1. Addressing Co-Occurring Conditions: A Provider’s Perspective Joan E. Zweben, Ph.D. Executive Director: 14 th Street Clinic & EBCRP Clinical Professor of Psychiatry; University of California, San Francisco

2. A Chance to Provide Comprehensive Care OTI/CSAT permitted and funded comprehensive services in 1990’s Psychiatric services to clients Training mental health programs in AOD Training addiction programs in mental health Integrate treatment of COD; psychotropic meds and methadone are included Limited primary care services; prevent deterioration to more costly ailments Moms and kids residential

3. Comprehensive Care (2) Provide licensed child care Begin to address HCV (1995) with encouragement from CSAT project officer Methamphetamine Treatment Project: strengthen commitment to evidence-based practices Developing and providing a universal wraparound case management model. Developing an integrated "therapeutic jurisprudence" model with a leading Drug Court.

4. Obstacle Providers are expected to collaborate to provide care, but government entities frequently do not communicate about common issues. This leads to conflicting expectations and requirements.

5. Remedy: Policy Statements Need for joint, interagency policy statement confirming commitment to, and expectations for, treatment for persons with COD Statement should clearly identify the impropriety of excluding persons with COD from either treatment system or other service systems

6. Licensing & Certification Naïve expectation that professional credentials include proficiency in addressing substance abuse No framework for specialized licensing and site certification Overlapping and conflicting requirements between health services, mental health, alcohol/other drug, social services, criminal justice system, etc.

7. Licensing & Certification Need comprehensive framework for program licensing and site certification, or Specify programs that are exempt from existing requirements Remove regulatory barriers that discourage providers from serving this population Create incentives through adequate reimbursement

8. Need for a Universal Chart Funding sources require different elements in the clinical chart, and have different audit protocols Need for a universal chart to reduce extra work, save many trees, and allow consistent data collection.

9. Training Need mechanism to cross-train professionals and continuously develop skill base of non-credentialed workers Need to align all elements of the system to promote mastery of content defined as important: intake process, treatment plan, staff evaluations, etc. Need for regular clinical supervision

10. Co-Occurring Disorders Workgroup Report http://www.adp.ca.gov/COD/dual diag.shtml Click on COD Workgroup Report on the left