excellence in emerging behavioral health strategies
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Excellence in Emerging Behavioral Health Strategies. November 10, 2011 Rhonda Bohs, Ph D. Emy Pesantes, M.S.W. Nitza Sevilla, M.S. Spectrum Programs Inc. - PowerPoint PPT PresentationTRANSCRIPT
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Excellence in Emerging Behavioral Health Strategies
November 10, 2011Rhonda Bohs, Ph D.
Emy Pesantes, M.S.W.Nitza Sevilla, M.S.
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Spectrum Programs Inc.
SPI located in Miami-Dade and Broward County is the oldest and largest non-profit substance abuse treatment provider in South Florida operating since 1970.
SPI provides Residential, Outpatient, Family and Intervention Services (Case Management) for adults, families, and adolescents.
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Miami Behavioral Health Center
MBHC has served the Latino community (children, adults, and severely mentally ill and substance abusing) since 1977 providing both mental health and substance abuse services.
MBHC provides Crisis Stabilization, Detox, Residential, Outpatient, Case Management, Peer Recovery-Oriented, Adult Day Care and On Site Services for children.
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Banyan Health Systems
Through a joint venture in 2003, SPI and MBHC have operated and provided services for substance abuse and mental health.
Primary Health Care Services have been offered since 2009 for all treatment programs.
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SAMHSA Grant Funding
Why did we need it? What did we do with funding? Sustainability
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1st Entry PointAssessed with•GAIN •SBIRT•Change Assessment Scale
Recovery Guide (stays with p.s. during all tx)
Get initial medical evaluation appointment.
Clubhouse Co-Occurring•Voluntary Day Treatment•WRAP modelMedical/Wellness
Coordinated by Recovery Guide
Physical completed by an ARNP.
Chronic care will be evaluated: high blood pressure, cholesterol, diabetes, respiratory disease, lung disease.
Wellness education on nutrition, dieting, relaxation, and coping skills.
JARFReferrals made by court
Schools based during day
13 bed inpatient facility for adolescent substance users•CASASTART•SUCCESS
Veteran ServicesPTSD for veteran
Family services for children
Family therapy
Elderly ProgramAdult Day Treatment
Criteria: Alzheimer's, Low-functioning, Depression
Case Management- Caregiver Support Group
Cognitive Behavioral Therapy; Psychosocial Rehabilitation.
P.S. can go from residential to outpatient and return if it is necessary.
Housing1 day to a month until assigned in tx or have a sustainable housing situation and in recovery management.
Vocational TrainingHigh School Diploma
English classes
Cooking assistant
Receptionist
Peer Counselors
Recovery Guides
Job DevelopmentWork readiness assessment
Job Matching
Job Training
Job Support
Services
PreventionSchool Based (Targeting: consumers with mental illness and veteran kids who are at greater risk) through DFYIT Program and Project ALERT.
Early InterventionMotivational Interviewing with at risk users and children of veterans in middle/high school.
Family Services• Case Management• Family Therapy• Support Groups• Increase awareness and understanding of treatment of substance abuse, mental health, and recovery.• Network families• Children of Veterans who have been affected
Detox/Crisis• Brief, intensive services for consumers with mental illness/chemically dependent individuals who are in a non-violent, non-combative state.• Assertive Community Treatment
MAT (Medication Assisted Treatment)
• Vivitrol• Suboxone• Methadone
OutpatientCo-Occurring, 30, 60, or 90 days of tx. Extend on a case by case basis.• Medication Assisted Treatment•Motivational Interviewing/ Motivational Incentives
ResidentialTreatment for: Mental Health, Residential, Forensic, Co-Occurring.
Those persons who are in the active stage of change.
30 days, 60 days, 90 days. Extensions when necessary.• Modified Therapeutic Community• Medication Assisted Treatment
Recovery ManagementCo-Occurring. Once consumers have completed residential and outpatient, they will be taken to aftercare for stress management, triggers, relaxation classes, and follow-up.
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Grant Funding
Goals/Objectives Staff cross-trained in co-occurring
treatment Integrated Model of Care Evidence Based Practices Training
Use of an integrated assessment (GAIN)
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Implementation:Training
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Adult Evidence Based Practices
Medication Assisted Treatment (Vivitrol)
Motivational Enhancement/ Motivational Interviewing Therapy
Seeking Safety Trauma Informed Care WRAP
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Adolescent Evidence Based Practices
Aggression Replacement Training Motivational Enhancement/
Motivational Interviewing Therapy Seeking Safety Solution Focused
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Trainings
Aggression Replacement Therapeutic Community Co-Occurring Motivational Interviewing Pharmacology of Substance Abuse Seeking Safety Trauma Informed Care WRAP
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Training
“A one-shot training workshop is unlikely to alter practice behavior sufficiently to make a difference in client outcomes,” (Miller & Mount, 2001; p. 468).
