CHANGING THE WORLD:CHANGING THE WORLD:WELCOMING, ACCESSIBLEWELCOMING, ACCESSIBLE

RECOVERY-ORIENTEDRECOVERY-ORIENTEDCULTURALLY FLUENTCULTURALLY FLUENT

COMPREHENSIVE, CONTINUOUS, COMPREHENSIVE, CONTINUOUS, INTEGRATED SYSTEMS OF CAREINTEGRATED SYSTEMS OF CARE

FOR INDIVIDUALS AND FAMILIES WITH FOR INDIVIDUALS AND FAMILIES WITH PSYCHIATRIC AND SUBSTANCE USE PSYCHIATRIC AND SUBSTANCE USE

DISORDERSDISORDERS

Presented by: Presented by:

Christie A. Cline, M.D., M.B.A., P.C.Christie A. Cline, M.D., M.B.A., P.C.Kenneth Minkoff, MDKenneth Minkoff, MD

Info@Info@ZiaLogicZiaLogic.org.org Kminkov@aol.comKminkov@aol.com www.ZiaLogic.orgwww.ZiaLogic.org www.kenminkoff.comwww.kenminkoff.com

ZiaLogicZiaLogic©2002, 2003©2002, 2003

TRANSFORMATIONTRANSFORMATIONThe process of recovery for systemsThe process of recovery for systems

UNIVERSAL WELCOMING PARTICIPATIONUNIVERSAL WELCOMING PARTICIPATION HOPEFUL VISION HOPEFUL VISION

PRINCIPLE DRIVENPRINCIPLE DRIVEN EMPOWERED PARTNERSHIPEMPOWERED PARTNERSHIP

CONTINUOUS QUALITY IMPROVEMENTCONTINUOUS QUALITY IMPROVEMENT STRENGTH-BASEDSTRENGTH-BASED

HONEST SELF-ASSESSMENTHONEST SELF-ASSESSMENT STEP-BY-STEP MEASURABLE PROGRESSSTEP-BY-STEP MEASURABLE PROGRESS

Serenity Prayer of System ChangeSerenity Prayer of System Change

““Co-occurring Psychiatric & Substance Co-occurring Psychiatric & Substance Disorders in Managed Care Systems: Disorders in Managed Care Systems:

Standards of Care, Practice Guidelines, Standards of Care, Practice Guidelines, Workforce Competencies & Training Curricula”Workforce Competencies & Training Curricula”

CENTER FOR MENTAL HEALTH SERVICESCENTER FOR MENTAL HEALTH SERVICES

MANAGED CARE INITIATIVEMANAGED CARE INITIATIVE

CONSENSUS PANEL REPORTCONSENSUS PANEL REPORT

19981998

FIVE SECTIONS OFFIVE SECTIONS OF PANEL REPORT PANEL REPORT

I.I. CONSUMER/FAMILY STANDARDS CONSUMER/FAMILY STANDARDS II.II. SYSTEM STANDARDS/PROGRAM SYSTEM STANDARDS/PROGRAM

COMPETENCIESCOMPETENCIES III.III. PRACTICE GUIDELINES PRACTICE GUIDELINES IV.IV. WORKFORCE COMPETENCIES WORKFORCE COMPETENCIES V.V. TRAINING CURRICULA TRAINING CURRICULA

CONSUMER/FAMILY SYSTEM CONSUMER/FAMILY SYSTEM STANDARDSSTANDARDS

WELCOMINGWELCOMING ACCESSIBLEACCESSIBLE INTEGRATEDINTEGRATED CONTINUOUSCONTINUOUS

COMPREHENSIVECOMPREHENSIVE

Individuals with Co-occurring DisordersIndividuals with Co-occurring Disorders

PRINCIPLES OF SUCCESSFUL PRINCIPLES OF SUCCESSFUL TREATMENT:TREATMENT:

Dual diagnosis is an Dual diagnosis is an expectationexpectation, , not an not an exceptionexception..

