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Co-occurring psychiatric and substance use
disorders: What’s the fuss?
Richard A. Rawson Ph.D.UCLA Integrated Substance Abuse Programs
San Diego, California
October 2004
What are we talking about?
An oversimplified picture of the behavioral healthcare service systems in the US
Mental Health Services • Leadership-psychiatrists
• Staffing-psychologists, social workers, nurses, MFTs
• Role of medications-Substantial
• Impact of behavioral therapies research-Substantial
• Knowledge of substance use disorders and their treatment Minimal
• Role of self-help-Minimal
Substance Abuse Services• Leadership-A mixture of
recovering addict/alcoholics, business people, professionals
• Staffing-paraprofessionals, with increasing role of professionals
• Role of medications and behavior therapies-Minimal
• Knowledge of psychiatric disorders-Minimal
• Role of self-help-Substantial
The prototype patients for the current service delivery systems
The mental health service system
• The uncomplicated schizophrenic
• The “simple” affective disordered individual
• The “pure” bi-polar patient
The substance abuse service system
• The “plain vanilla” alcoholic
• The addict who uses only heroin
• The stimulant dependent individual w/o other psych diagnoses
What’s the Problem?• Estimates of psychiatric co-morbidity among clinical
populations in substance abuse treatment settings range from 20-80%
• Estimates of substance use co-morbidity among clinical populations in mental health treatment settings range from 10-35%
* Differences in incidence due to: nature of population served (e.g.: homeless vs. middle class), sophistication of psychiatric diagnostic methods used (psychiatrist or DSM checklist) and severity of diagnoses included (major depression vs. dysthymia).
Why are substance use disorders treated in separate systems from other
psychiatric disorders?
How has the split occurred between substance use disorders and other psychiatric disorders?
• Before 1970 in the US, research and treatment for alcoholism and drug abuse were administered out of the National Institute of Mental Health.
• A number of factors prompted the separation of alcoholism/drug abuse into their own specialty areas, distinct and separate from general psychiatry.
Why are substance use disorders treated in separate systems from other
psychiatric disorders?
• A pervasive perception existed among the public and policymakers that the professional fields of psychiatry, psychology and medicine were extraordinarily unsuccessful in providing treatment to addicts and alcoholics; and, that there was a tendency within much of organized psychiatry (and psychology) to avoid alcoholics and addicts as inherently untreatable individuals, incapable of insight.
Why are substance use disorders treated in separate systems from other
psychiatric disorders?• Two major factors prompted the establishment of
new institutes in early 1970s:– Sen. Harold Hughes’ promotion of treatment for employees with alcohol
problems in the workplace was a major influence in the field of alcoholism. Health insurance began to include alcoholism treatment
benefits, EAPs began and NIAAA was created.
– Huge increases in drug experimentation in late 1960s and concerns about returning heroin addicted Vietnam Veterans, prompted public concern
about drug abuse and prompted the creation of NIDA.
Why are substance use disorders treated in separate systems from other psychiatric
disorders?
• The result was:– National Institute of Mental Health (NIMH) responsible for research on
and treatment of psychiatric disorders.
– National Institute on Alcoholism and Alcohol Abuse (NIAAA) responsible for research on and treatment for alcoholism and related issues.
– National Institute on Drug Abuse (NIDA) responsible for research on and treatment of illicit drug problems (and later nicotine).
– Each institute had its own experts, treatment systems, funding streams and each viewed the other as parochial, misinformed and naïve.
– Cooperation was uncommon.
Why are substance use disorders treated in separate systems from other psychiatric
disorders?
• Since early 1970s-– Within treatment settings, alcoholism and drug
abuse disorders are treated within the same treatment system; hence, there are now essentially two service delivery systems:
1. Alcoholism and Other Drug (AOD) system2. Mental health system
– Psychiatry has formally incorporated the study and treatment of substance use disorders as part of psychiatry.
