The Solutions Building Community Collaborative began in January, 2007. The intention of the collaborative is to improve the services provided to persons with dual (DD-MI) diagnoses by pooling the expertise of the multiple systems involved, thus contributing to emerging best practices in this specialty field. The goals of the funding partner (State Department of Developmental Services) and the host agency (San Diego Regional Center) and their co-sponsor (San Diego Behavioral Health Services) are as follows:
1. Maintain and/or Increase Community tenure through focused, integrated and therapeutic service delivery.
2. Maximize a person's ability to cope with day-to-day life stressors in socially appropriate and productive ways
3. Increase a person's support network and identify ways to use this network for crisis prevention and community integration
4. Provide appropriate, therapeutic environments to facilitate mental and behavioral health strategies.
Project Strategies: Recognizing that these objectives are inter-dependent, three basic strategies to meet them were developed. The project uses extensive community education to all interested community stakeholders, cross systems planning and consultation and crisis care coordination. These strategies are implemented using a Specialty Assessment and Treatment (SAT) team16 who were individual experts from multiple systems. A steering committee comprised of key stakeholders from multiple systems provided oversight to these efforts.
PHASE I
In Phase I, Project leaders focused on high intensity, high frequency users of the community's emergency medical response systems including the Emergency Rooms, psychiatric inpatient hospital stays, the PERT team, 911 calls and police officers. The outcomes in Phase I confirm the effectiveness of using strategies such as training, a cross systems consultation team and cross systems plans to encourage collaboration and integrated treatment strategies. This initial phase provided a solid foundation for cross systems communication and collaboration in the treatment and care of individuals with dual diagnoses. The Phase I work pointed to the need for additional consultation to individuals who are experiencing a sudden worsening of mental health symptoms that may be placing them at risk of losing services in the community.PHASE II
In Phase II, the project added a consultation clinic that expanded the projects efforts to include more individuals who are dually served including those experiencing a sudden worsening of symptoms. The once a month consultation clinic with the SAT team provides consultation and navigation earlier in a person's illness in the hope that the individuals needs can be met and high frequency use of multiple systems will be reduced or eliminated. Building upon Phase I work, the SAT team supports existing providers in accessing resources across systems, providing consultation regarding presenting symptoms, medication reviews and behavioral strategies. The team members also provide whenever possible requested training to direct care staff and providers. The clinic began on May 6, 2009 and as of June, 2010 has provided consultation, training, advocacy, systems navigation and clinical care to 22 individuals over 13 months. Referrals were primarily from Regional Center staff with some referrals from other sources including UCSD, Community Health Group, family members, regional center and mental health providers. The clinic's initial feedback has been very positive and it is anticipated that this additional resource to the project will further contribute to the emerging best practices in this specialty field. The SAT team was able to provide systems navigation, medication reviews, behavioral assessment, training, clinical recommendations, medical recommendations and follow up consultation to referring community members.In Phase II resources identified as useful and needing further development included using Wellness Recovery Action Plans (WRAP), formalizing education to the community (the Certificate of Excellence) and adapted therapy using the principles of dialectical behavior therapy or DBT (SKILLS). In Phase II, support was provided to other projects through consultation including an MHSA (Mental Health Services Act) grant with Westside Regional Center, and training in Dual Diagnosis in LA and in Northern California to other providers.
Phase II again provided extensive community based education including 6 provider trainings around San Diego county, the third annual conference in Dual Diagnosis, the second annual Mental Health Resources Fair, the second annual Grand Rounds Presentation for doctors, and six classes in the Certificate of Excellence program.
PHASE III
Phase III of the Solutions Building Community Collaborative will continue efforts in Phase I & II including extensive Community Education efforts. In Phase II the 40 hour Certificate of Excellence in Dual Diagnosis was begun. Phase III will continue these classes and the Certificate Program including putting this program online for those unable to travel to San Diego for the face to face class instruction. Other Community Education will include the 3rd annual Mental Health Resources Fair, the 4th Annual Conference in Dual Diagnosis, County wide Provider Trainings and the 3rd Annual Grand Rounds presentation for the medical profession. This Phase will continue to provide monthly clinic consultations to all community stakeholders who serve individuals with dual diagnosis and are in need of additional assessment, training support, or systems navigation. Added to the team this phase is a second psychiatrist, a drug and alcohol specialist and a forensic specialist. This Phase will include a pilot project in group therapy specifically for individuals with dual diagnosis, using the SKILLS approach authored by Julie Brown. This approach is based upon the principals of Dialectical Behavior Therapy and found to be effective for persons with dual diagnosis who would otherwise benefit from DBT therapy.