Transcript Santa Clarita Valley Dual Diagnosis Coordinating Council

Building and Sustaining
Coalitions:
Optimizing care through
Cross-System Collaboration
First Things First…
“DUAL
DIAGNOSIS”
…What is it?
Definitions
 Dual Diagnosis
› A mental health diagnosis and a developmental
disability (common descriptor in services for
developmental disabilities)
› A mental health diagnosis and a substance
abuse disorder (common descriptor in mental
health services)
 “Dually Served”
› Receiving eligible services from more
than one system
Historically….MYTH: Individuals with
ID cannot have a verifiable mental
health disorder
• PREMISE: Maladaptive Behaviors are a function of ID
• REALITY: The full range of psychiatric disorders can be
represented in persons with ID & DD
• TREATMENT IMPLICATIONS: Psychiatric diagnosis can be
made using the DSM IV-TR, the DM-ID, Behavioral
Equivalents ,interviews reports, observation and
screening tools for most people with ID
Adapted from Robert Fletcher, DSW, ACSW - 2004 -
Frequency
 Co-occurring Psychiatric conditions are as
likely to occur in individuals with
developmental disabilities as in the general
population.
 In fact, some research indicates the possibility
that mental illness occurs at a higher rate in
this population.
(Stress Vulnerability Model)
WHY WE CARE
Challenging Issues for Current
Services Delivery
Current research and our own statewide
information indicated that many of the
behaviors and challenges that define this
group of individuals are not typical of the
majority’s needs.
This particular group has sophisticated and
inter-dependent needs.
“No special needs group strains the
service capacity of community
mental health/mental retardation
services to a greater extent than
people with dual diagnoses
of developmental disabilities
and psychiatric conditions.”
(National Association for the Dually Diagnosed, 2006)
“We all have different gifts,
so we all have
different ways of
saying
to the world
who we are.”
~ Fred Rogers
ME
CITIZEN
Where
do I fit?
How do I
choose?
Where do I go?
Collaboration
What is COLLABORATION?
1 : to work jointly with others or together
especially in an intellectual endeavor
2 : to cooperate with or willingly assist an enemy
of one's country and especially an occupying
force
3 : to
cooperate with an agency or
instrumentality with which one is
not immediately connected
Is COLLABORATION Credible?
• INDUSTRY EXAMPLE
Collaboration
creates a forum within which consensus about the
problem can be sought,
mutually agreeable solutions can be invented, and
collective actions to resolve the problem.
IF COLLABORATION IS SUCCESSFUL, NEW SOLUTIONS
EMERGE THAT. NO SINGLE PARTY COULD HAVE
ENVISIONED AND ENACTED
•
*http://science.nasa.gov/media/medialibrary/2010/03/31
/OSS EPO Phase III report.pdf
What Other People say about
Collaboration
• Cross-system collaboration changes the way
individual systems operate and how existing
agencies do their work.
• Agencies and systems become more accessible
under the positive influence of collaboration and
demonstrate a greater readiness to tackle policy,
procedural, and attitudinal barriers
*http://www.ncsacw.samhsa.gov/files/Shared%20Values%20and%20Guiding
%20Principles.pdf
Leveraging Cross-Systems
Collaboration
“IF COLLABORATION IS SUCCESSFUL, NEW SOLUTIONS
EMERGE THAT. NO SINGLE PARTY COULD HAVE ENVISIONED
AND ENACTED”…
…If Collaboration is successful, professionals in
different agencies can work across
organizational boundaries and individual
agency mandates to produce results.
Looking For Solutions
California’s Mental
Health/Developmental Services
Statewide Task Force
Statewide Needs
Assessment
 results in proposal for a demonstration project to meet the
needs of multiply served, multiply diagnosed individuals.
*see www.sdrc.org or www.mosaiclink.org for full report
California – Dual Diagnosis
•
16.1 % (1 in 6 people) of the total number of people
served by the Regional Center System are listed as
having co-occurring psychiatric conditions.underestimate of actual need due to data constraints
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76% of these individuals are adults.
17% of individuals with MI-DD are listed as
having Pervasive Developmental Disorders.
27% of persons residing in Developmental
Centers are listed as having co-occurring
developmental and psychiatric conditions.
