Ventura County 2004 – 2005 Grand Jury Final Report

Ventura County Proposition 36:

Administrative Reforms Examined

Summary
In June 2004, the Ventura County 2003-2004 Grand Jury (2003 Grand Jury) published
a report critical of the county’s three-year implementation of the Substance Abuse and
Crime Prevention Act of 2000, also known as Proposition 36 (Prop 36).1 The Board of
Supervisors (the Board) dismissed, ignored or misinterpreted most of the 2003 Grand
Jury’s recommendations.

Overall, the Ventura County 2004-2005 Grand Jury (Grand Jury)- believes that the
Board has failed to thoughtfully consider the recommendations of the 2003 Grand Jury
and has failed to properly investigate and improve the leadership of Prop 36. Because
of this failure, the Board has squandered state funds and has neglected to provide
appropriate levels of treatment and oversight to addicted clients of Prop 36. The Board
has neglected to protect the citizens of the county from associated crimes while many
clients are unsupervised during the course of their treatment. The leadership has lost
sight of treatment objectives and client considerations. Leadership has instead
concentrated its efforts on belabored treatment protocols and spin.

The current Grand Jury’s investigation revealed a number of areas where the Board of
Supervisors, County Executive Officer, Director of the Health Care Agency, and the
Director of Behavioral Health Department failed to take appropriate action in assessing
and implementing the recommendations of the 2003 Grand Jury’s report on Prop 36.
The following are the result of last year’s unresolved issues coupled with additional
Grand Jury inquiries this year:
• Replace Behavioral Health Department’s Alcohol and Drug Programs
(BHD/ADP) as the Lead Agency for Prop 36
• Disband the Prop 36 Oversight Committee and establish appropriate policies
and procedures for the Operations Committee
• Close the BHD/ADP Central Assessment Center (CAC)
• Request the courts to place all Prop 36 offenders on formal probation for
enhanced supervision
• Reassess the cost effectiveness of the Prop 36 program
• Evaluate treatment provider contracts to ensure fairness

Fiscal year 2005-2006 may be the last remaining year of certain and adequate funding.
Because it is fully state funded, this initiative presently costs the county very little.
However, state funding for Prop 36 ends in the next fiscal year and, after that, funding
may or may not be provided by the state. If this proposition becomes a county-funded

1 Ventura County 2003-2004 Grand Jury, “Ventura County Proposition 36 Implementation,” June 2004.

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program, either wholly or partially, the Grand Jury believes the Board will finally be
required to pay more attention to whether the funds are allocated in the most
productive manner.

Background
The Substance Abuse and Crime Prevention Act of 2000 took effect on July 1, 2001. The
2003 Grand Jury conducted an inquiry into the effectiveness of Ventura County’s
implementation and leadership strategies for this law. In June of 2004, the 2003 Grand
Jury published a report, “Ventura County Proposition 36 Implementation” (the 2003
Report), that was highly critical of the leadership provided by the BHD/ADP. The 2003
Report, submitted to the Board, provided twelve detailed recommendations designed to
enhance public safety and help the program operate more efficiently.

The 2003 Report required that elected county officials respond to its findings and
recommendations. The Grand Jury decided to evaluate those responses for adequacy
and consistency. Additionally, the Grand Jury decided to review tangible changes that
may have taken place since Prop 36 implementation concerns were made known to the
Board. Finally, with the clear understanding that Prop 36 is a treatment initiative, the
Grand Jury wished to more closely examine the various aspects of treatment and the
services provided under this law.

Prop 36 funding is only guaranteed through fiscal year 2005-2006. Eventually the
county may be required to provide the $2.8 million annual cost of the program. The
Grand Jury sought to quantify inefficiencies created by the implementation and
leadership problems previously identified.

Methodology
The Grand Jury reviewed the 2003 Grand Jury’s findings and recommendations as well
as the responses provided by the county agencies. The Grand Jury interviewed county
Executive Office (CEO) and Information Systems Division (ISD) staff, management and
staff of BHD/ADP’s Proposition 36 Central Assessment Services (CAS)2, and various
professionals in the field of addiction treatment. The 2003 Grand Jury analyzed the
Ventura County “First Year Report, Substance Abuse Crime Prevention Act 2000,
Proposition 36, July 1, 2001 – June 30, 2002” (the First Year Report).

The Grand Jury obtained and reviewed two reports: “FY 2005/06 Behavioral Health
Department Alcohol and Drug Programs (BHD/ADP) County Plan for Proposition 36
Services,” approved by the Board and the California Department of Alcohol and Drug
Programs report, “Substance Abuse and Crime Prevention Act of 2000: Analysis of FY
2003/04 Plans from the 58 Counties” (the DADP Analysis).3 The Grand Jury obtained
budget information from the Prop 36 Program Manager and accounting transaction

2 For this report Central Assessment Services (CAS) and Central Assessment Center (CAC) may be used

interchangeably to refer to the same organizational function or location.

3 Health Systems Research, Inc., “Substance Abuse and Crime Prevention Act of 2000: Analysis of FY

2003/04 Plans from the 58 Counties,” [Link]

Plans_2003-[Link], September 30, 2004.

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details from the office of the Auditor-Controller. Questioning the financial aspects of
Prop 36 led to many of the findings in this report.
To discover why the Board determined to leave BHD/ADP as Lead Agency against the
Grand Jury recommendation, the CEO analyst was interviewed to determine the factors
that were considered. Seeing the result of this study, the Grand Jury decided to
undertake the analysis the county might have conducted. In addition, the Grand Jury
compared Prop 36 to different types of court-ordered treatment programs to determine if
the value of BHD/ADP involvement justified the inefficiencies and management
concerns documented in the 2003 Report.
The size, opulence and staffing of the CAS prompted the Grand Jury to question the cost
of maintaining that facility. On further inquiry, the Grand Jury began to question the
reason for its existence and the relative value of that service to the treatment providers
throughout the community.
The Grand Jury interviewed the agency heads and staff of stakeholder organizations:
Health Care Agency, Behavioral Health Department (BHD), District Attorney (D.A.),
Probation Agency (Probation), Public Defender, the Sheriff, and the CEO.
Wanting to gain more insight into the types and quality of services defined by Prop 36
as “treatment,” the Grand Jury focused a great deal of its attention on treatment
providers.
The findings in this report are determinations of the Grand Jury after deliberating on
the evidence. As required by Penal Code Section 916, all findings in this report are
supported by documented evidence.

Findings
Background

F-01. The Substance Abuse and Crime Prevention Act of 2000 (SACPA), also known
as Proposition 36 (Prop 36), is solely a drug treatment initiative. There is
neither provision nor funding in this initiative to perform drug testing on
offenders sentenced to Prop 36 probation. In fact, using SACPA funds for drug
testing is prohibited by law.
F-02. Prop 36 was designed to: (1) preserve jail and prison cells for serious and
violent offenders, (2) enhance public safety by reducing drug-related crime, and
(3) improve public health by reducing drug abuse through proven and effective
treatment strategies.4
F-03. A separate bill, the Substance Abuse Treatment and Testing Accountability
(SATTA), was passed by the California Senate in 2001. This law provides
funding and guidance for drug testing during treatment under Prop 36.
F-04. The fiscal year 2004-2005 funding allocation for Ventura County Prop 36
treatment was $2.86 million. There was an additional $1.08 million carried
over from unspent funds in the prior fiscal year. This brought the total
available funds to approximately $3.95 million.

4 State of California, Alcohol and Drug Programs, [Link]

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F-05. Ventura County has stayed well within its annual budget each year of Prop 36.
The provided funding has been more than adequate. SATTA, however, does
not have adequate funding for the level of drug testing required to support
treatment.
F-06. Drug Medi-Cal (DMC) can provide reimbursement for drug treatment services
through approved treatment providers. DMC cannot supplement Prop 36
funding, but it can be used instead of Prop 36 funds in some cases.
F-07. In Ventura County, the Prop 36 stakeholders are BHD/ADP, the Probation
Agency, the Superior Courts, the Sheriff, the District Attorney, County
Executive Officer, Public Defender, and drug treatment providers.

Lead Agency Designation

F-08. When Prop 36 was signed into law, each of California’s 58 counties was
required to designate a Lead Agency to receive the state funds and administer
the program. On February 27, 2001, the Board approved BHD/ADP as Lead
Agency in Ventura County for Prop 36.
F-09. When Prop 36 was initiated in Ventura County, the Implementation
Committee was formed to plan and coordinate the initial activities. Because it
was believed that clients would be first-time and second-time non-violent drug
offenders, this committee decided to place most of the program’s resources into
direct treatment services with lesser emphasis on probation oversight and
public safety.
F-10. In response to the 2003 Report, the Director/Chief Probation Officer for
Ventura County stated, “Tripling the number of offenders placed on formal
probation would require triple the resources to supervise. The Implementation
Committee believed, and we agree, that more resources needed to be allocated
for treatment rather than probation supervision for all but the highest risk
offenders.”5
F-11. The original assumptions regarding the client population were quickly proven
incorrect. By the end of the first year, there was a state-wide recognition that,
“What we are seeing in SACPA are clients who have severe drug histories,
serious physical health problems, and extensive criminal justice
backgrounds.”6
F-12. The 2003 Grand Jury found that, “The majority of California counties
designate Alcohol and Drug Programs or Behavioral Health as their Lead
Agency.”
F-13. The 2003 Grand Jury acknowledged that Ventura County was like other
California counties in deciding that BHD/ADP should lead Prop 36, but that

5 Calvin C. Remington, Director/Chief Probation Officer in response to Ventura County 2003-2004 Grand
Jury Final Report entitled “Ventura County Proposition 36 Implementation.” Letter to the Presiding Judge
of the Superior Court, dated August 13, 2004.
6 “Making It Work! 2002” Conference in San Diego, March 2002.

