INTEGRATED TREATMENT FOR COOCCURRING Mental Health Substance Abuse

INTEGRATED TREATMENT FOR CO-OCCURRING Mental Health & Substance Abuse DISORDERS IN A Personalized Recovery Oriented Service (PROS) PROGRAM SAINT VINCENT’S HOSPITAL/WESTCHESTER Jane Desouza, MPS, ATR-BC, LCAT jdesouza@svwsjmc. org Terrie Kelleher, MA, CRC, CASAC tkelleher@svwsjmc. org

• Jane Desouza, MPS, ATR-BC, LCAT has worked at Saint Vincent's Hospital-Westchester since 1980 and is Program Director for the hospital’s new Personalized Recovery Oriented Services Program (PROS). Previously she was the Team Leader for the DBT track in CDTP providing services for SMI clients with personality disorders. She has been an instructor for the SVCMC Maxtrain CASAC training, is a Behavioral Tech, LLC certified DBT team therapist and 1999 Westchester Art Therapy Association's Outstanding Clinician. She is active in the American Art Therapy Association and was Conference Chair from 2009 -2011. She has presented nationally on effective treatments for clients with Borderline Personality Disorders and suicidal/high risk behaviors.

• Terrie Kelleher, MA, CRC, CASAC has been working in the field of vocational and substance abuse rehabilitation and recovery for the past 20 years. As a CRC, CASAC, she has a stellar record of person-centered, rehabilitation driven and client focused work. Prior to coming to Saint Vincent’s Hospital in 2008 to start the co-occurring program, she worked as the CDT Director at Cabrini Medical Center (2007 -2008), the IPRT Director at The Bridge Inc (1997 -2007) and as a vocational counselor at New York Presbyterian Hospital (1992 -1998). In addition to being a CRC and CASAC, Ms. Kelleher is certified in multiple family group psycho-education through the Family Institute in NYC and graduated from Columbia University’s Work Opportunities for Rewarding Careers (WORC) program.

Statement from OMH • The purpose of Personalized Recovery-Oriented Services (PROS) programs is to assist individuals in recovery from the disabling effects of mental illness through the coordinated delivery of a customized array of rehabilitation, treatment and support services. Such services are expected to be available both in traditional program settings and in off-site locations where such individuals live, learn, work or socialize. Providers must create a therapeutic environment which fosters awareness, hopefulness and motivation for recovery, and which supports a harm reduction philosophy.

PROS components • Community Rehabilitation & Support (CRS): Assessment, Basic Living Skills Training, Benefits and Financial Management, Community Living Exploration, Crisis Intervention, Engagement, Individualized Recovery Planning, Information and Education Regarding Self-Help, Pre-admission Screening, Structured Skill Development and Support, Wellness Self Management • IR component: Family Psycho-Education, Integrated Treatment for Co-occurring Mental Health and Substance Abuse Disorders, Intensive Rehabilitation Goal Acquisition, and Intensive Relapse Prevention • Ongoing Rehabilitation & Support (ORS): Ongoing Rehabilitation and Support • Clinical component: Clinical Counseling and Therapy, Health Assessment, Medication Management, and Symptom Monitoring

Engagement • A service designed to reach out to individuals over time for the purpose of fostering a commitment on the part of an individual to enter into therapeutic relationships supportive of the individual's recovery • Developing an empathic relationship with an individual, resulting in trust • Understanding the benefits of participating

ASSESSMENT • Service designed to review and determine an individual's level of functioning, the past benefits of participating in mental health services, and the ability to function in specific life roles. • Comprehensive & Continuous process conducted within the context of an individual’s: • • Self identified needs and goals Ethnic identity Religious identity Cultural identity

Individualized Recovery Planning • An ongoing process to assist an individual in the development, review, and adjustment of a course of care, which supports their identified path to recovery

INFORMATION AND EDUCATION REGARDING SELF-HELP • This service is designed to encourage individuals to participate in self-help and mutual aid groups. • Designed to help an individual understand what self-help resources are available in the community and how to benefit from participating in them. • This service is intended to help the individual to learn how to share personal experiences with others who have had a common experience, to learn about the variety of available self-help groups, and to aid the individual in accessing the self-help options of their choice.

