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INTEGRATED RECOVERY Lessons Learned: Implementing IDDT

This report outlines the implementation of Integrated Dual Disorders Treatment (IDDT) in Stanislaus County, highlighting the organizational context and key factors affecting its success. The focus on integrated services for co-occurring mental health and substance use disorders served to improve treatment outcomes and reduce costs. Key challenges and successes experienced during implementation are discussed, including the need for specialized training, collaborative efforts, and strategies for sustaining positive change. Recommendations for future improvements stress the importance of dedicated resources and ongoing training for staff.

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INTEGRATED RECOVERY Lessons Learned: Implementing IDDT

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  1. INTEGRATED RECOVERYLessons Learned: Implementing IDDT Stanislaus County Elizabeth Oakes, MFT Adrian Carroll, MFT January 19, 2007

  2. Organizational Context • Why we selected IDDT: -Committed to integrated services BHRS -Integrated system isn’t integrated treatment -Established experience with co-occurring Tx -Valued EBP aspect -Interested in ‘implementation’ aspect -Not the Money -High mortality rate

  3. Organizational Context • Why we selected IDDT continued: -High co-morbidity -High treatment failure rate -Cost of not serving for system -Highly underserved -Co-occurring conditions often used as exclusion criteria, rather than inclusion criteria

  4. Organizational Context • Goals and expectations -Actual OP treatment track, consistent across programs, across department -Both: broad system-wide competence; and specialized enhanced expertise. -ID system barriers to implementing EBPs -Save money eventually -Accurate identification of AOD,MH, and COD -Develop staff training curriculum -Increased integration

  5. Key Factors • Factors that facilitated implementation : -Staff with MH and AOD knowledge -CIMH training -Effective use of project planning consultant -Inter-county collaboration -Learning collaborative -System-wide steering committee -Psychiatrists early adopters -Integrated system -Training coordinator

  6. Key Factors • Factors that impeded implementation: -Caseload size -Attempting treatment before engagement -MH downsizing and loss of funding -Resistance from some staff -Stigma, 2 types MH and AOD -Lack of COD housing -Funding categorical

  7. Team Structure • Project Team - Behavioral Health Integration Oversight Committee: -Assistant Director -Chiefs and other key managers -Selected site Program Coordinators -Program Coordinators MH and AOD -Residential AOD manager -Training Coordinator -Line staff -MHSA Coordinator

  8. Team Structure • Clinical/IDDT Team -Program Coordinator -Psychiatrist -Consumer -Select MH Case managers -Select MH Clinicians -Select AOD counselors

  9. Benefits of Integrated Recovery • Saves money • Helps staff motivation • Impacts long-time ‘stuck’ clients • Stage-based treatment • Formulation helps consumers understand how 2 conditions creates a 3rd condition • Recovering peers from either MH or AOD can support each other • DRA sustained • Recognition with in AOD for need of specialized track

  10. Team Structure

  11. Sustaining Positive Change • Challenges: -Staff changes -Caseload size -”Drift” -Integration into daily practices -Forms -Staff passion for MH or AOD -Separate funding

  12. Sustaining Positive Change • Successes -Hire consumers with COD recovery -Paperwork to forms committee -All FSPs trained -Written into MHSA plan -Residential AOD with COD track -Stages of Treatment -MH and AOD specific stages -MH board member trained

  13. SUPPORT WHEEL Phone Numbers Use In A Circular Manner So Not To Burn Out Any One Source My Recovery Be Selective In Choosing Support Phone Numbers

  14. Sustaining Positive Change • Failures -Caseload size -Growing own experts -Motivational Interviewing measure -Didn’t do own cost-benefit data -Greater consumer/family presence on steering committee

  15. Summary of Lessons Learned • What we would do again -We would do it again -All of it -Stage-based, Motivational Interviewing, AOD staff, clinical tools

  16. Summary of Lessons Learned • What we would do differently -Someone dedicated full time to implementation -More MI up front -More training for MH staff on state-of-art AOD treatment

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