Co-Occurring College: Selected Workshops for Implementation & Sustainability

Michigan Department of Health and Human Services & Michigan Association of CMH Boards Present the Following: Co-Occurring College: Selected Workshops for Implementation & Sustainability July 10, 2017 Great Wolf Lodge 3575 US-31, Traverse City, Michigan 49684 Synopsis & Conference Objective: Supports and services for persons with co-occurring mental health and substance use disorders must be the norm for all agencies across the network. It is more prevalent than addiction-only or mental illness-only among the people served by MDHHS providers. Practitioners in every program at all levels of care must be competent to address comorbidity in mental health and substance abuse treatment, as well as in the supports and services for developmental disabilities. COD competencies must be applied throughout the screening, intake and assessment, treatment planning, service and supports delivery processes. The Co- Occurring College is an annual staff training and development project that allows practitioners to select courses from the agenda that they feel will be most helpful in their personal and program development, and include administrative support, program development, quality improvement from outcome data, and practitioner competencies. The Co-Occurring College is not intended to be a regional conference but instead a number of courses that participants can pre-select, completing as many as they wish. The Co-Occurring College develops the curriculum for courses offered from polling the field to determine which topics are most wanted, and selects presenters based upon that information. Topics range from Prevalence of COD to treatment planning and use of data for improving outcomes. Continuing Education: The Michigan Association of Community Mental Health Boards (MACMHB), provider #1140, is approved as a provider for social work continuing education by the Association of Social Work Boards (ASWB) www.aswb.org, through the Approved Continuing Education (ACE) program. MACMHB maintains responsibility for the program. ASWB Approval Period: 10/10/16-10/10/19. Social workers should contact their regulatory board to determine course approval. Social workers participating in this course will receive. Social Workers participating in this conference may receive a maximum of 5 continuing education clock hours. Course Delivery Method: Face-to-Face Conference. The Michigan Association of Community Mental Health Boards is approved by the Michigan Certification Board for Addiction Professionals (MCBAP) to sponsor educational training for professional certification. MACMHB maintains the responsibility for the program and content. Substance abuse professionals participating in this conference will receive maximum of 5 SPECFIC MCBAP CE Hours. Who Should Attend? Clinical directors, case workers, supports coordinators, children s supervisors and other practitioners who must be able to address comorbid mental health and substance use disorders in at all levels of practice (beginning, intermediate and/or advanced). Overnight Accommodations: A block of rooms have been reserved at the Great Wolf Lodge for this conference. Call 1-866-962-9653 to reserve your room. Mention the group code of 1707STATE to receive a $75/per night rate + tax & $9.99 Resort Fee. Deadline to reserve your room is June 9, 2017 MACMHB Cancellation Policy: Substitutions are permitted at any time. No-shows will be billed at the full rate. Cancellations must be received in writing 10 business days prior to the conference for a full refund less a $35 administrative fee. If cancellation is received less than 10 business days prior to the conference the full charge will be incurred. Evaluation: There will be an opportunity to complete an evaluation of each workshop and presenter. If you have any issues with the way in which this training was conducted or other problems, you may note that on your evaluation of the conference or you may contact MACMHB at 517-374-6848. CEU & Attendance Certificate Awarded: At the conclusion of this conference, turn in your Verification of Attendance form to the MACMHB Staff to be initialed. They will return the bottom copy to serve as your certificate of participation & CE sheet. Registration Fee (Per Person): $75.00 Included in your registration fee: Materials, Breakfast, Lunch, and Morning/Afternoon Refreshments

Morning of Monday, July 10, 2017 Breakfast & Registration Opens Welcome & Opening Plenary Speaker Breakfast & Registration Breakfast Buffet is open to all participants in the conference foyer. Registration is open. 8:00am 9:00am 9:00am 10:15am 10:15am 10:30am Payment will be required prior to attendance. Payment methods available in advance and onsite: credit card, check or exact cash. If payment has not been received prior to the event, fees will be collected at registration the day of the event unless alternate arrangements are pre-approved by MACMHB. Purchase Orders (PO s) are NOT acceptable as pre-approved payment. Welcome & Opening Plenary Speaker Introduction and Welcome Speech by: -Nick Stratton, Michigan Association of Community Mental Health Boards National Accreditation rules indicate that if you are over 5 minutes late, you forfeit your CEUs for the entire training. Please note that this is a National rule that MACMHB must enforce or we could lose our provider status to provide CEUs in the future. This rule will be strictly followed. -Mark Lowis, Michigan Department of Health & Human Services Plenary- Integrated Services and Systems for People with Co-occurring MH, SUD, Health, and other human service needs. -Dr. Kenneth Minkoff, MD; Senior System Consultant, ZiaPartners Inc. This presentation expands upon the foundational principles of evidence-based integrated treatment to illustrate how to design all programs, all services, and all healthcare professionals providing care to be able to deliver integrated interventions for individuals with co-occurring health, mental health, substance use, and cognitive conditions, as well as other complex human service needs. The presentation demonstrates simple strategies that attendees can immediately use at home to improve the use of recovery oriented approaches, both psychopharmacologic (MAT) and nonpsychopharmacologic, to improve outcomes within existing resources. Participants will be able to: 1. Identify six principles of successful treatment that can be applied in any setting by any team to deliver integrated services to individuals and families with complex needs. 2. Understand how to identify strengths and stages of change for each patient having multiple issues in order to design an appropriately matched intervention strategy. 3. Develop programmatic strategies to improve capability in any type of program for routinely delivering integrated interventions. Coffee & Tea will be offered throughout the conference center.

