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Integration

Develop Infrastructure for Systems Integration

Creating an integrated system of care for individuals with co-occurring mental health and substance abuse disorders requires states to examine policies, financing, program standards, licensing, performance measurement, and management information systems. Changes across these multiple levels provide a foundation to support practitioners in providing integrated services and treatment.


Reviewing of State Statutes, Policies, Regulations, and Administrative Rules

Policy documents formalize a shared vision of integrated services and link this vision to particular standards and requirements. Examples include:

  • The Connecticut Department of Mental Health and Addiction Services created a Commissioner's Policy Statement and Implementing Procedures which lays out definitions and guiding principles for the provision of services to individuals with co-occurring disorders. They also implemented a statewide requirement that all state-operated and department-funded mental health and addiction treatment programs administer standardized admission screenings.
  • The Commissioner of the Maine Department of Health and Human Services established an integrated care policy requiring all agencies to be co-occurring capable. Language was also added to the MaineCare (Medicaid) regulations so that the definition of every relevant service, such as comprehensive assessments or intensive outpatient services, includes explicit mention of co-occurring disorders.
  • Missouri has added co-occurring skills to its core certification requirements for agencies.

Making Changes in Financing or Budget Appropriations

Systems may develop flexible funding streams by combining funding from multiple sources, such as federal block grant funds or state funding. SAMHSA has released a position statement with guidance on blending Substance Abuse Prevention and Treatment and Community Mental Health Services Block Grant funds to support services for individuals with co-occurring disorders.

Other strategies include:

  • Modifying Medicaid regulations regarding service definitions and billing codes so that co-occurring services are reimbursable
  • Negotiating for Medicaid-managed care contracts to cover integrated care
  • Creating performance-based contracts that align financial incentives/disincentives with system goals

Through contracts, systems can require specific service models and payments can be linked to performance. For example:

  • In Illinois, separate state mental health and substance abuse treatment authorities provide cross-over funds to agencies in the other system so that they can extend their services to include care for people with co-occurring disorders.
  • Alaska incorporated language into requests for proposals and contracts that required agencies to develop action plans for integrating services.
  • In South Carolina, service organizations can be reimbursed by Medicaid for screening for co-occurring disorders.

Developing Interagency Agreements and Joint Guidelines, Policies and Procedures

Interagency agreements or guidelines can spell out how agencies will work together. Areas of collaboration might include use of common

  • Screening instruments
  • Intake tools
  • Data collection instruments
  • Performance indicators

Agreements may also define the referral process and guidelines for sharing client information. Joint guidelines can ensure that agencies are using common practices to provide care. For example:

  • In South Carolina, to comply with HIPAA requirements, the Departments of Mental Health and Alcohol and Other Drug Abuse Services have signed a Memorandum of Understanding to protect the confidentiality of protected health information. The agreement also defines guidelines for collecting and sharing de-identified data among the Departments to improve treatment.
  • Maine has developed a resource manual outlining clinical guidelines for integrated care. It guides policy, programs, and staffing relating to provision of services. The guidelines address eleven different areas, including screening and assessment, client records, and integrated programming.
  • The Arizona Department of Health Services has developed a Practice Protocol that outlines best practice guidelines for assessment, treatment, and psychopharmacology of individuals with co-occurring disorders.

Refining Management Information Systems

One key to sustaining integration efforts is refining or integrating management information systems across mental health and substance abuse agencies. Integrated management information systems help states to collect data on the following:

  • Prevalence of co-occurring disorders within the state
  • Needs of individuals with co-occurring disorders
  • Services provided to individuals with co-occurring disorders across systems
  • Outcomes
  • Cost of treatment

Refinements to management information systems include coding data to allow cross-system comparisons, developing capacity to share information across systems and establishing data elements that specifically identify co-occurring disorder services.


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