INNOVATIONS IN INTEGRATED
TREATMENT FOR CO-OCCURRING
MENTAL HEALTH AND ADDICTION
CONDITIONS
NYAPRS 7th Annual Executive Seminar on Systems Transformation
Presenter: Shelley Scheffler Ph.D., LCSW
Integrated Care Specialist
April 27-28 2011
New York City. N Y
Introduction
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Title:
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Location:
Center for Excellence in Integrated Care
Funded by: New York State Health Foundation
In coordination with:
New York State (NYS) Offices of
Mental Health (OMH) and of
Alcoholism & Substance Abuse
Services (OASAS)
NDRI
Start Date: November 1, 2008
Period:
4 years
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•What does CEIC do?
•Provides technical assistance
(hands-on, intensive, and longitudinal)
 Engages Leadership
 Performs on-site assessments
 Presents site reports
 Conducts provider forums
 Builds collaborations and informal networks
 Holds Peer Recovery Workshops
 Supplies ongoing support, guidance,
and consultation
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WHY DO WE NEED TO MEASURE
CO-OCCURRING CAPABILITY?
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Generic terms like “integrated care” amount to “feel good” rhetoric but
lack specificity.
Full integration (a clinician or program fully treating both mental health
and substance use conditions) is often presented as the only model of
integration.
In reality, programs who’s history and culture are much closer to
substance abuse or mental health only are more likely to move towards
more intermediate levels of integration (co-occurring capable)
Ultimately we will have a system with a range of levels of integration
(capable to enhanced )
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COD Enhanced
COD Capable
Fully Integrated
COD Integrated
COD Enhanced
Addiction Only Tx
Building Co-occurring Capability
OMH / OASAS COD Targets
• COD Screening
• COD Domains of Assessment
• COD Evidence Based Practices
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•CEIC Assessment Methods
 Uses DDCA[MH]T
 Samples individual clinics within regions
 Employs direct onsite observation
 Scores and reports on 7 domains separately
and in total
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Levels of Capability
(DDCAT or DDCMHT survey)
LEVELS OF CAPABILITY
DIMENSIONS OF
CAPABILITY
S.A./M.H.ONLY
CAPABLE
ENHANCED
I
Program Structure
Program mission, structure and financing, format for
delivery of co-occurring services.
II
Program Milieu
Physical, social and cultural environment for persons
with mental health and substance use problems.
III
Clinical Process:
Assessment
Processes for access and entry into services,
screening, assessment & diagnosis.
IV
Clinical Process:
Treatment
Processes for treatment including pharmacological and
psychosocial evidence-based formats.
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Continuity of Care
Discharge and continuity for both substance use and
mental health services, peer recovery supports.
VI
Staffing
Presence, role and integration of staff with mental
health and addiction expertise, supervision process
VII
Training
Proportion of staff trained and program’s training
strategy for co-occurring disorder issues.
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•
Dual Disorder Capability
•Enhanced
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(N=251)
•closer to
Capable than to
Basic
•Capable
•Basic
•3.06
•3.05
•2.71
•Total Score
•2.74
•2.5
•Program
Structure
•2.53
•2.53
•Program •Screening & •Treatment •Continuity
Milieu
Assessment
of Care
•2.5
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•Staffing
•Training
•Scores based on DDCA[MH]T = Dual Diagnosis Capability in addiction [Mental Health] Treatment Index
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Observations
 The outpatient system has moved away from addiction and mental
health only status, and is moving towards co-occurring capable levels of
care.
 The outpatient mental health system is repositioning itself to provide
services for mild to moderate levels of substance abuse. (Quadrant 2:
high mental health – mild to moderate substance abuse)
 The outpatient substance abuse treatment system is repositioning itself
to provide services for mood and anxiety conditions. (Quadrant 3: high
substance abuse – mild to moderate mental health)
 Consumers with high severity of mental health and addiction (Quadrant
4: high substance abuse – high mental health) still have very few
service options, however more integrated collaborations between
substance abuse and mental health clinics have the potential to
address this significant gap.
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Issues for consideration
 With an average score of 2.71 the OASAS and OMH outpatient system is
moving towards a co-occurring capable level of service integration.
 The two systems are remarkably close in their capability scores2.76 OASAS, 2.67 OMH- the staffing domain is the only area with
any statistical significance.
 Its now feasible to consider that in time, a baseline of co-occurring capable
is achievable across the two systems.
 As programs who are currently in the midrange ( 2.71), move to capable
status there will be further movement of those currently capable (3.00 3.66), to more enhanced levels of care, however greater resources are
required to accomplish the latter
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Issues for consideration
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Programs who have undertaken a measure of their current co-occurring
capability using the DDCAT or DDCMHT are in a better position to target
specific areas requiring co-occurring competency building training.
Programs who have undertaken a measure of their current co-occurring
capability using the DDCAT or DDCMHT and then implement
recommendations to increase capability can use the same tool to guide
their evaluation of outcomes of changes in their capability
The results of each survey provides individual programs with possible
recommendations for increasing their co-occurring capability.
The aggregate trends that emerge from all programs surveyed across
the state will assist decision makers in identifying larger issues of
systemic change that could be considered for advancing capability.
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Key issues for building capability
 Not all programs have implemented a recommended co-occurring
screener and when implemented many programs lack a clear
protocol when a positive cut-off score is determined.
 Stage-wise assessment and treatment has not been incorporated
into most programs.
 Specialized interventions with either mental health or substance
abuse content are variable in treatment schedules and in a number
of cases non-existent.
 The systematic inclusion of peer recovery support positions for
patients with cod is a significant issue for most programs with the
majority rating poorly on the survey
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Key issues for building capability
 Out patient programs vary considerably from those that offer core
components of treatment to those where treatment is driven almost
entirely by individual clinician preference. In the case of the latter it
is proving far more difficult to implement programmatic change
 The implementation of recommended co-occurring evidence-based
practices at a programmatic level is at its infancy. This also is
consistent with a system that is moving from “only to capable”
 For many programs the next step in capability building will be to
increase either the mental health or the substance abuse content of
their existing treatment regimes rather than the implementation of a
specific cod evidence based practice.
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•"CEIC receives support (awards 208-2496857 & 2009-3426912) from the New York State Health Foundation (NYSHealth)."
Contact Information
Center for Excellence in Integrated Care
(CEIC)
71 W 23rd Street, 8th Floor
New York, NY 10010
tel 212.845.4400  fax 212.845.4650
www.nyshealth-ceic.org 
CEIC receives support (awards 208-2496857 & 2009-3426912)
from the New York State Health Foundation (NYSHealth)
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