HomeMy WebLinkAboutInformal Amendment II Revised Exhibit A1 220701 MHS Signed.pdf 1 AMENDMENT II TO AGREEMENT
2 THIS AMENDMENT (hereinafter "Amendment II") is made and entered into this 1st day of
3 July , 2022, by and between COUNTY OF FRESNO, a Political Subdivision of the State of
4 California, Fresno, California (hereinafter "COUNTY"), and MENTAL HEALTH SYSTEMS, INC., a
5 California non-profit corporation, whose address is 9465 Farnham Street, San Diego, California,
6 92123, (hereinafter "CONTRACTOR").
7 WITNESSETH:
8 WHEREAS, COUNTY and CONTRACTOR, entered into Agreement No. A-18-622, effective
9 November 1, 2018, and as amended by Amendment No. 18-622-1, effective January 1, 2019,
10 hereinafter collectively referred to as "Agreement", pursuant to which CONTRACTOR agreed to
11 provide mental health and substance use disorder (SUD) treatment services to youths incarcerated at
12 the Fresno County Juvenile Justice Campus (JJC), and SUD treatment services for youths and their
13 families referred by Fresno County Juvenile Drug Court, and SUD treatment services for youths
14 released from the JJC; and
15 WHEREAS, Senate Bill (SB) 823 formalized juvenile justice realignment at the state level by
16 transferring responsibility of care, custody and supervision of youths whose case originated in juvenile
17 court to county juvenile facilities until they turn twenty-five (25) years of age; and
18 WHEREAS, the Agreement included a Modification clause which allows "Any matters of this
19 Agreement may be modified from time to time by the written consent of all the parties without, in any
20 way, affecting the remainder. Notwithstanding the above, changes to Section One (1), SERVICES, as
21 needed to accommodate changes in State and Federal Law relating to mental health and SUD
22 treatment may be made with the signed written approval of COUNTY's DBH Director or his/her
23 designee and CONTRACTOR through an amendment approved by County Counsel and Auditor."; and
24 WHEREAS, CONTRACTOR is qualified and able to provide said services to all youth
25 incarcerated at JJC, and is willing to coordinate with COUNTY's Probation Department and its other
26 juvenile justice realignment providers for group interventions and related case management services;
27 and
28 WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement regarding the
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1 changes as stated below and restate the Agreement in its entirety.
2 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
3 is hereby acknowledged, the COUNTY and CONTRACTOR agree as follows:
4 1. That all references in the Agreement to "Exhibit A-1" shall be deemed references to
5 "Revised Exhibit A-1". Revised Exhibit A-1 is attached hereto and incorporated herein by this
6 reference.
7 2. The parties agree that this Amendment may be executed by electronic signature as
8 provided in this section. An "electronic signature" means any symbol or process intended by an
9 individual signing this Amendment to represent their signature, including but not limited to (1) a digital
10 signature; (2) a faxed version of an original handwritten signature; or (3) an electronically scanned and
11 transmitted (for example by PDF document) of a handwritten signature. Each electronic signature
12 affixed or attached to this Amendment (1) is deemed equivalent to a valid original handwritten
13 signature of the person signing this Amendment for all purposes, including but not limited to
14 evidentiary proof in any administrative or judicial proceeding, and (2) has the same force and effect as
15 the valid original handwritten signature of that person. The provisions of this section satisfy the
16 requirements of Civil Code section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act
17 (Civil Code, Division 3, Part 2, Title 2.5, beginning with section 1633.1). Each party using a digital
18 signature represents that it has undertaken and satisfied the requirements of Government Code
19 section 16.5, subdivision (a), paragraphs (1) through (5), and agrees that each other party may rely
20 upon that representation. This Amendment is not conditioned upon the parties conducting the
21 transactions under it by electronic means and either party may sign this Amendment with an original
22 handwritten signature.
23 COUNTY and CONTRACTOR agree that this Amendment II is sufficient to amend the
24 Agreement and, that upon execution of this Amendment II, the Agreement and this Amendment II
25 together shall be considered the Agreement.
26 The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
27 covenants, conditions, and promises contained in the Agreement and not amended herein shall
28 remain in full force and effect. This Amendment II shall become effective July 1, 2022.
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1 EXECUTED AND EFFECTIVE as of the date first above set forth.
2
3 CONTRACTOR: REVIEWED AND RECOMMENDED FOR
MENTAL HEALTH SYSTEMS, INC. APPROVAL:
4 A
James C Call,ghan 2G,2i122 1G:19 PDT) By
6 (Authorized Signature) Susan L. o t, LMFT
Director of Behavioral Health
7 James C Callaghan Jr CEO President
8 Print Name &Title
9
10
11 APPROVED AS TO LEGAL FORM:
12 DANIEL C. CEDERBORG, COUNTY COUNSEL
13 By 6g4�!J C,
14
15
16 APPROVED AS TO ACCOUNTING FORM:
OSCAR J. GARCIA, CPA, AUDITOR-
17 CONTROLLER/TREASURE-TAX COLLECTOR
18 ,
19
By
._
20 V//
21
FOR ACCOUNTING USE ONLY:
22
Fund/Subclass: 0001/10000
23 Organization: 56302081 (SUD); 56302235 (MH)
Account: 7295
24
25
26
27
28
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Revised Exhibit A-1
Page 1 of 35
All portions of this Revised Exhibit A-1 that have been changed from the previous Exhibit A-1 are
indicated by being both underlined and italicized. Revised Exhibit A-1 is effective July 1, 2022.
XI. SCOPE OF WORK-SUBSTANCE USE AND MENTAL HEALTH SERVICES FOR YOUTH
INCARCERATED AT THE JJC
General discussion of your understanding of the project, the Scope of Work proposed and
a summary of the features of your proposal.
The County of Fresno on behalf of the Department of Behavioral Health Contracts Division
- Substance Use Disorder Services (DBH) is requesting proposals from qualified Drug Medi-Cal
(DMC) certified vendors that have an established treatment service history, to provide a range of
evidence-based substance use disorder and mental health treatment and recovery services to
youths involved with the juvenile justice system or incarcerated at the Probation Department's
Juvenile Justice Campus (JJC). Mental Health Systems (MHS) meets the County's need for a
provider who possesses the ability to provide evidence-based, clinically proven. and cost-effective
services to residents of Fresno County. As the current successful provider of Juvenile Drug Court
(JDC) (SOW IIA), MHS Floyd Farrow Substance Abuse Unit(SAU)at Fresno's Juvenile Detention
Facility (SOW 11 B), and Post-Release Outpatient Program Services (PROPS) (SOW IIC), MHS
demonstrates the required experience to deliver.
MHS has maintained ongoing involvement in work groups and is informed and
participating in Fresno County's election to opt into the California Drug Medi-Cal Organized
Delivery System (DMC-ODS) Waiver. As such, MHS is well prepared for testing of the new
paradigm for the organized delivery of health care services for Medicaid eligible individuals with
a SUD diagnosis. Few agencies are better equipped to meet the required need to provide a
continuum of services to all eligible beneficiaries that is modeled after Adolescent American
Society of Addiction Medicine (ASAM) Criteria. MHS has extensive clinical experience and offers
a comprehensive array of services. MHS is able to be a strong partner as part of the resulting
continuum, as well as to provide unparalleled services to eligible participants according to the
plan developed by DBH. Further, MHS holds strong collaborative partnerships with Fresno
providers across such a continuum.
As the current service provider, the community-based JDC and PROPS SUD services
are currently Drug Medi-Cal certified, licensed by DHCS at the MHS Family and Youth
Alternatives site (FYA), and are ready for implementation without any interruption of services.
The services rendered at the Floyd Farrow SAU program onsite at JJC are delivered in
compliance with California Code of Regulations (CCR) Title 22 DMC regulations, apart from
Revised Exhibit A-1
Page 2 of 35
Medical Director roles and responsibilities.
The current JDC program (SOW 11A), JJC Floyd Farrow SA program (SOW 11B), and
PROPS services (SOW I1C) and the newest addition the JJC SUD Services, effective July 1,
2022, are prepared to continue consistent adherence to DBH's Guiding Principles of Care
Delivery and Youth Treatment Guidelines.
Based on the concept that discharge and community reintegration planning begins at
admission, in-custody treatment services are designed to help youths build and internalize skill
sets that will sustain their commitment to sobriety and emotional and behavioral stability during
and after the transition phase. MHS' experience serving youths and families at Floyd Farrow SAU
since 2000, FYA program since 2003 and in the New Horizon's program since 2009, has provided
a comprehensive understanding of the of the challenges unique to Fresno and its surrounding
rural communities. Families may also include caregivers and other natural supports. Cultural
norms and traditions put increased pressure on youth as they begin to sort out their identity,
orientation, confidence, and self-esteem. Such cultural issues may further complicate the
adolescent's response to and participation in treatment and, as such, program staff members
are experienced in serving youths and families from a wide range of ethnic, cultural, and
socioeconomic backgrounds.
The design of the proposed MHS Juvenile Justice in-custody and outpatient programs is
a continuum of care designed to meet each client's unique needs throughout the course of
treatment. The continuum of care is based on evidence-based, best-practice research, literature
review, model programs, and MHS' experience in providing similar services to youth and families
in Fresno and other counties. In general, research indicates that:
• Effectiveness is related to patient/client factors, such as severity of dependence
and psychiatric symptoms, social supports, and motivation.
• Program completion is determined by the youths' and families' ability to manage
the presenting problem appropriately, not by days or hours in treatment.
Better outcomes result from early intervention in the substance abuse cycle, a range and
intensity of services, and a flexible approach to individualized treatment. The services described
in these programs and currently being provided by MHS are grounded in research and years of
experience in a multitude of settings. Over time, MHS has developed and implemented a broad
scope of evidence-based, results-driven treatment and relapse prevention concepts that
successfully help youth and families achieve stable, healthy, drug-free, and crime-free lifestyles.
Youths and their families participate in an integrated, collaborative continuum of care model that
is culturally competent, gender responsive, and focused on assisting the youth and family
Revised Exhibit A-1
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members to develop the skills and resources necessary for successful community reintegration.
