Substance Abuse Service Units
There are four subsections under Substance Abuse Service Units:
1) Unit of Service Definition (UOS)
2) Unduplicated Clients Served (UDC)
3) Unit of Service Calculation
4) Unit of Service Cost
A response for each of these items is required for each contract exhibit.
Each program modality will utilize the standard definitions of a service unit described below.
All SUBSTANCE ABUSE contractors must use these definitions in calculating service units.
Residential Service Unit Definition
The unit of service for all residential programs (including residential detoxification described
below) is a 24-hr bed day. One unit of service equals a participant occupation of a bed for a 24-hr
period. Programs are expected to provide a minimum of 20 hours of alcohol and other drug
services per week. Choose an occupancy rate between 90% to 100% for your unit of service
calculation.
For clarification, the days on which a client is admitted to a program or discharged from a
program will not be full 24-hr bed days. By convention, the day of admission will be counted
toward units of service and entered into BIS. The day of discharge will not be counted
toward units of service and not entered into BIS. If a client completes the intake process and
then leaves without spending the night, the episode may be opened and closed the same day with
only one unit of service entered. The discharge code is #7, “assessment only, no treatment
provided”.
Detoxification Service Descriptions
16015 Levels of Detoxification Services
Each program shall establish policies and procedures to identify participants who are in need
medical services beyond the capacity of the program and to refer or transfer such participants
to more appropriate levels of service. All referrals to another level of service shall be
documented in participant’s file. The level of detoxification service is contingent upon the
severity of use, characteristics of the substance used, current physical health status of the
participant, current level of functioning of the participant and the availability of support
services. Detoxification services shall be provided or the participant referred to another level
of service in accordance with the criteria for the following levels of detoxification services:
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a.
Nonresidential Detoxification
Nonresidential detoxification services are appropriate for participants who are assessed as
being at minimal risk of severe withdrawal syndrome outside the program setting, are free of
severe physical and psychiatric complications and would safely respond to several hours of
monitoring, medication and treatment.
b.
Nonresidential Detoxification With Extended On-Site Monitoring
Nonresidential detoxification with extended on-site monitoring services are appropriate for
participants who are assessed as being at moderate risk of severe withdrawal syndrome
outside the program setting, are free of severe physical and psychiatric complications and
would safely respond to several hours each day of monitoring, medication, and treatment.
Appropriately credentialed and licensed individuals (such as licensed vocational nurses,
licensed psychiatric technicians, registered nurses, licensed practical nurses, nurse
practitioners, physician’s assistants, or physicians) shall monitor participants over a period of
several hours each day.
c.
Monitored Residential Detoxification
Monitored residential detoxification services are appropriate for participants assessed as not
requiring medication for the management of withdrawal, but require this level of service to
complete detoxification and enter into continued treatment or self-help recovery because of
inadequate home supervision or support structure. This level is characterized by its emphasis
on peer and social support.
d.
Medically-Managed Residential Detoxification
Medically-managed residential detoxification services are appropriate for participants whose
level of physiological dependence upon alcohol and/or other drug requires prescribed
medication for the management of withdrawal, but whose withdrawal signs and symptoms do
not require the full resources of a medically-monitored inpatient detoxification facility.
Medications for the management of withdrawal shall only be provided under the direction of
a licensed physician or other person authorized to prescribed drugs, pursuant to Section 4036,
Chapter 9, Division 2 of the Business and Professions Code. No participant shall be given
medication unless a physician or his/her licensed medical staff has personally examined the
participant.
e.
Medically-Monitored Inpatient Detoxification
Medically-monitored inpatient detoxification services are required for participants whose
withdrawal signs and symptoms are sufficiently severe to require primary medical and
nursing care services. These services are provided in an acute care hospital setting under the
direction of a licensed physician and delivered by medical and nursing professionals.
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Outpatient Service Unit Definition
The unit of service for outpatient programs (including outpatient detox. and aftercare, but
excluding methadone maintenance and methadone detoxification) is defined as one face-to-face
contact per day of at least 30 minutes duration to include one or more of the following:
assessment, treatment planning, individual and group counseling, education, family collateral
counseling, aftercare, crisis intervention, and case management. Except in well documented
crisis situations, only one contact per day is reimbursable. This per day contact is all inclusive of
the services provided by the program and must be a face-to-face contact of at least 30 minutes
duration to be considered for reimbursement. Please note that the time away from the client used
for development of assessments, treatment plans, collateral information is not included in this
calculation. However, these costs are recovered when unit cost (total program cost/number of
units) is calculated. State certification standards require a minimum of two (2) contacts per
month.
Intensive Outpatient Service Unit Definition
The intensive outpatient modality has been officially added to the substance abuse services
system of care to recognize programs whose frequency and intensity of services are more than
those defined in the outpatient service unit, but less than those defined by the day treatment
service unit.
One unit of intensive outpatient service is defined as one face-to-face contact per day of at least
50 minutes minimum duration to include one or more of the following: assessment, treatment
planning, individual and group counseling, education, family collateral counseling, crisis
intervention, case management, medication monitoring, aftercare, or related service activities
such as acupuncture. The modality requires a schedule of five (5) hours or more weekly for
each client with participation of at least four (4) attendance days per month.
Day Treatment Service Unit Definition
The unit of service for all programs that fall under this modality is a treatment day. This
treatment day contact is all inclusive of the services provided by the program. One unit of day
treatment service is defined as one face-to-face contact per day of at least 3 hours minimum
duration to include one or more of the following: assessment, treatment planning, individual and
group counseling, education, family collateral counseling, crisis intervention, case management,
medication monitoring, aftercare, or related service activities such as acupuncture. The modality
requires a schedule of at least three (3) hours per day, at least three (3) days per week for each
client.