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jury went on to describe numerous examples of management deficiencies that

were specific to Ventura County’s BHD/ADP.
F-14. Because of the specific Ventura County deficiencies and in spite of other
counties’ decisions, the 2003 Grand Jury recommended that a different agency
be designated as lead.
F-15. On September 28, 2004, in reviewing its responses to the 2003 Grand Jury
recommendations, the Board requested the CEO’s office to prepare a
comparative analysis to provide informed guidance regarding the Lead Agency.
F-16. The CEO’s office undertook generally to study and compare counties with
respect to Prop 36 and, specifically, to determine whether BHD/ADP should
remain as the Lead Agency.
F-17. The analyst did not identify any factors to compare other than the one already
provided in the 2003 Report, that is, which agency in other counties is
designated as the Prop 36 lead.
F-18. The CEO’s analysis found that, of the 12 largest counties, most designated
Behavioral Health as the Lead Agency for Prop 36. Further, of the nine mid-
sized counties, most designated Behavioral Health as the Lead Agency for Prop
36. Finally, of the 8 counties considered most similar to Ventura County, most
designated Behavioral Health as the Lead Agency for Prop 36.
F-19. Based on counting various groups and categories of counties, the CEO’s
analysis confirmed the information reported by the 2003 Grand Jury, that
most of the counties in California have designated Behavioral Health as the
Lead Agency.
F-20. The CEO’s analysis reported there is no other comparable data to compare
counties because all counties implement Prop 36 differently. The analyst
reported that counties screen candidates differently, that they have different
treatment protocols and that they have different processes in place for
implementing the program.
F-21. The CEO’s analysis did not address the differences between the counties and
the relative success rates.
F-22. The CEO’s Memorandum dated January 18, 2005, included this statement,
“There is a significant relationship between drug offenders and mental illness.
The designation of the Behavioral Health Department as the Lead Agency
allows the provider of several different related programs to administer
treatment.” The analysis did not address this relationship or determine if
there was a similar relationship between any other criminal offenses and
mental illness. The analysis did not state if there was any other Lead Agency
arrangement that would allow the same access to related treatment programs.
F-23. In a memorandum to the CEO, the analyst recommended that BHD/ADP
remain as the Lead Agency based on the investigative result that most other
counties assign that function to Behavioral Health.
F-24. As of the date of this report, the Board has taken no action to replace
BHD/ADP as the Lead Agency in the Prop 36 implementation in Ventura
County.

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Basis for Comparison

F-25. In September of 2003 UCLA published a report for the California Department
of Alcohol and Drug Programs. The “Evaluation of the Substance Abuse and
Crime Prevention Act 2003 Report”7 (the UCLA Report) states, “SACPA
represents a major shift in criminal justice policy. Adults convicted of
nonviolent drug-related offenses and otherwise eligible for SACPA can now be
sentenced to probation with drug treatment instead of either probation
without treatment or incarceration.”
F-26. The UCLA Report describes many aspects of Prop 36 that could be considered
characteristics of a successful implementation. The UCLA Report states,
“About one-third (34.4%) of offenders who entered treatment [emphasis added]
in SACPA’s first year completed treatment.” It also reported, “Overall, about
one-quarter (23.8%) of offenders who agreed to participate [emphasis added] in
SACPA in its first year completed treatment.” There is a big difference
between agreeing to treatment and actually entering treatment.
F-27. The UCLA Report describes “show rates” as indicators of how many clients
referred into Prop 36 show up at various stages of treatment. It states,
“Counties reported use of a variety of offender management strategies
intended to raise show rates at assessment and treatment. In at least half of
the counties, Probation and assessment staff were co-located, walk-in
assessments were allowed, offenders had more than one day to report for
assessment, and the assessment protocol required only one visit.”
F-28. The UCLA Report states, “Using drug-court procedures to manage offenders
might lead to a higher show rate at either the assessment or treatment
because the judge, case manager, and probation officer are providing close
supervision.”
F-29. The UCLA Report states, “Both assessment and treatment show rates were
lower in counties where the proportion of SACPA offenders with felony as
opposed to misdemeanor convictions was higher.”
F-30. Ventura County has a higher rate of misdemeanor offenders than felony
offenders, so the UCLA findings would imply that Ventura County should have
a higher show rate than other California counties.
F-31. Any attendance advantage derived from the higher misdemeanor rate in
Ventura County is negated by the fact that those misdemeanor offenders are
not on formal probation.

Oversight Committee

F-32. County stakeholders (BHD/ADP, Courts, D.A., Public Defender, Probation,

Sheriff, CEO, and treatment providers) needed an organized method of making
decisions as a group. These group efforts would include making a decision on

7Longshore, Douglas, Ph.D., et. al., “Evaluation of the Substance Abuse and Crime Prevention Act 2003
Report,” University of Southern California, Integrated Substance Abuse Programs, September 23, 2004.

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what constitutes successful completion of a drug treatment program in

Ventura County.
F-33. The 2003 Grand Jury described the committee that had evolved from the first
year’s Implementation Committee. The Implementation Committee had
documented that “policy oversight would be vested in a committee.” An
Implementation Committee report stated, “the exact composition of the
oversight committee was not agreed on.”
F-34. The original Implementation Committee had stated its plan to publish a
memorandum of agreement (MOA) or memorandum of understanding (MOU)
to document the new committee’s representation and authority as well as the
charter or rules of voting and reaching decisions.
F-35. The 2003 Grand Jury found that the county stakeholders, including BHD/ADP
personnel, called their committee either the Oversight Committee or the
Operations Committee. Both terms were used frequently and interchangeably
by the committee members.
F-36. The 2003 Grand Jury attempted to locate meeting agendas and minutes that
might refer to the committee name, but those documents were not available.
F-37. Because there was no stakeholder consistency in the name and because of the
documented intentions for this evolved committee, the 2003 Grand Jury
arbitrarily referred to the existing committee as the “Oversight Committee” or
the “Operations and Oversight Committee.”
F-38. Regardless of the committee name, the 2003 Grand Jury reported problems it
attributed to a lack of the intended MOA or MOU. The committee published
no minutes, the exact composition of the committee was not agreed upon, and
decisions were made informally by consensus if they were made at all.
Committee members were unsure of the procedure for overcoming a committee
deadlock.
F-39. Encompassing both names, the 2003 Grand Jury recommended that the
“Operations and Oversight Committee be reconstituted as the representative
body for all stakeholders.” The recommendation was specific as to a “charter,
guidelines, and by-laws,” plus voting procedures to be approved and
documented. The 2003 Grand Jury also recommended considering the “voice of
all stakeholders,” as well as carefully recording meeting minutes.
F-40. In the response to the recommendations of the 2003 Grand Jury, BHD/ADP
generally concurred with the findings, but noted that the Implementation
Committee had evolved into the Operations Committee, not the Oversight
Committee. It stated that an “Oversight Committee was never formed.”8
F-41. The BHD/ADP response includes this statement, “BHD/ADP believes that an
Oversight Committee – which has never been designated – should be created.
The Oversight Committee should then meet and officially create an MOU

8Shulman, Linda, “2003-2004 Ventura Grand Jury Report Behavioral Health Department Response,”
Letter to Honorable Bruce A. Clark, Presiding Judge of the Superior Court, August 16, 2004.

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which will provide clarity to the Operations Cabinet on implementation of this

law.”9
F-42. The recommendation of the Oversight Committee was made by BHD/ADP.
The 2003 Grand Jury did not make a recommendation that two committees
were necessary for Prop 36 oversight and operations.
F-43. The 2003 Grand Jury did recommend that the single formed committee should
establish a documented charter, guidelines, and by-laws “providing
membership requirements, stakeholder authority, quorum, and voting
procedures.” The recommendation stated, “Minutes should clearly document
all decisions, action items, and discussions.”
F-44. The Board decided to continue the Operations Committee and add an
Oversight Committee. In the Board’s response to the 2003 Grand Jury, it was
stated, “Once the Oversight Committee is officially designated, an MOU should
be created that defines the various roles of each agency in the operation of
Prop 36.”
F-45. On July 28, 2004, the ongoing Operations Committee published a draft
“Operational Procedures” that described the committee composition, the
responsibilities and roles of the committee, and the meeting schedule and rules
of governance. The rules included procedures for voting and taking minutes.
F-46. As there were no published minutes from this July 28 meeting or the four
subsequent meetings, there is no public indication or clear stakeholder
recollection that these recommended rules were decided or even fully
discussed.
F-47. The newly formed Oversight Committee directed the Operations Committee to
continue making decisions on consensus.
F-48. The “County of Ventura FY 2005-2006 County Plan” states, “In October 2004,
an Oversight Committee consisting of the department heads of the CEO’s
office, BH/ADP, Judge, Sheriff, District Attorney, Public Defender, and
Probation Agency was formed to help establish protocols and give direction to
the Operations Committee, along with strengthening collaboration.”
F-49. As of June 1, 2005, there have been three meetings of the Oversight
Committee. There was no committee until after the Board reviewed the
agency responses to the 2003 Grand Jury. The two October meetings were
immediately after the September 28, 2004, Board meeting where the 2003
Grand Jury criticisms were discussed. The April 2005 meeting was scheduled
within days of the Grand Jury asking the Director of BHD how many
Oversight Committee meetings have taken place during the year.
F-50. In public comments before the Board on March 17, 2005, the Director of BHD
suggested that frequent or regular meetings of the Oversight Committee had
been unnecessary as business was being conducted by email or private
conversations.

