Abstracts from COSIG

Abstracts from the COSIG State Grant Applications

Alaska

To improve the identification and treatment of individuals with co-occurring disorders throughout a diverse serve delivery system, Alaska has committed to addressing SAMHSA's goals of improved screening, assessment, treatment, and training, which will be accomplished through infrastructure development, focusing on staffing competency, credentialing, and licensure; financial planning and reimbursement; and information sharing and data collection. The work will be carried out in fulfillment of a State action plan for the integration of mental health and substance abuse services, developed in consultation with co-occurring disorders experts Dr. Kenneth Minkoff and Dr. Chris Cline. The conceptual model guiding the activities is based on eight clinical consensus best practice principles that promote an integrated clinical treatment philosophy applicable to the treatment of both mental health and substance disorders. The process will result in the development of an integrated planning and implementation structure; an organized strategic planning and quality improvement process; acceptance of a universal integrated screening process; implementation of a CQI program to monitor the provision of integrated treatment for individuals with co-occurring disorders; the elimination of barriers to integrated screening, assessment and treatment; establishment of an integrated management information system, Alaska Automated Information Management System; and a system-wide training plan to ensure the achievement of dual diagnosis capable competencies across agencies and among all clinicians. Dr. Amy Salomon of Advocates for Human Potential will evaluate the program. When fully implemented, the system will use the Comprehensive, Continuous, Integrated System of Care (CCISC) Outcome Fidelity and Implementation Tool (COFIT-100 ®) for measuring progress in CCISC implementation.

Arizona

This proposal is submitted by the Office of the Governor of Arizona and seeks to extend our state's existing co-occurring infrastructure and development that has occurred within our behavioral health system to our state's adult and juvenile criminal justice systems. The mission of this project is to build the workforce, clinical, and information infrastructure necessary to ensure that all individuals who come into contact with the criminal justice system are provided with a consistent and comprehensive approach to the detection, assessment, and treatment of co-morbid substance use and mental illness in a culturally competent manner that is reflective of evidence-based practices. This mission will be achieved through four key objectives. First, local and state criminal justice systems will implement a uniform process for ensuring that individuals within their custody are screened for the presence of both mental illness and substance use disorders. Second, individuals exiting adult and juvenile correctional systems who have screened positively for the presence of a co-occurring disorder will be diagnosed using an assessment process that is culturally and co-occurring sensitive and consistent with that which is in use within our state's Medicaid & block grant funded behavioral health system. Third, informational systems, including administrative databases and management information systems will be integrated to allow for transparency in clinically relevant information among and between criminal justice and behavioral health treatment systems and settings. Fourth, workforce development initiatives, the development of co-occurring coursework and programs within institutions of higher education, along with in-service training targeting criminal justice and behavioral health service professionals will be undertaken. In order to evaluate the viability of our approach, a quasi-experimental pilot demonstration study will be undertaken that incorporates pre-release screening, assessment, and transition planning for inmates of the state correctional system, and co-occurring and culturally competent post release services including housing supports and intensive case management and outpatient treatment services. This proposal will be administered by the Arizona Governor's Office for Children, Youth, and Families, Division for Substance Abuse Policy. The SAMHSA initiated Co-Occurring Policy Academy Team for the state of Arizona will serve as a Project Integrated Services Coordinating Council and will be organized into three working groups: Screening, Assessment, & Treatment Services; Workforce Development; and Information and Evaluation. Applied behavioral Health Policy, a unit of the University of Arizona that also co-manages the Pacific Southwest Addiction Technology Transfer Center (PSATTC), will support the Governor's office in overall project management and coordination by providing training, technical assistance and program evaluation support to the project.

Arkansas

To meet the needs of Arkansans dually diagnosed with substance abuse and mental health illness, the State of Arkansas, under the leadership of the Governor and his staff, proposes to institute standardized universal screening and assessment as a first step in its attempt to integrate the presently divided systems of substance abuse and mental health care. SAMHSA funding will also be used to train caregivers from both systems to better recognize co-occurring disorders, and to understand and create treatment plans that address the needs of these individuals. The barriers and facilitators to treatment throughout the process will be systematically evaluated.

