FINAL REPORT
CASE #0901 OFFICE OF SUBSTANCE ABUSE

REASON FOR INVESTIGATION:

Newspaper articles released January, March, and April 2002 spurred the 2002-2003 San Joaquin Count Civil Grand Jury (SJCCGJ) to make inquiry into continued issues that seem to plague San Joaquin County's Office of Substance Abuse (OSA). The articles reported favoritism, discrimination, harassment, and a list of complaints received by the San Joaquin County Board of Supervisors. The San Joaquin County Board of Supervisors had received so many complaints that the Maximus consulting firm was hired in 2001 to study and make recommendations regarding the Office of Substance Abuse. The Board of Supervisors accepted the final Maximus report in May of 2002. The report included a number of recommendations for future actions.

METHOD OF INVESTIGATION:

The following specific steps were taken in the course of this investigation:

  1. Reviewed newspaper articles from the Stockton Record dated January 18, 2002, March 23 and 30, 2002, and April 4, 2002.
  2. Performed announced and unannounced visits and tours of the OSA.
  3. Formally interviewed 19 current employees and 2 ex-employees. (Some were randomly selected). We also met with several others who were not asked for formal interviews, but who did talk to the grand jury during our announced or unannounced visits.
  4. Interviewed Board of Supervisors members Marenco and Guiterrez
  5. Interviewed Roger Speed, Health Care Services Director.
  6. Interviewed Dan Bava, Director of the Office of Substance Abuse.
  7. Interviewed Al Murillo, Deputy Director of the Office of Substance Abuse
  8. Interviewed George Feicht, Prevention/Special Assignments Coordinator.
  9. Interviewed Guadalupe Guns, Outpatient Services Coordinator.
  10. Interviewed Judy Anselmi, Director of Alternative Treatment Services.
  11. Interviewed Don Turko, Director of Human Resources for San Joaquin County.
  12. Reviewed the Policy and Procedure manuals received from the Office of Substance Abuse.
  13. Reviewed the agency's Employee Handbook and the Organizational Structure Chart.
  14. Reviewed Office of Substance Abuse Job Descriptions.
  15. Reviewed written complaints received by the Board of Supervisors.
  16. Reviewed information received by interviewees.
  17. Reviewed the Maximus report.
  18. Reviewed written updates by Deputy Director Al Murillo regarding implementation of the Maximus study.

BACKGROUND:

In evaluating our observations of the OSA and the information received through the many interviews conducted during this investigation, we came to the conclusion that while some areas of the OSA seem to be functioning satisfactorily, the Alternative Treatment Services (ATS) division seems to be experiencing on-going problems. The complaints and information about current and prior operations and practices that we reviewed did not point to specific problems in the other divisions; however, the ATS division continually surfaced as the subject of problem allegations. Consequently, the findings and recommendations of this report focus on the ATS division of the OSA.

The Maximus report presented the results of a comprehensive review of OSA and included the following recommendations:

  1. OSA should examine the potential to consolidate overlapping programs. There could be considerable savings associated with costs of administrative support to programs.
  2. OSA should improve client intake and quality assurance.
  3. Develop new approach to client case management, articulate a clear mission, establish a consistent approach to management, develop appropriate management and supervisory skills, and enhance information technology.
  4. OSA should conduct a staff retreat to address programmatic and service objectives.
  5. Provide more training to managers. Targets, minimum educational levels, as well as budgets for training should be established.
  6. Develop a centralized administrative unit to include Human Resources and fiscal staff.
  7. An information technology (IT) system should be developed in house for OSA.
  8. Address HR management and record keeping issues through the recommended IT plan and the reorganizational recommendations.
  9. Managers need training on how to conduct a meaningful performance-based appraisal.
  10. Develop a training assessment by position, program, and individual.
  11. Update employee training plans annually per State regulations.
  12. OSA should ensure that managers have educational backgrounds consistent with needed requirements and rely less on longevity and personal background.
  13. A dedicated employee counseling program should be developed for OSA.
  14. Improvements should be made in the training program.
  15. Certain programs should be realigned to realize better coordination of service and efficiency.
  16. Convert coordinator positions to division manager positions.
  17. The fourth coordinator position should be converted to a Deputy Director who would function as a second in command as well as be in charge of client management.
  18. Another Coordinator should be placed in charge of administrative support functions.
  19. Strengthen administrative support through the addition of up to five staff in information services, human resources, and finance.

