Magazine article Behavioral Healthcare Executive

Building Integrated Treatment for Dually Diagnosed Youth: Sound Mental Health's Team Recounts Lessons Learned in Developing a Much-Needed Approach

Magazine article Behavioral Healthcare Executive

Building Integrated Treatment for Dually Diagnosed Youth: Sound Mental Health's Team Recounts Lessons Learned in Developing a Much-Needed Approach

Article excerpt

For adolescents, there's no shortage of turmoil in daily life: hormonal changes, peer pressure, the meandering path to adulthood. As if this isn't enough, youth must also cope with the dual threat of mental health and substance-use disorders. Statistics pointing to the link between the two simply cannot be ignored: A 2002 SAMHSA report noted that children with serious emotional disturbances are at greater risk for substance abuse, while young people who experience major depressive episodes are twice as likely to use alcohol or illegal drugs than kids who do not. According to a 2011 World Health Organization report, 45 percent of disability among adolescents and young adults is related to depression, bipolar disorder, schizophrenia, alcohol abuse, and other behavioral health disorders.


There's no arguing that addressing co-occurring mental health and substance use disorders among adolescents is a significant public health priority. Doing so effectively demands integrated mental health and substance abuse services, but, as we found in our own effort, developing and integrating the key components of such services is no simple task.

Integrated treatment for co-occurring disorders is more effective because both problems are treated at the same time, in an inclusive and holistic manner. This requires clinicians who are "dually credentialed" in both areas or, alternatively, a work environment that fosters a "side-by-side" treatment mentality, an environment that shares clinical and assessment information freely among all treatment team members and that develops and works from jointly developed consultation and care plans.

Our experience with integrated treatment for co-occurring disorders among young people indicates that overall client engagement is improved, care modifications are made faster--often in real time, care teams work more efficiently, and our young clients themselves typically have a more positive treatment experience.

Key components of an integrated approach

1. A shared vision. Agency leadership must develop and articulate a strong vision for an integrated practice and staff must buy in to it. Unless your professionals embrace and practice integrated programming, no program, despite best intentions, can succeed.

2. A strong foundation. A second critical component is determining the "orientation" of the program, or more accurately, the foundation on which that program will be built. At Sound Mental Health, we believe that integrated programs are most effective when built atop a recovery-oriented mental health foundation, with the SUD treatment component woven into it. There may be other models, but this approach has been highly effective.

3. Capable clinicians. Integrated treatment demands motivated professionals who are able to look beyond established interventions and modify their treatment approaches to fit the complex needs of dually diagnosed youth. Ideal candidates for additional chemical dependency training include Masters' level mental health clinicians, who must be proficient in conducting Global Assessment of Individual Needs (GAIN) assessments and other substance abuse interventions designed to treat dual diagnosed adolescents. With a Master's degree in Social Work, Psychology or other mental health fields, these professionals have the foundation to ensure integrated treatments that are in-depth and comprehensive.

4. Ongoing financial support Agencies committed to an integrated, recovery-based program should expect to invest in sustained support for clinical staff as they complete the additional training required for chemical dependency certification and licensure. This support should include not only the financial help needed to cover the costs of the additional training, but also financial incentives to attract and retain the most capable, dually credentialed staff.

5. Able supervisors and leaders. …

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