9 Ibid.

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F-51. The MOU requested by the Board could not be created by the Oversight
Committee because the Public Defender and the District Attorney would not
sign a document that might create a conflict of interest with representation of
their respective clients.
F-52. Ventura County now has a Prop 36 Operations Committee and a Prop 36
Oversight Committee, both chaired by BHD and run by consensus. If the
Operations Committee cannot reach a decision, it will be referred to the
Oversight Committee. If no Oversight consensus is reached, the individual
members may or may not negotiate by email or private dialogues and decide to
go forward without committee approval. These things might or might not be
known because the minutes may or may not be published.
F-53. There is not yet an agreement or consensus as to what constitutes successful
completion of a drug treatment program in Ventura County.

Completion Standard – Mischaracterized Statistics and Sliding Benchmarks

F-54. It is the responsibility of BHD/ADP, as the designated Lead Agency, to

“coordinate evaluation of the services and treatment provided.”10
F-55. The 2003 Grand Jury recommended the “immediate establishment of a
meaningful treatment completion standard in accordance with the spirit and
intent of Prop 36.” The 2003 Grand Jury criticized BHD/ADP for attempting
“to weave success from failure by mischaracterizing statistics, sliding
benchmarks for successful drug treatment, and portraying program liabilities
as assets.”
F-56. The law provides a definition of successful treatment completion in Penal Code
section 1210(c):
The term “successful completion of treatment” means that a
defendant who has had drug treatment imposed as a condition of
probation has completed the prescribed course of drug treatment
and, as a result, there is reasonable cause to believe that the
defendant will not abuse controlled substances in the future.
F-57. On September 28, 2004, Ms. Linda Shulman, Director of BHD, spoke before
the Board regarding the success of Prop 36 clients,
UCLA put out a second-year report that compared ten counties,
so it’s not comprehensive, but in that report, they said that a
third of the people referred into Prop 36 were succeeding in
treatment, and that’s the same number that we have here in
Ventura County.
Ms. Shulman further explained,
We have about 2500 clients referred into the program annually.
Only 800 of them are in treatment. The other 1700 we have non-
complied and sent back to the courts, and said, they’re not
participating in the program, they’re having dirty drug tests,

10 Ventura County Implementation Committee, “Report of the Implementation Committee,” June 5, 2001.

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whatever the reasons for the noncompliance are, so we’re turning

back two-thirds to the court system – we’re only actively treating
a third.
F-58. Rather than gauge success on the number of clients in treatment as suggested
by Ms. Shulman, the UCLA Report actually states, “About one-third (34.4%) of
offenders who entered treatment in SACPA's first year completed treatment.
SACPA requires completion of treatment.” It goes on to clarify,
Satisfactory progress and sustained participation in treatment
are good signs, but SACPA requires completion of treatment.
Clients who complete treatment may fail to comply with
additional requirements, and clients who fail to complete
treatment may or may not commit new crimes.
F-59. “One-third success” and “comparable to other counties” is often heard in
relation to Prop 36.
F-60. The D.A. has frequently documented the lack of statistical reporting on Prop
36 treatment outcomes. Requests have been made in writing that Prop 36
develop or compile statistics or measure the success of various treatment
protocols that have been implemented.
F-61. The 2003 Grand Jury recommended that Prop 36 should fund basic
information systems and risk management systems to meet information
objectives of the stakeholders.
F-62. There is no indication that requests for statistics and metrics have ever been
addressed or that any Ventura County Prop 36 funds have ever been allocated
for the purpose of quantifying treatment results.
F-63. There is no commonly understood meaning of “successful completion” in
Ventura County.

Prop 36 Services Pipeline

F-64. The process whereby a drug offender is referred to treatment after sentencing
was originally designed by the Prop 36 Implementation Committee. This
process has not changed substantially over the past four years of Prop 36
implementation.
F-65. After sentencing in the courts, felony and high-risk misdemeanor Prop 36
offenders are referred to a Probation Officer for formal probation terms. The
Probation Officer will maintain a case file for tracking and reporting purposes.
F-66. All Prop 36 clients, felony and misdemeanor, are referred to the BHD/ADP
CAS for assessment and placement in treatment. The court currently allows
the client up to five days to contact the CAS for an appointment.
F-67. After receiving an assessment appointment, the client is also told by CAS to
attend an orientation meeting. Orientation is separate from assessment and is
held at the CAC in groups of three clients, up to three times a day.
F-68. The client’s transition from court to treatment is accomplished through the
assessment process. The purpose of the assessment is to make a decision

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about the client’s treatment placement. According to the County Plan, “The
County BH/ADP is the single entity responsible for determining a client’s level
of need for, placement in, and referral to drug treatment and other services.”
F-69. The assessment process currently takes place at the CAS with an Alcohol and
Drug Treatment Specialist (ADTS) assigned to perform initial and exit
assessments.
F-70. There are generally two considerations in treatment placement: the severity of
the addiction and proximity to the treatment provider.
F-71. There are three levels of treatment determined by addiction severity:
Level 1 is for slight to problematic substance abuse
Level 2 is for problematic to moderate substance abuse/dependence
Level 3 is for serious to acute substance dependence
F-72. In the current fiscal year, approximately 3% of the assessed clients were
referred to Level 1 treatment, 74% were referred to Level 2, and 6% were
referred to Level 3. The remaining 17% of assessed clients were pending or
transferring out of county, on leave of absence or refused treatment.
F-73. Level 1 treatment consists of 28 total outpatient program hours over a 6-month
period. Fewer than 30 clients have been placed in Level 1 treatment during
the first 11 months of the current fiscal year.
F-74. Level 2 treatment consists of 66 total outpatient program hours over a 12-
month period. Approximately 600 clients were placed in Level 2 treatment
during the first 11 months of the current fiscal year.
F-75. Level 3 treatment consists of residential care, for either 45 or 90 days, followed
by outpatient care for the remainder of the program. Level 3 treatment
consists of a total of 108 program hours over an 18-month period. Fewer than
50 clients have been placed in Level 3 treatment during the first 11 months of
the current fiscal year.
F-76. Treatment depends on regular attendance at classes, and proximity is of
primary concern during treatment placement as most clients do not have
reliable transportation.
F-77. Clients have been known to specifically request treatment providers where
they know drug testing is not observed, but this practice has recently been
discouraged by CAS supervision.
F-78. There are two major outpatient treatment providers in Ventura County. One
is in Oxnard and the other is in Thousand Oaks. The three smaller county-run
facilities are in Ventura, Oxnard, and Simi Valley. As a practical matter, most
clients are placed in the appropriate treatment facility closest to their home.
F-79. Prop 36 beds in residential treatment centers are frequently filled, and the
decision of which residential treatment center is generally made based on
gender and bed availability.
F-80. CAS assessment personnel will perform a clinical assessment and make

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referrals to a treatment provider plus any ancillary services they believe will
benefit the client.11
F-81. Assessment personnel will then transfer the file to a CAS case manager for the
duration of the client’s treatment. The case manager will maintain a case file
for tracking and reporting purposes.
F-82. Treatment begins when the client reports to the referred treatment provider.
There is no substance abuse treatment at the CAS.
F-83. When the client reports to the designated treatment provider, the first step in
the intake process can be described as a clinical assessment and treatment
orientation.
F-84. CAS staff and supervision as well as treatment providers agree that a clinical
assessment by the treatment provider is required in order to provide the
appropriate treatment for the client.
F-85. Once the orientations and assessments are completed, the treatment
counseling sessions begin.
F-86. Based on their own clinical assessments and frequent contacts with the client,
treatment providers may recommend treatment level adjustments and other
referrals to the CAS case manager. The County Plan states, “Once placed in
outpatient treatment, it is the responsibility of the treatment provider to
report the need for residential services and a treatment adjustment to the
Assessment Center case manager.”
F-87. Once in treatment, communication between the treatment providers and the
courts is coordinated through the CAS case managers. Communication
includes reporting of drug test results, session attendance, and levels of
participation.

Criminal Justice (Probation) Services

F-88. Based primarily on the goal of keeping the majority of funding in treatment,
Ventura County made a decision to place felons on formal probation under
Probation supervision. Misdemeanants are placed on conditional release with
no probation oversight or supervision.
F-89. When Prop 36 was initiated into this county, BHD/ADP assumed responsibility
for treatment monitoring and reporting for all Prop 36 offenders. It was
considered practical to allow Probation to supervise felony offenders with
information provided by BHD/ADP.
F-90. The BHD/ADP CAS function would provide general oversight to misdemeanor
offenders not on formal probation. The case managers were responsible for
filing charges of non-compliance for misdemeanor clients. This function was
considered practical because CAS has immediate access to compliance
information for these clients.

