The Escondido Health Care and Community Services Project aims 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. 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 many related 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). The program involves routine screening for alcohol or drug use in high-volume, high-risk situations. It includes a three- to five-minute screening interview and brief intervention, which 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 assists individuals who would otherwise be sent to the police or to the emergency room for alcohol- or drug-related care.

Three important lessons have been learned. First, the ability to cross sectors and create an integrated program has made it possible to capture savings in one sector and make those resources available to the program. For example, the city is investing in the project the money that would normally be spent on booking people for alcohol-related offenses. The project may become self-sustaining because local private funds may soon be raised from managed care firms and combined with ongoing public funding for uninsured participants. (Initial funding for the project came from local city general funds, county government funds, and a matching grant from The Robert Wood Johnson Foundation.)

Second, the availability of data has helped to identify stakeholders for the project and to create a collaborative value system, based on community participation. Third, development of a data system will be important in monitoring and maintaining the integration of screening and brief intervention services within multiple collaborating agencies.

SOURCE: D. Kelso, workshop presentation (1995); see Appendix D.

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