INTEGRATED CHEMICAL &

MENTAL HEALTH CARE

Heidi Kammer MSW, LICSW, LADC

NAMI Minnesota State Conference

Saturday, November 15, 2014

10:15am-11:30am

PURPOSE This session focuses on strategies for

delivering effective, outcome-based co-occurring chemical and mental health care Explore the best practice of integrated dual

diagnosis treatment. What makes substance use disorder treatment

and mental health treatment unique Benefits of integrated treatment. Key components of effective integrated

treatment Culturally responsive and trauma informed

care components

OBJECTIVES Importance of integrating chemical and

mental health, including integration with primary medical care in response to the changing landscape of the Affordable Care Act

Practices for co-occurring disorders along the continuum of care

The theme of the "right care at the right time" as a model of effective practice.

Evaluating recovery outcomes through client satisfaction and the use of evidence-based practices

ABOUT THE PRESENTER

Heidi Kammer MSW, LICSW, LADCVice President- Chemical & Mental Health

RESOURCE, Inc.1900 Chicago Avenue South

Minneapolis, MN 554046127528092 phone 6128043417 cellular

hkammer@resource-mn.orgwww.resource-mn.org

ABOUT RESOURCE

RESOURCE’s mission is to: Empower people to achieve greater personal, social, economic success. Our commitment is to undoing racism and promoting diversity through reducing health and racial disparities.

www.resource-mn.org

WHAT IS/ARE CO-OCCURRING DISORDERS?Co-occurring Disorder (COD)

Co-occurring disorders may include any combination of two or more substance abuse disorders and mental disorders identified in the Diagnostic and Statistical Manual of Mental Disorders 5

There are no specific combinations of substance abuse disorders and mental disorders that are defined uniquely as co-occurring disorders

Substance abuse and mental health problems (such as binge drinking by people with mental disorders) that do not reach the diagnostic threshold are also part of the co-occurring disorders landscape and may offer opportunities for early intervention

Both substance abuse disorders and mental disorders have biological, psychological and social components

Co-occurring disorders may vary among individuals and in the same individual over time

Both disorders may be severe or mild, or one may be more severe than the other

CHEMICAL & MENTAL HEALTH CARE IS HEALTH CARE!

WHAT IS INTEGRATED CARE? The solution lies in integrated care, the

systematic coordination of general and behavioral healthcare. Integrating mental health, substance abuse, and primary care services produces the best outcomes and proves the most effective approach to caring for people with multiple healthcare needs.

Source: The SAMHSA-HRSA Center for Integrated Health Solutions (CIHS)

IMPORTANCE OF INTEGRATED CARE

More than 80% of persons with co-occurring disorders do not perceive the need for treatment/ care

Source: National Survey on Drug Use & Health

CHANGING LANDSCAPE The Affordable

Care Act/Health Care Reform

http://kff.org/health-reform/video/youtoons-obamacare-video/

Source: Kaiser Family Foundation

THE GOAL OF ACA

The Triple Aim

Achieve Improved Patient Health

Provide High Quality Care

Do This in a Cost Effective Way

KEY CONSIDERATIONS “Right services at the right time in the right

amount”: this should be our new mantra! A true longitudinal continuum perspective vs.

episodic Chemical Health & Mental Health care is “HEALTH”

care. We must be able to educate consumers, clients,

about impact of health care reform. (web resources & handouts)

We must engage with organizational decision makers about our care model- “that’s the way we always did it” doesn’t fly

Develop treatment plans from a “holistic” perspective

Ensure “true” multidisciplinary coordination and care (chemical health, mental health, primary care/ health)

RECOVERY AND INTEGRATED CARE

Promoting Recovery…

“A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”

(SAMHSA, 2011)

CULTURALLY RESPONSIVE CARE

Integrated Care ensures culturally responsive care.

Considering health and racial disparities Culturally responsive care is a key

strategy for relapse prevention The impact of oppression, racism,

classism…on health and relapse prevention

Consider the cultural experience and hope of the consumer

COMPONENTS OF INTEGRATED CARE Multidisciplinary Team Stage-Wise Interventions (stages of change, stages of

treatment) Access to Comprehensive Services (e.g., residential,

employment, etc.) Time-Unlimited Services Assertive Outreach Motivational Interventions Substance Abuse Counseling Group Treatment Family Psychoeducation Participation in Alcohol & Drug Self-Help Groups Pharmacological Treatment Interventions to Promote Health Secondary Interventions for Treatment of Non-

Responders Case Western Handout/ Resource

THE INTEGRATED CARE PLAN

A Sample: http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/dhs16_181625.pdf

CREATING IMPACT AND OUTCOMES

Stage-wise care/ treatment A continuum of care Measuring impact via the Triple Aim

AccessQuality of CareCost of Care Improved Health

The right services at the right time!

CASE STUDY- MARIA

The client is a 38-year-old Hispanic/Latina woman who is the mother of two teenagers. Maria M. presents with an 11-year history of cocaine dependence, a two-year history of opioid dependence, and a history of trauma related to a longstanding abusive relationship (which has been over for six years). She is not in an intimate relationship at present and there is no current indication that she is at risk for either violence or self-harm. She also has persistent major depression and panic treated with antidepressants. She is very motivated to receive treatment.

Source:

KEY REFLECTION QUESTIONS1. What would be the ideal treatment plan

strategies? 2. What services involved in providing

services to this client?3. What, if any, adjustments to existing

services would have to be made?4. Would there be gaps in service? How

might these be filled?5. Who would be the best suited to act as

case manager for this client?6. What barriers would exist for care

coordination?

CASE STUDY- GEORGEThe client is a 34-year-old married, employed African-American man with cocaine dependence, alcohol abuse, and bipolar disorder (stabilized on lithium) who is mandated to cocaine treatment by his employer due to a failed drug test. George T. and his family acknowledge that he needs help not to use cocaine, but do not agree that alcohol is a significant problem (nor does his employer). He complains that his mood swings intensify when he is using cocaine.

Source:

KEY REFLECTION QUESTIONS1. What would be the ideal treatment plan

strategies? 2. What services involved in providing

services to this client?3. What, if any, adjustments to existing

services would have to be made?4. Would there be gaps in service? How

might these be filled?5. Who would be the best suited to act as

case manager for this client?6. What barriers would exist for care

coordination?

INTEGRATED TREATMENT IN ACTION

http://www.youtube.com/view_play_list?p=85C1E36206E17BB3

RESOURCES Integrated Treatment for Co-

Occurring Disorders Evidence-Based Practices (EBP) KIT http://store.samhsa.gov/product/SMA08-4367

Substance Abuse Treatment for Persons With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series 42. http://www.ncbi.nlm.nih.gov/books/NBK64190/

Practical Approaches to Staging Change in Dual Diagnosis http://www.samhsa.gov/co-occurring/topics/training/staging-change.aspx

QUESTIONS & DISCUSSION