Excellence in Emerging Behavioral Health Strategies Florida

Report
Excellence in Emerging
Behavioral Health
Strategies
November 10, 2011
Rhonda Bohs, Ph D.
Emy Pesantes, M.S.W.
Nitza Sevilla, M.S.
Spectrum Programs Inc.
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SPI located in Miami-Dade and Broward County
is the oldest and largest non-profit substance
abuse treatment provider in South Florida
operating since 1970.
SPI provides Residential, Outpatient, Family and
Intervention Services (Case Management) for
adults, families, and adolescents.
Miami Behavioral Health Center
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MBHC has served the Latino community
(children, adults, and severely mentally ill and
substance abusing) since 1977 providing both
mental health and substance abuse services.
MBHC provides Crisis Stabilization, Detox,
Residential, Outpatient, Case Management, Peer
Recovery-Oriented, Adult Day Care and On Site
Services for children.
Banyan Health Systems
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Through a joint venture in 2003, SPI and MBHC
have operated and provided services for
substance abuse and mental health.
Primary Health Care Services have been offered
since 2009 for all treatment programs.
SAMHSA Grant Funding
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Why did we need it?
What did we do with funding?
Sustainability
Outpatient
Prevention
School Based (Targeting:
consumers with mental illness
and veteran kids who are at
greater risk) through DFYIT
Program and Project ALERT.
Residential
Co-Occurring, 30, 60, or 90
days of tx. Extend on a
case by case basis.
Treatment for: Mental Health,
Residential, Forensic, Co-Occurring.
Those persons who are in the active
stage of change.
• Medication Assisted
Treatment
30 days, 60 days, 90 days.
Extensions when necessary.
•Motivational Interviewing/
Motivational Incentives
• Modified Therapeutic Community
Early Intervention
Motivational Interviewing with
at risk users and children of
veterans in middle/high school.
• Medication Assisted Treatment
P.S. can go from residential
to outpatient and return if it is
necessary.
Recovery Management
Co-Occurring. Once
consumers have completed
residential and outpatient,
they will be taken to
aftercare for stress
management, triggers,
relaxation classes, and
follow-up.
Clubhouse
Co-Occurring
1st
Family Services
• Case Management
• Family Therapy
• Support Groups
• Increase awareness and
understanding of treatment of
substance abuse, mental
health, and recovery.
• Network families
• Children of Veterans who
have been affected
•Voluntary Day Treatment
Entry Point
Medical/Wellness
Assessed with
•WRAP model
•GAIN
Coordinated by Recovery Guide
•SBIRT
Physical completed by an ARNP.
•Change Assessment Scale
Chronic care will be evaluated: high
blood pressure, cholesterol, diabetes,
respiratory disease, lung disease.
Referrals made by court
Wellness education on nutrition,
dieting, relaxation, and coping skills.
13 bed inpatient facility for
adolescent substance users
Recovery Guide (stays with
p.s. during all tx)
Get initial medical evaluation
appointment.
JARF
Schools based during day
•CASASTART
•SUCCESS
Detox/Crisis
• Brief, intensive services for
consumers with mental
illness/chemically dependent
individuals who are in a nonviolent, non-combative state.
• Assertive Community
Treatment
MAT (Medication Assisted
Treatment)
• Vivitrol
• Suboxone
• Methadone
Veteran Services
Services
PTSD for veteran
Family services for children
Family therapy
Housing
1 day to a month until
assigned in tx or have a
sustainable housing
situation and in recovery
management.
Vocational Training
Job Development
High School Diploma
Work readiness
assessment
English classes
Cooking assistant
Receptionist
Peer Counselors
Recovery Guides
Job Matching
Job Training
Job Support
Elderly Program
Adult Day Treatment
Criteria: Alzheimer's, Lowfunctioning, Depression
Case Management- Caregiver
Support Group
Cognitive Behavioral Therapy;
Psychosocial Rehabilitation.
