In the state of Maine, a Co-Occurring State Incentive Grant (COSIG) from SAMHSA funds systems integration to improve treatment for persons with co-occurring substance-related and mental disorders. The HRC talks with Catherine Chichester, Executive Director of the Co-Occurring Collaborative Serving Maine (CCSME) to learn more about the initiative.
The Co-Occurring Collaborative Serving Maine (CCSME) is comprised of over 50 agencies and individuals, some of whom have life experiences with co-occurring conditions, that work together to coordinate and integrate services for people who experience co-occurring disorders. Their goal is to reduce reducing barriers to service and to create effective, integrated community based services
A Co-Occurring State Incentive Grant (COSIG) from SAMHSA to the Maine Department of Health and Human Services (DHHS) funds a portion of CCSME’s current work through the Office of Substance Abuse. The COSIG grant funds have supported CCSME, in partnership with DHHS, in enhancing the treatment of persons with co-occurring substance-related and mental disorders. COSIG funds at the state level have supported changes in the infrastructure in order to provide accessible, effective, comprehensive, integrated, and evidence-based treatment services to people who experience co-occurring substance abuse and mental disorders.
Catherine (Kate) S. Chichester is the Executive Director of CCSME. She shares the story of her journey to the work of systems integration. Kate began her career as a nurse working in psychiatric behavioral health environments. “I was struck by the separation between psychiatric services and substance use services,” she says. After observing the separation between substance use treatment and mental health services, she began focusing on systems integration, earning a MS in the process. In 1992, Kate was hired by an agency that had received a grant from the Maine Office of Substance Abuse to lead a collaborative project on systems integration. After several years Kate oversaw the incorporation of that project as a Maine non-profit agency, the CCSME. It has become her life’s work.
“I have seen so many people who have been affected by mental health and substance use issues and I want to make this an easier process for each person who needs support. Everyone deserves a happy life,” says Kate.
She quickly recognized that the collaborative needed to help agencies develop better relationships. “Much of our work has been about building relationships with both individuals and systems,” explains Kate. The initial plan was to develop one common assessment tool that each agency would use. This shifted to building relationships. Each member agency looked at their own assessment tools and built in components that they needed. At the time, people were not talking about the interplay between substance use and mental health, just if they included mental health and substance abuse services.
“Today we ask how one is affecting the other over the course of a person’s recovery, using a strengths-based approach,” says Kate. “I think there are so many pathways to recovery. I feel it is important to recognize that treatment is only a small piece of this particular pie.”
“The recovery movement,” continues Kate, “is creating more opportunities for people who have experienced these challenges to be part of the solution in creating change and to mentor others as a natural part of the recovery process. This helps reduce stigma."
Moving away from a pathology-based approach has created opportunities to improve treatment systems and communities in Maine. “We have embraced people, encouraging individual involvement in their own recovery,” says Kate. CCSME was the first group in the state of Maine to validate consumer involvement by hiring people who experience co-occurring disorders on an ACT Team and as participants in the CCSME. This kind of coordinated effort brought many people together to be part of the systems change process.
As a result of the COSIG grant, CCSME has been able to chip away at the policies and language that sustain old practices, creating a pathway for systems integration. “My hope is that we have created enough change to build momentum at all different levels. CCSME has addressed projects related to criminal justice, diversion, and bringing together medical and behavioral health providers. “We were able to change some of the language and regulations. Substance use regulations now have integrated language,” says Kate. Under the COSIG grant a uniform screening tool for use by all mental health and substance use providers in Maine that addresses mental health, substance use, and trauma was adopted.
Across the state, the COSIG grant supported 30 different pilot sites for improving integrated treatment services for people with co-occurring disorders. CCSME worked individually with agencies to develop action plans and to help them meet their objectives. They addressed policies, procedures, screening and assessment tools, and provided training. They have also brought agencies from around the state to meet with each other to build relationships, share experiences, and network with each other. “We observed that agencies would generate excitement when they shared how they were responding to issues related to mental health and substance use,” says Kate.
“Public systems are slow to change. It is both grassroots organizing and figuring out how to address larger systems issues. I hope that the new Federal Healthcare Reform can be a catalyst for change,” says Kate. She is hopeful about change. She believes that it is important to celebrate at every stage with the people who have been part of the process.
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