Utilizing an intentionally integrated and developmentally-focused treatment approach, the Integrated Co-Occurring Treatment (ICT) model is framed by the structure of Intensive Home-Based Treatment (IHBT). The reciprocal interactions of Mental Health needs and Substance use needs are addressed directly, with each area of need considered ‘primary’. Other areas of need internal to the youth are also integrated, as are contextual interactions with external domains. As each of these areas, or dimensions, are conceptualized both individually and in interactive context of each other area, the ICT model is an Integrated Dimensional Approach of care for youth with co-occurring needs and their families with special attention to the impact of psychoactive substances.
ICT Model Basics
Youth
- 12 to 17 ½ years (typically)
- 18+ years may be considered if youth is expected to remain at home and under parental care/rules
- Have significant concerns related to mental health and substance use.
- Be living in a permanent placement with parents, caregivers or family (adoptive homes are considered permanent and family). Long-term foster may qualify, but must be reviewed and pre-approved.
Family
- Parent(s) or caregiver must be willing to engage in home-based treatment
- Parent(s) or caregiver will be expected to participate in weekly sessions/meetings with the ICT Therapist
- A Safety/Crisis Management Plan, Intake Assessment, and completion of research paperwork are expected portions of this participation.
- Unsecured weapons are not permitted in the home during ICT involvement.
Frequency/Intensity
- ICT Therapist will meet with the youth and family 2-5 times per week, for approximately 4 or more hours per week
- ICT Therapist will have a flexible schedule to accommodate parent(s) or caregiver
- ICT Therapist is Clinical Lead in the case (no other clinical services – except psychiatry. Care Coordination is also permitted and partnered.
- ICT Therapist provides all therapeutic services, including integrated individual and youth-focused family work, case management services and community coordination
- ICT Therapist or team member remains on call to youth/families 24/7
ICT Team
- Weekly case/model consultation calls or weekly case/model conceptualization teaming
- Dedicated (at least 50%) model supervisor; dually licensed and experienced
ICT Background
The ICT Model began with growing recognition of the lack of developmentally-appropriate, integrated and intensive programming for youth with co-occurring mental health and substance use needs. Models of care existed for adults with co-occurring mental health and substance use needs, but adult-designed models typically cannot effectively be matched to the unique needs of adolescents. With this understanding, in the fall of 1999, supported by the Ohio Department of Mental Health (now the Ohio Department of Mental Health and Addiction Services, or OhioMHAS), the Center for Family Studies at the University of Akron convened a group of state, university, juvenile justice, community stakeholders and youth and families to identify barriers and propose strategies to address this lack of youth-matched treatment availability. From these workgroups, and informed by experiences from existing practice approaches (eg: see The Homebuilders Model by Kinney, Happala, Booth and Leavit, 1990, ISBN 9781315128047; Everything is Normal Until Proven Otherwise: A Book About Wraparound Services by Dennis, Lourie and Jordan, 2006, ISBN 1587600781) the Integrated Co-Occurring Treatment (ICT) model was outlined. The history, design and initial implantation is described in the 2005 article The Integrated Co-Occurring Treatment (ICT) Model: A Promising Practice for Youth with Mental Health and Substance Use Disorders in the volume 1(3) issue of Dual Diagnosis (https://doi.org/10.1300/J374v01n03_11).
Role of CIP
In 2005, the Center for Family Studies developed a partnership with the Center for Innovative Practices (CIP) to disseminate ICT and to further develop and refine the model. The Center for Innovative Practices is one of the Ohio Department of Mental Health and Addiction Services’ (OhioMHAS) Coordinating Centers of Excellence. As of July 2007, the Center for Innovative Practices is the central location for the development, dissemination, and future research on ICT.
ICT has been recognized nationally as a promising program model in the Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System (The National Center for Mental Health and Juvenile Justice, 2007).
Additional ICT Description and Information
Download a 2-page brief about ICT: ICT Brief
View a 20-minute video about ICT: ICT Video
Read a 2013 article about the measured effectiveness of ICT: Behavioral Health in Ohio v1(2)
ICT Supportive Resources
Intensive Home-Based Treatment (IHBT)
Intensive Home-Based Treatment (IHBT) is a mental health service designed to meet the needs of youth with serious emotional disturbances who are at risk of out-of-home placement or who are returning home from placement. It is the service design utilized by ICT. The goal of IHBT is to provide the necessary mental health services and supports to enable youth to live in/remain in their homes in the least restrictive, most normative setting possible. IHBT services are provided in the home, school and community where youth live and function. These services focus on the mental health issues that put the youth at risk, while promoting positive development and health family functioning. IHBT integrates core mental health services (community psychiatric supportive treatment, behavioral health counseling and therapy, mental health assessment and crisis response) into one seamless service. Service is flexibly delivered at a time that is convenient for the entire family and is available around the clock
IHBT Links
Ohio Administrative Code 5122-29-28: IHBT
Ohio Department of Mental Health and Addiction Services (OhioMHAS)
Researchers at the Ohio Department of Mental Health and Addiction Services identify questions of importance to the agency and the public behavioral health system and lead studies that can inform planning priorities, disparities and quality of care. Major statewide research has been conducted on services and outcomes for adults with serious mental illness, as well as children/adolescents with serious emotional disturbances, and youth and young adults in transition.
