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2020-RSAT-MONR-1-D2-002_5th Adjustment Office of Criminal Justice Grants Florida Department of Law Enforcement 2331 Phillips Road Tallahassee, Florida 32308 Residential Substance Abuse Treatment Subgrantee: Monroe County Board of Commissioners Project Title: MEN'S JAIL IN-HOUSE DRUG ABUSE TREATMENT PROGRAM Grant Number: 2020-RSAT-MONR-1-D2-002 Adjustment Number: 5 Nature of Extension To Subgrantee: Pursuant to your request of 06/24/2020, the following change, amendment or adjustment in the above grant project is approved subject to such conditions or limitations as may be set forth below. Retain this Grant Adjustment Notice as part of official project records. Electronically Signed By: Tennille E Robinette Date 06/29/2020 Authorized Official Rona Kay Cradit Administrator OCJG Adjustment The grant period is extended to December 31, 2020. NOTE: Retain this grant Adjustment Notice as part of official project records. Application Ref#2019-RSAT-123 Contract#2020-RSAT-MONR-1-D2-002 Application for Funding Assistance Florida Department of Law Enforcement Residential Substance Abuse Treatment In January 2020, the COVID-19 pandemic broke out in the U.S., thus causing the need for social distancing guidelines to be established to contain the spread of the COVID-19 virus. The Executive Ordered social distancing guidelines and restrictions established in the jail in response to COVID-19 significantly encumbered the services provided for the Men?s Residential Substance Abuse Treatment (RSAT) program. Monroe County is requesting a six-month no cost extension, extending the deadline to December 31, 2020. All other aspects of this grant remain the same. By electronically submitting this adjustment, I hereby certify that I have reviewed the changes and find them necessary for program activities. I am the signing authority or have been delegated as such by the appropriate official. Information regarding the signing authority is Electronically Signed By: 06/24/2020 Heather Carruthers Date Authorized Official or Designated Representative Application Ref# 2019-RSAT-123 Contract# 2020-RSAT-MONR-1-D2-002 OCJG-005(rev.April 2005) Application for Funding Assistance Florida Department of Law Enforcement Residential Substance Abuse Treatment General Project Information Project Title: MEN'S JAIL IN-HOUSE DRUG ABUSE TREATMENT PROGRAM Subgrant Recipient: Monroe County Board of Commissioners Implementing Agency: Monroe County Board of Commissioners Project Start Date: 7/1/2019 End Date: 12/31/2020 Problem Identification Description of the need/issue required to be addressed: South Florida, including Monroe County and the Florida Keys, continues to have the unfortunate distinction of being designated as a high-intensity drug trafficking area and, as such, is a leading illicit drug importation area. This has increased the availability of illicit drugs in Monroe County resulting in drug abuse rates higher than both the state and national averages. The Monroe County Sheriff's Office recorded 3,727 drug-related arrests for males during the six-year period of 2012 through 2017. Approximately 570 males were arrested on drug-related charges in 2012, which grew to 1,100 in 2017 (a 93% increase). In Monroe County, the number of accidental deaths caused by prescription drugs increased 75% in one year(from 12 in 2015 to 21 in 2016) according to the Florida Department of Law Enforcement (FDLE) Medical Examiners Annual Report. Cocaine deaths in Monroe County increased to historically high levels as well and in 2016 and 2017 were among the highest rates of accidental deaths in the state with more than 25 per 100,000 individuals. The FDLE 2017 Medical Examiners Commission Drug Report also indicates a rise in Monroe County from 40 prescription drug-related deaths to 48 deaths (20% increase) from 2016 to 2017. Opioid-related accidental deaths continue to remain a significant problem in Monroe County as well with morphine (9 deaths), oxycodone (9 deaths), hydrocodone (8 deaths), fentanyl (6 deaths), and heroin (4 deaths) accounting for at least 36 deaths. The Monroe County Sheriff's Office, Public Defender, and State Attorney's office have indicated a need for additional diversion and treatment services including programs which will allow the county to decrease the number of days' individuals spend incarcerated. Monroe County has over twice the state average for DUI arrests and, consequently, almost three times the state average for vehicular deaths involving drug use. For drug involved parents, statistics from the Florida Department of Children and Families indicate that 34% of Monroe County foster care placements between October 2017 to September 2017 were as a result of parental substance abuse. Opioid and crack cocaine addiction also continues to ravage the community and lead addicts quickly into the criminal justice system. South Florida, including Monroe County and the Florida Keys, like many areas of the country has seen an influx of opiate related deaths and increase in opiate abuse. The project proposed by the service provider supports Monroe County's strategic plan that addresses an identified priority in reducing criminal recidivism related to substance use. Repercussions/impact if need/issue is not addressed: Research has concluded that conditions are ripe for the opioid epidemic to Application Ref#2019-RSAT-123 Section#2 Page 1 of 5 Contract# 2020-RSAT-MONR-1-D2-002 OCJG-005(rev.April 2005) Application for Funding Assistance Florida Department of Law Enforcement Residential Substance Abuse Treatment worsen in the coming years and that current efforts to reduce misuse of prescription opioids are unlikely to have a significant effect on