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

• About CEIC
  • Overview
  • Staff
  • Press
  • Partners
  • Register
  • Contact Us
• Target Areas
  • Overview
  • Program Structure & Milieu
  • Screening
  • Assessment
  • Treatment & Continuity of Care
  • Staffing
  • Training
• Services
  • Overview
  • Leadership Forums
  • On-Site DDCA/MHT Surveys
  • Building Capability Forums
  • Sustainability Supports
  • Technical Assistance
• Activities
  • Overview
  • By Region
  • Western
  • Finger Lakes
  • Central
  • North Country
  • Northeastern
  • Mid-Hudson
  • Long Island
  • New York City
  • Across NY State
  • CEIC Activity Map
• Tools & Links
  • Overview
  • For Agencies/Providers
  • Glossary
  • Tools & Resources
  • Innovative Approaches

On-site, documented clinical supervision sessions, with a focus on co-occurring disorders, should be provided. Other non-clinical, service delivery staff should also receive clinical supervision. Case review, staffing, and utilization review procedures emphasize and support treatment for co-occurring disorders. In addition, the program should build its capabilities, including the development of the capacity to prescribe pharmacological therapies for both addiction and mental health conditions, and the ability to have co-occurring disorders peer/alumni supports available.

Staffing

• A “Dual Disorder Capable” program consults with, or contracts, a psychiatrist for on-site services;
• at least 25% of staff members have certification/licensure in the co-occurring disorder;
• staff has on-site access to supervision in, or consultation (documented PRN) on, the co-occurring disorder.
  A program that is advancing from addiction only services to “Dual Disorder Capable” status will have, in addition to the prescriber, at least one direct care staff member with mental health licensure. Staff members who provide clinical services will receive hour-long on-site documented clinical supervision sessions, which incorporate a concentration on co-occurring disorders, at least once each week. The clinical director should determine the frequency of the clinical supervision that the other non-clinical service delivery staff receives.
• Enhancing psychiatric or other prescriber services in addiction agencies.
  Many addiction treatment providers consider enhancement of psychiatric capabilities to be pivotal. Access to a psychiatrist, physician or other prescriber can leverage a program from “Addiction Only Services” to “Dual Disorder Capable,” and is associated with many other items necessary for building capability. Yet many programs with physician coverage retain their “addiction only” status, according to the role the agencies have assigned to the physician, policies for clinical practice, traditions, and patient admission criteria.
  
  Typically, programs offering only addiction services have not established a formal relationship with a prescriber. Such programs must refer patients in need of prescribed medication or medication evaluations to a prescriber outside the program. “Dual Disorder Capable” programs will have a contract or consultant agreement with a prescriber who is qualified to evaluate and treat patients on-site. At times, these contractual arrangements can be inadequate to cover the needs of certain clients, but most can begin a medication regimen when indicated. Prescribers under contract to “Dual Disorder Capable” program usually are available for circumscribed clinical duties only.
• Enhancing psychiatric or other prescriber services in mental health agencies.
  Mental health programs will normally have access to a psychiatrist or other qualified specialist who will prescribe and monitor mental health pharmacotherapy. For a mental health program to achieve “Dual Disorder Capable” status, access to someone qualified to prescribe and monitor substance abuse pharmacotherapy must be available.
• Programs that offer treatment to individuals with co-occurring mental health disorders must maintain staff or enlist volunteers who can serve as co-occurring disorders peer/alumni.
  To become “Dual Disorder Capable,” a program that offers only addiction or mental health services must consider improving their ability to match clients with specific comorbidities to similarly diagnosed peer role models. One way to accomplish this is to employ alumni, volunteers, or recovering staff members (under careful supervision). The key is for the client with a co-occurring disorder to recognize that he or she is not alone in having dual disorders, and that someone else who has been successful in dealing with the conditions can help to navigate and connect with mutual peer support groups in the community.

CEIC Experience in New York State – Limited access to a psychiatrist is a barrier for many substance abuse programs – those with access either have a psychiatrist on staff or collaborate with a mental health clinic. Similarly, alumni supports for clients with co-occurring disorders are not readily available. Few clinical staff members have a license, certification or a formal testament of competency in the co-occurring disorder[s] and, in most cases, a staff member or consulting professional will provide supervision or consultation. Case reviews, when needed, emphasize and support co-occurring disorders treatment. The collaborative cohorts that CEIC is building have considerable potential to overcome some of these deficits in developing cooperative agreements between substance abuse and mental health service providers. The Building Capability Forum discusses this potential and the Learning Collaborative (with other “Sustainability Supports”) explores ways of achieving the desired outcome.

CEIC COD Staffing Document

• Download PDF

SAMHSA’s Treatment Improvement Protocol (TIP) 42 “Substance Abuse Treatment for Persons with Co-occurring Disorders”

• Download PDF