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Coordinated Care SystemsCoordinated Care Systems

NIAAA Social Work Education

Module 7

(revised 3/04)

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OutlineOutline

Background and RationaleBackground and Rationale

Specialized versus Non-specialized Specialized versus Non-specialized Alcohol Treatment SettingsAlcohol Treatment Settings

Components of a Coordinated Components of a Coordinated SystemSystem

Barriers to Coordinated CareBarriers to Coordinated Care

Social Work Roles in Resource Social Work Roles in Resource ManagementManagement

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RationaleRationale

Recovery requires Recovery requires multi-level continuum multi-level continuum of careof care

Interaction with Interaction with services occurs in a services occurs in a wide variety (bouquet) wide variety (bouquet) of settingsof settings

Consider levels of care Consider levels of care (intensity)(intensity)

Consider type of careConsider type of care ©2002 Microsoft Corporation.

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Specialized/Non-Specialized/Non-SpecializedSpecialized

©2002 Microsoft Corporation.

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Specialized/Non-specialized Specialized/Non-specialized (continued)(continued)

SpecializedSpecialized Focus on alcohol use Focus on alcohol use

disordersdisorders Accept referrals Accept referrals

from non-specializedfrom non-specialized Coordinate servicesCoordinate services Variety of types and Variety of types and

levels of programslevels of programs

Non-specializedNon-specialized Focus on other than Focus on other than

alcohol problemsalcohol problemsMayMay make referrals make referrals ifif screening for themscreening for them

Philosophy, goals Philosophy, goals may be incompatiblemay be incompatible

Wide variety of Wide variety of settingssettings

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Component SystemsComponent Systems

Child welfareChild welfare Primary health/Primary health/

mental health caremental health care Social serviceSocial service Educational and Educational and

vocationalvocational Legal and criminal Legal and criminal

justicejustice©2002 Microsoft Corporation.

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Component Systems Component Systems (continued)(continued)

CHILD WELFARECHILD WELFARE 26% of reported child 26% of reported child

maltreatment cases involve maltreatment cases involve substance abusesubstance abuse

675,000 children (substantiated) 675,000 children (substantiated) are seriously maltreated by are seriously maltreated by substance abusing caretakerssubstance abusing caretakers

47% of women child-bearing age 47% of women child-bearing age use alcohol; unwanted pregnancy use alcohol; unwanted pregnancy is major consequence to women is major consequence to women who drink who drink

©2002 Microsoft Corporation.

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Component Systems Component Systems (continued)(continued)

PRIMARY HEALTH/MENTAL HEALTHPRIMARY HEALTH/MENTAL HEALTH Ambulatory care settings:Ambulatory care settings:

– 15% of men are risky drinkers 15% of men are risky drinkers – 10% of women are risky drinkers10% of women are risky drinkers– 5% are alcohol dependent5% are alcohol dependent

50% of trauma center admissions are 50% of trauma center admissions are drunkdrunk

37% lifetime prevalence of alcohol abuse 37% lifetime prevalence of alcohol abuse and other mental health disordersand other mental health disorders

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CAGECAGE Ewing, 1984Ewing, 1984

MASTMAST Selzer, 1971Selzer, 1971

AUDITAUDIT Babor & Grant, Babor & Grant, 19891989

HSQHSQ Cutler, et al, 1988Cutler, et al, 1988

HSSHSS Fleming & Barry, Fleming & Barry, 19911991

RAPSRAPS Cherpitel, 1995Cherpitel, 1995

PRIMARY HEALTH/MENTAL HEALTHPRIMARY HEALTH/MENTAL HEALTH Alcohol Screening InstrumentsAlcohol Screening Instruments

Component Systems Component Systems (continued)(continued)

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Component Systems Component Systems (continued)(continued)

SOCIAL SERVICESSOCIAL SERVICES Uncertain Uncertain

prevalenceprevalence

Non-dependent and Non-dependent and dependent drinkers dependent drinkers fail to self-identifyfail to self-identify

Professionals fail to Professionals fail to interview about interview about alcoholalcohol ©2002 Microsoft Corporation.

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Component Systems Component Systems (continued)(continued)

CRIMINAL JUSTICECRIMINAL JUSTICE 1.4 million arrests for 1.4 million arrests for

DWI in 1997DWI in 1997 Underaged drinking Underaged drinking

arrests increased by 43% arrests increased by 43% from 1984 to 1993from 1984 to 1993

Arrests for DWI increased Arrests for DWI increased by 50%by 50%

©2002 Microsoft Corporation.