11 See findings F-123 thru F-148

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F-91. In regard to this complementary oversight function of Probation and

BHD/ADP, the Implementation Committee Report stated,
It was recognized that the treatment sessions and drug testing
performed as part of treatment will provide significant levels of
monitoring, and therefore the overall supervision and monitoring
of drug offenders will increase through the combined efforts of
Probation and ADP under the plan.
F-92. Probation has no legal jurisdiction or authority over the Prop 36 misdemeanor
offenders placed on conditional release. As the system is now implemented, if
there is any court supervision of these particular clients, it must take place
through the treatment process.
F-93. The division between felons and misdemeanants was chosen as a convenient
way to manage the large number of clients. In retrospect, Probation
acknowledges that many misdemeanor offenders require as much or more
supervision than felony offenders. The arbitrary division between felons and
misdemeanants does not appropriately address the criminality or actual need
for probation supervision.
F-94. As described in the UCLA Report, the intention of Prop 36 is to provide
“probation with drug treatment instead of either probation without treatment
or incarceration.” For misdemeanor offenders, Ventura County created an
additional alternative: drug treatment without probation.

Drug Treatment without Probation

F-95. For a variety of reasons, BHD/ADP CAS did not fulfill the Implementation
Committee’s expectation of client supervision.
F-96. The transfer of information between treatment providers and CAS and
between CAS and the courts has been slower than desired. There has been
some loss of or miscommunication of information at different levels of the
process.
F-97. Initially there was a “firewall” that prohibited the treatment providers from
communicating directly with Probation. This firewall further increased the
times for communication to flow from treatment through BHD/ADP and on to
criminal justice.
F-98. Delays in obtaining assessments, delays in non-compliance communications,
and delays in processing violations created large gaps in time where clients
who were again using drugs were free in the communities.
F-99. Although statistics are unavailable, increases in crime rates coupled with
many of the offenders’ criminal histories suggested to law enforcement that
some of the unsupervised and unemployed drug users were committing
property crimes to sustain their drug habits.
F-100. Prior to the 2003 Grand Jury report, BHD/CAS was solely responsible for
reviewing treatment information, including attendance and drug testing
results, and determining non-compliance of clients.
F-101. Faced with the 2003 Grand Jury’s criticism of client supervision, the BHD

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Ventura County 2004 – 2005 Grand Jury Final Report

response to the findings stated, “Probation and Parole are responsible for
supervision. BHD/ADP and the treatment providers are responsible for case
management.”12
F-102. In the cover letter to the BHD response, Ms. Shulman stated,
At this time, BHD/ADP and the contracted treatment
providers [emphasis added] are responsible for determining non-
compliance of clients. BHD/ADP would propose that non
compliance be determined by the courts. BHD/ADP would report
all activities of clients in treatment – including attendance and
drug testing results. The courts would then be responsible for
determining if these activities are violation and strikes or a
normal part of treatment recovery. Recommendations from
treatment, along with Probation and representation of the Public
Defender and the D.A. would be included in this process. Details
of implementation of this procedure could be determined in the
MOU by the Operations Committee.
F-103. Although contract treatment providers pass treatment and compliance
information to BHD/ADP case managers, contractors never had responsibility
for making client non-compliance determinations. That responsibility, for
misdemeanor offenders on conditional release, rests entirely with BHD/ADP.
F-104. Because BHD/ADP either failed to perform or determined that it was never
required to perform supervision functions on clients of Prop 36, the Oversight
Committee determined that the D.A.’s office could perform this Probation
function.
F-105. With Board approval, for fiscal year 2005-2006, the D.A. has established
positions funded by $150 thousand in Prop 36 money to review client
treatment information in order to file non-compliances.
F-106. This function was originally planned by the Implementation Committee to be a
treatment function. Because the funding provided to Probation (25% of the
total) was only adequate for felony supervision, the misdemeanor supervision
and non-compliance filings were originally to be paid by the 75% directed
toward treatment.
F-107. Despite the fact that the D.A. is taking on a function that was originally
established with treatment funds at BHD/ADP, the Oversight Committee
determined that the funding to replace that capability will be taken from
Probation.
F-108. It is considered unusual for the D.A. to assume Probation functions.
F-109. In juvenile and adult court-ordered treatment programs other than Prop 36,
Probation has maintained their own lists of approved treatment and service
providers. In those programs, Probation provides assessments and referrals to
treatment services for drug and alcohol abuse as well as domestic violence and

12 Shulman, Linda, “2003-2004 Ventura Grand Jury Report Behavioral Health Department Response,”

August 16, 2004. Response to finding F-35.

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Ventura County 2004 – 2005 Grand Jury Final Report

anger management. Probation provides supervision and case management

and they assume responsibility to document and process probation violations
and non-compliances for the courts.
F-110. With adequate funding, Probation could provide assessments, referrals, case
management, supervision and violation processing for Prop 36 clients.
F-111. The 2003 Grand Jury recommended that an effective risk management system
would assist Probation in supervising all Prop 36 clients, not just felony
convictions.
F-112. Probation already assesses risk with their internal risk management system,
but the process requires time and cannot be done continuously for such a large
population of clients.
F-113. A probation officer will typically see a client once a month. Treatment
providers have significantly more contact, as often as several times a week.
Those providers are frequently evaluating the client’s progress and risk to
society.
F-114. The 2003 Grand Jury recommended that all Prop 36 offenders be placed on
formal probation under the supervision of the Probation Agency and that an
information system be developed to provide a regularly updated risk
assessment. This recommendation was based on findings that a misdemeanor
drug offender could often have serious and repetitive criminal behaviors.
F-115. The recommended risk management system would not have replaced existing
systems, but could have been an additional source of information to Probation
Officers. It could collect and prioritize Prop 36 client information from
treatment providers without the added burden of data entry by Probation staff.
F-116. The Board declined the 2003 Grand Jury’s recommendation due to budgetary
considerations. The Board replied that it would “consider this
recommendation when funding becomes available, but it must be considered
along with other county priorities.” This response suggests that Prop 36 funds
would not be available for this type of oversight function. BHD seems to agree
with the Board when it replies that it “has made this same Recommendation in
prior Annual Reports to the Board.”
F-117. The Board did not research this proposal or the funding source before citing
the cost prohibition.
F-118. As a cost of providing supervision to Prop 36 offenders, this expenditure would
be appropriate and justified for use of Prop 36 funds.
F-119. The Grand Jury queried treatment providers, and they all collect information
that is useful in evaluating the risk to society presented by their clients. The
data collected are basic risk assessment indicators such as employment status,
family relationships, education involvement, adherence to program attendance
and sobriety goals, etc.
F-120. The Grand Jury obtained a representative questionnaire, know as “Passport,”
from a local treatment provider and asked the ISD to provide a cost estimate
for a two-part project: (1) develop an on-line, web-based form for treatment
providers to fill in with risk information and (2) develop a screen at the

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Ventura County 2004 – 2005 Grand Jury Final Report

Probation office to display a scored, sorted listing so that any probation officer
could review their cases for risk factors on a daily or weekly basis.
F-121. The cost to develop the system described to ISD was approximately $3,900.
F-122. Based on the plan prepared by BHD/ADP, approved by the Board, and
submitted to the State of California last year, Prop 36 had $1 million of
unspent funding to carry over into fiscal year 2005-2006. Prop 36 earned over
$33,000 in interest on carry over funds during the last fiscal year.

Central Assessment Services (CAS)

F-123. BHD/ADP maintains an office of Prop 36 CAS to provide orientation,

assessment, referral, and case management for all Prop 36 clients.
F-124. Clients are not treated for addiction in the CAS. Clients are placed into
treatment subsequent to assessment. The CAS does not provide drug
treatment sessions.
F-125. A secondary purpose of the CAS is to refer clients to ancillary services that
might enhance their recovery. Ancillary services include vocational services,
educational services, medical treatment, psychiatric treatment, and family
counseling. The DADP Analysis provides a table that compares “Planned
Services by Type Using SACPA Funds in the 12 Large Counties in FY 2003/04”
(see Attachment 1).
F-126. Prop 36 funds may be used to pay for these ancillary treatment services;
however, BHD/ADP proposed and the Board approved through the annual
plans to the state, that the existing public health system will be used to
provide those services to Prop 36 clients in this county. In the most recent FY
2005-2006 County Plan, these ancillary services are referred to as, “currently
leveraged with existing County-operated programs.”
F-127. The FY 2005-2006 County Plan states that, with regard to the county-financed
ancillary services, “So far there has not been a capacity problem.”
F-128. Despite the statement to the contrary, the Grand Jury finds that budget cuts
in county programs this fiscal year have forced CAS counselors to curtail many
of their ancillary referral services.
F-129. Those free services that are still widely available, such as employment and
vocational assistance, are still referred but are rarely followed up by Prop 36
clients. There is no requirement for the clients to follow up on any of the
referrals other than substance abuse treatment.
F-130. One service considered vital by the CAS staff is the psychiatric evaluation and
treatment. Over a year ago, a single psychiatrist was dedicated to Prop 36
treatment of clients with psychiatric needs. This psychiatrist would coordinate
a client’s treatment as well as provide client feedback to the case managers.
On his retirement, he was not replaced due to budget cuts.
F-131. CAS continued to refer clients to mental health services for a while after the
dedicated psychiatrist left. Unfortunately, without a single dedicated
psychiatrist who understood addiction medicine, those referred clients would