DSM and ICD: The “Bibles”
Studies on Co-morbidity
Most widely cited studies:
•Epidemiologic Catchment Area (ECA) study
•National Comorbidity Study
ECA Study
•Epidemiologic Catchment Area (ECA) Study
•20,291 interviews at 5 sites
•Data Collected 1980 – 1984
•DSM – III Diagnoses
Regier, DA, et al. (1990). Comorbidity of Mental Disorders with Alcohol and other Drug Abuse: Results From the Epidemiologic Catchment Area (ECA) Study, JAMA, 264, 2511-2518
ECA DSM-III Diagnoses (rates per 100 people)
1 Month Lifetime
Any Alcohol, Drug or Mental Health Disorder
15.7 32.7
Any Mental 13.0 22.5
Alcohol Dependence 1.7 7.9
Drug Dependence 0.8 3.5
Regier, et al. (1990)
Lifetime Prevalence and Odds Ratios ECA Study
Alcohol OROtherDrug OR
Any mental 36.6% 2.3 53.1% 4.5
Schizophrenia 3.8% 3.3 6.8% 6.2
Any affective 13.4% 1.9 26.4% 4.7
Anti-social 14.3% 21.0 17.8% 13.4
Alcohol 47.3% 7.1
Regier, 1990
NC Study
•National Comorbidity Study
•8,098 interviews across the country
•Data collected 1990 – 1992
•DSM-III-R Diagnoses
Merikangas, KR, et al. (1998). Comorbidity of substance use disorders with mood and anxiety disorders: Results o the international consortium in psychiatric epidemiology. Addictive Behavior, 23, 893-907.
NCS DSM-III Diagnoses
3641
45
55
37
44
0
10
20
30
40
50
60
Mood Anxiety Antisocial
Alc DepDrug Dep
Merikangas, KR, et al. (1998)
%
NCS DSM-III Diagnoses
1.82.2
2.6
3.0
3.74.0
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
1 2 3
Alc DepDrug Dep
Merikangas, KR, et al. (1998)
OR
Number of mental disorders
Summary
• There is a problem
• We have documented it for a long time
• We need more information to figure out– The current state of affairs– What we do about it
Treatment of Co-occurring Disorders
• Treatment System Paradigms– Independent, disconnected– Sequential, disconnected – Parallel, connected– Integrated
Treatment of Co-occurring Disorders
• Independent, disconnected “model”
– Result of very different and somewhat antagonistic systems
– Contributed to by different funding streams– Fragmented, inappropriate and ineffective care
Treatment of Co-occurring Disorders
• Sequential Model– Treat SA Disorder, then MH disorder– Treat MH Disorder, then SA disorder– Urgency of needs often makes this approach
inadequate– Disorders are not completely independent– Diagnoses are often unclear and complex
Treatment of Co-occurring Disorders
• Parallel Model– Treat SA disorder in SA system, while
concurrently treating MH disorder in MH system. Connect treatments with ongoing communication
– Easier said than done– Languages, cultures, training differences
between systems– Compliance problems with patients
Treatment of Co-occurring Disorders
• Integrated Model– Model with best conceptual rationale– Treatment coordinated best– Challenges
• Funding streams• Staff integration• Threatens existing system• Short term cost increases (better long term cost
outcomes).
Elements of an integrated model
• Staffing– A true team approach including: Psychiatrist
(trained in addiction medicine/psychiatry); Nursing support; Psychologist; Social worker; Marriage and family therapist; Counselor with familiarity with self-help programs. (Others possible, vocational, recreational educational specialists).
