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Burrell Behavioral Health
When Burrell Behavioral Health opened its doors over thirty years ago, it was the only community mental health agency in the state of Missouri that did not have a state hospital in its region. From its earliest days, Burrell has been pushed to utilize creative and progressive interventions for those served. The implementation of Integrated Dual Disorders Treatment (IDDT) is a present-day demonstration of this and has revolutionized the care that Burrell offers clients with co-occurring disorders.
The need for IDDT is considerable in southwest and central Missouri. The area has been branded the “Meth Capitol of the World,” and has a large and growing population of adult clients with mental illness being served by Burrell’s CPRC program. As the sole provider of CPRC services in the greater Springfield, Burrell is serving over 2,400 adults with mental illness at any given time. Burrell is currently building this same set of services in ten counties in central Missouri.
With the implementation of IDDT came the development of a system of care that includes screening mechanisms, assessments, stage-wise dual diagnosis groups, topical dual diagnosis groups, and a treatment program that offers individuals co-occurring counseling. Since the implementation process began, the goal has been to change not only the procedures and protocols, but to also change the culture of the agency. As Burrell staff are trained in the science of addiction and equipped with tools to serve the co-occurring population, the agency culture has become increasingly marked by compassion, empathy and hope. Burrell Behavioral Health is committed to providing competent integrated treatment for CPRC and homeless clients with co-occurring disorders in a manner that is welcoming, strength-based, time unlimited and individualized for each client’s needs.
Florida Department of Juvenile Justice
The State of Florida, Department of Juvenile Justice launched the Redirection project in 2004 in an effort to “redirect” youth in its custody from costly residential placements to, family-focused, evidence-based treatments in local communities. Over the four years that the project has been in operation, Redirection has expanded from serving three to serving eighteen judicial circuits, provided effective treatments for over 2,800 referred youth and families, and saved the state millions of dollars in placement costs.
Since inception, the Redirection Project has focused on two Blueprints for Violence Prevention Model programs that have demonstrated strong positive outcomes in addressing the multiple needs of delinquent youth and their families – Functional Family Therapy (FFT) and Multisystemic Therapy (MST). The programs help to promote a stronger, more supportive family system based upon effective parenting and improved communications between family members and among others outside the family who work with the youth (e.g., teachers and probation officers).
The Redirection project was carefully planned, executed and methodically expanded in collaboration with a management team, Evidence-based Associates (EBA), who oversaw implementation, established quality assurance protocols, coordinated program evaluation, and facilitated statewide communication among key stakeholders (e.g., judges and state’s attorneys). According to a recent report produced by the Office of Program Policy Analysis and Government Accountability, the Redirection project has reduced felony adjudications by 31% compared to youth released from state-funded residential programs and avoided nearly $15 million in residential placement costs.
Founded in 1969, NEIGHBORING’s mission is to empower adults with mental illness and substance use disorders to live, learn, work and participate fully in family and community. Located in Lake County in northeast Ohio, NEIGHBORING’s staff of some 70 mental health professionals last year served over 1800 adults, nearly 700 who have severe and persistent mental illnesses.
NEIGHBORING’s efforts to serve consumers with co-occurring disorders began in 2001, with the recognition that dually-diagnosed consumers were inadequately treated by parallel systems of mental health and addiction services. NEIGHBORING began implementation of the evidence-based Integrated Dual Disorders Treatment (IDDT) model, with training and consultation from Ohio’s newly formed Substance Abuse and Mental Illness Coordinating Center of Excellence (SAMI CCOE). Annual independent Fidelity Reviews conducted by the SAMI CCOE have confirmed the agency’s strong implementation of IDDT. Fidelity ratings have increased for four consecutive years, with our most recent scores averaging 4.45 on the 5 point scale.
Sustaining this level of fidelity has led the program’s clients to attain significant improvements in community functioning, in such areas as lower hospitalization rates, stability of housing, lowered rates of incarceration, increased employment and school participation, and symptom reduction. A sustained stage-wise treatment approach has supported consumers in building their internal motivation for change, their hope and confidence in their ability to reach personal recovery goals, and their transition to becoming more productive members of their communities.
With funding support from the Lake County Alcohol, Drug Addiction and Mental Health Services (ADAMHS) Board, the NEIGHBORING Dual Disorders team has grown steadily from “an army of one” in 2001, to its present multidisciplinary team of ten. Serving more than 100 clients per year, the program continues to grow and to demonstrate high fidelity, positive consumer outcomes, and significant benefits to the communities served.
In addition to IDDT, NEIGHBORING has expanded its commitment to providing evidence-based practices, and program offerings now include Crisis Intervention Team (CIT) training for law enforcement personnel (since 2004), Supported Employment (2005) and the promising/“emerging best practice” of Wellness Management and Recovery (2006), a program of Ohio’s newest Coordinating Center of Excellence.