MHS understands the importance of addressing all the life domains in a comprehensive
treatment program. The programs provide welcoming, accessible, integrated, continuous, and
comprehensive services, including often marginalized individuals with co-occurring disorders. In
order to ensure the success of participating youth, the programs focus on utilizing behavioral
interventions to reach treatment goals. By following clients from incarceration to post release,
MHS can work with the youth in a variety of settings and meet the unique needs clients present
within each setting. MHS has an agency-wide Continuous Quality Improvement plan in place, to
assure ongoing monitoring and evaluation of all program services and client outcomes.
At the core of the program is the belief that minors in the program can, with additional
skills, values, insight, and resources, reintegrate into their communities with greater stability and
success. Engaging youths and families in treatment and relapse prevention, and keeping families
Involved in supportive roles, can be particularly challenging but is critical for success. The
proposed design strives to help them develop the social, educational, vocational, financial and
recreational supports required to keep youth in their homes and/or communities.
As the incumbent of the current JDC services in Fresno County, MHS is proposing to
continue to provide said services by providing mental health counseling, intensive case
management, intervention, drug testing, and liaison services that address alcohol and other
drug problems of juvenile participants.
MHS will continue to provide family-centered, strength based and culturally
appropriate services for youth and their families to address all barriers affecting the youth's
success. MHS is proud of the significant role it has played in the development,
implementation, and mission of the Fresno Juvenile Drug Court. As an agency, an
integral part of MHS' mission is to change the lens through which challenged youth are often
viewed. MHS strives to engender hope and success and assimilation of life changing skills.
The programs are based on a comprehensive understanding of the target population,
evidence-based and best practices, and the community. Having more than three
decades of experience working with youth and their families, MHS understands that
success depends on collaboration, innovation, specialized knowledge, family
engagement and education:
• Collaboration with Community Partners: MHS understands that staff must work
with a variety of partners to help youth turn their lives around. In addition to working
with Probation, Superior Court, the District Attorney, and the Public Defender,
MHS will continue to partner with other treatment providers, school
Revised Exhibit A-1
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representatives, teen centers, faith- based organizations, transportation companies,
local businesses, local police, and any other community organization that could make
a positive impact on each youth's life. This collaboration is essential to the success of
the program and its enrolled youth. It helps the youth develop a support system
outside of our program, which in turn provides the youth with additional confidence
and resiliency to address life challenges after graduating.
• Innovation: MHS has been successfully helping people for 40 years because of the
ongoing effort to be innovative and visionary with treatment strategies. One
example of the commitment to innovation is the company-wide incorporation of
Motivational Interviewing (MI); this is a goal-directed, participant-centered counseling
style that elicits behavior change through helping clients explore and resolve
ambivalence. MHS currently has several (Motivational Interviewing Network of
Trainers) MINT Certified trainers, offering extensive training opportunities for alt
MHS staff within California. Staff members are trained to facilitate expression or
both sides of the ambivalence and guide the participant toward an acceptable
resolution that triggers change. MI stimulates behavior change by engaging the
participant to identify and mobilize his or her own intrinsic values and goals. The result
is that the client is proactive in changing his/her life instead of being pushed to make
changes for which they are not ready (Rollnick and Miller, 1995). In addition, MI
assists families in connecting to and engaging with the program and treatment
process which adds overall success for the client. MHS remains committed to pursuing
and implementing innovative approaches as a means of enhancing quality service
delivery.
Specialized Knowledge: Within the organization, MHS provides an array of service
deliveries and continuum of care for teen recovery. From providing drug testing to case
management to substance abuse treatment and a foundational focus on co-occurring
disorders, MHS has specialized knowledge and understanding of teen recovery issues.
MHS hires staff with both educational accomplishments and personal accomplishments
of recovery so that the team can successfully help youth struggling with and facing the
challenges of addiction. MHS is also committed to providing culturally appropriate services
from diverse staff.
Family Engagement: In any youth program, it is critical to engage the family whenever
possible. MHS' staff are trained to go above and beyond to connect with family members.
MHS recognizes the critical importance and benefit of having family/caretaker voice
Revised Exhibit A-1
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integrated throughout the Drug Court process. Staff communicate weekly by serving as
liaison between the family and probation/court, develop relationships with family members
who show interest, serve as mentors and family support partners, provide crisis
management, help educate families on co-dependency and drug use, and involve them in
family activities such as potluck events. field trips and special activities. In addition, MHS
has made significant changes over the years that have helped to shift the typical view of
the treatment services as an extension of law enforcement to that of a mentoring role for
youth and their families. MHS has incorporated strength-based and family-centered
techniques for engaging the family and serving more as a mentor and liaison between the
youth and his/her parents, treatment providers, Drug Court, Probation, law enforcement,
etc. MHS employees serve as a resource and coach to help the participant and his/her
family achieve their self-directed goals. This has further led to the success of really
engaging the participants and their families.
• Education: MHS' programs have a sophisticated understanding and experience in
providing education to both our collaborators/partners and families. MHS affords
educational opportunities to the Superior Court, Probation, Public Defenders and
District Attorney and families/caretakers on multiple aspects of the recovery process
including teen substance abuse, disease process, codependency, drug testing and
psychopharmacology. In addition, families are provided with consultation and education
throughout the juvenile's tenure through the three elements of Fresno County Juvenile
Drug Court: 12 months of outpatient services through the JDC program, 6 months of
intensive inpatient services through the FFSAU program, and 6 months of continued
outpatient services following FFSAU and through PROPS.
MHS has been successfully operating the Fresno JDC program since 2000. MHS is
proud of the following accomplishments which feel sets MHS apart from other providers:
o Strong and Experienced Partnerships/Collaborations: MHS has strong
working relationships with current Probation, Superior Court, and law
enforcement staff. MHS has worked with these team members for five years as
part of the JDC and for nineteen years as an organization. These long.-term
relationships have led to the creation of a strong culture of trust that enhances
our service delivery, collaboration, and partnership
o Drug Court Advocacy: When faced with Federal funding cuts, MHS collaborated
with Probation and the Superior Court in conjunction with the National Association
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of Drug Court Professionals to successfully lobby Washington for money.
Nationally, drug courts were at risk of losing $45 million, and our collaborative
lobbying effort was successful atsustaining the current level of funding.
o State and National Recognition: MHS San Diego JDC Program was recognized
as a model for Juvenile Drug Courts by the California Association of Drug Court
Professionals. As a result, our youth and San Francisco Drug Court's youth were
asked to participate in a panel discussion at CADCP Annual Conference.
o Experienced and Innovative Service Delivery and Model Development: MHS
offers extensive expertise working with the Juvenile Justice System and takes an
active role in the court proceedings which is uncommon for many case
management programs. While staff members provide case management and drug
testing services, they also take an active role in every aspect of the minor's
movement through the Drug Court System, including consult and advisement to
Superior Court Judges, District Attorney's, and Public Defenders in closed and
open Courts.
o Employee Recognition: Susan Murdock, MHS Program Manager of the
respective Juvenile Justice programs received a Resolution from Fresno County
Board of Supervisors for her excellent service and dedication to the youth in the
juvenile justice system. Two MHS SUD Counselors were awarded certificates of
appreciation for theiroutstanding service to Fresno's Juvenile Drug Court by the
Probation Department.
MHS is committed to continuing to work with the Fresno County Juvenile Drug Court,
as well as custody staff, probation, families, and communities to address funding changes found
in the current RFP, and resulting staffing changes, while still providing the highest quality and
standard of service delivery. MHS will provide the following services per the three d3rart3of Fresno
County Juvenile Drug Court System, which include 6 months of outpatient services through the
JDC program, 6 months of intensive inpatient services through the FFSAU program, and 6 months
of continued outpatient services following FFSAU through PROPS:
• Orientation, Intake and Assessment
• Scheduling Services for Youth and Families
Incentive Programs
Random Drug Testing and Reporting
0 Reporting to the JDC/Probation Drug Education
Revised Exhibit A-1
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• Treatment & Recovery Plan Development and Implementation
• Referrals to Appropriate and Accessible Ancillary Services
• Case Management
• Data Collection, Entry, and Reporting
• Representation and Participation at Program Meetings
• Discharge Planning and Program Exit Conference
• Treatment Team Meetings
• Transportation Assistance
• Family Support, Consultation and Education
• Sober pro-social activities and training
MHS is motivated by the outcomes of services. Those outcomes are most clearly
conveyed through young lives changed-forever altered-as a result of program services. The words
of the following MHS Floyd Farrow SAU program graduate reflects this potential. The following
was excerpted from the former SAU client's letter of support, which can be found in its entirety in
Reports section 8:
"I started drinking and experimenting with drugs at around the age of
12...Drugs and alcohol were an escape for me ...at 16, 1 met at 23-year-o/d man. I
thought I knew what love was. I wanted to impress him. He drank, I drank. He did
meth, I did meth. 1 became homeless by choice. 1 completely gave into drug culture.
During that year and a half, 5 people I knew died, one of them in front of me. By
that time, I was an IV drug user.../was sentenced to the SAU as well as probation.
To say 1 was challenging would be generous. I wrote letters expressing outrage. I
was disrespectful. I was angry. 1 was hurt. I was afraid. But I was not alone. The
staff at SAU were able to take all those emotions I had, and they were able to help
me, and my family heal. They gave me structure, they gave me acceptance, they
gave me safety, they taught me to be accountable ...15 years ago, 1 was a
homeless teenage drug addict and was killing myself slowly. Today I am a Licensed
Clinical Social Worker and Accredited Case Manager. I teach Social Work part time
at Fresno State. I am also a small business owner and provide qualify and affordable
low-income housing through my rental property company. I continue to stay
actively involved in a group program that supports my sobriety. Most importantly, 1
have a beautiful family life. I have been married to my husband for 7 years. We met
Revised Exhibit A-1
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my senior of my bachelor's degree and have been deeply in love ever since. That
love has produced a wonderful 6-year-old little boy who is the light of my life...How
do you thank a group of people for your life? Words are not enough. But 1 hope that
the way I have lived my life since they changed it has in some way demonstrated
the deep gratitude 1 feel."