This expectation must be This expectation must be incorporated in a incorporated in a welcomingwelcoming

manner into all clinical contact, to manner into all clinical contact, to promote promote accessaccess to care and to care and

accurate identificationaccurate identification of the of the population.population.

The Four Quadrant Model is a viable The Four Quadrant Model is a viable mechanism for categorizing mechanism for categorizing individuals with co-occurring individuals with co-occurring

disorders for purpose of service disorders for purpose of service planning and system responsibility. planning and system responsibility.

SUB-GROUPS OF PEOPLE WITH SUB-GROUPS OF PEOPLE WITH COEXISTING DISORDERSCOEXISTING DISORDERS

Patients with “Dual Diagnosis” - combined psychiatric and substance abuse Patients with “Dual Diagnosis” - combined psychiatric and substance abuse problems - who are eligible for services fall into four major quadrantsproblems - who are eligible for services fall into four major quadrants

PSYCH. HIGH SUBSTANCE HIGH

Serious & Persistent Mental Illness with Substance Dependence QUADRANT IV

PSYCH. LOW SUBSTANCE HIGH

Psychiatrically Complicated Substance Dependence QUADRANT III

PSYCH. HIGH SUBSTANCE LOW

Serious & Persistent Mental Illness with Substance Abuse QUADRANT II

PSYCH. LOW SUBSTANCE LOW

Mild Psychopathology with Substance Abuse QUADRANT I

Treatment success derives from the Treatment success derives from the implementation of an implementation of an empathicempathic,, hopefulhopeful,, continuous continuous treatment treatment

relationship, which provides integrated relationship, which provides integrated treatment and coordination of care treatment and coordination of care

through the course of multiple treatment through the course of multiple treatment episodes.episodes.

Within the context of the empathic, Within the context of the empathic, hopeful, continuous, integrated hopeful, continuous, integrated

relationship, relationship, case management/carecase management/care

(based on level of impairment) and (based on level of impairment) and empathic empathic

detachment/confrontationdetachment/confrontation (based (based on strengths and contingencies) on strengths and contingencies)

are appropriately balanced are appropriately balanced at each point in time.at each point in time.

When substance disorder and When substance disorder and psychiatric disorder co-exist, each psychiatric disorder co-exist, each

disorder should be considered disorder should be considered primaryprimary, and , and integrated dual integrated dual

primary treatmentprimary treatment is is recommended, where each disorder recommended, where each disorder

receives appropriately intensive receives appropriately intensive diagnosis-specific treatment.diagnosis-specific treatment.

Both substance dependence and Both substance dependence and serious mental illness are examples of serious mental illness are examples of

primary, chronic, biologic mental primary, chronic, biologic mental illnesses, which can be understood illnesses, which can be understood

using a using a disease and recoverydisease and recovery model, with model, with parallel phases of parallel phases of

recoveryrecovery..

PARALLELSPARALLELSPROCESS OF RECOVERYPROCESS OF RECOVERY

PHASE 1:PHASE 1: Stabilization Stabilization- - Stabilization of active substance use or acute Stabilization of active substance use or acute

psychiatric psychiatric symptomssymptoms

PHASE 2:PHASE 2: Engagement/Engagement/Motivational EnhancementMotivational Enhancement- - Engagement in treatment Engagement in treatment - - Contemplation, Preparation, PersuasionContemplation, Preparation, Persuasion

PHASE 3:PHASE 3: Prolonged StabilizationProlonged Stabilization- - Active treatment, Maintenance, Relapse Active treatment, Maintenance, Relapse

PreventionPrevention

PHASE 4:PHASE 4: Recovery & RehabilitationRecovery & Rehabilitation- - Continued sobriety and stabilityContinued sobriety and stability-- One year - ongoing One year - ongoing

SUMMARYSUMMARY

EMPATHIC, HOPEFUL, CONTINUOUS, EMPATHIC, HOPEFUL, CONTINUOUS, INTEGRATED MULTIPLE PRIMARY INTEGRATED MULTIPLE PRIMARY PROBLEM, ADEQUATELY SUPPORTED, PROBLEM, ADEQUATELY SUPPORTED, ADEQUATELY REWARDED, ADEQUATELY REWARDED, STRENGTH-BASED, SKILL-BASED, STRENGTH-BASED, SKILL-BASED, STAGE-MATCHED COMMUNITY STAGE-MATCHED COMMUNITY BASED LEARNING.BASED LEARNING.

