1. Co-Occurring Disorder Treatment with People Involved in the Criminal Justice System Presented by Center for Evidence Based Practices at Case/ Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence the Ohio SAMI CCOE is a partnership between the Mandel School of Applied Social Sciences and the Department of Psychiatry, CWRU School of Medicine, Case Western Reserve University in collaboration with the Ohio Departments of Mental Health and Alcohol Dependence and Addiction Services

2. www.centerforebp.case.edu

3. Why focus on Co-Occurring Disorders? Substance use disorders are common in people with severe mental illness Mental illness is common in people with substance use disorders Co-occurring disorders lead to worse outcomes and higher costs than single disorders

4. Co-Occurring Disorders lead to worse outcomes than single disorders Relapse of mental illness Treatment problems and hospitalization Violence, victimization, and suicidal behavior Homelessness and Incarceration Medical problems, HIV & Hepatitis risk behaviors and infection Family problems Increase service use and cost

5. Traditional Co-Occurring Disorders Treatment Treat each disorder separately –May be parallel or sequential Separate treatment is less effective

6. Integrated Dual Disorders Treatment (IDDT): What is it? Treatment of substance use disorder and mental illness together – Same team – Same location – Same time – Other characteristics to be described later ACT (Assertive Community Treatment) DD-CAT and DD-CMHT

8. Abstinence leads to improvements in other outcomes Reduce institutionalization Reduce symptoms, suicide Reduce violence, victimization, legal problems Better physical health Improve function, work Improve relationships and family

9. Now What… Treatment Works How To Get and Keep People in Treatment Rapport and Relationship Stage-Wise and Motivational Implications 9

10. Introduction of Panelists: Organizational Missions and History Nikki Bisig: Greater Cincinnati Behavioral Health (GCB) John Scalish and Lou LaMarca, Community Assessment and Treatment Services, Inc. (CATS)

11. The Benefits Why did your organization endeavor to provide co- occurring treatment? Why did your organization seek to work with the criminal justice system?

12. The Challenges and Solutions Differing cultures between the criminal justice system and the mental health and substance abuse treatment systems Compliance vs. Adherence and Risk Management What is “Treatment”? What is “Success” in Treatment?

13. Lessons Learned Training implications Communication and developing trust between treatment providers and criminal justice staff A range of treatment services (case management, groups, meds, etc) Stagewise treatment and motivational interventions

14. Questions?

15. www.centerforebp.case.edu Scott Gerhard, MA, LSW Consultant and Trainer Center for Evidence-Based Practices (CEBP) Case Western Reserve University scott.gerhard@case.edu 216-268-0808

16. www.centerforepb.case.edu

17. www.centerforebp.case.edu