To increase accessibility, effectiveness, and efficiency in these systems, Arkansas will first choose reliable and valid screening and assessment instruments and then implement them. This effort will begin with a statewide conference and training for identified training coordinators from each mental health and substance abuse facility who will then be contact persons for the project and who will have administrative support and backing. These individuals will then be responsible for training efforts and in-services in their respective sites. In addition, Arkansas will create a web-based training program that will be sustained even after the end of the project, and intended for the use of all providers to train them in the use of screening and assessment protocols and improve knowledge and skills.

The proposed plan also includes several critical infrastructure changes. A permanent dual diagnosis unit will be established to increase service coordination. Changes to reimbursement policies will be investigated and considered so that this does not continue to be a barrier to treatment. The licensing and credentialing criteria in both systems will be reviewed for potential modification that could lead toward a system wherein frontline caregivers are cross trained and certified to provide care to dually diagnosed persons. A more integrated information management system will be created. All of this is timely for Arkansas given the recent merging of the two State agencies—the Alcohol and Drug Abuse Prevention and Division of Mental Health Services—that provide services to persons with substance use disorders and persons with mental illness respectively. The newly created government entity, the Division of Behavioral Health, will focus on encouraging, supervising, and empowering these collaborative efforts. An evaluation component will evaluate the progress of the project and provide timely feedback to improve implementation and enhance the chances of achieving the project's goals.

Connecticut

Connecticut proposes to use CaSIG funds to better serve individuals with co-occurring disorders (CaDs) through the following infrastructure enhancements: 1) Standardized Screening and Assessment; 2) Service Coordination and Network Building; and 3) Information Sharing. Additionally, CT proposes to provide sufficient testing ground for these infrastructure enhancements through two service pilots, one in Quadrant II and one in Quadrant III.

1. Standardized Screening & Assessment will be established to identify individuals with CaDs and their treatment needs, regardless of where the individual initially presents for care. The ultimate goal is that all substance abuse providers will be required to implement a brief screening tool for mental health concerns. In turn, all mental health providers will be required to implement a brief screening tool for substance abuse concerns.

2. Service Coordination and Network Building are essential to enhance the quality of services by removing barriers that impede access, retention, and favorable treatment outcomes, leading to a cohesive, coordinated, and integrated delivery of services and programs for individuals with CaDs, thus, reducing the burden on the individual to negotiate services and maximizing use of limited resources within both treatment "silos".

3. Develop infrastructure that allows information sharing to all stakeholders and promotes the use of data in a quality improvement framework.

The Enhancing psychiatric Services Pilot seeks to develop and implement effective, integrated, and culturally responsive clinical and administrative dual diagnosis enhanced care for Latinos/as with CaDs. The Addiction Services Pilot will design and implement an integrated system of services for individuals with CaDs, which includes use of system change technology with clinical practice technology at the system, program, and clinician competency levels to create comprehensive system change. These pilots will establish an integrated system of care for persons with CaDs and will implement a coordinated outreach, intake, and screening process to ensure that individuals who present in either system with CaDs are engaged in appropriate care.

The CT Department of Mental Health and Addiction Services (DMHAS), as the Single State Agency (SSA) for substance abuse services and the State Mental Health Authority (SMHA), has taken significant steps to increase capacity to provide accessible, effective, comprehensive, . integrated, and evidence-based services for adults with CaDs. Additionally, CT, as one of the 10 states selected to participate in the National Policy Academy on CaDs, is benefiting from the Academy's intensive policy-building forum to develop a State action plan for improving access to services for persons with CaDs. Building upon CT's existing initiatives and infrastructure, CT is well-positioned to make maximal use of the opportunity presented by SAMHSA's COSIG.

Delaware

As part of its system transformation efforts, the Delaware Division of Mental Health and Substance Abuse is proposing an initiative to: 1) integrate mental health and substance abuse treatment through the development of a state level infrastructure to provide an organizational framework for planning and implementing integrated services and 2) pilot enhancement activities that will inform the development of a comprehensive, integrated approach to serving persons with co-occurring disorders throughout Delaware. This project will provide knowledge to the Division for planning and to the field on the challenges and successes possible for states engaging in the process of developing integrated systems that involve complex boundary spanning activities.

