Prevention/Treatment Needs Assessment

Bureau of Drug and Alc ohol Programs

SCA Name: Franklin/Fulton Drug & Alcohol Program Date Submitted: May 31, 2012

Table of Contents
General Information/Instructions........................................................................................................... 3 SCA/County Information......................................................................................................................... 5 Objectives ............................................................................................................................................. 14 Appendix A: Key Representative and Convenience Survey Administration Information (needs to be completed by SCA) ........................................................................................................... 48 Appendix B: Prevalence of substance use disorders in the total population......................................... 50 Appendix C: Prevalence of substance abuse dependency disorders in special populations (needs to be completed by SCA) ........................................................................................................... 54 Appendix D: BDAP Risk & Protective Factors ........................................................................................ 58 Appendix E: CIS Pattern of Referrals for SCA ........................................................................................ 59 Appendix F: CIS Treatment Admissions by Type of Service ................................................................... 60 Appendix G: CIS: SCA Paid Admission by Primary Substance of Abuse ................................................. 61

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General Information/Instructions
Read all directions before completing this needs assessment. It is the intent of the Bureau of Drug and Alcohol Programs (BDAP) to further enhance and improve substance abuse prevention, intervention, treatment, and recovery policies and practices throughout the commonwealth. This work is carried out in conjunction with Single County Authorities (SCAs), their contracted providers and the community at large. As a result, the SCAs have flexibility to develop their service delivery system in response to community needs. The SCA has the role of planning and coordinating all substance abuse services in the county(ies) it serves. In order to effectively plan and coordinate services, a needs assessment is required. This needs assessment combines the former Prevention Needs Assessment and Treatment Needs Assessment into one comprehensive needs assessment. The process involves the identification, collection, analysis, and synthesis of data to define problems within a geographic area. This needs assessment will be the foundation for your Prevention/Treatment Comprehensive Strategic Plan. Many of the issues/needs/resources you identify here will become the focus of your plan. Although your needs assessment will be used in planning, keep in mind that issues/needs/resources that you identify need to be discussed regardless of whether they will be something you plan to address. This is particularly important because BDAP will use the information from these needs assessments to help guide the State Plan. The needs assessments will also be used by BDAP to identify common or unmet needs across SCAs, and determine possible avenues for addressing these issues at the state level. This needs assessment should utilize a data driven decision-making process. Areas of need/problems that are discussed in this needs assessment report must be identified using the best available data sources. The needs assessment team that you assemble should work to identify and collect the data necessary to determine the needs of your population. The needs assessment team should also work to determine what resources are currently available to meet identified needs. When reviewing data it is important the needs assessment team thinks about factors that may be skewing or biasing the data and how representative the data may (or may not) be for certain populations. Suggested and required data sources have been provided to you throughout this document. These are by no means an exhaustive list of possible data sources. Feel free to seek out and discuss data other than what has been noted in this document when responding to the questions and objectives within the document. The SCA shall submit the combined Prevention/Treatment Needs Assessment to BDAP in accordance with the BDAP Report Schedule. The SCA must submit the Prevention/Treatment Needs Assessment in the template provided. Do not delete the headings, questions, objectives and sub-objectives from the template; insert the corresponding narrative where directed. Directions are provided for the completion of each section. These directions provide essential information to be able to respond correctly to each section. Please read all directions before completing any section, appendix, Page 3 of 62

question, or objective. Clarifying examples and definitions have been provided as a guide. Appendices have also been provided for your reference to assist in the completion of each section. There are no requirements regarding length of responses for any question or objective. It is understood that SCAs cannot discuss every relevant data finding or other piece of information. SCAs are expected to use their best judgment to determine the appropriate length of each response needs. Included with this template document is a copy of the BDAP Key Representative Survey on Alcohol, Tobacco and Other Drugs and the BDAP Convenience Survey on Alcohol Tobacco and Other Drugs along with directions for these surveys. You are required to administer the Key Representative Survey, but the Convenience Survey is optional. Information about how you administered these surveys must be recorded on Appendix A. Please note that review and analysis of secondary data sources (i.e. data collected by someone other than the SCA) must take place before starting the process of primary data collection through the Key Representative Survey. Analysis of secondary data sources will provide the information needed to identify the high risk communities where they Key Representative Survey should be administered. It may also be necessary to collect additional data (beyond the Key Representative and Convenience Surveys) from focus groups, public forums, interviews, etc. Remember to cite the source of all data or other findings that you refer to in your responses. Please make sure your needs assessment addresses the entire county(ies) you serve. Even though you may not be able to address all the issues identified through this needs assessment, this should be a comprehensive process in which you examine all communities in each county you serve. While completing this needs assessment include discussion of needs, resources, etc. for not just the SCA but the county(ies)/communities as a whole. * Note to Joinders SCAs who are joinders must address each element of the SCA/County Information section for each county. If information is the same for multiple counties be sure to note that. When completing the objectives each county must also be addressed. Be sure to cite data and other findings for each county.

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SCA/County Information
Reminder: Please provide the requested information about each of the counties served by your SCA. Enter your responses into the following template. Please note the source of any data you provide in your responses. SCA Information: a. Please describe how your SCA functions in terms of what services (e.g. prevention programming, screenings, assessments, case management, treatment) are provided/conducted by the SCA and which are contracted out to providers. (Use space provided below. Add additional space as needed.) Treatment/Case Management: Franklin/Fulton Drug and Alcohol Program (FFDA) provides screening and assessment services primarily for other county departments including Children and Youth, Jail, Day Reporting Center, the Behavioral Health Unit at the Chambersburg Hospital, and State Parole. Other case management services include monitoring providers and ensuring necessary required paperwork is completed. Reviewing and managing individual cases to provide necessary referrals to the appropriate level of care as individuals move through the treatment continuum. Screening and LOC Assessments are also provided for the SCA through contracted outpatient providers. FFDA contracts with a variety of treatment providers for the following level of care service: Outpatient/Intensive Outpatient Short/Long-term Inpatient Rehabilitation (both medically monitored and medically managed) Partial Hospitalization Halfway House Detoxification

Prevention: FFDA contracts with services providers in both Franklin and Fulton Counties to complete the activities required for the provision of prevention services. Combined with an FFDA Prevention Specialist, prevention services funded cover all six (6) of the Federal Strategies as required. The program uses data collected through the PA Youth Survey along with UCR data to determine the problem behavior to address with the limited funds. The following programs and curriculums have been implemented or are in process of implementation for both counties: Too Good for Drugs/Too Good For Violence (elementary schools, middle schools, after-school and community programs) Girls Circle/Boys Council (elementary, middle, and high schools) Mentoring/Leadership Programs (middle, and high schools) Alternative Activities (Skate and Dance, Kick Off Your Drug Free Summer) Page 5 of 62

Red Ribbon Week events Various speaking engagements Fulton County Communities That Care Waynesboro Communities That Care Community Coalition Student Assistance Program liaison services

Intervention: FFDA provides intervention services through services at local schools and with providers for intravenous drug use outreach programs. Student Assistance Program intervention groups Student Assistance Program screening and referrals Student Assistance Program Parent/Teacher consultations Elementary school intervention groups HIV intravenous drug users outreach

Population Trends and Demographics: a. List trends in population growth/movement and demographics (i.e. rapid population growth, changes in demographics such as an aging population or new populations coming in or leaving area) List only trends that are impacting substance use/abuse and the prevention, intervention, treatment of and recovery from substance abuse for the county(ies) you serve. (Use space provided below. Add additional space as needed)

Franklin and Fulton counties are rural counties in South Central Pennsylvania, though covering a large amount of land, bring together similar populations with similar goals, ideas and challenges. The make-up of the area is overwhelmingly Caucasian (92%), though there has been a steady increase in the Hispanic population over the past several years. The last census bureau estimates the Hispanic population in Franklin County at 4.3% (2010), although taking into account the migrant population and undocumented residents, this number is most likely higher. About 3.1% of the population is African American, while the remaining population statistics come from Asian, Native American and persons more than one race. The general population is nearly split between male and females (48.7 and 51.3 respectively). Residents in each county under the age of 18 make up slightly more than 23.5% of the population, while residents over age 65 are approximately 16% of the population. Specific statistics are not available related to sexual orientation but there is nothing that would indicate that the GLTB populations in Franklin or Fulton County are vastly different from nationally reported data (7% lesbian, 8% gay).

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The majority of adult persons in the counties are high school graduates (83.8%) with 18.3% in Franklin County and 9.9% of Fulton county residents reporting have a bachelor s degree or higher education. The median annual income in Franklin County is $46,929 while Fulton s median income is $43,069. According to the Bureau of Labor and Statistics, the unemployment rates for Franklin County, as January 2012 was 6.1%, below the state rate 7.6%, while in Fulton County; unemployment for the same month was 8.6%. In 2010, a reported 17.1% of Franklin County residents were living at or below the poverty level. In Fulton County, that number was 15.0%. In this primarily rural area, income levels play an important factor in how the Coalition works to meet the needs of area residents. Information developed for the communities, including coalition information reflects the state suggested reading level of approximately the 8th grade, while other outreach efforts are directed at the low-income and underserved populations in the area.

b. Outline cultural/religious/ethnic groups in your county(ies) that may be important subpopulations or communities that need to be addressed as you plan prevention, intervention, treatment, and recovery services. Cultural groups can be defined as groups of people that share common ties of language, nationality, practices, or some other set of shared experiences. (Use space provided below. Add additional space as needed.)

The make-up of the area is overwhelmingly Caucasian (92%), though there has been a steady increase in the Hispanic population over the past several years. The last census bureau estimates the Hispanic population in Franklin County at 4.3% (2010), although taking into account the migrant population and undocumented residents, this number is most likely higher. About 3.1% of the population is African American, while the remaining population statistics come from Asian, Native American and persons more than one race. The Hispanic culture is increasing in Franklin County; however it has not increased to the threshold requiring most agencies to translate materials into Spanish. This leads to language barriers being a common problem when accessing services. The Hispanic population tends to stick together and often does not tend to reach out for help and services. Another important aspect to be noted is the strong traditional, conservative, values, belief systems and sense of religiosity. About 55% of residents in these areas have stated that they have faith based ties. There are more than 230 religious congregations in the two counties, one faith based school in Fulton County, and 3 faith based schools in Franklin County that collectively house 1,001 students, making this a key cultural area to be addressed and considered. Activities and services are promoted to congregations; however there are still many church leaders who are uninterested in openly addressing drug and alcohol use with youth. Faith leaders often serve Page 7 of 62

not only their congregations but provide counseling on family issues, drug and alcohol dependence and have active youth groups. Outreach to youth has included contacting religious leaders, as well as educating church youth and adult groups about abuse issues. Several church leaders work and serve on the coalition and the coalition continually works to ensure successful engagement of this population.

Community Changes: a. List any significant changes in your county(ies) in the last five years. This could include social and economic conditions, new businesses or loss of businesses, a new school or school closing, new places of worship or closing of places of worship, etc. This could also include changes to law enforcement including changes to local laws, ordinances, funding, etc. List only trends that are impacting substance use/abuse and the prevention, intervention, treatment of and recovery from substance abuse for the county(ies) you serve. (Use space provided below. Add additional space as needed) Scotland School for Veteran s Children closed its doors in 2009, displacing the approximately 350 kids and many employees. Chambersburg school district modified the distribution of their secondary student s beginning with the 2011/2012 school year. Previously, they had a high school for grades 10-12, a Jr. High schools for grades 8-9, and a middle school for grades 6-7. This year, their high school is for students in grades 9-12. They have changed the Jr. High building into a second middle school for half of the district s 6-8th grade students, which is called Chambersburg Middle School North (CAMS North). The original middle school houses the other half of the 6-8th grade students , which is now called Chambersburg Middle School South (CAMS South). In 2012, four new liquor licenses were made available by the PA State Liquor Control Board due to increases in population for Franklin County. Three of the four licenses have been assigned to new restaurants coming into the area. The final license is open for assignment and several area restaurants are competing for the license. In the past few years, several of the area s Elementary Schools in Chambersburg Area School District have been closed and students have been combined into larger elementary schools. The district is moving away from the small, community elementaries. Unemployment rates have declined slightly in the last 12 months, however many of the counties residents still remain out of work. Franklin County unemployment rates have declined from 7.4% to 6.6% from March 2011 to March 2012. Fulton County rates have declined from 10.9% in March 2011 to 9.3% in March of 2012. The relatively high unemployment rates continue to have an effect on local economies. Page 8 of 62

 In the last two years, two new urgent care medical facilities have opened in Chambersburg. Both MedExpress Urgent Care and Keystone Walk-In Clinic have opened their doors to urgent care to offer a level of care between emergency rooms and waiting for doctor s offices to be open.

History and Traditions: a. Describe how the history of the county(ies) influences how people feel about the county(ies), and how people view substance use/abuse and the prevention/treatment of substance abuse. Note traditions and celebrations that are relevant to substance use/abuse and the prevention, intervention, treatment of and recovery from substance abuse. (Use space provided below. Add additional space as needed)

Because of the history dating back to Revolutionary times, Franklin and Fulton County would both be considered conservative counties by many people. In addition, when driving through Franklin County, there are many churches and houses of worship. It is easy to see that Franklin County is in the bible belt of PA. This conservative background causes many residents (especially older residents) to be intolerant of substance use. There seem to be two prevailing viewpoints one of those who use substances and find it acceptable, and the other view of those who are intolerant to any use. There seem to be these two extreme viewpoints on drug and alcohol use. Because of that label, many residents don t realize the extent of our drug and alcohol usage problems. There are many residents who live in denial that there are drugs in our communities; however youth would report high amounts of usage and a wide variety of drugs. Although there are festivals and celebrations in the county annually, most do not include alcohol use and are typically all family-friendly events. The exception to this would be the local private clubs (Legion, Elks, Marine Corps, Moose, etc) often have events with alcohol included.

