1. Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services (CMHS) Center for Substance Abuse Treatment (CSAT) Co-Occurring Center for Excellence (COCE) 3 rd Annual COSIG Grantee Meeting March 1-3, 2006 Omni Shoreham Hotel Washington, DC Texas COSIG Project Laurel Mangrum, Ph.D. Project Evaluator, University of Texas, Addiction Research Institute Kwame Bruce, Psy.D. Project Director, Texas Department of State Health Services

2. Texas COSIG Project The goal of the COSIG project is to improve the delivery of state-funded services for clients in Texas with co-occurring psychiatric and substance use disorders (COPSD). The project consists of two components designed to promote system change and to enhance specialized clinical skills of providers treating COPSD.

3. COSIG Project Component #1 Focused education at the clinician level regarding treatment issues relevant to COPSD and training on the use of diagnostic and assessment instruments to enhance identification of psychiatric comorbidity and monitor progress of clients.

4. COPSD Curriculum Modules Module 1: Substance Use and Mental Health Disorders Module 2: Depression and Substance Use Disorders Module 3: Substance Use and Bipolar Disorders Module 4: Anxiety and Substance Use Module 5: Schizophrenia, Schizoaffective, and Substance Use Disorders Module 6: Substance Use – Motives and Consequences Module 7: Principles of Treatment Module 8: Relapse Prevention

5. Diagnostic and Assessment Measures  Mini International Neuropsychiatric Interview (MINI)  Brief Symptom Inventory (BSI)  Brief Derogatis Psychiatric Rating Scale (BDPRS)  Substance Abuse Treatment Scale (SATS)  Ancillary Service Assessment  Client Evaluation of Self in Treatment (CEST)

6. COSIG Project Component #2 A voucher system that provides additional funding for procurement of ancillary services in an effort to address the multifaceted needs of COPSD clients and to support the treatment and recovery process.

7. COSIG Voucher Categories  Child Care  Housing Support  Transportation  Food Assistance  Education Support  Employment Assistance  Clothing  Medical Care  Prescriptions  Peer Mentoring

8. Participating Treatment Programs

9. Administration of Evaluation Measures

10. Psychiatric Diagnostic Impressions 271 COSIG Clients

11. Substance Use Disorders 271 COSIG Clients

12. BSI and BDPRS Scores in Clinically Significant Range at Admission 266 COSIG Clients

13. Reductions in Client Reported BSI Symptom Severity After One Month in COSIG 87 COSIG Clients

14. Reductions in Clinician Rated BDPRS Symptom Severity After One Month in COSIG 80 COSIG Clients

15. Increases in Treatment Engagement on Clinician SATS Ratings after One Month in COSIG 88 COSIG Clients

16. Ancillary Services Needed and Received at One Month in COSIG 80 COSIG Clients

17. Lessons Learned  Training on use of diagnostic and assessment instruments is not a one time event  Tiered training on clinical interventions is needed  Training to build clinician skills in identifying ancillary service needs is needed  Programs benefit from regular feedback reports  Compensation for increased clinician workload is needed

18. Next Steps for the Texas COSIG Project  Expansion of the pilot sites to five additional programs  Design training curriculum for identification of ancillary service needs and treatment planning  Design intermediate and advanced training modules in COPSD treatment  Development of COPSD fidelity instrument for use in both SA and MH programs in Texas  Information technology infrastructure development

19. COSIG Expansion Programs