CHANGING THE WORLD:CHANGING THE WORLD:

COMPREHENSIVE, CONTINUOUS, COMPREHENSIVE, CONTINUOUS, INTEGRATED SYSTEMS OF CAREINTEGRATED SYSTEMS OF CARE

FOR INDIVIDUALS WITH CO-FOR INDIVIDUALS WITH CO-OCCURRING PSYCHIATRIC AND OCCURRING PSYCHIATRIC AND SUBSTANCE USE DISORDERSSUBSTANCE USE DISORDERS

Presented by: Presented by: Christie A. Cline, M.D., M.B.A., P.C.Christie A. Cline, M.D., M.B.A., P.C.

andandKenneth Minkoff, MDKenneth Minkoff, MD

Info@ZiaLogic.orgInfo@ZiaLogic.org Kminkov@aol.comKminkov@aol.com

www.ZiaLogic.orgwww.ZiaLogic.orgwww.kenminkoff.comwww.kenminkoff.com

ZiaLogicZiaLogic©2002, 2003©2002, 2003

““Co-occurring Psychiatric & Substance Co-occurring Psychiatric & Substance Disorders in Managed Care Systems: Disorders in Managed Care Systems:

Standards of Care, Practice Guidelines, Standards of Care, Practice Guidelines, Workforce Competencies & Training Curricula”Workforce Competencies & Training Curricula”

CENTER FOR MENTAL HEALTH SERVICESCENTER FOR MENTAL HEALTH SERVICES

MANAGED CARE INITIATIVEMANAGED CARE INITIATIVE

CONSENSUS PANEL REPORTCONSENSUS PANEL REPORT

19981998

FIVE SECTIONS OFFIVE SECTIONS OF PANEL REPORT PANEL REPORT

CONSUMER/FAMILY STANDARDSCONSUMER/FAMILY STANDARDS SYSTEM STANDARDS/PROGRAM SYSTEM STANDARDS/PROGRAM

COMPETENCIESCOMPETENCIES PRACTICE GUIDELINESPRACTICE GUIDELINES WORKFORCE COMPETENCIESWORKFORCE COMPETENCIES TRAINING CURRICULATRAINING CURRICULA

CONSUMER/FAMILY SYSTEM CONSUMER/FAMILY SYSTEM STANDARDSSTANDARDS

WELCOMINGWELCOMING ACCESSIBLEACCESSIBLE INTEGRATEDINTEGRATED CONTINUOUSCONTINUOUS COMPREHENSIVECOMPREHENSIVE

Individuals with Co-occurring DisordersIndividuals with Co-occurring Disorders

PRINCIPLES OF SUCCESSFUL PRINCIPLES OF SUCCESSFUL TREATMENT:TREATMENT:

Dual diagnosis is an Dual diagnosis is an expectationexpectation, , not an not an exception.exception. This expectation This expectation

must be incorporated in a must be incorporated in a welcomingwelcoming manner into all clinical manner into all clinical

contact.contact.

The Four Quadrant Model is a viable The Four Quadrant Model is a viable mechanism for categorizing mechanism for categorizing individuals with co-occurring individuals with co-occurring

disorders for purpose of service disorders for purpose of service planning and system responsibility. planning and system responsibility.

SUB-GROUPS OF PEOPLE WITH SUB-GROUPS OF PEOPLE WITH COEXISTING DISORDERSCOEXISTING DISORDERS

Patients with “Dual Diagnosis” - combined psychiatric and substance Patients with “Dual Diagnosis” - combined psychiatric and substance abuse problems - who are eligible for services fall into four major abuse problems - who are eligible for services fall into four major

quadrantsquadrants

PSYCH. HIGH SUBSTANCE HIGH

Serious & Persistent Mental Illness with Substance Dependence QUADRANT IV

PSYCH. LOW SUBSTANCE HIGH

Psychiatrically Complicated Substance Dependence QUADRANT III

PSYCH. HIGH SUBSTANCE LOW

Serious & Persistent Mental Illness with Substance Abuse QUADRANT II

PSYCH. LOW SUBSTANCE LOW

Mild Psychopathology with Substance Abuse QUADRANT I

Treatment success derives from the Treatment success derives from the implementation of an implementation of an empathic, empathic, hopeful, continuoushopeful, continuous treatment treatment

relationship, which provides integrated relationship, which provides integrated treatment and coordination of care treatment and coordination of care

through the course of multiple treatment through the course of multiple treatment episodes.episodes.