Elements of an Integrated Model
• Preliminary assessment of mental health and substance use urgent conditions– Suicidality– Risk to self or others– Withdrawal potential– Medical risks associated with alcohol/drug use
Elements of an integrated model
• Diagnostic process that produces provisional diagnosis of psychiatric and substance use disorders using:
– Urine and breath alcohol tests
– Review of signs and symptoms (psychiatric and substance use)
– Personal history timeline of symptom emergence (what started when)
– Family history of psychiatric/substance use disorders
– Psychiatric/substance use treatment history
Elements of an integrated model• Initial treatment plan that includes (min- one day-max
ten days):
– Choice of a treatment setting appropriate to initially stabilize medical conditions, psychiatric symptom and drug/alcohol withdrawal symptoms
– Initiation of medications to control urgent psychiatric symptoms (psychotic, severe anxiety, etc)
– Implementation of medication protocol appropriate for treating withdrawal syndrome(s)
– Ongoing assessment and monitoring for safety, stabilization and withdrawal
Elements of an integrated model• Early stage treatment plan that includes ( min day 2-max
day 14)– Selection of treatment setting/housing with adequate supervision– Completion of withdrawal medication– Review of psychiatric medications– Completion of assessment in all domains (psychology, family,
educational, legal, vocational, recreational)– Initiation of individual therapy and counseling (extensive use of
motivational strategies and other techniques to reduce attrition)– Introduction to behavioral skills group and educational groups– Introduction to self help programs– Urine testing and breath alcohol testing
Elements of an integrated model• Intermediate treatment plan that includes (up to six
weeks):– Housing plan that addresses psychiatric and substance use
needs– Plan of ongoing medication for psychiatric and substance use
treatment with strategies to enhance compliance– Plan of individual and group therapies and psychoeducation
with attention to both psychiatric and substance use needs– Skills training for successful community participation and
relapse prevention– Family involvement in treatment processes– Self-help program participation– Process of monitoring treatment participation (attendance and
goal attainment– Urine and breath alcohol testing
Elements of an integrated model• Extended treatment plan that includes (up to 6 months):
– Housing plan
– Ongoing medication for psych and substance use treatment
– Plan of individual and group therapies and psychoeducation with attention to both psychiatric and substance use needs
– Ongoing participation in relapse prevention groups and appropriate behavioral skills groups and family involvement
– Initiation of new skill groups (e.g.; education, vocational, recreational skills)
– Self help involvement and ongoing testing
– Monitoring attendance and goal attainment
Elements of an integrated model• Ongoing plan of visits for review of:
– Medication needs
– Individual therapies
– Support groups for psych and substance use conditions
– Self help involvement
– Instructions to family to recognize relapse to psych and substance use
In short, a chronic care model is used to reduce relapse and if/when relapse (psychiatric or substance use) occurs, treatment intensity can be intensified.
Building integrated models• Challenges of building an integrated model
– Cost of staffing
– Training of staff
– Resistance from existing system
– Providing comprehensive, integrated care with efficient protocols
– The most likely strategy for moving toward this system is in increments
• Psychiatrist attend at AOD centers
• Relapse prevention groups introduced to mental health centers
• Staff exchanges; attending case conferences; joint trainings
• Gradual shifting of funding
Treatment of Co-occurring Disorders: Areas of Promise
• Integration of SA treatment and treatment of affective disorders– Depression
• Use of tricyclics and SSRIs produces excellent treatment response in SA patients with depression. Can be used with SA populations with minimal controversy.
• Good evidence of effectiveness with methadone patients, women with alcoholism and depression.
Treatment of Co-occurring Disorders: Areas of Promise
• Bipolar Disorder and SA Disorders– Medications for BPD often essential to stabilize
patients to allow SU treatment to be effective
– Challenges often occur in diagnosis• Cocaine/methamphetamine use disorders often mimic
BPD, medications for these disorders not yet with demonstrated efficacy and do not respond to medications for bipolar disorders
Treatment of Co-occurring Disorders: Areas of Promise
• Schizophrenia and SU Disorders
– Differential diagnosis with cocaine and methamphetamine psychosis can be difficult.
– Medication treatments frequently essential.– Knowledge about medication side effects and the
possibility that these side effects can trigger drug use is important.
Treatment of Co-occurring Disorders: Areas of Promise
• Understanding of neurobiological mechanisms and genetic foundations may provide key knowledge for both sets of disorders.
• Key issues in improving treatment effectiveness – Training, training, training– Increased contact between professionals from both
systems– Flexibility of funding streams– Training, training, training
Treatment of Co-occurring Disorders: Areas of Controversy
• Should the treatment of SUDs be fully incorporated within the mental health system(e.g.;Integrated Behavioral Health Agency)?
• If yes, will treatment protocols unique to substance abuse system be discarded?
