Integrating Research-Based Alcohol & Drug Treatment Into the System of Care:

1. Integrating Research-Based Alcohol & Drug Treatment Into the System of Care: Santa Cruz County’s Reclaiming FuturesProject CSOC Committee Presentation February 22, 2007

2. Systems of Care:Where Substance Abuse, Juvenile Justice& Mental Health Redesign Meet Dane Cervine, Chief Santa Cruz County Children’s Mental Health

3. RWJ “Reclaiming Futures” Grant • 1 of 10 national “redesign” sites • Probation as lead agency, Substance Abuse & Mental Health as implementing partners • Each site a “learning lab”: integrating national research, feeding back innovation & implementation issues

4. What’s It All About... • More research about “What Works” in adolescent substance abuse treatment in last 5 years than in previous 30. • Assisting youth in developing strength-based, crime-free identities, with strong community links, so that AOD use becomes less appealing…no longer fits in to youth’s daily life and plans.

5. Scanning The Landscape... • Substance Abuse issues are beginning to be identified as the heretofore “missing piece” of Systems of Care development • New AOD grants in Juvenile Justice field beginning to proliferate (response to “epidemic”) • Mental Health & Substance Abuse organizational structures are in flux (county & state levels) • Conflicts/opportunities with AOD approaches coming down through Probation, Mental Health, & Substance Abuse channels

6. System of Care as Context for New Partnership with Substance Abuse • Strong collaboration with Probation & Juvenile Court---as well as integration of Substance Abuse as partner into System of Care. • Performance Outcomes: maintaining low group home use, shortened Juvenile Hall stays, while increasing focus on residential and out pt. substance abuse assessment & treatment.

7. Factors Shaping AOD Development in System of Care: • Restorative Justice Approach in Probation • Related grants/initiatives used to develop AOD focus: Challenge Grant, AB1913, Robert Wood Johnson, CSAT, SB 163. • EPSDT as Mental Health vehicle for Dual Diagnosis development: Tyler House, Dual Diagnosis classrooms, Out-pt.

8. First Steps in Santa Cruz • Integrating Substance Abuse Dept into Mental Health/Substance Abuse Division • Use of data (eg., CAFAS sub-scales) to identify high substance abuse need • Setting the stage for new focus on adolescent AOD assessment & treatment, rather than just prevention & education (or Adult programs)

9. Increasing use of Evidence-Based Practices throughout the system: • GAIN Assessment Tool (or DRUG Grid) • Dual Diagnosis MH/Substance Abuse Tx. in Context of Wraparound • (general wraparound + SB163) • Cognitive-Behavioral Curriculum & Approaches • Thinking For A Change • Seven Challenges • Evidence-based Practice & Practice-based Evidence in real world environments

10. EPSDT Mental Health services have been used to help fill dual diagnosis program gaps for MH/substance abuse needs: • if Mental Health diagnosis listed as primary, Substance Abuse diagnosis and issues can be addressed via “dual diagnosis” mental health rehabilitative service format • provides more flexible services at higher rate than Drug Medi-Cal billing • inherent limitation: AOD as “secondary” focus

11. Mental Health Dual Diagnosis Issues in Providing Substance Abuse Treatment • Strong grounding in System of Care & Wraparound principles (similar to Laura Nissen’s overview of “What Works” for Adolescent Substance Abuse Treatment) • Integration of Mental Health & Substance Abuse issues possible in single behavioral health treatment approach

12. However, clarity of Substance Abuse focus, knowledge, supervision, and influence can be watered-down • Substance Abuse staff often have different career background, qualifications, and pathways “in” to the behavioral health system

13. Key Issue: what form will “integration” of Mental Health & Substance Abuse at practice & fiscal levels take... • Charles Curie, SAMHSA Director, recommends integrated practice but separate funding, so that Substance Abuse doesn’t get “lost”

14. The Challenge of “Assumptions” • MH: “Yea, yea, I got it covered” but providing only token attention to AOD issues • AOD: “Yea, yea, I got it covered” but having less experience with family-preservation SOC service intensities • Probation: “Yea, yea, I got it covered” but approaching treatment modalities without therapeutic breadth/background

15. System of Care Partner Tasks: • Mental Health: Promote partnership, integration, & new EBP infusion with Probation & AOD throughout the System of Care • Explore the opportunities & challenges of braided funding, missions, governance, risks of tokenism, opportunities of integration

16. Probation: Adopt & infuse system with Restorative Justice principles & practices as context for addressing AOD issues. • Substance Abuse: Integrate solid knowledge of addiction & adult treatment with new EBP’s for adolescent assessment & treatment • Strength-based, Harm-reduction models integrated with AA/NA, medical & addiction models

17. Santa Cruz System of Care Post-RWJ • Adopted/integrated the CRAFT as AOD screening tool into MH Assessment • Positive CRAFT scores trigger full DRUG Grid assessment (phasing out the GAIN) • Increased training for all staff in Dual Diagnosis issues • Sustained key RWJ grant AOD positions by moving into MH budget (QA + EPSDT)

18. Dedicated Dual Diagnosis Services… • Tyler House (6-bed residential tx) • YES and Escuela Quetzal COE clean & sober classrooms/tx. • Dedicated “expert” clinicians embedded in key MH teams • QA Dual Diagnosis support staff monitoring quality assurance of DD focus • Specific Substance Abuse community contracts for parents/adults