Educational Institutions: a. Describe how engaged schools in your county(ies) are in prevention/intervention programming. Also note if any schools offer on-site treatment services. Include public, private, and charter schools in your discussion. Describe to what extent schools are willing to cooperate in providing prevention, intervention, and treatment programs and services. Are schools unwilling to provide any such programming? Are schools willing to work with the SCA and providers to implement needed programs and services even if barriers such as lack of time exist? (Use space provided below. Add additional space as needed)

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Prevention is not highly prioritized however some schools are engaged in accepting programming, especially at the lower levels (elementary and middle). We are seeing an increase in interest and collaboration between schools and prevention providers. There are several reasons for this recent increase in acceptance. The first reason is school district budget and staff cuts. As the districts are trying to work with less funding, they are beginning to reach out to others who can help to provide services for their students. Another reason is the SCA has changed from being a functional unit with one prevention specialist for two counties to an SCA with contracted providers in each county, therefore increasing the number of people/staff who are available to offer services. With one prevention specialist providing all of the prevention services, the number of programs and availability was much more limited. Now, the prevention specialist provides fewer services, but monitors the services delivered by contracted providers, which has caused an increase in the number of services available and completed. In Franklin County there has been an increase since July 1, 2011; partly because our prevention services provider in Franklin County also is the new contractor for Student Assistance Program (SAP) services in both counties, which has also increased the collaboration between providers in the adjoining counties. The SAP liaisons and SAP supervisor are becoming familiar faces to the school personnel and they are more willing to work with someone who is in their school on a weekly basis than someone who only comes occasionally or who does not have time available when needed. The supervisor for the SAP Program at Healthy Communities Partnership Inc. (HCP) is also the supervisor of HCP s education and prevention services. This makes is easier to coordinate programs with school personnel. Fulton County is very engaged, especially at younger ages. I believe the reason for this is because the contractor, Fulton County Center for Families (FCCF) is well known throughout the county and they have offered other services for many years prior to becoming a prevention provider for the SCA. The programs that FCCF offers in the community include child care, after-school program, and in-home services to families. Early initiation of services offered by the provider increases the trust of families in the provider to deliver services to their children. Also, Fulton County agencies are very collaborative, therefore offering support and resources when necessary to each other in order to meet the needs of the small county of residents who count on each other. One lacking piece is school-based treatment, which no schools in either county have at this time. Providers have discussed whether this will be a future endeavor in the upcoming school year, however nothing definite is in place at this time. The SCA has limited information regarding services for private and charter schools. The only services that the SCA is aware of for that population are a few prevention services that are provided by the SCA to Shalom Christian Academy and Cumberland Valley Christian School. Twice per year, the SCA prevention specialist provides activities that include information dissemination via brochures and speaking engagements to both middle and high school students at Shalom Christian Academy. Once per year, the SCA prevention specialist provides educational programs in the form of a power point presentation or other prepared program to teach about the dangers of ATOD, addiction, and how to access treatment services for the students and/or family members and friends of students. In 2009/2010, 2010/2011, and 2011/2012 school year, SCA prevention specialist partnered with the Page 10 of 62

Chamber of Commerce and other agencies to offer a county-wide youth leadership program in Franklin County. In 2009/2010, two of the students who participated in the youth leadership program were home schooled students who resided in the Shippensburg School District. In 2011/2012, one of the students who participated was a student from Cumberland Valley Christian School. In the upcoming 2012/2013 school year, several students from Shalom Christian Academy will participate in the youth leadership program. There are school districts in both counties who implement evidence-based curriculums (Olweus Bullying, Too Good for Drugs, etc.) to their students, but do not provide data to the SCA. The SCA has knowledge of this information through anecdotal information received during conversations with people in schools and the community. I think local schools would provide more prevention programming (if time permitted) if the SCA had the resources to purchase the curriculums and offer the training to implement the programs. Schools may even provide SCA with data if we purchased materials, however the SCA does not have adequate staff to enter data for schools, especially if data entry would require a 14 day deadline. During 2011/2012 school year, multiple schools in both counties agreed to permit prevention providers to teach Too Good for Drugs Programs, but the provider had to teach the curriculums, gather the data, keep attendance, and enter the data for the programs, which is time consuming. There is not enough staff or time to offer this type of service to all schools. This program has been implemented through a prevention grant through PCCD and will continue throughout the remainder of 2012 and 2013. The contractors are working to provide sustainability by training teachers (school district employees) to implement the curriculum so that the use of the evidence-based curriculum can be expanded. So far, schools have been open to receiving this service and have taken been agreeable to their staff taking an active role in future teachings. Overall, the relationship between prevention providers and school districts has greatly improved and we look forward to continuing to build these strong bonds to increase prevention offerings in both counties.

b. Pennsylvania Youth Survey (PAYS) and Youth Risk Behavior Survey (YRBS) Participation Please list the school districts you are aware of that are participating in PAYS and/or YRBS. For each school district also note the school buildings and grades in which the surveys are administered. (Use space provided below. Add additional space as needed) All school districts participated in the 2011 PAYS survey, however two schools (one in each county) have active consent, requiring written parent permission for students to participate. Those schools have very low rates of participation. Franklin County Schools Chambersburg Area School District is one of the districts with active consent so few students participate in the PAYS survey. All 6th, 8th, 10th, and 12th were provided permissions to take the survey, Page 11 of 62

however only a small percentage of middle school students returned permissions and participated. No high schools students participated. Some students at Chambersburg Area Middle School North and Chambersburg Area Middle School South took the survey. Although offered the opportunity, no Chambersburg Area Senior High School students participated. Waynesboro Area School District had passive consent for the 2011 administration of the PAYS survey (although this will be changed to active consent by the next survey in 2013.) Almost all 6th, 8th, 10th, and 12th grade students completed the survey. School buildings participating include Waynesboro Area Senior High School and Waynesboro Area Middle School. Waynesboro Area School District houses 6th graders in their elementary schools, so all elementary schools participated including: Summitview Elementary, Hooverville Elementary, Mowrey Elementary, and Fairview Elementary. Greencastle-Antrim School District also participates in the PAYS administration and uses passive consent. Almost all students in 6th, 8th, 10th, and 12th grades participated and completed the survey in 2011. Both Greencastle-Antrim Middle School and Greencastle-Antrim High School participated. Tuscarora School District participated in the 2011 administration of PAYS. They had 6th, 8th, 10th, and 12th graders participate and both the James Buchanan High School and James Buchanan Middle School buildings administered the survey with passive consent. This was the first year that Tuscarora School District allowed their 6th graders to participate in the administration of the survey. Fannett-Metal School District had 6th, 8th, 10th, and 12th graders participate in the 2011 PAYS survey. Both Fannett-Metal High School and Fannett-Metal Middle School administered the survey with passive consent. Fulton County Schools Southern Fulton has K-6th graders in their elementary schools. 7th-12th graders are in the junior/senior high school. Students in 6th, 8th, 10th, and 12th grades participated in the survey. Southern Fulton Elementary school participated with active consent, however Southern Fulton Jr/Sr high participated with passive consent. Central Fulton administered the surveys utilizing passive consent to 6th, 8th, 10th, and 12th graders in 2011 at Central Fulton Middle School and Central Fulton High School Forbes Road had 6th, 8th, 10th, 12th graders participate in the 2011 administration of the PAYS survey. 6th graders at Forbes Road are in the Forbes Road Elementary School and all other grades are in Forbes Road Junior/Senior High. Forbes Road School District utilizes passive consent.

Resources:

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a. List all sources of additional grant funding for prevention, intervention, treatment and recovery coming to the SCA (do not include pass through funding or funding that goes directly to your contracted providers). (Complete table below. Add rows to table as needed.) Name of Funding Source Human Services Development Funds (HSDF) PCCD Grant Attorney General Grant PLCB Grant TANF Brief Description of Grant Categorical grant used for Prevention Restrictive Intermediate Punishment grant used for Treatment and Case Management Prevention grant PA Liquor Control Board grant used for Prevention Received from Franklin/Fulton Mental Health. Used for Case Management Start Date July 1, 2010 July 1, 2010 December 2010 January 2011 July 2010 End Date June 30, 2011 June 30, 2011 Decembe r 2010 June 2011 12/2010

b.

Note whether the SCA had to return (to BDAP, the Hub, or other entity) any unused funds for State Fiscal Year 2010/2011 for any of the sources of funding coming to the SCA for prevention, intervention, treatment, and recovery (e.g. BHSI Funds, Act 152 Funds). List the name of the funding sources and the amount that was unused or had to be returned. In instances where unused funds had to be returned, please discuss the barriers to efficiently utilizing these funds (i.e. what if anything hinders the SCA s ability to expend these funds within their required timeframe). (Use space provided below. Add additional space as needed)

ACT 152: SENT $50,000 TO THE HUB PCCD: $51,019 UNUSED FUNDS FROM GRANT

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To obtain a.) information regarding use of ATOD and b.) an estimate of the prevalence of substance use disorder in the total population of an SCA.

Definitions Estimate: A quantitative description of the current or past situation, based on data from known sources relating to the same time period using a known method which can be replicated. Prevalence: The number with a diagnosable condition at a given time. Substance use disorder: A condition of substance abuse or dependency as defined by DSM IV-TR. Total Population: All people who are located in the geographic region of the SCA.

Objectives
Directions for 1a. Utilizing a variety of data sources, discuss the use of ATOD for the counties you serve. Information regarding substance use would include age at first use, past 30 day use, and other rates of use for various populations. The goal is to determine what substances are being used, at what rate, where, and by whom. Focus your response on issues and populations that the data suggest may be the biggest concerns. Note any gaps in available data that you believe may be obscuring to what extent certain issues/problems exist. Examples of data gaps include: the ER department at the regional hospital was unable to provide any data regarding ER visits and two school districts in your county have not participated in PAYS, which has limited your ability to assess patterns of use for that population. Where possible, list not only county level data but also community level data. (The term community can have many different meanings and can carry different connotations. It can mean town, township, borough, certain number of blocks within a city, or even a specific demographic group.) Sources of this data include arrest reports, Uniform Crime Reporting System (UCR), emergency room admissions, and surveys such as Pennsylvania Youth Survey (PAYS) and Youth Risk Behavior Survey (YRBS). Data from AOPC (Administrative Office of Pennsylvania Courts) on offenses charged for crimes such as DUI, drug-related offenses, and underage drinking for the county(ies) you serve has been provided to you in tables posted to the BDAP Communicator. You are required to discuss this provided AOPC data in your response. You are also required to include data you have entered into PBPS such as NOMs surveys and pre/post tests in your response. Utilize service location information in PBPS to link this data to specific communities. Page 14 of 62

Please compare local data to state and national data. Other local data you have collected can also be discussed in response to this objective.

Response to 1a. (Insert response below.) The most recent PAYS data available is from 2009 (summarized below) as 2011 data has not yet been released). The problem of youth substance abuse in Franklin and Fulton counties is real and increasingly concerning. Overall, rural Franklin and Fulton counties in south central Pennsylvania have higher than average youth usage rates for tobacco, alcohol, inhalants, and prescription drugs when compared to national usage rates (Pennsylvania Commission on Crime and Delinquency, 2009). The same survey indicates that more than one in five youth in 10th grade report being offered, given, or sold an illegal drug on school property in the past year. Similarly, a 2009 bi-county-wide Needs Assessment Survey of key representatives, indicated that tobacco, alcohol, inhalants, prescription drugs, and marijuana are all very or somewhat easy for area youth to obtain. Survey respondents indicate that youth (age 13-18) and young adults (age19-25) are most impacted by substance use and abuse in our counties. The most recent data from PAYS, with a sample size just over 1450, shows high school students in both counties, report higher lifetime alcohol usage than national usage rates in the same grades (Johnston, et.al., 2009). Past-30-day cigarette usage by high school students is 50% higher than national averages in both Franklin and Fulton counties. Smokeless tobacco usage in both counties in the past 30 days is near 150% the national rate in every grade surveyed. The tables below give additional details:

PAYS data 2009

Table 1: Franklin County Past 30-day Substance Use (% within grade) 6th grade 8th grade 10th grade 12th grade Alcohol 5.9 12.3 38.3 39.3 Cigarettes 0.8 2.9 20.7 29.5 Smokeless Tobacco 1.9 5.8 9.2 13.2 Marijuana 0.3 1.9 15.0 17.9 Pain Relievers 1.1 2.6 10.7 7.9 Tranquilizers 0.6 1.0 2.4 2.1 Stimulants 0.6 0.6 5.2 2.6 Table 2: Franklin County Youth who Reported Perception of Great Risk of Harm (% within grade) th th th th 6 grade 8 grade 10 grade 12 grade Drinking Alcohol Regularly 39.1 27.8 22.4 26.5 Smoking Cigarettes Regularly 68.9 69.3 56.j9 57.1 Trying Marijuana Once or Twice 40.5 37.4 21.0 17.9 Smoking Marijuana Regularly 81.0 81.0 58.6 49.0 Table 3: Franklin County Percentage of Youth Who Indicated Parental Disapproval of (% within grade) 6th grade 8th grade 10th grade 12th grade

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Drink Alcohol Regularly Smoke Cigarettes Smoke Marijuana