• Will funding for SUDs be reduced?
Co-Occurring Disorders Center for Excellence (COCE)
Subcontractor’s Kick-Off Meeting
February 13, 2004
The CDM Group, Inc.
Chevy Chase, MarylandRose M. Urban, M.S.W., J.D., LCSW
COCE Executive Project Director The CDM Group,
Inc.
Co-Occurring Disorders -Advances in the Field
• Better definitions
• Treatment needs better understood
• Improved screening and assessment
• Improved systems and processes
• Evidence-based practices exist
Key COD Products and Technology Transfer Initiatives
• CSAT’s National Treatment Plan, Changing the Conversation;
• CSAT’s Substance Abuse Treatment for Persons with Co-Occurring Disorders TIP;
• CMHS’s Co-Occurring Disorders: Integrated Dual Disorders Treatment Implementation Resource Kit;
• SAMHSA’s Report to Congress on the Prevention and Treatment of Co-Occurring Disorders and Mental Disorders;
• SAMHSA’s Strategies for Developing Treatment Programs for People with Co-Occurring Substance Abuse and Mental Disorders
Contributors to Knowledge Base
• Federal agencies• Grantees (Including COSIG grantees)• States • Service providers• Consumers• Researchers• Addiction Technology Transfer Centers (ATTCs)• Centers for the Application of Prevention
Technologies (CAPTs)• National Mental Health Information Center (NMHIC)
SAMHSA’S VISION FOR COD
PROVIDE LEADERSHIP AND DIRECTION IN DEFINING AND TRANSFERRING THE LATEST EVIDENCE-BASED PRACTICES/ SYSTEMS, SERVICES, & INFRASTRUCTURE TO ALL LEVELS OF THE COD SERVICE SYSTEM
OPERATIONALIZING THE VISION:
SAMHSA’S CO-OCCURRING CENTER
FOR EXCELLENCE (COCE)
COCE APPROACH
COCE will:
• Advance a unified substance abuse and mental health approach;
• Address all levels of client disorder severity; and
• Adapt solutions to the unique needs of each service recipient
What is the COCE?CRITICAL INPUTS
COCE:Analysis Integration Priorities
State/Local Experience &
Innovation
Consumer Needs And
Perspectives
Mental Health,Substance
Abuse,& CODResearch
Federal Policy WORK OF THE COCE
COCE GOALS
SAMHSA’sMission &Priorities
LEADERSHIP IN CLARIFYING
Definitions
Nosology
Measurement
Evidence & Consensus-Based Practices
Unified Approach
AGENDA SETTING
Professional Education
Practice Improvement
Research
Policy
Workforce Development
RESOURCE TO SAMHSA
Logistical/Operational
Execution/Implementation
Informational
ACTIVITIESTraining
Technical AssistanceTraining of Trainers
InstitutesCoordination with other
SAMHSA Centers
PRODUCTSTemplates for Product
DevelopmentTechnical Reports
ArticlesLiterature ReviewsModels of Change
Technology Transfer Principles and Practices
StatePolicy
THE COD SERVICE SYSTEM
Who is the COCE?
