IC&RC Announces 2011 Conference Details

IC&RC has released more detailed information about “A Principled Practice: Ethics in Addiction Treatment and Prevention,” IC&RC’s first-ever professional training conference. 

Scheduled for October 28 & 29, 2011 at the Rosen Centre Hotel in Orlando, Florida, we are looking forward to the:

• Friday Keynote Address by Stephen J. Morse, J.D., Ph.D. on “Neuroscience, Morality and Addiction”
• Saturday Half-Day Workshop on “Culturally Complex Ethical Challenges” with Stephanie Murtaugh, MA, MBA, LPC, CAC, CCS, CCJP, CCDP Diplomate
• Conference Sessions on Prevention, Clinical Supervision, Criminal Justice, Co-Occurring Disorders, and Organizational Ethics
• Conference Schedule, including Invitation to IC&RC’s 30th Anniversary Reception 

This conference is open to all credentialed addiction and prevention professionals, individuals in the process of becoming credentialed, and behavioral health and affiliated professionals. Conference registration also includes complimentary access to IC&RC Professional Services – priced at $25 a year but valued much higher.

Register online today!

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From the Executive Director

Welcome, Colorado Prevention!

Last week in Denver, Colorado, more than 75 delegates from Member Boards gathered to set the direction for the future of the international organization. Being in Colorado was made all the more special, when the Colorado Prevention Certification Board was joyfully welcomed into the organization. Carmelita Muniz, Mary Anne Burdick, and Cheryl Reid represented the new board at the meeting and already made their contributions clear.

I’m also happy to announce that Tammi Lewis, LPC, AADC, ALPS, Therapist at CAMC Family Resource Center in Charleston, West Virginia, is the new co-chair of the Advanced Alcohol and Drug Counselor (AADC) Committee. Frank Davis, IAADC, ICCJP, LCDC, of the Texas Certification Board of Addiction Professionals has agreed to become the new co-chair of the Certified Criminal Justice Addictions Professional (CCJP) committee.

The Peer Recovery Support Specialist credential is continuing toward adoption. Based on three states that already offer a peer recovery credential, minimum standards have been developed, and the credential will undergo IC&RC’s evaluation process over the next six months.

As our 30th anniversary year continues, the staff is working to make all of our activities special. So don’t forget to mark your calendars for the Fall Meeting – October 25 to 27 in Orlando, Florida. See you there! 

Sincerely,

Mary Jo Mather
Executive Director

Advocacy Corner

By Andrew Kessler, Federal Policy Liaison

First, the good news: SAMHSA has set aside $50 million for prevention in tribal areas, as a result of funds taken from the Affordable Care Act. This money will go directly to the tribes and not through IHS. There’s also another $395 million in prevention for the states, but there will be new mechanisms in place that make the prevention block grant a little different than in the past. I’ll share more details as they become clear.

On another front, the advocacy community for addiction prevention and treatment has followed the review process that is examining whether a merger between the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National institute on Drug Abuse (NIDA) is in the best interests of research and the public. Both institutes are part of the National Institutes of Health (NIH), located in Bethesda, MD. The task of investigating whether a merger is in the best interest of science and the NIH falls to the Scientific Management Review Board (SMRB.)  

Not less than once each seven years, the Board must provide advice to the NIH Director and other appropriate agency officials, through a report to the NIH Director, regarding the use of organizational authorities reaffirmed by the NIH Reform Act of 2006. A working group of the Board, the Substance Use, Abuse, and Addiction workgroup, has been charged with investigating the plausibility of a merger.  The working group spent close to a year soliciting comments from experts in addiction research, from the public, and experts in NIH administration. Their work to date has been transparent and open.  Recently, the SMRB voted 12-3 in favor of combining the two institutes.

Several complex steps remain in the process.  Their recommendation will be sent to NIH Director Dr. Francis Collins.  Dr. Collins may then decide to accept or ignore the recommendation.  If he chooses to ignore the recommendation, he must explain his reasons in writing.  If he accepts the recommendation, he will notify Congress via the Office of the HHS Secretary.  Congress then may refute the recommendation, or accept it by taking no action. This procedure is guided by statute, the aforementioned NIH Reform Act of 2006, which is also responsible for the creation of the SMRB. 

