Outstanding Clinical Care Award: UCSD Co-Occurring Disorders Treatment Program

(EDITOR'S NOTE: This is the second of three profiles of the recipients of Addiction Professional's 2016 Outstanding Clinical Care Awards. Our honorees will be recognized Aug. 20 at our National Conference on Addiction Disorders in Denver.)

University of California, San Diego Co-Occurring Disorders Treatment Program

Location: San Diego

Target population: Individuals with high substance use and mental health needs; many have a history of homelessness and/or criminal justice involvement

Quote: “We started using peer volunteers in 2007. They have really become our ambassadors,” says program manager Ami Roeschlein.

The University of California, San Diego's (UCSD's) Co-Occurring Disorders Treatment Program grew out of a partnership under which the academic psychiatry department operated a safety-net mental health clinic for San Diego County. Observing that many patients also were dealing with substance use issues, UCSD leveraged a Substance Abuse and Mental Health Services Administration (SAMHSA) demonstration grant to establish an integated-care model.

Ami Roeschlein, manager of the program, says it gained momentum after leaders requested that other professionals in the community, “Give us your failures.”

Around 40% of the clients in the program have an incarceration or probation history, and intermittent or chronic homelessness is common as well. The program is situated in a community that still sees high levels of methamphetamine use, while prescription opioid use has been rising of late.

“We accept them at whichever level of recovery they're at—we don't have entry criteria,” Roeschlein says of the patient population. “We use the Stages of Change model, and the majority of our clients are in precontemplation or contemplation.”

The program has a capacity of 120 patients and maintains a four-month wait list, indicative of the community need (patients generally are served for about six to 12 months, with many of them Medicaid-eligible). The university has found that the use of peer volunteers who have demonstrated six months of clinical stability helps establish a bridge to the full program while clients await formal admission. Those on the wait list are required to attend several pretreatment groups per week, coordinated by the peer volunteers.

“The peers create a sense of community,” says Roeschlein. “They are useful to the clients when they come to check us out to see what we're about. The peers also give us wonderful feedback.”

The peer volunteers link clients to both 12-Step and SMART Recovery group options. Roeschlein says the co-occurring disorders program generally espouses a harm reduction approach, in which all participants are gradually moving toward better health.

The program also has a research component that has collected data on around 400 individuals, says Steve Koh, an assistant professor of psychiatry and director of outpatient psychiatric services at UCSD. The integrated approach to substance use and mental health treatment, using cross-trained staff, has had a positive impact on hospital, jail and housing outcomes. Less tangible areas such as life satisfaction and client self-efficacy have seen marked improvement as well, leaders say. The progress is seen as even more noteworthy because these individuals generally become the earliest dropout statistics in conventional treatment.