HomeMy WebLinkAboutCOM 0751.000 1998-2000
An i~~rt r
JAY T. KIMURA 34 RAINBOW DRIVE
PROSECUTING ATTORNEY ~V OF HILO. HAWAII 98720
~y ~ry • PH. 961-0466
CHARLENE Y. IBOSHI FAX. 961-2703
969-1159
FIRST DEPUTY 961-25W
PROSECUTING ATTORNEY •'•i
,t WBSTHaWAII UNIT
PO BOX 748
~M•oi'N~«' KEALAKEKUA, HAWAII 96750
322-2552
OFFICE OF THE PROSECUTING ATTORNEY 322-2552
April 18, 2000
To: County Council Members
From: Jay T. Kimura
Prosecuting Attorney
Re: ADAD Strategic Plan
Please find attached a copy of the Alcohol and Drug Abuse Divisions Strategic Plan for substance
abuse that you requested. The strategic plan has been compiled statewide. Any questions
regarding the State's plan may be referred to Howard Medeiros at 934-3390
attachment - On file in the office of the County Clerk
Comm. No._L 5n/
File No. P~C-
Ref. To:
xef. Date APR 2 0 Ann NOVI
Statewide
Substance Abuse
Treatment Plan
A Foundation Document
.
State of Hawaii
Department of Health
Alcohol and Drug Abuse Division
January 2000
Statewide Substance Abuse Treatment Plan
A Foundation Document
Kauai "Because significant segments of the treatment services are
limited or lacking altogether, there exists a continuum with
many cracks through which client needing services can fall. "
- Kauai County
Niihau
Oahu
"The funding currently available for substance abuse
treatment services appears to be seriously inadequate
for all segments of the populations.
- "
Honolulu County
0o i
'Increasing public funding to support services for substance Maui
abusers will ultimately realize cost avoidance if one were to
consider the consequences and impact on the heath and social Lanai
costs if treatment services were not available and accessible. " r
- Maui County Kahoolawe
_ Hawaii
"Adequate resources are necessary to result in desirable
outcomesforsubstanceabusers ofallages, lheirfamilies, and
community. "
Hawaii County
Statewide Substance Abuse Treatment Plan
A Foundation Document
Table of Contents
Abstract i
Section 1: Introduction 1
Purpose of the plan
Process of developing the plan
The National Problem
Treatment is Effectiverfreatment Works
Section 2.: The Comprehensive Model 5
Principles of effective treatment
Critical Components of Treatment
A model of a comprehensive system of substance abuse treatment services
The Modalities of Treatment Services
Section 3: Treatment Needs in the State of Hawaii 9
General adult population 9
Adolescent population 12
Criminal Justice population li
Pregnant and parenting women population 21
Injection drug user population 24
Co-occurring disorder population 26
Section 4: Treatment Issues and Needs of Neighbor Island Counties 29
Hawaii Count) 29
KauaiCounn 29
Maui Counn 31
. . . .
Section 5: Infrastructure Issues 33
Section 6: Funding Needs ............................................35
References .......................................................37
Appendix A. Participants in the Planning Process
Appendix B. Listing of School-Based Treatment Services
Statewide Substance Abuse Treatment Plan
A Foundation Document
Executive Summary
The purpose of this document is:
• To provide a foundation for the development of statewide strategies for assuring the
availability of a full continuum of substance abuse services.
• To involve the collective efforts of persons in recovery, community service providers,
representatives of diverse segments of the state, Neighbor Island communities, and
interested citizens.
• To provide in one document the substance abuse treatment needs of different sub-
populations.
• To estimate the resources necessary to close the treatment gap.
Six subcommittees on Oahu met to identify and define the needs for the following sub-
populations: general adult, adolescent, pregnant and parenting women, criminal justice, injection
drug user, and co-occurring disorders. For each of the segments of the population, the total number
of clients in need of public funded substance abuse treatment services is estimated and when
possible, total costs for funding these services are included. The committees on the three Neighbor
Island counties identified the special and unique issues that impact on the substance abuse services
delivery system within their communities.
Substance abuse is a national public health problem that affects millions of people with
enormous financial and social burdens on society. The Center for Substance Abuse Treatment has
documented that even- man, woman and child in America pays nearly 51,050 each year to cover the
5276 billion total national costs of untreated substance abuse. In the State of Hawaii, for 1990, the
total cost for alcohol and other drug abuse was 5731.2 million with costs due to alcohol abuse and
dependence at 5439.5 million and other drugs at 5291.7 million.
Current research shows that substance abuse treatment is a good investment and is far less
expensive than the alternatives. Substance abuse treatment reduces health care cost by reducing the
need for emergency room care and prolonged and chronic hospitalizations for conditions related to
substance use Substance abuse treatment reduces the prevalence of crime. Substance abuse
treatment for women reduces complicated pregnancy costs, welfare costs, and restores families.
Research documents that of women in treatment for substance abuse, 81% had no new criminal
charges following treatment, 75% who successfully completed treatment remained drug-free, 46%
obtained employment following treatment, and 40% eliminated or reduced their dependance on
welfare So, the evidence shows that substance abuse treatment can reduce the prevalence of drug
use and abuse and is cost effective.
The National Institute on Drug .Abuse, Principles of Drug Addiction Treatment (1999),
states that alcohol and/or drug addiction is a complex illness and for many people becomes chronic
with relapses even after long periods of abstinence. Addiction is a bio-psycho-social disease, a
-i-
distinct disorder requiring on-going treatment and intervention, not only episodic or acute care. A
person's addictive disorder cannot be addressed in isolation from addressing his or her biological,
psychological or social needs. The critical components of treatment include: (1) Assessment, an
essential first step, that uses diagnostic instruments and processes to determine an individual's needs
and problems. (2) Patient-Treatment Matching, a process that ensures that an individual receives the
type of treatment corresponding with his or her personality, background, mental condition, and the
extent and duration of substance abuse determined by the assessment. (3) Comprehensive services
that include the range of services needed in addition to specific alcohol or drug treatment including
health care, financial and legal services, care for psychological problems, and many others. (4)
Relapse Prevention, an important component, because addiction is a chronic and relapsing disorder.
This document summarizes the substance abuse treatment needs that have been estimated
for six sub-populations who would need public funded treatment services in the State of Hawaii.
The estimated costs for expanding programs to provide the appropriate treatment services for
individuals in these six sub-populations are summarized as follows.
General Adult Population. A total of 536,330,000 in additional funding is required to
provide public funded treatment services to 5,190 adults.
Estimated Costs for Public Funded Services for Adults by County, 1998
Assumption in Estimating Populanan Honolulu Maui Hawaii Kauai Total
Total need of treatment services 57,673 9,877 17,176 3,259 82.880
f:dude special populations (80%) 46,098 7,858 9,741 607 66,304
federal poverty level(73°h) 10,602 1,807 2,740 600 15,749
Anticipated demand (50'A) 5,301 904 1,170 300 7,675
Receiving pubh(funded services (1,705) (198) (4441 (88) (7435)
Unmet need fare is funded treatment 3,596 706 676 712 5,190
Estimated cost per treatment episode 51,000 57,000 $7,000 57,000 57,000
Projected cost for oublic funded treatment S75, 177,000 54942,000 $4,732.000 S1,484000 536.330.000
Adolescent Population. A total of 59,945,500 in additional funding is required for three
major programs to serve this population. One program is to provide school-based substance
treatment services in all of the public middle schools and high schools in the state. Additional
funding of 5998,000 is needed for the Juvenile Drug Court, and 52,737,500 is needed for additional
residential treatment services on Oahu, the Big Island, and Kauai.
Estimated Costs for School-Based Treatment Programs b County, 1999
- -Middle Schools High Schools
County Number Treatment « Schools Number Treatment Schools Cost
of Sites Needing of sites Needing
Schools Treatment Schools Treatment
Honolulu 28 0 28 23 19 4 $2,880,000
Hawaii 16 0 16 10 4 6 $1,980,000
Maui 8 1 7 7 4 3 $900,000
Kauai 4 1 3 4 2 2 $450,000
Total 56 2 54 44 29 15 $6,210,000
-ii-
Pregnant and Parenting Women Population. A total of 59,234,000 is required to serve
this unique population of women with children under 5 years of age and who are also being served
by Children's Protective Services (CPS).
Estimated Cost of Treatment Services for Parenting Women
Active child welfare services cases 3,800
Parents with at least one child <5 years (45%) 1,710
Access specialize treatment services (90%) 1,539
Need for public funded treatment services 1,539
Cost based on 56,000/treatment episode 59,234,000
Criminal Justice Population. A total of approximately 54,400,000 is requested for a
collaborative program among the Departments of Health, Public Safety, the Hawaii Paroling
Authority, and the Judiciary to provide a continuum of substance abuse treatment services and
integrated case management services for 500 offenders under community supervision who are at
risk of having that supervision revoked as a result of continued substance abuse.
Injection Drug User Population. A total of 513,606,800 is needed to provide treatment
services to an estimated 2,346 adults at a cost of 55,800 per client per year. These figures are based
on preliminary data from a household telephone survey and should be considered very conservative
estimates and significantly under-estimated.
Co-Occurring Disorders Population. A total of $8,420,000 is needed to provide services
to an estimated 842 persons with co-occurring disorders at an estimated S 10,000 per client per
year. These figures are extrapolated from national estimates and information from the mental health
services system and should be considered very conservative and significantly under-estimated.
The total amount required to fund all of the unmet demand for public funded substance
abuse treatment services is estimated to be 581,936,300 annually. In projecting the allocation of
funding needed over a five year period, 54.4 million is being requested for fiscal year 2001. Starting
in fiscal year 2002, the request increases to S23,784,075 and in each subsequent fiscal year the
request increases by an additional 519,384,075 above the previous fiscal year's request until the
581,936,300 is requested in fiscal year 2005.
The infrastructure issues that affect the system of services may be categorized as
administrative issues, training issues, and funding issues. The administrative issues include the
problems associated with health insurance coverage, limitations, eligibility, and access to services.
Parity, the equalizing of access to health insurance coverage is also a major administrative issue.
Training issues are related to the shortage of certified substance abuse counselors and the need to
maintain quality of services. It is recognized that the level of funding for substance abuse treatment
services in the state is seriously inadequate for all segments of the population, for all treatment
=dalities, and for all geographic areas. This document identifies the need by population and area
and provides an estimate of the level of funding required to assure that substance abuse treatment
services are available and accessible-
-iii-
Statewide Substance Abuse Treatment Plan
A Foundation Document
Section 1: Introduction
Purpose of the plan. The purpose of this document is to provide a foundation for
the development of statewide strategies for assuring the availability of the full continuum
of substance abuse treatment services. The document represents the collective efforts of
persons in recovery, community service providers, representatives of all segments of the
state and the three Neighbor Island county governments, and interested citizens.
The document describes the current research that establishes the fact that
substance abuse treatment works and is cost effective. With the availability of appropriate
treatment services, costs for health care is reduced, the prevalence of crime is reduced,
the welfare costs are reduced, and families are restored. Within this context of the
effectiveness of treatment, the needs are defined for each of the following segments of the
population in Hawaii: general adult population, adolescent population, pregnant and
parenting women, criminal justice population, injection drug user, and the population
with co-occurring disorders. For each of the segments of the population, the total number
of clients in need of public funded substance abuse treatment services is estimated and
when possible, estimates of total costs for funding these services are included.
Process of developing the plan. The mission of the Department of Health is to
protect and promote the physical, psychological, and environmental health of the people
of the State of Hawaii through the implementation of core public and environmental
health functions. Within this mission, the role of the Alcohol and Drug Abuse Division
(ADAD) is to provide the leadership necessary for the development and delivery of
quality substance abuse prevention, intervention and treatment services for the residents
of the State of Hawaii. The Division plans, coordinates, provides technical assistance,
accredits treatment programs, certifies substance abuse counselors, establishes
mechanisms for training, assures quality services, data collection, research, and
evaluation to ensure that resources are utilized in an effective and efficient manner.
Treatment efforts are designed to promote a statewide comprehensive system of culturally
appropriate services to meet the treatment and the on-going recovery needs of individuals
and families.
In fulfilling one of the responsibilities of leadership, the Hawaii Department of
Health's Alcohol and Drug Abuse Division initiated the effort to describe the need for
treatment services and to define strategies for meeting those needs. This effort is based on
the following premises: (1) the communities shall be active participants in this process;
(2) the needs should be described for specific sub-populations and by specific geographic
areas, and (3) the needs should be limited to the description of treatment services only
Page -1-
'
and not prevention services. To accomplish this task, the ADAD invited a wide spectrum
of people in recovery, community based service providers, and representatives from
public agencies and programs to an initial meeting to describe the need for defining
substance abuse treatment services and to request the communities assistance. Because of
the large population on Oahu, six committees were developed to identify the needs and
related issues for each of the identified populations- general adult, adolescent, pregnant
and parenting women, the criminal justice population, injection drug users, and the
population of persons with co-occurring disorders (dual diagnosis). In addition to these
six committees to address the issues on Oahu, the District Health Officers from the three
Neighbor Island counties were invited and asked to convene service providers, agency
representatives, government officials, and interested citizens to address the issues and
concerns for the populations in need of substance abuse treatment services in their
counties. This report is a compilation of the data related to the needs for substance abuse
treatment services for each of the specified populations, the unique issues and problems
identified, and some recommendations to begin to address the issues .
The National Problem. Substance abuse is a national public health problem that
affects millions of people with enormous financial and social burdens on society. The
Center for Substance Abuse Treatment (CSAT)
has documented that every man, woman and
child in America pays nearly S1,050 each year to ...substance abuse is the nation's
cover the 5276 billion total national costs of number one health problem...
untreated substance abuse. Costs are from lost
productivity, law enforcement, health care,
justice, welfare and other social costs (CSAT, January 1999). More than one-fourth of
Americans over age 15 have a physiological dependence on at least one addictive
substance. As a result, 25% of all deaths in the United States are caused by addictive
substances and approximately 40 million illnesses and injuries each year are due to
addiction (Center for Substance Abuse Prevention, July 23, 1999). The 1997 National
Household Survey on drug abuse estimates 27.8 million Americans need substance abuse
treatment, and only three million persons are admitted for services in any year (CSAT,
January 1999). The data strongly suggest untreated substance abuse is the nation's
number one health problem and a major economic problem as well.
Treatment is Effective/Treatment Works. In contrast to the costs of untreated
substance abuse, it would cost about S45 per year per
each American to provide the full continuum of services
Sl invested in substance needed to effectively treat addictive disorders (CSAT,
abuse treatment saves January 1999). Substance abuse treatment is a good
taxpayers S7 in future costs.... investment and is far less expensive than the
alternatives. One year of methadone treatment for
Page -2-
heroin addiction costs 53,500; one year of incarceration costs 539,600; and one year of
untreated addiction costs society an estimated 543,200 (NIDA, 1991). Studies in various
states found that S1 invested in substance abuse treatment saves taxpayers S7 in future
costs (California Department of Alcohol and Drug Abuse Programs, 1994). Other studies
have shown that for every S 1 spent on substance abuse treatment, 55.60 was returned in
reduced costs for welfare, food stamps, Medicaid, crime courts and imprisonment. The
1995 National Treatment Improvement Evaluation Study showed that with adequate
treatment:
¦ Crack use decreased by 85% during treatment and after one year of treatment
remained down by 60%;
¦ Cocaine use decreased by 62% during treatment and after one year of treatment
remained down by 42%;
¦ Heroin use decreased by 40% during treatment and after one year of treatment
remained down by 45%;
¦ Marijuana use decreased by 73% during treatment and after one year of
treatment remained down by 41%;
¦ Alcohol used decreased by 67% during treatment and after one year of
treatment remained down by 25%.
Substance abuse treatment reduces health care costs. More than 70 conditions
requiring hospitalization - including cancer, heart disease, and HIV/AIDS - have risk
factors associated with substance abuse. In the 12 months before treatment, the cost for
health care for an alcoholic is 300% higher than after treatment; and on the average,
untreated alcoholics generally incur health care costs that are at least 100% higher than
those of the non-alcoholic. Several studies over the years have documented the evidence
that substance abuse treatment ultimately reduces the utilization and cost of medical care.
One study showed that treatment reduced overall hospital admission rates by 38% and
hospital admissions for drug overdose decreased by 58%. A study in California showed
that among those patients treated for alcohol and illicit drug abuse, there was a 36%
decrease in hospitalizations for physical health problems, a 58% decrease in
hospitalizations for drug overdose, a 44% decrease in hospitalization for mental health
programs and a 25% reduction in the total number of hospital days.
Substance abuse treatment reduces crime. The Bureau of Justice Statistics reports
that the majority of state felony convictions in 1994 were for drug (31%) or property
(32%) offenses. Thirty-three percent of all murders or manslaughter cases are related to
illicit drug or alcohol use. Over 50% of spousal murders are drug or alcohol related. Cost
studies have shown that 33% of all criminal justice costs relate to substance abuse. The
need for substance abuse treatment among the criminal justice population is evident -
over 1.6 million (55%) adults in probation and parole programs need alcohol or drug
treatment; and only 1.1 million (37%) of the total population of inmates receive any kind
Page -3-
of drug treatment. Criminal justice costs can be avoided through reduced arrest rates
resulting from effective treatment. Studies have shown that the national average rate of
recidivism and repeat arrests without substance abuse treatment is 47%. After one year of
treatment, arrests in Ohio dropped by 90%, in Texas by 80%, in California by 604/x, and
in Iowa by 50%. Data from the California Alcohol and Drug Programs show that on I
follow-up after alcohol and drug treatment, criminal activity declined by 66% and the
longer the individual remained in treatment, the greater the reduction in criminal activity.
