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Competency 1: Overview and Definition of Co-Occurring Disorders & Integrated Care

Skill 1A: Able to define what a co-occurring disorder is, share information on the prevalence of co-occurring disorders, and promote the importance of integrated treatment.

  • Knowledge of the prevalence rate of co-occurring disorders and barriers to receiving care.
  • Knowledge that overall health is influenced by many factors (genetics, behavior, environmental and physical influences, medical care and social factors). 
  • Familiarity with the impact of the social determinants of health.
  • Knowledge of the impact that age, gender, race, and culture have on the prevalence rate and treatment of individuals with co-occurring disorders.
  • Knowledge of Integrated Care Models and Treatment and the importance of treating both disorders at the same time.
  • Understanding the limitations of only treating one disorder at a time.
  • Understanding the barriers of addressing each disorder at different locations, by different clinicians and/or programs.
  • Understanding that while integrated treatment is the goal, not all treatment organizations have capacity for integrated care (i.e., organizational structures and systems, certifications, staff and capacities to treat both categories of disorders in one place). However, all treatment programs have, or can develop, the capacity to coordinate care.

Skill 1B: Able to understand and describe an individual’s mental-health and substance-use history.

  • Knowledge of common mental-health terms.
  • Knowledge of common substance-use terms.
  • Knowledge of commonly misused drugs.
  • Knowledge of psychotropic medications.
  • Knowledge of medication-assisted treatment.

Skill 1C: Able to explain the comorbidity in co-occurring disorders in a way that individual and families can understand.

  • Knowledge of how substance use and mental illness interact.
  • Knowledge of how co-occurring disorders and other disorders interact.

Skill 1D: Able to identify both risk and protective factors that contribute to substance-use and mental-health disorders.

  • Knowledge of the characteristics (biological, psychological, family, community, or cultural) that are associated with a higher likelihood of developing a mental-health or substance-use disorder.
  • Knowledge of the characteristics associated with a lower likelihood of developing a mental-health or substance-use disorder or that reduce a risk factor’s impact.

Skill 1E: Able to identify common triggers and coping strategies as they relate to mental health and substance use.

  • Knowledge of triggers and warning signs that maintain or increase substance-use or mental-health symptoms.
  • Knowledge of coping strategies that relieve symptoms.
  • Understand that diet, sleep, stress, gut health, and exercise impact overall physical and behavioral health.

Skill 1F: Able to engage individuals with complex needs in a welcoming manner at all points within an integrated system of care.

  • Knowledge that successful engagement involves instilling hope, treating individuals with respect and dignity, and supporting individuals as active participants in their care.
  • Understanding the importance of establishing and maintaining engagement and alignment with individuals and other key players throughout the treatment process.
  • Knowledge that establishing a good rapport impacts an individual’s initial and ongoing engagement in the treatment process, as well as treatment outcomes.
  • Knowledge of the stigma and internalized stigma experienced by people with co-occurring disorders.
  • Understanding how the presence of a substance-use disorder and mental illness might impact an individual’s ability to engage in treatment.
  • Understanding the importance of identifying an individual’s readiness to change, knowledgeable of the stages of change and of the tools for strategies and tools to promote treatment engagement.
  • Knowledge of system-level barriers to treatment engagement (housing, financial, insurance, transportation, etc.).
  • Knowledge that cultural minorities are underserved in the current behavioral-health system and barriers that present, which include mistrust of the behavioral-healthcare system based on previous experiences, historical oppression, culturally based help-seeking behaviors, individual and institutional discrimination, and lack of cultural competency on the treatment community’s part.
  • Knowledge of the adjustments needed to make behavioral-health treatment accessible and effective for different ages, races, cultures, ages, genders, and sexual orientations.

Resources for Skill 1F

Skill 1G: Able to identify the supports available to individuals with co-occurring disorders, as well as the barriers that present when integrating care for individuals with co-occurring disorders in Anne Arundel County.

  • Knowledge of the various local and national agencies often utilized by individuals with co-occurring disorders.
  • Knowledge of own organizations’ role within the larger behavioral-health system.
  • Knowledgeable of the barriers to service integration in Anne Arundel County.

Skill 1H: Able to identify the steps of the treatment and recovery process (screening, assessment, diagnosis, treatment, recovery, and wellness).

  • Understanding that engagement and building a therapeutic rapport is the first step in the treatment process.
  • Understanding the difference between conducting a screen (identifying the possibility of having a disorder) vs. an assessment (confirming the presence of a disorder, the type, severity, protective factors, and other disorders that are present that affect the functioning of the patient).
  • Understanding that a diagnosis often follows a comprehensive assessment and is the identification and labeling of a disorder based on its signs and symptoms. Clinicians (licensed drug and alcohol counselors, licensed clinical social workers and counselors, psychiatrists, psychologists, and psychiatric nurse practitioners) diagnose mental disorders and substance-use disorders using the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM).
  • Understanding that a comprehensive assessment serves as the basis for an individualized treatment plan that is matched to the individual needs, readiness, preferences, and personal goals.
  • Understanding that treatment refers to the services provided, such as therapy or counseling, and/or medication that incorporate strategies and techniques to address the treatment plan goals.
  • Understanding that recovery supports and services that reinforce (peer support, family, housing assistance) can work in conjunction with treatment and support gains made in treatment.
  • Understanding that recovery as defined by SAMHSA is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
  • Understand that wellness as defined by the World Health Organization, is a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his or her community.