Dual Diagnosis Treatment Team (DDTT)

Dual Diagnosis Treatment Team (DDTT)
One Individual at a Time Welcome! – we’re from NHS – provide Behavioral health, IDD, autism & educational services in PA, NJ, NY, DE, MD, VA, MI, LA Today we are presenting on dual diagnosis treatment team - Questions welcomed!!!

Objectives To gain an overall understanding of:
The structure of the DDTT model The dynamics of the team approach The effectiveness of this model and review recent outcomes The use of care coordination in facilitating high quality care How to create and evaluate a care coordination plan

What is a Dual Diagnosis Treatment Team?

What is DDTT? Dual Diagnosis Treatment Team (DDTT) is recovery oriented: Diagnosis of mental illness and IDD Team approach to service coordination and treatment Person-centered, holistic approach Community-based Focus is on skill transfer Providers of care coordination for consumers, supports and treatment entities Recovery-oriented approach to supporting individuals who are diagnosed with serious and persistent mental illness and an intellectual developmental disability. This program offers a team approach to service coordination and treatment for individuals who have encountered challenges with more traditional treatment settings. Staff, the individuals and other supports work together using person-centered, recovery services to promote the principles of everyday lives with individuals, family members and the community.

Local County MH/MR Entities
Origin of the DDTT Individual BHARP Counties Community Care NHS Local County MH/MR Entities Explain Pennsylvania OMHSAS, ODP and MCO make up and relationship The Behavioral Health Alliance of Rural Pennsylvania (BHARP) along with Community Care Behavioral Health Organization (Community Care) identified several priority populations that are underserved in the twenty-three county area designated by the HealthChoices State Option contract. Individuals that have been diagnosed with both an intellectual and developmental disability and a mental health diagnosis (IDD/MH). BHARP formed the Dual Diagnosis Workgroup to address the specific service delivery needs for this population. county human service directors, mental health/mental retardation (MH/MR) administrators, and MR directors, clinical psychologists, and representatives from the Department of Public Welfare’s Office of Developmental Programs (ODP), the Office of Mental Health and Substance Abuse Services (OMHSAS), Community Care, the ODP/OMHSAS Positive Practices Resources Team (PPRT) and the Health Care Quality Units (HCQUs). From the Workgroup came the RFQ for the DDTT Team, which was issued to providers in January 2011. From January 2011 to NHS Submission in March 2011, NHS embarked on Conceptualizing what a DDTT would look like. May 2011 NHS was awards the DDTT program Individuals with co-existing IDD/MH often present with extremely complex emotional, behavioral, physical, and social problems, thereby creating numerous challenges for families, providers, educators, and community supports. These individuals may require some of the highest total cost of services annually. Yet, the clinical outcomes for the persons served are often not as comprehensive as desired and the outcomes have relatively low success rates overall. In an attempt to meet these individuals’ needs, some of the most expensive supports, often through multiple delivery systems within ODP, OMHSAS and their county of residence, are utilized. These services may include residential, acute care hospitalization, partial hospitalization, and individualized residential programs utilizing extremely high staffing ratios. Given that this population often requires a more restrictive level of care, individuals with IDD/MH challenges frequently represent many of the individuals most at risk for placement in state hospitals or state centers. Often the most challenging and costly to serve population. Poor clinical outcomes Now expanded to other areas and other MCOs

DDTT Director: Rebecca Dempsey DDTT Director: Michelle Hetrick,
Erie Creekside Warren Susquehanna McKean Bradford Potter Tioga Crawford Bradford-Sullivan Wayne NEPA Wyoming Forest Elk Cameron Sullivan Lackawanna Lycoming Mercer Venango Pike Clinton Clarion Jefferson Luzerne Susquehanna Pocono Mountain High Point Columbia Lawrence Montour Monroe Union Butler Clearfield Carbon Armstrong Centre Snyder Beaver JRC Northumberland Schuylkill Northampton Indiana Schuylkill Lehigh Cambrian Hills Lehigh Valley Mifflin Pittsburgh Region Allegheny Twin Lakes/Blue Spruce Cambria Blair Juniata Dauphin Berks Berks Lebanon Bucks Canal Ways Westmoreland Huntington Perry Capital Region Washington Montgomery Cumberland Woodland Center Somerset Bedford Lancaster Montgomery York Lancaster Chester Greene Fayette Fulton Franklin Adams York-Adams Delaware NHS F/F Center Delaware DDTT Director: Rebecca Dempsey DDTT Director: Michelle Hetrick, DDTT Director: Samantha Stitzel DDTT Director: Deonna Walker DDTT Director: Nancy Hamilton DDTT Director: Gerardo Grasso DDTT Director: Elizabeth Moore DDTT Director: Alison Berger