Please also indicate the minimum hours per day and minimum days per week of required
attendance for each participant. CBHS Substance Abuse and State certification standards
require a minimum of nine (9) hours of services per week, three (3) hours per day, three (3)
days per week.
Prevention Service Unit Definition
Prevention consists of a comprehensive framework of organized, planned and concrete strategies
and activities aimed not only at preventing substance use and abuse but also at promoting
healthful behaviors, decisions and environments among individuals, families and communities.
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A comprehensive program may include services provided in a variety of settings for both the
general population and targeted at-risk sub-populations.
CBHS needs to define its services in terms used also by the State and Federal governments.
Before proceeding, determine the exact nature of your program’s prevention activities. As in
previous years, this information will be used on your annual Prevention Activities Data System
(PADS) report prepared for primary prevention programs.
Following this section on pages 15-18 is a listing of prevention service descriptions used by State
and Federal officials. Please identify whether the strategy is considered primary or secondary
followed by the service code name(s) that best describe(s) your prevention services. Use these
descriptors in determining Substance Abuse Services modality for Section 3, calculating units of
service in Section 4, and in describing the goals and objectives and strategies used to accomplish
these in Section 6: Methodology. It is advisable to choose reasonably. Select strategies in
which your program can develop focused expertise.
One unit of prevention is defined as one face-to-face contact per day of at least five (5) minutes
duration for an individual and thirty (30) minutes duration for a group between a member of the
target population and a staff person for the purpose of information, risk reduction, education and
referral. The exception to this definition is for telephone hotline services specifically contracted
as such. For those programs, the unit of service is defined as either a face-to-face or telephone
contact between a member of the target population and a staff person for the purpose of
information dissemination.
To clarify, there is no maximum duration for a prevention activity occurring on the same day.
For example, a group of 4 hours duration with 16 participants doing prevention strategy “xyz”
yields 16 units of service, the same number as if the group were 60 minutes in duration.
However, if on the same day with the same participants, the activity changes substantially to
strategy “abc,” then a second set of units can be generated. Caution must be exercised in
employing this option. Selection of strategies must be part of the planned overall
curriculum in place and documented at the beginning of the contract year. Changing
activities frequently at mid-year for the purpose of gaining more units of service will not be
permitted.
Prevention Service Descriptions
Primary Prevention - These strategies count toward the 20 percent primary prevention
requirement of DADP funding
12 – Information Dissemination [Federal Definition]
This strategy provides awareness and knowledge of the nature and extent of alcohol, tobacco
and drug use, abuse and addiction and their effects on individuals, families and communities.
It also provides knowledge and awareness of available prevention programs and services.
Information dissemination is characterized by one-way communication from the source to
the audience, with limited contact between the two. Examples of activities conducted and
methods used for this strategy include (but are not limited to) the following:
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a.
b.
c.
d.
e.
f.
g.
h.
Clearinghouse/information resource center(s)
Resource directories
Media campaigns
Brochures
Radio/TV public service announcements
Speaking engagements
Health fairs/health promotion
Information lines
13 – Education [Federal Definition]
This strategy involves two-way communication and is distinguished from the Information
Dissemination strategy by the fact that interaction between the educator/facilitator and the
participants is the basis of its activities. Activities under this strategy aim to affect critical
life and social skills, including decision-making, refusal skills, critical analysis (e.g., of
media messages) and systematic judgment abilities. Examples of activities conducted and
methods used for this strategy include (but are not limited to) the following:
a.
b.
c.
d.
e.
Classroom and/or small group sessions (all ages);
Parenting and family management classes;
Peer leader/helper programs;
Education programs for youth groups; and
Children of substance abusers groups.
14 – Alternatives [Federal Definition]
This strategy provides for the participation of target populations in activities that exclude
alcohol, tobacco and other drug use. The assumption is that constructive and healthy
activities offset the attraction to, or otherwise meet the needs usually filled by, alcohol,
tobacco and other drug and would, therefore, minimize or obviate resorting to the latter.
Examples of activities conducted and methods used for this strategy include (but are not
limited to) the following:
a.
b.
c.
d.
Drug free dance and parties;
Youth/adult leadership activities;
Community drop-in services; and
Community service activities.
15 – Problem Identification and Referral [Federal Definition]
This strategy aims at identification of those who have indulged in illegal/ageinappropriate use of tobacco or alcohol and those individuals who have indulged in the
first use of illicit drugs in order to assess if their behavior can be reversed through
education. It should be noted, however, that this strategy does not include any activity
designed to determine if a person is in need of treatment. Examples of activities
conducted and methods used for this strategy include (but are not limited to) the
following:
a.
Employee assistance programs;
b.
Student assistance programs; and
c.
Driving while under the influence/driving while intoxicated education programs.
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16 – Community-Based Process [Federal Definition]
This strategy aims to enhance the ability of the community to more effectively provide
prevention and treatment services for alcohol, tobacco and drug abuse disorders. Activities
in this strategy include organizing, planning, enhancing efficiency and effectiveness of
services implementation, inter-agency collaboration, coalition building and networking.
Examples of activities conducted and methods used for this strategy include (but are not
limited to) the following:
a.
Community and volunteer training, e.g. neighborhood action training, training of
key people in the system, staff officials training;
b.
Systematic planning;
c.
Accessing services and funding; and
d.
Community team-building.
17 – Environmental [Federal Definition]
This strategy establishes or changes written and unwritten community standards, codes and
attitudes, thereby influencing incidence and prevalence of the abuse of alcohol, tobacco, and
other drugs used in the general population. This strategy can be divided into two
subcategories to permit distinction between activities which center on legal and regulatory
initiatives and those which relate to the service and action-oriented initiatives. Examples of
activities conducted and methods used for this strategy shall include, but not be limited to,
the following:
a. Promoting the establishment and review of alcohol, tobacco and drug use policies in
schools;
b. Technical assistance to communities to maximize local enforcement procedures
governing availability and distribution of alcohol, tobacco and other drug use;
c. Modifying alcohol and tobacco advertising practices; and
d. Product pricing strategies.