The caliber of services and staff that lead to outcomes such as these are both the
essence of what MHS proposes and of the passion that fuels the mission.
MHS is responding to Fresno County Department of Behavioral Health Substance Use
Disorder Services (DBH)'s request for qualified organizations that have an established treatment
service history, to provide a range of evidence-based substance use disorder and mental health
treatment and recovery services to youths who have been adjudicated for drug and/or alcohol
offenses or for other delinquency offenses throughout Fresno County. MHS is prepared to
provide services to youths and their families referred by the Fresno County Juvenile Justice
System for the following services:
• SOW ILA: Juvenile Drug Court Services (10-20 clients per month):
• SOW II.B: Juvenile Justice Campus In-Custody (Co-occurring - Substance Abuse and
Mental Health Services) (40 beds; 30 male; 10 female)
• SOW 11.C: Post Release Outpatient - PROPS (10-20 clients per month)
• SOW 11.D JJC SUD Services effective July 1, 2022
The population to be served for Juvenile Drug Court (JDC) are youths and their families
referred by the Fresno Juvenile Drug Court. These youth are between 14 years and 17 years of
age, and they have been adjudicated for drug and/or alcohol offenses or for other delinquency
offenses if the youth have significant drug and alcohol issues for if the use of drugs and/or alcohol
was involved in the offenses). Youth who are eligible for JDC services must complete a drug and
alcohol evaluation and are assessed using ASAM PPC II Criteria.
The population served at the Juvenile Justice Campus are between the ages of 14 and 25
and are referred by the Fresno County Courts and Probation Department and placed in the SAU.
These youth are placed by Fresno County Delinquency Court into the program and the Court has
the sole discretion to modify the eligibility criteria. The JJC-SAV's clients have a primary diagnosis
of substance use disorder and some have co-occurring mental health issues.
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The population served by the Post Release Outpatient Program Services (PROPS) are
Fresno County youths who have been discharged from the JJC SAU programs. Their services
are provided in accordance with Drug Medi-Cal Standards and Youth Treatment Guidelines.
These youth have been deemed in need of community reentry monitoring and outpatient activity
with self-help groups, ancillary service referrals, vocational/employment assistance, family,
relapse prevention skills and other areas of self-improved.
The population served by the JJC SUD are any in-custody youth identified as meeting
ASAM-PPC II criteria and Medical Necessity for a substance use disorder. The four programs
addressed herein will address the full range of complex issues impacting youth with co-occurring
substance abuse and mental health issues in a family focused continuum of care. The goal of
services is for youths to become drug free- crime free productive members of their community,
with the active engagement and support of family and friends.
Any meaningful understanding of the project requires an understanding of the target
population. The average age of the youth served in the JJC programs is 15 to 17 years old. Most
of the youth are from a single parent household and are behind in school. Their most common
drugs of choice are Marijuana and Methamphetamine.
The current racial demographics of the Juvenile Justice Campus treatment units are as
follows: Females in the JJC program units are currently: 31.25% Black/African American, 62.5%
Hispanic/Latina, 6.25% White. Males in the JJC program units are currently: 0.79% Native
American/Alaskan; 25.98% Black/African American; 0.79% Hawaiian; 60.63% Hispanic/Latino;
0.79% Other; 11.02% White. These numbers indicate that minorities are disproportionately
represented, which is common in correctional facilities throughout the criminal justice system.
One such reason given is higher poverty rates within minority populations, as poverty has been
linked to increase in crime. Not only does research show high-poverty neighborhoods are often
characterized by high crime rates, it also results In low educational attainment rates, and high
unemployment.
Using data from the U.S. Census Bureau, 24/7 Wall St. compared the percentage point
change in concentrated poverty rates in U.S. metro areas between 2010 and 2016 to identify the
cities where concentrated poverty is increasing most. The cities on this list span the United States
geographically, from the West Coast to the East and from the South to the Midwest. Between
2010-2016, the share of Fresno's extremely poor residents living in high poverty neighborhoods
increased by 12.8 percentage points since 2010, the second largest increase of any metro area.
As a result, the metro area's 42.2% concentrated poverty rate is the highest of any metro area
in the country. Further, in that timeframe there was a 66% increase in what are classified as poor
Revised Exhibit A-1
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neighborhoods in Fresno. Again, this is relevant because high poverty areas are at increased risk
of a high incidence of crime. Fresno's high concentrated poverty rate may largely explain the
city's high violent crime rate, which impacts the County's youth. In fact. the Department of Justice
reported that person's ages 12 to 17 had the highest prevalence of violence of all age groups.
There were 613 violent crimes for every 100,000 Fresno metro area residents in 2016, well above
the U.S. violent crime rate of 384 per 100,000. The 24/7 Wall St's report indicates that presently
an individual is safer in 93% of all U.S. cities.
These facts impact the troubling statistics related to Fresno's youth: One study examined
youth populations as of Dec. 31, 2017, for each U.S. County per 100,000 youth age10-17. The
rate of juvenile felony arrests shown according to the size of the county's juvenile justice
population relative to its total youth population reveals that there are 542 Juvenile felony arrests
per 100,000 Fresno youth ages 10-17, while the number for California as whole was 78 Juvenile
felony arrests per 100,000 youth ages 10-17. In addition, Io these numbers, Fresno County's teen
birth rate is higher than 90% of counties statewide; and Fresno is reported to have high rates of
gang involvement (Fresno County has 238 Active Gangs and 20,750 Gang Members, and the
trend in gang activity is increasing.
In addition to the problematic demographic issues described above, the youths and
families treated in Fresno juvenile justice services present with multiple problems only
complicated by co-occurring disorders. Many of these youths and families have experienced
neglect, physical and sexual abuse, multi-generational gang involvement, and have
generational histories of substance abuse and co-occurring mental health disorders. They
also have problems in school, poor social skills, poor impulse control, and family
dysfunction. Many of these youth are living in chaotic family situations or have been
removed from their homes; have failed multiple placements; and many have family members
who are incarcerated. In addition, some youth in Fresno's juvenile justice system represent the
third generation of family gang involvement. These youth and their families have some of
the highest levels of unmet needs, but normally have fewer resources to meet these needs.
Their socio-economic status. culture, language, isolation, and family situations are
significant risk factors that exacerbate the symptoms of their substance abuse and co-occurring
mental health disorders. In addition, undiagnosed and untreated mental illness and/or co-
occurring substance abuse in the parent can create additional problems when treating youth.
MHS has been successful in overcoming many of the issues associated with a project
of this scope. The overarching goal of every MHS program, whether focused on mental health,
substance abuse, or co-occurring disorders, is to improve lives and instill hope by using
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innovative treatment strategies while respecting time. Proven methods of intervention. The
collaboration of services between MHS and county, state and federal agencies is at the core
of our success.
The rigorously trained program staff are knowledgeable in the diagnostic criteria for
substance use disorders and treatment approaches for this population and will be sensitive to
the factors that impact youth in recovery including developmental age and issues, environmental
considerations, differences in cultural and ethnic values, stage of readiness to change, family
dynamics, and co-occurring disorders. Staff knowledge extends to an understanding that the
majority of youth involved with the juvenile justice system have experienced traumatic events,
with at least 75% having experienced traumatic victimization (Sprague, 2008). A recent study
of youth in detention found that over 90% had experienced at least one trauma, 84%
experienced more than one trauma, and over 55% reported being exposed to trauma six or
more limes (Abram et al., 2013).
Traumatic events can have profound effects on emotional and mental well-being, how
one relates to others, how an individual acts and a person's overall health. This is substantiated
by the 2010 Adverse Childhood Experiences (AGE) Study (an observational study of the
relationship between trauma in early childhood and morbidity, disability, and mortality in the
United States), which demonstrated that trauma is associated with lifelong problems in behavioral
health and general health, Society is just beginning to grasp the extent of trauma and its toll:
Severe trauma in early childhood affects all areas of development, including cognitive, social,
emotional. physical, psychological, and moral, and its effects last tong into adulthood. The
pervasive negative effects of early trauma result in significantly higher levels of behavioral and
emotional problems. Children exposed to early trauma due to abuse or neglect lag behind in
school readiness, school performance, and they have diminished cognitive abilities coupled with
a greater risk of going on to develop substance problems, health problems and serious mental
health disorders. Trauma can affect the developing brain, the body, and alter the body's stress
response mechanisms.
MHS understands that victims and their families can be paralyzed by feelings of shame,
guilt, rage, depression, isolation, and disconnection. There can be guilt in the family for not
protecting a child from trauma or for not being able to provide a safer community for one's
children. Society is just beginning to deal with trauma and finding new ways of healing its
wounds. Overcoming family shame that can prevent parents from seeking help for their children
who are trauma survivorsis a critical step. Providing family focused care to provide the family
with the needed support, education, skills, and tools is the approach that MHS Juvenile Justice
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programs provide. In view of these realities, MHS Juvenile Justice programs screen for trauma
and offer trauma informed care in every aspect of treatment services.
JUVENILE DRUG COURT (SOW ILA)
MHS proposes to continue to incorporate the following interventions in the Juvenile Drug
Court services provided through Family and Youth Alternatives program; combining family-
centered services that are strength based. These servicesalso recognize that the youth and
family are part of a larger system and likely have needs other than substance abuse or mental
health that may impact their progress in treatment if not addressed. MHS staff will partner with
the youth and family to develop and implement a structured program that addresses academic,
social, emotional, psychological, substance abuse, and socio-economic needs. Collaborative
development of the Treatment Plan will guide the selection of appropriate treatment services.
The Juvenile Drug Court is consulted with any recommended changes in treatment plans.(SOW
11.A.2.b)The program includes attendance of frequent progress reviews with the Judge. (SOW
I IA2.c)
Interventions: Treatment components will include process and community groups,
psychoeducation, individual counseling, individual therapy, family counseling. multi-family
group sessions, case management, and discharge planning, Specialized groups may include
process groups on the topics of: SLID education, Anger Management, Life Skills, Recreation
Therapy, Art Therapy, Gender specific activities, Support groups, and additional groups as
indicated by court orders and for client population demographics.
