1. Heidi Kammer MSW, LICSW, LADC NAMI Minnesota State Conference Saturday, November 15, 2014 10:15am-11:30am

2.  This session focuses on strategies for delivering effective, outcome-based co- occurring chemical and mental health care  Explore the best practice of integrated dual diagnosis treatment.  What makes substance use disorder treatment and mental health treatment unique  Benefits of integrated treatment.  Key components of effective integrated treatment  Culturally responsive and trauma informed care components

3.  Importance of integrating chemical and mental health, including integration with primary medical care in response to the changing landscape of the Affordable Care Act  Practices for co-occurring disorders along the continuum of care  The theme of the "right care at the right time" as a model of effective practice.  Evaluating recovery outcomes through client satisfaction and the use of evidence-based practices

4. Heidi Kammer MSW, LICSW, LADC Vice President- Chemical & Mental Health RESOURCE, Inc. 1900 Chicago Avenue South Minneapolis, MN 55404 6127528092 phone 6128043417 cellular hkammer@resource-mn.org www.resource-mn.org

5. RESOURCE’s mission is to: Empower people to achieve greater personal, social, economic success. Our commitment is to undoing racism and promoting diversity through reducing health and racial disparities. www.resource-mn.org

6. Co-occurring Disorder (COD)  Co-occurring disorders may include any combination of two or more substance abuse disorders and mental disorders identified in the Diagnostic and Statistical Manual of Mental Disorders 5  There are no specific combinations of substance abuse disorders and mental disorders that are defined uniquely as co-occurring disorders  Substance abuse and mental health problems (such as binge drinking by people with mental disorders) that do not reach the diagnostic threshold are also part of the co-occurring disorders landscape and may offer opportunities for early intervention  Both substance abuse disorders and mental disorders have biological, psychological and social components  Co-occurring disorders may vary among individuals and in the same individual over time  Both disorders may be severe or mild, or one may be more severe than the other

8.  The solution lies in integrated care, the systematic coordination of general and behavioral healthcare. Integrating mental health, substance abuse, and primary care services produces the best outcomes and proves the most effective approach to caring for people with multiple healthcare needs. Source: The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS)

9.  More than 80% of persons with co- occurring disorders do not perceive the need for treatment/ care  Source: National Survey on Drug Use & Health

13.  The Affordable Care Act/Health Care Reform http://kff.org/healt h- reform/video/youto ons-obamacare- video/ Source: Kaiser Family Foundation

14.  The Triple Aim  Achieve Improved Patient Health  Provide High Quality Care  Do This in a Cost Effective Way

15.  “Right services at the right time in the right amount”: this should be our new mantra!  A true longitudinal continuum perspective vs. episodic  Chemical Health & Mental Health care is “HEALTH” care.  We must be able to educate consumers, clients, about impact of health care reform. (web resources & handouts)  We must engage with organizational decision makers about our care model- “that’s the way we always did it” doesn’t fly  Develop treatment plans from a “holistic” perspective  Ensure “true” multidisciplinary coordination and care (chemical health, mental health, primary care/ health)

16. Promoting Recovery…  “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” (SAMHSA, 2011)

17.  Integrated Care ensures culturally responsive care.  Considering health and racial disparities  Culturally responsive care is a key strategy for relapse prevention  The impact of oppression, racism, classism…on health and relapse prevention  Consider the cultural experience and hope of the consumer

18.  Multidisciplinary Team  Stage-Wise Interventions (stages of change, stages of treatment)  Access to Comprehensive Services (e.g., residential, employment, etc.)  Time-Unlimited Services  Assertive Outreach  Motivational Interventions  Substance Abuse Counseling  Group Treatment  Family Psychoeducation  Participation in Alcohol & Drug Self-Help Groups  Pharmacological Treatment  Interventions to Promote Health  Secondary Interventions for Treatment of Non- Responders  Case Western Handout/ Resource

19. A Sample: http://www.dhs.state.mn.us/main/groups/dis abilities/documents/pub/dhs16_181625.pdf

20.  Stage-wise care/ treatment  A continuum of care  Measuring impact via the Triple Aim  Access  Quality of Care  Cost of Care  Improved Health  The right services at the right time!

21. The client is a 38-year-old Hispanic/Latina woman who is the mother of two teenagers. Maria M. presents with an 11-year history of cocaine dependence, a two-year history of opioid dependence, and a history of trauma related to a longstanding abusive relationship (which has been over for six years). She is not in an intimate relationship at present and there is no current indication that she is at risk for either violence or self-harm. She also has persistent major depression and panic treated with antidepressants. She is very motivated to receive treatment. Source:

22. 1. What would be the ideal treatment plan strategies? 2. What services involved in providing services to this client? 3. What, if any, adjustments to existing services would have to be made? 4. Would there be gaps in service? How might these be filled? 5. Who would be the best suited to act as case manager for this client? 6. What barriers would exist for care coordination?

23. The client is a 34-year-old married, employed African-American man with cocaine dependence, alcohol abuse, and bipolar disorder (stabilized on lithium) who is mandated to cocaine treatment by his employer due to a failed drug test. George T. and his family acknowledge that he needs help not to use cocaine, but do not agree that alcohol is a significant problem (nor does his employer). He complains that his mood swings intensify when he is using cocaine. Source:

24. 1. What would be the ideal treatment plan strategies? 2. What services involved in providing services to this client? 3. What, if any, adjustments to existing services would have to be made? 4. Would there be gaps in service? How might these be filled? 5. Who would be the best suited to act as case manager for this client? 6. What barriers would exist for care coordination?

25.  http://www.youtube.com/view_play_list?p=8 5C1E36206E17BB3 http://www.youtube.com/view_play_list?p=8 5C1E36206E17BB3

26.  Integrated Treatment for Co-Occurring Disorders Evidence-Based Practices (EBP) KIT http://store.samhsa.gov/product/SMA08-4367 http://store.samhsa.gov/product/SMA08-4367  Substance Abuse Treatment for Persons With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series 42. http://www.ncbi.nlm.nih.gov/books/NBK64190/ http://www.ncbi.nlm.nih.gov/books/NBK64190/  Practical Approaches to Staging Change in Dual Diagnosis http://www.samhsa.gov/co- occurring/topics/training/staging-change.aspxhttp://www.samhsa.gov/co- occurring/topics/training/staging-change.aspx