Within the context of the empathic, Within the context of the empathic, hopeful, continuous, integrated hopeful, continuous, integrated

relationship, relationship, case management/care case management/care

(based on level of impairment) and (based on level of impairment) and empathic empathic

detachment/confrontation detachment/confrontation (based (based on strengths and contingencies) on strengths and contingencies)

are appropriately balanced are appropriately balanced at each point in time.at each point in time.

When substance disorder and When substance disorder and psychiatric disorder co-exist, each psychiatric disorder co-exist, each

disorder should be considered disorder should be considered primaryprimary, and , and integrated dual integrated dual

primary treatmentprimary treatment is is recommended, where each disorder recommended, where each disorder

receives appropriately intensive receives appropriately intensive diagnosis-specific treatment.diagnosis-specific treatment.

Both substance dependence and Both substance dependence and serious mental illness are examples of serious mental illness are examples of

primary, chronic, biologic mental primary, chronic, biologic mental illnesses, which can be understood illnesses, which can be understood

using a using a disease and recoverydisease and recovery model, with model, with parallel phases of parallel phases of

recovery.recovery.

PARALLELSPARALLELSPROCESS OF RECOVERYPROCESS OF RECOVERY

PHASE 1:PHASE 1: StabilizationStabilization

Stabilization of active substance use or acute Stabilization of active substance use or acute psychiatric symptomspsychiatric symptoms

PHASE 2:PHASE 2: Engagement/Motivational EnhancementEngagement/Motivational Enhancement

Engagement in treatment Engagement in treatment Contemplation, Preparation, PersuasionContemplation, Preparation, Persuasion

PHASE 3: PHASE 3: Prolonged StabilizationProlonged Stabilization

Active treatment, Maintenance, Relapse PreventionActive treatment, Maintenance, Relapse Prevention

PHASE 4: PHASE 4: Recovery & RehabilitationRecovery & Rehabilitation

Continued sobriety and stabilityContinued sobriety and stability One year - ongoingOne year - ongoing

There is no one type of dual There is no one type of dual diagnosis program or diagnosis program or

interventionintervention. For each person, the . For each person, the correct treatment intervention must correct treatment intervention must

be individualized according to be individualized according to subtype of dual disorder and subtype of dual disorder and

diagnosis, phase of diagnosis, phase of recovery/treatment, level of recovery/treatment, level of functioning and/or disability functioning and/or disability

associated with each disorder. associated with each disorder.

In a In a managed care systemmanaged care system, , individualized treatment matching individualized treatment matching

also requires multidimensional level also requires multidimensional level of care assessment involving of care assessment involving acuityacuity, ,

dangerousnessdangerousness, , motivationmotivation, , capacity for treatment capacity for treatment

adherenceadherence, and availability of , and availability of continuing empathic treatment continuing empathic treatment

relationships and other recovery relationships and other recovery supports. supports.