NHS DDTT Service Divisional (Service Line) Structure supports integrated approach Collaboration between Clinical and Operational leadership across the Behavioral Health and Intellectual and Developmental Disabilities divisions Intensive development phase Ongoing monitoring and review of service delivery Who is NHS? – large behavioral health org with expertise in supporting people with IDD and Mental Illness Serve PA, NJ, NY, DE, MD, VA, MI, LA. NHS’s structure gave the organization the unique ability to develop a program that represented Best practice standards in treatment and quality across the human service delivery system. Healthy discourse between the service delivery models has lead to the development of this unique service. Operations Team within the Geographic area- County Directors, Executive Directors, Finance, Performance Improvement In May 2011 NHS’s team (IDD, ABH, Operations) – Discussion where we started, developed, deliver, and continue to refine the service. Behavioral style, group, and panel interviewing Service Design and development – process, standards, forms Comprehensive Training of staff>>> 1/4/12 first individual ongoing monitoring – supervision, MCOs work directly with teams identifying and problem solving, auditing from MCOs, monthly GMP (robust PQI process), ODP and BHARP attend meetings as well as local county administration and supports coordination

DDTT Staff Psychiatrist Psychiatric Consultants
Certified Registered Nurse Practitioner Registered Nurse Pharmacist Consultant Director Behavior Specialist Recovery Coordinators Administrative Assistant The team shares responsibility for all individuals in the program - Each individual gets to know each and every member of the team. If a team member goes on vacation, gets sick, or leaves the program, individuals have working relationships with the other team members

Dual Diagnosis Treatment
Focuses on: Continuity of care Hospital diversion Service and care coordination Specialized staff education and training Enhancing the individual’s support network Concepts based on: Assertive Outreach Mobile Treatment Teams Continuous Treatment Teams Person Centered Orientation Holistic Approach The team’s primary focus will be on crisis intervention, hospital diversion, and community stabilization. This will be achieved through the delivery of integrated case management, medication modification/management, behavioral assessment, and subsequent development of behavioral support plans. Intensive staff training and education to more effectively meet the needs of this population CAPACITY: East team = 14-22 West Team = 14-22 Allegheny team = 30 Westmoreland team = 20-22 SW team = 20-22 Delco/Montco team = 14-22 Lehigh team = 22 Luzerne/Wyoming = 14-22

Characterization of DDTT
A team approach Services in natural environment A small caseload of individuals * Extended team 30 DDTT of Allegheny Time-limited services (12-18 months) A shared caseload Flexible service delivery Fixed point of responsibility Crisis management available 24 hours a day, 7 days a week Care coordination with individuals and their supports (personal and professional) Operation – 24/7, rotating weekend coverage, small caseload The team is to average 3 face to face contacts per week increased capacity of teams – Allegheny – urban area , DDTTE and W expansive geography Crisis mgt

Attention to Individuals’ Needs
DDTT staff work closely with individuals to develop plans to help facilitate their recovery An average of three face-to-face contacts per week Maintain open availability for updates and ongoing collaboration for coordination of care Communication through morning meeting structure As individuals’ needs change, the team adapts immediately Person centered approach Morning Treatment Team Meetings at least 3x/week to discuss individuals progress (this allows the team members frequent opportunities to discuss how each case is progressing and creating plans for critical or acute needs). Continual communication among team members Sharing information from face to face meetings so all team members are current

Innovative Treatment Strategies: Pharmacogenomics & DDTT
NHS DDTT is partnering with Assurex Health Inc. to provide GeneSight testing Analyzes genes within an individual’s DNA to evaluate metabolism and responses to medications Provides the prescriber with valuable information when considering psychiatric medications GeneSight testing is a treatment decision support tool for prescribers of medication. The testing analyzes particular combinations of genes within an individual’s- DNA that affect the metabolism of and response to medications. The goal of such pharmacogenomic-based personalized medicine is to provide information that can better define medication treatments for individuals and increase the rate or amount of their therapeutic improvement. GeneSight testing is especially targeted for those individuals who are not stable on their medications and for individuals who are starting out on medications. Feedback from the testing will help prescribers know which psychiatric medications will be more effective for an individual. The NHS prescriber will need to order the laboratory testing. Upon analysis, Assurex sends the genotyping report to the prescriber who can use the report recommendations to guide medication prescribing.