California – Summary
Consistent with National Outcomes and Dual Diagnosis
Research
o Multiple systems- overlapping systems care
o increased cost, inefficient and
o fragmented services, often with disparate
messages
o sometimes counterproductive services and
o growing need due to ongoing progress of the deinstitutionalization movement
o Current problem of Trans Institutionalization
Institutional Movement
• 200 years ago -- severe or disabling challenges
housed in jails…. no public mental health system
or specialized system of care
• Mid 1800’s – Moral treatment movement –
seeking to hospitalize and treat
• Mid 1900’s – more than ½ million people in state
psychiatric hospitals… a system stretched beyond
it’s limits
• Mid- 1900’s – medications for effective treatment
of serious mental illness begin to emerge
De-Institutionalization Movement
• 1960’s Normalization Principle first developed
in Scandinavia and articulated by Bengt Nirje
later expounded upon by Wolf Wolfensberger
in US.
• Normalization movement provided a
construct for a better life and was a primary
impetus behind the DE Institutionalization
movement.
Coming full circle…
TransInstitutionalization
• “For many individuals unable to access care in the
community, the only options to receive treatment is
by accessing care through the some of the most costly
and inefficient points of entry into the healthcare
delivery system including emergency rooms, acute
crisis services, and ultimately the juvenile and
criminal justice systems. “
http://www.floridasupremecourt.org/pub_info/docum
ents/11-14-2007_Mental_Health_Report.pdf
The Issue…ACCESS TO Effective
SERVICES….
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Systems begin to specialize
Budgets allocated to expertise and services
Encourages specialization but also segregation
No unified approach is legislated
– Exception : MOUs
Who can’t say no?
Looking For Solutions
Looking for Effective Outcomes in Dual
Diagnosis
• Increase a person’s ability to cope with day to
day life stressors
• Improve cross systems coordination including
crisis care coordination
• Create key linkages in support networks that
would improve access to eligible services
across systems
• Identify areas where new resources were
needed.
One Model of many…
Solutions Building Community
Collaborative…
Effective Strategies in Cross Systems
Collaboration
.
©2010
SBCC – Phases I to III
A Model of Collaboration
PHASE I
COMMUNITY
EDUCATION
PHASE III
ADD ADOLESCANTS
+ GROUP THERAPY
+ online Training
STEERING COMMITTEE
SAT TEAM
PHASE II
CLINIC
CONSULTATION FOR
MI/DD +
CERTIFICATE OF
EXCELLENCE
PHASE I
PHASE I
CRISIS CARE
COORDATION
CROSS SYSTEMS
PLANS
SUPPORT, ASSESSMENT & TREATMENT TEAM
SAT TEAM
Focus on Comprehensive ASSESSMENT,
CONSULTATION and RESOURCE CONNECTIONS
 Consulting Psychiatrists
 Clinical Psychologist/Behavior Specialist
 DD Navigator
 Mental Health Navigator
 Forensic Navigator
 Substance Use Disorders Navigator
Commitment to Community Tenure for targeted
Individuals
SUPPORT …..NAVIGATION
SAT TEAM
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Regional Center
Behavioral Health
Hospitals/ERs
PERT, Probation, Courts, Parole
Drug and Alcohol System
Schools
SUPPORT..ASSESSMENT….
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Psychiatric
Clinical
Behavioral
Forensic
Substance Use Disorders
SUPPORT
…..ASSESSMENT…TREATMENT
SAT TEAM
TREATMENT
Frequent Recommendations from the
Team
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Neurological exam or psycho-neurological exam
Medication review& history
IM medication
Medication Education for ind. , staff or family
Escalation hierarchy including behavioral
strategies for individuals with dual diagnosis.
• Adapt the Wellness Recovery Action Plan (WRAP)
• Reiss Profile
• Consider Individual and Group Therapy (SKILLS
System)
EFFECTIVE STRATEGIES
• SUPPORT ASSESSMENT AND TREATMENT (SAT)
TEAM..
• COMMUNITY EDUCATION TO ALL INTERESTED
STAKEHOLDERS
• CRISIS CARE COORDINATION
• CROSS SYSTEMS PLANS
• CONSULATION CLINIC
• NEW RESOURCE DEVELOPMENT
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ADAPTED WRAP
REISS PROFILE
SKILLS SYSTEM ; GROUP THERAPY – SKILLS COACHING
ONLINE TRAINING TO MEET GROWING INTEREST
Outcomes
Open doors to Eligible services across systems through Expert
Navigation
Escalation Hierarchies and Cross Systems Plans that create options
to eviction notices, 911 calls, ER and Inpatient stays
Increase Training & Discharge Planning with ERs and Inpatient staff
to reduce returns
Comprehensive Medical, Psychiatric and Behavioral Consultation
across system of experts with available training.
