Co-occurring psychiatric
and substance use
disorders: What’s the fuss?
Richard A. Rawson Ph.D.
UCLA Integrated Substance Abuse Programs
San Diego, California
October 2004
What are we talking about?
An oversimplified picture of the behavioral
healthcare service systems in the US
Mental Health Services
Substance Abuse Services
• Leadership-psychiatrists
• Staffing-psychologists, social
workers, nurses, MFTs
• Role of medications-Substantial
• Impact of behavioral therapies
research-Substantial
• Knowledge of substance use
disorders and their treatment
Minimal
• Role of self-help-Minimal
• Leadership-A mixture of
recovering addict/alcoholics,
business people, professionals
• Staffing-paraprofessionals, with
increasing role of professionals
• Role of medications and
behavior therapies-Minimal
• Knowledge of psychiatric
disorders-Minimal
• Role of self-help-Substantial
The prototype patients for the
current service delivery systems
The mental health
service system
The substance abuse
service system
• The uncomplicated
schizophrenic
• The “simple” affective
disordered individual
• The “pure” bi-polar
patient
• The “plain vanilla”
alcoholic
• The addict who uses only
heroin
• The stimulant dependent
individual w/o other psych
diagnoses
What’s the Problem?
• Estimates of psychiatric co-morbidity among clinical
populations in substance abuse treatment settings range
from 20-80%
• Estimates of substance use co-morbidity among clinical
populations in mental health treatment settings range
from 10-35%
* Differences in incidence due to: nature of population served (e.g.: homeless vs.
middle class), sophistication of psychiatric diagnostic methods used
(psychiatrist or DSM checklist) and severity of diagnoses included (major
depression vs. dysthymia).
Why are substance use disorders
treated in separate systems from other
psychiatric disorders?
How has the split occurred between substance use
disorders and other psychiatric disorders?
• Before 1970 in the US, research and treatment for alcoholism and
drug abuse were administered out of the National Institute of
Mental Health.
• A number of factors prompted the separation of alcoholism/drug
abuse into their own specialty areas, distinct and separate from
general psychiatry.
Why are substance use disorders
treated in separate systems from other
psychiatric disorders?
• A pervasive perception existed among the public and
policymakers that the professional fields of psychiatry,
psychology and medicine were extraordinarily
unsuccessful in providing treatment to addicts and
alcoholics; and, that there was a tendency within much
of organized psychiatry (and psychology) to avoid
alcoholics and addicts as inherently untreatable
individuals, incapable of insight.
Why are substance use disorders
treated in separate systems from other
psychiatric disorders?
• Two major factors prompted the establishment of
new institutes in early 1970s:
– Sen. Harold Hughes’ promotion of treatment for employees with alcohol
problems in the workplace was a major influence in the field of
alcoholism. Health insurance began to include alcoholism treatment
benefits, EAPs began and NIAAA was created.
– Huge increases in drug experimentation in late 1960s and concerns about
returning heroin addicted Vietnam Veterans, prompted public concern
about drug abuse and prompted the creation of NIDA.
Why are substance use disorders treated in
separate systems from other psychiatric
disorders?
• The result was:
– National Institute of Mental Health (NIMH) responsible for research on
and treatment of psychiatric disorders.
– National Institute on Alcoholism and Alcohol Abuse (NIAAA) responsible
for research on and treatment for alcoholism and related issues.
– National Institute on Drug Abuse (NIDA) responsible for research on and
treatment of illicit drug problems (and later nicotine).
– Each institute had its own experts, treatment systems, funding streams and
each viewed the other as parochial, misinformed and naïve.
– Cooperation was uncommon.
Why are substance use disorders treated in
separate systems from other psychiatric
disorders?
• Since early 1970s–
Within treatment settings, alcoholism and drug
abuse disorders are treated within the same
treatment system; hence, there are now essentially
two service delivery systems:
1. Alcoholism and Other Drug (AOD) system
2. Mental health system
–
Psychiatry has formally incorporated the study
and treatment of substance use disorders as part of
psychiatry.