Mid-Morning of Monday, July 10, 2017 1. Implementation of Housing Models and Interventions for Individuals with Co-Occurring 10:30am 11:30am Conditions 2. Writing Strength-based Treatment Plan Goals Specific to Co-Occurring Disorders 10:30am 11:30am 3. The Purpose and Power of Peers in a COD Program 10:30am 11:30am 4. Substance Abuse and the Brain 10:30am 11:30am Lunch 11:30am 12:30pm 1. Implementation of Housing Models and Interventions for Individuals with Co-Occurring Conditions -Dr. Kenneth Minkoff, MD; Senior System Consultant, ZiaPartners Inc., This workshop applies the evidence-based principles of successful integrated treatment to the design, development, and implementation of a continuum of appropriately matched supported housing interventions for individuals with COD. The first principle is that all housing programs must be designed to be co-occurring housing with a specific design matched to the individuals who will be residing in that housing. The next principle is that housing approaches need to be matched to the needs and preferences of the individuals living in them, including accommodation for level of function, preference for individual vs group living, and stage of change regarding substance use. Within this paradigm, the workshop will describe the characteristics of wet, damp, and dry housing, and how to implement those housing models programmatically. The presentation will then go on to illustrate the specifics of how to intervene with individuals who may be actively using or symptomatic within each of those types of housing. Learning Objectives: 1) Understand the differences between wet, damp, and dry housing models for individuals with COD; 2) Be able to describe the specific policies and procedures associated with each type of housing in order to be successful; 3) Be able to apply specific types of stage matched intervention strategies to work successfully with individuals in each type of housing model, particularly individuals who may be having a difficult time with MH symptoms and/or substance use. 2. Writing Strength-base Treatment Plan Goals for Individuals with Co-occurring Disorder -Robert Compton, MA, LLP; Clinical Specialist, Detroit Wayne Mental Health Authority -Tinetra Burns, MSA, RSST, CADC-M; Project Contractor, Detroit Wayne Mental Health Authority -Trent Sanford, BA; Contractor Dual Diagnosis Site Reviewer The Writing Strength-base Treatment Plan Goals for Individuals with Co-occurring Disorder presentation will increase knowledge of the need for integrated treatment. Individuals will learn how to identify strength-based goals and objectives, helping consumers identify their own strengths that can be easily documented in the treatment plan. Facilitators will teach how integrated treatment is proven to work well for people with cooccurring substance use and mental illness disorders. This is documented to show measurable outcomes: stable remission of substance use, reduction in hospitalization, and housing stability. A brief introduction about evidence-based practice modalities, i.e. motivational interviewing, referencing how motivational interviewing is utilized to evoke change and develop a person-centered treatment plan will be discussed. Learning Objectives: 1) Develop a co-occurring substance use and mental illness disorder treatment plan; 2) Identify strength-based goals and objectives to be documented in the treatment plan; 3) Learn how motivational interviewing is utilized to evoke change for those with co-occurring disorders. 3. The Purpose and Power of Peers in a COD Program -Julia Kline, LMSW, CAADC; Clinical Supervisor, Easter Seals of Michigan -Tanisha Moir, LMSW, CAADC; Behavioral Health Clinician, Easter Seals of Michigan -McArthur Brassfield, CPSS; Certified Peer Support Specialist, Easter Seals of Michigan Peer support is an integral part of an individual s journey to well-being. In particular with co-occurring disorders programs, peer support is a critical element in helping individuals recognize they are not alone, they have support, and they have the skills and ability to thrive. This workshop will not only help you learn about the role a peer support specialist can have in a COD program, but also learn about their essentiality in the success of the individual in treatment. Additionally, participants will learn how to fully maximize the potential of a peer support specialist in their own COD program. Participants will hear first-hand from a COD peer support specialist about how a peer can share their recovery story and use their personal and professional experience to empower individuals in the program. Learning Objectives: 1) Identify the importance the role a COD peer support specialist plays in a COD program; 2) Define the different modalities in which a peer support specialist can utilize their talents in a COD program; 3) Recognize opportunities to effectively utilize peers in their own COD program. 