Improving Care For Co-Occurring Disorder Patients In NY

Patient-Centered Care, Regulatory Change Proposed by OASAS/OMH Task Force

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ALBANY, NY (12/31/2007)(readMedia)-- New Yorkers with both mental health and substance abuse disorders, known as co-occurring disorders, will benefit from more integrated treatment under recommendations released today by the statewide Task Force on Co-Occurring Disorders.

At the request of State Office of Alcoholism and Substance Abuse Services (OASAS) Commissioner Karen M. Carpenter-Palumbo and state Office of Mental Health (OMH) Commissioner Michael Hogan, the task force was convened last summer to identify barriers to care and propose evidence-based solutions to better serve this population. Today the Task Force released its comprehensive report, which includes recommendations to foster integrated treatment for individuals with co-occurring disorders. Both Commissioners pledged their commitment to bettering care in New York through implementation of the recommendations.

OASAS Commissioner Karen M. Carpenter-Palumbo said, “For too long in this state, individuals with co-occurring disorders received ‘silo-based’ approaches to care, which led to poor treatment outcomes and hindered their recovery. The recommendations of this task force will help OASAS and OMH provide individuals with co-occurring disorders with a unified system of care that always puts their needs first.”

Michael F. Hogan, PhD, Commissioner of the Office of Mental Health said, "Common sense tells us that mental health concerns and alcohol and drug problems often go together for many adults and even teenagers. Yet our treatment systems often force people into 'dis-integrated care.' When someone has the courage to ask for help, we must have a treatment system that provides effective care for both mental health and addictive disorders. With this report, we take a step toward that reality. Now we will work together to get the needed changes accomplished--quickly."

According to research outlined in the report, in any given year, 2.5 million adults in the nation have a co-occurring serious mental illness and substance abuse disorder. Also, between 40-60 percent of individuals presenting in mental health settings have a co-occurring substance abuse diagnosis and 60-80 percent of individuals presenting in a substance abuse facility have a co-occurring mental health disorder. Individuals with co-occurring disorders have higher rates of suicide and homelessness, along with serious medical conditions, including diabetes, heart disease, obesity, infectious diseases. Many are victims of abuse and may suffer from Post Traumatic Stress Disorder. -more-

The Task Force divided its recommendations into four domains - Clinical; Regulatory; Fiscal; and Systemic Support. Each recommendation seeks to ensure that patients and families can access care anywhere in OMH and OASAS-licensed programs; receive one evaluation; learn if they have a co-occurring disorder; learn about treatment options; collaborate in establishing a single treatment plan; receive evidence or consensus-based treatment (or referral); and participate in recovery-oriented care.

In addition, the Task Force recommended that the Commissioners appoint four Steering Committees to organize this work, comprised of all stakeholder groups and not limited to government representatives. Each Steering Committee will have up to one year to allow for implementation.

A complete account of the Task Force’s recommendations is listed below:

Clinical:

  • Establish a Clinical Advisory Group to identify and recommend evidence-based practices and clinical tools.
  • Implement standardized screening and assessment instruments and evaluate their impact on the processes and outcomes of care.
  • Focus training efforts on clinical supervisors.
  • Establish a Web-based training course to be completed by all staff.
  • Create a common education package for consumers and families.
  • Increase use of peers and mutual aid dual recovery programming.

Regulatory:

  • Summarize OASAS and OMH current regulations and create a common set of standards and requirements wherever possible (staffing; space; case records; licensure)
  • Adjust or create regulations to support common clinical processes such as screening, assessment, and educational packages.

Fiscal:

  • Revise reimbursement methodologies to create appropriate rates to support EBP implementation.
  • Remove fiscal barriers to more effective care;
  • Modify no second service Medicaid rules for OASAS programs;
  • Waive OASAS 822.11 to allow collateral visits without admission;
  • Reimburse off-site services; reimburse for peer services.

Systemic Support:

  • Allow “braided funding” within a Local Governmental Unit (LGU) and increase the state’s flexibility in the use of multiple funding streams to treat this population.
  • Allow for reinvestment of savings generated by the LGU within the LGU’s service systems.
  • Waive regulatory requirements to implement innovative approaches, if appropriate.
  • Report on the two agencies’ progress on a regular basis.
  • Propose a multi-year plan for technology transfer and culture change.

OASAS oversees the nation’s largest addiction services system in the nation, with 1,550 providers which treat 110,000 New Yorkers on any given day. OMH oversees a mental health system that serves more than 500,000 individuals each year. For additional information, go to: www.omh.state.ny.us or www.oasas.state.ny.us.

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