DSM and ICD: The “Bibles”
Studies on Co-morbidity
Most widely cited studies:
•Epidemiologic Catchment Area (ECA)
study
•National Comorbidity Study
ECA Study
•Epidemiologic Catchment Area (ECA) Study
•20,291 interviews at 5 sites
•Data Collected 1980 – 1984
•DSM – III Diagnoses
Regier, DA, et al. (1990). Comorbidity of Mental Disorders with Alcohol and
other Drug Abuse: Results From the Epidemiologic Catchment Area (ECA)
Study, JAMA, 264, 2511-2518
ECA DSM-III Diagnoses
(rates per 100 people)
1 Month
Lifetime
15.7
32.7
13.0
22.5
Alcohol Dependence
1.7
7.9
Drug Dependence
0.8
3.5
Any Alcohol, Drug or
Mental Health Disorder
Any Mental
Regier, et al. (1990)
Lifetime Prevalence and Odds Ratios
ECA Study
OR
O th e r
D rug
3 6 .6 %
2 .3
5 3 .1 %
4 .5
3 .8 %
3 .3
6 .8 %
6 .2
 A n y a ffe ctive
1 3 .4 %
1 .9
2 6 .4 %
4 .7
 A n ti-socia l
1 4 .3 %
2 1 .0
1 7 .8 %
1 3 .4
4 7 .3 %
7 .1
A lco h o l
 A n y m e n ta l
 S ch izo p hre n ia
 A lco h o l
R egier, 1990
OR
NC Study
•National Comorbidity Study
•8,098 interviews across the country
•Data collected 1990 – 1992
•DSM-III-R Diagnoses
Merikangas, KR, et al. (1998). Comorbidity of substance use disorders with
mood and anxiety disorders: Results o the international consortium in psychiatric
epidemiology. Addictive Behavior, 23, 893-907.
NCS DSM-III Diagnoses
60
55
50
45
44
41
40
%
37
36
Alc Dep
Drug Dep
30
20
10
0
Mood
Merikangas, KR, et al. (1998)
Anxiety
Antisocial
NCS DSM-III Diagnoses
4.5
4
4.0
3.7
3.5
OR
3
2.5
2
3.0
2.6
1.8
2.2
Alc Dep
Drug Dep
1.5
1
0.5
0
1
2
3
Number of mental disorders
Merikangas, KR, et al. (1998)
Summary
• There is a problem
• We have documented it for a long time
• We need more information to figure out
– The current state of affairs
– What we do about it
Treatment of Co-occurring
Disorders
• Treatment System Paradigms
–
–
–
–
Independent, disconnected
Sequential, disconnected
Parallel, connected
Integrated
Treatment of Co-occurring
Disorders
• Independent, disconnected “model”
– Result of very different and somewhat
antagonistic systems
– Contributed to by different funding streams
– Fragmented, inappropriate and ineffective care
Treatment of Co-occurring
Disorders
• Sequential Model
– Treat SA Disorder, then MH disorder
– Treat MH Disorder, then SA disorder
– Urgency of needs often makes this approach
inadequate
– Disorders are not completely independent
– Diagnoses are often unclear and complex
Treatment of Co-occurring
Disorders
• Parallel Model
– Treat SA disorder in SA system, while
concurrently treating MH disorder in MH
system. Connect treatments with ongoing
communication
– Easier said than done
– Languages, cultures, training differences
between systems
– Compliance problems with patients
Treatment of Co-occurring
Disorders
• Integrated Model
– Model with best conceptual rationale
– Treatment coordinated best
– Challenges
•
•
•
•
Funding streams
Staff integration
Threatens existing system
Short term cost increases (better long term cost
outcomes).
Elements of an integrated model
• Staffing
– A true team approach including: Psychiatrist
(trained in addiction medicine/psychiatry);
Nursing support; Psychologist; Social worker;
Marriage and family therapist; Counselor with
familiarity with self-help programs. (Others
possible, vocational, recreational educational
specialists).
