Substance Abuse and Mental Health Services Administration (SAMHSA)Center for Mental Health Services (CMHS)

Center for Substance Abuse Treatment (CSAT)Co-Occurring Center for Excellence (COCE)

3rd Annual COSIG Grantee Meeting March 1-3, 2006

Omni Shoreham HotelWashington, DC

Texas COSIG ProjectLaurel Mangrum, Ph.D.

Project Evaluator, University of Texas, Addiction Research Institute

Kwame Bruce, Psy.D.Project Director, Texas Department of State Health Services

Texas COSIG Project

The goal of the COSIG project is to improve

the delivery of state-funded services for clients in Texas with co-occurring psychiatric and substance use disorders (COPSD).

The project consists of two components designed to promote system change and to enhance specialized clinical skills of providers treating COPSD.

COSIG Project Component #1

Focused education at the clinician level

regarding treatment issues relevant to COPSD and training on the use of diagnostic and assessment instruments to enhance identification of psychiatric comorbidity and monitor progress of clients.

COPSD Curriculum Modules

Module 1: Substance Use and Mental Health Disorders

Module 2: Depression and Substance Use Disorders

Module 3: Substance Use and Bipolar Disorders

Module 4: Anxiety and Substance Use

Module 5: Schizophrenia, Schizoaffective, and Substance Use Disorders

Module 6: Substance Use – Motives and Consequences

Module 7: Principles of Treatment

Module 8: Relapse Prevention

Diagnostic and Assessment Measures

Mini International Neuropsychiatric Interview (MINI)

Brief Symptom Inventory (BSI)

Brief Derogatis Psychiatric Rating Scale (BDPRS)

Substance Abuse Treatment Scale (SATS)

Ancillary Service Assessment

Client Evaluation of Self in Treatment (CEST)

COSIG Project Component #2

A voucher system that provides additional

funding for procurement of ancillary services in an effort to address the multifaceted needs of COPSD clients and to support the treatment and recovery process.

COSIG Voucher Categories

Child Care

Housing Support

Transportation

Food Assistance

Education Support

Employment Assistance

Clothing

Medical Care

Prescriptions

Peer Mentoring

Participating Treatment Programs

Lubbock Regional MHMR Center

Hill Country MHMR Center Montrose

Counseling Center

Fort Bend Council on Family and

Community Development, Inc.

Association for the Advancement of

Mexican Americans, Inc.

Homeward Bound, Inc.

Administration of Evaluation Measures

CLINICIAN

CLIENT

Ancillary ServicesAssessment

BHIPS Termination

TERMINATION

BDPRS

SATS

BSI

Motivation & Treatment

FOLLOW-UP

60-Day FU

MONTHLYADMISSION

BHIPS Assessment

MINI Diagnostic

BDPRS

BHIPS

SATS

Motivation Scales

BHIPS Wrap-Around

BDPRS

BSIBSI

CEST Treatment

Assessment

SATS

Process ScalesProcess Scales

Ancillary Services

CEST TreatmentCEST TreatmentMotivation & Treatment

Psychiatric Diagnostic Impressions

271 COSIG Clients

39%

47%

4%

9%

25% 26%29%

5%

42%

BIPOLAR DEP HYPO DYSTH PANIC OCD PTSD PSYCHO GEN ANX

Substance Use Disorders

271 COSIG Clients

18%

34%

49%

ALCOHOL ONLY DRUG ONLY ALCOHOL AND DRUG

BSI and BDPRS Scores in Clinically Significant Range at Admission

31%

14%

19% 20%

28%

45% 46%

37%

18%15%

13%16%

18%

24%

16%15%18%

11%

20%

27%

SOM OC IS DEP ANX HOS PHO PAR PSY GSI

BSI Client Report BDPRS Clinician Ratings

266 COSIG Clients

Reductions in Client Reported BSI Symptom Severity After One Month in COSIG

45

50

55

60

65

SOM OC IS DEP ANX HOS PHO PAR PSY GSI PSDI PST

Admission One Month in COSIG

87 COSIG Clients

Reductions in Clinician Rated BDPRS Symptom Severity After One Month in COSIG

0

1

2

3

4

5

SOM OC IS DEP ANX HOS PHO PAR PSY GPI

Admission One Month in COSIG

80 COSIG Clients

Increases in Treatment Engagement on Clinician SATS Ratings after One Month in COSIG

1% 1%

28%

17%

1%

52%

8%5%

23%23%

0%

23%

13%

3%1%0%

Pre-Engagement Engagement Early Persuasion Late Persuasion Early ActiveTreatment

Late ActiveTreatment

Relapse Prevention In Remission orRecovery

Admission One Month in COSIG

88 COSIG Clients

Ancillary Services Needed and Received at One Month in COSIG

0%

66%

42%

46%

24%

23%

13%

55%

45%

41%

7%

79%

51%

57%

41%

40%

26%

69%

63%

50%

Child Care

Housing

Transportation

Food Assistance

Education Support

Employment Assistance

Clothing

Medical Care

Prescriptions

Peer Mentoring

Received Service Needed Service

80 COSIG Clients

Lessons Learned

Training on use of diagnostic and assessment instruments is not a one time event

Tiered training on clinical interventions is needed

Training to build clinician skills in identifying ancillary service needs is needed

Programs benefit from regular feedback reports

Compensation for increased clinician workload is needed

Next Steps for the Texas COSIG Project

Expansion of the pilot sites to five additional programs

Design training curriculum for identification of ancillary service needs and treatment planning

Design intermediate and advanced training modules in COPSD treatment

Development of COPSD fidelity instrument for use in both SA and MH programs in Texas

Information technology infrastructure development

COSIG Expansion Programs

Lubbock Regional MHMR Center

Hill Country MHMR Center Montrose

Counseling Center

Fort Bend Council on Family and

Community Development, Inc.

Association for the Advancement of

Mexican Americans, Inc.

Homeward Bound, Inc.

Nexus Recovery Center, Inc. --AND--Homeward Bound, Inc.

Northeast Texas Council on Alcoholism and Drug Abuse

Central Texas Council on Alcoholism and Drug Abuse

Santa Maria Hostel, Inc