Delaware has participated in the federally supported Policy Academy focused on the development of strategies to introduce services for persons with co-occurring disorders. Based on this experience, and the input of stakeholders from other Delaware systems, professionals and consumers and advocates, the following infrastructure goals are proposed for this grant: 1) statewide screening for co-occurring disorders across four systems; 2) training and credentialing of professionals; 3) implementation of evidenced-based practice (EBP) integrated dual diagnosis (IDDT) treatment in four pilot sites; and 4) evaluation of services. Four service pilot sites and activities will be used to examine the effectiveness of the EBP IDDT service model and an enhanced training credentialing program will be used to test the feasibility and effectiveness of treatment delivery and infrastructure enhancement strategies being developed. This approach uses planning strategies that are already in place in Delaware by leveraging and building upon the experiences currently available at the program level. A feedback loop will be created between statewide planners, local service programs and consumers and advocates, using data from the pilots and the infrastructure activities to shape strategic planning for Delaware.

District of Columbia

The District of Columbia proposes to use the opportunity of the COSIG program to accelerate the steps already underway to:

Establish an integrated approach to service delivery for persons with co-occurring mental illness and substance use disorders.
Screen. all individuals who present for treatment in partner agencies for the presence of co-occurring disorders.
Provide integrated clinical assessments for all individuals who screen positive for both MH and SA disorders
Treat people with co-occurring conditions with the most appropriate interventions and recovery supports consistent with current science and best practices
Create the financial incentives, programmatic infrastructure and information system supports so that clinicians and service programs will continue to improve screening, assessment, treatment, and recovery support for people with co-occurring conditions when the COSIO funding goes away.
Build a learning network for continuous quality improvement that extends across historical gaps that have inhibited effective care:

between mental health and substance use treatment agencies,
across clinicians trained in mental health and those trained in substance use treatment,
between professionals, consumers, and families,
between the District of Columbia and other Federal, state and local groups working to improve the quality of care for people with co-occurring disorders.

The COSIG grant will be combined with the considerable resources already committed by the District of Columbia to intensify work initiated in 2001, and to construct the infrastructure so that, by 2007, there will be no "wrong" door for people with co-occurring conditions. With strong support from the District's first Director of Mental Health, Marti Knisely, and the District's new Director of Addictions Prevention and Recovery, Robert Johnson, we are changing the State's care delivery to the Comprehensive Continuous Integrated Systems of Care model (CCISC). Two leading experts on co-occurring disorders and systems change, Ken Minkoff, M.D. and Chris Cline, M.D., will continue to guide the District's efforts to integrate mental health and substance abuse services through clinical and system change training and consultation. Eric Goplerud and George Washington University will assist in creating pay-for-performance and value-based purchasing strategies that align financial incentives to support and sustain high quality assessment and treatment of co-occurring disorders. The evaluation is integrated into a continuous quality improvement and performance incentives. By the conclusion of the COSIG grant period, the District of Columbia will deliver state-of-the-art screening, assessment, and treatment for its residents with co-occurring mental illness and substance use disorders.

Hawaii

The collaborative and cooperative efforts of Hawaii's Department of Health, including the Adult Mental Health Division and Alcohol and Drug Abuse Division propose to develop and enhance the capacity and infrastructure of the State of Hawaii's service system to provide integrated, evidence-based treatment services to people who have co-occurring substance use and mental health disorders. The grant initiative will be managed through the Office of the Governor, with active participation of the State's Lieutenant Governor, who has agreed to co-chair the project's coordinating committee. This project will also include the establishment of collaborative relations and common agendas with the Departments of Human Services (responsible for the State's Medicare and Medicaid programs) and Public Safety (responsible for the State's criminal justice system). It is expected that this cross-system cooperation will foster the ultimate development of an infrastructure leading to a seamless and comprehensive system of care for people who have co-occurring disorders.

Three overarching long-range goals comprise the proposed project. The first goal is to establish a system spanning task force (the Project Taskforce) that will be responsible for the continuing development and implementation of action plans and protocols to (a) assess the status of the State's co-occurring disorder services system, (b) identify unmet needs, gaps, and other problems within this system, (c) develop and enact strategies to resolve these obstacles to care, and (d) build capacity and infrastructure to sustain a high-quality, integrated, and seamless system of care.

The second goal is to conduct a services pilot to test a locally developed set of capacity and infrastructure enhancement strategies. This pilot will promote the plans and protocols of the system-spanning task force that relate directly to the improvement of service to people who have co-occurring disorders. The pilot will be designed to sustain the system and service improvements that it implements.