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Ventura County 2004 – 2005 Grand Jury Final Report

be assigned to various psychiatrists in the public system. Those clients were

often not forthcoming about their addiction, and they were sometimes
prescribed medications such as psychotropic drugs that would conflict with
their substance abuse treatment.
F-132. In addition to prescription problems, the clients would be provided counseling
that was in conflict with their court-ordered drug treatment. There was no
coordination with the case managers, and the resulting chaos undermined the
treatment providers and was detrimental to the client’s overall treatment
progress.
F-133. Since CAS management did not make arrangements for a dedicated
psychiatrist, access to psychiatric services has been purposely limited to avoid
future problems.
F-134. The County Plan characterizes this curtailment of services as, “The funding for
mental health services (psychiatric evaluations and medications) is being
decreased, since the need for these services has been decreasing.”
F-135. In direct contradiction of the County Plan, the first stated priority for all
counselors and court-team personnel is the requirement for mental health
services. This need was communicated by members of the same organizations
that signed the County Plan stating there was decreasing need for those
services.
F-136. The CAS has overstated its workload. It claims to book about 50 client
appointments per day. After deductions for “no shows” for assessments and
orientation, the actual show rate is claimed to be about 35 clients per day. The
Grand Jury’s review of CAS scheduling calendars for a one-month period in
May-June 2005 shows there were 286 total appointments, averaging about 12
appointments per day. Of those, about 55, or 18%, were no-shows.
F-137. The calendars also revealed that over half of the appointments, 163 of the 286,
were not assessments but group orientation sessions. Based on the
appointments and no-shows clients, the CAS is performing about four or five
assessments a day.
F-138. CAS provides “telephone assessment” to clients who need to be re-assessed
before returning to treatment after being non-complied. Staff members at the
CAS describe telephone assessments with the admonition that, counselors
have to listen really well if assessing by telephone.
F-139. Many of the staff may not feel qualified to use all of the assessment
instruments appropriately. These instruments include the Global Assessment
of Functioning (GAF), the Addiction Severity Index (ASI), and the American
Society of Addiction Medicine (ASAM) criteria. The use of these instruments
will produce numerical scores that describe, among other things, the need for
treatment.
F-140. The CAS staff knows what range of assessment scores their supervisor will
approve, and they frequently put those scores on the assessment to assure
their supervisors’ approval.

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Ventura County 2004 – 2005 Grand Jury Final Report

F-141. Contract treatment providers notice that most of the assessments from the
CAS are very similar (like boilerplate) even for dissimilar clients.
F-142. The assessment result from CAS is a combination of the staff’s interview with
the client and the known expectations of the supervisor.
F-143. Drug addicted clients have a hard time dealing with many layers of
government bureaucracy. CAS staff members and contract treatment
providers all report that dealing with as few different people as possible is best
for the clients.
F-144. In spite of client confusion caused by layers of bureaucracy, the CAS has
further divided their duties so that staff members have specialties of
assessment and case management. The client may see one counselor to be
assessed and then might be assigned to a different counselor for case
management. This is all before they go to a different facility and meet yet
another counselor for substance abuse treatment.
F-145. There is a specific treatment bottleneck. The flow of information seems to stop
at CAS. CAS has told the criminal justice side of the process that bottlenecks
are caused by the treatment providers. CAS had told treatment providers the
problem is caused by the criminal justice side.
F-146. The Grand Jury has found the consistent bottleneck is at the BHD/ADP CAS
operation.

Assessment Timeliness

F-147. The 2003 Grand Jury was critical of the length of time that would elapse
before a client would be required to report to the CAS for assessment. Prior to
the 2003 Grand Jury report, it was not unusual to have a client wait two
weeks or more to obtain an assessment.
F-148. With regard to assessment, the 2003 Grand Jury recommended, and all
responding parties concurred, that a “goal of early and positive supervision
experience should be pursued to initially set the tone for Prop 36 treatment.”
The recommendation was specifically to establish an office in the Hall of
Justice or Probation for use in immediate assessments subsequent to
sentencing.
F-149. The Probation Agency expressed in their response to the 2003 Grand Jury that
their experience shows, “proximity and timeliness are key elements to success.
For this population, allowing five days for a telephone contact and up to three
weeks for an initial assessment will result in higher no-show rates.”
F-150. In public response at the September 28, 2004 meeting of the Board, Ms.
Shulman stated,
We agree as far as being able to move assessment into the
Courthouse. We think that would be great. Although now we
have looked at the assessment process and I think that a client
can get into an assessment within 24 hours of calling now. So
that, at least now, the timeframe from which they’re referred
from the Courts and are able to get assessed, the turnaround

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Ventura County 2004 – 2005 Grand Jury Final Report

times are much quicker. So, you know, you’ll see in our response
to the Grand Jury, we pretty much agreed with most of what they
had to say, a little taken aback by the tone of the report and do
think there are some basic philosophical realities that we’re all
going to struggle with around whether this is the right way to be
dealing with people with drug problems and certainly that’ll
continue to be an issue.
F-151. In the nearly nine months since Ms. Shulman’s statement, there appears to be
no documented improvement in the time between sentencing and assessment.
F-152. The Courts allow a client to take up to five days before calling CAS for an
assessment. When a client does call CAS, the appointment could be two weeks
or more in the future.
F-153. The Grand Jury randomly selected groups of client records (redacted for
personally-identifiable client information) to calculate the number of days
between sentencing and assessment. As late as May of 2005, dozens of client
records show an average of 12 calendar days between sentencing and
assessment. One client sampled was seen in two days, four clients were seen
within three days, and dozens took nearly two weeks. A few of the sampled
clients took more than 30 days to reach the assessment.
F-154. Ms. Shulman’s statement (see F-152) is technically correct. With a staff of ten
full-time addiction and drug treatment specialists, and an average of fewer
than five actual assessments a day, it would be possible that a client walking
in off the street could be assessed immediately, if the CAS operated in that
manner.
F-155. In reality there is little or no likelihood of clients actually being assessed that
quickly. The CAS appointment calendar, with initial assessments booked days
and weeks into the future, contradicts the 24-hour suggestion of Ms. Shulman.
F-156. The County Plan approved on May 17, 2005, by the Board and submitted to
the State of California states,
Not all clients who are eligible and referred to Prop. 36 make it to
the CAS; however, 90% of the clients assessed do enter
treatment. In order to address this issue, for 2005-2006 we plan
to have an assessment office in the Hall of Justice, and clients
will be required to schedule an appointment or complete an
assessment before reporting to Probation if so ordered.
F-157. At the Board meeting of May 17, 2005, Ms. Shulman reported that space had
been identified to open an assessment center location in the courthouse,
stating that she was working on a pilot program with the courts to begin
assessments for Prop 36, but looking to use the assessment center for Domestic
Violence (DV) Court. She stated that the goal was ultimately to do
assessments in the courthouse for all the courtrooms that need referrals.
F-158. DV Court does not currently use BHD for assessment services. The current
assessments and DV case management is through the Probation Agency.

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Ventura County 2004 – 2005 Grand Jury Final Report

F-159. The assessment process performed by CAS staff, sometimes taking two to two
and a half hours, is too lengthy and unpredictable to perform routinely in the
Hall of Justice.
F-160. After the assessment office is opened in the Hall of Justice, BHD/ADP plans to
provide staff to greet new clients as well as schedule their assessment
appointments at the CAS. There is a plan to conduct a few assessments to
meet the requirements of the 2003 Grand Jury’s recommendations, but the
majority of the assessments will be conducted in the CAS.
F-161. It would be feasible for CAS staff to use this time in the court, after
sentencing, to find out where the client lives and send him or her to the
nearest treatment facility for assessment and to get started on a treatment
program.
F-162. Funding for Prop 36 and CAS will be uncertain in the future after the sunset of
Prop 36 next year. In addition, the Grand Jury has focused attention on the
questionable necessity of BHD/ADP and the CAS assessment and case
management functions.

Treatment Providers

F-163. It is the responsibility of BHD/ADP, as the designated Lead Agency, to

“provide or contract for drug treatment programs.”13
F-164. CAS sends Prop 36 clients to treatment providers to undergo their actual drug
treatment services.
F-165. All treatment providers, even those operated by the county, reported that they
must do their own assessment in order to properly treat a client. Both of the
largest outpatient facilities reported that they also conduct an orientation for
new clients.
F-166. Treatment providers do not rely on the assessments provided by the CAS.
Treatment providers frequently disagree with the assessments of the CAS.
F-167. Treatment providers also make referrals to ancillary services in the interest of
their clients.
F-168. The County Plan states, “Once placed in outpatient treatment, it is the
responsibility of the treatment provider to report the need for residential
services and a treatment adjustment to the CAS case manager.”
F-169. Treatment providers have been presented with clients who have severe mental
illness who have not been referred to mental health treatment by the CAS
F-170. The CAS staff members maintain the client files and provide case management
functions. The majority of information in the client files is duplicated from
files created and maintained at the treatment provider.
F-171. Probation and contract treatment providers are capable of providing case
management functions. In fact, as the primary contact with the clients, the

