1. Co-occurring Disorders and System of Care
Kari Collins, LCSW New Orleans – April, 2014

2. What are co-occurring disorders?
Youth who have substance use disorders as well as mental health disorders are diagnosed as having co- occurring disorders, or dual disorders. This is also sometimes called a dual diagnosis.
The term Behavioral Health refers to both substance use and mental health.

3. A substance use disorder includes:
alcohol or drug abuse
alcohol or drug dependence
Some of the most common mental health disorders found in youth with abuse and dependency are mood and anxiety disorders.
internalized behaviors
externalized behaviors
Don’t forget the impact of different abilities in learning!
Major depression, Dysthymia, Bipolar disorder
Post-traumatic stress disorder, Panic disorder, Social anxiety, Generalized anxiety disorder. Obsessive-compulsive disorder

4. Co-occurring disorders can sometimes be difficult to diagnose
Co-occurring disorders can sometimes be difficult to diagnose. Symptoms of the co-occurring disorders can be masked or confused.
Those diagnosed with mental health disorders often use substances to feel better.
Anxious? Use something to make them feel calm.
Depressed? Use something to make them feel more animated.
Fearful? Use something to make them feel more relaxed and less inhibited.
Psychological pain? Use something to make them feel numb.

5. What we often encounter…
For four out of five kids aged in the juvenile justice system, one or more of the following is true: they are under the influence of alcohol or drugs while committing their crimes; they test positive for drugs; they are arrested for committing an alcohol or drug offense; or they admit to having substance abuse problems.P1
Nearly 85 percent of youth treated for substance abuse problems, also have a mental health disorder.P2
Teens in the juvenile justice system are more likely to commit crimes as adults because delinquent behavior is "contagious", according to a 20-year research project in Canada.P3
Suicide is a serious concern. Suicide is the 3rd leading cause of death for year olds (nationally, approximately 5,000 youth per year).

6. What we are often see…
Substance Abuse

7. Effective Treatment?
In the past, mental health and substance use disorders were often treated separately in a parallel or consecutive way.
We now know that co-occurring mental health and substance use disorders impact one another and must be treated together. This is called integrated treatment.

8. Addressing the needs of Youth within a
System of Care

9. What is a System of Care?
A spectrum of effective, community-based services and supports for children and youth with or at-risk of having behavioral health and/or other challenges and their families…
organized into a coordinated network,
builds meaningful partnerships with families and youth,
addresses their cultural and linguistic needs
…in order to help them function better at home, in school, in the community, and throughout life.
SOC Values
Heather

10. System of Care Partners Include:
Courts
Families and Family Networks
Youth and Youth Networks
Juvenile Justice
Education
Public Health
Behavioral Health
Medicaid
(e.g. spiritual community)
Natural Supports
Child Welfare
Formal Support Services (e.g. Mentoring)
Heather –
Distinguish difference between youth/family being served (center of circle) and family and youth networks and agencies in bubbles (for example, KPFC, KY Youth MOVE as partners to support families and youth)

11. System of Care Guiding Principles
Availability and access to a comprehensive array of effective, community-based services and supports
Strength-based, individualized service planning
Evidence-informed and promising practices
Services and supports delivered in the least restrictive, most normative environments possible
Partnerships with families, youth & other caregivers
Cross-agency coordination
Heather

12. System of Care Guiding Principles cont.
Care management/Service Coordination
Developmentally appropriate services
Incorporate behavioral health promotion, prevention, early identification and intervention
Accountability and quality improvement tracking
Protect the rights of children, youth and families
Provide services without discrimination
Heather

