INTEGRATED TREATMENT FOR INTEGRATED TREATMENT FOR CO-OCCURRING CO-OCCURRING

Mental Health & Substance Mental Health & Substance Abuse DISORDERSAbuse DISORDERS

IN A IN A Personalized Recovery Oriented Personalized Recovery Oriented

Service (PROS) PROGRAMService (PROS) PROGRAM SAINT VINCENT’S SAINT VINCENT’S

HOSPITAL/WESTCHESTERHOSPITAL/WESTCHESTER Jane Desouza, MPS, ATR-BC, LCAT Jane Desouza, MPS, ATR-BC, LCAT jdesouza@svwsjmc.orgjdesouza@svwsjmc.org

Terrie Kelleher, MA, CRC, CASACTerrie Kelleher, MA, CRC, CASACtkelleher@svwsjmc.orgtkelleher@svwsjmc.org

• Jane Desouza, MPS, ATR-BC, LCAT Jane Desouza, MPS, ATR-BC, LCAT has worked at Saint Vincent's Hospital-Westchesterhas worked at Saint Vincent's Hospital-Westchester

since 1980 and is Program Director for the hospital’ssince 1980 and is Program Director for the hospital’snew Personalized Recovery Oriented Servicesnew Personalized Recovery Oriented ServicesProgram (PROS). Previously she was the TeamProgram (PROS). Previously she was the TeamLeader for the DBT track in CDTP providingLeader for the DBT track in CDTP providing

services for SMI clients with personality disorders. services for SMI clients with personality disorders. She has been an instructor for the SVCMC MaxtrainShe has been an instructor for the SVCMC MaxtrainCASAC training, is a Behavioral Tech, LLC certifiedCASAC training, is a Behavioral Tech, LLC certified

DBT team therapist and 1999 Westchester Art DBT team therapist and 1999 Westchester Art TherapyTherapy

Association's Outstanding Clinician. She is active in Association's Outstanding Clinician. She is active in thethe

American Art Therapy Association and was American Art Therapy Association and was Conference ChairConference Chair

from 2009-2011. She has presented nationally on from 2009-2011. She has presented nationally on effectiveeffective

treatments for clients with Borderline Personality treatments for clients with Borderline Personality DisordersDisorders

and suicidal/high risk behaviors.and suicidal/high risk behaviors.

• Terrie Kelleher, MA, CRC, CASACTerrie Kelleher, MA, CRC, CASAC has been working in the field of vocational and substancehas been working in the field of vocational and substance

abuse rehabilitation and recovery for the past 20 years. As abuse rehabilitation and recovery for the past 20 years. As aa

CRC, CASAC, she has a stellar record of person-centered,CRC, CASAC, she has a stellar record of person-centered,rehabilitation driven and client focused work. Prior to rehabilitation driven and client focused work. Prior to

comingcomingto Saint Vincent’s Hospital in 2008 to start the co-occurringto Saint Vincent’s Hospital in 2008 to start the co-occurring

program, she worked as the CDT Director at Cabrini program, she worked as the CDT Director at Cabrini MedicalMedical

Center (2007-2008), the IPRT Director at The Bridge IncCenter (2007-2008), the IPRT Director at The Bridge Inc(1997-2007) and as a vocational counselor at New York(1997-2007) and as a vocational counselor at New York

Presbyterian Hospital (1992-1998). In addition to being a Presbyterian Hospital (1992-1998). In addition to being a CRCCRC

and CASAC, Ms. Kelleher is certified in multiple family and CASAC, Ms. Kelleher is certified in multiple family groupgroup

psycho-education through the Family Institute in NYC andpsycho-education through the Family Institute in NYC andgraduated from Columbia University’s Work Opportunities graduated from Columbia University’s Work Opportunities

forforRewarding Careers (WORC) program. Rewarding Careers (WORC) program.

Statement from OMHStatement from OMH• The purpose of Personalized Recovery-Oriented The purpose of Personalized Recovery-Oriented

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

PROS componentsPROS components• Community Rehabilitation & Support (CRS):Community Rehabilitation & Support (CRS): Assessment, Basic Living Skills Assessment, Basic Living Skills

Training, Benefits and Financial Management, Community Living Exploration, Crisis Training, Benefits and Financial Management, Community Living Exploration, Crisis Intervention, Engagement, Individualized Recovery Planning, Information and Intervention, Engagement, Individualized Recovery Planning, Information and Education Regarding Self-Help, Pre-admission Screening, Structured Skill Education Regarding Self-Help, Pre-admission Screening, Structured Skill Development and Support, Wellness Self ManagementDevelopment and Support, Wellness Self Management

• IR component:IR component: Family Psycho-Education, Family Psycho-Education, Integrated Treatment for Co-Integrated Treatment for Co-occurring Mental Health and Substance Abuse Disordersoccurring Mental Health and Substance Abuse Disorders, Intensive , Intensive Rehabilitation Goal Acquisition, and Intensive Relapse PreventionRehabilitation Goal Acquisition, and Intensive Relapse Prevention