IC&RC has made comments to the SMRB, both written and oral, in support of creating one institute in the place of the two that currently exist.  We believe that one institute handling one disorder (substance abuse and addiction) will increase the profile of the field that works on this issue.  Also, due to the high frequency of patients who suffer from the abuse of both alcohol and narcotics, this process will increase the research profile for such co-morbidity.  We have received a letter from the NIH in response to our efforts.

Snapshot of Survey Results

The Co-Occurring Disorders Committee polled the membership and was grateful to have such a significant response. Here are few highlights from the survey:

• 18 Boards hold the CCDP credential. 10 Boards are considering adopting the CCDP credential.
• 19 Boards offer the CCDPD credential. 5 Members have plans to offer the CCDPD credential.
• 58 percent of Boards with credentials welcomed assistance, and marketing and promotional materials were the main form of assistance requested.
• Barriers to success include budget cuts, resistance to credentialing at the state level, practice acts, turf wars with other professions.

This succinct comment sums it up perfectly, “This is a ‘most wanted’ certification as we all work with co-occurring clients.”

Q&A: Charting a Course

Lee Dalphonse

With this first special issue for Co-Occurring Disorders, it seems like a perfect time to get to know the Co-Chairs a little better.

Lee A. Dalphonse, CAGS, LMHC, LCDS, ICCDP-D has over 28 years of experience planning, implementing, and evaluating behavioral health programs and services for individuals with co-occurring mental health and substance abuse problems, and he has also provided training and consultation to audiences and organizations throughout the United States and Canada.

Dave Parcher, LCPC, LPCMH, CCS, CCDPD has 27 years of experience in direct service provision, and behavioral health program development, implementation, and management for persons with co-occurring substance dependence, mental health and other co-morbidities such as HIV/AIDS. He serves as Executive Director and senior clinical supervisor for an organization providing treatment and prevention services to persons with these co-occurring disorders and provides training seminars for the State of Delaware Division of Substance Abuse and Mental Health.

IC&RC: Do you hold any IC&RC credentials?

LD: Actually, I hold a couple of IC&RC credentials. I’ve been a Clinical Supervisor for 15 years, and I hold the Diplomate level of the Co-Occurring certification. I’m also licensed in the State of Rhode Island as a mental health counselor.

DP: I hold the IC&RC Co-Occurring certification at the Diplomate level (CCDPD) and the Clinical Supervisor certification (CCS). I am also a Licensed Clinical Professional Counselor (LCPC) in Maryland and a Licensed Counselor of Mental Health (LPCMH) in Delaware.

IC&RC: Why are co-occurring disorders so important to you?

LD: The driving force behind my desire to seek credentialing as a co-occurring treatment specialist was that I have worked in both traditional mental health and traditional substance abuse settings, where I witnessed first-hand individuals with dual needs bouncing back and forth between providers. In too many instances, both systems failed to address the needs of this population. The more I witnessed this, the more I became convinced of the need to develop an expertise regarding the interactive relationship between addiction and mental health problems.

DP: My interest in developing integrated treatment that would be effective for co-occurring disorders grew during the 13 years I served as the director of an Assertive Community Treatment (ACT) Team treating persons with severe and persistent mental health disorders. At least 30 percent of individuals treated in that program presented with diagnosable co-occurring substance abuse/dependence. Through that experience and literature review by some of the pioneers in this arena, it became apparent to me that treatment would have to address both disorders simultaneously through an integrated set of protocols to address the impact of the symbiotic relation between these disorders. As a function of this concept, it seemed critical to me that co-occurring morbidity must be treated as a standalone disorder in and of itself for successful stabilization and long-term recovery.

IC&RC: When did you first hear of IC&RC?

LD: I joined the Rhode Island Board for the Certification of Chemical Dependency Professionals in 1991, partly out of a desire to learn about more about credentialing and also out of a desire to help bridge the gap between the substance abuse and mental health fields. In 2004, I became a delegate to IC&RC.

