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>> Just ahead on "Need to Know," Rochester has led the way in
dealing with substance abuse offenders through means other
than imprisonment, by treating the addiction.
But is there enough treatment to go around? We’ll look at that issue.
Also we'll give you the differing views on how Monroe county's
social service reorganization is going.
One from county executive Jack Doyle and one from the social workers
themselves and we'll have the business section with the Democrat and Chronicle. That's next on "Need to Know."

>> Now they have a waiting list but before I would have to call
every hour, every two hours to see if there was any bed.

>> This is "Need to Know," the Rochester area's only in-depth news production. It's a production of WXXI news and current affairs covering issues, politics, education and current events.

>> "Need to Know" is made possible by Dorschell Lexus and through the support of viewers like you.

>> Thanks for joining us. I'm Michael Caputo. We'll get to the availability of drug treatment in just a moment. But first the two visions of Monroe county's leaner social services department. It's roughly a $400 million county operation that deals with welfare, Medicaid and child protective services among others. Last year the county government facing a multimillion dollar deficit announced a vast reorganization of the department. The goal, make it more efficient and save the county $30 million in the process. Last week, county executive jack Doyle said the program is working. This week the federation of social workers, the county social services union had a differing opinion. With us to discuss
that is Bud Lowell.
It's like the dualing spin here.

>> You might call it that.

>> Jack Doyle first. What did he say? I think he called the effort operation transform. How does he think it's going?

>> A couple of weeks ago he had a news conference and he said
that we were on track.
We have achieved savings of $19 million out of the $30 million we have to achieve to balance the county budget and close that $65 million revenue gap. That's about half of it. He says we're well on the way. The Monroe county federation of social workers in late march and in early April conducted a survey and essentially five surveys in one. The part we're most concerned with right now is they interviewed clients. They didn't get enough people to make it statistically significant and they found about 220 positions. About 60% of the staff don't feel they have adequate training for the new responsibilities. 70% don't think they can manage the workload after reorganization. 97% can't get the new workload done without pulling overtime. 91% have more work. 88% say they don't have time to adequately review new cases. And almost 70% don't think they're providing the minimum oversight to ensure the safety of their clients. That's a lot of numbers. It basically adds up to they don't think it's going very well.

>> Also they took away some of the homeless shelters and 2/3 said they are seeing more.

>> They think they're seeing more. Part of the streamlining and restructuring is to get people that the county thinks don't belong on social services programs off of them, welfare to work continues to expand. They say it's causing a large surge in demand for homeless shelters, help paying your rent, clothing assistance, things like that.

>> What is the county's reaction to what the union has been
saying?

>> Work in progress.
I talked to James Smith, Mr. Doyle's spokesman, and he said we're reorganizing, over three months into the process. It started in January. And we're essentially building like a new car from the ground up. We have the engine, frame, three wheels on. You're expecting it to go 120 miles an hour right away. It doesn't work like that basically.

>> We thank you for being here with us.
For the latest developments on this story and others, tune in
to WXXI-AM 1370.
Now for the main story of the evening, the availability of substance abuse treatment. Monroe county's alternatives to incarceration, the Rochester drug court. These are initiatives that are dependent on programs that treat people with substance abuse. The hope, that drug addiction which fuels crimes committed can be reduced before the crimes become serious. But those who try to treat substance abuse offenders say it is harder to find them a place in the facility. When considering the important of this issue, mull over these statistics provided by the Monroe county office of mental health. Based on the 2000 census, 11% or more than 59,000 people over the age 18 may be in need of substance abuse treatment of some sort. The agency also projects that 16% or nearly 10,000 kids ages 12 to 17 need some sort of treatment. What's fueling the increased demand, a host of reasons. Government looking to rein in runaway spending on social service programs. "Need to Know’s” Matt Cummings give us a closer look at what is fueling the substance abuse treatment centers.

>> An open spot in one of Monroe County's drug treatment
facilities is difficult to find these days.
Two weeks ago, the main quest treatment center in Rochester
started a waiting list of clients looking to get into the
program. 20 to 50 people are on it at any one time. Jessica Dean's cocaine habit has landed her in treatment for the fourth time. She considers herself lucky to get into main quest this time around.

>> Now they have a waiting list but before I would have to call every hour, every two hours to see if there was any beds for females. main quest is a nice facility. They don't have enough beds for females. And so I put my name on the waiting list this time and I still kept calling every couple of hours just to make sure. But I finally got it -- it took me about a day and a half this time to get in.

>> Dean said she would continue using while waiting for a spot
to open up.

>> That's what the majority of the people that I've talked to said
they've been doing. You know, constantly using, you know, some women prostitute, thank God I've never done that but, you know, that's what they do. Waiting to get in. Hoping to get in. Some people said they've been waiting two weeks. It's kind of sad.

>> There has been an explosion this year. I'm probably running 10% ahead of where I was at this time last year in people seeking treatment, people needing treatment. Frank Ryan is a supervisor at the Evelyn Brandon Health Center, a drug treatment facility in Rochester. He sees a variety of people seeking help.