Urinalysis (UA) Drug Testing and Reporting: Drug testing and reporting will
address Issues of reducing the use and incidence of substance abuse. Mandatory UA
testing has been and is proposed to continue to be an important part of treatment services.
Results are recorded and shared within the treatment team as needed and ordered by the
Juvenile Drug Court to measure the overall effectiveness of the treatment services. MHS
outpatient program incorporates a UA testing hotline that clients call on a daily basis to ensure
random testing for our clients.
JDC Levels and Phases: As youth progress through the treatment program, they learn
pro-social roles and adaptive skills, Youth are exposed to new roles as they learn to hold each
other accountable and provide peer support in groups. The Juvenile Drug Court's Social Learning
model promotes the character values that will include Trustworthiness, Respect, Caring,
Citizenship, Responsibility, and Fairness. The goal is to provide a safe, sober, supportive, and
positively structured environment for youths to work a program of recovery in all areas of life,
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including school, work, home, social relationships, leisure, and play, promoting personal
responsibility for one's own behaviors. The program presents treatment activities in levels and
phases, structured in logical progression from orientation through graduation and discharge.
• Phase One: During this time, clients continue to become familiar with the Juvenile
Drug Court program and expectations. Clients in this phase attend treatment groups
three times a week for 90 minutes as well as AIM group once a week for 60 minutes, in
addition to any Intake and Assessment, Treatment Planning, Crisis Intervention, and
Collateral Services as needed and averaging 60 minutes a session. Additionally, clients
and adult family members meet bi-weekly for 60-minute Parent Advisory groups. Youth
must complete 60 days sober to obtain Phase Two. other conditions affecting promotion
are UA, substance use, daily group attendance and participation according to "Character
Counts" pillars, Adolescents in Motion (AIM) group attendance and participation, school
attendance and participation, and attending court appointments.
• Phase Two: During this time, clients continue to become acclimated to the program and
treatment process, Clients in this phase attend treatment groups twice a week for 90
minutes as well as AIM group once a week for 60 minutes, in addition to any Intake and
Assessment, Treatment Planning, Crisis Intervention, and Collateral Services as needed
and averaging 60 minutes a session. Additionally, clients and adult family members meet
bi-weekly for 60-minute Parent Advisory groups. Youth must complete 60 days sober to
obtain Phase Three. other conditions affecting promotion are UA, substance use, daily
group attendance and participation according to "Character Counts" pillars, AIM group
attendance and participation, school attendance and participation, and attending court
appointments.
• Phase Three: During this time, clients actively engage in program activities and the
treatment process. Clients in this phase attend treatment groups once a week for 90
minutes as well as AIM group bi-weekly for 60 minutes, in addition to any Intake and
Assessment, Treatment Planning, Crisis Intervention, and Collateral Services as needed
and averaging 60 minutes a session. Additionally, clients and adult family members meet
bi-weekly for 60-minute Parent Advisory groups, Youth must complete 60 days sober
meeting their treatment plan goals to reach Phase 4. other conditions affecting promotion
are UA, daily group attendance and participation according to "Character Counts",
attendance and participation in AIM group, school, and court appointments.
Process Groups: Clients process how they are feeling, their personal struggles with
relapse, triggers, and issues they want to share with the group to receive feedback. With a group
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size of 2 to 12 youth, process groups allow youth to share their experience, receive feedback from
multiple perspectives, and witness peers in recovery. Process Groups are a powerful tool used in
substance abuse treatment that assists reducing isolation, building a positive peer support
system, and motivating youth to achieve the same success they see their peers achieving.
Psycho-educational Groups: The program consists of SUD education groups and
process groups. An effective adolescent SUD program must address four principal areas: 1)
symptoms and patterns of behavior common to all addictive diseases; 2) issues specific to
adolescents; 3)unique issues directly related to culture or ethnicity; and 4) Issues related to family
dynamics. The program's Educational Component addresses issues using age-appropriate
methods that educate youth in a manner relevant to their lives. Exercises from the curriculum
workbook are incorporated in adolescent groups. The curriculum currently in use is available
for review upon request.
The curriculum workbooks, "Matrix Model for Teens," combine years of experience
between two organizations, the Hazelden Foundation, and the Minnesota Department of
Corrections. The cognitive-behavioral treatment curriculum mapsa life of recovery and freedom
for chemically dependent offenders. Assignments are step by step through intake and
orientation, criminal and addictive thinking, drug and alcohol education, socialization, relapse
prevention, and release and reintegration preparation. The curriculum is designed to help
clients see how thought processes lock in destructive behaviors, recognize links between
addiction and criminal activity, develop healthier ways of relating to others, and learn to keep
recovery strong. They are incorporated into treatment plans based on the individual's strengths,
and supported throughworkbook study groups, peer discussions, school activities, individual
check-ins with counselors, and a self-monitored system to encourage individual
responsibility. Workbook completion is part of the program requirements for successful
graduation and serves as a concrete, visual measurement for clients and an outcome
measurement tool for the program.
Individual Counseling: Individual substance abuse counseling is available to Juvenile
Drug Court youth for Intake and Assessment, Treatment Planning, Crisis Intervention, and
Collateral Services as needed and averages 60 minutes a session. The youth is encouraged to
discuss recovery related issues in the group and community meetings to fully benefit from the
therapeutic community. However, some youth may find certain Issues too sensitive or
emotionally overwhelming to divulge to the community but may be able to effectively work on
these problems through individual counseling.
Family Counseling Groups: Family group substance abuse counseling is provided bi-
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weekly in a multi-family group setting. During the initial phase of the program families are
informed of the support group and encouraged to participate. Any family member can speak with
the substance abuse counselor at any time.
Family Group Psycho-Educational Sessions: Focus on prevention topics and allow
families to share experiences. Many families fear talking about 'family secrets." Some "secrets"
include other members using drugs, violence in the home, financial struggles, judicial problems,
and fears of losing their children. The group is designed to allow members to speak freely and
fosters mutual identification of possible solutions to common problems. Issues, such as abuse
and domestic violence, are referred for further assistance to appropriate resources. Family
members are asked to sign information release forms when using outside resources, to allow
communication between agencies and maximize support for the clients and avoid duplication of
services.
Self-Help Group Participation (12-Step Programs): Twelve-Step meetings are an
important adjunct support system and a requirement of each treatment plan. Clients learn about
the program via workbooks and guest speakers sharing their experiences, strength, and hope.
Many youths report a reluctance to attend outside meetings, so this helps to familiarize themand
experience the positive benefits.
Fresno County Juvenile Delinquency Court has historically funded and maintained an
"Adolescents In Motion" (AIM) group which has been supported and co-located at Family
Youth and Alternatives through a Memorandum of Understanding. The AIM group has been a
critical element of Juvenile Drug Court and mandatory attendance has been part of the Judge's
orders and required collaborative reporting. The AIM group is currently facilitated twice weekly for
60 minutes to accommodate one mandatory attendance per week for those youth ordered to
Juvenile Drug Court and in consideration of group size limits. The AIM group will continue to be
court ordered as part of the Juvenile Drug Court program.
Education: Most youth in the Juvenile Drug Court have histories of academic failure that
increases their risk of substance abuse, delinquency, and violence. In most cases the reason for
failure is not for lack of ability, but rather the experience of failure itself. MHS believes that every
youth can be successful and will work with the youth and educational system to ensure success.
During the youth's time in the program this may mean coordinating referrals for specialized
tutoring, developing incentive programs, advocating for diagnostic educational assessment for
learning disabilities, or inviting teachers to be part of the treatment team. Academic success is a
key predictor for maintaining a drug and crime free life and, as such, is a key component of the
youth's discharge and outpatient treatment plan. The SUD counselor will coordinate school
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placement at discharge, arrange mentoring/tutoring, and other support services as necessary.
Discharge Plan: Discharge planning begins at intake and is revised during the treatment
phase with input from the treatment team. The discharge plan will recommend the level of care
required; describe SUD outpatient care, mental health follow-up, educational and/or vocational
plan, and necessary services and referrals for the family to support recovery.
Case Management: The certified SUD counselor has been responsible to provide case
management services for the program youth and their families. This includes coordination of
services from various agencies, collaboration on discharge planning to ensure youth and family
have a complete and appropriate plan, access to outpatient services that address language and
cultural needs and identify barriers to obtaining services.
SUD-Free Recreational and Pro-Social Activities: Drug-free, organized,
interactive social and recreational activities are a key feature and are built into the program
structure. Such activities help the participants that they can have fun without the influence of
substances. Progress is monitored and documented by the counselor. Supervised activities may
include basketball, flag football, baseball, aerobics, and yoga, and social events such as holiday
celebrations. The program will seek volunteers to demonstrate various sport and recreational
opportunities, such as music, dance, yoga, meditation, sports, makeup and fashion skills,
camping, hiking, and backpacking. Youth are encouraged to attend sober and clean social and
recreational events during a phase of treatment.
Sanctions: All youth and families voluntarily agree to participate in the Juvenile Drug
Court and state their understanding that to continue to participate in the program, compliance
with program requirements is necessary. While each situation is considered on a case-by-case
basis and all program staff endeavor to make reasonable accommodations, the Judge reserves
the right to impose sanctions on the youth for not meeting program requirements. MHS proposes
to continue to support the Judge imposed sanctions which range from community service hours,
to flash incarceration of 1-30 days, phase demotion, and removal from the Juvenile Drug Court
with recommendation for referral to Floyd Farrow Substance Abuse Unit or other appropriate
services.
IN-CUSTODY SUBSTANCE ABUSE UNIT (SAU) (SOW ILA):
MHS proposes implementation of a streamlined organization of evidence-based models
and services within the Substance Abuse Unit, identifying and continuing to utilize the wealth of
effective facets of the current program within the framework of more robust evidence-based
models. The selected models inherently integrate those evidence-based practices that are
Revised Exhibit A-1
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successfully being used at the program.
Youth within the U.S.juvenile justice system are among the most traumatized, therefore is
a need for trauma sensitive treatment to address the mental health needs of traumatized,
delinquent youth and prevent re-traumatization within the juvenile justice system. As such, MHS'
Floyd Farrow Substance Abuse Unit (FFSAU) will implement dialectical behavior therapy (DBT)
to meet the needs of the target population.