There is no one type of dual There is no one type of dual diagnosis program or diagnosis program or

interventionintervention. For each person, the . For each person, the correct treatment intervention must correct treatment intervention must

be individualized according to be individualized according to subtype of dual disorder and subtype of dual disorder and

diagnosis, phase of diagnosis, phase of recovery/treatment, level of recovery/treatment, level of functioning and/or disability functioning and/or disability

associated with each disorder. associated with each disorder.

In a In a managed care systemmanaged care system, , individualized treatment matching individualized treatment matching

also requires multidimensional level also requires multidimensional level of care assessment involving of care assessment involving acuityacuity, ,

dangerousnessdangerousness,, motivationmotivation,, capacity for treatment capacity for treatment

adherenceadherence, and availability of , and availability of continuing empathic treatment continuing empathic treatment

relationships and other recovery relationships and other recovery supports. supports.

Treatment MatchingTreatment Matchingand and

Treatment PlanningTreatment Planning

CCISC CHARACTERISTICSCCISC CHARACTERISTICS

1.1. SYSTEM LEVEL CHANGE SYSTEM LEVEL CHANGE 2.2. USE OF EXISTING RESOURCES USE OF EXISTING RESOURCES 3.3. BEST PRACTICES UTILIZATION BEST PRACTICES UTILIZATION

4.4. INTEGRATED TREATMENT INTEGRATED TREATMENT PHILOSOPHYPHILOSOPHY

CHANGING THE WORLDCHANGING THE WORLD

A.A. SYSTEMS SYSTEMS

B.B. PROGRAM PROGRAM

C.C. CLINICAL PRACTICE CLINICAL PRACTICE

D.D. CLINICIAN CLINICIAN

12 STEPS OF 12 STEPS OF IMPLEMENTATIONIMPLEMENTATION

1.1. INTEGRATED SYSTEM PLANNING INTEGRATED SYSTEM PLANNING 2.2. CONSENSUS ON CCISC MODEL CONSENSUS ON CCISC MODEL 3.3. CONSENSUS ON FUNDING PLAN CONSENSUS ON FUNDING PLAN 4.4. IDENTIFICATION OF PRIORITY IDENTIFICATION OF PRIORITY

POPULATIONS WITH 4 BOX MODELPOPULATIONS WITH 4 BOX MODEL 5.5. DDC/DDE PROGRAM STANDARDS DDC/DDE PROGRAM STANDARDS 6.6. INTERSYSTEM CARE INTERSYSTEM CARE

COORDINATIONCOORDINATION

12 STEPS OF 12 STEPS OF IMPLEMENTATIONIMPLEMENTATION

7.7. PRACTICE GUIDELINES PRACTICE GUIDELINES 8.8. IDENTIFICATION, WELCOMING, IDENTIFICATION, WELCOMING,

ACCESSIBILITY: NO WRONG DOORACCESSIBILITY: NO WRONG DOOR 9.9. SCOPE OF PRACTICE FOR SCOPE OF PRACTICE FOR

INTEGRATED TREATMENTINTEGRATED TREATMENT 10.10. DDC CLINICIAN COMPETENCIES DDC CLINICIAN COMPETENCIES 11.11. SYSTEM WIDE TRAINING PLAN SYSTEM WIDE TRAINING PLAN

12 STEPS OF IMPLEMENTATION12 STEPS OF IMPLEMENTATION

12.12. PLAN FOR COMPREHENSIVE PLAN FOR COMPREHENSIVE PROGRAM ARRAYPROGRAM ARRAY A.A. EVIDENCE-BASED BEST PRACTICE EVIDENCE-BASED BEST PRACTICE B.B. PEER DUAL RECOVERY SUPPORT PEER DUAL RECOVERY SUPPORT C.C. RESIDENTIAL ARRAY: WET, RESIDENTIAL ARRAY: WET,

