Drug rehabilitation activities in neighborhood health centers, status report, Aug. 1, 1971-Continued The Watts Neighborhood Health Center which serves a population of 30,000 people offers the following services to drug offenders: methadone maintenance; ambulatory detoxification; hospitalization; counseling and referral to appropriate social agencies; complete health exams and treatment. In addition, the center has an extensive Outreach and prevention program in the neighborhood public schools, vocational training schools, and other community institutions. A large recreational, aftercare and followup program is a very important element of the prevention component. The addicts' family receives counseling and supportive services including comprehensive health care and referral to other social service agencies in the area. Approximately 300 addicts were registered and treated during January-April 1971. The Neighborhood Health Center in San Diego is planning a multimodality approach to serve drug offenders. Methadone maintenance, group followup, detoxification, and abstinence programs are being developed. An extensive Outreach and prevention program is an important part of the plan. The University of California at San Diego is working closely in the planning and providing some of the staff. The Upper Cardozo Neighborhood Health Center through agreement with the community mental health program located in the same building offers the following services to drug offenders: individual and group therapy; hospitalization; complete medical treatment; referral to the city's drug program for detoxification and methadone maintenance with aftercare counseling and rehabilitation. The addicts' families receive comprehensive health care through the health center. The community mental health staff works closely with the neighborhood health center teams to ensure continuity of care for the addicts and their families. The Southside Neighborhood Health Center in Atlanta has a program funded jointly by OEO and NIMH which provides services to drug offenders. Services offered through the center and its 5 satellites are methadone maintenance; ambulatory detoxification; counseling and referral to appropriate agencies; hospitalization; complete medical exams and treatment; Outreach and prevention. Coun seling and comprehensive health care is also available for the addicts' families. An exaddict is the program's coordinator. The Mile Square Neighborhood Health Center is the medical backup facility for drug offenders that are referred to St. Leonards House, an OEO-sponsored halfway house. The St. Leonards House offers individual and group therapy, detoxification, residential care, and employment services. In addition to medical services offered by the NHC, it gives sup portive social services to the addicts and their families. St. Leonards and the NHC have served about 2,000 addicts. Drug rehabilitation activities in neighborhood health centers, status report, Aug. 1, 1971-Continued 7. Location-Baltimore, Md.; grantee Community Action Agency; administrative agency-Provident Hospital, Inc.; estimated amount-$60,000; period-Oct. 1, 1970Sept. 30, 1971. 8. Location-Boston, Mass.; grantee Action for Boston Community-Development, Inc.; administrative agency-Boston University School of Medicine; estimated amount-$80,000; period-Oct. 1, 1970-Sept. 30, 1971; grant No.8925-D. 9. Location-New York City, N.Y. (Bronx); grantee Montefiore Hospital and Medical Center; administrative agency-same estimated amount$120.000; period-Jan. 1, 1971-Dec. 31, 1971; grant No.-8815-D. 10. Location-New York City, N.Y. (Brooklyn); grantee- -Community Development Agency. Human Resources Administration; administrative agency-Catholic Medical Center of Brooklyn and Queens (St. Mary's Hospital): estimated amount-$70,000; period-Oct. 1, 1970-Sept. 30, 1971; grant No.-8912-C. The South Baltimore Neighborhood Health Center offers services to drug addicts and their families through a jointly sponsored program by the health center and project ADAPT (antidrug abuse program with therapy), at the Provident Hospital. A mental health services specialist is resposible for coordinating services for drug offenders through the NHC and the ADAPT program. Addicts are given individual and group therapy, behavior modifications, referral to rehabilitation programs, complete medical care; methadone maintenance and detoxification is obtained through the ADAPT program and the NHC staff follows up to give supportive services. The center also has an outreach prevention program. About 60 addicts are currently being served. The Roxbury Neighborhood Health Center which serves a population of 48,000 persons has a joint program with Boston University Hospital to serve drug offenders. A mental health drug specialist in the center does extensive outreach in the community to identify addicts and potential drug offenders; group therapy is