Co-Occurring Co-Occurring Disorders Disorders Expected rather than the Exception Expected rather than the Exception Tribal Justice & Safety – One OJP Tribal Justice & Safety – One OJP Tribal Training and Technical Assistance – Session III Tribal Training and Technical Assistance – Session III Shelton, WA Shelton, WA June 5, 2007 June 5, 2007 Elizabeth I. Lopez, Ph.D. Elizabeth I. Lopez, Ph.D. US Department of Health and Humans Services US Department of Health and Humans Services Substance Abuse and Mental Health Services Administration Substance Abuse and Mental Health Services Administration
Transcript
Co-Occurring DisordersCo-Occurring DisordersExpected rather than the ExceptionExpected rather than the Exception
Tribal Justice & Safety – One OJPTribal Justice & Safety – One OJPTribal Training and Technical Assistance – Session IIITribal Training and Technical Assistance – Session III
Shelton, WAShelton, WAJune 5, 2007June 5, 2007
Elizabeth I. Lopez, Ph.D.Elizabeth I. Lopez, Ph.D.US Department of Health and Humans ServicesUS Department of Health and Humans Services
Substance Abuse and Mental Health Services AdministrationSubstance Abuse and Mental Health Services Administration
Presentation OverviewPresentation Overview
• Definition of Co-Occurring Disorders
• Epidemiology of Co-Occurring Disorders
• Overview of SAMHSA Co-Occurring Activities
• SAMHSA Targeted Co-Occurring Programs
– COSIG – COCE – National Policy Academy on Co-Occurring Disorders
• Upcoming AI/AN Policy Academy
• Discussion
Definition: Co-occurring Disorders
• The term refers to co-occurring substance use (abuse or dependence) and mental disorders.
• Clients said to have co-occurring disorders have one or more mental disorders as well as one or more disorders relating to the use of alcohol and/or other drugs.
• A diagnosis of a co-occurring disorder (COD) occurs when at least one disorder of each type can be established independently of the other and is not simply a cluster of symptoms resulting from a single disorder.
Co-Occurring DisordersCo-Occurring Disorders
Epidemiology
What do we know about
Co-Occurring Disorders?
Co-Occurring DisordersCo-Occurring Disorders
We know that co-occurring disorders are increasing
becoming the expectation rather than the exception.
66
Co-Occurrence of SMI and Substance Co-Occurrence of SMI and Substance Use Disorders among Adults Use Disorders among Adults
Aged 18 or Older: 2003Aged 18 or Older: 2003
15.2 Million 15.4
Million
Co-OccurringDisorders
Substance Use
Disorder Only
SMI Only
4.2 Million
* NSDUH 2003
Co-Occurrence of SPD and Substance Use Co-Occurrence of SPD and Substance Use Disorder in the Past Year among Adults Disorder in the Past Year among Adults
Aged 18 or Older: 2005Aged 18 or Older: 2005
14.9 Million
19.4Million
Co-OccurringSUD and SPD
Substance Use Disorder (SUD) Only
Serious Psychological
Distress (SPD) Only
5.2 Million
Up by 1 million in
2 years
Substance Use among Adults Aged Substance Use among Adults Aged 18 or Older, by Major Depressive 18 or Older, by Major Depressive Episode in the Past Year: 2005Episode in the Past Year: 2005
26.8 28
8.4
12.7
16.3
7
0
5
10
15
20
25
30
Past Year Illicit DrugUse
Daily Cigarette Use inPast Month
Past Month HeavyAlcohol Use
Had Major Depressive Episodein the Past Year
Did Not Have Major DepressiveEpisode in the Past Year
Substance Use among Youths Substance Use among Youths Aged 12 to 17, by Major Depressive Episode Aged 12 to 17, by Major Depressive Episode
in the Past Year: 2005in the Past Year: 2005Percent Using Substance
38.0
25.2
19.3
5.33.8
18.0
12.1
7.2
2.5 2.2
0
5
10
15
20
25
30
35
40 Had Major DepressiveEpisode in the Past Year
Did Not Have MajorDepressive Episode in thePast Year
Source: CSAT AT Outcome Data Set (n=9,276 adolescents)
79%
54%
45%
37%
26%
17%
59%
47%
31%
25%
16%
0% 10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Any Co-occurring Psychiatric
Conduct Disorder
Attention Deficit/Hyperactivity Disorder
Major Depressive Disorder
Traumatic Stress Disorder
General Anxiety Disorder
Ever Physical, Sexual or Emotional Victimization
High severity victimization (GVS>3)
Ever Homeless or Runaway
Any homicidal/suicidal thoughts past year
Any Self Mutilation
Co-Occurring Disorders Co-Occurring Disorders Expected rather than the ExceptionExpected rather than the Exception
We know that individuals with a
co-occurring disorder are less likely to receive treatment for BOTH
disorders.