Elements of an Integrated Model
• Preliminary assessment of mental health
and substance use urgent conditions
–
–
–
–
Suicidality
Risk to self or others
Withdrawal potential
Medical risks associated with alcohol/drug use
Elements of an integrated model
• Diagnostic process that produces provisional diagnosis of
psychiatric and substance use disorders using:
– Urine and breath alcohol tests
– Review of signs and symptoms (psychiatric and
substance use)
– Personal history timeline of symptom emergence (what
started when)
– Family history of psychiatric/substance use disorders
– Psychiatric/substance use treatment history
Elements of an integrated model
• Initial treatment plan that includes (min- one day-max
ten days):
– Choice of a treatment setting appropriate to initially
stabilize medical conditions, psychiatric symptom
and drug/alcohol withdrawal symptoms
– Initiation of medications to control urgent psychiatric
symptoms (psychotic, severe anxiety, etc)
– Implementation of medication protocol appropriate
for treating withdrawal syndrome(s)
– Ongoing assessment and monitoring for safety,
stabilization and withdrawal
Elements of an integrated model
• Early stage treatment plan that includes ( min day 2max day 14)
– Selection of treatment setting/housing with adequate
supervision
– Completion of withdrawal medication
– Review of psychiatric medications
– Completion of assessment in all domains (psychology, family,
educational, legal, vocational, recreational)
– Initiation of individual therapy and counseling (extensive use
of motivational strategies and other techniques to reduce
attrition)
– Introduction to behavioral skills group and educational groups
– Introduction to self help programs
– Urine testing and breath alcohol testing
Elements of an integrated model
• Intermediate treatment plan that includes (up to six
weeks):
– Housing plan that addresses psychiatric and substance use
needs
– Plan of ongoing medication for psychiatric and substance use
treatment with strategies to enhance compliance
– Plan of individual and group therapies and psychoeducation
with attention to both psychiatric and substance use needs
– Skills training for successful community participation and
relapse prevention
– Family involvement in treatment processes
– Self-help program participation
– Process of monitoring treatment participation (attendance and
goal attainment
– Urine and breath alcohol testing
Elements of an integrated model
• Extended treatment plan that includes (up to 6 months):
– Housing plan
– Ongoing medication for psych and substance use treatment
– Plan of individual and group therapies and psychoeducation
with attention to both psychiatric and substance use needs
– Ongoing participation in relapse prevention groups and
appropriate behavioral skills groups and family involvement
– Initiation of new skill groups (e.g.; education, vocational,
recreational skills)
– Self help involvement and ongoing testing
– Monitoring attendance and goal attainment
Elements of an integrated model
• Ongoing plan of visits for review of:
–
–
–
–
–
Medication needs
Individual therapies
Support groups for psych and substance use conditions
Self help involvement
Instructions to family to recognize relapse to psych and
substance use
In short, a chronic care model is used to reduce relapse and
if/when relapse (psychiatric or substance use) occurs,
treatment intensity can be intensified.
Building integrated models
• Challenges of building an integrated model
–
–
–
–
Cost of staffing
Training of staff
Resistance from existing system
Providing comprehensive, integrated care with efficient
protocols
– The most likely strategy for moving toward this system is in
increments
•
•
•
•
Psychiatrist attend at AOD centers
Relapse prevention groups introduced to mental health centers
Staff exchanges; attending case conferences; joint trainings
Gradual shifting of funding
Treatment of Co-occurring
Disorders: Areas of Promise
• Integration of SA treatment and treatment of
affective disorders
– Depression
• Use of tricyclics and SSRIs produces excellent treatment
response in SA patients with depression. Can be used with
SA populations with minimal controversy.
• Good evidence of effectiveness with methadone patients,
women with alcoholism and depression.
Treatment of Co-occurring
Disorders: Areas of Promise
• Bipolar Disorder and SA Disorders
– Medications for BPD often essential to stabilize
patients to allow SU treatment to be effective
– Challenges often occur in diagnosis
• Cocaine/methamphetamine use disorders often mimic
BPD, medications for these disorders not yet with
demonstrated efficacy and do not respond to medications
for bipolar disorders
Treatment of Co-occurring
Disorders: Areas of Promise
• Schizophrenia and SU Disorders
– Differential diagnosis with cocaine and
methamphetamine psychosis can be difficult.
– Medication treatments frequently essential.
– Knowledge about medication side effects and the
possibility that these side effects can trigger drug use
is important.
Treatment of Co-occurring
Disorders: Areas of Promise
• Understanding of neurobiological mechanisms
and genetic foundations may provide key
knowledge for both sets of disorders.
• Key issues in improving treatment effectiveness
– Training, training, training
– Increased contact between professionals from both
systems
– Flexibility of funding streams
– Training, training, training
Treatment of Co-occurring
Disorders: Areas of Controversy
• Should the treatment of SUDs be fully
incorporated within the mental health
system(e.g.;Integrated Behavioral Health
Agency)?
