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RAND Cross-Site Evaluation of a National Demonstration Project for State Systems Improvement for Care of Individuals with Co-Occurring Substance Related and Mental Disorders

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Project Summary:

This project is one component of a larger three-phase effort designed by the RAND Corporation to identify and overcome clinical, organizational, financing, and policy barriers between the substance abuse and mental health fields to improve the treatment of individuals with co-occurring substance abuse and mental disorders (COD). This effort, funded by an active collaboration between the public and private sectors, has had a special clinical focus on individuals with substance use disorders that do not meet criteria for serious mental illness (SMI); typically those with mood and anxiety disorders who enter care largely through the substance abuse system. Phase I of this effort was designed to identify effective treatment programs and ways to overcome clinical, financial, and organizational barriers to providing high-quality care for people with COD. Phase II of the effort, of which the proposed project is one part, is designed to develop a formal in-depth implementation evaluation of the newly created Co-Occurring State Infrastructure Grant (COSIG) initiative developed by the Substance Abuse and Mental Health Services Administration (SAMHSA). This initiative is intended to stimulate states to develop and track innovative approaches that increase their capacity to provide "accessible, effective, comprehensive, coordinated/integrated, and evidence-based services to persons with co-occurring substance abuse and mental health disorders, and their families.” Phase III of the effort is designed to monitor and evaluate state-level efforts to improve quality of care, to encourage the application of evidence based practices, and to conduct the implementation evaluation designed in Phase II. We are requesting funding for a portion of Phase II of the project, for a period of one year, specifically to conduct the first wave of the implementation evaluation of the COSIG initiative. This portion of Phase II has two aims to: -examine state-level goals, strategies, and policy or programmatic activities intended to improve access to or quality of COD services. -define and begin to develop process of care measures that can be used to evaluate the impact of state policy and programmatic initiatives. To accomplish Aim 1, we will interview key officials within state mental health, substance abuse, and Medicaid authorities in the early implementation phase of their COSIG initiatives. To accomplish Aim 2, we will collaborate with states to: 1) define process of care variables that link to intended goals, 2) evaluate existing capability to measure and monitor these variables, 3) identify opportunities to conduct evaluations of the impact of their COSIG initiatives on access to and quality of COD services. For each of these aims we will especially consider the impact on the clinical population noted above.

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