93.3 95.5 96.3

85.8 89.9 94.0

67.0 71.4 82.9

60.3 62.2 76.6

Table 4: Franklin County Percentage of Youth Who Indicated Peer Approval of (% within grade) th th th th 6 grade 8 grade 10 grade 12 grade Drinking Alcohol Regularly 2.9 7.4 17.7 20.9 Smoking Cigarettes 2.3 3.0 11.0 10.9 Smoking Marijuana 2.6 2.7 15.7 15.4 Table 5: Franklin County Age of Onset as Reported by (reported by grade) th th th th 6 grade 8 grade 10 grade 12 grade Trying Alcohol 10.5 11.6 12.8 14.1 Drinking Alcohol Regularly 11.6 12.6 14.1 15.6 Smoking Cigarettes 10.4 11.8 12.6 13.5 Smoking Marijuana 10.8 12.4 13.9 14.2 Table 1: Fulton County Past 30-day Substance Use (% within grade) 6th grade 8th grade 10th grade 12th grade Alcohol 9.6 26.4 31.8 52.4 Cigarettes 3.8 6.4 25.0 35.7 Smokeless Tobacco 1.9 13.0 14.6 24.4 Marijuana 1.9 5.5 18.2 9.5 Pain Relievers 3.8 2.7 7.3 4.9 Tranquilizers 0.0 0.9 7.5 4.9 Stimulants 1.9 0.9 2.4 0.0 Table 2: Fulton County Youth who Reported Perception of Great Risk of Harm (% within grade) 6th grade 8th grade 10th grade 12th grade Drinking Alcohol Regularly 34.6 30.9 27.9 28.6 Smoking Cigarettes Regularly 71.2 70.9 60.5 54.8 Trying Marijuana Once or Twice 48.1 32.7 23.3 38.1 Smoking Marijuana Regularly 82.7 85.5 55.8 64.3 Table 3: Fulton County Percentage of Youth Who Indicated Parental Disapproval of (% within grade) 6th grade 8th grade 10th grade 12th grade Drink Alcohol Regularly 88.5 76.4 52.3 52.4 Smoke Cigarettes 94.2 88.2 63.6 69.0 Smoke Marijuana 94.2 90.9 75.0 85.7 Table 4: Fulton County Percentage of Youth Who Indicated Peer Approval of (% within grade) 6th grade 8th grade 10th grade 12th grade Drinking Alcohol Regularly 2.0 15.6 18.2 28.6 Smoking Cigarettes 0.0 9.2 15.9 11.9 Smoking Marijuana 0.0 9.2 13.6 11.9 Table 5: Fulton County Age of Onset as Reported by (reported by grade) 6th grade 8th grade 10th grade 12th grade Trying Alcohol 10.9 11.8 13.2 14.4 Drinking Alcohol Regularly 11.0 12.5 14.3 15.3 Smoking Cigarettes 10.8 12.2 13.0 14.5 Smoking Marijuana 11.0 12.8 13.2 15.4

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Fulton County statistics indicate 31.7% of high school seniors report using smokeless tobacco in their lifetime and 51.2% report using cigarettes (compared to 16.3% and 43.6% nationally). Franklin and Fulton County students in 12th grade show a higher than average past-30-day usage of cigarettes, smokeless tobacco, and inhalants. Data on prescription drug use show Franklin County high school students have a considerably higher than average usage of prescription medication. Lifetime use of pain relievers by sophomores in both counties is almost double the statewide average (Pennsylvania Commission on Crime and Delinquency, 2009). In 2009 data shows that 13.2% of Franklin County and 26.8% of Fulton County 12th graders report having driven under the influence of alcohol. In Franklin and Fulton counties, 13.8% and 22.0% respectively, have driven under the influence of marijuana (Pennsylvania Commission on Crime and Delinquency, 2009). Franklin County has an especially high DUI arrest rate compared to other counties in Pennsylvania. From 2008 to 2010, Franklin and Fulton counties saw 23.7% and 78.1% increases, respectively, in adult DUI arrests. Likewise, Franklin County saw a two-year increase of 22.5% and Fulton County had a 14.2% increase in underage (under 21) DUI arrests (Pennsylvania State Police, 2012). According to the 2009-2010 Annual Report by Franklin/Fulton Drug and Alcohol Program, an estimated 10% of clients receiving treatment are age 18 and younger. Alcohol, marijuana, and prescription drugs make up over 70% of the primary substances used in those undergoing treatment for substance abuse. In addition to these substances, anecdotal evidence from area police stations, state police, EMS and school personnel suggest an increasing problem with prescription drug use among youth. Additional data from the 2010 Franklin County Juvenile Probation Annual Report shows drastic increases in several high-risk youth behaviors. For example, incidents of rape and indecent assault arrests increased significantly from 2006 to 2010. Aggravated assault, simple assault and criminal mischief both increased from 2009 to 2010. Possession of drug paraphernalia has increased tenfold from 2006 to 2010. The Franklin County Children and Youth Service 2010 Annual Report shows 106 referrals (out of 1,144 total referrals) had a drug and alcohol concern with parent (2010 Franklin County Juvenile Probation and Children and Youth Services Annual Report, 2011). Juveniles charged with driving under the influence of alcohol or a controlled substance in Franklin County increased by about 150% from 2006 to 2010, while possession of weapons on school property have increased 25% during that period of time (Franklin County Juvenile Probation, 2010). Data from 2001-2007 show both counties have high teen pregnancy rates, over 30% more than the overall state average (Robert Wood Johnson, 2011). Data from various sources shows Franklin and Fulton counties will greatly benefit from the combined resources and strategies of the coalition. Both counties report higher than average youth usage of tobacco, alcohol, and prescription drugs in high school, compared to national and state rates. In addition, youth in these counties show an increase in high-risk behaviors (driving under the influence, teenage pregnancy, sexual and other assault) indicating increased substance use. The increased threat

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for drug and alcohol use/abuse among the youth of Franklin and Fulton counties has greatly influenced community mobilization and volunteer involvement on this issue.

AOPC data shows alarming trends as well. When looking at Franklin County trends, the DUI-alcohol rate has increased from 21% from 2004 to 2010. DUI rates for minors have increased by 28% from 20092010. However the most disturbing DUI trends are those involving substances. 2010 DUI charges involving alcohol and other substances have quadrupled since 2004. Also DUIs involving other substances in 2010 were over six times the 2004 rate. Underage drinking, drug possession, and drug sales have all remained fairly steady over the last 10 years. In addition, public drunkenness has increased by 36% over recent years. Fulton County has similar issues, however since the population is significantly smaller, data is often not as revealing. In Fulton, DUI arrests for alcohol increased by 170% from 2004 to 2010. In addition driving under the influence of substances was significantly higher in 2010 than any of the previous six years. Drug possession arrests have increased by 259% since 2000. The data gathered from AOPC shows alarming trends in drug and alcohol charges throughout both counties. Increased DUI checkpoints and enforcement may play a role in the increases. In addition, NOMS data from adults showed that all adults surveyed believed that cigarette use causes moderate to great risk of physical harm. Most adults reported having their first alcoholic drink (more than a sip) between the ages of 15-17 or 18-21. All adults except one agreed that there is a moderate to great risk of physical harm from drinking five or more drinks once or twice per week. Surprisingly, only half of adults reported never smoking marijuana, although all except one reported not using marijuana in the last 30 days. Over 1/3 of adults and 13% of surveyed youth have taken a prescription drug not prescribed for them. Of all adults surveyed, 18% believe there is only a slight risk of physical harm when taking prescription drugs prescribed for others. Adults and youth both reported a moderate to great risk of harm from using synthetic drugs, however anecdotal data shows heavy use of synthetic drugs by both adults and youth. 96% of youth reported moderate or great risk of harm for smoking cigarettes, compared to 93.2% reporting moderate or great risk for drinking five or more drinks once or twice per week and 92% for inhalants. 86% of surveyed youth disapprove of someone their age trying marijuana. Sadly, 54% of youth report not having any conversations at all with at least one parent in the last 12 months about the dangers of tobacco, alcohol, or drug use. This shows a great opportunity for community leaders to educate parents on the importance of discussing these dangers with their children. Directions for 1b. Appendix B provides a table showing the prevalence of substance use disorders in the total population. Appendix C provides a table of the prevalence of substance use disorders by local special populations. The table in Appendix B has been completed for you, but you must complete the table in Appendix C. Instructions for the completion of the table in Appendix C Page 18 of 62

have been included with the table. Certain special populations have been defined for you, but you may include other special population categories (e.g. co-occurring) as desired. If you add special populations, the additional populations must be added as new rows in the table. After completing the table in Appendix C and reviewing the information in Appendix B and C, briefly describe the extent of substance use disorders in the county(ies) you serve. You are not limited to only the data sources provided to you in Appendix B and C. You may also collect and/or discuss other local data sources that provide additional information regarding the extent of substance use disorders in the county(ies) you serve. Response to 1b. (Insert response below.) According to Appendix B, the prevalence of substance use disorders is approximately 7.70% of the population ages 12 and older. This places approximately 10,342 drug users in Franklin/Fulton Counties. Additionally, in 2011, there were 266 arrests in Franklin County for drug charges for possession (outlined in Appendix C). There were also 55 arrests in Fulton County for the same types of charges. Arrests for violations including DUIs, liquor law violations, and public drunkenness numbered 1314 in Franklin County and 116 in Fulton County. Seventy percent of the annual jail population is estimated to have a drug and/or alcohol abuse problem. The Franklin County jail had 2317 Franklin County commitments in 2011 and 163 Fulton County residents committed in 2011. This means an estimated 1736 inmates are in need of drug and/or alcohol treatment each year. Approximately 70% of the total population on county probation is estimated to have a drug/alcohol abuse problem, numbering 1798 people in Franklin County and 26 residents in Fulton County. State Probationers are also estimated to be drug abusers in 70% of cases and this amounts to an additional 1201 residents in Franklin County (638 state probation and 563 state parole). In Fulton this has an additional 164 residents (83 on state probation and 81 on state parole). Substantiated child abuse reports are estimated to involve alcohol or drug abuse in 50% of cases. According to this estimate, 27 cases in Franklin County and 7 cases in Fulton County involve drug and/or alcohol abuse. Protection from Abuse orders (PFA) also frequently involve alcohol and/or drug abuse in 25% of cases. This would be an additional 43 residents in Franklin County with a drug/alcohol problem. Additionally, 227 Day Reporting Center Clients (approximately 70% of the 324 intakes) participated in drug and alcohol treatment while at the Day Reporting Center. As outlined above, Franklin and Fulton Counties have a wide extent of abuse. These numbers are likely only a small portion of the total number of drug and/or alcohol abusers in the counties. There are a number of reasons for possible discrepancies, including law enforcement amounts and the amount of residents that go uncharged and unnoticed with a drug or alcohol problem and do not readily fall into one of the above categories. It can be estimated that a relatively large population in the counties is in need of help for a use or abuse problem.

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To identify risk and protective factors, in regard to the prevention of substance abuse, that are present in the communities served by your SCA.

Definitions Risk Factor: Risk factors are individual characteristics and environmental influences associated with an increased vulnerability to the initiation, continuation, or escalation of substance use. Protective Factor: Protective factors include individual resilience and other circumstances that are associated with a reduction in the likelihood of substance use.

Directions for 2 Please use data such as Key Representative Surveys or focus groups to support your claims. See Appendix D for a list of risk and protective factors. Risk factors can increase a person s chances for substance use/abuse, while protective factors can reduce the risk. For the risk and protective factors you identify also remark on their changeability, i.e. how possible or difficult would it be to change these factors. Reminder: Please complete Appendix A Key Representative and Convenience Survey Administration Information. Response to 2 (Insert response below.) Key Representative Surveys give an overall glimpse of the county and associated issues and behaviors. Twenty-nine total representatives completed at least part of the survey. Of those, 82% strongly agree or agree that residents feel at home in our communities. Additionally, 64% agree residents feel safe in the community. However, 41% of respondents agree or strongly agree that drug use is tolerated in the community. Social norms are conducive to drug and alcohol use, a definite risk for area youth. Safety topics have a variety of responses. 86% of respondents agree that laws against having weapons on school property are strictly enforced. Most respondents believed schools (79%), churches (68%), law enforcement (86%) support no use policies. However, only 39% believe that businesses in the communities support no use policies. This could be in part due to the number of businesses that profit from alcohol use (bars, restaurants, etc). Only 50% of respondents agree that people in the community share the same values and 54% believe that if there is a problem in the community, people living here will work together to solve it. Over 60% agree that healthy behaviors are encouraged in our community. Healthy behaviors are encouraged by local agencies and organizations, but are not always accepted by residents.

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With regards to drug and alcohol problems, a startling 96% of those surveyed agree there is a drug or alcohol problem in the community. Only 43% of respondents agree that people in the community view addiction as a disease, and just over a third of people agree that the community views tobacco use as a problem. When surveyed about the availability of various drugs to youth, 100% of respondents think it is easy or fairly easy for youth to get tobacco in our communities. Many youth tobacco users report parents are aware of their use and even help them obtain tobacco products. Others hide it from families but report buying it on their own (without being asked for age identification) or stealing it from family and friends. Many drugs were rated as very or fairly available to youth, including: alcohol (93%), inhalants (86%), marijuana (86%), steroids (61%), and prescription drugs (89%). When surveyed about drug availability for adults, 100% of thought marijuana and prescription drugs were easy or fairly easy to obtain. Additionally, over 50% of respondents thought the following drugs were easy for adults to access: cocaine/crack, heroin, methamphetamine, steroids, and date rape drugs. Key respondents definitely feel that a broad variety of drugs are readily available in the counties. When it comes to risky behaviors, many respondents felt that several negative behaviors somewhat or definitely described our communities, including crime (96%), drug-selling (93%), fights (86%), empty/abandoned buildings (71%), graffiti (51%), and drug overdoses (89%). Protective factors were also surveyed and the respondents found the following to somewhat or definitely describe the communities: drug and alcohol laws are enforced (96%), schools support youth (96%), churches support youth (100%), schools and families work with each other (93%), media provides messages that discourage drug use (61%), and media provides messages that discourage alcohol use (50%). When asked how severe the impact of drug and alcohol use is in our communities, 40% of key representatives reported that it is a major problem, 56% reported it to be somewhat of a problem, and only 4% felt like it is not at all a problem. When asked to rate which age groups are most affected by drug use, the ages between 16-25 were the most frequently chosen ages affected. However, every age range listed was chosen by at least one respondent. Based on the data from the key representatives surveys as described above, the highest risk factors are availability of ATOD as well as perceived availability. Additionally, anecdotal data from Student Assistance and other youth-serving programs outline these additional risk factors: perceived risk/harm, family management, lack of monitoring, and favorable parental attitudes toward ATOD use. Family and parent disorganization and acceptance of ATOD use are major problems in our communities and definite risk factors for our youth. The protective factor most apparent from the key representative data include community supported substance abuse prevention efforts and programs. The Community Coalition, together with the SCA and providers work hard to provide community based education and substance abuse prevention efforts. In addition, consistency in rule enforcement (particularly law enforcement) and reinforcement for prosocial involvement are protective factors in the counties. Page 21 of 62

To identify local, state, and national trends that may impact the SCA and may influence prevention, intervention, treatment and recovery efforts.

