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By Howard Shiffman, MA

Monday, November 19, 2012

We are more than the sum of our parts. In the past year, OPEN MINDS has had lots of coverage of the effects of co-morbid conditions (see Health Care Costs Higher in Patients With Chronic Medical Conditions & Comorbid Psychological Disorders , Risk Of Inpatient Stay Six Times Higher For People With Mental Illness & Opioid Dependence all members, and Costs of Complex Consumers Dominate Health Policy Concerns all members) and the emerging models for “integrated” treatment (see Why Should Behavioral Health Organizations Consider Primary Care Integration Strategies? and Thinking About Integration? You’re Not Alone all members). With my interest in children, I was particularly interested in a related story that ran in the OPEN MINDS Weekly Wire earlier this month – see Co-Occurring Disorder Treatment Programs Superior In Reducing Youth Substance Use .

The research found that for adolescents with addiction problems, facilities offering comprehensive treatment for co-occurring disorders reported lower substance use, than programs with less comprehensive psychiatric services or no psychiatric services. This is one more testament to the phenomena of co-morbid conditions and the power of integrated treatment.

I think the study results have big implications for program planning for organizations that serve adolescents for two reasons. The first is that children that have mental health and substance abuse problems are an increasingly common focus of payers – and programs that address one condition and not the other don’t appear to be the best treatment choice. The second reason is the need to shrink the 5% of high-utilizing adults, before they become adults.

The new paradigm for treating the whole child and working with co-occurring problems is progressing toward the concept of integrating services for youth. Integration of mental health, substance abuse and physical health is already well on its way to becoming the “new normal” in the adult population (see An Executive Update On Integrated Care Models For Behavioral Health Systems ). I predict that the way we treat youth with co-occurring disorders will soon encompass physical health interventions and be required by payers. The emerging health homes for children are just one example of this type of integrated model.

In the adult population, the fact that 5% of U.S. population with multiple chronic conditions account for half (49 percent) of health care spending (see Five Percent of Americans Responsible for Half of U.S. Health Spending ), is a major challenge in our national drive to “bend the cost curve.” Any investment in children’s treatment that prevents the youth with the co-occurring disorder from becoming that “high resource using” adult is a great investment.

Our team is committed to keeping you posted on this emerging research data – and on the integrated models for serving children that are developing in many markets. I will keep you posted on how co-occurring disorders treatment progresses across the country and what we learn along the way.

Howard Shiffman
Senior Associate, OPEN MINDS

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For another free resource, see: Specialist Strategy In A World Of Integrated Care  all members

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