Secondary Prevention – These strategies do not count toward the 20 percent primary
prevention requirement of DADP funding
18 – Early Intervention
This strategy is designed to come between a substance use and his or her actions in order to
modify behavior. It includes a wide spectrum of activities ranging from user education to
formal intervention and referral to appropriate treatment/recovery services.
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19 – Outreach and Intervention
This service code is defined as activities for the purpose of encouraging those individuals in
need of treatment such treatment.
20 – Intravenous Drug User (IDU or IVDU)
Activities for the purpose of encouraging those individuals in need of treatment to undergo
such treatment.
21 – Referrals, Screening, and Intake
Activities involved in the assessment of a client’s needs regarding treatment to ensure the
most appropriate treatment. This may include the completion of record-keeping documents.
24 – California Mentor Initiative (CMI)
The CMI is designed to enhance and expand mentor service programs across the state. For
the purposes of CMI, mentoring is defined as a relationship over a prolonged period of time
between two or more people where older, wiser, more experienced individuals provide
constant, as needed support, guidance, and concrete help to the younger at-risk persons as
they go through life. An “at risk” youth is an individual under 19 years of age whose
environment increases his/her chance of becoming a teen parent, school dropout, gang
member, or user of alcohol or drugs.
Targeted children and youth must not be normally served by the State or local
educational agencies or must be in need of special services or additional resources.
[Title IX, Section 4114(b) or the Safe and Drug Free Schools and Communities
{SDFSC) Act]
Funding under the CMI is restricted to five percent administrative costs, primary
prevention, and secondary prevention services. [Title IX, Section 4114(a)(3) of the
SDFSC Act]
Program Code 12 shall be used to support mentoring services for youth which are in
need of treatment under Secondary Prevention (code 24 only) and Support Services
(codes 00-06 only). Units of services are staff hours. Mentor hours are displayed in
the field titled “Description” [ADP Bulletin #99-02, January 14, 1999].
Program Code 13 shall be used to support mentoring services for children and youth
who are not in need of treatment under service codes 11 through 17. Units of services
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are staff hours. Mentor hours are displayed in the field titled “Description”. [ADP
Bulletin #99-02, January 14, 1999]
Ancillary Service Unit Definition
Like prevention, ancillary services consist of a comprehensive framework of organized, planned
and concrete strategies and activities. Unlike prevention, these services more often have a
medical intervention or a health coordination nature.
As stated previously, CBHS needs to define its services in terms used also by the State and
Federal governments. Before proceeding, determine the exact nature of your program's ancillary
strategies.
Following the section listing Prevention Strategies is a listing of Ancillary Service descriptions
used by State and Federal officials. Please identify the strategy number followed by the service
code name(s) that best describe(s) your ancillary services. Use these descriptors in determining
Substance Abuse Services modality for Section 3, calculating units of service in Section 4, and in
describing the goals and objectives and strategies used to accomplish these in Section 6:
Methodology. It is advisable to choose reasonably. Select strategies in which your program can
develop focused expertise. Historically, CBHS/CSAS has not funded all the ancillary options.
To date, ancillary services have been only Perinatal Outreach, HIV Early Intervention Services,
Tuberculosis (TB) Services, and stand alone Case Management.
One unit of ancillary service is defined as one face-to-face contact per day of at least five (5)
minutes duration for an individual and thirty (30) minutes duration for a group between a
member of the target population and a staff person for the purpose of information, risk reduction,
education, referral, testing and case management.
Ancillary Service Unit Descriptions
22 – Perinatal Outreach
Perinatal Outreach is an element of service that identifies and encourages eligible pregnant
and parenting women in need of treatment services to take advantages of these services.
Outreach may also to educate the professional community on perinatal services so that they
become referral sources for potential clients. [Perinatal Services Network Guidelines – Fall
1995]
63 – Cooperative Projects
This code allows for funding of special projects that have been approved by the Department
prior to funding. [ADP Letter #96-21 dated April 12, 1996]
Cooperative Projects are those which the Department and a County conjointly utilize
strategies and activities to expand or enhance alcohol and drug services.
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64 – Vocational Rehabilitation
Services which provide for gaining and maintaining job skills which will allow for
productive employment. Vocational rehabilitation includes vocational testing, counseling,
guidance, job training, job placement, and other relevant activities designed to improve the
alcoholic person’s ability to become economically self-supporting. [Alcohol Services
Reporting System Manual]
65 – HIV Early Intervention Services
Those activities involved in the prevention and delay of the progression of HIV by
encouraging HIV counseling, testing, assessment of the progression of the disease and the
provision of prophylactic and anti-viral prescription drugs.
66 – Tuberculosis (TB) Services
These services provide counseling and testing regarding tuberculosis offered to individuals
either seeking treatment for substance abuse.
67 – Interim Services (within 48 hours)
Interim services are those services offered to injecting drug users or pregnant women seeking
substance abuse treatment who cannot be admitted to a program due to capacity limitations.
68 – Case Management
Case Management services are activities involved in the integrating and coordinating of all
necessary services to ensure successful treatment and recovery. Services may include
outreach, intake, assessment, individual services plans, monitoring and evaluation of
progress, and community resource referrals.