Park Place Partial Hospitalization Program/Jersey Shore University Medical Center
The Park Place Partial Hospitalization program is a service of Jersey Shore University Medical Center. Park Place has been providing services to people with severe mental illnesses since 1975. The program has provided comprehensive treatment to adults with co-occurring mental illness and substance abuse disorders since 1986.
In October 2004, Park Place was selected by the New Jersey Division of Mental Health to be a pilot site for the implementation of Integrated Dual Disorders Treatment (IDDT) services. Park Place’s programmatic integrity, recovery oriented treatment philosophy, experience working with those suffering from severe mental illnesses, and the willingness to work with clients in pre–action stages of change were key components in being selected.
In June 2005, subsequent to training in IDDT, an implementation work group convened and programmatic changes recommended by the work group began to be implemented. Since the time of implementation the program was assessed twice for fidelity. It was noted that Park Place had increased its fidelity by: increasing admission and treatment of active substance users and those in pre-action stages of change; initiating a persuasion group to address the treatment needs of active substance users; allowing clients unrestricted time for treatment; well matched substance abuse treatment interventions for clients in the active and relapse prevention stages of treatment; and in its efforts to outreach to disengaged clients.
Since the implementation of IDDT, 85% of clients at intake were assessed to be in the engagement stage. At termination 48% were assessed to be in the active treatment or relapse prevention stage. Moreover, at intake 24% were homeless and 22% had criminal justice involvement, and 10% had vocational involvement. Upon termination, 9% were homeless, 6% had criminal justice involvement and 28% had vocational involvement.
For 26 years Residence XII has served the greater Seattle area and surrounding states by providing gender-specific treatment for women with chemical dependency issues. A leader in the community, Residence XII has been the recipient of awards such as the James W. West Quality Improvement Award 2008, University of Washington Preferred Partner Award 2007 and the 2005 Non Profit of the Year Award. In addition, Residence XII has consistently received the highest level of accreditation from the Commission on Accreditation of Rehabilitation Facilities (CARF) and is a federation member of the Women’s Funding Alliance. In an effort to continue providing state of the art women-specific treatment Residence XII began the Trauma Integration Project in February 2007. This project addressed the need for substance abuse treatment that took into account the high rate of women who have co-occurring traumatic life experiences.
The results indicated that the frequency and severity of trauma symptoms decreased in patients engaged in the trauma curricula. In addition, substance use inventories revealed a decline in the number of patients reporting substance use between the initial assessment and exit assessment in both groups. Continually, discharge rates were consistent between groups with no significant difference. Lastly, the implementation of assessment and curricula went smoothly with few barriers. The project was considered successful due to the accomplishment of the integration, its low overhead cost, positive impact on client services and potential for long term sustainability.
Western Psychiatric Institute and Clinic – Addiction Medicine Services
The Addiction Medicine Services (AMS) at the Western Psychiatric Institute and Clinic (WPIC) provides clinical services to individuals with substance use disorders (SUDs) and co-occurring psychiatric disorders (COD) throughout the Western Pennsylvania region in over 20 programs in 8 locations. AMS programs serve over 8,000 individuals each year in inpatient, residential and ambulatory settings. For over a decade, AMS has been a leader in disseminating and implementing evidenced-based practices (EBPs) in the treatment of SUDs and CODs. This includes the presentation of over 200 local, national and international lectures, workshops and 1-day and 2-day training programs on Motivational Interviewing (MI) which have reached thousands of professionals. We have several certified Motivational Interviewing Network of Trainers. In addition, training and consultation on MI has been provided to numerous local community providers, including initial training, booster training sessions, and consultation on MI strategies, supervision and adherence to the model.
AMS adapted MI to facilitate the transition from inpatient to ambulatory care and compared two cohorts of COD patients who received an MI intervention prior to psychiatric hospital discharge to those receiving treatment-as-usual (TAU, n=183). In cohort 1 (n=57), 63% of patients entered outpatient treatment following hospital discharge compared to 40% of TAU patients, an improvement of 57.5% (p=<.01). In cohort 2 (n=51), 76% of patients entered outpatient treatment following hospital discharge, an improvement of 90% (p=<.01). Several strategies are employed to ensure fidelity to MI interventions: 1) direct observations of sessions during the early training period; 2) review of tapes of sessions; 3) discussion of specific cases; and 4) completion of fidelity scales by both supervisors and clinicians delivering the intervention.
An important result of this work has been collaboration with a third party payer to develop billing codes for a pre-discharge motivational session so that an outpatient clinician’s time is reimbursed for seeing inpatients prior to hospital discharge.
Substance Abuse & Mental Health Services Administration • 1 Choke Cherry Road • Rockville, MD 20857