DP: I heard about IC&RC through certified persons I knew in the field. I became more educated about IC&RC when I joined the Delaware Certification Board in 2000. I have served as a delegate to IC&RC for the last 3 years and increased my participation with committee membership in the last year.

IC&RC: Why did you decide to become involved in IC&RC?

LD: I had a personal crusade to push for a co-occurring credential, and I wanted to be part of moving that agenda forward on an international level. I recognized IC&RC as the industry leader in setting standards for our profession and I saw a natural synergy between my own personal vision and the work of the IC&RC.

 Soon after I started attending IC&RC meetings, a Task Force was formed to explore the feasibility of a co-occurring focused credential, and I was appointed Co-Chair of that Task Force, along with Marshall Rosier from the Connecticut Certification Board. Based upon the work and recommendations of that Task Force, the IC&RC Member Boards formally endorsed the development of co-occurring credentials about a year and half later. I think the quick timeframe for formal approval of these credentials was thanks to a “perfect storm.”

It was clear that at the same time that the health care system was being strained by growing costs and a dramatic increase in uninsured, individuals with co-occurring treatment needs were being under-recognized and under-treated. No longer could the treatment system afford to have duplication of efforts and ineffective treatment approaches for a population that ends up accessing high end services such as hospitals and emergency rooms when the treatment system fails to adequately meet their needs.

DP: Delaware was one of the first IC&RC States. Our State contracting authorities have recognized IC&RC as the leader in setting standards since the beginning. So, here in Delaware when one thinks of standards, one thinks IC&RC.

Delaware has had the Alcohol and Drug Counselor certification from the beginning of IC&RC. When I became president of the Delaware Certification Board and aware that IC&RC offered the co-occurring credential, I saw it as my obligation to bring that credential to Delaware during my tenure as President. This initiative was based on my clinical experience and the fact that through the Co-occurring State Incentive Grant (COSIG) the State was taking action to support the integration of co-occurring disorders as standard within the treatment constellation.

IC&RC: Where do you see the field going?

LD: I believe the writing is on the wall. The statistics show clearly that, in publicly funded programs, co-occurring disorders are the rule not the exception. Given that, it is incumbent on programs to ensure that all members of their staff are able to meet the needs of the majority of their clients. I think there will be growing pressure to demonstrate that program staff are competent in co-occurring disorders, and the best way to do that is to have staff that are dually licensed or hold a co-occurring credentials.

DP: I believe that integrated treatment is the rule of the future. Programs need to have the capacity to provide treatment at all levels of care without the barriers and inefficiency created by the treatment silos in parallel infrastructures. With the Affordable Care Act, there will be increased pressure for programs to create the economies of scale offered by integrated prevention and treatment. Persons who are trained and certified to treat co-occurring disorders will have a tremendous advantage in this arena.

IC&RC: What do you like to do in your free time?

LD: Music is one of my passions – I love all kinds of music. I also try to spend as much time as possible with my wife of 26 years and my 15-year-old daughter. I strive to maintain a balance between being an active, committed professional and an active, committed family person. It’s not always an easy balance.

DP:  My two daughters are in college and doing their own thing but, I love to spend time with them when our schedules permit. With regard to activities, first and foremost, I am a martial artist. I hold two black belts in Shukoki and Tikwondo. I also like to ride motorcycles and bicycles. I love to sail, fish, and hunt. I love to dance and love music (all kinds). I am by no means a guitarist, but I like to play just to relieve stress but only when no one is listening. Balancing professional life with personal life is always a challenge.

Advocacy Corner

Federal Policy Liaison Andrew Kessler

By Andrew Kessler, Federal Policy Liaison

Let’s start by looking at some facts:

• The cost of treating a patient with a co-occurring disorder can be seven times higher than the cost of treating a patient with a single chronic condition.
• 19.7 percent of persons with any mental/cognitive condition have more than one.
• Hospitalization is much more likely for those with multiple conditions, especially among the aged. Close to two‐fifths of those with multiple physical conditions or physical and mental/cognitive conditions – half of those with multiple mental/cognitive conditions – will be hospitalized. This is compared to 18% of the general population over age 65 that require a hospital visit each year.

