Archived Grand Rounds Web Cast
Changing the World : Comprehensive, Continuous, Integrated Systems of Care for Individuals and Families with Co-occurring Psychiatric and Substance Abuse Disorders
Dr. Kenneth Minkoff
January 9, 2006
Please note, CEU's are no longer available for this presentation.
Individuals with co-occurring disorders are associated with poor outcomes and high costs throughout the service system yet have been traditionally defined as “misfits” rather than priorities within all systems of care. Recently, SAMHSA has begun to make system strategies to address the needs of these individuals a priority, and has funded COSIG grants in fifteen states to create system change to support integrated treatment. This presentation reviews examples of systems difficulties faced by individuals with co-occurring psychiatric and substance disorders in public and private settings, and identifies research based principles of successful treatment intervention for these individuals in the context of a parallel disease and recovery integrated conceptual framework that uses a common language that makes sense from the perspective of both the addiction field and the mental health field. The presentation then illustrates the application of these principles to the design of a strategy for the resolution of these systems difficulties through the development of a comprehensive, continuous, integrated system of care (CCISC) for psychiatric and substance disorders that maximizes use of all existing resources to initiate integrated treatment, and develops expectations that all programs achieve Dual Diagnosis Capability to provide properly matched services within existing resources to the individuals with cod that they already are serving. This model is recognized by SAMHSA as a best practice, and is being utilized in thirteen of the fifteen COSIG states.
Web cast Learning Objectives
- To identify 8 principles of evidence based treatment intervention upon which to base the design of a comprehensive, continuous, integrated system of care.
- To describe the components of a CCISC, using DDC and DDE terminology
- To identify characteristics of Dual Diagnosis Capable and Dual Diagnosis Enhanced programs, and strategies for implementation.
- To identify funding strategies to maximize use of existing resources for developing Dual Diagnosis Capable treatment of dual diagnosis.
- To delineate potential change strategies at the system, program, clinical practice, and clinician competency levels to implement a CCISC at any level of the system.
Kenneth Minkoff, M.D. is a board-certified psychiatrist with a certificate of additional qualifications in addiction psychiatry; a dedicated community psychiatrist, and currently is a clinical assistant professor of psychiatry at Harvard Medical School and a senior systems consultant for Zialogic in Albuquerque, NM. He is recognized as one of the nation's leading experts on integrated treatment of individuals with co-occurring psychiatric and substance disorders, and on the development of integrated systems of care for such individuals, through the implementation of a national consensus best practice model for systems design: the Comprehensive Continuous Integrated System of Care (CCISC), referenced in SAMHSA's Report to Congress on Co-occurring Disorders (2002). He has developed an integrated conceptual framework for treatment of co-occurring disorders based on application of a disease and recovery model - with parallel phases of treatment and recovery - for each disorder, and co-edited, with Robert Drake, MD, Dual Diagnosis Major Mental Illness and Substance Disorder (1991).
In addition, Dr. Minkoff is a member of the Board of Directors of the American Association of Community Psychiatrists (AACP), and is chair of the Health Care Policy Committee. Combining his expertise in dual diagnosis and managed care, Dr. Minkoff was panel chair for CMHS Managed Care Initiative report entitled: Co-occurring Psychiatric and Substance Disorders in Managed Care Systems: Standards of Care, Practice Guidelines, Workforce Competencies and Training Curricula (1998).
Dr. Minkoff 's major professional activity is the provision of training and consultation on clinical services and systems design for individuals with co-occurring disorders. With his consulting partner, Christie A. Cline, MD, MBA (former Medical Director for the Behavioral Health Services Division of the New Mexico Department of Health), Dr. Minkoff has developed a systems change toolkit for CCISC implementation (www.zialogic.org). Dr. Minkoff and/or Dr. Cline are currently providing (or have provided) consultation for CCISC implementation in over 25 states and 3 Canadian provinces.