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1 Stanley Sacks, PHD, CIRP, NDRI, New York, NY Michael Chaple, PHD, CIRP, NDRI, New York, NY ChackuMathai, CPRP, NYAPRS, Albany, NY presentation to — NYAPRS.

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Presentation on theme: "1 Stanley Sacks, PHD, CIRP, NDRI, New York, NY Michael Chaple, PHD, CIRP, NDRI, New York, NY ChackuMathai, CPRP, NYAPRS, Albany, NY presentation to — NYAPRS."— Presentation transcript:

1 1 Stanley Sacks, PHD, CIRP, NDRI, New York, NY Michael Chaple, PHD, CIRP, NDRI, New York, NY ChackuMathai, CPRP, NYAPRS, Albany, NY presentation to — NYAPRS 29 th Annual Conference, “Bringing Recovery Home for All,” September 14-16, 2011, Hudson Valley Resort and Conference Center, Kerhonkson, NY

2 2 What is CEIC’s purpose? Fosters the implementation of integrated care in screening, assessment, and evidence-based interventions for New York State (NYS) residents with co-occurring conditions andfacilitates OMH and OASAS initiatives in this area Fosters the implementation of integrated care in screening, assessment, and evidence-based interventions for New York State (NYS) residents with co-occurring conditions andfacilitates OMH and OASAS initiatives in this area

3 3 Timeline New York State (NYS) Office of Alcoholism & Substance Abuse Services (OASAS) and Office of Mental Health (OMH) convene a Co-occurring Disorders (COD) Task Force (2007) May, 2007 The NYS COD Task force makes recommendations December, 2007 The Directors of licensed substance abuse and mental health programs receive two letters with recommendations for integrating services for COD from the Commissioners of OASAS and OMH June 20 & July 31, 2008 The New York State Health Foundation (NYSHealth) funds the Center for Excellence in Integrated Care (CEIC, pronounced “seek”) November 1, 2008

4 4 What does CEIC do? Engages Leadership Engages Leadership Performs on-site assessments Performs on-site assessments Presents site reports Presents site reports Conducts provider forums Conducts provider forums Builds collaborations and informal networks Builds collaborations and informal networks Holds Peer Recovery Workshops Holds Peer Recovery Workshops Supplies ongoing support, guidance, and consultation Supplies ongoing support, guidance, and consultation Links programs to resources, such as FIT, TIP 42, and related in- service training, as well as other trainings and curricula Links programs to resources, such as FIT, TIP 42, and related in- service training, as well as other trainings and curricula Provides technical assistance (hands-on, intensive, and longitudinal)

5 5  Uses DDCA[MH]T (Dual Disorder Capability in Addiction Treatment and Dual Disorder Capability in Mental Health Treatment)  Samples individual clinics within regions  Employs direct onsite observation  Scores and reports on 7 domains and overall  Makes specific recommendations to raise capability  Uses DDCA[MH]T (Dual Disorder Capability in Addiction Treatment and Dual Disorder Capability in Mental Health Treatment)  Samples individual clinics within regions  Employs direct onsite observation  Scores and reports on 7 domains and overall  Makes specific recommendations to raise capability CEIC Assessment Methods

6 6 Improving Co-occurring Capability Recommendations by DDCA[MH]T Dimensions Dimensions of Capability Levels of Capability SA/MH only Capable Enhanced I Program Structure Program mission, structure and financing, format for delivery of co-occurring services II Program Milieu Physical, social and cultural environment for persons with mental health and substance use problems III Clinical Process: [screening &] Assessment Processes for access and entry into services, screening, assessment &diagnosis IV Clinical Process: Treatment Processes for treatment including pharmacological and psychosocial evidence-based formats V Continuity of Care Discharge and continuity for both substance use and mental health services, peer recovery supports VIStaffing Presence, role and integration of staff with mental health and addiction expertise, supervision process VIITraining Proportion of staff trained and program’s training strategy for co-occurring disorder issues

7 7 D ual Disorder Capability Total Score Program Structure Program Milieu Assessment Treatment StaffingTraining Continuity of Care Enhanced Capable Basic Scores based on DDCA[MH]T = Dual Diagnosis Capability in addiction [Mental Health] Treatment Index (N=300) Transformation of the Service System may be said to occur when the majority of outpatient clinics are rated capable or above

