Neighboring puts premium on IDDT fidelity, innovative outreach to homeless

—by Paul M. Kubek and Matthew K. Weiland

Mentor, OH—A few years back, the City of Painesville had a problem: what to do about the homeless population hanging out in its picturesque town square. Painesville is the seat of Lake County and is a center of civic and commercial activity. Its storefronts, offices, and county courthouse make it a busy place. And while the homeless were mostly a non-threatening presence, they were known, at times, to be a little disruptive.

To find a solution that was both sensitive and helpful to all, including the homeless, the local United Way convened a group of community service organizations and other stakeholders. For NEIGHBORING, a mental-health and substance-abuse service agency headquartered in the City of Mentor, this was another chance to step up and help out. They knew from years of experience in Lake County that many homeless persons suffered from severe mental illness. Ultimately, the organization and its Integrated Dual Disorder Treatment (IDDT) team began collaborating with 12 other organizations in a new assertive-outreach initiative that illustrates one of the reasons why NEIGHBORING is the 2008 recipient of the Ohio SAMI CCOE's third annual Lynn Goff Spirit of Integrated Treatment Award.

Stages Of Treatment & Motivational Approaches

Here's how the partnership took shape. The Salvation Army was already providing services to non-homeless populations in the evening just south of the town square, so it decided to open its doors during the daytime hours as well, giving its community partners a space to access and provide their services to the homeless—services such as meals, nursing care for acute medical needs, and transportation, among others. NEIGHBORING was already providing mental health outreach in other parts of Lake County, so it decided to make a case manager available at the Painesville facility twice a week, simply to provide homeless persons with a friendly face and a safe and trusted presence. This person would also provide counsel, facilitate educational peer-support groups, and help consumers navigate the various social service systems—if and when they expressed the need.

According to NEIGHBORING's Chief Operating Officer Ken Gill, MSSA, LISW-S, LICDC, the mental health outreach was not initially designed as an IDDT initiative. However, the implementation team chose to utilize some of the core components of the IDDT model. For instance, the team decided to use the stages-of-treatment approach, which emphasizes that in the initial engagement stage, each service provider simply seeks to build trust with consumers. The team also chose to use motivational interviewing, a conversational therapeutic technique that equips service team members with skills to help people assess their own readiness, willingness, and ability to make meaningful personal changes in their lives.

"We felt that it would be a good opportunity for outreach in a way that we hadn't been doing before, and not just for our IDDT program but for the behavioral healthcare system at large," says Gill. "I think we've been able to engage a number of new folks in services, and that's great."

Gill adds that it wasn't long before NEIGHBORING's service team discovered that a significant portion of the homeless population exhibited symptoms of both severe mental illness and substance abuse. Therefore, it quickly made the outreach initiative at The Salvation Army an extension of its IDDT services.

Learn more about the homeless outreach initiative.

Above And Beyond The Fidelity Scale

Now in its third year, The Lynn Goff Spirit of Integrated Treatment Award has become an annual tribute to a service organization that consistently goes above and beyond the expectations of the IDDT model and, in doing so, raises the standard of exceptional care.
According to Ric Kruszynski, MSSA, LISW, LICDC, director of consultation and training at the Ohio SAMI CCOE, the Lynn Goff Award is designed to highlight a team that not only achieves high fidelity to IDDT but also finds innovative ways to implement the model's core components. For instance, the IDDT fidelity scale requires service organizations to provide assertive outreach in the community. However, it does not require an organization to collaborate with community partners to resolve a local problem like homelessness on the town square.

"NEIGHBORING has continued to pursue new innovations to enhance their services continually," says Kruszynski. "They've created new initiatives such as their Salvation Army assertive outreach effort and an art-therapy approach to enhancing persuasion groups. They haven't stopped there. They have also gone on to implement additional EBPs [evidence-based practices], developing excellence in Supported Employment and Wellness Management and Recovery."

Kruszynski adds that NEIGHBORING is also very generous with other organizations interested in professional peer-networking. It has hosted other IDDT teams to teach them about the challenges faced and successes achieved during the implementation process. IDDT teams throughout the Buckeye State have made the trek to the Mentor agency, along with interested integrated-treatment pilgrims from Duke University and The Netherlands.

An Innovative Force For Lake County

NEIGHBORING began in the late 1960s as a small agency and has grown along with Lake County's population. NEIGHBORING has become a full-service CARF-accredited outpatient mental health and substance-abuse services organization.

According to Dual Diagnosis Program Supervisor Deana Leber-George, MEd, PCC-S, the agency provides services for almost 1,800 adult consumers. Approximately 130 to 150 adults have been diagnosed with co-occurring severe mental and substance use disorders, and approximately 75 (the team's current maximum capacity) receive IDDT services from a team consisting of the following:

  • 3 therapists
  • 3 case managers
  • 1.5 Supported Employment specialists
  • 1 nurse liaison
  • 1 psychiatrist
  • 1 team leader

The team has helped consumers achieve some impressive outcomes. "These women are not just here to do a job," says Leber-George. "They completely believe that they can make a difference in the lives of people. I'm inspired by them." Learn more of our conversation with Leber-George.

Community Support And Board Buy-In

According to COO Ken Gill, none of NEIGHBORING's success would be possible without exceptional community support from local businesses, residents who continuously vote for the tax levies that help fund services, and the Lake County Alcohol Drug Addiction and Mental Health Service (ADAMHS) Board.

Gill has provided the leadership to nurture the important relationship with the board by making a conscious effort to keep its members informed and to solicit their input during the implementation process.

"You need to identify whose support you will need internally and externally to be successful with a project," says Gill. Read more of our conversation with Gill.

Impressive Numbers

Populations served:

  • 1,800 total adult consumers
  • 650 to 700 with severe mental illness
  • 130 to 150 with co-occurring mental and substance use disorders eligible for IDDT services
  • 75 receiving IDDT services (max. team capacity)
  • IDDT service team
  • 3 therapists
  • 3 case managers
  • 1.5 Supported Employment specialists
  • 1 nurse liaison
  • 1 psychiatrist
  • 1 team leader
  • A sample of IDDT outcomes
  • Numbers for May 2008 are as follows:
  • 75 consumers served
  • 52 have their own apartments
  • 18 live with family members
  • 48 are compliant with medication treatments (10 unknown)
  • 11 have family members active in psychoeducational programs
  • 25 employed competitively for at least 10 hours a week
  • 6 are attending school, either toward technical training or college degrees
  • 38 reported total abstinence from alcohol and other drugs
  • 36 reported being involved in 12-step programs (e.g. AA, NA, or DRA)
  • 4 reported some alcohol or drug use without impairment, hospitalization, or incarceration
  • 6 reported being incarcerated for three days or fewer

Paul M. Kubek, MA, is director of communications at the Center for Evidence-Based Practices at Case Western Reserve University. Matthew K. Weiland, MA, is senior writer, producer, and new-media specialist.