. "D Using Performance Monitoring to Improve Community Health: Conceptual Framework and Community Experience (Workshop Summary)." Improving Health in the Community: A Role for Performance Monitoring. Washington, DC: The National Academies Press, 1997.
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Improving Health in the Community: A Role for Performance Monitoring
City of Escondido Health Care and Community Services Project8
The goal of the Health Care and Community Services Project is to reduce the harmful effects of alcohol and other drug use in the community of Escondido, California (population, 120,000; county population, 2.6 million). The project coordinates a cross section of community services, including law enforcement, hospital emergency rooms, and community agencies. Integration of data systems, administrative coordination, financing, and training are other integral elements of the project's success. The municipal government functions as a facilitator for the community collaboration but does not provide services directly. Its interest is to reduce the cost of alcohol and drug use to the city and to improve the city's health.
Unlike most alcohol or drug control programs, which target individuals who are already dependent on alcohol or drugs, the Escondido project seeks to identify users who are at high risk of becoming dependent in the future. The objective is to influence drinking behavior before it reaches a critically destructive level, not to identify those already in need of specialized services (although such referrals are made when necessary). This approach is consistent with population data showing that the majority of alcohol and drug incidents involve users, not addicts. The program involves routine screening for alcohol or drug use in high-volume, high-risk situations. It includes a threeto five-minute screening interview and brief intervention. It is administered to all adults in hospital emergency rooms, health centers, and law enforcement settings. A new component of the program is the "Sobering Service," which provides services to individuals who would otherwise be sent to the police or to the emergency room for alcoholor drug-related care.
Three important lessons were emphasized to the committee. First, the ability to cross sectors and create an integrated program made it possible to capture savings in one sector and make these resources available to the program. For example, the city is saving the money normally spent on booking people for alcohol-related offenses and investing it in the project. The project may become self-sustaining, because local private funds may soon be raised from managed care firms and combined with ongoing public fund-
This section is based on a presentation by Dennis Kelso.