Excellence in Emerging Behavioral Health StrategiesFlorida Alcohol Drug Abuse Association and

Florida Council Community Mental Health Conference

August 24, 2011Rhonda Bohs, Ph D.

Emy Pesantes, M.S.W.Nitza Sevilla, M.S.

Spectrum Programs Inc.

SPI located in Miami-Dade and Broward County is the oldest and largest non-profit substance abuse treatment provider in South Florida operating since 1970.

SPI provides Residential, Outpatient, Family and Intervention Services (Case Management) for adults, families, and adolescents.

Miami Behavioral Health Center

MBHC has served the Latino community (children, adults, and severely mentally ill and substance abusing) since 1977 providing both mental health and substance abuse services.

MBHC provides Crisis Stabilization, Detox, Residential, Outpatient, Case Management, Peer Recovery-Oriented, Adult Day Care and On Site Services for children.

Banyan Health Systems

Through a joint venture in 2003, SPI and MBHC have operated and provided services for substance abuse and mental health.

Primary Health Care Services have been offered since 2009 for all treatment programs.

SAMHSA Grant Funding

Why did we need it? What did we do with funding? Sustainability

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1st Entry Point

Assessed with

•GAIN

•SBIRT

•Change Assessment Scale

Recovery Guide (stays with p.s. during all tx)

Get initial medical evaluation appointment.

Clubhouse

Co-Occurring

•Voluntary Day Treatment

•WRAP modelMedical/Wellness

Coordinated by Recovery Guide

Physical completed by an ARNP.

Chronic care will be evaluated: high blood pressure, cholesterol, diabetes, respiratory disease, lung disease.

Wellness education on nutrition, dieting, relaxation, and coping skills.

JARF

Referrals made by court

Schools based during day

13 bed inpatient facility for adolescent substance users

•CASASTART

•SUCCESS

Veteran Services

PTSD for veteran

Family services for children

Family therapy

Elderly Program

Adult Day Treatment

Criteria: Alzheimer's, Low-functioning, Depression

Case Management- Caregiver Support Group

Cognitive Behavioral Therapy; Psychosocial Rehabilitation.

P.S. can go from residential to outpatient and return if it is necessary.

Housing

1 day to a month until assigned in tx or have a sustainable housing situation and in recovery management.

Vocational Training

High School Diploma

English classes

Cooking assistant

Receptionist

Peer Counselors

Recovery Guides

Job Development

Work readiness assessment

Job Matching

Job Training

Job Support

Services

Prevention

School Based (Targeting: consumers with mental illness and veteran kids who are at greater risk) through DFYIT Program and Project ALERT.

Early Intervention

Motivational Interviewing with at risk users and children of veterans in middle/high school.

Family Services• Case Management• Family Therapy• Support Groups• Increase awareness and understanding of treatment of substance abuse, mental health, and recovery.• Network families• Children of Veterans who have been affected

Detox/Crisis

• Brief, intensive services for consumers with mental illness/chemically dependent individuals who are in a non-violent, non-combative state.

• Assertive Community Treatment

MAT (Medication Assisted Treatment)

• Vivitrol

• Suboxone

• Methadone

Outpatient

Co-Occurring, 30, 60, or 90 days of tx. Extend on a case by case basis.

• Medication Assisted Treatment

•Motivational Interviewing/ Motivational Incentives

Residential

Treatment for: Mental Health, Residential, Forensic, Co-Occurring.

Those persons who are in the active stage of change.

30 days, 60 days, 90 days. Extensions when necessary.

• Modified Therapeutic Community

• Medication Assisted Treatment

Recovery Management

Co-Occurring. Once consumers have completed residential and outpatient, they will be taken to aftercare for stress management, triggers, relaxation classes, and follow-up.

Grant Funding

Goals/Objectives Staff cross-trained in co-occurring

treatment Integrated Model of Care Evidence Based Practices Training

Use of an integrated assessment (GAIN)

Implementation:Training

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Adult Evidence Based Practices

Medication Assisted Treatment (Vivitrol)

Motivational Enhancement/ Motivational Interviewing Therapy

Seeking Safety Trauma Informed Care WRAP

Adolescent Evidence Based Practices

Aggression Replacement Training Motivational Enhancement/

Motivational Interviewing Therapy Seeking Safety Solution Focused

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Trainings

Aggression Replacement Therapeutic Community Co-Occurring Motivational Interviewing Pharmacology of Substance Abuse Seeking Safety Trauma Informed Care WRAP

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Training

“A one-shot training workshop is unlikely to alter practice behavior sufficiently to make a difference in client outcomes,” (Miller & Mount, 2001; p. 468).