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Barriers to CoordinationBarriers to Coordination

Conflicting goals between Conflicting goals between agenciesagencies

Incompatible definitions of Incompatible definitions of alcohol usealcohol use

Inconsistent screening toolsInconsistent screening tools Use of disparate interventionsUse of disparate interventions No incentives for No incentives for

coordination; agency coordination; agency certification conflictscertification conflicts

Confidentiality concernsConfidentiality concerns ©2002 Microsoft Corporation

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Case Level Social Worker Case Level Social Worker SkillsSkills

Common screening practicesCommon screening practices Variety of interventions (includes referral Variety of interventions (includes referral

and compliance strategies)and compliance strategies) Early diagnosisEarly diagnosis Case management, consultation, Case management, consultation,

collaborationcollaboration Identify alcohol problems in special Identify alcohol problems in special

populationspopulations Cultural competenceCultural competence

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System Level Social System Level Social Worker SkillsWorker Skills

Cross-system familiarity with Cross-system familiarity with all parts of the systemall parts of the system

Knowing system barriers and Knowing system barriers and strategies for addressing themstrategies for addressing them

Establishing communication Establishing communication and collaboration pathwaysand collaboration pathways

System and political advocacySystem and political advocacy

Integrated fundingIntegrated funding©2002 Microsoft Corporation.

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Practice InterventionsPractice Interventions

AssessAssess Develop care Develop care

planplan Identify services Identify services

receivedreceived Identify services Identify services

still neededstill needed

Identify contacts, Identify contacts, make referralsmake referrals

Formulate case Formulate case planning groupplanning group

Define rolesDefine roles Monitor Monitor

implementationimplementation Evaluate planEvaluate plan

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ExampleExample

The Milwaukee County AODA/TANF The Milwaukee County AODA/TANF Coordinated Service SystemCoordinated Service System

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Example Example (continued)(continued)

Purposes of evaluation Purposes of evaluation project:project:

Describe evolution of current Describe evolution of current system into coordinated system into coordinated care system (process)care system (process)

Understand how service Understand how service users fare (outcome)users fare (outcome)

Fulfill state mandate Fulfill state mandate (accountability)(accountability)

Provide information to service Provide information to service providers for use in improving providers for use in improving care (best practices)care (best practices)

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Example Example (continued)(continued)

Data Collection InstrumentsData Collection Instruments Prescreening:Prescreening:

– Rapid Alcohol Problem Screen (and Drugs; Rapid Alcohol Problem Screen (and Drugs; RAPS-D)RAPS-D)

Screening:Screening:– Multiproblem Screening Instrument (MPSI)Multiproblem Screening Instrument (MPSI)– Alcohol Use Disorders Identification Test Alcohol Use Disorders Identification Test

(AUDIT-13)(AUDIT-13) Assessment:Assessment:

– Addiction Severity Index-Female (ASI-F)Addiction Severity Index-Female (ASI-F)

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Example Example (continued)(continued)

Evaluation measures placed into service system:Evaluation measures placed into service system:

17 community service providers: RAPS-D

3 agencies central intake

3 agencies free-standing intake:AUDIT-13, MPSI-A15 treatment provider

agencies: ASI-F

ExampleExample (continued)(continued)

Brief Screen (RAPS-D)Crisis Intervention

ReferralFollow-up

Substance Abuse

Care by Other

Providers(ASI-F)

Criminal Justice

Central Intake Unit

Eligibility Determination

(MPSI-AAUDIT-13)

Milwaukee AODA/TANF Service System

Chi

ld W

elfa

re

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Example Example (continued)(continued)

System Outcomes:System Outcomes: Adoption of standardized Adoption of standardized

measuresmeasures Early identification at Early identification at

multiple sitesmultiple sites Expedited linkage to Expedited linkage to

treatmenttreatment Expanded cross-systems Expanded cross-systems

linkageslinkages Coordinate care planCoordinate care plan

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Example Example (continued)(continued)

Case OutcomesCase Outcomes 3 mos.3 mos. 6 mos.6 mos.No cocaine useNo cocaine use 62%62% 100%100%

No alcohol useNo alcohol use 61%61% 100%100%

No intoxicationNo intoxication 70%70% 100%100%

Voc training/educVoc training/educ 32%32% 44%44%

EmployedEmployed 45%45% 68%68%

Not homelessNot homeless 59%59% 89%89%

No criminal No criminal activitiesactivities

90%90% 100%100%

No days in jailNo days in jail 86%86% 100%100%

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Example Example (continued)(continued)

Case OutcomesCase Outcomes 3 mos.3 mos. 6 6 mos.mos.

No serious depressionNo serious depression 52%52% 63%63%

No serious No serious anxiety/tensionanxiety/tension

59%59% 50%50%

Non-suicidalNon-suicidal 97%97% 100%100%

Child custody regainedChild custody regained 15%15% 38%38%

No conflict w/familyNo conflict w/family 74%74% 67%67%

No conflict w/othersNo conflict w/others 87%87% 78%78%

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ConclusionConclusion

Social workers must become knowledgeable about managing a significantly more complicated system of care, in which persons with alcohol use problems of varying intensity are moved quickly through levels of care that are matched to their problem level and empirically demonstrated to be effective. ©2002 Microsoft

Corporation.