2019-007 Sobering CentersDate: January 18, 2019 Report No. 2019-007
INFORMAL STAFF REPORT
TO MAYOR AND CITY COUNCIL
SUBJECT: Provide information on sobering centers that operate as an alternative to hospitals or jails offering a safe place where a publicly intoxicated person can be observed until he or she becomes sober.
DISCUSSION: During Concluding Items on November 13, 2018, Council Member Armintor requested information about sobering centers, including the sobering center located in Austin, TX.
The National Sobering Collaborative explains that “Sobering Centers provide an alternative place where intoxicated people (frequently homeless) are observed for safe sobering instead of jails, emergency departments or homeless shelters”. The National Sobering Collaborative report,
Sobering Center Care in the United States: An alternative to hospital-based and police-based
holding policies, finds that, “sobering centers tend to focus on one of three main programmatic
purposes: 1. Police diversion, 2. Emergency Department diversion and 3. Homeless/Social welfare practices. This distinction is based upon how the programs began, what their overall goals are and how each program is funded.” (p. 5)
Sobering Centers in Travis County, TX and Other Places
Chief Dixon recently provided documents related to the development of a sobering facility and program in Austin, TX. This planning process and report were a result of a federal grant for criminal justice planning received in 2012, where the implementation of a sobriety center was the recommendation. Upon that earlier planning group’s recommendation, resolutions supporting
implementation of a Sobriety Center were passed unanimously by both Travis County and the
Austin City Council. To implement this mandate, a Sobriety Center Planning Committee was convened in March 2014 and the committee issued the Sobriety Center Implementation Report prepared for the Austin City Council and the Travis County Commissioners Court on April 27, 2015 (Exhibit 1). The committee analyzed existing national and local data on the cost of public
intoxication on Public Health and Criminal Justice. Using local demographic and arrest data, the
committee was able to calculate some of the estimated costs associated with responding to publically intoxicated individuals within Travis County. To estimate costs and operational structure of a sobering center, the committee adopted the Houston Recovery Center model to estimate staff and facility costs as well as governance structure.
Research and anecdotal evidence shared in the Austin report and other programs reviewed offer support for the development of a sobering centers and identify benefits as summarized below.
• Providing a safe place for recovery from alcohol intoxication
• Emergency care for an intoxicated people who are also experiencing homelessness
• Alternative to booking/jail reducing citations for individuals
• Allow Social Services to more efficiently intervene with chronic inebriates
Date: January 18, 2019 Report No. 2019-007
• Return law enforcement officers more quickly to patrol duties
• Reduced Costs of public safety and emergency services:
o Decrease in ambulance visits
o Reduce ER visits
o Lower officer overtime costs
o Generate savings from a decrease in City/County Jail bookings, stays. In reviewing available research and the National Sobering Collaborative website, sobering centers are operating in multiple cities across the country. This assessment is supported by
"Identification and Practice Patterns of Sobering Centers in the United States" research that
includes a comprehensive chart of programs from 2013 (Exhibit 2) and a similar chart in Appendix 3 of the 2015 Austin report. In addition, staff contacted programs from these lists and confirmed that the majority are still active or have returned from inactive to active operations again. These programs confirmed the following:
City Annual
Clients # Beds/Mats Ratio of Staff
to Clients
Structure of Organization
(Private/Public/Non‐Prof
it/Government)
Simple Annual
Budget Estimate
Austin, TX New 60 1 to 15 Non‐Profit Not Available
San Antonio, TX 4200 30 Variable Local Mental Health
Authority $1,200,000
Houston, TX 5200 84 1 to 15
Non‐Profit, Local
Government
Corporations
$1,646,000*
San Francisco, CA 4450 11 1 to 11 Public Not Available
Cambridge, MA NA 107 Variable Non‐Profit Not Available
Seattle, WA 22,000 60 1 to 15 Non‐Profit 1,000,000*
Bethel, AK 1800 16 Variable Non‐Profit $700,600
San Leandro, CA 7000 50 1 to 11 Non‐Profit Not Available
Portland, OR 8400 70 3 to 20 Non‐Profit Not Available
Santa Barbara, CA 1,500 8 1 to 8 Non‐Profit $700,000
* This organization's budget figure does not include building costs for its owned or rented facility. The structure and support of these organizations vary from private, nonprofit, government, or some combination of these. Funding is similarly structured with some programs also receiving
support from private donors and healthcare funding including Medicare, hospital, and emergency
room (ER) sources. Government funding primarily comes from law enforcement and jail budgets, but health and human services funding is also a source in some programs.
Date: January 18, 2019 Report No. 2019-007
Local Discussions in Denton County The potential for sobering centers in Denton and Denton County has been discussed in a variety
of behavioral health discussions involving public safety and substance abuse. For example, the Denton County Behavioral Health Leadership Team’s Jail Diversion Workgroup heard a presentation on the Houston Recovery Center’s Sobering Center.
