Appendix 3: Synopsis Reports by Region and Topic
Education/Recognition of Need
Region 1
Change 1
Change 2
Change 3
Influential people must be involved
Develop speakers bureau
Develop resource materials
Step 1
Recruit powerful people to join the region co-occurrence committee
Create speakers bureau by recruiting speakers from mental health, A&D, co-occurrence fields with coordinator
Create online resource directory with "if this, then this" flow chart
Step 2
Hold legislative panel event with policymakers and third party payors to educate all about the needs in Region I
Develop talking points that all speakers will incorporate into their presentations
Monthly or quarterly online one-page article that could be downloaded as an insert into other publications
Step 3
Recruit powerful people to join the speakers bureau to influence others
Develop and coordinate speaking opportunities with community groups, etc.
Distribute article and link to resource directory via email/mail across constituencies, inc. criminal justice, A&D, mental health, etc.
Education/Recognition of Need
Region 2
Change 1
Change 2
Change 3
Community outreach regarding resources and how to access
Media champion(s) promote the cause
Provider commitment increases
Step 1
Metropolitan Drug Commission, partnering with A&D Bureau, supported by A&D/MH cmty. has agreed to develop a plan to train trainers for outreach to faith cmty., medical cmty, etc.
Identify panel of champions (well-known/respected individuals, preferably recovering w/ co-occurring disorder)
Recommend that Summit and other A&D/MH trainings include co-occurring disorders training, education
Step 2
Create a coordinated speakers' bureau with bullet points developed that each will present, listing each speaker, inc. consumers, family, advocates, providers, etc., by are of expertise
Collaborate w/ champion(s) and key leaders to do media campaign
Convene local focus groups, possibly through drop-in centers, w/ consumers, family, advocates and providers to talk about dual consumers' needs
Step 3
Advertise availability of 211 online directory in Region II and continually update
List opportunities that currently exist or could be created, such as community events-exhibits and/or speaking- forums, other venues at which champions could attend to promote the cause
Encourage provider organizations to embrace co-occurrence in their mission statements
Education/Recognition of Need
Region 3
Change 1
Change 2
Change 3
Cmty Anti-Stigma Campaign
Targeted education
Criminal Justice System to address co-occurrence humanely
Step 1
Identify resources in entire region and compile a directory with the name of a contact person (Chattanooga has a loose-leaf directory that the task force should review)
Develop a speakers' bureau with all speakers listed by area(s) of expertise and agreement to share same basic information about co-occurrence, possibly through MHA
Educate in person about the need/impact of unrecognized/untreated co-occurrence to the CJ system (by sharing statistics and medical aspects) and about the treatments/diversions available throughout the region
Step 2
Media Involvement: A) Print media to write articles that refer to directory; B) TV panel w/ providers, consumers, sheriff, advocates as a public service; C) PSA on TV and radio; D) Panel on talk radio program
Coordinator- possibly Reg. III Advocacy and Public Education Committee- to advertise availability of speakers, identify target groups, to set up speaking engagements
Promote diversion as preferable if appropriate
Step 3
Directories subsidized for distribution or available as link to websites with a toll-free contact number to call
Town Hall Meetings about co-occurrence for targeted groups
Advocate for increased availability of psychiatric treatment including medications, early and in coordination with current treatment provider(s) and the provision of transition services
Education
Lack of funding/resources
State identification/endorsement
Step 1
Case management is a huge place to start with dual diagnosis teams
Gather data from central intake, jails, AdvoCare, and from everyone who has data to find out specifically what is not available
Letter to local politicians- mayors, Roscoe Dixon, Katherine Bowers
Step 2
Reciprocal trainings between A&D and mental health once a month (Sharon Trammell-Grace House) to open communication lines
Present some local numbers to the legislature and to state A&D and MH divisions.
