FINANCING AND MARKETING THE NEW CONCEPTUAL FRAMEWORK FOR CO-OCCURRING MENTAL HEALTH AND SUBSTANCE ABUSE DISORDERS

Blueprint for Systems Change

(Final Report of the Joint Task Force, June 1999)

TABLE OF CONTENTS

ACKNOWLEDGMENTS

EXECUTIVE SUMMARY

INTRODUCTION

SECTION I: An Overview of a Comprehensive System of Care

SECTION II: Developing a Comprehensive System of Care

SECTION III: Financing a Comprehensive System of Care

SECTION IV: Marketing the Framework for a Comprehensive System of Care

SECTION V: Recommendations for Next Steps

CONCLUSION

REFERENCES

PowerPoint Presentation for Marketing the Conceptual Framework 

ACKNOWLEDGMENTS

The National Association of State Mental Health Program Directors (NASMHPD) and the National Association of State Alcohol and Drug Abuse Directors (NASADAD) are pleased to present this report of the June 1999 meeting of their Joint Task Force on Co-Occurring Mental Health and Substance Abuse Disorders. Established in 1998, the Task Force guides the Associations program-related efforts to help ensure that the needs of individuals with co-occurring mental health and substance abuse disorders are identified and met throughout the nation.

Participating State Alcohol and Other Drug Directors included Michael Couty (MO), Christie Dye (AZ), Lewis Gallant, Ph.D. (VA, Co-Chair), Elizabeth Howell, M.D. (GA), Thomas Kirk, Ph.D. (CT) and Mayra Rodriquez-Howard (MA). Mental Health Commissioners included Sharon Autio (MN), Paul Gorman, Ed.D. (NH), Stephen Mayberg, Ph.D. (CA), James Stone, M.S.W. (NY), Marylou Sudders (MA) and Roy Wilson, M.D. (MO, Co-Chair). We are grateful for the participation and contributions of Paul Barreira, M.D. (MA) and Jeff Davis, M.S.W. (OR), representing the National Association of County Behavioral Health Directors (NACBHD) and Elizabeth Earls (RI), representing the National Council for Community Behavioral Healthcare.

Special thanks are due to the consultant experts who so ably facilitated and informed the group s discussions: James B. Bixler, Rhea Blanken and Terry Bleier. Both NASMHPD and NASADAD wish to express appreciation to federal staff for their continued support, guidance and encouragement: Government Project Officers Michael English, J.D. from the Center for Mental Health Services (CMHS) and Edith Jungblut, Ph.D. from the Center for Substance Abuse Treatment (CSAT); Jane Taylor, Ph.D., George Kanuck and Carol Coley, Ph.D. (CSAT); and Larry Rickards (CMHS).

We acknowledge the able assistance of Susan Milstrey Wells who prepared the first draft of this document. We are also grateful for the work of other NASMHPD and NASADAD members and staff who continue to provide invaluable support and assistance to the Task Force in its work.

Finally, we wish to recognize the work of Bruce Emery, M.S.W. (NASMHPD) and Robert Anderson (NASADAD), who have served as directors of the Associations joint co-occurring project.

Robert W. Glover, Ph.D.                 John S. Gustafson

NASMHPD Executive Director NASADAD Executive Director

April 2000

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EXECUTIVE SUMMARY

Traditional barriers between the mental health and substance abuse systems have too often prevented them from working together on behalf of individuals with co-occurring mental health and substance abuse disorders. That began to change in June 1998, when the first National Dialogue on Co-Occurring Mental Health and Substance Abuse Disorders was held.

Two key outcomes resulted from that discussion, which was supported by two Substance Abuse and Mental Health Services Administration (SAMHSA) centers, the Center for Mental Health Services (CMHS) and the Center for Substance Abuse Treatment (CSAT) and co-sponsored by the National Association of State Mental Health Program Directors (NASMHPD) and the National Association of State Alcohol and Drug Abuse Directors (NASADAD).

First, participants developed a conceptual framework that views co-occurring disorders in terms of symptom multiplicity and severity rather than specific diagnoses. The framework specifies the level of service coordination, defined as consultation, collaboration, or integration, needed to improve consumer outcomes. Use of the conceptual framework encourages development and funding of a continuum of care for people with co-occurring disorders.

Second, to further their commitment to work together, participants in the first national dialogue urged their respective national associations to formally name a joint task force. This report summarizes the June 1999 meeting of the Joint NASMHPD-NASADAD Task Force on Co-Occurring Disorders, and the group's progress in finding ways to: 1) finance a system of care for people with co-occurring disorders and 2) market the work of the task force (i.e., the conceptual framework) to help bring about widespread improvements in care for persons with co-occurring disorders.

The June 1999 meeting was also supported by CMHS and CSAT and co-sponsored by NASMHPD and NASADAD. Representatives from the National Association of County Behavioral Health Directors (NACBHD) and the National Council for Community Behavioral Healthcare (NCCBH) provided a unique, local perspective.

Developing and Financing a Comprehensive System of Care.

Task Force members stressed that a comprehensive, coordinated system of care for people with co-occurring disorders must be the expectation, not the exception. Developing and financing a comprehensive system of care requires a significant commitment of time, creativity, resources, and expertise.

In particular, Task Force members agreed that there is no single set of financing mechanisms that will be appropriate in all cases. They pointed to the lack of an economic model that clearly delineates how the specific levels of coordination reflected in the framework consultation, collaboration, and integration should be funded, and what the cost savings (if any) and consumer outcomes of such models might be.

However, Task Force members embraced a set of general principles needed to finance a continuum of care for people with co-occurring disorders that parallel those needed for its creation. These principles include:

• joint purchasing of effective services

• use of funding combined from multiple sources, and

• adoption of performance-based contracts that align financial incentives and disincentives with system goals.

Marketing the Conceptual Framework.

To help further the dialogue, Task Force members discussed ways to market the conceptual framework and financing principles to those who fund, provide, and consume mental health and substance abuse services. The critical marketing messages for funders are that the framework is flexible, cost-effective, client-centered, evidence-driven and can lead directly to the development of best practices.

For providers, the framework is a useful tool, one that will allow them to recognize the full array of a client"s symptoms and craft a treatment plan that draws on the expertise found in both mental health and substance abuse systems. The framework’s message to consumers is four-fold: we heard your concerns, we are working together to resolve them, we understand the critical need to plan for serving the whole person, and the level of care for people with co-occurring disorders will improve as a result.

Moving Forward

The overarching goal of the Task Force’s efforts is to help make appropriate services available for person with co-occurring disorders throughout the country. Each of the key players who participated in the second national dialogue has an important role to play in that broad-based system change. Task Force members encouraged SAMHSA, through its Centers, to support research on treatment models and consumer outcomes; recommended that the States reduce or eliminate financial barriers to serving the needs of people with co-occurring disorders; and urged NASMHPD and NASADAD to begin collecting case studies that illustrate model approaches and best practices for financing and delivering co-occurring mental health and substance abuse services.

Despite the inherent difficulties in financing a comprehensive system of care and marketing the conceptual framework, Task Force members pledged their commitment to move forward together. By joining forces at the State level and working in partnership with their Federal funders,

national associations, county authorities and community counterparts, State mental health commissioners and State alcohol and drug abuse directors have taken another vital step forward in placing co-occurring disorders at the forefront of the national agenda.

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