ATTACHMENT(S): 1. Exhibit 1 – April 27, 2015 Sobriety Center Implementation Report
2. Exhibit 2 – Sobering Centers 2013 Chart
STAFF CONTACT Dani Shaw Community Development Manager
danielle.shaw@cityofdenton.com
(940) 349-7237 Sarah Kuechler Director of Public Affairs
sarah.kuechler@cityofdenton.com
(940) 349-8356
Sobriety Center
Implementation
Report
April 27, 2015
A place to enhance public health and public safety by providing
an alternative to the emergency room and jail for publically
intoxicated individuals to sober up and, where appropriate,
provide a safe environment to initiate recovery.
--Sobriety Center Planning Committee
Prepared for the Austin City Council
And the Travis County Commissioners Court
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1
Table of Contents
Executive Summary ......................................................................................................................... 2
History ............................................................................................................................................. 3
Mission Statement .......................................................................................................................... 4
Public Intoxication: a Costly Public Health and Criminal Justice Problem ...................................... 4
The Law on Public Intoxication ....................................................................................................... 5
Travis County Data on Public Intoxication Arrests and Demographics .......................................... 6
Current Costs Associated with Publically Intoxicated Individuals .................................................. 9
Scope of Services Recommended ................................................................................................. 10
Proposed Staffing and Estimated Costs ........................................................................................ 11
Facility & Location ......................................................................................................................... 12
Governance ................................................................................................................................... 13
Funding ......................................................................................................................................... 14
Recommendations for Implementation ....................................................................................... 14
Summary ....................................................................................................................................... 15
Acknowledgements ....................................................................................................................... 16
Appendices:
1. City of Austin Resolution .......................................................................................................... 17
2. Travis County Resolution ......................................................................................................... 20
3. Researched Sobriety Centers Comparison Chart ..................................................................... 22
4. Public Intoxication Arrests Site Mapping ................................................................................. 23
5. Houston Recovery Center Photos ............................................................................................ 26
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Executive Summary
For more than a decade, the need for a sobriety center in Austin/Travis County has been an important
but missing component needed to effectively address public intoxication in our community.
The human and fiscal costs of public intoxication are significant. In addition to the costs related to
police officer time and the costs of court proceedings and incarceration, the county incurs a cost for
court‐appointed attorneys for indigent defendants. There are costs associated with the emergency room
visits, as well as other costs incurred by the community each year.
This report contains the findings of the Sobriety Center Planning Committee, makes specific
recommendations where appropriate, and identifies issues that need to be addressed by the Travis
County Commissioners Court and Austin City Council. Based on the information gathered during
stakeholder input, a sobriety center facility should provide the following capabilities:
A safe place for sobering up
Medical screening to ensure appropriateness for services at the center
Referrals to treatment
Peer recovery in lieu of clinicians or counselors
Security
The annual staffing expense is estimated at $1,333,500 for 27 full time equivalent positions and related
staffing and administrative costs. The facility should be about 5,000 square feet with a 30 to 40 bed
capacity. It should be easily accessible from the central Austin area, in close proximity to public
transportation, medical, psychiatric, and detoxification services.
Three topics remain to be addressed: governance of the sobriety center, location, and allocation of
costs. As a result of the historic transition of the Austin City Council to ten district‐based council
members as well as 3 seats up for election on the Travis County Commissioners Court at the end of
2014, the Committee determined the best course of action was to report its current findings and obtain
a sense of direction from the Commissioners Court and new City Council before addressing the
remaining items.
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History
In January 2002, Travis County Commissioner Margaret Gomez, Austin City Council Member Beverly
Griffith, and Integral Care Executive Director David Evans announced funding for a study to assess the
feasibility of creating a Sobering‐Up Station for Austin/Travis County. After six months of work by
numerous stakeholders a “Sobering‐Up Station Feasibility Study” was released on June 14, 2002.
Subsequent to the feasibility study, unfortunately, no further planning occurred until March 2009 when
the Travis County Justice and Public Safety Department was selected to participate in the national
Justice Reinvestment at the Local Level (JRLL) initiative. The objective of this initiative was to identify,
through a collaborative process, recommendations to reduce jail populations and reinvest the savings
into more proactive public safety measures. Planning sessions were held from October 2009 through
January 2010, and the top recommendation resulting from the process was to implement a sobriety
center. Grant funding was denied for this initiative and, as an alternative, Travis County received
funding to implement a permanent supportive housing program for frequent offenders.
In 2012, Travis County received a federal grant for criminal justice planning. Once again, implementation
of a sobriety center was a recommendation of the planning group, now called the Behavioral Health
Advisory Committee. As Chair of the Committee, Travis County Court at Law 5 Judge Nancy
Hohengarten drafted resolutions for both the Austin City Council and Travis County Commissioner’s
Court in support of implementation planning. With the sponsorship of Council Members Kathie Tovo,
Chris Riley and Mike Martinez and Commissioner’s Court Judge Sam Biscoe, the resolutions supporting
implementation of a Sobriety Center were passed unanimously by both local governmental bodies.
(Appendices 1 and 2)
Pursuant to the resolutions’ mandates, a Sobriety Center Planning Committee was convened by Judge
Hohengarten in March 2014. Andy Brown was selected to lead the committee. This new stakeholder
group, which involved a variety of community public and private partners, including those from the
business, nonprofit and health care sectors, met for the last year updating research, learning best
practices, visiting centers, and reaching consensus on the need and focus of a proposed sobriety center
for Austin/Travis County. And, as part of that discussion, there was also consideration and discussion of
potential treatment models, staffing, funding and location.