DAMP, DRY, MODIFIED TCDAMP, DRY, MODIFIED TC D.D. CONTINUUM OF LEVELS OF CARE CONTINUUM OF LEVELS OF CARE

IN MANAGED CARE SYSTEM: ASAM-IN MANAGED CARE SYSTEM: ASAM-2R, LOCUS 2.0 2R, LOCUS 2.0

DUAL DIAGNOSIS CAPABLEDUAL DIAGNOSIS CAPABLE

ROUTINELY ACCEPTS DUAL DIAGNOSIS ROUTINELY ACCEPTS DUAL DIAGNOSIS PATIENTPATIENT

WELCOMING ATTITUDES TO COMORBIDITYWELCOMING ATTITUDES TO COMORBIDITY

CD PROGRAM:CD PROGRAM: MH CONDITION STABLE AND MH CONDITION STABLE AND PATIENT CAN PARTICIPATE IN TREATMENTPATIENT CAN PARTICIPATE IN TREATMENT

MH PROGRAM:MH PROGRAM: COORDINATES PHASE-SPECIFIC COORDINATES PHASE-SPECIFIC INTERVENTIONS FOR ANY SUBSTANCE DX.INTERVENTIONS FOR ANY SUBSTANCE DX.

POLICIES AND PROCEDURES ROUTINELY LOOK POLICIES AND PROCEDURES ROUTINELY LOOK AT COMORBIDITY IN ASSESSMENT, RX PLAN, AT COMORBIDITY IN ASSESSMENT, RX PLAN, DX PLAN, PROGRAMMINGDX PLAN, PROGRAMMING

CARE COORDINATION RE MEDS (CD)CARE COORDINATION RE MEDS (CD)

Dual Diagnosis Capable: Dual Diagnosis Capable: DDC-CDDDC-CD

Routinely accepts dual patients, provided:Routinely accepts dual patients, provided: Low MH symptom acuity and/or disability, Low MH symptom acuity and/or disability,

that do not seriously interfere with CD Rxthat do not seriously interfere with CD Rx Policies and procedures present re: dual Policies and procedures present re: dual

assessment, rx and d/c planning, meds assessment, rx and d/c planning, meds Groups address comorbidity openlyGroups address comorbidity openly Staff cross-trained in basic competenciesStaff cross-trained in basic competencies Routine access to MH/MD Routine access to MH/MD

consultation/coord.consultation/coord. Standard addiction program staffing Standard addiction program staffing

level/cost level/cost

Dual Diagnosis Capable:Dual Diagnosis Capable:DDC-MHDDC-MH

Welcomes active substance usersWelcomes active substance users Policies and procedures address dual Policies and procedures address dual

assessment, rx & d/c planningassessment, rx & d/c planning Assessment includes integrated mh/sa hx, Assessment includes integrated mh/sa hx,

substance diagnosis, phase-specific needssubstance diagnosis, phase-specific needs Rx plan: 2 primary problems/goalsRx plan: 2 primary problems/goals D/c plan identifies substance specific skillsD/c plan identifies substance specific skills Staff competencies: assessment, motiv.enh., rx Staff competencies: assessment, motiv.enh., rx

planning, continuity of engagementplanning, continuity of engagement Continuous integrated case mgt/ phase-specific Continuous integrated case mgt/ phase-specific

groups provided: standard staffing levelsgroups provided: standard staffing levels

DUAL DIAGNOSIS DUAL DIAGNOSIS ENHANCED (DDE)ENHANCED (DDE)

MEETS DDC CRITERIA MEETS DDC CRITERIA PLUS:PLUS:

CD:CD: MODIFICATION TO ACCOMMODATE MH MODIFICATION TO ACCOMMODATE MH ACUITY OR DISABILITYACUITY OR DISABILITY

MH SPECIFIC PROGRAMMING, STAFF, MH SPECIFIC PROGRAMMING, STAFF, AND COMPTENCIES, INCLUDING MDAND COMPTENCIES, INCLUDING MD

FLEXIBLE EXPECTATIONS; CONTINUITYFLEXIBLE EXPECTATIONS; CONTINUITY

MH;MH; ADDICTION TREATMENT IN PSYCH ADDICTION TREATMENT IN PSYCH MANAGED SETTINGS (DUAL DX INPT UNIT) MANAGED SETTINGS (DUAL DX INPT UNIT) OROR

INTENSIVE CASE MGT/OUTREACH TO INTENSIVE CASE MGT/OUTREACH TO MOST SERIOUSLY MI AND ADDICTED PEOPLEMOST SERIOUSLY MI AND ADDICTED PEOPLE

Dual Diagnosis Enhanced:Dual Diagnosis Enhanced:DDE-CDDDE-CD

Meets criteria for DDC-CD, Meets criteria for DDC-CD, plusplus:: Accepts moderate MH symptomatology or Accepts moderate MH symptomatology or

disability, that would affect usual rx.disability, that would affect usual rx. Higher staff/patient ratio; higher costHigher staff/patient ratio; higher cost Braided/blended funding neededBraided/blended funding needed More flexible expectations re:group workMore flexible expectations re:group work Programming addresses mh as well as dualProgramming addresses mh as well as dual Staff more cross-trained/ senior mh Staff more cross-trained/ senior mh

supervisionsupervision More consistent on site psychiatry/psych RNMore consistent on site psychiatry/psych RN More continuity if patient slips More continuity if patient slips

Dual Diagnosis EnhancedDual Diagnosis EnhancedDDE-MHDDE-MH

Meets all criteria for DDC-MH, Meets all criteria for DDC-MH, plus:plus: Supervisors and staff: advanced competenciesSupervisors and staff: advanced competencies Standard staffing; specialized programming:Standard staffing; specialized programming:

a.a. Intensive addiction programming in Intensive addiction programming in psychiatrically managed setting (dual inpt psychiatrically managed setting (dual inpt unit; dry dual dx housing, supported sober unit; dry dual dx housing, supported sober house)house)b.b. Range of phase-specific rx options in Range of phase-specific rx options in ongoing care setting: dual dx day treatment; ongoing care setting: dual dx day treatment; damp dual dx housingdamp dual dx housingc.c. Intensive case mgt outreach/motiv. enh.: Intensive case mgt outreach/motiv. enh.: CTT, wet housing, payeeship management CTT, wet housing, payeeship management

CCISC INITIATIVESCCISC INITIATIVESState/ProvinceState/Province

Alaska – CCISC implementation, Alaska – CCISC implementation, COSIGCOSIG

Arizona – CCISC implementation, Arizona – CCISC implementation, COSIGCOSIG

Arkansas – COSIG, CCISC consultationArkansas – COSIG, CCISC consultation California – CCISC consultationCalifornia – CCISC consultation Colorado – CCISC consult, tool licenseColorado – CCISC consult, tool license District of Columbia – CCISC District of Columbia – CCISC

implementation, COSIGimplementation, COSIG Florida – CCISC consultation, state Florida – CCISC consultation, state

provider association tool licenseprovider association tool license Hawaii – CCISC implementation, Hawaii – CCISC implementation,

COSIGCOSIG Idaho – CCISC consultation 2001Idaho – CCISC consultation 2001 Louisiana – CCISC implementation, Louisiana – CCISC implementation,

COSIGCOSIG Maine – CCISC implementation, COSIGMaine – CCISC implementation, COSIG Manitoba – CCISC implementationManitoba – CCISC implementation Maryland – CCISC consultation, tool Maryland – CCISC consultation, tool

licenselicense Massachusetts – CCISC consensus Massachusetts – CCISC consensus

19991999

Michigan – CCISC implementation multiple Michigan – CCISC implementation multiple local projects, tool licenselocal projects, tool license