Past Year Treatment among Adults Aged Past Year Treatment among Adults Aged 18 or Older with Both Serious Psychological 18 or Older with Both Serious Psychological
Distress and a Substance Use Disorder: Distress and a Substance Use Disorder: 20052005
Substance Use Treatment Only
5.2 Million Adults with Co-Occurring SPD and Substance Use Disorder
Treatment for Both Mental Health and Substance Use Problems
No Treatment
34.3%
53.0%
8.5%
4.1%
Treatment Only for Mental Health Problems
Note: Due to rounding, these percentages do not add to 100 percent.
Mean Age for Past Year Mean Age for Past Year Initiates, Initiates,
by Illicit Drug: 2004by Illicit Drug: 2004Age
16.018.0 18.4 18.9 19.5 20.0
23.3 24.1 24.4 25.2
29.3
0
5
10
15
20
25
30
Marijuana
HeroinPain Relievers
Cocaine
LSD
TranquilizersPCP
EcstasyInhalants
Stimulants
SedativesNSDUH, 2004
Past Month Illicit Drug Use among Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age: Persons Aged 12 or Older, by Age:
20042004
3.8
10.9
17.3
21.7
17.9
13.2
9.47.2 7.5 6.8
4.82.6
1.1 0.40
5
10
15
20
25
12-13
14-15
16-17
18-20
21-25
26-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65+
Percent Using in Past Month
Age in Years
Co-Occurring DisordersCo-Occurring DisordersExpected rather than the ExceptionExpected rather than the Exception
American Indian/Alaskan Native Communities faceunique challenges with co-occurring substance abuse and psychological conditions
• Historical trauma
• Stigma / Discrimination • Preserving cultural healing traditions
• Multiple funding streams / delivery systems for behavioral health services
Substance Use and AI/ANSubstance Use and AI/AN
• Rates of past year use disorders were higher among American Indians and Alaska Natives than members of other racial groups for alcohol, illicit drug use, marijuana, cocaine, and hallucinogen use disorders.
• Although in the past year American Indians and Alaska Natives were
less likely than persons of other racial backgrounds to have used alcohol (60.8% vs. 65.8%), they were more likely to have an alcohol use disorder (10.7% vs. 7.6%).
• For illicit drug use in the past year, American Indians and Alaska Natives were more likely than persons of other racial backgrounds both to have used an illicit drug (18.4% vs. 14.6%) and to have an illicit drug use disorder (5.0% vs. 2.9%).