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Mission Statement
The Committee recommends the following mission statement:
The mission of the Austin/Travis County Sobriety Center is to enhance public health and
public safety by providing an alternative to the emergency room and jail for publically
intoxicated individuals to sober up and, where appropriate, provide a safe environment
to initiate recovery.
Public Intoxication: a Costly Public Health and Criminal Justice
Problem
A Sobriety Center is a critical need in Austin/Travis County. Public intoxication (PI) is a serious
public health issue with significant health, quality of life, and fiscal impact on the local
community and government. In 2006, excessive drinking cost the US $223.5 billion (72.2%
from lost productivity, 11.0% from health care costs, 9.4% from criminal justice costs, and 7.5%
from other effects)1 Binge drinking2 is of particular concern, especially in Austin / Travis County.
Of the total estimated cost of excess drinking in the US, $170.7 billion (76.4%) can be attributed
to binge drinking. Reducing the prevalence of binge drinking among adults is a leading health
indicator in Healthy People 2020 (objective SA‐14.3). According to Texas Behavioral Risk Factor
Surveillance System Survey Data3, the prevalence of binge drinking amongst Austin
Metropolitan Statistical Area adults has been consistently and notably higher than Texas and
U.S. binge drinking averages (see chart below). This fact contributed to Austin being named the
5th Drunkest City in the nation in 20124.
1Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD. Economic costs of excessive alcohol consumption in the United
States, 2006. Am J Prev Med 2011;41:516–24.
2 According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), a “binge” is a pattern of drinking alcohol that
brings blood alcohol concentration (BAC) to 0.08 gram percent or above. For the typical adult, this pattern corresponds to
consuming 5 or more drinks (male), or 4 or more drinks (female), in about 2 hours.#
3 https://www.dshs.state.tx.us/chs/brfss/query/brfss_form.shtm
4 http://www.thedailybeast.com/galleries/2012/12/28/25‐drunkest‐cities‐2012‐from‐milwaukee‐to‐burlington‐
vermont.html#5b3d8d96‐f4ca‐4102‐9fbf‐946deb652cc7
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Prevalence of Binge Drinking Among Adults
2008 2009 2010
Austin MSA 19.7% 18.9% 17.3%
Dallas MSA 14.2% 10.1% 13.9%
Houston MSA 17.2% 14.6% 14.9%
Texas 14.7% 14.9% 14.6%
US 15.1% 15.1% 14.7%
Center for Health (CHS) Statistics Texas Behavioral Risk Factor Surveillance System Survey Data. Austin, Texas:
Texas Department of State Health Services.
Excessive alcohol consumption is the third leading cause of preventable death in the United
States accounting for an estimated average of 80,000 deaths and 2.3 million years of potential
life lost (YPLL)† during 2001–2005. Binge drinking accounted for more than half of the excessive
alcohol consumption deaths and two thirds of the YPLL5. Moreover, drinking too much
contributes to over 54 different injuries and diseases, including: unintentional injuries (e.g., car
crashes, falls, burns, drowning), intentional injuries (e.g., firearm injuries, sexual assault,
domestic violence), alcohol poisoning, HIV and other sexually transmitted diseases, unintended
pregnancy, children born with Fetal Alcohol Spectrum Disorder, high blood pressure, stroke,
and other cardiovascular diseases, liver disease, neurological damage, and poor control of
diabetes.
The Law on Public Intoxication
Public intoxication (PI) is a criminal offense in the State of Texas, as it is in many other states.
Some states do not criminalize PI but allow law enforcement to take a person into protective
custody. In Texas, PI is defined by Texas Penal Code Section 49.02 which states: “A person
commits an offense if the person appears in a public place while intoxicated to the degree that
the person may endanger the person or another.” PI is a Class C misdemeanor punishable by a
fine of up to $500. However, if a person has been convicted of PI three previous times in a 24‐
5 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5337a2.htm
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6
month period, the offense can be filed as a Class B misdemeanor, which is punishable by up to
180 days in jail and a fine not to exceed $2000.
Peace officers are not required to arrest or ticket PI cases under Texas Code of Criminal
Procedure Art. 14.031. Instead, an officer may release the individual to the care of an adult who
agrees to assume responsibility for the individual, if the officer believes detention in a penal
facility is unnecessary for the protection of the individual or others. Under the proposed
Austin/Travis County Sobriety Center, law enforcement will retain the right to decide whether
to arrest, ticket, or release an individual they believe is publically intoxicated. Release to a
sobriety center qualifies under the responsible adult standard. Persons arrested on multiple
charges that happen to include PI would not be taken to the sobriety center.
Travis County Data on PI Arrests & Demographics
It is estimated that approximately 76 percent of the people arrested for PI in Travis County
during fiscal years 2008 through 2014 might be eligible clients for the Sobriety Center. Twenty‐
four percent of the people arrested for PI were considered ineligible because their arrest also
contained charges for non‐PI offenses, such as assault or driving while intoxicated, which would
make them ineligible for the sobriety center. The table below provides a breakdown of these
specific PI arrests by fiscal year.