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Steps to Consider in Training
Training Implementation timeline Sustainability Weekly Supervision to sustain
fidelity of EBP Video recordings and Coaching
ratings Agency wide culture change
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Data:Clients Served &
Retention
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Clients Served/ Staff
235 Staff trained Aggression Replacement Training Motivational Interviewing Solution Focused Case Management WRAP
How many clients across all programs were touched by grant? MAT: 68 un-duplicated Adults Seeking Safety: 208 un-duplicated Adults MI/MET: 250 un-duplicated Adults/ 100 un-
duplicated Adolescents Aggression Replacement Training: 106 un-
duplicated Adolescents15
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GAIN Administration
3,670 GAIN Q completed during FY 2010-2011
320 GAIN I completed during FY 2010-2011
Issues with an integrated assessment Mental Health Staff Substance Abuse Staff
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EBP Outcomes Data
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Medication Assisted Treatment
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2 or more 3 or more 4 or more 5 or more 6 or more 0%
10%20%30%40%50%60%70%80%90%
100%82%
64%50%
42% 36%
Vivitrol Injectionsn=68
Number of Injections Received
% o
f Peo
ple
who
Rece
ived
Inje
ctio
n
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Seeking Safety PTSD Results
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% o
f Clie
nts
who
Ex
peri
ence
d Sy
mpt
oms
Re-experiencing Avoidance & Numbing
Hyperarousal0%
10%20%30%40%50%60%70%80%90%
100% 92%87% 87%
65%
47%56%
Pre-Test n= 168
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Seeking Safety Trauma Symptom Results
Dissoci
ation
Anxie
ty
Depres
sion
Sexua
l Abu
se Tra
uma I
ndex
Sleep
Disturba
nce
Sexua
l Prob
lems
0%20%40%60%80%
100%
44%32%
46% 38%63%
25%32% 22%39%
27%39%
18%
Pre n=168 Post n= 119
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% o
f Sym
ptom
s Ex
peri
ence
d
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Retention
Of those Adult clients who reported trauma there was an 88% client retention rate within the first 30 days of treatment.
Of those Adult clients who reported trauma there was a client retention rate of 79% among clients through 90 days of treatment.
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Aggression Replacement Training
Pre-Test Post-Test0%
10%20%30%40%50%60%70%80%90%
100%
65% 69%
Matched Sample n=31
% o
f Ski
lls A
ttain
ed
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Aggression Replacement Training
Social Skills
Feelings Altruism Anger Fair Planning0%
10%20%30%40%50%60%70%80%90%
100%
63% 58% 61%68%
60% 63%67% 66%69% 69% 67% 66%
Pre n=82 Post n=39
23Symptoms
% o
f Ski
lls A
ttain
ed
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Retention
Adult Residential (BR) Adult Residential (DC)0%
10%20%30%40%50%60%70%80%90%
100%85% 83%
76%84%85% 87%
2009-2010 July 1- Dec. 31, 2010Jan. 1- June 30, 2011
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Retention of 30 days or more
Rete
ntio
n Ra
te
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Wrap Up Outcomes
Specific Impact of Evidence Based Practices
Effect of Chaining Evidence Based Practices
Does EBP impact retention?
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Lessons Learned
Staff Buy In/Staff Turnover Staff Training and Consistency Sustainability and Organizational
Requirements Effectiveness of Evidence Based
Practices
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Next Steps
New Evidence Based Practices Solution Focused Case Management Eye Movement Desensitization and
Reprocessing (EMDR) Street Smart
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For a copy of today’s presentation, go to:
www.banyanhealth.org
Click on the research tab and go to the program evaluation subsection
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Questions or Comments
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Resources
Seeking Safety www.seekingsafety.org Najavits, L. M. (2002). Seeking Safety A Treatment Manual for
PTSD and Substance Abuse. New York: The Guilford Press
Aggression Replacement Traininghttp://www.promoteprevent.org/publications/ebi-factsheets/aggression-replacement-training%C2%AE-art%C2%AE
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