Note: Programs that receive perinatal funds must provide or arrange for case management
services. [Perinatal Services Network Guidelines – Fall 1995]
69 – Primary Medical Care (Perinatal Only)
This is an element required in SAPT Block Grant funded perinatal programs. The program
must provide or arrange for this service, which does not include specialist care or
hospitalization for pregnant women and women with dependent children who are receiving
substance abuse services. If the care is not covered by a third party provider, SAPT Block
Grant funds may be used as the payment of last resort. This service must include referrals for
prenatal care. [Perinatal Services Network Guidelines – Fall 1995]
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70 – Pediatric Medical Care (Perinatal Only)
This is an element required in SAPT Block Grant funded perinatal programs. The program
must provide or arrange for this service, which does not include specialist care or
hospitalization for the children of women who are receiving substance abuse services. If the
care is not covered by a third party provider, SAPT Block Grant funds may be used as the
payment of last resort. This service must include immunizations.
71 – Transportation (Parolee Services Only)
This service is the provision of or arrangement for the transportation of a client to and from
treatment services.
Narcotic Treatment Program Service Unit Definition
Narcotic Treatment Programs (NTP) are commonly called methadone maintenance programs,
methadone detoxification programs, or LAAM maintenance programs in San Francisco.
The unit of service definitions for NTPs are based on California Code of Regulations (CCR)
Title 9, Narcotic Treatment Protocols, and Title 22, Medi-Cal Protocols. One unit of service for
a Narcotic Treatment Program is defined as either one dose of methadone or LAAM (either for
clinic consumption or take-home) or one 10 minute period of face-to-face individual or group
counseling to include assessment, treatment planning, collateral counseling to family and friends,
medication review, and crisis intervention. Groups must be 4-10 members in size. For Medi-Cal
reimbursement, the standards for service delivery specify daily dosing and five units of
counseling per month in maintenance programs.
Driving Under the Influence Service Unit Definition
DUI programs are established by California Health and Safety Codes and are regulated by
California Code of Regulations (CCR), Title 9. One unit of service for a DUI Program is defined
as one hour of education, one hour of group counseling, or 15 minutes of individual counseling
in a program licensed as meeting State DADP standards.
CBHS needs to measure client capacity in several ways. ‘Unduplicated clients’ corresponds to
slots measured annually. For each contract exhibit please indicate as exactly as possible the
number of unduplicated clients that will be seen annually. Unduplicated clients are those
individuals who receive at least one treatment service during the fiscal year. For residential
programs, UDC can be calculated by multiplying the number of daily slots available by the
number of treatment cycles that can be offered during the fiscal year. For outpatient programs,
the UDC calculation equals number of weekly slots available multiplied by number of treatment
cycles offered annually.
Residential Service UDC
Required formula to be used in renewal application for typical residential programs.
Documentation consists of data entry into BIS.
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# of slots (program’s daily bed capacity) x # treatment cycles offered annually = UDC
Example 1: Definite treatment cycle
A treatment cycle of 90 days (1/4 year) can be offered four times annually. Show this
calculation.
20 clients (program’s capacity) x 4 treatment cycles annually = 80 UDC annually
Example 2: Indefinite treatment cycle
A treatment program offers a treatment cycle of 45 days but permits clients to extend to 90
days. The average length of stay for all clients is 63 days (1/6 year).
30 clients x 6 cycles annually = 180 UDC annually
Required formula to be used in renewal application for residential detoxification programs with
high recidivism rates. If the typical client returns an average of 3 times during the year, then
only 1/3 of the client treatment episodes are unique. The remainder are repeat client episodes for
the year. This applies to 5 programs.
# of slots x # of treatment cycles offered annually x recidivism factor = UDC
Example 3:
A 12-bed residential detox program offers detox for 3-21 days with the typical client
staying 7 days (1/52 of a year). From prior years it is known that most clients re-enter
about three times during the year.
12 clients x 52 cycles annually x .33 recidivism factor = 206 UDC
Outpatient Service UDC
Required formula to be used in renewal application. Documentation consists of data entry
into BIS.
Example 1: Definite treatment cycle
A treatment cycle of 6 months (1/2 year) can be offered two times annually. Show this
calculation.
50 clients (program’s weekly capacity) x 2 treatment cycles annually = 100 UDC annually
Example 2: Indefinite treatment cycle
A treatment program offers a treatment cycle of 6 months but several clients do not engage
and drop out early while others extend to one year. The average length of stay for all
clients is 103 days (0.28 year).
50 clients x 3.57 cycles annually(1.00/0.28 = 3.57) = 178 UDC annually
Intensive Outpatient Service UDC
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Required formula to be used in renewal application. Documentation consists of data entry
into BIS.
Examples: See Outpatient UDC
Day Treatment Service UDC
Required formula to be used in renewal application. Documentation consists of data entry
into BIS.
Examples: See Outpatient UDC
Prevention Service UDC
Before completing the UDC calculation, begin by estimating the number of times each
participant will be seen during the year. Participants of each prevention strategy will be counted
separately from other prevention strategies. It is acceptable that across different strategies there
will be duplication of clients.
Use of strategies not described below requires the approval of CBHS Progam Staff.
Required formula to be used in renewal application:
Example 1: Information Dissemination (12):
A program sets up a booth in a Health Fair three times annually, all in diverse locations.
At each fair 200 pieces of promotional information are handed out. It is assumed that the
fairs’ attendees are unique. Staff also go to four Parent Teacher meetings giving a brief
presentation, staying afterwards for questions, and passing out information to 35 parents
each time. In these cases the UDC calculations and the UOS calculations will be the
same. Documentation consists of a log of date, time duration, staff present, # of
materials distributed, general description of target population.
200 attendees x 3 health fairs annually = 600 UDC
35 parents x 4 meetings annually = 140 UDC
total = 540 UDC for Information Dissemination
Example 2: Education (13)
Classroom education is given in five classrooms with an average enrollment of 28 students.