13 Ventura County Implementation Committee, “Report of the Implementation Committee,” June 5, 2001.

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Ventura County 2004 – 2005 Grand Jury Final Report

treatment providers are required to complete a great deal of duplicative

paperwork intended to keep the CAS staff informed of the clients’ progress.
F-172. When the CAS refers clients to treatment in the county-run facilities in
Ventura, Oxnard, and Simi Valley, treatment for those clients can be provided
with Drug Medi-Cal (DMC) funds versus Prop 36 funds. Since treatment
cannot be billed to Prop 36 for services where DMC is billed, Prop 36 funds are
saved when a client is funded by DMC, and county-treated clients do not
generally expend Prop 36 funds.
F-173. BHD/ADP and the CAS staff do not make recommendations as to treatment
methods. Each treatment provider determines its own methods, even within
the county-operated facilities.
F-174. When the Prop 36 law was placed in effect, the county contracted with
treatment providers for substance abuse treatment services. These services
can be compared to the services already being provided to drug courts and
other court-ordered treatment scenarios.
F-175. Treatment providers signed contracts whereby the client is required to pay
directly to the treatment provider a co-payment for the major portion of their
treatment services. This is an expected part of treatment so that the client has
an investment in recovery.
F-176. For outpatient services, the county has written contracts that refer to “units of
service” that can be billed to the county for Prop 36 treatment. The treatment
contracts reimburse the providers only for group and individual counseling
hours. There is no reimbursement for assessment, case management, special
ancillary treatment services, compliance tracking and reports required by the
county. The treatment providers conduct interim assessments throughout the
treatment process and those are not compensated either.
F-177. In addition to the compensated units of service, the contract treatment
providers are required to perform specific case management functions for
BHD/ADP CAS such as progress reports, non-compliance reports, termination
and discharge reports, attendance summary tracking, drug testing compliance
tracking, records preparation for subpoena, job search verifications, and
certificates of completion. None of these activities are compensated under the
terms of the contracts.
F-178. In addition to paperwork required by CAS case managers, treatment providers
have daily telephone conferences with CAS personnel answering requests for
information such as client whereabouts, non-compliance issues and treatment
adjustments. None of these activities are compensated under the contracts.
F-179. Written into the formal Probation terms, as well as the treatment provider
contracts, is the requirement for clients to make a co-payment for treatment.
A client should not be allowed to complete treatment without paying his or her
fees. Also, the protocols describe the procedure to non-comply clients who are
able to pay but refuse to pay a co-payment.
F-180. Treatment providers see the clients more frequently than Probation, the
courts, and the CAS case managers. They come to know the clients well

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Ventura County 2004 – 2005 Grand Jury Final Report

during the course of treatment. The treatment providers can tell when a client
is serious about recovery and whether the client shows signs of being unable to
pay.
F-181. Treatment providers provide services to clients at reduced rates or for free
when the client is dedicated to recovery. Treatment providers will report a
client to the courts when they appear to have the ability to pay but refuse to do
so.
F-182. There are times when the treatment providers determine a client can pay, but
the courts determine that the client cannot pay. When the courts determine
the client cannot pay, the treatment provider may be ordered to perform pro-
bono (free) services.
F-183. The contract treatment providers are the only Prop 36 stakeholders required to
donate services or pay out of pocket to treat Prop 36 clients.
F-184. The BHD/ADP requires the contract treatment providers to provide services
unrelated to treatment each month. Each month the treatment providers are
required to submit a supplemental report of the number of children the clients
have, whether they are on DMC, and whether the client left treatment within
30 days or before treatment was completed.
F-185. Contract treatment providers are inundated with requirements to provide
numerous budget reports to the CAS. The providers are required to submit
quarterly reports showing units of service. The county required many
quarterly budget and cost reports. Monthly, the providers are called to the
county to explain their supplemental reports.
F-186. The treatment providers are not compensated for any administrative activities
that are associated with drug treatment. The treatment providers have been
told by BHD/ADP that administrative activities are not allowable charges
under Prop 36.
F-187. Although the treatment providers are not allowed to be compensated for the
administrative costs under Prop 36, the CAS staff duplicates many of the same
functions and CAS staff is fully compensated by Prop 36 funds. It is not clear
whether the treatment providers cannot be compensated because those
activities are being paid for at the CAS or whether the CAS is using different
criteria for their own billing than they use for their contract providers.
F-188. The Prop 36 Court has not ordered government employees to work for free:
• When the Probation Agency did not have adequate funding, they were
allowed to forego supervision services for misdemeanor defendants.
• When the county-operated treatment facilities provide substance abuse
services for a client who cannot pay, their staff salaries are still paid by the
county.
• When Mental Health experienced financial cutbacks, they eliminated the
psychiatric position that was previously dedicated to Prop 36 clients. There
was no Court-ordered pro-bono work for psychiatrists.
• When BHD lacks funds for any service, they quit providing that service.
• The D.A.’s office can limit its services to those services for which it has
funding. The county continues to pay the salaries of the D.A.’s attorneys.

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Ventura County 2004 – 2005 Grand Jury Final Report

• The Public Defender’s office can limit its services for which it has funding.
The county continues to pay the salaries of the Public Defender’s attorneys.
F-189. When the Court orders a client to receive free treatment services, the county
and Prop 36 do not provide the client’s co-payment fees. The contract
treatment providers, who are private companies, are required to comply with
the Courts, even though the money comes out of their private accounts.
F-190. The County of Ventura compensates outpatient treatment providers at the
rate of about $9-10 per hour for group sessions and $18-25 per hour for private
sessions. These fees are for direct treatment session hours. There is no
compensation for other services such as coordinating paperwork or providing
documents to the CAS.
F-191. Even though their contracts allow treatment providers to collect a co-payment
for treatment services, the county restricts this ability by giving the clients a
reduced fee. Approximately 80% of the Prop 36 clients at the contract
treatment providers have a reduced fee or refuse to pay. The treatment
provider is not allowed to provide sanctions to clients who refuse to pay. The
BHD/ADP does not compensate the treatment providers’ losses from Prop 36
funds.
F-192. Capacity continues to be a problem with Prop 36 treatment providers. The
County Plan states, “Funding decreases from other sources has caused some
treatment providers to lay off staff and reduce the number of slots and beds
available.”
F-193. Whether the county is exercising good business or sharp practices, the contract
treatment provider appears to bear the entire risk for clients who might be
inappropriate risks and who cannot be forced to pay treatment fees.
F-194. BHD/ADP certainly knows the terms of the contracts, and the contractors have
made BHD/ADP aware of their concerns.
F-195. Other than BHD/ADP, the stakeholders share the opinion that treatment
providers have a competing profit motive that prevents them for being
objective about compliance and non-compliance. This perception of the
treatment providers has not been discouraged by BHD/ADP.

Treatment Examined

F-196. BHD/ADP management and CAS treatment specialists provide no added value
to the treatment process for Prop 36.
F-197. Even without the bureaucratic creations of BDH/ADP, there are some
paperwork and bookkeeping functions required by Prop 36. There is a
requirement for bookkeeping or clerical employees.
F-198. Assessment must be redone by the treatment provider before treatment
begins, but the treatment provider cannot bill the county for assessment
services.
F-199. Referrals to ancillary services can be performed by the treatment providers or
Probation with the same or more effectiveness than CAS.

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Ventura County 2004 – 2005 Grand Jury Final Report

F-200. CAS has insinuated itself into the communication channels and has effectively
lengthened the time required to pass information from the treatment providers
to the Courts.
F-201. As a central delivery point for drug test results, CAS is a bottleneck when
disseminating the test results to treatment providers for treatment
adjustments.

Wrestling with Protocols

F-202. Treatment providers are the experts in addiction. In any other court-ordered
treatment programs, the treatment providers establish the protocols and work
closely with Probation to ensure those protocols are followed.
F-203. Since the inception of Prop 36, the stakeholders have been wrestling with
treatment and compliance protocols. This struggle over the protocols is
unprecedented.
F-204. From the first year of implementation, there was a mandated communication
firewall between the treatment providers and the Probation Agency and the
courts. Partially as a result of this firewall, treatment information was
bottlenecked in the BHD/ADP CAS facility.
F-205. Information on non-compliances was of particular concern. Treatment
providers were sending non-compliance information to CAS to be passed to the
Courts, and CAS was making a local determination that those offenses were
not to be a violation.
F-206. When criminal justice stakeholders noticed that many known offenders were
still at large, BHD/AP blamed the contract treatment providers.
F-207. The Grand Jury finds that the continual adjustments to treatment protocols
and non-compliance reporting requirements are likely a direct result of
communications problems mostly attributable to BHD/ADP.
F-208. Changes to the protocols are of concern when there is no effort to collect and
report data on the success of any given protocol.
F-209. Constantly changing treatment, testing, and attendance protocols is confusing
to providers and clients alike.
F-210. All Ventura County stakeholders are trying to define the parameters of
successful drug treatment services. These agencies are not deferring to the
treatment providers with regard to treatment decisions.
F-211. The treatment decisions are now being made by the Operations Committee.
Treatment is no longer based on the reasoned treatment experience of
treatment providers. Treatment is now based on the need for public safety
official to close the gate on the problems created by BHD/ADP.
F-212. Removing BHD/ADP from the process can promote a return to a more logical
and natural process with improved information flow.
F-213. Probation is very good at coordinating with treatment providers for delivery of
services in a court-ordered drug treatment program.