Public Intoxication Bookings Eligible for Sobering Center FY08‐FY14
Public Intoxication – Enhanced (Class B)
210 197 204 166
110 85 77
531 475 559
442
270
183 162
0
100
200
300
400
500
600
2008 2009 2010 2011 2012 2013 2014
People
Bookings
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Public Intoxication (Class B and Class C)
Overall public intoxication arrests have declined during the past seven years due to changes in
police policy that emphasize arrest for other chargeable offenses, such as criminal trespass.
Detailed analyses of the people booked for PI, found that they were overwhelmingly male and
aged 22‐40, and that the race/ethnicity demographics roughly correspond to the demographics
of Travis County. In fiscal year 2014, for example, 56 percent were white, 30 percent were
Latino, 11 percent were African American, and 2 percent were Asian.
Of these arrestees, 75 percent lived in Travis County and 84 percent were housed (as opposed
to homeless).
4,924 4,648
4,369 3,995
3,350 3,166
2,518
6,296 5,844 5,728
4,986
4,037 3,754
3,032
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
2008 2009 2010 2011 2012 2013 2014
People
Bookings
56%
2%
11%
30%
FY14 Demographics ‐PI Bookings
White
Asian
Af. American
Latino
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During the seven‐year data analysis period, 85 percent of the people booked charged only with
PI and, were never re‐arrested for PI.
The Committee also examined data gathered by the Travis County Sheriff’s Office, which
screened people who were arrested for PI in fiscal years 2011 through 2014. The findings
showed that only about 3 percent of the people arrested for Class C PI offenses had a potential
mental health issue, compared to 30‐40 percent of people arrested on Class B PI enhanced
charges. Even though this data was collected for administrative purposes rather than research
purposes, it may provide a starting point for considering the needs of potential sobriety center
consumers.
79%76%73%71%70%
72%75%
21%24%27%29%29%27%25%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
2008 2009 2010 2011 2012 2013 2014
Public Intoxication Arrests by Origin of Residence
FYs 2008‐2014
Austin/Travis County
Out‐of‐Town
19,589
1,995 590 252 173 512
0
5,000
10,000
15,000
20,000
123456 or more
Frequency of Public Intoxication Bookings Per Person
FYs 2008‐2014
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In a separate analysis that examined the frequency and occurrence of public intoxication
bookings, data showed that arrests occurred most often on weekends, peaking at 3:00 a.m.,
and that arrests for PI were spread out fairly evenly across all months of the year with no
month driving up the overall arrest numbers.
Current Costs Associated with Publically Intoxicated Individuals
The Committee has calculated some of the estimated costs associated with responding to
publically intoxicated individuals within Travis County. It is important to note that not all costs
are contained in the report as many are difficult to ascertain and estimate accurately. The
three major cost categories included are the Austin Police Department, the Travis County
Sheriff’s Office Central Booking Facility and Jail, and Seton Healthcare Family system.
Austin Police Department: Officer‐time costs to arrest an individual for PI range from $55 to
$97 per person. Based upon 2014 data the estimated total cost for 3,032 PI bookings is
between $166,760 and $294,104.
Travis County Sheriff’s Office: Costs (last calculated in 2011) are $152.99 per booking and
$96.71 per jail bed day. In 2014, there were 3,032 bookings for PI that accounted for 75,487 jail
bed‐day hours (calculated hourly due to releases in less than 24 hours). Therefore, the total
estimated booking costs were $463,866 and the total estimated jail bed‐day costs were
$304,181.
Seton Healthcare Family: Seton Healthcare Family (Seton) has estimated associated direct costs
for individuals they encountered in their Emergency Departments within Travis County in
FY2013, that might have met the criteria for a sobriety center. Therefore, the estimates do not
include those patients who were most likely to be disqualified based on the presence of a
medical diagnosis that would warrant an acute care Emergency Department visit. Seton
estimates that there were approximately 4,317 individuals that might have met the criteria in
FY2013. The per patient costs for those individuals ranged from $619 to $275 (using mean and
median data); for a total direct cost range of $2.6M to $1.1M. (Note: Hospital Corporation of
America/HCA St. David’s estimated that the number of publically intoxicated people they had
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contact with in 2013 was 2,368, but this number may include some who would not qualify for
admittance to a sobriety center. No cost figures were obtained)
While reductions in arrests, hospitalizations and bookings may not result in a dollar‐for‐dollar
reduction in these direct costs, it is anticipated that the cost of a sobriety center will be
substantially less than sum of the current annual direct costs. (And the potential impact is even
greater if indirect costs are considered.)
Scope of Services Recommendation
The primary function of the sobering center should be to provide a safe, monitored
environment for intoxicated individuals to sober up, regain baseline functioning and return to
regular activities. A secondary priority should be to seize an opportunity to engage, motivate
and link hazardous substance users to recovery‐oriented community resources and to stay
engaged with individuals once they return to the community supporting them as they start and
sustain long‐term recovery.
