Integrated Treatment Coordination

Integrated Treatment Coordination

Case Management Challenges

Co-occurring mental and substance use disorders are very common among people who receive psychiatric services. Co-occurring disorders enhance symptom severity, complicate treatment, and result in poor client outcomes (Padwa et al., 2015). Statistics reveal that over 40 percent of individuals with a substance use disorder have a co-occurring mental health disorder or Dual Diagnosis, but only about 6.8 percent of this population receives treatment for the two conditions (Addiction Hope, 2020). It is even more surprising that 52 percent of them do not get any form of treatment (Addiction Hope, 2020). Whether it is the use of alcohol or drug that resulted in the mental illness or the mental problem that led the individual to self-medicate, it is clear that the treatment of co-occurring disorders is very complex and continues to evolve with time.

One major challenge in the treatment of a person with a dual diagnosis is the issue of accepting the reality of the existence of these conditions. In most cases, a patient might want to focus on the treatment of one, say, addiction and ignore the underlying psychological issue. When a relapse takes place, they get disappointed or continue to battle with the same imbalances or anxieties after apparently overcoming the addiction. Getting clients to understand the need for the treatment of both can be difficult until the co-existence of these conditions is acknowledged. Dual-diagnosis treatment also needs specialization (Psychological Care & Healing Center, 2020). Certain facilities concentrate on treating addiction, whereas others focus on treating emotional or psychological issues. This means that they might not be well-equipped to tackle the other issue and hence the need for a holistic approach with experts having experience helping people reflect on the psychological or emotional imbalances and how such imbalances contribute to addictive tendencies. The treatment of individuals with dual diagnosis is also complex due to the heightened risk of developing maladaptive behaviors or relapse even following treatment. When a holistic approach to the dual diagnosis is not taken, the underlying struggles heighten the probability of relapse when untreated. If one fails to relapse, they are likely to develop other maladaptive coping mechanisms and tendencies that might result in an additional form of addiction.

Potential Referrals for Thomas’ Case Management Needs

Mercy Hospital and Medical Center Mental Health Unit are one of the best referrals that can meet the needs of Thomas based on his current condition. The facility offers both mental health services and anger management services. It also has financial assistance options for patients who cannot pay, are underinsured, or are uninsured. Catholic Charities Archdiocese of Chicago is also another option that Thomas should consider. This facility offers various services, such as referral services, transportation services, and comprehensive case management. The services offered are also free of charge and will be beneficial for the transport services that Thomas needs at the moment.

Another referral is known as Thresholds. This is a service in Illinois that usually offers hope, housing and healthcare to individuals with mental illnesses as well as substance use disorders every year. Through housing, advocacy, employment and care, Thresholds strives to inspire and help individuals with mental and substance use issues to reclaim their lives. Most individuals with co-occurring disorders are usually denied the chance to live in certain areas. Finding a place that offers stable housing, such as Thresholds, can be important in the recovery process of Thomas, and it will also help him find employment and be able to pay for some of the services that he is unable to pay for at the moment.

Challenges of Coordinating Thomas’ Care

Traditionally, individuals with co-occurring disorders either underwent treatment of one condition, leaving out the other, or they got parallel treatment in which substance use and mental health issues were separately treated by varying medical professionals at varying facilities and using dissimilar approaches. Only a single condition was assigned primary; with time, this method proved costly and ineffective for patients. A new technique involving the use of integrated treatment of behavioral and primary care was incorporated, and a multidisciplinary team worked collaboratively to treat both substance abuse and mental health issues simultaneously as primary (Addiction Hope, 2020). Coordination of care for patients with dual diagnosis is generally complex. According to Bjørkquist and Hansen (2018), the major challenge in the treatment of dual-diagnosis patients is to identify the individuals to collaborate in the care management, how the collaboration will occur and get organized.

In Thomas’s case, care coordination might be difficult for various reasons. First, he has been unemployed for the past 3 months and might not be able to afford treatment. He has also been evicted and hence the need to address this. According to Horsfall et al. (2009), basic factors like housing have to be dealt with concurrently, and rehabilitation for consequent employment might be important for some people’s recovery. Thomas claims he might be forced to discontinue treatment due to his diverse needs and limited resources. Furthermore, supportive relationships have been proven important in the treatment of individuals with dual diagnosis (Horsfall et al., 2009). However, in this case, the divorce might have detrimental consequences for Thomas, which is only exacerbated by the threat of losing his parental rights. Care coordination might be difficult if basic needs such as housing are not addressed. Savic et al. (2017) claim that coordination between alcohol and other drugs (AOD) services and coordination between the AOD services and the non-AOD services like community and mental health as well as housing is important for the recovery of patients as it ensures various needs are met simultaneously. It will be important to address all these basic needs to be able to effectively help Thomas in the recovery process. Additionally, coordination of the interagency referrals and the interagency might be difficult due to the varying specialty of each agency. At the moment, Thomas is also at high risk of relapse, given that he has stopped treatment for bipolar 1 disorder.

Strategies for Building Trust during Interagency Coordination

Integrated care in treating dual-diagnosis patients has been proven highly effective but simultaneously highly complex (Savic et al., 2017). Given the effectiveness linked to integrated care, building trust during interagency coordination is important. To be able to enhance coordination, it will be important to ensure constant communication among all these agencies so that all members are up-to-date with the strategies used in the treatment and the progress made. Finding proper communication strategies, such as constant face-to-face meetings, can be important for creating mutual understanding in the care process.

