CPI Brings Best Practices to NYS
Focus on Integrated Treatment for
Co-Occurring Disorders (FIT)
Nancy Covell, Ph.D.
Paul Margolies, Ph.D.
Forrest Foster, MSW
Center for Practice Innovations
at Columbia Psychiatry
September 15, 2011
Agenda
• Review of participants’ interests and
experiences
• Questions for participants
• Integrated treatment – what is it and why
is it important?
• CPI’s efforts to bring theses services to
consumers in NYS
• How can you find out if these services are
being provided by an agency/program?
Question
True or False:
It is important to get a substance use
problem under control before dealing with
mental health issues.
Answer
False
Mueser, Noordsy, Drake & Fox (2003)
Question
For individuals who have been diagnosed
with both a serious mental illness and a
substance use problem – is it best to
receive treatment for substance use from
agencies that offer only substance use
treatment so that they can fully
concentrate on this issue?
Answer
No
Drake, RE, Essock, SM, et al. (2001). Psychiatric Services, 52, 469-476.
Question
Traditionally, have people who have been
diagnosed with both a serious mental
illness and a substance use problem been
able to receive treatment for both issues
simultaneously at either mental health or
substance use treatment programs?
Answer
No
Mueser, Noordsy, Drake & Fox (2003)
Question
True or False:
Group treatment for co-occurring disorders
has not been found to be helpful.
Answer
False
Mueser, Noordsy, Drake & Fox (2003)
Question
True or False:
Practitioners can’t really help to motivate
someone with co-occurring disorders.
Motivation is the person’s responsibility.
Answer
False
Mueser, Noordsy, Drake & Fox (2003)
Integrated treatment –
what is it and why is it important?
What is integrated treatment for people
with co-occurring mental health and
substance use disorders (COD)?
Both mental health and substance
use treatment provided by the same
clinician or team.
Receive treatment whether you
walk into an OMH-licensed or
OASAS-certified program.
No Wrong Door
What does integrated treatment
for COD include?
•
•
•
•
•
•
Assertive outreach and engagement
Screening and assessment
Motivational interventions
Education about mental health and substance use
Counseling – group, individual and/or family
Staged interventions to target an individual’s stage
of readiness for change
• Linkage to 12-step programs
• Long-term and comprehensive perspective
• Culturally sensitive
Drake, RE, Essock, SM, et al. (2001). Psychiatric Services, 52, 469-476.
Integrated Treatment for COD is Effective!
Majority achieve abstinence or lessen
substance use substantially.
Most experience improvements in:
 independent living
 control of symptoms
 competitive employment
 social contacts with people who don’t use
substances
 overall life satisfaction
Drake RE, Mueser KT, Brunette MF, et al. (2004). A review of treatments for people with severe mental illnesses and
co-occurring substance use disorders. Psychiatric Rehabilitation Journal, 27, 360–374.
Essock SM, Mueser KT, Drake RE, et al. (2006). Comparison of ACT and standard case management for delivering
integrated treatment for co-occurring disorders. Psychiatric Services, 57, 185-196.
Why is treatment for COD important?
During 1 week of 2003, in NYS:
• OMH programs: ~ 18% COD
• OASAS programs: ~ 30% COD
Conservative estimate because in our
programs, recording more than one diagnosis is
not required and is not usually done. Thus,
many people who present with both issues do
not receive diagnoses that reflect this reality.
The number of New Yorkers who can
benefit from treatment for COD is huge!
CPI’s efforts to bring theses
services to consumers in NYS
Focus on Integrated Treatment
Funded Jointly by
and
What is Unique about FIT?
We offer all training
and supports online.
We are one of a few
blazing this new trail.
Advantages to Distance Learning
Practitioners do not leave the
office for extended periods to
obtain training.
No cancelled resulting in lost
resources.
Travel costs are eliminated.
Advantages to Distance Learning
Log in and complete
modules when convenient.
New staff trained immediately
and consistently.
Re-review modules
any time.
35 Modules Available
Recovery
Stories
Interactive
Exercises
Video Skill
Demonstrations
Modules Address Core Competencies
of Integrated Treatment
Motivational
Interviewing
Cognitivebehavioral
therapy
Stage-wise
Treatment
Screening &
Assessment
Peer recovery
supports
Individual collaborative
treatment
Supervision
Leadership
Capability & Fidelity
What learners are saying
“I love the trainings. They are so welcome
because it is difficult to get out of the office. I
enjoy learning more about substance abuse
and value the melding of the two disciplines.”
“Very clear, effective presentation
of different types of supervision.”
“I like the mix of video and text. The information
about stages of treatment and stages of change
gives one some very concrete information which I
can directly utilize when working with an
individual”
What learners are saying
“I like the way you showed a real person in a real
situation. It made it easy to identify with the person
and view their needs as able to be met in
manageable steps ... the steps of each module were
broken down to make them easy to learn,
manageable and much in the same way I would hope
I treat my clients.”
“This module addresses the critical issue of what
leadership should look like, and what a leader
should be doing. The sections about supervision
were excellent.”
“It reinforced my beliefs about what my agency needs to
do to move our integrated program forward.”
Award-Winning
Brandon Hall Gold, Communicator, and 2 Silver Omni Intermedia
Module Demonstration
(10-15 minutes)
Supports for Implementation
Distance Implementation Supports
Monthly
Online
Discussions
and Calls
Developing
Supervisor
Skills
Practice
Improvement
Networks
Reach of FIT as of July 31, 2011
• 503 programs actively participating in FIT
• Programs include mental health-licensed
and addictions treatment-certified
facilities across a variety of delivery
settings (e.g., inpatient, outpatient,
residential)
• 5,570 individuals from those programs
registered in the learning community
Cumulative Number of FIT Modules – ALL Programs
14000
12000
10000
8000
6000
4000
2000
0
Nov.
09
Jan.
10
Apr.
10
Jul.
10
Oct.
10
Completed (n=12,699)
Jan.
11
Apr
11
Jul
11
For more information, visit our Website
http://practiceinnovations.org/
How can you find out if these
services are being provided by
an agency/program?
Ask the agency/program:
• What percentage of consumers in your
program have mental health and substance
use problems?
• Do you offer integrated treatment for mental
health and substance use problems?
• Do these services take into account the
individual’s stage of readiness for change?
How?
• Do you offer groups specifically designed for
co-occurring disorders? What is their focus?
Ask the agency/program:
• Do you offer access to 12-step programs?
• How many of your staff members provide this
kind of treatment?
• How have your staff been trained to provide
this kind of treatment?
Questions and Answers