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EXAMPLES OF INTEGRATED SERVICES FOR INDIVIDUALS WITH
Arizona has a federal Substance Abuse and Mental Health Services Administration (SAMHSA) Integrated Treatment Consensus Panel grant to support statewide consensus building and technical assistance related to the implementation of best practice integrated dual diagnosis services. Under this grant, the state has received consultation from some of the foremost experts in the field of co-occurring disorders. The anticipated outcome of this process is the development of state policies, practice guidelines, and training curricula to foster implementation of integrated services and competencies throughout the Arizona public behavioral health system. LADDER Program (Life Affirming Dual Diagnosis Education and Recovery) The Ladder day treatment program serves the seriously mentally ill who also have a substance abuse problem. All clients are on psychotropic drugs, have an assigned case manager, and are SSI or SSD eligible. The program is highly structured and offers a variety of groups on illness management and recovery. Transportation to and from outside medical appointments is provided. The program serves approximately 80 people annually, with an average of 22 clients at any point in time. The average length of stay at LADDER is three months. The program serves to train clients in every day life skills and is believed to be effective at keeping clients safe and out of the hospital.
Caulfield Center, near Boston, Massachusetts. This Center, started by Dr. Kenneth Minkoff,21 has developed and proven the major tenets of integrated treatment (i.e., definition as lifelong disorders, effective use of rehabilitation models, the need to address stigma, etc.) The program combines substance abuse and mental health treatment on an individualized basis, and is adjusted to both the individual's specific diagnoses and her/his phase of recovery.
In New Hampshire, integrated treatment of individuals presenting with co-occurring disorders is commonplace, and is the expected mode of treatment for the public mental health system for adults.22
EXAMPLES OF GERIATRIC SERVICES Gate Openers - PGBHA This program provides outreach to isolated elders to identify signs of isolation, poor nutrition, health problems, etc. Individuals who would normally come in contact with isolated elders, such as postal workers and delivery people, are trained to identify elder with needs and to notify the area mental health center which has trained case management staff who will reach out to elders and engage them in services. The service is coordinated with the local Area Agency on Aging (AAA), which facilitates access to socialization, nutrition, primary health care etc. The program has reported the following benefits: Reduced isolation, reduced risk of hospitalization and/or negative health consequences, improved access to physical and behavioral health services, and improved coordination of geriatric health services with other elder services. The Bazelon Center has identified a number of programs that meet the above criteria for competent and integrated elder behavioral health programming. These include the Elderly Services Program in Spokane, WA, the Older Adult Services Program in Detroit, MI, The Philadelphia Mental Health Corporation in Philadelphia, PA, and Gulf Coast Jewish Family and Mental Health Services in Florida.
EXAMPLES OF HOUSING Vera French Housing Development Corporation In Davenport, Iowa, the Vera French Community Mental Health Center (VFCMHC) recognized a need for supported housing for persons with mental illness. Persons served in their system needed housing, but not a placement in a treatment setting or the county care home operated by the VFCMHC. With broad participation of stakeholders, including DHS, Scott County, HUD, community leaders, the Chamber of Commerce, the Real Estate Board, NAMI, Iowa, and local banking and finance representatives, they formed the Vera French Housing Development Corporation (VFHDC). This non-profit developed a housing plan and financing strategy aimed at leveraging federal, state, and local funding and technical assistance. The VFHDC now is responsible for over 120 units, including single family homes duplexes, and a couple large apartment buildings for persons with mental illness and development disabilities. Because VFHDC was an outgrowth of the VFCMHC, there are natural linkages with the services of the VFCMHC, including case management and other supportive services. Over the past couple years, the program has involved other local ecumenical organizations, and organizations concerned with homelessness and poverty to secure grant funding for continued development projects in the community.
Baltimore Community Housing Associates In 1992, Community Housing Associates (CHA), Inc., completed the purchase and rehabilitation of 15 residential properties in Baltimore, Maryland, to provide affordable housing for adults with mental illnesses. CHA blended private and public funding to develop the project, and made innovative use of case management services to provide supports to its residents. The CHA project is a useful model for mental health or community development agencies interested in developing housing for people with mental illnesses.
Michigan Supported Housing Development In Michigan, several demonstration programs are underway to develop and support housing for low-income and special needs populations. The program strives to develop permanent independent living residences in non-institutional settings that offer access to other community services. The Michigan Department of Community Health has joined with the Michigan State Housing Development Agency (MSHDA) and the New York City-based Corporation for Supportive Housing (CSH) to initiate demonstration programs in four Michigan sites to develop affordable supportive housing for individuals who are homeless or at risk of becoming homeless, including those with psychiatric disabilities. The program will explore ways that state health (including mental health) and housing agencies can work together, in cooperation with other public and private organizations, to provide housing and supportive services to individuals who have very low incomes and special needs. Local nonprofit sponsors selected by community-level partnerships will develop about 300 units of housing. Funding for the initiative will come from state allocations of federal housing and development program moneys including H.O.M.E., Community Development Block Grants (CDBG), low-income tax credits, and donations from private sources such as foundations. CSH will assist nonprofit housing developers to build organizational capacity and will provide bridge financing. To date the program has generated $650,000, with the goal of reaching $1.4 million for capacity building and bridge financing.
EXAMPLES OF EMPLOYMENT In New Hampshire, increasing the number of individuals with serious mental illness in competitive employment has been a priority for many years. The state sets performance targets, and measures each community mental health center against these targets. This had the effect of having all local service components working towards the same goal - to see that consumers found and kept competitive employment or other productive activity of their choice. In Wisconsin, state behavioral health dollars have been used to match federal VR funds to create VR capacity in rural areas. The behavioral health system then uses ACT teams to provide all the pre and post employment services and supports that are not provided through VR funding. In several jurisdictions in Michigan, VR staffing and equipment grants have been used to enhance the capacity of psychosocial clubhouses to provide meaningful training and employment experiences that are relevant to the local employment marketplace.
21Dr. Minkoff is a national expert on dual diagnosis services, and is the primary consultant to Arizona under the SAMHSA Integrated Treatment Consensus Panel Grant. 22New Hampshire is the home state of Robert Drake, MD, who, along with Dr. Minkoff has been a leading pioneer in dual diagnosis services delivery and research. |