OBSERVATIONS:

During our interviews with current and ex-employees we were told by some of instances of what they believed were harassment, favoritism, discrimination, a lack of leadership, and a lack of focused direction. Several employees shared with us that they believe that, because they either had a felony record and/or an unsavory past, they had been discriminated against when they had tried to communicate frustration to management. They believe that they were being given a not-so-subtle hint to "just keep your mouth shut and do your job" and that, because of their past "they should be grateful that they had a job, because who else would hire them".

Many of those interviewed did not feel that they had adequate training by management. Their job and the job expectations were unclear and there was no apparent recourse for obtaining positive and clear answers and direction. When asked if they had at least a working understanding of the employee handbook, or policy and procedure manual the majority response was "No".

Requirements and procedures for advancement and promotion of counselors at ATS is unclear to many of the counseling staff. Some counselors stated that they had been promised a promotion and then passed over with no explanation, but assured that they would be considered at another time. Others who were either civil service or civil service eligible were also not promoted or had their hours cut only to be replaced by non-certified workers, who according to the current job description are not supposed to be carrying client caseloads and are not certified to be doing individual counseling. It was repeated by many interviewees that there exists a "clique" of employees/managers who seem to control who gets hired, promoted, hours cut, or let go. Those employees expressing these concerns either indicated that they did not have a clear understanding of the grievance procedures regarding discrimination, or indicated that they were afraid of retaliation.

We were given a copy of a signed confidential memo to ATS staff apparently written by a manager, which suggested that the counselors and workers should concentrate primarily on a particular type of treatment that would maximize reimbursement from Medi-Cal, thus increasing the revenue received. This seems to support testimony by employees that they were told to maximize the billable time they spend with clients, and if necessary "be creative" in doing so. Some employees testified that they understood these instructions to mean that they should do whatever it takes to report the maximum allowed billable time with clients, even if it meant false reporting. One female employee testified that she had refused and soon after had her hours cut, cut again, and then let go due to a conflict she had with a manager. She stated that she believed that they were determined to find a way to get rid of her because she refused to be "creative".

According to the job descriptions we received from Don Turko, Director of Human Resources for San Joaquin County, it appears that the ATS division has not strictly complied with the definition of Substance Abuse Worker. We found that Workers were not under immediate supervision and in fact were performing individual counseling, which the first sentence under the Worker job definition says they are not approved to do. The job description refers only to non-counseling work. Workers are to perform tasks as support and intake only. Many of the Workers interviewed were still in the process of obtaining their certification in Human Services, and told us that there was no time constraint placed on them to finish in a timely manner.

The policy and procedure manual we received lacked clarity, and the information gathered during our interviews indicates it has been neither implemented nor shared with all of the counseling staff at ATS. The manual also lacked all of the required signatures.

One of the managers interviewed indicated that there was pressure from upper management to give a favorable evaluation to an employee, who not only lacked the educational requirement for his job, but also didn't meet the basic most important skills needed for his job. This situation forces him to depend on others to do his work. It appears that, at least in this instance, the performance evaluation process is not being done truthfully and fairly. Some of the counselors and workers interviewed told us that they believe that if an employee's "minutes" (with clients) are good, then their evaluation would be good.

It was unclear from the interviews what the current audit system is for overseeing how money is accounted for, especially if it is intended for a particular program. From the interviews, it appears that money has been moved around at the discretion of the Director of the Office of Substance Abuse.

Even though some of the Maximus recommendations appear to have been implemented, the general impressions left by the information we gathered from some of the management and non-management employees suggests that many of the problems identified in the Maximus report still persist at OSA.

FINDINGS:

Management at the Office of Substance Abuse (OSA) has not provided effective leadership, positive direction, and motivation to its supervisors and staff in the Alternative Treatment Services (ATS) division.