Grant Funding
Goals/Objectives
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Staff cross-trained in co-occurring treatment
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Integrated Model of Care
Evidence Based Practices
Training
Use of an integrated assessment (GAIN)
Implementation:
Training
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Adult Evidence Based Practices
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Medication Assisted Treatment (Vivitrol)
Motivational Enhancement/ Motivational
Interviewing Therapy
Seeking Safety
Trauma Informed Care
WRAP
Adolescent Evidence Based Practices
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Aggression Replacement Training
Motivational Enhancement/ Motivational
Interviewing Therapy
Seeking Safety
Solution Focused
Trainings
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Aggression Replacement
Therapeutic Community
Co-Occurring
Motivational Interviewing
Pharmacology of Substance Abuse
Seeking Safety
Trauma Informed Care
WRAP
Training
“A one-shot training workshop is unlikely to alter
practice behavior sufficiently to make a
difference in client outcomes,” (Miller & Mount,
2001; p. 468).
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Steps to Consider in Training
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Training Implementation timeline
Sustainability
Weekly Supervision to sustain fidelity of EBP
Video recordings and Coaching ratings
Agency wide culture change
Data:
Clients Served &
Retention
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Clients Served/ Staff
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235 Staff trained
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How many clients across all programs were touched by grant?
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Aggression Replacement Training
Motivational Interviewing
Solution Focused Case Management
WRAP
MAT: 68 un-duplicated Adults
Seeking Safety: 208 un-duplicated Adults
MI/MET: 250 un-duplicated Adults/ 100 un-duplicated
Adolescents
Aggression Replacement Training: 106 un-duplicated Adolescents
GAIN Administration
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3,670 GAIN Q completed during FY 2010-2011
320 GAIN I completed during FY 2010-2011
Issues with an integrated assessment
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Mental Health Staff
Substance Abuse Staff
EBP Outcomes Data
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Medication Assisted Treatment
Vivitrol Injections
% of People who Received Injection
n=68
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
82%
64%
50%
42%
2 or more
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3 or more
4 or more
5 or more
Number of Injections Received
36%
6 or more
Seeking Safety PTSD Results
% of Clients who Experienced Symptoms
100%
Pre-Test n= 168
92%
Post-Test n= 119
87%
90%
87%
80%
70%
65%
56%
60%
47%
50%
40%
30%
20%
10%
0%
Re-experiencing
Avoidance & Numbing
Hyperarousal
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Seeking Safety Trauma Symptom
Results
Pre n=168
Post n= 119
100%
% of Symptoms Experienced
90%
80%
70%
63%
60%
50%
40%
30%
46%
44%
32%
32%
22%
20%
39%
39%
38%
27%
25%
18%
10%
0%
Dissociation
Anxiety
Depression Sexual Abuse
Sleep
Trauma Index Disturbance
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Sexual
Problems
Retention
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Of those Adult clients who reported trauma
there was an 88% client retention rate
within the first 30 days of treatment.
Of those Adult clients who reported trauma
there was a client retention rate of 79%
among clients through 90 days of
treatment.
Aggression Replacement Training
% of Skills Attained
Matched Sample n=31
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
65%
69%
Pre-Test
Post-Test
Aggression Replacement Training
Pre n=82
Post n=39
100%
90%
% of Skills Attained
80%
70%
60%
63%
67%
66%
58%
69%
68% 69%
61%
67%
60%
63%
66%
50%
40%
30%
20%
10%
0%
Social Skills
Feelings
Altruism
Anger
Symptoms
Fair
Planning
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Retention
Retention of 30 days or more
100%
90%
Retention Rate
80%
85%
85%
83%
84%
87%
76%
70%
60%
50%
40%
30%
20%
10%
0%
Adult Residential (BR)
2009-2010
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July 1- Dec. 31, 2010
Adult Residential (DC)
Jan. 1- June 30, 2011
Wrap Up Outcomes
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Specific Impact of Evidence Based Practices
Effect of Chaining Evidence Based Practices
Does EBP impact retention?
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Lessons Learned
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Staff Buy In/Staff Turnover
Staff Training and Consistency
Sustainability and Organizational Requirements
Effectiveness of Evidence Based Practices
Next Steps
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New Evidence Based Practices
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Solution Focused Case Management
Eye Movement Desensitization and Reprocessing
(EMDR)
Street Smart
For a copy of today’s presentation, go to:
www.banyanhealth.org
Click on the research tab and go to the program
evaluation subsection
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Questions or Comments
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Resources
Seeking Safety
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www.seekingsafety.org
Najavits, L. M. (2002). Seeking Safety A Treatment Manual for PTSD and Substance
Abuse. New York: The Guilford Press
Aggression Replacement Training
http://www.promoteprevent.org/publications/ebi-factsheets/aggression-replacementtraining%C2%AE-art%C2%AE
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