offered in the center to addicts and their families, as well as complete medical care and other appropriate social services. The drug specialist facilitates the entry for addicts into the Boston University Hospital program if methadone maintenance, and detoxification is needed, then he follows up the patient after his release with counseling and referral to rehabilitation programs in the area. The center also provides a prevention and educational program in the schools. A drug addiction specialist at the Martin Luther King Neighborhood Health Center and a satellite in the south Bronx is coordinating a program to serve drug offenders in the commuity. He works very closely with the health center teams and mental health specialists which offers the addicts intensive group therapy. individual counseling, medical care, referral to rehabilitation programs and followup. Detoxification and methadone maintenance and hospitalization is arranged through the Montefiore Hospital. The addicts' families also receive counseling and complete medical care. The Charles Drew Neighborhood Health Center in Brooklyn is planning an expanded drug abuse program to be jointly supported by the city drug abuse program. The neighborhood health center now has six mental health workers who identify addicts and potential drug offenders. They are given medical treatment, Counseling and followup aftercare and referred to available facilities for methadone maintenance, detoxification, and hospitalization. Nonprofesstionals will be used as counselors wherever possible. Drug rehabilitation activities in neighborhood health centers, status report, Aug. 1, 1971---Continued The Rochester Neighborhood Health Center Mr. ROGERS. Thank you, Mr. Carlucci. Dr. Roy? Mr. Roy. Mr. Carlucci, how many neighborhood centers are there presently involved in the drug treatment programs? Mr. CARLUCCI. Let me ask Dr. Cooper if he has that figure. Dr. COOPER. The figure offhand would be for Atlanta and Los Angeles on a formal basis. We have other centers beginning operational programs. But 20 of them have come in and asked for such funds. Mr. Roy. This is out of 100 neighborhood health centers? Dr. COOPER. Out of that, 25 of those have been spun off to HEW, and we are now maintaining roughly 60-odd operational programs to date. Mr. Roy. So you have less neighborhood health centers than you formely maintained; is that correct? Dr. COOPER. Yes; as they become operational and mature, the effort has been to spin these off to HEW. Mr. CARLUCCI. I might note there are some additional plans to spin some additional health centers off to HEW in 1972. Dr. COOPER. Twenty-five to date. Mr. CARLUCCI. That includes another nine planned to be transferred in fiscal year 1972. Mr. Roy. Do these change form when they are spun off to HEW, or do they continue to operate primarily as they initially have been set up? I don't understand this process. Mr. COOPER. Our efforts in the comprehensive mental health program has been to develop alternative methods of delivery of health care. Many of them develop a team approach to that delivery model. Some of them are different from others, and as they mature into operational programs of their own and reach the goals that they themselves have set and we agree on at some predetermined time, those programs then become eligible for spinoff into the HEW area. When that happens, they may go in several different forms, but basically the comprehensive effort is maintained and intended to be so. And HEW has been in close liaison with us and we with them in an effort to keep that going. Mr. Roy. Do each of your health centers have the services of psychiatrists or psychologists or both? Dr. COOPER. Not each of them. In rural areas it is difficult, as you can imagine, but quite a few of them do, I cannot give you an exact number, although all of the urban ones have the services of a psychiatrist. Mr. Roy. I notice in several places in your statement you mention ambulatory detoxification. Do you have any figures or indications that this is the successful way of detoxifying addicts? Mr. CARLUCCI. Well, Congressman, as you know, the evaluation techniques in this area are less than perfect, and I wouldn't like to make any claims. Let me ask Dr. Smith if he would care to comment on that. I don't think we have any figures. Dr. SMITH. I think we haven't really been in that business long enough to have good data on this. One should not state categorically that ambulatory treatment is more successful than inpatient treatment. I think it would probably be somewhat dependent on the level of addiction or the state of the addict, et cetera, as to whether this would be a preferable way. We do both, but we emphasize particularly ambulatory care following detoxification. Mr. Roy. Has each neighborhood health center which has become. involved in treating drug addicts offered methadone therapy? Dr. COOPER. Not to