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How can CEIC help us increase the co-occurring capability of our programs?
My agency wants technical assistance from CEIC.
In 2008, the New York State Health Foundation (“NYSHealth” or the “Foundation”) established CEIC (the “Center for Excellence in Integrated Care”) as a non-governmental organization that would collaborate with other interested constituencies and with New York State (OMH and OASAS, the Offices of Mental Health and of Alcohol & Substance Abuse Services) to advance statewide improvements in care for persons with mental health and substance use problems. The initiative makes it possible for CEIC to offer technical assistance to all OASAS- and OMH-licensed, adult outpatient treatment programs across the entire State in implementing integrated treatment for co-occurring mental health and substance use disorders (typically called “co-occurring disorders” or “COD”) in a process of “building co-occurring capability,” or simply “building capability.”
CEIC technical assistance specialists begin the process of building capability with an on-site assessment that measures a program’s “co-occurring capability” – the degree to which the program is able to deliver services for both mental health and substance use problems. Using a nationally-recognized measurement index that generates a confidential comprehensive report, CEIC’s technical assistance team is able to provide details of the program’s current level of integrated care along with associated observations and practical recommendations that will “build capability,” advancing the co-occurring capability of every program visited. All providers who have completed the on-site consultation are eligible for, and offered, follow-up technical assistance designed to help programs continue to build their co-occurring capability. CEIC will also link individual programs to other fully-funded opportunities that are available in the State.
NYS Office of Mental Health (OMH) & Office of Alcoholism & Substance Abuse Services (OASAS) Guidelines for Co-Occurring Disorders
CEIC Building Co-Occurring Capability Resource
CEIC Clinical Pathways Resource Guide
Target Areas for Building Capability
The process of “Building Co-occurring Capability” takes place across seven (7) dimensions of care, each associated with various content items – a total of 35 in all. This framework of integrated care comes from the nationally recognized indexes that CEIC uses to assess a program’s current co-occurring capability, the Dual Diagnosis in Addiction [or in Mental Health] Treatment (DDCAT or DDCMHT). CEIC assists service providers, both on- and off-site, to “build their capability”; in other words, to improve and expand their service delivery for persons with co-occurring problems in these seven areas – (Dimension 1) Program Structure; (Dimension 2) Program Milieu; (Dimension 3) Clinical Process: Assessment (includes Screening & Treatment Planning); (Dimension 4) Clinical Process: Treatment & (Dimension 5) Continuity of Care; (Dimension 6) Staffing; and (Dimension 7) Training.
CEIC includes all of these dimensions in its six “Target Areas,” listed immediately below.
- Program Structure & Milieu
- Screening
- Assessment
- Treatment & Continuity of Care
- Staffing
- Training
In arriving at these six Target Area categories, we have taken into consideration the objectives of the New York State Office of Mental Health (OMH) and the Office of Alcoholism and Substance Abuse Services (OASAS) as well as the seven dimensions of care. Each “Target Area” (and corresponding dimension[s]) is introduced in the paragraphs that follow. The links at the end of each “Target Area” introduction will take you to a detailed description of that target as well as additional resources and tools.
1. Program Structure & Milieu
Program Structure – Dimension 1 – Typically, an agency’s mission statement and policies are inclusive of persons with co-occurring disorders. When a program is not licensed to provide both mental health and addiction treatment services, a formal process will be established to ensure that individuals have access to those services that are not provided by the agency, and that concurrent services are integrated. For substance abuse programs, this often entails collaboration with a mental health program; mental health settings will likewise collaborate with a substance abuse program.
Program Milieu – Dimension 2 – The milieu is defined by the program’s expectations and the routine welcome given to those with co-occurring conditions and expressed in the treatment of both disorders. The program should display, distribute, and use literature and client/family educational materials that address both mental health and substance use disorders.
read more about program structure & milieu >>
2. Screening
Screening – included in Dimension 3, “Clinical Process: Assessment” with Assessment & Treatment Planning – Screening is a formal process of testing to determine whether or not a person has a disorder that warrants further attention at the time of testing and, within this context, to determine whether or not a co-occurring substance use or mental disorder may be present. The Commissioners of New York State’s Office of Mental Health (OMH) and Office of Alcoholism and Substance Abuse Services (OASAS) have underscored their support for statewide screening to identify persons with co-occurring disorder, noting that, unless both conditions are detected and treated effectively, recovery from either is unlikely. Part of CEIC’s mission is to help providers to implement appropriate screening practices.
3. Assessment
Assessment – included in Dimension 3, “Clinical Process: Assessment” with Screening & Treatment Planning – Assessment is a bio-psychosocial process that gathers information about a client’s psychiatric and substance use history, and continues to compile an integrated account of strengths, history, current symptoms, any self-reported diagnoses, the stages of change for both disorders, and other pertinent information. Family members and/or others who support the client’s recovery should be encouraged to participate in the assessment process.
4. Treatment & Continuity of Care
Treatment – Dimension 4 – Program services for co-occurring disorders should integrate motivational interventions, education about the symptoms, course, and treatments for both mental health and substance use disorders, and information about the interactive nature of co-occurring conditions. If psychopharmacologic and addiction pharmacotherapy interventions are not provided on-site, the program should establish a process to ensure access to such interventions through a seamless and integrated collaboration with a complementary entity. Peer supports for persons with co-occurring disorders should be available on-site or through collaboration (e.g., assertive linkage to 12-step groups that welcome individuals with co-occurring disorders, alumni groups, Dual Disorders Anonymous, Double Trouble in Recovery). Treatment should encourage the participation of family members and/or others who support the person's recovery. Interventions, which incorporate a focus on co-occurring disorders, could include family psycho-education, multi-family peer support groups, or family therapy.
Continuity of Care – Dimension 5 – Co-occurring disorders should be considered during the discharge planning process. Upon discharge, willing individuals should be connected with recovery support services, including (but not limited to) clinical recovery check-ups and a referral to telephone peer-recovery support.
read more about treatment & continuity of care >>
5. Staffing
Staffing – Dimension 6 – 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.
6. Training
Training – Dimension 7 – Each program requires a written training plan, which should include the means by which the program will assist staff to maintain and enhance their competencies to provide services for people with co-occurring disorders (e.g., through the use of current literature, film or other media, inservice trainings, and external trainings). The plan should incorporate training in specialized treatment approaches and pharmacotherapies.
General /
Technical Assistance
Michael Chaple, Ph.D.
Project Coordinator
(212) 845-4539
chaple@ndri.org
OMH-OASAS COD Package
Commissioners’ letter to Clinic Directors & NYS Guidelines for COD
CEIC Clinical Pathways Resource Guide
This document is intended to provide basic guidance for counselors working with people with co-occurring conditions (July 1, 2009 v4).