  1. The lack of effective management has seriously limited and hindered the ability of OSA to implement the Maximus recommendations.
  2. The current practices of recruitment, training, and management of counselors appears to be less than satisfactory, and has resulted in staff that are not fully qualified, or properly trained.
  3. The current written policies and procedures in some instances lack clarity, and are not being followed. Many of the employees interviewed did not have a clear understanding of what is required by the policies and procedures.
  4. At least one manager at Alternative Treatment Services has given counseling staff ethically questionable written directions that emphasized providing those services to clients that would generate the most revenue for OSA.
  5. There is a clear impression among some of the counseling staff at ATS that the evaluation of their job performance by their supervisors is directly tied to the extent to which they meet targets for how much time they report being spent with clients that is chargeable for reimbursement by Medi-Cal. The perception of these counselors is that the supervisors don't care how counselors meet these targets, even if it means falsely reporting time spent with clients.
  6. The management of OSA and those in supervisory positions need to improve their communication with staff, not only verbally, but in written form as well.
  7. Sensitivity and management skills training for supervisors appears to be needed.
  8. All staff members do not seem to have a copy of and full understanding of their job description and the employee handbook, which should define the rules of conduct and consequences for non-compliance.
  9. All staff members do not seem to know the procedures for filing a report regarding discrimination, harassment, and or any other violation of an employee's rights.
  10. Program policies and procedures do not seem to be clearly defined and consistently followed by counseling staff, managers, and directors.
  11. It appears that the requirement that new employees be trained and given orientation by the assistant director is not always being done.
  12. Alternative Treatment Services does not always adhere to the job description for Substance Abuse Worker. Job description #1687/RS1000 specifies that this position is "under immediate supervision and performs routine, non-counseling work in a San Joaquin County Alcohol or Drug Program; and does related or other work as required in accordance with Rule 3, Section 3 of the Civil Services Rule". Our interviews with Substance Abuse Workers from ATS revealed that at least some of these employees are not yet certified and have caseloads of 30-plus clients whom they counsel individually and in groups with no supervision.
  13. The hiring and promotion process at the Office of Substance Abuse has left the impression with some that unfair hiring and promoting practices exist.
  14. It appears that employee performance evaluations are not always being done in a way that is specific, factual, and complete.
  15. Upper management is not making sure that persons holding mid-level management positions possess the requisite managerial, supervisory, and verbal and written communication skills required to properly perform the duties of their respective job descriptions. Our interviews revealed that this is not the case for all current mid-level management staff at ATS.
  16. Regular audits are apparently not being performed of all accounts to ensure that monies reserved for particular programs are used just for those programs and nothing else. A system of accountability should be in place with the San Joaquin County Auditor Controller's department to oversee the flow of account funds by the Office of Substance Abuse.
  17. A time limit standard has not been established for staff who are in the process of obtaining certification in order to do counseling at the Office of Substance Abuse. Currently there is no time constraint on how long a person has to obtain their certificate, which has resulted in counseling sessions being conducted by staff that have not demonstrated by virtue of certification that they are qualified to do so.
  18. While many of the counselors/staff at the OSA are recovering addicts/users, it is not clear how far into their recovery treatment they are before being hired to work with clients. The guidelines used in determining their ability to counsel others who are struggling with similar issues don't appear to be formalized and consistently followed.
  19. The SJCCGJ's findings indicate that at least the following relevant Maximus recommendations (indicated by bold highlighting where appropriate) have not been successfully implemented to date:
    1. Develop new approach to client case management, articulate a clear mission, establish a consistent approach to management, develop appropriate management and supervisory skills, and enhance information technology.
    2. Provide more training to managers. Targets, minimum educational levels, as well as budgets for training should be established.
    3. Managers need training on how to conduct a meaningful performance-based appraisal.
    4. Develop a training assessment by position, program, and individual.
    5. Update employee training plans annually per State regulations.
    6. OSA should ensure that managers have educational backgrounds consistent with needed requirements and rely less on longevity and personal background.
    7. A dedicated employee counseling program should be developed for OSA.
    8. Improvements should be made in the training program.
  20. The SJCCGJ's finds that the reports submitted to the Board of Supervisors to track the status of actions taken to implement each of the Maximus recommendations are vague, lacking in specific details, and unconvincing in their indications that specific Maximus recommendations have been or are being implemented in a thorough and timely manner.