• Ongoing Rehabilitation & Support (ORS):Ongoing Rehabilitation & Support (ORS): Ongoing Rehabilitation and SupportOngoing Rehabilitation and Support

• Clinical component:Clinical component: Clinical Counseling and Therapy, Health Assessment, Clinical Counseling and Therapy, Health Assessment, Medication Management, and Symptom MonitoringMedication Management, and Symptom Monitoring

EngagementEngagement• A service designed to reach out to A service designed to reach out to

individuals over time for the purpose of individuals over time for the purpose of fostering a commitment on the part of an fostering a commitment on the part of an individual to enter into therapeutic individual to enter into therapeutic relationships supportive of the individual's relationships supportive of the individual's recoveryrecovery

• Developing an empathic relationship with an Developing an empathic relationship with an individual, resulting in trustindividual, resulting in trust

• Understanding the benefits of participatingUnderstanding the benefits of participating

ASSESSMENTASSESSMENT• Service designed to review and determine an individual's Service designed to review and determine an individual's

level of functioning, the past benefits of participating in level of functioning, the past benefits of participating in mental health services, and the ability to function in mental health services, and the ability to function in specific life roles. specific life roles.

• Comprehensive & Comprehensive & Continuous Continuous process conducted within process conducted within the context of an individual’s:the context of an individual’s:

• Self identified needs and goalsSelf identified needs and goals• Ethnic identityEthnic identity• Religious identityReligious identity• Cultural identityCultural identity

Individualized Recovery Individualized Recovery PlanningPlanning

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

INFORMATION AND EDUCATION INFORMATION AND EDUCATION REGARDING SELF-HELPREGARDING SELF-HELP

• This service is designed to encourage individuals to participate in self-This service is designed to encourage individuals to participate in self-help and mutual aid groups. help and mutual aid groups.

• Designed to help an individual understand what self-help resources Designed to help an individual understand what self-help resources are available in the community and how to benefit from participating in are available in the community and how to benefit from participating in them.them.

• This service is intended to help the individual to learn how to share This service is intended to help the individual to learn how to share personal experiences with others who have had a common personal experiences with others who have had a common experience, to learn about the variety of available self-help groups, experience, to learn about the variety of available self-help groups, and to aid the individual in accessing the self-help options of their and to aid the individual in accessing the self-help options of their choice.choice.

RELAPSE PREVENTIONRELAPSE PREVENTION• A service designed to prevent/address an exacerbation of acute A service designed to prevent/address an exacerbation of acute

symptoms, or manage existing symptoms that are not symptoms, or manage existing symptoms that are not responsive to the current service formulation.responsive to the current service formulation.

• Designed to prevent relapse or loss of a life role, which can be Designed to prevent relapse or loss of a life role, which can be an imminent riskan imminent risk

• Every client develops a relapse prevention plan and is Every client develops a relapse prevention plan and is continuously reviewing and revising as skills and environments continuously reviewing and revising as skills and environments change.change.

Integrated Treatment for Co-occurring Integrated Treatment for Co-occurring Mental Health and Substance Abuse Mental Health and Substance Abuse

DisordersDisorders• Simultaneously addresses the mental health and substance Simultaneously addresses the mental health and substance

abuse needs of individuals with co-occurring disordersabuse needs of individuals with co-occurring disorders

• Includes stage-wise interventions, motivational interviewing, Includes stage-wise interventions, motivational interviewing, harm reduction approaches and promotion of cognitive harm reduction approaches and promotion of cognitive behavioral skillsbehavioral skills

• One of the Evidence Based Practices in the IR componentOne of the Evidence Based Practices in the IR component

Integrated Treatment for Co-occurring Integrated Treatment for Co-occurring Mental Health and Substance Abuse Mental Health and Substance Abuse

DisordersDisorders• Interventions are related to the barriers Interventions are related to the barriers

and obstacles linked to the individual’s and obstacles linked to the individual’s mental illness that hinder their ability to mental illness that hinder their ability to overcome the co-occurring illness or to overcome the co-occurring illness or to achieve a specified life goalachieve a specified life goal

• Motivational, cognitive-behavioral and Motivational, cognitive-behavioral and harm reduction approachesharm reduction approaches

• Training includes assisting recipients in Training includes assisting recipients in planning for and practicing skills in planning for and practicing skills in preferred and needed environmentspreferred and needed environments

• Practitioners utilize opportunities to Practitioners utilize opportunities to observe, reinforce, and improve the observe, reinforce, and improve the recipient’s skill performancerecipient’s skill performance

• Recipients advance through the stages of Recipients advance through the stages of recoveryrecovery

• Increased success and satisfaction in Increased success and satisfaction in needed roles and preferred community needed roles and preferred community environments including work and/or schoolenvironments including work and/or school