The 15 week curriculum is given once per year for each classroom. Documentation
consists of a log of date, time duration, subject matter covered, number of students
present each time, teachers signature, general description of target population.
140 students (28 x 5) x 1 cycle annually = 140 UDC
Example 3: Alternatives (14)
Recreational activities that act as alternatives to hanging out in high risk environments are
provided three times weekly at a youth center. Neighborhood youth may drop-in as they
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choose, but they are encouraged to join ongoing activities. Approximately 18 youth are
present each of the three days. Each youth comes an average of twice weekly for
approximately 6 months of the year. Documentation consists of daily sign-in logs for the
activity or one sign-in for the center with a check box for the activity which will be
attended.
18 youth x 3 sessions weekly x 50 weeks annually = 2700 maximum possible
each youth attends 2 sessions weekly x 25 weeks annually = 50
2700 / 50 = 54 UDC
Example 4: Problem Identification and Referral (15)
An after school program conducts periodic (quarterly) rap sessions to find out if drug
experimentation is occurring among the youth. Another staff person enters club scene
frequented by young adults to find out if they are using designer drugs. Neither staff
person is doing on-site education or counseling. The target population is seen only once
each year. Documentation consists of a log of date, time duration, number of
participants present each time, teachers signature, general description of target
population.
15 (average # of youth/young adults present) x 4 sessions annually (if quarterly) = 60 UDC
Example 5: Early Intervention (18)
A trained staff person meets with selected individuals of a drop-in center to engage them
and facilitate their making some change in their life circumstances. One FTE staff person
can see about 5 individuals daily for each of that person’s 230 working days annually (52
weeks minus 6 wks vacation/sick/holiday=46 wks x 5 days weekly). Although client
attendance is sporadic, each individual may be seen about once every couple of months.
Documentation consists of data entry into BIS.
5 participants x 230 days annually = 1150 maximum possible
each person attends 6 sessions annually = 6
1150 / 6 = 192 UDC
Example 6: Outreach and Intervention (19)
A trained Community Health Outreach Worker (CHOW) goes out into the community and
talks with people about problems in their lives, provides resource material for where they
might seek help, and encourages them to follow-through with seeking help.
Documentation consists of a log of date, time duration, number of participants seen each
time, staff signature, general description of each participant. Follow the example of
Early Intervention above.
Example 7: Intravenous Drug User (Strategy 20):
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A staff person anticipates that most participants will be seen 1-3 times. Follow example for
Early Intervention above.
Example 8: Referrals, Screening, and Intake (21)
A staff person anticipates that most participants will be seen once only. Follow example
for Early Intervention above.
Ancillary Service UDC
Before completing the UDC calculation, begin by estimating the number of times each
participant will be seen during the year. Participants of each prevention strategy will be counted
separately from other prevention strategies. It is acceptable that across different strategies there
will be duplication of clients.
Use of strategies not described below requires the approval of CBHS Progam Staff.
Required formula to be used in renewal application. Documentation consists of data entry
into BIS or its approved alternative database.
Example 5: HIV Early Intervention (65), Tuberculosis Services (66), Case Management
(68), Acupuncture, or Perinatal Outreach (22)
A trained staff person meets with selected individuals in a service center to engage them
and facilitate their making some change in their life circumstances. One FTE staff person
can see about 5 individuals daily for each of that person’s 230 working days annually (52
weeks minus 6 wks vacation/sick/holiday=46 wks x 5 days weekly). Although client
attendance is sporadic, each individual may be seen about 4 times over a period of months.
Documentation consists of data entry into BIS when clients can be identified by name or
a log of date, time duration, number of participants seen each time, staff signature,
general description of each participant when participants can not be identified by name.
5 participants x 230 days annually = 1150 maximum possible
each person attends 4 sessions annually = 4
1150 / 4 = 288 UDC
Narcotic Treatment Program Service UDC
Required formulas to be used in renewal application. Documentation consists of data entry
into BIS.
Maintenance formula
# of slots (program’s daily capacity) x # treatment cycles offered annually = UDC
Example: Maintenance
A methadone maintenance program provides a continuous treatment cycle of greater than
one year, but a few clients drop out each year. The average length of stay for all clients is
340 day (0.93 year).
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250 clients x 1.08 cycles annually(1.00/0.93 = 1.08) = 270 UDC annually
Detoxification formula
# of slots x # of treatment cycles offered annually x recidivism factor = UDC
Example: Detoxification
A 30-slot methadone detox program offers detox for 21 days with the typical client staying
14 days (0.04 of a year). From prior years it is known that most clients re-enter about
three times during the year.
30 clients x 25 cycles annually x .33 recidivism factor = 248 UDC
Driving Under the Influence Service UDC
Required formula to be used in renewal application. Documentation consists of data entry
into BIS or its approved alternative database.
Example 1: Definite treatment cycle
A treatment cycle of 1 year is offered annually. Show this calculation.
100 clients (program’s weekly capacity) x 1 treatment cycle annually = 100 UDC
annually
Example 2: Mid-year turnover in a definite treatment cycle
A treatment cycle of 18 months (1 1/2 years) is offered. As groups end, new ones will
begin. Show this calculation.
25 clients (average group size) x 6 groups annually x 1 treatment cycle annually per
group = 150 UDC annually
When completing this section, use only the formula indicated for the appropriate service
modality and show this calculation on your renewal application in this section.
Residential Service UOS Calculation
Required formula to be used in renewal application:
# CBHS funded beds x 365 days x occupancy rate no less than 90% = total units
Note: All formulas used for calculating units of service and costs per unit of service rates
for residential programs shall be based on whole beds. There will be no partial beds.