RELAPSE PREVENTION • A service designed to prevent/address an exacerbation of acute symptoms, or manage existing symptoms that are not responsive to the current service formulation. • Designed to prevent relapse or loss of a life role, which can be an imminent risk • Every client develops a relapse prevention plan and is continuously reviewing and revising as skills and environments change.

Integrated Treatment for Co-occurring Mental Health and Substance Abuse Disorders • Simultaneously addresses the mental health and substance abuse needs of individuals with cooccurring disorders • Includes stage-wise interventions, motivational interviewing, harm reduction approaches and promotion of cognitive behavioral skills • One of the Evidence Based Practices in the IR component

Integrated Treatment for Co-occurring Mental Health and Substance Abuse Disorders Key Activities or Features Anticipated Outcomes • Interventions are related to the • Recipients advance through the barriers and obstacles linked to the stages of recovery individual’s mental illness that hinder their ability to overcome the co-occurring illness or to achieve a • Increased success and satisfaction specified life goal in needed roles and preferred community environments including • Motivational, cognitive-behavioral work and/or school and harm reduction approaches • Training includes assisting recipients in planning for and practicing skills in preferred and needed environments • Prevention of relapse associated with mental illness and substance abuse • Practitioners utilize opportunities to • Reduction of risk for homelessness observe, reinforce, and improve and legal difficulties the recipient’s skill performance

Issues in Co-occurring Population • Stress level is higher with two disorders • Crisis levels are more intense and occur more frequently • Vulnerable to both AOD relapse and worsening of psychiatric symptoms • Clients with co-occurring disorders experience more severe and chronic medical, social and emotional problems • Combination and depth of disorders limits functioning

Issues in Co-occurring Population As a result: • More concrete and direct guidance necessary • Treatment for recovery is less confrontational

Challenges in Providing Services • Fewer relationships and social support networks • More unstable housing, employment and income histories • More likely to have legal or criminal problems • Poorer overall functional skills • Hazardous self medication urges • Experiences substance abuse psychiatric crashes • More health risks • Frequent relapses • Reluctance to engage in treatment

Challenges in Providing Services • Only one of the problems may be recognized • Services may be designed for one disorder or the other resulting in clients being ping-ponged back and forth • If in treatment for one disorder the other may not be tolerated in treatment or at home • Treatment is slow

Goals Long Term Abstinence and Psychiatric Stability

Goals Short Term Indentify benefits of recovery and addressing both substance abuse and psychiatric symptomotology Reduce frequency of relapses Increase behaviors that support abstinence and symptom management

Goals Ultimate and Main Goal Return to productive functioning in desired life role

PROS Recovery Process • • Individualized Person Centered Reduce negative effects of both disorders Relapse Prevention Planning Establish connections to self-help supports Increase sense of Empowerment Accept clients right to choose

Motivational Interviewing • Used in both individual and group sessions • Ongoing component of assessment and individualized recovery planning • Focused on person and goals • Fosters hope • Reduces resistance

Stage Wise Treatment • Provided in both individual and group sessions • Stages: – Precontemplation, Contemplation, Preparation, Action, Maintenance, Relapse • Recognize that stage client is ready for may differ for their separate disorders

Primary Group Therapy • Important throughout participation in PROS • Establishes therapeutic relationship with both primary therapist and primary peer group • Provides opportunity for ongoing assessment at any stage of change

Co-occurring PROS Curriculums Attached to the back of your handouts Please note each curriculum is designed to last 14 -16 weeks. There are 12 lessons for each curriculum.

Questions and Answers Thank you!