NYAPRS 28 TH Annual Conference Integrating Mental Health and Addiction Recovery into our Lives and Systems Presenter: John Challis B.A., B.S.W., Dip Teach. Director of Technical Assistance Thursday September 23 rd 11:30 AM to 12.45 PM Kerhonkson, New York. 1
Introduction Title: Center for Excellence in Integrated Care Funded by: New York State Health Foundation In coordination with: New York State (NYS) Offices of Mental Health (OMH) and of Alcoholism & Substance Abuse Services (OASAS) Location: NDRI Start Date: November 1, 2008 Period: 4 years 2
Co-occurring occurring disorders Co-occurring occurring disorders Refers to co-occurring occurring substance use (abuse or dependence) and mental health disorders. Clients said to have co-occurring occurring disorders have: one or more disorders relating to the use of alcohol and/or other drugs of abuse and one or more mental disorders. Diagnosis of co-occurring occurring disorders (COD) occurs when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from the one disorder. 3
Co-occurring occurring treatment developments No Services: : Turned away from the front doors Sequential Services: : Treatment for only one disorder at a time Parallel Services: : Simultaneous treatment in two or more program service systems Integrated Parallel Services: Simultaneous treatment in two programs ( S.A. and M.H.) but care is coordinated. Integrated Services: : Coordinated care provided by one program with single treatment plan that addresses co-occurring occurring disorders simultaneously. 4
Defining consumers by levels of severity MICA Mentally ill chemical abusers. MICAA- Mentally ill chemical abusers, addicted CAMI- Chemical Abusers who are mentally ill. 5
Defining the system by severity. The Four Quadrants High Severity III Less severe mental disorder/more severe substance abuse disorder IV More severe mental disorder/more severe substance abuse disorder Low Severity I II Less severe mental More severe mental disorder/less severe disorder/less severe substance abuse substance abuse disorder disorder Mental Illness Adapted from Substance Abuse Treatment for Persons With Co-Occurring Disorders, TIP #42 (2005a) High Severity 6
COD Capability Categories Addiction Only or Mental Health Only Services No services for consumers with co-occurring occurring disorders. Co-occurring occurring Capable Mental health programs- services for mild to moderate substance abuse Substance abuse programs- services for mild to moderate mental health.. Co-occurring occurring Enhanced Full treatment for all levels of both substance abuse and mental health severity. 7
8
SA & MH Program Comparisons: Dual Diagnosis Capability 9
Observations The outpatient treatment system has moved away for addiction and mental health only status and is moving towards co-occurring occurring capable levels of care. The outpatient mental health treatment system is repositioning itself to provide services for mild to moderate levels of substance abuse. The outpatient substance abuse treatment system is repositioning itself to provide services for mood and anxiety conditions. Consumers with high severity of mental health and addiction still have very few service options, however more integrated collaborations between substance abuse and mental health clinics have the potential to address this significant gap. 10
Observations The systematic inclusion of peer recovery support positions for patients with cod is not prevalent in the system. While most programs are invested in operating integrated recovery oriented programs, is an area requiring input and further development. Out patient programs vary considerably, from those that offer core components of treatment, to those where treatment is driven almost entirely by individual clinician preference. In the case of the latter it is proving far more difficult to implement programmatic change Furthermore it is very difficult to develop a peer culture in settings where consumers are only seen one to one. 11
Observations Not all programs have implemented a recommended co-occurring occurring screener and when implemented many programs lack a clear protocol when a positive cut-off score is determined. This results in many clients who score positive not receiving an integrated assessment. Stage-wise assessment and treatment has not been incorporated into most programs 12
Contact Information Center for Excellence in Integrated Care (CEIC) 71 W 23rd Street, 8th Floor New York, NY 10010 tel 212.845.4400 fax 212.845.4650 challis@ndri.org www.nyshealth-ceic.org 13