Short-Term Service Services will be provided for an individual over a month period in various phases: Assessment … Stabilization… Treatment … Transition … Discharge planning begins on day one Brief service period Short term treatment Immediate focus on interventions – triage approach to goal setting Begin building resources, network, capacity of individual and team form day 1 Option of a “Brief Service Period” for individuals who have been discharged from the program within the last year who experience symptoms that may put them at risk for inpatient admission or otherwise jeopardize their community placement. The Brief Service Period is up to Four Months. Strengthens aftercare planning for individuals served by the team.

Admission Criteria 18 years of age or older Major psychiatric disorder
Intellectual Developmental Disability (IDD) Frequent crisis services and at least one psychiatric hospitalization within the last year At risk of losing current community housing/support At risk of placement in a criminal detention setting Requires transitional services back to the community from a higher level of care Talk here about the limitations of the admission criteria in regard to the Hospitalizations. Not everyone uses hospitals – may use crisis or mobile teams, many individuals are being restrained to manage outbursts – able to do case by case review looking at level of need When get a referral DDTT review and Doc approves for criteria goes to MCO for review and approves admission – especially if there is extenuating criteria each team works thru specific process for admission – magellan does admission determinition - each case is reviewed specifically for admission criteria

Supervision Robust structure that support the team members
Supervision is ongoing Occurs in field at meetings and case reviews This outlines minimal supervision levels, most of the team are receiving more frequent supervision. Consultation with leaders in Dual Diagnosis: Dr. Un, Dr. Pary, Dr. Barnhill, Dr. Fleisher as well as pharmacist consultant

DDTT: A Recap Explicit admission criteria
Small caseload of 14 to 22* individuals 24-hour coverage Responsible for coordination of care with existing and new providers Delivery of direct treatment services Time-limited services: 12 to 18 months *Allegheny team has an enhanced staffing compliment to accommodate a larger caseload A DDTT must have very clear admission criteria. This is so that the program can specialize in serving individuals with severe and persistent mental illness and a developmental Disability with the greatest needs. This means better services for the individuals in the program. Individuals are admitted at a slow rate. When people are first admitted into the program, they typically have many very challenging needs. If a program is flooded with a large number of people all at once, it makes it difficult for the staff to get to know people really well and provide the level of services that may be needed at first. By keeping the admission rate low, individuals are assured that they will get high quality, personalized services and won’t get lost in the shuffle. The Team is limited to 5 intakes per month to allow a higher quality of care that will engage the individual throughout the treatment process. Because DDTT work with people who have some of the most challenging needs, the team is available 24-hours a day, 365 days a year. Because the team can provide support around the clock if needed, it becomes possible to keep problems from snow balling into crises that might otherwise lead to injury, eviction, or arrest. Even with the support a team can provide, people may still sometimes need to be in the hospital. When hospitalization is necessary, the team works closely with the individual and hospital staff to make sure that the individual’s preferences are respected and that the hospital knows about the individuals recent history so the hospital staff won’t have to ‘start from scratch’. The team is also proactive in keeping the individuals housing and benefits in place so the individual doesn’t have to go back to square one when he or she is released. Because of this careful coordination, when hospitalization occurs, the length of time the consumer is in the hospital can be minimized. A DDTT program should always be providing what the team can do themselves rather than referring people to other programs, with the exception of specific competencies. This means, at a minimum, a program should be providing psychiatric treatment and rehabilitation, case management, assistance with employment, coordinating medical care, and working with individuals, who choose to use them, regarding medication education and monitoring. DDTT is time limited- 18 to 24 months. This increases the need to work closely with community providers to train and coordinate with community services. QUESTIONS?

