Center for Mental Health Services/Center for Substance Abuse
Treatment (CMHS/CSAT) Collaboration Meeting on
Co-occurring Disorders
Summary Report
Background
This report contains a summary of the Center for Mental Health Services/Center for
Substance Abuse Treatment Collaboration Meeting on Co-occurring Disorders that
occurred in Washington, DC on September 27-28, 2004.
The meeting was the outcome of a year long effort exploring the challenges and
opportunities to bridge gaps between the Center for Substance Abuse Treatment (CSAT)
and Center for Mental Health Services (CMHS) funded communities. The goal of the
meeting was to facilitate a process that will lead to the implementation of action plans for
future collaboration between funded communities and eventual transformation of services
to youth with co-occurring disorders.
The meeting brought together four system of care communities funded by CMHS and
five communities funded by CSAT. There were representatives from a CMHS system of
care community and at least one CSAT-funded community from each of the following
areas of the country: Connecticut; St. Louis, Missouri; Cuyahoga County, Ohio; and
Oakland/San Francisco, California. The four communities were selected by Federal
administrators, the Substance Abuse Senior Advisor, and consultants based on many
factors including current resources, geographic proximity, and motivation and readiness
to collaborate across CMHS/CSAT youth programs.
The CMHS system of care communities represented at the meeting were as follows:
1.
Urban Trails, Oakland and San Francisco, California,
2.
The Partnership for Kids (PARK Project), Bridgeport, Connecticut,
3.
Transitions, St. Louis, Missouri,
4.
Project Tapestry, Cuyahoga County, Ohio.
The following CSAT communities were represented at the meeting:
1.
Strengthening Communities for Youth, Cuyahoga County, Ohio
2.
Hartford Youth Project, Hartford, Connecticut
3.
Community Treatment Options Project (CTOP), Alameda County, California
4.
Enhancing Support for Substance Abusing Youth (ESSAY), St. Louis,
Missouri
5.
Greater Bridgeport Adolescent Pregnancy Program, Bridgeport, Connecticut.
Meeting Format
Fifty-five participants, including representatives from CMHS/CSAT communities,
consultants, and Federal administrators, participated in the meeting. Throughout the two
days, communities had the opportunity to connect with others in their region, discuss
concerns about collaboration with content experts and Substance Abuse and Mental
Health Services Administration (SAMHSA) administrators, provide recommendations for
program change, and network with one another.
The meeting agenda was developed with extensive feedback from participating
communities and technical assistance consultants. The communities determined that the
meeting format needed to a) maximize peer to peer dialogue time, b) allow for focused
discussions with Federal administrators, and c) include presentations to illuminate critical
aspects of each topic area. The meeting agenda focused on the following five topic areas:

Opportunities for Collaboration: Overview of CSAT and CMHS Program
Requirements – Question and Answer Discussion with SAMHSA Grants
Management Officers.

Financing Care: Presentations on the different avenues for Medicaid financing of
children’s mental health and substance abuse treatment including: state specific
regulations, EPSDT, 1915 B & Waivers, and 1115 Waivers.

Evaluation and Management Information Systems: Presentations on how to
decide what is most needed before developing an integrated management
information system.

Clinical Practices for Co-occurring Disorders: Presentations including the
family voice in treatment, epidemiology, comprehensive assessment, treatment
planning, psychopharmacology, victimization, continued care, and integrated
community treatment for youth with co-occurring disorders.

Infrastructure Development: Communities developed answers to a list of
questions concerning integration across: governing boards, cross- training, social
marketing, technical assistance, program development, and workforce
development.
Communities recommended that the meeting should end with a report-out of communitygenerated recommendations and action plans, followed by a response from SAMHSA
administrators (Gary Blau, Chief of Child, Adolescent and Family Branch (CMHS) was
available). The meeting was scheduled to end with a “talking circle” to allow for
inclusive, reflective, and intuitive feedback on the meeting process.
Outcomes
The meeting produced a variety of outcomes. One important outcome was the
networking that occurred between communities through discussions and strategy
development. For several community participants, these discussions marked the first
opportunity that they had to work with others in similar geographic regions. In addition,
this was the first time communities had the opportunity to converse directly with
SAMHSA administrators on the topic of CSAT/CMHS collaboration.
Tangible outcomes from the meeting included: a) four community-specific action plans,
b) fifteen recommendations for SAMHSA’s consideration, c) responses from Gary Blau
and, d) presentation notes and PowerPoint slides (See Appendices).
Action Plans
After a series of discussions with Federal administrators, presentations, and discussions
with content experts, communities developed a list of follow up activities.
Missouri
 Cross Training – Increase CSAT (ESSAY project) staff that attend CMHS
(Transitions) training and education committee meetings
 Increase governing board focus on CSAT (ESSAY Project)
 Increase collaboration around co-occurring disorders
 Introduce Global Appraisal of Individual Needs (GAIN) screening tool into
Transitions project
Connecticut
 Will share resources and support one another in developing an evidence-based
practices training initiative
 Will request supplemental funds from Federal resources to support cross-training
 Regional Department of Children and Families directors will facilitate meetings
with all provider types to coordinate planning to serve youth with co-occurring
disorders
 Will request technical assistance on how to create better linkage to increase cooccurring treatment capacity through supplemental funding and/or through
incentives
 Gather information on what the Federal branch is doing to help with workforce
development
California
 Will work together to increase access to co-occurring services for youth by
developing provider, state, and local partnerships for Medicaid waivers



