December 11, 2008

WAITING FOR A MIRACLE

Dianne Asher talks about her own conversion to integrated treatment and how it has changed her professional life

—by Paul M. Kubek and Matthew K. Weiland

Lawrence, Kansas—Before getting a formal introduction to the Integrated Dual Disorder Treatment (IDDT) model, Dianne Asher, LSCSW, CADC-I, often felt frustrated and powerless in her work as a case manager and team leader. She did not have the training to understand and address the complex clinical circumstances faced by many people with severe mental illness who also have a co-occurring substance-use disorder.

In the 1990s, she sought the training she wanted and needed and became one of the first practitioners in the Sunflower State of Kansas to be introduced to IDDT, which helped transform her approach. In 1999, Asher was recruited by The University of Kansas School of Social Welfare to lead the implementation of IDDT in that state and has been an IDDT project manager and consultant-trainer there ever since. In this role, she trains, consults, and presents regularly about IDDT, Motivational Interviewing (MI), and clinical supervision throughout Kansas and across the United States, often sharing stories of consumer recovery from her own experience to demonstrate the effectiveness of integrated treatment. Asher brings over 25 years of experience in mental-health and substance-abuse treatment to her work.


THE CONVERSATION

At the Annual Ohio SAMI CCOE/IDDT Conference that took place in Columbus, Ohio, on September 16 & 17, 2008, Asher presented a workshop, titled "Supervisory Skills for Effectively Implementing Evidenced-Based Practices." The Ohio SAMI CCOE is an initiative of the Center for Evidence-Based Practices at Case Western Reserve University. Prior to her workshop, she joined us for a discussion about the importance of focused clinical supervision—a challenge for many IDDT team leaders—as well as her life's work before and after her introduction to the IDDT model.


1.) Pioneers in IDDT (2m 41s)
As a case manager and team leader in the days before IDDT, Dianne Asher witnessed the ineffectiveness of traditional addiction treatment for people with severe mental illness. Then Kansas joined the IDDT revolution.
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2.) Waiting for a Miracle (2m 30s)
Asher remembers one consumer sitting at home in the throes of addiction recovery waiting hopelessly for a miracle to happen. It inspired her to become certified in addictions counseling on her own.
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3.) A Motivational Moment (2m 3s)
Cognitive impairments from severe mental illness made this consumer's addiction treatment inaccessible to him: he did not have the ability to distinguish the figurative from the literal.
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4.) Two Steps Forward (1m 54s)
The stages-of-change model helped Asher evaluate the readiness of each consumer to start his or her recovery journey, or take it to the next level, (part 1).
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5.) Breaking Down the Barricades (2m 13s)
The stages-of-change model helped Asher evaluate the readiness of each consumer to start his or her recovery journey, or take it to the next level, (part 2).
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6.) IDDTMeets DBT (2m 15s)
The right tools for each job: specific treatments for specific kinds of disorders improve outcomes and, thus, staff satisfaction, reducing burn-out and attrition.
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7.) IDDT Does Take Time (1m 18s)
The duration of IDDT implementation is one of the greatest challenges to a service team, an organization, and systems of care, especially since time is always at a premium. But the outcomes are worth it.
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8.) Supervising Through Stages (2m 9s)
To implement IDDT successfully, know what stage of change each team member, administrator, and stakeholder is in.
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9.) Supervision Strategies (1m 32s)
Client-outcome-based supervision has been a hallmark of training at The University of Kansas for some 20 years, and now for IDDT implementation in the state.
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10.) Supervisors Need System Buy-In (1m 37s)
To make an EBP work, supervisors need effective protocols, as well as support from administrators and policymakers in service systems.
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11.) Supervision as a Learning Process (58s)
Look at the evaluation of each team member's documentation practices as a learning process, as an opportunity for supervision and professional development. Do team members appear to understand the model? In what areas of practice do they need advice?
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IDDT & THE NATIONAL SCENE

Integrated Dual Disorder Treatment (IDDT), the evidence-based practice, was developed and continues to be studied by researchers at the Psychiatric Research Center of Dartmouth Medical School in Lebanon, New Hampshire. The researchers include Robert E. Drake, MD, PhD, and his colleagues.

The Dartmouth PRC has provided leadership for national implementation of IDDT via the Substance Abuse and Mental Health Services Administration. The State of Ohio and the Center for Evidence-Based Practices at Case Western Reserve University—through its Ohio SAMI CCOE initiative—have participated and continue to participate in these national initiatives.

The University of Kansas School of Social Welfare has also participated in this national initiative, providing technical assistance for the implementation of IDDT and other evidence-based practices in the State of Kansas.


Paul M. Kubek, MA, is director of communications and Matthew K. Weiland, MA, is senior writer, producer, and new-media specialist at the Center for Evidence-Based Practices at Case Western Reserve University.