CROSS-SYSTEMS COLLABORATION INITIATIVE Helpful and Promising Practices for Service Providers Supporting Individuals with Intellectual/Developmental Disabilities and Chemical Dependency Treatment Needs

Cross-Systems Collaboration Initiative.  Developed in recognition that people with ID/DD with significant co-occurring substance abuse treatment needs were not effectively served across Substance Abuse and ID/DD service systems  These individuals needed assistance to successfully access and engage in care and treatment, including inpatient rehabilitation and aftercare services, that would help them achieve and maintain sobriety

Cross-Systems Collaboration Initiative.  A number of barriers and challenges were identified that made it difficult for these clients to access the level of specialized care they needed including: - services and support needed from multiple systems across the continuum of care - client anxiety, fear, cognitive factors - exclusionary admission criteria for rehabilitation and residential services - provider awareness and comfort working with this population

Cross-Systems Collaboration Initiative  In 2009, the New York City Department of Health and Mental Hygiene (DOHMH), in collaboration with ACCESS CHC, New York State Office of Alcoholism and Substance Abuse Services (OASAS), and DD and CD services providers established a demonstration project for systems collaboration and service coordination to meet the needs of this population.  The project was funded through a generous grant from the NYS Developmental Disabilities Planning Council.

Cross-Systems Collaboration Initiative  The model demonstration project targeted individuals with developmental disabilities in New York City who require support from multiple systems that support and maintain their abstinence from alcohol and other drugs.  The project created a part-time Sobriety Community Linkages Coordinator (SCLC) position at the ACCESS CHC chemical dependency outpatient program to help meet the treatment needs of this specialized population

ACCESS Community Health Center.  ACCESS Community Health Center is a Federally Qualified Health Care provider mandated to provide comprehensive health care services to individuals who are uninsured.  The chemical dependency program specializes in treating adolescents and adults with co-occurring substance use disorders, cognitive disabilities and mental illness.  ACCESS Community Health Center is licensed by the Department of Health and the New York State Office of Alcoholism and Substance Abuse Services

Sobriety Community Linkages Coordinator The SCLC is part of an interdisciplinary treatment team at the ACCESS CHC Outpatient Chemical Dependency Program. The SCLC  provides direct services, including case management, motivational counseling, and individualized service plan and care coordination, for clients enrolled in the program  educates and engages providers of substance abuse and DD services about the needs of this population and shares helpful and promising practices

The Population  The average age of the clients presenting for treatment is in the 40’s with 65% identified as African American, 30% of Hispanic Origin, and 5% Caucasian. The majority of the consumer population is comprised of racial minorities from low-income families.

The Population  All clients have been diagnosed with an intellectual or other developmental disability.  50% are eligible for OPWDD services  75% have a co-occurring mental health disorder as well as a substance use disorder (i.e. “triply diagnosed”)

 75% of clients referred to the SCLC have been in need of supportive housing placement either because of an unstable home environment where the family is also using substances or the client is in a more restrictive housing placement that is no longer clinically necessary and the client needs to be reassessed for a more appropriate housing placement. The Population

Helpful and Promising Practices Navigate Multiple Systems  Create a check list of needed evaluations and screenings for admission to treatment programs  Set up appointments for needed screenings and medical evaluations including a current PPD reading  Develop relationships with staff within treatment settings that foster collaboration

Helpful and Promising Practices  Utilize motivational interviewing techniques and the stages of change model  Ask the person to repeat in their own words what has been said to them to gauge level of comprehension

Helpful and Promising Practices  Coordinate with Medicaid service coordinators and family members  Utilize photographs and other visual cues to alleviate anxiety about accessing a higher level of care

 Make sure that all diagnoses that the person is carrying are up to date.  Request evaluations to re-assess the individual if the evaluations are older than 3 years and the evaluations do not appear to accurately reflect the person’s current level of functioning Helpful and Promising Practices

Points to Remember  Individuals in need of a higher level of care may need:  A higher level of chemical dependency treatment- detoxification, long term residential treatment or 28 day rehabilitation  A higher level of supported housing or a less restrictive setting- clients can re-apply for HRA housing if their current housing situation is inadequate and their needs have changed.

Points to Remember  Many clients are have mental health treatment needs, in addition to an intellectual or other developmental disability and a substance use disorder.  Clinicians must treat the whole person and address mental health and substance abuse simultaneously while adapting materials, teaching, and communication styles to address the specific developmental disability.

Points to Remember  Clients may need a higher level of community involvement and engagement  May need help in identifying and then accessing these support services  Vocational training programs through ACCES- VR and recreation programs can keep clients active and engaged, preventing possible relapse

Points to Remember  Clients in need of supportive housing will most likely be interviewed/screened and asked questions that reveal personal information such as past trauma history/abuse history  If allowed, ask to sit in on the interview to offer support  Prepare clients in advance/practice interviews using role play

Summary  Clients with multiple diagnoses need to seek services from multiple systems  Cross systems collaboration can help clients access services in a timely manner  Cross systems collaboration minimizes gaps in service provision and streamlines the intake process so clients get the services and supports they need

CONTACT For more information about the grant project and for technical assistance please contact: Barbara Cajdler, LCSW, CASAC, Director of Recovery Services at:   LisaGail, LCAT Permit, Sobriety Community Linkages Coordinator at:  ext:1017 