Will focus on social marketing efforts to link programs to target populations
within primary health care and juvenile justice settings (e.g. pediatricians and law
enforcement agencies)
Will focus on workforce development through increased cost sharing, training,
and partnerships with human services agencies in Alameda county
Training curricula expansion could focus on the following:
a) Global Appraisal of Individual Needs (GAIN) training and support
b) Cultural competency
c) Cross discipline
Ohio
 Develop an integrated treatment program that uses a blended funding stream
 Create and send a letter to Gary Blau and Randy Muck to initiate the development
 Hold annual retreats with all SAMHSA youth grantees as a mode to increase
networking
 Develop social marketing plan
a) Highlight the CSAT-SCY management information system
b) Trainings with a common agenda
 Need to develop collaborative training plan
a) Evidence-based treatment
b) Wraparound
Recommendations to SAMHSA
In order to increase the development of co-occurring treatment for youth and families, the
meeting participants had the following recommendations for the Substance Abuse and
Mental Health Services Administration (SAMHSA):
1.
2.
3.
4.
5.
6.
Build a culture of collaboration within the agency and among other funding
sources (including CSAP).
Help influence Federal and state Medicaid staff for increased collaboration of
SA/MH. Center for Medicaid Service representatives should attend CSAT and
CMHS meetings and conferences for collaborative discussions on financing
issues.
Prioritize the development of an integrated management information system
(MIS). CSAT has begun implementation across several communities; CMHS
should dovetail with that effort.
Promote (and fund long-term) the development of practice-based evidence on
treatment. This includes a family service approach.
Support efforts to braid or blend funding across existing grantees to develop a
system of “no wrong door” for co-occurring treatment.
Reduce the burden of the individual-level evaluation in the following ways:
 allow the use of local protocols to determine which evaluation should be
used for families that are involved with both CSAT and CMHS grants.
7.
8.
9.
10.
11.
12.
13.
14.
15.
The project officer and a team of community liaisons should discuss this
together.
 reduce the length of the follow-up protocol.
 focus the evaluation on the clinical intervention and treatment planning
and services delivered (including claims).
Work with colleges and universities to improve their curriculums around cooccurring disorders for youth and include youth and families as trainers.
Provide specific TA for making the evaluation useful at the community level
(see above on evaluation and clinical reports) and how to share data across
grants.
Do not allow the encryption of data that makes it difficult to use at the local
level and share across CSAT and CMHS communities. Communities would
like to use evaluation software at the local level that gives them access to the
data even if they are required to export data to a Federal contractor.
Advocate and work with states to enable grantees to:
 share information.
 facilitate state/local requirements.
 access data more easily.
Develop an evaluation tool specifically designed for integrated treatment.
Facilitate a community feedback process and include the community voice in
the development of the RFA’s for SOC technical assistance and evaluation.
Prioritize and create more opportunities for peer-to-peer discussion.
Prioritize (fund) and create more opportunities for TA on clinical usefulness
of evaluation tools and make immediately available reports that can be
generated from the evaluation data. Build on the CSAT GAIN reporting
functions (individual clinical profile and narrative) and its ability to help with
treatment matching and planning.
Provide information through written and peer-to-peer communication on
pragmatic strategies for clinical, financial, family-informed, systemic
organizational, and pragmatic sustainability strategies (lessons learned) and
the outcomes from the SOC/CMHS-CSAT grants
Response to Action Plans and Recommendations (Gary Blau-SAMHSA)
Gary Blau, Chief of the Child, Adolescent and Family Branch, responded to the
community action plans and recommendations in a positive and complementary tone. He
remarked that this meeting helped him to recognize the necessity of more peer to peer
learning opportunities. He expressed enthusiasm about the proposed community action
plans and the development of cross training and integrated programs for youth with cooccurring disorders. He reinstated his belief that communities must help take
responsibility for the creativity and the collaboration efforts to develop co-occurring
programs. He stated that an ability to braid funding is important to SAMHSA. He
believes CMHS and CSAT should seek guidance from the Center for Medicaid Services
(CMS). During the meeting, it was stated that Randy Muck and Doreen Cavanaugh are
currently working with CMS to convene a conference to examine funding for youth.