Embracing Change: How Northwest ATTC is Helping Programs Enhance Their Co-occurring Disorder Services – A Model for Success

By Denna Vandersloot, co-director, Northwest Addiction Technology Transfer Center

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.

While the list of barriers to integrating SUD and MH services is long, providers remain interested in and committed to better serving this population, something evidenced by a group of Oregon SUD providers who signed up for a year-long Northwest ATTC and Oregon Council on Behavioral Health (OCBH) intensive technical assistance project aimed at enhancing their programs’ capacity to serve clients with co-occurring disorders.

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 Health

For 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.

For a comprehensive list of resources designed to assist providers and others in integrating behavioral and physical health care to better address the needs of individuals with co-occurring mental, physical, and substance use conditions, check out this guide from NWATTC. 

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.

Embracing Change: Diversity Inclusion Project Showcase (DIPS) Promotes Recovery Community Organizations

Editor's note: This post is part of the ATTC Network's "Embracing Change" series.

The work to curb the impact of opioid use disorder and other forms of addiction is diverse and expansive. However, one fundamental portion of the effort comes via Recovery Community Organizations (RCOs), which deliver needed recovery support services to community members from historically marginalized, underserved communities. 

On October 5, 2021, an array of addiction and recovery support professionals and representatives from four of the premier RCOs in Massachusetts and Connecticut joined for an event designed to spur innovative collaboration. The Diversity Inclusion Project Showcase (DIPS): Promoting Recovery-Oriented Organizations, co-hosted by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the New England Addiction Technology Transfer Center (ATTC), was conceived as a platform to facilitate collaborations between RCOs serving historically marginalized communities, state leaders, policy makers, purveyors of technical assistance, and funders. The virtual meeting had an audience of more than 100 participants. 

Among the first to address the audience was Dr. Haner Hernandez, Senior Trainer for the New England ATTC. He established the tone of profound, personal connection that he and his colleagues have with their work. Hernandez noted the importance of RCOs, quoting renowned recovery expert William White, saying, “‘Recovery can be initiated in treatment, but recovery happens in community.’”

Dr. Haner Hernandez

The first two RCO representatives to speak were Louray Barton, Recovery Coach and Peer Specialist at STEPRox Recovery Center and Efrain Baez, Director of Stairway to Recovery. Barton emphasized the engagement and enthusiasm of STEPRox’s community members.

Baez discussed Stairway’s strides in offering an array of support services, as well as its enduring struggles and needs for support with obtaining adequate resources such as housing and multilingual health professionals.

Dr. Sara Becker, Director of the New England ATTC, spoke briefly about its mission and commitment to RCOs.

“We work to foster regional and national connections among diverse stakeholders,” she said.
Following Becker was Michele Stewart-Copes, Senior Trainer at New England ATTC. “To me, the opposite of addiction is connection,” Stewart-Copes said.

The next two CBO representatives to speak were Dr. Marie Spivey, Administrative Coordinator for Recovery Support Services, and Pastor Dana Smith, Director of New Life Ministries II. Each spoke about their RCO’s services, successes, and ongoing challenges.

“The Recovery Support Services is the first of this corporation (The Spott Unlimited Inc., a nonprofit service created by the Spottswood African Methodist Episcopal Zion Church in Connecticut) to launch a supportive program which is led by a recovery coach and eight to 10 recovery support assistants who are committed to work with individuals to help them find a pathway of recovery…”, Spivey said.
Smith followed her, saying, “Recovery is not a cookie-cutter kind of thing…All of us could be in the same accident, but it’s going to affect each of us differently.”

The DIPS Showcase, hosted by the New England ATTC and sponsored by SAMHSA, succeeded in highlighting the work of Massachusetts and Connecticut RCOs.

“(Community health workers) have been the unsung heroes of the pandemic, never giving up on their respective missions to save lives and lift up families,” said Nancy Navarretta, acting Commissioner of the Connecticut Department of Mental Health and Addiction Services.

Deidre Calvert, Director of the Bureau of Substance Addiction Services at the Massachusetts Department of Public Health, also recorded a personal message of gratitude for the leadership of StepRox, Stairway to Recovery, and other RCOs in her state.

“I would like to express the Commonwealth’s sincere appreciation for all of you who’ve been on the frontlines saving lives every day,” she said.

Having only introduced a few of the myriad of RCOs serving the 6-state region, the New England ATTC has plans to present similar showcase events in the future.

Encouragingly, collaborations have already occurred since the October 2021 showcase. In 2022, New Life Ministries II reached out to the New England ATTC to request intensive technical assistance to help members of the clergy learn and infuse harm reduction principles into the church community. Among the results of the collaboration were a harm reduction training workshop, production and analysis of graphic messaging, and iterative development of innovative recovery tools. The New England ATTC and New Life Ministries II are now partnering to develop a train-the-trainer curriculum focused on harm reduction in faith-based communities.

For agencies interested in participating in future showcase events, or in proposing any partnerships, please contact the New England ATTC at newenglandattc@brown.edu.

Author Bios
A native of Varnville, SC, Levell Williams considers himself a product of faith, family, and community. He gained his BA in Mass Communication from Tougaloo College in 2021. Levell is a Health Equity Scholar at the Brown University School of Public Health and is pursuing a Master’s in Public Health focused on science communication.

Dr. Kelli Scott is a clinical psychologist and Assistant Professor at the Brown University School of Public Health. Dr. Scott serves as the Evaluation Director for the New England ATTC, and works to assess the impact of ATTC training and technical assistance initiatives throughout the New England region.