Minnesota – CCISC consultation, statewide Minnesota – CCISC consultation, statewide provider network tool licenseprovider network tool license

Montana – CCISC implementationMontana – CCISC implementationNew Mexico – CCISC implementation New Mexico – CCISC implementation

(BHSD), COSIG(BHSD), COSIGNew York – CCISC consultationNew York – CCISC consultationOklahoma – CCISC implementation, COSIGOklahoma – CCISC implementation, COSIGPennsylvania – CCISC implementation, Pennsylvania – CCISC implementation,

COSIGCOSIGSouth Carolina – CCISC consultation, tool South Carolina – CCISC consultation, tool

licenselicenseSouth Dakota – CCISC implementationSouth Dakota – CCISC implementationTexas – CCISC consultation (state Texas – CCISC consultation (state

hospitals), COSIGhospitals), COSIGVermont – CCISC implementation, COSIGVermont – CCISC implementation, COSIGVirginia – CCISC implementation, COSIGVirginia – CCISC implementation, COSIGWisconsin – CCISC consult, tool license Wisconsin – CCISC consult, tool license

CCISC INITIATIVESCCISC INITIATIVESLocal/Network (non-state)Local/Network (non-state)

Alabama – BirminghamAlabama – Birmingham British Columbia – Vancouver Island British Columbia – Vancouver Island

Health Authority, and multiple Health Authority, and multiple locations with tool licenseslocations with tool licenses

California – San Diego, San California – San Diego, San Francisco, Placer, Kern, San Mateo Francisco, Placer, Kern, San Mateo Counties, Mental Health Systems, Counties, Mental Health Systems, Inc (network)Inc (network)

Colorado – Larimer CountyColorado – Larimer County Florida – Tampa, Miami, Ft. Florida – Tampa, Miami, Ft.

Lauderdale, West Palm Beach, Lauderdale, West Palm Beach, Pensacola DistrictsPensacola Districts

Illinois – Peoria (Fayette Companies)Illinois – Peoria (Fayette Companies) Indiana – Regional provider networkIndiana – Regional provider network Maryland – Montgomery, Worcester, Maryland – Montgomery, Worcester,

Kent CountiesKent Counties Manitoba – Winnipeg RHAManitoba – Winnipeg RHA Michigan – Kent, Oakland, Venture Michigan – Kent, Oakland, Venture

Behavioral Health, CareLink Behavioral Health, CareLink network, Washtenaw, and multiple network, Washtenaw, and multiple other networks and counties.other networks and counties.

Minnesota – CrookstonMinnesota – Crookston Missouri – Mark Twain Area Missouri – Mark Twain Area

Counseling CtrCounseling Ctr

New York – Oneida CountyNew York – Oneida County Nova Scotia – Cape Breton RHANova Scotia – Cape Breton RHA Ohio – AkronOhio – Akron Ontario - HamiltonOntario - Hamilton Oregon – Mid Valley Behavioral Oregon – Mid Valley Behavioral

Care NetworkCare Network Pennsylvania – Blair CountyPennsylvania – Blair County Virginia – Lynchburg (CVCSB)Virginia – Lynchburg (CVCSB) Washington – Spokane RSNWashington – Spokane RSN Wisconsin – Green Bay, Milwaukee Wisconsin – Green Bay, Milwaukee

consultationconsultation

SYSTEM FEATURESSYSTEM FEATURES All systems are complex with unique structures All systems are complex with unique structures

and culturesand cultures All systems work within the context of limited All systems work within the context of limited

resources and with complex funding issuesresources and with complex funding issues Data is often inconsistent with epidemiologic Data is often inconsistent with epidemiologic

findings findings Each has significant strengths and weaknesses Each has significant strengths and weaknesses

at all levels (system, program, clinical practice, at all levels (system, program, clinical practice, and clinician)and clinician)