4. Substance Abuse and the Brain -Laura Moore, LLMSW, CADC; ACT/IDDT Case Manager & Substance Abuse Treatment Specialist, Community Network Services -John Moir, BA, CADC-M; State Hospital Liaison & Substance Abuse Treatment Specialist, Community Network Services Developments in neurobiology have greatly increased our understanding of the role brain functioning plays in addiction and co-occurring disorders. This workshop will explore both addiction and mental illness as brain diseases that can be treated concurrently. Discussion of basic brain functioning as it relates to the development of addictions and the role that co-occurring mental illness plays in complicating the addiction process. Risk factor and protective factors that affect the development of both addiction and mental illness will be discussed. Brain scans will be used to provide visual examples of the effects that addiction and mental illness have on the brain. Learning Objectives: 1) Identify at least 3 risk factors and 3 protective factors that play a role in the development of co-occurring disorders; 2) Identify how substance use affects neural pathways in the brain; 3) Identify how different substances affect various neural transmitters in the brain; 4) Identify 3 structures involved in the pleasure/reward system in the brain. Buffet Lunch

Early Afternoon of Monday, July 10, 2017 5. Movement and Meditation for Smoking Cessation 12:30pm 1:30pm 6. COD Issues in Supervision: Using Bloom s Taxonomy to Increase Clinician 12:30pm 1:30pm Competency 7. Pain Management and Opiate Dependence: Dueling Needs for Individuals with Co- 12:30pm 1:30pm Occurring Disorders 8. Addressing Trauma in Dual Disorders Treatment 12:30pm 1:30pm Afternoon Break 1:30pm 1:45pm 5. Movement and Meditation for Smoking Cessation -Sara Shields, MA, RN; Executive Director, Team Wellness Center -Erin McArthur, LMSW, CAADC, RYT; Clinical Therapist, Team Wellness Center This workshop introduces meditation, yoga, and mindfulness as interventions to be used to promote smoking cessation for individuals with cooccurring disorders. Not only do these interventions provide individuals with tools to cope with stress, they also teach self-regulation and give people a renewed respect for their bodies and physical wellbeing. This workshop will provide an overview of the research related to using movement and meditation for smoking cessation, and discuss how these modalities can be implemented and used in a clinical setting. Workshop participants will also have an opportunity to experience the effects of meditation in a group setting. Learning Objectives: 1) Summarize research findings related to the use of movement and meditation for smoking; 2) Identify barriers to smoking cessation for individuals with co-occurring disorders; 3) Explain how movement and meditation interventions can be implemented in a clinical setting. 6. COD Issues in Supervision: Using Bloom s Taxonomy to Increase Clinician Competency -Thomas Moore, LMSW, LLP, CAADAC, MAC, CCS; Owner & Founder, Two Moons Consulting COD supervision presents an increased level of complexity for the supervisee and the supervisor. For the supervisee, competence needs to be obtained in both mental health and substance use disorders. The supervisor, if using a case presentation approach, may be taxed to address issues of co-morbidity. If content about disorders represents the primary discussion, it is questionable establishment of supervisee competence occurs. Bloom s Taxonomy of Learning, applied to the supervision format, increases probability of transfer of knowledge and technical skills. This workshop will offer a highly interactive, informative, and individualized approach to COD supervision. Learning Objectives: 1) Identify levels of Bloom s Taxonomy of Learning as they apply to COD supervision; 2) Compare and contrast Bloom s Taxonomy to other approaches of supervision; 3) Using, as a frame of reference, a past or current supervisee, create an individualized, strength based treatment plan for a client with a COD. 7. Pain Management and Opiate Dependence: Dueling Needs for Individuals with Co-Occurring Disorders -Jennifer Harrison, PhD, LMSW, CAADC; Faculty and Field Director, Western Michigan University School of Social Work The ability to manage both acute and chronic pain is a significant issue for primary and behavioral medicine. The Centers for Disease Control and Prevention estimate that there