Example:
20 funded beds x 365days x 0.92 = 6,716 total units
CBHS 2009/10 Request for Renewal Instructions
Substance Abuse Service Units Section Page 15 of 24
Note 2: Programs funded by SACPA, the Substance Abuse and Crime Prevention Act of
2000, are not permitted to have an occupancy rate below 100% in their formulas.
Outpatient Service UOS Calculation
Required formula to be used in Renewal application:
# contracted slots x # of contacts per week x 50 weeks = units of service
* Note: All formulas used for calculating units of service and costs per unit of service rates for
non-residential programs shall be based on 50 weeks of service per year in order to account for
anticipated closure for holidays. Formulas shall be based on whole slots. There will be no
partial slots.
Example:
40 slots x 3 weekly meetings x 50 weeks = 6,000 total units
Intensive Outpatient Service UOS Calculation
Required formula to be used in Renewal application:
# of contracted slots x # of contacts per week x 50 weeks per year = total units of service
* Note: All formulas used for calculating units of service and costs per unit of service rates for
non-residential programs shall be based on 50 weeks of service per year in order to account for
anticipated closure for holidays. Formulas shall be based on whole slots. There will be no
partial slots.
Example:
20 slots x 3 weekly meetings x 50 weeks per year = 3,000 total units
Day Treatment Service UOS Calculation
Required formula to be used in Renewal application:
# of slots available daily x # of days per week program is open x 50 weeks per year
x a utilization rate no less than 90% = total units of service
* Note: All formulas used for calculating units of service and costs per unit of service rates for
non-residential programs shall be based on 50 weeks of service per year in order to account for
anticipated closure for holidays. Formulas shall be based on whole slots. There will be no
partial slots.
Example:
CBHS 2009/10 Request for Renewal Instructions
Substance Abuse Service Units Section Page 16 of 24
25 slots x 5 weekly meetings x 50 weeks per year x .90 = 5,625 total units
Prevention Service UOS Calculation
Required formulas to be used in the Renewal application: Note services may be conducted in
group settings or individually.
Group: # of participants per activity x # of activities per year = units of service
Individual: # of contacts per week x 50 weeks per year = units service
Note: If your program offers more than one type of prevention service, you must provide a
separate formula and calculation for each category of prevention strategy. List the different
calculations according to each unique type of service provided, then sum all to give total units of
service. Your unit cost will be based on this aggregate total. Under no circumstances will there
be separate costs attached to each service type within the same exhibit. The list of prevention
strategies paired with the number of units of service for each and the grand total of units paired
with the single overall unit cost must also be transferred to the Exhibit B, DPH #1A page.
Formulas shall be based on whole participants. There will be no partial participants.
Example:
A Primary Prevention program for youth uses (13) Education and (14) Alternatives as
strategies and does its work in group settings.
(13) Education: 50 youth x 12 sessions per year (classroom curriculum) = 600 units
(13) Education: 12 parents x 2 sessions per year (2-hr workshop) = 24 units
Education sub-total = 624
(14) Alternatives: 150 youth x 6 parties per year (clean & sober dance) = 900 units
Grand Total Units = 1,524
A Secondary Prevention program does (20) Outreach to IDUs and (19) Outreach and
Intervention to crack users.
(20) IDU: 50 IDUs contacts per week x 50 weeks per year = 2,500 units
(19) Outreach and Intervention: 75 crack users contacts x 50 weeks per year = 3,700 units
Grand Total Units = 6,200
Ancillary Service UOS Calculation
Required formulas to be used in the Renewal application: Note services may be conducted in
group settings or individually.
Group: # of participants per activity x # of activities per year = units of service
Individual: # of contacts per week x 50 weeks per year = units service
Note: If your program offers more than one type of ancillary service, you must provide a
separate formula and calculation for each category of ancillary strategy. List the different
CBHS 2009/10 Request for Renewal Instructions
Substance Abuse Service Units Section Page 17 of 24
calculations according to each unique type of service provided, then sum all to give total units of
service. Your unit cost will be based on this aggregate total. Under no circumstances will there
be separate costs attached to each service type within the same exhibit. The list of ancillary
strategies paired with the number of units of service for each and the grand total of units paired
with the single overall unit cost must also be transferred to the Exhibit B, DPH #1A page.
Formulas shall be based on whole participants. There will be no partial participants.
Example:
An ancillary program for heroin addicts employs (65) HIV Early Intervention and (66)
Tuberculosis (TB) Services as strategies. Its work is with individuals.
(65) HIV Early Intervention: 50 HIV contacts per week x 50 weeks per year = 2,500 units
(66) Tuberculosis (TB) Services: 75 TB contacts per week x 50 weeks per year = 3,700
units
Grand Total Units = 6,200
A Perinatal Outreach program conducts both individual and group activities.
(22) Perinatal Outreach: 15 women x 12 forums per year = 180 units
(13) Perinatal Outreach: 12 contacts per week x 50 weeks per year = 600 units
Grand Total Units = 780
Narcotic Treatment Program Service UOS Calculation
Required formulas to be used in Renewal application:
Dosing:
# contracted slots x 365 days per year x utilization rate = units of service
Individual Counseling:
# clients x # of 10 minute increments of individual counseling per month
x 12 months per year = units of service
Group Counseling:
# clients x # of 10 minute increments of group counseling per month
x 12 months per year = units of service
Total Units = sum of the above
Note: CBHS unit calculation requirements for this section are patterned off the State
regulatory guidelines for narcotic treatment programs but are NOT exactly the same.
CBHS requirements differ from the State in the manner in which dosing/dispensing units
are calculated. CBHS allows the calculation formula to contain a utilization factor between
90-100% accounting for absentee rates. Also, CBHS requirements differ from the State in
how payment for services is computed. There are no separate reimbursement rates for
different services. In CBHS contracts all Substance Abuse Service units will be summed
and a single unit cost computed.
