Door to Hope was once a residential addiction treatment program that occupied a single facility in Salinas, California. Today it is a comprehensive human services agency that provides an array of related services such as dual diagnosis treatment for adolescents; screening, assessment, and intervention for drug-exposed infants; and substance use treatment for women involved in the criminal justice system. Most of this service expansion is the result of the agency's ability to take advantage of voter initiatives that expanded or reformed public policy and service delivery in the Golden State.
The voter initiative process historically has addressed taxes and financial bonds, but increasingly in recent years voters have used the initiative process to express their will on social issues, such as drug and justice policy reform, treatment of minority groups, and human services delivery.
Approximately half the states use voter referenda to allow citizens direct access to the legislative process. Sometimes known as citizens' initiatives, these measures usually qualify for the ballot through the collection of thousands of voter signatures.
Chris Shannon, Door to Hope's executive director since 2000, has creatively engineered the agency's expansion using opportunities afforded by three voter initiatives. "Our core residential services budget has not increased since 1999," she says, "but through Propositions 10, 36, and 63, we have grown the program by at least tenfold."
Approved by voters in 1998, Proposition 10 increased taxes on tobacco products and established the California Children and Families Program. Spearheaded by actor/activist Rob Reiner, Proposition 10 was designed to provide significant new revenue to support services to infants and children up to five years old. Each California county established a local "First 5" commission to determine needs and administer funds.
In 2001, Door to Hope received $315,000 from First 5 Monterey County for capital development of a new perinatal residential recovery program to serve Monterey County's Hispanic community.
Since 2003, Door to Hope has received more than $2 million to fund the Monterey County Screening Team for Assessment, Referral and Treatment (MCSTART). The program provides a comprehensive care model to identify, assess, refer, and treat children exposed to alcohol and other drugs in utero. The program closes a critical gap in the existing care system and complements and supplements existing efforts to address the needs of high-risk children and their families.
California's Substance Abuse and Crime Prevention Act of 2000 (Proposition 36) represented a tectonic shift in our society's approach to the addicted. Instead of incarceration, Proposition 36 offers nonviolent drug offenders the opportunity to enter treatment. The program has been controversial because of its emphasis on treatment rather than coercion and punishment. However, a recent evaluation found that for every $1 invested, Proposition 36 has saved the state $2.50, and that in the first four years of the program more than 140,000 offenders were diverted to treatment.
Beginning in 2002, Door to Hope used Proposition 36 funding to create the agency's first outpatient services, annually serving more than 180 men and women. The service offers a structured alternative to more intensive residential services. Clients are in the program three or four months and attend sessions two to three times a week. Referrals come directly through the court system but bypass traditional drug courts.
Says Shannon, "Prop 36 funding allowed us to begin providing services to men, something we might not have done otherwise. It has also enabled us to improve our abilities with clients experiencing problems with methamphetamine, since they comprise a significant percentage of the Prop 36 caseload."
To expand funding for mental health services, in 2004 voters approved a 1% tax on incomes of more than $1 million. The initiative, the Mental Health Services Act, is raising hundreds of millions in new dollars for a major statewide expansion of mental health programs. Proposition 63 funds cannot supplant existing funding.
Upon passage of Proposition 63, Monterey County initiated a robust community planning process to determine how to spend the new funding. Door to Hope was an active organizational participant in the process. After 77 community meetings attended by 1,800 participants, a three-year mental health services expansion plan was developed. Door to Hope engaged in a competitive bidding process to provide those services consistent with its mission and scope of practice. Under Proposition 63, Door to Hope receives $400,000 per year to provide mental health and substance use services for 50 adolescent boys and girls and their families.
Reasons for Success
Shannon credits the initiative process with creating opportunities and opening doors for her agency. "Our service delivery mix has changed substantially with the infusion of dollars from these voter initiatives. We now serve children and adolescents, and have a more diversified funding base as a result of the wisdom of California's voters.
"There are several reasons we were able to benefit from these initiatives," she adds. Among these:
Door to Hope always has had a professional approach to service delivery and is well-respected in the community.
Shannon had been advocating for the need to create services for drug-exposed children well before the First 5 initiative was passed.
Door to Hope's Board of Directors included several members of the local bar, who acted as a bridge to the criminal justice system when Proposition 36 was coming online.