Maryland’s Co-Occurring Substance Use and Mental Disorders Initiatives Presented by: Pat Miedusiewski (Med-a-chef-ski) & Tom Godwin

Focus of Today’s Presentation Federal initiatives State level initiatives Regional initiatives Projected areas of focus

Federal Initiatives: SAMHSA’s Strategic Plan Purpose: To expand and improve prevention and where appropriate, integrated treatment and other supportive services to individuals with or at risk for co-occurring disorders. Approximately 4 million individuals in the U.S. are estimated to be affected by co-occurring disorders. However, only a small percentage receive treatment for both.

Federal Initiatives: SAMHSA’s Strategic Plan Outcome measures: - Increase percentage of prevention and treatment settings that: screen for co-occurring disorders; assess for co-occurring disorders; provide treatment to clients through collaborative,consultative and integrated models of care. - Increase percentage of reduced impairment for persons with co-occurring disorders following tx

Federal Initiatives: SAMHSA’s Strategic Plan Process Measures: Increase number of grantees (States, communities, and providers) measuring and reporting on co-occurring program performance (accountability); Increase access to appropriate prevention and integrated treatment services for people with or at-risk for co-occurring disorders (capacity);

Federal Initiatives: SAMHSA’s Strategic Plan Process Measures: Increase number of States, communities, providers, and consumers trained to implement effective co-occurring prevention and integrated treatments among States, communities, providers, and consumers (effectiveness).

Federal Initiatives: SAMHSA’s Strategic Plan Policy and Program Parameters: SAMHSA’s commitment to full implementation of recommendations in the “Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders” (11/02’)

Federal Initiatives: SAMHSA’s Strategic Plan Policy and Program Parameters: The need to integrate the issue of co-occurring disorders into the following major SAMHSA initiatives: Mental Health System Transformation Substance Abuse Treatment Initiative Strategic Prevention Framework

Federal Initiatives: SAMHSA’s Strategic Plan Key Activities 04’ & 05’: Build State infrastructure: Change of System Incentive Grant (COSIG); Incorporate specific requirements in State plans developed through new Child and Adolescent State Incentive Grants; Sponsor 1st National State Policy Academy for 10 States on co-occurring disorders, and provide technical assistance to participating States on action plan implementation.

Federal Initiatives: SAMHSA’s Strategic Plan Key Activities 04’ & 05’: Identify evidence-based practices (ebp) to prevent and treat co-occurring disorders. Provide technical assistance and training materials to promote ebp: Finalize and publish revised Treatment Improvement Protocol (TIP) Pilot Co-Occurring Integrated Treatment Resources Kit as part of CMHS EBP Resources Kits. Disseminate Resource Kit

Federal Initiatives: SAMHSA’s Strategic Plan Key Activities 04’ & 05’: Provide technical assistance and training materials to promote ebp: Develop a Treatment Improvement Protocol on “Substance Abuse Treatment and Trauma”; Use the National Co-Occurring Center for Excellence (COCE) to provide technical assistance on co-occurring disorders to COSIG States, Policy Academy States, other States, tribal communities, and providers.

Federal Initiatives: SAMHSA’s Strategic Plan Key Activities 04’ & 05’: Begin to develop outcome measures to be used by SAMHSA grantees. Support partnerships and networking in the field to address co-occurring disorders: NASMHPD/NASADAD Joint Task Force Maximize State provider, and workforce implementation of TA through CSAT Treatment Improvement Exchange, State TA, Co-occurring Listserv, Addiction Technology Transfer Centers.

Federal Initiatives: SAMHSA’s Strategic Plan Key Activities 04’ & 05’: Provide Technical Assistance: Support State-to-State technical assistance in the development of education and training programs. Pilot a simple screening and assessment instrument

Federal Initiatives: SAMHSA’s Strategic Plan Key Activities 04’ & 05’: Co-Occurring State Incentive Grants (COSIG): Capacity building goals - screening, assessment, treatment, training, and evaluation Areas of infrastructure development: Standardized screening and assessment Complementary licensure and credentialing requirements Service building and coordination Financial planning Information sharing

Federal Initiatives: SAMHSA’s Strategic Plan Key Activities 04’ & 05’: National Policy Academy: Maryland has been granted participation in the September, 05’ Policy Academy Provides technical assistance toward implementation of action plan for infrastructure development To create and/or reinforce relationships among Governor’s office, State legislators, and stakeholders, from public/private sectors

Federal Initiatives: SAMHSA’s Strategic Plan Key Activities 04’ & 05’: National Policy Academy: To provide an environment conducive to the progress of strategic decision-making within the context of co-occurring disorders To assist state and local policy-makers in identifying issues or areas of concern that may result in a formal request for technical assistance

Federal Initiatives: SAMHSA’s Strategic Plan Key Activities 04’ & 05’: Co-Occurring Center for Excellence (COCE): Joint SAMHSA initiative (CSAT & CHMS) Mission - “…to transmit advances in sa & mh treatment at all levels of severity that can be adapted to the needs of each client; to guide enhancements in infrastructure and clinical capacities, and, foster evidence-based and consensus-based co-occurring treatment and program innovation.”