DDTT Cycle of Care

DDTT Lifecycle Assessment
Stabilization Treatment Transition DDTT begins with a comprehensive assessment process Working for day one towards stabilization Treatment is based on an integrated approach – all disciplines provide an assessment in which the recommendations are integrated to formulate and prioritize treatment plan goals Team continually works to build network and resources so that the individual has continued success after discharge

Referral Referral criteria Interagency Meeting
**other DDTTs - Referral from Community at Large  County Point Person  Program Director Initial A Mtg to Determine Admission  Recovery Coordinator ** Allegheny referral direct from CCBO and approved Completes Intake DDTT Program Director (PD) or designee attends Interagency (IA) Meeting within 3 working days of receiving referral Determination is based on DDTT admission criteria in service description Referral paperwork needed Referral Profile Most recent Psychiatric Evaluation Authorization PD assigns DDTT staff to complete the intake the day of the IA Meeting

Admission Responsibilities and Documentation
Complete intake the day of interagency meeting Complete initial Treatment Plan Complete Personal Safety Plan Develop communication strategy Assigned DDTT staff complete the following on the day of admission/intake: Intake Packet includes Consent Packet Release of Information Electronic record Registration form Referral and linkage agreements Review DDTT Handbook Initial Assessment if ISP does not exist Developing the Initial treatment Plan PD must sign within 5 working days of IA Developing the initial Personal Safety Plan (review with significant changes or every 30 days) Assignment of Individual Treatment Team (ITT) Communication Plan Provide on-call information Exchange phone number and contact info Recovery Coordinator specific functions Start Medical Record Arrange meeting with psychiatrist Ensure Initial Tx Plan was completed Schedule initial visits for first few days Nursing specific functions Initial nursing visit completed within 3 business days of admission

Comprehensive Assessment
Multimodal in design Bio-psychosocial Typically includes Functional Behavior Assessment Medical Assessment Sensory Evaluation Trauma Screening Social Assessment and Timeline Psychiatric Evaluation Adaptive Functioning Comprehensive Assessment completed 7 weeks from admission Elements for review during this phase Progress notes Ongoing team assessments - medical, social, psychiatric eval Daily Log Functional Behavior Assessment Medication logs and documentation DDTT Timeline Summary Psychiatric Evaluation Record Review Direct Observation Stress need for multidimensional approach – “the whole is much more than the sum of the parts”

Integrated Recovery Treatment Plan
Person centered outcomes Long-term and short-term objectives Actions steps Addresses specific aspects and complexities of individual Includes the Personal Safety Plan Resource Guide Integrated Recovery Treatment Plan is due 8 weeks after admission Discuss resources needed to carry-out the new plan Roles of the ITT members and of other staff needed to implement Tx Plan Incorporates dimensions usually found in a behavioral support plan and treatment plan and combines them into one document Goal Planning Sheet Formulation and prioritization of tx plan goals (Here you’ll find information on stregthens, barriers, proactive/reactive approaches and things to avoid). Include W.R.A.P. (Wellness Recovery Action Plan), personal medicine etc PLEASE HELP WITH THIS AREA!!!! Assigned DDTT staff must complete a comprehensive treatment plan within 8 weeks of admission with psychiatrist sign off to become effective Holistic/Integrative Approach to mental health treatment is a systemic approach, looking at the person as a whole and very complex being with multiple {biological (physical health, mental health, genetic conditions), psychological (emotional regulation, stress, trauma issues) and social (family, community, work, housing, relational concerns)} aspects that need to be considered and integrated when developing a treatment plan. It is based on the belief that the whole person must be considered and addressed to understand the complexities of a person’s life and why particular thoughts and feelings lead to his/her behavior. This approach values the complexity of each individual’s makeup and how this relates to their identity and relationships with others and the community. Use of Person first language The plan includes the treatment for the DDTT month service period And the particular individualized support for the person’s lifetime – road map

Continuous Treatment Planning
Evaluates the individual’s needs and effectiveness of treatment Morning meetings – three times per week Treatment team/planning meetings every 30 days Update Treatment Plan every 120 days Update psychiatric evaluation every 6 months GOAL: to evaluate the individual’s needs and effectiveness of tx Morning Meeting Purpose is to adjust tx to meet changing day to day needs Assists in determining when Tx Plan needs substantial revisions and to assign team members to make changes rather than waiting until the plan is due for revision Tx Team/planning Meeting every 90 days Updated Tx Plan due every 120 days (can be updated more often if needed) Psychiatric Evaluations completed every 6 months Annually: review/update Consent Packet, obtained signed DDTT Annual Review form and complete new releases Safety plans updated every 120 days or if there is a hospital admission updated in five days

Discharge Short-term service is 12 to 18 months Discharge Summary
Timeline Discharge should occur within months Assigned DDTT staff will complete a Discharge Summary that includes referral linkages for sustained support(use transitional spreadsheet) upon discharge

