Complexities of Co-occurring Disorders

STATE AGENCY PERSPECTIVE

June 24, 2004Renata J. Henry, M.Ed.

Mental Health Commissioners and Substance Abuse Directors would agree…

Need to improve services for people with co-occurring disorders.

 

Definition of co-occurring has broadened to include other disabilities, physical health, and infectious disease.

 

Best approach is an integrated system both across disciplines and systems

Several conceptual models…

Dual-Diagnosis Capable and Dual Diagnosis Enhanced – ASAM

Dual-Diagnosis Integrated Treatment – Drake

Co-Occurring Disorders Matrix – NASADAD/NASMHPD

Service Coordination

Service CoordinationService Coordination by

Locus of Care

Barriers exist to truly integrated services and systems…..

Separate and uncoordinated State MH and SA systems

Little connection between providers and programs

Few staff bridges between programs Categorical funding streams Disparate insurance coverage

Barriers exist to truly integrated services and systems Cont…..

Differences in workforce

Limited research and evidence based practices

Lack of assessment and screening tools

Regulatory and licensing contradictions

In Delaware……

Integrated administrative structure

Commitment by leadership

No wrong door approach

Moving away from silo funding toward blended funding

Minimum standard for the system is dual diagnosis capable

Training effort with MH and SA staff…

Interagency Program Development for Integrated Treatment Services Across Systems.

Focus on co-occurring MH, SA, and HIV MH, SA, Homeless, CJ, and HIV systems. Addresses all four quadrants with emphasis on II,

III, and IV Model includes: screening, assessment,

engagement, client readiness, phase and stage treatment, outcome measures and data collection.

Delaware’s System

Service Coordination by Program

Overcoming barriers……

Action needed at three levels:

  Administration

  Federal

  Research

Administration…. 

Leadership at all levels is a necessary ingredient in the development and implementation of services

Establish the standard and sets expectations Leadership brings the players together and

initiates the dialogue. Leadership takes responsibility for dissemination

of tools and information to the field Develop methods to overcome funding and

regulatory barriers at various system levels

Federal……

Develop policies and methods that promote integration and collaboration.

Eliminate the funding barriers and develop a method to pay for co-occurring services.

Various agencies have to define their role in the development of a co-occurring infrastructure.

Earlier investigation of the barriers to adoption of new research.

Improve dissemination of co-occurring research Connect service researchers to state systems

Research: What State Directors Want to Know….

What are the most effective models for this population? What combination of drugs, psychosocial interventions work?

 Is integrated treatment cost effective?  What client, staff factors or other variables are

associated with better outcomes from a fully integrated co-occurring team/site approach vs. lesser integrated models, e.g. consultation or collaboration?

Research: What State Directors Want to Know Cont…. What EBP’s work for the majority of this population? What portion

of this specific population does an EBP work better for?

  What skill sets/competencies does staff need to have for co-occurring

services and what is the impact on client outcomes? Who should be providing what types of care?

  Are there organizational prerequisites for integrated services to be

successful? What SMHA/SSA actions create readiness to adopt co-occurring services?

  Which elements of identified EBP’s must be implemented with fidelity

to attain outcomes associated with the practices? Which can be modified without sacrificing outcomes? What should be modified with this population?

In conclusion…

Treatment of co-occurring disorders is an important issue for State Directors

  States play a key role in developing, improving and

maintaining an infrastructure in which co-occurring services are provided

  Progress made, but barriers still remain: financing,

workforce, special populations, and research  Partnerships between state agencies, federal agencies,

and researchers is imperative in moving forward