INTEGRATED RECOVERY Lessons Learned: Implementing IDDT

1. INTEGRATED RECOVERYLessons Learned: Implementing IDDT Stanislaus County Elizabeth Oakes, MFT Adrian Carroll, MFT January 19, 2007

2. Organizational Context • Why we selected IDDT: -Committed to integrated services BHRS -Integrated system isn’t integrated treatment -Established experience with co-occurring Tx -Valued EBP aspect -Interested in ‘implementation’ aspect -Not the Money -High mortality rate

3. Organizational Context • Why we selected IDDT continued: -High co-morbidity -High treatment failure rate -Cost of not serving for system -Highly underserved -Co-occurring conditions often used as exclusion criteria, rather than inclusion criteria

4. Organizational Context • Goals and expectations -Actual OP treatment track, consistent across programs, across department -Both: broad system-wide competence; and specialized enhanced expertise. -ID system barriers to implementing EBPs -Save money eventually -Accurate identification of AOD,MH, and COD -Develop staff training curriculum -Increased integration

5. Key Factors • Factors that facilitated implementation : -Staff with MH and AOD knowledge -CIMH training -Effective use of project planning consultant -Inter-county collaboration -Learning collaborative -System-wide steering committee -Psychiatrists early adopters -Integrated system -Training coordinator

6. Key Factors • Factors that impeded implementation: -Caseload size -Attempting treatment before engagement -MH downsizing and loss of funding -Resistance from some staff -Stigma, 2 types MH and AOD -Lack of COD housing -Funding categorical

7. Team Structure • Project Team - Behavioral Health Integration Oversight Committee: -Assistant Director -Chiefs and other key managers -Selected site Program Coordinators -Program Coordinators MH and AOD -Residential AOD manager -Training Coordinator -Line staff -MHSA Coordinator

8. Team Structure • Clinical/IDDT Team -Program Coordinator -Psychiatrist -Consumer -Select MH Case managers -Select MH Clinicians -Select AOD counselors

9. Benefits of Integrated Recovery • Saves money • Helps staff motivation • Impacts long-time ‘stuck’ clients • Stage-based treatment • Formulation helps consumers understand how 2 conditions creates a 3rd condition • Recovering peers from either MH or AOD can support each other • DRA sustained • Recognition with in AOD for need of specialized track

10. Team Structure

11. Sustaining Positive Change • Challenges: -Staff changes -Caseload size -”Drift” -Integration into daily practices -Forms -Staff passion for MH or AOD -Separate funding

12. Sustaining Positive Change • Successes -Hire consumers with COD recovery -Paperwork to forms committee -All FSPs trained -Written into MHSA plan -Residential AOD with COD track -Stages of Treatment -MH and AOD specific stages -MH board member trained

16. 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

18. Sustaining Positive Change • Failures -Caseload size -Growing own experts -Motivational Interviewing measure -Didn’t do own cost-benefit data -Greater consumer/family presence on steering committee

19. Summary of Lessons Learned • What we would do again -We would do it again -All of it -Stage-based, Motivational Interviewing, AOD staff, clinical tools

20. Summary of Lessons Learned • What we would do differently -Someone dedicated full time to implementation -More MI up front -More training for MH staff on state-of-art AOD treatment