Implementing Integrated Dual Disorders Treatment

An Evidence Based Practices Grant from The Kentucky Department of Mental Health & Mental Retardation Services To Kentucky River Community Care Inc.

• With the assistance of an evidence based practice training grant from the KDMHMRS, KRCC and ARH-PC have undertaken training and system transformation activities aimed at improving treatment and continuity for persons with Serious mental Illness and Substance Use Disorders.
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About Kentucky River Community Care Inc.
•Kentucky River Community Care, Inc., (KRCC) is a private nonprofit Community Mental Health Center dedicated to improving the health and wellbeing of the people of our region. •We help individuals and families in the eight counties of the Kentucky River region by providing mental health, developmental disabilities, substance abuse and trauma services.

•KRCC seeks to promote public safety, boost economic wellbeing and improve community and individual quality of life.
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home health agencies. 2005 4 .000 residents in Kentucky and West Virginia. clinics. ARH provides continuity of care through a system of hospitals. (ARH). • ARH celebrated 50 years of service this year. is a non-profit healthcare system serving more than 35.About ARH-PC • Appalachian Regional Healthcare. and home care stores. October 26. Inc.

and works closely with the CMHCs in that service area. 2005 5 . Dual Diagnosis. • Average length of stay on Dual Unit is 4. with three distinct programs – General.the flagship facility of the organization. It is a 100-bed distinct part unit of the ARH Regional Medical Center in Hazard.5 days October 26. • We have four units. and Rehabilitation. KY .About ARH-PC • ARH Psychiatric Center opened in the summer of 1993. • ARH-PC contracts with DMH to serve 21 counties.

2005 6 . Collaboration means there is no wrong door to receive needed treatment October 26.Why Collaboration? • Persons seeking treatment for co-occurring mental health and substance use disorders often find services through multiple routes such as the hospital emergency room or physical health care professionals.

October 26. 2005 7 . Mental health professionals did not know how to treat substance abuse and considered it a symptom of the mental illness.Approach to IDDT Implementation • Historically substance abuse treatment was not extended to persons with serious mental illness.

Co-Occurring Disorders by Severity III High Severity Less severe mental IV More severe mental disorder .more severe disorder/more severe substance abuse substance abuse disorder disorder I Less severe mental disorder/less severe substance abuse disorder II More severe mental disorder/less severe substance abuse disorder Low Severity October 26. 2005 Mental Illness High Severity 8 .

Service Location & Coordination High Severity IV III State hospitals. system Consultation etc. Substance abuse jails/prisons. emergency rooms. Collaboration Integrated Services I Primary health care settings II Mental health system Low Severity October 26. 2005 Mental Illness High Severity 9 .

Any Illicit Drug Use excluding marijuana 2002-2004 October 26. 2005 10 .

2005 11 .Non-medical use of pain relievers October 26.

Tobacco Use October 26. 2005 12 .

2005 13 .Serious Psychological Distress October 26.

2005 14 .Co-occurring Disorders: Report to Congress 2003 • Consumers bounce back and forth between the mental health and substance abuse service systems • Services need to address both disorders • Substance abuse and mental health disorders reinforce each other • Individuals with alcohol and drug disorders are at risk for mental illness. October 26.

7 9.7 Illicit Drugs or Alcohol Illicit Drugs Alcohol 15 Percent with Past Year Substance Dependence or Abuse 15 10 5 0 5. 2005 Past Year SMI No Past Year SMI . by Serious Mental Illness: 2001 25 20 20.2 6.Past Year Substance Dependence or Abuse among Adults Aged 18 or Older.3 1.3 October 26.3 15.

Goal 1 • Increase continuity and treatment integration for persons receiving dual disorders treatment moving from hospital to community health and behavioral health. 2005 16 . October 26.

Goal 2 • Increase competence of staff and programs in the provision of IDDT among the staffs of KRCC and ARH-PC October 26. 2005 17 .

