CoOccurring Disorders Center for Excellence COCE

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Substance Abuse and Mental Health Services
Administration (SAMHSA) Center for Mental Health
Services (CMHS) Center for Substance Abuse
Treatment (CSAT) Co-Occurring Center for
Excellence (COCE)
3rd Annual COSIG Grantee Meeting March 1-3,
2006 Omni Shoreham Hotel Washington, DC Texas
COSIG Project Laurel Mangrum, Ph.D. Project
Evaluator, University of Texas, Addiction
Research Institute Kwame Bruce, Psy.D. Project
Director, Texas Department of State Health
Services
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Texas COSIG Project

• The goal of the COSIG project is to improve
  the delivery of state-funded services for clients
  in Texas with co-occurring psychiatric and
  substance use disorders (COPSD).
• The project consists of two components
  designed to promote system change and to enhance
  specialized clinical skills of providers treating
  COPSD.

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COSIG Project Component 1

• Focused education at the clinician level
  regarding treatment issues relevant to COPSD and
  training on the use of diagnostic and assessment
  instruments to enhance identification of
  psychiatric comorbidity and monitor progress of
  clients.

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COPSD Curriculum Modules

• Module 1 Substance Use and Mental Health
  Disorders
• Module 2 Depression and Substance Use Disorders
• Module 3 Substance Use and Bipolar Disorders
• Module 4 Anxiety and Substance Use
• Module 5 Schizophrenia, Schizoaffective, and
  Substance
• Use Disorders
• Module 6 Substance Use Motives and
  Consequences
• Module 7 Principles of Treatment
• Module 8 Relapse Prevention

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Diagnostic and Assessment Measures

• Mini International Neuropsychiatric Interview
  (MINI)
• Brief Symptom Inventory (BSI)
• Brief Derogatis Psychiatric Rating Scale (BDPRS)
• Substance Abuse Treatment Scale (SATS)
• Ancillary Service Assessment
• Client Evaluation of Self in Treatment (CEST)

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COSIG Project Component 2

• A voucher system that provides additional
  funding for procurement of ancillary services in
  an effort to address the multifaceted needs of
  COPSD clients and to support the treatment and
  recovery process.

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COSIG Voucher Categories

• Child Care
• Housing Support
• Transportation
• Food Assistance
• Education Support

• Employment Assistance
• Clothing
• Medical Care
• Prescriptions
• Peer Mentoring

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Participating Treatment Programs
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Administration of Evaluation Measures
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Psychiatric Diagnostic Impressions
271 COSIG Clients
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Substance Use Disorders
271 COSIG Clients
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BSI and BDPRS Scores in Clinically Significant
Range at Admission
266 COSIG Clients
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Reductions in Client Reported BSI Symptom
Severity After One Month in COSIG
87 COSIG Clients
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Reductions in Clinician Rated BDPRS Symptom
Severity After One Month in COSIG
80 COSIG Clients
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Increases in Treatment Engagement on Clinician
SATS Ratings after One Month in COSIG
88 COSIG Clients
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Ancillary Services Needed and Received at One
Month in COSIG
80 COSIG Clients
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Lessons Learned

• Training on use of diagnostic and assessment
  instruments is not a one time event
• Tiered training on clinical interventions is
  needed
• Training to build clinician skills in identifying
  ancillary service needs is needed
• Programs benefit from regular feedback reports
• Compensation for increased clinician workload is
  needed

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Next Steps for the Texas COSIG Project

• Expansion of the pilot sites to five additional
  programs
• Design training curriculum for identification of
  ancillary service needs and treatment planning
• Design intermediate and advanced training modules
  in COPSD treatment
• Development of COPSD fidelity instrument for use
  in both SA and MH programs in Texas
• Information technology infrastructure development

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COSIG Expansion Programs