Brief Service Period Available within 1 year of discharge
If relapse of original behaviors Life event Trauma Change of supports Four weeks Review of original assessment and Integrated Recovery Treatment Plan Opportunity for Brief Service Period if individual is struggling after discharge 4 weeks refresher average, additional service is approved on a weekly basis QUESTIONS? Alison next

DDTT Quality Assessment and Outcomes

Challenges Large geographic area Level of trauma with this population
Travel time Level of trauma with this population Lack of specialized treatment providers throughout PA Lack of stabilization options/unique need of this population Co-morbidity issues that effect this group Building dual diagnosis capacity in the community This population lack stabilization services in the community, unique to this population. Inpatient psych untis unable to serve folks, respite is difficult, Defined unit of service – 15 minute minutes is a long time and we make many calls but usually don’t make the 15 minute of any one call Medical comorbidity effecting this population make treatment challenging

Outcome Expectations Key Performance Indicators Reduction in:
ER visits for behavioral health needs Inpatient hospitalizations Readmissions (inpatient stays within 30 days of prior stay) Number of ER presentations and inpatient hospitalizations Number of incarcerations and days incarcerated Number of calls to crisis services and law enforcement Increase in: Length of time an individual maintains housing Acquisition of independent living skills Number of individuals engaged in meaningful day activities Connections to and support from natural supports Evidence of satisfaction with program delivery

NADD Certified Programs
In May of 2016 three out of eight DDTTs pursued NADD accreditation All three DDTTs were fully accredited through NADD! Allegheny, N23E (Highpoint), N23W (Schuylkill) Discuss additional teams pursuing certification, and individuals pursuing individual certification

Outcomes Da

Outcomes

Outcomes – Decreased Hospitalizations
Data Includes Residential Treatment Facility stays in pre-admission Sample size differences Pre-admission data may not be all inclusive

Outcomes – Decreased Days Spent in Acute Care
Data Includes Residential Treatment Facility stays in pre-admission Sample size differences Pre-admission data may not be all inclusive

Care Coordination Over the years of providing services across the state of Pennsylvania, one area which stands out as a key component to the success of an individual in treatment is the time and efforts put into care coordination. Let’s take a moment to learn a little bit about care coordination and then focus on two case studies which really highlight how strong care coordination lead to positive treatment outcomes for these folks.

What is Care Coordination?
Is an ongoing process Helps ensure that an individual’s needs and preferences for health services Ensures that information sharing occurs across various domains (people, functions, and sites) Determines points of care and accountability between providers to support an individual through the system in the most efficient way possible

Failure of Care Coordination
When systems working with individuals do not do care coordination well, results can be devastating Individuals may end up in a system that cannot meet their needs. When treatment entities don’t communicate, individuals may be improperly treated for physical, mental, social and emotional needs. Gaps in treatment or failed transition to appropriate care may occur. Example of failed care coordination (could come directly from training)

Failure of Care Coordination
Misinformation can lead to a host of issues, including: Inadequate support during transitions Duplication of services or failure to follow through with recommendations Clinically significant “mishaps”

managed by the professionals
Care coordination should always involve consumers and their supports, but should be managed by the professionals providing support.

Care Coordination The level of care coordination need will increase with: greater system fragmentation (e.g., wider gaps between circles) greater clinical complexity (e.g., greater number of circles on ring) decreased consumer capacity for participating effectively in coordinating one's own care, as illustrated by the following scenarios The level of need is not fixed in time, nor by consumer. Assessment of level of care coordination is likely important to tailor interventions appropriately and to evaluate their effectiveness.

What is the Central Goal of Care Coordination?
Meet the consumer’s needs and preferences of high quality, high-value care

DDTT Provides Care Coordination
Activities of daily living Housing Family life Employment Benefits Behavioral Supports Health care Medications Co-Occurring disorders integrated treatment (IDD/MH) Counseling Evidence Based/Best Practice Treatment Key to having holistic approach person centered that all integral parts are aware and synched with one another – health care providers are aware, meds are not overlapped, docs well aware of diagnosis and behavioral issues sometime 14 different people involved – DDTT helps all to be aware of other and they are working in harmony and successful in providing care Evidence Based/Best Practice Treatment: Illness Management and Recovery Cognitive Behavior Therapy Functional Behavioral Assessment (FBA)

Key Components to writing a Quality Care Coordination Plan
DDTT imbeds it into the design of the model Processes are standardized for every case DDTT Imbeds Care Coordination into the model in the model in the following ways: Creating Team Distribution Lists Obtaining releases for all providers including medical, specialist, local hospitals and crisis services 30 day meetings with formatted meeting minutes which are holistic and meant to “highlight” barriers so they are addressed and resolved with a plan by the end of the meeting.