Substance abuse treatment for women reduces complicated pregnancy costs,
welfare costs, and restores families. Over 5% of the four million women who aave birth
in the United States in 1992 used illegal drugs sometime during their pregnancy and over
750,000 (18.8%) used alcohol at some time during their pregnancy. Approximately 78% j
of children entering foster care are from families in which substance abuse is a major
factor, and drug exposure is a major factor in 87% of abandoned infants. hl CSAT funded
programs, 95% of women reported uncomplicated drug-free births after one year of
treatment; and costs of between 543,000 - 5145,000 can be avoided for each pregnancy i
and delivery uncomplicated by alcohol or substance abuse. Further documentation shows f
that of women in treatment for substance abuse, 81% had no new criminal charges
following treatment, 75% who successfully completed treatment remained drug-free, 46%
obtained employment following treatment, and 40% eliminated or reduced their I`
dependance on welfare. A study of CSAT's Knowledge Development and Application j
Program showed that 87% of children and mothers were reunited one year after the
mothers had completed treatment.
f
f
Page -4-
Section 2: The Comprehensive Model
Principles of effective treatment. The National Institute on Drug Abuse,
Principles of Drug Addiction Treatment (1999), states that alcohol and/or drug addiction
is a complex illness and for many people becomes chronic with relapses even after long
periods of abstinence. Addiction is a bio-psycho-social disease, a distinct disorder
requiring on-going treatment and intervention, not only episodic or acute care. A person's
addictive disorder cannot be addressed in isolation from addressing his or her biological,
psychological or social needs. Because addiction has so many complex dimensions,
treatment for this illness is not simple. Substance abuse treatment must help the
individual stop using drugs and maintain a drums free lifestyle while achieving productive
functioning within the family, in the work environment, and in society. The following are
principles that should form the basis of effective treatment:
PRINCIPLES OF EFFECTIVE TREATMENT
1. No single treatment is appropriate for all individuals.
2. Treatment needs to be readily available.
3. Effective treatment attends to multiple needs of the individual, not just his or
her drug use.
4. An individual's treatment and services plan must be assessed continually and
modified as necessary to ensure that the plan meets the person's changing needs.
5. Remaining in treatment for on adequate period of time is critical for treatment
effectiveness.
6. Counseling (individual and/or group) and other behavioral therapies are critical
components of effective treatment for addiction.
7. Medications are an important element of treatment for many patients, especially
when combined with counseling and other behavioral therapies.
8. Addicted or drug-abusing individuals with coexisting mental disorders should
have both disorders treated in an integrated way.
9. Medical detoxification is only the first stage of addiction treatment and by
itself does little to change long-term drug use.
10. Treatment does not need to be voluntary to be effective.
11. Possible drug use during treatment must be monitored continuously.
12. Treatment programs should provide assessment for HIV/AIDS, hepatitis B and
C, tuberculosis, and other infectious diseases, and counseling to help individuals
modify or change behaviors that place themselves or others at risk of infection.
13. Recovery from drug addiction can be a long-term process and frequently requires
multiple episodes of treatment.
National Institute on Drug Abuse, Pcincip1,es of pray Addiction Treatment, 1999
Page -5-
4
Critical Components of Treatment. The Center for Substance Abuse Treatment
defines the critical components of treatment and states that..."it is particularly important
that treatment strategies incorporate the five critical components to enhance
effectiveness..." The components include:
(1) Assessment that uses diagnostic instruments and processes to determine an
individual's needs and problems. Assessment is an essential first step in
determining the possible causes of addiction for the person and the most
appropriate treatment modality for his or her needs.
(2) Patient-Treatment Matching, a process that ensures that an individual receives
the type of treatment corresponding with his or her personality, background,
mental condition, and the extent and duration of substance abuse determined by
the assessment.
(3) Comprehensive Services that include the range of services needed in addition
to specific alcohol or drug treatment. The needs of addicted persons are often very
complex, including health problems, financial and legal issues, psychological
problems, and many others. Effective treatment must help people access the full
extent of the supportive services needed to make their lives whole.
(4) Relapse Prevention as an important component, because addiction is a chronic
and relapsing disorder. Relapse prevention strategies are based on assessing an
individual's triggers - those situations, events, people places, thoughts, and
activities - that rekindle the need for drugs. Strategies for coping with these when
they occur are then developed.
(5) Accountability of treatment programs is crucial for determining the success of
specific approaches and modalities. The need for the program, its integrity, and its
results, including abstinence, social adjustment, and reduction of criminal behavior
by those treated in the program, must be evaluated.
A model of a comprehensive system of substance abuse treatment services.
The critical components of treatment services can be depicted in a model of a
comprehensive system of services for individuals and their families in need of substance
abuse treatment services (Figure 1). The model is comprised of two segments:
(1) A central core of a comprehensive array of services that should include the
assessment, patient-treatment matching and treatment planning, substance abuse
specific treatment services such as pharmacotherapy, individual, group, and/or
family therapy and counseling, and relapse prevention which includes continuing
care, monitoring, case management, and support groups. These services should be
available and provided by specially trained health professionals and staff in
substance abuse treatment programs.
In Hawaii, the central core of services includes screening for tuberculosis, HIV,
and Hepatitis B' screening for partner abuse and domestic violence; offering
tobacco cessation classes, cognitive restructuring, life skills training; and providing
culturally appropriate and gender specific treatment services.
Page -6-
(2) An outer laver of health, psychological, financial, legal, and social services,
that forms the foundation of support for the individual and the family to be able to
be successful in the substance abuse treatment program. These support services
should be available through other agencies in the community.
Figure 1. Components of Comprehensive Substance Abuse Treatment
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The Modalities of Treatment Services. Substance abuse specific treatment
services may be provided in a variety of settings or modalities within the treatment
program. The treatment modality selected will depend on the findings of the initial
assessment, the determination of needs of the client, and the matching of treatment
services to meet the specific needs. The modalities include:
Detoxification (Medically monitored residential treatment) - Around the clock
medical monitdring,-evaluation, and treatment in a residential setting for patients who
have acute and severe alcohol and other drug (AOD) use disorders and who may also
have a coexisting medical or psychiatric problem. Generally involves a short to
intermediate length of stay (7-45 days) and may include non-medical or social model
programs with variable lengths of stay.
Medical Detoxifcation (Medically managed intensive inpatient treatment) -
Around the clock medically directed evaluation and treatment in an acute care inpatient
setting. This level of care is appropriate for the treatment of medical and psychiatric
Page -7-
problems that may require biomedical treatment (such as life support) or secure services
(such as locked units). Such treatment generally involves a short to intermediate length of
say (7-45 days).
Outpatient treatment services - AOD focused treatment that includes
professionally directed evaluation and treatment typically of less than 9 hours per week in
regularly scheduled sessions.
Intensive outpatient treatment services - AOD focused, professionally directed
evaluation and treatment of 9-20 hours per week in a structured program. These programs
may be evening programs, and frequently include some weekend programming.
Methadone/LAAM - A medically supervised outpatient treatment which provides
counseling while maintaining the client onthe drug methadone/LA-AM.
Day treatment or partial hospitalization - AOD focused, professionally directed
evaluation and treatment of more than 20 hours per week in a structured program. This is
the most intensive of the outpatient treatment options and can be used for treating clients
who demonstrate the greatest degree of dysfunction but do not require inpatient or
residential treatment. Evening and weekend programming may be included.
Short term intensive residential treatment - Generally 21-45 days treatment
designed to teach the client how to live an AOD-free life and to provide motivation for
the maintenance of such a lifestyle. Followup care on an outpatient basis and continued
participation in peer support groups is recommended to maintain the recovery process
begun in the residential setting.
Lon- term intensive residential treatment - This long term treatment model (over
45 days) may be directed by an AOD treatment professional or may be medically
directed. The model is similar to a therapeutic community model. It is appropriate for
persons with multiple problems, especially those with dual disorders involving a
personality and an AOD use disorder. The goal of psychosocial rehabilitation is always
part of treatment.
Therapeutic living - A residential transitional living arrangement with minimal
treatment in which residents are supervised by paid staff. Residents may work and receive
education, training, or treatment in the surrounding community, although some treatment
may be provided in the house. House responsibilities are shared, and rules must be
followed.
Page -8-
Section 3: Treatment Needs in the State of Hawaii
In 1990, the estimated economic cost in the State of Hawaii for alcohol and other
drug abuse was 57312 million with costs due to alcohol abuse and dependence at 5439.5
million and other drugs at S291.7 million. These costs included lost productivity due to
illnesses and death, health care including treatment and other related diseases, motor
vehicle crashes, crime and incarceration, and other related costs. (Adapted from National
Association of State Alcohol and Drug Abuse Directors, Invest in Treatment for Alcohol
and Other Drug Problems: It Pays, July 1994).
General Adult Population
Description of the need. The preliminary findings of the 1998 Hmvaii Adult
Household Survey of Substance Use (Table 1) reveal that of the state's population of
895,414 adults 18 years and over, a total of 82,880 (9.3%) were found to be in need of
treatment for alcohol and/or other drugs. Of this total, those individuals needing treatment
services in Honolulu County number 57,623 (8.6x/0), of which 28,615 (49.7%) are male
Table 1. Estimated Need for Adult Alcohol and Drug Abuse Treatment in Howaii, 1996
County
Honolulu Maui Kauai Hawaii TOTAL
Population (218 years) 668,524 85,645 41,304 99,941 895,414
Needing Treatment
Alcohol only 49,285 (7.401.) 7,496 (8.8% 2,463 (6.01/.) 9,682 (9.7%) 68,926 (7.7%)
Drugs only 8,338 (1.2%) 2,326 (2.7%) 796(l.9%) 2,494 (2-5%) 13,954 (1.6%)
Alcohol and/or Drugs 57,623 (8.6%) 9,822 H 1 3,259 (7.9' 1 2,176 (12.2%) 82,880 (9.3%)
and 29,008 (50.3°/x) are female. In Maui County there are 9,822 (11.5°/x) persons in need
of treatment of which 5,308 (54%) are male and 4,514 (46%) are female, while a total of
3,259 (7.9°/x) persons in Kauai County require treatment of which 1,815 (55.7%) are male
and 1,444 (443%) are female. In Hawaii County there are 12,176 (122°/x) persons in
need of treatment services and of these, 7,369 (60.5°/x) are male and 4,807 (39.5°/x) are
female. These estimated needs are based on the clinical definition of dependence and
abuse as specified by the American Society ofAddiction Medicine and the National
Technical Center for Substance Use Needs Assessment.
Estimating the unmet demand for treatment services in Honolulu County. For
purposes of this document, the general adult population is defined as all men and women
18 years and over except for adults who are incarcerated, on probation, parole, or pretrial
Page -9-
status; injection drug using adults; pregnant and parenting women; and adults diagnosed
with co-occurring serious mental health disorders. Taking into consideration that a small
portion of the general adult population is excluded by these special populations, we can
assume that approximately 46,098 (80%) individuals of the total general population is a
more accurate representation of the general adult population requiring treatment services
(Table 2). If we further assess the need for funding, then we can assume that 23% (federal
poverty level) or 10,602 individuals in the general adult population may lack the financial
resources to pay for treatment
services. Therefore, 10,602
individuals is the target Table 2. Estimating the Unmet Need for Public Funded
population of general adults in Services, Honolulu County, 1998
Honolulu County who may be Assumption in Estimating Population Number
eligible for public funded Total in need of treatment services 57,623
treatment services through the Exclude special populations (Less 20%) 46,098
Health Department's Alcohol Federal poverty level (23%) 10,602
and Drug Abuse Division Anticipated demand (50%) 5,301
(ADAD) or other public Received services (FY 1998) (1,705)
funded agencies. In planning Unmet demand 3,596
for the unmet need for public
funded treatment services, the
estimate should be based on
the anticipated demand for the service rather than based on the total need. Therefore, of
the 10,602 individual eligible for public subsidized services, if we assume that 50% of the
individuals eligible for the services will participate in treatment programs, then the
adjusted estimate for the demand for services is 5,301 individuals. For state fiscal year
1998, approximately 1,705 (32% of the demand population who are eligible for public
funded services) persons received treatment services on Oahu through ADAD-funded
programs. Therefore, the gap (unmet demand) between those individuals eligible for
publically funded services and also needing treatment services and those who are
currently receiving services is 3,596 individuals on Oahu.
It is assumed that the treatment services for the remaining 35,496 persons will be
funded through sources - primarily private insurance - other than the Health Department.
In estimating the unmet needs for this population, it is assumed that the demand for
services in this population is estimated at only 20%. Therefore, based on this assumption,
7,099 individuals annually are seeking services. It is also estimated that approximately
2,000 persons annually receive substance abuse treatment in the private sector. Based on
these estimates, the anticipated unmet demand for substance abuse treatment services in
the private sector is 5,099 persons annually.
Current resources on Oahu. Substance abuse treatment resources for the general
adult population on Oahu are primarily provided by the following agencies: Drug
Pape-10-
llllllpw~
Addiction Services of Hawaii, Hina Mauka, Ho'omau Ke Ola, Kahi Mohala, Salvation
Army Addiction Treatment Services, Sand Island Treatment Center, and St. Francis
Women's Addiction Treatment Center of Hawaii. During the 1998 state fiscal year, these
seven agencies provided substance abuse treatment services on Oahu for approximately
1,705 clients through the following levels of care: medical inpatient detoxification, non-
medical residential detoxification, residential treatment, day treatment, intensive
outpatient and outpatient treatment. In addition, the Medicaid Program's QUEST health
plans pay for approximately 1.7% of the QUEST beneficiaries for inpatient and
outpatient treatment provided by hospitals, private psychologists, psychiatrists and other
licensed providers.
Estimating the unmet demand for treatment services in Neighbor Island
Counties. In determining the unmet demand for public funded treatment services for the
general adult populations on the Neighbor Islands (Table 3), the same assumptions that
were used to estimate the unmet needs on Oahu can be applied. For Maui County, the
total population 18 years and over who need alcohol and/or drug treatment services is
9,822 persons. In applying the assumptions that 20% of the adult population in need are
represented in other sub-populations, and that 2')% of the general population are at or
below the federal poverty level, and that 50% of the population in need will actually
participate in treatment services if offered, there are 904 individuals who may be eligible
and participate in public funded treatment services. During the 1998 state fiscal year, a
total of 198 individuals received treatment services on Maui or Molokai from programs
that were funded through the Alcohol and Drug Abuse Division. Therefore, the unmet
need for Maui County is 706 individuals. In applying the same assumptions and
calculations for Hawaii County and Kauai County, there are unmet needs for treatment
services for 676 and 212 persons in Hawaii County and Kauai County respectively.
Table 3. Estimated Costs for Public funded Services for Adults by County, 1998
Assumption in Estimating Population Honolulu Maui Hawaii Kauai Total
Total need of treatment services 11,623 9,822 12,116 3.259 82,880
Exclude special populations (80%)' 46,098 1,858 9,141 601 66,304
federal poverty level (23%) 10,602 1,801 2,240 600 15,249
Anticipated demand (50%) 1,301 904 1,120 300 7,625
Receiving public funded services (1,105) (198) (444) (BB) (2,435)
Unmet need for public funded treatment 3,596 706 676 212 5,190
Estimated cost per treatment episode 57,000 57,000 $7,000 57,000 57,000
Projected costfor ublicfundedtreatment 525,112,000 54,942,000 54,132,000 51,484,000 536,330000
* Special populations mean the criminal justice population, pregnant parenting women, injection drug users, and persons with co-occurring disorders
Page-11-
I
In estimating the costs to assure that treatment services are available (Table 3), it is
assumed that, taking into consideration the fact that the number and types of treatment
services will be different for every individual, the average cost per client is estimated at
57,000 per year. When this figure is applied to the total number of eligible adults over 1S
years of age who are anticipated to demand public funded treatment services, the total for
the state is 536.330.000.
Adolescent Population
Description of the need In 1998 the Hawaii State Department of Health, Alcohol
and Drug Abuse Division and the University of Hawaii Speech Department conducted a
survey in 204 public schools and 44 private schools in Hawaii to determine the
prevalence and trends in substance use and treatment needs. The results of the 1998
Hawaii Student Alcohol and Drug Use Study indicate that substance use continues to be a
significant problem affecting youths in Hawaii. Alcohol remains the most prevalent
substance, prevalence rates for cigarette use have started to show a decline, and rates for
illicit drugs continue to climb for tenth and twelfth grade students, decrease for eighth
grade students and stabilize for sixth graders. Although 1998 witnessed decreases in
prevalence reports for all substances, the rates are still
higher than in 1993.
The most alarming finding in the 1998 study is the Table 4. Estimated Treatment
increase in statewide adolescent treatment need estimates Needs b school Districts
District Number
for alcohol and/or drug use (Table 4). At least 16% Honolulu 2,282 (14%)
(16,701) of the students statewide in both public and Central 2,312 (15%)
private schools grades six through twelve are estimated to Leeward 2,484 (16%)
need treatment for either alcohol or drug abuse. The windward 1,623 (18%)
greatest needs are in Hawaii district where 21% (2,867) of Hawaii 2,867(21%)
the students are estimated to need treatment, followed by Maui 1,819 (18%)
18% each in Maui (1,819) and Windward Oahu (1,623) Kauai 869 (17%)
districts. The study further identified a total of 869 students Private 2,445 (13%
in Kauai district (17%), 2,484 students in Leeward Oahu TOTAL 16,701 (16%
(16%), 2,313 students in Central Oahu (15%), and 2,282
students in Honolulu district (14%).