DBT is a promising treatment for juvenile delinquents with trauma histories. DBT for
Juvenile Justice involved youth supports rehabilitation through the mechanism of mindfulness by
targeting post-traumatic stress reactions,which in turn may reduce anti-social behaviors. Through
decreased experiential avoidance and enhanced emotional regulation skills, our program youth
can learn life-long skills that lead to improved social relationships, long-term behavioral change,
and ultimately the likelihood of reduced recidivism.
DBT itself is a specific type of cognitive-behavioral therapy. The central dialectic within
DBT is to balance acceptance of the person exactly they are in this moment with intense efforts
to change the person's life to increase adaptive functioning and decrease maladaptive behavior.
The overarching goal of treatment with DBT is to help individuals develop, as its founder, Dr.
Marsha Linehan would say, "a life worth living."
DBT has four major components:
• Weekly individual (one-to-one) therapy
• Weekly skills-training sessions, usually in the form of groups
• As-needed consultation between client and therapist outside of sessions
• Weekly therapist consultation meeting in which DBT therapists meet to discuss
their DBT cases
The content of the therapy session generally revolves around targeting a high-priority
event that occurred within the past week, helping the youth identify all the factors that led up to
and followed the event (via a process called behavioral analysis) and then determining and
practicing new ways of responding in the similar situations. The skills-training component of DBT
involves teaching the youth specific skills designed to help improve their life in four major areas:
mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance. Therapists
make themselves available between sessions for consultation to help youth apply new skills to
prevent the use of problematic behaviors. Finally, the weekly treatment/consultation team is
designed to help therapists get the support they need, as well as increase their motivation and
adherence to DBT principles.
The central concept of DBT is mindfulness. Which means being in the present, being
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aware of what is happening and what you are doing, observing what is going on, participating fully
in what is going on around you. It is a skill that is practiced and learned throughout DBT, little by
little. The 3 primary states are: 1) Reasonable Mind: When a person uses Reasonable Mind they
approach things intellectually, thinking logically, planning behavior. paying attention to empirical
facts (facts that can be observed or measured or counted), focusing their attention, and when
they are not emotional in their approaches to solving problems; 2) Emotional Mind: When a person
is in Emotional Mind their thinking and behavior are controlled primarily by their emotions. It is
difficult to think and plan, facts can be distorted or exaggerated or seem more important than is
so, thoughts and behaviors tend to match the intensity of the often-irrational feeling; and 3) Wise
Mind Is the integration of Reasonable Mind and Emotional Mind. When they come together, they
create something bigger than either of them separately. There Is room for intuition, as a sense of
"knowing" what is right, some people feel this in their body (head, heart, stomach) and just know
something is right, whether it's the right thing to do or the right way for things to be. Intuition can
let a person know what's right without thinking about it,without knowing it intellectually,just feeling
it. DBT provides a way for youth to achieve a greater level of wellness and gain the tools to react
in a balanced manner.
Though originally developed for individuals who suffered from borderline personality
disorder, DBT has been adapted to treat self-Injurious behavior in youths and substance use
problems. Applying use of DBT in the case where substance abuse is the highest order DBT
target within the category of behaviors that interfere with quality of life. DBT's substance-abuse-
specific behavioral targets include:
• Learning to avoid opportunities and cues to abuse, for example by burning bridges
to persons, places, and things associated with drug abuse.
• Reducing behaviors conducive to drug abuse, such as momentarily giving up the
goal to gel off drugs and instead functioning as if the use of drugs cannot be avoided.
• Increasing community reinforcement of healthy behaviors, such as fostering the
development of new friends, rekindling old friendships, pursuing social/vocational
activities, and seeking environments that support abstinence and punish behaviors related
to drug abuse (this is the point in which Social Learning naturally integrates with DBT).
It is important to note that the reason DBT has been adapted for those different disorders
is because each of these conditions is theorized to be associated with problems that stem from
maladaptive efforts to control intense, negative emotions. Coupled with its being trauma-informed,
CBT intervention, and conducive to integration with a Social Learning model, which is discussed
next, DBT is uniquely well-suited for use in the SAU program.
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Social Learning suggests that addiction is rooted in the way individuals observe and learn from
their peers and role models. Treatment based on this theory can help individuals to break out of
negative thought and behavioral patterns. Sadly, individuals don't just learn from the positive
influences of people whom they admire-negative influences throughout their lives have the
capacity to shape them too.
A person's observations and expectations of other's experiences with drugs and alcohol
can influence the way that person views and uses these substances. Human nature is to learn by
example. The social learning theory explains how social observations alter attitudes and
behaviors in a way which could make an individual more vulnerable to addiction. Social learning
theory asserts that humans can learn by watching another person, not just from her or his own
experiences. Behaviors, thought processes, and even emotional reactions are developed from
these observations. While this type of learning can be empowering and even protective, no one
is immune to the bad influences in their lives. According to UMASS Lowell, Social Learning
impacts individuals in the following ways:
Self-Regulation: Attitudes, beliefs, expectations, and perceptions of circumstances shape
how a person relates this or her environment to his or her behaviors. An individual's understanding
of this relationship alters how the person self- regulates his or her future behaviors.
Modeling
• Modeling: Youth (indeed all humans) learn and make decisions based on what
they see their peers or rote models doing. This happens by:
• Acquisition: People are far more likely to use substances if they see someone
doing so.
• Inhibition or dis-inhibition: The ability to abstain from using is either built up or
weakened by how a person sees other people resisting or giving In to drugs.
• Response facilitation: The risk of using goes up when a person sees people around
them abusing drugs or alcohol.
• Expectations: If a person expects positive outcomes or rewards to accompany
drinking or using drugs the person is more likely to engage in these risky behaviors.
• Self-Efficacy: How person views him- or herself and his or her capability to handle
certain situations impacts the person's capacity to change or set healthy goals.
Fortunately, treatment can counteract harmful perspectives within the lives of participants.
Even though people learn a lot of unhealthy mindsets in childhood, it's also important to stay away
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from negative influences as adolescents-and adults. If a person is exposed to positive influences
and experiences within treatment, they can begin to model their own behaviors in these ways. In
view of this, New Horizons Programs help program youth to build better self-efficacy through
Social Learning and DBTs integration of the following:
• Cognitive Behavioral Therapy (CBT): Individual and group CBTs focus primarily
on reducing patients' positive expectances about substance use, enhancing their overall
self-confidence and self-efficacy to resist substance misuse, and improving their skills in
coping with daily life stressors, including relapse-inducing situations.
• Family Counseling: These sessions help families to resolve conflicts, build
solidarity, lend support, and reward each other for abstinence.
• Treatment Community's Support: These methods encourage abstinence with
reward-based incentives and expose participating youth to positive role models.
• Motivational Interviewing (MI): Helps to increase the youth's motivation for and
dedication to change.
• Twelve-Step Facilitation: Provides abstinent role models and teaches enhanced
coping and stress-management skills. (Youth will be introduced to this within the Unit at
SAU but will not attend meetings.)
• Diary Cards: The introduction of DBT-informed Diary Cards will help guide
journaling and provide them with a means for tracking their feelings and behaviors.
(Please see Appendices.)
The complementary combination of services is organized to treat the interaction of mental
health and substance abuse disorders for youths incarcerated in the Fresno County Juvenile
Justice Campus. In providing these services, MHS uses a team approach, with County Mental
Health serving as a key partner.
MHS proposes to continue to incorporate the following interventions in the New Horizons
Program. Combining family centered services that are strength based and recognizing that the
youth and family are part of a larger system and likely have needs other than substance abuse or
mental health that may impact their progress in treatment if not addressed. MHS staff will partner
with the youth and family do develop and implement a structured program that addresses
academic, social, emotional, psychological, substance abuse, and socio-economic needs.
Collaborative development of the Treatment Plan will guide the selection of appropriate treatment
services:
Interventions: Treatment components will include process and community groups,
Revised Exhibit A-1
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psychoeducation, individual counseling, individual therapy, cognitive behavioral therapy, family
counseling, multi-family group sessions, case management, and discharge planning. Specialized
groups may include process groups on the topics or: SUD education, Anger Management, Life
Skills, Recreation Therapy, Art Therapy, Gender specific activities, support groups, and additional
groups as indicated by court orders and for client population demographics. Treatment
components are further matched with specific and individual needs as identified during the intake,
assessment. and evaluation process.
Urinalysis (UA) Drug Testing and Reporting: Urinalysis drug testing and reporting will
continue to be provided in collaboration with Fresno County Probation and Fresno County
Juvenile Justice Campus as needed to address Issues of reducing the use and incidence of
substance abuse. Testing concerns will continue to be communicated to the supervising probation
officers who arrange for testing and share those reports with program staff as needed.
In-Custody Program Levels and Phases: As youth progress through the treatment
program, they learn pro-social roles and adaptive skills. During orientation, members are exposed
to new roles as they learn to hold each other accountable and provide peer support in groups.
Each adolescent is assigned tasks in the community, with increasing responsibility as he/she
progresses through the program. The New Horizons Program's Social Learning community
promotes the character values of trustworthiness, respect. caring, citizenship, responsibility, and
fairness. The goal is to provide a safe, sober. supportive and positively structured environment
for youths to work a program of recovery in all areas of life, including school, work, home, social
relationships, leisure, and play, promoting personal responsibility for one's own behaviors. The
program presents treatment activities in levels and phases, structured in logical progression from
orientation through graduation and discharge.
Orientation Stage: Clients first entering the New Horizons Program start with the
Orientation Stage. During this time, they will become familiar with the program. process, and
expectations. They will have 3 group days to complete an Orientation Test and journal
assignment. During this time, the clients will be assigned "mentors- from their group who will help
them through this stage. After 3 group days, the group will vote as to whether or not the youth has
successfully completed the requirements of Orientation Stage and is ready to progress to Stage
One. If the group feels the youth is not ready to progress, they may vote to leave them on
Orientation for a specific time or place them on Contract Stage with very clear about the
expectations to advance.
