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Science and Service

Co-Occurring Disorders Programs

2009 Winners

Advanced Behavioral Health
Multisystemic Therapy
(860) 638-5309

Advanced Behavioral Health is a non-profit behavioral health management company that specializes in utilization management, provider network administration, research and dissemination of best practices and health information technology.

Multi Systemic Therapy (MST) was brought to Connecticut in 1999 in order to keep youth who were at risk of placement in a residential facility at home with their families. Over the past 10 years, the Department of Children and Families (DCF) and the Court Support Services Division (CSSD) have increased funding for MST and the number of teams has grown from 2 to 28. Since becoming the CT MST Network Partner in 2004, Advanced Behavioral Health (ABH®) has provided all quality assurance measures and training and support for the DCF and CSSD MST teams from a local level. ABH established a monthly provider meeting and a MST Workforce Development Committee in order to bring together providers and stakeholders to support the implementation of MST consistently and effectively across the state.

One of the primary goals of MST is to keep youth at home and out of residential placement. From 2004 to 2008, 3649 youth were served by MST teams in Connecticut. 82% of youth were living in the community at the time of discharge and only 14.9 % of the youth discharged from MST were placed in a more restrictive setting. Additional goals of MST are to increase school attendance and to prevent future arrests. During the same period, 84% of youth discharged from MST were enrolled in school or working and 73% of the discharged youth had not been arrested during treatment.

CenterPointe, Inc.
Integrated Dual Disorders Treatment

Located in Lincoln Nebraska, CenterPointe Inc. offers a full continuum of behavioral health care for people with co-occurring disorders including short and long term Residential, Outpatient counseling, supportive Case Management, Day Rehabilitation, Assertive Community Treatment (ACT) and Housing for 77 people. Since 1989, all programs and services have been focused on persons with co occurring disorders and are based on the Integrated Dual Disorders Treatment (IDDT) Evidence Based Practice. Psychiatric care is fully integrated with substance treatment to provide holistic recovery services. Staff are dually trained and credentialed in substance and mental health treatment. Services are not time specific and are provided using a harm reduction model, with abstinence as an ultimate goal.

A consumer can establish a behavioral healthcare home with CenterPointe and move from one level of care to another as their needs change, without the stress and disruption of referrals to other service provider(s). Using stage-wise interventions and motivational interviewing, consumers are engaged in services that meet their current needs. In 2004 a local Substance Abuse Action Coalition (SAAC) conducted an IDDT fidelity analysis of 11 local substance programs. CenterPointe programs were most closely aligned with the IDDT fidelity scale, scoring 65 of 75.

CenterPointe services for persons with co-occurring disorders benefits the community with reduced admissions to crisis centers, hospitals and jails. Consumers benefit from living as independently as possible in the community, with reduced or eliminated substance use and improved management of the symptoms of their mental health problems and an overall healthier, productive life.

Chrysalis House, Inc.
Dialectical Behavior Therapy
859-977-0500 or 859-977-2507

Established over 30 years ago, Chrysalis House is Kentucky’s largest licensed substance abuse treatment program for women and their families. The agency provides residential and transitional treatment for over 200 families annually offering therapy, case management, child care, job training and placement, and permanent housing opportunities. Dually trained mental health/substance abuse professionals assess and treat numerous co-occurring disorders among the families served.

The high level of care and extensiveness of treatment offered by Chrysalis House often attracts a large number of women with serious and disabling co-occurring disorders. One disorder that in the past has been recalcitrant to treatment is Borderline Personality Disorder (BPD). The instability and emotional disregulation associated with this diagnosis often led to self-harm attempts, chaos in the community, therapist burn-out, and early drop-out. To address this issue, Chrysalis House, Inc. instituted Dialectical Behavior Therapy (DBT) groups. National trials have shown that DBT is more effective than treatment-as-usual in the treatment of BPD and a co-morbid diagnosis of substance abuse. Further research has shown that DBT results in greater treatment retention, reduced suicidality, and reduced episodes of self-harm.

Since 2007, over 30 women have completed a Chrysalis House DBT group. Pre and post assessment completed by these women has resulted in an overall 77% decrease of BPD symptoms. The provision of DBT groups necessitates a substantial investment including staff training, controls to assure fidelity to the intervention, and staff dedicated to the objectives of DBT. However, the benefits of this intervention outweigh the investment by reducing staff time, reducing turmoil in the community, and significantly increasing coping skills of those diagnosed with BPD.