• If yes, will treatment protocols unique to
substance abuse system be discarded?
• Will funding for SUDs be reduced?
Co-Occurring Disorders Center
for Excellence (COCE)
Subcontractor’s Kick-Off Meeting
February 13, 2004
The CDM Group, Inc.
Chevy Chase, Maryland
Rose M. Urban, M.S.W., J.D., LCSW
COCE Executive Project Director
The CDM Group, Inc.
Co-Occurring Disorders Advances in the Field
•
•
•
•
•
Better definitions
Treatment needs better understood
Improved screening and assessment
Improved systems and processes
Evidence-based practices exist
Key COD Products and Technology
Transfer Initiatives
• CSAT’s National Treatment Plan, Changing the
Conversation;
• CSAT’s Substance Abuse Treatment for Persons with
Co-Occurring Disorders TIP;
• CMHS’s Co-Occurring Disorders: Integrated Dual
Disorders Treatment Implementation Resource Kit;
• SAMHSA’s Report to Congress on the Prevention and
Treatment of Co-Occurring Disorders and Mental
Disorders;
• SAMHSA’s Strategies for Developing Treatment
Programs for People with Co-Occurring Substance
Abuse and Mental Disorders
Contributors to Knowledge Base
•
•
•
•
•
•
•
•
Federal agencies
Grantees (Including COSIG grantees)
States
Service providers
Consumers
Researchers
Addiction Technology Transfer Centers (ATTCs)
Centers for the Application of Prevention
Technologies (CAPTs)
• National Mental Health Information Center (NMHIC)
SAMHSA’S VISION FOR COD
PROVIDE LEADERSHIP AND DIRECTION IN
DEFINING AND TRANSFERRING THE
LATEST EVIDENCE-BASED PRACTICES/
SYSTEMS, SERVICES, & INFRASTRUCTURE
TO ALL LEVELS OF THE COD SERVICE
SYSTEM
OPERATIONALIZING THE
VISION:
SAMHSA’S COOCCURRING CENTER
FOR EXCELLENCE
(COCE)
COCE APPROACH
COCE will:
• Advance a unified substance abuse and
mental health approach;
• Address all levels of client disorder
severity; and
• Adapt solutions to the unique needs of each
service recipient
CRITICAL INPUTS
Mental Health,
Substance
Abuse,& COD
Research
Federal
Policy
State
Policy
SAMHSA’s
Mission &
Priorities
State/Local
Experience &
Innovation
Consumer
Needs And
Perspectives
THE COD SERVICE SYSTEM
What is the COCE?
COCE:
Analysis Integration Priorities
COCE GOALS
LEADERSHIP IN CLARIFYING
Definitions
Nosology
Measurement
Evidence & Consensus-Based
Practices
Unified Approach
AGENDA SETTING
Professional Education
Practice Improvement
Research
Policy
Workforce Development
RESOURCE TO SAMHSA
Logistical/Operational
Execution/Implementation
Informational
WORK OF THE COCE
ACTIVITIES
Training
Technical Assistance
Training of Trainers
Institutes
Coordination with other
SAMHSA Centers
PRODUCTS
Templates for Product
Development
Technical Reports
Articles
Literature Reviews
Models of Change
Technology Transfer
Principles and Practices
Who is the COCE?
