Innovative Conversations | An Overview of Integrated Co-occurring Treatment (ICT) with the CIP’s Mike Fox

In the fall of 1999, with the support of the Ohio Department of Mental Health (ODMH) and the Center for Family Studies at the University of Akron convened a group of state, university, and community experts (including youth and families) to develop an integrated treatment program especially designed for adolescents with co-occurring disorders and their families.The guidelines for the model development were that services had to include a system of care service philosophy, including the centrality of partnerships with youth and family, as well as the following components:1) Cultural mindfulness
2) Integrated treatment approach
3) Home-based intervention service delivery mechanism
4) Developmentally appropriate
5) Components that are grounded in prior empirical research
6) Theoretically and conceptually driven

In 2005, the Center for Family Studies developed a partnership with the Center for Innovative Practices (CIP) to disseminate ICT and to further develop and refine the model.The Center for Innovative Practices is one of the Ohio Department of Mental Health’s Coordinating Centers of Excellence. As of July 2007, the Center for Innovative Practices is the central location for the development, dissemination, and future research on ICT.Recently, ICT was recognized nationally as a promising program model in the Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System (The National Center for Mental Health and Juvenile Justice, 2007).

Currently, ICT is being implemented in four sites nationally. These sites are located in Akron, Ohio; Cuyahoga County, Ohio; Kalamazoo, Michigan; and McHenry County, Illinois. A past ICT site is located in Salinas, California.

The central goals of ICT for the individual are risk reduction, appropriate developmental functioning in major life domains, symptom reduction, improved family functioning, relapse prevention, and ongoing recovery and resilience. A co-occurring disorder exists when an individual experiences mental and substance use disorders at the same time. Although these disorders may exist independently, they interact within the individual to the extent that one exacerbates the other. In youth with co-occurring disorders, this interaction underpins the complexity of symptom patterns and behaviors, which adversely affects youth’s functioning in developmentally important life domains. To further complicate matters, the presence of co-occurring disorders in youth, particularly substance use, impacts brain development. Contextual factors – such as peers, family, school, neighborhood, and the risk and protective factors associated with them – play a mediating role in youth behaviors, use patterns, and the recovery trajectory. As a result, youth with co-occurring disorders are an extremely diverse group, making sustained recovery a significant challenge.The ICT core treatment components consist of:

• Providers embodying a system of care service philosophy, including ongoing collaboration, persistence, and engagement of the youth and family
• Interventions that are rooted in an intensive home-based service delivery model
• Services utilizing an integrated treatment and case conceptualization process designed to increase clinicians’ ability to provide the appropriate level of intensity, integration, and balance when delivering interventions to youth with co-occurring disorders.

Researchers at the Ohio Department of Mental Health and Addiction Services identify questions of importance to the agency and the public behavioral health system and lead studies that can inform planning priorities, disparities and quality of care. Major statewide research has been conducted on services and outcomes for adults with serious mental illness, as well as children/adolescents with serious emotional disturbances, and youth and young adults in transition.

The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.

The Behavioral Health Juvenile Justice (BHJJ) initiative, a shared effort of the Ohio Department of Mental Health and Addiction Services (OhioMHAS) and the Ohio Department of Youth Services (DYS), was created to enhance local options for providing services to juvenile offenders with serious behavioral healthcare needs. Pilot projects that started in a few Ohio counties in early 2000 have grown into a statewide initiative with strong support from additional state and local stakeholders. The projects are designed to transform child-serving systems by enhancing their assessment, evaluation, and treatment of multi-need, multi-system youth and their families. In addition, they provide the Juvenile Court judges an alternative to incarceration.