KITCHEN AND LAUNDRY EQUIPMENT

A commercial kitchen that meets the State of Hawaii, Special Use Facility standards will be established.

Equipment will include a set of commercial pots and pans, commercial range with a fire suppression system, commercial refrigerators, an ice machine, freezers, dishwasher, mixers, and a microwave/

convection oven. Lockable built-in cabinets should be part of the kitchen interior design. The laundry room should have two commercial washers and dryers.

6.14.3. CLASSROOMS

There should be a classroom with eight student workstations and one teacher workstation. Each

workstation will be equipped with a laptop and a secure docking station and networked to a shared printer. Each workstation will have sufficient desk space in addition to the secure docking station. The workstations will be networked to a shared printer.

6.14.4. OFFICE

There should be an office space with 4 networked workstations for staff. There should be a networked telephone system to support the office, conference room, and throughout the facility. Commercial shredder, copy/fax/scanner printer, fire proof safe, lockable fire-proof file cabinets and storage cabinets should be part of the office space.

6.14. OTHER

The program cannot be a secured, locked facility. The doors may be alarmed. The boundaries of the property should be fenced as much as possible to ensure a safe and sober environment. The fence should not be used to keep the adolescents on the facility grounds. The fence should be used to ensure a safe and sober environment and to separate the facility from the public.

Two 12-passenger vans and a 6 passenger vehicle should be provided.

6.15. ANALYSIS:

The service model to treat Kauai adolescents must include a program that will prepare adolescents to be successful adults.

The service model of the proposed adolescent treatment facility should be based on the integration of existing substance abuse services on Kauai. Service integration refers to the overall vision of an integrated system that will effectively serve adolescents with substance abuse issues, no matter where they enter the system. Integration of services is more important now because fewer monies are available to Kauai for all services. Closer integration of programs would multiply the effectiveness of substance abuse services. The agencies appear to provide their services in silos, with little coordination to integrate

their services. Because there are fewer community-based agencies on Kauai, integration of services should be possible.

Emerging best practices suggest that the proposed adolescent treatment facilities should implement evidence-based approaches, such as cognitive behavior therapy, multisystemic therapy, behavioral therapy, Alcoholics Anonymous (AA) 12-step facilitation therapy, multidimensional family therapy, and the community reinforcement approach. Post-treatment monitoring or aftercare should also be available to maintain the adolescent’s motivation for recovery, including phone call check-ups. Regardless of which specific model is used, treatment for adolescents with substance use disorders works best when the services are provided and implemented with adolescents' particular needs and concerns in mind.

An adolescent substance abuse treatment facility should be based on the Therapeutic Community Model.

The Therapeutic Model maintains that substance abuse is an outward manifestation of a broad set of personal and developmental problems in the adolescent and that successful recovery is built upon change involving the whole person--psychologically, socially, and behaviorally. The Model recognizes the extended family as primary to the adolescent’s life and outcomes. The Model is centered on the adolescent and encourages and models respect, responsibility, empowerment and loyalty to the community, family, and cultures. Milieu Therapy is a major component of the Therapeutic Community and is important to the adolescents’ healing and health. Milieu Therapy requires that everything within the adolescent’s environment is therapeutic. To meet the requirements of an effective Milieu, an adolescent residential treatment facility must be separated from outside people and other influences to provide a safe and sober environment. In addition, the Milieu should be a healing environment that speaks to the adolescent’s inner self. The Milieu should include parts of the healing island environment to help adolescents to return to “sense of place”.

Male adolescents were identified as being dependent on substance more than 3 times as female adolescents. Female adolescents should be provided with multisystemic therapy, an intensive outpatient service. If needed, female adolescents may be sent to Bobby Benson Center and Marimed Foundation on Oahu. While not optimal, the number of female adolescents requiring residential substance abuse treatment is not sufficient to maintain a program on Kauai. Female adolescents from other jurisdictions should not be included in the Kauai residential program just to support the facility. Adolescents outside of Kauai have different life experiences and will have an impact on the facility’s Milieu. Maintaining a mix of males and females in a facility is very demanding on staff, especially in a small facility, and additional staff would be required.

Remaining in substance abuse treatment for an adequate period of time is critical for a successful intervention. The appropriate duration for an individual depends on the type and degree of his or her problems and needs. Research indicates that most addicted individuals need at least a year in treatment to significantly reduce or stop their substance abuse and that the best outcomes occur with longer durations of treatment. Because adolescents often leave treatment prematurely, best practices require programs to include strategies to engage and keep patients in treatment. Intensive aftercare must be provided because substance abuse should be considered a chronic disease, rather than an acute problem.

The professional foster parents model should serve as the foundation for the 24/7 staffing requirements for the adolescent treatment facility.

The Service Provider will ensure that adolescents will: become engaged in treatment for a sufficient amount of time and intensity to obtain maximum therapeutic benefit; achieve abstinence use of mood altering substances; become motivated to change alcohol/substance using attitudes and behaviors;

achieve a safe, stable, and recovery-appropriate living situation; achieve positive family interactions and relationships; have no new contact with the juvenile/criminal justice system (or at least reduced contact);

have a positive perception of services received; improve mental or psychological health or receive mental health care; meet school attendance and academic requirements; eliminate physical, sexual, or emotional abuse or receive appropriate trauma services; acquire and use effective relapse prevention skills; acquire and use a positive support system.

The facility should have 4 client bedrooms and 3 client bathrooms. The professional parents’ should have a suite consisting of a bedroom, bathroom, small living area, and a kitchenette. The kitchen and laundry equipment should be commercial grade and support the 24/7 program. There should be a classroom and office space. The facility cannot be a locked, secured facility but the boundaries of the facility should be fenced to maintain a safe and sober environment. The facility does not need to be in close proximity to hospitals or the Courts.

In 2006, Kauai County issued a Request for Proposal in which the County proposed that it would build a facility and furnish the facility in exchange for a service provider to provide adolescent residential substance abuse treatment services. The County would not pay any fee to the service provider for the services. The service provider would not pay any fee to Kauai County for the use of the facility. The County of Kauai took responsibility for any repairs to the exterior structural potion of the premises while the service provider would be responsible for costs related to the program, insurance, utilities, and maintenance and repairs or replacement of the equipment. Kauai County expected that the service provider would obtain operating funds through client funding including private insurance, Department of Health, direct client payment, grants and other methods as appropriate.

Today, the County and community-based service providers are facing the challenge of managing and responding to adolescents’ substance abuse needs in an environment of rapid, dramatic fiscal change.

7.1. THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (OBAMACARE)