CONTENT IMPLEMENTATION
SENIOR FELLOWSe.g.,
Richard Ries, MD
FELLOWSCONSULTANT AND
SUBCONTRACTOR POOL
PLANNING, MANAGEMENT, & ACCOUNTABILITY
EXPERT LEADERSHIP GROUP
SENIOR MANAGEMENT TEAM
Insures accuracy and integrity of scientific and clinical content
Plans and oversees COCE activities
Advises and assists Expert Leaders in developing overall COCE content
Provides expert input on specific COD content areas
Conducts technical assistance, cross-training, and assists in
development of materials
STEERING COUNCIL
Advises SAMHSA and COCE on planning and
conduct of COCE activities
VISION & LEADERSHIP
SAMHSA
CMHSCSAT CSAP
The COCE Team• Awarded as a 5-year contract to The CDM
Group, Inc. (CDM) on September 29, 2003 in association with:– The National Development Research Institutes
(NDRI)– The Center for Behavioral Health, Justice & Public
Policy (CBHJPP) at The University of Maryland– The National Opinion Research Center (NORC) at
the University of Chicago
The COCE Senior Team
• Directed by CDM– Rose M. Urban, J.D., M.S.W., Executive
Project Director– Jill G. Hensley, M.A., Project Director
The COCE Senior TeamCDM
• Michael Klitzner, Ph.D. – Senior Social Scientist
• William Reidy, Jr., M.S.W. – TA/CT Specialist
• Sheldon Weinberg, Ph.D. – TA/CT Specialist
• Robert O’Brien, Ph.D. – Evaluation Adviser
The COCE Senior TeamNDRI• Stan Sacks, Ph.D. – Expert Adviser on Co-Occurring Disorders• JoAnn Sacks, Ph.D. - Director of State Technical Assistance
(TA) • John Challis, B.A., B.S.W. – Project DirectorCBHJPP, University of Maryland• Fred Osher, M.D. – Expert Medical Adviser on Co-Occurring
Disorders NORC• Sam Schildhaus, Ph.D. – Director of the PPG Pilot Evaluation
Other COCE Subcontractors• 52 other staff from key subcontractors:
• Policy Research Associates, Inc. (PRA)• National Addiction Technology Transfer Center;• Regional ATTCs (Northeast/IRETA, Northwest Frontier,
and Pacific Southwest)• National Center on Family Homelessness• The George Washington University• New England Research Institutes, Inc.• Foundations Associates
• Potential Collaboration with:• National Association of State Mental Health Program
Directors (NASMHPD)• National Association of State Alcohol and Drug Abuse
Directors (NASADAD)
The COCE Consultants• 227 expert consultants with a range of expertise
across disciplines, populations, and service settings, including:– Thomas Backer, Ph.D.
– Carlo DiClemente, Ph.D.
– Alan Marlatt, Ph.D.
– Tom McLellan, Ph.D.
– Richard K. Ries, M.D.
– Steven Schinke, Ph.D.
– Douglas M. Ziedonis, M.D.
Providing Guidance: The COCE National Steering Council
• National Association of State Mental Health Program Directors (NASMHPD) – Andrew Hyman, J.D.
• National Association of State Alcohol and Drug Abuse Directors (NASADAD)• State Associations of Addiction Services (SAAS)• National Council of Community Behavioral Health (NCCBH) – Jennifer
Michaels, M.D.• American Association of Addiction Psychiatry (AAAP) – Richard Rosenthal,
M.D.• National Association of Alcohol and Drug Abuse Counselors (NAADAC)• National Mental Health Association (NMHA)• Research Community – Richard Ries, M.D.• Primary Care Community• Consumer/Survivor/Recovery Community – Michael Cartwright• Homelessness Community – Ellen Bassuk, M.D.• Criminal Justice/Drug Court Community – Joe Coccoza, Ph.D.• Tribal/Rural Community – Raymond Daw• Trauma/Violence Prevention Community – Lisa Najavits, Ph.D.
THE COCE AS A CENTER FOR EXCELLENCE
COCE WILL:
• Address the wide range of clinical, administrative and systems issues that impact the quality and accessibility of care for persons with COD
• Address the needs of a broad range of individuals and organizations including practitioners, researchers and scholars, policy makers, administrators, affected populations, and concerned citizens
• Have a multidisciplinary staff who have a common interest in COD and science-to-service
• Emphasize knowledge synthesis, research-to-practice, and dissemination
• Model its message through the application of management, communications, and dissemination science in its own work
• Be responsive to the field’s changing needs and priorities
• Take a long term view of system change and system improvement
THE COCE AS A CENTER FOR EXCELLENCE
COCE IS COMMITTED TO:
• Advancing a unified substance abuse and mental health approach;
• Addressing all levels of client disorder severity; and
• Adapting solutions to the unique needs of each service recipient
THE FOUNDATIONS OF COCE’S WORK ARE
• Evidence-based treatment models and strategies
• Comprehensive and integrated services and systems
• Client/consumer focus and cultural competence
• Quality improvement process
TOOLS FOR EXCELLENCE:
Services and Service Systems
Infrastructure Special Populations
Prevention Principles of Care Children and Adolescents
Screening Legislation and Regulation
Children of Individuals with COD
Assessment Standards (Federal, State, Other)
Women
Treatment Planning Credentialing Gay, Lesbian, Bi-Sexual, Transgendered
Treatment Service Staff Development and Training
Geriatric
Support Services System Coordination Supports
Ethnic/ Linguistic Minorities
Service Integration Information Systems Homeless
System Integration Health Care Finance Criminal Justice Involved
Evaluation/Research Persons with Medical Comorbidity
Resources
* Each category contains several subcategories, allowing greater specificity
COCE Conceptual Framework
TOOLS FOR EXCELLENCE:
COCE Conceptual Framework
COD SCIENTIFIC BASE – e.g.
