City of Alexandria, Virginia
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MEMORANDUM
DATE: MARCH 20, 2019
TO: THE HONORABLE MAYOR AND MEMBERS OF CITY COUNCIL
FROM: MARK B. JINKS, CITY MANAGER /s/
DOCKET TITLE:
TITLE
Consideration of Approval for the Department of Community and Human Services to Utilize State Opioid Response Funds.
BODY
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ISSUE: City Council’s consideration of approval for the Department of Community and Human Services (DCHS)/Community Services Board (CSB) to accept funds from the Virginia Department of Behavioral Health and Developmental Services (DBHDS) aimed at addressing the opioid crisis.
RECOMMENDATION: That City Council:
1. Approve DCHS’s receipt of $340,000 in year-one funding to create 3.5 positions in the Alexandria Residential Treatment Center (ARTC) program (formerly known as Detox;
2. Authorize an increase of 3.5 positions; and
3. Authorize the City Manager to execute all necessary documents that may be required.
BACKGROUND: The opioid crisis has had a significant impact across the Commonwealth of Virginia (“Commonwealth”). In 2017, 1,227 Virginians died from opioid overdoses. In 2014, for the first time, more Virginians died from drug overdoses than car accidents. As in other communities in Virginia, the number of Alexandria CSB clients reporting opioid use as a significant problem has increased significantly during the past five years. More CSB clients reported problematic opioid use during the first four months of the current fiscal year than during the entirety of FY 2014. The Alexandria Police Department (APD) reported 59 suspected opioid overdoses from January to December 2017, nine of which were fatal. Preliminary data for calendar year 2018 looks similar: 57 total opioid overdoses, eight of which were fatal.
In response to the growing needs in Virginia, as well as the strengthening collaborative efforts taking place there, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) awarded about $16 million in a State Opioid Response (SOR) grant to the Commonwealth. These federal funds provide targeted assistance to states that are battling the ongoing opioid crisis.
As with previous federal grants, the funds from this SOR opportunity are being distributed to localities to support prevention, treatment, and recovery efforts administered by Virginia’s Community Services Boards (CSB). After receiving the SOR funds, DBHDS requested that CSBs submit plans to utilize the funding. There was no formal grant application process. Staff submitted a request in early January and was notified on January 21, 2019 that DCHS/CSB would receive $340,000 in first-year funding. Per DBHDS, the year two funds will be adjusted pending the results of year one allocations. This funding will address critical treatment and support needs in our efforts to combat the opioid crisis. Increasing capacity and oversight at ARTC will support the multiple initiatives of the Opioid Work Group, the Opioid Coordinator and the Drug Treatment Court. These new positions are in addition to the six new positions added from City monies for opioid treatment over the last two years.
DISCUSSION: In response to this opportunity, Alexandria DCHS/CSB staff focused on the critical treatment and oversight demands that currently exist and submitted the following requests:
• Create one FTE Therapist Supervisor position in ARTC: $106,600
The ARTC program employs 22+ employees, operates 24/7, and serves clients with some of the most significant needs in the Department. The program has evolved over the last decade to provide best-practice clinical approaches and also now serves clients with co-morbid substance use, medical, and psychiatric concerns. Additional supervisory staff is required to ensure that services and staff are supported as needed. Funds from the SOR grant will support the addition of one Therapist Supervisor who will manage all new programming associated with the increase in opioid-related admissions, as well as assume supervision for approximately seven of the fifteen Residential Support Counselors.
• Create two FTEs Residential Support Counselor positions in ARTC: $137,400
The ratio of Alexandria Residential Support Counselor positions in ARTC is significantly below that of other programs that provide similar services within Virginia. This staffing pattern, coupled with the increase in duties associated with the increase in admissions of clients with an opioid use disorder, requires an increase to shift staffing in ARTC. SOR funding will be used to hire two additional Residential Support Counselors, which will bring staffing levels up to a more appropriate level.
• Increase the salary of the sole Pharmacist in Opioid Treatment Program: $43,749
One part-time Pharmacist manages all of the pharmacist duties in the Opioid Treatment Program. This position serves as the Pharmacy Manager and also guides the program in relevant policies and procedures, and through all the Drug Enforcement Agency and Virginia Board of Pharmacy inspections and regulations. The position is currently classified as a Grade 23, with an hourly rate of $33.210 to $54.589. Because this pay range is significantly lower than what pharmacists earn in more traditional pharmacy employment settings (hospitals, pharmacies) and in order to retain the incumbent in the position who had competing employment offers at substantially higher rates of pay, DCHS requested that DBHDS approve the SOR funds to be used to increase the hourly rate of pay from $52.984 per hour to $71.034 per hour, which has been determined by the City’s HR department to be market-competitive and which would be approved by the Human Resources Department when these state grants become available.
• Create .5 FTE Management Analyst position in ARTC/OTP: $34,260
Significant data reporting to DBHDS is required for agencies utilizing SOR funding. Current staffing is not sufficient to absorb this function, so SOR funding will be used to create one part-time FTE to manage this reporting.
FISCAL IMPACT: DCHS has been awarded $340,000 in first-year funding to support the positions noted above. Funding for year two is contingent on the programmatic outcomes in year one. Ongoing funding is not guaranteed, though DBHDS staff has indicated that it is highly likely that it would be ongoing funding. Should funding not continue, DCHS will evaluate other funding alternatives to either continue these positions or discontinue them if alternative finding cannot be secured. Those hired for these positions will be informed of the nature of the funding for the positions.
ATTACHMENTS: None.
STAFF:
Debra Collins, Deputy City Manager
Kate Garvey, Director, Department of Community & Human Services (DCHS)
Carol Layer, LCSW, Director, Center for Adult Services, DCHS
Liz Wixson, LCSW, Director, Clinical and Emergency Services, DCHS