8 8 Program Structure RecommendationsRecommendations Update agency mission statement (or develop a program service statement) to reflect that co-occurring services are provided Update agency mission statement (or develop a program service statement) to reflect that co-occurring services are provided Ensure that the program’s licensure agreement (or state permit) identifies the target population as individuals with substance related disorders (for addiction clinics) or mental health disorders (for mental health clinics) but does not restrict the program from treating individuals with co- occurring mental disorders or substance use disorders, respectively Ensure that the program’s licensure agreement (or state permit) identifies the target population as individuals with substance related disorders (for addiction clinics) or mental health disorders (for mental health clinics) but does not restrict the program from treating individuals with co- occurring mental disorders or substance use disorders, respectively Demonstrate that your program’s system of care meets the definition of collaboration; that is, shared responsibility for treating a person with co-occurring conditions, involving regular and planned communication, and shared progress reports or memoranda of agreement Demonstrate that your program’s system of care meets the definition of collaboration; that is, shared responsibility for treating a person with co-occurring conditions, involving regular and planned communication, and shared progress reports or memoranda of agreement Update agency mission statement (or develop a program service statement) to reflect that co-occurring services are provided Update agency mission statement (or develop a program service statement) to reflect that co-occurring services are provided Ensure that the program’s licensure agreement (or state permit) identifies the target population as individuals with substance related disorders (for addiction clinics) or mental health disorders (for mental health clinics) but does not restrict the program from treating individuals with co- occurring mental disorders or substance use disorders, respectively Ensure that the program’s licensure agreement (or state permit) identifies the target population as individuals with substance related disorders (for addiction clinics) or mental health disorders (for mental health clinics) but does not restrict the program from treating individuals with co- occurring mental disorders or substance use disorders, respectively Demonstrate that your program’s system of care meets the definition of collaboration; that is, shared responsibility for treating a person with co-occurring conditions, involving regular and planned communication, and shared progress reports or memoranda of agreement Demonstrate that your program’s system of care meets the definition of collaboration; that is, shared responsibility for treating a person with co-occurring conditions, involving regular and planned communication, and shared progress reports or memoranda of agreement 2.48 Enhanced – Capable – Basic – Program Structure

9 9 Recommendations Expect and welcome clients with both disorders Expect and welcome clients with both disorders Ensure that materials for both substance related and mental disorders are posted and distributed Ensure that materials for both substance related and mental disorders are posted and distributed Engage in a discussion with staff regarding "attitudes and values" towards treatment of co-occurring disorder Engage in a discussion with staff regarding "attitudes and values" towards treatment of co-occurring disorder Expect and welcome clients with both disorders Expect and welcome clients with both disorders Ensure that materials for both substance related and mental disorders are posted and distributed Ensure that materials for both substance related and mental disorders are posted and distributed Engage in a discussion with staff regarding "attitudes and values" towards treatment of co-occurring disorder Engage in a discussion with staff regarding "attitudes and values" towards treatment of co-occurring disorder Program Milieu 2.50 Enhanced – Capable – Basic – DDCA[MH]T Score

10 10 Recommendations Clinical Process — Screening (one item from Assessment Domain) Implement one of the state-recommended standardized screening instruments (these are all free, brief, and do not require clinical expertise to administer) Implement one of the state-recommended standardized screening instruments (these are all free, brief, and do not require clinical expertise to administer) Establish a protocol that will direct all those with a positive score on the screen to an integrated assessment Establish a protocol that will direct all those with a positive score on the screen to an integrated assessment Separate the screen from the assessment protocol; the screen should drive the assessment, but it is not a diagnostic evaluation nor should it be used to determine severity of a mental health or substance use condition Separate the screen from the assessment protocol; the screen should drive the assessment, but it is not a diagnostic evaluation nor should it be used to determine severity of a mental health or substance use condition Implement one of the state-recommended standardized screening instruments (these are all free, brief, and do not require clinical expertise to administer) Implement one of the state-recommended standardized screening instruments (these are all free, brief, and do not require clinical expertise to administer) Establish a protocol that will direct all those with a positive score on the screen to an integrated assessment Establish a protocol that will direct all those with a positive score on the screen to an integrated assessment Separate the screen from the assessment protocol; the screen should drive the assessment, but it is not a diagnostic evaluation nor should it be used to determine severity of a mental health or substance use condition Separate the screen from the assessment protocol; the screen should drive the assessment, but it is not a diagnostic evaluation nor should it be used to determine severity of a mental health or substance use condition 3.24 Enhanced – Capable – Basic –

