—by Paul M. Kubek
Columbus & Cleveland, OH—The State of Ohio is taking another important step to integrate behavioral healthcare services, this time by enhancing the capacity of halfway houses and residential addiction-treatment centers to provide treatment for people with co-occurring substance use and mental disorders.
The initiative kicks off in November 2013 as the Ohio Department of Mental Health and Addiction Services (OhioMHAS) partners with the Center for Evidence-Based Practices at Case Western Reserve University to provide a series of training events for supervisors and direct service staff of residential facilities and halfway houses. The Center is also providing technical assistance to a select number of these organizations, which will pilot the implementation of integrated services for co-occurring substance abuse and mental illness (SAMI) using the Dual Diagnosis Capability in Addiction Treatment (DDCAT) instrument, an organizational assessment, planning, and implementation tool. Important goals of the initiative include organizational policy and practice changes and the enhancement of clinical skills among all direct-service providers, skills that are needed to facilitate what is called co-occurring capable service delivery.
Organizations that are selected to participate in the pilot project are expected to develop action plans with assistance from the Center for the implementation of integrated treatment. The organizations will also be expected to participate in a learning community to share challenges, successes, and lessons learned during implementation as a way to avoid pitfalls and maximize positive outcomes.
The Center is also teaming up with Community Assessment & Treatment Services, Inc. (CATS) in Cleveland to provide the state-wide training and the consultation to pilot sites. CATS is a substance-abuse rehabilitation center that offers men and women comprehensive residential and outpatient recovery services. CATS began a process of enhancing its dual-diagnosis-treatment capability in 2010 under the leadership of John Scalish, PCC, LICDC, ICCS, director of clinical services, and Lou LaMarca, MSASS ‘12, LSW, director of continuous quality improvement.
INTEGRATED OPTIONS
According to Patrick E. Boyle, MSSA, LISW, LICDC-CS, director of implementation services at the Center, this enhancement in Ohio's system will provide broader treatment options and, thus, a continuity of integrated care in the state. Historically, many of Ohio's 93 residential treatment centers and halfway houses have served people with substance use disorders exclusively and have not developed the capacity to serve people with co-occurring mental illness.
"Service providers at residential facilities and halfway houses are usually trained to deal with addiction only," Boyle says. "This initiative will teach interested participants about effective methods for assessing co-occurring substance use and mental disorders while utilizing a stage-wise and person-centered approach to treatment, which includes motivational interviewing."
STEP-DOWN FROM INPATIENT
Boyle explains that, ideally, the State needs a system of care that includes a step down from integrated inpatient care to integrated outpatient community-based care. The clinically enhanced halfway houses and residential-treatment centers could provide an important transition in care.
Boyle adds that all of Ohio's regional psychiatric hospitals provide inpatient Integrated Dual Disorder Treatment. These state hospitals need more referral options for integrated care. Private psychiatric units in community hospitals also need more options as they serve a large number of patients with co-occurring disorders. Residential-treatment centers with enhanced dual-diagnosis capabilities can play an important role during hospital discharge to reduce cyclical inpatient readmission, homelessness, and involvement in the criminal justice system.
INTEGRATED SYSTEM | Q & A
This past summer, the State of Ohio created a new integrated Department of Mental Health and Addiction Services (OhioMHAS) with a merger of two separate departments, one that focused on mental health services and another that focused on addiction services. OhioMHAS' new initiative to enhance dual-diagnosis-treatment capability in halfway houses and residential treatment is one of several that demonstrates its commitment to the expansion of integrated behavioral healthcare.
We asked several leaders at OhioMHAS for their perspectives about enhancing dual-diagnosis-treatment capability.
Joyce Starr, LSW, LICDC-CS, ICADC, Chief of Addiction Services
Q: How does this initiative align with the mission of the newly merged Ohio Department of Mental Health and Addiction Services?
JS: As a newly consolidated agency, the mission of providing statewide leadership for high quality treatment and prevention services aligns positively with the need for providing integrated behavioral healthcare. Having access to integrated services promotes effective treatment to sustain a healthy recovery, maximizes community resources, and works towards achieving desired outcomes. For individuals living with a dual disorder, it is exciting to be able to provide those treatment and prevention opportunities which will enhance client-centered services and remove barriers to recovery.
Mark Hurst, MD, medical director
Q: What is your vision for Ohio's residential-treatment system? How might it evolve over the coming years toward integrated treatment for co-occurring substance abuse and mental illness (SAMI)?
MH: We are all aware of the effectiveness of treatment for mental illness and addiction, which is at least as helpful as the treatment for other biological disorders such as hypertension and asthma. When individuals experience both mental illness and addiction, the treatment is too frequently fragmented with resulting poor outcomes. We have been fortunate in Ohio to have the Center for Evidence-Based Practices, which has led the way in implementing integrated treatment for dual disorders. Extending integrated treatment to residential settings complements the excellent work already underway in inpatient and outpatient settings, bringing the opportunity for improved continuity and even better outcomes. We hope to continue to decrease fragmentation and improve continuity in all areas of our healthcare system, and this is another important step in that direction.
Drew Palmiter, BS, LICDC-CS, LSW, CCDP
Q: What are the potential benefits to residential-treatment centers and to halfway houses that engage in training and consultation offered by the Center for Evidence-Based Practices and its collaborator, Community Assessment & Treatment Services, Inc.?
DP: We have funded the Center for Evidence-Based Practices and its Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence (SAMI CCOE) for over ten years to provide an array of training, consultation, and baseline fidelity monitoring for our boards and treatment providers. Training helps staff engage consumers using motivational techniques and the stages of change. The initial focus is on assisting the individuals served to get their needs and wants addressed while they evaluate next steps in collaboration with service staff.
Over the years, we have seen that consumers who receive integrated treatment get better and use fewer acute services over a long period of time. They have fewer arrests, are more productive, are more employed, and have more stable housing. When people need fewer treatment episodes, that capacity is available to treat other consumers and, thus, more people are served.
Not all providers can implement Integrated Dual Disorder Treatment, the evidenced-based practice, completely. The SAMI CCOE works with these providers to implement what parts they can. These providers are either mental health or addiction providers.