are enough opiates prescribed for every adult to have two bottles in their home each year. As a result, managing pain, particularly for individuals with addiction, through medication and non-medication interventions, is a significant need for the individuals and families we serve. A review of the recent opiate prescribing recommendation, opiate dependence and treatment options for recovery, and nonmedication/behavioral pain management best practice strategies will be reviewed. Learning Objectives: 1) Understand the recent research on opiate use for pain management for adults with acute or chronic pain; 2) Assess for opiate dependence and pain in clients using validated measures; 3) Discuss behavioral interventions for pain, and know where to find them in their community. 8. Addressing Trauma in Dual Disorders Treatment -Steve Wiland, LMSW, ICADC; Director, Foundations Detroit This presentation will address trauma-informed and trauma-specific service practices as they pertain to the effective treatment of Co-Occurring post-traumatic stress and substance use disorders, and describe the importance of including trauma-informed and trauma-specific interventions in a comprehensive service array. The trauma-informed care model popularized by Community Connections in Washington D.C. will be discussed, and a number of evidence-based trauma treatments. TREM & Seeking Safety groups, and EMDR, Trauma-informed CBT, and PET will be described. Learning Objectives: 1) Know the difference between trauma-informed and trauma-specific services; 2) Learn about two types of evidence-based, trauma-specific group treatments and three models of evidence-based, trauma-specific individual treatments, and why they constitute such an important part of the co-occurring disorders service array; 3) Be provided with six no-cost resources to support the development and implementation of trauma-informed and trauma-specific service delivery. Afternoon Break

Afternoon of Monday, July 10, 2017 9. Motivational Interviewing to Create Strength-Based Treatment Goals for Person with 1:45pm 2:45pm Co-Occurring Disorders 10. Principles of Psychopharmacology for Individuals with Co-Occurring Mental Health and 1:45pm 2:45pm Substance Use Disorders 11. Engaging Groups: Getting Co-Occurring Consumers Involved 1:45pm 2:45pm 12. Stage Wise Mental Health and Substance Use Disorder Treatment 1:45pm 2:45pm 2:45pm 3:00pm 9. Motivational Interviewing to Create Strength-Based Treatment Goals for Person with Co-Occurring Disorders -Meghan Perrault, MA, LPC, CAADC; Motivational Interviewing Trainer Creating a Person-Centered Plan is a pivotal piece in the treatment process in integrated health, mental health, and substance use treatment. A key element is helping the consumer identify what they would like to gain or improve (critical life function), while highlighting their strengths and supports. Motivational Interviewing will be reviewed as the Spirit and Principles focus specifically on highlighting strengths and treatment planning. The two elements, Identifying Strengths and Motivational Interviewing, are combined to help providers build a collaborative-assistive relationship in order to identify ambivalence, evoke change talk, and help consumers communicate their critical life function. Learning Objectives: 1) Identify 4 elements of Motivational Interviewing Spirit and Principles; 2) Identify 2 components of Strength-Based Treatment; 3) Assist consumers in the communication of their goal(s) for Person-Centered Planning. 10. Principles of Psychopharmacology for Individuals with Co-Occurring Mental Health and Substance Use Disorders -Dr. Kenneth Minkoff, MD; Senior System Consultant, ZiaPartners Inc., This workshop applies the evidence-based principles of successful integrated treatment to psychopharmacologic assessment and treatment in any setting, and then addresses specific strategies for utilizing psychotropic medication in individuals with co-occurring SUD, and using medication assisted SUD treatment in individuals with co-occurring psychiatric disorders. Strategies related to opioid pain medication and benzodiazepine use are also addressed. Learning Objectives: 1) Identify basic principles and approaches to psychopharmacologic management of individuals with cooccurring condition, that should be applied by both prescribers and non-prescribers; 2) Understand specific approaches to provision of psychiatric medication to individuals with co-occurring SUD; 3) Understand the use of Medication Assisted SUD Treatment for individuals with co-occurring mental health conditions; 4) Utilize core strategies for working with individuals with COD who may also be on benzodiazepines or opioid pain medications. 