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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.
October 26, 2005 2
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.
October 26, 2005 3
• ARH celebrated 50 years of service this year. home health agencies. ARH provides continuity of care through a system of hospitals. clinics. is a non-profit healthcare system serving more than 35.000 residents in Kentucky and West Virginia.About ARH-PC • Appalachian Regional Healthcare. (ARH). 2005 4 . Inc. and home care stores. October 26.
• We have four units. • ARH-PC contracts with DMH to serve 21 counties. Dual Diagnosis.5 days October 26. KY . It is a 100-bed distinct part unit of the ARH Regional Medical Center in Hazard.the flagship facility of the organization. • Average length of stay on Dual Unit is 4.About ARH-PC • ARH Psychiatric Center opened in the summer of 1993. and Rehabilitation. with three distinct programs – General. 2005 5 . and works closely with the CMHCs in that service area.
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. 2005 6 . Collaboration means there is no wrong door to receive needed treatment October 26.
October 26. 2005 7 .Approach to IDDT Implementation • Historically substance abuse treatment was not extended to persons with serious mental illness. Mental health professionals did not know how to treat substance abuse and considered it a symptom of the mental illness.
2005 Mental Illness High Severity 8 .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.Co-Occurring Disorders by Severity III High Severity Less severe mental IV More severe mental disorder .
system Consultation etc.Service Location & Coordination High Severity IV III State hospitals. 2005 Mental Illness High Severity 9 . Substance abuse jails/prisons. Collaboration Integrated Services I Primary health care settings II Mental health system Low Severity October 26. emergency rooms.
Any Illicit Drug Use excluding marijuana 2002-2004 October 26. 2005 10 .
Non-medical use of pain relievers October 26. 2005 11 .
2005 12 .Tobacco Use October 26.
Serious Psychological Distress October 26. 2005 13 .
2005 14 . October 26.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.
by Serious Mental Illness: 2001 25 20 20. 2005 Past Year SMI No Past Year SMI .7 Illicit Drugs or Alcohol Illicit Drugs Alcohol 15 Percent with Past Year Substance Dependence or Abuse 15 10 5 0 5.3 15.2 6.3 October 26.3 1.Past Year Substance Dependence or Abuse among Adults Aged 18 or Older.7 9.
October 26. 2005 16 .Goal 1 • Increase continuity and treatment integration for persons receiving dual disorders treatment moving from hospital to community health and behavioral health.
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 .
2005 18 .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 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.
2005 20 .NIATX Technology of Change • • • • • • Change Teams Rapid Change Cycles Plan Do Study Act Clear AIMS Sustainability Measurement October 26.
Change Teams • Group of persons led by change leader who identifies. 2005 21 . one level of care. one location. • Client involvement key • Baseline & measurement • One issue. • Persons close to issue under study. • Change cycle short for each change October 26.
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. 2005 23 .Walk .
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. 2005 24 .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.Walk. but no plan developed for which meeting to attend.
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 .
2005 27 16% 15% 17% 15% 6% 5% June 5% July Aug Sep . Dual Diagnosis (Perry Co.July 2006 35% 30% Percentage 31% 25% 20% 15% 10% 5% 0% Jan Feb 0% Mar Apr May Month October 26.) January .And the results are….
Model of Integrated Treatment Planning October 26. 2005 28 .
• Dr. and is certified by examination of the American Society of Addiction Medicine (ASAM). and costconsciousness.D. October 26. • Past academic appointments have included clinical affiliations in the Departments of Psychiatry at Harvard University. M. he has focused on developing and promoting innovative behavioral health treatment that values clinical integrity. Davis. • David Mee-Lee. high quality. • For over twenty-five years. the University of Hawaii and the University of California.David Mee Lee. 2005 29 . • 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.D. Mee-Lee is involved in training and consultation full-time. M. is a board-certified psychiatrist.
Person Centered Approach • ASAM-PPC • Motivational Interviewing • Client October 26. 2005 30 .
2005 31 .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.
Future Project Goals • ACLADDA – Assertive Community Living for Appalachian Dually Diagnosed Adults – New CSAT/SAMHSA grant • P. 2005 32 .A.K. – Partnership for Advancing Recovery in Kentucky– New Robert Wood Johnson Foundation Grant October 26.R.
com • Wendy Morris..N.N. 2005 33 .D. R. wdmathews@aol. Ph. Director of Adult services Kentucky River Community Care.Thanks for your attention! • David Mathews. Executive Director Appalachian Regional Health Care – Hazard Psychiatric Center wmorris@arh. M.S.org October 26. Inc.