The third goal is to develop a continuous quality improvement framework for co-occurring disorders services using an array of evaluation methodologies. All of the activities of this proposal will be evaluated with regard to their processes, impact, and outcomes. Evaluation information will be used to inform the project's activities, make recommendations for change when necessary, and document outcomes. This evaluation perspective will be completely interwoven into the activities and operations of the project so that the acquisition and use of evaluation information is as integral to the project as the consumer-focused interventions.

Louisiana

Louisiana has developed the Louisiana Integrated Treatment Services (LITS) Model for serving persons with co-occurring mental and substance abuse disorders. This model, developed through two SAMHSA Community Action Grants, was successfully piloted in one region of the state and has been adopted for statewide implementation. The COSIG grant will focus on implementation of the LITS Model in the State's remaining regions and on development of statewide infrastructure to support and sustain LITS. Major infrastructure developments will include (a) cross agency screening and assessments tools; (b) integrated management information and program evaluation systems; (c) funding structures that include new Medicaid funds for substance abuse services, maximizing current funding to support a broad range of services for people with co-occurring disorders; and (d) professional licensing standards that support integrated treatment. Regional implementation of LITS will include ongoing intensive education, cross training, and specialized consultation. Stakeholder involvement will be supported at both the State and local levels through direct partnership with consumer and community-based mental health substance abuse organizations. Organizational structure for the COSIG grant will include a State-level Coordinating Council with decision-making and oversight responsibilities; 10 regional steering committees; 20 regional LITS specialists; 10 regional LITS facilitators; and a full-time project director. Expert consultants will provide technical assistance throughout the project.

Maine

The State of Maine is poised to institute broad and far-reaching changes in its services to an estimated 10,000 people who experience psychiatric and alcohol or drug-related co-occurring disorders. These changes to create a welcoming system will be tested with diverse populations including Native Americans, migrant workers and immigrants from Asia and Africa and will be supported through infrastructure enhancements. As attested in the Governor's letter accompanying this proposal, the COSIG project supports a logical progression for Maine. With a Phase 1 SAMHSA Community Action Grant last year which garnered agreements from 58 agencies to implement co-occurring services, followed by Maine's selection to participate in SAMHSA's National Policy Academy on Co-occurring Disorders, Maine is ready to take the next steps represented in this proposal. Those steps are consistent with SAMHSA's capacity building goals as reported to Congress and its infrastructure enhancement goals needed to support the co-occurring system in the long run.

Specifically, the goals of COSIG Works for Maine are to work in nine diverse pilot sites and then replicate more broadly throughout the state activities to:

Screen at least 3000 individuals per year for the presence of co-occurring disorders;
Assess the level of severity of co-occurring disorders in at least 2000 people per year ;
Treat both disorders in a comprehensive and coordinated manner in at least 1000 people per year;
Train providers in 50 agencies per year to screen, assess and develop a treatment plan for people with co-occurring disorders; and
Evaluate the impact of treatment services on individuals who have co-occurring disorders and their families.

The project will function at two levels: developing the state infrastructure to effectively monitor and serve people of all cultures who experience co-occurring disorders and implementing capacity-building goals in a variety of settings throughout the state. It includes a rigorous third party evaluation to determine whether the changes increase the percent of programs that screen, assess and treat people with co-occurring disorders and reduce the percentage of clients who experience impairment from the co-occurring disorders following treatment. The evaluation will help people to understand whether interventions are consistently effective in different treatment settings serving diverse ethnic and cultural populations.

Minnesota

Minnesota COSIG proposes to expand current standardized screening and assessment to quadrants 2 and 3 with infrastructure development activities in mental health centers and substance abuse agencies that are co-located and dually licensed as mental health centers and substance abuse agencies. These agencies will work in collaboration with primary care partners Neighborhood HealthCare Network and the American Indian Behavioral Health clinics to also improve service integration between primary care physicians, American Indian behavioral health services, and mental health and substance abuse agencies.

MN COSIG infrastructure development activities have been identified through consumer focus groups, provider workgroups and surveys, state policymakers and planners, and information gained from evidence-based research, Co-Occurring Center of Excellence publications, and consultation from national experts. Minnesota's COSIG proposal is a comprehensive plan to meet all five of the capacity building goals in SAMHSA's Co-Occurring Report to Congress (screen, assess, treat, train and evaluate). MN COSIG will build upon the extensive work currently underway by a mental health public-private partnership action group in Minnesota to conduct an analysis of the fiscal framework specifically targeted on services for quadrants 2 and 3 that will significantly increase the likelihood that services will be available for persons with co-occurring disorders.