• Stage One: During this time, clients continue to become familiar with the program
and the group process. They continue working with assigned "mentors" from their group
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who will help them through this stage. Stage One is summarized best by a former youth
participant"this is when I start to figure out what my problems are and what I can do about
fixing them. After 28 days of satisfactory progress, the group will vote as to whether or not
the youth has successfully completed the requirements of Stage One and is ready to
progress to Stage Two. Other conditions affecting promotion are daily points earned
according to "Character Counts" pillars,journal assignments. Daily group attendance and
participation, school attendance and participation, and avoiding demotions by Fresno
County Probation staff for behavior issues. If the group feels the youth is not ready to
progress, they may vote to leave them on Stage One for a specific time or place them on
Contract Stage with very clear about the expectations to advance.
• Stage Two: During this time, clients are expected to have become familiar with the
program and the group process. They continue working with assigned mentors from their
group who will help them through this stage. Stage Two is summarized best by a former
youth participant: "this is when I knew what my problems are, and I am making an effort
to fix them."After 28 days of satisfactory progress, the group will vote as to whether or not
the youth has successfully completed the requirements of Stage Two and is ready to
progress to Stage Three. Other conditions affecting promotion are daily points earned
according to "Character Counts" pillars, journal assignments, daily group attendance and
participation, school attendance and participation, and avoiding demotions by Fresno
County Probation staff for behavior issues. If the group feels the youth is not ready to
progress, they may vote to leave them on Stage Two for a specific time or place them on
Contract Stage.
• Stage Three:At this stage, clients are fully engaged and actively addressing issues
and goals as identified on the treatment plan. Due to their experience and familiarization
with the program, they begin working in a "Leadership Group" to co-facilitate Community
Groups, with assistance from the program staff, as well as being assigned as "mentors"
for others in their group to help them through their stages. Stage Three is summarized
best by a former youth participant, "this is when I know what my problems are, I have been
trying to fix them, and I am recognizing personal success." Conditions affecting stage
preservation are daily points earned according to "Character Counts" pillars, journal
assignments, dally group attendance and participation, school attendance and
participation, and avoiding demotions by Fresno County Probation staff for behavior
issues. Also, at this stage of progress in the program, youth become eligible to apply for
home passes known as "Furloughs" under the supervision and structure of the Fresno
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County Juvenile Justice Campus. Extra attention and support are provided to the youth
and families for reintegration into the family and community structure, especially regarding
relapse. Stage Three is a graduating stage and all of the youth who leave the program at
this stage do so with successful progress in identifying problem areas, competence at new
skills to address concurrent and future problem areas in a sober and socially responsible
manner and recognizing personal and family success in using their newly learned skills.
• Stage Four: Clients attaining Stage Four have completed (60) days in Stage Three
and have further demonstrated their successful experience and high level of familiarization
with the program as they regularly work together with other Stage Three's and Four's in a
"Leadership Group" to co-facilitate Community Groups, with assistance from the program
staff, as well as being assigned as "mentors"for others in their group to help them through
their stages. Stage Four is summarized best by a former youth participant: "This is when
I know what my problems are, I have been making an effort to fix them, I am recognizing
personal success and I can help show the way to others." Conditions affecting stage
preservation are daily points earned according to "Character Counts" pillars, journal
assignments, daily group attendance and participation, school attendance and
participation, and avoiding demotions by Fresno County Probation staff for behavior
issues. Also, at this stage of progress in the program, youth continue to be eligible to apply
for home passes known as "Furloughs" under the supervision and structure of the Fresno
County Juvenile Justice Campus. Extra attention and support are provided to the youth
and families for reintegration into the family and community structure, especially regarding
relapse. Stage Four is a graduating stage and all of the youth do so with successful
progress in identifying problem areas, competence of new skills to address concurrent
and future problem areas in a sober and socially responsible manner and recognizing
personal and family success in using learned skills.
Following are components of treatment provided within the program's framework of DBT and
Social Learning.
Process Groups: Address issues of personal responsibilities, such as journals, daily self-
responsibility, behavior on the unit, and progress toward goals. They will also involve with
evaluations, level advancement, and disciplinary actions.
Community Groups: Which include everyone on the unit allow youths to have an active
voice in the treatment community. Youth can discuss concerns or make suggestions during the
meeting and are encouraged to address peer behaviors that are not supportive of the community
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or healthy living as a group, with staff oversight. Participants come together to resolve shared
problems, plan activities, give and receive feedback to shape pro-social behavior, and share
successes and failures.
Psycho-Educational Groups: The program consists of SUD education groups and
process groups. An effective adolescent SUD treatment program must address four principal
areas: 1) symptoms and patterns of behavior common to all addictive diseases; 2) issues specific
to adolescents; 3) unique issues directly related to culture or ethnicity; and 4) issues related to
family dynamics. The program's Educational Component addresses issues using age-appropriate
methods that educate youth in a manner relevant to their lives. Exercises from the evidenced-
based curriculum workbook are incorporated in adolescent groups. The curriculum currently in
use is available for review upon request.
The workbooks include the Matrix Model for Teens, and Hazelden's Criminal and Addictive
Thinking offer cognitive behavioral treatment curriculums that map a life of recovery and freedom
for chemically dependent offenders. Assignments are step by step through intake and orientation,
criminal and addictive thinking, drug and alcohol education, socialization, relapse prevention, and
release and reintegration preparation. The curriculum is designed to help clients see how thought
processes lock in destructive behaviors, recognize links between addiction and criminal activity,
develop healthier ways of relating to others and learn to keep recovery strong. They are
Incorporated into treatment plans based on the individual's strengths, and supported through
workbook study groups, peer discussions, school activities, individual check-ins with counselors,
and a self-monitored system to encourage individual responsibility. Workbook completion is part
of the program requirements for successful graduation and serves as a concrete, visual
measurement for clients and an outcome measurement tool for the program.
MHS' experience in providing substance abuse treatment to similar target populations of
youth as those in the New Horizons Program at the Fresno County Juvenile Justice Campus
informs of the need to continue providing Anger Management. As youth leave the bio-chemical
influences of substances they often find they lack sufficient knowledge and tools to manage their
emotions.
Individual Counseling: Individual substance abuse counseling is available to youth in
the program in the form of Intake and Assessment, Treatment Planning, Crisis Intervention, and
Collateral Services as needed and averages (60) minutes per session. The youth are encouraged
to discuss recovery related issues in the group and community meetings to fully benefit from the
therapeutic community; however, some youth may find certain issues too sensitive or emotionally
overwhelming to divulge to the community but may be able to effectively work on these problems
Revised Exhibit A-1
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through individual counseling.
Individual Therapy: Individual psychotherapy has been identified a crucial part of dual
treatment in co-occurring disorders. Individual psychotherapy is provided by a qualified mental
health clinician under the direct supervision of a licensed mental health clinician, in accordance
with California Board of Behavioral Health requirements and as needed to assess, diagnose, and
treat Severe Emotional Disorders pursuant to Section 1911(c) of the Public Health Service Act.
Individual therapy is guided by the therapeutic goals established with the minor during the
assessment. These goals focus on alleviating the symptoms of the mental health diagnosis,
address impairment in functioning and build on the strengths and coping skills of the minor.
Family Therapy: Family psychotherapy has been identified a crucial part of dual
treatment in co-occurring disorders. Family psychotherapy is provided by a qualified mental health
clinician under the direct supervision of a licensed mental health clinician, in accordance with
California Board of Behavioral Health requirements and as needed to assess, diagnose, and treat
Severe Emotional Disorders. Family psychotherapy is guided by the therapeutic goals established
with the minor during the assessment. These goals focus on alleviating the symptoms of the
mental health diagnosis, address impairment in functioning and build on the strengths and coping
skills of the minor.
Family Counseling Groups: Family counseling groups for substance abuse are provided
weekly in a multi-family group setting. During the initial phase of the program families are informed
of the support group and encouraged to participate. Any family member can speak with the
substance abuse counselor at any time.
Family Group Psycho-Educational Sessions: Focus on prevention topics and allow
families to share experiences. Many families fear talking about "family secrets." Some "secrets"
include other members using drugs, violence in the home, financial struggles, judicial problems,
and fears of losing their children. The group is designed to allow members to speak freely and
fosters mutual identification of possible solutions to common problems. Issues such as abuse and
domestic violence, are referred for further assistance to appropriate resources. Family members
are asked to sign information release forms when using outside resources, to allow
communication between agencies and maximize support for the clients and avoid duplication of
services.
Family services may be provided in person, virtually, or via telephone. Outreach to families
will be tracked.
Self Help Group Participation (12-Step Programs): Twelve-Step meetings are an
important adjunct support system and introduction of them is part of each treatment plan. Clients
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learn about the program via workbooks and guest speakers sharing their experiences, strength,
and hope. Many youths report reluctance to attend outside meetings so this helps to familiarize
them and experience the positive benefits.
Education: Most youth in the program have histories of academic failure that increases
their risk of substance abuse, delinquency, and violence. In most cases the reason for failure is
not for lack of ability, but rather the structure and reinforcement of successful experience. MHS
believes that youth must not be allowed to fail and will work with the educational system to ensure
success. During the youth's time in the program this may mean coordinating referrals for
specialized tutoring, developing incentive programs, advocating for diagnostic educational
assessment for learning disabilities, or inviting teachers to be part of the treatment team.
Academic success is a key predictor for maintaining a drug and crime free life and, as such, is a
key component of the youth's discharge and outpatient treatment plan. The SUD counselor,
mental health clinician, and Family Support Partner will coordinate school placement at discharge,
arrange mentoring/tutoring, and other support services as necessary.
Gang Prevention: For those youth who report or are otherwise identified by Fresno
County Probation or Courts as being at risk of gang affiliation, being gang affiliated, or having
validated membership in a gang, SAU utilizes specifically adapted cognitive behavioral therapy
and evidence-based curriculum to address underlying issues and promote reintegration into the
community with pro-social skills and behaviors.