Treatment MatchingTreatment Matchingand and

Treatment PlanningTreatment Planning

CCISC CHARACTERISTICSCCISC CHARACTERISTICS

1.1. SYSTEM LEVEL CHANGESYSTEM LEVEL CHANGE

2.2. USE OF EXISTING RESOURCESUSE OF EXISTING RESOURCES

3.3. BEST PRACTICES UTILIZATIONBEST PRACTICES UTILIZATION

4.4. INTEGRATED TREATMENT INTEGRATED TREATMENT PHILOSOPHYPHILOSOPHY

CHANGING THE WORLDCHANGING THE WORLD

A.A. SYSTEMSSYSTEMS

B.B. PROGRAMPROGRAM

C.C. CLINICAL PRACTICECLINICAL PRACTICE

D.D. CLINICIANCLINICIAN

12 STEPS OF 12 STEPS OF IMPLEMENTATIONIMPLEMENTATION

1.1. INTEGRATED SYSTEM PLANNINGINTEGRATED SYSTEM PLANNING2.2. CONSENSUS ON CCISC MODELCONSENSUS ON CCISC MODEL3.3. CONSENSUS ON FUNDING PLANCONSENSUS ON FUNDING PLAN4.4. IDENTIFICATION OF PRIORITY IDENTIFICATION OF PRIORITY

POPULATIONS WITH 4 BOX MODELPOPULATIONS WITH 4 BOX MODEL5.5. DDC/DDE PROGRAM STANDARDSDDC/DDE PROGRAM STANDARDS6.6. INTERSYSTEM CARE COORDINATIONINTERSYSTEM CARE COORDINATION

12 STEPS OF 12 STEPS OF IMPLEMENTATIONIMPLEMENTATION

7.7. PRACTICE GUIDELINESPRACTICE GUIDELINES

8.8. IDENTIFICATION, WELCOMING, IDENTIFICATION, WELCOMING, ACCESSIBILITY: NO WRONG ACCESSIBILITY: NO WRONG DOORDOOR

9.9. SCOPE OF PRACTICE FOR SCOPE OF PRACTICE FOR INTEGRATED TREATMENTINTEGRATED TREATMENT

10.10. DDC CLINICIAN COMPETENCIESDDC CLINICIAN COMPETENCIES

11.11. SYSTEM WIDE TRAINING PLANSYSTEM WIDE TRAINING PLAN

12 STEPS OF 12 STEPS OF IMPLEMENTATIONIMPLEMENTATION

12.12. PLAN FOR COMPREHENSIVE PLAN FOR COMPREHENSIVE PROGRAM ARRAYPROGRAM ARRAY

A.A. EVIDENCE-BASED BEST PRACTICEEVIDENCE-BASED BEST PRACTICEB.B. PEER DUAL RECOVERY SUPPORTPEER DUAL RECOVERY SUPPORTC.C. RESIDENTIAL ARRAY: WET, DAMP, RESIDENTIAL ARRAY: WET, DAMP,

DRY, MODIFIED TC DRY, MODIFIED TCD.D. CONTINUUM OF LEVELS OF CARE CONTINUUM OF LEVELS OF CARE

IN MANAGED CARE SYSTEM: ASAM-IN MANAGED CARE SYSTEM: ASAM-2R, LOCUS 2.0 2R, LOCUS 2.0

DUAL DIAGNOSIS CAPABLEDUAL DIAGNOSIS CAPABLE

ROUTINELY ACCEPTS DUAL DIAGNOSIS ROUTINELY ACCEPTS DUAL DIAGNOSIS PATIENTPATIENT

WELCOMING ATTITUDES TO COMORBIDITYWELCOMING ATTITUDES TO COMORBIDITY CD PROGRAM: MH CONDITION STABLE AND CD PROGRAM: MH CONDITION STABLE AND

PATIENT CAN PARTICIPATE IN TREATMENTPATIENT CAN PARTICIPATE IN TREATMENT MH PROGRAM: COORDINATES PHASE-MH PROGRAM: COORDINATES PHASE-

SPECIFIC INTERVENTIONS FOR ANY SPECIFIC INTERVENTIONS FOR ANY SUBSTANCE DX.SUBSTANCE DX.