COD TIP
OTHER TIPS
COD TOOL KIT
REPORT TO CONGRESS
NEW FREEDOM INITIATIVE
POSITION PAPERS & TECHNICAL
REPORTS – e.g.
Screening Assessment & Treatment Planning
Definitions
Training and Workforce Development
PRODUCTS – e.g.
Training
Technical Assistance
Monographs
Curricula
Fact Sheets
Treatment Services
SCIENCE-BASED COD PRINCIPLES
Etc.
COCE SCIENCE TO SERVICE PROCESS
Etc.
TOOLS FOR EXCELLENCE:
THE COCE BRAIN TRUST
SENIOR FELLOWS
e.g.,
Richard Ries, M.D.
FELLOWS
EXPERT LEADERSHIP GROUP
Stan Sacks, Ph.D.
Fred Osher, M.D.
Rose Urban, J.D., MSW
STEERING
COUNCIL
COCE’s Target Audiences• States that have received Incentive Grants for
Treatment of Persons with Co-Occurring Substance Related and Mental Disorders (COSIGs)
• States selected for the COD Policy Academy• Selected Data Incentive Grant (DIG) States and State
Data Infrastructure (SDI) Grants • Sub-State entities including cities, counties, tribes and
tribal organizations• Providers (community-based, educational
establishments, homelessness system, criminal justice, other social and public health)
The COCE Technology Transfer Approach
Technology Transfer
Principles:• Relevance• Credibility• Clarity• Feasibility• Psychosocial factors
Practices:• Matching goals to
readiness• Interpersonal
strategies• Organizational
support• Use of:
– Translators– Early adopters– Champions
• Peer networking• Follow-up and
support
CRITICAL INPUTS
State/Local Experience &
Innovation
Consumer Needs And
Perspectives
Mental Health,Substance
Abuse, & CODResearch
Federal Policy
SAMHSA’sMission &Priorities
StatePolicy
COCE Technology Transfer Mechanisms
• Provide technical assistance • Provide training• Prepare and distribute state-of-the-art materials on COD• Analyze materials and develop taxonomies • Design and manage a co-occurring disorders Web site• Support regional and National meetings• Develop and conduct a pilot evaluation of the co-occurring
Performance Partnership Grant (PPG) measures• Sustain technical assistance and cross-training through
coordination with SAMHSA’s existing TA/CT sources
Technical Assistance• Individual and Group• On-Site • Off-Site
– Telephone– Literature Reviews– Networking– Web sites– General Information– Materials, reports, etc.