11 11 Enhanced – Capable – Basic – Recommendations Clinical Process — Assessment Provide a comprehensive assessment that covers all 12 recommended domains and includes a thorough substance use and mental health evaluation Provide a comprehensive assessment that covers all 12 recommended domains and includes a thorough substance use and mental health evaluation Obtain diagnostic evaluation as part of the assessment process Obtain diagnostic evaluation as part of the assessment process Build on the stages of change for both disorders Build on the stages of change for both disorders Synthesize assessment information into main problem areas that need to be addressed Synthesize assessment information into main problem areas that need to be addressed Use assessment data to inform the treatment plan Use assessment data to inform the treatment plan Provide a comprehensive assessment that covers all 12 recommended domains and includes a thorough substance use and mental health evaluation Provide a comprehensive assessment that covers all 12 recommended domains and includes a thorough substance use and mental health evaluation Obtain diagnostic evaluation as part of the assessment process Obtain diagnostic evaluation as part of the assessment process Build on the stages of change for both disorders Build on the stages of change for both disorders Synthesize assessment information into main problem areas that need to be addressed Synthesize assessment information into main problem areas that need to be addressed Use assessment data to inform the treatment plan Use assessment data to inform the treatment plan 3.06

12 12 Recommendations Clinical Process — Treatment Integrated COD Services Allow the free expression and discussion of co-occurring problems in group and individual sessions Allow the free expression and discussion of co-occurring problems in group and individual sessions Ensure inclusion of mental health and substance use content in all groups Ensure inclusion of mental health and substance use content in all groups Create a “home” for co-occurring disorders in the treatment schedule (i.e., offer a psycho-educational class for COD and a dual recovery group) Create a “home” for co-occurring disorders in the treatment schedule (i.e., offer a psycho-educational class for COD and a dual recovery group) Provide supervision and coaching to increase staff competency in COD Provide supervision and coaching to increase staff competency in COD Allow the free expression and discussion of co-occurring problems in group and individual sessions Allow the free expression and discussion of co-occurring problems in group and individual sessions Ensure inclusion of mental health and substance use content in all groups Ensure inclusion of mental health and substance use content in all groups Create a “home” for co-occurring disorders in the treatment schedule (i.e., offer a psycho-educational class for COD and a dual recovery group) Create a “home” for co-occurring disorders in the treatment schedule (i.e., offer a psycho-educational class for COD and a dual recovery group) Provide supervision and coaching to increase staff competency in COD Provide supervision and coaching to increase staff competency in COD 2.53 Enhanced – Capable – Basic – Treatment: Integrated COD Services Treatment: Integrated COD Services

13 13 Recommendations Clinical Process — Treatment Evidence Based Interventions Organize treatment with a stage-wise approach Organize treatment with a stage-wise approach Build staff competencies in Motivational Interviewing Build staff competencies in Motivational Interviewing Employ existing trauma curriculums; for example, Seeking Safety and Trauma Recovery & Empowerment Model (TREM) Employ existing trauma curriculums; for example, Seeking Safety and Trauma Recovery & Empowerment Model (TREM) Offer Wellness Self-Management curriculum to integrate co-occurring content further Offer Wellness Self-Management curriculum to integrate co-occurring content further Gradually introduce other NYS recommended evidence-based interventions Gradually introduce other NYS recommended evidence-based interventions Organize treatment with a stage-wise approach Organize treatment with a stage-wise approach Build staff competencies in Motivational Interviewing Build staff competencies in Motivational Interviewing Employ existing trauma curriculums; for example, Seeking Safety and Trauma Recovery & Empowerment Model (TREM) Employ existing trauma curriculums; for example, Seeking Safety and Trauma Recovery & Empowerment Model (TREM) Offer Wellness Self-Management curriculum to integrate co-occurring content further Offer Wellness Self-Management curriculum to integrate co-occurring content further Gradually introduce other NYS recommended evidence-based interventions Gradually introduce other NYS recommended evidence-based interventions 24% Evidence-based Interventions Evidence-based Interventions