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Ventura County 2004 – 2005 Grand Jury Final Report

Funding

F-214. It is the responsibility of BHD/ADP, as the designated Lead Agency, to

“administer Prop. 36 funds” and “coordinate the county plan.”14
F-215. Each fiscal year, the Prop 36 County Plan is prepared for submission to the
State. The County Plan describes, among other things, the funding
distribution. The plan usually states that it was compiled by BHD/ADP with
input from the Operations Committee, community-based treatment providers,
and others. The Board approves the plan and then it is submitted to the state.
F-216. Operations Committee members (other than BHD/ADP) and community-based
treatment providers do not actively participate in the financial aspects of the
County Plan.
F-217. Other than BHD/ADP, members of the newly-formed Oversight Committee do
not participate in the financial aspects of the County Plan. Oversight
members refer to the high levels of trust required when working with inter-
agency collaborations.
F-218. There are two categories of funding in Prop 36. The “criminal justice” category
in Prop 36 includes probation, supervision, monitoring, and other related
activities. “Treatment services” refers to drug treatment and related services
such as literacy training, vocational training, family counseling, and
psychiatric services.
F-219. Ventura County has chosen to allocate approximately 75 percent of the budget
to direct treatment services and 25 percent to criminal justice.15
F-220. A funding limitation is cited as the sole reason that Probation cannot provide
oversight to the entire Prop 36 client community.
F-221. Since inception of Prop 36, Ventura County has shown an excess of more than
a million dollars at the end of each fiscal year. In fiscal year 2003-2004,
BHD/ADP earned over $33,000 in interest on unspent Prop 36 funds.
F-222. The California Department of Drug and Alcohol Programs (DDAP),
administrators of Prop 36, have published memos stating that counties that
have excess Prop 36 funds may be required to return them to the state for
redistribution to under-funded counties.
F-223. In the annual reporting to the State of California, Ventura County BHD/ADP
reports that, over the first three years of implementation, approximately 75%
of Prop 36 funding is allocated to direct treatment services.16
F-224. The Board Letter to submit the FY 2004-2005 Ventura County Plan was
signed by Linda Shulman, M.F.T., Director of Behavioral Health and Dr.

14 Ventura County Implementation Committee, “Report of the Implementation Committee,” June 5, 2001.
15 Proposition 36 Analysis of Plans from the 58 Counties, [Link]
[Link]
16 Health Systems Research, Inc., “Substance Abuse and Crime Prevention Act of 2000: Analysis of FY

2003/04 Plans from the 58 Counties,” [Link]

Plans_2003-[Link], September 30, 2004.

Ventura County Proposition 36: Administrative Reforms Examined 25

Ventura County 2004 – 2005 Grand Jury Final Report

Pierre Durand, Director of the Health Care Agency on June 8, 2004.17 This
Board Letter states,
In FY2004/05, State funding for Prop 36 services has been
allocated at $2,865,608, an increase of $102,941 over
FY2003/04. An additional estimated $1,080,044 in rollover
funding from prior years will bring the total available funding
to $3,945,652. Under agreement, 75% of these funds will be
used to fund direct substance abuse treatment services. The
remaining 25% of the allocation will be used by the Probation
Agency to fund services for the supervision and monitoring of
offenders. $614,311 will be held back to be rolled over to FY
2005-06 to assist with maintaining the current level of service
over two-year period.
F-225. As described in this Board Letter, the intentions of BHD/ADP for FY 2004-05
are shown in Table 1. The table differs from the text in that the carryover
funding of $614 thousand is reserved before the total available funding is
distributed.

Description from June 8, 2004 Board Letter

Amount Purpose
FY 04-05 State “Allocated” $2,865,608
Prior Year “rollover funding” $1,080,044
“held back and rolled over to FY $ 614,311 “to assist with maintaining the
2005-06” current level of service over
two-year period”
“total available funding” $3,331,341
“75% of these funds” $2,498,506 “direct substance abuse
treatment services”
“remaining 25% of the allocation” $ 832,835 “Probation Agency to fund
services for supervision and
monitoring of offenders”

Table 1. Funding description from June 8, 2004 Board Letter

F-226. The Board Letter states, “The FY2004/05 Plan specifies core treatment
services as follows: 52% of the funds will be provided for residential treatment
services, 38% will go towards outpatient services, 3% will go towards medical
detoxification services, and another 7% will be utilized for sober living.
F-227. The 75% of the funds allocated to “direct substance abuse treatment” are seen
in Table 2.

17 Behavioral Health Department, “Approval of FY 2004/05 Behavioral Health Department Alcohol and
Drug Program (BHD/ADP) County Plan for Proposition 36 Services ,“ Letter to Board of Supervisors. June
8, 2004. [Link]

26 Ventura County Proposition 36: Administrative Reforms Examined

Ventura County 2004 – 2005 Grand Jury Final Report

Description from June FY 04-05 FY 03-04 Current FY

8, 2004 Board Letter Allocated Actual Expenditures Current FY
Amount Expenditures (Thru May 2005) Budget
($) ($) ($) ($)
“75% of FY 2004- 2,498,506 Direct substance abuse treatment services
2005 Prop 36
funds”
52% for residential 1,299,223
572,035 466,811
7% sober living 174,895
38% for outpatient 949,432 365,306 $ 324,665 1,293,632

3% medical detox 74,955 --- 16,800

Other services 77,660 0 60,000
CAS/CAC - Salaries and ----- 996,111 1,258,995
Benefits
CAS/CAC - Everything ----- 173,100 286,780
Else

Table 2. Funding narrative from FY 2004-05 County Plan

F-228. Although the County Plans and other documents do not highlight the cost of
the CAS assessment center, this facility and its staff consume more than half
of the allocated treatment dollars.
F-229. In Table 2, as of May 2005 a total of $808,276 of Prop 36 funds was paid to
treatment providers for residential services, sober living, detox and outpatient
services. A total of $1,169,211 has been paid for the CAS assessments and
case management as well as program administrative costs.
F-230. As a general reference, CAS performs a two-hour assessment for a Level 2
client who receives an average of 66 program hours in a year. Including case
management and assuming the services were not redundant, the CAS provides
no more than 5% of the services and receives over 60% of the treatment
funding.
F-231. The Board Letter to submit the FY 2005-2006 Ventura County Plan was
signed by all members of the Oversight Committee: John F. Johnston, Chief
Executive Officer; Bob Brooks, Sheriff; Gregory D. Totten, District Attorney;
Honorable John E. Dobroth, County of Ventura Superior Court; Dr. Pierre
Durand, Health Care Agency Director; Linda Shulman, M.F.T., Director,
Behavioral Health Department, Calvin C. Remington, Director/Chief Probation
Officer; and Kenneth Clayman, Public Defender. It states,
In FY2005/06, State funding for Prop. 36 services has been
allocated at $2,856,660. A projected $1,000,000 in rollover
monies from FY 2004-2005 will bring total available for the
proposed Plan to $3,856,660: approximately 75% will be used for
direct substance treatment services, 23% will be used for criminal
justice expenditures (courts, probation, etc.), and the remaining
2% will be used for supplemental services for treatment. The

Ventura County Proposition 36: Administrative Reforms Examined 27

Ventura County 2004 – 2005 Grand Jury Final Report

funds that are designated for treatment services will be

distributed as follows: 34% residential treatment services, 64%
outpatient services, and 2% are medical detoxification services.
F-232. The 75% of the funds allocated to “direct substance abuse treatment” are seen
in Table 3. There are no actual costs for FY 2005-2006 to compare, but there is
nothing in the County Plan or proposed budget to indicate that CAS costs will
be any different from those seen today.

Description from May 17, 2005 Treatment

Board Letter funds
Amount Purpose
FY 05-06 State “Allocated” $2,856,660
Prior Year “rollover funding” $1,000,000
“total available funding” $3,856,660
“75% of these funds” $2,892,495 “Direct substance abuse
treatment services”
34% Residential Treatment $ 983,448
64% Outpatient Treatment $ 1,735,497 FY 04-05 Combined outpatient
contracts approximately
$370,000
2% Medical Detox $ 57,850
“23% criminal justice” $ 887,032
“2% medical detox” $ 77,133

Table 3. Funding description from May 17, 2005 Board Letter

F-233. The two largest Prop 36 treatment providers have a combined 5,500 square
feet of space dedicated to treating Prop 36 offenders. The CAC is roughly 5,900
square feet. The CAC treats no clients.
F-234. DMC will pay for many of the same drug treatment services that Prop 36
provides. BHD/ADP encourages contractors to qualify for DMC
reimbursement.
F-235. When a client is referred to a county drug treatment provider, DMC is billed
for the treatment if possible. BHD/ADP is not required to expend Prop 36
funds for clients paid through DMC.
F-236. As defined by Prop 36, “direct treatment services” includes the CAS building
and staff. Direct treatment includes the indirect salaries of CAS support staff
and management personnel.
F-237. When the Operations Committee and BHD/ADP limit the Prop 36 funds
allowed for Probation, that agency must pay for some Prop 36 supervision from
their county-funded budget (general fund dollars).
F-238. General fund dollars, as well as reimbursable public health referrals, are

28 Ventura County Proposition 36: Administrative Reforms Examined

Ventura County 2004 – 2005 Grand Jury Final Report

currently being used to pay some ancillary services for Prop 36 clients based on
agreements between the Board and BHD/ADP.18
F-239. Prop 36 funds cannot be used for drug testing. However, County general fund
dollars can be used for drug testing.