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Steps to Consider in Training

Training Implementation timeline Sustainability Weekly Supervision to sustain

fidelity of EBP Video recordings and Coaching

ratings Agency wide culture change

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Data:Clients Served &

Retention

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Clients Served/ Staff

235 Staff trained Aggression Replacement Training Motivational Interviewing Solution Focused Case Management WRAP

How many clients across all programs were touched by grant? MAT: 68 un-duplicated Adults Seeking Safety: 208 un-duplicated Adults MI/MET: 250 un-duplicated Adults/ 100 un-

duplicated Adolescents Aggression Replacement Training: 106 un-

duplicated Adolescents15

GAIN Administration

3,670 GAIN Q completed during FY 2010-2011

320 GAIN I completed during FY 2010-2011

Issues with an integrated assessment Mental Health Staff Substance Abuse Staff

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EBP Outcomes Data

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Medication Assisted Treatment

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2 or more 3 or more 4 or more 5 or more 6 or more 0%

10%20%30%40%50%60%70%80%90%

100%

82%

64%

50%42%

36%

Vivitrol Injectionsn=68

Number of Injections Received

%

of

People

who

Rece

ived In

ject

ion

Seeking Safety PTSD Results

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% o

f C

lien

ts w

ho

Exp

eri

en

ced

Sym

pto

ms

Re-experiencing Avoidance & Numbing

Hyperarousal0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 92%87% 87%

65%

47%

56%

Pre-Test n= 168

Seeking Safety Trauma Symptom Results

Dissoc

iatio

n

Anxiet

y

Depre

ssion

Sexu

al A

buse

Tra

uma

Inde

x

Slee

p Dist

urba

nce

Sexu

al P

roblem

s0%

20%

40%

60%

80%

100%

44%32%

46%38%

63%

25%32%22%

39%27%

39%

18%

Pre n=168 Post n= 119

20

% o

f S

ym

pto

ms E

xp

eri

en

ced

Retention

Of those Adult clients who reported trauma there was an 88% client retention rate within the first 30 days of treatment.

Of those Adult clients who reported trauma there was a client retention rate of 79% among clients through 90 days of treatment.

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Aggression Replacement Training

Pre-Test Post-Test0%

10%20%30%40%50%60%70%80%90%

100%

65% 69%

Matched Sample n=31

% o

f Ski

lls A

ttain

ed

Aggression Replacement Training

Social Skills

Feelings Altruism Anger Fair Planning0%

10%20%30%40%50%60%70%80%90%

100%

63%58% 61%

68%

60% 63%67% 66%

69% 69% 67%66%

Pre n=82 Post n=39

23Symptoms

% o

f Ski

lls A

ttain

ed

Retention

Adult Residential (BR) Adult Residential (DC)0%

10%20%30%40%50%60%70%80%90%

100%85% 83%

76%84%85% 87%

2009-2010 July 1- Dec. 31, 2010Jan. 1- June 30, 2011

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Retention of 30 days or more

Rete

nti

on

Rate

Wrap Up Outcomes

Specific Impact of Evidence Based Practices

Effect of Chaining Evidence Based Practices

Does EBP impact retention?

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Lessons Learned

Staff Buy In/Staff Turnover Staff Training and Consistency Sustainability and Organizational

Requirements Effectiveness of Evidence Based

Practices

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Next Steps

New Evidence Based Practices Solution Focused Case Management Eye Movement Desensitization and

Reprocessing (EMDR) Street Smart

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Questions or Comments

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Resources

Seeking Safety www.seekingsafety.org Najavits, L. M. (2002). Seeking Safety A Treatment Manual for

PTSD and Substance Abuse. New York: The Guilford Press

Aggression Replacement Traininghttp://www.promoteprevent.org/publications/ebi-factsheets/aggression-replacement-training%C2%AE-art%C2%AE

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