NSDUH 2005
Substance Abuse/Dependence & Substance Abuse/Dependence & MDE or SPD by AI/AN and Non-MDE or SPD by AI/AN and Non-
Current Use of Illicit Drugs among Current Use of Illicit Drugs among Persons Aged 12 or Older, by Race: Persons Aged 12 or Older, by Race:
2002 -20042002 -2004
8.5 9.7
3.5
7.2
11.48.3 8.7
12.1
3.8
8
12
8.1 8.7
3.1
7.2
13.3
10.112.3
02468
10121416
White
Black
Amer
. Indian
/Ala
ska N
ative
Asian
Hispan
ic
Two or M
ore R
aces
2002 2003 2004
Per
cent
Usi
ng in
Pas
t Mon
th
NSDUH 2002-2004
Current Use of Illicit Drugs among Current Use of Illicit Drugs among Youth Aged 12 to 17, by Race: 2002-Youth Aged 12 to 17, by Race: 2002-
20042004
12.610
20.9
4.8
10.712.511.8
9.6
19.3
6.5
11
15.1
11.19.3
26
6
10.212.2
0
5
10
15
20
25
Wh
ite
Bla
ck
Am
er.
Ind
ian
/Ala
ska
Nat
ive Asi
an
His
pan
ic
Tw
o or
Mor
eR
aces
2002 2003 2004
Perc
ent U
sing
in P
ast M
onth
NDSUH 2002-2004
Current Use of Illicit Drugs among Current Use of Illicit Drugs among Persons Aged 26 or Older, by Race: Persons Aged 26 or Older, by Race:
2002-20042002-2004
5.9
7.8
4.3
2.2
4.5
6.95.8 6.4 6.8
1.9
5.2
7.9
5.7 6.37.9
1.7
4.7
10.1
02468
101214
Wh
ite
Bla
ck
Am
er.
Ind
ian
/Ala
ska
Nat
ive Asi
an
His
pan
ic
Tw
o or
Mor
eR
aces
2002 2003 2004
Perc
ent U
sing
in P
ast M
onth
National Survey on Drug Use and Health 2004
Current Use of Alcohol among Persons Current Use of Alcohol among Persons Aged 12 or Older, by Race: 2002- 2004Aged 12 or Older, by Race: 2002- 2004
55
39.944.7
37.142.8
49.954.4
37.942 39.8 41.5
44.4
55.2
37.1 36.2 37.440.2
52.4
0
10
20
30
40
50
60
Wh
ite
Bla
ck
Am
er.
Ind
ian
/Ala
ska
Nat
ive Asi
an
His
pan
ic
Tw
o or
Mor
eR
aces
2002 2003 2004
Per
cent
Usi
ng in
Pas
t Mon
th
National Survey on Drug Use and Health 2004
Heavy Use of Alcohol among Persons Heavy Use of Alcohol among Persons Aged 12 or Older, by Race: 2002-2004Aged 12 or Older, by Race: 2002-2004
7.5
4.4
8.7
2.6
5.9
7.57.7
4.5
10
2.3
5.26.1
7.9
4.4
7.7
2.7
5.3
6.9
-113579
111315
Wh
ite
Bla
ck
Am
er.
Ind
ian
/Ala
ska
Nat
ive Asi
an
His
pan
ic
Tw
o or
Mor
eR
aces
2002 2003 2004
Per
cent
Usi
ng in
Pas
t Mon
th
National Survey on Drug Use and Health 2004
Received Substance Use Treatment in the Past Received Substance Use Treatment in the Past Year among Persons Aged 12 or Older, by Race: Year among Persons Aged 12 or Older, by Race:
20042004
0.5
1.2
0.5 0.5 0.5
1.3
0.6
1
2
0.1
0.8
1.2
0.9
1.6
2.1
0.6
1
1.6
0
1
2
3
White Black Amer.Indian/Alaska
Native
Asian Hispanic Two or MoreRaces
Illicit Drug Alcohol Illicit Drug or Alcohol
Per
cent
age
Substance Dependence or Abuse in the Past Substance Dependence or Abuse in the Past Year among Persons Aged 12 or Older, by Year among Persons Aged 12 or Older, by
Race: 2004Race: 2004
3 3.7
8
1.3
3.4
6.57.7
6.3
14.8
3.7
8
9.99.38.3
20.2
4.7
9.8
12.2
0
5
10
15
20
25
White Black Amer.Indian/Alaska
Native
Asian Hispanic Two or MoreRaces
Illicit Drug Alcohol Illicit Drug or Alcohol
Per
cent
age
Substance AbuseSubstance Abuse
Individuals with alcohol and drug problems
• Prevalence rates for current alcohol abuse and/or dependence among Northern Plains and Southwestern Vietnam veterans have been estimated to be as high as 70% compared to 11 - 32% of their white, black, and Japanese American counterparts.