For adolescents in Honolulu County in the juvenile
justice system, the Office of Youth Services reports that there are 236 adolescents
committed to the Hawaii Youth Correctional Facility and of these youths, 80% are
reported to have abused alcohol and drugs and 50% are recommended to receive
residential treatment services. There are also 60 adolescents on furlough from the facility
at any given time who are living in a variety of community placements. In the Family
Courts, of those adolescents who are under court supervision due to various problems
such as 6olations and preying on the community, in fiscal year 1995, a total of 286
adolescents were referred for a drug related offense.
Page -12-
Current resources. The resources available to this population for treatment
services include: (a) School-based services provided on all of the four major islands,
however, not in most of the middle schools or all of the high schools. On Oahu, the
YMCA and Hina Mauka provide treatment services in 19 of the 23 high schools; on the
Big Island, the Big Island Substance Abuse Council provides services in four of the ten
high schools; on Maui, Aloha House serves four of the seven high schools; and on Kauai,
Hina Mauka is providing treatment in two of the four high schools. During fiscal year
1999, these programs provided services to a total of 1,306 students statewide. (b) The
Bobbv Benson Center provides an outpatient program for ten students with insurance. (c)
The Bobbv Benson Center on Oahu, with 24 licensed beds, and the Maui Youth and
Family Service with 26 licensed beds provides residential services to adolescents. (d) The
Family Court funding of four YMCA counselors to provide outpatient treatment services
for adolescents who are ordered by the court to receive treatment. There is one counselor
each in the Central, Waianae, Honolulu, and Windward districts with an approximate
caseload of one counselor to twelve clients. (e) The Hawaii Youth Correctional Facility
provides limited treatment services at the facility through funds provided by the Office of
Youth Services.
Estimated aap in treatment services.. Overall, there appears to be not only a
significant lack of resources to provide the treatment services to meet the needs for
adolescents, but there is also a lack of the comprehensive array of treatment services that
should be available. There is a need for the development and expansion of programs to
provide a broader continuum of treatment modalities to include more residential treatment
services on other islands, an expansion of treatment services for the court ordered
adolescent population, increased school-based treatment services so that services are
provided in all public middle schools and high schools in the state, and a juvenile drug
court program. The Department of Education, the Department of Health's Alcohol and
Drug Abuse Division, and Children and Adolescent Mental Health Division, and the
Office of Youth Services will need to continue to collaborate to assure that a
comprehensive system of services is available and accessible for all adolescents who need
treatment services.
School-based treatment services are currently being provided in two (one on
Maui and one on Kauai) of the 56 middle schools and 29 of the 44 high schools in all of
the counties in the state (See Appendix B for list of schools). The school-based programs
promote a holistic approach to treatment, intervention, and counseling that includes
services such as: crisis intervention, screening and assessment, individual, group, and
family sessions for education and counseling, peer and adult role modeling, information
dissemination: referral services; tobacco cessation classes; and clean and sober
Page -13-
recreational activities. In addition, school-based programs provide education and
consultation to school faculty which serves to strengthen student-teacher-counselor
relationships. In order to expand school based services to include 54 middle schools and
Table 5. Estimated Costs for School-Based Treatment Programs by County, 1999
Middle Schools High Schools
County of Treatment Schools I of Treatment # Schools Cost
Schools Sites Needing Schools Sites Needing
Treatment Treatment
Honolulu 28 0 28 23 19 4 $2,680,000
Hawaii 16 0 16 10 4 6 $1,980,000
Maui B 1 7 7 4 3 5900,000
Kauai 4 1 3 4 2 2 $450,000
Total 56 2 54 44 29 15 $6,210,000
15 high schools statewide, a total of 56,210.000 annually will be needed for this
expansion (Table 5). The total is based on the costs for two counselors and related
operational and administrative expenses at 590,000 per school per year.
The Hawaii Juvenile Drug Court Program is being proposed by the Family
Court, First Circuit of the City and County of Honolulu as a solution to the problem of
adolescent substance abuse and delinquent behavior. The goal of the program is to
provide a comprehensive range of interventions and services that will assist adolescents
who have alcohol and other drug abuse problems and are involved in the juvenile justice
system in achieving a state of independent living without the use of alcohol and other
drugs. To achieve this goal, the Individual and Family Treatment Program is proposed as
an eighteen month substance abuse treatment and life shills enhancement program. The
program will provide comprehensive assessment, counseling, life skills training, and case
management services to selected juveniles referred to the Family Court and their families
in conjunction with intense supervision and monitoring. The components of the program
include the Multi-Systemic Therapy (MST) approach which views individuals as being
nested within a complex of interconnected systems that encompass the individual, family,
and extrafamilial factors. Behavior problems can be maintained by problematic
transactions within or between combinations of these systems. MST targets factors that
are contributing to the antisocial behavior and the interventions are pragmatic, goal
oriented, and emphasize the development of family strengths. Some of the other essential
elements of the program that will contribute to the success of the program include: (1)
rapid intervention. (2) immediate access to treatment, (3) a systemic and coordinated
approach, (4) judicial leadership, (5) frequent and direct contact with the drug court
judge, and (6) use of sanctions and incentives. The cost for the development and
Page -14-
implementation of the Juvenile Drug Court Program for a period of 18 months is
estimated at S99S.000 for staff salaries, consultant fees, training of staff, equipment,
supplies; and other administrative and operating cost.
Residential services are currently provided in only two facilities - one on Oahu
and one on Maui with a total of 50 licensed beds. It is estimated that on any given day,
there are approximately 50-100 adolescents who are on a wait-list to be admitted to a
residential program. It is recommended that an additional 50 licensed beds in residential
facilities be planned to meet this need. There should be residential treatment services for
25 licensed beds on the Big Island, ten licensed beds on Kauai, and an additional 15 beds
on Oahu. At an estimated S 150/day to pay for these residential treatment services, a total
of 52,737,500 would be required for these 50 beds for a period of one year. This figure
does not include capital improvement project funds for the building or the maintenance of
the facility. Because of the enormous costs for the actual building of a physical facility,
we should explore alternative methods of providing residential treatment services - for
example support a certified substance abuse counselor to provide treatment services in an
existing group home for adolescents.
Criminal Justice Population
Substance abuse in general has profound impacts on the social fabric of families
and on the economic health of the state. For the criminal justice population, this impact is
greater in that 70% of the people entering Hawaii's criminal justice system have a
substance abuse problem and 85% of the men and women incarcerated in our jails and
prisons have a history of drug abuse.
The estimates for the need for substance abuse treatment services in the criminal
justice populations are presented in Table 6.
Table 6. Criminal Justice Population - Estimated Needs for Substance Abuse Treatment Services, 1999
supervised Probation Incarcerated Parole TotoI
Release Jail Prison
Estimated population 600 16,000 1,050 3,234 1,350 22,234
Estimated need for treatment 420 13,600 893 2,749 1,148 18,810
Treatment ser,ices 9 1,063 0 713 65 1,850
Goo in services 411 12,537 693 2,036 1,083 16,960
The Criminal Justice system is comprised of two major components: (1) the State
Judiciary's Circuit and District Courts that is responsible for the population in probation
and (2) the Department of Public Safety and the Hawaii Paroling Authority that are
responsible for the populations who are in supervised release, the incarcerated
population, and those individuals on parole.
Page-15-
Supervised Release Population. Of the 600 offenders with supervised release
status, approximately 70% (420 individuals) have a substance abuse problem. During FY
1999, 150 (250/10) of the 600 offenders had their supervised release status revoked and of
the 150 revocations, 120 (80°6) were due to drug related offenses. The difference or gap
in services between those in need of treatment (420 individuals) and those actually
enrolled (9 individuals or 2.1% of the total supervised release population) is 411 persons
or 97.9% of the population in need.
The Intake Service Center (ISC) is a division within the Department of Public
Safety and is responsible for the supervised release program in which a pretrial offender
who has been assessed and is not a flight risk or a danger to the community is released
into the community pending trial or sentencing. This provides for an alternative to
incarceration while simultaneously providing for enrollment and participation in
substance abuse treatment. if applicable. The ISC Division has locations on Oahu, Kauai,
Maui, and Hawaii and provides casework (bail and prison placement) services to accused
offenders who are pending arraignment or trial, and convicted offenders who are serving
sentences that do not exceed one year. The ISC also makes recommendations on
alternative placement of offenders in diversionary programs in lieu of incarceration (Drug
Court) and supervises offenders who are conditionally released by the courts. The ISC
develops and maintains an ongoing drug testing and counseling program for pretrial
offenders who are monitored while on supervised release.
Probation Population. There are approximately 15,500 probationers statewide
who are under the supervision of the State Judiciary's Circuit and District Courts with an
additional 500 probationers under the supervision of the United States District Court's
Probation Department. Of the total 16,000 probationers under supervision, 13,600
individuals (85%) are in need of substance abuse treatment and approximately 1,063
(7.8%) actually receive treatment services which means that there is potential gap in
treatment services for 12,537 probationers.
The Judiciary's Adult Probation Division (APD) provides pre-sentence
investigation, supervision, treatment and other correctional services to those who are
sentenced to court supervision, including conditional release from the Hawaii State
Hospital. The APD promotes public safety through services that emphasize offender
accountability and facilitate services that bring about improvement in resolving the
problems of the offender. The APD provides treatment services in coordination with law
enforcement and service provider agencies and organizations. They conduct pre-sentence
investigations and prepare diagnostic reports as their core functions. Probation officers
and investigators make sentence recommendations to the court. The sentencing judge has
the authority to revoke the probation of those who fail to live up to the conditions of
probation. The probation officer to probationer staffing ratio is 1:180, which is more than
-double the ideal 1:70 rate.
Page -16-
The Ha),iaii Drug Court program is administratively supported and is
operationally within the First Circuit Court's Criminal Division and the Adult Probation
Division. The Drug Court program is a State- and federally- funded program for diverted
adult drug offenders. Drug Court services, which are the only "front end" intermediate
sanction funded by the State were extended to 300 clients in September 1998. The
program has been operational since January 1996 and provides drug testing, educational,
and outpatient treatment services to program-referred substance abusing offenders.
Participation is possible at three points within the criminal justice system: prior to
arraignment, prior to trial, and either prior to or after revocation of probation. Criteria for
acceptance into the Drug Court program include: commission of a Class B or C felony
charge (Class A is the most serious of felonies); offenses that occurred to support
substance abuse addiction (not necessarily a drug-related crime); voluntary participation
by the offender: documentation of history of substance abuse or dependence; offender's
motivation and willingness to adhere to the rules and attend needed treatment sessions;
and nonviolent offenders who have caused no serious bodily injury to another person
within the past five years. Admission to the program entails the offender's petitioning the
court (having admitted to the crime) and requesting treatment for substance abuse. Before
admission to treatment, the Drug Court staff administers screening to clinically determine
an addiction problem as well as the motivational level of the offender. Upon admission to
the program, a determination is made on the severity of addiction and a treatment plan is
developed. Staff members also assess the severity of the offender's criminality and
history of legal interventions. Depending on results of the screening process, the offender
may be placed in a residential program or in outpatient treatment. The treatment plan is
based on the results of the ASI and tailored to the needs of the abusing offender. The
offender appears before the Drug Court judge regularly. The judge monitors progress in
treatment, employment status and the offender's family life. Offenders must submit to
random urinalyses: positive results are dealt with immediately with progressively more
serious sanctions.
Incarcerated Population, The incarcerated population consists of approximately
1,050 pre-trial/pre-sentence detainees (or "jail" population) who are incarcerated for less
than one year, and the "prison" population of 3,234 incarcerated for a period exceeding
one year. (The prison population count includes 1,200 inmates transferred to out-of-state
facilities.). Of the 1,050 incarcerated individuals in the jail population, 893 (85%) are in
need of substance abuse treatment. With no treatment services available for this
population, there is an unmet need for the 893 persons in jail. Of the 3,234 in the prison
population who are incarcerated for a period of more than one year, 2,749 (85%) are in
need of substance abuse treatment. Of those in the prison population, 713 are receiving
treatment services which leaves a gap in services for 2,036 inmates in prison.
The Department of Public Safety (PSD), Corrections Division provides custody,
care and assistance for the rehabilitation of offenders incarcerated in jails (for a period
Page-17-
not exceedin« one year) and prisons (for a period exceeding one year). The Division
develops standards and guidelines and provides technical support, administrative support
and assistance to all correctional institutions, Units within the Division provide substance
abuse programming and education, therapeutic community programs and transitional
therapeutic living services. The Division also coordinates with the staff of correctional
institutions and the Classification Office to assess, interview, and select inmates for
participation in treatment programs.
The Therapeutic Community Branch develops and maintains a program of
treatment services for inmates who have substance abuse problems or are perpetrators of
sexual abuse. Branch locations at Waiawa, Maui, Women's, Oahu, and Kulani
correctional facilities manage substance abuse treatment programs for inmates. The
Therapeutic Community Branch reviews the progress of inmates in treatment and makes
recommendations for transfer to other facilities for further programming, placement on
furlough, or parole.
KASH BOX, a therapeutic treatment community at Waiawa Correctional Facility,
opened in 1990 with 14 beds. With its 200-bed capacity, the program provides substance
abuse treatment for 9 to 15 months with treatment focusing on dealing with criminal
thinking before addressing substance abuse problems. The primary PSD treatment is
called Level III, which consists of assignment to nine to fifteen months of participation in
a residential therapeutic community setting. The program includes meetings, seminars,
education sessions, encounter and therapy groups and work assignments. Level III
programming operates at four correctional facilities and serves about 180 inmates a year.
Level II treatment consists of 80 hours of group education and skill building sessions.
In addition to KASHBOX, PSD has operated Project Bridge, a 6-12 month
program, at Laumaka Work Furlough Center since April 1998 with a capacity of 32 slots
and is scheduled to expand to 64 slots in the year 2000. Ho'omana Therapeutic
Community is a 6-12 month program that serves 14 females at the Women's Community
Correctional Center.
Parole Population. Of the 1,350 individuals in the parolee population (excludes
interstate transfers and revocations), approximately 1,148 (85.0%) are in need of
substance abuse treatment. Approximately 65 individuals (4.6%) are enrolled in treatment
which leaves a gap of 1,083 individuals (94.3%). In this population, approximately 60% i
are employed either full- or part-time and may be covered by health insurance; 30.0%
receive workers compensation or public assistance and may be eligible for the Medicaid
QUEST program.
The Hawaii Paroling Authority (HPA) is a quasi-judicial body attached to the
Department of Public Safety for administrative purposes. The statutory responsibility of
Page -18-
the HPA is two-fold: public safety ; and reintegration of the offender. The protection of
the communirv and the successful reintegration of the offender is sought by the HPA
through its fixing an appropriate minimum term of imprisonment, the granting or denial
of parole, the supervision of those on parole and the revocation of parole, whenever
necessary.
Upon being granted parole, the majority of parolees are placed under community
supervision, which is the regular unit that supervises parolees who are not deemed a high
risk to public safety and who do not have special needs. When an inmate is released on
parole, he or she is assigned to a parole officer on the basis of area of residence. The
present parole officer to parolee staffing ratio is 1:100, which is nearly 50% over the ideal
rate if 1:70. Through office visits, curfew checks and urinalyses, parole officers assess
compliance with the terms and conditions of parole. Failure to attend scheduled office
visits or not being home for a curfew check constitutes a violation, repeated violations
can result in reclassification. If a parolee absconds, the parole officer issues a warrant for
the parolee's arrest. If a parolee tests positive for drugs, he or she is considered to be in
violation of a condition of parole - being in possession of a controlled substance. Once it
has been confirmed that a parolee has breached any or all of the conditions of parole, the
parolee may be counseled about the misconduct and warned about future consequences,
or the parolee may be sent aback to prison for violating parole. The parole officer makes
the initial recommendation for parole revocation, which is either approved or disapproved
by the supervisor. If the supervisor approves the recommendation to revoke the parolee, a
warrant is issued and the parolee is sent aback to prison for a parole violation. After the
parolee is in custody, a Parole Board hearing is scheduled to decide on parole revocation
or allowing the parolee to continue on parole. If parole status is revoked, it does not
necessarily mean that the parolee must then serve the rest of his or her maximum sentence
incarcerated; it is more common for the parolee to be re-released on parole after a brief
return to prison.
Proposal for a Comprehensive Approach to Substance Abuse Treatment in the
Criminal.lustice Continuum. Because of the increasing problems associated with
substance abuse and the criminal justice population, representatives from The Judiciary,
the Family Courts, the Department of Health, the Hawaii Paroling Authority, and the
Department of Public Safety came together to assess the status of the current substance
abuse treatment programs and to develop a collaborative proposal to address issues that
impact on the effective delivery of drug treatment services to this population. The
committee focused on a drug treatment strategy to divert offenders who were at highest
risk of being incarcerated. System improvements to divert non-violent drug offenders
from entering prison requires a balance of treatment services and expanded correctional
options. Treatment programs need to have a more thorough assessment process to be able
to match the substance abuser with the appropriate program to meet their specific needs.
