Lessons Learned: Implementing IDDT
Organizational / System Aspect2 County ExamplesDebbie Innes-Gomberg, Ph.D. -Los AngelesAdrian Carroll, MFT - StanislausJanuary 19, 2007
Organization-Wide and IDDT Team SpecificIDDT provides principles and tools that can be used organization-wide to improve Co-occurring capability throughout
Organization-Wide and IDDT Team SpecificIDDT provides principles and tools that can be used organization-wide to improve Co-occurring capability throughoutAs well as build specific enhanced IDDT teams
Organization-Wide Elements:Commitment Philosophy TrainingAccess policyTime unlimitedOutcome monitoringSelf-help Housing and employmentResidential servicesLevels of careSteering committee
System Elements that Support IDDT Specific Programs:Client to staff ratioSupervising to the modelTeam approachEnhanced trainingsQuality managementFidelity monitoringSpecific OutcomesQuality Improvement (forms, processes)Access to housing (wet, damp, dry)
Use of IDDT in Larger System Change Efforts in L.A.
Los Angeles Countys Adult Systems of Care TransformationCreating a continuum of recovery-oriented servicesUsing stages of change to guide service delivery and treatment planningCreating strategies for client flow through the continuum of services
COUNTY OF LOS ANGELES DEPARTMENT OF MENATL HEALTH ADULT SYSTEMS OF CARE TRANSFORMATION-RECOVERY-BASED LEVELS OF OUTPATIENT CARE
COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH
ADULT SYSTEMS OF CARE TRANSFORMATION RECOVERY-BASED LEVELS OF OUTPATIENT CARE
Strategic Services and Supports
Full Service Partnerships
Key Focus: short term, intensive welcoming and assessment resulting in quality referrals and enhanced use of community resources
Key Focus: Strategic mental health and supportive services resulting in client movement to wellness services and enhanced recovery.
Key Focus: Self-directed services with peer and professional support geared toward physical/emotional recovery and increased community assimilation
Key Focus: Intensive, whatever it takes service approach for clients who are homeless, incarcerated, in institutions or for whom care is provided solely through the family
IDDT Elements: Integrated assessment and Tx planning, stage-wise interventions, use of motivational interviewing, self-help services, multi-disciplinary treatment team
IDDT Elements: Integrated assessment and Tx planning, stage-wise interventions, use of motivational interviewing, self-help services, family education and support, secondary interventions for non-responders, multi-disciplinary treatment team
IDDT Elements: stage-wise interventions, self-help, family education and support, focus on health and well-being
IDDT Elements: Integrated assessment and Tx planning, stage-wise interventions, use of motivational interviewing, self-help services, family education and support, secondary interventions for non-responders, access to comprehensive services, multi-disciplinary treatment team
MORS levels: 2-7
MORS levels: 3-6
MORS levels: 6-8
MORS levels: At enrollment: 1-2
At graduation: 7
Engagement of clients for < 60 days to determine level of need, using extended assessment and recovery scale( referral and linkage to specific service
Evidence based/best practices designed to enhance recovery, engagement, self-coordination and coping skills short term, intensive and longer term.
Including CBT, DBT, illness management, referral to housing and employment specialists within Center
Peer-directed support groups and individualized problem solving, including Wellness Recovery Action Planning
Multidisciplinary team, including housing and employment specialists and a peer advocate.
Client to staff ratio
Use of IDDT Model Elements to Enhance Service Delivery in L.A.
Focus on person-centered treatment planningTeam-based servicesStage-based assessment and interventions based on readiness for change
COUNTY OF LOS ANGELES DEPARTMENT OF MENTAL HEALTH
ADULT SYSTEMS OF CARE
Big 7 Organizational Transformation
I. Domains of Change:
Staff Transformation (enhancing staff belief in recovery, instilling hope in staff).
Staff-consumer interactions (developing welcoming environments, developing successful strategies to work with challenging individuals).
Organizational structures and processes (collecting and using quality of life and recovery-based outcome measures, developing structures to promote consumer flow through the system, building strong team structures).
Available services and capacity (developing quality of life support services, strengthening collaboration with other social service agencies, developing community belonging and connections).
II. Values of recovery-oriented change:
III. Use of Integrated Dual Diagnosis Treatment principles to create a recovery-oriented service continuum:
Integrated assessment and treatment planning.
Use of stage-specific interventions that match client readiness for change, including motivational interviewing.
Incorporating self-help services into all levels of care.
Use of SAMHSA-supported practices such as Illness Management, Family Education and Support, psychoeducation, Supported Housing and Employment
Focus on health and wellness.
SAMHSA 4 QuadrantsTarget population for IDDT are those COD individuals with Serious Mental Illness
Stanislaus experienceRecovery focusIntegrated system vs. Integrated treatmentWellness Recovery Center Exit strategies as a recovery conceptIdentify internal experts and early adoptersRecovery Milestones
Stanislaus experienceStages of change model:-SATS (AOD)-MH stages based on Milestones (MH)-Stage-based treatment-Staff change model
STAGES OF CHANGE
STAGES OF IMPLEMENTATION
Unaware or uninterested
Ask important questions
Conduct a needs assessment
Define your rationale
Conduct a baseline fidelity review
Begin the change process
Develop awareness of available options
Develop a baseline fidelity action plan
Identify current practices and rationales
Develop stage-wise interventions
Examine your mission, values, goals, and vision
Find your champions
Acquire and integrate training
Network with others
Check it out
Identify financial resources
Engage in clinical consultation
Provide ongoing training
Engage technical assistance
Assemble a steering committee
Provide stage-wise interventions
Engage in ongoing consultation
Assess the pros and cons
Conduct a readiness assessment
Develop and monitor outcomes
Develop informed consent and consensus
Decide to implement or not
Continue to educate and train stakeholders
Transform the organizational culture
Recruit a team leader
Plan to start small
Address unintended consequences
Assemble the multi-disciplinary service team
Begin an implementation plan
Stanislaus experienceSystem Transformation-MHSA FSP, 2034, ACT-Wellness Recovery level of care-LOCUS LOC system, caseload ratio-Normalizing use of Primary Care PhysicianLevels of Care
Stanislaus County Behavioral Health and Recovery Services Draft 7/2005
Community Supports & Integrated Services
Stage of Recovery.
Level of Functioning.
KEY COMPONENTS (that support Recovery)
Case Management / Care Coordination
Housing, Employment, Education, and Wraparound Supports
Meds, MD, RN, Physical Health Services
Counseling and Therapy
ACT or ACT-lite
Pre-contemplation to early active treatment.
High degree of impairment.
>50% in field
Outreach and engagement.
Stage-based. Follow while in hospital.
Extensive use of wrap-around supports, housing and employment services. Housing 1st
Stanislaus experienceClient flow through System-Early expectations-Ease of re-admission-SSI concerns-PCP relationships-Peer support throughout-Recovery conversation-Transparency of treatment process-Measurement and accountability
SUPPORT WHEELBe Selective In Choosing Support Phone NumbersPhone NumbersUse In A Circular Manner So Not To Burn Out Any One SourceMy Recovery
Cornerstones of Empowerment
Developed by Consumers and Family Members
I have the right to know my diagnosis, criteria, and what medications are used to treat said diagnosis AND I have the responsibili