POLICIES AND PROCEDURES ROUTINELY LOOK POLICIES AND PROCEDURES ROUTINELY LOOK AT COMORBIDITY IN ASSESSMENT, RX PLAN, AT COMORBIDITY IN ASSESSMENT, RX PLAN, DX PLAN, PROGRAMMINGDX PLAN, PROGRAMMING

CARE COORDINATION RE MEDS (CD)CARE COORDINATION RE MEDS (CD)

Dual Diagnosis Capable: Dual Diagnosis Capable: DDC-CDDDC-CD

Routinely accepts dual patients, provided:Routinely accepts dual patients, provided: Low MH symptom acuity and/or disability, Low MH symptom acuity and/or disability,

that do not seriously interfere with CD Rxthat do not seriously interfere with CD Rx Policies and procedures present re: dual Policies and procedures present re: dual

assessment, rx and d/c planning, meds assessment, rx and d/c planning, meds Groups address comorbidity openlyGroups address comorbidity openly Staff cross-trained in basic competenciesStaff cross-trained in basic competencies Routine access to MH/MD Routine access to MH/MD

consultation/coord.consultation/coord. Standard addiction program staffing Standard addiction program staffing

level/cost level/cost

Dual Diagnosis Capable:Dual Diagnosis Capable:DDC-MHDDC-MH

Welcomes active substance usersWelcomes active substance users Policies and procedures address dual Policies and procedures address dual

assessment, rx & d/c planningassessment, rx & d/c planning Assessment includes integrated mh/sa hx, Assessment includes integrated mh/sa hx,

substance diagnosis, phase-specific needssubstance diagnosis, phase-specific needs Rx plan: 2 primary problems/goalsRx plan: 2 primary problems/goals D/c plan identifies substance specific skillsD/c plan identifies substance specific skills Staff competencies: assessment, motiv.enh., rx Staff competencies: assessment, motiv.enh., rx

planning, continuity of engagementplanning, continuity of engagement Continuous integrated case mgt/ phase-specific Continuous integrated case mgt/ phase-specific

groups provided: standard staffing levelsgroups provided: standard staffing levels

DUAL DIAGNOSIS DUAL DIAGNOSIS ENHANCED (DDE)ENHANCED (DDE)

MEETS DDC CRITERIA MEETS DDC CRITERIA PLUS:PLUS: CD:CD: MODIFICATION TO ACCOMMODATE MH MODIFICATION TO ACCOMMODATE MH

ACUITY OR DISABILITYACUITY OR DISABILITY MH SPECIFIC PROGRAMMING, STAFF, AND MH SPECIFIC PROGRAMMING, STAFF, AND

COMPTENCIES, INCLUDING MDCOMPTENCIES, INCLUDING MD FLEXIBLE EXPECTATIONS; CONTINUITYFLEXIBLE EXPECTATIONS; CONTINUITY

MH; MH; ADDICTION TREATMENT IN PSYCH ADDICTION TREATMENT IN PSYCH MANAGED SETTINGS (DUAL DX INPT UNIT) MANAGED SETTINGS (DUAL DX INPT UNIT) OROR INTENSIVE CASE MGT/OUTREACH TO MOST INTENSIVE CASE MGT/OUTREACH TO MOST

SERIOUSLY MI AND ADDICTED PEOPLESERIOUSLY MI AND ADDICTED PEOPLE

Dual Diagnosis Dual Diagnosis Enhanced:Enhanced:

DDE-CDDDE-CD Meets criteria for DDC-CD, Meets criteria for DDC-CD, plusplus::

Accepts moderate MH symptomatology or Accepts moderate MH symptomatology or disability, that would affect usual rx.disability, that would affect usual rx.

Higher staff/patient ratio; higher costHigher staff/patient ratio; higher cost Braided/blended funding neededBraided/blended funding needed More flexible expectations re:group workMore flexible expectations re:group work Programming addresses mh as well as dualProgramming addresses mh as well as dual Staff more cross-trained/ senior mh Staff more cross-trained/ senior mh

supervisionsupervision More consistent on site psychiatry/psych RNMore consistent on site psychiatry/psych RN More continuity if patient slipsMore continuity if patient slips