Definitions: Local, state, and national trends: A prevailing tendency or information relating to the economy, government, legal issues, technological and medical advances, or socio-cultural patterns that may influence business practices of the SCA. Intervention: Intervention focuses on providing individuals who engage in hazardous substance use services to develop the skills necessary to reduce their risk. Intervention services may also be provided for individuals who need substance use disorder treatment but are unable to access treatment. The goal of intervention is to enhance and maintain the individual s motivation to access and engage with appropriate substance use services. Intervention also includes Early Intervention, which is defined as follows: Early Intervention is a term generally used to describe those early efforts to intervene where an individual is seen as being at risk. An early intervention is often brief, designed to assess and provide some initial feedback to the individual about his or her alcohol or other drug (AOD) use and its consequences. Early Intervention takes place prior to a Level of Care Assessment. Examples: Student Assistance Program, Underage Drinking Program, DUI Offender Program.

Directions for 3 Describe local, state, and national trends that may impact the SCA and may influence prevention, intervention, treatment and recovery efforts. Examples of local, state, or national trends may include a move to integrated health/behavioral health care, local unemployment rates, aging of baby boomers, electronic medical records, implementation of evidencebased/promising practices, focus on special initiatives (i.e., Underage Drinking, offender reentry, co-occurring), medication management, political priorities, changes in laws or local ordinances, school policies and federal education requirements, etc. Response to 3 (Insert response below.) It is important to consider trends that influence the ability of the SCA to provide drug and alcohol services, including treatment and case management to residents needing these services. The economic situation of the country, state, and communities has had a broad effect on the prevention, intervention, treatment, and recovery efforts. Although the unemployment rates in Franklin and Fulton County have decreased since 2011, rates remain fairly high. The table below details unemployment trends. Unemployment Rates March 2011

March 2012 Page 22 of 62

USA PA Franklin County Fulton County

9.2% 8.2% 7.4% 10.9%

8.4% 7.7% 6.6% 9.3%

Historically, tough economic times correlate with increased drug and alcohol use among affected populations. Franklin/Fulton SCA program planners are preparing for the profound impact that the economic recession will have on society in general. Studies of the past recessions, including those of the 1980 s and 1990 s, show that rates of alcoholism, drug abuse, and depression positively relate to the unemployment rate: as the numbers of jobless grew, so too did the number of residents needing drug and alcohol treatment and services. It is anticipated that the current recession will impact drug and alcohol use and abuse, and depressive disorders, in the same way. Alcohol Since DUI laws were modified in 2006, Franklin/Fulton Counties have worked diligently to provide treatment and services to the increased numbers of offenders with alcohol-related charges. The SCA has funding from the PA Commission on Crime and Delinquency to implement a Drug and alcohol Probation Partnership that brings D&A treatment to level 3 and 4 offenses, including M1 DUIs. In addition, a recently implemented Jail Diversion program, also grant-funded, provides drug and alcohol treatment to offenders with mental health issues and, perhaps, co-occurring alcohol abuse. Marijuana For the Franklin/Fulton SCA, marijuana is identified as the primary substance for about 18% of cases. This number may rise, however, if Franklin/Fulton counties follow the national trends among aging baby boomers that show an increase in the use of illicit drugs among US residents ages 50-59 (CITE: 2005 National Survey on Drug Use and Health). Federal anti-drug officials say the survey indicates some baby boomers that were in their teens and 20 s when drug-use rates peaked in the 1970s are taking their drug habits well into middle age. Additionally, for 70% of the baby-boomers who report using drugs, marijuana is listed as their drug of choice. Heroin Like other communities around the state and nation, the Franklin/Fulton SCA is experiencing a rise in heroin addiction. Treatment admissions referred by the SCA show heroin as the primary drug of choice in 28.4% of clients. This is higher than the state average of 22.4%. This rate has continued to increase over the past several years. Prescription Drug Abuse In 2008, 15.2 million Americans age 12 and older had taken a prescription pain reliever, tranquilizer, stimulant, or sedative for nonmedical purposes at least once in the year prior to being surveyed. (National Survey on Drug Use and Health, SAMHSA). Part of the reason is also the existence of online Page 23 of 62

pharmacies that make it easy to get the prescription drugs without a prescription a tactic that works even for youngsters. In addition, doctors today are prescribing more drugs for more health problems than ever before and it is becoming increasingly more common for the prescribed patient to sell, rather than use, the prescribed medication. The local trends in prescription drug use are still under investigation. The SCA is currently working with Health Choices to mine data from their systems in order to better understand the scope of the problem. The data can be quantitatively and qualitatively analyzed to identify trends as well as improve outreach, identification, treatment and prevention practices.

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To identify emerging substance use problems by type of chemical, route of administration, population, availability and cost, etc.

Definitions: Emerging substance use problems: This implies that there is a situation which is different from what came before, and which could not have been fully anticipated and planned for. For the purposes of this needs assessment consider emerging to be something that arose within the last two years or since your last plan was completed. The difference may be the population of users, the type of substance, the nature of the substance or the rate of increase. The implication is that a new problem confronts the community and it may need to be dealt with. The new problem may be an isolated event that requires immediate action or it may take the form of a gradual pattern change that was initially anecdotal information, tracked over time, and now requires a response impacting service delivery.

Directions for 4 Discuss any emerging substance use problems. These may have been problems you discussed in Objective 1, but please note them again here in regard to their emerging nature. For example: you may describe new substances such as synthetic drugs that have taken off in popularity or you may note the growing use of heroin in a specific population such as children of middle/upper class. Also identify in your response any indicators of emerging treatment needs for the SCA. Note that only those indicators of an emerging treatment need should be included in your discussion. Examples of changes that may indicate a growth in the need for treatment are: an increase in DUI offenders based on reduction of BAC level to .08, an increase in methamphetamine labs, identification of new drugs of abuse, or an increase in the number of inmates released from state/county probation and parole. Be sure to note the data and source of the data that is evidence of the emerging substance use problems you discuss in your response. Sources of data may include: Client Information System (CIS), Case Management Resource Report (CMRR), anecdotal information obtained from treatments providers, police, probation/parole officers or human service staff, emergency room data, arrest data, and Student Assistance Program (SAP) data, or any other local data sources you have. Response to 4 (Insert response below.)

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A review of emerging treatment needs for the FY 2009-2010 (see Appendix G) reveals that Franklin/Futon Counties fair worse with respect to use of heroin, other opiates/synthetics, and benzodiazepine abuse. Franklin/Fulton County SCA clients report heroin as the primary substance in 28.4% of cases (compared to a state rate of 22.4%). This trend is alarming as it has continued to increase. In addition, primary drugs have been reported as opiates/synthetics at a higher rate than state average 17.7% compared to 12.7%. Benzodiazepine also is reported at a rate of 4.3% (compared to 1.0% statewide). While the statistics included with the report do not shed light on the patterns of prescription medication abuse, our treatment providers and health professionals report anecdotally that use and abuse of prescription drugs continues to rise in Franklin/Fulton Counties. Persons abusing prescription drugs are difficult to quantify, in part due to the manner in which data are recording at the SCA and in CIS. While outside supply routes (Interstates 70, 81, 522, and turnpike), make obtaining illegal drugs easy for some Franklin/Fulton residents, the availability of legal prescription drugs is influenced mostly by pharmacies and physicians. A range of research is needed to combat prescription drug abuse. Anecdotal data suggests huge increases in newer synthetic drugs, including synthetic marijuana and bath salts. Local police departments and hospitals report huge increases in usage of these drugs. Local SAP data also suggests a large number of youth reporting usage of the synthetic drugs and that students are unaware of the long-term consequences of these synthetic drugs. Students believe that since the drugs are sold in stores (gas stations, head shops, etc) the drugs must be safer than other, illegal drugs. In addition, students are using and abusing prescription drugs at a frightening rate, believing that since the drugs are medicines they must be safe. Youth often pay little heed to which drugs they are combining, often forming lethal combinations by prescription drugs of various types, and alcohol.

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To identify demand. a. Identify demand for prevention services. b. Identify demand for intervention services. c. Identify demand for treatment services. d. Identify demand for recovery support services.

Definitions Prevention Demand: Organizations or individuals seeking specific prevention services or programming. Intervention Demand: Organizations or individuals seeking specific intervention services or programming. Treatment Demand: The number of people who will seek treatment for a substance use disorder. Recovery Demand: The number of people who will seek recovery support services.

Directions for 5a. Discuss the number of organizations or individuals that requested specific prevention services or programs from the SCA and your contracted providers for the past state fiscal year (2010/2011). Identify who the requests came from, and the number of requests received. Note whether you have been able to meet this demand or if there are requests for prevention services that you are unable to address due to a lack of resources. Resources can be money, staff, time, etc. Example: A local school district has requested that you provide Project Northland, but you do not currently have the funding to do so. It is understood that you may not have been formally tracking these types of requests. In this case please provide, based on any informal records you may have, information regarding requests for prevention services or programs. You will be required in your Prevention/Treatment Comprehensive Strategic Plan to describe your plan for how you will track this information. Response to 5a. (Insert response below.) Fulton County: In 2011-2012, school education was provided in all three school districts (Forbes Road, Central Fulton, and Southern Fulton) as requested. Education was requested in all districts and all needs were met. The following prevention was completed Susan Byrnes Tobacco Prevention Program in 6th-8th grades in Central Fulton, 3rd, 4th, and 6th grades in Forbes Road, and 5th and 7th Page 27 of 62

grades in Southern Fulton. Too Good For Drugs (TGFD) was requested and offered in two school districts (the third did not request). At Central Fulton, 5th grade classes received TGFD. At Forbes Road School Districts 1st, 4th, and 8th graders received TGFD. In addition, community agencies and organizations requested education and all needs were met within the following agencies/organizations: Early HeadStart, Fulton County Medical Center s Children s Wellness Days, Fatherhood initiative, Independent Living students, various health fairs and events.

Franklin County Abraxas requested prevention education groups on a monthly basis for detention consumers. In addition, services were requested for the fire starters/sex offenders unit, however Abraxas was looking more for treatment groups for detained juvenile inmates, which were not appropriate services from either the SCA or prevention contractors. Summit Health for Children's Wellness Days requests annual support and education for county 3rd graders over three days each May. All requested needs were met. Wilson College requested prevention education for education majors at the college. These students attended the local Reality Tour. In addition, nursing students requested education on street drugs. Both these needs were met. Penn State, Mont Alto- nursing students and Human Development/ Family Studies students requested drug education and all needs were met. Franklin County Jail requested education services for booking officers and staff. This need was fulfilled. Franklin County Leadership-Youth request prevention education and also leadership roles which are both fulfilled by Franklin/Fulton SCA and providers. Shalom Christian Academy requests education and information dissemination and all needs are met. All public schools requested education and the following needs were met: 5th graders throughout the county request and receive a two-day recurring education program with one day the Tar Wars tobacco prevention program and one day of alcohol education and peer pressure resistance. All needs were met. In addition, Chambersburg School District requested education for all 7th grade health students. This need was met utilizing the Too Good For Drugs program which was taught to all 7th graders in Chambersburg. Franklin Learning Center has requested recurring education for students and all drug and alcohol education needs were met.

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Boys and Girls Club also requested recurring education services for their afterschool program all needs were met. NETwork Ministries afterschool program has also requested education and needs have been met using various evidence-based curricula. Chambersburg YMCA requested recurring education for their afterschool Teen Club. The need was met utilizing the evidence-based Too Good For Violence program. Chambersburg YMCA s Sam s Club (evening program for at-risk kids) requested recurring education and needs were met utilizing evidence-based programming. Library teen programming requested drug and alcohol education and were provided with the Above the Influence program. Greencastle-Antrim School District requested education for their high school Peer Leaders program. These students were offered the Above the Influence program and all needs were met. ARC requested prevention education and needs were met. Boy Scouts request education and attend local Reality Tour offerings all needs were met. Girl Scouts request education and attend local Reality Tour offerings all needs were met Community Forum requests presentations on drug/alcohol services and trends. All requested presentations are provided. Vision Quest requested the Project Alert curriculum and all needs were met. They also requested Above the Influence education and this need was also met. Human Service Training Days annually requests sessions like drug/alcohol data and trends. These requests have been fulfilled. Lion's Club requested a drug/alcohol prevention speaker to provide information about local needs and services. This was provided. Women In Need requested an in-service for staff on prevention and treatment and available services. This need was met. Juvenile Probation occasionally requests prevention education, however due to lack of resources (mainly time), materials are now supplied to Probation and prevention education is taught by internal staff who have previous drug and alcohol backgrounds. Children & Youth requests education for Independent Living classes, however materials were provided to internal CYS staff due to lack of resources (money and time). Page 29 of 62

Chambersburg Hospital requested drug and alcohol education on new drug trends and diversion and this need was met. Exchange Club also requested drug/alcohol education and this need was met. Church Youth Groups requested education and several participated in Reality Tour. All needs were met.