Conclusions
C-01. If drug abuse and the associated criminal behaviors are truly reduced, public
safety will likely be enhanced. Jail and prison cells would be preserved for
serious offenders. (F-01, F-02)
C-02. BHD/ADP has not demonstrated true leadership. There is an obvious
knowledge of funding – how to acquire it and how to keep it – but there is no
indication that the leadership can make effective policy and see it through
implementation. (F-119 thru F-122, F-230)
C-03. BHD/ADP manages reactively, driven to deflect criticism. Rather than real
policy changes, the change often witnessed is verbal: the situation may be
redefined verbally so that action is not necessary. In the absence of critical
thinking, this technique of redefining the problem and fashioning words to
appear successful appears to work very well in Ventura County. (F-13, F-49,
F-50, F-52, F-102, F-103, F-104, F-107)
C-04. True collaboration involves open communication. While emails and private
conversations are necessary to coordinate meetings and introduce topics, the
meetings should be held so that all opinions are heard by all parties at the
same time. The individual conversations and emails can appear secretive, and
in a meeting that makes decisions by consensus, it is often unclear how that
consensus was reached. (F-49, F-50)
C-05. It is hard for the Grand Jury to understand how Prop 36 is lacking in
psychiatric services. It was reported that a psychiatrist is not available
because of funding cuts in the county budget. It was found that BHD/ADP was
allowed to pay for a psychiatrist with Prop 36 funds as an ancillary service.
The County Plan states that there is no need to issue contracts for services
because there is no problem at this time. Yet everyone treating clients states
there is a problem with the lack of psychiatric services. (F-125, F-126, F-127,
F-130 thru F-135)
C-06. BHD/ADP has not been forthcoming in communicating how little the CAS
actually accomplishes. (F-123 thru F-146)
C-07. BHD/ADP has not been proactive in analyzing or balancing the costs of
treatment delivery. Their neglect in this area is self-serving to the detriment
of clients and public safety. (F-119 thru F-122, F-230)
C-08. BHD/ADP has not been proactive in determining the needs of the clients and
establishing means to satisfy those needs. (F-130 thru F-135)

18 FY 2005-2006 County Plan, “Many of the additional ancillary services…are currently leveraged with

existing County-operated programs.”

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Ventura County 2004 – 2005 Grand Jury Final Report

C-09. BHD/ADP has not been forthcoming in describing court assessment as only an
added layer to the already confusing bureaucracy. (F-123 thru F-146)
C-10. One measure of program leadership is the ability to develop a service-delivery
plan and then execute that plan. Every year BHD/ADP has funds in excess of
their intentions, and this equates to services not delivered and program
objectives not achieved. (F-221 thru F-231)
C-11. The differences between the BHD and the Probation Agency strongly
demonstrate the difference between “bureaucracy” and “public service.”
(F-110, F-146)
C-12. Probation has a long and accomplished track record of supervising offenders
and providing treatment services as court-ordered terms of probation. (F-109,
F-110, F-112, F-113)
C-13. With adequate funding, Probation is the appropriate agency to lead the
implementation of Prop 36 in Ventura County. (F-114, F-115)
C-14. The Oversight Committee was never recommended by the 2003 Grand Jury
and is, indeed, another ineffective layer of bureaucracy. (F-32 thru F-63)
C-15. The cost of operating the CAS is not justified by the results obtained. This one
organization consumes vast financial resources in pursuit of unnecessary
duplication of services. (F-228, F-229, F-230)
C-16. The largest problem acknowledged by all stakeholders is the lack of money for
adequate drug testing. If Prop 36 funds were used for treatment and oversight
as originally intended, then the general fund dollars now needlessly
supplementing Prop 36 could be redirected to the drug testing efforts. (F-237,
F-238, F-239)
C-17. The decision to place more than half of all Prop 36 offenders on conditional
release, without formal probation, may have been effective had BHD/ADP
fulfilled their promise of oversight and non-compliance reporting. (F-10, F-31,
F-65, F-88 thru F-94)
C-18. Having early recognized that it could not fulfill the client supervision role,
BHD/ADP should have accepted that it was its responsibility as a stakeholder,
and particularly as the Lead Agency, to fulfill this objective in another way.
Shirking responsibility until it was forced on it by events and criticism is an
indicator that the department lacks leadership. (F-93 thru F-108)
C-19. Addiction specialists working in the CAS are very dedicated individuals who
were convinced by BHD/ADP management that their function was necessary
and vital to the treatment delivery process. They should be reassigned to a
position where their skills as drug counselors can be used to the real benefit of
the Prop 36 clients. (F-123 thru F-145)
C-20. Treatment providers, both within the county as well as the contract providers,
are continuing to do what they do best – treat substance abuse and addiction.
They are stubbornly treating addiction and showing success with clients
despite everything the county has done to hinder their efforts. The Grand Jury
believes they could accomplish much more if the county would help them.
(F-163 thru F-195)

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Ventura County 2004 – 2005 Grand Jury Final Report

C-21. Treatment providers are experts at addiction treatment. Probation is expert at

supervision of offenders. These two stakeholders will produce the most
effective delivery model for treatment and supervision that should satisfy all
stakeholders. (F-164 thru F-169, F-173, F-180, F-109 thru F-113, F-213)
C-22. Adjusting and readjusting the protocols was only necessary because BHD/ADP
was in the process, prohibiting the natural flow of communication from
treatment providers and the courts. By removing the impediments to
communications, a simple protocol can be implemented with the assistance of
treatment providers to incorporate treatment objectives and supervision
objectives. (F-54, F-55, F-97, F-202 thru F-213
C-23. Treatment providers have been used to absorb unrecoverable costs of Prop 36
and they have been called upon to absorb addition bureaucratic requirements
as they come up. BHD/ADP has offloaded as many administrative burdens of
the program to the contractors as they could, without cost reimbursement.
(F-176, F-177, F-178)
C-24. Any success that Prop 36 has had in Ventura County is directly attributable to
the dedication of the treatment providers. These contractors, county
employees, and charity-based providers have held the programs on course in
spite of BHD/ADP. It is obvious that these providers believe in the work they
are doing, and they have demonstrated that, if necessary, they would do it for
free. The county should be grateful we have such dedicated treatment
providers and should not take advantage of their dedication. (F-181, F-182,
F-183, F-190, F-191, F-194, F-195)
C-25. The present contracts with treatment providers have problems that need to be
analyzed and addressed. Treatment providers have not been adequately
compensated for their services. There are too many government-driven
variances in the fees that can negatively impact the treatment providers.
Contracts should be rewritten so that the government and the treatment
providers more equitably share the risk when the government makes an
arbitrary program adjustment or new program requirement. (F-165 thru 170,
F-176, F-177, F-178, F-182 thru F-195)

Recommendations
R-01. Immediate remove BHD/ADP as Lead Agency of Prop 36. Contact the State
Department of Alcohol and Drug Programs to coordinate an emergency halt to
the submitted County Plan.
R-02. Immediately designate Probation as the Lead Agency for Prop 36.
R-03. Immediately disband the Prop 36 Oversight Committee and establish
guidelines for the Operations Committee to operate in an organized fashion
and make decisions, with provisions to obtain approvals from department
heads when necessary.
R-04. Immediately initiate action to close the BHD/ADP Prop 36 CAC and free the
funding and other resources for more direct treatment use.
R-05. Formally request through the courts that all Prop 36 offenders be placed on

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Ventura County 2004 – 2005 Grand Jury Final Report

formal probation.
R-06. Allow Probation, as Lead Agency, to make arrangement for assessment and
treatment referral at a location of their choosing, immediately after Court
sentencing.
R-07. As the Lead Agency, allow Probation and treatment providers to determine,
with input from the Operations Committee, the best delivery model for
treatment services and required communications.
R-08. Move the addiction specialists from the CAC to the county-operated treatment
centers and establish additional DMC reimbursed treatment capacity.
R-09. Under Probation leadership, provide financial accountability and oversight of
all Prop 36 funds. Bring funding allocation decisions back to the Operations
Committee.
R-10. Encourage the Operations Committee to abandon the pursuit of the perfect
protocol and leave treatment decisions to treatment providers with Lead
Agency oversight. Instead, focus Operations Committee efforts on obtaining
actionable metrics so that recommendations can be made based on reality
instead of perception and spin.
R-11. Evaluate the contracts of the treatment providers to ensure that the county is
not taking advantage of treatment partners. Consider using hoarded
BHD/ADP Prop 36 funds to reimburse the accounts receivable that these
providers have accrued by being from ordered to treat Prop 36 clients on a pro-
bono basis.
R-12. In the interest of cost, efficiency, and treatment delivery, BHD/ADP should not
be encouraged or even allowed to participate in leadership of any future court-
ordered treatment programs.

Responses
Responses Required (R-1 thru R-12):
Board of Supervisors
County Executive Officer
District Attorney
Health Care Agency
Probation Agency
Public Defender
Ventura County Sheriff

Commendations
The successes in treatment seen by Prop 36 clients are directly attributable to the
dedication and selflessness of all treatment providers. The treatment providers and
counselors have such dedication to drug treatment that they refuse to allow poor
management and bureaucratic ineffectiveness to interfere with the treatment of their
clients.

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Ventura County 2004 – 2005 Grand Jury Final Report

Attachments
Attachment 1. “Planned Services by Type Using SACPA Funds in the 12 Large
Counties in FY 2003/04” from “Substance Abuse and Crime Prevention Act of 2000:
Analysis of FY 2003/04 Plans from the 58 Counties”

Ventura County Proposition 36: Administrative Reforms Examined 33

Ventura County 2004 – 2005 Grand Jury Final Report

Attachment 1. “Planned Services by Type Using SACPA Funds in the 12 Large

Counties in FY 2003/04”

34 Ventura County Proposition 36: Administrative Reforms Examined