate of 5- youth treatment 7% per biennium.

51 TREATMENT EXPANSION: GOAL #10 Increase outreach and engagement for aged, blind, disabled, people receiving TANF, SSI, GAU, and/or GAX assistance in need of CD treatment. OBJECTIVE: People qualifying for Treatment Expansion funding are aware of financial resources and know how to access chemical dependency treatment. Problem Statement Strategy Available Resources Who/By When Target Indicator We need to increase Increase collaboration Funding for position Collaboration between Improved utilization of outreach and and effectiveness of available Coordinator, treatment outstationed staff person’s engagement of outstationed counselor Desire to maintain provider, and DSHS staff to time and staff perception Treatment Expansion positions at DSHS offices and improve positionbrainstorm and implement of the position clients. in Goldendale and White Successful CA position improvements by Salmon outstation September ‘07 Increase collaboration ESD 112 and county County staff, treatment Collaboration plan with KC Developmental willing to partner provider staff, ESD 112 developed by December, Disabilities provider (ESD staff to meet by Dec ’08 to 2008 112) develop collaboration plan Increase collaboration DV staff, county DV staff, county staff, Collaboration plan Target Population with domestic violence staff, treatment treatment provider to meet developed by January, People who qualify for resources (DVR) provider and develop collab. plan 2008 Treatment Expansion Increase outreach, Behavioral Health Treatment provider staff Collaboration plan funds collaboration and Crisis Coord. Grant, and County Coordinator to developed by March, 2008 Referral agencies communication to ER and KVHS, Skyline facilitate collaborative Health Services, hospital, treatment discussions with Indicators of Success especially detox services provider staff appropriate healthcare Increase in numbers of in East end of the county providers beginning Feb ‘08 Treatment Expansion to facilitate smooth clients served referrals and treatment admissions Provide training and Large network of in County Coordinator, Trainings and information referral information to home care treatment provider staff, provided to in home care Senior Services In Home providers, strong Senior Services staff to providers Care Providers senior services meet July ‘07

52 Supporting Data: Treatment Expansion

Treatment Expansion Adult Clients: Klickitat County

Treatment Expansion Youth Clients: Klickitat County

53 Criminal Justice Section

Initial Networking and Community Assessment: During the networking and assessment phase of the strategic planning process, efforts were made to specifically identify the needs of clients involved in the criminal justice system. A very active member of our Substance Abuse Advisory Board is also the director of Adult Probation Services. During the collection of the PITA Community Questionnaires, the survey was included in the paper work required by offenders to ensure that the criminal justice involved client’s perspective was voiced. While service needs specific to the criminal justice population were included in the PITA Community Questionnaire, these needs were not identified as priority by the survey results. However, a significant portion of the additional comments collected on the survey discussed the need for improved coordination with law enforcement and chemical dependency treatment services. Through the assessment process, we noted that Criminal Justice Treatment Account (CJTA) funding has been extremely well utilized in our county. In year one of the current biennium, the annual allocation of CJTA funds awarded for outpatient treatment was expended in only six months. We increased county services to court involved clients significantly over the past biennium. According to reports generated using DASA Treatment Analyzer, criminal justice involved clients admitted increased by 66% between 2004 (54 admits involved with court or probation) and 2005 (90 admits involved with court or probation), and by 76% between 2004 and 2007 (estimated 95 admits involved with court or probation). This increase in services to criminal justice clients can be attributed to the increase in CJTA funding, as well as the excellent collaborative relationship between our Adult Probation office and the county’s chemical dependency treatment provider.

Mobilization and Capacity Building to Address the Needs: Efforts were made to include the County prosecutor, County sheriff, County superior court and the chemical dependency treatment provider in planning activities for the criminal justice section of the plan. Personalized invitations were mailed out to the Substance Abuse Advisory Board’s Strategic Planning Retreat held in February, and we did have representatives from the Sheriff’s department (including the newly elected Sheriff himself), Adult Probation, and the Police Action League attend the full day planning retreat. Additionally, collaborative discussions began through a small Behavioral Health Crisis Coordination Grant awarded to the Klickitat Valley Health Services, which brought the County Alcohol and Drug Coordinator together with representatives from the healthcare facility, Sheriff’s department, city police, county jail, chemical dependency treatment provider and secured transport providers.

