Presented by: John. J. Campbell, M.A. John M. Morrow, Ph.D.

1. Presented by: John. J. Campbell, M.A. John M. Morrow, Ph.D. Optimizing Federal Funding Streams to Support COD Services

2. Financing Integrated Service Programs for Persons with Co-Occurring Disorders John J. Campbell, MA Acting Director, Center for Substance Abuse Treatment, Division of State and Community Assistance

3. Co-Occurring Disorders • Substance Abuse Prevention and Treatment Block Grant (SAPTBG) • Purposes • “…planning, carrying out, and evaluating activities to prevent and treat substance abuse and for related activities authorized in section 1924.” • Section 1921(b) of Title XIX, Part B, Subpart II of the PHS Act (42 U.S.C. 300x-21(b)) Authorized Activities

4. SAPTBG Funds Utilization Services Covered  • SAPTBG funds are designated for substance abuse prevention and treatment services statute and regulations • Title XIX, Part B, Subpart II and Subpart III of the Public Health Service Act (42 U.S.C. §§ 300x-21-66) as amended by P.L. 102-321 and P.L. 106-310) • Substance Abuse Prevention and Treatment Block Grant; Interim Final Rule (45 C.F.R. §§ 96.120-137) 4

5. SAPTBG and other CSAT Funding FY 2010 Appropriation The FY 2010 SAPT Block Grant is $1,798,591,000 which represents and increase of $20,000,000 (1.12 percent) relative to the FY 2009 appropriation of $1,778,591,000. • Consolidated Appropriations Act, 2010 (P.L. 111-117) • http://www.samhsa.gov/Budget/FY2010/index.aspx • Discretionary Portfolio total: $143,575,000 5

6. Co-Occurring Disorders Description of the Problem/Issue • Co-occurring substance-related and mental disorders (individual-level and service level are distinct) • Some evidence supports an increased prevalence of people with COD • Rates of mental disorders increase as the number of substance use disorders increases, further complicating treatment

7. Co-Occurring Disorders • Description of the Problem/Issue (con.) Compared to people with mental or substance use disorders alone, people with COD are more likely to have: • More frequent hospital visits • Increased severity, disability, and impairment in social/occupational functioning • Increased resistance to traditional pharmacologic treatment • Increased suicidality • Increased economic burden of each co-morbid condition • Lower probability of recovery

8. Co-Occurring Disorder Strategies Long Term Goals • Increase the percentage of persons with CODs who receive appropriate treatment services that address both disorders • Increase the percentage of adolescents aged 12 – 17 who receive appropriate prevention services that address CODs • Increase the percentage of persons who experience reduced impairment from their CODs following appropriate treatment

9. Co-Occurring Disorder Strategies • Measurable Objectives • Increase the percentage of prevention and treatment settings that: • screen for CODs • assess for CODs • provide treatment to clients through collaborative, consultative and integrated models of care • Increase the number of grantees (States, communities, and providers) measuring and reporting on co-occurring programs and practices and models of treatment

10. Co-Occurring Disorder Strategies • Measurable Objectives (con.) • Increase the number of people trained to implement appropriate co-occurring prevention and integrated treatments among States, communities, providers and consumers • Increase the number of States and Tribes with State and Tribal-level action plans for improving access to mainstream and specialty services for individuals with CODs

11. Four Quadrant Typology (TIP 42) III Less severe mental disorder/more severe substance abuse disorder IV More severe mental disorder/more severe substance abuse disorder High Severity Alcohol and other drug abuse I Less severe mental disorder/less severe substance abuse disorder II More severe mental disorder/less severe substance abuse disorder Mental Illness Low Severity High Severity

12. SAMHSA’s COD Position Statement(February 1999) • Conceptual Framework - 3 levels of service coordination: consultation, collaboration, or integration. • Developed by state substance abuse and mental health directors. • Definitional reliance on severity of functional impairment as depicted by the 4 quadrant typology published in TIP 42.

13. SAMHSA’s COD Position Statement(February 1999) • Consultative Approach – based upon informal provider relationships: Quad I • Collaborative Approach – based upon more formal provider relationships: Quad II & III • Integrated Treatment – Single Treatment Plan and Team: Quad IV • A caveat: recent trends in policy and practice suggest that more, not less integrated treatment will be the norm.

14. SAMHSA’s COD Position Statement(February 1999) • “…specifically the Substance Abuse Prevention and Treatment Block Grant (SAPTBG) funds and Community Mental Health Services Block Grant (CMHSBG) funds may be used to provide services for people with co-occurring disorders as long as those funds are used for the purposes for which they are authorized by law and can be appropriately tracked for accounting purposes.”

15. Substance Abuse Services Funding • Substance Abuse State Agency Spending Report (FY 2010):

16. Tracking Block Grant Funds Tracking funds for COD services When states have SAPTBG and MHBG, they should: • Develop systems to track funding of services by grant • Broken down by substance abuse (SAPTBG) and mental health (MHBG) services • Systematic and quantifiable • Coded correctly • While this may be easier when services are provided separately, there are ways to account for more integrated service provision

17. Optimizing Federal Funding: Discussion Questions: Does your State use MHBG and SAPT block grant dollars to finance COD services? How? Has your State experienced any barriers to using block grant dollars to finance COD services? What were those barriers? What recommendations or suggestions do you have for SAMHSA to help address these barriers? What recommendations or suggestions do you have for other States that may encounter these barriers?