the number of opioid overdose deaths in the near future. What's needed, they wrote, is a multipronged approach that includes not only programs that monitor and restrict prescriptions, but one that also improves access to treatment, expands the number of interventions that reduce the harms associated with opioid use, and reduces exposure to illicit opioids. [1] [1] Devitt, Michael, "Research Shows Nation's Opioid Epidemic Is Far from Over, More Comprehensive Approach Is Needed to Reduce Opioid Use, Deaths; For family physicians who grapple with the effects of the opioid epidemic on a daily basis, there's new evidence that things may, unfortunately, get worse before they start to get better", 20 Feb, 2019. American Academy of Family Physicians (AAFP) <https://www.aafp.org/news/health-of-the- public/20190220opioidprojections.htmI> Summary of project accomplishments from pre-existing subgrant (2018-RSAT-MONR-1-U4-004) that have been achieved: Data reported in "Completions" and "Reincarcerations" sections the Quarterly Performance Report from the most recent grant period, January 1, 2018 through December 31, 2018 *Q2. Completions - "How many successful RSAT completions were released in the community during the reporting period?" Jan-18 to Mar-18 = 7; Apr to June = 8; Jul to Sept = 10; Oct to Dec = 14; Total Successful Completions = 39 *Q5. Completions - "During the reporting period, how many successful RSAT completions were released into the community with a continuity of care arrangement, re-entry and/or transitional plan?" Jan-18 to Mar-18 = 7; Apr to June = 8; Jul to Sept = 10; Oct to Dec = 14; Total Successful Completions Released with a Continuity of Care Arrangement = 39 (100%) *Q1. Reincarcerations - "How many successful RSAT completions were released, and subsequently reincarcerated on a new criminal charge during the reporting period?" Jan-18 to Mar-18 = 1; Apr to June = 0; Jul to Sept = 0; Oct to Dec = 3; Total Successful Completions Released then Reincarcerated = 4 (10% of successful completions) In the proposal of 2018-RSAT it was estimated that 8% of the successful completions would be reincarcerated for a new criminal charge; data results from 2018-RSAT indicate a successful outcome of a 10% recidivism rate. Note: The shortfall for the estimated number of successful completions is likely due to the aftermath of Hurricane Irma. In summary, based on new evidence that the opioid epidemic may, unfortunately, get worse before it starts to get better and the belief that what's needed is a multipronged approach that includes not only programs that monitor and restrict prescriptions, but one that also improves access to treatment, expands the number of interventions that reduce the harms associated with opioid use, and reduces exposure to illicit opioids; this program is more important now, than ever. Application Ref#2019-RSAT-123 Section#2 Page 2 of 5 Contract# 2020-RSAT-MONR-1-D2-002 OCJG-005(rev.April 2005) Application for Funding Assistance Florida Department of Law Enforcement Residential Substance Abuse Treatment Thus, an increase in funding for the 2019-RSAT program is requested. Project Summary (Scope of Work) The Jail-In House Drug Treatment Program (JIP) located within the Monroe County Detention Center began in 1992. It remains today as one of the few such programs operated within a county jail in Florida and the only opportunity for some men to receive intensive drug abuse treatment within Monroe County. Moreover, these men are able to get treatment quickly instead of being one of the 66% of substance abusing Florida residents who desire help but are unable to access treatment due to Florida's lengthy waiting list for substance abuse services as reported by the Florida Department of Children and Families. This program has been able to attain and maintain a very low recidivism rate (under 25%)for participants in the last 8 years with the addition of evidence-based practices and special attention to the unique needs of substance abusing men. The program has a very close relationship with county judges, attorneys, and the administration of the Monroe County Detention Center as well as city and county authorities. Men who complete treatment are often granted early release from incarceration to begin rebuilding their lives, thereby saving the county the expense of their continued detainment. Clients are taught coping skills to manage stress, anxiety, triggers to relapse. Groups also coverjob interviewing skills, resume creation, professionalism, budgeting, opening a bank account and household management skills. These skills attained within the context of treatment increases the chances of sustained recovery, healthier family and other personal relationships and safer communities; as they have successfully completed an intensive, comprehensive treatment program. JIP was developed in order to provide substance abuse treatment services to county inmates to lay the foundation for sustained recovery. The majority of clients are court ordered by the Drug Court, Circuit Court and County Court Judges in Monroe County. The rest enter the program as volunteers who have met the criteria for drug/alcohol treatment and will be in the county jail a minimum of 182 days. JIP will serve 70 male inmates. Clients must have a minimum of 6 months' jail time to complete the program, agree to follow all program rules including the absence of disciplinary infractions while incarcerated and complete all program assignments and attend groups 5 days per week. Once clients have been referred to JIP, a biopsychosocial and program orientation is completed to determine treatment needs within 7 days of receiving court order. Additional assessments are conducted including Mental