Domestic Violence and Batterer's Classes: For those youth who report or are otherwise
identified by Fresno County Probation or Courts as being required to complete Domestic Violence
or Batterer's Classes, SAU proposes to continue to provide classes by certified facilitators at the
request of Fresno County Probation. SAU has staff who are certified facilitators and include
facilitator certification as part of the staff training plan.
Discharge Plan: Discharge planning begins at intake and is revised during the treatment
phase with input from the treatment team. The discharge plan will recommend the level of care
required; describe SUD outpatient care, mental health follow-up, educational and/or vocational
plan, and necessary referrals for the family to support recovery. The discharge plan is
documented on the Release Plan form.
Case Management: The certified SUD counselor, mental health clinician, and Family
Support Partner have been responsible for providing case management services for the youth
and their families. This includes coordination of services from various agencies, collaboration on
discharge planning to ensure youth and family have a complete and appropriate reentry plan,
access to outpatient services that address language and cultural needs and identify barriers Io
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obtaining services.
SUD-Free Recreational and Pro-Social Activities: Drug-free, organized, interactive
social and recreational activities are a key feature and are built into the program structure. Such
activities help the participants that they can have fun without the influence of substances.
Progress is monitored and documented by the counselor. Supervised activities may include
basketball, flag football, baseball, aerobics, and yoga, and social events such as holiday
celebrations. The program will seek volunteers to demonstrate various sport and recreational
opportunities, such as music, dance, meditation, sports. and life skills classes.
Bringing family and/or caretakers into the treatment process as soon as possible assists
in reducing post release risks, decreases recidivism, and facilitates a successful reintegration into
the community. However, MHS understands that a youth's parents may not be available or, as a
result of their own substance abuse or criminal involvement, may be unable to be a positive
support for the youth's treatment. MHS staff will help the youth identify and engage another
linguistically and culturally appropriate adult, preferably a relative who has the youth's trust and
faith. Family describes a biologically or socially related adult with a positive relationship to the
youth. In this context, parent includes biological, adoptive, or foster parents, grandparents, or any
adult caretaker assuming responsibility for the youth's care and custody.
Following is a description of SAU Program Groups within the context of how they may be
scheduled weekly. The frequency of participation in groups will be determined by the youth's
treatment plan. MHS may also coordinate with Probation's other provider of group intervention
curriculum services for group services.
• Monday: Core Leadership Group: Selected Stage Three's and Stage Four's meet
together as a peer leadership group to address community issues and strategize solutions.
They further discuss the youth who recently arrived too the program, evaluate peer
mentoring relationships, and discuss youth who will be sitting for evaluation and stages
promotions.
• Monday: Social Learning Community Group: Selected Stage Threes and Stage
Fours co-facilitate with staff a peer process group with all youth in the program to address
community issues and solutions. They further discuss the youth who recently arrived at
the program, evaluate peer mentoring relationships, and discuss youth who will be sitting
for evaluation and stages promotions. Promotions only occur during the Community
Group.
0 Monday Night: Family Awareness Group: All parents/guardians of the youth in the
Revised Exhibit A-1
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program are invited to attend a process group with their children. Various topics are
presented by the SUD counselor, mental health clinicians, and Family Support Partner
including substance abuse education and treatment, drug prevention and education,
multiple family group psychotherapy, psychoeducational groups, parenting skills,
awareness of community resources available to families, as well as aftercare resources
for youth.
• Tuesday: Substance Abuse Treatment and Process Group: Youth in the program
participate in processing topics including: substance abuse education and treatment, drug
prevention and education, triggers/cravings, identifying supportive relationships, and
introduction to the 12-step model. Treatment is planned using the Matrix Model for Teens
and Hazelden New Directions Curriculum.
• Wednesday: Clinical Process Group: Youth in the program participate in
psychotherapeutic process groups. Topics frequently support processing the substance
abuse groups but are customized to meet the needs of the group; however, all youth in
the program participate in curriculum topics that address all psycho-social development
and barriers that teens may face, including emotional barriers, cognitive barriers and
distortions that can inhibit a youth's success, such as substance abuse, trauma, gang
involvement and mental health challenges. Staff also include other topics as identified by
program staff or court order and Fresno County Probation. The topics are rotated on a
quarterly basis to ensure that all youth receive all necessary and court ordered services.
Thursday: Group topics may vary and can address delinquent behaviors and teach
pro-social skills by motivating the group members to actively participate in their own
learninq and takinq responsibility for their own life situations. Group facilitators will
demonstrate cognitive perspectives of the program: social skills, the skill of cognitive self-
change and problem-solving skills. The program staff re-enforce skills by utilizing them in
the daily programming with the youth to ensure the skills are learned.
• Friday. Group topics are kept to lighter issues and serve to wrap up the week's
learning. Program staff further take advantage of Friday groups to closely evaluate youth's
current status and formulate weekend strategies for maintaining appropriate behaviors
and attitudes through the weekend when regular program services resume.
Weekends can be a difficult time for some youth as others leave for home passes to spend
time with family and they remain in the program. The program manager is available by cell
phone to provide support through the weekend and after hours. Mental Health and medical
emergencies are referred to Fresno County Juvenile Justice Campus staff, Contracted
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Mental Health staff, and 911 if needed.
• Fridays: Client Raffle Incentive - Client recognition of goals for the week is
available to au youth who meet behavior criteria to participate. Youth earn credits based
on daily scores which are related to behavior, taking responsibility and completion of
assigned tasks. -occurring disorders.
• Store: Every two weeks on Fridays: The JJC campus store privilege is available to all
youth who meet behavior criteria to participate. Youth earn credits based on daily scores
which are related to behavior, taking responsibility andcompletion of assigned tasks. The
store contains items such as snacks, stationary, and hygiene items. MHS proposes
continued cooperation with Fresno County Behavioral Health Court, Fresno County
Probation, Fresno County Mental Health, other agencies, and staff located at the
Fresno County Juvenile Justice Campus, as well as appropriate community resources
in sustaining evidenced based curriculum for the youth and families in the community to
treat severe emotional disturbances, substance abuse, and other co-occurring disorders.
POST RELEASE OUTPATIENT PROGRAM SERVICES (PROPS) (SOW 11.C)
Upon successful completion of the in-custody SAU program youths are returned home
to their families and those identified as needing post-release out-patient services continue the
continuum of care. PROPS services will be provided in accordance with Drug Medi-Cal
Standards in addition to the Youth Treatment Guidelines, and all youth will continue to be
screened for Medi-Cal eligibility as Drug Medi-Cal be the primary funding for PROPS. (SOW
11.C.2.a&b)
The six-month post-release program (PROPS) provides intensive out-patient services.
The continuity of service allows clinicians to develop a consistent and longer-term therapeutic
relationship with the youths and their family (6 months in-custody, 6 months post-release).
This consistent and stable relationship between client and clinician assists in maintaining
stability, family participation and treatment compliance as the client reintegrates into their
community and peer culture. The PROPS program provides the following services:
• Intensive substance abuse treatment services
• Individual and family therapy and mental health services as needed.
• Crisis intervention.
• Case management provided by the multidisciplinary team.
• Process and family groups, ancillary referrals, educational/vocational assistance, Life
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Page 30 of 35
Skills curriculum. coordination of clean and sober activities, educational forums, and
family centered activities
• Information and referral to community-based 12-Step programs.
• Opportunities for community service work; and clean and Sober social and recreational
activities.
MHS will continue to incorporate the following interventions in PROPS provided through
Family and Youth Alternatives program. This will be achieved while combining family-centered
services that are strength based and recognizing that the youth and family are part of a larger
system and likely to have needs other than substance abuse or mental health that may impact
their progress In treatment if not addressed. MHS staff will partner with the youth and family
to develop and implementa structured program that addresses academic, social, emotional,
psychological, substance abuse, and socio-economic needs. Collaborative development of
the Treatment Plan will guide the selection of appropriate treatment services.
Interventions: Treatment components will include psychoeducation, individual
counseling, individual therapy, family counseling. family counseling, multi-family group
sessions, case management, and discharge planning. Specialized groups may include
process groups on the topics of: SUD education, Anger Management, Life Skills, Recreation
Therapy, Art Therapy, Gender specific activities, Support groups, and additional groups as
indicated by court orders and for client population demographics.
Urinary Analysis (UA) Drug Testing and Reporting: Urinalysis drug testing and
reporting will address issues of reducing the use and incidence of substance abuse.
Mandatory UA testing has been and is proposed to continue to be an important part of
treatment services. Results are recorded and shared within the treatment team as needed
and ordered by the FresnoCounty Juvenile Drug Court to measure the overall effectiveness
of the treatment services. MHS outpatient program incorporates a UA testing hotline that
clients call on a daily basis to ensure random testing for our clients.
PROPS Program Levels and Phases: As youth progress through the continuum of
care from incarcerate programs to post release,they learn pro-social roles and adaptive skills.
Youth are exposed to new roles as they learn to hold each other accountable and provide
peer support in groups. The goal is to provide a safe, sober, supportive, and positively
structured environment for youths to work a program of recovery in an area of life, including
school, work, home, social relationships, leisure, and play, promoting personal responsibility
for one's own behaviors. The program presents treatment activities in levels and phases
Revised Exhibit A-1
Page 31 of 35
continued from the FFSAU, structured in logical progression from orientation through
graduation and discharge.
• Phase Five: During this time, clients continue to become familiar with the PROPS
program and the treatment process. Clients in this phase attend treatment groups three
times a week for 90 minutes as well as AIM group once a week for 60 minutes. in
addition to any Intake and Assessment, Treatment Planning, Crisis Intervention, and
Collateral Services as needed and averaging 60 minutes a session. Additionally,
clients and adult family members meet bi-weekly for 60-minute Parent Advisory groups.
Youth must complete 30 days sober to obtain Phase Two. Otherconditions affecting
promotion are UA, substance use, daily group attendance and participation, AIM group
attendance and participation, and school attendance and participation.
• Phase Six: Clients in this phase attend treatment groups two times a week for 90
minutes as wen as AIM group oncea week for 60 minutes, in addition to any Intake
and Assessment, Treatment Planning, Crisis Intervention. And Collateral Services as
needed and averaging 60 minutes a session. Additionally, clients and adult family
member$ meet bi-weekly for 60-minute Parent Advisory groups. Youth must complete
(30) days sober to obtain Phase Three. Other conditions affecting promotion are UA,
substance use, daily group attendance and participation, AIM group attendance and
participation, school attendance and participation, and attending court appointments.
