Alcohol/Substance Abuse Programs At New York State Psychiatric Centers Develop And Expand...

By
Kathleen Sciacca, M.A.
Executive Director,
Sciacca Comprehensive Service Development
for Mental Illness, Drug Addiction, and Alcoholism (MIDAA)
299 Riverside Drive
New York, N.Y. 10025
(212) 866-5935

An alcohol/substance abuse treatment program in community services began in December of 1984 with the initiative of one group program and the development of a treatment model to address the multiple needs of this special client population. The program has grown steadily and is presently included in six of our Community Service Areas. An assessment questionnaire has been developed specifically for these clients, and the majority of treatment staff throughout the community reviewed this questionnaire and have access to its use.

The development of a Liaison Group of treatment staff throughout the community services is a major contributing factor to the implementation and success of our community programs, as is the interest and involvement of many of our professional staff.

In late 1984, faced with a majority of day treatment program clients who had alcohol and/or drug problems, a N.Y. State Day Treatment Team set out to find a solution. A first attempt was that of identifying and cultivating the use of outside treatment programs. This proved to be a discouraging pursuit, and an ineffective one as far as the treatment of our clients was concerned. As a result, a group for substance users was planned within the Day Treatment Program. Kathleen Sciacca volunteered and was selected for this new project. Although Sciacca had treated primary substance abusers for more than seven years before joining the New York State Office of Mental Health Staff, there was not a clear treatment model available that was directly applicable to the dually diagnosed client population with a primary chronic mental illness, and an alcohol or substance abuse problem. Sciacca developed a treatment model that continually adapted to the needs of this special population, and that features a "Non-Confrontational" approach. It is presently included in clinic programs, continuing treatment programs, day treatment programs and, inpatient programs.

The first group which began in December 1984, proved to be successful in both areas of client treatment and in programmatic improvements. Clients who attended the group improved along some of the following criteria:

1. They were better able to discuss their substance use problems more openly with staff and peers. 2. They gained insight into their substance using behavior.

3. They remained out of the hospital for longer periods of time.

4. They were able to attend outside programming such as A.A., N.A., in addition to Harlem Valley programs.

5. They remained abstinent from substance abuse.

6. They were able to give and receive support.

7. They gained education and awareness which included pertinent information about substance abuse.

Different clients improved along different dimensions. Programmatically, the following improvements took place:

1. Clients were clearly identified by staff as having alcohol/substance abuse problems.

2. Staff were better able to identify the interaction effects between substance use and psychiatric symptoms and to avert some hospitalizations.

3. There was a substance abuse program readily available when clients were discharged from inpatient or came from other referral sources. This enabled work on prevention to begin immediately with clients from inpatient.

4. As the program took hold, staff became more amenable to learning about the etiology and treatment of substance abuse, and more comfortable with addressing these issues with their clients.

The results of the treatment model and treatment program proved successful and a formal approach was taken to develop system-wide substance abuse programming throughout the multi-site community services. Liaisons for substance abuse programming were appointed and a Liaison Group was formed under the leadership of Kathleen Sciacca, Director. An overview of substance abuse treatment programming for community services was drawn up by Sciacca. It included assessment criteria and treatment objectives, a group treatment model, and individual treatment strategies. Later, the assessment criteria were separated out and developed to form a separate instrument. The assessment questionnaire serves as a treatment guide for use by primary therapists. Staff education and training needs were also outlined, and in part, included the presentation of some materials by Liaisons to staff at their respective Service Areas. Liaisons lead substance abuse groups within their Areas. Many of them have co-leaders who are not Liaisons which has enabled more staff to be included in treating this special population of clients.

Implementation of the program model in each of the community services is reliant upon the efforts of Liaisons to structure programs in their Service Areas.

In effect, the goals of the Liaison Group are as follows:

1. To unify and assure staff exposure to educational and training materials, and to introduce them to new program initiatives.

2. To provide education and training materials to Liaisons, as well as initiatives for learning at other training programs.

3. To provide a case conference that includes peer support and consultation for Liaisons who are providing individual and group treatment.

4. To review and learn new program initiatives such as screening tools, assessment tools, patient progress reviews, and to plan approaches to introduce these program initiatives to staff in the community.

5. To serve as a forum for invited guest speakers and literature and media reviews for education and training.

6. To network materials such as video tapes and literature to staff and clients throughout the community services.

7. To share experiences and resources from all aspects of substance abuse programming.

8. To develop treatment groups in the community that are in keeping with the treatment model and approach initially developed for this patient population.

The Liaison Group began meeting in November, 1985, and continues to meet once a month. New initiatives in substance abuse programming continue to develop throughout the community services. Six Service Areas provide substance abuse treatment some have more than one group, totalling eleven groups thus far.

Many of the clients who participate in our programming are actively using drugs and/or alcohol. Liaisons and other group leaders continually grapple with the difficult treatment issues these clients present. Liaisons also engage in addressing the issues inherent in introducing this programming and new initiatives into their Service Areas.

The treatment model and program proved replicable and adaptable to numerous program settings. At the request of many professionals from across other agencies, i.e., N.Y. State, county, voluntary agencies, and agencies from Connecticut, Ms. Sciacca has formed an "Inter-Agency Liaison group for the Advancement of treatment of the Mentally Ill Chemical Abusers (MICA)". This group, which also meets monthly (since May '87), has been the source of development of a variety of MICA programs in both inpatient and outpatient settings, and the source of education and training for program leaders, administrators, and direct care staff in the community who now provide services for MICA patients.

Ms. Sciacca has recently been appointed Mental Health Program Specialist to the New York State Office of Mental Health. She will be the Director of the first training site the State will establish to train professional staff to treat MICA patients. Ms. Sciacca will develop programs for various New York State facilities, and train the staff from those facilities to provide treatment and to implement programming.

Sciacca's program has grown to include initiatives for family members of MICA patients, and a collaborative treatment approach for necessary services that psychiatric facilities do not provide.

Ms. Sciacca has presented at numerous conferences, and she has conducted workshops, all day seminars and lectures across the country and in Canada. Her approach has sparked a great deal of enthusiasm among professionals from all of the disciplines. New programming, task forces, committees and academic courses have developed as a result of her work and her consultations.

It is clear that MICA patients are amenable to treatment and that they can improve along a number of criteria. As more attention is paid to this patient population, more professionals are gaining interest in providing treatment for them. As is evidenced in Sciacca's work, and her consultations, entire professional communities can engage in this effort once they are convinced that they can effect positive results through their treatment efforts and program initiatives.

Update: 12/17/87

Published: AID Bulletin, Addictive Intervention with the Disabled, Winter, 1987.