14 14 Recommendations Continuity of Care Ensure that the discharge plans address both the substance use and mental health disorders Ensure that the discharge plans address both the substance use and mental health disorders Encourage and arrange connections to community support groups during treatment and as part of discharge planning (e.g. Double Trouble in Recovery, Dual Recovery Anonymous ) Encourage and arrange connections to community support groups during treatment and as part of discharge planning (e.g. Double Trouble in Recovery, Dual Recovery Anonymous ) Provide a supply of medication sufficient to span from discharge until continuing treatment has been established Provide a supply of medication sufficient to span from discharge until continuing treatment has been established 2.76 Enhanced – Capable – Basic –

15 15 Recommendations Ensure that at least one direct care staff member has mental health and substance use competency or licensure Ensure that at least one direct care staff member has mental health and substance use competency or licensure Provide on–site clinical supervision sessions that include a focus on co- occurring disorders Provide on–site clinical supervision sessions that include a focus on co- occurring disorders Ensure that team meetings and case reviews incorporate co-occurring disorders Ensure that team meetings and case reviews incorporate co-occurring disorders Ensure that at least one direct care staff member has mental health and substance use competency or licensure Ensure that at least one direct care staff member has mental health and substance use competency or licensure Provide on–site clinical supervision sessions that include a focus on co- occurring disorders Provide on–site clinical supervision sessions that include a focus on co- occurring disorders Ensure that team meetings and case reviews incorporate co-occurring disorders Ensure that team meetings and case reviews incorporate co-occurring disordersStaffing 3.09 Enhanced – Capable – Basic –

16 16 Recommendation Demonstrate that the program has a written training plan Demonstrate that the program has a written training plan Maintain and enhance staff competencies in co-occurring services using up-to-date literature, films, and other media, as well as in-service and external trainings Maintain and enhance staff competencies in co-occurring services using up-to-date literature, films, and other media, as well as in-service and external trainings Train staff in specialized treatment approaches and pharmacotherapy Train staff in specialized treatment approaches and pharmacotherapy Demonstrate that the program has a written training plan Demonstrate that the program has a written training plan Maintain and enhance staff competencies in co-occurring services using up-to-date literature, films, and other media, as well as in-service and external trainings Maintain and enhance staff competencies in co-occurring services using up-to-date literature, films, and other media, as well as in-service and external trainings Train staff in specialized treatment approaches and pharmacotherapy Train staff in specialized treatment approaches and pharmacotherapyTraining 2.47 Enhanced – Capable – Basic –

17 17 Recommendation Training — Focus on Integrated Treatment Description of FIT This training helps practitioners gain a firm foundation in evidence-based integrated treatment for COD including screening and assessment, stage- wise treatment, motivational interviewing, and more. Additional modules help clinical supervisors develop their supervision skills and guide agency leaders through changes to ensure sustainability of integrated treatment. This training helps practitioners gain a firm foundation in evidence-based integrated treatment for COD including screening and assessment, stage- wise treatment, motivational interviewing, and more. Additional modules help clinical supervisors develop their supervision skills and guide agency leaders through changes to ensure sustainability of integrated treatment. Along with learning modules, CPI (the Center for Practice Innovation) offers inline implementations supports through webinars, “Ask the Expert” forums, and discussion threads. Along with learning modules, CPI (the Center for Practice Innovation) offers inline implementations supports through webinars, “Ask the Expert” forums, and discussion threads. The training is comprised of 35 individual modules developed alongside experts at the Dartmouth Psychiatric Research Center The training is comprised of 35 individual modules developed alongside experts at the Dartmouth Psychiatric Research Center This training helps practitioners gain a firm foundation in evidence-based integrated treatment for COD including screening and assessment, stage- wise treatment, motivational interviewing, and more. Additional modules help clinical supervisors develop their supervision skills and guide agency leaders through changes to ensure sustainability of integrated treatment. This training helps practitioners gain a firm foundation in evidence-based integrated treatment for COD including screening and assessment, stage- wise treatment, motivational interviewing, and more. Additional modules help clinical supervisors develop their supervision skills and guide agency leaders through changes to ensure sustainability of integrated treatment. Along with learning modules, CPI (the Center for Practice Innovation) offers inline implementations supports through webinars, “Ask the Expert” forums, and discussion threads. Along with learning modules, CPI (the Center for Practice Innovation) offers inline implementations supports through webinars, “Ask the Expert” forums, and discussion threads. The training is comprised of 35 individual modules developed alongside experts at the Dartmouth Psychiatric Research Center The training is comprised of 35 individual modules developed alongside experts at the Dartmouth Psychiatric Research Center Urge staff to enroll in FIT (Focus on Integrated Treatment) online learning Urge staff to enroll in FIT (Focus on Integrated Treatment) online learning