CBHS 2009/10 Request for Renewal Instructions
Substance Abuse Service Units Section Page 18 of 24
Reimbursement for NTP programs is based on billing the State Medi-Cal office at their
rates for the itemized dosing, individual and group counseling units applicable to Medi-Cal
eligible clients. The remaining units generated by non-Medi-Cal clients may be considered
billable to CBHS at the all-inclusive rate which will equal the total/gross funding (DPH
revenues + Other Revenues) divided by the total units of service.
Example:
300 contracted slots x 365 days per year x .93 (utilization rate) = 101,835 dosing units
300 clients x 5 (10 min. couns. increments) per month x 12 months = 18,000 indiv. couns.
units
150 clients x 9 (10 min. couns. increments) per month x 12 months = 13,500 group
counseling units
total units of service = 121,185
Driving Under the Influence Service UOS
Required formulas to be used in Renewal application:
# contracted slots x # of contacts per week x 50 weeks = units of service
Example:
100 slots x 1 weekly meeting x 50 weeks = 5,000 total units
Divide the total revenue by the number of units of service to arrive at the Substance Abuse
Service unit cost and show the calculation. Unit cost calculations must be based on total/gross
funding (DPH Revenues + Other Revenues).
CBHS uses these Substance Abuse Service unit calculations based on available staff hours in its
NNA Unit Report to the State of California, Department of Alcohol and Drug Programs
(DADP).
In general, the State Department of Alcohol and Drug Programs (DADP) requires CBHS to
obtain information based on available staff hours to use as a capacity measure within each
program called “Net Negotiated Amount” (NNA). Each contractor must report — in addition to
client contact based units of service described above — units of service that are a State
requirement in response to NNA. For residential programs (based on bed days) and narcotic
treatment programs (based on slot days), the NNA units may appear the same. In other cases
there will be a difference between units of service based on client contacts and units based on
available staff hours.
CBHS 2009/10 Request for Renewal Instructions
Substance Abuse Service Units Section Page 19 of 24
The term “Net Negotiated Amount” refers to CBHS’s Net Funding from the State of
California/DADP, NOT an amount based on the contractor’s net funds from CBHS in any
program. CBHS payments to contractors will be based on the Substance Abuse Services units
described in section 4A above and will not be based on State units of service definitions.
Note: The instructions below show that the NNA units are calculated for any contract program
based on the total gross program funding (CBHS revenues plus contractor’s other revenue)
divided by total NNA units as defined below.
State DADP Net Negotiated Amount (NNA) Terminology
“Available Capacity” means the number of units of service (bed days, hours, slots, etc.) that a
county actually makes available in the current fiscal year.
“Dedicated Capacity” means the historically calculated service modality and service capacity
that is adjusted for the projected expansion or reduction in services that the counties agree to
make available to provide drug and alcohol services to persons otherwise eligible for county
services.
“Modality” means those necessary general activities to provide alcohol/drug prevention or
treatment or both, which conform to the services available in the following categories:
Support Services
Primary Prevention
Secondary Prevention
Nonresidential Treatment
Day Care Habilitative
Residential Treatment
Chemically Assisted Treatment - Methadone
Chemically Assisted - Non Methadone
Ancillary Services
Driving Under the Influence Program
State DADP Net Negotiated Amount (NNA) Definitions and Calculations
Provide NNA units for each Program and each modality within that program if more than one
modality is provided. Following are examples of how to calculate NNA units for each modality.
Show calculations for each modality of NNA units in this section of your exhibit.
All calculations must show deductions for sick leave, vacations, and holidays.
NNA Support Services
(Not applicable to CBHS contractors.)
NNA Prevention
CBHS 2009/10 Request for Renewal Instructions
Substance Abuse Service Units Section Page 20 of 24
Available staff hours.
The number of staff available to provide prevention activities x the number of annual hours staff
is available minus a hypothetical 30 days of vacation, holidays and sick leave = available staff
hours. Unit cost is then calculated by dividing total revenues (CBHS + Other Revenues such as
client fees, fundraising, etc.) by staff hours.
Example:
1.00 FTE staff works 40 hours each week to provide prevention activities.
40 hrs. x 46 weeks (52 weeks per year – 2 weeks vacation, 2 weeks sick leave, 2 weeks
holidays) = 1,840 hrs. for each 1.0 FTE staff.
2.75 FTE staff x 1,840 hrs. = 5,060 annual available staff hours.
Total funding (CBHS + Other Revenues) is $250,000.
Unit cost is calculated: $250,000/5,060 = $49.41.
NNA Nonresidential
Available staff hours (direct service staff only)
The number of staff available to provide direct non-residential activities x the number of annual
hours staff is available = available staff hours. The FTE of staff available must match the total
FTE on the corresponding Salaries & Benefits detail page of Exhibit B. Unit cost is then
calculated by dividing total revenues (CBHS + Other Revenues such as client fees, fundraising,
etc.) by staff hours.
Example:
1.00 FTE staff works 35 hours each week to provide non-residential activities.
35 hrs x 46 weeks (52 weeks per year – 2 weeks vacation, 2 weeks sick leave, 2 weeks
holidays) = 1,610 hrs for each 1.0 FTE staff.
8.15 FTE staff x 1,610 hrs = 13,122 annual available staff hours.
If the total revenues (CBHS + Other Revenues, such as client fees, fundraising, etc.) for
non-residential services is $476,223, the unit cost would be:
$476,223/13,122 = $36.29.
NNA Day Care Habilitative
Available days (days x capacity). The number of annual days the program is open for business x
the number of slots available (capacity). Although the term Day Care Habilitative refers to
Medi-Cal services, this same formula applies to all CBHS Substance Abuse Day Treatment
Programs.