>> A tremendous influx of people coming in looking for
treatment, wanting treatment.
Issues of how to get reimbursed for that treatment.
There's a lot of them and they've recently lost their jobs or
been sanctioned off D.S.S. assistance or have no insurance. How do you work back a scaled back version on scaled down, hardship cases? We have people coming into the homeless shelters so there's issues around finding a place to live so you can do treatment with them. That's kind of the heirarchy. If they're not safe, they don't have a place to live and then they're not able to feed themselves. How do you treat them? Those are some of the main issues. We're also seeing a large influx of clients that we haven't Seen in a long time. Probably in the past year, year and a half, more mentally ill, chemically dependent percentage, it's probably quadrupled.

>> Local treatment professionals say the number of people in
need of treatment may not be increasing but rather people who previously flew under the radar are being discovered through social service applications and then referred to treatment centers for further evaluation. They say this influx is putting a greater strain on the overall system.

>> Welfare to work is sending us a case. Some are appropriate being sent to us, some are not ready to go to treatment. They don't want treatment but they need to have some sort of assistance. Working with that piece has been very difficult for all of us. Welfare to work. There's a mandate they have to go through which is created on our end, on the treatment end, a revolving door. They'll come in and stay for a couple of weeks and leave. 30 days later they're back again.

>> Ryan says the real time lag occurs when it comes to longer term care.

>> There are problems if you're talking about extended care.
If you're looking at residential treatment.
If you're looking at halfway house beds.
We have only a certain amount of them.
They could be a problem in accessing one of them. I believe the wait list for a halfway house today is between four and six weeks. Which isn't as bad as it used to be. Used to be 12 to 20.

>> Judge John Schwartz helped found Rochester's drug court
which tries to move drug offenders out of the prison system and into treatment. The court deals with 500 to 600 drug offenders each year. However, he doesn't believe mandating treatment for drug offenders is stressing the system.

>> If more people are sent to treatment and there's funds available to pay for that treatment, treatment will expand. It is a business. And if you build it, they will come. From field of dreams. They'll expand. If there's a need and there truly is a need, they'll expand provided the expansion is funded.

>> Substance abuse treatment officials say that when you can't
provide services to a client when they arrive, you lose them.

>> There's probably one in 10 that will actually lose, that
won't accept the fact that they'll have to wait a couple of
days. They want the instant gratification, the same gratification they get from drugs and if it's not there, they run away from it.

>> Tom Haschmann is the regional director for the NYS Office of
Alcoholism and Substance Abuse Services.
He says lack of state funding and an overlap in social programs are causing headaches.

>> When the state funding is flat, this is reality that if the
number of unsponsored clients are going up and you could treat
in 1994 2,000 people that you receive from the state in addition to Medicaid and insurance, there's no more money now and you have 4,000 people knocking at your door and see where the dilemma can be. So that that's where the tensions begun to play into the system. If you go to welfare reform and this is all successful, people go off public assistance and Medicaid and try to get a job. They're the ones that come in unsponsored looking for help. So the systems interplay that complicates things.

>> Local HMO's and the Monroe county department of social services are playing a role in the availability of drug treatment. Ryan says 20 years ago he could call a patient's provider and explain the treatments he wanted them to cover. And they would. Today, that's changed.

>> They want you to try the least invasive treatments that are available. They don't want -- they don't want people leaving the neighborhoods. They want people to still be involved with their families and I mean, I spend most of my day trying to do the paperwork and meet the criteria for these different HMO's and governmental agencies that we have to comply with. It lowers how many clients you can see in a week. If a counselor is working 40 hours a week, he's doing how many hours of direct care. It limits how many people you can bring into the agency.

>> Jessica Dean feels lucky to have gotten into main quest.
She now hopes to move on to a halfway house to continue her
treatment.

>> If that doesn't happen, I know I'm going to use again.
I don't want to but that's just something that happens.

>> Thank you, matt.
In studio with us to continue the discussion we have Mary Jo Muscolino,
deputy director at main quest, city court judge John Schwartz,
founder of the Rochester drug court and Bill Youngman, director
of behavioral health for Excellus. I would like to bring up the consortium of alcohol and substance abuse providers says it stands for the right to treatment on demand. Treatment on demand I think implies a lot. It implies you get it when you want it. It complies you're going to get the amount of time you need. I want to ask you first, how realistic is that when you take into account two things, one, taxpayers and the amount of money that they're going to pay into the Medicaid system for something like that and two, rate payers who were always seeing -- you know, are worried about what they're paying for insurance.

>> Obviously you have to look at the care -- is the care
available?
Is it the appropriate setting for the needs of the patient?
And then you have to look at what services have the purchaser or the consumers purchased. You have to actually look at a gamut of items.

>> But I think treatment on demand, the way I hear it, means they can get what they need. Doesn't there need to be a filter, a mechanism that looks at this and says you don't need this. You do need this.