18 18 1.Introduction 2.Definitions, Terms, & Classification 3.Systems for COD 4.Keys to Successful Programming 5.Assessment 6.Strategies for Working with Clients with COD 7.Traditional Settings & Models 8.Special Settings & Models 9.Special Settings & Specific Populations 10.A Brief Overview of Specific Mental Disorders & Cross-Cutting Issues 11.Substance-Induced Disorders 1.Introduction 2.Definitions, Terms, & Classification 3.Systems for COD 4.Keys to Successful Programming 5.Assessment 6.Strategies for Working with Clients with COD 7.Traditional Settings & Models 8.Special Settings & Models 9.Special Settings & Specific Populations 10.A Brief Overview of Specific Mental Disorders & Cross-Cutting Issues 11.Substance-Induced Disorders RecommendationRecommendation Training — TIP 42 Refer to and use TIP 42 and its associatedin-service training curriculum Description of TIP 42

19 19 Improving Co-occurring Capability — Quick Guide 1. Provide educational material for both disorders 2. Revise agency mission statement or develop a program service statement 3. Implement one of the NYS-recommended standardized screening instruments 4. Use assessment data to inform the treatment plan 5. Allow co-occurring concerns to be expressed and discussed in all group and individual sessions 6. Ensure that all groups include mental health and substance use content 7. Offer a psycho-educational class on COD and a dual recovery group to create a “home” for co-occurring disorders in the program schedule 8. Include both substance use and mental health treatment in discharge plans and provide sufficient medication to last until continuing care has been established 9. Urge staff to enroll in FIT web-based learning 10. Refer to and use TIP 42 and its associated training curriculum 1. Provide educational material for both disorders 2. Revise agency mission statement or develop a program service statement 3. Implement one of the NYS-recommended standardized screening instruments 4. Use assessment data to inform the treatment plan 5. Allow co-occurring concerns to be expressed and discussed in all group and individual sessions 6. Ensure that all groups include mental health and substance use content 7. Offer a psycho-educational class on COD and a dual recovery group to create a “home” for co-occurring disorders in the program schedule 8. Include both substance use and mental health treatment in discharge plans and provide sufficient medication to last until continuing care has been established 9. Urge staff to enroll in FIT web-based learning 10. Refer to and use TIP 42 and its associated training curriculum 10 recommendations for Getting to “Capable” Easy to Employ & Conserves Resources

20 20 Improving Co-occurring Capability – Quick Guide Clinical Process: Screening & Assessment Clinical Process: Treatment Continuity of Care StaffingStaffing TrainingTraining Program Structure 1. _________________________________________________________________________________________________________ 2. _________________________________________________________________________________________________________ 3. _________________________________________________________________________________________________________ Program Milieu 1. _________________________________________________________________________________________________________ 2. _________________________________________________________________________________________________________ 3. _________________________________________________________________________________________________________ 1. _________________________________________________________________________________________________________ 2. _________________________________________________________________________________________________________ 3. _________________________________________________________________________________________________________ 1. _________________________________________________________________________________________________________ 2. _________________________________________________________________________________________________________ 3. _________________________________________________________________________________________________________ 1. _________________________________________________________________________________________________________ 2. _________________________________________________________________________________________________________ 3. _________________________________________________________________________________________________________ 1. _________________________________________________________________________________________________________ 2. _________________________________________________________________________________________________________ 3. _________________________________________________________________________________________________________ 1. _________________________________________________________________________________________________________ 2. _________________________________________________________________________________________________________ 3. _________________________________________________________________________________________________________ Clinic Name:Your Name: Phone:

21 21 Taskforce and Commissioners’ Recommendations Screening Instruments For mental disorders:  Modified MINI Screen (MMS)  Mental Health Screening Form III (MHSF III)  K6 Screening Scale (K6) For substance use disorders:  Modified Simple Screening Instrument for Substance Abuse (MSSI-SA)  CAGE Adapted to Include Drugs (CAGE-AID)  Alcohol, Smoking, and Substance Involvement Screening Test – v3 (ASSIST v3) For mental disorders:  Modified MINI Screen (MMS)  Mental Health Screening Form III (MHSF III)  K6 Screening Scale (K6) For substance use disorders:  Modified Simple Screening Instrument for Substance Abuse (MSSI-SA)  CAGE Adapted to Include Drugs (CAGE-AID)  Alcohol, Smoking, and Substance Involvement Screening Test – v3 (ASSIST v3) Assessment Domains  Presenting problem[s]  Current symptoms & functioning  Background  Individual history  Substance use  Mental health  Medical history  Mental status examination  Client perception[s]  Cultural and linguistic considerations  Supports & strengths  Diagnostic impressions on 5 DSM Axes  Presenting problem[s]  Current symptoms & functioning  Background  Individual history  Substance use  Mental health  Medical history  Mental status examination  Client perception[s]  Cultural and linguistic considerations  Supports & strengths  Diagnostic impressions on 5 DSM Axes Evidence-based Interventions For both disorders:  Approved medications For substance use disorders:  Evidence-based individual, group, couples, and family treatments –including motivational enhancement motivational enhancement CBT CBT 12-step facilitation 12-step facilitation behavioral couples & family therapy behavioral couples & family therapy contingency management contingency management For mental illness:  CBT, medication For serious mental illness:  Managing illness (IDDT, education, medication, CBT) family psychoeducation, supported employment, social skills training  Peer support For both disorders:  Approved medications For substance use disorders:  Evidence-based individual, group, couples, and family treatments –including motivational enhancement motivational enhancement CBT CBT 12-step facilitation 12-step facilitation behavioral couples & family therapy behavioral couples & family therapy contingency management contingency management For mental illness:  CBT, medication For serious mental illness:  Managing illness (IDDT, education, medication, CBT) family psychoeducation, supported employment, social skills training  Peer support

22 Training & Technical Assistance Activities Year 1, Year 2, Year 3 (4 th Quarter of Year 3 is projected) 14 Leadership Forums 22 Bldg Capability Forums 7 Bldg Recovery Workshops 451 DDCA[MH]T assessments Year 1 (Nov ’08 - Dec ’09) Year 2 (Nov ’09 - Oct ’10) Year 3 (Nov ’10 – Oct ’11) DDCA[MH]T = Dual Diagnosis Capability in Addiction [Mental Health] Treatment Index

23 23 CEIC TA Services have been provided in about ¾ of the state’s regions/counties

24 24 D ual Disorder Capability Total Score Program Structure Program Milieu Assessment Treatment StaffingTraining Continuity of Care Enhanced Capable Basic Scores based on DDCA[MH]T = Dual Diagnosis Capability in addiction [Mental Health] Treatment Index (N=300) Closer to Capable than to Basic

25 25 Dual Disorder Capability— Percentage Capable Scores based on DDCA[MH]T = Dual Diagnosis Capability in Addiction [Mental Health] Treatment Index %7% 22 % 30 % 6%6%6%6% 15% 21% 43% are near or above Capable Enhanced Capable Basic

26 26 Bi-annual OASAS EBP Survey  Surveydesigned to obtain EBP integration by implementation stages (Fixsen et al.)  Added items on COD in collaboration with CEIC (and NKI) to assess COD practices  Sent to all OASAS certified programs  Rated on a 5- point implementation scale 5. Sustainability 4. Innovation 3. Implementation 2. Installation 1. Exploration  Employs drop-down menu of additional questions to increase the accuracy of reporting  Response rate 96% of all licensed programs

27 27 Local Services Plan (LSP) Survey Tool Local Services Plan (LSP) Survey Tool (sample page)

28 28 Evidence-Based Practices and Evidence-Based Interventions: Level of Implementation Level of Implementation Scale: 5 = Sustainability 4 = Innovation 3 = Implementation 2 = Installation 1 = Exploration 0 = Not applicable (hasn’t moved to implement at all) PracticesInterventions

29 29 Screening, Assessment, Integrated Services Screening, Assessment, Integrated Services Based on OASAS Survey (Level 5)

30 30 Total Motivational Interviewing Cognitive Behavioral Therapy Behavioral Couples Therapy Mutual Self-help Contingency Management 23% About ¼ regularly employ evidence-based interventions Evidence-Based Treatment for COD Evidence-Based Treatment for COD Based on OASAS Survey (Level 5)

