Question: What is the full scope of youth opioid prevention and treatment programs in the City including ACPS? (Councilman R. Kirk McPike)
Response:
Treatment Interventions
Child and Family Behavioral Health Services (CFBHS) for Youth (under 18) with opioid use:
CFBHS engages youth diagnosed with opioid use disorders (OUD) and their families when a clinical assessment is conducted. Following the clinical assessment youth are provided with case management, care coordination and outpatient treatment services. Services are provided in the Del Pepper Community Resource Center, family homes, Northern Virginia Juvenile Detention Center (NVJDC), ACPS secondary schools, Jefferson Houston K-8 school, and the Douglas MacArthur elementary school. In FY 2023, CFBHS served 52 youth diagnosed with opioid use disorders and during the first half of FY 2024 the number was 41. The numbers below are subsets of these totals.
At the NVJDC, CFBHS provides the above services in addition to supportive counseling. In FY 2023 CFBHS served 17 residents of NVJDC with OUD and 10 in the first half of FY 2024. CFBHS sees a fraction of NVJDC residents. Arlington CSB and Alexandria Court Service Unit also provide counseling services in NVJDC.
CFBHS provided intensive care coordination services for families in need of, in, and exiting residential treatment for youth with OUD; 16 in FY 2023 and 14 the first half of FY 2024.
CFBHS assisted families with youth with OUD access residential services; eight families in FY 2023 and seven in the first half of FY 2024. The scarcity of youth OUD residential facilities is challenging in ensuring the spectrum of care required for this population, especially for those who speak a language other than English. This results in having to look for residential treatment options that are not close to home for our youth and families. CFBHS has used:
- Timber Ridge (boys), Cross Junction, VA – about two hours from Alexandria
- Only accepts boys
- Only Virginia Medicaid Addiction and Recovery Treatment Services (ARTS) program for youth in Virginia
- FY 2023: three youth; FY 2025: five
- Sandstone, Crownsville, MD – about an hour from Alexandria
- Psychiatric residential treatment with a substance use component; accepts primary substance use disorder diagnosis
- FY 2023: three youth; FY 2024: zero
- Youth for Tomorrow, Bristow, VA – about an hour from Alexandria
- Psychiatric residential treatment with a substance use component; primary diagnosis must be psychiatric
- FY 2023: one youth; FY 2024: one youth
- Jackson Field, Jarratt, VA – about three hours from Alexandria
- Psychiatric residential treatment with a substance use component; primary diagnosis must be psychiatric
- FY 2023: one youth; FY 2024: one youth
The two facilities listed below are also available but have not been used during this timeframe. Both are psychiatric residential treatment with a substance use component; primary diagnosis must be psychiatric:
- Hallmark, Richmond, VA – about two hours from Alexandria
- Newport News Behavioral Health Center, Newport News, VA – about three hours from Alexandria
Alexandria DCHS provides Medication Assisted Therapy (MAT) for youth with OUD; 2 youth were served in FY 2023 and 4 in the first half of FY 2024. The other primary provider of MAT is the Manassas Addiction Center.
CFBHS supervisors and school-based providers regularly provide OUD consultation and psychoeducation to system partners. They also partner with the ACPS Substance Abuse Prevention & Intervention Services Coordinator, providing information regarding CFBHS services at the ACPS Substance Abuse Seminar and supporting linkage to services. CFBHS staff support harm reduction through psychoeducation and offering Narcan Fentanyl test strips to youth and families.
Virginia currently does not have a residential inpatient withdrawal management facility for youth. Prince William County expects to open a regional behavioral health facility in 2025. Using regional Opioid Abatement Funds, Fairfax County, on behalf of the Region containing Alexandria City, Arlington County Fairfax County, Prince Willam and Loudoun Counties, is planning to establish a regional project for opioid withdrawal management and residential treatment that would fill this gap for youth with OUD. Additionally, there are long waitlists and lack of care for higher levels of community-based care for youth with OUD and their families, especially for those needing services in Spanish. This is due to low Virginia Medicaid reimbursement rates and challenges in hiring and retaining behavioral health staff.
CFBHS description of services relevant to OUD:
Community based outpatient substance use therapy includes substance use treatment practices that are trauma-informed and based on research and evidence such as Motivational Interviewing, Cognitive Behavioral Therapy, Trauma Focused-Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing, and elements of Multi Systemic Therapy. This includes weekly individual and/or family therapy sessions related to an individualized treatment plan created with the youth/family.
Clinical case management services assist families with children with challenges in accessing medical, psychiatric, social, educational, vocational, and other supports essential to meeting basic needs. Supports linkage to adult services when they turn 18.
Medication Assisted Treatment (MAT) psychiatry services include specialized psychiatric assessment and medication management for youth and adults with opioid use. Youth MAT does not include withdrawal management.
High Fidelity Wraparound is a structured, evidence based, team-based collaborative planning intensive care coordination process that develops and carries out individualized care plans for youth and their families. Youth may also be involved with child welfare or juvenile justice.