SAMHSA
CSAT
CMHS
CSAP
VISION & LEADERSHIP
Insures accuracy and
integrity of scientific
and clinical content
Advises SAMHSA and
COCE on planning and
conduct of COCE activities
EXPERT LEADERSHIP
GROUP
STEERING COUNCIL
Plans and oversees
COCE activities
SENIOR
MANAGEMENT TEAM
PLANNING, MANAGEMENT, & ACCOUNTABILITY
SENIOR FELLOWS
FELLOWS
e.g.,
Richard Ries, MD
CONTENT
Advises and assists Expert
Leaders in developing
overall COCE content
Provides expert input on
specific COD content areas
CONSULTANT AND
SUBCONTRACTOR POOL
IMPLEMENTATION
Conducts technical assistance,
cross-training, and assists in
development of materials
The COCE Team
• Awarded as a 5-year contract to The CDM
Group, Inc. (CDM) on September 29, 2003 in
association with:
– The National Development Research Institutes
(NDRI)
– The Center for Behavioral Health, Justice & Public
Policy (CBHJPP) at The University of Maryland
– The National Opinion Research Center (NORC) at
the University of Chicago
The COCE Senior Team
• Directed by CDM
– Rose M. Urban, J.D., M.S.W., Executive
Project Director
– Jill G. Hensley, M.A., Project Director
The COCE Senior Team
CDM
• Michael Klitzner, Ph.D. – Senior Social
Scientist
• William Reidy, Jr., M.S.W. – TA/CT Specialist
• Sheldon Weinberg, Ph.D. – TA/CT Specialist
• Robert O’Brien, Ph.D. – Evaluation Adviser
The COCE Senior Team
NDRI
• Stan Sacks, Ph.D. – Expert Adviser on Co-Occurring
Disorders
• JoAnn Sacks, Ph.D. - Director of State Technical
Assistance (TA)
• John Challis, B.A., B.S.W. – Project Director
CBHJPP, University of Maryland
• Fred Osher, M.D. – Expert Medical Adviser on CoOccurring Disorders
NORC
• Sam Schildhaus, Ph.D. – Director of the PPG Pilot
Evaluation
Other COCE Subcontractors
• 52 other staff from key subcontractors:
• Policy Research Associates, Inc. (PRA)
• National Addiction Technology Transfer Center;
• Regional ATTCs (Northeast/IRETA, Northwest Frontier,
and Pacific Southwest)
• National Center on Family Homelessness
• The George Washington University
• New England Research Institutes, Inc.
• Foundations Associates
• Potential Collaboration with:
• National Association of State Mental Health Program
Directors (NASMHPD)
• National Association of State Alcohol and Drug Abuse
Directors (NASADAD)
The COCE Consultants
• 227 expert consultants with a range of expertise
across disciplines, populations, and service settings,
including:
–
–
–
–
–
–
–
Thomas Backer, Ph.D.
Carlo DiClemente, Ph.D.
Alan Marlatt, Ph.D.
Tom McLellan, Ph.D.
Richard K. Ries, M.D.
Steven Schinke, Ph.D.
Douglas M. Ziedonis, M.D.
Providing Guidance: The COCE
National Steering Council
•
•
•
•
•
•
•
•
•
•
•
•
•
•
National Association of State Mental Health Program Directors (NASMHPD) –
Andrew Hyman, J.D.
National Association of State Alcohol and Drug Abuse Directors (NASADAD)
State Associations of Addiction Services (SAAS)
National Council of Community Behavioral Health (NCCBH) – Jennifer
Michaels, M.D.
American Association of Addiction Psychiatry (AAAP) – Richard Rosenthal,
M.D.
National Association of Alcohol and Drug Abuse Counselors (NAADAC)
National Mental Health Association (NMHA)
Research Community – Richard Ries, M.D.
Primary Care Community
Consumer/Survivor/Recovery Community – Michael Cartwright
Homelessness Community – Ellen Bassuk, M.D.
Criminal Justice/Drug Court Community – Joe Coccoza, Ph.D.
Tribal/Rural Community – Raymond Daw
Trauma/Violence Prevention Community – Lisa Najavits, Ph.D.
THE COCE AS A CENTER FOR
EXCELLENCE
COCE WILL:
• Address the wide range of clinical, administrative and systems issues
that impact the quality and accessibility of care for persons with COD
• Address the needs of a broad range of individuals and organizations
including practitioners, researchers and scholars, policy makers,
administrators, affected populations, and concerned citizens
• Have a multidisciplinary staff who have a common interest in COD and
science-to-service
• Emphasize knowledge synthesis, research-to-practice, and dissemination
• Model its message through the application of management,
communications, and dissemination science in its own work
• Be responsive to the field’s changing needs and priorities
• Take a long term view of system change and system improvement
THE COCE AS A CENTER FOR
EXCELLENCE
COCE IS COMMITTED TO:
• Advancing a unified substance abuse and mental health
approach;
• Addressing all levels of client disorder severity; and
• Adapting solutions to the unique needs of each service recipient
THE FOUNDATIONS OF COCE’S WORK ARE
• Evidence-based treatment models and strategies
• Comprehensive and integrated services and systems
• Client/consumer focus and cultural competence
• Quality improvement process
Conceptual Framework
TOOLS FORCOCE
EXCELLENCE:
Services and Service
Systems
Infrastructure
Special Populations
Prevention
Principles of Care
Children and
Adolescents
Screening
Legislation and
Regulation
Children of Individuals
with COD
Assessment
Standards (Federal,
State, Other)
Women
Treatment Planning
Credentialing
Gay, Lesbian, BiSexual, Transgendered
Treatment Service
Staff Development and
Training
Geriatric
Support Services
System Coordination
Supports
Ethnic/ Linguistic
Minorities
Service Integration
Information Systems
Homeless
System Integration
Health Care Finance
Criminal Justice
Involved
Evaluation/Research
Persons with Medical
Comorbidity
Resources
* Each category contains several subcategories, allowing greater specificity
TOOLS FOR EXCELLENCE:
COCE SCIENCE TO SERVICE PROCESS
SCIENCE-BASED
COD
PRINCIPLES
COCE Conceptual
Framework
COD SCIENTIFIC
BASE – e.g.