Directions for 5b. Discuss the number of organizations or individuals that requested specific intervention services from the SCA and your contracted providers for the past state fiscal year (2010/2011). Identify who the requests have come from, and the number of requests received. Note whether you have been able to meet this demand or if there are requests for intervention services that you are unable to address due to a lack of resources. Resources can be money, staff, time, etc. Please address this objective in regard to intervention and early intervention as defined in Objective 3. Example: A Boys & Girls Club would like to start an underage drinking program for adolescents who have related charges against them. The Boys & Girls Club contacts a local provider to see if they could provide such a program. The provider is unable to provide the program because they would need additional qualified staff in order to make the program available. It is understood that you may not have been formally tracking these types of requests. In this case please provide, based on any informal records you may have, information regarding requests for intervention services. You will be required in your Prevention/Treatment Comprehensive Strategic Plan to describe your plan for how you will track this information. Response to 5b. (Insert response below.) All Franklin and Fulton County school districts requested secondary Student Assistance Program (SAP) services, including liaison services for Core Team meetings, screenings for referred students, and SAP prevention and intervention groups. SAP liaison services are funded through Franklin/Fulton County Drug & Alcohol Program and Franklin/Fulton Mental Health/Intellectual Disabilities/Early Intervention, provided through a contract with Healthy Communities Partnership. All districts had all needs met including the following: Chambersburg Area School District receives liaison services in four secondary school buildings Chambersburg Area Senior High School (CASHS), Chambersburg Area Middle School North (CAMS North), Chambersburg Area Middle School South (CAMS South), and Chambersburg Academic Wing of the FCCTC. The liaisons provide professional knowledge and information at all Core Team meetings on a weekly basis at CAMS North and CAMS South. CASHS has meetings once every other week and twice on the other weeks. The Academic Wing meets every other week. In addition, screenings were carried out in every school building for all referred students Page 30 of 62

for which the school had parent and student permission for screening. Finally, SAP groups were offered at both CAMS North and CASHS as requested (other buildings did not request). Waynesboro Area School District receives liaison services in two secondary buildings Waynesboro Area Senior High School (WASHS) and Waynesboro Area Middle School (WAMS). The liaison provides professional knowledge and input at all Core Team meetings (occurring weekly at both schools) as well as screenings for all referred students for which the school has signed permission for screening from both child and parent. SAP groups were not requested from WAMS or WASHS this year. Greencastle-Antrim School District receives liaison services in two secondary buildings Greencastle-Antrim Middle School (GAMS) and Greencastle-Antrim High School (GAHS). The liaisons provide assistance at all Core Team meetings (weekly). They also provide screenings for all referred students with parent and student permission. In addition, liaison and other education staff work closely with GAHS Peer Leaders to give them the tools and resources to effectively provide peer education and awareness events. Fannett-Metal School District has one SAP team for their Fannett-Metal Junior/Senior High School. This team meets bi-weekly and has been provided with all requested services, including Core Team meeting attendance, screenings and referrals. Franklin County Career And Technology Center has a SAP team that meets weekly. Liaisons attend these meetings as well as provide screenings and referrals for appropriate students. SAP groups are also led by the liaison at this school including two Teen Pregnancy groups this year. Southern Fulton School District has a SAP team for the Junior/Senior High School. The liaison attends the weekly Core Team meetings and provides screenings for appropriate students. In addition, two groups have been led in the district by the SAP liaison Social Skills group and a New Student group. Central Fulton School District has a SAP team for the Middle/High School. The liaison attends Core Team meetings weekly. In addition, screenings are provided. Forbes Road School District has a Jr/Senior High SAP Core team meeting every other week which is attended by the SAP liaison. Screenings are provided for appropriate groups. And Girls Circle groups were facilitated by the liaison. Directions for 5c. Tables with information needed to address this objective have been provided to you in Appendix E, F, and G. These tables provide a description of treatment demand for the SCA. Data from the CMRR can be used to identify demand for both assessment and treatment services. It will show where the gaps are in the availability of specific levels of care. There are three specific questions you must respond to in regard to your CMRR data. The three questions Page 31 of 62

have been provided to you in the response section below. Please enter your response below each question (bullet). Appendix E provides a table with data from CIS on the pattern of referrals. Review this table and discuss the pattern of referrals (i.e. why a particular referral source is the most or least common.) Also highlight where your percentages differ greatly from the state percentages and the reason(s) why those differences exist. Appendix F provides a table with CIS data on treatment admissions by type of service. Review this table and discuss to which level of care individuals are most commonly or least commonly admitted and why. Also highlight where your percentages differ greatly from the state percentages and the reason(s) why those differences exist. Appendix G provides two tables with CIS data on admissions by primary substance of abuse for ages under 18 and 18 and over. Review these tables and compare SCA percentages to state percentages. Discuss possibilities for why your percentages differ from state percentages (e.g. alcohol is higher due to inappropriate court-stipulated treatment for person arrested for DUI). To the extent that CIS data in Tables E, F, and G are rendered invalid by reporting issues, describe the issues and what the SCA is doing to correct them. Include concerns about the validity of your CIS data in the discussion of the aforementioned tables (i.e. note that differences between SCA percentages and state percentages may be due to CIS data reporting issues.) If the SCA collects data it deems to be more accurate than CIS data, the SCA may use such data to respond to Objective 5c. However, the alternate data must be included as a table and attached in the corresponding appendix. It is also permissible for the SCA to discuss CIS data along with other local data that speaks to demand if it is determined that CIS data may not be invalid but is still not sufficient to get a clear picture of demand. Response to 5c. (This response has multiple components. Enter your response below each bulleted item.) Enter below for state fiscal year 2010/2011 the number of individuals waiting longer than 7 days for an assessment, and discuss/explain why individuals had to wait longer than 7 days for an assessment. In 2010/2011, 12 people waited longer than seven days for an assessment. However, this was due to client choice. Our providers have been documenting clients who chose to wait longer than 7 days. We addressed this issue at a provider meeting and has since not been an issue. So in reality, no one waited longer than seven days due to an SCA or provider issue. Enter below for state fiscal year 2010/2011 the number of individuals recommended for treatment that did not receive the recommended level of care, and provide reasons why individuals recommended for treatment did not receive the recommended level of care. (Your response should provide as much detail as possible, to elaborate on responses already provided in the monthly CMRR reports.) Page 32 of 62

In 2010/2011, the total number of individuals who did not receive the recommended LOC was 113. This was due to client choice and/or legal issues. Those clients waiting due to client choice typically are recommended for a level of care of treatment but don t think they need the recommended treatment so they don t return for service. Legal issues include clients who go to jail and are unable to start services. This frequently occurs with DUI assessments. Enter below for state fiscal year 2010/2011 the number of individuals recommended for treatment that had to wait longer than two weeks to access the recommended level of care, broken down by level of care. Discuss the reasons why individuals had to wait longer than two weeks to access treatment.

According to 2010/2011 data, the following numbers of clients waited longer than two weeks for the recommended level of care: 1 - Detox, 10 - Outpatient, 1 - Methadone, 1 Intensive Outpatient, 11 Short-Term Rehabilitation. There are several reasons for the wait time for recommended levels of care, including three clients waiting due to capacity Issues (at treatment facilities), one due to lack of appropriate service (Methadone is not provided locally), two due to clients choices, two for other reasons, and sixteen due to legal issues. Enter below your discussion on the table in Appendix E.

According to 2009/2010 patterns of referral (Appendix E), almost half of SCA clients are referred from Drug & Alcohol Abuse providers. This is much higher than the statewide average of 24%. This is because providers are contracted to provide LOC assessments for the SCA, which has increased the number of clients referred for levels of care. There were no referrals from either employers or religious organizations. Perhaps no referrals are coming from employers due to pre-employment drug screenings. It may also be possible that individuals labeled as client s friends are actually congregants but prefer the friend title when they are asked how they are associated with the client. Self-referrals and friend referrals are also slightly higher than the state average (25.6% vs 21%). Referrals come from the criminal justice system refers clients to the SCA (16.7%) less often than state average of 36%. This rate has increased three-fold, possibly due to collaboration with the Criminal Justice Advisory Board, which have been working with D/A staff to ensure clients do not fall through the cracks . Only one juvenile client was referred for admission funded by the SCA, possibly because children in the counties have a relatively low rate of non-insurance.

Enter below your discussion on the table in Appendix F. When looking at 2009/2010 treatment admission data (Appendix F) several differences are noted between state and local statistics. Franklin/Fulton SCA sends almost four times the state average of clients to non-hospital detox (47.1% vs 13%). However, Franklin/Fulton SCA sends 1/3 of the clients to outpatient drug free treatment (15.4% vs 45%) when compared with the state. In addition, the SCA sends 22.8% of clients to short-term non-hospital rehab, compared to just 15% averages across the state. This data indicates that Franklin/Fulton Counties are responding to the demand for treatment differently than the average level of care provided throughout the state: this SCA is placing more clients Page 33 of 62

into short-term, non-hospital rehabilitation and non-hospital detox than the state. Overall in PA, more clients are receiving an outpatient drug-free level of care. In turn, this may mean a higher per-client cost for treatment in the SCA. However, placing more clients in short-term non-hospital rehab versus outpatient drug-free treatment may also mean that clients served in the counties are receiving more intense treatment. It is thought that a future shift from non-hospital rehab will be seen as economic trends continue to influence referrals for less costly treatment options such as outpatient drug-free. Franklin/Fulton SCA also admits fewer clients to halfway house, partial hospitalization, intensive outpatient, and methadone maintenance. This is for a variety of reasons, including lack of a partial hospitalization, halfway house or methadone clinic locally.

Enter below your discussion on the tables in Appendix G.

A review of admissions by primary substance of abuse for adults in the FY 2009-2010 (see Appendix G) reveals that Franklin/Futon Counties fair worse than state averages with respect to use of heroin, other opiates/synthetics, and benzodiazepine abuse. In this SCA, alcohol was most frequently reported primary substance of abuse for those 18 and older. Franklin/Fulton adults reported alcohol as the primary substance of abuse at a rate of 34.8% which is similar to the state rate of 38.3%. Franklin/Fulton County SCA clients report heroin as the primary substance in 28.4% of cases (compared to a state rate of 22.4%). This trend is alarming as it has continued to increase. In addition, primary drugs have been reported as opiates/synthetics at a higher rate than state average 17.7% compared to 12.7%. Benzodiazepine also is reported at a rate of 4.3% (compared to 1.0% statewide).

Enter below your description of CIS data reporting issues and what the SCA is doing to correct them. At this time no data reporting issues are being reported by the new administrative officer of the SCA. Directions for 5d. Discuss the number of individuals in need of recovery support services. While it is understood that this may be difficult to assess, provide your best estimate based on any data you may have available. The estimate of the prevalence of substance use disorders provided in Appendix B may be your best estimate of the number of individuals in need of recovery support services. If you have other data available that provides information about the potential demand for (i.e. number of people in need of) recovery support services, please discuss it below. Recovery Support Services (RSS) are non-clinical services that assist individuals and families to recover from alcohol and other drug problems. These services complement the focus of treatment, outreach, engagement and other strategies and interventions to assist people in recovery in Page 34 of 62

gaining the skills and resources needed to initiate, maintain, and sustain long-term recovery. Services may include Mentoring Programs, Training & Education Programs, Family Programs, Telephonic Recovery Support, Recovery Planning, Support Groups, Recovery Housing, Recovery Centers, Childcare, and Transportation. Response to 5d. (Insert response below.) According to estimates of the Prevalence of Substance Abuse Disorders based on the 2009 National Survey on Drug Use and Health, approximately 10,342 residents of Franklin and Fulton Counties have a substance abuse disorder. This represents almost 7.7% of the entire population of the two counties. While it is understood that many of these residents will not receive treatment due to denial and nonidentification, this is the overall potential for those in need of recovery services. According to the 20102011 Franklin/Fulton Drug & Alcohol Annual Report, approximately 1324 residents in the two counties had public funded (SCA and Managed Care) treatment. Privately funded treatment numbers are unavailable, however this shows that at a minimum 1324 clients were in need of recovery services in the counties (this is very under-estimated due to the lack of private insurance funded treatment data).

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To identify assets or resources available in the county(ies) or region. a. Identify assets or resources available to prevent substance abuse. b. Identify intervention services that are currently available. c. Indentify assets or resources available to help respond to treatment demand. d. Identify recovery support services that are currently available. e. Please list the trainings you and your providers have had to prepare for addressing the issues and problems identified in Objectives 1-4. Reminder: These lists should not be limited to assets and resources of only the SCA and its contracted providers but should include any applicable/relevant assets and resources within the entire county(ies).