Based upon these objectives, it is recommended that the following services/staffing be
provided:
1) Safe Sobering ‐ The center should provide a safe place for sobering up prior to check
out. It is expected that the typical stay will last from four to eight hours, during
which the individual would be assigned a bed/mattress (or possibly a mat), and
regularly observed and monitored for safety and comfort prior to checking out. No
food service will need to be provided, but liquids to promote hydration should be
available.
2) Medical Screening ‐ The center should provide medical screenings at check‐in and
again prior to checkout, to ensure the individual’s safety and appropriateness for
services at the center. This service could be provided by Emergency Medical
Technicians (EMT).
3) Referrals to Treatment – It is recommended that the sobering center NOT be a
licensed treatment provider but, rather, should attempt to engage its clients,
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encourage continued sobriety, and refer clients to treatment alternatives in the
community.
4 Peer Recovery ‐ The center should employ and train peer recovery specialists (in lieu
of licensed clinicians and counselors) to monitor individuals throughout their stay at
the center, and to provide brief interventions, motivational interviewing and referral
to community resources.
5 Security ‐ The center should employ off‐duty law enforcement officers to provide
security and intervention with unruly or violent individuals and to ensure the safety
of all clients and staff.
Proposed Staffing and Estimated Costs
The Committee strongly endorses the Houston Recovery Center staffing model (see appendix 5
for HRC photos). Below are the staff positions with estimated costs for the volume of clients
anticipated for Austin.
Number Annual
Salary
Total
Salaries
Management and Administration:
Center Director/Executive Director 1 85,000 85,000
Human Resources/Accounting 1 55,000 55,000
Administrative Coordinator 1 40,000 40,000
Program Staffing:
Program Director 1 55,000 55,000
Intake:
Intake Supervisor 1 40,000 40,000
Intake Specialists (EMT) 5 40,000 200,000
Psychiatric Technicians 3 35,000 105,000
Support:
Recovery Support Supervisor 1 40,000 40,000
Recovery Support Shift Leads 4 37,500 150,000
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Peer Recovery Support Specialists 6 35,000 210,000
Case Manager/Community
Support Services 2 35,000 70,000
Total Salaries 1,050,000
Benefits (22%) 231,000
Other Personnel Costs (Training, Licensure, etc.) (5%) 52,500
Security
Contract Basis
Off Duty Law Enforcement
8 hours/day/ 10p.m. to 6a.m. 1 $63/hour $183,960
Total Projected Personnel Costs $1,333,500
Facility & Location
Based upon Austin/Travis County data and information gathered from other cities, there are a
number of recommendations for size, type, and location of a sobriety center.
Building Size: It is estimated that the facility should be about 5,000 square feet with 3,000 to
4,000 square feet for sobriety serves and 1,000 to 2,000 square feet for administrative and
office areas.
General Location: The sobriety center should be easily accessible from the central
Austin/downtown area and in close proximity to medical, psychiatric, and detoxification
services as well as public transportation. Appendix 4 shows the locations of PI arrest and the
volume in central Austin for 2013.
Surrounding Area: The sobriety center should not be located in an area where there is
immediate access to alcohol, high numbers of drug or alcohol abuse related crimes or close
residential neighborhoods, but rather a commercial, industrial or medical complex site.
Secure drop off/pick up: The site must provide for a secure area where law enforcement patrol
cars or vans and ambulances can securely enter and transfer persons to and from the sobriety
center.
Bed Capacity: Based upon local data (see chart below) and the need for hospital ER diversion, it
is recommended that the sobriety center have 30‐40 beds.
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Governance
Governance and management models for sobriety centers vary across the country, but most
are operated by non‐profit organizations. (See appendix 3). Options for Austin include
contracting with a non‐profit or for‐profit organization, establishing a governmental non‐profit
pursuant to Texas laws, or delegating this function to a specific city and/or county department
or jointly administered effort pursuant to the Texas Inter‐local Cooperation Act.
The Houston City Council established a local governmental organization (LGC) non‐profit
pursuant to these Texas statutes: Chapter 431 Transportation Code, Chapter 394 Local
Government Code, and Chapter 22 Business Organizations Code. The City of San Antonio opted
to contract with the local mental health authority (LMHA) in Bexar County to provide a sobriety
center that agency’s Restoration Center. In San Francisco the public health department is
funded to operate the sobriety center. Portland, Seattle and San Diego all contract with non‐
profits that were independently established, in some cases for decades, to provide sobriety
center services.
To date, no local for‐profit or non‐profit organization has expressed interest in providing
sobriety center services in Austin/Travis County. However, once a governance structure has
been determined, a formal process to request proposals may spur interest. Austin Travis
County Integral Care, our Local Mental Health Authority (LMHA), is not interested operating a
sobriety center because it falls outside its treatment mission. The most practical scenario may
be the creation of a Local Government Corporation (LGC) for an Austin/Travis Sobriety Center,
by either the City of Austin or Travis County (or a combination of the two).
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The City of Austin and Travis County should consult with their legal representatives regarding
the pros and cons of the different governing options.
