COSIG: Co-Occurring State Incentive Grant The goal of the COSIG project is to improve the delivery of state-funded services for clients in Texas with co-occurring psychiatric and substance use disorders (COPSD). The project implements two components designed to promote system change and to enhance specialized clinical skills of providers treating this population. The first component consists of focused education at the clinician level regarding treatment issues relevant to this population and training on the use of diagnostic and assessment instruments to enhance identification of psychiatric comorbidity and monitor progress of COPSD clients. The second component of the project is a voucher system that provides additional funding for procurement of ancillary services in an effort to address the multifaceted needs presented by COPSD clients and to support the treatment process. The ten service categories in the voucher system are: child care, housing support, transportation, food assistance, education support, employment assistance, clothing, medical care, prescriptions, and peer mentoring. During the first year of implementation, six substance abuse treatment programs that are funded by the Texas Department of State Health Services participated in the COSIG project: Association for the Advancement of Mexican-Americans, Inc., Edinburg, Texas Fort Bend Council on Family and Community Development, Inc., Stafford, Texas Hill Country Community MHMR Center, Kerrville, Texas Homeward Bound, Inc., El Paso, Texas Lubbock Regional MHMR Center, Lubbock, Texas Montrose Counseling Center, Inc., Houston, Texas In March of 2006, the COSIG project expanded to five additional substance abuse treatment programs. The programs received training in March and will begin providing COSIG services in April 2006. The new expansion programs are: Central Texas Council on Alcohol and Drug Abuse, Harker Heights, Texas Homeward Bound, Inc., Dallas, Texas Nexus Recovery Center, Dallas, Texas
Northeast Texas Council on Alcohol and Drug Abuse, Paris, Texas Santa Maria Hostel, Houston, Texas ARI is providing evaluation services for the COSIG project and the training for clinicians on the use of diagnostic and assessment tools at the participating sites. The COSIG project manager at the Texas Department of State Health Services is Dr. Kwame Bruce. Dr. Bruce conducts statewide training on COPSD treatment issues for clinicians providing services in state-funded treatment programs. The lead evaluator at ARI is Dr. Laurel Mangrum. Co-Occurring Psychiatric and Substance Use Disorder Fidelity Instrument Development Project (NEW) The fidelity instrument development is an additional project that will be funded through the COSIG grant. The principal aim of the project is to develop a co-occurring psychiatric and substance use disorder (COPSD) program fidelity self-rating instrument for use in treatment programs funded by the Texas Department of State Health Services (TDSHS). The design of this instrument will be based on the current resiliency and disease management (RDM) format used by TDSHS in the mental health service system. In the existing array of RDM self-rating fidelity instruments developed by DSHS, a 4-item COPSD fidelity scale is embedded in the Adult Mental Health Programs - Psychosocial Rehabilitation (Rehabilitative Case Management) Fidelity Toolkit. The purpose of the current project is to expand this subset of items to create an independent COPSD fidelity tool for use in both substance abuse and mental health programs. The project is designed to assist in technology transfer of COPSD evidenceand consensus-based practices to treatment providers. Numerous studies have documented the high prevalence of COPSD in both substance abuse and mental health treatment systems. Often, COPSD clients receive treatment targeting either their psychiatric or substance abuse issues, depending on the client's point of entry into the treatment system. This treatment approach neglects the interactive nature of the COPSD client's dual disorders and may lead to "revolving door" treatments between the mental health and substance abuse service systems. Recognition of this deficit in the behavior health field led to the development of specialized interventions that recognize the unique needs of the COPSD population by providing coordinated psychiatric and substance abuse services, as well as
enhanced case management to obtain adjunct services to address other social problems common in individuals with co-occurring disorders. These specialized practices can be implemented in either substance abuse or mental health settings by tailoring practices to the characteristics of the treatment setting. The development of COPSD fidelity instruments provides a means for treatment providers to examine their current practices and systems to determine the extent to which their program ms are capable of meeting the needs of this population. Further, a treatment program's results on a fidelity instrument can assist in identifying areas of training needs and systems development that may enhance COPSD treatment capability. The project is currently in the planning stages and implementation is scheduled for the summer of 2006. CO-SIG Final Evaluation The Texas Co-Occurring State Incentive Grant Project Final Evaluation Report for the Texas Department of State Health Services (December 2008). University of Texas, Addiction Research Institute. CO-SIG Assessment Training CO-SIG Progress Report through May 2007 CO-SIG Products Mangrum, L. F. (in press). Client and service characteristics associated with addiction treatment completion of clients with co-occurring disorders. Addictive Behaviors. Mangrum, L.F., Spence R. T., & Lopez, M. (2008). A comparison of integrated dual diagnosis treatment service delivery models on fidelity and client outcomes at 1- and 2-year follow-ups. In L. A. Klein & E. L. Neumann (Eds.), Integrated Health Care Delivery, pp. 19-34. Hauppauge, NY: Nova Publishers. Mangrum, L. F. (2008, June). Recovery support services and client outcomes: Results of two interim evaluations in Texas. Paper presented at the annual College on Problems of Drug Dependence Conference, San Juan, PR. View the presentation. Mangrum, L. F. (2008, June). Recovery oriented systems of care:
An examination of recovery support service types and client outcomes. Poster presented at the annual College on Problems of Drug Dependence Conference, San Juan, PR. View the Mangrum, L. F. (2008, May). Gender differences in substance use severity and psychopathology in clients with co-occurring disorders. Paper presented at the annual COSIG Grantee Meeting, Washington, D.C. View the presentation. Mangrum, L.F.& Spence, R.T. (2008). Client and counselor characteristics in mental health versus substance abuse treatment settings providing services for co-occurring disorders. Community Mental Health Journal, 44, 155-169. Read the abstract. Mangrum, L. F. (2007, December). Recovery support services and client outcomes: What do the data tell us? Paper presented at the Recovery Community Services Program Grantee Meeting, Baltimore, MD.View the presentation. Mangrum, L.F. (2007, October). Dual diagnosis capability in addiction treatment: A comparison of client characteristics and treatment outcomes. Paper presented at the annual Addiction Health Services Research conference, Athens, GA. View the presentation. Mangrum, L. F. (2007, July). Alcohol and drug use, psychopathology, and treatment characteristics of Hispanic vs. non-hispanic clients with co-occurring disorders. Poster presented at the annual Research Society on Alcoholism conference, Chicago, IL. View the Mangrum, L. F. (2007, June). Substance use, psychiatric, and service characteristics of clients with co-occurring disorders completing substance abuse treatment. Poster presented at the annual College on Problems of Drug Dependence Conference, Quebec City, Quebec, Canada. View the Mangrum, L. F. (2007, May) Enhancing Co-Occurring Disorder Services in Addiction Treatment: Preliminary Findings of the Texas Co-Occurring State Incentive Grant, presented at a seminar at the Dartmouth Psychiatric Research Center View the presentation
Mangrum, L. F. (2007, March). Client and service characteristics associated with treatment completion. Paper presented at the annual COSIG Grantee Meeting, Baltimore, MD. View the presentation. Mangrum, L. F., & Bruce, K. (2007, March). The Texas COSIG project. Poster presented at the annual COSIG Grantee Meeting, Baltimore, MD. View the Mangrum, L. F., and Bruce, K. (March, 2006). Texas COSIG Project. Paper presented at the 3rd Annual COSIG Grantee Meeting, Washington, DC.View the presentation. Mangrum, L. F., and Spence, R. (2004, October). A Comparison of Characteristics and Outcomes of Clients with Co-Occurring Psychological and Substance Use Disorders with a General Substance Abuse Population. Paper presented at the Addiction Health Services Research Conference, Philadelphia, PA. View the presentation. Mangrum, L. F., and Spence, R. (2004, June). Alcohol abuse characteristics of individuals with co-occurring psychiatric and substance abuse disorders. Paper presented at the Annual Conference of the Research Society on Alcoholism, Vancouver, Canada. View the Mangrum, L. F. and Spence, R. (2006 June). Categorical Versus Dimensional Analysis of Substance Use Severity in Individuals with Co-Occurring Psychiatric and Substance Use Disorders, College on Problems of Drug Dependence, Scottsdale, Arizona. View the Mangrum, L. F., and Spence, R. (2003, September). Characteristics and outcomes of clients with concurring psychological and substance use disorders: Comparisons with a general substance abuse treatment population. Presentation and poster at the 2003 Annual Conference of the American College of Counselors, St. Louis, MO. View the poster Mangrum, L. F. and Spence, R. (2005). Characteristics of Substance Abuse Treatment Completion of Clients with Co-Occurring Psychiatric and Substance Use Disorders. Poster at the 2005 Annual Conference
of the College on Problems of Drug Dependence, Orlando, Florida. View the Mangrum, L. F. and Spence, R. (2005). Treatment of Co-Occurring Psychiatric and Substance Use Disorders in Mental Health Versus Substance Abuse Service Systems. Poster at the Addiction Health Services Research Conference, Santa Monica, California. View the Mangrum, L. F., Spence, R., and Lopez, M. (2004, June). Comparative analyses of integrated versus parallel treatment of individuals with co-occurring psychiatric and substance abuse disorders. Paper presented at the 2004 Annual Conference of the College on Problems of Drug Dependence, San Juan, Puerto Rico. View the presentation Mangrum, L. F., Spence, R. T., & Lopez, M. (2006, October) Effects of integrated treatment fidelity on 1-year client outcomes: A comparison of implementation models. Poster presented at the annual Addiction Health Services Research Conference, Little Rock, AR. View the Mangrum, L. F., Spence, R., and Lopez, M. (2006). Integrated versus parallel treatment of co-occurring psychiatric and substance use disorders. Journal of Substance Abuse Treatment, 3, 79-84. Read the abstract. Mangrum, L. F., Spence, R., and Steinley-Bumgarner, M. (2006, June) Gender Differences in Alcohol and Drug Use Severity and Psychopathology in Clients with Co-Occurring Disorders. Poster presented at Research Society on Alcoholism, Baltimore. View the Mangrum, L. F., Spence, R. T., & Steinley-Bumgarner, M. D. (2006). Gender differences in substance abuse treatment clients with co-occurring psychiatric and substance use disorders. Brief Treatment and Crisis Intervention, 6(3), 255-267. Read the abstract. Spence, R., Mangrum, L. and Ernst, A. (2004). Workforce Assessment: COPSD Specialists in Texas. Presented at the NASHMPD Research Institute Conference. See the presentation.
Important Links: Workforce Assessment COPSD Specialists in Texas Populations with Co-occurring Substance Use & Mental Disorders SAMHSA's Co-Occurring Center for Excellence