Dual Diagnosis EnhancedDual Diagnosis EnhancedDDE-MHDDE-MH

Meets all criteria for DDC-MH, Meets all criteria for DDC-MH, plus:plus: Supervisors and staff: advanced Supervisors and staff: advanced

competenciescompetencies Standard staffing; specialized Standard staffing; specialized

programming:programming:a.a. Intensive addiction programming in Intensive addiction programming in

psychiatrically managed setting (dual inpt psychiatrically managed setting (dual inpt unit; dry dual dx housing, supported sober unit; dry dual dx housing, supported sober house)house)

b.b. Range of phase-specific rx options in ongoing Range of phase-specific rx options in ongoing care setting: dual dx day treatment; damp care setting: dual dx day treatment; damp dual dx housingdual dx housing

c.c. Intensive case mgt outreach/motiv. enh.: Intensive case mgt outreach/motiv. enh.: CTT, wet housing, payeeship management CTT, wet housing, payeeship management

CCISC INITIATIVESCCISC INITIATIVESState/Province LevelState/Province Level

AlaskaAlaska ArizonaArizona District of Columbia District of Columbia MaineMaine ManitobaManitoba MarylandMaryland MontanaMontana New MexicoNew Mexico VermontVermont CO-SIG (LA, HI, AK, PA)CO-SIG (LA, HI, AK, PA)

Network LevelNetwork Level Mid-Valley Behavioral Care Mid-Valley Behavioral Care

Network, OregonNetwork, Oregon Southwest Counseling, Detroit MISouthwest Counseling, Detroit MI Mental Health Systems, Mental Health Systems,

CaliforniaCalifornia

City/County LevelCity/County Level San Diego, San Francisco CASan Diego, San Francisco CA Birmingham, AlabamaBirmingham, Alabama Lynchburg, VirginiaLynchburg, Virginia Grand Rapids, Kalamazoo, Grand Rapids, Kalamazoo,

Washtenaw, Lansing, MIWashtenaw, Lansing, MI Bay City, Traverse City, Midland, Bay City, Traverse City, Midland,

Marquette, MIMarquette, MI Tampa, Broward, Miami, West Tampa, Broward, Miami, West

Palm Beach, Pensacola, FLPalm Beach, Pensacola, FL Peoria, IllinoisPeoria, Illinois Victoria, British ColumbiaVictoria, British Columbia Winnipeg, ManitobaWinnipeg, Manitoba Montgomery, Worcester MDMontgomery, Worcester MD Blair Co, PennsylvaniaBlair Co, Pennsylvania Spokane, WashingtonSpokane, Washington

SYSTEM FEATURESSYSTEM FEATURES

All systems are complex with unique structures and All systems are complex with unique structures and culturescultures

All systems work within the context of limited All systems work within the context of limited resources and with complex funding issuesresources and with complex funding issues

Data is often inconsistent with epidemiologic findings Data is often inconsistent with epidemiologic findings Each has significant strengths and weaknesses at all Each has significant strengths and weaknesses at all

levels (system, program, clinical practice, and levels (system, program, clinical practice, and clinician)clinician)

Under utilization of leverage (carrots and sticks)Under utilization of leverage (carrots and sticks) Everyone falls into the training trap at some pointEveryone falls into the training trap at some point Each is becoming more sophisticated about Each is becoming more sophisticated about

outcomes measurement (system and clinical) and outcomes measurement (system and clinical) and continuous quality improvement approachescontinuous quality improvement approaches

PUBLIC BEHAVIORAL PUBLIC BEHAVIORAL HEALTH CARE HEALTH CARE

Multiple State Agencies and Governing Multiple State Agencies and Governing BodiesBodies

Multiple Funding StreamsMultiple Funding Streams Multiple Systems of CareMultiple Systems of Care Severely Limited ResourcesSeverely Limited Resources PovertyPoverty Rural and UrbanRural and Urban Cultural DiversityCultural Diversity

Creating Integrated Creating Integrated Services for Individuals Services for Individuals

with Psychiatric and with Psychiatric and Substance Use DisordersSubstance Use Disorders

