Community Based Responses to Individuals with Co-Occurring Mental Health and Substance Abuse Disorders

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Community Based Responses to Individuals with
Co-Occurring Mental Health and Substance Abuse
Disorders

• Olmstead Annual Training Institute
• September 30, 2002
• Jim Winarski, MSW and
• Mark Engelhardt, MS, ACSW

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ELEMENTS OF THE IDEAL SYSTEM

• Co-Occurring Disorders are Expected
• Both Disorders considered Primary, biological
  Illnesses
• Both Understood by Disease and Recovery Model
• Integrated Treatment
• No Wrong Door Policy

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Barriers to Systems Integration

• Philosophical and Professional Differences
• Anxiety over Limited Resources
• Separate Funding Streams
• Systems of Accountability
• Cultural Differences

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PREDICTOR OF SUCCESS

• The most significant predictor of treatment
  success for people with co-occurring disorders is
  the presence of an empathic, hopeful, continuous,
  treatment relationship in which integrated
  treatment and coordination of care can take place
  through multiple treatment episodes (Minkoff)

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System Integration

• Designed to change service delivery for a defined
  population
• Requires change in how agencies interact with
  each other
• Requires that agencies share information,
  resources, and clients
• Strategies Include
• Interagency coordinating bodies
• Strategic planning
• Interagency agreements
• Joint or braided funding
• Centralized authority
• Dennis et al., 1999

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System Integration Continuum

• Information Sharing/Communication
• Cooperation and/or Coordination
• Collaboration
• Integration
• Konrad, 1996

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Four Quadrant Framework(Reis and Miller, 1993
NASMHPD/NASADAD, 1999)
I. Psych Low Substance Abuse Low Primary Health
Setting Community Programs
II. Psych High Substance Abuse Low Mental Health
System

• IV.
• Psych High
• Substance Abuse High
• State Hospitals

III. Psych Low Substance Abuse High Substance
Abuse System
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Key System Development Components

• Provide Leadership / Build Consensus
• Identify Resources
• Train Staff
• Decide on Outcomes
• Evaluate Program
• (NASMHPD/NASADAD, 2000)

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Provide Leadership/Build Consensus

• Create Opportunity
• Need more than charismatic leaders
• Create a problem to change
• Committed leadership is key to success

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Achieve Consensus on a Common Set of Values

• mental Illness and substance abuse are unique,
  primary medical conditions that deserve
  treatment
• the simultaneous occurrence of mental illness and
  substance abuse disorders creates a need for
  specialized and targeted services geared to the
  unique nature of co-occurring disorders
• services should focus on recovery, rather than
  just symptom reduction

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Achieve Consensus on a Common Set of Values
(continued)

• a no wrong door approach, in which consumers
  can receive help for both disorders no matter
  where or how they enter the service system, is
  vital
• providers and programs must be culturally
  appropriate and
• the system must be prepared to address the needs
  of all people with co-occurring disorders, not
  just adults who have serious mental illness or
  children who have severe emotional disturbance.

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Identify Resources

• Need flexible funding for multiple sources when
  clients do not fall neatly into a funding stream
• Strategy to include
• Align financial incentives with expected outcomes
  to achieve goals e.g. inpatient savings
  redirected to outpatient care
• Reduce or Eliminate statue Barriers
• Need to identify and address barriers that
  restrict access

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Identify Resources (continued)

• Combine funds at the local level
• May be more effective than Federal and State
  level
• Braided Funding
• Draws on distinct sources of funds that can be
  tracked and audited separately

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Train Staff

• Need to address gap between research and clinical
  practice
• Train staff to develop clinical competence at all
  front doors of service
• Train primary health care providers (e.g. family
  practitioners, pediatricians, emergency room
  staff)
• Train future providers
• Train consumers, recovering persons, and family
  members

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Measure Outcomes

• Systems should provide quality, cost effective,
  and results driven services
• Need more than process measures
• Focus on cost off-set

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Measure Outcomes

• Client level measures may include
• Decrease in psychiatric symptoms
• Decreased substance abuse
• Improvement in housing status
• Increase in employment
• Improved social networks
• Decreased criminal justice involvement
• Improved quality of life

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Evaluate Program

• Build evaluation into program design
• Need outcome measures and a process for tracking
• Design information system to record data
• Move beyond process
• The goal is to create data that are comparable
  across programs, jurisdiction, or geographical
  areas.

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Evaluate Program (continued)

• Use evaluations to provide immediate feedback
• Results need to be available to key stakeholders
• Providers should adapt interventions
• Funders can revise expectations for future
  contracts

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