INTEGRATED RECOVERY Lessons Learned: Implementing IDDT

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INTEGRATED RECOVERYLessons Learned
Implementing IDDT

• Stanislaus County
• Elizabeth Oakes, MFT
• Adrian Carroll, MFT
• January 19, 2007

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Organizational Context

• Why we selected IDDT
• -Committed to integrated services BHRS
• -Integrated system isnt integrated treatment
• -Established experience with co-occurring Tx
• -Valued EBP aspect
• -Interested in implementation aspect
• -Not the Money
• -High mortality rate

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Organizational Context

• Why we selected IDDT continued
• -High co-morbidity
• -High treatment failure rate
• -Cost of not serving for system
• -Highly underserved
• -Co-occurring conditions often used as
  exclusion criteria, rather than inclusion
  criteria

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Organizational Context

• Goals and expectations
• -Actual OP treatment track, consistent across
  programs, across department
• -Both broad system-wide competence
• and specialized enhanced expertise.
• -ID system barriers to implementing EBPs
• -Save money eventually
• -Accurate identification of AOD,MH, and COD
• -Develop staff training curriculum
• -Increased integration

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Key Factors

• Factors that facilitated implementation
• -Staff with MH and AOD knowledge
• -CIMH training
• -Effective use of project planning consultant
• -Inter-county collaboration
• -Learning collaborative
• -System-wide steering committee
• -Psychiatrists early adopters
• -Integrated system
• -Training coordinator

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Key Factors

• Factors that impeded implementation
• -Caseload size
• -Attempting treatment before engagement
• -MH downsizing and loss of funding
• -Resistance from some staff
• -Stigma, 2 types MH and AOD
• -Lack of COD housing
• -Funding categorical

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Team Structure

• Project Team - Behavioral Health Integration
  Oversight Committee
• -Assistant Director
• -Chiefs and other key managers
• -Selected site Program Coordinators
• -Program Coordinators MH and AOD
• -Residential AOD manager
• -Training Coordinator
• -Line staff
• -MHSA Coordinator

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Team Structure

• Clinical/IDDT Team
• -Program Coordinator
• -Psychiatrist
• -Consumer
• -Select MH Case managers
• -Select MH Clinicians
• -Select AOD counselors

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Benefits of Integrated Recovery

• Saves money
• Helps staff motivation
• Impacts long-time stuck clients
• Stage-based treatment
• Formulation helps consumers understand how 2
  conditions creates a 3rd condition
• Recovering peers from either MH or AOD can
  support each other
• DRA sustained
• Recognition with in AOD for need of specialized
  track

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Team Structure

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Sustaining Positive Change

• Challenges
• -Staff changes
• -Caseload size
• -Drift
• -Integration into daily practices
• -Forms
• -Staff passion for MH or AOD
• -Separate funding

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Sustaining Positive Change

• Successes
• -Hire consumers with COD recovery
• -Paperwork to forms committee
• -All FSPs trained
• -Written into MHSA plan
• -Residential AOD with COD track
• -Stages of Treatment
• -MH and AOD specific stages
• -MH board member trained

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SUPPORT WHEEL
Phone Numbers
Use In A Circular Manner So Not To Burn Out Any
One Source
My Recovery
Be Selective In Choosing Support Phone Numbers
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Sustaining Positive Change

• Failures
• -Caseload size
• -Growing own experts
• -Motivational Interviewing measure
• -Didnt do own cost-benefit data
• -Greater consumer/family presence on steering
  committee

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Summary of Lessons Learned

• What we would do again
• -We would do it again
• -All of it
• -Stage-based, Motivational Interviewing, AOD
  staff, clinical tools

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Summary of Lessons Learned

• What we would do differently
• -Someone dedicated full time to implementation
• -More MI up front
• -More training for MH staff on state-of-art AOD
  treatment