11. Engaging Groups: Getting Co-Occurring Consumers Involved -Laura Moore, LLMSW, CADC; ACT/IDDT Case Manager & Substance Abuse Treatment Specialist, Community Network Services -John Moir, BA, CADC-M; State Hospital Liaison & Substance Abuse Treatment Specialist, Community Network Services Engagement at every stage of change is a core strategy when helping consumers with co-occurring disorders to recover from addiction and mental illness. Biological and social barriers to engagement will be reviewed and discussed including how these barriers affect group dynamics. Integrating mental health and substance use treatment is a critical component of support groups for consumers with co-occurring conditions. The Presentation will focus on strategies to engage clients with co-occurring disorders in support groups for managing recovery at different stages of change. Options will be presented for a variety of groups to address different life domains that affect recovery. Integrating the stages of treatment into group design will be explored. Learning Objectives: 1) Identify at least 3 barriers to engaging the co-occurring population in groups; 2) Identify 3 strategies for engaging co-occurring consumers in support groups for managing recovery; 3) Identify the 8 stages of treatment and how this affects group development; 4) Identify different types of groups that help consumers to manage recovery. 12. Stage Wise Mental Health and Substance Use Disorder Treatment -Stephanie Lagalo, LMSW, CAADC, CCS; Clinical Director for ACT & Therapy Services, InterACT of Michigan, Inc. This workshop will focus on motivational techniques that help move individuals with co-occurring disorders out of homelessness and into safe and affordable housing. Learning Objectives: 1) Identify and describe the 6 stages of change; 2) Describe 4 interaction techniques to increase behavior change; 3) Apply the effective use of 3 motivational interventions to work in housing and homeless programs. Enjoy Assorted Cookies, Fudge Brownies and Assorted Sodas

Near the End of Training on Monday, July 10, 2017 13. Pain Management and Opiate Dependence: Dueling Needs for Individuals 3:00pm 4:00pm with Co-Occurring Disorders 14. Motivational Interviewing to Create Strength-Based Treatment Goals for 3:00pm 4:00pm Persons with Co-Occurring Disorders 15. A Community Approach to Harm Reduction and Action Stage Readiness 3:00pm 4:00pm 16. Understanding the Role of COD Treatment in Drug Courts 3:00pm 4:00pm Adjournment 4:00pm 13. Pain Management and Opiate Dependence: Dueling Needs for Individuals with Co-Occurring Disorders -Jennifer Harrison, PhD, LMSW, CAADC; Faculty and Field Director, Western Michigan University School of Social Work The ability to manage both acute and chronic pain is a significant issue for primary and behavioral medicine. The Centers for Disease Control and Prevention estimate that there are enough opiates prescribed for every adult to have two bottles in their home each year. As a result, managing pain, particularly for individuals with addiction, through medication and non-medication interventions, is a significant need for the individuals and families we serve. A review of the recent opiate prescribing recommendation, opiate dependence and treatment options for recovery, and nonmedication/behavioral pain management best practice strategies will be reviewed. Learning Objectives: 1) Understand the recent research on opiate use for pain management for adults with acute or chronic pain; 2) Assess for opiate dependence and pain in clients using validated measures; 3) Discuss behavioral interventions for pain, and know where to find them in their community. 14. Motivational Interviewing to Create Strength-Based Treatment Goals for Person with Co-Occurring Disorders -Meghan Perrault, MA, LPC, CAADC; Motivational Interviewing Trainer Creating a Person-Centered Plan is a pivotal piece in the treatment process in integrated health, mental health, and substance use treatment. A key element is helping the consumer identify what they would like to gain or improve (critical life function), while highlighting their strengths and supports. Motivational Interviewing will be reviewed as the Spirit and Principles focus specifically on highlighting strengths and treatment planning. The two elements, Identifying Strengths and Motivational Interviewing, are combined to help providers build a collaborative-assistive relationship in order to identify ambivalence, evoke change talk, and help consumers communicate their critical life function. Learning Objectives: 1) Identify 4 elements of Motivational Interviewing Spirit and Principles; 2) Identify 2 components of Strength-Based Treatment; 3) Assist consumers in the communication of their goal(s) for Person-Centered Planning. 