Comprehensive Strategic Plan: Please see the Criminal Justice Treatment Goal #11 below for detailed strategies and desired outcomes for our criminal justice involved clients. Criminal Justice Treatment Account dollars in the coming biennia will be used to provide outpatient treatment to individuals in Klickitat County who are involved with the criminal justice system. Assessments, both in the clinic as well as in the jail, individual, and group outpatient treatment have proved to be well utilized services, and we hope to continue offering these valuable services using the CJTA funds. 54 In July 2005, participating counties developed an integrated residential co-occurring disorder program for women by wrapping best practice chemical dependency treatment models combined with existing mental health residential treatment services. This project will continue indefinitely. The project meets three project types:  Regional – Yakima, Benton, Franklin, Walla Walla, Klickitat and Whitman Counties will participate.  Best Practice – Integrated co-occurring disorders treatment provided by an interdisciplinary team that includes mental health case managers, chemical dependency professionals, psychiatric, and nursing staff. Comprehensive integrated COD treatment is recognized by SAMHSA as an EBP for persons with co- occurring disorders. In addition the program will be modeled on the very successful Pathways program that has served males with co-occurring disorders for several years.  Innovation – No residential treatment for women with co-occurring disorders presently exists in the state. A fully residential program for men no longer exists in Eastern Washington. The program will continue to occupy a portion of the existing Sunnyside Adult Residential Rehabilitation Center (ARRC) operated by Central Washington Comprehensive Mental Health (CWCMH). CWCMH is dually licensed by both the DSHS – Mental Health Division and DSHS – DASA. The Sunnyside ARRC is licensed by the Department of Health and the Mental Health Division. CWCMH is JCAHO accredited.

In August 2006, the program began serving both men and women with serious and persistent mental illnesses and a co-occurring chemical dependency. Initially the program was only open to women. Due to limited referrals for CJTA eligible women with co- occurring disorders it was been difficult to maintain a full census in the six designated beds. Adding men allowed an increase of enrollments. Women will still be given priority when identifying individuals for admission. A distinct integrated co-occurring track of treatment is provided to the participants. While the residents of the ARTF share basic functions such as dining, the treatment tracks are entirely separate. Additional services provided include:  Chemical dependency treatment  Increased nursing monitoring for physical concerns and medication adjustment  Increase staffing level to increase program intensity  Increased psychiatric staffing for medication dose adjustment  A physical fitness component

The program is designed for a total of six residents. With co-gender services, it is expected that average daily occupancy will continue to be maintained at approximately 5.5, and will serve 70 residents per year.

Evaluation:

The program will conduct outcome evaluations at six month intervals during the life of the project. The following outcome measures will be utilized:  Treatment completion – goal: 75%  Treatment Outcome Package – goal: demonstrate improved standard scores on measures of chemical dependency, psychosis, depression, suicide ideation and interpersonal skills

55 Follow-up studies will also be completed through contacts with the client and/or the client’s MH and CD providers. The follow-up will compare treatment compliance, criminal activity and psychiatric hospitalization with pre-treatment information gathered at admission. Services will be provided under both a drug-court and non-drug court model.

56 CRIMINAL JUSTICE TREATMENT: GOAL #11 Improve access to treatment for criminal justice involved clients. OBJECTIVE: People involved in the criminal justice system have access to chemical dependency treatment. Problem Statement Strategy Available Resources Who/By When Target Indicator We need to increase Encourage faith based, Existing faith based County Coordinator will Groups available in jail for access to treatment for 12-step, and other groups (SAFE, invite group reps to a people who want to Criminal Justice support group presence Freedom Now) SAAB meeting & ask how participate by January involved clients in local jail. Supportive law we can support them 2008. enforcement November, 2007 AA/NA contacts Facilitate collaboration DHS Set up necessary Resource plan in place by Target Population between Sheriff’s Supportive law meetings to develop January, 2008 Criminal Justice Department, jail, and enforcement treatment resource plan involved clients Chemical Dependency Crisis coordination for jail services by Jail services as needed in treatment provider to grant September, 2007 place by July, 2008 assess unmet inmate needs and develop a plan as needed Request additional CJTA State funds available County Coordinator Additional funds awarded funds for 07-09 and for 07-09 biennium Indicators of Success subsequent biennia More criminal justice involved clients entering treatment Continue participation in Program is up and CC to allocate funds, Adequate utilization of the regional CJTA running and was well renew contracts, audit service by Klickitat County Innovative project for the utilized by Klickitat facilities, and monitor clients. Pathways Co-occurring County in the 05-07 services on an ongoing mental health and biennium. basis. chemical dependency inpatient program in Sunnyside.

57 Supporting Data: Criminal Justice

About 30% of respondents to the PITA Community Questionnaire felt that “People in the criminal justice system need more help getting treatment.” Related comments from the PITA Survey include: “The courts need to require more treatment.” “Legal services should mandate a series of counseling, activities, housing, faith based involvement, and work source to reinforce the skills needed to make lifestyle changes.” “Throw all known drug users, manufacturers, and dealers in jail!”

Criminal Justice Involvement for Admissions made between 7/05-12/06 d e t t i m d A

s t n e i l C

Criminal Justice Program

Other considerations when assessing criminal justice client needs: About half of the clients admitted to Outpatient services are on probation or parole Adult Probation Services conservatively estimates that 74% of their cases are Chemical Dependency related. Of 456 total cases: 297 cases (65%) are for drug related charges 40 cases (9%) are for assault charges involving substance use 6% of clients admitted to outpatient treatment have had previous violent crime charges

58 59 60 The following graphs were taken from the Washington State Department of Health and Human Services – Data and Research Division Website and are specific to Klickitat County.

61 62 Criminal Justice Admission2 Outpatient3 Admissions

Comparison of Admissions Over Time Change in Criminal Justice Jan-Jun 2006 Admission Change in Compared to... Admissions5 All Admissions5

Jan-Jun 2005 -84.21% 25.60% Jan-Jun 2003 undefinedXX 368.18% Jan-Jun 2000 undefinedXX 22.61%

Criminal Justice Admission Yes No Admits %6 Admits % Total

1 County is defined using the Facility County field in TARGET. Private pay funded admissions are excluded. Contract type = ‘DOC-Community’ are included. 2 Identified using the contract type field in TARGET. Values of 1) Criminal Justice or 2) Criminal Justice - Innovations. 3 Includes Intensive Outpatient, Outpatient, MICA Outpatient. 4 (Number of CJTA Admissions/Total Outpatient Admissions) * 100. This line shows the trend in CJTA admissions relative to overall admissions. It is included on the graph because of the additional information it provides. For example, it is possible for the total number of CJTA admissions to be falling over time and still represent an increasing percentage of overall admissions. 5 [(Admissions:Jan-Jun 06 – Admissions: Previous Period)/Admissions: Previous Period] * 100. 6 (N/Total)*100. Figures in this column represent the percent of all admissions funded by the CJTA during a given period of time.

63 Exhibit A: SAAB Logic Model SCHOOLS FAITH COUNTY SOCIAL HEALTH DASA DSHS AA/ MAT SKCN BASED SERVICES SERVICES NA

COMMUNITY STRENGTHS: *Strong and committed community and faith-based groups with similar missions work throughout the county. *NA and AA community

leaders facilitate regular meetings. *Good communication and involvement I T N A T T G M A

between law enforcement, SAAB, and our treatment provider. *Historically we L T A U N N N C M L I R I R P have strong community support for the needs of children. O O I O R O A N O N Chemical dependency negatively impacts our entire community by I E C C P U increasing crime and abuse, costing the county money, and decreasing B the quality of life and sense of community connection in our area.

KLICKITAT COUNTY SUBSTANCE ABUSE ADVISORY BOARD OUR MISSION: To assist in the development, implementation, and evaluation of Klickitat County chemical dependency programs. We are made up of community members, people in recovery, and agency representatives. We meet monthly to promote the awareness and effective treatment of chemical dependency issues in our county. We believe that addiction is a disease that can be overcome. It is a symptom of a deeper problem that can affect anyone. With community support and personal desire, people are able to heal in mind, body, and spirit.

SUBSTANCE ABUSE ADVISORY BOARD ACTIVIES: Monthly public meetings Lead P-I-T-A six-year Strategic Review monthly fiscal reports Planning process Provide community input regarding Conduct community needs assessment chemical dependency needs Collaborate with community partners in Advise the county on quality of county planning services, fiscal decisions, and service Raise awareness of chemical needs dependency issues in the county

SUBSTANCE ABUSE ADVISORY BOARD PRODUCTS: Comprehensive six-year strategic plan for prevention, intervention, treatment and aftercare (P-I-T-A) services within the county Service needs assessment and quality improvement plan Local awareness campaign highlighting chemical dependency related issues

DESIRED OUTCOMES: Increase public awareness of chemical dependency in our community. Decrease public acceptance of substance abuse in our community. Increase public knowledge and understanding of available resources. Increase number of people accessing treatment in our county. Ensure fiscal and social support for County chemical dependency programs. Improve community collaboration with respect to referrals and accessing services. 64 65 Exhibit B: PITA Community Questionnaire Which of the following items do you think contribute most to substance abuse in Klickitat County? Please check as many items as you’d like! Substance abuse includes: underage drinking, any harmful drinking by people over 21, any use of tobacco or illegal drugs, misuse of prescription medicines or other substances like aerosols, and use of any harmful substance by pregnant women.

Prevention: Supporting the community to make healthy life choices In our community…  Drugs and alcohol are easy for youth to get  There is too much acceptance of drug use and underage drinking  People are unaware of substance abuse problems  There is little or no feeling of neighborhood or community  Poverty and unemployment is too high  Other ______

Our families…  Lack parenting skills  Are too accepting of substance abuse and underage drinking  Experience a lot of family conflict  Other ______

At school…  Many kids struggle academically  Many kids do not feel connected  Parents are not involved  Other ______

Our youth…  Experiment with alcohol and drugs at a young age  Lack skills to find enjoyment without using drugs or alcohol  Have a history of abuse (sexual, emotional, and/or physical)  Want more excitement in their lives  Do not understand the problems caused by alcohol and drug use  Don’t have enough alcohol/drug-free activities to participate in  Other ______

Intervention: Supporting youth and adults at risk of substance abuse Our community…  Lacks school-based intervention services for educating and assessing youth at risk of substance use and connecting youth with treatment when needed  Doesn’t have mentoring programs that link youth with caring adults  Lacks affordable and available counseling for children, families and individuals  Lacks agency assistance for individuals struggling with substance abuse issues  Doesn’t support individuals struggling with chemical dependency or other abuse issues  Professionals ignore the symptoms of substance abuse and/or do not refer people for help  Professionals and community members don’t know who to contact for help  Other ______ I don’t have experience in this area/am not sure about our community’s needs

66 Treatment: Supporting the healing of people suffering from chemical dependency

 Treatment is not available  Treatment is available, but people don’t know about it  People can’t afford to pay for treatment  The quality of treatment in Klickitat County is poor  People in the criminal justice system need more help getting treatment  The community doesn’t think that treatment works  It’s difficult for other agencies to refer people to treatment  Transportation makes it hard for people to attend treatment  People have to be sent out of the county for residential services  I/people I know get drug and alcohol services outside of Klickitat County  Other ______ I don’t have experience in this area/am not sure about our community’s needs

Aftercare: Supporting the successful recovery of people with chemical dependency

 Our community lacks clean and sober housing  Our community lacks recovery support groups (ex. Alcoholics Anonymous)  Recovery supports exist, but people don’t know about them  Recovery support groups exist, but are not helpful  There is high acceptance of drug and alcohol use in the community  We don’t have enough clean and sober activities  It’s too hard for people to find new friends who don’t use  People need more professional support after they have completed treatment  Other ______ I don’t have experience in this area/am not sure about our community’s needs

What do you think the county should do about substance abuse? ______Other comments: ______

Your Age: Gender: Ethnicity: Zip Code:  Under 13  Male  White  14-20  Female  Native American  21-35  Hispanic GROUP:  36-49 Are you disabled?  African American  50-65  YES  Other  Over 65  NO

Thanks for taking the time to complete this survey! Your anonymous responses will be used to identify the needs of our county and will help us create a six-year plan for addressing substance abuse in the area. Questionnaires may be identified by completing group for data analysis purposes.

67 Exhibit C: PITA Community Questionnaire Dissemination Plan Substance Abuse Advisory Board July 6th, 2006 Group# TARGET AUDIENCE (281) COMMUNITY GROUP/EVENT CONTACT PERSON Agency Staff (29) WGAP Linda Schneider KCHD Lindsay Miller 2 Courts Larry Barker CPS/DSHS Deidre Duffy CHR/JOM Kathy Schwartz Businesses (24) Rotary Linda Schneider Goldendale Chamber Jeff Teal 3 White Salmon Chamber Deidre Duffy Soroptimist Chris Connolly Community members (64) Family Planning/STD programs Terry Rundell Community Days Linda Schneider 1 Community Council Chris Connolly Friends/Family/People we know Everyone Criminal Offenders (9) Corrections Larry Barker 4 Juvenile offenders Larry Barker Parents of juvenile offenders Larry Barker Disabled (16) Children with Special Healthcare needs Lindsay Miller Early Childhood program Lindsay Miller 5 Mental Health clients Becky Twohy New Hope Farm Jeff Teal 6 Elderly (30) Senior Services Lindsay Miller Faith Based (21) Churches Terry Rundell 7 Rene Smith 8 Gay/lesbian/bisexual (0) ? Jeff Teal will research Grandparent caregivers Kinship Support Group Deidre Duffy 9 (3) 10 Health Care Staff (5) Klickitat Valley Health Jeff Teal Homeless (11) Homeless shelter Linda Schneider 11 Transitional housing Linda Schneider 12 IV Drug Users (3) Dependency Health Services Becky Twohy 13 Low Income (6) Food Bank Linda Scheider 14 Native American (6) Tribal connections Kathy Schwartz 15 Parents (7) Parenting class in Goldendale Terry Rundell People in Recovery (16) AA Roy Goff Gil Randall 16 NA Kathy Schwartz Dependency Health Services Becky Twohy 17 People in Treatment (2) Dependency Health Services Becky Twohy Pregnant Women (0) Maternity Support Services Terry Rundell 18 WIC Joni Zolp 19 Relatives of Addicts (2) Dependency Health Services Becky Twohy School Staff (6) Goldendale School Staff Chris Twohy 20 Superintendent Group Deidre Duffy

68 Group# TARGET AUDIENCE (281) COMMUNITY GROUP/EVENT CONTACT PERSON Spanish Speaking (9) KCHD clients Joni Zolp Via Victor Benevidas Lindsay Miller 21 Via Maria Sanchez Lindsay Miller Via Kathy’s sister Kathy Schwartz 22 Transitioning Youth (4) Via Youth Pastor Rene Smith 23 Unemployed (4) Work Source Deidre Duffy Youth in school (8) Goldendale Youth Chris Twohy 24 Youth Center Linda Schneider

69 Exhibit D: PITA Community Questionnaire Results and Responses PREVENTION: Which of the following items do you think contributes most to substance abuse in Klickitat County? Please check as many items as you’d like: Response Response In our community… % Total Drugs and alcohol are easy for youth to get 77.7% 213 There is too much acceptance of drug use and underage drinking 61.3% 168 People are unaware of substance abuse problems 37.6% 103 There is little or no feeling of neighborhood or community 26.3% 72 Poverty and unemployment is too high 58.4% 160 Other (please specify) 16.1% 44 Total Respondents: 274 Skipped this questions: 7

Response Response Our families… % Total Lack parenting skills 68.7% 178 Are too accepting of substance abuse and underage drinking 59.8% 155 Experience a lot of family conflict 61.8% 160 Other (please specify) 18.5% 48 Total Respondents: 259 Skipped this questions: 22

Response Response At school… % Total Many kids struggle academically 46.9% 123 Many kids do not feel connected 63.7% 167 Parents are not involved 73.7% 193 Other (please specify) 19.8% 52 Total Respondents: 262 Skipped this questions: 19

Response Response Our youth… % Total Experiment with alcohol and drugs at a young age 75.4% 205 Lack skills to find enjoyment without using drugs or alcohol 49.3% 134 Have a history of abuse (sexual, emotional, and/or physical) 45.6% 124 Want more excitement in their lives 56.6% 154 Do not understand the problems caused by alcohol and drug use 59.2% 161 Don't have enough alcohol/drug-free activities to participate in 58.8% 160

70 Other (please specify) 13.6% 37 Total Respondents: 272 Skipped this questions: 9

INTERVENTION: Which of the following items do you think contributes most to substance abuse in Klickitat County? Please check as many items as you’d like: Response Response Our community… % Total Lacks school-based intervention services for educating and assessing youth 41% 110 at risk of substance use and connecting youth with treatment when needed Doesn't have mentoring programs that link youth with caring adults 47.4% 127 Lacks affordable and available counseling for children, families, and 48.1% 129 individuals Lacks agency assistance for individuals struggling with chemical 32.8% 88 dependency or other abuse issues Doesn't support individuals struggling with chemical dependency or other 32.5% 87 abuse issues Professionals ignore the symptoms of substance abuse and/or do not refer 20.5% 55 people for help Professionals and community members don't know who to contact for help 29.5% 79 I don't have experience in this area/am not sure about our community's 28% 75 needs Other (please specify) 18.3% 49 Total Respondents: 268 Skipped this questions: 13

TREATMENT: Which of the following items do you think contributes most to substance abuse in Klickitat County? Please check as many items as you’d like: Response Response % Total Treatment is not available 12.7% 34 Treatment is available, but people don't know about it 31.5% 84 People can't afford to pay for treatment 53.2% 142 The quality of treatment in Klickitat County is poor 28.5% 76

71 People in the criminal justice system need more help getting treatment 30.3% 81 The community doesn't think that treatment works 25.8% 69 It's difficult for other agencies to refer people to treatment 14.2% 38 Transportation makes it hard for people to attend treatment 49.8% 133 People have to be sent out of the county for residential services 39% 104 I/people I know get drug and alcohol services outside of Klickitat County 14.2% 38 I don't have experience in this area/am not sure about our community's 27% 72 needs Other (please specify) 16.9% 45 Total Respondents: 267 Skipped this questions: 14

AFTERCARE: Which of the following items do you think contributes most to substance abuse in Klickitat County? Please check as many items as you’d like: Response Response % Total Our community lacks clean and sober housing 44.9% 119 Our community lacks recovery support groups (ex. Alcoholics Anonymous) 16.2% 43 Recovery supports exist, but people don't know about them 21.9% 58 Recovery support groups exist, but are not helpful 7.5% 20 There is high acceptance of drug and alcohol use in the community 48.7% 129 We don't have enough clean and sober activities 42.6% 113 It's too hard for people to find new friends who don't use 48.7% 129 People need more professional support after they have completed 43% 114 treatment I don't have experience in this area/am not sure of our community's needs 22.6% 60 Other (please specify) 10.2% 27 Total Respondents: 265 Skipped this questions: 16

72 119. Attempt to promote programs that do not accept drug or alcohol use as okay. Put a stigma on Whatuse. do Doyou not think promote we use should by acceptance. do about substance abuse in our County?

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Must 103.150.57.29.87. Justkeep?funds,makeforIntervene those continue going the other students 12at as than youngerStep tois work from supportwho towardage. theskip groupsHoldfeds/state/, school. sharing parents mandatory. information shouldaccountable be a part for children'sof county abuse.budget planning. 13. Check in teachers! Teachers (some) use substance abuse. Some teachers doesn’t care about kids education or don’t try to keep them out of drugs. 14. I am very glad to see another group concerned about the community!!! Thank you 15. The community needs to just stop and restart with an actual goal and solution. Quit chasing the obvious and look into things with out stereotyping and prejudice. 16. The county lacks activities for teenagers to do, to many people are set in their ways and don’t want any change 17. The youth in Klickitat (town) do have anything to do. No youth center or any entertainment. So they search out their own and are influenced by older persons and supplied drugs and alcohol. Too much boredom. 18. People know that there is help but don’t seem to think they have a problem.

19. need more for the young adults to do - other than "cig" parties. 20. Rx Drugs should NOT be so available from our doctors. They give out to much. "Everyone knows which doctors to go to, to get pain pills." Everyone should be on pain contracts. 21. The county should encourage more business so more people have jobs thus less time to engage in illegal activity. 22. there is nothing for kids to do but be disrespectful and get into trouble 23. Do fun activities, make and keep sports affordable 24. The support in Goldendale for youth/adults is not a good one. lack of interest from the community 25. I heard a lot of kids say there’s nothing to do so they drink to get high when they get bored or to hang out with others. Teach law to Jr High consequence of actions when they choose to engage in crimes like stealing for dope, hate crimes etc., instead of Home etc. or in detention hour. Goldendale & other towns need a scared straight program for our youth who are headed the wrong way. 26. I see unemployed people all over this community high or drunk they walk around probably breaking the law to support their habit what about their children 27. There should be a clause when paperwork is completed, a client has to go to treatment. Most places will not take a client, if the client decides not to go. If the client carries on his or her previous bad habits, it is mandatory to receive treatment again; repeat, repeat, until maybe the client will finally see the light. And see someone cares! 28. Since a great deal of professionals identify drug/alcohol abuse as a disease, the community and youth ought to treat it as a disease. We don't throw cancer patients, diabetics and others with medical problems in jail do we? 29. keep the people that are there to help to quite being control freaks 30. we need more alcohol treatment center in our Co. 31. I have been attending several different AA meetings and its been a lot of help 32. Under group - survey participant stated they were an "ex addict" 33. Same as above "Look after people" 34. I have not ever done any type of substance abuse, but have had friends who have, so I know and understand the problem from a teen's point of view. 35. have more counselors in our area, not everyone responds the same to the same counselor, more structured treatment, and more informed process to treatment, more support

74 36. If you want to get rid of a weed you don't cut it off at the tip you go to the root. This is the only way to kill it. If we find the root and become proactive in killing it then we will see a significant change in our county. One person can help the world and those that are in it. We know this because Christ, one person, saved all who choose to receive Him and He has empowered us to walk in His authority. 37. The false premise of separation of church and state (it is not in the constitution-check it out) has caused the government to leave out the only real hope for what’s missing in man's inner being. It's more than just being spiritual according to a persons whim, it requires us being submitted to the one who has made us in the beginning. 38. My brother had to ask for help, he got it and has done great since. his friends who have gone to treatment haven't been as strong. coming back to the same town and friends is a big mistake! we as a family went to support meetings and have tried not to enable him in all areas of his life! this has helped him and us!! When treatment is offered it has to include the whole family!

39. This country needs to accept the fact that all children don't learn in the same fashion and that some need to proceed on a vocational track instead of through a system wherein they're doomed to failure. If any one thing might be identified to give the country (it's a national problem) the biggest bang for the buck, it would be preventing 1/4 of it's high school students from dropping out -- leaving them and their offspring no hope for economic survival in the modern world! 40. People need to feel they have a chance to contribute to the good of the community without spending a lot of money. Get more adults involved in the schools; in adopting families or old- people, in being physically fit. 41. I would like to see our county take the bull by the horns and stop the weekend parties the kids are having. There are weekly drag races, and lots of speeding. There needs to be more activities for kids and they need to be monitored activities. Where can we as a community put our funding that would be of better use than into the kids who in all essence the future of our great communities. 42. Let’s take back our community. 43. good luck 44. I know for a fact that people who receive Food Stamps trade their benefits for cash, then use that cash to buy drugs/alcohol. The state is being an enabler! Why couldn't they receive a check like WIC? I know from personal experience with family members who've had drug/alcohol problems, that abusers have a low self esteem. They don't have pride in their culture, family or self. I think that is very important to any individual. 45. Counselors and teachers must be more positive about a vision for the future of these young people. Its the job of the school to prepare them for a working environment. Counselors who assist them with summer employment, job skill improvement and job shadowing are a must. Putting down youth is not helpful. Forceful discipline acted upon quickly will be beneficial. 46. I don't actually live in Klickitat County, however I have worked with a lot of people that do, and answered these questions based on that. 47. I have lived with alcohol and drug addiction in my family and know that the addicted person must take responsibility for their actions. Those of us who don't use must not enable others to use. Parents need to set boundaries for there children early in life. 48. Any movement, activities and culture that will seek to marginalized few users and that is inclusive of everyone in the community will have a positive impact. It will not be perceivable immediately, but it will be beneficial in the long run. 49. If I had to guess, I would speculate that the main reasons people abuse substances are: 1) boredom and 2) depression. Other things, like peer pressure and /or acceptance of alcohol/drug use are contributing factors but in my mind they are not CAUSES. The causes of substance abuse come from some deep lack or pain within. If we can address those, maybe we can diminish the problem.

75 50. Thanks for the opportunity to comment. Hope it's useful information. 51. If CPS would start taking the kids out of these drug homes and keeping them exposed to the lifestyles of druggies we might have an opportunity with breaking the cycle. 52. I appreciate all you do in our community to help combat drug/alcohol activity. 53. From some of the cases I have seen, I think that putting the youth in jail is wrong --- the parent needs to go. Too many parents don't seem to care about what might be happening with their children.

54. Community Pride and involvement needs to be a priority throughout the county. Depressed community values (lack of jobs, lack of decent housing, no pride in local schools, etc) leads to a decreased social status community wide and can lead to increased substance abuse. Why work when I can sell drugs? Why play sports for a town who don't care whether we win or lose? I can go out and party instead. Why drive an hour to watch a movie? Welfare (or disability) will take care of me, so why work? I can stay home and get drunk instead. Take care of the social status of the communities, clean up the towns, provide jobs, better education, and develop pride in children at a young age. 55. There are plenty of people who care and are willing to help. There are too few who are motivated to change their use because there are too many 'safety nets' available to them so they don't have to change. 56. I know that there are some parents in the community that take control of their children and watch what they do but I am sure there are a lot of people who do not care what their children are up to. If more parents were involved in the daily lives of their kids instead of sending them outside and ignoring what they are doing I think a lot of the drug and alcoholic problems would be solved. I have always believed that Parents are the number one person a child should look up to and for a lot of the adults in Klickitat County are either on drugs or have been in substance abuse programs and for a child this would be hard. 57. This is an important issue! SA disrupts generations of families and places a tremendous burden on society. SA seems more evident in Goldendale than any place else I have lived. 58. People with drug dependency problems should always have the option of treatment over jail. To give someone a felony for drugs means that for a long time after leaving prison/treatment they have an extremely hard time finding housing and employment...putting more stress on them and making it harder for them to succeed. 59. kids simply do not believe what they hear about addiction - they don't think it will happen to them. they need early intervention and people who've made the wrong choice to explain that they can and likely will get in trouble - and it isn't just a matter of criminal charges, it affects friendships, family relationships, job performance, etc. 60. I believe more kindness should be addressed to those with substance abuse. It is not just under privileged children that have this problem but the more privileged children as well. I think that children with less or below average grades in school get push to the side by teachers. Which in turn causes low self esteem to our children. Parents are afraid to discipline there children because of the laws today. Substance abuse has been and on going issue for as long as I can remember. The Meth epidemic is almost like the 60's LSD epidemic. 61. I don't know how much knowledge community members have in regards to the substance abuse issue in Klickitat County? They may hear how bad the Meth problem is, but do they know all of the facts about substance abuse (i.e. what services are available, what are the biggest needs in our county, what can community members do to help this problem...etc...) More community members who do not work in the social services/human services field need to be educated about the details of substance abuse. Including substance abuse needs, prevention, treatment, county

76 facts...etc...