COD TIP
POSITION PAPERS
& TECHNICAL
REPORTS – e.g.
PRODUCTS – e.g.
Training
Definitions
Technical Assistance
OTHER TIPS
COD TOOL KIT
REPORT TO
CONGRESS
NEW FREEDOM
INITIATIVE
Screening Assessment
& Treatment Planning
Monographs
Treatment Services
Curricula
Training and Workforce
Development
Fact Sheets
Etc.
Etc.
TOOLS FOR EXCELLENCE:
THE COCE BRAIN TRUST
EXPERT LEADERSHIP
GROUP
Stan Sacks, Ph.D.
Fred Osher, M.D.
Rose Urban, J.D.,
MSW
SENIOR FELLOWS
e.g.,
Richard Ries, M.D.
STEERING
COUNCIL
FELLOWS
COCE’s Target Audiences
• States that have received Incentive Grants for
Treatment of Persons with Co-Occurring Substance
Related and Mental Disorders (COSIGs)
• States selected for the COD Policy Academy
• Selected Data Incentive Grant (DIG) States and State
Data Infrastructure (SDI) Grants
• Sub-State entities including cities, counties, tribes and
tribal organizations
• Providers (community-based, educational
establishments, homelessness system, criminal justice,
other social and public health)
The COCE Technology Transfer
Approach
CRITICAL INPUTS
Mental Health,
Substance
Abuse, & COD
Research
Federal
Policy
State
Policy
SAMHSA’s
Mission &
Priorities
State/Local
Experience &
Innovation
Technology Transfer
Principles:
• Relevance
• Credibility
• Clarity
• Feasibility
• Psychosocial factors
Consumer
Needs And
Perspectives
Practices:
• Matching goals to
readiness
• Interpersonal strategies
• Organizational support
• Use of:
– Translators
– Early adopters
– Champions
• Peer networking
• Follow-up and support
COCE Technology Transfer
Mechanisms
•
•
•
•
•
•
•
Provide technical assistance
Provide training
Prepare and distribute state-of-the-art materials on COD
Analyze materials and develop taxonomies
Design and manage a co-occurring disorders Web site
Support regional and National meetings
Develop and conduct a pilot evaluation of the co-occurring
Performance Partnership Grant (PPG) measures
• Sustain technical assistance and cross-training through
coordination with SAMHSA’s existing TA/CT sources
Technical Assistance
• Individual and Group
• On-Site
• Off-Site
–
–
–
–
–
–
Telephone
Literature Reviews
Networking
Web sites
General Information
Materials, reports, etc.