As a result of MN COSIG, the State will have a formal state policy for Integrated Dual Disorder Treatment (IDDT) across a wide range of stakeholders who are invested in implementing and maintaining the IDDT infrastructure.

Missouri

Missouri will implement infrastructure development and services activities for clients with co-occurring disorders in Quadrants II and III. A Governor-appointed Steering Committee will oversee the project, which will include developing a standardized screening and assessment system; implementing evidence-based practices; and training staff who will pilot the new systems at selected Department of Mental Health-contracted rural and urban sites.

Missouri’s Governor Bob Holden has appointed a chairperson for a Governor’s Steering Committee on Services for Individuals with Co-Occurring Disorders to administer this project and provide a vital mechanism for network building. The committee will also analyze public policies related to co-occurring disorders and identify opportunities to collaborate on service provision. Steering Committee members will be drawn from government agencies concerned with co-occurring disorders and other key stakeholders including consumers and their family members, local business and faith community leaders, service providers, and researchers.

Missouri will use the CAGE-AID to screen for substance abuse. The Addiction Severity Index (ASI) psychiatric scale, modified with additional items from the Mental Health Screening Form III, will be used to screen for mental disorders. When indicated, individuals will receive the complete ASI for substance abuse assessment and the Computerized Diagnostic Interview Schedule (CDIS) for assessment of mental disorders. Screening and assessment will be deployed via the Missouri Department of Mental Health’s (DMH) automated web-based information system. Missouri will expand treatment options for individuals with co-occurring mental and substance-related disorders by implementing treatment based on the Resource Kit and TIP.

A services pilot will test the screening, assessment, and treatment protocols at rural and urban contractors of the DMH divisions of Alcohol and Drub Abuse (ADA) and Comprehensive Psychiatric Services (CPS). The pilot phase will also compare agencies that have both ADA and CPS contracts to agencies that provide services for only one division. The project will assess the readiness of State and local program leadership and direct-care staff to implement these services. A comprehensive training/technology transfer process will address infrastructure and skill development for State-level and agency administrative and clinical staff.

The Missouri Institute of Mental Health will conduct the evaluation and the University of Missouri-Kansas City’s Mid-America Addiction Technology Transfer Center will conduct the training. Washington University in St. Louis will provide training on the CDIS.

New Mexico

New Mexico will expand implementation of the evidence-based practice of integrated treatment for co-occurring disorders to increase the identification and assessment of persons with co-occurring substance use and mental health disorders, and to increase provision of integrated treatment services known to positively impact consumer outcomes. The Office of the Governor will oversee this collaborative initiative of the Department of Health (lead agency), Human Services, Corrections, and Children Youth and Families.

The Behavioral Health Services Division of New Mexico’s Department of Health (DOH/BHSD) has more than three years experience of implementing this system development model. In the coming fiscal year (July 2004-June 2005), DOH/BHSD will expand the already strong capacity of its provider networks to screen, assess and treat individuals who may have co-occurring disorders, and evaluate system progress and client outcomes. Beginning in July 2005, all New Mexico State agencies tasked with the delivery, funding or oversight of behavioral health services will form a single Interagency Behavioral Health Purchasing Collaborative (herein referred to as the ‘Collaborative’) which will contract with a single behavioral health entity to deliver behavioral health services throughout the state. Within the Collaborative, DOH/BHSD will serve as lead agency overseeing implementation of integrated treatment of co-occurring disorders throughout this new system of care. Initially, interagency implementation efforts will focus on behavioral health services administered by the Departments of Health, Human Services, Corrections, and Children Youth and Families.

DOH/BHSD will work with the Collaborative to establish an Evidence-Based Practices Implementation Center to provide training and technical assistance for implementation of integrated treatment of co-occurring disorders and other best practices at the system level (state, regional, and local). Provider level and clinical practice level. Partnerships will be sought with teaching and research institutions in New Mexico.

