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Your Trainers

Effective Use of Revised Supplemental COD Forms for Treating Consumers with Co-Occurring Mental Health and Substance Use Disorders. Your Trainers. Thomas E. Freese , Ph.D. UCLA Integrated Substance Abuse Programs Sherry Larkins , Ph.D. UCLA Integrated Substance Abuse Programs

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Your Trainers

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  1. Effective Use of Revised Supplemental COD Forms for Treating Consumers with Co-Occurring Mental Health and Substance Use Disorders

  2. Your Trainers Thomas E. Freese, Ph.D. UCLA Integrated Substance Abuse Programs Sherry Larkins, Ph.D. UCLA Integrated Substance Abuse Programs James Peck, Psy.D. UCLA Integrated Substance Abuse Programs UCLA

  3. Introduction:What we will cover Review of Co-Occurring Disorders and Vision for Fully Integrated Treatment Introduction to Supplemental COD Session Guide Review Purpose of Screening and Assessment Introduction to COJAC Screener Review Revised Supplemental COD Assessment Review Session Guide/Treatment Planning Tool Wrap-Up, Q & A

  4. Past Year Treatment of Adults with Both Serious Psychological Distress (SPD) and SUD (2006) 5.6 Million adults with co-occurring SPD and substance use disorder. SOURCE: 2007 National Survey on Drug Use and Health, SAMHSA.

  5. Vision of Fully Integrated Treatment • One program that provides treatment for both disorders • Mental and substance use disorders are treated by the same clinicians • The clinicians are trained in psychopathology, assessment, and treatment strategies for both disorders

  6. Vision of Fully Integrated Treatment (continued) • Treatment is characterized by a slow pace and a long-term perspective • Clinicians offer motivational counseling • 12-Step groups are available to those who choose to participate • Pharmacotherapies are utilized according to consumers’ psychiatric and other medical needs • Sensitivity to issues of trauma,culture, gender, and sexualorientation

  7. Stages of ChangeProchaska & DiClemente Precontem- plation Contemplation Recurrence Preparation Maintenance Action

  8. 1. Precontemplation Definition: Not yet considering change or is unwilling or unable to change. Primary Task: Raising Awareness 6. Recurrence Definition: Experienced a recurrence of the symptoms. Primary Task: Cope with consequences and determine what to do next 2. Contemplation Definition: Sees the possibility of change but is ambivalent and uncertain. Primary Task: Resolving ambivalence/ Helping to choose change Stages of Change:Primary Tasks 5. Maintenance Definition: Has achieved the goals and is working to maintain change. Primary Task: Develop new skills for maintaining recovery 3. Determination Definition: Committed to changing. Still considering what to do. Primary Task: Help identify appropriate change strategies 4. Action Definition: Taking steps toward change but hasn’t stabilized in the process. Primary Task: Help implement change strategies and learn to eliminate potential relapses

  9. Screening and Assessing Consumers for COD

  10. What is the Difference between… What’s Going On in These Pictures? Screening Assessment

  11. Screening Conducted with large numbersof people to identify the potentialthat a problem exists Screening is intended to be broad scale and produce false positives Screening leads to more in-depth assessment and intervention for people identified with a potential problem

  12. Assessment Assessment is individualized andspecific. Assessment is designed to identify particular needs and rule-out false positives Assessment leads to more individualized intervention for people identified with a problem

  13. What can be determined through the screening and assessment process? The interplay between the substance use and the mental health problem The degree to which each disorder affects functioning (positively &/or negatively) The frequency, duration and quantity of use and resulting diagnosis (i.e., substance abuse or dependence) Using the Substance Use Screener ensures that the topic will be raised

  14. The COJAC* Screening Tool Simple tool to determine if a problem might exist in each of these key areas: Mental Health Addiction Trauma * Co-Occurring Joint Action Policy Council (COJAC) Workgroup

  15. Practice with the COJAC • Form pairs. • One person will play the role of clinician and will interview the client. • The other person will use the “Natalie” vignette to play the role of the client. • Conduct the COJAC Screener. • What did you notice? • What is good and what is not-so-good about using a tool like this?

  16. Adult Initial Assessment Revisions

  17. Rationale for Revising COD Assessment Process • While substance use/abuse cannot be the principal mental health diagnosis of a DMH Medi-Cal client, many DMH clients are severely impacted by their substance use/abuse which compounds mental health symptoms. It is important to recognize the impact of substance use/abuse on mental health diagnoses. • The Adult COD forms are designed to assist the clinician in gathering important information that will assist the clinician to develop appropriate interventions or referrals based on this impact and the client’s readiness for change.

  18. AIA Revisions • Section III Part B, and Section IX Part I: Added symptoms/impairments in daily functioning • These are also vital to supporting Medi-Cal reimbursement for substance abuse-related services

  19. AIA Revisions • Section VI: Moved detailed sub abuse questions to Supp COD Assessment page 1 • Added 3 items referencing COJAC, which determine whether Supp COD Assessment is needed • Added “How is MH impacted by substance abuse?” • Vital to answer this to support Medi-Cal reimbursement for any sub abuse-related services (hint: see COD Supp Assessment benefits/costs sections)

  20. Supplemental COD Assessment Revisions

  21. Supplemental COD Assessment • By the time you get to this form, you will have completed the initial assessment & will already have a great deal of information about this client that will inform this section • Sections IV-V (Benefits & Costs of Use): should be done as a conversation, not a checklist

  22. If answer “yes,” then ask these follow-up questions: • Do you use protection when you have sex while using? • Do you find that there is a particular type or kind of sex you prefer when using? • Have you ever felt like your sexual behavior was getting riskier or more extreme when using?  If yes, • Have you been tested for HIV in the past 12 months?

  23. Supplemental COD Assessment Demonstration of Sections IV-V interview

  24. Supplemental COD Assessment Participants roleplay Sections IV-V interview

  25. Supplemental COD Assessment • Section VI (Readiness for Change/Tx Plan) • The majority of your clients will range from Precontemplation to Action • Item #7: use the following guidelines to match their answer (0-5) with the appropriate stage of change on the Session Guide:

  26. Supplemental COD Session Guide/Treatment Planning Tool

  27. Supplemental COD Session Guide • Utilize recommended session activities and treatment goals to inform development of initial treatment plan • At subsequent sessions, use Questions 1-4 to assess progress since last visit • This information will help you determine if client is in same stage of readiness or has moved (forward or back) • Use recommended activities/goals to guide session

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