Download - Complexities of Co-occurring Disorders STATE AGENCY PERSPECTIVE June 24, 2004 Renata 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
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.
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