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NYSHealth Hosts “A Conversation About Improving Outcomes in Treatment for Co-Occurring Substance Use and Mental Health Disorders”

October 18, 2013

On October 18, 2013, the New York State Health Foundation (NYSHealth) hosted a conversation to discuss outcomes and lessons learned from a statewide effort to improve the treatment for people with co-occurring substance use and mental health disorders.

In 2008, NYSHealth established the Center for Excellence in Integrated Care (CEIC) initiative to help mental health and substance use programs across New York State make the necessary changes to address people’s mental health and substance use problems at the same time. The program was created in response to the widespread lack of integrated care for people struggling with both addiction and mental illness, which affects as many as 1.4 million New Yorkers. Studies have shown that as few as 10% of people with co-occurring conditions receive evidence-based care for both conditions. During the discussion, speakers shared their perspectives on this effort:

Stanley Sacks, Ph.D., Director, Center for the Integration of Research & Practice at the National Development and Research Institutes, Inc.

Paul Jellinek, Ph.D., Principal, Isaacs-Jellinek

Ileana Acosta, Clinician, St. George MICA (Mentally Ill, Chemically Addicted) program, Richmond University Medical Center

Tiffany Lazok, Client, St. George MICA (Mentally Ill, Chemically Addicted) program, Richmond University Medical Center

Dr. Sacks opened the discussion with an overview and results of the five-year CEIC initiative, which exceeded its target of working with 600 of the estimated 1,000 mental health and substance use clinics across New York State. Its goal was to help clinics better integrate their care for clients who struggle with both substance use disorders and mental health issues. CEIC staff members conducted a thorough analysis of each clinic’s screening, assessment, treatment, and training methods. Afterwards, CEIC provided clinics with a report that included feedback and recommendations on program modifications and evidence-based techniques to improve their integrated care services. It also offered implementation support, as well as follow-up visits to see how well client care and outcomes improved. In its follow-up assessments, CEIC found that the number of clinics now capable of providing services for people with both mental illness and substance use disorders had more than doubled—from 22% to 52%. “The idea was to make an impact at these clinics in a meaningful way,” said Sacks. “These types of improvements are associated with client reductions in substance use, psychological symptoms, and hospitalizations and improvements in employment, housing, and quality of life. Many people will lead full and productive lives in the community as a result.”

Dr. Jellinek is one of the coauthors of a report that took a look at the Foundation’s role and strategy to improve integrated care services for co-occurring conditions. Jellinek offered background on how and why the Foundation became involved in this work; the regulatory barriers that were overcome at the State level and the systemwide transformation that ensued; and the process that led to CEIC’s creation and what it actually accomplished in the field. “The bottom line is that CEIC did make a difference in a very tough problem and well over 200,000 clients were touched by CEIC’s intervention,” said Jellinek. Another important lesson was that collaboration among all the stakeholders involved was key to the initiative’s success. “Together they were able to do something they wouldn’t have been able to do on their own.”

Ms. Acosta discussed how integrated services are put into practice at the St. George MICA program offered through the Richmond University Medical Center, one of the clinics CEIC worked with. She noted that while St. George MICA already had integrated services in place, CEIC’s recommendations were helpful in fine-tuning practices, with treatment plans updated every three months. “We were already practicing integrated health; however the [CEIC] intervention was so important to reinforcing this,” said Acosta. It also helped Richmond University Medical Center take the next step and expand integrated services from the St. George MICA program to the clinic’s wider system.

Ms. Lazok spoke on what it was like to live with incomplete care for her co-occurring conditions and how her life was transformed after receiving integrated services at St. George MICA. Throughout her teen years and early 20s, Lazok struggled with addiction and mental health issues. While doctors had treated her for conventional depression for some years, her true diagnosis of bipolar disorder wasn’t given until she came to St. George MICA. With her new diagnosis, change in medication, and services from the clinic, Lazok has been able to stay drug- and alcohol-free and is now a college student with a 3.3 GPA. “I’m very thankful for this program because I wouldn’t be where I am right now without it,” said Lazok. She also credits the group therapy for clients with co-occurring disorders—a technique that CEIC recommends clinics adopt—as particularly important for her recovery. “The groups really help, especially to see other people struggling with the same issues and they let me learn from my peers.”

View PowerPoint slides from the event.

Access an article in Health Affairs for an in-depth examination of the CEIC initiative and results from the program.

Read the stories of clients and providers affected by the CEIC initiative.