Directions for 6a. List and describe the assets or resources available to prevent substance abuse. Assets and resources are many and varied (e.g. financial, social, human, organizational). Please consider the wide range of assets and resources that may be available and discuss those that will be most important to preventing substance abuse. Examples of assets/resources are: numerous afterschool programs, supportive law enforcement, engaged elected officials, active coalitions, local company/business foundations that have made drug and alcohol prevention a priority, good public transportation system, all schools willing to share PAYS data, most licensed establishments have had Responsible Alcohol Management Program (RAMP) training, good relationships with media, numerous volunteers for mentoring programs, community is willing and able to pull together to address problems, community is willing to change, and recovery community is involved in prevention efforts. Also note resources respondents to the Key Representative and Convenience surveys marked in question 5 of these surveys. Response to 6a. (Insert response below.) Franklin and Fulton counties have a variety of assets and resources available to prevent substance abuse. Chambersburg Area School District and Central Fulton School District (the biggest districts in each county, both of which are also in the county seats) have a variety of after-school programs, both free and at a charge. Many other districts, particularly the rural ones do not have this asset. In addition there is a bi-county Community Coalition (for the Prevention of Substance Use and Abuse). Many local agencies and organizations are involved with this coalition that meets monthly to address local prevention efforts and events. This coalition began in 2009 and was spurred out of a workgroup began in 2007. The coalition has also applied for Drug-Free Page 36 of 62

Communities federal grant monies which would enable a much more active and involved coalition role in the communities. Franklin and Fulton Counties are both fortunate to have supportive law enforcement and engaged elected officials. Many of these officials are actively involved in the Community Coalition. In addition, many of our law enforcement entities participate in the DEA drug takeback initiatives. Local law enforcement and criminal justice authorities are strict enforcers of the local DUI laws and help create a very supportive environment for prevention efforts. Schools are all involved in prevention efforts in varying degrees. All schools share PAYS data with county agencies. Local media outlets are also involved in Coalition efforts and both a local radio talk host (Kelly Spinner) and local newspaper (Public Opinion) are supportive of prevention efforts, highlighting local initiatives and activities on the air and on print. A local mentoring program is also in place, however at this time resources and assets only apply for mentoring efforts in one school district. A county-wide Youth Leadership program is also offered in Franklin County, with specially selected 10th grade students from every district participating in leadership development and educational opportunities. Directions for 6b. List and describe the intervention and early intervention services that are available in the county(ies) served by your SCA. Examples of intervention services could be DUI programs, Student Assistance Programs, Employee Assistance Programs, or a provider run substance use education group for individuals who are waiting to access treatment services. Response to 6b. (Provide response in the space below. Add space as needed.) At this time, the primary intervention services available in the county include the Student Assistance Program in secondary schools. Programming with elementary interventions including elementary support and intervention groups has been piloted in the 2011-2012 year using Integrated Children s Services Plan funding. In addition, SCA and contractors are working with the Criminal Justice Advisory Board to begin utilizing a monthly DUI Victim Impact Panel through MADD. The Aids Community Alliance provided outreach services. The agency uses empirical evidence-based programming to reach ID users in the community. They conduct and maintain accurate community observation records that include the location of drug activity, identification of types and levels of drug activity, and drug usage. Aids Community Alliance developed and implemented a community-based HIV prevention program targeting injection drug users and their partners.

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Directions for 6c. List and describe the assets or resources available to help respond to treatment demand. Resources include money, staff, assessment and treatment capacity, capacity to serve acute and chronic need, the capability to provide various types, level, and intensities of care, funds and/or services available through other systems (i.e. Children, Youth & Families, Office of Vocational Rehabilitation, HealthChoices, PA Commission on Crime & Delinquency, Liquor Control Board, federal grants, Centers for Disease Control, Department of Education, private industry), regional or local partnerships, other service systems that are meeting part of the treatment demand, etc. Complete the table below by listing the number of treatment (inpatient and outpatient) providers and the number of licensed and unlicensed case management providers in the county(ies) you serve and the number with whom the SCA contracts. Total # in the County(ies) Served by the SCA 1 6 0

# SCA Contracts with 1 6 0

Licensed Inpatient Treatment Providers Licensed Outpatient Treatment Providers Licensed and Unlicensed Case Management Providers Response to 6c. (Insert response below.)

Franklin/Fulton Drug/Alcohol Program employs three full-time case managers during the FY10/11 year. One case manager works solely for clients in the Drug and Alcohol Probation Partnership (DAPP) for individuals referred to the Restricted Intermediate Punishment Program (RIPP) program. Two case managers are for general public clients entering the systems of treatment. These case managers served 878 individuals through their treatment and recovery process during this period. Providers are each assigned an SCA case manager, who then manages referrals coming in and discharging out of the provider agencies. HealthChoices continues to be a major asset providing reimbursement for Drug & Alcohol treatment that previously may have been the responsibility of the SCA. Through our involvement on the Integrated Children Service Plan in both counties, we work closely with MH/ID/EI, Children & Youth, and Juvenile Justice. Together we identify addicted youth by broadening and standardizing behavioral health screening efforts, including drug and alcohol problems. FFDA has an agreement with our inpatient provider, White Deer Run, to utilize a 24-hour hotline for after-hours crisis. These services are a great benefit. The hospital staff, instead of providing services directly, provides individuals with the White Deer Run contact information. By calling the toll-free number, individuals are screened over the phone. If in need of detoxification, transportation is provided to the facility from the individual s location.

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The SCA also works closely with the county s Grants Management department to identify and apply for D&A treatment/criminal justice grants. The local Day Reporting Center (DRC) provides treatment to clients with a need and approximately 70% of their clients (227 of 324 intakes in 2011) received treatment while participating in the program. Clients pay back the cost of their treatment through fines and fees. The Day Reporting Center has been a huge asset in the justice system and has reduced jail crowding. The DRC program also assists offenders in accessing necessary treatment. Directions for 6d. List and describe recovery support services that are currently available. Resources include money, staff, recovery centers, recovery houses, transportation, tutoring, volunteers, community agencies, support groups, etc. Examples of recovery resources may include, but are not limited to the following: mentoring programs in which individuals newer to recovery are paired with more experienced people in recovery to obtain support and advice on an individual basis and to assist with issues potentially impacting recovery (these mentors are not the same as 12-step sponsors), training and education utilizing a structured curriculum relating to addiction and recovery, life skills, job skills, health and wellness that is conducted in a group setting, family programs utilizing a structured curriculum that provides resources and information needed to help families and significant others who are impacted by an individual s addiction, telephonic recovery support (recovery check-ups) designed for individuals who can benefit from a weekly call to keep them engaged in the recovery process and to help them maintain their commitment to their recovery, recovery planning to assist an individual in managing their recovery, and support groups for recovering individuals that are population focused (i.e. HIV/AIDS, veterans, youth, bereavement, etc.). Please list the number of recovery support providers in the county(ies) you serve and the number of recovery support providers with whom the SCA contracts.

Response to 6d. (Insert response below.) There are few resources and assets in Franklin and Fulton Counties at this time those that are in place include Narcotics Anonymous, Alcoholics Anonymous, and Dual Recovery Anonymous. Online support groups have become very popular with clients throughout the treatment and recovery process due to anonymity and availability. Individuals who have MA are able to utilize county transportation to make treatment appointments. We do not have any recovery housing in the two counties. Pyramid Healthcare in Chambersburg is currently operating a recovery based group with no more than 10 participants at a time.

Directions for 6e. Page 39 of 62

List the trainings that you and your providers have had to prepare for addressing the issues and problems indentified in Objectives 1-4. You do not need to list every training that you and your providers have had. Instead, list trainings you and your providers have had that directly relate to the issues and problems you identified in Objectives 1-4. For example if you found upon examination of various data sources that prescription drug abuse has grown dramatically in the past two years among teens throughout the county, then list a training you attended about prescription drug abuse treatment and prevention. Response to 6e. (Insert response below.) 2010 A New High: Drug Trends Heroin Cocaine 2011 Consequence RX Drug Trends Media Literacy and Its Impact on Substance Abuse Overview of Designer Drugs, Generation RX Brain and Addiction Treating Depression and Addiction Fetal Alcohol Spectrum Disorder Bath Salts Family Group Decision-Making

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To identify and quantify the resources needed/necessary. a. Identify the resources needed to effectively prevent the issues/problems/trends identified in Objectives 1-4. b. Identify the resources needed to provide effective intervention services for issues/problems/trends identified in Objectives 1-4. c. Identify and quantify the resources necessary to meet the estimated treatment demand and any trends identified in Objectives 3, 4 and 5 that impact this demand. d. Identify recovery support services that the SCA needs in developing a Recovery Oriented System of Care (ROSC). e. Identify any areas where training for staff would be needed, given issues/problems/trends identified in Objectives 1-4. Definitions: Needed Resources: Needed resources are resources that the SCA, its providers, the community, etc. do not already have. Needed resources would not be those assets/resources that are currently available and were discussed in Objective 6. Recovery Oriented System of Care: A recovery management model of care, also known as a chronic care approach to recovery. The foundation of this approach includes: accessible services; a continuum of services rather than crisis-oriented care; culturally competent care that is age and gender appropriate; and where possible, is embedded in the person s community and home using natural supports. Creating a ROSC requires a transformation of the service system as it shifts to becoming responsive to meet the needs of individuals and families seeking services. Recoveryoriented systems support person-centered and self-directed approaches to care that build on strengths and resilience. Individuals, families, and communities take responsibility for their sustained health, wellness, and recovery from alcohol and other drug related issues through the various life phases of recovery. This system refers to the larger cultural and community environment in which long-term recovery is nested and offers a complete network of formal and informal resources that support long-term recovery of individuals and families.

Directions for 7a. Identify the resources needed to effectively prevent the issues/problems/trends identified in Objectives 1-4. Only discuss the resources needed to address issues you identified in Objectives 1-4. In your response note what issue/problem/trend the resource is needed to address. Please discuss more than just needs in terms of funding and staff. For example, a needed resource that you do not currently have may be strong relationships with school district administrators or support from district justices.

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Response to 7a. (Insert response below.) There are many resources needed to effectively prevent substance use and abuse in such a large geographic area. The funding level currently funds one prevention specialist for two counties and eight school districts. The amount of prevention necessary to impact this large of a population and area is definitely more than one person can provide. Contracted providers increase the amount of support and prevention education in the areas, however funding remains too low to reach a large amount of the population. Additional funding, if present, would allow for increased staff so that all elementary, secondary, public and private schools could receive prevention education from county or contracted staff. Relationships with districts have improved greatly over the past several years. Districts are more aware of which agencies provide prevention services and are more likely to request services than they were in the past. Another resource necessary for prevention, especially to help combat prescription drug abuse, would be prescription drug disposal units. There are many youth who access prescription drugs at home in medicine cabinets of family members and a concerted effort to educate the communities about disposal and have disposal options available would be a huge asset in the counties. Directions for 7b. Identify the resources needed to provide effective intervention and early intervention services for issues/problems/trends indentified in Objectives 1-4. Only discuss the resources needed to address issues you identified in Objectives 1-4. In your response note what issue/problem/trend the resource is needed to address. Resources that may be needed include money, staff, providers, etc. Response to 7b. (Provide response in the space below. Add space as needed.) MONEY is the main resource needed for increased intervention services. Increased youth interventions are always needed, especially considering the popularity of the small elementary intervention pilot project. Many schools are interested in participating in these small group interventions, and secondary schools would like SAP expansion and more intervention programming, however budget constrictions limit any increases in programming at this time. Money for additional staff would be especially helpful in expanding intervention programs to meet more need in schools. Directions for 7c. Identify and quantify what specific resources are needed to address the demand for assessment and treatment services and any trends identified in Objectives 3, 4 and 5 that impact this demand. Explain the basis for any estimates provided. Resources that may be needed include money, staff, providers, Drug Courts, Buprenorphine eligible physicians, intersystems collaboration, SCA policies & procedures, assessment and treatment capacity, capacity to serve Page 42 of 62

acute need and chronic need, the capability to provide various types, levels, and intensities of care, etc. Response to 7c. (Insert response below.) We have a need to educate physicians to properly prescribe and utilize Buprenorphine. Also, we are currently working on introducing our local medical professionals to Vivitrol for alcohol and opiate addiction. The hard part is finding providers who can administer the monthly injection. We currently do not have a drug court. Therefore, we get an overwhelming number of individuals from the forensic system that need assessed. However, we do not receive any funds from that system to help use pay for these individuals. It is something that we are currently looking into, especially with our DUI clients. We do not currently have a good representation of the levels of care. Our providers are only able to offer one or two levels and there are serious gaps in the system. For example, we do not have any partial (adult or youth)programs, IOP for youth, early intervention for youth; and all our contracted providers offer group treatment. Therefore, getting a client seen on an individual basis is very difficult. Directions for 7d. Identify what specific recovery services would be necessary to support the development of a ROSC. Response to 7d. (Insert response below.) One challenge and necessary resource is a peer mentoring program. Providers engaged in the past have been unable to provide the capacity needed in the community. We would highly benefit from building a peer-support mentoring program. However, our efforts do not seem to gain enough interest. It seems that individuals in recovery are highly interested in having this type of support. However, there seems to be no way of funding this type of program due to lack of community interest. In addition, recovery housing would allow us to provide the full continuum of care for the residents of our county. Telephonic recovery support would also be a great option, including check-ups, for individuals needing extra help with maintaining their recovery. Directions for 7e. Given issues/problems/trends identified in Objectives 1-4, list any areas where training for staff would be needed. Only list trainings you and your providers need that directly relate to the issues and problems you identified in Objectives 1-4. For example if you found upon examination of various data sources that substance abuse among the elderly in your county has been increasing for the past four years, then list training you need about treatment and prevention of substance abuse among the elderly. Response to 7e. (Insert response below.) Page 43 of 62

Continued and expanded trainings on abuse of over the counter medications and prescription drug abuse are needed. In addition, synthetic drugs are a growing trend on which training would be very helpful. Trainings on co-occurring competency and medication assisted treatment would also be helpful in addressing needs.

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To identify barriers to addressing the needs that have been identified. a. Identify barriers that would impede the ability to meet the prevention needs of your communities. b. Identify barriers that would impede the ability to meet the intervention needs of your communities. c. Identify barriers that would impede the ability to meet the assessment and treatment demand in the SCA. d. Identify barriers that would impede the ability to meet the recovery support services demand in the SCA.

