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% 2

Substance Use Treatment Services Adult System of Care

Substance Use Treatment Services - Adult Services Funding Sources Funding Sources Courtesy Patient CGF Modality County Contract Reimb SAPT AB109 Medi-Cal Realignment Measure A CDCR (Dosing) Fees Subsidy Total Rev (SSA) Residential 0 9,692,186 765,254 2,217,000 988,247 0 441,637 2,300,431 0 0 0 2,979,617 9,692,186 AMT Clinics 6,214,768 0 0 1,142,187 0 666,475 527,387 0 0 4,250 70,000 3,804,470 6,214,768 Outpatient Svcs 2,100,305 4,941,368 0 575,086 1,574,749 352,176 0 0 0 0 4,500 4,535,162 7,041,673 IOP Svcs 0 447,922 0 0 177,403 20,000 0 0 0 0 0 250,519 447,922 THU 0 4,176,752 0 0 730,143 0 880,188 0 269,731 0 0 2,296,690 4,176,752 DWC 774,763 0 0 207,804 0 0 221,410 0 0 0 0 345,548 774,763 RRC & OTP 1,671,671 0 0 0 1,669,099 0 0 0 0 0 0 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 System of Care Guiding Principles • Learning Organization • Participative Management • Continuous Quality Improvement • Plan, Do, Study, Act 5

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 • 6

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 7

Substance Use Treatment Services Adult System of Care How the System Works 8

Substance Use Treatment Services Adult System of Care The System One System: A Continuum of Care • County & Contract providers • Operating interdependently • Standardized • Continuous oversight • Accountability 9

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 10

Substance Use Treatment Services Adult System of Care The System • All clients accepted  Screening out “difficult” clients  “Not appropriate for our program 11

Substance Use Treatment Services Adult System of Care Treatment • Unique to each client • Client-driven • Individualized •“One size does not fit all” 12

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 13

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 14

Substance Use Treatment Services Adult System of Care Standardized Forms / Information • System Consent • LOC Screening Tool • Continuum of Care (COC) Referral Summary Form • Treatment Status Report (TSR) • Treatment Plan • Treatment Assessment 15

Substance Use Treatment Services Adult System of Care Continuum of Care

Substance Use Treatment Services Adult System of Care Screening, Assessment & Referral  Initially placed in level of care based on individual needs.  Transferred to most Detox appropriate level of AMT care, back and forth along the continuum as needs change. Peri OP Res 17

Substance Use Treatment Services Adult System of Care Client Movement Up and Down the Continuum • 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 18

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. 19

ASAM Stages of Change Individualized Treatment 20

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 Clinical Guidelines Table Counselor’s Stage of Interventions Change Tasks Consciousness Raise Doubt: Precontemplation increase client’s Raising, Social Liberation perception of risks and problems with current behavior Contemplation As above, plus Tip the balance: Emotional Arousal, Evoke reasons to Self Evaluation change, risks of not changing; strengthen client’s self-efficacy for change of current behavior 24

Clinical Guidelines Table Counselor’s Stage of Interventions Change Tasks Emotional Arousal, Self- Help client Preparation Evaluation, determine best Commitment course of action to take in seeking change Commitment, Reward, Help client to take Action Countering, steps toward Environment Control, change and Helping Relationships identify triggers to use and strategies to prevent relapse 25

Clinical Guidelines Table Counselor’s Stage of Change Interventions Tasks Helping, Help client identify, Maintenance relationships, sample and practice Environmental drug-free solutions reevaluation, Self- and sources of Liberation, pleasure, affirm Reinforcement client self efficacy Management Based on assessed Help client renew Relapse Recycling Stage of Change to processes of which client has contemplation, regressed or preparation, and recycled action, without becoming stuck or demoralized because of relapse 26

Substance Use Treatment Services Adult System of Care Ancillary Services • Transitional Housing • Psychiatric Evaluation & Medication • Targeted Case Management 27

Questions?