Under utilization of leverage (carrots and sticks)Under utilization of leverage (carrots and sticks) Everyone falls into the training trap at some Everyone falls into the training trap at some

pointpoint Each is becoming more sophisticated about Each is becoming more sophisticated about

outcomes measurement (system and clinical) outcomes measurement (system and clinical) and continuous quality improvement approachesand continuous quality improvement approaches

PUBLIC BEHAVIORAL PUBLIC BEHAVIORAL HEALTH CAREHEALTH CARE

Multiple State Agencies and Multiple State Agencies and Governing BodiesGoverning Bodies

Multiple Funding StreamsMultiple Funding Streams Multiple Systems of CareMultiple Systems of Care Severely Limited ResourcesSeverely Limited Resources PovertyPoverty Rural and UrbanRural and Urban Cultural DiversityCultural Diversity

IDENTIFICATION OF NEEDIDENTIFICATION OF NEED

Morbidity and MortalityMorbidity and Mortality Gross Under IdentificationGross Under Identification Inefficient Use of ResourcesInefficient Use of Resources Unmet NeedsUnmet Needs

STRATEGIC ALIGNMENTSTRATEGIC ALIGNMENT

CCISC – Principle-driven Systems CCISC – Principle-driven Systems Improvement ApproachImprovement Approach

CCISC – Supports Implementation of CCISC – Supports Implementation of Evidence-based Approaches and Evidence-based Approaches and Improves Routine PracticesImproves Routine Practices

CCISC – Can be Implemented with CCISC – Can be Implemented with Existing Resources Using Existing Resources Using Traditional Funding StreamsTraditional Funding Streams

IMPLEMENTATIONIMPLEMENTATION Top-down/Bottom-up Development Top-down/Bottom-up Development Aligning the Parts of the System Aligning the Parts of the System Inclusion, not Exclusion (programs and Inclusion, not Exclusion (programs and

populations)populations) Strategic Use of Leverage (Incentives, Strategic Use of Leverage (Incentives,

Contracts, Standards, Licensure, etc….)Contracts, Standards, Licensure, etc….) Outcomes and CQI (CO-FIT 100Outcomes and CQI (CO-FIT 100)) Model ProgramsModel Programs Evaluation of Core Competencies Evaluation of Core Competencies

(COMPASS(COMPASS and CODECAT and CODECAT)) ““Action Planning”Action Planning” Train-the-TrainersTrain-the-Trainers ““Backfilling”Backfilling”

STARTING PLACESSTARTING PLACES

Identification of the Population in NeedIdentification of the Population in Need Administrative Barriers – Access: Administrative Barriers – Access:

Welcoming, No Wrong DoorWelcoming, No Wrong Door Administrative Barriers – Data Capture: MIS Administrative Barriers – Data Capture: MIS

system; feedbacksystem; feedback Administrative Barriers – Fiscal: Billing and Administrative Barriers – Fiscal: Billing and

auditing practice auditing practice Universal Integrated ScreeningUniversal Integrated Screening Assessment Process (ILSA™)Assessment Process (ILSA™) Treatment Matching Treatment Matching Treatment PlanningTreatment Planning Engagement, Stage of Change and Engagement, Stage of Change and

Contingency ManagementContingency Management Evaluation of Trauma Evaluation of Trauma Interagency Coordination Interagency Coordination

PRINCIPLES OF SUCCESSFUL PRINCIPLES OF SUCCESSFUL TREATEMENT…TREATEMENT…

Co-morbidity is an expectation, not an exception.Co-morbidity is an expectation, not an exception. Treatment success derives from the Treatment success derives from the

implementation of an empathic, hopeful, implementation of an empathic, hopeful, continuous treatment relationship, which continuous treatment relationship, which provides integrated treatment and coordination provides integrated treatment and coordination of care through the course of multiple treatment of care through the course of multiple treatment episodes.episodes.

Within the context of the empathic, hopeful, Within the context of the empathic, hopeful, continuous, integrated relationship, case continuous, integrated relationship, case management/care and empathic detachment/ management/care and empathic detachment/ confrontation are appropriately balanced at each confrontation are appropriately balanced at each point in time.point in time.