Furthermore, in the decision of the appropriate strategies to be used and other important aspects involving the treatment of the patient, it will be important to involve all the members of the agencies to enhance trust, accountability and transparency. Shared decision-making is a very good strategy for building trust in interagency coordination. Having a shared understanding of the roles and goals will also provide clarity of the role to be played by each agency and prevent role conflict and confusion (Institute of Medicine Staff et al, 2006). This will enhance collaboration, which will help build trust.

According to Savic et al. (2017), some interconnected approaches that can encourage integrated care at 5 different interrelated levels include funding, clinical, organizational, administrative, and service delivery. At the funding level, how welfare and health services are funded impacts how services work together and collaborate (Savic et al., 2017). To build trust among these agencies, taking on a non-competitive approach in which block funding is given to these services will be important.

Trust can also be enhanced through inter-departmental planning as this is said to have the probability of enhancing integrated systems that can accommodate the various needs of clients. It would be important to consider joint working approaches to enhance integration and trust among the agencies. This could involve multi-agency teams and co-location of staff whereby a staff from a single agency is positioned in another agency for about one day a week. Collaboration builds on coordination and involves joint work to develop mutual goals (US Department of Health and Human Services, 2009). It also involves participants following a set of protocols that complement and support the work of others.

Case Managers and Service Coordination

Case managers are generally involved in various therapeutic and medical disciplines and this position requires the case manager to advocate for every form of assistance. Case managers can use service coordination to tackle general community needs for serving individuals diagnosed with co-occurring disorders by brokering for resources, determining eligibility for the benefits and taking regular checks and evaluation of progress. A case manager can help individuals with co-occurring disorders by coordinating various outpatient services such as rehabilitation and care continuation (Editorial Staff, 2019). They can also help these individuals to find a sober living area, sustain prescription medication, get transportation to therapy and find support groups. To be able to do so, it would be important to secure proper funding for all of these services through local or community support. The care manager can also help identify the individuals in the community who are at risk and are eligible for the services for individuals diagnosed with co-occurring disorders and ensure that they receive proper treatment. The progress of treatment should be monitored regularly.

Appropriate Services in Chicago Area

Some of the services that could be created in the Chicago area to aid co-occurring clients in better access to services are better transportation and more integrated facilities for the patients. Finding integrated facilities is quite difficult, yet they have been proven to more effective and less costly for patients. Ensuring the availability of more such resources will benefit individuals with co-occurring disorders, particularly when the facilities are within the community for ease of accessibility. Facilitating transport services will also enable and encourage clients to attend therapy sessions. Since most of the clients lack a stable source of income, providing transportation services will help cut costs and help in the treatment process.

References

Addiction Hope. (2020). The Unique Challenges of Co-Occurring Disorders. Retrieved from https://www.addictionhope.com/blog/challenges-co-occurring-disorders/

Bjørkquist, C., & Hansen, G. V. (2018). Coordination of services for dual diagnosis clients in the interface between specialist and community care. Journal of multidisciplinary healthcare, 11, 233-243. DOI: 10.2147/JMDH.S157769

Editorial Staff. (June 25, 2019). How a Case Manager Helps with the Treatment Process. Sunrise House Treatment Center. Retrieved from https://sunrisehouse.com/consulting-experts/case-manager/

Horsfall, J., Cleary, M., Hunt, G. E., & Walter, G. (2009). Psychosocial treatments for people with co-occurring severe mental illnesses and substance use disorders (dual diagnosis): A review of empirical evidence. Harvard review of psychiatry, 17(1), 24-34.

Institute of Medicine Staff, Committee on Crossing the Quality Chasm, Adaptation to Mental Health, Addictive Disorders, Institute of Medicine, Board on Health Care Services, & Institute of Medicine (US). Committee on Crossing the Quality Chasm. (2006). Improving the quality of health care for mental and substance-use conditions: Quality chasm series. National Academy Press.

Padwa, H., Guerrero, E. G., Braslow, J. T., & Fenwick, K. M. (2015). Barriers to serving clients with co-occurring disorders in a transformed mental health system. Psychiatric Services, 66(5), 547-550.

Psychological Care & Healing Center. (November 5, 2020). The Most Common Challenges of Dual Diagnosis Treatment. Retrieved from https://www.pchtreatment.com/most-common-challenges-dual-diagnosis-treatment/

Savic, M., Best, D., Manning, V., & Lubman, D. I. (2017). Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review. Substance abuse treatment, prevention, and policy, 12(1), 1-12.

US Department of Health and Human Services. (2009). Recommendations for Case Management Collaboration and Coordination in Federally Funded HIV/ AIDS Programs. Retrieved from https://hiv.rutgers.edu/wp-content/uploads/2016/05/Case_Management_Collaboration_2011.pdf

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Integrated Treatment Coordination

• PS450-4: Create multidisciplinary referrals for assessment. (5: Synthesis)
• PC-2.5: Model leadership skills by developing trusting relationships, respect, conflict resolution skills, and civic-mindedness.

For this assignment, you will develop a 4–6 page multidisciplinary coordination plan utilizing your knowledge of co-occurring disorders and integrated treatment. Using appropriate referrals for the client’s specific needs, you will discuss some of the complications of coordinating these interagency and interagency referrals. You will also propose solutions for the creation of new community resources to make access to services easier for all local citizens.

Complete the learning activity to prepare for this week’s assignment.

Assume that you are a case manager working with a client diagnosed with co-occurring disorders of Cannabis Use Disorder (305.20, F12.20), severe and Bipolar I Disorder (296.01, Single Manic Episode, mild). You work in an addiction agency and the client’s mental health can be managed at your agency.

Read the Following Scenario: Thomas