In the last year, there has been a lot of movement on the federal front to address the treatment of co-occurring disorders in behavioral health, yet a large part of it is still unfolding. Many changes are being made within the federal government, and how new programs are funded and structured remains to be seen.

The Affordable Care for America Act- better known as “health care reform”- will expand the treatment of co-occurring disorders and build better systems of care for comorbidity through the emphasis on prevention and the integration of services. Prevention services, and hopefully the resources to promote them, will be more readily available for all health professionals in the coming years. This will enable more counselors to work with patients who are at risk of developing co-occurring disorders – and prevent them from needing treatment in the future. With integration, the goal is to have a stronger, more efficient network of services. Health professionals from across the spectrum of care will be able to work in concert and treat the multiple needs of a patient with co-occurring disorders.

Last July, the Kaiser Family Foundation (KFF) issued a report on the subject of health care reform and comorbidity. This study used Medicare and Medicaid data to examine the chronic physical and mental conditions and multiple comorbidities that create substantial needs for medical and long-term services among “dual eligibles.”

Dual eligibles include individuals with some of the most severely disabling chronic conditions. The KFF study found that they are a costly segment of beneficiaries for both programs, with annual mean per person spending of $19,400. For persons with both physical and mental/cognitive conditions, spending rose to $31,000, and the number reaches $38,500 for those with more than one mental/cognitive condition.

The report also found that almost 20 percent of dual eligibles use community‐based supportive services – with somewhat higher levels of use among older duals and those with multiple mental/cognitive conditions. Not surprisingly then, the proportion of expenses covered by Medicaid is substantially higher among individuals who need the supportive services (institutional or community‐based, through waiver programs or the personal care option) that are part of the Medicaid benefit package. With more people eligible for Medicaid coverage under the Affordable Care Act and substance abuse services are considered an essential benefit, treatment for co-occurring disorders should expand significantly.

The Affordable Care Act also increased the profile of the Substance Abuse and Mental Health Services Administration (SAMHSA), by placing their leadership on a variety of bodies that will evaluate the level of care called for in the legislation. SAMHSA has long been a leader in evaluating co-occurring disorders, through both their Office of Applied Studies, and their Centers of Excellence. Hopefully, SAMHSA will be able to bring comorbidity to the forefront of the national conversation on health.

Finally and perhaps most importantly, the creation of two new institutes at NIH should have a great effect on the treatment and prevention of co-occurring disorders. The first will combine the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), so it can encompass all addiction studies, including alcohol, tobacco, and substance abuse. This is a tremendous opportunity to increase the research profile of co-occurring disorders, by recognizing that comorbidity is more often the rule than the exception.

Another new institute can also advance this agenda, by applying research to clinical settings. NIH Director Dr. Francis Collins, following the guidance of the Scientific Management Review Board, has called for the creation of the National Center for Advancing Translational Sciences (NCATS.)  This institute will focus on the delivery of research results into the stream of treatment, for all health sciences and all diseases, with the goal being an accelerated application of the findings. The new director of the Office of Behavioral and Social Science Research (OBSSR,) Bob Kaplan, will be very involved in forming the agenda and direction of NCATS.

With all these developments, treatment of co-occurring disorders is sure to receive more and more attention. IC&RC’s credentials are sure to have a place in this dialogue.

Focus On: Co-Occurring Disorders

Dave Parcher

Dear Colleagues,

Since Scottsdale, the Co-Occurring Disorders Committee has been energized, moving forward with marketing the credential. Probably the largest factor in this new energy has been my new Co-Chair, Lee Dalphonse of Rhode Island. Many of you know Lee by his thoughtful contributions to IC&RC meetings. He has brought that same mind to our work, and I’m proud to call him my Co-Chair.

Another driver in our work is health care reform. Lee and I believe this is creating vast new opportunities for co-occurring professionals, and we want IC&RC Member Boards to be as prepared as possible to meet these growing needs. We’re glad to have an article from Andrew Kessler, IC&RC’s Federal Policy Liaison to discuss this issue more fully.

Lastly, we want to thank each of you who took the time to complete a survey on Co-Occurring Disorders last year. We hope you find the summary of results as interesting as we did.

Sincerely,

Dave Parcher
Co-Chair, Co-Occurring Disorders