Funding
From the onset of the committee’s effort, it has been anticipated that the primary funding
needed for a sobriety center would be derived from the City of Austin and Travis County. This is
due to the fact that most arrests for public intoxication originate in and are adjudicated by the
City of Austin (in the case of Class C offenses) and Travis County (in the case of Class B
offenses). However, considering the widespread negative impact of PI on our community, other
potential funding alternatives should be vetted as well. For example, in addition to reaching
out to the health and wellness community, e.g., Central Health and local hospitals for financial
contributions and/or in‐kind support, we also suggest similar conversations with non‐health
care related businesses; and the exploration of grants from charitable foundations, and the
applicability of social innovation financing (e.g., social impact bonds).
Texas Department of State Health Services (TDSHS) committed to a one‐time award of
$500,000 for operational expenses for a Sobriety Center in Austin as long as the funds are paid
to the city or county. These funds could then be transferred to a LGC established by the City
Council or Travis County Commissioners.
Recommendations for Implementation
First, the City of Austin Council and the Travis County Commissioners must together determine
governance and management of the facility after consultation with their legal representatives.
Second, eligible locations need to be identified by City and County staff in order to cost out any
building construction or renovation.
Third, a comprehensive budget should be developed with the information contained in this
report regarding services.
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Summary
The need for a sobriety center in Austin/Travis County has been identified repeatedly through
different studies and collaborative processes that have involved top City/County officials and
key community partners. It has been demonstrated that PI has many major impacts on our
community, including loss of life, reduced productivity, diminished community health and
quality of life, and significant cost to taxpayers.
Up to now, we have attempted to address this community problem through our criminal justice
system and in our hospitals. Under the current system, there is little focus given to engaging
public intoxicants in treatment or behavior modification programs that might help to mitigate
the problem. Every year, we spend millions of taxpayer dollars on very costly modalities that
are not designed to address this serious community health problem.
The Austin/Travis County Sobriety Center Planning Committee urges the Austin City Council and
Travis County Commissioners Court to take immediate steps toward implementing a sobriety
center as a strategy to improve public safety, to reduce costs to the community, and to
appropriately treat people with alcohol and substance use disorders.
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Acknowledgements
This status report is made possible by the hard work and dedication of the participants in the
Austin‐Travis County Sobriety Center Committee who were responsible for the research and
development of the ideas contained within this report, as well as for writing this report. The
committee especially thanks Leonard Kincaid of the Houston Recovery Center and Shannon
Bernadin‐Smith of the San Francisco Sobriety Center for their willingness to provide significant
assistance. Members of the Austin‐Travis County Sobriety Center Committee included:
Andy Brown, Attorney at Law
Judge Nancy Hohengarten, County Court at Law #5
Roger Jefferies, County Executive, Travis County Justice and Public Safety and his staff:
Carsten Andreson, Cathy McClaugherty, and Efrain Davila
Art Acevedo, Austin Police Chief
Asst. Chief Jason Dusterhoft, Austin Police Department
Robin Peyson, Austin ROSC (Recovery‐Oriented Systems of Care) Initiative
Dr. Paul Hinchey, Austin‐Travis County Office of the Medical Director
Dr. Tom Coopwood, Central Health
Joel Ferguson of Austin Recovery
Bill Brice of the Downtown Austin Alliance
Pete Valdez of Downtown Austin Community Court
Dr. Carlos Tirado
Ashton Cumberbatch of Seton Healthcare Family
Dr. Chris Ziebell, Emergency Department University Medical Center
Dr. Kerby Stewart and Philander Moore, Texas Department of State Health Services
Dick Rathgeber and Sgt. Henry Gonzalez of the Salvation Army Austin
David Escamilla, Travis County Attorney
Ana Almaguel, Travis County Health and Human Services & Veteran’s Services
Jason Howell, SoberHood
Maria Talamo, Austin Recovery Oriented System of Care
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Appendix 1
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Appendix 2
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Sobering Centers in the United States –March 2015
Name
Volunteers of
America‐Sobering
Services Center
The San Francisco
Sobering Center
Hooper Detox
Center Sobering
Station (Central
City Concern)
Houston Center for
Sobriety
Center for Health
Care Services
(CHCS)
Dutch Shisler
Sobering Support
Center
City San Diego San Francisco Portland Houston San Antonio Seattle
State CA CA OR TX TX WA
Start Year 2000 2003 1971 2013 2011 1998
Annual Budget
$200,000
Funded by County
HHS 60%, San Diego
PD 15% and fees
charged to clients.
$1,030,000
Funded by
City/County (one
entity that includes
hospital, ER, and all
healthcare funding)
$742,754 Funders
unknown
$1,500,000
Funded by City
$1,521,292
$1 million from City,
$130,920 from
University Health
System, $390,372
from CHCS
Medicaid receipts.
$436,474
Funded by City and
County
Detox Yes No Yes No Yes No
Client Encounters
(Annual) 6,884 4,450 6,500 5,000 6,600 2,000
Beds 55 11 6 84 40 60
Referral Police
Emergency
Departments EMS,
Police, Street
Outreach Teams,
Homeless Van
Service, Other Van
Services
Emergency
Departments, Walk‐
In/Self‐Referral,
Police, Homeless
Van, Other Van
Services
Police Police
Emergency
Departments, Walk‐
In/Self‐Referral,
EMS, Police,
Homeless Van,
Other Van Services
Clients Admitted
Voluntarily or Non‐
Voluntarily?
