Behavioral Health Services Department Substance Use Treatment - - PowerPoint PPT Presentation

Behavioral Health Services Department

Substance Use Treatment Services Adult System of Care April 1, 2016

Presented by: Cheryl Berman, Ph.D. Division Director, BHSD/SUTS Adult Treatment Services

Substance Use Treatment Services Adult System of Care FY2014

• Serves 6,000 – 7,000 adults per year
• Two thirds (2/3) male
• Approximately 66% - 70% criminal justice
• Age 31-50 years 49%
• Caucasian 34%
• Hispanic / Latino 47%
• Primary Substance – Meth 43%

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Substance Use Treatment Services Adult System of Care

Modality County Contract Reimb SAPT AB109 Medi-Cal Realignment Measure A CDCR Courtesy (Dosing) Patient Fees CGF Subsidy Total Rev Residential 9,692,186 (SSA) 765,254 2,217,000 988,247 441,637 2,300,431 2,979,617 9,692,186 AMT Clinics 6,214,768 0 1,142,187 666,475 527,387 4,250 70,000 3,804,470 6,214,768 Outpatient Svcs 2,100,305 4,941,368 575,086 1,574,749 352,176 4,500 4,535,162 7,041,673 IOP Svcs 447,922 177,403 20,000 250,519 447,922 THU 4,176,752 730,143 880,188 0 269,731 2,296,690 4,176,752 DWC 774,763 207,804 221,410 345,548 774,763 RRC & OTP 1,671,671 0 1,669,099 2,572 1,671,671 TOTAL 10,761,507 19,258,228 765,254 4,142,077 5,139,641 1,038,651 2,070,621 2,300,431 269,731 4,250 74,500 14,214,578 30,019,735

Substance Use Treatment Services - Adult Services Funding Sources

Funding Sources

Substance Use Treatment Services Adult System of Care

Guiding Principles

• Learning Organization
• Participative Management
• Continuous Quality Improvement
• Plan, Do, Study, Act

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Substance Use Treatment Services Adult System of Care Constants for almost two decades

• Innovative Partnership (IP) Meetings
• System Business Meetings
• Maintaining connection
• Hot Groups
• Finding solutions for Systemic problems
• Continuous process improvement
• Learning Institute/Partnership
• Evidence Based Practices
• System of Care

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Substance Use Treatment Services Adult System of Care Important Milestones

• In-custody Screening
• Tx Status Reports (TSRs)
• Clients with meds in residential
• AMT clients in residential
• THUs for DWC men w/children
• Education of Judges
• Monthly Clinical Supervision Meetings

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Substance Use Treatment Services Adult System of Care

How the System Works

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One System: A Continuum of Care

• County & Contract providers
• Operating interdependently
• Standardized
• Continuous oversight
• Accountability

Substance Use Treatment Services Adult System of Care The System

Substance Use Treatment Services Adult System of Care

The System

Access

• Gateway entry: 1-800 Number
• Satellite Sites entry:
• CJS-MH Drug Tx Court
• Dependency Drug Tx Court
• Detox Sites (after hours, post-detox)
• Re- Entry Resource Center

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The System

• All clients accepted

 Screening out “difficult” clients  “Not appropriate for our program

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Substance Use Treatment Services Adult System of Care

Substance Use Treatment Services Adult System of Care Treatment

• Unique to each client
• Client-driven
• Individualized
• “One size does not fit all”

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Substance Use Treatment Services Adult System of Care Utilization – Efficient & Effective

• LOC determined by initial screening

followed by TX Assessment (ASAM)

• Tx intensity matched to needs
• Problem severity (ASAM)
• Stages of change
• LOS based on clinical need

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Substance Use Treatment Services Adult System of Care Dual Diagnosis Capable

• Address symptoms and functional impairment
• Address issues related to psychotropic medication
• Train and supervise addiction counselors to deal with

issues related to co-occurring illness

• Maintain more flexible position on client relapses in either

MH or SA related areas

Substance Use Treatment Services Adult System of Care

• System Consent
• LOC Screening Tool
• Continuum of Care (COC) Referral Summary Form
• Treatment Status Report (TSR)
• Treatment Plan
• Treatment Assessment

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Standardized Forms / Information

Substance Use Treatment Services Adult System of Care

Continuum of Care

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Substance Use Treatment Services Adult System of Care

 Initially placed in

level of care based

• n individual needs.

Screening, Assessment & Referral

Peri Detox OP AMT

 Transferred to most

appropriate level of care, back and forth along the continuum as needs change. Res

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• Direct Referrals: Provider to Provider
• As client’s needs change
• Exceptions:
• Increased Level of Care (OP to Res)
• QI Consult and Authorization
• THU Referrals & Placement
• Authorized and managed by QI

Substance Use Treatment Services Adult System of Care

Client Movement Up and Down the Continuum

ASAM Introduction

All decisions, level of care placement, treatment planning, continued services, transfer, discharge plans are based on evaluation of client using the six ASAM dimensions and considers the client’s stage of change.

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ASAM Stages of Change

Individualized Treatment

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The ASAM Criteria Multi-Dimensional Assessment

DIMENSION 1 Acute Intoxication and/or Withdrawal Potential DIMENSION 2 Biomedical Conditions and Complications DIMENSION 3 Emotional, Behavioral or Cognitive Conditions and Complications 21

The ASAM Criteria Multi-Dimensional Assessment

DIMENSION 4 Readiness to Change Assessed for both Substance Abuse and Mental Health Problems DIMENSION 5 Relapse, Continued Use or Continued Problem Potential Assessed for both Substance Abuse and Mental Health Problems DIMENSION 6 Recovery/Living Environment Assessed for both Substance Abuse and Mental Health Problems 22

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Santa Clara Valley Health & Hospital System DADS Adult Managed Care Services

Stage of Change Interventions Counselor’s Tasks

Precontemplation

Consciousness Raising, Social Liberation Raise Doubt: increase client’s perception of risks and problems with current behavior

Contemplation

As above, plus Emotional Arousal, Self Evaluation Tip the balance: Evoke reasons to change, risks of not changing; strengthen client’s self-efficacy for change of current behavior 24

Clinical Guidelines Table

Clinical Guidelines Table

Stage of Change Interventions Counselor’s Tasks

Preparation

Emotional Arousal, Self- Evaluation, Commitment Help client determine best course of action to take in seeking change

Action

Commitment, Reward, Countering, Environment Control, Helping Relationships Help client to take steps toward change and identify triggers to use and strategies to prevent relapse

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Clinical Guidelines Table

Stage of Change Interventions Counselor’s Tasks

Maintenance

Helping, relationships, Environmental reevaluation, Self- Liberation, Reinforcement Management Help client identify, sample and practice drug-free solutions and sources of pleasure, affirm client self efficacy

Relapse Recycling

Based on assessed Stage of Change to which client has regressed or recycled Help client renew processes of contemplation, preparation, and action, without becoming stuck or demoralized because

• f relapse

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Substance Use Treatment Services Adult System of Care Ancillary Services

• Transitional Housing
• Psychiatric Evaluation & Medication
• Targeted Case Management

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Questions?