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

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

3. 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.

4. 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

5. 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);

6. 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).

7. 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’)

8. 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

9. 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.

10. 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

11. 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.

12. 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.

13. 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

14. 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

15. 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

16. 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

17. 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.”

18. 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

19. 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

20. 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

21. 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

22. State Initiatives 1997 - Managed Care Task Force
MHA/ADAA Conference
MD MHA/ATAM Workgroup - provider survey
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

23. State Initiatives 2003 - DHMH State Co-Occurring Program Administrator
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

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

25. State Initiatives
MHA/MCO/APS Coordination of Care Committee reconvenes
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

26. State Infrastructure

27. Local Infrastructure

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

29. 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

30. 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

31. 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

32. 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

33. 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)

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

35. 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