Integrated Treatment for Co-Occurring Disorders An Evidence-Based Practice

Why Integrated Treatment for Co-Occurring Disorders? Community Health Centers of Southern Iowa (CHCSI) is the only Federally Qualified Health Center (FQHC) in the state of Iowa that has also been designated as a Community Mental Health Center (CMHC). CHCSI offers both mental health and substance abuse services….why not Integrated Treatment for Co-Occurring Disorders??

Integrated Treatment Recovery Model Hope is critical Services and treatment goals are consumer- driven Unconditional respect and compassion for consumers is essential Integrated treatment specialists are responsible for engaging consumers and supporting their recovery

Integrated Treatment Recovery Model (continued) Integrated treatment is associated with the following positive outcomes: Reduced substance use Improvement in psychiatric symptoms and functioning; Decreased hospitalization Increased housing stability Fewer arrests and Improved quality of life -(Drake et al.,2001)

Implementation Process 2013 – Onsite TA with Dr. Ken Minkoff and Dr. Christie Cline : Multi-occurring capabilities within CHCSI (Behavioral, SA, Senior Mgmt) 2012-2015 – Participation in CCISC Multi-Occurring Conditions Training June 2015 – CHCSI hosts Dr. Ken Minkoff at annual CHCSI all staff training

Implementation Process Oct. 2015 – Formal decision to pursue Integrated Treatment for Co-Occurring Disorders Oct. 2015 – Readiness Assessment Jan. 2016 – Action planning begins, continues quarterly thereafter Jan. 2017 – Change Companies Training Feb. 2017 – Implementation of Integrated Treatment for Co-Occurring Disorders

Costs Initial Training Ongoing Training Implementation Materials Staff Time Marketing Oversight/Supervision Costs Internal/External Fidelity Assessment

Associated Costs Change Companies 3 day, Train the Trainer : Paid for by South Central Behavioral Region = $7,300 (included 3 community health centers as well as other SA agencies in the area Complete set of Facilitator Journals $150.00 per set Complete set of Participant Journals $39.95 per set, individual journals range from $2.70-$6.30 per journal

Associated Costs Mental Health Block Grant: $19,426 dedicated to development of policies, procedures, staff time and internal fidelity assessments Other Costs: Marketing/Brochures Hosting Family Educational Nights Additional journals/check pads

Integrated Treatment KIT Getting Started

Integrated Treatment KIT (continued) Building Your Program

Integrated Treatment KIT (continued) Training Frontline Staff Module 1: Basic Elements and Practice Principles Module 2: Practical Knowledge of Common Substances Module 3: Stages of Treatment and Core Processes Module 4: Practical Skills for Integrated Treatment Module 5: Service Formats

Integrated Treatment KIT (continued) Evaluating Your Program

Integrated Treatment KIT (continued) Additional KITS: The Evidence Using Multimedia Brochure (English & Spanish) How to Use the EBP KIT

Integrated Treatment Team All consumers in the Integrated Treatment program receive care from a multidisciplinary team: Substance Abuse Counselor Nurse/Psychiatric Facilitator Psychiatrist Mental Health Provider Case Manager/Care Coordinator

Training Needs All Integrated Treatment team members receive initial and ongoing training to maintain fidelity to co-occurring guiding principles

Interactive Journaling Managing Co-occurring Disorders Through the use of Interactive Journaling®, this cognitive-behaviorally based series provides structure, knowledge and coping strategies in a single resource to individuals who have co-existing mental health and substance-related conditions. It also addresses the needs of individuals who are facing legal problems resulting from criminal behavior. Serves as a tool to support Integrated Treatment for Co-Occurring Disorders Provides consistent curriculum and messaging Consistent with the practice principles for Integrated Treatment for Co-Occurring Disorders Application focus – education alone is not effective in creating lasting change Rule of Thirds – each page of the journals balances text, graphics, and interactive questions Graphics for Visual Learners 30 Second Rule – slower readers should be able to read the core content in 30 seconds or fewer 7th grade reading level Emphasis on Thoughts, Feelings and Beliefs – Consistent with Cognitive Behavioral Therapy Combines Interactive Journaling, Motivational Interviewing and Cognitive Behavioral Therapy (CBT)

Fidelity Integrated Treatment Fidelity Scales, Protocol and Scoring Sheets included in the Evaluating Your Program KIT CHCSI conducts internal review bi-annually Results from internal review result in action plan bi-annually Continuous improvement in achievable areas is emphasized

Additional Resources For more information about Integrated Treatment for Co-Occurring Disorders and other evidence-based practices, visit www.samhsa.gov For more information about Interactive Journaling, visit www.changecompanies.net