31 31 Comparative Survey Results

32 32 Strategic Plan — Reach & Penetration DRCs DRCs FIT FIT Regional / County Networks Regional / County Networks Direct (“hands-on”) TechnicalAssistance amplifies Direct TA and promotes Sustainability The strategic plan to reach & penetrate more than 1,000 out- patient substance abuse & mental health clinics over 4 years

33 33 1) Follow up DDCA[MH]T survey on representative sample 2) Follow up on OASAS survey — planned for ) Analysis combining these data sources (as briefly illustrated here) 4) Focus groups 5) Case studies 6) Brief web-based survey 1) Follow up DDCA[MH]T survey on representative sample 2) Follow up on OASAS survey — planned for ) Analysis combining these data sources (as briefly illustrated here) 4) Focus groups 5) Case studies 6) Brief web-based survey Evaluation Plan How will we know the system status?

34 34 Integrated Services – Nassau County to integrate services both within clinics and across the service system Video – creating a video on building COD capability in the areas of Screening, Assessment and Evidence-Based Practices called “Getting to Capable” Manuscript – writing a descriptive study of the current status of the system for publication New Instrument – developing and refining an instrument to measure recovery-oriented services integration with NYAPRS New Instrument – developing and field testing an instrument with Dr. Mark McGovern to measure the degree to which primary health care services have been integrated with mental health and substance use interventions. This has particular significance for health care reform. Integrated Services – Nassau County to integrate services both within clinics and across the service system Video – creating a video on building COD capability in the areas of Screening, Assessment and Evidence-Based Practices called “Getting to Capable” Manuscript – writing a descriptive study of the current status of the system for publication New Instrument – developing and refining an instrument to measure recovery-oriented services integration with NYAPRS New Instrument – developing and field testing an instrument with Dr. Mark McGovern to measure the degree to which primary health care services have been integrated with mental health and substance use interventions. This has particular significance for health care reform. Recent Developments

35 35  There exists a clear and increasingly positive picture of the status of OMH and OASAS outpatient clinics regarding evidence based practices and interventions 45% for screening 40% for assessment ⅓ for integrated services ¼ for evidence based interventions  The potential for advancement is greatest in the domains of Program Structure, Milieu, Treatment, Training and Continuity of Care, areas where certain improvements are considered to be fairly easy to achieve given the current status of staffing and resources  Transformation of the Service System may be said to occur when the majority of outpatient clinics are rated capable or above  There exists a clear and increasingly positive picture of the status of OMH and OASAS outpatient clinics regarding evidence based practices and interventions 45% for screening 40% for assessment ⅓ for integrated services ¼ for evidence based interventions  The potential for advancement is greatest in the domains of Program Structure, Milieu, Treatment, Training and Continuity of Care, areas where certain improvements are considered to be fairly easy to achieve given the current status of staffing and resources  Transformation of the Service System may be said to occur when the majority of outpatient clinics are rated capable or aboveSummary OMH and OASAS outpatient clinics are moving toward a COD capable status

36 36 The project is significant in its:  Promise of improving the health of NYS residents with co-occurring conditions  Potential to reduce health disparities  Ability to inform allocation of resources  Capacity to effect system transformation in the delivery of services  Implications for health care reform: Identifying capable programs Illustrating methods and approaches for advancing integration The project is significant in its:  Promise of improving the health of NYS residents with co-occurring conditions  Potential to reduce health disparities  Ability to inform allocation of resources  Capacity to effect system transformation in the delivery of services  Implications for health care reform: Identifying capable programs Illustrating methods and approaches for advancing integrationConclusion

37 37 Contact Information Stanley Sacks, P H D, Director Center for the Integration of Research & Practice (CIRP) & Center for Excellence in Integrated Care (CEIC) National Development & Research Institutes, Inc. (NDRI) 71 W 23rd Street, 8th Floor New York, NY TF  tel  fax  Michael Chaple, P H D, Deputy Director Center for the Integration of Research & Practice (CIRP) & Center for Excellence in Integrated Care (CEIC) National Development & Research Institutes, Inc. (NDRI) 71 W 23rd Street, 8th Floor New York, NY TF  tel  fax  ChackuMathai, CPRP, Associate Executive Director New York Association of Psychiatric Rehabilitation Services 1 Columbia Place, 2 nd Floor Albany, NY tel CEIC receives support (awards & ) from the New York State Health Foundation


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