Directions for 8a. Identify barriers that would impede the ability to meet the prevention needs of your communities. Be sure to note barriers specific to the issues/problems identified in Objectives 14 and reflect on their changeability. Barriers may be not having those items you stated were needed in Objective 7 or there may be other barriers, for example: strong community beliefs of underage drinking as a harmless rite of passage or schools and parents will not accept certain prevention programming because they do not want the school s issues with drug use known to the general public. There is no need to repeat your response to Objective 7; instead, use this space to discuss the changeability of these barriers. How easy or difficult will it be to remove or get over these barriers? Where possible, cite data such as data from Key Representative surveys that provides evidence of the barrier. Response to 8a. (Insert response below.) One huge barrier to effective prevention is funding levels. A large increase in funding would be necessary to meet the demand that our large counties have. Another barrier is the time that schools have available to offer for prevention programming. Schools are under such rigid and demanding levels of testing and other requirements that it is often difficult to schedule time with students to do prevention education. Although strong relationships with the schools have helped decrease this barrier, schools are bound by instructional time and testing requirements and have difficulty fitting in drug and alcohol education in all grades. Some schools are hesitant to accept drug and alcohol education, thinking their kids don t need the lessons yet . Residents of both counties are often in denial and unwilling to accept that drug use is happening in their communities. Another barrier remains the long-held norms and beliefs that underage drinking is a rite of passage and parents who think that as long as kids are drinking with them at home it is not a problem. These social norms and expectations take a lot of effort and time to change. Tobacco is another drug with a social Page 45 of 62

norm problem, as many adults in the area are tobacco users and are not concerned with youth tobacco usage.

Directions for 8b. Identify barriers that would impede the ability to meet the intervention and early intervention needs of your communities. Barriers may be not having those items you stated were needed in Objective 7, or there may be other barriers such as stigma associated with identifying oneself as someone with a potential substance use problem. There is no need to repeat your response to Objective 7; instead, use this space to discuss the changeability of these barriers. How easy or difficult will it be to remove or get over these barriers? Where possible, cite data that provides evidence of the barrier. Response to 8b. (Provide response in the space below. Add space as needed.) In addition to funding, other barriers to youth intervention include the relationship between child and parent, and the schools resistance to labeling youth as having a need for intervention services. Often students are unwilling to have their parents know about drug use and therefore will not take part in intervention programs and groups. Many times even when parents know a child is using they are unwilling to believe or accept their child may have a potential problem and deny intervention and/or treatment. Schools are often unwilling to single out students they are concerned about to schedule interventions. School administration members often hesitate to select or label students, even for group interventions. Social and community stigma are also a barrier to implementing effective interventions. Many families are unaware (or unwilling to admit) that youth alcohol use is a problem (when social norms make youth alcohol use seem acceptable). In addition, by the time adults get to the case managers or providers, they are often at the level of needing treatment. The SCA and providers do provide limited intervention for adults who HIV/AIDS, as well as pregnant mothers who are using drugs. However, most of the adults coming into the SCA have progressed so far into their use that treatment is necessary. The adults served seem to have difficulty acknowledging that there is a substance abuse issue; therefore, intervention services are not appropriate for their current stage of change. Directions for 8c. Describe the barriers that impede or prevent the SCA from meeting assessment and treatment demands. Barriers may be not having those items you stated were needed in Objective 7 or there may be other barriers. Examples of barriers include lack of access, quality and appropriateness of care, insurance denials, childcare, transportation, location, language, zoning restrictions, payment for co-occurring services outside of managed care, parental resistance to permitting SAP assessments, interface with county systems, to include confidentiality issues Page 46 of 62

(i.e., courts, CY&F), length of time from application to acceptance for HealthChoices, restrictions of available funds, ineffectual tracking of individuals between payers, varied perceptions of medical necessity criteria, SCA protocols/policies & procedures, etc. There is no need to repeat your response to Objective 7; instead, use this space to discuss the changeability of these barriers. How easy or difficult will it be to remove or get over these barriers? Provide any objective data that is evidence of the barrier. For example if lack of childcare is a barrier, cite data such as the length of the waiting list for state subsidized child day care. Response to 8c. (Insert response below.) Due to the rural nature of both counties, the lack of both transportation and providers are barriers to being successful in meeting treatment demand. Those convicted of DUIs who do not have a license are most affected by the rural nature since neither county has a solid public transportation system. Another barrier can be the relatively small variety of providers to choose from. We currently do not have enough providers doing each specific Level of Care, and it is difficult to attract providers due to the rural nature of the counties. Start-up costs are relatively high and prospective providers fear they may lack the steady volume of clients necessary to have a successful business. Current providers all provide outpatient services. However, IOP for adults is limited to two providers. Intensive outpatient for youth does not exist in either county. Early intervention for youth also does not exist. No one provides partial hospitalization in either county. With such a small pool of agencies to pick from, individual s needs are not always met. We have had issues with Spanish speaking clients because none of our providers offer Spanish (or translation) services. Directions for 8d. Describe the barriers that impede or prevent the SCA from meeting recovery support services demand. Barriers may be not having those items you stated were needed in Objective 7 or there may be other barriers. Examples of barriers include: limited understanding of recovery support services and ROSC, lack of community and family involvement, need to mobilize the recovery community, concern that recovery support services will take the place of clinical services, need to expand and develop new linkages in the community, conflicting priorities and limited funding. There is no need to repeat your response to Objective 7; instead, use this space to discuss the changeability of these barriers. How easy or difficult will it be to remove or get over these barriers? Provide any objective data that is evidence of the barrier. Response to 8d. (Insert response below.) There are huge barriers to recovery support services. None of the current providers are able to take on the capacity needed to provide these services. They are busy providing treatment services and do not have the capacity necessary to expand to recovery services. Individuals are engaging in AA and NA for support, however, this does not work for everyone so we do have a need for more support services. A new provider in Fulton County is working on developing a recovery support group that operates itself. Franklin County also had a Dual Recovery Anonymous group start on May 15 of this year. Historically, it Page 47 of 62

seems that our rural community does not take a strong interest in D&A needs. Therefore, we do not have community-based resources needed for our individuals in recovery.

Appendix A
Key Representative and Convenience Survey Administration Information BDAP Key Representative Survey on Alcohol, Tobacco and Other Drugs a. Total Number of Surveys Given Out: __34___ b. Total Number of Surveys Completed: __29___ c. Explain how the Key Representative Survey was administered and provide justification regarding the total number administered. (Use the space below. Add additional space as needed.) The key representative surveys were printed out and given to key representatives at a strategic planning meeting. Some completed them that day and returned them, while others took the survey with them and returned it to the SCA. For those who returned the hard copy of the survey, the prevention specialist entered their surveys into PBPS for them. For those who did not return the hard copy of the survey, the prevention specialist entered them into PBPS and sent an email with link to the survey through PBPS. Multiple email reminders were sent to those who still did not complete the survey. We asked that 34 people take the survey because we had representation from 12 of the 13 community role categories.

d. If you were unable to obtain a survey from a Key Representative for one of the defined community roles (see list of roles on page 3 of survey instructions), please provide explanation/justification for why you were not able to get a Key Representative for the particular community role. (Use space below. Add additional space as needed.) The key representative requested to fill this one role did not complete and return the survey. BDAP Convenience Survey on Alcohol, Tobacco and Other Drugs (The use of this survey is optional. If you did not utilize this survey, please check did not use convenience survey below.) _x_ Did not use convenience survey a. Total Number of Surveys Completed: __0__ b. Explain how the Convenience Survey was administered and discuss to whom it was administered. Page 48 of 62

(Use the space below. Add additional space as needed.)

Convenience surveys were not required by the state and none were administered.

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Appendix B
Prevalence of substance use disorders in the total population The Department of Health has provided data for each SCA (see table below) based on surveys which yield valid estimates of the prevalence of substance abuse disorders. Only 7% to 10% of the estimated number of dependent people presented in this table would admit to having a substance abuse problem, but the larger number may be thought of as those whose behavior is creating personal consequences and affecting their associates. They are also the pool of people, who eventually, under the right circumstances, may present for treatment services. These numbers may be used by SCAs to describe need (as distinguished from demand) and the extent of the problem. They show the potential for demand for services.

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Estimates of the Prevalence of Substance Use Disorders (Dependence or Abuse)1 Pennsylvania, Single County Authorities and State 2 Based on 2009 National Survey on Drug Use and Health (NSDUH) Age 12+ SCA Total 2009 Population Population Prevalence ( Rate = 7.7% ) Age 12-17 Population Prevalence ( Rate = 7.1% ) Age 18-25 Population Prevalence ( Rate = 20.4% ) Age 26+ Population Prevalence ( Rate = 5.7% )

Allegheny Armstrong / Indiana / Clarion Beaver Bedford Berks Blair Bradford / Sullivan Bucks Butler Cambria Cameron / Elk / McKean Carbon / Monroe / Pike Centre Chester Clearfield / Jefferson Columbia / Montour / Snyder / Union Crawford Cumberland / Perry Dauphin Delaware Erie Fayette Forest / Warren Franklin / Fulton Greene

1,218,494 194,780 171,673 49,579 407,125 126,122 67,271 626,015 184,694 143,998 80,370 290,749 146,212 498,894 126,958 164,905 88,521 277,985 258,934 558,028 280,291 142,605 47,413 159,846 39,245

1,056,102 169,075 149,425 42,538 340,836 108,639 57,660 534,091 157,576 126,079 69,956 251,929 131,607 417,709 110,700 144,692 75,681 240,735 218,333 474,502 239,642 123,708 41,632 134,315 34,528

81,320 13,019 11,506 3,275 26,244 8,365 4,440 41,125 12,133 9,708 5,387 19,399 10,134 32,164 8,524 11,141 5,827 18,537 16,812 36,537 18,452 9,526 3,206 10,342 2,659

96,210 15,548 13,196 3,893 34,635 9,615 5,800 50,892 15,615 10,581 6,691 25,487 10,562 44,572 9,222 13,011 7,559 22,274 20,557 46,980 23,736 11,184 3,686 12,336 2,851

6,831 1,104 937 276 2,459 683 412 3,613 1,109 751 475 1,810 750 3,165 655 924 537 1,581 1,460 3,336 1,685 794 262 876 202

138,863 28,849 16,516 3,972 45,561 13,182 5,728 55,477 19,535 15,517 7,302 32,850 47,366 52,889 11,699 27,097 9,781 38,036 24,124 67,139 36,270 12,638 4,600 16,370 4,527

28,328 5885 3,369 810 9,294 2,689 1,169 11,317 3,985 3,165 1,490 6,701 9,663 10,789 2,387 5,528 1,995 7,759 4,921 13,696 7,399 2,578 938 3,340 923

821,029 124,678 119,713 34,673 260,640 85,842 46,132 427,722 122,426 99,981 55,963 193,592 73,679 320,248 89,779 104,584 58,341 180,425 173,652 360,383 179,636 99,886 33,346 105,609 27,150

46,799 7,107 6,824 1,976 14,856 4,893 2,630 24,380 6,978 5,699 3,190 11,035 4,200 18,254 5,117 5,961 3,325 10,284 9,898 20,542 10,239 5,693 1,901 6,020 1,548

Estimates of the Prevalence of Substance Use Disorders (Dependence or Abuse)1 Pennsylvania, Single County Authorities and State 2 Based on 2009 National Survey on Drug Use and Health (NSDUH) Age 12+ SCA Total 2009 Population Population Prevalence ( Rate = 7.7% ) Age 12-17 Population Prevalence ( Rate = 7.1% ) Age 18-25 Population Prevalence ( Rate = 20.4% ) Age 26+ Population Prevalence ( Rate = 5.7% )

Huntingdon / Mifflin / Juniata Lackawanna Lancaster Lawrence Lebanon Lehigh Luzerne / Wyoming Lycoming / Clinton Mercer Montgomery Northampton Northumberland Philadelphia Potter Schuylkill Somerset Susquehanna Tioga Venango Washington Wayne Westmoreland York / Adams Pennsylvania

114,450 208,801 507,766 90,160 130,506 343,519 340,653 153,637 116,071 782,339 298,990 91,311 1,547,297 16,714 146,952 76,953 40,646 40,875 54,183 207,389 51,337 362,251 531,260 12,604,767

98,040 180,978 425,089 77,969 111,593 292,542 296,823 133,102 100,033 662,286 255,549 79,049 1,296,728 14,223 128,818 67,581 35,421 35,091 46,544 179,262 45,247 316,496 451,332 10,781,486

7,549 13,935 32,732 6,004 8,593 22,526 22,855 10,249 7,703 50,996 19,677 6,087 99,848 1,095 9,919 5,204 2,727 2,702 3,584 13,803 3,484 24,370 34,753 830,174

8,954 16,111 44,976 7,414 9,881 28,229 25,159 12,111 9,885 60,854 25,688 7,056 133,480 1,365 10,626 5,570 3,446 3,883 4,482 15,708 3,478 27,572 43,457 1,026,078

636 1,144 3,193 526 702 2,004 1,786 860 702 4,321 1,824 501 9,477 97 754 395 245 276 318 1,115 247 1,958 3,085 72,852

11,370 23,854 59,163 9,575 14,744 39,934 37,815 19,556 12,847 72,413 36,285 7,538 222,703 1,592 13,103 6,731 3,670 5,489 4,467 22,316 4,381 32,608 53,915 1,451,954

2,319 4,866 12,069 1,953 3,008 8,147 7,714 3,989 2,621 14,772 7,402 1,538 45,431 325 2,673 1,373 749 1,120 911 4,553 894 6,652 10,999 296,199

77,716 141,013 320,950 60,980 86,968 224,379 233,849 101,435 77,301 529,019 193,576 64,455 940,545 11,266 105,089 55,280 28,305 25,719 37,595 141,238 37,388 256,316 353,960 8,303,454

4,430 8,038 18,294 3,476 4,957 12,790 13,329 5,782 4,406 30,154 11,034 3,674 53,611 642 5,990 3,151 1,613 1,466 2,143 8,051 2,131 14,610 20,176 473,297

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1. Past year dependence or abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 2. The National Survey on Drug Use and Health (NSDUH), formerly known as the National Household Survey on Drug Abuse (NHSDA), is an annual survey conducted by SAMHSA's Office of Applied Studies. NSDUH is the primary source of statistical information on the use of illicit drugs by the U.S. civilian population aged 12 or older, based on face-to-face interviews at their place of residence. The survey covers residents of households, non-institutional group quarters (e.g., shelters, rooming houses, dormitories), and civilians living on military bases. Persons excluded from the survey include homeless people who do not use shelters, active military personnel, and residents of institutional group quarters, such as prisons and long-term hospitals. State level estimates are based on a survey-weighted hierarchical Bayes estimation approach. Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2008 and 2009, Table 5.4B.

