ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Ohio’sMental Illness/Developmental

DisabilitiesCoordinating Center of

Excellence

(MIDD CCOE)

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Incidence

There are an estimated 30,000 individuals in Ohio who would qualify at any given time as being dually diagnosed with developmental disabilities and mental illness.

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Incidence, Cont’d.• Approximately 34% of individuals with

developmental disabilities served in the community have dual diagnoses*

• Approximately 71% of individuals with DD in institutional settings have dual diagnoses.

*National Core Indicators, 2008-2009

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Trauma-Informed Care: A Universal PrecautionIt is estimated that an overwhelming percentage of the population has suffered “adverse events” that can be considered traumatic (SAMSHA, 2011). People with developmental disabilities are at greater risk of victimization. Also, smaller, “everyday” adverse events and losses can overwhelm coping skills, resulting in cumulative traumatic effects. Given this, it makes sense to consider safety and control (the main issues

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

of people suffering the aftereffects of trauma), for everyone you treat. In this way you can offer elements of trauma-informed care without missing someone who’s trauma history has gone unreported. If an individual does NOT have a significant trauma history, making sure they feel safe and in control will not hurt. Consider trauma-informed care the “universal precaution” for this population.

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Our Philosophy

• Mental health can work with people with DD. In most cases they already have the tools, and just need some specific modifications. DD can work with people with mental illness. In most cases they already have the tools, and just need some specific modifications.

• In both systems, the way to begin working with people with dual diagnoses is with the universal precaution of trauma-informed care: making sure each individual feels safe and in control.

• To address the gaps in what each system can do, we must collaborate with each other.

• The MIDD CCOE can help with all three of the above points.

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Our Mission

The mission of the MIDD CCOE is to make lifebetter for people who are diagnosed with both mental illness

anddevelopmental disabilities. The MIDD CCOE

• funds expert psychiatric diagnostic assessments

• sponsors and supports local/county trainings and conferences

• encourages county MH and DD systems to talk to each other and train their staff to improve their work together

• helps colleges, universities and professional schools include dual diagnosis in their programs

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Department of Developmental DisabilitiesOversight by Director

Project management*

Ohio Department of Mental HealthOversight by Director

Funding: $75,000.00

Ohio Developmental Disabilities CouncilOversight by Executive Director

Funding: $75,000.00 (Grant)

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Diagnosis/Assessment

Oversight: Psychiatrist •Teaching med students and residents in dual diagnosis•Provide expert diagnostic assessments and med consults for SW Ohio region•Present locally, regionally, state and nationally•Research, journal articles and scholarship•Coordinate CCOE-funded assessment clinicians

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

EducationOversight: sharedShort-term:support, speakers and materials for topics

such as DD and MH systems, collaboration and clinical issues.

Long-term: Incorporate dual diagnosis material and issues

into professional and post-graduate programs in Ohio universities

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Community DevelopmentOversight: DODD/ODMH Project Manager

• Reports to directors• Coordination and support of assessment and

education areas• Seed/Nurture County DDIT Teams (incl training $)• Larger Grants for Regional Trainings• Infrastructure: Listserv

Website Resources National Conferences

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

There are many formal and informal ways systems collaborate. Formal teams meet regularly and have one or more levels of involvement (the administrator level and the direct service level, e.g.). They are likely to have shared funding, typically in one of the following ways:

• Pooled funds• Medicaid match agreements• In-kind donations of staff time/services• Grant partnerships

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Advantages for teams/collaboration

• Relieves some financial pressure• Assists in maintaining some tough cases in the

community• Improves service delivery for sub-acute cases• Allows for more organized access to resources • Better management of crises.

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Challenges: Teams are still working to find...

• Better resources for crisis/respite care (some counties are getting their local MH centers to become certified as provider agencies, thus allowing them to bill for respite for DD consumers)

• Easier access to brief hospitalization/sub hospital care• More accessible outpatient psychiatry• Psychotherapy and other mental health interventions• Better integration of treatment/service plans • Housing, esp. for offender or sexually reactive population and transitional

age youth• Specialized treatment for sex offenders or sexually reactive consumers• Valid, meaningful outcome measures• Ongoing and advanced training for staff, including video and web-based

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

The Magic Ingredient…

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

DiagnosisFor DD staff, diagnosis is often less important than other considerations, or circumstances force DD staff to proceed without them. Sometimes it is helpful, such as in a particular syndrome (Prader-Willi, eg.), but often knowing a “diagnosis” does not tell staff much. They may rely more on assessments of functioning.

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

For MH staff, a diagnosis is critically important. Depression can look the same as a depressive episode of bipolar disorder (manic depression). Major (unipolar) depression is often treated with anti-depressants. Giving antidepressants to a bipolar person, however, can cause a manic episode. It is important to know what you’re dealing with.

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Challenge

MH people may be reluctant to work with a person with dual diagnosis if they do not have a diagnosis to start with. DD staff may not have that diagnosis to give, and may feel that MH is unnecessarily reliant or rigid on this.

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Strength

Once a diagnosis has been made, the features of that diagnosis may be very important and helpful for DD staff.

DD staff can help MH professionals avoid being overly “cook-book” in their approach by encouraging looking at what is presented by that individual.

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Working Together

Dual diagnosis teams can help each system maximize the other’s strengths and meet challenges. A mental health worker might come to a group home and offer training on working with traumatized clients. A DD worker might offer to bring DD clients to their MH sessions, greatly reducing the risk of no-shows and thus improving productivity for that worker.

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Recommended tools for Collaboration

•Shared funding pool (for training, materials, innovative interventions and “good faith” money from each system)

•Streamlined (one page if possible) DDIT referral•Shared releases of information•Shared treatment plans (where this is not feasible, a brief

outline of the treatment/service goals of each system for easy reference and coordination)•Collaboration “tool kits” for teams, including the principles and tools noted above or special protocols (such as Cuyahoga model)

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Some guiding principles for collaboration•Shared responsibility for clients•Administrative buy-in and support at the upper levels•Strong relationships among system leaders and among direct service staff •Willingness to create new things•Good training for staff •Constant close communication, especially during crises or at times when expert help is needed•Multi-disciplinary team membership, including AOD, law enforcement/court system, others

ODODD ODMH ODDC

Coordinating Center of Excellence forMental Illness and Developmental Disabilities

Want to know more?

Contact:Lara Palay, LISW-S

Department of Mental Health/Department of Developmental Disabilities

Lara.palay@dodd.ohio.gov(614) 301-3557

Or go to our website:www.midd.ohio.gov