• Phase Seven: Clients in this phase attend treatment groups once per week for 90
minutes as well as AIM group bi-weekly for 60 minutes, in addition to any Intake and
Assessment, Treatment Planning, Crisis Intervention, and Collateral Services as needed
and averaging 60 minutes a session. Additionally, clients and adult family members meet
bi-weekly for 60--minute Parent Advisory groups. Youth must complete 30 days sober to
obtain Phase Four. Other conditions affecting promotion are UA, substance use. daily
group attendance and participation, AIM group attendance and participation, school
attendance and participation, and attending court appointments.
Process Groups: Clients process how they are feeling, their personal struggles
with relapse, triggers, and issues that they want to share with the group to receive feedback.
Group size is 2 to 12 youth. Process group allows youth to share their experience, receive
feedback from multiple perspectives, and witness peers in recovery. Process Groups are a
powerful tool used in substance abuse treatment that assists reducing isolation, building a
positive peer support system, and motivating youth to achieve the same success they see
Revised Exhibit A-1
Page 32 of 35
their peers achieving.
Psycho-educational Groups: An effective adolescent SUD program must address
four principal areas: 1) symptoms and patterns of behavior common to all addictive
diseases; 2) issues specific to adolescents; 3) unique issues directly related to culture or
ethnicity; and 4) issues related to family dynamics. The program's Educational Component
addresses issues using age-appropriate methods that educate youth in a manner relevant to
their lives. Exercises from the curriculum workbook are incorporated in adolescent groups.
The curriculum currently in use is available for review upon request.
The curriculum workbook "The Matrix Model for Teens "offers a cognitive behavioral
treatment curriculum map a life of recovery and freedom for chemically dependent offenders.
Assignments are step by step through intake and orientation, criminal and addictive thinking,
drug and alcohol education, socialization, relapse prevention, and release and reintegration
preparation.
The curriculum is designed to help clients see how thought processes lock in
destructive behaviors, recognize finks between addiction and criminal activity, develop
healthier ways of relating to others, and learn to keep recovery strong. Theyare incorporated
into treatment plans based on the individual's strengths, and supported through workbook
study groups, peer discussions, school activities, individual check-ins with counselors, and a
self-monitored system to encourage individual responsibility. Workbook completion is part of
the program requirements for successful graduation and serves as a concrete, unusual I
measurement for clients and an outcome measurement tool for the program.
MHS' experience in providing substance abuse treatment to similar target populations
of youth in the Floyd Farrow Substance Abuse Unit and New Horizons Program at the Fresno
County Juvenile Justice Campus has provided experience and supporting data on the
effectiveness or providing Anger Management to each youth in treatment. As youth leave the
bio-chemical Influences of substances they often find they lack sufficient knowledge and tools
to manage their emotions. Floyd Farrow Substance Abuse Unit and New Horizons propose
to continue provision of approved Anger Management.
Individual Counseling: Individual substance abuse counseling is available to
PROPS youth for Intake and Assessment. Treatment Planning, Crisis Intervention, and
Collateral Services as needed and averages 60 minutes a session. The youth is encouraged
to discuss recovery related issues in the group and community meetings to fully benefit from
the therapeutic community; however, some youth may find certain issues too sensitive or
emotionally overwhelming to divulge to the community but may be able to effectively work
Revised Exhibit A-1
Page 33 of 35
on these problems through individual counseling.
Individual Therapy: Individual psychotherapy has been identified a crucial part of
dual treatment in co-occurring disorders. Individual psychotherapy is provided by a qualified
mental health clinician under the direct supervision of a licensed mental health clinician, in
accordance with California Board of Behavioral Health requirements and as needed to
assess, diagnose, and treat Severe Emotional Disorders. Individual therapy is guided by the
therapeutic goals established with the minor during the assessment. These goals focus on
alleviating the symptoms of the mental health diagnosis, address impairment in functioning
and build on the strengths and coping skills of the minor.
Family Therapy: Family psychotherapy has been identified a crucial part of dual
treatment in substance use and co- occurring disorders. Family psychotherapy is provided
by a qualified mental health clinician under the direct supervision ofa licensed mental health
clinician. Family psychotherapy is guided by the therapeutic goals established with the minor
duringthe assessment. These goals focus on alleviating the symptoms of the mental
health diagnosis, address impairment infunctioning and build on the strengths and coping
skills of the minor. Goals of family therapy are based on the needs of the family; frequently
the expressed need includes improving family relationships and communication. Family
therapy builds on the strengths of the family system and addresses family roles and
boundaries. Families may participate in family psychotherapy together with their child
and assigned mental health clinician as needed.
Family Counseling Groups: Family group substance abuse counseling is provided
bi- weekly in a multi-family group setting. During the initial phase of the program families are
Informed of the support group and encouraged to participate. Any family member can speak
with the substance abuse counselor or mental health clinician at any time. Focus on
prevention topics and allow families to share experiences. Many families fear talking about
"family secrets." Some "secrets' include other members using drugs, violence in the home,
financial struggles,judicial problems, and fears of losing their children. The group is designed
to allow members to speak freely and fosters mutual identification of possible solutions to
common problems. Issues, such as abuse and domestic violence, are referred for further
assistance to appropriate resources. Family members are asked to sign information release
forms when using outside resources, to allow communication between agencies and
maximize support for the clients and avoid duplication of services.
Self-Help Group Participation (12-Step Programs): Twelve-Step meetings are an
Important adjunct support system and are a requirement of each treatment plan. Clients learn
Revised Exhibit A-1
Page 34 of 35
about the program via workbooks and guest speakers sharing their experiences, strength,
and hope. MHS proposes to integrate regularly scheduled presentations and introduction
of the Adolescents in Motion (AIM) groups into PROPS.
Fresno County Juvenile Delinquency Court has historically funded and maintained the
AIM group, which has been supported and co-located at Family Youth and Alternatives
through a Memo of Understanding. The AIM group is currently facilitated twice weekly for 60
minutes. It should be noted that the AIM group is open to any youth in the Fresno area.
Education: Most youth in PROPS have histories of academic failure that increases
their risk of substance abuse,delinquency, and violence. In most cases the reason for failure
is not for lack of ability, but rather the experience of failure itself. MHS believes that youth must
not be allowed to fail and will work with the youth and educational system to ensure success.
During the youth's lime in the program this may mean coordinating referrals for specialized
tutoring, developing incentive programs, advocating for diagnostic educational assessment for
learning disabilities, or inviting teachers to be part of the treatment team. Academic success is
a key predictor for maintaining a drug and crime free life and, as such, is a key component of
the youth's discharge and outpatient treatment plan. The SUD counselor will coordinate school
placement at discharge, arrange mentoring/tutoring, and other support services as necessary.
Discharge Plan: Discharge planning begins al intake and is revised during the treatment
phase with input from the treatment team. The discharge plan will recommend the level of care
required; describe SUD outpatient care, mental health follow-up, educational and/or vocational
plan, and necessary services and referrals for the family to support recovery.
Case Management: The certified SUD counselor has been responsible to provide case
management services for the youth and their family. This includes coordination of services
from various agencies, collaboration on discharge planning to ensure youth and family have a
complete and appropriate plan, access to outpatient services that address language and
cultural needs and identify barriers to obtaining services.
SUD-Free Recreational and Pro-Social Activities: Drug-free, organized, interactive
social and recreational activities are a key feature and are built into the program structure.
Such activities help the participants that they can have fun without the influence of substances.
Progress is monitored and documented by the counselor. Supervised activities may include
basketball, flag football, baseball, aerobics, and yoga, and social events such as holiday
celebrations. The program will seek volunteers to demonstrate various sport and recreational
opportunities, such as music, dance, yoga, meditation, sports, makeup and fashion skills,
camping, hiking, and backpacking. Youth are encouraged to attend sober and clean social
Revised Exhibit A-1
Page 35 of 35
and recreational events during all phases of treatment.
JJC SUD SERVICES (SOW ILD) effective July 1, 2022
MHS shall provide evidenced-based SUD services to every youth at the Fresno Juvenile
Justice Campus regardless of housing location or status in their adjudication process. Every
youth with a completed initial mental health assessment bV the JJC mental health service
provider, and an identified substance use disorder need bV either JJC mental health service
provider, DBH, Courts, Probation or self-report by person served, will be referred to services. The
Fresno County SUD ASAM PPC /I will be completed by a qualified Substance Abuse Specialist
and a Licensed Practitioner of the Healing Arts (LPHA) for all referred youth. Additionally, the
LPHA will complete the Medical Necessity and Initial Determination of Diagnosis (IDD) within 72
hours of the referral. The completed ASAM PPC II assessment will determine the appropriate
frequency of services. The frequency of groups should not exceed five per week. Youth will attend
as indicated in their Assessment and Treatment Plan. The frequency of individual sessions should
not exceed four per month. SUD services will also include a minimum of one family service a
month not to exceed four a month. Upon release, all youth will receive a referral to a community-
based provider for appropriate placement in treatment based on the assessment outcome.
Groups and Individuals will include evidenced-based Clinical Practices such as
Motivational Interviewing Techniques, Cognitive Behavioral Therapy, Cultural Responsiveness
and Trauma Informed practices bV highly trained and skilled practitioners. Curricula will include
Hazelden's Criminal and Addictive Thinking, Change Company, Young Men's Work, and
Stephanie Covington's Voices for young women.
Additional Probation Data Reporting and Outcome Measures
MHS will provide the Probation JJC Liaison with monthly statistics on individual youth
attendance for all group, individual, and family sessions for each of the programs identified in the
Scopes of Work. MHS will maintain a tracking log to identify delivery of services and length of
time in services after each session for each youth. MHS will provide any other reports requested
bV the Probation Department. All reports submitted bV MHS to Probation shall be sent to
ProbationContracts(a)fresnocountyca.gov and DBHContractedServices(a)fresnocountyca.gov.