Select TA/CTProviders
Field Requestsand Assess
Needs
Develop TA/CTPlan
Off-SiteCOCE Staff
and/or Consultant TA/CT Provider(s)
perform TA/CT activities:TelephoneLit ReviewsNetworking
Web site
On-Site
DevelopConsultation
Plan
Plan and ManageLogistics
Evaluation andReporting
Pre-Delivery Phase
Post-Delivery Phase
Follow-up
On-Site TA/CT
Delivery
COCE TA Coordinator
Support
On SiteOff-SiteBoth
MaintainFiles
To Inform SimilarTA Events
Off-Site
COCE Technical Assistance Delivery Process
Interim TA Plan
• Pilot of TA Plans and Procedures• Federal Project Officer Reviews and Approves TA
Plan Before Services are Provided• Pilot Findings used to Refine Process for Full-
Scale Rollout
Training
• Training of Trainers (TOT)– Addiction Technology Transfer Centers (ATTCs)– Centers for the Application of Prevention Technology
(CAPTs)– States– Provider Organizations (e.g., NCCBH, SAAS)
• Cross-Training (CT)• Curriculum Development
Materials Development and Analysis
• Position Papers
• Monographs
• Training Curricula
• Brochures
• Newsletter
• Fact Sheets
• Program Briefs
CLINICAL CAPACITY BUILDING
INFRASTRUCTURE DEVELOPMENT
Screening, Assessment, and Treatment Planning
Financing Mechanisms
Treatment Services Certification and Licensure
Terminology, Nosology, Definitions
System Integration
Training and Workforce Development
Services Integration
Evaluation and Monitoring
Information Sharing
COCE Web Site
Will be designed to:
• Motivate exploration of COD;
• Clarify users’ interests and concerns;
• Guide users to relevant information; and
• Provide users with support in understanding and using information.
Regional and National Meetings
• Annual National meeting• Three regional meetings in year 1, four regional
meetings in years 2-5– Increase awareness of recent research– Bridge the gaps between research, practice, and policy– Form and sustain relationships among providers across
constituencies– Create peer networks – Provide cross-training of providers
The COCE Contract Emphasizes Sustainability
Early and substantive linkages with:– CSAT’s Addiction Technology Transfer Centers (ATTCs)– CSAP’s Centers for the Application of Prevention
Technology (CAPTs) (6 regional centers)– CMHS’s National Mental Health Information Center
(NMHIC) Development of sustainable systems of technology
transfer Establishment of science-based practices as the norm Impact on agendas of knowledge producers to better
meet the needs of a science-to-service model
Role of the Subcontractors• Policy Research Associates (PRA) – Criminal Justice
Expertise• National Center on Family Homelessness –
Homelessness Expertise• George Washington University – Treatment Systems
Finance and Organization; Cross-Systems Infrastructure Expertise
• New England Research Institutes, Inc. (NERI) – Financial Strategy Development and Analysis Expertise
• Foundations Associates (FA) – Consumer/Recovery Community Expertise
Role of the ATTCsCURRENT PARTNERS
National ATTC
NE ATTC NW ATTC SW ATTC
• Coordinate ATTC activities with COCE activities
• Logistical support for NE ATTC TOTs
• Plan for marketing & dissemination of COCE products through ATTCs
• Convene an ATTC COD Workgroup to collaborate with COCE
• Work with COCE to design and implement a TOT for ATTCs
• Adapt COCE products and services to meet specific ATTC needs
• Assist in convening ATTC COD Workgroup
• Provide advice and planning concerning dissemination of COCE knowledge throughout the ATTC system
• inventory existing COD-related ATTC materials/databases; assess these for suitability for COCE efforts; and assist in revising for SAMHSA content clearance, if necessary
• Assist in convening ATTC COD Workgroup
• provide consultation to COCE staff on developing and/or revising curricula and training materials on COD for use by the ATTCs, particularly with respect to evaluating treatment outcomes
MAXIMUMIMPACT
MotivateOrientTrain
Role of the ATTCs
CURRENT ATTC
PARTNERS
OTHERATTCs
THE COD FIELD
COCE TimetableSep 29 – Dec 30, 2003• Conceptualize Approach and Develop Plans• Initial COSIG Meeting December 15-17Jan 1 – Mar 31, 2004• Provide Interim TA• Establish Coordination Mechanisms• Convene National Steering Council• Convene COSIG, DIG, and SDI Grants Involved in the PPG Pilot
EvaluationApril 1, 2004• Full TA services• Continued development of
– COCE infrastructure– Linkages– TIP– Curricula– Other materials– Web site
How to Request COCE Services• Requests for services must be in writing• Direct requests to:
– [email protected] or– COCE Phone Line: 301-951-3369
• Questions?– Jill Hensley, COCE Project Director
301-654-6740 (x 201)
– George Kanuck, Federal Project Officer301-443-8642