15. A Community Approach to Harm Reduction and Action Stage Readiness -Katie Hoener, MSW, LMSW; Program Administrator, Washtenaw County Community Mental Health -Ebony Montgomery, MS, LPC; Mental Health Professional, Washtenaw County Community Mental Health -John Shovels, MSW, LMSW; Program Administrator, Washtenaw County Community Mental Health Washtenaw County Community Mental Health has developed two effective co-occurring housing models in partnership with community housing specialists. The programs use a housing first philosophy and target individuals with complex mental health and substance abuse conditions. The Ashley housing program uses a harm reduction approach to engage individuals at their stage of readiness with the goal of improving overall health outcomes. The Platt housing program engages individuals that have demonstrated a preparation to action stage readiness in their recovery. The goal is to develop life-long recovery skills through the use of a wrap-around model that connects to community supports (AA, NA, etc.) Learning Objectives: 1) Describe the importance of community partnerships in program design and development; 2) Explain the benefits of using a housing first model to impact positive change on tri-morbid conditions (mental, physical, and substance); 3) Name the components of each treatment approach including interventions and the role of CMH. 16. Understanding the Role of COD Treatment in Drug Courts -Carol Smith, MA, LPC, CCS, CAADC; Behavioral Health Director, Catholic Human Services Drug courts have successfully addressed the issues of effective treatment of SUD and MH disorders while reducing recidivism in the criminal justice system since their inception in 1989. The drug court provides the accountability of the criminal justice system with the support of the COD treatment system to keep the participant in the program long enough to allow the participant to stabilize in a program of recovery and establish a comprehensive support network. The drug court model utilizes a team approach where, under the leadership of the judge, all team members participate in planning treatment, rewards and sanctions of the defendant. Drug courts are based on 10 key components that must be in place to ensure success of the program. This workshop will focus on the role of the treatment provider in the effectiveness of the drug court by presenting information on Michigan s Standards, Best Practices, and Promising Practices in drug courts. Learning Objectives: 1) Identify the 10 key components of drug courts; 2) Understand the role of the treatment provider on the drug court team; 3) Describe the Standards and Best Practices of SUD and MH treatment in drug courts. Adjournment Don t forget to have your Verification of Attendance/CE Sheet Signed before you leave!

Co-Occurring College: Selected Workshops for Implementation & Sustainability July 10, 2017 Great Wolf Lodge, Traverse City, MI REGISTRATION FEE (PER PERSON): $75.00 Fee includes: Materials, Breakfast, Lunch, and Refreshments 3 EASY WAYS TO REGISTER : ATTENTION NICK STRATTON BY FAX: BY MAIL: MACMHB 517-374-1053 426 S. WALNUT, LANSING, MI 48933 ONLINE: WWW.MACMHB.ORG DON T FORGET TO BOOK YOUR OVERNIGHT AS SOON AS POSSIBLE IF ONE IS NEEDED! Registration starts at 8:00am Conference starts at 9:00am Training ends at 4:00pm Please Check the Workshops You Plan to Attend: 1: 2: 3: 4: 5: 6: 7: 8: 9: 10: 11: 12: 13: 14: 15: 16: Name to be printed on Badge: Title: Agency/Company: Address: City, St, Zip: Phone: Fax: Individual Work Email Address: Dietary Needs: Vegetarian Vegan Gluten-free Allergic/Other: In Case Of Emergency during Conference, Please Contact: Daytime Phone: Accessibility Needs: MACMHB Cancellation Policy: Substitutions are permitted at any time. No-shows will be billed at the full training rate. Cancellations must be received in writing 10 business days prior to the conference for a full refund less than a $35 administrative fee. If cancellation is received less than 10 business days prior to the conference the full charge will Be incurred. PAYMENT METHOD: Payment DOES NOT need to accompany registration form. However, payment or purchase order must be received by the day of the conference. You must pay with check, credit card or cash on-site. Check Enclosed (payable to MACMHB) Purchase Order (attached) Credit Card / PayPal: https://www.macmhb.org/services/make-payment BY SUBMITTING THIS REGISTRATION, I AM AGREEING TO THE TERMS AND CONDITIONS OF MACMHB S CANCELLATION POLICY. Questions? Contact MACMHB at 517-374-6848