Health Status and the Post Traumatic Check List (PCL-5)which identify suicide risk levels, trauma and impairments in functioning. If a mental health diagnosis is identified as part of the assessment, the client receives a referral for mental health services. These clients continue to participate in the JIP to address the substance use disorder and criminal thinking and behavior. During client treatment, JIP program staff will collaborate with other service providers, since treatment of co-occurring disorders are seen as a vital part of recovery from substance abuse. Admission policies are welcoming to individuals with co-occurring disorders, learning disabilities, illiteracy and other special individualized needs allowing access for all who probably otherwise would not receive services. Client-centered individualized treatment plans, funded by this RSAT program are tailored to the needs of men, are a cornerstone of gender-responsive treatment. Following completion of the comprehensive assessment the JIP counselors and clients collaboratively develop a person- centered Wellness Plan in the first month of service. Application Ref#2019-RSAT-123 Section#2 Page 3 of 5 Contract# 2020-RSAT-MONR-1-D2-002 OCJG-005(rev.April 2005) Application for Funding Assistance Florida Department of Law Enforcement Residential Substance Abuse Treatment This plan is continuously being developed and then reviewed and updated with the participant every 30 days throughout the course of the program. JIP treatment services are delivered by 3 program staff and a program coordinator. Groups are facilitated 5 days per week. In addition, each program participant is assigned a primary counselor/case manager for monthly individual sessions, to assist with treatment planning, provide comprehensive case management and to monitor progress and discharge planning. Treatment services use several evidence-based practices including Cognitive Behavioral Therapy (CBT) curriculum entitled "Substance Abuse and Criminal Conduct: Strategies for Self- Improvement and Change, Pathways to Responsible Living" authored by Harvey Milkman and Kenneth Wanberg which includes a client workbook for them to keep. Moral Reconation Therapy (MRT), is also used to decrease recidivism among criminal offenders by increasing moral reasoning. Additionally, treatment in the correctional setting incorporates trauma-informed and gender- responsive treatment through the use of the evidenced-based. "Seeking Safety" treatment model to promote the healing and edification of the human spirit. These relational models support the development of healthy relationships with self, significant others, and the community at large in order to reduce the risk of relapse and recidivism. An evidenced-based Relapse Prevention Therapy program will also be incorporated. Clients are required to complete all program service components in 2 phases in a minimum of 6 months. Each phase of treatment includes phase specific"dorm-work" assignments that are reviewed and graded by program staff. Clients are only allowed to phase up to level 2 and successfully graduate the program once all assignments are completed and presented to staff and peers. Clients are required to submit daily homework assignments, attend groups and maintain their behavior in the dorm and groups. When clients move from one phase to the next is not pre- determined and the timeline is individualized based on progress. To ensure the program achieves its intended outcomes and community impact, outcome data is collected from the electronic health record so the program can monitor deliverables; assess where it needs improvements; and make timely adjustments to address the desired outcomes more effectively and efficiently. JIP staff submit monthly status report to Jail Program Director. Program coordinator submits quarterly and annual reports to the County grant administrators. Treatment in the program is a minimum of 6-months and a maximum of one year. Successful program completion rate will be 80% or higher. Recidivism will be collected and monitored post- discharge using the county arrest data system. JIP staff plan for the client's discharge. Aftercare services are encouraged as a part of re-entry planning and last up to 6-months once the client is released. Aftercare includes both mental health and substance abuse needs. Clients are given appointments with a psychiatrist as part of aftercare and assigned a case worker to help them with appointments, treatment adherence, accessing of community services and medication assistance. If MAT (Medication Assisted Treatment) is needed it will be added to discharge planning to occur post release. Corrections staff conduct random drug testing of program participants with tests provided by the contracted services. If a client tests positive for drugs, there is disciplinary action resulting in 30 days in lock down and a return to court for judicial Application Ref#2019-RSAT-123 Section#2 Page 4 of 5 Contract# 2020-RSAT-MONR-1-D2-002 OCJG-005(rev.April 2005) Application for Funding Assistance Florida Department of Law Enforcement Residential Substance Abuse Treatment review of the case. Tests used are the Reditest icup which is a 10 panel dip sticks testing for amphetamine, benzodiazepines, cocaine, opiates, synthetic opiates, THC, PCP, barbiturates, and MDMA. The JIP program has been evaluated and accredited by the Council on Accreditation for Rehabilitation Facilities (CARF) over the past 9 years. JIP met the highest CARF standards and received recognition for its positive relationships between correctional staff and program staff. Application Ref#2019-RSAT-123 Section#2 Page 5 of 5 Contract# 2020-RSAT-MONR-1-D2-002 OCJG-005(rev.April 2005)