Voluntary Voluntary Both Voluntary Voluntary Voluntary
Are Clients
Charged?
No Charge /
Adjudication.
No Charge /
Adjudication for
person brought to
center. San
Francisco police do
arrest some PI
offenders.
No Charge /
Adjudication.
No Charge /
Adjudication for
person brought to
center. Houston
police do arrest
some PI offenders.
No Charge /
Adjudication for
person brought to
center. San Antonio
police do arrest
some PI offenders.
No Charge /
Adjudication.
PI by State Misdemeanor Misdemeanor None Class C
Misdemeanor
Class C
Misdemeanor None
Governance Non‐Profit Public Health
Department Non‐Profit
Non‐Profit (local
governmental
organization non‐
profit)
Local mental health
authority contract Non‐Profit
Notes:
‐ There are other centers in the U.S. that once provided sobriety services, but that are no longer funded. Additionally, there are centers that offered services
similar to those of sobriety centers, but they are not considered sobriety centers. A list of those centers can be provided if needed.
‐ Annual Budget is taken from most recent year found.
‐ Beds may also refer to mats, cots, or openings in the sobriety center.
‐ The number of beds does not necessarily refer to the number of total people served at any one time. For example, the Hooper Detox Center Sobering Station
(Central City Concern), in Portland, may serve up to 30 people at a time. This also explains difference between the annual client encounters and the number
of bed.
‐ Sobering Centers have received little attention from researchers‐social scientists. Shannon Smith‐Bernardin, a PhD candidate in Nursing/Health Policy who
has worked at the Center for Health Care Services (CHCS) in San Francisco, is currently conducting a national study of sobering centers. She has shared a part
of this work with Travis County (a table entitled Sobering Centers in the US ‐2013) which some data on this table is derived from. She has also written two
short articles about the CHCS. Finally, Dr. Scott Campbell has written an overview of the CHCS on ambulance diversion.
Appendix 3
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ARREST MAPPING
These FY13 Public Intoxication Maps were created using arrest data from Travis County’s Tiburon
database. Arrest location and addresses were converted into latitude‐longitude coordinate pairs using
free internet software at www.findlatitudeandlongitude.com. Coordinate pairs where then mapped
using batchgeo.com software (free internet software).
Total PI bookings = 3,754 of which Class C = 3,571 – Mapped 3,536 (Oct 2012 – Mar 2013 = 1,804 and
Apr 2013 – Sep 2013 = 1,732) Class B = 183 – Mapped 181
Public Intoxication Misdemeanor C Bookings
6 Month Snapshot, 1804 bookings
October 2012 – March 2013
Appendix 4
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Public Intoxication Misdemeanor C Bookings
6 Month Snapshot
April 2013 – September 2013
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Public Intoxication Misdemeanor B Bookings
12 Month Snapshot
October 2012 – September 2013
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Sobering Room for Males (female room has less beds)
Front from street with secured entrance on right Secure entrance for law enforcement and
Medical Intake Control Center for Male and Female Rooms
Sobering Room for Males (Female Room Has Less Beds)
Houston Recovery Center Photos Appendix 5
EXHIBIT 1
Sobering Centers in the US ‐ 2013Center NameSan Francisco Sobering CenterHouston Recovery Center: Houston Center for SobrietyCASPAR Inc. Emergency Services CenterVolunteers of America‐ Sobering Services CenterDutch Shisler Service Center (DSSC)Yukon Kuskokwim Health Corporation Sobering CenterCherry Hill Detoxification Services ProgramCentral City Concern Sobering StationSanta Barbara Community Sobering CenterMid‐Arkansas Substance Abuse Services*Dallas Serial Inebriate Program (SIP)*Center InformationCenter LocationSan Francisco, CAHouston, TX Cambridge, MA Sandiego, CA Seattle, WA Bethel, AKSan Leandro, CAPortland, OR Santa Barbara, CALittle Rock, ARDallas, TXWebsite or Contact Information415‐734‐4200 houstonrecoverycenter.orgcasparinc.orgvoa‐swcal.org 202‐205‐1092 907‐543‐3781 horizonservices.orgcentralcityconcern.org805‐966‐3017 501‐686‐9393 none givenNumber of Client Encounters 4450 5200 NA 6884 18,522 1800 7000 6500 1200‐1500900NANumber of Unduplicated Clients1500NA880NA20001000NANANANANANumber of Beds/Mats1184107556020500020NAMale Beds86800Female Beds31600Max Clients at One Time118610755602050708205If at Max Capacity, do you refer Clients to ER/ED? YesNoNo Not SpecifiedYesYesNoYesNoYesNoIf