RECOMMENDATIONS:

  1. An independent evaluation should be performed for the current upper managers at the Office of Substance Abuse (OSA) with the goal of identifying and correcting any weaknesses in providing effective leadership, positive direction, and motivation to its supervisors and staff in the Alternative Treatment Services (ATS) division.
  2. The Board of Supervisors should critically evaluate the actions being taken by the upper management of OSA to implement the recommendations of the Maximus study and make any substantive changes required to accelerate the effective and timely implementation of the recommendations in the full spirit of the intent with which they were originally recommended.
  3. Overhaul the current practices of recruitment, training, and management of counselors to ensure that the ATS staff are fully qualified and properly trained.
  4. Update the current written policies and procedures to ensure completeness and clarity and institute training and procedures that ensure that all employees have a clear understanding of what is required by the policies and procedures.
  5. Make it priority item to clearly and unequivocally communicate to all ATS staff that, notwithstanding prior written and verbal communications to the contrary,
    1. decisions about client treatment are not to be made on the basis of which services would generate the most revenue for OSA, and
    2. their performance evaluation does not in any way depend on how much time they report being spent with clients that is chargeable for reimbursement by Medi-Cal.
  6. Take meaningful and effective steps to improve the written and verbal communication by OSA management and supervisors to ATS staff.
  7. Institute a new-employee and continuing-employee formal training program for counseling staff, managers, and directors that covers the following areas:
    1. sensitivity and management skills training for all supervisors;
    2. understanding of job descriptions and the employee handbook;
    3. procedures for filing reports of discrimination, harassment, and or any other violation of an employee's rights;
    4. the importance of and requirements for clearly defining and consistently following program policies and procedures;
    5. new employee training and orientation;
    6. how to complete and give employee evaluations that are specific, factual, and complete;
  8. Review all Substance Abuse Worker positions and take the necessary steps to ensure that staff holding those positions are not working outside of the parameters of their job description, including managing caseloads and performing counseling without holding the requisite certifications.
  9. Place all hiring and promotion responsibilities at the Office of Substance Abuse under the auspices of the San Joaquin County Human Resources Department in order to ensure fair hiring and promoting practices.
  10. Take steps to ensure that persons holding mid-level management positions possess the requisite managerial, supervisory, and verbal and written communication skills required to properly perform the duties of their respective job descriptions.
  11. Regular audits should be performed of all accounts to ensure that monies reserved for particular programs are used strictly for those programs. A system of accountability should be put in place with the San Joaquin County Accounting department to oversee the flow of account funds by the Office of Substance Abuse.
  12. Take steps to establish and enforce a time limit for staff to obtain certification to do counseling at the Office of Substance Abuse.
  13. Take the necessary steps to formalize and consistently follow guidelines for determining at what point in their recovery treatment process recovering addicts/users may be considered able to counsel others who are struggling with similar issues.
  14. Because the employees of this office deal with people having drug problems, it would be advisable that the employees demonstrate that they are drug free. We therefore recommend that random drug testing of all employees in this office be considered.

    RESPONSE REQUIRED:

    Pursuant to Section §933.05 of the Penal Code:

    The San Joaquin County Office of Substance Abuse shall report to the Presiding Judge of the San Joaquin Superior Court, in writing and within 90 days of publication of this report, with a response as follows:

    As to each finding in the report a response indicating one of the following:

    1. The respondent agrees with the finding.
    2. The respondent disagrees with the finding, with an explanation of the reasons therefore.

    As to each recommendation, a response indicating one of the following:

    1. The recommendation has been implemented, with a summary of the action taken.
    2. The recommendation has not yet been implemented, but will be with a time frame for implementation.
    3. The recommendation requires further analysis, with an explanation of the scope of the analysis and a time frame not to exceed (6) six months.
    4. The recommendation will not be implemented, with an explanation therefore.