>> when considering treatment, you still have to consider what
has the consumer purchased. If they haven't purchased certain
programs, then they may need that treatment but the consumer hasn't purchased that for insurance purposes.

>> Is treatment on demand, is that something we need to strive
for?

>> Absolutely.
I think that once referenced that folks with addiction usually
don't wake up one day and say given my life circumstances, I think I'm going to go in for treatment today. Usually there's many things that have happened in that person's life that have built up to the point where they say I need to do something or someone else more than likely has said you need to do something. The longer you delay someone from getting those circumstances, the more likely they are as Jessica said, to go out and medicate that anxiety or to continue on with their drug use so
there's an opportunity that will exist that may come around
again but may not come around before more damage is done.

>> Jessica also said that this was her fourth time in treatment.

>> Correct.

>> There are going to be people out there who will say there
has to be -- so where do you draw the line and say it doesn't look like treatment is working for this person. We're spending money and it's not working. How is that line drawn?

>> I don't know that it's there to draw a line.
I think that because chemical dependency is not as socially
acceptable of a disease as heart disease, where do you draw a line for someone who has heart disease but continues to not follow their diet, continues to smoke, continues to do the things they're not supposed to do? When do they go into their physician's office and the physician says I'm sorry. We're not going to medicate you or treat you for the heart disease. The same is true for chemical dependency. However, the community, all of us, take a look at folks who are chemically dependent and they don't elicit the same amount of sympathy as someone who has heart disease. They're caught up in criminal justice issues, they may have family issues, they certainly impact the social service system so they don't elicit our sympathy.

>> I want to get to you in one second.
I want to ask you, it's not fair to draw a line? Do you believe that?

>> I do believe that.

>> Then again, I come back to the taxpayers, the rate payers.
They're out there probably saying, we have to draw a line
somewhere.
There's some people who cannot be helped. Is that fair for them to be -- for that judgement to be made?

>> I do believe that everyone needs to be part of curing the
illness.
That does include the patient.
But at the same sense, you have to consider what factors go
into curing that illness. You have to consider what has been purchased, what is available, where is the best treatment, level of treatment for the care that that patient needs. And then you move from there.

>> Judge, I have heard other law enforcement officials, one
that I think of is chief Duffy say that the way we can reduce crime is by providing treatment on demand. Do you agree with that? If so, why?

>> Yes.
I do agree with it.
Fortunately the court system does provide treatment on demand.
We demand you go into treatment or we're going to incarcerate you. But I would like to get back to the point you say where do you draw the line? The first place we draw the line and I think it's illustrated by the example four times in treatment, you must redefine treatment for the community and for politicians. Treatment goes beyond clinical treatment. If you really want to arrest the disease of addiction in a person, you have to provide more than clinical treatment. You have to provide educational programs, you have to provide job training. You have to rebuild that person. You have to design a program, a drug treatment program that takes them from the welfare roles to the tax roles. And in fact, that's what the Rochester drug treatment does. It goes beyond clinical treatment. It goes in to education and it goes into job placement. You cannot get out of the program.

>> Of course, that means money.
What you're talking about means money and what you're looking
at these days, is every level of government saying we have to cut back. How do you make the argument to provide more money, even the same level of funding to treat addiction when they're talking about cutting education and they're talking about cutting other programs? How do you make that argument?

>> It's a difficult argument to make because certainly all people are entitled with their disabilities, with problems, certainly educating the young, it's very difficult to take a small piece of the pie and cut it up smaller. However, in the long run, we pay anyway. And if we don't pay proactively as judge Schwartz said, I agree that treatment coming into an agency is a piece of what people need to do. They need to get back into school, further their education, go back onto the roles of the taxpayers, Deal with their mental health issues as frank Ryan had alluded to. It's more important we proactively do something to put folks into a better working stance than it is to continue to pay for them coming through the criminal justice system. We will still pay. It's just a choice of how will we pay for the folks.

>> You know, judge, the argument with drug court was I think, that although there wasn't a level of personal responsibility with all of this, you let them off the hook, basically. That was the argument back then. I'm not sure that's the argument these days. Talk about personal responsibility. There are people out there who are going to say, where do they come in? Where does the addict come in? When do they take stock of themselvess?

>> That's the whole design of drug court. We have designed a program along with treatment, along with experts. The program is designed so that the person does take responsibility for themselves. And if they don't take responsibility for themselves, as we go through the program, then we use the alternative of jail. Now, you talk about the taxpayers say, well, where do you draw the line moneywise? It cost us $30,000 a year to house someone in a maximum security jail and that's what the Monroe county jail is. It cost us $6,000 to give a person inpatient treatment, outpatient services and educational services per year. Do the math. That's a savings of $24,000 per person. It might not sound as fancy but that's the bottom line math.

>> Thank you all very much for coming. My time is short and I really appreciate you being here to add to the conversation. Your comments can be part of the conversation, either on the web at www.WXXI.org/ntk or by E-mailing us at Needtoknow@wxxi.org.