Many clients seeking care for their substance use disorder also have co-occurring mental health disorders – and vice versa. Treating both types of conditions at the same time by providing quality integrated services is more effective than treating each disorder separately.
Yet while integrated care has been increasingly prioritized, it remains an often-elusive goal. An estimated 17 million adults in the United States live with co-occurring mental health (MH) and substance use disorders (SUD), yet only 5.7% of these individuals receive treatment for both disorders (NSDUH, 2020).
So, what is getting in the way?
- We have a divided system of care where MH and SUD services are often funded separately and governed by different administrative rules.
- There is a long list of system-, program-, clinical-, and client-related barriers to integration of services.
- “Integrated care” has become a buzzword and isn’t always clearly defined.
The project was divided into phases aligning with Gregory Aarons and colleagues’ EPIS model for implementing innovative practices:
1) The Exploration phase involved securing leadership buy-in, assessing the programs’ existing co-occurring disorder services capacity using the Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index, and providing a detailed summary report with program-specific recommendations for enhancing the level of integration.
2) The Preparation and Implementation phases involved leaderships’ participation in a NIATx Change Leader Academy featuring learning sessions and monthly coaching calls with an experienced NIATx coach.
The Sustainment phase: involved delivery of a final DDCAT site review to evaluate progress and document sustainability efforts.
Participating programs worked on a variety of change projects ranging from increasing mental health referrals, to matching treatment to stages of change for both MH and SUD conditions, to increasing the availability of co-occurring disorder group counseling.
Click to watch a video testimonial on this project, produced by Northwest ATTC and the Oregon Council for Behavioral HealthFor example, Grants Pass Treatment Center (ORTC, LLC) increased their identification of mental health needs and referral to MH services within the first thirty days of treatment from 14% to 72% by increasing collaboration and coordination with mental health agencies, adding MH screening, and increasing the focus on mental health issues in case consultations.
The primary goal of this project was to improve co-occurring disorder services for clients by having program leaders engage in an intensive technical assistance process that combined the use of the DDCAT Index and the NIATx process improvement model. This goal was achieved with noteworthy results. The mean DDCAT score at the beginning (baseline) of the project was 3.21; this score had increased to 3.86 by the end of the project. Additionally, at baseline, just 30% of the programs were dual diagnosis capable, while at the final review, that figure had grown to 71%.
This suggests that future clients will be offered useful, integrated services to address their co-occurring MH and SUD challenges, a very exciting outcome for all involved.A secondary goal of the project was to collect qualitative data on the system-level barriers standing in the way of providers’ integrating care. This data was used by the Oregon Council on Behavioral Health to help advocate for additional funding to support integrated COD care. House Bill 2086 was passed by the Oregon legislature allocating $10,200,000 in funding to support the development and implementation of payment structures/models that support integration of treatment and recovery support for individuals dealing with addiction and mental health diagnoses under one payment model.
Supporting the renewed interest in integration of MH and SUD services, this project provides a model for assisting programs to align policy, practice, and training efforts to support co-occurring disorder services.
About the author: Denna Vandersloot is the co-director of the Northwest ATTC at the University of Washington. Her work with the ATTC Network over the past 20 years includes providing leadership, training, and technical assistance services to the Northwest region.