13. System of Care Communities
1993–
1997–
1999–
2002–
2005–
East Baltimore, MD
Passamaquoddy Tribe, ME
Albany County, NY
Delaware 1 (statewide)
New London County, CT
Worcester, MA
Westchester County, NY
Bismarck, Fargo, & Minot, ND
Northern Arapaho Tribe, WY
Wisconsin
(6 counties)
Sacred Child Project, ND
Willmar, MN
Nebraska
(22 counties)
Birmingham, AL
Hillsborough
County, FL
West Palm Beach, FL
Clark
County, NV
Navajo Nation
Las Cruces, NM
King County, WA
Clark County, WA
Clackamas County, OR
Lane County, OR
Wai'anae & Leeward, HI
Napa & Sonoma Counties, CA
California 5 (Riverside, San Mateo,
Santa Cruz, Solano, & Ventura Counties)
Santa Barbara County, CA
Sedgwick County, KS
Southeastern Kansas
San Diego County, CA
Eastern Kentucky
St. Charles
County, MO
Rural
Frontier, UT
Travis
County, TX
Sault Ste. Marie Tribe, MI
Detroit, MI
Allegheny County 1, PA
Southern Consortium
& Stark County, OH
Pima County, AZ
Yukon Kuskokwim
Delta Region, AK
Contra Costa County, CA
United Indian Health Service, CA
Denver area, CO
Gwinnett & Rockdale Counties, GA
Lake County, IN
Nashville, TN
Guam
Puerto Rico
Northern
Kentucky
Fairbanks Native Association, AK
Choctaw
Nation, OK
Southwest Missouri
Southeastern
Louisiana
Colorado (4 counties)
El Paso County, TX
Oklahoma
(5 counties)
Ft. Worth, TX
San Francisco, CA
Sacramento County, CA
Glenn County, CA
Idaho
Urban Trails,
Oakland, CA
Monterey, CA
Montana &
Crow Nation
Mid-Columbia
Region
(4 counties), OR
Los Angeles County, CA
Butte County, CA
Placer County, CA
Blackfeet Tribe, MT
Wyoming
(statewide)
Minnesota
(4 counties)
Kalamazoo County, MI
Ingham County, MI
Beaver County, PA
Allegheny County 2, PA
Monroe County, NY
Mississippi
River Delta
area, AR
Harris
Honolulu, HI
Maury
County, TN
Mecklenburg County, NC
Sarasota
Broward County, FL
Lyons, Riverside,
& Proviso, IL
Chicago, IL
Cuyahoga
County, OH
Charleston, WV
Greenwood, SC
North Carolina (11 counties)
Burlington County, NJ
New Hampshire (3 regions)
Montgomery County, MD
Rhode Island 3 (statewide)
Worcester County, MA
Maine (3 counties)
Vermont 2 (statewide)
Rhode Island 2 (statewide)
Maine (4 counties)
Vermont 1 (statewide)
Edgecombe, Nash, & Pitt Counties, NC
Alexandria, VA
Rhode Island 1 (statewide)
Charleston, SC
South Philadelphia, PA
Mott Haven, NY
South Carolina (3 counties & Catawba Nation)
Washington, DC
Bridgeport, CT
New York, NY
Erie County, NY
Seven Generations System of Care, CA
Pascua Yaqui
Tribe, AZ
Lancaster
County, NE
St. Louis, MO
St. Joseph, MO
Marion
County, IN
Oglalla
Sioux
Tribe, SD
Yankton
McHenry County, IL
Iowa
(10 counties)
Milwaukee, WI
Hinds
County, MS
(3 counties)
Multnomah County, OR
Vermont 3 (statewide)
Northwest Georgia
Delaware 2 (statewide)
Nassau County, NY
Orange
County, NY
Shelby
Texas
(11 counties)
Northwest Portland Area Indian Health Board
Yakima County, WA
Alamance County, NC
Southeastern Indiana
Oklahoma (statewide)
Chautauqua
Lummi Nation
Creek Nation
Baltimore City, MD
federal SAMHSA grant program -- Comprehensive Community Mental Health Services for Children and Their Families Program
Provides 6-year cooperative agreement to states, tribes, and territories to improve and expand existing systems for children and youth with mental health challenges and their families
121 communities funded to date
57 active grantees across the country 13

14. Your Community?

15. Co-occurring Disorders and System of Care
Kari Collins, LCSW
Lexington, Kentucky