At the same time, expanded probation alternatives for non-violent offenders are critical to
Pale -19-
creating a coordinated and integrated system of services. The following recommendations
are being made:
• An inter-jurisdictional, integrated case management model needs to be
implemented so that an efficient, effective continuum of treatment is possible.
By linking substance abuse treatment services with all phases of the criminal
justice system, the offender is provided a better change at successful
integration.
• Hawaii needs to create a system of graduated intermediate sanctions for non-
violent drug abusers. In order to successfully divert criminal justice clients,
additional resources in supervision and treatment services are critical.
• More residential beds and outpatient services are needed at each of the four
phases of the criminal justice system: pretrial diversion, probation,
incarceration, and parole.
• The process of screening, risk assessment, and treatment needs to be
improved. A variety of screening and assessment tools are in use - a standard
needs to be recogmized.
• The comprehensive information system that cuts across agencies and is able to
be accessed by The Judiciary and the Executive Branch would be a
tremendous device for tracking the offender's substance abuse treatment
histor} and progress.
Based on these recommendations, the committee is proposing the improvement of
substance abuse treatment services at a cost of S4.4 million for the first year in the
following areas:
Pretrial Diversion. The target population will include 120 pretrial felons, male
and female, incarcerated at the community correctional centers. Currently there are no
funds for substance abuse treatment services. The proposed substance abuse treatment
services will include: referral for residential services, referral for outpatient services,
referral for transitional therapeutic services. Additional funding of 5510,000 is being
requested for 120 inmates at an average treatment cost of $4,250 per inmate.
Probation. The target population will include 150 male and female felons who
would be incarcerated because of probation violations for drug-related reasons. Currently
there are 51,080,577 for 229 placement slots and an additional $1,600,500 is being
requested to provide substance abuse treatment services for the 150 individuals at an
average treatment cost of S10,670 per individual.
Incarceration. The target population will include 16 male inmates and eight
female inmates on Maui, eight male inmates and four female inmates on Kauai. Proposed
services for this population include: (1) the use of an improved screening and assessment
instrument to provide a more appropriate match for placement and treatment; (2)
comprehensive treatment planning, and (3) transitional therapeutic living services.
Additional funds of S259,200 is being requested to serve the 36 inmates at an average
cost of 57,200 per inmate.
Page -20-
Parole. The target population will include male and female felongs who would be
incarcerated because of parole violations for drug-related reasons. Currently there are no
funds for substance abuse treatment for this population and $868,525 is being requested
to provide substance abuse treatment services for 175 parolees at an average cost of
$4,963 per parolee.
Integrated Case Management. The Department of Public Safety, The Judiciary,
and the Department of Health are developing a model to integrate case management
services with substance abuse treatment A treatment team made up of the substance abuse
case manager and the supervising officer will share responsibilities in providing
comprehensive case management services to the offender. The substance abuse case
manager will be responsible to screen, assess and link the offender to appropriate
treatment services, develop treatment plans, coordinate services, make treatment service
referrals, and monitor treatment compliance. The substance abuse case manager will also
be available 24 hours a day to provide crisis intervention services. The supervising officer
will be responsible to monitor and supervise the offender, develop case plans to meet the
service needs without compromising public safety. Case conferences will be held to
review the offender's treatment needs, assess treatment goals, assess progress and
accomplishments. and address compliance issues. The team will be responsible for
monitoring treatment costs by making appropriate decisions related to client placements
for treatment. A total budget of S1, 147,171 is being requested for personnel and operating
expenses of the integrated case management segment.
Although the current proposal is requesting approximately $4.4 million to divert
500 non-violent drug offenders from entering the prison, it is anticipated that with the
success of this program, that these services will expand so that the majority of the non-
violent drug offenders will be diverted from the costly prison alternative.
Pregnant and Parenting Women Population
Substance abuse among pregnant and parenting women is a significant public
health problem. Substance abuse among women in general has adverse effects not only on
the woman involved, but also on her child, her family, and her community. The pregnant
women who use alcohol and other drugs risk the safe and healthy development of their
unborn child. Research has documented the adverse effects of alcohol or other drugs on
the fetus as well as the pregnancy itself. Maternal substance abuse is often associated
with complications such as low birth weight infants, increased risks of infant mortality, a
higher incidence of stillbirths, miscarriages, and premature infants. The physical,
neurological and behavioral effects of exposure to tobacco, alcohol and other drugs
during the pregnancy on the infant have been well documented. The rate of infant deaths
increases by 50% among babies whose mothers smoke during the pregnancy; the
incidence of sudden infant death is at least twice that of mothers who do not smoke;
respiratory infections and complications among infants and children are more common
when mothers smoke; and tobacco use accounts for 20% of the low birthweight infants.
Page-21-
I
The long term impact of in-utero exposure to illegal drugs on a child's physical and
mental development is not yet known, however, the short term effects are well
documented. Iv9aternal cocaine use is linked to preterm delivery, low birthweight infants,
neonatal seizures, and fetal physical abnormalities. It is also linked to a higher incidence
of behavioral and learning disorders among the preschool and school age children.
Alcohol use during pregnancy is responsible for a high incidence of stillbirths and
premature infants. According to the Centers for Disease Control and Prevention, alcohol
is the leading known preventable cause of birth defects and mental retardation. Infants
born with Fetal Alcohol Syndrome (FAS) suffer from irreversible physical and mental
defects including microcephaly, facial abnormalities, poor coordination, short attention
span, and mental retardation. Nationally, there are more than 7,000 infants born with FAS
annually and three to four times as many infants born with fetal alcohol effects.
For the parenting women, the effects of alcohol and other drug abuse continue to
takes its toll even after the pregnancy in that it is often associated with various other
significant social and health problems. Alcohol and drug use is closely linked to domestic
violence as well as sexual and physical abuse in which women are usually the victims.
Nationally, more than half of all domestic violence cases involve alcohol drinking at the
time of the attack. Women with serious alcohol and other drug problems usually report a
history of having been sexually or physically abused. Three in every four women in drug
treatment programs report having been assaulted by family members or partners. Incest
and rape during adolescence are common experiences. Depression and attempted suicide
are common among women substance abusers; at least one in two women in drug
treatment are also diaenosed with mental disorders.
The child of the substance abusing parent faces multiple risks and life-long
consequences. Research by The National Center on Addiction and Substance Abuse at
Columbia University supports the fact that substance abuse causes or exacerbates seven
out of ten cases of child abuse or neglect. Children of substance abusing parents are three
times more likely to be abused and four times more likely to be neglected than children of
parents who are not substance abusers. Children who are prenatally exposed to substance
abuse are two to three times more likely to be abused or neglected. Children who are
abused or neglected are significantly more likely to engage in serious or violent
delinquency; and they are at higher risk of a range of socially problematic behavior
including drug use, poor academic performance, teen pregnancy, and emotional and
mental health disorders.
Description of the need - pregnant women. In 1996 the Hawaii Department of
Health contracted for a "Blind Study of Substance Abuse and Need for Treatment Among
Women of Childbearing Age in Hawaii " to ascertain the point prevalence of substance
use from a sample of women of childbearing age in Hawaii. The sample of 973 women
came from 28 prenatal clinics situated in the four counties in the State of Hawaii. The
-urine samples were tested for illegal drugs and alcohol testing was not part of the
Page -22-
protocol. Key findings of the study revealed that 50% of the women tested positive for
pregnancy confirmed by a urinanalysis. Of the women who were not pregnant, 15.7%
tested positive for the use of one or more illegal drugs within the previous 48 hours prior
to the testing; of the women wvho were pregnant, 12.7% tested positive for use of one or
more illegal drugs within the 48 hours prior to testing. In stratifying the results by the
county of residence (Table 7) the highest prevalence rates occurred in Maui County with
a total of 19.3% of the women testing positive for one drug or more drugs. Of the women
residing in Hawaii County, a total of
17.0% tested for one or more drugs; lsmwmmm~
11.6% of the women in Oahu tested Table 7. Blind Study of Substance Abuse and Need for Treatment
positive and the lowest prevalence at Among Women of Childbearing Age in Hawaii, 1996.
9.7% were of the women in Kauai Kauai Maui Hawaii Honolulu
County. Based on the assumption No drug 90.2% 80.7% 83.0% 88.4%
that 12.7% of the sample of 973 One drug 7.3% 14.8% 12.7% 6.3%
women who were pregnant and Two or more 2.4% 4.5% 4.3% 5.3%
tested positive for use of illegal Total 9.7% 19.3% 17.0% 1 1.6%
drugs during the pregnancy is
representative of the 18,552 women
who gave birth in 1995, then it can be assumed that 2,356 infants were bom exposed to
substances during their fetal development. Therefore, a comprehensive statewide
screening and early identification program is needed as an integrated part of the array of
prenatal care services currently provided to pregnant women.
Description of the need - parenting women. The Hawaii Department of Health
and the Department of Human Services are working collaboratively to address the needs
of substance abusing women known to Child Protective Services programs. There are an
estimated 3,800 families
who are active in the
child protective services Table 8. Estimated Cost of Treatment Services for Parentin Women
svstem (Table 8). Of this Active child welfare service cases 3,800
Parents with at least one child <5 years (45%) 1,710
total, approximately 45%
Access specialize treatment services (90%) 1,539
(1,710) of the parents -
usually women - have at Need for public funded treatment services 1,539
least one child under five
years of age. Estimating
that 90% of these women would need specialized substance abuse treatment services
specifically designed for the mother-child dyad, a total of 1,539 women and their young
children could benefit from treatment.
The specialized treatment programs would provide an array of services such as
early identification and screening, outpatient and intensive outpatient services,
specialized residential treatment programs and therapeutic living programs designed for
Page -23-
i
the mother-child dead, and aftercare services. These types of services for the special
population requiring the array of child protective services as well as substance abuse
treatment senices are extremely limited in Hawaii. The agencies that provide these types
of services include:
• Salvation Arniv Familv Treatment Services on Oahu - outpatient, intensive
outpatient, residential, therapeutic living, and aftercare services.
• Malama Na Makua A Keiki - therapeutic living program on Maui.
• Child and Family Services -outreach and treatment services on Kauai.
Other programs are available in the community that provide the supportive
services that are required to increase the opportunities for success in the treatment
programs. These programs include:
• BabvSAFE - Outreach, screening, case management, and referral to treatment
programs on Maui, in Hilo, Kona, and in Waianae.
• Title IV B."? -support services.
The definition of a more comprehensive array
of specialized treatment services for the substance ...1,539 women known to
abusing mother and her child should include linkage CPS and their children need
to prenatal care for pregnant women, primary health services at an annual cost of
care services for both the mother and child, child care $9,234,000
and child development services, educational, legal
and vocational services. Based on this definition, the
estimated costs for this array of services would
approximate S6,000 per year per mother-child dyad. Therefore, a total of 59,234,000 a
year would be needed for the 1,539 women and their children who are currently receiving
child protective services.
Injection Drug User Population
Nationally, thirty-six percent of all AIDS cases have been associated with injection
drug use either occurring among injection drug users (IDUs), the sexual partners of IDUs,
or the children of IDUs. However, the data in Hawaii shows that as of September 1999,
of the total number of AIDS cases (2,315) reported, a maximum of 18% of the cases are
classified in the categories of injection drug use, male having sex with male and injection
drug use, all female heterosexual cases, and all perinatal transmissions. The population of
IDUs is a diverse population which includes people who are homeless, men who have sex
with men, transgendered persons, sex industry workers, and single parents. Although
these groups may be identified as separate, the common factors that affect these groups
are their drug using behaviors and the risk of exposure to blood borne diseases. Because
of the nature of their drug use behaviors and the stereotypes associated with this type of
drug use, IDUs are more likely to experience social stigmatization which contributes to
the reluctance of 1DUs to seek out and utilize the available sources of health care. These
barriers to accessing-, health care leads to chronic infections and illnesses, potential
Page -24-
resistance to antibiotics. higher risks of exposure to communicable diseases, and an
overall debilitated health status.
Because of the effects of the drugs and the lifestyles of the users, IDUs need
unique incentives to allow access to services and to retain them in treatment services.
Many need to have access to the basic needs of life - bathing facilities, telephones, mail
drops, temporary housing. In addition to the basic immediate needs, IDUs require social
"wrap around" services and case management. The holistic model of the comprehensive
array of substance abuse treatment services and the full complement of support services is
an ideal model for this population in need of all of the critical components described in
this model.
Estimates of need. There exists no reliable source of a single epidemiological data
base that can accurately ascertain the population of IDUs in Hawaii. There are other
possible sources and methods for obtaining these data, however, each source presents its
own problems. The following is a discussion of the range of estimates of the total IDU
population, with the qualifications that must be considered for each source.
The preliminary data of the 1998 Hmvaii Adult Household Survey of Substance
Use reveals that 0.32% of adults surveyed (2,884 persons) were diagnosed as having a
definite dependence on heroin, and 0.03% (264 persons) were diagnosed with
indeterminate dependence on heroin or abusing heroin. Therefore, based on these
preliminary data, there are 2,975 persons in Hawaii who are injection drug users. It is
believed that this fi`_ure is a very conservative estimate because the data was obtained by
a telephone household survey and the responses may also reflect the reluctance of persons
to admit to heroin use over the telephone.
Current resources. The ADAD 1998 Report to the Nineteenth Legislature of the
State of Hawaii documents that heroin was the primary drug of choice for five percent of
the adults admitted to ADAD-funded treatment services in fiscal year 1997. Data on the
purchase of services for fiscal year 1999 indicate that there were 3,927 new admissions
for both adults and adolescents. Therefore, if five percent of the persons who were
admitted for services reported that heroin was the primary drug of choice and if there
were 3,927 new admissions for 1999, then it is assumed that approximately 196 persons
were admitted for treatment of heroin for that same time period.
Currently, the-Drug Addiction Services of Hawaii (a non-profit agency) is
providing methadone maintenance services to 172 persons in Honolulu, 123 persons in
Hilo, and 84 persons in Hilo (a total of 379, of whom 83 are ADAD-funded); CHAMP (a
for-profit corporation) is providing methadone maintenance services to approximately
250 persons in Honolulu. Thus, there is an estimated total of 629 persons currently
receiving methadone maintenance services statewide.
Page -25-
Unmet Need. Because of the difficulty in attempting to estimate the number of
persons in Hawaii who are injection drug users, extrapolated data were used to estimate
the prevalence, however, it is an accepted fact that these estimates are significantly under-
estimating the actual number of injection drug users. In using the data that are available,
there is an estimated 2.975 adults over 18 years of age who are dependant or abusing
heroin and only 629 adults are receiving services. Therefore, at a minimum, there are
2,346 adults in need of treatment services. It is estimated that it costs S5,800 per client
per year to provide the array of treatment and maintenance services for an injection drug
user. In estimating the total costs, it would take an additional S 13,606,800 to expand the
treatment services to serve this population.
Co-occurring Disorder Population
The term co-occurring disorder (also known as dual disorders) is a broad term that
indicates the simultaneous presence of two independent (but invariably interactive)
medical disorders and is used to describe the coexistence of a mental health disorder and
problems with alcohol and/or other drugs. Patients with co-occurring disorders often
experience more severe and chronic medical, social and emotional problems. Compared
with patients who have a single disorder, patients with co-occurring disorders often
require longer treatment, have more crises, and progress more gradually in treatment. The
National Dialogue on
Co-occurring Mental
Health and Substance
Abuse Disorders has Figure 2. Co-occurring disorders by severity
developed a model
(Figure 2) that Ni=l'
ccvcrir~' III I~
categorizes patients Lcss scverc More sever
based on the severity of - mental disordcrt mrntal d~sordcd
more severe more >:vere
the two disorders and cc substance sunna"ce
describes the folloNving abuse disorder abuse disorder
four categories. I II
The lar°est = Lcss severe More scvcr_
number of patients in this men al disordcrl men al disordcri
less scverc Lcss scverc
population would, be ~unstanee s°nsa"«
abuse disorder abuse disorder
those in Category I,
however, the Hien
ceverin' seven[}'
documentation of this M°nral Hlncs
number cannot be National Dialogue on Cooacurnng Mental Health and Substance Abuse Disorders,1998
determined because
patients usually do not
participate in treatment at either the mental health center or in a substance abuse program.
Patients in CateLories II, if in treatment, are most likely to be receiving mental health
Page -26-
services and substance abuse problems are usually unrecognized and under-reported.
Patients in Category III are most likely to be receiving substance abuse treatment services
and mental health problems are usually unrecognized and under-reported. Patients in
Category IV are the most difficult to treat and are most likely to be in treatment for the
rest of their lives.
Estimating the need. Estimating the number of individuals who may be diagnosed
as having a co-occurring disorder is difficult because health professionals often mis-
diagnosis the condition; individuals may be treated for a substance abuse problem or a
mental health problem and the co-occurring problem is unrecognized. The 1999 U.S.
Department of Health and Human Services publication, Mental Health: A Report of
Surgeon General, provides national estimates of the percentage of persons with serious
mental illness who also have a substance abuse disorder. Extrapolating the national
figures to Hawaii, it is estimated that 25% or 12,088 persons with serious mental illness
also have a substance abuse disorder.
