Spotlight on the States: Connecticut's Co-Occurring Program Guidelines

The Spotlight on the States is a quarterly series designed to highlight valuable resources that have been developed by states to further the integration of mental health and substance abuse systems and services. States highlighted in this series were a part of a SAMHSA-supported learning collaborative and agreed to share their experiences, resources and lessons learned.

Connecticut's Co-Occurring Capable and Co-Occurring Enhanced Program Guidelines, developed as part of the state's Co-Occurring State Incentive Grant (COSIG) from SAMHSA, have been recognized as models by a workgroup of COSIG states and other experts convened by SAMHSA's Co-Occurring Disorders Integration and Innovation (CODI) in 2010.

The program guidelines are rooted in Connecticut's vision for recovery-oriented services, articulated by the state's Department of Mental Health and Addiction Services (DMHAS) in its Practice Guidelines for Recovery-Oriented Behavioral Health Care. Designed to provide direction, rather than to be proscriptive, each set of guidelines was developed by a diverse group of mental health and addiction treatment practitioners and informed by the latest research, models, and tools for delivering and monitoring progress in co-occurring service delivery.

The program guidelines apply the Four Quadrant Model of service delivery to provide guidance regarding appropriate service settings for treatment of co-occurring disorders. The program guidelines directly address complex issues such as minimum staff and practitioner licensing requirements, the use of pharmacological interventions, and peer support.

By January 2011, 17 programs across 11 service agencies in Connecticut met the guidelines in their Intensive Outpatient Programs (IOPs) and were designated as Co-Occurring Enhanced Programs. They received a 25% increase boost in their state fee-for-service reimbursement rate for individuals with co-occurring disorders. This advanced level of care and enhanced rate was funded through Connecticut's SAMHSA-funded Access to Recovery (ATR) grant, during the life of the grant.

These enhanced guidelines were also used to create an Integrated Care Policy for the state's Medicaid Enhanced Care Clinics (ECCs); those behavioral health clinics also receive a 25% enhanced rate. "This financial incentive really helps engage programs to provide integrated services on-site," said Julienne Giard, MSW, Project Manager for the Co-Occurring Initiative at DMHAS. "It also ensures the sustainability of our work beyond the life of our COSIG grant."