Peer support via Family Support Partners (FSPs) engage parents/guardians in individual or group services that support family voice and choice, increase family engagement in child’s services and build natural support with the goal of self-sufficiency; FSPs are professionals with personal experience navigating a child serving system with children in their care.
Assessment for Residential Treatment provides assessment for medical necessity and recommendations when substance use residential treatment is a consideration for youth using opioids. Funding sources include Medicaid or funding from the Children’s Services Act.
Intensive Care Coordination (ICC) assists families with youth who are at risk of out-of-home placement and their professional and natural supports to find solutions, so youth remain in their community. If they are found by the assessment for residential treatment (see above) to meet criteria for a higher level of care, ICC services assist the family in finding an appropriate placement (i.e. group home or residential treatment)
Prevention Programs and Initiatives:
Parent Support and Prevention Approaches
The Opioid Workgroup, (OWG) in partnership with the Alexandria City Public Schools developed a series of town hall meetings to facilitate community conversations in neighborhoods significantly impacted by opioid use as part of its strategic plan. These will launch, for a second year, in early April and will be geared towards providing prevention education to parents. Two of the four training sessions will be conducted in Spanish. The OWG previously launched a social media campaign called “Think you know, think again,” aimed at providing short educational video clips regarding the dangers of counterfeit pills and fentanyl. The City is also supporting parents and teens through Harm Reduction initiatives and access to Naloxone and Fentanyl Test Strips, including Narcan distribution in the Teen Wellness Center. The OWG has conducted several educational events in the private school community across the city this year, as well as interactive prevention presentations for students. The OWG, in partnership with the West End Business Association and Alexandria City Public Libraries, is offering three large community education events to launch in late March, several of which will also be offered exclusively in Spanish.
The Substance Abuse Prevention Coalition of Alexandria (SAPCA) distributed 1,600 free parent handbooks through in-person outreach events in 2023. This resource guide raises awareness about substance use trends, warning signs associated with youth substance use, and tips for effective parent-child communication.
Youth Engagement in Prevention Efforts
In 2023, SAPCA delivered substance use prevention education workshops and assemblies to more than 4,300 youth at Alexandria City High School, Francis C. Hammond Middle School, George Washington Middle School, Jefferson Houston PreK-8 IB School, Patrick Henry K-8 School, Bishop Ireton High School, and Commonwealth Academy. During these presentations, students learn about the consequences of using alcohol, e-cigarettes, marijuana, and prescription and over-the-counter medication. Students also learned about the dangers of fentanyl, where to access Narcan, and school and community resources for seeking help regarding substance use concerns.
Prevention Campaigns
In January 2023, SAPCA launched a prevention campaign featuring a series of short videos created by Alexandria City High School students that encourage youth to be marijuana free. These videos also highlight the risks of marijuana use – including that marijuana and other drugs sold on the street can be laced with fentanyl without the user’s knowledge. SAPCA also collaborated with Harris Teeter to disseminate information in English and Spanish about the dangers of fentanyl through ads placed on 48,000 pharmacy bags.
Reducing Access to Medication
In 2023, the City of Alexandria collected and safely disposed of 2,647 pounds of medication – 673 pounds stemming from two drug take back day events and the remaining 1,974 pounds resulting from the City’s three permanent medication drop-boxes. These permanent drop boxes provide year-round access to safe drug disposal for all Alexandria residents. Information about safe medication disposal at home is also available on the City’s website.
In collaboration with Harris Teeter, SAPCA promoted the City’s permanent medication drop boxes through ads placed on 48,000 pharmacy bags. SAPCA also supported residents to safely dispose of medication at home through the distribution of 400 drug disposal kits.
DCHS continues to distribute locking medication boxes for safe medication storage. Through partnerships with ALIVE!, the Alexandria Police Department, the Alexandria Sheriff’s Office, Alfred Street Baptist Church, and several other community partners, DCHS distributed 1,776 locking medication boxes to Alexandria residents between May 1, 2021, and February 1, 2023.
Opioid Coordinator works in collaboration with other City agencies and community partners to coordinate the response to the opioid epidemic with the support of the Opioid Workgroup1. The Opioid Coordinator also provides community education and outreach, data collection, and works in partnership with other agencies to implement key initiatives, including a program with the Alexandria Health Department to provide Narcan to local restaurants to distribute to customers; development of a virtual regional support group for youth seeking recovery resources.
The Opioid Workgroup (OWG) membership consists of Alexandria City Public Schools (ACPS), Alexandria Fire Department, Alexandria Health Department, Alexandria Police Department (APD), Alexandria Sheriff’s Office, Care First BlueCross BlueShield, Commonwealth Attorney’s Office, Department of Community and Human Services, Guest House, Inova Alexandria Hospital, Substance Abuse Prevention Coalition of Alexandria (SAPCA), and the Virginia Department of Corrections/Probation and Parole.