DRUG ABUSER CARE PROGRAM REACHES FEW

Maryland set aside $9.4 million over the past two years to provide drug
treatment for welfare recipients and new mothers, but only a fraction of
the money has been spent for that purpose, records show.

Less than 15 percent of the money -- $1.3 million -- has been used for drug
treatment. Most of the rest has paid for job training, foster care and
other social service programs. Maryland Department of Human Resources
officials say it has been harder than expected to find people in the two
targeted groups willing to enter treatment. But advocates say the agency's
failure is inexcusable.

"This is a tremendous opportunity that's being squandered, and it's being
squandered basically because of bureaucratic bungling," said J. Peter
Sabonis, director of the Family Investment Program Legal Clinic, which
provides legal and other services to the poor.

Sabonis said the basic problem is that the state's system for screening
people for substance abuse doesn't work, which means thousands who need
treatment do not get it.

The failure to use the money as intended also drew the ire of an
influential legislator, Sen. Barbara A. Hoffman, the Baltimore Democrat who
sponsored the bill creating one of the two programs involved.

"We've lost two years of potential here," Hoffman said. "It's totally
unacceptable."

Human Resources Secretary Lynda G. Fox acknowledged shortcomings in her
agency's implementation of the programs, but said efforts to reach drug
addicts pose complicated problems. "That money did not go unspent for lack
of trying to get it spent," she said.

She does not disagree, however, that her agency should be able to use the
money for treatment.

Fox said it was difficult to get the programs going because of the need to
coordinate efforts between her agency and the state health department,
hospitals and privately run managed care organizations.

"These issues are incredibly complex," Fox said. "The more experience we
have, the more able we are to make changes to make the programs more
effective."

Hospital Policies Vary:

One of the two programs was the result of legislation Hoffman sponsored in
1997 that targets mothers who give birth to babies with drugs in their
systems. It aims to get the mothers into treatment before they go back to
the community.

If they refuse or fail to complete treatment, their infants are supposed to
be placed with relatives or in foster care, and parental rights can be
terminated. The program was established as a pilot in Baltimore City and
six Maryland counties.

Fox's department counted on hospitals to identify mothers needing
treatment, but she said hospital policies varied. Some tested all newborns
for drug exposure and others tested only if the mother or infant was in
distress during delivery.

"It's difficult to identify drug-exposed infants, and it's difficult to get
the mothers into treatment," Fox said. "Some of those mothers go AWOL, or
they enter treatment and quickly drop it."

`Hard-Core' Addicts:

Another Human Resources administrator, Linda E. Mouzon, said one big
problem has been getting to the mothers during their brief hospital stays
so they can be placed into drug treatment programs.

Once they leave the hospital, it is harder to get them into treatment, she
said. "We picked one of the most difficult groups to deal with," Mouzon
said. "They are probably more hard-core in their addictions."

Although $1.7 million was budgeted for the first fiscal year of the
program, ending June 30, 1998, none of it was spent. The first year was
spent developing the program and working out protocols with hospitals to
share information, Mouzon said.

The next year, another $1.7 million was budgeted. Only $83,637 of that was
spent on drug treatment because efforts to identify mothers and move them
into treatment proved ineffective, she said.

Mouzon said hospitals have been doing a better job in recent months
identifying mothers who need treatment, and state substance abuse
counselors will be dispatched to work with them before they are discharged.

More Screening Problems:

Fox acknowledged there have been problems with the program for welfare
recipients as well.

The state budgeted $3 million in each of the past two fiscal years to cover
inpatient costs and other expenses for welfare recipients. But only
$374,000 was spent on drug treatment the first year and $843,671 the
second, records show.

Again, the main problem was with screening, Fox said.

When a client applies for welfare benefits, a caseworker asks four
questions designed to determine if the person might be a drug addict. If
so, they are offered treatment.

But few people responded in ways indicating they might have a drug problem,
Fox said.

Her agency had thought those who slipped through the initial screening
would be identified when they were assigned to the managed care
organizations that run the state's Medicaid program.

But that didn't happen either, Fox said.

The managed care organizations, which are overseen by the health
department, are involved because they are responsible for providing
outpatient drug treatment. They also make referrals for more expensive
inpatient treatment, which is funded by the drug program for welfare
recipients.

Doctors Avoid Role:

Fox said her department got little feedback from the managed care
organizations on their screening efforts. The managed care organizations
lacked the information because they were not hearing back from the doctors
who see Medicaid clients, she said.

"There's a real cultural issue involved in that the primary care physicians
do not believe that it is part of their role to report to a public agency
whether someone is addicted," Fox said.

There also have been questions raised about the extent to which the managed
care organizations are screening Medicaid clients for substance abuse. In
August, a report on their performance found little evidence such screening
was being done.

"It's an ongoing issue we're trying to get resolved," Mouzon said.

Specialists Improve Rate:

Fox said that addiction specialists have been moved into selected welfare
offices to help identify more recipients in need of treatment as they apply
for benefits or renew applications.

That effort, which started in May, has doubled the number of people
referred for treatment from about 5 percent to about 10 percent of those
seeking benefits, Fox said.

Still, Hoffman said she is disappointed and frustrated by the Department of
Human Resources' slow response.

"Look around at what the causes of social ills are, and drugs are the root
of this," she said.

"You can't be productive workers, parents, people if you are addicted to
drugs."