COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

COSIG Co-Occurring Disorders Conference, Hershey PA, May 15-17, 2006
Trauma History and Risk Assessment in the
Co-occurring Disorder Program Planning Model:
Case-based Implications for Treatment, Rehabilitation, and Recovery.
Trauma History and Risk Assessment
in the Co-occurring Disorder Program Planning Model:
Case-based Implications for Treatment, Rehabilitation, and Recovery.
Hershey, Pennsylvania
Stefan Larkin, Ed.D.
Gregory Sathananthan, M.D.
Kristina Muenzenmaier, M.D.
Linda L. Hawkins, M.D.
May, 2006
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© 2006, Dual Diagnosis Resources and Research, LLC.
®
© 2006, Dual Diagnosis Resources and Research, LLC.
Trauma History and Risk Assessment in the
Co-occurring Disorder Program Planning Model:
Case-based Implications for Treatment, Rehabilitation, and Recovery.
I. Brief History and Core Concepts
II. QUAD IV
III. Dual Diagnosis Program Planning Grid
IV. Case Exercise I
V. Stages of Change, Symptom Severity and Time
VI. Trauma and time
VII. Risk and Program Planning
VIII. Case Exercise II
IX. Questions and Discussion
Brief History and Core Concepts
1. The original New York Model (Larkin, 1987) grew out of a problem in
communicating about CoD clients: staff from different agencies and service
systems talking about their CoD clients would share and ultimately defend (on
the beaches, in the hills, on the landing grounds, never surrendering) the
policies and practices they knew to work, even though they and nobody else in
the room were talking about clients who were closely similar to one another.
The first New York model was the simple 2 X 2 grid seen below.
New York Model (Fall 1987)
HI
MI
HI -LO
HI -HI
LO -LO LO -HI
LO
LO SA
HI
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© 2006, Dual Diagnosis Resources and Research, LLC.
®
© 2006, Dual Diagnosis Resources and Research, LLC.
3. Before QUAD IV used the earliest version of the New York Model as a basis for
matching mental illness and substance abuse disorder symptom severity to
service systems and providers, the New York Model, what was then known as
the Dual Diagnosis Program Planning Grid, had already grown two additional
dimensions.
In 1988, Linda Hawkins, M.D., then leading a dual diagnosis day program at
Buffalo Psychiatric Center and on the New York MICA Training Task Force,
suggested adding Level of Function as an additional dimension to the model,
noting she had clients within the same quadrant of the first 2 X 2 version of the
New York Model, who if served together would relate as predator and prey.
The easiest way to understand this is to imagine that at this very moment there
is a CEO of a Fortune 500 company within 100 miles of here who has Bipolar
Affective Disorder and has been an alcoholic for more than 20 years and when
his depressive symptoms become severe and he increases his alcohol intake,
the corporate aircraft quickly brings the necessary psychiatrists to intervene.
Not far from the corporate headquarters there is a homeless shelter and in that
shelter is a person with schizophrenia who abuses crack. Both clients fit in the
same HI-Hi region of the New York Model pre Dr. Hawkins and QUAD IV. One
might expect the service systems for the two clients to be somewhat different.
In that same 1988 meeting, in literally the same breath five minutes later, Dr.
Hawkins and I said “and we have to add time as well. We need to know how old
was the person when they got each illness and how long have they been sick
with each illness? In 2000 Dr. Sathananthan detailed the time dimension to
include age of onset for each illness, and progression of each illness and up
until today the New York you will see on the next slide has been what we have
been using. Before we propose some changes we want to try using it with you.
Hi
®
© 2006, Dual Diagnosis Resources and Research, LLC.
®
© 2006, Dual Diagnosis Resources and Research, LLC.
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