no, where are they sent?Jail Other SheltersOther SheltersJailJailRatio of Staff to Clients1 to 111 to 15Variable1 to 101 to 15Variable1 to 11 3 to 20 or 5 to 201 to 81 to 5UnknownLength of Stay:Minimum Length: No Miminum4 Hours No Minimum4 Hours No MinimumNA No Minimum1 Hour4 Hours3 DaysNAMaximum Length:24 Hours12 Hours No MaximumNA12 Hours12 Hours23 Hours24 Hours10 Hours21 DaysNAAverage Length of Stay: 6‐10 Hours7 HoursAre you open 24/7?YesYesYesYesYesYesYesYesYesYesYesFounding of Center20032012197019791996 (PHS took over in 2009)200920081971199319822011Entity of a City/State/County Division?City/CountyNoNo City/County City/County/StateNo‐ Part of HIS SystemNo‐ "County Grant"City/CountyNoNoCity/CountyOversight, or regulatory agencyNoneNoneBuilding Inspectors, Health Inspectors City/County ReviewsCounty Contract MonitorState Division of Behavioral Health, State Health CorporationInternal Financial Audits, County/State AuditsUnknownNoneState Office Division of Behavioral HealthNoneStructure of Organization (Private/Public/Non‐Profit/Government)PublicNon‐Profit, Local Government Private, Non‐Profit Non‐Profit Non‐Profit Non‐Profit Non‐ProfitNon‐Profit Private, Non‐ProfitPrivate, Non‐Profit Local GovernmentPositions included in Staff:Full‐time or Part‐time?Full‐timeBothBoth Full‐TimeBothBothBothBoth Part‐TimeBothBothPaid or Volunteer?PaidPaidPaidPaidPaidPaidPaidPaidPaidPaidPaidStaff TrainingRN EMT/Paramedic, CANLocal Training ‐ No specific degreeLocal Training‐ No specific degree EMT/ParamedicEMTRN EMT/ParamedicLocal Training‐ No specific degreeRNVariedClient InformationAge Restrictions?<18<18<18<18<18<18<18<18<18<18<18Do you treat only Alcohol Intoxication?NoNoNoYesNoYesNoNoYesNoNoEXHIBIT 2
Sobering Centers in the US ‐ 2013How are Clients Referred:Emergency Departments EMS, Police, Street Outreach Teams, Homeless Van Service, Other Van Services PoliceWalk‐In/Self‐Referral, PolicePoliceEmergency Departments, Walk‐In/Self‐Referral, EMS, Police, Homeless Van Service, Other Van servicesEmergency Departments, Walk‐In/Self‐Referral, Police, Homeless Van, Other Van ServicesEmergency Departments, Walk‐In/Self‐Referral, Police, Homeless Van, Other Van ServicesEmergency Departments, Walk‐In/Self‐Referral, Police, Homeless Van, Other Van ServicesPoliceEmergency Departments, Walk‐In/Self‐Referral, Police, Treatment FacilitiesEmergency Departments, EMS, Police, Homeless Van Service, Other Van ServicesMedical TriageRN based: Mini‐Mental Status, Vital Signs, General AssessmentEMT and Paramedic Based: Breathalyzer , Vital Signs, General Assessment Non medical assessment. Must be able to walk. No specific triage criteria.Non medical assessment of general well being. No specific triage criteria.EMT based: Vital Signs, complaints, signs of injury and illness.EMT based: Vital Signs, complaints, signs of injury and illness.Telephone screen, followed by RN assessmentEMT based : Vital Signs, complaints, signs of injury and illness.Police based intake. No specific medical assesmentTelephone screen, followed by nurse assessmentEMS protocols use. No specific intake assessment at center.Percentage of refered clients deamed appropirate96‐100%96‐100%96‐100%90‐95%90‐95%96‐100%96‐100%96‐100%90‐95%80‐89%90‐95%If requiring ER/ED Care, how is client transported?EMS or Sobering Center VanEMSEMSEMS or Law Enforcement EMS or ESP VanEMSEMS or Sobering Center VanEMSEMSEMS or Sobering Center VanEMS or "Partner City Medical Vans"Can Client be Banned from the Program?YesYesYesYesYesYesYesYesYesNoNoTreatments Provided:Some Medications, Case ManagementBrief Intervention, Motivational Interviewing, Peer Support, Referral to TreatmentNone at Center, Co‐located with other homeless servicesNoneWound Care, Vital Signs, Medical Assessment and Monitoring, Case Management, Referrals to other ServicesScreening Brief Intervention, Referral TreatmentVitals, Medical History, Medication HistoryNone at Center, Co‐located with other homeless servicesNoneSome medications, Group Counseling, Individual Counseling, Case ManagementIntravenous Fluids, Some Medications, Peer Counseling, Coordinate Ongoing Medical and Psychiatric careDoes Client Receive Follow‐Up Care?NoYesNoNo YesNoNoYesNoNoYesClients are admitted Voluntarily or Non‐Voluntarily?VoluntaryVoluntary Voluntary Voluntary Voluntary Voluntary VoluntaryBoth VoluntaryBoth VoluntaryDo you admit clients in Custody or on Psychiatric Holds?NoNoNoNoNoNoNo Yes‐ Civil HoldsNoNANoDo you have Security/Law Enforcement on‐site?NoYesNoNoNoNoNoNoNoYesYesDo you offer referral/rehab/housing?YesYesYesYesYesYesYesYesNoYesYesEXHIBIT 2