Connecticut Department of Mental Health and Addiction Services (DMHAS)
Integrated Dual Disorders Treatment (IDDT) for Latinos/as
860-418-6946 (click on “Major Initiatives” then “Co-Occurring Disorders Initiative”)

DMHAS is the state healthcare service agency responsible for health promotion, and the prevention and treatment of mental illness and substance abuse in Connecticut. DMHAS is focused on promoting and achieving a quality-focused, culturally responsive, and recovery-oriented system of care for individuals with mental health, substance use or co-occurring mental health and substance use disorders.

With people of Latino/a origin at increased risk for suffering from untreated substance use and mental health disorders, the implementation of integrated and culturally/ linguistically responsive services for this underserved population was a pressing need. The CT Mental Health Center’s La Clinica Hispana (Hispanic Clinic), a DMHAS behavioral healthcare facility that provides bilingual and bicultural mental health and addiction services, was chosen to implement the evidence-based Integrated Dual Disorders Treatment (IDDT) practice, with adaptations for Latinos/as with co-occurring disorders (COD), to improve services and outcomes.

Successful implementation of the model was achieved using multiple, varied strategies over a three-year period. The Hispanic Clinic observed, and a comprehensive evaluation revealed, positive client outcomes as a result of implementing IDDT, including an increase in engagement of clients in treatment, increase in adaptive coping skills, decrease in substance use and mental health symptoms, and an increase in employment. Clients with CODs served at the Hispanic Clinic clearly improve from receiving integrated services consistent with the implementation of the IDDT model, as evidenced by qualitative and quantitative findings. The implementation has required ingenuity in terms of ensuring that the model will be responsive to Latino/a clients and to the local community, all while remaining faithful to the IDDT model.

Hartford Dispensary
Co-occurring Disorder Program

Hartford Dispensary is a private, non-profit, behavioral healthcare agency providing mental health and substance abuse treatment, prevention, community health services, and research. Presently, the agency treats over 4,000 patients per day within its network of nine (9) clinics.

In 2003, the agency created a co-occurring disorders (CODS) program at our 1100 Henderson-Johnson clinic in Hartford. The program is staffed with three full-time master level, licensed clinicians and a part-time psychiatrist to treat mental health and substance dependence issues utilizing evidenced-based practices. All persons applying to the clinic are screened for co-occurring disorders and further evaluated for admittance into our CODS unit which can service up to 90 patients.

An evaluation of the unit, beginning in 2004, found that the improvements in co-occurring disorders patients were significant, including reductions in depression and anxiety, and improvements in quality of life. The agency is continuously monitoring outcomes and quality of patient care, as evidenced by the recent addition of a bi-lingual, bi-cultural clinician. The CODS program is an essential patient recovery service and an integral service component of the clinic.

Mental Health Center of Denver
Growth and Recovery Opportunities for Women
(303) 504-6500

At the Mental Health Center of Denver (MHCD) our mission is enriching lives and minds by focusing on strengths and recovery. We believe people can, and do, recover from mental illness. We are recognized nationally for our successful, ground-breaking treatment which supports recovery. At MHCD, consumers are involved in shaping their own recovery and given the chance to regain control of their lives. MHCD was created in 1989 as the mental health authority in Denver; in 2009 we celebrate 20 years of excellence. Last year, MHCD provided services to 11,500 individuals and assisted an additional 22,000 individuals on their journey to recovery. We provide services in 37 locations throughout Denver (including 17 public schools), have over 500 highly qualified professionals, and have 95 professional affiliations.

MHCD’s Growth and Recovery Opportunities for Women (GROW) program is a multi-faceted program of treatment which integrates a broad range of evidence-based practices delivered with high fidelity, including Assertive Community Treatment, Integrated Dual Disorders Treatment, Motivational Interviewing/Stages of Change, Supported Employment, Supportive Housing, and the Trauma Recovery and Empowerment Model. In the GROW program, at intake, 100% of women had a mental illness, were homeless with a substance abuse problem, and had experienced significant trauma. Their average recovery score was 3.4 (on a 10-point scale.) At six month follow-up, 80% had secured permanent housing, 20% were in a stable shelter, 60% reported abstinence from substance use, with a 48% increase in their overall recovery score. The women now have jobs, are attending school, and are parenting their children.