New Mexico Department of HealthNew Mexico Department of Health

Behavioral Health Services DivisionBehavioral Health Services Division

BEHAVIORAL HEALTH SERVICE BEHAVIORAL HEALTH SERVICE DIVISION OF THE NEW MEXICO DIVISION OF THE NEW MEXICO

DEPARTMENT OF HEALTHDEPARTMENT OF HEALTH Single State Authority for Mental Single State Authority for Mental

Health and Substance ServicesHealth and Substance Services Operates the “Safety Net” Service Operates the “Safety Net” Service

System for New Mexico (Indigent and System for New Mexico (Indigent and Priority)Priority)

Community-based Services and State Community-based Services and State Facilities ServicesFacilities Services

Primary System for Substance ServicesPrimary System for Substance Services

REGIONAL CARE REGIONAL CARE COORDINATORSCOORDINATORS

Regional Fund ManagersRegional Fund Managers Care CoordinationCare Coordination Administrative Service OrganizationsAdministrative Service Organizations

Identification of NeedIdentification of Need

Morbidity and MortalityMorbidity and Mortality Gross Under IdentificationGross Under Identification Inefficient Use of ResourcesInefficient Use of Resources Unmet NeedsUnmet Needs

STRATEGIC ALIGNMENTSTRATEGIC ALIGNMENT

CCISC – Principle-driven Systems CCISC – Principle-driven Systems Improvement ApproachImprovement Approach

CCISC – Supports Implementation CCISC – Supports Implementation of Evidence-based Approaches and of Evidence-based Approaches and Improves Routine PracticesImproves Routine Practices

CCISC – Can be Implemented with CCISC – Can be Implemented with Existing Resources Using Existing Resources Using Traditional Funding StreamsTraditional Funding Streams

IMPLEMENTATIONIMPLEMENTATION Top-down/Bottom-up Development Top-down/Bottom-up Development Aligning the Parts of the System Aligning the Parts of the System Inclusion, not Exclusion (programs and populations)Inclusion, not Exclusion (programs and populations) Strategic Use of Leverage (Incentives, Contracts, Strategic Use of Leverage (Incentives, Contracts,

Standards, Licensure, etc….)Standards, Licensure, etc….) Outcomes and CQI (CO-FIT 100Outcomes and CQI (CO-FIT 100)) Model ProgramsModel Programs Evaluation of Core Competencies (COMPASSEvaluation of Core Competencies (COMPASS and and

CODECATCODECAT)) ““Action Planning”Action Planning” Train-the-TrainersTrain-the-Trainers ““Backfilling”Backfilling”

STARTING PLACESSTARTING PLACES Identification of the Population in NeedIdentification of the Population in Need Administrative Barriers – Access: Welcoming, No Wrong DoorAdministrative Barriers – Access: Welcoming, No Wrong Door Administrative Barriers – Data Capture: MIS system; Administrative Barriers – Data Capture: MIS system;

feedbackfeedback Administrative Barriers – Fiscal: Billing and auditing practice Administrative Barriers – Fiscal: Billing and auditing practice Universal Integrated ScreeningUniversal Integrated Screening Assessment Process (ILSA™)Assessment Process (ILSA™) Treatment Matching Treatment Matching Treatment PlanningTreatment Planning Engagement, Stage of Change and Contingency Engagement, Stage of Change and Contingency

ManagementManagement Evaluation of Trauma Evaluation of Trauma Interagency Coordination Interagency Coordination

PRINCIPLES OF SUCCESSFUL PRINCIPLES OF SUCCESSFUL TREATEMENT TREATEMENT

Co-morbidity is an expectation, not an exception.Co-morbidity is an expectation, not an exception.

Treatment success derives from the implementation of Treatment success derives from the implementation of an an empathic, hopeful, continuousempathic, hopeful, continuous treatment treatment relationship, which provides integrated treatment and relationship, which provides integrated treatment and coordination of care through the course of multiple coordination of care through the course of multiple treatment episodes.treatment episodes.

Within the context of the empathic, hopeful, continuous, Within the context of the empathic, hopeful, continuous, integrated relationship, integrated relationship, case management/carecase management/care and and empathic detachment/ confrontationempathic detachment/ confrontation are are appropriately balanced at each point in time.appropriately balanced at each point in time.