• The estimated rate of alcohol-related deaths for AI/AN is much higher than for the general population.
Mental healthMental healthExposure to trauma
• The rate of violent victimization of AI/AN is more than twice the national average
• Higher rate of traumatic exposure - 22% rate of PTSD for AI/AN, compared to 8% in the general U.S. population
Mental healthMental health
Availability of Mental Health Services
• Approximately 101 AI/AN mental health professionals are available per 100,000 AI/AN, compared to 173 per 100,000 for whites.
• In 1996, only about 29 psychiatrists in the U.S. were of AI/AN heritage.
Mental healthMental health
Access to Mental Health Services
• The Indian Health Service (IHS) is the Federal agency responsible for providing health care to Native populations
• 20% of AI/AN report access to IHS clinics, which are located mainly on reservations
Mental healthMental health
• Medicaid is the primary insurer for 25% of AI/AN
• Approximately 50% of AI/AN have employer-based insurance coverage, compared to 72% of whites
• 24% of AI/AN have no health insurance, compared to 16% of the U.S. population
Risk and Protective Factors for Risk and Protective Factors for Substance Use among American Indian Substance Use among American Indian
or Alaska Native Youthsor Alaska Native Youths• American Indian or Alaska Native youths were more
likely to perceive moderate to no risk of substance use
• A larger percentage of American Indian or Alaska Native youths did not perceive strong parental disapproval of youth substance use than youths in other racial/ethnic groups
• American Indian or Alaska Native youths were more likely to believe that all or most of the students in their school get drunk at least once a week
NSDUH 2002 - 2003NSDUH 2002 - 2003
SAMHSA Response to addressSAMHSA Response to addressthe Co-occurring Disordersthe Co-occurring Disorders
Congress called on SAMHSA to prepare a report outlining the scope of the problem of co-occurring disorders, current treatment approaches, best practice models, and prevention efforts. This report was mandated to include: · a summary of the manner in which individuals with co-occurring disorders are receiving treatment,
· a summary of practices for preventing substance abuse disorders among individuals who have a mental illness and are at risk of having or acquiring a substance abuse disorder; · a summary of evidence-based practices for treating individuals with co-occurring disorders and recommendations for implementing such practices; and
· a summary of improvements necessary to ensure that individuals with co-occurring disorders receive the services they need.
• Released November 2002
• Raised the awareness of Co-occurring Disorders
• Included a Five-Year Blueprint for Action
• SAMHSA adopted road map to address Co-occurring Disorders
Report to Congress on the PreventionReport to Congress on the Preventionand Treatment of Co-Occurringand Treatment of Co-Occurring
Substance Abuse Disorders and Mental Substance Abuse Disorders and Mental DisordersDisorders
Co-Occurring Matrix WorkgroupCo-Occurring Matrix WorkgroupChair and MembershipChair and Membership
A. Kathryn Power. M.Ed.
Director
Center for Mental Health Service (CMHS)
H. Westley Clark, M.D., J.D. M.P.H
Director
Center for Substance Abuse Treatment (CSAT)
SAMHSA Workgroup representation:
Center for Mental Health Services Office of the Administrator
Center for Substance Abuse Treatment Office of Applied Studies
Center for Substance Abuse Prevention Office of Communications
Office of Policy, Planning & Budget
““No Wrong Door” PolicyNo Wrong Door” Policy
• Each provider should be aware that he/she has the responsibility to address the range of client needs…
• wherever a client presents for care
• whenever a client presents for care
• properly refer clients for appropriate care as needed
• follow-up on referrals to ensure clients received proper care
To expand and improve prevention, appropriate treatment and other supportive services to individuals with and/or at risk for co-occurring disorders.