……PRINCIPLES OF SUCCESSFUL PRINCIPLES OF SUCCESSFUL TREATEMENT…TREATEMENT…

When substance disorder and psychiatric When substance disorder and psychiatric disorder co-exist, each disorder should be disorder co-exist, each disorder should be considered primary, and integrated dual considered primary, and integrated dual primary treatment is recommended, where primary treatment is recommended, where each disorder receives appropriately each disorder receives appropriately intensive diagnosis-specific treatment.intensive diagnosis-specific treatment.

Both major mental illness and substance Both major mental illness and substance dependence are examples of primary mental dependence are examples of primary mental illnesses which can be understood using a illnesses which can be understood using a disease and recovery model, with parallel disease and recovery model, with parallel phases of recovery, each requiring phase-phases of recovery, each requiring phase-specific treatment.specific treatment.

……PRINCIPLES OF SUCCESSFUL PRINCIPLES OF SUCCESSFUL TREATEMENTTREATEMENT

There is no one type of dual diagnosis There is no one type of dual diagnosis program or interventionprogram or intervention.. For each person, For each person, the correct treatment intervention must be the correct treatment intervention must be individualized according to diagnosis, phase individualized according to diagnosis, phase of recovery/treatment, level of functioning of recovery/treatment, level of functioning and/or disability associated with each and/or disability associated with each disorder, and level of acuity, dangerousness, disorder, and level of acuity, dangerousness, motivation, capacity for treatment adherence, motivation, capacity for treatment adherence, and availability of continuing empathic and availability of continuing empathic treatment relationships and other recovery treatment relationships and other recovery supports.supports.

LINKING PRINCIPLES, LINKING PRINCIPLES, IMPLEMENTATION AND IMPLEMENTATION AND

OUTCOMESOUTCOMES Examples:Examples:

PrinciplePrinciple:: Co-morbidity is an Co-morbidity is an Expectation, not an ExceptionExpectation, not an Exception

CQI InitiativeCQI Initiative:: Removal of Removal of Administrative Barriers to Data Administrative Barriers to Data Collection Collection

Measure of SuccessMeasure of Success:: Improved Improved Population Identification and Data Population Identification and Data CollectionCollection

LINKING PRINCIPLES, LINKING PRINCIPLES, IMPLEMENTATION AND IMPLEMENTATION AND

OUTCOMESOUTCOMES Examples:Examples:

PrinciplePrinciple:: Individualized Treatment Matching Individualized Treatment Matching according to diagnosis, phase of according to diagnosis, phase of recovery/treatment, level of functioning/disability, recovery/treatment, level of functioning/disability, level of acuity, dangerousness, motivation, level of acuity, dangerousness, motivation, capacity for treatment adherence, availability of capacity for treatment adherence, availability of continuing empathic treatment relationships and continuing empathic treatment relationships and recovery supportsrecovery supports

CQI InitiativeCQI Initiative:: Integrated Longitudinal Strength- Integrated Longitudinal Strength-based Assessments (ILSAbased Assessments (ILSA))

Measure of SuccessMeasure of Success:: Improved Identification of Improved Identification of Need and Improved Treatment MatchingNeed and Improved Treatment Matching

TRAIN THE TRAINER TRAIN THE TRAINER PROGRAMPROGRAM

ROLES OF THE TRAINERROLES OF THE TRAINER

Develops Systems and Clinicians Develops Systems and Clinicians Identifies Barriers to ImplementationIdentifies Barriers to Implementation Informs Policy and ProcedureInforms Policy and Procedure Bridges Systems and CliniciansBridges Systems and Clinicians Extends Training and TA CapacityExtends Training and TA Capacity

COMPONENTS OF THE COMPONENTS OF THE PROGRAMPROGRAM

Master TrainersMaster Trainers Master Trainer SessionsMaster Trainer Sessions Master Trainer CurriculumMaster Trainer Curriculum Trainings and Technical AssistanceTrainings and Technical Assistance Development and Feedback LoopsDevelopment and Feedback Loops