COCE Technical Assistance Delivery Process
Post-Delivery
Phase
Pre-Delivery Phase
Off-Site
On-Site
Off-Site
Select TA/CT
Providers
Field Requests
and Assess
Needs
Plan and Manage
Logistics
COCE Staff
and/or Consultant
TA/CT Provider(s)
perform TA/CT activities:
Telephone
Lit Reviews
Networking
Web site
Maintain
Files
To Inform Similar
TA Events
Follow-up
On-Site
TA/CT
Delivery
Develop
TA/CT
Plan
On Site
Off-Site
Both
Develop
Consultation
Plan
COCE TA
Coordinator
Support
Evaluation and
Reporting
Interim TA Plan
• Pilot of TA Plans and Procedures
• Federal Project Officer Reviews and Approves TA
Plan Before Services are Provided
• Pilot Findings used to Refine Process for FullScale Rollout
Training
• Training of Trainers (TOT)
– Addiction Technology Transfer Centers (ATTCs)
– Centers for the Application of Prevention Technology
(CAPTs)
– States
– Provider Organizations (e.g., NCCBH, SAAS)
• Cross-Training (CT)
• Curriculum Development
Materials Development and Analysis
•
•
•
•
•
•
•
Position Papers
Monographs
Training Curricula
Brochures
Newsletter
Fact Sheets
Program Briefs
CLINICAL
CAPACITY
BUILDING
INFRASTRUCTUR
E DEVELOPMENT
Screening,
Assessment, and
Treatment Planning
Financing
Mechanisms
Treatment Services
Certification and
Licensure
Terminology,
Nosology,
Definitions
System Integration
Training and
Workforce
Development
Services Integration
Evaluation and
Monitoring
Information Sharing
COCE Web Site
Will be designed to:
• Motivate exploration of COD;
• Clarify users’ interests and concerns;
• Guide users to relevant information; and
• Provide users with support in understanding
and using information.
Regional and National Meetings
• Annual National meeting
• Three regional meetings in year 1, four regional
meetings in years 2-5
– Increase awareness of recent research
– Bridge the gaps between research, practice, and policy
– Form and sustain relationships among providers across
constituencies
– Create peer networks
– Provide cross-training of providers
The COCE Contract Emphasizes
Sustainability
 Early and substantive linkages with:
– CSAT’s Addiction Technology Transfer Centers (ATTCs)
– CSAP’s Centers for the Application of Prevention
Technology (CAPTs) (6 regional centers)
– CMHS’s National Mental Health Information Center
(NMHIC)
 Development of sustainable systems of technology
transfer
 Establishment of science-based practices as the norm
 Impact on agendas of knowledge producers to better
meet the needs of a science-to-service model
Role of the Subcontractors
• Policy Research Associates (PRA) – Criminal Justice
Expertise
• National Center on Family Homelessness –
Homelessness Expertise
• George Washington University – Treatment Systems
Finance and Organization; Cross-Systems Infrastructure
Expertise
• New England Research Institutes, Inc. (NERI) –
Financial Strategy Development and Analysis Expertise
• Foundations Associates (FA) – Consumer/Recovery
Community Expertise
Role of the ATTCs
CURRENT PARTNERS
National
ATTC
NE ATTC
NW ATTC
SW ATTC
• Coordinate ATTC
• Work with COCE to
• Assist in convening
• Assist in convening
activities with COCE
design and implement a
ATTC COD
ATTC COD Workgroup
activities
TOT for ATTCs
Workgroup
• provide consultation to
• Logistical support for
• Adapt COCE products • Provide advice and
COCE staff on
NE ATTC TOTs
and services to meet
planning concerning
developing and/or
specific ATTC needs
dissemination of COCE revising curricula and
• Plan for marketing &
knowledge throughout
training materials on
dissemination of COCE
the ATTC system
COD for use by the
products through
ATTCs, particularly with
ATTCs
• inventory existing
respect to evaluating
COD-related ATTC
• Convene an ATTC
treatment outcomes
materials/databases;
COD Workgroup to
assess these for
collaborate with COCE
suitability for COCE
efforts; and assist in
revising for SAMHSA
content clearance, if
Role of the ATTCs
CURRENT
ATTC
PARTNERS
Motivate
Orient
Train
OTHER
ATTCs
MAXIMUM
IMPACT
THE COD FIELD
COCE Timetable
Sep 29 – Dec 30, 2003
• Conceptualize Approach and Develop Plans
• Initial COSIG Meeting December 15-17
Jan 1 – Mar 31, 2004
• Provide Interim TA
• Establish Coordination Mechanisms
• Convene National Steering Council
• Convene COSIG, DIG, and SDI Grants Involved in the PPG Pilot
Evaluation
April 1, 2004
• Full TA services
• Continued development of
–
–
–
–
–
–
COCE infrastructure
Linkages
TIP
Curricula
Other materials
Web site
How to Request COCE Services
• Requests for services must be in writing
• Direct requests to:
– [email protected] or
– COCE Phone Line: 301-951-3369
• Questions?
– Jill Hensley, COCE Project Director
301-654-6740 (x 201)
– George Kanuck, Federal Project Officer
301-443-8642
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Co-occurring psychiatric and substance use disorders: …