date. Outstanding again are the Watts and Atlanta centers. The Altanta center has some strong relationship with the community health centers there. That program and the Los Angeles program both have been actively engaged in methadone. Mr. Rox. Mr. Carlucci, how do you visualize your relationship to Dr. Jaffe and the Special Action Office? Mr. CARLUCCI. We have had a fairly lengthy session with Dr. Jaffe. As was noted, he is just getting organized. We have also had substantial contact with his staff. From what I have heard from Dr. Jaffe, he intends to bring about a greater degree of interagency coordina tion and to try to introduce some flexibility in the approach that we take with regard to different communities. We see Dr. Jaffe's office as being very helpful to us in setting overall priorities and in letting us know the kind of delivery service systems that are needed in particular neighborhoods and how we can fit into the total administration effort. We have considerable flexibility, as you probably know, Congressman, under our legislation. Our only constraint is that we have to serve low-income persons. As I indicated in my prepared statement, we can range from statewide programs to programs in individual neighborhoods and citywide programs. Therefore, we see ourselves as being very flexible and tying in closely with other agencies according to the priorities set by Dr. Jaffe. Mr. Roy. Do you anticipate, for example, before 20 additional neighborhood health centers become active in treating heroin addicts that this will go to Dr. Jaffe but that 15 of these will be fine and the others will duplicate other facilities? Mr. CARLUCCI. I would anticipate that, yes. Mr. Roy. But no formal structure has been set up in that regard? Mr. CARLUCCI. It is my understanding that legislation requires Dr. Jaffe to have memorandums of agreement with such agencies, and we have not yet drawn up such memorandums. We have made the in formal contact, and we anticipate no trouble working with Dr. Jaffe. Mr. Roy. How do you determine from the legislation as to what control he will have over the proposed $18 million fiscal year 1972 budget? Mr. CARLUCCI. I would interpret it as meaning he will be able to set goals and priorities and to evaluate our programs in terms of those goals and priorities. If we are not functioning properly in areas that he thinks a need exists, he could indicate to us that we should alter our method of operation in such a way to meet the goals and priorities he has set. Mr. Roy. What is the overall OEO budget? Mr. CARLUCCI. We have asked for $780 million this year in programs directly operated by OEO. The total budget under the Economic Opportunity Act is in the neighborhood of $2 billion. Mr. Roy. So we are not talking about a larger percentage of your budget that will be, perhaps, under the control of the special action office? Mr. CARLUCCI. No; we are talking about next year if we get our appropriation request, some $18 million out of some $780 million. Mr. Roy. Thank you very much. I appreciate your testimony. Mr. ROGERS. Mr. Hastings? Mr. HASTINGS. Thank you, Mr. Chairman. Mr. Carlucci, can you tell me how many methadone maintenance ! centers you actually participate in? Mr. CARLUCCI. Do you mean OEO? Mr. HASTINGS. Yes. Mr. CARLUCCI. Let me ask Dr. Smith. Dr. SMITH. Two of the 22 projects that we described here are entering into methadone maintenance and methadone detoxification on a large scale. We have others which use as one of the many modalities of treatment both methadone for the detoxification and also for methadone maintenance in appropriate cases. Mr. HASTINGS. Do you have any idea of the numbers of the other kinds you are talking about? I understand there are 250 or 260 metha done maintenance centers authorized by FDA around the country, and I would like to have some idea of OEO participation. Dr. SMITH. We are talking about only 22 projects in our program at the present time. Of that I think about a third of those utilize methadone. We will provide the exact figure. (The following information was received for the record:) PROGRAMS UTILIZING METHADONE TREATMENT EXCLUSIVELY, PRIMARILY, OR AS ONE OF SEVERAL MODALITIES Programs exclusively or primarily methadone programs are located in De troit, Michigan and Chattanooga, Tennessee (see status report p. 872, 874, this hearing). Programs utilizing methadone treatment as one of several modalities are located in: Atlanta, Georgia: Boston, Massachusetts; El Paso, Texas; Richmond. Virginia. Mr. HASTINGS. A small part of your budget then goes to methadone maintenance; is that correct? Dr. SMITH. Many of the programs have as a part of their treatment methadone in one form or another, but it is not necessarily the basis for the whole program. Mr. HASTINGS. How successful do you feel that OEO, particularly where you operate in the poverty areas, the ghetto areas, has been with rehabilitation? |