Public Service Announcements- contact TV stations; TN Protection & Advocacy to put info in their newsletter; El Shaddai- television opportunity
Step 3
Talk to AdvoCare about dual diagnosis case management, pushing for additional resources for co-occurrence teams
Policy
Region 1
Region 1
Change 1
Change 2
Change 3
Combine A&D with Mental Health
Create a co-occurrence state liaison
Create a safety net for co-occurring disorders treatment
Step 1
Recommend combination to MHDD Policy & Planning Council
Recommend combination to MHDD Policy & Planning Council
Ask state co-occurrence committee to ask AdvoCare what services and supports they are contractually obligated to pay and under what circumstances
Step 2
Inform legislators of the need for a combined department
Recommend to Commissioners Wadley & Rukeyser
Ask Bob Benning to write a letter co-signed by Rukeyser & Wadley to the governor to ask for establishment of a contract change indicating who is responsible for co-occurrence treatment and supports
Step 3
Recommend pursuit of joint grant opportunities
Inform legislators of the need for a combined department
Go to the TennCare Oversight Committee of the Legislature asking for a safety net
Policy
Region 2
Change 1
Change 2
Change 3
Licensure changes needed
Need outcome measures
Criminal justice system is not an appropriate treatment venue
Step 1
Demystify the process of licensure and /or examine licensure through TAMHO, TAADAS, and the DMHDD Planning & Policy Council
Research outcome measures in other states and how they have affected policy
Recommend that DRI-Doc be reinstituted with mental health crisis capabilities
Step 2
Recommend that licensure rules and Title 33 need to facilitate the provision of effective co-occurrence services
Advocate that desired outcomes drive policy
Recommend training for judges, district attorneys, and public defenders that promotes diversion, use of drug court where appropriate, and appropriate treatment in jail
Step 3
Need to create a local media strategy to educate the public about barriers and bring attention to the issue so public sentiment will help insure changes happen
Convene a TN committee to develop outcome measures
Appeal to Dept. of Justice to investigate issues of inmates w/ co-occurring disorders having ADA rights violated by being denied treatment, mistreated, having a lack of both continuing care and transition planning
Policy
Region 3
Change 1
Change 2
Change 3
Need coordination between state and local agencies
Change policy of cutting off TennCare in jail without automatic reinstatement
TennCare limits on A&D treatment should be removed
Step 1
Region III Co-Occurrence committee will advocate for this
Find out more about reasons for this policy and alternatives
Advocate for parity in TN by all co-occurrence committees, with all stakeholders being informed of current/proposed policies and encouraged to act to change policy
Step 2
Develop a flow chart of "if this, then this"... what to do for agencies who encounter persons with co-occurrence in various stages of need
Advocate for change, inc. suspension, not revocation
Advocate for federal parity
Step 3
Committee to monitor progress
Advocate for services for inmates, whatever the payor source
Clear Identification
Jail
Medical Necessity
Step 1
Check on how Arizona's plan is working.
Get list of current mental health liaisons by next meeting
Find out what this currently means and why our clients don't fit
Step 2
Have A&D and MH divisions clearly identify where they stand
Get input from Nacy Lawhead of the Memphis Mayor's office
Find out what the insurance company policies are regarding dual diagnosis and medical necessity
Step 3
Contact Insurance Commissioner
Present info to other task forces around Memphis
Recommend to follow ASAM as a part of medical necessity
Step 4
Care and treatment of clients (care home auditing, etc.)
Find out Drug Court's position
(none)
Provider Capabilities
Region 1
Change 1
Change 2
Change 3
Revise TennCare to follow best practice guidelines
Cross-train providers
Improve treatment access in jails
Step 1
(unclear)
Ask licensure to require A&D and mental health education at higher education levels for degrees that are necessary for clinicians
Recommend that TennCare be suspended, not revoked, for inmates
Step 2
(unclear)
Provide continuing education for providers
Find out who provides effective services in jail and advocate to replicate treatment & DRA meetings statewide
Step 3
(unclear)
Ask appropriate body to require that all state-supported and/or -funded provider trainings and conferences have a co-occurrence component
Recommend that judges facilitate transition services so that consumers in jail are hooked up with outpatient services immediately upon release
Provider Capabilities
Region 2
Change 1
Change 2
Change 3
Educate providers
Assess capacity to meet needs
Training at Higher Education level
Step 1
Step 2
Step 3
Provider Capabilities
Region 3
Change 1
Change 2
Change 3
Flexible Funding
Full continuum of care
Housing
Step 1
Advocate for a blended rate for co-occurrence treatment so that chemical dependency is treated, as needed, equal to and in coordination with treatment for psychiatric illness
Identify service gaps
Contact Marie Williams about options for persons with co-occurring disorders
Step 2
Advocate for co-equal divisions of Alcohol and Drug Abuse Services and Mental Health Services within their own department
Prioritize specific service needs with Planning Councils, TennCare Partners Roundtable, TAMHO, TAADAS, etc.
Identify what housing is available and where gaps exists
Step 3
Add a dual diagnosis component to the next statewide NAMI conference to be held in Memphis
Advocate for needed services
Plan to address housing barriers
Cross-training staff
CEU Requirements
Screening Tools
Step 1
Come up with dual diagnosis training
Propose to state health boards planning a dual diagnosis training track
