California State University, Northridge Certificate in LGBTQ+ Health

Focus on Integrated Treatment (FIT)

Person-centered recovery and treatment includes understanding a person’s individual strengths and challenges. For many, the path to recovery includes addressing both mental health and substance use disorders; however, historically, treatment settings offering help with both have been difficult to find. For example, in 2007, 5.4 million adults in the U.S. had a co-occurring mental illness and substance abuse disorder (COD), yet only 10% received treatment for both (Substance Abuse and Mental Health Services Administration (2008). Results from the 2007 national survey on drug use and health: National findings (Office of Applied Studies, NSDUH Series H-34, DHHS Publication No. SMA 08-4343). Rockville, MD).

Individuals who have co-occurring substance use and mental health disorders who are not able to address both experience significant difficulties including greater rates of hospitalization, homelessness, incarceration, and violence (Drake, R.E., & Brunette, M.F. (1998) Complications of severe mental illness related to alcohol and other drug use disorders, in Recent Developments in Alcoholism: Consequences of Alcoholism: Vol 14. Edited by Galanter M. New York, Plenum). These negative experiences interfere with recovery.

When both disorders are addressed, however, individuals can achieve and sustain recovery. The integrated approach emphasizes people setting their own recovery goals and the key role of peers in the recovery process. In fact, research has shown that integrated treatment reduces negative consequences and treatment costs, and promotes individuals’ recovery, independent living, and employment (Drake RE, McHugo GJ, Xie H, et al. (2006) Ten-year recovery outcomes for clients with severe mental illness. Schizophrenia Bulletin, 32, 464-473).

Recognizing a critical need for better integration of care, the New York State Offices of Mental Health (OMH) and of Alcoholism and Substance Abuse Services (OASAS) created a joint task force on co-occurring disorders. The joint task force developed a number of recommendations to increase to provision of integrated care throughout New York, including core competencies for treatment staff. As a follow up, OMH and OASAS provided funding to the Center for Practice Innovations (CPI) to create web-based training and distance implementation supports to promote uptake of integrated treatment. CPI supports OMH’s mission to promote the widespread availability of evidence-based practices to improve mental health services, ensure accountability, and promote recovery-oriented outcomes for consumers and families. CPI also offers free tools and supports through learning collaboratives, webinars, phone calls, and a resource library to help programs implement integrated treatment.

The Focus on Integrated Treatment (FIT) Initiative began in the fall of 2009 when CPI released the first 10 online training modules developed to help practitioners, supervisors, and agency leadership learn the skills necessary to treat people with co-occurring mental health disorders. As of today, staff from participating programs in New York State can access 39 modules which cover a variety of topics including screening and assessment, stage-wise treatment, tobacco dependence treatment, cognitive-behavioral therapy, motivational interviewing, and more. Individuals that complete 29 modules covering basic, intermediate, and advanced practitioner competencies can earn the Integrated Mental Health/Addictions Treatment Training (IMHATT) certificate signed by both OMH and OASAS Commissioners. Over 15,000 practitioners in programs across the care spectrum in NYS have taken advantage of the free training and implementation supports in this initiative, and many more are joining every day (over 100,000 modules have been completed to date and over 600 individuals have earned the IMHATT certificate thus far).

CPI is beginning to assess whether the training and implementation supports are increasing the availability of integrated treatment throughout New York State. Indeed, programs are reporting that they have implemented key components of integrated treatment and have begun to embed the core competencies within their policies and procedures. With continued implementation, we hope that increasing numbers of people will have access to care that addresses their whole person and facilitates recovery.

CPI continues to develop additional modules in other areas such as wellness self-management (which includes attention to both behavioral and physical health), suicide prevention, Assertive Community Treatment, and supported employment. CPI is also developing videos and modules for consumers and their families. To view one of these modules (e.g., “Becoming Tobacco Free”) or for more information, please visit http://practiceinnovations.org/.

Co-authors of this article also include, Paul J. Margolies, PhD, Associate Director, Forrest P. Foster, MSW, Implementation Specialist, and Luis O. Lopez, MS, HSBCP, Implementation Specialist, at the Center for Practice Innovations at Columbia Psychiatry, New York State Psychiatric Institute.

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