Transcript Integrating recovery-orientated relapse prevention

Heidi Kammer MSW, LICSW, LADC
NAMI Minnesota State Conference
Saturday, November 15, 2014
10:15am-11:30am
 This
session focuses on strategies for
delivering effective, outcome-based cooccurring chemical and mental health care
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Explore the best practice of integrated dual
diagnosis treatment.
What makes substance use disorder treatment
and mental health treatment unique
Benefits of integrated treatment.
Key components of effective integrated
treatment
Culturally responsive and trauma informed care
components
 Importance
of integrating chemical and
mental health, including integration with
primary medical care in response to the
changing landscape of the Affordable Care
Act
 Practices for co-occurring disorders along the
continuum of care
 The theme of the "right care at the right
time" as a model of effective practice.
 Evaluating recovery outcomes through client
satisfaction and the use of evidence-based
practices
Heidi Kammer MSW, LICSW, LADC
Vice President- Chemical & Mental Health
RESOURCE, Inc.
1900 Chicago Avenue South
Minneapolis, MN 55404
6127528092 phone 6128043417 cellular
[email protected]
www.resource-mn.org
RESOURCE’s mission is
to:
Empower people to
achieve greater
personal, social,
economic success.
Our commitment is to
undoing racism and
promoting diversity
through reducing
health and racial
disparities.
www.resource-mn.org
Co-occurring Disorder (COD)
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Co-occurring disorders may include any combination of two or
more substance abuse disorders and mental disorders identified
in the Diagnostic and Statistical Manual of Mental Disorders 5
There are no specific combinations of substance abuse disorders
and mental disorders that are defined uniquely as co-occurring
disorders
Substance abuse and mental health problems (such as binge
drinking by people with mental disorders) that do not reach the
diagnostic threshold are also part of the co-occurring disorders
landscape and may offer opportunities for early intervention
Both substance abuse disorders and mental disorders have
biological, psychological and social components
Co-occurring disorders may vary among individuals and in the
same individual over time
Both disorders may be severe or mild, or one may be more severe
than the other
 The
solution lies in integrated care, the
systematic coordination of general and
behavioral healthcare. Integrating mental
health, substance abuse, and primary care
services produces the best outcomes and
proves the most effective approach to caring
for people with multiple healthcare needs.
Source: The SAMHSA-HRSA Center for Integrated Health
Solutions (CIHS)
 More
than 80% of persons with cooccurring disorders do not perceive
the need for treatment/ care
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Source: National Survey on Drug Use & Health
 The
Affordable
Care Act/Health
Care Reform
http://kff.org/healt
hreform/video/youto
ons-obamacarevideo/
Source: Kaiser Family
Foundation
 Achieve
The
Triple Aim
Improved
Patient Health
 Provide High
Quality Care
 Do This in a
Cost Effective
Way
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“Right services at the right time in the right amount”: this
should be our new mantra!
A true longitudinal continuum perspective vs. episodic
Chemical Health & Mental Health care is “HEALTH” care.
We must be able to educate consumers, clients, about
impact of health care reform. (web resources & handouts)
We must engage with organizational decision makers
about our care model- “that’s the way we always did it”
doesn’t fly
Develop treatment plans from a “holistic” perspective
Ensure “true” multidisciplinary coordination and care
(chemical health, mental health, primary care/ health)
Promoting Recovery…
 “A
process of change through which
individuals improve their health and
wellness, live a self-directed life, and strive
to reach their full potential.”
(SAMHSA, 2011)
 Integrated
Care ensures culturally responsive
care.
 Considering health and racial disparities
 Culturally responsive care is a key strategy
for relapse prevention
 The impact of oppression, racism,
classism…on health and relapse prevention
 Consider the cultural experience and hope of
the consumer
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Multidisciplinary Team
Stage-Wise Interventions (stages of change, stages of treatment)
Access to Comprehensive Services (e.g., residential, employment,
etc.)
Time-Unlimited Services
Assertive Outreach
Motivational Interventions
Substance Abuse Counseling
Group Treatment
Family Psychoeducation
Participation in Alcohol & Drug Self-Help Groups
Pharmacological Treatment
Interventions to Promote Health
Secondary Interventions for Treatment of Non- Responders
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Case Western Handout/ Resource
A Sample:
http://www.dhs.state.mn.us/main/groups/dis
abilities/documents/pub/dhs16_181625.pdf
 Stage-wise
care/ treatment
 A continuum of care
 Measuring impact via the Triple Aim
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Access
Quality of Care
Cost of Care
Improved Health
The
right services at the
right time!
The client is a 38-year-old Hispanic/Latina woman
who is the mother of two teenagers. Maria M.
presents with an 11-year history of cocaine
dependence, a two-year history of opioid
dependence, and a history of trauma related to a
longstanding abusive relationship (which has been
over for six years). She is not in an intimate
relationship at present and there is no current
indication that she is at risk for either violence or
self-harm. She also has persistent major
depression and panic treated with antidepressants.
She is very motivated to receive treatment.
Source:
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6.
What would be the ideal treatment plan
strategies?
What services involved in providing services
to this client?
What, if any, adjustments to existing
services would have to be made?
Would there be gaps in service? How might
these be filled?
Who would be the best suited to act as case
manager for this client?
What barriers would exist for care
coordination?
The client is a 34-year-old married, employed
African-American man with cocaine
dependence, alcohol abuse, and bipolar
disorder (stabilized on lithium) who is
mandated to cocaine treatment by his
employer due to a failed drug test. George T.
and his family acknowledge that he needs help
not to use cocaine, but do not agree that
alcohol is a significant problem (nor does his
employer). He complains that his mood swings
intensify when he is using cocaine.
Source:
1.
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5.
6.
What would be the ideal treatment plan
strategies?
What services involved in providing services
to this client?
What, if any, adjustments to existing
services would have to be made?
Would there be gaps in service? How might
these be filled?
Who would be the best suited to act as case
manager for this client?
What barriers would exist for care
coordination?
 http://www.youtube.com/view_play_list?p=8
5C1E36206E17BB3
Integrated Treatment for Co-Occurring
Disorders Evidence-Based Practices (EBP) KIT
http://store.samhsa.gov/product/SMA08-4367
 Substance Abuse Treatment for Persons With
Co-Occurring Disorders. Treatment
Improvement Protocol (TIP) Series 42.
http://www.ncbi.nlm.nih.gov/books/NBK64190/
 Practical Approaches to Staging Change in Dual
Diagnosis http://www.samhsa.gov/cooccurring/topics/training/staging-change.aspx
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