Example:
CBHS 2009/10 Request for Renewal Instructions
Substance Abuse Service Units Section Page 21 of 24
Program is open 5 days a week throughout the year, but closes for 10 holidays.
It has a capacity of 35 slots at any given time.
Available days would = (5 days/ wk x 52 wks - 10 holidays) x 35 slots = 8,750 available
days.
If the total revenues (CBHS + Other Revenues such as client fees, fundraising, etc.) for the
day treatment program = $486,991, the unit cost would be $486,991/8,750 = $55.66.
NNA Residential Treatment
Available bed days (days x capacity). The annual number of days (365) x the number of beds.
Example:
The program has 23 beds with total revenues (CBHS + Other Revenues such as client fees,
fundraising, etc.) of $513,672.
The number of available bed days = 365 x 23 or 8,395.
The unit cost would be $513,672/8,395 = $61.19.
NNA Chemically Assisted Treatment — Methadone
Slot days (slots x available days) Maintenance and Detox.
The annual number of days open x the number of slots
Example:
The program is open every day except for two holidays.
It has a capacity of 125 slots with total revenues (CBHS + Other Revenues
such as client fees, fundraising, etc.) of $389,976.
The number of slot days is (365-2) x 125 or 45,375 slot days.
Unit cost is $389,976/45,375 = $8.60.
NNA Chemically Assisted Treatment — Non Methadone
Slot days (slots x available days) Calculations are the same as NNA Chemically Assisted
Treatment — Methadone above.
NNA Ancillary Services
Available staff hours. Calculations are the same as NNA Nonresidential above.
NNA Driving Under the Influence (DUI) Program
The number of clients served annually. Provide the actual number of clients to be served for the
year.
CBHS 2009/10 Request for Renewal Instructions
Substance Abuse Service Units Section Page 22 of 24
CBHS is asked to measure its services’ capacity by several different methods, e.g., 24-hour
capacity, 7-day capacity (usually called static slots), 30-day capacity (usually called active caseload), and annual capacity (referred to as unduplicated clients). Please state the maximum
number of clients that may be seen by your program during a regular week-day, 24-hr.
time period. This can be done by dividing the total annual units of service by the number of
days the program is open to provide services, that is, UOS per year/ 250 days/year for most
programs. For a residential program, point in time capacity cannot exceed the overall bed
capacity. In a drop-in program it cannot exceed the Fire Marshall’s stated building capacity.
Residential Service 24-hour capacity
Example for Residential Services:
The residential treatment program has 25 beds supported by CBHS funding. These beds
are usually, but not always, full. The capacity for enrollment at any point in time equals
25.
Outpatient Service 24-hour capacity
Example for Outpatient Services:
In an outpatient clinic 5,500 units of service are contracted for annually. The program is
open five days per week, 50 weeks per year, and closed on 10-13 major holidays.
5,500 UOS per year/ 250 working days per year = 22 clients seen on a typical day
Note: You can double check this calculation by multiplying the number of counselors
seeing clients times the maximum number of clients each counselor sees daily, for example,
three FTE counselors’ time and twenty percent of the clinical supervisor’s time are
dedicated to seeing clients. Each FTE sees seven to nine clients on a typical workday.
3.2 counselors x 7 clients per day each FTE = 22 clients = 24-hour point in time capacity
Intensive Outpatient Service 24-hour capacity
Example: See Outpatient Services:
Day Treatment Service 24-hour capacity
Example for Day Treatment Services:
The day treatment program has 25 slots supported by CBHS funding and a weekly
schedule stating clients attend daily. However, average attendance is 3 times weekly. Use
the OP formula, e.g., in the program 5,500 units of service are contracted for annually.
CBHS 2009/10 Request for Renewal Instructions
Substance Abuse Service Units Section Page 23 of 24
The program is open five days per week, 50 weeks per year, and closed on 10-13 major
holidays.
5,500 UOS per year/ 250 working days per year = 22 clients seen on a typical day
Prevention Service 24-hour capacity
Example for Prevention and Ancillary Services:
A program is open five days per week and provides street outreach and school based
education on a varying schedule that includes a large presentation once monthly. To view
services on a daily point in time basis divide the projected annual total by 250 (clinic open
5 days per week x 50 weeks per year).
7,200 projected annual units of service/ 250 working days per year = 29 daily capacity
Example for Drop-In Services:
The Fire Marshall has issued a permit stating building capacity to be 140 people. There
are eight staff on duty. While there are frequently fewer people in the building, at any
point in time there could be 140.
140 building capacity – 8 staff = 132 point in time capacity
Ancillary Service 24-hour capacity
Example for Prevention and Ancillary Services:
A program is open five days per week and provides street outreach and school based
education on a varying schedule that includes a large presentation once monthly. To view
services on a daily point in time basis divide the projected annual total by 250 (clinic open
5 days per week x 50 weeks per year).
7,200 projected annual units of service/ 250 working days per year = 29 daily capacity
Narcotic Treatment Program Service 24-hour capacity
Example for NTP Services:
The methadone treatment program has 250 slots supported by CBHS funding. These
clients are usually, but not always, in attendance daily. The capacity for enrollment at any
point in time equals 250.
Driving Under the Influence Service 24-hour capacity
Example for DUI Services:
A program is open three evenings per week to offer one DUI class nightly of 25 students.
To view services on a daily point in time basis divide the projected annual total by 250 (as
if clinic were open 5 days per week x 50 weeks per year).
3,750 projected annual units of service/ 250 working days per year = 15 daily capacity
CBHS 2009/10 Request for Renewal Instructions
Substance Abuse Service Units Section Page 24 of 24