Southcentral Foundation
Integrated Primary Care Behavioral Health Services

Southcentral Foundation (SCF) is an Alaska Native nonprofit health corporation that provides health and related services to primarily Alaska Native and American Indian people in Southcentral Alaska. It operates several primary care clinics, two community health centers, and several outpatient and residential behavioral health treatment programs, as well as other wellness programs and services. Integration of behavioral health clinicians into the primary care setting was facilitated initially by a SAMHSA SBIRT grant in 2001 to our partner agency, Cook Inlet Tribal Council, and has been sustained well beyond the grant period.

In keeping with SCF’s vision of wellness for the whole person, Behavioral Health Consultants (BHCs) were integrated into the Anchorage Native Primary Care Center provider teams to provide preventative, brief, and solution-focused interventions for issues ranging from basic lifestyle change to various acute mental health conditions. Customers can receive comprehensive and immediate treatment in the exam room while visiting their primary care provider, thus making behavioral health a routine part of overall heath care.

The 11 BHCs on staff completed 7,659 visits during 2008, and only 20 percent of the customers seen required referrals to specialty behavioral health clinics. After the introduction of BHCs, 25 percent of those screened for substance abuse were shown to have alcohol or drug problems, but between intake and a 6-month follow-up, the percentage of individuals with no past-month substance use more than doubled—from almost 26 percent to 57 percent abstinence. Improvements were also shown in the percentage of individuals who obtained stable housing, jobs, and secondary education, as well as a decrease in involvement in the legal system.

The Village South
Seeking Safety

The Village, established in 1973 and located in Miami, Florida, an affiliate of WestCare Foundation, provides integrated services to individuals with co-occurring substance abuse and mental health disorders. It admits in excess of 600 clients each year to its residential programs. Over 70% of those admitted have been in or witnessed life threatening situations. Approximately 50% of the women in Village residential treatment meet the criteria for PTSD, and 40% of this group report sexual abuse as children.

In order to better serve these individuals, the Village became a participant in the NIDA Clinical Trials Network (CTN) study of Seeking Safety, a cognitive behavioral intervention designed to address trauma and substance abuse simultaneously. Following study completion in its outpatient center in 2006, the Village implemented Seeking Safety first in its women’s program, followed by the men’s and adolescent female programs. All clients assessed as experiencing PTSD or subclinical PTSD are offered an opportunity to participate in the program. As sustainability has been an intrinsic element of the planning of this program, the Village systematically develops additional Seeking Safety counselors and supervisors.

Baseline and post-treatment assessments of the women reveal significant improvement on 82.4% of the symptom frequency and 100% of the severity items. This pattern of improvement has been similar for the men and adolescent participants. Overall, 97.6% of the clients exhibited improvement in the frequency and/or severity of symptoms. As has been found in research studies and in the CTN study in which the Village participated, clients with the highest levels of symptom severity improve most rapidly and show the most change, with high- moderate to severe symptomology usually diminishing to the high-mild to low moderate range within 6 weeks.

Valeo Behavioral Health Care, Inc.
Integrated Dual Diagnosis Treatment
785-357-0580 x2163

Valeo Behavioral Health Care, Inc. has been serving the Shawnee County community since 1967, and is the designated mental health authority for public mental health services. Valeo provides comprehensive mental health and recovery services on a sliding fee schedule, and does not deny services to anyone due to inability to pay. Valeo has a very positive working relationship with the Kansas University School of Social Welfare, and the Office of Mental Health Research & Training. Implementation of the evidence based IDDT program at Valeo Behavioral Health Care, Inc. was an outgrowth of these pre-existing working relationships developed to better serve individuals dealing with mental health issues and co-occurring disorders.

There has been a strong organizational commitment to success of the Valeo IDDT program since its inception, and fidelity reviews continue to reflect that commitment. Valeo currently utilizes seven multidisciplinary teams to provide services with the approach of: The Same Team; The Same Location; and The Same Time, for improved outcomes. Currently in 2009, Valeo provides IDDT services to 418 consumers within the Community Support Services Department. This current number reflects 33% of the total population of consumers served within the department.

The pre-existing and ongoing positive working relationship with the Kansas University School of Social Welfare and the Office of Mental Health Research and Training has been of tremendous benefit to the Valeo IDDT program from development through implementation and continued progress toward program excellence. The fidelity review and rating of allegiance to the best in evidence-based practices in caring for dually diagnosed consumers has ensured program quality and continued success.

Last Update: 9/21/2009