When substance disorder and psychiatric disorder co-exist, each disorder When substance disorder and psychiatric disorder co-exist, each disorder should be considered should be considered primaryprimary, and , and integrated dual primary treatmentintegrated dual primary treatment is is recommended, where each disorder receives appropriately intensive recommended, where each disorder receives appropriately intensive diagnosis-specific treatment.diagnosis-specific treatment.

Both major mental illness and substance dependence are examples of Both major mental illness and substance dependence are examples of primary mental illnesses which can be understood using a primary mental illnesses which can be understood using a disease and disease and recovery modelrecovery model, with parallel , with parallel phases of recoveryphases of recovery, each requiring , each requiring phase-specific treatmentphase-specific treatment..

There is no one type of dual diagnosis program or interventionThere is no one type of dual diagnosis program or intervention . For . For each person, the correct treatment intervention must be individualized each person, the correct treatment intervention must be individualized according to diagnosis, phase of recovery/treatment, level of functioning according to diagnosis, phase of recovery/treatment, level of functioning and/or disability associated with each disorder, and level of and/or disability associated with each disorder, and level of acuityacuity, , dangerousnessdangerousness, , motivationmotivation, , capacity for treatment adherencecapacity for treatment adherence, and , and availability of continuing empathic treatment relationships and other availability of continuing empathic treatment relationships and other recovery supports.recovery supports.

PRINCIPLES OF SUCCESSFUL PRINCIPLES OF SUCCESSFUL TREATEMENT, cont’d. TREATEMENT, cont’d.

LINKING PRINCIPLES, LINKING PRINCIPLES, IMPLEMENTATION AND OUTCOMESIMPLEMENTATION AND OUTCOMES

Examples:Examples: PrinciplePrinciple: Co-morbidity is an : Co-morbidity is an

Expectation, not an ExceptionExpectation, not an Exception CQI InitiativeCQI Initiative: Removal of : Removal of

Administrative Barriers to Data Administrative Barriers to Data Collection Collection

Measure of SuccessMeasure of Success: Improved : Improved Population Identification and Data Population Identification and Data CollectionCollection

LINKING PRINCIPLES, LINKING PRINCIPLES, IMPLEMENTATION AND OUTCOMESIMPLEMENTATION AND OUTCOMES

Examples:Examples: PrinciplePrinciple: Individualized Treatment Matching : Individualized Treatment Matching

according to diagnosis, phase of according to diagnosis, phase of recovery/treatment, level of functioning/disability, recovery/treatment, level of functioning/disability, level of acuity, dangerousness, motivation, level of acuity, dangerousness, motivation, capacity for treatment adherence, availability of capacity for treatment adherence, availability of continuing empathic treatment relationships and continuing empathic treatment relationships and recovery supportsrecovery supports

CQI InitiativeCQI Initiative: Integrated Longitudinal Strength-: Integrated Longitudinal Strength-based Assessments (ILSAbased Assessments (ILSA))

Measure of SuccessMeasure of Success: Improved Identification of : Improved Identification of Need and Improved Treatment MatchingNeed and Improved Treatment Matching

TRAIN THE TRAINER TRAIN THE TRAINER PROGRAMPROGRAM

ROLES OF THE TRAINERROLES OF THE TRAINER

Develops Systems and Clinicians Develops Systems and Clinicians Identifies Barriers to ImplementationIdentifies Barriers to Implementation Informs Policy and ProcedureInforms Policy and Procedure Bridges Systems and CliniciansBridges Systems and Clinicians Extends Training and TA CapacityExtends Training and TA Capacity

COMPONENTS OF THE COMPONENTS OF THE PROGRAMPROGRAM

Master TrainersMaster Trainers Master Trainer SessionsMaster Trainer Sessions Master Trainer CurriculumMaster Trainer Curriculum Trainings and Technical AssistanceTrainings and Technical Assistance Development and Feedback LoopsDevelopment and Feedback Loops