Transcript Integrated Co-Occurring Treatment (ICT)

Integrated Co-Occurring
Treatment (ICT) ©
A Developing Practice for Youth with CoOccurring Conditions and Juvenile Justice
Involvement
The Center for Innovative Practices
What is Integrated Treatment?
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Mental Health and Substance Abuse Services are
integrated
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One provider team
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One assessment
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One treatment plan
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One youth
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Why Integrated Care?
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Unrecognized mental health disorders reduce
engagement, retention and completion
Untreated co-morbid disorders persist after
recovery: ADHD, Mood Disorders
After recovery from SUD, depression in youth is
much more likely to persist compared to adults.
(Turner)
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Co-occurring Disorders with
Juvenile Justice Involved Youth
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63% of juvenile detainees assessed with a substance
abuse disorder were also co-morbid for at least one
mental health diagnosis (Cleveland SAMHSA SCY project,
Hussey, D., Drinkard, A., Murphy, M., & Ols, K., March,
2005).
60% of youth with a substance abuse diagnosis had a
co-morbid psychiatric diagnosis of which conduct
disorder and oppositional defiant disorder were the most
common co-morbid diagnoses (Armstrong and Costello
2002)
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OJJDP Multi-State Prevalence Study
(Skowrya & Cocozza, 2006)
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70.4% of justice-involved youth meet criteria for a diagnosable
mental disorder
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27% of justice-involved youth have serious mental disorders
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55.2% met criteria for at least two diagnoses
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90.3% of youth with Conduct Disorder also met criteria for at least
one other disorder
37.5% of youth in the sample had both a mental health
disorder and a substance use disorder
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MH Needs of Youth in JJ System
NIMH Study (Teplin et al., 2002)
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66% of boys and 75% of girls in Cook County Juvenile
Detention had at least 1 psychiatric disorder
50% abused or addicted to drugs
When Conduct Disorder removed, 60% of males and
66% of females met Dx criteria one or more MH or SA
disorders
Rates of dysthymia or depression: 17.2% for males;
26.3% for females
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Treating one disorder in isolation is
not sufficient
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Substance abuse treatment helps to reduce the
frequency of use and the number of
abuse/dependence symptoms but has only
indirect impact on emotional and behavioral
problems (M. Dennis, 2004)
Psychiatric treatment alone for youth with mood
disorders and co-occurring SUD does not
significantly reduce substance use (Geller et al.,
1998)
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Integrated Co-occurring Treatment
(H. Cleminshaw and R. Shepler; P. Kanary)
ICT Model Definition
ICT is an integrated treatment approach
embedded in an intensive home-based
model of service delivery, that serves
youth with the co-occurring conditions of
substance abuse and serious emotional
disability
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Key Components of ICT
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System of care service philosophy
Home-based service delivery model
Integrated Contextual Treatment (MH and SA)
Comprehensive service array matched to need
Focus on risk and protective factor (resilience)
Resulting in an integrated approach that identifies
the strengths and needs of the youth and family,
in context of the culture, community, and
various systems’ mandates.
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ICT Target Population
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Adolescents who have a diagnosable
substance use/abuse disorder AND a
mental health disorder (excluding sole
diagnosis of conduct disorder). The
severity of the disorders are such that
the youth experiences serious
impairment in major life domains,
particularly increased risk for
involvement in the juvenile justice
system and/or out of home placement.
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Home-Based Service
Delivery Model
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Location of Service:
Intensive:
Crisis Response
Small caseloads:
Flexible:
Treatment Duration:
Home & Community
2-5 sessions/wk
24/7
3-6 families
Convenient to family
12-24 weeks
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Objectives of ICT
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To provide clinicians with a process and framework for organizing
information in order to assess, conceptualize, and intervene in a
coordinated and integrated fashion.
To assist clinicians with positive engagement and retention of youth
and families, as well as, better recognition of family culture and
contexts.
To aid clinicians, program leaders, and relevant stakeholders in
creating a service with realistic expectations for the types of
interactions and relationships necessary to reach mutual outcomes.
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To improve treatment outcomes.
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To decrease clinician frustration, burnout, fatigue when dealing with
a challenging population.
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Target Outcomes
FAMILY
 Create and maintain a family
recovery environment
 Reestablish hierarchy and
boundaries
 Decrease family conflicts
 Rebuild bonds and
relationships
 Increase positive family
communication
 Increase supervision and
monitoring
 Collaborative Problem Solving
(Greene & Ablon)
YOUTH
 Living at home or in a
permanent home setting
 Attending and achieving at
school/work
 Reduced involvement in the JJ
system
 Reduced use of substances
 Participating in positive family,
peer, and community life
 Accessing resources and
natural supports as needed to
maintain gains
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Results of ICT Study (2001-2002)
ICT Youth
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56 youth
25% recidivism rate
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Usual Services
Comparison
Group
Size of Difference
in commitment
and/or recidivism
rates
29 Youth
72% commitment rate
Chi Square (1, 29): 17.74
Level of significance: .001
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Ohio Scales Gain Scores (2005 – October 2006)
General Clinical Population
(Statewide)
ICT Participants
30 days
180 days
Gain
30 days
180 days
Gain
Problem Severity Adult
28.60
22.74
5.86
31.28
19.38
11.90
Problem Severity Child
23.93
18.85
5.08
30.33
19.48
10.85
Hopefulness Adult
12.29
10.60
1.69
13.52
10.88
2.64
Hopefulness Child
10.60
9.44
1.16
13.09
10.18
2.91
Satisfaction Adult
8.87
6.42
2.45
10.25
7.25
3.00
Satisfaction Child
10.60
8.53
2.07
10.13
8.05
2.08
Functioning Adult
44.98
48.65
3.67
36.20
44.71
8.51
Functioning Child
55.75
59.34
3.59
49.42
58.76
9.34
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Total = 27 youth; 3
ODYS Commitments
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For "Functioning", the higher the score the better - for all others, the
lower the score the better
Clinical cutoffs= 20 for problem severity and 51 for parent rating
functioning and 60 for youth rated functioning
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Clinical and Policy
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Integrated documentation
Complexity of conceptualization
Finding and retaining staff
Need a county wide consistent assessment/screening
process for youth with co-occurring disorders
Comprehensive understanding of population
Differing clinical perspectives between MH and SA
Clinical capacity and certification/licensure to treat both
disorders
Ethical and safety issues related to delivering services in
the home and community
Complexity of putting it all together
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Systemic
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Aligning policy outcomes across public entities,
providers, and funders
Setting Co-Occurring as a priority treatment
population
Creating an infrastructure that supports
integrated treatment
Creating funding streams that support integrated
treatment
Identifying cross systems shared outcomes
Resources to support research and evaluation
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Financial
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Need diverse and flexible funding to maximize
effectiveness of the model
Medicaid: 1) complicated documentation and
choices: MH vs. SA; 2) clinical impacts of using
Medicaid. E.g., not being able to directly address
parent and family issues and basic needs
Fee for service not an effective or efficient billing
procedure for ICT
Funding innovative practices with traditional
funding streams
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Implementation
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Qualified practitioners and providers
Initial training and ongoing coaching
Organizational infrastructure to support
the model
High level of collaboration among MH, SA,
JJ referrals sources and partners
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More Information on ICT
Richard Shepler, Ph.D.
[email protected]
Eric Baltrinic
[email protected]
Patrick Kanary
[email protected]
CIP: 330-455-3811
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