Approximately 5.2 million individuals in the United States are estimated to be affected by co-occurring mental and substance abuse disorders. However, only a small percentage of these individuals receive treatment that addresses both disorders.
SAMHSA Co-Occurring Matrix Action PlanSAMHSA Co-Occurring Matrix Action PlanLong Term MeasuresLong Term Measures
• Increase the percentage of persons with co-occurring disorders who receive appropriate treatment services that address both disorders.
• Increase the percentage of adolescents aged 12 – 17 who receive appropriate prevention services that address substance abuse and mental health.
• Increase the percentage of persons who experience reduced impairment from their co-occurring disorders following appropriate treatment.
• Increase the number of grantees (States, Tribes, communities, and providers) measuring and reporting on co-occurring programs, practices, and models of treatment (accountability)
• Increase the number of States and Tribes with State or Tribal-Level actions plans for improving access to mainstream and specialty services for individuals with co-occurring disorders(capacity)
• Increase the number of people trained to implement appropriate co-occurring prevention and integrated treatments among States, communities, providers and consumers (effectiveness)
• Ensure that co-occurring disorders are a significant focus in the following major grant programs, as appropriate: Mental Health Systems Transformation SIG, Access to Recovery, and the Strategic Prevention Framework SIG
• Monitor the extent to which the Co-Occurring State Incentive Grant (COSIG) addresses those populations prioritized on the SAMHSA Matrix that are appropriate and relevant to the programs within the matrix area
• Create and disseminate a nationally accepted framework for developing, implementing, and sustaining co-occurring disorders prevention and treatment service systems.
• Increase the number of candidate programs addressing co-occurring disorders that apply for review to the National Registry of Evidence-based Programs and Practices (NREPP) addressing co-occurring disorders
• Hold a policy academy for Tribal organizations, tribal communities, and tribal governments to assist in developing and sustaining service systems for the unique needs of AI/AN with and at risk for co-occurring disorders and for interested States who have not participate in a policy academy to date.
SAMHSA Strategic Plan for Co-SAMHSA Strategic Plan for Co-Occurring DisordersOccurring Disorders
Mission
To expand and improve prevention, appropriate treatment and other supportive services to individuals with and/or at risk for co-occurring disorders
Key Drivers
•Report to Congress
•Presidents New Freedom Initiative
•SAMHSA Co-Occurring Action Plan
•SAMHSA Matrix
•IOM Report
Target Population
Adult and Youth with Co-Occurring Disorders
Adult and Youth at risk for Co-Occurring Disorders
States, Tribes, Local Communities
Mechanisms
COSIG
Specialized TA
(COCE/Policy Academy)
Training Curriculum/Publication (TIP 42/Tool Kits)
Outcomes
Individual
Increase access to appropriate prevention & treatment services
Provider
Increase number of people trained to implement appropriate COD treatment
Community/System
Increase number of States, Tribes, Communities with comprehensive action plans
National Outcome Measures (NOMS)National Outcome Measures (NOMS)DomainsDomains
Abstinence from Drug / Alcohol Use / Reduced Morbidity
Employment / Education Crime and Criminal Justice Family and Living Conditions Access / Capacity Retention Social Connectedness Perception of Care Cost Effectiveness Use of Evidence-Based Practices
Co-Occurring DisordersCo-Occurring DisordersExpected rather than the ExceptionExpected rather than the Exception
Linking Co-Occurring Disorders with key SAMHSA Matrix Areas
• Mental Health System Transformation
• Substance Abuse Treatment Capacity
• Strategic Prevention Framework
Treatment Implications of Comorbidity Treatment Implications of Comorbidity Between Alcohol and/or Drug Use Disorders Between Alcohol and/or Drug Use Disorders
and Other Psychiatric Disordersand Other Psychiatric Disorders• Adolescents and adults with co-occurring