During statewide implementation of integrated treatment for co-occurring disorders, several provider sites will be chosen for more intensive support consisting of training and technical assistance. These sites will represent the geographic, community, provider, cultural and ethnic diversity present within the state of New Mexico. The impact of state system change and implementation efforts on the local site will be evaluated to provide information to the statewide system regarding barriers/supports to successful change in treatment practice.

Project oversight will be provided by the State Incentive Grants Policy Steering Committee, representing multiple agencies, consumer advocates and other stakeholders. This committee will address system issues to reduce barriers to integrated behavioral Health care throughout all state agencies.

Oklahoma

With funding from the Department of Health and Human Services Substance Abuse and Mental Health Services Administration (DHHS/SAMHSA), the Oklahoma Department of Mental and Substance Abuse Services (ODMHSAS/Department) will seek to develop an integrated system of care for persons with co-occurring disorders in State funded mental health and substance abuse treatment facilities that is accessible to consumers and their families, culturally competent, and grounded in evidence-based practices. Two goals are proposed to guide this vision: to develop, implement, and evaluate a standard protocol for the screening and assessment of persons with co-occurring disorders across mental health and substance abuse treatment settings, and to develop, implement, and evaluate an integrated treatment model that conforms to the best standards of care for persons with co-occurring disorders. The project will develop the infrastructure necessary to realize the vision by capitalizing on the strengths of the existing system, including training, information technology, the leadership of the Single State Agency (ODMHSAS), and the active involvement of consumers and their advocates. Barriers to integration will also be addressed, including the frontier status of the State, the absence of a standardized screening and assessment protocol across mental health and substance abuse treatment providers, the fragmented system of care for persons with co-occurring disorders, and problems in adequately funding care for this service population.

Pennsylvania

Pennsylvania’s Departments of Public Welfare and Health are proposing an initiative to integrate mental health and substance abuse treatment though (1) the construction of a permanent, State level infrastructure using the knowledge and experience gained through MISA pilots at the county level; and (2) pilot enhancement activities that will result in a comprehensive, integrated approach to serving persons with co-occurring disorders throughout the Commonwealth. This project will provide knowledge to the field on the challenges and successes possible for States already engaged in the process of developing new initiatives involving complex boundary-spanning activities.

In 1997, the Pennsylvania Office of Mental Health and Substance Abuse Services in the Department of Public Welfare and the Bureau of Drug and Alcohol Programs in the Department of Health, jointly sponsored a statewide Mental Illness and Substance Abuse (MISA) Consortium to examine integrated approaches to working with people who have co-occurring substance abuse and mental disorders. Stakeholders from the mental health and drug and alcohol systems participated. The group’s 1999 report recommended service and systems integration in four areas: screening and assessment, professional credentialing and training, the development of service standards, and the development of adolescent services. Pennsylvania’s MISA Pilot Project was the embodiment of those recommendations. Five pilot programs were involved in testing different models of service delivery for various population groups.

Based on the pilot experience, the following infrastructure goals are proposed for this grant: (1) Screening and Assessment; (2) Training; (3) Evaluation; and (4) Treatment. Six service pilot sites and activities will be used to examine the effectiveness of different service models and five service enhancement pilots will be used to test the feasibility and effectiveness of particular infrastructure enhancement strategies at the State and or local level. This approach uses planning strategies that are already in place in Pennsylvania by leveraging and building upon experience currently available at the county level. A feedback loop will be created between statewide planners and program level service programs with information from all pilots informing the State planning process and State information informing the county programs.

South Carolina

On behalf of state and local mental health and substance abuse treatment agencies and consumers, South Carolina’s Governor is proposing a bold initiative to benefit adults with co-occurring mental health and substance abuse disorders. Through a uniform screening and assessment protocol, intensive training and cross-training of staff in best practices, better collaboration and information sharing, adults with co-occurring disorders will receive improved treatment. While national data suggest that a significant percentage of clients receiving either mental health or substance abuse services have co-occurring disorders, South Carolina data show that not all of these disorders are being recognized, diagnosed, or treated in our systems. This project is designed to improve recognition, diagnosis, and treatment. System changes will be developed during the first two years of the grant, with pilot projects in the Charleston and Georgetown areas serving as test sites for implementation. Once perfected, theses changes will be disseminated statewide during the later years of the grant. Evaluation efforts will continue through all five years to monitor statewide implementation efforts, assess sustainability of the changes, and monitor the expected improvement in client outcomes. Project objectives include:

To develop and implement a standard protocol for screening and assessing individuals with co-occurring disorders within the mental health, substance abuse, and vocational rehabilitation systems;
To train and cross-train agency staff in both mental health and substance abuse disciplines;
To broaden the membership and the mission of the interagency Substance Abuse/Mentally Ill Committee, which has been working for five years to open the state treatment systems’ doors to recovery for people with co-occurring disorders;
To formalize collaboration among local mental health, substance abuse, and vocational rehabilitation agencies to assure appropriate treatment for co-occurring disorders;
To resolve reimbursement issues for mental health and substance abuse agencies, with the intent to fund seamless services for co-occurring disorders across agencies;
To develop management and information systems that allow tracking of services and outcomes for adults with co-occurring disorders and exchange of administrative and clinical information among local mental health, substance abuse, and vocational rehabilitation service agencies, and among local service agencies and state agencies.

The purpose of the pilot initiatives is to test the new methods to see if they are feasible, effective, and efficient. While the office of the Governor is responsible for the project, activities will be overseen by the Substance Abuse/Mentally Ill (SAMI) Committee. The Committee is chaired by representatives of the state’s mental and substance agencies, and includes public and private stakeholders (including patients and their advocates) responsible for addressing the diverse needs of persons with co-occurring disorders.

South Dakota

South Dakota (S.D.) has committed to narrowing gaps in services for individuals with co-occurring disorders utilizing SAMHSA’s capacity-building goals. The State’s plan will concentrate on creating a sustained state-wide infrastructure that will implement quality training procedures on screening and assessment measures as well as address issues of staffing competency, licensure, and credentialing; service coordination and network building; financial planning; information sharing; and barrier reduction. South Dakota is dedicated to five core strategies: 1) establishment of a well-informed and coordinated state-level infrastructure, 2) development of a clear and concrete action plan with regional and local input, 3) development of a plan for the integrated screening process and identification of a screening instruments and assessment protocols, 4) development of a quality improvement process to monitor outcomes of the screening process, and 5) development and implementation of a system-wide training curriculum and plan for the 7 Community Mental Health Centers (CMHC’s), which are also Core Services Substance Abuse Agencies (CSA’s) with a roll-out to all CMHC’s and CSA’s to follow.

To develop this permanent infrastructure and complete the above named goals, the Governor’s Office has committed to facilitating the collaboration of the three service agencies under the Department of Human Services (DHS) and commissioned the Co-Occurring Disorders Steering Committee. This committee, along with a Co-Occurring Program Manager will spearhead the movement towards providing more efficient integrated services across the state. The Co-occurring Steering Committee will be composed of personnel from the State’s Division of Alcohol and Drug Abuse (DADA) and Division of Mental Health (DM11), Community Mental Health Centers (CMHC’s) Core Services Substance Abuse Agencies (CSA’s), other State divisions (e.g., Department of Corrections, Social Services), and stakeholders from the community (e.g., consumer advocacy groups, Native American organizations). Committees will be charged with oversight of the project in their areas and finding solutions to multilevel barriers to service integration.

With stakeholder input, independent evaluators will help develop the necessary training curriculum, collect data regarding training outcomes and clinical performance, then help to modify training and or implementation as needed. The project will be conducted at the seven CMITC’s/CSA’s and the HSC (State Hospital). Data collection and analysis will be built into all phases of the project. The project will enable success by providing opportunities to further identify barriers to integrated services, creative solutions, and a solid knowledge base for expanding into other regions or agencies in the State. As the system crystallizes across the State, South Dakota will be able to build on its success through future development of programs that provide comprehensive, integrated services to individuals with co-occurring disorders.

Texas

Governor Rick Perry presents the Texas State Incentive Grant (COSIG) for the treatment of person’s with co-occurring substance related and mental disorders (TI 03-003). This project will support an expansion of service delivery and co-occurring psychiatric and substance use disorders (COPSD) competency throughout the State while continuing the State’s interagency coordination and collaborative commitment to strengthen the systems of care for the persons with COPSD.

Since the Dual Diagnosis Project was initially funded in 1996, the Texas Department of Mental Health and Mental Retardation and the Texas Commission on Alcohol and Drug Abuse have demonstrated their commitment to address co-occurring disorders. In 1999, these efforts were awarded the National Council Award of Excellence by the National Council for Community Behavioral Health, and in 2001 they were selected as “exemplary” by the Center for Mental Health Services.

