To foster the implementation of integrated approaches for New York State residents with co-occurring mental health and substance abuse conditions.

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  • Innovative Approaches

This area assembles innovative approaches from different New York State provider agencies. Each of these agencies is using a novel approach to the problems associated with co-occurring mental health and substance use disorders and has successfully incorporated this approach into their outpatient programming. In publicizing these successes to a broader audience, we want to acknowledge the achievements of each of these agencies and to inspire other outpatient programs to apply one or more of these approaches or to devise their own innovations. If your agency is taking an unusual path to helping improve the lives of those struggling with mental health and substance use problems, let us know!

Clinton County Mental Health and Addiction Services

The first approach is from the Clinton County Mental Health and Addiction Services agency in Plattsburg, part of the North Country Region. The Director, Sherrie Gillette, writes about some of the initiatives they have undertaken to bring integrated care to their co-located programs.

Toward Integrated Care

Initially we recognized that we had a large co-occurring population in our separate mental health and addiction clinics. We established a committee of management and staff from both clinics and arranged cross training that included motivational interviewing techniques. We then developed co-occurring pre-contemplative and action stage groups, co-led with clinicians from each clinic. This however was just the beginning.

We took seriously the “no wrong door” policy and combined the two separate buildings that housed the mental health and the addiction services. A single waiting room and one main door were constructed along with the integration of support staff from both clinics. This integration included reception, switchboard, medical records, billing, and secretarial. As a result, a high degree of efficiency was instituted, which had been impossible to achieve when maintaining two offices. Our challenge however, was to maintain the integrity of each of the individual clinics according to licensure requirements. We found various ways to do this. For instance, in medical records, we used a locked half-door to control access to the space along with full-time support staff coverage. Confidentiality between the two systems was secured. This change also cut down “missing” charts.

Fortunately, we had the experience of a CEIC site visit. We had already established a walk-in service for registration and triaging potential clients for treatment. In this process we were screening for both mental health and addiction using the “Modified Simple Screening Instrument for Substance Abuse” and the “Modified Mini,” respectively; however, the site visit revealed that we fell short in carrying the findings through to assessment and treatment planning. We also discovered that, when clients needed both mental health and addiction services, they were required to go through the walk-in service twice. To remove this duplication, we integrated our intake procedure so that only one registration and triage screening was done. Currently, we are expanding our walk-in capacity to include clinical evaluation. Several of our QHP clinical staff are trained in co-occurring disorders and are able to conduct a single assessment that can be used in either clinic. Our clinics use a single software product that encompasses scheduling, billing, and medical record modules. Firewalls have been installed between systems to maintain confidentiality, but the software functions are essentially identical, which facilitates the use of a single assessment.

Staff training, regular cross-system case review, and consultation assist in the development of sound treatment planning. Training for the clinical staff has progressed through the use of the NYS PI/Columbia online training. This training has been very well received and has been accessed by our entire mental health and addiction treatment team. It is our intent to weave the various aspects of co-occurring issues throughout our overall approach to care. Each clinician incorporates co-occurring issues into individual and group sessions routinely.

Finally we are fortunate to have shared staff between the two systems, most notably the coordinator of services and the psychiatrist. These two pivotal positions facilitate and foster understanding and ongoing communication between the clinicians, as well as incorporation of the intricacies of co-occurring disorders into clinical supervision. In addition, a review of screening, assessment, and treatment planning for co-occurring conditions has been embedded in our utilization review process to ensure that “the golden thread” is being maintained. We also collect monthly admission data of those with a co-occurring diagnosis. We believe that we have effectively integrated services to the degree that licensure allows, and that we are providing a much more comprehensive service to our recipients.