disorders are not treated
• Increased severity, disability and impairment in social/occupational functioning
• Resistance to pharmacologic treatment
• Lower probability of recovery
• Increased suicidality
• Increased economic burden of each comorbid condition
Co-Occurring Disorders Co-Occurring Disorders Expected rather than the ExceptionExpected rather than the Exception
Areas of Focus for the Treatment of COD
• Innovative Models of Integrated Treatment• Sharing Lessons Learned across programs• Workforce Development• Working with Tribal, Rural Communities• Child, Adolescent, Family and Older Adults• Cultural Competency Training for Local
Providers
Co-Occurring Disorders Co-Occurring Disorders Expected rather than the ExceptionExpected rather than the Exception
Co-Occurring Programs
Co-Occurring State Incentive Grant
(COSIG)
Co-occurring State Incentive Grants Co-occurring State Incentive Grants (COSIG)(COSIG)
• Supports grantees in overcoming service delivery barriers
• Supports grantees in systems change and infrastructure development
• Enhancing service coordination, networks and linkages to support quality care
• Improving financial incentives for integrated care• Information sharing among stakeholders • 17 grantees
Co-occurring State Incentive Grants Co-occurring State Incentive Grants (COSIG)(COSIG)
Key Program Accomplishments
Implemented first COD program within CJ System
Redesigned and implemented a website to transfer information between local practitioners and States
Implemented a voucher system to acquire ancillary services needed by COD clients
Established Statewide common data warehouse about persons within the MH and SA systems
History of COSIG FundingHistory of COSIG FundingGrants Awarded (annually in September)
YearNumber Awarded
States Receiving Award Funding Agency
2003 7 AR, PA, HI, MO, TX, AK, LAJointly by CSAT and CMHS
2004 4 OK, VA, AZ, NM CMHS
2005 4 CT, DC, ME, VT CMHS
2006 2 MN, SC CSAT
Co-occurring State Incentive Grants Co-occurring State Incentive Grants (COSIG)(COSIG)
Lessons Learned
Involve Senior State/Tribal Leadership Family/Consumer Participation Engage provider community in COSIG planning Program accountability Measures of success – Linking outcomes
Evaluation Update
Co-Occurring Disorders Co-Occurring Disorders Expected rather than the ExceptionExpected rather than the Exception
SAMHSA Co-Occurring Center for Excellence (COCE)
http://coce.samhsa.gov
• Funded through SAMHSA, is a leading national resource for the field of co-occurring mental and substance use disorders
• Consists of national and regional experts who join service recipients in shaping COCE’s mission, guiding principles, and approaches
• Accomplishes its mission through technical assistance and training, delivered through multiple vehicles
COCECOCE
COCE MissionCOCE Mission• To receive and transmit advances in treatment
for all levels of COD severity
• To guide enhancements in the infrastructure and clinical capacities of service systems
• To foster the infusion and adoption of evidence- and consensus-based COD treatment and program innovations into clinical practice.
• States / Tribes not yet receiving COSIG funding, including Co-Occurring Policy Academy States and all other States / Tribes
• AI/AN tribes and organizations, clinical providers, other providers, agencies and systems through which clients might enter the COD treatment system
Key Focus of COCE ProgramKey Focus of COCE Program
• COSIG TA
• Policy Academy TA
• Community TA
• COCE Web site
• COCE Training / Material Development
Co-Occurring DisordersCo-Occurring DisordersExpected rather than the ExceptionExpected rather than the Exception
Prevention & Co-Occurring Disorders
Operationalizing the Role of Prevention
Prevention Strategies for Prevention Strategies for Co-Occurring DisordersCo-Occurring Disorders
• Develop evidence based strategies, programs, and practices that target risk/protective factors of at risk kids
• Develop individual and family-based case management systems that target families of addicted and/or those presenting w/ mental health disorders to clinics, hospitals etc.
