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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
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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
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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.
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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.
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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
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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.
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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
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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.
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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
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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