It is further estimated that of the 12,088 persons with a serious mental illness who
also have a substance abuse disorder, 33%, or 3,989 of them, would seek treatment. Of
the 3,989 persons with serious mental illness and a substance abuse disorder (co-
occurring disorder) who would seek treatment, 50% or 1,995 would need treatment from
the public mental health system. This group of individuals consists of two sub-
populations: adults with chronic mental illness (serious and persistent mental illness) who
typically receive services from the Department of Health's Adult Mental Health Division
(estimated to be 1,153 persons), and adults with other serious mental illnesses (estimated
to be 842 persons). There remains a need for public funded treatment services for these
additional 842 persons.
Current resources. The Alcohol and Drug Abuse Division (ADAD) allocates
approximately 5276,091 to community agencies who treat a total of 137 clients statewide.
The Adult Mental Health Division (AMHD) provides the largest amount of services for
persons with co-occurring disorders both by contracted and direct services.
The estimated need. In comparing the estimated numbers of persons with a co-
occurring disorder with the number of persons who are receiving services, there is a large
gap of 842 persons. Because of the unique situation of two co-existing medical conditions
requiring treatment services from two different service delivery systems, the issues
related to treatment services are compounded in complexity. Based on the severity of the
co-occurring mental health disorder and the substance abuse disorder, the individual may
receive services in one of the following settings: primary health care setting, community
programs, the mental health system, the substance abuse system, state hospitals, prisons,
homeless service programs, emergency rooms, or, no care at all. Compared with persons
who have a single disorder, persons with co-occurring disorders often require longer
Page -27-
treatment, have more crises, are more vulnerable to relapse, and progress more gradually
in treatment. Because of the difficulties encountered in treating a person with a co-
occurring disorder, it is conservatively estimated that it would cost 810,000 per client per
year which means that approximately 88,420,000 would be needed to provide the
appropriate treatment services for 842 persons with co-occurring disorders.
Page-28-
Section 4: Treatment Issues and Needs of Neighbor Island Counties
Hawaii County. The Department of Health's Hawaii District Health Officer
convened approximately 30 individuals from all parts of the Big Island and facilitated a
series of five meetings. Participants at these meetings included representatives from
service providing agencies; government agencies including education, health, criminal
justice, and human service agencies, law enforcement; and interested committed citizens.
The guiding principles established by the group for the planning process included: (1)
community ownership, (2) education; and (3) community safety. In providing input into
the planning, the vision statement of the group was..."having accessible and
comprehensive services that are respectful of community and cultural diversity. Adequate
resources are necessary to result in desirable outcomes for substance abusers of all ages,
their families, and community."
In assessing available resources for each of the identified populations of general
adults, adolescents, criminal justice, pregnant and parenting women, injection drug user,
and co-occurring disorders, it was evident that there are limited services available in only
the heavily populated areas of the island. The following services or facilities are not
available on the island: medical detoxification, social detoxification, acute care beds,
residential treatment facility, and day treatment services. The following services are
available; however; considered to be minimal in comparison to the need: therapeutic
living homes, intensive outpatient services, after care services, self-help groups, and
school-based treatment services in some of the high schools.
The recommendations of the planning group are to examine a new concept: Big
Island Village Concept of keeping the individual in need of treatment in a "real life"
environment within the community and to assure that services are available and
accessible in each community so that individuals are able to stay within the community
and receive treatment services. The Big Island Village Concept identified four districts on
the Big Island - Hilo, Kona, Kohala, Kau and a possible fifth district Puna to be
considered. The( oal is to establish adequate resources in at least two of the districts and
slowly expand to all the districts.
Kauai County. In a collaborative effort between the state and county governments,
the Kauai Mayor's Office, the Health Department's Kauai District Health Office, and the
Kauai Drug Abuse Coalition sponsored a community conference to discuss the issues of
substance abuse treatment in Kauai. The conference was attended by representatives from
both state and county government programs, private providers of services, and
community representative. In addition to this conference, meetings with the Kauai Drug
Abuse Coalition were held to discuss the issues of substance abuse treatment services on
Kauai.
For the general adult population, it was noted that if every adult on Kauai who was
identified as needing substance abuse treatment services and who was not able to pay for
Page -29-
the service were to request services, only 35% could be accommodated with the current
available resources. The absence of residential, day treatment, and therapeutic living
programs on Kauai means that the continuum of modality of services is disrupted.
Detoxification services are available, but severely limited and methadone/LA-AM
treatment services are not available. Because significant segments of the treatment
services are limited or lackin_ altogether, there exist a continuum with many cracks
through which clients needing services can fall.
Data from the 1998 Hawaii Student Alcohol and Drug Use Study on estimating the
need for treatment services for the adolescent population reveals that 869 students in the
public schools on Kauai are in need of treatment. It has been estimated that 300 students
are currently receiving treatment services through the Hina Mauka Program through two
high schools and one intermediate school, the Ke Ala Porto Program, and the DOH/DOE
Mokihana Program. However, there clearly continues to be a need for more treatment
services. As with other populations, the continuum of treatment services for adolescents
is very limited and fragmented. There are no residential treatment services for adolescents
on Kauai and it is difficult to obtain services off-island away from family and friends. Of
all the services, the two greatest needs for the adolescent population are additional
school- based treatment programs and residential treatment services.
There is difficulty in estimating the population of pregnant women in need of
substance abuse treatment services, however, in the 1996 Blind Study of Substance Abuse
and need for Treatment Among Pi%omen of Childbearing Age in Hawaii, it was estimated
that 9.7% of the pregnant women in Kauai tested positive for drug use. If there are 700
births in Kauai, then it can be estimated that 68 women are potentially exposing their
infants to drugs. There is only one outpatient treatment program that serves 35 women
and there are no residential programs for mothers with children on Kauai, no day
treatment services. and no therapeutic living programs. Therefore, clearly there is not
only a severe limitation in the types of treatment modalities available for these women,
but there is also a limitation in the only treatment service that is available.
For the criminal justice population on Kauai, there are an estimated 127
individuals who are in need of treatment services. There are no treatment programs
specifically designed for this population and what treatment services are offered are
provided through the programs for the general adult population. Some inmates are
currently receiving residential treatment services off-island, however, the number is very
small. The needs for the criminal justice population on Kauai are for residential
treatment, day treatment, and a therapeutic living program.
If the national estimate that 3% of any population may be diagnosed with a co-
occurring disorder is applied to the 54,000 residents on Kauai, it can be estimated that
there are potentially 1,620 individuals with a co-occurring disorder on Kauai and of this
372 individuals are below the federal poverty level and would be eligible for public
funded services. In 1998, the Kauai Community Mental Health Center reported that 32
individuals were diagnosed as having a co-occurring disorder and were treated despite the
Page -30-
fact that the center has a capacity for 60 clients. It is felt that the majority of these
individuals are receivine services either in the mental health system or the substance
abuse treatment system and not being treated as an individual with a co-occurring
disorder. This is a difficult population to accurately diagnose and involve in treatment
that addresses both problems. The expansion of outpatient treatment services does not
appear to be the solution, however, there may be a need for residential beds in a treatment
facility. This is based on the fact that there are long waiting lists for off-island placements
in treatment facilities of this type.
The 1998 Haivaii Adult Household Sunvy of Subsiance Use identified 72 persons
diagnosed as dependent or abusing heroin on Kauai; however, it is believed that there are
many more injection drug users, the numbers are unknown. There are very limited
detoxification services on Kauai and what is available often does not lead to a smooth
transitions to further treatment; there are no methadone/LAAM programs, no day or
residential treatment services, and no therapeutic living programs for this population. One
facility that is able to provide the full continuum of modalities of services for this
population would be useful.
Maui Count 'v. At the request of the Maui District Health Officer, the Health
Department's Public Health Educator and the Executive Director of the Aloha House,
Inc. served as the co-conveners of the planning process to develop a substance abuse
treatment strategic plan for Maui County. The cross-section of participants in the
planning included representatives of state and county governments, service providers
from nonprofit organizations, independent contractors, and service delivery program staff
from the islands of Maui, Molokai, and Lanai. One of the significant benefit of this
planning process was the fact that although some members of this group had met to
discuss substance abuse treatment issues, this was the first time that all had the
opportunity to come together as a large group to discuss the development of a community
strategic plan for the comprehensive system of substance abuse treatment services. As
part of the planning, the participants identified the following issues that were unique to
Maui County and need to be taken into consideration as the planning continues:
Geographic isolation. Providing substance abuse treatment services in Maui
County is unique and challenging because no other county is comprised of an isolated
rural community such-as Hana and three separate islands - Maui, Molokai, and Lanai. For
rural communities physical isolation often means being left out of the decision making
process in the allocation and distribution of resources. It is a hardship for most people in
neighbor island communities to travel to Oahu to be present at legislative hearings, speak
directly with legislators. funding agencies, and other decision makers. At times not being
physically present and not having a voice at the table is interpreted as a lack of interest
when it fact it is actually because of the lack of resources and personnel to travel. These
barriers are not limited to traveling to Oahu. For those in Hana or on Molokai or Lanai,
Page -3 1 -
long hours of travel are required to be able to participate in discussions and decision
making meetings.
Infrastructure. The lack of public transportation systems is a major access issue
for Maui County. It is one of the primary barriers to access to services, resources and
decision making processes. Service delivery on Maui is frequently provided by off-island
personnel. The primary mode of transportation is air travel and consideration must be
made to anticipate infrequent flight schedules and adverse weather conditions. Other
issues include but are not limited to the lack of child care services for clients, limits to
insurance coverage, complicated and restrictive government policies, inconsistent funding
and resources that contribute to intermittent service delivery.
Culture. Each island in Maui County has a diverse ethnic population with its own
cultural practices and traditions. Programs must take these differences into account and
services delivered should be culturally sensitive and linguistically appropriate. Traditional
healing practices and other non-western treatment modalities should be a primary
consideration in designing services rather than after thoughts when working with
culturally diverse communities. Among the islands of Hawaii, Molokai has the largest
proportion of Native Hawaiians. To be culturally appropriate programs should include the
kupuna and the elders and treatment services should include the family as an important
part of the healing. Asian and Pacific Island peoples culturally are private and sensitive
about disclosing personal information needing time to develop trusting relationships and
assurances of confidentiality before they are able to fully respond to the therapeutic
intervention.
Personnel. The recruitment and retention of professionals and staff is critical to
the availability and access to services. Areas like Hana, Molokai, and Lanai offer unique
lifestyle opportunities, however, it is difficult to attract and retain professionals in
isolated rural communities. This shortage of professionals and staff and the inability to
retain them leads to the lack of continuity of services and a diminished level of trust and
acceptance by the community. Currently all areas of Maui County are in need of certified
substance abuse counselors; there is one counselor residing on Molokai and none on
Lanai.
Uninsured/underinsured population. The inability to pay for substance abuse
treatment services is a critical barrier to access to these services. The uninsured and
underinsured clients are part of the gap group that often falls through the cracks of the
public health safety net. Increasing public funding to support treatment services for this
group will ultimately realize cost avoidance if one were to consider the consequences and
impact on the health and social costs if treatment services are not available and
accessible.
Page -32-
Section 5: Infrastructure Issues
As part of the discussions in developing the strategic document, participants
identified unique problems and issues related to the barriers of the infrastructure of the
service delivery system for all the segments of the population. These infrastructure issues
can be categorized into two major areas: administrative issues and training of certified
counselors.
Administrative Issues. The administrative issues included the limitations and
problems associated with:
• Private insurance coverage limitations - unlike treatment for other chronic
diseases, annual and lifetime limits have been placed on most alcohol and drug
treatment services. With the exception of detoxification services, annual limits
have been placed on all other levels of substance abuse treatment services to
two treatment episodes during a person's lifetime.
• The issue of parity - equalizing the access to health insurance coverage
between mental health/substance abuse services and other health and medical
care services - has been long debated at the national level and in 1996,
Congress passed and the President signed the Mental Health Parity Act which
requires that health plans provide the same annual and lifetime benefits as they
do for other health care benefits. The act does not affect service limits or cost
sharing: nor does it apply to substance abuse benefits. States have also
mandated parity and as of September 1997, 12 states have passed laws that
require parity in mental health and/or substance abuse benefits in varying
degrees.
Because opinions differed as to the costs and effects of parity mandates, a
study was conducted by the Substance Abuse and Mental Health Services
Administration (SAMHSA) in 1998 that analyzed actuarial estimates of the
costs of parity and provided estimates of premium increases due to full and
partial parity.
The key findings of the study showed the following:
¦ Most State parity laws are limited in scope or application. Few address
substance abuse treatment, and many are limited to treatment for serious
rnentahllnesses. Many exempt small employers or only apply to plans for
government employees.
¦ Costs have not shifted from the public to the private sector. Most people
who receive publicly funded services are not privately insured.
• Previous predictions of premium increases due to MH/SA parity ranged
from 3.2% to 11.4% - primarily due to differences in their assumptions.
• Current updated actuarial models estimated an increase in premiums of
3.6% on average for full parity for mental health and substance abuse
Page -33-
services. Of the 3.6°/0, 3.4% of the increase is for mental health services
only and 0.2% of the increase is for substance abuse services only.
¦ Premium increases are lower for plans that more tightly manage care, and
they are greater for plans that are limited to children.
• Lack of the consistent implementation the American Society of Addiction
Medicine (ASA\4) standard for assessing and authorizing levels of treatment -
the lack of implementing standards and common procedures to determine
placement for treatment has led to inconsistencies among the private insurance
plans in authorizing the level and length of treatment services for their
beneficiaries.
• Barriers and limitations to accessing public funded treatment services through
the Medicaid QUEST program - enrollment into the QUEST program takes an
average of 8-12 weeks because of the enrollment process and the mandatory
"non-urgent" 30-day waiting period. Once enrolled, other limitations are placed
on recipients such as annual limits for all levels of treatment services, and
limitations in choice of treatment providers within the network of providers.
Training Issues. Despite the fact that there are currently 438 substance abuse
counselors certified by the State of Hawaii, there continues to be a shortage of adequately
trained counselors and administrators in the programs. There may be many reasons for
this continued shortage of counselors - because of the stigma attached to substance
abusers and the difficulty in working with this population, most professionals are
reluctant to establish a career in this field. Professionals who do work in this field are
traditionally on the lower end of the salary scales which is exacerbated by the fact that
additional funding for these types of services have not increased in several years and
therefore salaries have not been able to be increased. Certified substance abuse
counselors are not licensed and therefore are not eligible for reimbursement from private
insurance for services rendered; there are no financial incentives to become a certified
counselor. The primary concern for the shortage of adequately trained counselors is that
in the event that there are additional resources to fund more substance abuse treatment
services, this shortage of trained counselors will be exacerbated and will result in
difficulties in maintaining the quality of treatment and the opportunity to expand
treatment services and programs.
Page -34-
Section 6: Funding Needs
The fundinu currently available for substance abuse treatment services appears to
be seriously inadequate for all segments of the populations examined.
• For the general adult population, it will require an additional $36,330,000
million to meet the unmet demand for public-funded services.
• For adolescents an additional S9,945,500 is needed for three major programs -
school-based treatment services will require an additional $6,210,000 million
to be able to assure programs in all the middle and high schools in the state
with an additional 5998,000 for the Juvenile Drug Court and $2,737,500 for
additional residential treatment services.
• For pregnant and parenting women, an additional $9,234,000 million is needed
just for those women with children under 5 years of age and who are known to
the child protective services programs.
• In the criminal justice population, there are an estimated 16, 900 persons in
need of some level of treatment for substance abuse. A legislative bill is being
submitted requesting approximately $4,400,000 million to establish an
interagency collaboration between the Department of Public Safely and Health,
the Hawaii Paroling Authority, and the Judiciary to provide substance abuse
treatment services and integrated case management services to 500 offenders
under community supervision who are at risk of having that supervision
revoked as a result of continued substance abuse.
• To provide an adequate level of treatment services for the injection drug user
population, an additional 513,606,800 million is required.
• For the population of persons with co-occurringg disorders, an additional
58,420;000 million may be needed to provide specialized treatment services.
The total amount
required to fund all of Year Previous Year Additional Total
the unmet demand for 2001 Not applicable 54,400,000 54,400,000
public funded substance 2002 54,400,000 519,384,075 523,784,075
abuse treatment 2003 523,784,075 $19,384,075 543,168,150
services is estimated to 2004 543,168,150 $19,384,075 562,552,225
be $81,936,300 2005 562,552,300 $19,384,075 SS 1,936,375
annually. In projecting
Page -35-
the allocation of funding required over a five year period starting with fiscal year 2001.
the request is limited to S4.4 million for the collaborative program to provide a
continuum of substance abuse treatment services and integrated case management
services for 500 offenders in the criminal justice population. Starting in fiscal year 2002,
the request would increase to 523,784,075, which includes the S4.4 million to continue
the collaborative program for the criminal justice population. In each of the subsequent
years, the cost continues to increase proportionally until in the year 2005, a request of
581,936,300 would be made to fund all of the services required.
;z;,
Page -36-
References
California Department of Alcohol and Drug Programs. Evaluating Recovery Services: The
California Drug and Alcohol Treatment Assessment (CALDATA) General Report.
Sacramento, CA., 1994.
National Association of State Mental Health Directors and the National Association of Alcohol
and Drug Abuse Directors. National Dialogue on Co-occurring Mental Health and
Substance Abuse Disorders. March, 1999.
National Institute of Health, National Institute on Drug Abuse. Principles of Drug Addiction
Treatment. A Research-Based Guide. NIH Publication No. 99-4180, October 1999.