• Develop programs across the life span
Tip 42: Substance Abuse Treatment for Persons with Co-Occurring Disorders
• This TIP revises TIP 9, Assessment and Treatment of Patients With Coexisting Mental Illness and Alcohol and Other Drug Abuse.
• 1st printing of Tip 42—27,000
• 2nd printing of Tip 42—50,000
Co-Occurring Disorders: Co-Occurring Disorders: Expected rather than the ExceptionExpected rather than the Exception
National Policy Academy on Co-Occurring Disorders
National Policy Academy on National Policy Academy on Co-Occurring DisordersCo-Occurring Disorders
The purpose of the National Policy Academy on Co-Occurring Mental and Substance Abuse Disorders is to enhance the provision of co-occurring services in States, Tribes and communities.
The Policy Academy brings together Teams comprised of individuals with policy-making influence in conjunction with nationally recognized faculty and facilitators who assist the Teams to develop a comprehensive Action Plan to enhance the provision of, and expand access to, effective prevention, treatment, and related services for co-occurring disorders within their jurisdiction.
National Policy Academy on National Policy Academy on Co-Occurring DisordersCo-Occurring Disorders
The overarching goal of SAMHSA’s National Policy on Co-Occurring Substance Use and Mental Disorders is to enhance the provision of co-occurring services in States, Tribes and communities.
This goal is supported by four objectives of the Policy Academy.
National Policy Academy on National Policy Academy on Co-Occurring DisordersCo-Occurring Disorders
ObjectivesObjectives
• To assist States, Tribes and local policymakers in the development of an Action Plan intended to improve access to appropriate services for people with co-occurring substance use and mental disorders;
• To create and/or reinforce relationships among the Governor’s office, Legislators, Government and local program administrators, and stakeholders from the public and private sectors;
• To provide an environment conducive to the process of strategic decision-making within the context of co-occurring disorders; and
• To assist State, Tribal and local policymakers in identifying issues or areas of concern that may result in a formal request for technical assistance.
National Policy Academy on National Policy Academy on Co-Occurring DisordersCo-Occurring Disorders
The Policy Academy model sequential process:
1. Pre-meeting work, a technical assistance site visit, and SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis
2. Formal Academy meeting (on-site “live” technical assistance)
3. Post-meeting technical assistance and follow-up
• Not a grant program - no new funding for services
• Focus on improving services for people with co-occurring disorders
• Innovation in health care reimbursement
• Focus on prevention / recovery
• Evidence of partnership with substance abuse and mental health treatment systems
National Policy Academy on National Policy Academy on Co-Occurring DisordersCo-Occurring Disorders
Desired Outcomes
• Operationalize “No Wrong Door” for all people with co-occurring disorders
• Culturally relevant and appropriate service systems
• Building partnership across mental health andand substance abuse prevention services & treatment
systems
• Identify institutionalized barriers and develop strategies to overcome
National Policy Academy on National Policy Academy on Co-Occurring DisordersCo-Occurring Disorders
• Cohort I (April 2004)—Alabama; Arizona; Connecticut; Hawaii; Louisiana; Maine; Michigan; Missouri; North Carolina; South Dakota
• Cohort II (Jan 2005)—California; Georgia; Illinois; Iowa; New Mexico; Oklahoma; Texas; Virginia; Washington
• Cohort III (Sept. 2005)—Delaware; Indiana; Kansas; Maryland; Montana; New York; Ohio; Rhode Island;
• Tribal Policy Academy (Sept. 2007)
National Policy Academy on National Policy Academy on Co-Occurring DisordersCo-Occurring Disorders
Key Program Accomplishments
Much of the success of the Policy Academy is that it transcends a typical strategic planning retreat or a conference, in that it seeds a process of cross-agency collaboration and systems change.
