1. CPI Brings Best Practices to NYS Focus on Integrated Treatment for Co-Occurring Disorders (FIT) Nancy Covell, Ph.D. Paul Margolies, Ph.D. Forrest Foster, MSW Center for Practice Innovations at Columbia Psychiatry September 15, 2011

2. Agenda Review of participants’ interests and experiences Questions for participants Integrated treatment – what is it and why is it important? CPI’s efforts to bring theses services to consumers in NYS How can you find out if these services are being provided by an agency/program?

3. Question True or False: It is important to get a substance use problem under control before dealing with mental health issues.

4. Answer False Mueser, Noordsy, Drake & Fox (2003)

5. Question For individuals who have been diagnosed with both a serious mental illness and a substance use problem – is it best to receive treatment for substance use from agencies that offer only substance use treatment so that they can fully concentrate on this issue?

6. Answer No Drake, RE, Essock, SM, et al. (2001). Psychiatric Services, 52, 469-476.

7. Question Traditionally, have people who have been diagnosed with both a serious mental illness and a substance use problem been able to receive treatment for both issues simultaneously at either mental health or substance use treatment programs?

8. Answer No Mueser, Noordsy, Drake & Fox (2003)

9. Question True or False: Group treatment for co-occurring disorders has not been found to be helpful.

10. Answer False Mueser, Noordsy, Drake & Fox (2003)

11. Question True or False: Practitioners can’t really help to motivate someone with co-occurring disorders. Motivation is the person’s responsibility.

12. Answer False Mueser, Noordsy, Drake & Fox (2003)

13. Integrated treatment – what is it and why is it important?

14. What is integrated treatment for people with co-occurring mental health and substance use disorders (COD)? Both mental health and substance use treatment provided by the same clinician or team. No Wrong Door Receive treatment whether you walk into an OMH-licensed or OASAS-certified program.

15. Assertive outreach and engagement Screening and assessment Motivational interventions Education about mental health and substance use Counseling – group, individual and/or family Staged interventions to target an individual’s stage of readiness for change Linkage to 12-step programs Long-term and comprehensive perspective Culturally sensitive Drake, RE, Essock, SM, et al. (2001). Psychiatric Services, 52, 469-476. What does integrated treatment for COD include?

16. Majority achieve abstinence or lessen substance use substantially. Most experience improvements in:  independent living  control of symptoms  competitive employment  social contacts with people who don’t use substances  overall life satisfaction Drake RE, Mueser KT, Brunette MF, et al. (2004). A review of treatments for people with severe mental illnesses and co-occurring substance use disorders. Psychiatric Rehabilitation Journal, 27, 360–374. Essock SM, Mueser KT, Drake RE, et al. (2006). Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders. Psychiatric Services, 57, 185-196. Integrated Treatment for COD is Effective!

17. During 1 week of 2003, in NYS: OMH programs: ~ 18% COD OASAS programs: ~ 30% COD Conservative estimate because in our programs, recording more than one diagnosis is not required and is not usually done. Thus, many people who present with both issues do not receive diagnoses that reflect this reality. The number of New Yorkers who can benefit from treatment for COD is huge! Why is treatment for COD important?

18. CPI’s efforts to bring theses services to consumers in NYS

19. Focus on Integrated Treatment Funded Jointly by and

20. What is Unique about FIT? We offer all training and supports online. We are one of a few blazing this new trail.

21. Advantages to Distance Learning Practitioners do not leave the office for extended periods to obtain training. Travel costs are eliminated. No cancelled resulting in lost resources.

22. Advantages to Distance Learning Log in and complete modules when convenient. Re-review modules any time. New staff trained immediately and consistently.

23. 35 Modules Available Video Skill Demonstrations Interactive Exercises Recovery Stories

24. Modules Address Core Competencies of Integrated Treatment Stage-wise Treatment Cognitive- behavioral therapy Motivational Interviewing

25. Screening & Assessment Individual collaborative treatment Peer recovery supports

26. Supervision Capability & Fidelity Leadership

27. What learners are saying “I love the trainings. They are so welcome because it is difficult to get out of the office. I enjoy learning more about substance abuse and value the melding of the two disciplines.” “Very clear, effective presentation of different types of supervision.” “I like the mix of video and text. The information about stages of treatment and stages of change gives one some very concrete information which I can directly utilize when working with an individual”

28. What learners are saying “I like the way you showed a real person in a real situation. It made it easy to identify with the person and view their needs as able to be met in manageable steps... the steps of each module were broken down to make them easy to learn, manageable and much in the same way I would hope I treat my clients.” “This module addresses the critical issue of what leadership should look like, and what a leader should be doing. The sections about supervision were excellent.” “It reinforced my beliefs about what my agency needs to do to move our integrated program forward.”

29. Award-Winning Brandon Hall Gold, Communicator, and 2 Silver Omni Intermedia

30. Module Demonstration (10-15 minutes)

31. Supports for Implementation

32. Distance Implementation Supports Monthly Online Discussions and Calls Practice Improvement Networks Developing Supervisor Skills

33. Reach of FIT as of July 31, 2011 503 programs actively participating in FIT Programs include mental health-licensed and addictions treatment-certified facilities across a variety of delivery settings (e.g., inpatient, outpatient, residential) 5,570 individuals from those programs registered in the learning community

34. Cumulative Number of FIT Modules – ALL Programs

35. For more information, visit our Website http://practiceinnovations.org/

36. How can you find out if these services are being provided by an agency/program?

37. Ask the agency/program: What percentage of consumers in your program have mental health and substance use problems? Do you offer integrated treatment for mental health and substance use problems? Do these services take into account the individual’s stage of readiness for change? How? Do you offer groups specifically designed for co-occurring disorders? What is their focus?

38. Ask the agency/program: Do you offer access to 12-step programs? How many of your staff members provide this kind of treatment? How have your staff been trained to provide this kind of treatment?

39. Questions and Answers