INTEGRATED RECOVERY Lessons Learned: Implementing IDDT

1. INTEGRATED RECOVERYLessons Learned: Implementing IDDT Organizational / System Aspect 2 County Examples Debbie Innes-Gomberg, Ph.D. -Los Angeles Adrian Carroll, MFT - Stanislaus January 19, 2007

2. Organization-Wide and IDDT Team Specific • IDDT provides principles and tools that can be used organization-wide to improve Co-occurring capability throughout

3. Organization-Wide and IDDT Team Specific • IDDT provides principles and tools that can be used organization-wide to improve Co-occurring capability throughout • As well as build specific enhanced IDDT teams

4. Organization-Wide Elements: • Commitment • Philosophy • Training • Access policy • Time unlimited • Outcome monitoring • Self-help • Housing and employment • Residential services • Levels of care • Steering committee

5. System Elements that Support IDDT Specific Programs: • Client to staff ratio • Supervising to the model • Team approach • Enhanced trainings • Quality management • Fidelity monitoring • Specific Outcomes • Quality Improvement (forms, processes) • Access to housing (wet, damp, dry)

6. Use of IDDT in Larger System Change Efforts in L.A. • Los Angeles County’s Adult Systems of Care Transformation • Creating a continuum of recovery-oriented services • Using stages of change to guide service delivery and treatment planning • Creating strategies for client flow through the continuum of services

7. COUNTY OF LOS ANGELES – DEPARTMENT OF MENATL HEALTH ADULT SYSTEMS OF CARE TRANSFORMATION-RECOVERY-BASED LEVELS OF OUTPATIENT CARE

8. Use of IDDT Model Elements to Enhance Service Delivery in L.A. • Focus on person-centered treatment planning • Team-based services • Stage-based assessment and interventions based on readiness for change

10. SAMHSA 4 Quadrants • Target population for IDDT are those COD individuals with Serious Mental Illness

12. Stanislaus experience • Recovery focus • Integrated system vs. Integrated treatment • Wellness Recovery Center • Exit strategies as a recovery concept • Identify internal experts and early adopters • Recovery Milestones

14. Stanislaus experience • Stages of change model: -SATS (AOD) -MH stages based on Milestones (MH) -Stage-based treatment -Staff change model

17. Stanislaus experience • System Transformation -MHSA FSP, 2034, ACT -Wellness Recovery level of care -LOCUS LOC system, caseload ratio -Normalizing use of Primary Care Physician • Levels of Care

20. Stanislaus experience • Client flow through System -Early expectations -Ease of re-admission -SSI concerns -PCP relationships -Peer support throughout -Recovery conversation -Transparency of treatment process -Measurement and accountability

21. Team Structure

22. SUPPORT WHEEL Phone Numbers Use In A Circular Manner So Not To Burn Out Any One Source My Recovery Be Selective In Choosing Support Phone Numbers

24. Stanislaus experience • IDDT as model for implementing any EBP -Levels of implementation • Fidelity Scales as a guide and measure • Promotes team approach -Multidisciplinary -AOD, Psychiatrist, RN, CM, Clinician, E&H • Stages -provides conceptual framework to bridge MH/AOD, Harm reduction & recovery -Consumer centered

25. Summary of Lessons Learned • QUESTIONS