Integrated Co-Occurring Treatment
The Purpose of the ICT Model
- To improve treatment outcomes for youth and families including:
- Decreased substance use disorder symptoms
- Decreased mental health disorder symptoms
- Decreased juvenile justice charges and placements
- Decreased out of home placements
- Improved school functioning
- Improved family functioning
- Improved community functioning and involvement
- To provide clinicians with a process and framework for organizing information in order to assess, conceptualize, and intervene in a coordinated and integrated fashion.
- To assist clinicians with the positive engagement and retention of youth and families, as well as, better recognition of family culture and contexts.
- To aid clinicians, program leaders, and relevant stakeholders in creating realistic service expectations
- To decrease clinician frustration, burnout, fatigue when dealing with a challenging population.
ICT Target Population
ICT providers work with adolescents 12-17.5 years old who exhibit co-occurring mental health and substance use disorders. ICT is also intended to provide intervention that impacts the contextual factors that impact and are affected by the youth’s co-occurring disorders. Thus, ICT requires both youth and family participation which means at least one parent/guardian needs to be involved in the intervention process.
ICT Program Background and Piloting
In the fall of 1999, with the support of the Ohio Department of Mental Health (ODMH), the Center for Family Studies at the University of Akron convened a group of state, university, and community experts (including youth and families) to develop an integrated treatment program especially designed for adolescents with co-occurring disorders and their families.
The guidelines for the model development were that services had to include the following components:
- System of Care service philosophy, including the centrality of partnerships with youth and family; cultural mindfulness
- Integrated treatment approach
- Home-based intervention service delivery mechanism
- Developmentally appropriate
- Components that are grounded in prior empirical research
- Theoretically and conceptually driven
One of the central goals was to make the model salient to youth, families, and practitioners alike. To this end, a combination of consumer feedback, practice-based knowledge, and review of the literature citations was employed in the development of the model. Four focus groups were convened and feedback from youth, parents, juvenile justice, mental health, substance abuse, and school professionals was utilized to inform the workgroup’s decision making for the model.
Pilot Implementation Study
The resulting model was initially piloted in Akron, utilizing funding through federal juvenile justice grants (Juvenile Accountability Block Grants; Byrne Grant). ICT was compared to a group of court-involved youth, identified with substance abuse problems who received usual community services. This usual services comparison group (n=29) had a Department of Youth Service commitment rate of 72% during a two-year time frame from 2000 to 2001. In comparison, the ICT youth (n=56) had a commitment and/or recidivism rate of 25%. Because the time frames for the two cohort groups were different and the groups were not matched for co-existing mental health diagnoses one must cautiously interpret this comparison. However, the size of the difference in commitment and/or recidivism rates [c2 (1, 29): 17.74 with a level of significance of .001], was promising and supported our goal for continued study of this innovative model. ICT is currently in the middle of its second study and plans are underway to pursue a randomized controlled study of the model.
In 2005, the Center for Family Studies developed a partnership with the Center for Innovative Practices to disseminate ICT and to further develop and refine the model. The Center for Innovative Practices is one of the Ohio Department of Mental Health’s Coordinating Centers of Excellence. As of July 2007, the Center for Innovative Practices is the central location for the development, dissemination, and future research on ICT. Recently, ICT was recognized nationally as a promising program model in the Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System (The National Center for Mental Health and Juvenile Justice, 2007).
Current Implementation Sites
Currently, ICT is being implemented in 4 sites nationally: Akron, Ohio (current site); Cuyahoga County, Ohio (current site)-(SAMHSA and CSAT grant funded); Kalamazoo, Michigan (current site)-(SAMHSA); and Salinas, California (past site), McHenry County, Illinois (current site).
ICT Core Components
The core ingredients of the ICT model pertain to a variety of clinical processes. The notion of a standard-based, process-oriented model is in accordance with the standards adopted by the Co-Occurring Centers of Excellence, (2006). Practitioners seldom have as much evidence as they would like about the ‘best’ clinical approach to use in any given situation. This is particularly true of the co-occurring disorders population, given its heterogeneous nature. Choosing the optimal approach for each client requires clinicians to draw on a variety of sources including research, theory, practical experience, and client perspectives. Picking the best options available in the moment using the best information available has been referred to as “evidence-based thinking” (Hyde, P.S., Falls, K., Morris, J.A., & Schoenwald, S. K., 2003). It is also important to consider culture, community values, and the competing priorities that are not generally informed by research (Reed, 2005).
The ICT core treatment components are listed below: