Bringing agencies together

BOISE – Idaho has made a big change in how it approaches substance abuse treatment, moving from a fragmented system that had various agencies doing their own thing with no particular coordination, to one in which they’re forced to work in concert.

“You can just see this new feeling out there of cooperation that I’ve not seen before,” said Debbie Field, the new head of Gov. Butch Otter’s Office on Drug Policy, a position some are still calling Idaho’s “drug czar.”

Field, a former longtime legislator and chairwoman of the House Judiciary Committee, overflows with enthusiasm for her new task and says she’s hearing the same from state employees, agency directors, treatment providers and others.

“Somebody that’s been in this field for 20 years … said, ‘I’m about ready to retire and I wish I was just starting,’ because they’re feeling so good about, finally, this new direction,” Field said. She added, “Everybody can expect that they all need to work together. … To me, that’s the best thing we’re doing.”

It’s a huge task. A 2005 state performance audit found that Idaho’s substance abuse intervention and treatment efforts were so fragmented that no one knew how much was being spent, how many people were being served, or whether it was working. There were high rates of failure and dropouts among those who received treatment, and little oversight of providers’ qualifications.

Last week, an update to that audit found substantial progress, including the passage of a slew of major legislation in this year’s legislative session. Among the changes was the bill creating Field’s office, which passed both houses unanimously.

“This has probably been one of the best projects I’ve ever been involved in in my life,” said Rep. Jim Clark, R-Hayden Lake, current chairman of the House Judiciary Committee. “It’s never been done before – it’s a brand-new idea.”

Clark serves on an interagency committee chaired by Field that includes the heads of all the major state agencies involved in substance abuse treatment and prevention. He’s chairman of a subcommittee that’s working on a new interagency budget for all substance abuse efforts. That means if one agency wants to start something new and request state funding, it’ll have to be reviewed by all. Once they’ve agreed, Field will pitch the joint funding requests to the Legislature.

Patti Tobias, administrative director of the state courts, said the judicial branch can’t say enough good things about the changes. “Last session was truly a historic, watershed year in terms of making significant changes to improve the delivery of substance abuse treatment in Idaho,” Tobias said.

Among the new legislation were bills to allow Idaho judges to order substance abuse and mental health assessments and community-based treatment as a condition of probation, with the state Health and Welfare Department paying for the treatment; funds to expand Idaho’s drug courts to take hundreds more offenders; and a resolution to develop a single, standardized “assessment tool” that all state agencies would use to evaluate a particular person’s treatment needs for mental health and substance abuse.

“It doesn’t seem like it would be as big a deal as it really is,” Rep. Margaret Henbest, D-Boise, a nurse practitioner, said of the new standard assessment tool. But she said Idaho traditionally has treated each agency’s clients as if they were segregated into “silos,” which prevented any coordination between the programs. “I think it’s the first step to dropping those silos,” she said.

Field, who was appointed in January, proved she meant business when she started on the standardized assessment tool. She brought all the agencies together, planned weekly meetings, and set a goal of agreeing on an assessment by the end of the next month.

“I said … if we haven’t reached that solution by 5 o’clock on Feb. 28, you’re all invited to a pajama party, because nobody gets to leave without the decision,” she said with a grin. “We all had a great time.”

At the time, each agency had a different way of evaluating treatment needs for a patient, and some agencies used several methods. With in-depth research, visits from the authors of the various assessments, and serious and extended discussion and negotiation, Field shepherded the group into defining what it needed, eliminating those that didn’t fit all the criteria, then settling on just one. Three weeks ago, nearly 40 Idaho workers from all agencies were trained as trainers in using the new assessment. It becomes the official one on Jan. 1, 2008.

Already, Field said, people in different programs and agencies around the state are using the new, common terms from the new assessment. “People are speaking the same language,” she said.

Rakesh Mohan, director of the state Office of Performance Evaluations, said Field “has done an amazing job of pulling all the parties together at the table and talking about this in an open way. It has been a big change.”

He said, “The statute that created the position of drug czar and that office gives authority to basically not just provide guidance, but provide directives to all the agencies that are using the state substance abuse funds. That makes a big change.”

Gov. Otter said he had lots of confidence in Field – his campaign manager in his run for governor – and her ability to lead Idaho to a new, coordinated approach to addressing substance abuse. “Through this coordinated effort, there should be no duplicated efforts, no battling over the same treatment funds and a common assessment tool to use across agencies in every area of the state,” he said.

Field said, “We all know the drug courts work, and there’s a reason why they work. They get an assessment, they get treatment, they’re watched and monitored – so that can happen here on this front end as well.”

She said she hopes that if Idahoans with substance abuse problems who can’t afford treatment can be identified, diagnosed and properly treated, maybe Idaho won’t have to build so many more new prisons.

“That’d be a great outcome,” said Brent Reinke, Idaho’s state prisons director. He’s coping with overflowing prisons that have forced him to ship hundreds of Idaho inmates out of state, and house hundreds more in county jails.

As of January, drug or alcohol offenses were the main crimes for which 30.4 percent of Idaho’s prison inmates were serving time. Corrections officials say 85 percent of prisoners have substance abuse problems.

State Juvenile Corrections Director Larry Callicut said that 76 percent of the juveniles committed to his agency’s custody have issues with alcohol or drugs.

Idaho still has a long way to go. Last week’s report found that 1,310 adults and 209 adolescents are on waiting lists now for state substance abuse treatment services.

Sen. Shawn Keough, R-Sandpoint, said, “I know for some it’s frustrating because it’s slow to turn the ship around, but I do think we’re making progress, and that’s good.”

Keough co-chairs the Joint Legislative Oversight Committee, which asked the state’s performance auditors to give it another update on substance abuse efforts in six months. Usually, updates are made once a year.

Keough said all branches of state government have come together to try to solve the problem, and Field has been key in bringing them together. “She’s a natural leader and a doer,” Keough said. “She’s just very passionate about it, and it’s infectious.”