State of Hawaii, Department of Health, Alcohol and Drug Abuse Division. Report to the
Nineteenth Legislature State of Hawaii. 1998.
State of Hawaii, Department of Health, Alcohol and Drug Abuse Division. Substance Abuse
Treatment Works. (Unpublished) 1998.
State of Hawaii, Department of Health, Alcohol and Drug Abuse Division. 1998 Hawaii Student
Alcohol and Drug Use Study. 1999.
U.S. Department of Health and Human Services, National Institute on Drug Abuse. Drug Abuse
Treatment: An Economical Approach to Addressing the Drug Problem in America. 1991.
U.S. Department of Health and Human Services, Center for Substance Abuse Treatment (CSAT).
Treatment for Alcohol and Other Drug Abuse: Opportunities for Coordination. Technical
Assistance Publication Series 11, 1994.
U.S. Department of Health and Human Services, Center for Substance Abuse Treatment (CSAT).
National Treatment Improvement Evaluation Study. 1995.
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services
Administration. The Costs and Effects of Parity for Menial Health and Substance Abuse
Insurance Benefits. DHHS Publication No. (SMA) 98-3205, Printed 1998.
U.S. Department of Health and Human Services, Center for Substance Abuse Treatment (CSAT).
Substance Abuse in Brief. Effective Treatment Saves Money. January 1999.
U.S. Department of Health and Human Services, Center for Substance Abuse Prevention (CSAP)_
Prevention-Alert Volume 2, Number 22, July 23, 1999.
U. S. Department of Health and Human Services. Mental Health: A Report of the Surgeon
General. 1999.
U. S. Department of Justice, Office of Justice Programs. Bureau of Justice Statistics Special
Report: Mental Health and Treatment of Inmates and Probationers. NCI 174463, July
1999.
Page -37-
Appendix A. Participant Lis[ - Big Island, Page I
BIG ISLAND
CONVENER
Ms. Phyllis Funada
MS. JUNE T. KUNINIOTO Section Administrator
District Health Services Administrator Benefit, Employment and Support Services
State Building Division - West Hawaii Section
75 Aupuni Street 75-5591 Palani Road, Suite 2004
Hilo, Hawaii 96720 Kailua-Kona, Hawaii 96740
PH: 974-6006 FAX: 974-6000 PH: 327-4755 FAX: 327-4779
Ms. Judith Akamine, PFIN Ms. Lorraine Godoy, Member
Hawaii Advisory Commission on Drug Hawaii Advisory Commission on Drug
Abuse and Controlled Substances Abuse and Controlled Substances
P.O. Box 916 P.O. Box 6223
Hilo, Hawaii 96721-0916 Hilo, Hawaii 96720
PH: 974-6025 FAX: 974-6000 PH: 961-0031 FAX: 969-9936
Mr. Lito M. Asuncion Ms. Corinne Gushiken
Council Member Supervising Probation Officer
State Health Planning and Development District Court, Third Judicial Circuit
Agency Waiakea Plaza Building
266 Makaala Street 345 Kekuanaoa Street Room 41
Hilo Hawaii 96720 Hilo, Hawaii 96720-4388
PH: 969-7565 FAX: 969-7672 PH: 934-5730 FAX: 934-5737
Ms. Lani Bowman Mr. Glenn Hanson
Facilitator Psychiatric Social Worker
T.E.A.M. Kohala Hawaii Community Correctional Center
P.O. Box 295 60 Punahele Street
Hawi, Hawaii 96719 Hilo, Hawaii 96720
PH: 889-5852 FAX: 889-5852 PH: 933-0428 FAX: 933-0425
e-mail: lanibow@ilhawaii.net
Mr. Zachary Higa
Ms. Kelaukila Carter Probation Administrator
Drug Addiction Services of Hawaii - Puna Third Circuit Court
P.O. Box 2300 1045 Kilauea Avenue
Pahoa, Hawaii 96778 Hilo, Hawaii 96720-4201
PH: 966-6226 PH: 961-7611 FAX: 961-7676
Ms. Gloria Egle-Oaks Ms. Peggy Hilton
Executive Director Acting Section Administrator
Big Island Substance Abuse Council East Hawaii Child Welfare Services Sec
1420 Kalauea Avenue 75 Aupuni Street, Room 112
Hilo, Hawaii 96720 Hilo, Hawaii 96720
PH: 935-4927 FAX: 969-7570 PH: 933-0689 FAX: 933-0690/3
Appendix A. Panicipant List - Big Island, Page 2
Officer Darren Horio Mr. Jesse Rosenbloom
Community Police Officer Adrrnistrator
Police Department - Hawaii County West Hawaii Child Welfare Services Sec
349 Kapiolani Street Captain Cook State Civic Center
Hilo, Hawaii 96720 P.O. Box 230
PH: 961-2350 FAX: 961-8845 Captain Cook, Hawaii 96704
PH: 323-4581 FAX: 323-4587
Ms. Aileen Lum, Director
Family Court, Third Judicial Circuit Mr. Dan Sakai
345 Kekuanaoa Street, Room 40 District Superintendent
Hilo, Hawaii 96720-4388 Department of Education
PH 934-5767 FAX: 969-4914 75 Aupuni Street, Room 203
Hilo Hawaii 96720
Mr. Francis Malani PH: 974-6600 FAX: 974-6604
Substance Abuse Counselor
Kulani Correctional Facility Branch Sgt. James Sanborn
HC 01, Stainback Highway Police Department - Hawaii County
Hilo, Hawaii 96720 349 Kapiolani Street
PH'. 935-2280 FAX: 969-9107 Hilo, Hawaii 96720
PH: 961-2350 FAX: 961-8845
Mr. Wesley Margheim
Big Island Substance Abuse Council Mr. Rueben Soriano
1420 Kilauea Avenue Probation Supervisor
Hilo, Hawaii 96720 Third Circuit Court
PH: 935-4927 FAX: 969-1861 1045 Kilauea Avenue
Hilo, Hawaii 96720-4201
Mr. Howard G. Medeiros PH: 961-7600 FAX: 961-7676
Volunteer Services Coordinator
Prosecuting Attorney's Office - Hawaii Ms. Susan Segawa
County Corrections Supervisor I
34 Rainbow Drive Kulani Correctional Facility Branch
I- lo, Hawaii 96720 HC 01, Stainback Highway
PH: 934-3390 FAX: 934-3305 Hilo, Hawaii 96720
e-mail: howardm thaea.ora PH: 935-2280 FAX: 969-9107
Ms. Kathleen Mishima, PHN Mr. Wesley T. Suwa
Member, Subarea Health Planning Council Court Administrator
State Health Planning and Development Office of the District Court Administrator
P.O. Box 228 Room 205, State Building
Kealakekua, Hawaii 96750 75 Aupuni Street
PH: 322-1500 FAX: 322-1504 Hilo, Hawaii 96720-4253
PH: 961-7431 FAX: 961-7447
Ms. Ida Otake
Hawaii County Community Mental Health
Services
37 Kekaulike Street
Hilo, Hawaii 96720
PH: 974-4300 FAX: 974-4310
Appendix A. Participant List - Big Island, Page 3
Mr. Henry Tavares Ms. Karleen Yoshioka
Police Department - Hawaii County Public Health Nurse
349 Kapiolani Street Department of Health
Hilo, Hawaii 96720 75 Aupuni Street
PH: 961-2253 FAX: 961-2372 Hilo, Hawaii 96720
PH: 974-6013 FAX: 974-6000
Ms. Karen Teshima
Case Management Ms. Jenny Younger
Bay Clinic, Inc. Bay Clinic, Inc.
31 I Kalanianaole Avenue 311 Kalanianaole Avenue
Hilo, Hawaii 96720 Hilo, Hawaii 96720
PH: 934-3222 FAX: 934-3226 PH: 934-3216 FAX: 934-3226
Ms. Sandy Tomiyama
Matemal and Child Support Services Unit
46 Keawe Street
Hilo, Hawaii 96720
PH: 974-4291 FAX: 974-4285
Ms. Maria Tsue
Drug Addiction Services of Hawaii
1130 North Nimitz Highway, C-302
Honolulu, Hawaii 96817
PH: 538-0704 FAX: 538-0474
Ms. Lisa Vankralingen
Executive Assistant
Bay Clinic, Inc.
31 I Kalanianaole Avenue
Hilo, Hawaii 96720
PH: 934-3209 FAX: 961-4795
Ms. Paula Vickery
Care Manager
Community Care Services-
73 Puuhonu Place
Hilo, Hawaii 96720
PH: 935-3481 FAX: 935-4436
Pc-6ckerv2z1oha.net
Ms. Maya Yonting-Domes
Coordinator
Project S.T.O.R.M.
P.O. Box 1241
Pahoa, Hawaii 96778
PH: 965-7263 FAX-
e-mail : mavavd.ruvahoo com
Appendix A. Participant List - Kauai, Page 1
KAUAI
DRUG ABUSE COALITION
CO-CONVENERS
MS. SHARON AGNEW Mr. Clayton Arinaga
Office of the Mayor Police Department - Kauai County
4444 Rice Street, Suite 235 3060 Umi Street
Lihue, Hawaii 96766 Lihue, Hawaii 96766
PH: 241-6240 PH: 241-6709
e-mail: cok vouZalohamet
Mr. Brien Ariss
TOM DORSEY, Ph.D. P.O. Box 1023
Clinical Psychologist Lawai, Hawaii 96765
Department of Health PH: 332-5454
Family Guidance Center
3040 Umi Street Ms. Melinda Barnes
Lihue, Hawaii 96766 Turning Point
PH: 241-3564 FAX: 241-3480 44' )1 Kale Place, n7
e-mail: tedorsev~it mail.healthstate.hi.us Lihue, Hawaii 96766
PH: 245-4813
MS. MARILYN WONG e-mail: clubsoberruwebrv.net
Coalition for a Drug Free Hawaii
Ke Anuenue Connection Mr. Henry Barriga
P.O. Box 3421 Police Department - Kauai County
Princeville, Hawaii 96722 3060 Umi Street
PH: 826-6789 FAX: 826-1536 Lihue, Hawaii 96766
PH: 241-6709
Mr. Alton Amimoto Mr. Chad Bertelman
Senior Probation Officer Counselor
District Court of the Fifth Judicial Circuit Teen Care - Kapaa High School
4357 Rice Street, Suite 201 4695 Mailihuna Road
Lihue, Hawaii 96766 Kapaa, Hawaii 96746
PH: 246-3356 FAX: 245-3634 PH: 821-4401 ext 131
Ms. Donna Apo Mr. Lopaka Bodnar
Community Outreach Worker Mediator
Child and Family Services Kauai Economic Opportunity
4375 Puaole Street, Suite A 2804 Wehe Road
Lihue, Hawaii 96766 Lihue, Hawaii 96766
PH: 245-5914 FAX: 246-0133 PH: 245-4077
Appendix A. Participant List - Kauai, Page 2
Ms. Janice Bond Ms. Diane Forsyth
Coordinator Family Therapist
Kauai Tobacco Free Coalition Ke Ala Porto Recovery Center
3920 Hunakai Street P.O. Box 280
Lihue, Hawaii 96766 Koloa, Hawaii 96756
PH: 246-0174 PH: 742-1160 FAX: 742-2083
e-mail: diane(Zt)aloha.net
Ms. Valerie Campbell
Boys and Girls Club of Hawaii Mr. Tom French
P.O. Box 1389 Family Court, Fifth Judicial Circuit
Kapaa, Hawaii 96746 3059 Umi Street, Suite 201
PH: 821-4406 FAX: 823-8613 Lihue, Hawaii 96766-1809
PH'. 246-3361 FAX: 246-3372
Mr. Bill Clifford
Rotary Club of Hanalei Ms. Lynn Garci
4568 Emmalam Drive Probation Officer
Princeville, Hawaii 96772-3300 District Court of the Fifth Judicial Circuit
PH: 826-7721 4357 Rice Street, Suite 201
e-mail: ordinarvOthawaiian net Lihue, Hawaii 96766
PH: 246-3356 FAX: 245-3634
Ms. Tona Donigan
Health Care Services Ms. Araceli Gonzalez, CSAC
Kauai Community Correctional Center Child and Family Services
5350 Kuhio Highway 4375 Puaole Street
Lihue, Kauai 96766 Lihue, Hawaii 96766
PH: 241-3062 PH: 245-5914 FAX: 246-0133
Ms. Josephine Duvauchelle Mr. David Gonzalez, CSAC
Kauai County Subarea Health Planning Hina Mauka
Council 2970 Kele Street
3101 Poipu Road Lihue, Hawaii 96766
Koloa, Hawaii 96756 PH: 245-8883 FAX: 245-8858
PH: 742-6753 FAX: 742-6753
Ms. Marilyn Harker
Ms. Pua Flores - Social Worker
District Coordinator Kauai Community Mental Health Center
Alu Like, Inc. 3-3212 Kuhio Highway
Pulama I Na Keiki Lihue, Hawaii 96766
4365 Kukui Grove Street, Suite 101 PH: 274-3190 FAX: 274-3194
Lihue, Hawaii 96766
PH: 245-8859 FAX: 241-1456 Ms. Joy Jobson, CSAC
Crisis Coordinator
- Hale `Opio
2959 Umi Street
Lihue, Hawaii 96766
PH: 822-7533
Appendix A. Panicipwu List - Kauai, Page 3
Ms. Barbara Johnson Ms. Mardi Malone, CSAC
Social Worker Maluhia Treatment Services
Kauai Community Mental Health Center P.O. Box 35
3-3212 Kuhio Highway Kapaa, Hawaii 96746
Lihue, Hawaii 96766 PH: 823-8933
PH: 274-3190 e-mail: mardminters,21aloha.net
Ms. Sherry Kekina Ms. Michelle Mazzolini
Kauai Community Mental Health Center Boys and Girls Club
3-3212 Kuhio Highway P.O. Box 1389
Lihue, Hawaii 96766 Kapaa, Hawaii 96746
PH: 274-3190 FAX: 274-3194 PH: 821-4406
The Honorable Maryanne Kusaka Ronald L. Metler, M.D.
Mayor of Kauai District Health Services Administrator
4444 Rice Street, Suite 235 3040 Umi Street
Lihue, Hawaii 96766 Lihue, Hawaii 96766
PH: 241-6300 PH: 241-3614 FAX: 241-3480
Ms. Nam Larsen Mr. Abel Medeiros
Hawaii Community Foundation Kauai County SAC
P.O. Box 623 P.O. Box 503
Lihue, Hawaii 96766 Koloa, Hawaii 96756
PH: 245-4585 PH: 742-6718
Mr. Bill Lennox Mr. Todd Motoyama
Social Worker Coalition for a Drug-Free Hawaii
Kauai Community Mental Health Center 1130 North Nimitz Highway, Suite A-259
3-3212 Kuhio Highway Honolulu, Hawaii 96819
Lihue, Hawaii 96766 PH: 545-3028 ext 34 FAX: 545-2686
PH: 274-3190 FAX: 274-3194 e-mail: cdth,fi-b.aloha.net
Ms. Karen Lopez, CSAC Ms. June Munoz
Social Worker Parent Educator
Child and Family Services Pulama I Na Keiki
4375 Puaole Street 4365 Kukui Grove Street, -"'101
Lihue, Hawaii 96766 Lihue, Hawaii 96766
PH: 245-5914 FAX: 246-8040 PH: 245-8859 FAX: 241-1456
Ms. Roslynne Lowry Ms. Faye Newfield
YWCA Health Educator
3094 Elua Street Kauai District Health Office
Lihue, Hawaii 96766 3040 Umi Street
PH: 245-5959 FAX: 245-5961 Lihue, Hawaii 96766
PH: 241-3564
Appendix A. Participant List - Kauai. Page 4
Mr. Roy Nishida Mr. Llewellyn Wynne
Governor's Liaison Office, Kauai District Program Director
3060 Eiwa Street, Room 106 Child and Family Services
Lihue, Hawaii 96766 4375 Puaole Street, Suite A
PH: 274-3100 FAX: 274-3103 Lihue, Hawaii 96766
PH: 245-5914 FAX: 246-0133
Mr. Paul Ochoa, CSAC
Alu Like, Inc. Mr. Norman Yamaoka
3129 Peleke Street Ke Ala Pono Recovery Center
Lihue, Hawaii 96766 4374 Kukui Grove Street
PH: 245-8545 FAX: 245-1720 Lihue, Hawaii 96766
PH: 246-0663
Ms. Diana Puahala
Alu Like, Inc. Mr. Stan Yates
4365 Kukui Grove Street, '1101 Department of Health
Lihue, Hawaii 96766 Comm ssion on Persons with Disabilities
PH: 245-8859 3060 Ewai Street, '1207
Lihue, Hawaii 96766
Mr. Jimmy Trujillio PH: 274-3308 FAX: 241-3480
Kukuna Program
P.O. Box 2138
Kapaa, Hawaii 96746
PH: 823-6701 FAX: 822-1542
Mr. Kenneth Villabrille
Kauai County Subarea Health Planning
Council
5814 Meli Place
Kapaa, Hawaii 96746
PH: 241-6525
Ms. Roberta Williams
School Social Worker
Department of Education
3060 Eiwa Street, 43105
Lihue, Hawaii 96766
PH: 241-3175
Ms. Selene Witte-Mersereau
Director
Hina Mauka - Teen C.A.R.E. Program
45-845 Pookela
Kaneohe, Hawaii 96744
PH 236-2600 ext. 222 FAX: 236-2626
I
it
Appendix A. Participant List - Maui, Molokai, Lanai, Page I
MAUI, MOLOKAI, LANAI
CO-CONVENERS
Ms. Dianne Benedict
MR. GEN IINUMA Case Manager, New Millennium
State Building Aloha House, Inc.