The design facilitates leaders, policy makers and advocates from each Team to build on its strengths, develop policy strategies and implement action plans for transforming practice before, during, and after the Academy meeting.
National Policy Academy on National Policy Academy on Co-Occurring DisordersCo-Occurring Disorders
Key Program Accomplishments (cont.)
• Locally defined shared vision
• Innovative financing strategies and leverage existing resources
• Culturally relevant approach
• Cross sector policy makers / providers / stakeholders working together
National Policy Academy on National Policy Academy on Co-Occurring Disorders – AI/ANCo-Occurring Disorders – AI/AN
• Planning Underway for tentatively scheduled academy - September 2007
• Invitation released May 2007 – applications due June 15, 2007.
National Policy Academy on National Policy Academy on Co-Occurring DisordersCo-Occurring Disorders
Key review factors that will shape eligibility criteria:
Capacity/Readiness
Outline NeedCurrent Health/ Behavioral Health
Delivery ApproachMulti-level commitment Current Health / Behavioral Health
Financing Structures
Willingness to collaborate / partner with other entities delivering behavioral health delivery services
Interest and willingness to share lessons learned from the policy academy with other communities
The National Policy Academy on Co-Occurring Substance Use and Mental Disorders: The National Policy Academy on Co-Occurring Substance Use and Mental Disorders: A Schematic OverviewA Schematic Overview
The Policy Academy Model: A Multi-Stage Process
Selection Process Academy Orientation Formal Academy MeetingPost-Academy Technical
Assistance
Applicants responded to a Letter of Invitation specifying formal eligibility criteria
• clearly defined problem
• high-level commitment
• breadth, depth, and
authority of proposed
Tribal team
Peer review selection process of participating teams/delegations
Conference calls, SAMHSA communications introduce Tribes to Academy process
Pre-Academy site visits:
• provide Academy orientation
• enhance understanding of
Academy model
• develop common vision, priorities, strategies, and draft S.W.O.T. analysis
• initiate identification of technical assistance needs
• formalizes team leadership and
decision- making process
Facilitates delivery of technical assistance and action plan development across multiple formats (i.e., plenaries, presentations, Team working sessions)
Teams present vision statements and Tribal-related key issues and efforts
Formal presentations on systems change, evidence- based practices, prevention, funding, resources, and other co-occurring curriculum areas
• Policy Teams:
• continue developing action plans and
identifying technical assistance needs
• receive feedback and technical assistance from
faculty and peers
• report out on action plan, priorities, next steps, and
technical assistance needs
Policy teams
•finalize strategies (short-and long-range) and specific action steps
• submit revised action plan for SAMHSA review/feedback
• prioritize and coordinate
technical assistance with COCE and other TA
• implement action plans
• submit semi-annual progress reports to
SAMHSA
Enhances the Provision of Co-Occurring Services in Communities
Next Steps for SAMHSANext Steps for SAMHSACo-occurring PortfolioCo-occurring Portfolio
• Institutionalizing “No Wrong Door”• Unique needs of special populations
– (Children, rural, AI/AN)
• Core Co-Occurring Competencies• Supporting Integrated System Sustainability• Evidence-based COD programs• Disparate Funding Streams/Reimbursement• Licensing/Certification• Cultural Competent/Relevant Service System
Co-Occurring Disorders Co-Occurring Disorders Expected rather than the ExceptionExpected rather than the Exception
For more information:
www.samhsa.gov
www.samhsa.gov/Matrix/matrix_cooc.aspx
1-800-729-6686
1-800-487-4889 (TDD)
Publication Ordering and Funding Information
Co-Occurring DisordersCo-Occurring DisordersExpected rather than the ExceptionExpected rather than the Exception
Thank you!Elizabeth I. Lopez, Ph.D.
US Department of Health & Human Services
Substance Abuse and Mental Health Services AdministrationOffice of Policy, Planning & Budget