DDTT Imbeds Care Coordination into the Design of the Model
Examples: Inter-agency meeting format at time of admission Proactive releases of information Primary care collaboration letters Attendance at medical/dental appointments to develop 1:1 relationship and expectations Structured meetings every 30 days Scheduled meetings at the convenience of the individual, team and family to ensure participation Distributed meeting minutes Transparent communication with the whole team Getting creative! Using distribution lists Obtaining PCP and specialists’ direct addresses DDTT Imbeds Care Coordination into the model in the model in the following ways: Creating Team Distribution Lists Obtaining releases for all providers including medical, specialist, local hospitals and crisis services 30 day meetings with formatted meeting minutes which are holistic and meant to “highlight” barriers so they are addressed and resolved with a plan by the end of the meeting.

High quality care coordination leads to high quality treatment outcomes: case study examples

Case Study 1 “DJ” Individual served by the Washington DDTT Team:
Introduction to “DJ” and his supports: “DJ” is a 45 year old male with Hispanic origin Referred to the DDTT by his supports coordinator in September Lives in a Community Living Arrangement living with 2 peers. Receives 1:3 ratio in the home, 1:6 ratio at day program. Received supports coordination through his local county. Psychotropic medications being managed by nurse practitioner, not psychiatrist, prior to admission to DDTT. Not receiving counseling or therapy Diagnosis at the time of intake: Organic Brain Syndrome Moderate Intellectual Disability

Case #1 Reasons for referral:
Behavioral, environmental, psychological and medical supports needed. Assessment findings DDTT Treatment - Bio/Psycho/Social Holistic Care Medical/Physiological Interventions Pharmocological treatment/medication changes Sleep & Wellness Care Coordination and consultation with other medical providers

Case #1 Updated Diagnostic Information Fade/Discharge Planning
Linkage with providers for all needs Ongoing Care Coordination through d/c process

Case #2 “Mary” Mary is supported by the Allegheny DDT Team
Introduction to Mary & Her Supports: 35 yr old white single female Lives with biological parents in small neighborhood Limited supports or engagement with peers Inpatient psychiatric hospital – 2nd in two weeks Father & Mary both present Reasons for Referral/Initial Meeting Diagnoses/Symptomology Autism Spectrum D/O Intermittent Explosive D/O Obsessive Compulsive D/O Intellectual disability

Case #2 Prior Tx Psychiatric in childhood Natural /Homeopathic
Biological Considerations Father – traits Mother-clinical depression Psychosocial Development Mary – Intimacy vs. Isolation (20-39 yrs) Parents – Generativity vs. Stagnation (40-64 yrs) Cultural/Spiritual Perspective “the Group” Conservative Baptists

Case #2 Coordinated Services
Prior services vs. services after Care Coordination/DDTT Engagement Treatment/Interventions Observable changes Decrease in symptoms Change in Mother/Father, Direct Natural Supports Discharge Planning

DDTT -- East Molly Brown-Steranko Lead Specialist
Schuylkill/North Central Contract East Team Lehigh/Northampton/Berks Team Montgomery/Delaware County Team Luzerne/Wyoming/Susquehanna/Lackawanna County Team

DDTT – East Program Directors
Rebecca Dempsey North Central East Team Gerry Grasso Lehigh/Northampton/Berks Team Elizabeth Moore Montgomery/Delaware County Team Alison Berger Luzerne / Wyoming / Lackawanna / Susquehanna NHS was recently awarded an RFP for Wyoming and Luzerne Counties for DDTT services. We are actively recruiting staff for this new team, which will be ramping up in May.

DDTT -- West Kristin Cline Lead Specialist North Central West Team
Allegheny County Team Westmoreland/Armstrong/Indiana County Team Washington/Beaver/Butler/Lawrence County Team

DDTT – West Program Directors
Michelle Hetrick North Central West Team Nancy Hamilton Allegheny Team Deonna Walker Westmoreland /Armstrong/Indiana Samantha Adams Washington/ Butler/Beaver/Lawrence Team

Contact Information Tinnesia Snyder Regional Executive Director/DDTT (724)

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Dual Diagnosis Treatment Team (DDTT)

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