54 High Street 4593 Ike Drive
Wailuku, Hawaii 96793 Makawao, Hawaii 96768
PH: 984-8216 FAX: 984-8222 PH: 249-2011 FAX: 244-1857
MR. JUD CUNNINGHAM Ms. Lyn Bonk
Executive Director Executive Director
Aloha House, Inc. Hale Ho'Okupa'a
4593 Ike Drive P.O. Box 1812
Makawao, Hawaii 96768 Kaunakakai, Hawaii 96748
PH: 579-9584 FAX: 579-8902 PH: 553-3231 FAX: 553-5474
Mr. Mark Breithaupt
Administrator
Ms. Susan Anderson Maui Community Mental Health Center
Public Health Nurse - Maternal and Child 121 Mahalani Street
Health Wailuku, Hawaii 96793
Department of Health PH: 984-2150 FAX: 984-2155
54 High Street
Wailuku, Hawaii 96793 Ms. Ellen Brewerton
PH: 984-2143 FAX: 243-5202 Social Worker
Child Welfare Services Unit
Alfred M. Arensdorf, M.D. 1885 Main Street, 9306
District Health Services Administrator Wailuku, Hawaii 96793
State Building PH: 243-5149 FAX: 243-5198
54 High Street
Wailuku, Hawaii 96793 Mr. Sam Clark
PH: 984-8200 FAX: 984-8222 Vice President
Community Partnerships, Inc.
Ms. Cindy Askam-Weber 60 Kapuai Road
Social Worker Haiku, Hawaii 96708
Maui Community Mental Health Center PH: 572-2549 FAX: 572-4617
121 Mahalani Street
Wailuku, Hawaii 96793 Mr. Ernest DeLima
PH: 984-2150 FAX: 984-2155 Supervisor, Family Violence Unit
e-mail: cindv-ks cyaol.com Family Court, Second Judicial Circuit
2145 Main Street
Wailuku, Hawaii 96793-1679
PH: 244-2768 FAX: 244-2870
Appendix A. Panicipant List - Maui, Molokai, Lanai, Page 2
Ms. Christina Dependahl Mr. James Hirano
Chemical Dependency Program Evaluator Corrections Supervisor
Maui County - Department of Housing and Maui Community Correctional Center
Human Concerns 600 Waiale Drive
200 South High Street Wailuku, Hawaii 96793
Wailuku, Hawaii 96793 PH: 243-5106 FAX: 243-5167
PH: 249-2081 FAX: 249-2304
Ms. Karen Holt
Mr. Rudy Esquer Executive Director
Grants Management Administrator Molokai Community Service Center
Maui County - Department of Housing and P.O. Box 1046
Human Concerns Kaunakakai, Hawaii 96748
200 South High Street PH: 553-3244 FAX: 553-3370
Wailuku, Hawaii 96793
PH: 270-7807 FAX 270-7165 Ms. Lee Hoxie
Deputy District Superintendent
Ms. M. Nalani Fujimori Department of Education
Attorney 54 High Street, 4i° Floor
Legal Aid Society of Hawaii - Molokai Wailuku, Hawaii 96793
Ala Malama PH: 984-8011 FAX: 984-8008
Kaunakakai, Hawaii 96748
PH: 553-3251 FAX: 553-5809 Ms. Debra Kaiwi
Social Worker, Counseling and Probation
Ms. Linda Fukunaga Service
Section Administrator Office of the District Court Administrator
Maui Section (N-MMAUI) 2145 Main Street, Suite 137
Waiehu Beach Center Wailuku, Hawaii 96793-1679
270 Waiehu Beach Road, Suite 107 PH: 244-2919 FAX: 244-2849
Wailuku, Hawaii 96793
PH: 243-5875 FAX: 243-5879 Mr. JeffKelton
Psychologist
Mr. Reynold "Butch" Gima Maui Community Mental Health Center
Social Worker 121 Mahalani Street
Maui Community Mental Health Center - Wailuku, Hawaii 96793
Lanai Counseling Center PH: 984-2150/4968 FAX: 984-2155
911 Fraser Avenue
Lanai City, Hawaii 96763 Ms. Alice Lee
PH: 565-6189 FAX: 565-7426 Director
Maui County - Department of Housing and
Mr. Rav Henderson Human Concerns
Executive Director 200 South High Street
Ohana Makamae, Inc. Wailuku, Hawaii 96793
P.O. Box 914 PH: 270-7805 FAX: 270-7165
Hana, Hawaii 96713
PH: 248-8538 FAX: 248-7099
e-mail. ohanam(iijete.net
Appendix A. Participant List - Maui, Molokai, Lanai, Page 3
Ms. Rachelle Maikui Ms. Carlayna Nakamura
Program Advisor Executive Director
Hale Ho'Okupa'a Community Clinic of Maui
P.O. Box 1812 48 Lono Avenue
Kaunakakai, Hawaii 96748 Kahului, Hawaii 96732
PH: 553-3231 FAX: 553-5474 PH: 872-4017 FAX: 872-4067
e-mail: biitccmaui.com
Ms. Cheryl Marlow
Adult Probation Administrator Mr. Francisco Palencia
Second Circuit Court Addictions Counselor
1844 Wili Pa Loop Castle Counseling Services
Wailuku, Hawaii 96793-1272 270 Hookahi Street, Suite 301
PH: 243-1530 FAX: 244-0452 Wailuku, Hawaii 96793
PH: 242-9733 FAX: 244-9719
Mr. Gary Maxwell
Staff Attorney Mr. Daryl Selman
Legal Aid Society of Hawaii - Maui Deputy Director
2287 Main Maui Youth and Family Services, Inc.
Wailuku, Hawaii 96793 200 Ike Drive
PH: 244-3731 FAX: 244-5856 Makawao, Hawaii 96768
PH: 579-8414 ext 29 FAX: 579-8426
Ms. Kelly McGinnis
Outreach Worker Ms. Lee Stein
Community Health Outreach Worker Clinical Director
(CHOW) Project Malama Na Makua A Keiki
PH: (800) 445-7243 388 Ano Street
Kahului, Hawaii 96732
Ms. Laurie Mallet PH: 877-7117 FAX: 877-7120
Women Helping Women e-mail: Cronsnest(aaloha net
P.O. Box 760
Paia, Hawaii 96779 Mr. Joe Thompson
PH: 579-9696 FAX: 579-8501 Outreach Worker
Community Health Outreach Worker
Ms. Gail Nakamae (CHOW) Project
Supervisor, Program Services Branch PH: 243-9633
Family Court, Second Judicial Circuit
2145 Main Street Ms. Dee White, M.S., CSAC
Wailuku, Hawaii 96793-1679 Service Coordinator
PH: 244-2871 FAX: 244-2777 CCM "Ice" Project
48 Lono Avenue
Kahului, Hawaii 96732
PH: 244-5775 FAX: 242-7073
Appendix A. Participant List - Maui, Molokai, Lanai, Page 4
Officer Tod Wong
K-9 Unit
Department of Police - Maui County
200 South High Street
Wailuku, Hawaii 96793
PH: 244-6455 FAX: 244-6458
Ms. Jackie Woolsey
Public Health Nurse
Department of Health
628 7' Avenue
Lanai City, Hawaii 96763
PH: 565-7114 FAX: 565-6887
Ms. Ruth Yap
Public Health Nurse
Department of Health
P.O. Box 2007
Kaunakakai, Hawaii 96748
PH: 553-3208 FAX: 553-9859
Appendix A. Panicipant List - Oahu, Page I
OAHU
CONVENER Mr. Terrence Aratani
Department of Commerce and Consumer
HENRY M. ICHIHO, M.D., M.P.H. Affairs - Insurance Division
One Coelho Way, #J 250 South King Street, 5' Floor
Honolulu, Hawaii 96817 Honolulu, HI 96813
PH: 595-7722 PH: 586-2790 FAX: 586-2806
e-mail: ichiho @msn.com
The Honorable Alfred K. Beaver, Sr.
Chairman, Hawaii Paroling Authority
Ms. Caroline Affonso Capitol Center, Ground Floor
Oahu Intake Service Center 1177 Alakea Street
2199 Kamehameha Highway . Honolulu, Hawaii 96813
Honolulu, Hawaii 96819 PH: 587-1290 FAX: 587-1314
PH: 832-1579 FAX: 832-1499
Gary L. Blaich, M.D.
Ms. May Akamine Hawaii Advisory Commission on Drug
Executive Director Abuse and Controlled Substances
Kalihi-Palama Health Center (HACDACS)
915 North King Street 2120 Kakela Place
Honolulu, Hawaii 96817 Honolulu, Hawaii 96822
PH: 845-8578 FAX: 841-1265 PH: 733-9260 FAX: 733-9187
The Honorable Steven S. Alm Ms. Kat Brady
United States Attorney Coordinator
300 Ala Moana Boulevard, Room 6-100 Community Alliance on Prisons
Box 50183 76 North King Street, Suite 203
Honolulu, Hawaii 96850 Honolulu, Hawaii 96817
PH: 541-2850 FAX: 541-2958 PH: 533-3454 FAX: 533-0993
Mr. "Andy" Anderson Ms. Lisa Cook
Executive Director Executive Director
Hina Mauka - Drug Addiction Services of Hawaii
45-845 Po'okela Street 1130 North Nimitz Highway
Kaneohe, Hawaii 96744 Honolulu, Hawaii 96817
PH: 236-2600 ext 227 FAX: 236-2626 PH: 538-0704 FAX: 538-0474
Mr. Bart Aranoff Mr. Steven Cooper
Communicable Disease Division Department of Budget and Finance
Department of Health No. 1 Capitol District
1250 Punchbowl Street 250 South Hotel Street
Honolulu, Hawaii 96813 Honolulu, Hawaii 96813
PH: 586-4581 FAX: 586-4595 PH: 586-1545 FAX 586-1873)
Appendix A. Panicipant List - Oahu. Paee 2
Ms. Judy Crockett Ms. Deanna Espinas
Adult Mental Health Division Corrections Program Services
Department of Health Department of Public Safety
1250 Punchbowl Street 919 Ala Moana Boulevard
Honolulu, Hawaii 96813 Honolulu, Hawaii 96814
PH'. 586-4677 FAX: 586-4745 PH: 587-1264 FAX: 587-1280
Ms. Alice Dickow Ms. Mary Alice Evans
Executive Director Office of the Governor
St. Francis Medical Center - WATCH State Capitol, 4" Floor
Program 415 South Beretania Street
2230 Liliha Street Honolulu, Hawaii 96813
Honolulu, Hawaii 96817 PH: 586-0141 FAX: 586-0019
PH: 547-6273 FAX: 547-6714
Nos. Barbara A. Fabrey
Ms. Laura Dike Hawaii Advisory Commission on Drug
Matlock Hale Abuse and Controlled Substances
1326 Matlock Avenue (HACDACS)
Honolulu, Hawaii 96814 94-639 Kuaie Street
PH: 538-9840 FAX: 536-2106 Mililani, Hawaii 96789
PH: 536-4302 FAX: 531-3215
The Reverend Alison M. Dingley
Hawaii Advisory Commission on Drug Mr. Mark Forman
Abuse and Controlled Substances Office of Community Services
(HACDACS) Department of Labor & Industrial Relations
2563 Date Street, Apt. 111 830 Punchbowl Street
Honolulu, Hawaii 96826 Honolulu, Hawaii 96813
PH 533-3481 FAX: 533-7221 PH: 586-8675 FAX: 586-8685
Major Susan Dowsett Ms. Kristine Foster
NarcoticsNice Division Benefits, Employment and Support
Honolulu Police Department Services Division
801 South Beretania Street Department of Human Services
Honolulu, Hawaii 96813 820 Mililani Street, Suite 606
PH: 529-3101 FAX: 529-3476 Honolulu, Hawaii 96813
PH: 586-5729 FAX: 586-5744
Mr. Chuck Duarte
Med-QUEST Division Linda Fox, Ph.D.
Department of Human Services Chief, Adult Mental Health Division
601 Kamokila Boulevard, 5' Floor Department of Health
Kapolei, Hawaii 96707 1250 Punchbowl Street
PH: 692-8050 FAX: 692-8173 Honolulu, Hawaii 96813
PH: 586-4686 FAX: 586-4745
Appendix A. Participant List - Oahu, Page J
Ms. Loretta Fuddy, Chief Ms. Darlene Hein
Maternal and Child Health Branch Harm Reduction Hawaii
Family Health Services Division PH: 263-7794
741 Sunset Avenue, Room 204 e-mail: Dhein@pixi.net
Honolulu, Hawaii 96816
PH: 733-9024 FAX: 733-9032 Eva Hillman, Ph.D.
