Connecticut State Department of Mental Health and Addiction Services

Co-Occurring Disorders Initiative

Background

CT has taken significant and important steps over the years to increase capacity to provide accessible, effective, comprehensive, integrated, and evidence-based services for adults with co-occurring disorders (CODs): 

  • A Dual Diagnosis Task Force issued recommendations (all 4 of which were adopted) in 1997. The implementation of one of the Task Force recommendations led to development of a comprehensive CODs training curriculum as a basis for cross-training providers and educating people in recovery in both Mental Health and Addiction Treatment Systems.   

  • DMHAS, through academic partnerships with Yale, the University of CT, and Dartmouth College, has a decade-long history of participation in research, including research relative to use of Integrated Dual Disorders Treatment within ACT Teams. This work has culminated in multi-year CODs projects, taking place within both the mental health and substance abuse treatment systems. 

  • In 2002, DMHAS, through Stage I of its Assessment/Treatment of Persons w/Psychiatric Co-Morbidity in Substance Abuse Treatment Initiative, assessed the current practices of treatment programs with respect to CODs. Prevalence estimates, typical assessment & treatment practices, attitudes, resources, perceived training & staffing needs, and program and provider characteristics were obtained from 48 substance abuse agencies, with a total of 456 providers composing the sample (see Stage I final report).  In 2003, the Stage II report summarized the progress on developing a fidelity measure for Dual Diagnosis Capability in Addiction Treatment.   

  • Also in 2002, The CT Integrated Dual Disorder Treatment (CT-IDDT) Initiative, a partnership between DMHAS and Dartmouth, began and the goal was to integrate IDDT into the day-to-day practice of CT’s 14 Local Mental Health Authorities (LMHAs). Through this initiative, a total of almost 500 clinicians have received direct training. A particular emphasis of this technology transfer project is application of the IDDT Fidelity Scale and ongoing support of sustaining these practice changes through selection of agency “Champions”, development of peer supervision groups, and Integrated Treatment Steering Committees. 

  • CT was selected to participate in the National Policy Academy on CODs, and we are benefiting from the Academy’s intensive policy-building forum to develop a State Action Plan in 2004 for improving access to services for persons with CODs.  

  • In 2007, the Commissioner's Policy Statement on Serving Individuals with Co-Occurring Mental Health and Substance Use Disorders was released, the Co-Occurring State Facilities Workgroup started convening on a monthly basis including point persons from each DMHAS facility, the Co-Occurring Practice Improvement Collaborative including eight DMHAS funded agencies began, the use of standardized mental health and substance use screening measures became a requirement of programs upon all admissions, the Co-Occurring Academy began, and the DMHAS Co-Occurring Enhanced Program Guidelines were developed using a statewide workgroup process.
  • In 2008, the above activities continued and the Co-Occurring Enhanced Intensive Outpatient Program (IOP) with an enhanced rate through the Access to Recovery (ATR) grant was implemented, and two new 20-bed co-occurring enhanced residential programs were selected through a RFP process and implemented.
DMHAS was one of four states to be awarded a SAMHSA Co-Occurring State Incentive Grant (COSIG) in 2005. The $4 million dollars over five years is designed to implement integrated care for people with co-occurring mental health and substance abuse disorders statewide. The goals of the grant are to implement standardized screening, integrated assessment, service coordination and network building, integrated models of treatment, and data-based decision making at the pilot sites and then throughout the system. The two pilot sites are the Hispanic Clinic at the Connecticut Mental Health Center in New Haven and the Morris Foundation in Waterbury. Researchers from Yale's Program for Recovery and Community Health (PRCH) have been contracted to conduct a process and outcome evaluation of the pilot interventions. Significant management information systems (MIS) tasks have been initiated by DMHAS’ Evaluation, Quality Management and Improvement (EQMI) and Information Services Division (ISD) to facilitate use of the new screening data, diagnosis data, and other co-occurring disorders related data from the DMHAS system. Lessons learned from these pilot interventions, other successful co-occurring disorders initiatives in the state, and data will inform the statewide implementation of integrated treatment. 

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