Addressing Co-Occurring Conditions: A Provider’s Perspective

Addressing Co-Occurring Conditions: A Provider’s Perspective

Joan E. Zweben, Ph.D.Executive Director: 14th Street Clinic & EBCRPClinical Professor of Psychiatry; University of

California, San Francisco

A Chance to Provide Comprehensive CareA Chance to Provide Comprehensive Care

OTI/CSAT permitted and funded comprehensive services in 1990’s

Psychiatric services to clients Training mental health programs in AOD Training addiction programs in mental health Integrate treatment of COD; psychotropic

meds and methadone are included Limited primary care services; prevent

deterioration to more costly ailments Moms and kids residential

Comprehensive Care (2)Comprehensive Care (2)

Provide licensed child care Begin to address HCV (1995) with encouragement

from CSAT project officer Methamphetamine Treatment Project: strengthen

commitment to evidence-based practices Developing and providing a universal wraparound

case management model.Developing an integrated "therapeutic jurisprudence" model with a leading Drug Court.

ObstacleObstacle

Providers are expected to collaborate to provide care, but government entities frequently do not communicate about common issues. This leads to conflicting expectations and requirements.

Remedy: Policy Statements Remedy: Policy Statements Need for joint, interagency policy

statement confirming commitment to, and expectations for, treatment for persons with COD

Statement should clearly identify the impropriety of excluding persons with COD from either treatment system or other service systems

Licensing & CertificationLicensing & Certification Naïve expectation that professional

credentials include proficiency in addressing substance abuse

No framework for specialized licensing and site certification

Overlapping and conflicting requirements between health services, mental health, alcohol/other drug, social services, criminal justice system, etc.

Licensing & CertificationLicensing & Certification

Need comprehensive framework for program licensing and site certification, or

Specify programs that are exempt from existing requirements

Remove regulatory barriers that discourage providers from serving this population

Create incentives through adequate reimbursement

Need for a Universal ChartNeed for a Universal Chart Funding sources require different

elements in the clinical chart, and have different audit protocols

Need for a universal chart to reduce extra work, save many trees, and allow consistent data collection.

TrainingTraining Need mechanism to cross-train

professionals and continuously develop skill base of non-credentialed workers

Need to align all elements of the system to promote mastery of content defined as important: intake process, treatment plan, staff evaluations, etc.

Need for regular clinical supervision

Co-Occurring Disorders Workgroup ReportCo-Occurring Disorders Workgroup Report

http://www.adp.ca.gov/COD/dualdiag.shtml

Click on COD Workgroup Report on the left