Executive Director
Mr. Colin Fukunaga Bobby Benson Center
Acting Supervisor 56-660 Kamehameha Highway
Oahu Parole Section Kahuku, Hawaii 96731
Hawaii Paroling Authority PH: 293-7555 FAX: 293-7196
Capitol Center, Ground Floor
1177 Alakea Street Mr. Gordon Hong
Honolulu, Hawaii 96813 Motor Vehicle Safety Office
PH: 587-1290 FAX: 587-1314 Department of Transportation
601 Kamokila Boulevard, 5's Floor
Ms. Beth Geisting Kapolei, Hawaii 96707
Executive Director PH: 692-7657 FAX: 692-7665
Hawaii State Primary Care Association
345 Queen Street, Suite 702 Ms. Patricia Hunter
Honolulu, Hawaii 96813 Community Consultative Services Branch
PH: 536-8442 FAX: 524-0347 Alcohol & Drug Abuse Division
601 Kamokila Boulevard, Room 360
Mr. Robert Golden, Director Kapolei, Hawaii 96707
Student Support Services Group PH: 692-7522 FAX: 692-7521
Department of Education
637 I8' Avenue Bldg. C, 2nd Floor Mr. Duane Ikeda
Honolulu, Hawaii 96816 Family Court of the First Circuit
PH: 735-6222 FAX: 733-9890 Kaauhumanu Hale
777 Punchbowl Street
Mr. Lance Goto Honolulu, Hawaii 96813
Crirrnal Justice Division PH; 539-4408 FAX: 539-4402
Department of the Attorney General
425 Queen Street Mr. Dominic K. Inocelda
Honolulu, Hawaii 9681-) Hawaii Advisory Commission on Drug
PH: 586-1160 FAX: 586-1375 Abuse and Controlled Substances
(HACDACS)
Mr. Ronald Hajime 94-1004 Ukee Place
Administrator Waipahu, Hawaii 96797
Adult Probation Division PH: 847-1535 ext. 118 FAX: 847-0787
777 Punchbowl Street
Honolulu, Hawaii 96813 Ms. Virginia Jackson
PH: 539-4585 FAX: 539-4559 Program Development Services Office
Alcohol & Drug Abuse Division
601 Kamokila Boulevard, Room 360
Kapolei, Hawaii 96707
PH: 692-7510 FAX: 692-7519
Appendix A. Panicipant List - Oahu, Page 4
Mr. Alan Johnson, CFO Ms. Ann Kobayashi
Hina Mauka Office of the Governor
45-845 Po'okela Street State Capitol
Kaneohe, Hawaii 96744 Honolulu, Hawaii 96813
PH: 236-2600 ext 225 FAX: 236-2626 PH: 586-9422 FAX: 586-0159
Mr. Thomas H. Kaaiai, Jr. Mr. Thomas Koenig
Hawaii Advisory Commission on Drug Deputy Prosecuting Attorney
Abuse and Controlled Substances Department of the Prosecuting Attorney
(HACDACS) City and County of Honolulu
51-406 Kamehameha Highway 1060 Richards Street
Kaaawa, Hawaii 96730 Honolulu, Hawaii 96813
PH: 842-8519 FAX:842-8515 PH: 527-6426 FAX: 527-6552
Ms. Maile Kanemaru Ms. Lari Koga, Chief
Weed and Seed Coordinator Crime Prevention and Justice Assistance
200 North Vineyard Boulevard, Suite 700 Division
Honolulu, Hawaii 96817 Department of the Attorney General
PH: 536-1951 FAX: 543-2222 425 Queen Street
Honolulu, Hawaii 96813
Ms. Iris Kaneshiro PH: 586-1150 FAX: 586-1373
Family Court of the First Circuit
Kaahumanu Hale Mr. Edwin L'Esperance
777 Punchbowl Street Community Consultative Services Branch
Honolulu, Hawaii 96813 Alcohol & Drug Abuse Division
PH: 539-4410 FAX: 539-4402 601 Kamokila Boulevard, Room 360
Kapolei, Hawaii 96707
Ms. Malina Kaulukukui PH: 692-7522 FAX: 692-7519
Assistant Administrator I
Kahi Mohala Ms. Pamela G. Lichty
91-2301 Fort Weaver Road Vice President
Ewa Beach, Hawaii 96706 Drug Policy Forum of Hawaii
i
PH: 671-8511 FAX: 677-2570 2216 Ala Niu Place
Honolulu, Hawaii 96821
Mr. John Kim - PH: 735-8001 FAX: 735-2971
Life Foundation e-mail: plichtv,R;hawaii rr com
233 Keawe Street, '1226
Honolulu, Hawaii 96813 Mr. Jully Lim
PH: 521-2437 ext 222 FAX: 521-1552 Public Health Administrative Officer
e-mail: Jkimi lifcfoundarion.on, Alcohol & Drug Abuse Division
601 Kamokila Boulevard, Room 360
Mr. Kendall Ko Kapolei, Hawaii 96707
Student Support Services Group PH: 692-7515 FAX: 692-7521
Department of Education
637 18`' Avenue Bldg. C, 2nd Floor
Honolulu, Hawaii 96816
PH: 735-6222 FAX: 733-9890
Appendix A. Participant List - Oahu, Page 5
Mr. Tom Maedo Mr. Billy Mills
Office of Youth Services Substance Abuse Treatment Program
820 Mililani Street, Suite 817 Administrator
Honolulu, Hawaii 97813 Department of Public Safety
PH: 587-5700 FAX: 587-5734 919 Ala Moana Boulevard
e-mail: Ovsiayixi.com Honolulu, Hawaii 96814
PH: 587-2558 FAX: 587-1280
Ms. Charlotte Malott
YMCA Outreach Services Ms. Colleen Minami
1335 Kalihi Street Community Health Nursing Division
Honolulu, Hawaii 96819 Department of Health
PH: 848-2494 FAX: 842-7736 1250 Punchbowl Street
Honolulu, Hawaii 96813
Mr. Alan Matsunami PH: 733-9255 FAX: 733-9375
Med-QUEST Division
Department of Human Services Ms. Sharyn Miyashiro
601 Kamokila Boulevard, 5' Floor Deputy Director
Kapolei, Hawaii 96707 Housing and Community Development
PH: 692-8098 FAX: 692-8173 Corporation of Hawaii
1002 North School Street
Mr. Bert Matsuoka Honolulu, Hawaii 96817
Hawaii Advisory Commission on Drug PH: 832-6060 FAX: 832-6030
Abuse and Controlled Substances
(HACDACS) Ms. Sandi Miyoshi, Chief
Executive Director Homeless Programs Branch
Office of Youth Services Housing and Community Development
820 Mililani Street, Suite 817 Corporation of Hawaii
Honolulu, Hawaii 97813 1002 North School Street
PH: 587-5700 FAX: 587-5734 Honolulu, Hawaii 96817
PH: 832-5930 FAX: 832-5932
Ms. Lynn Maunakea
Executive Director Ms. Stephanie Monet
Institute for Human Services Hawaii Nurses Association
546 Kaaahi Street 677 Ala Moana Boulevard, Suite 301
Honolulu, Hawaii 96817 Honolulu, Hawaii 96813
PH: 845-7150 FAX: 845-7190 PH: 531-1628 FAX: 524-2760
Mr. Timothy McCormick Mr. Jeffery Morgan-Hermes
STD/AIDS Prevention Services Branch KASHBOX Program
Department of Health Department of Public Safety
3627 Kilauea Avenue, Room 306 P.O. Box 1839
Honolulu, Hawaii 96816 Pearl City, Hawaii 96782-8839
PH: 733-9281 FAX: 733-9291 PH: 455-6417 FAX: 455-5625
e-mail: Timccormucamhis health.state hi.us
Appendix A. Participant List - Oahu, Page 6
Ms. Sandy Morishige Ms. Lori Nishimura
Benefits, Employment and Support Deputy Prosecuting Attorney
Services Division Department of the Prosecuting Attorney
Department of Human Services City and County of Honolulu
820 Mililani Street, Suite 606 1060 Richards Street
Honolulu, Hawaii 96813 Honolulu, Hawaii 96813
PH: 586-5713 FAX: 586-5744 PH: 527-6232 FAX: 527-5901
Mr. Wendell Murakawa, Administrator Ms. Julie Okamoto
Intake Service Centers Crime Prevention and Justice Assistance
Department of Public Safety Division
919 Ala Moana Boulevard Department of the Attorney General
Honolulu, Hawaii 96814 425 Queen Street j
PH: 587-1260 FAX: 587-1280 Honolulu, Hawaii 96813
PH: 586-7442 FAX: 586-1373
Mr. Wesley Mun
Health Care Officer Mr. Max Otani
Department of Public Safety Acting Administrator
919 Ala Moana Boulevard Hawaii Paroling Authority
Honolulu, Hawaii 96814 Capitol Center, Ground Floor
PH: 587-2536 FAX: 587-1280 1177 Alakea Street
Honolulu, Hawaii 96813
Mr. James Nagle PH: 587-1295 FAX: 587-1314
Commerce and Economic Development
Division Gregory Pai, Ph.D.
Department of the Attorney General Public Utilities Commission
425 Queen Street Kekuanaoa Building
Honolulu, Hawaii 96813 465 North King Street, Room 103
PH: 586-1180 FAX: 586-1205 Honolulu, Hawaii 96813
PH: 586-2028 FAX: 586-2066
Terri Needles, Ph.D.
Hawaii Psychological Association Mr. Tony Pfaltzgraff
P.O. Box 10456 Executive Director
Honolulu, Hawaii 96816 YMCA of Honolulu
PH: 949-5525 FAX- 943-0566 1335 Kalihi Street
Honolulu, Hawaii 96819
Ms. Thelma C. Nip PH: 848-2494 FAX: 842-7736
Hawaii Advisory Commission on Drug
Abuse and Controlled Substances Mr. Paul Pladera
(HACDACS) Office of Community Services
465 Luakini Street Department of Labor & Industrial Relations
Honolulu, Hawaii 96817 830 Punchbowl Street
PSI: 595-2692 Honolulu, Hawaii 96813
PH: 586-8675 FAX: 586-8685
Appendix A. Participant List - Oahu, Page 7
Ms. Jeanne Reinhart The Honorable Ted Sakai
Child Welfare Services Branch Director of Public Safety
Department of Human Services Department of Public Safety
810 Richards Street, Suite 400 919 Ala Moana Boulevard
Honolulu, Hawaii 96813 Honolulu, Hawaii 96814
PH: 586-5794 FAX: 586-5700/4008 PH: 587-1338 FAX: 587-1280
Ms. April Renceful Ms. Rhonda Sasaki
Child and Adolescent Mental Health Inmate Classification Officer
Services Division Department of Public Safety
Department of Health 919 Ala Moana Boulevard
3627 Kilauea Avenue, Room 101 Honolulu, Hawaii 96814
Honolulu, Hawaii 96816 PH: 587-1336 FAX: 587-1282
PH: 733-9339 FAX: 733-9357
Ms. Debbie Shimizu
Ms. Linda Rich National Association of Social Workers
Executive Director 200 North Vineyard Blvd, Suite 415
The Salvation Army - Family Treatment Honolulu, Hawaii 96817
Services PH: 521-1787 FAX: 531-3299
845 22"d Avenue
Honolulu, Hawaii 96816 Ms. Suzette Smetka, Director
PH: 732-2802 FAX: 734-7470 The CHOW Project
33 South King Street, Suite 313
Ms. Lorraine Robinson Honolulu, Hawaii 96813
Director, Matlock Hale PH: 848-2469 FAX: 842-0838
T.J. Mahoney and Associates e-mail: SSMETKA r<GTE.NET
1326 Matlock Avenue
Honolulu, Hawaii 96814 Ms. Patricia Snyder, Administrator
PH: 545-3888 FAX: 545-3960 Social Services Division
Department of Human Services
Richard Rohde, Ph.D. 810 Richards Street, Suite 400
Community Consultative Services Branch Honolulu, Hawaii 96813
Alcohol & Drug Abuse Division PH: 586-5701 FAX: 586-5700
601 Kamokila Boulevard, Room 360
Kapolei, Hawaii 96707 - Catherine Sorenson, Ph.D.
PH: 692-7522 FAX: 692-7519 Alcohol & Drug Abuse Division
601 Kamokila Boulevard, Room 360
Ms. Joan Sakaba Kapolei, Hawaii 96707
Program Specialist PH: 692-7530 FAX: 692-7521
Adult Probation Division
777 Punchbowl Street Ms. Ramona Suan
Honolulu, Hawaii 96813 Counseling and Probation Division
PH: 5.39-4510 FAX: 539-4559 Kauikeaouli Hale
1111 Alakea Street
Honolulu, Hawaii 96813
PH: 538-5098 FAX 538-5077
i
AppendIN .A. Panicipa t List - Oahu. Paee 8
Ms. Anita Swanson Ms. Amy Tsark, Administrator
Special Assistant for Behavioral Health Child Welfare Services Branch
Department of Health Department of Human Services
1250 Punchbowl Street 810 Richards Street, Suite 400
Honolulu, Hawaii 96813 Honolulu, Hawaii 96813
PH: 586-4416 FAX: 586-4444 PH: 586-5677 FAX: 586-5700
Millie Tanabe, Ph. D. Ms. Marian Tsuji
Kalihi-Palama Health Center Deputy Director of Public Safety
915 North King Street Department of Public Safety
Honolulu, Hawaii 96817 919 Ala Moana Boulevard
PH: 848-8578 FAX: 841-1265 Honolulu, Hawaii 96814
PH: 587-1340 FAX: 587-1282
Ms. Gwen Tani
Community Consultative Services Branch Mr. Patrick Wade
Alcohol & Drug Abuse Division Director, Adult Services
601 Kamokila Boulevard, Room 360 Hina Mauka
Kapolei, Hawaii 96707 45-845 Po'okela Street i
PH: 692-7522 FAX: 692-7519 Kaneohe, Hawaii 96744
PH: 236-2600 ext 245 FAX: 236-2626 j
Mr. Kenneth L. Tano e-mail: Pawmkw o%msn.com
Hawaii Advisory Commission on Drug AdminirDhinamauka.or,
Abuse and Controlled Substances
(HACDACS) Mr. John Walters
801 South Beretania Street Child Welfare Services Branch
Honolulu, Hawaii 96813 Department of Human Services
PH: 529-3991 FAX: 529-3476 810 Richards Street, Suite 400
Honolulu, Hawaii 96813
Margaret Tom, Branch Chief PH: 586-5697 FAX: 586-4806
Community Consultative Services Branch
Alcohol & Drug Abuse Division Mr. Peter Whitaker, Chief
601 Kamokila Boulevard, Room 360 STD/AIDS Prevention Services Branch
Kapolei, Hawaii 96707 Department of Health
PH: 692-7522 FAX: 692-7521 3627 Kilauea Avenue, Room 306
- Honolulu, Hawaii 96816
Donald Topping, Ph.D. PH: 733-9010 FAX: 733-9015 j
~
Drug Policy Forum of Hawaii
P.O. Box 61233 Mr. Larry Williams
Honolulu, Hawaii 96839 Executive Director
PH: 988-4386 FAX: 988-4386 The Salvation Army - Addiction Treatment
Services
Ms. Martha Torney 3624 Waokanaka Street
Corrections Program Specialist Honolulu, Hawaii 96817
Department of Public Safety PH'. 595-6371 FAX: 595-8250
919 Ala Ivloana Boulevard
Honolulu, Hawaii 96814
PH'. 587-3477 FAX: 587-3481
Appendix A. Participant List - Oahu, Page 9
Kenneth Willinger, Ph.D. Ms. Barbara Yamashita
Clinical Psychologist Matemal and Child Health Branch
Community Consultative Services Branch Family Health Services Division
Alcohol & Drug Abuse Division 741 Sunset Avenue, Room 204
601 Kamokila Boulevard, Room 360 Honolulu, Hawaii 96816
Kapolei, Hawaii 96707 PH: 733-9033/4061 FAX: 733-9032
PH: 692-7522 FAX: 692-7521
Victor Yee, Ph.D.
Elaine Wilson, Chief Adult Mental Health Division
Alcohol & Drug Abuse Division Department of Health
601 Kamokila Boulevard, Room 360 1250 Punchbowl Street
Kapolei, Hawaii 96707 Honolulu, HI 96813
PH: 692-7507 FAX: 692-7521 PH: 586-4691 FAX: 586-4745
Ms. Selene Witte-Mersereau Ms. Earline Yokoi
Program Director, Teen Care Crime Prevention and Justice Assistance
Hina Mauka Division
45-845 Po'okela Street Department of the Attorney General
Kaneohe, Hawaii 96744 425 Queen Street
PH: 236-2600 ext 222 FAX: 236-2626 Honolulu, Hawaii 96813
e-mail: Admin(~hinamauka.or,, PH: 586-1150 FAX: 586-1373
Mr. Charles Wong Ms. Ellena Young, Administrator
CHAMP Clinic, Inc. Corrections Program Services
173 South Kukui Department of Public Safety
Honolulu, Hawaii 96813 919 Ala Moana Boulevard
PH: 528-0550 FAX: 528-0024 Honolulu, Hawaii 96814
PH: 587-1266 FAX: 587-1280
Mr. Wayne Wong
United States District Court Mr. Robert S.N. Young
Probation Department Housing and Community Development
300 Ala Moana Boulevard, C110 Corporation of Hawaii
Honolulu, Hawaii 96850 1002 North School Street
PH. 541-1283 FAX: 541-1345 Honolulu, Hawaii 96817
_ PH: 832-5919 FAX: 832-5910
Ms. Claire Woods
Executive Director Ms. Georgina Yuen
The Salvation Army - Family Treatment Deputy Director
Services Department of Customer Services
845 22nd Avenue 650 South King Street
Honolulu, Hawaii 96816 Honolulu, Hawaii 96813
PH: 732-2802 FAX: 734-7470 PH: 527-4740 FAX: 523-4386
Ms Jean Yamane
District Court Administrator
Kauikeaouli Hale
1111 Alakea Street
Honolulu, Hawaii 96813
PH: 535-5121 FAX: 538-5233
Appendix B. Listin.- of School-Based Treatment Senices
1999-2000 HAWAII PUBLIC MIDDLE SCHOOLS Grades 7 & 8
School District SCHOOL Students (Grades 7 8 8) ADAD Treatment
ANUENUE 44
CENTRAL 317
DOLE 597
Honolulu District JARRETT 311
(Oahu)
KAIMUKI 596
KALAKAUA 699
KAWANANAKOA 687
NIU VALLEY 506
t
STEVENSON 415
I WASHINGTON 593
AIEA 664
ALIAMANU 875
Central District MILILANI 1,058
(Oahu) MOANALUA 870
WAHIAWA 537
WAIALUA 262
WHEELER 469
HIGHLANDS 1,095
KAPOLEI 632
Leeward District NANAKULI 463
(Oahu) WAIANAE 1,068
WAIPAHU 1,173
(LIMA 930
KAHUKU 637
KAILUA 900
Windward District
(Oahu) KING 993
WAIMANALO 239
OLOMANA 27
Appendix B. Listing of School-Based Treatment Senices
1999-2000 HAWAII PUBLIC MIDDLE SCHOOLS Grades 7 & 8
School District SCHOOL # Students (Grades 7 & 8) ADAD Treatment
77
HILO 690
HONAUNAU 9C
HONOKAA 149
HOOKENA 75
Hawaii District KALANIANAOLE 105
KAU l PAHALA 65
KEAAU 477
KOHALA 157
KONAWAENA 231
LAUPAHOEHOE 44
NAALEHU 96
PAAUILO 54
PAHOA 344
WAIAKEA 673
WAIMEA 316
KEALAKEHE 592
HANA 68
IAO 575
LAHAINA 429 X
Maui District MAMA 746 1
(Maui, Lanai, Molokai)
MAUI-WAENA 638
LOKELANI 437
LANAI 107
MOLOKAI 309
KAPAA 638 I X '
Kauai District KAUAI 607 '
(Kauai, Niihau)
WAIMEA CANYON 431 1
i
- NIIHAU 9
Note: Enrollment counts include regular and special education students.
Appendix B. Listing of School-Based Treatment Senices
1999-2000 HAWAII PUBLIC HIGH SCHOOLS (Grades 9-12)
School District SCHOOL it Students (Grades 9-12) ADAD Treatment
ANUENUE 33
FARRINGTON 2,538 X
KAWUKI 1.454 X
Honolulu District
(Oahu) KAISER 1,140
KALANI 1,174 X
MCKINLEY 2,002
ROOSEVELT 1,512 X
AIEA 1,377 X
LEILEHUA 1,745 X
Central District MILILANI 1,993 X
(Oahu) MOANALUA 1,883 X
RADFORD 1,320
WAIALUA 490 X
CAMPBELL 2,318 X
NANAKULI 647 X
Leeward District PEARL CITY 2,108 X
(Oahu)
WAIANAE 2,211 X
WAIPAHU 2,358 X
CASTLE 1,931 X
KAHUKU 1,269 X
Windward District KAILUA 1,091 X
(Oahu) KALAHEO 1,115 X
OLOMANA 155 X
HILO 1,812
HONOKAA 706
KONAWAENA 1,187 X
KA U 343 X
Hawaii District KEAAU 238
KEALAKEHE 1,119
KOHALA 336
LAUPAHOEHOE 79
PAHOA 667 X
WAIAKEA 2,180 X
BALDWIN 1,693 X
HANA 92
KEKAULIKE 1,396 X
Maui District LAHAINALUNA 889
(Maui, Lanai, Molokai) MAUI 1,709 X
LANAI 218 X
MOLOKAI 503
- KAPAA 1,215 X
Kauai District KAUAI 1,188
(Kauai, Niihau) WAIMEA 876 X
NIIHAU 13