Goal 3 • Increase staff competence in planning and implementing evidence based process improvement strategies using well researched process improvement techniques such as team which include client involvement in quality improvement October 26. 2005 18 .

2005 19 .NIATX – Process Improvement MISSION: To assist the addiction treatment community in making more efficient use of their treatment capacity and to create an infrastructure for ongoing improvements in treatment access and retention October 26.

NIATX Technology of Change • • • • • • Change Teams Rapid Change Cycles Plan Do Study Act Clear AIMS Sustainability Measurement October 26. 2005 20 .

Change Teams • Group of persons led by change leader who identifies. • Persons close to issue under study. one location. • Change cycle short for each change October 26. 2005 21 . • Client involvement key • Baseline & measurement • One issue. one level of care.

Walk .Through as Method for Identifying Improvements • Staff experience what client experiences • No deception involved • Pairs go through process to understand and analyze • Notes taken by observer • Barriers to client care identified October 26. 2005 22 .

through Results KRCC • Referral form unavailable • Staff did not know process • Form did not include phone number and needed information • Staff not impressed with agency process • Reasons for aftercare not identified with client October 26.Walk . 2005 23 .

2005 24 . but no plan developed for which meeting to attend. or how to stay sober during interim • Collaboration between ARH and KRCC not apparent • Focus on immediate and short term rather than long term goals October 26.Walk.through Results ARH-PC • Extensive discharge planning process evident • Limited explanation given to patient about reason for followup appointments • Focus on mental illness symptoms and medications • NA meeting schedule given.

KRCC Change Team • Included ARH-PC staff • Perry County Outpatient staff • Focused on case management contact and follow up • 100% of study group continued • 40% of contrast group • No readmissions with study group October 26. 2005 25 .

ARH Change Team • Multidisciplinary team from Dual Diagnosis Unit • Focused on bridging gap between inpatient and community resources – Developed community resource brochure – Began giving NA schedule upon admission – Invited NA to provide H&I panel weekly – Encouraged contact with CMHC case worker prior to discharge • Patient surveys showed 90% believed changes were beneficial October 26. 2005 26 .

Dual Diagnosis (Perry Co.) January . 2005 27 16% 15% 17% 15% 6% 5% June 5% July Aug Sep .July 2006 35% 30% Percentage 31% 25% 20% 15% 10% 5% 0% Jan Feb 0% Mar Apr May Month October 26.And the results are….

2005 28 .Model of Integrated Treatment Planning October 26.

M. • Dr.D. October 26. • For over twenty-five years. 2005 29 . the University of Hawaii and the University of California. and costconsciousness. • Past academic appointments have included clinical affiliations in the Departments of Psychiatry at Harvard University. and is certified by examination of the American Society of Addiction Medicine (ASAM). • David Mee-Lee. is a board-certified psychiatrist. Davis. M. he has focused on developing and promoting innovative behavioral health treatment that values clinical integrity.David Mee Lee.D. Mee-Lee is involved in training and consultation full-time. • He has over twenty-five years experience with dual diagnosis (co-occurring addiction and mental illness) treatment and program development since being trained at the Ohio State University. high quality.

Person Centered Approach • ASAM-PPC • Motivational Interviewing • Client October 26. 2005 30 .

Training of Trainers • Final Training 12/11-14/06 • Key staff at KRCC and ARH • Perry outpatient and Dual unit • Medical Staff at both facilities in special session October 26. 2005 31 .

A.R. 2005 32 . – Partnership for Advancing Recovery in Kentucky– New Robert Wood Johnson Foundation Grant October 26.K.Future Project Goals • ACLADDA – Assertive Community Living for Appalachian Dually Diagnosed Adults – New CSAT/SAMHSA grant • P.

. 2005 33 .S. • Wendy October 26. Inc.Thanks for your attention! • David Mathews. Director of Adult services Kentucky River Community Care.N. Ph.D. M. Executive Director Appalachian Regional Health Care – Hazard Psychiatric Center wmorris@arh. R.N.