Federal Initiatives: SAMHSA’s Strategic Plan Key Activities 04’ & 05’: Co-Occurring Center for Excellence (COCE): Activities include: Technical assistance and cross-training State-or-art materials on COD Co-Occurring Disorders web site National, regional meetings Evaluation of co-occurring Performance Partnership Grant (PPG) measures in State Incentive Grants (COSIG) & Data Incentive Grant (DIG) National Steering Council

Other National Efforts NASMHPD & NASADAD Task Force: Articulated conceptual framework for treatment systems (4 quad model) Established expectation for a comprehensive, coordinated system of care Encourages improvement of existing services within limited budgets, in a fiscally constrained environment In-depth analysis of multiple state programs A call for an in-depth look at children’s issues

Other National Efforts NASMHPD & NASADAD Task Force: Areas of concern: Identifying new fiscal resources Strategic use of existing resources Ebp’s for adults and children Development of a political constituency for systems change Integration of services across disparate delivery systems and funding mechanisms

Other National Efforts NASMHPD & NASADAD Task Force: Areas of concern: Strategies for consumer/family-centered services Creating a skilled and committed workforce Performance outcome measurement Stigma issues

State Initiatives 1997 - Managed Care Task Force 2000 - MHA/ADAA Conference 2002 - MD MHA/ATAM Workgroup - provider survey 2003-2005 Legislative Task Force (HB433) 5 workgroups - finance, workforce competency, clinical practices, information/data, systems Interim report submitted 12/04’ (final due 12/05’) Enlistment of COCE Technical support for County Initiatives Leadership Symposium - year 2003 Ongoing efforts for COSIG and Policy Academy

State Initiatives 2003 - DHMH State Co-Occurring Program Administrator 2003 - Formation of DHMH Leadership Team Vision statement Focus on 5 COSIG infrastructure areas Action planning Co-occurring Center of Excellence (COCE) enlisted Service Capacity Survey

State Initiatives 2003, 2004, 2005 - MHA Conferences on COD 2003 - application for COSIG 2003 - 1st application for National Policy Academy 2003 - DHMH State Program Administrator for COD appointed 2003 - Charter signed by Governor and State Leadership Team

State Initiatives 2005 - MHA/MCO/APS Coordination of Care Committee reconvenes 2005 - HB1273 passed Expands membership of Legislative Task Force Added focus on racial disparity, children and adolescents, and the elderly Child and Adolescent Conference - 6/9/05

State Infrastructure

Local Infrastructure

Local Initiatives Worcester County - (2001 - present) Implementation of CCISC systems change model Consensus document (Charter) Steering Committee & Training Cadre Strategic Plan Policies and Competencies

Local Initiatives Worcester County - (2001 - present): Training manual developed MH & SA screening/assessments Uniform data collection across system DDC throughout system - “no wrong door” MOU’s Interactive website Process Improvement (PI) Plan & outcomes obtained

Local Initiatives Montgomery County - (2002 - present) Implementation of CCISC systems change model Consensus document (Charter) Steering Committee & Trainers Group County “Welcoming Policy” 3 Training modules developed

Local Initiatives Anne Arundel County - (2004 - present) Implementation of CCISC systems change model under consideration Consensus document (Charter) in draft form Steering Committee & Stakeholders Group Strategic planning process underway

Local Initiatives Baltimore City Project - 2000-2002 Pilot: Initiated at 3MH & 3SA clinics Screening for SA at MH, MH screening at SA clinics Provided training for ebp and bp at clinics Case-based & Didactic training provided - Steering Committee formed with consensus building process underway

Local Initiatives Baltimore City Project - 2004 - present: MH screening at all SA clinics Standardized procedure for reporting MH Also reports whether referral is made Includes clinical treatment evaluation plan (BSAS)

Other Local Initiatives Mid-Shore Upper Shore Harford County Howard/Carroll/Frederick Counties Calvert County

Future Initiatives Participation at Policy Academy Application for COSIG Ongoing utilization of COCE Conversion of Task Force to Advisory Board ? Development of State level Implementation Team County to county support for local infrastructure development