Population Data Source: Penn State Data Center 2009 Population Estimates. County-level estimates prepared by the Division of Statistical Support, Pennsylvania Department of Health. Estimates may not sum to totals due to rounding. Use of the data: These estimates may be used to describe the need for treatment services (as distinguished from demand) and the extent of the problem. They show potential for demand for services.

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Appendix C
Prevalence of substance abuse dependency disorders in special populations Each SCA will be responsible for developing prevalence estimates of substance abuse disorders (for its service area) for the special population groups listed in the table below. These numbers may be used by the SCA to describe the possible need (as distinguished from demand) and the extent of the problem. The special population groups listed in column 1 are the minimum requirements for this needs assessment. SCAs may include other special population groups, as desired. Add these other special populations as rows in the table below. Be sure to list the source of the data in column 2. The Department of Health will provide appropriate web links for county level population data for the criminal justice and family court categories in column 2 (items 1-3, 6, and 7). The SCA is then responsible for adding the statistical information relevant for each category. Based on Department of Corrections (DOC) and national estimates, approximately 70% of all inmates are substance dependent and require some form of treatment. This information will be used to provide the estimates needed for columns 4 & 5, where appropriate (items 3-5). Based on The National Center on Substance Abuse & Child Welfare, approximately 50% of substantiated child abuse cases have an underlying substance abuse issue and require some level of treatment. This information will be used to provide the estimates needed for columns 4 & 5, where appropriate (item 6). Based on SAMHSA Substance Abuse Treatment & Domestic Violence TIP 25, approximately 25% of Protection From Abuse (PFA) orders issued by the court have an underlying substance abuse issue and require some level of treatment. This information will be used to provide the estimates needed for columns 4 & 5, where appropriate (item 7). To get similar estimates for County Jail Population and Persons on State Probation or Parole in the county, phone calls should be made to local contacts to ask: What is the annual caseload (Column 4)? Based on Department of Corrections (DOC) and national estimates, approximately 70% of all inmates are substance dependent and require some form of treatment.

Local Special Population Need Data As reported by (SCA name) Special Population Category (Column 1) Source of Data and web link (Column 2) How to Locate Data (Column 3) (Column 4) Enter Total Number from Column 1 (Column 5) Percent of these persons who have substance abuse problems.
100% Franklin

(Column 6) Estimated number who have substance abuse problems =Col 4 x Col 5 for each category

1.

Drug Possession Arrests: 18EDrug Possession - Opium Cocaine;18F-Drug Possession Marijuana;18G-Drug Possession Synthetic;18H-Drug Possession - Other (Total Arrests Adult & Juvenile)

Pennsylvania Uniform Crime Reporting Program

http://ucr.psp.state.pa.us/ UCR/Reporting/Monthly/ Summary/MonthlySumAr restUI.asp Pennsylvania Uniform Crime Reporting Program http://ucr.psp.state.pa.us/ UCR/Reporting/Monthly/ Summary/MonthlySumAr restUI.asp

1) Select Arrests by Age & Sex 2) Select Year 3) Select Month (December) 4) Select YTD 5) Select County 6) Select Appropriate UCR Codes 7) Click Submit 8) Record Total 1) Select Arrests by Age & Sex 2) Select Year 3) Select Month (December) 4) Select YTD 5) Select County 6) Select Appropriate UCR Codes 7) Click Submit 8) Record Total Arrests 1) Open 2009 CAPP Report and go to Table 1 on Page 7 Caseload Information 2009 2)Locate the county or

2011 Franklin 18E, 18F, 18G, 18H total 266 Fulton 18E, 18F, 18G, 18H total 55 2011 Franklin 210, 220, 230 total 1314 Fulton 210, 220, 230 total 116 2010 Franklin County total caseload 2569 2010 Fulton

2011 266

Fulton 55

2.

Arrests for 210-Driving Under the Influence; 220-Liquor Law; 230-Drunkenness (Total Adult & Juvenile Arrests)

100% Franklin

2011 1314

Fulton 116

3.

Adult County Probation and Parole

Pennsylvania Board of Probation and Parole http://www.pbpp.state.pa. us/portal/server.pt/commu nity/reports_and_publicat

70% (DOC estimate)

2010 Franklin County 1798

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4.

County jail population

ions/5358/county_adult_p robation_and_parole_info rmation/502401 SCA to provide from local contacts

counties 3)Record the Total Caseload. Contact Local Source

County total caseload - 366 2011 Franklin County total commitments 2317 2011 Fulton County total commitments 163 70% (DOC estimate)

2010 Fulton County 26

2011 Franklin County 1622 2011 Fulton County - 114

5.

Persons on state probation or parole in county

SCA to provide from local contacts

Contact Local Source

2010 Franklin County Probation 911 2010 Franklin County Parole 804 2010 Fulton County Probation 119 2010 Fulton County Parole 116

70% (DOC estimate)

2010 Franklin County Probation 638 2010 Franklin County Parole 563 2010 Fulton County Probation 83 2010 Fulton County Parole 81

Special Population Category (Column 1)

Local Special Population Need Data As reported by (SCA name) Source of Data and How to Locate Data (Column 4) web link (Column 3) Enter Total (Column 2) Number from Column 1

(Column 5) Percent of these persons who have

(Column 6) Estimated number who have substance abuse problems =Col 4 x Col 5 for
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substance abuse problems.

6. Reported Substantiated Child Abuse & Neglect Cases (Total) Pennsylvania Department of Public Welfare http://www.dpw.state.pa. us/ucmprd/groups/webco ntent/documents/report/d _00536.pdf 1) Select Annual Report Year 2) Click on Table and Charts 3) Locate status of evaluation, rates of reporting and substantiation by county Table 4) Locate your County 5) Record Total Substantiated Cases 1) Select the Caseload Statistics Year 2) Click on Common Pleas 3) Click on Family Court 4) Click on Filings & Dispositions 5) Click on Protection From Abuse 6) Locate County or Counties 7) Record Total Number of Final Order by Stipulation or Agreement 2011 Franklin County 54 2011 Fulton County - 14 50 % (National Center on Substance Abuse and Child Welfare April 2005) 25% (SAMHSA Substance Abuse Treatment & Domestic Violence TIP 25)

each category

2011 Franklin County 27 2011 Fulton County - 7

7.

Domestic Violence (PFA)

Administrative Office of Pennsylvania Courts http://www.pacourts.us/T/ AOPC/ResearchandStatis tics.htm Then click on 2007 AOPC Caseload Statistics

2010 Franklin County 85 2010 Fulton County - 0

2010 Franklin County 43 2010 Fulton County - 0

8.

Other Categories * - Day Reporting Center

Day Reporting Center from local contacts

2011 Franklin County Day Reporting Center clients 324 intakes

Varies (approximat ely 70% in 2011)

2011 Franklin County Day Reporting Center 227 had Drug/Alcohol treatment in 2011

* SCAs should include other special population categories that are identified, e.g. co-occurring. Other special populations that are discussed elsewhere in the needs assessment must be included in this table.

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Appendix D
BDAP Risk & Protective Factors Risk Factors:
Low Neighborhood Attachment Community Disorganization Availability of ATOD Laws and Norms Favorable To Substance Abuse Lack of Clear Healthy Beliefs and Standards from Parents, Schools and Communities Perceived Availability Lack of Clear, Enforced Policy on the Use of ATOD Availability of ATOD in School Laws and Norms Favorable to Substance Abuse Perceived Risk/Harm of Substance Abuse Favorable Attitudes Toward Substance Use Family Management Problems Lack of Monitoring/Supervision Favorable Parental Attitudes Toward ATOD Abuse

Protective Factors
Community Bonding Healthy Beliefs and Clear Standards Community Supported Substance Abuse Prevention Efforts and Programs Availability of Constructive Recreation High Monitoring of Youth Activities Strong Classroom Management Norm of Positive Behavior Pro-Social Opportunities Social Bonding Social Skills Competency Academic Achievement Regular School Attendance Social Competence Autonomy Sense of Purpose and Belief in a Bright Future Problem Solving Abilities Consistency in Rule Enforcement Reinforcement for Pro-social Involvement High Parental Monitoring Strong Parental Bonding Strong Family Bonding Positive Family Dynamics No ATOD Use/Abuse Extended Family Networks

Appendix E
CIS Pattern of Referrals for SCA This table will present the number and percentage of all first admissions for SCA-paid clients (referring SCA) for the previous year, which came from each referral source (except juveniles, which would be identified by age and total number from all referral sources). The percentages for the individual SCA and the state as a whole will be displayed side by side for comparison.

Referral Source for New Clients Drug & Alcohol Abuse Providers Criminal Justice/NonVoluntary Social Service Agencies Employers Religious Organizations Self, Friends Primary Care (Physicians, Emergency Rooms) Total:

SFY 09/10 CIS Pattern of Referrals for SCA (Franklin/Fulton) SCA Paid Unique Clients Number of Clients Percentage of Statewide Percentage of SCA Clients 40 15 8 0 0 23 4 44.4% 16.7% 8.9% 0% 0% 25.6% 4.4% 24% 36% 13% 1% 0% 21% 5% 100%

90 100% Below is the percentage for juveniles only 1 1.1%

Juveniles

6.4%

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Appendix F
CIS: Treatment Admissions by Type of Service This table is slightly different from the referral source tables and will be specific for each SCA. Sample SCA data is provided in this example. Again, the table is limited to SCA clients as defined by the Referring SCA item in CIS. However, what are counted are treatment admissions which began during the year, rather than individual clients. We would expect to see differences in the pattern of services provided by individual SCAs, compared to the statewide data, since we know that some SCAs simply do not utilize certain levels of care.

SFY 09/10 Service Strategy for SCA (Franklin/Fulton) Level of Care Usage for Treatment Admissions Hospital Detox Hospital Rehab Non-Hospital Detox Short-term Non-Hospital Rehab (30 days or less) Long-Term Non-Hospital Rehab Halfway house Partial Hospitalization Intensive Outpatient Outpatient drug free Methadone Maintenance Total Admissions paid by SCA Number of Admissions 0 0 64 31 19 1 0 0 21 0 136 Percentage of SCA 0% 0% 47.1% 22.8% 14% 0.7% 0% 0% 15.4% 0% 100% Percentage of Statewide 1% 0% 13% 15% 8% 2% 5% 9% 45% 2% 100%

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Appendix G
CIS: SCA Paid Admissions by Primary Substance of Abuse These two tables are also limited to SCA clients as defined by the Referring SCA (paying SCA) item in CIS. It shows the treatment admissions that began during the year, rather than individual clients, based on the primary drug of choice at admission. The percentage of admissions attributed to each substance is compared with the percentage of statewide admissions for that substance for age categories: under 18 and age 18+.

SFY 09/10 Demand for Service by Primary Substance of Abuse SCA Paid Admissions (Under Age 18) for: Primary Substance of Abuse SCA (Franklin/Fulton)
Number of Percentage of Percentage of Admissions Statewide SCA (Under Age Admissions Admissions (Under Age 18) 18) (Under Age 18) 0 0% 18.0%

Alcohol Cocaine/Crack Marijuana/Hashish Heroin Non-Prescript. Methadone Other Opiates/Synthetics PCP Other Hallucinogens Methamphetamine Other Amphetamines Other Stimulants Benzodiazepine Other Tranquilizers Barbiturates Other Sedatives/Hypnotic Inhalants Over-The-Counter Other Total paid by SCA

0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1

0% 0% 0% 100% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 100%

1.4% 67.0% 2.9% 0.2% 5.0% 0.0% 0.3% 0.3% 0.3% 0.0% 1.0% 0.1% 0.0% 0.3% 0.3% 0.3% 2.6% 100%

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SFY 09/10 Demand for Service by Primary Substance of Abuse SCA Paid Admissions (Age 18+) for: Primary Substance of Abuse SCA (Franklin/Fulton) Number of Percentage Percentage Admission of SCA of s (Age Admission Statewide s (Age Admission 18+) 18+) s 38.3% (Age 49 34.8% 8 5 40 0 25 0 0 0 0 0 6 0 0 0 0 0 8 141 5.7% 3.5% 28.4% 0% 17.7% 0% 0% 0% 0% 0% 4.3% 0% 0% 0% 0% 0% 5.7% 100% 10.0% 12.5% 22.4% 0.3% 12.7% 0.3% 0.2% 0.3% 0.1% 0.1% 1.0% 0.1% 0.1% 0.2% 0.1% 0.1% 1.2% 100%

Alcohol Cocaine/Crack Marijuana/Hashish Heroin Non-Prescript. Methadone Other Opiates/Synthetics PCP Other Hallucinogens Methamphetamine Other Amphetamines Other Stimulants Benzodiazepine Other Tranquilizers Barbiturates Other Sedatives/Hypnotic Inhalants Over-The-Counter Other Total paid by SCA

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