Meaningful Recommendations for Community Tenure
Adapting Existing Tools and Strategies to fit this specialty
population
Training… training… training… in Dual Diagnosis and systems
protocol to all Community Stakeholders creates
CROSS SYSTEMS COLLABORATION
Other Effective Models…
Santa Clarita Valley
Dual Diagnosis Coordinating Council
A subcommittee of the Santa Clarita
Valley Interagency Committee
SCV Interagency Committee
• Child & Family Center (MH Provider)
• 5 School Districts (Special Education and Pupil
Services Directors
• Sheriff
• DCFS (Assistant Regional Administrators)
• DMH (AB 3632 Program Head)
• DMH Wrap Around
• Wrap Around (Program Manager)
• Family Preservation (Program Manager)
SCV Interagency Committee (2)
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Full Service Partnerships
CCS ( California Children’s Services)
Dept of Probation
Regional Center
Guests: Kaiser, City of Santa Clarita Anti Gang
Task Force, AB 3632 Placement Unit
• Northeast Valley Health Corporation, a
Federally Qualified Health Center (FQHC)
• SCV Early Start
SCV Dual Diagnosis Coalition
• Los Angeles County Department of Mental
Health
• Department of Child and Family Services
• North LA County Regional Center
• SCV SELPA: 5 School Districts
• Child & Family Center
Comprehensive and Integrated
Services
• Mental Health including counseling, parent
groups, psychiatric services, TBS if qualified,
case management, family therapy etc
• DMH incl. systems navigators, funding
• Regional Center Services i.e. case
management, assessment, ABA etc
• Educational services in the schools
(e.g., referral, assessment, special education
services, additional adult assistance, etc.)
No Wrong Door
• “Warm Handoff”
• Participants know who to call
• Participants know referral criteria and
processes for each agency and share that
information with their colleagues
• The committee is collectively responsible for
the families presented. No single agency can
do it alone.
AB 3632
• Dual Educational Diagnosis: Must have an ED
educational diagnosis in order to qualify for
DMH AB 3632 Services, along with any other
educational diagnosis (language, ID , Autism)
• DMH/C&FC: Treats the mental health issues, and
can address only a limited amount of the
behavioral issues through TBS
• Regional Center: Can access in-house behavioral
therapy through vendored contractors, housing
AB 3632 (con’t)
• Special Education: Can add education services,
additional adult assistance, small classroom, speech
and language, adaptive PE etc.
• If DCFS or AB 3632: Wraparound can add a host of
supportive services including parent partners, in
home therapy, strength based partnerships, flex
funds
• Interagency , TDM’s, Wraparound, IEP’s, Meetings
and collegial relationships: Can track progress and
keep communication vibrant and goal-directed
AB 3632 Today
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The Governor’s Veto
Lawsuits and Court Cases
MOU’s with School Districts and DMH
Status Quo until June, 2011.
MHSA/Prop 63 and other options, scenarios,
and alternatives
• Reasons for hope
Additional Factors to Consider
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“It takes a village…”
Small Geographic Area Coalitions
Cost Effectiveness
Communication
Interpersonal Relations with Agency Reps
Stretch traditional boundaries and procedures
Training: Dr. Fletcher, Developmental
Disabilities Coordinator, SCAAN, City of SC
• Outcomes: what and how to measure?
• MOU’s
Other Community Partners
• City of Santa Clarita: Family education groups,
trainings, small grants, parks and recreation,
community services
• Sheriff: Identification programs
• CLEAR
• SCAAN
• Downs Syndrome Parent Group
• LARC Ranch
Other Partners (con’t.)
• ARC: Socialization and Recreation, Family
Support (in NOHO)
• Kaiser Permanente: Special evaluation unit for
Autism Spec.
• UCLA
• Diagnostic Center
• TLC (Transition Learning Center): Charter School for
transition aged youth education and support
• COC: Supports TLC and Asperger’s Services Group on
campus (funded by William S. Hart Unified School
District)
The Panel
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• Paul Frisina, Director of Special Education, Sulphur Springs School District
• Lisa Kimura, Branch Supervisor, North LA County Regional Center, Santa Clarita
office
• Paul McIver, DMH District Chief, Children, Youth and Families Program
Administration
• Larry Schallert, Director of Adult, Education and Outreach Services, Child and
Family Center
• Laura Shotzbarger, Assistant Regional Administrator, Department of Child and
Family Services
• Sandee Sumber, Director of Student Support Services, Castaic Union School
District
• Peggie Webb, Executive Director, Mosaic Connections and Non-Profit
Organization Management Consultant
• John Youngbauer, Behavioral Services Supervisor, North LA County Regional
Center