• Prevention of relapse associated with Prevention of relapse associated with mental illness and substance abuse mental illness and substance abuse

• Reduction of risk for homelessness and Reduction of risk for homelessness and legal difficultieslegal difficulties

Key Activities or FeaturesKey Activities or Features Anticipated OutcomesAnticipated Outcomes

Issues in Co-occurring Issues in Co-occurring PopulationPopulation• Stress level is higher with two disorders Stress level is higher with two disorders

• Crisis levels are more intense and occur Crisis levels are more intense and occur more frequently more frequently

• Vulnerable to both AOD relapse and Vulnerable to both AOD relapse and worsening of psychiatric symptoms worsening of psychiatric symptoms

• Clients with co-occurring disorders Clients with co-occurring disorders experience more severe and chronic experience more severe and chronic medical, social and emotional problems medical, social and emotional problems

• Combination and depth of disorders Combination and depth of disorders limits functioninglimits functioning

Issues in Co-occurring Issues in Co-occurring PopulationPopulation

As a result:As a result:• More concrete and More concrete and

direct guidance direct guidance necessarynecessary

• Treatment for recovery Treatment for recovery is less confrontationalis less confrontational

Challenges in Providing Challenges in Providing ServicesServices

• Fewer relationships and social support Fewer relationships and social support networksnetworks

• More unstable housing, employment and More unstable housing, employment and income historiesincome histories

• More likely to have legal or criminal problemsMore likely to have legal or criminal problems• Poorer overall functional skillsPoorer overall functional skills• Hazardous self medication urgesHazardous self medication urges• Experiences substance abuse psychiatric Experiences substance abuse psychiatric

crashescrashes• More health risksMore health risks• Frequent relapsesFrequent relapses• Reluctance to engage in treatmentReluctance to engage in treatment

Challenges in Providing Challenges in Providing ServicesServices

• Only one of the problems may be Only one of the problems may be recognizedrecognized

• Services may be designed for one Services may be designed for one disorder or the other resulting in clients disorder or the other resulting in clients being ping-ponged back and forthbeing ping-ponged back and forth

• If in treatment for one disorder the If in treatment for one disorder the other may not be tolerated in treatment other may not be tolerated in treatment or at homeor at home

• Treatment is slowTreatment is slow

GoalsGoalsLong TermLong Term

Abstinence and Abstinence and Psychiatric StabilityPsychiatric Stability

GoalsGoalsShort TermShort Term

Indentify benefits of recovery and Indentify benefits of recovery and addressing both substance abuse addressing both substance abuse and psychiatric symptomotology and psychiatric symptomotology

Reduce frequency of relapses Reduce frequency of relapses

Increase behaviors that support Increase behaviors that support abstinence and symptom abstinence and symptom managementmanagement

GoalsGoals

Ultimate and Main GoalUltimate and Main Goal

Return to productive Return to productive functioning in desired life rolefunctioning in desired life role

PROS Recovery ProcessPROS Recovery Process• IndividualizedIndividualized• Person CenteredPerson Centered• Reduce negative effects of both disordersReduce negative effects of both disorders• Relapse Prevention PlanningRelapse Prevention Planning• Establish connections to self-help Establish connections to self-help

supportssupports• Increase sense of EmpowermentIncrease sense of Empowerment• Accept clients right to chooseAccept clients right to choose

Motivational Motivational InterviewingInterviewing

• Used in both individual and group Used in both individual and group sessionssessions

• Ongoing component of assessment Ongoing component of assessment and individualized recovery planningand individualized recovery planning

• Focused on person and goalsFocused on person and goals• Fosters hopeFosters hope• Reduces resistanceReduces resistance

Stage Wise TreatmentStage Wise Treatment• Provided in both individual and group Provided in both individual and group

sessionssessions

• Stages: Stages: – Precontemplation, Contemplation, Precontemplation, Contemplation,

Preparation, Action, Maintenance, RelapsePreparation, Action, Maintenance, Relapse

• Recognize that stage client is ready for Recognize that stage client is ready for may differ for their separate disordersmay differ for their separate disorders

Primary Group TherapyPrimary Group Therapy• Important throughout participation Important throughout participation

in PROSin PROS• Establishes therapeutic relationship Establishes therapeutic relationship

with both primary therapist and with both primary therapist and primary peer groupprimary peer group

• Provides opportunity for ongoing Provides opportunity for ongoing assessment at any stage of changeassessment at any stage of change

Co-occurring PROS Co-occurring PROS CurriculumsCurriculums

Attached to the back of your handoutsAttached to the back of your handouts

Please note each curriculum is Please note each curriculum is designed to last 14-16 weeks. There designed to last 14-16 weeks. There are 12 lessons for each curriculum.are 12 lessons for each curriculum.

Questions and Questions and AnswersAnswers

Thank you!Thank you!