The Texas COSIG will increase co-occurring capacity by building on existing services, ensuring co-occurring competencies of systems of providers through training, and by conducting an evaluation of the State’s current practice for serving clients with co-occurring disorders (referred to in this application as the COPSD Specialist model) to a proposed system of methodology (referred to as the COPSD System Model) that promotes a “no wrong door” approach to placing clients into integrated services. By evaluating client data from both models to validate co-occurring performance measures and quadrant framework, Texas can enhance the State’s ability to sustain long-term change in the service delivery system to meet the needs of more Texans with co-occurring disorders.

Vermont

Vermont Governor James Douglas has instructed the Vermont Department of Health to improve Vermont's capacity to provide effective treatment for individuals with co-occurring substance and mental health disorders. Go. Douglas, in applying for this State Incentive Grant, has directed that the state will use evidence-based practices for outpatient client populations. Vermont will employ the Comprehensive, Continuous, Integrated System of Care framework to organize the systems change at the state and local program levels. The project will focus on quadrants two and three of the four quadrant State Director's Conceptual Planning Framework.

The Vermont Integrated Services Project will focus on the publicly funded outpatient behavioral health treatment systems operated by the State's Mental Health Authority (DMH) and the Alcohol and Substance Abuse Authority (ADAP). As of July 1, 2004, both ADAP and DMH will be located in the Vermont Department of Health, a reorganization that recognizes the common links of these two agencies. The project will also include Vermont's two Federally Qualified Health Center primary health care agencies.

The Vermont Integrated Services Project will focus on the following infrastructure development goals. ADAP and DMH will create the expectation, and provide requisite supports, to ensure that service providers screen for both mental and substance use disorders and perform integrated assessments to understand the course, severity, and interaction of co-occurring disorders on an individual in order to plan appropriate treatment. We will train local clinical and administrative leaders on the principles and practices of integrated treatment using evidence¬based approaches to prevention, intervention, screening, assessment, treatment, and recovery services. ADAP and DMH will create a state-level management group tasked to re-design our respective Information and Business systems to fund, contract for, and evaluate integrated treatment services through information sharing and financial planning. We will use an organized, systems change framework to sequentially guide our work at both the local service and state levels. The implementation process for the Vermont Integrated Services Project will be evaluated using a quality improvement approach allowing rapid feedback and adjustments to implementation. In addition, we will use the performance measures adopted by the National Associations of State Alcohol and Drug Abuse and Mental Health Program Directors.

Virginia

This proposal seeks to enhance the data infrastructure capacity for Virginia’s public substance abuse and mental health services system by building on the State’s existing data collection and reporting systems. This grant, if awarded, will facilitate reporting of the co-occurring indicator for the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) and Mental Health Block Grant (MHBG) by FY2005. Throughout this effort, stakeholder collaboration and participant confidentiality will be of paramount importance.

The Commonwealth of Virginia does not have a distinctive, planned, comprehensive, and coordinated approach to delivering services to consumers with co-occurring disorders. There are no mandated guidelines or existing forums that propose or promote minimum acceptable standards for delivery of care. The Substance Abuse and Mental Health offices within the Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS) advocate the use of “best practices” and evidence-based practices as a part of larger systems change initiatives. The COSIG grant will enhance the current data infrastructure that guides decisions concerning service delivery for persons with co-occurring disorders.

The specific goals of the proposed project are to: (1) develop, implement, and standardize screening and assessment protocols statewide for persons with co-occurring disorder through infrastructure development; (2) identify and implement strategies for data collection and reporting of the co-occurring indicator for the SAPT and MH BGs, as defined by the workgroup for Performance Partnership Grants (PPGs); (3) implement a service pilot that delivers evidence based treatment to youths and adults with co-occurring disorders; and (4) establish a center for excellence in the heart of Virginia to serve as a resource for other providers.

A multi-stakeholder process will be used for these efforts, with an emphasis on facilitating collaboration between the Department of Mental Health, Mental Retardation, and Substance Abuse Services; consumers/family member organizations; Community Services Boards; and other state agencies. In addition, all 40 CSBs will receive funds to modify their management information systems and to improve service delivery to consumers with co-occurring disorders.