American Society of Addiction Medicine (ASAM)
Ohio Administrative Code (OAC) 5122 (Dept of Mental Health and Addiction Services), Chapter 27 (Minimum Requirements for Integrated Clinical Records), Rule 7 (Addiction Treatment Levels of Care) indicates in part (B): Providers shall determine level of care at admission, for continued stay, for change in level of care recommendation, and at discharge by conducting a multi-dimensional assessment utilizing the American society of addiction medicine criteria, also known as the ASAM patient placement criteria.
See: OAC 5122-27-07
Also, youth appropriate for ICT services will have needs related to substance use at some level. As ICT is a specialty application of IHBT, it is likely the youth will be assessed using the Ohio Children’s Initiative Child and Adolescent Needs and Strengths (CANS). The Behavioral/Emotional Needs Domain rates needs related to Substance Use, and indicates that a “rating of ‘1’, ‘2’, or ‘3’ may also indicate that the youth may require an ASAM assessment. Please complete an ASAM assessment or refer the youth for an ASAM assessment to determine Medicaid medical necessity for SUD services”.
See: ODM CANS resources
In the preface of the 3rd edition of the American Society of Addiction Medicine’s The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions (2013), the purpose of ASAM is described as, “…to enhance the use of multidimensional assessments to develop patient-centered service plans and to guide clinicians, counselors, and care managers in making objective decisions about patient admission, continuing care, and transfer/discharge for various levels of care…” (p. x). It includes adolescent-specific treatment information at numerous points and has defined adolescent-targeted levels-of-care.
See: ASAM site
See: Nice primer by ASAM and Aetna
Substance Abuse and Mental Health Services Administration (SAMHSA)
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
Behavioral Health Juvenile Justice
The Behavioral Health Juvenile Justice (BHJJ) initiative, a shared effort of the Ohio Department of Mental Health and Addiction Services (OhioMHAS) and the Ohio Department of Youth Services (DYS), was created to enhance local options for providing services to juvenile offenders with serious behavioral healthcare needs. Pilot projects that started in a few Ohio counties in early 2000 have grown into a statewide initiative with strong support from additional state and local stakeholders. The projects are designed to transform child-serving systems by enhancing their assessment, evaluation, and treatment of multi-need, multi-system youth and their families. In addition, they provide th
American Society of Addiction Medicine (ASAM)
Ohio Administrative Code (OAC) 5122 (Dept of Mental Health and Addiction Services), Chapter 27 (Minimum Requirements for Integrated Clinical Records), Rule 7 (Addiction Treatment Levels of Care) indicates in part (B): Providers shall determine level of care at admission, for continued stay, for change in level of care recommendation, and at discharge by conducting a multi-dimensional assessment utilizing the American society of addiction medicine criteria, also known as the ASAM patient placement criteria.
See: OAC 5122-27-07
Also, youth appropriate for ICT services will have needs related to substance use at some level. As ICT is a specialty application of IHBT, it is likely the youth will be assessed using the Ohio Children’s Initiative Child and Adolescent Needs and Strengths (CANS). The Behavioral/Emotional Needs Domain rates needs related to Substance Use, and indicates that a “rating of ‘1’, ‘2’, or ‘3’ may also indicate that the youth may require an ASAM assessment. Please complete an ASAM assessment or refer the youth for an ASAM assessment to determine Medicaid medical necessity for SUD services”.
See: ODM CANS resources
In the preface of the 3rd edition of the American Society of Addiction Medicine’s The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions (2013), the purpose of ASAM is described as, “…to enhance the use of multidimensional assessments to develop patient-centered service plans and to guide clinicians, counselors, and care managers in making objective decisions about patient admission, continuing care, and transfer/discharge for various levels of care…” (p. x). It includes adolescent-specific treatment information at numerous points and has defined adolescent-targeted levels-of-care.
See: ASAM site
See: Nice primer by ASAM and Aetna
Substance Abuse and Mental Health Services Administration (SAMHSA)
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
Behavioral Health Juvenile Justice
The Behavioral Health Juvenile Justice (BHJJ) initiative, a shared effort of the Ohio Department of Mental Health and Addiction Services (OhioMHAS) and the Ohio Department of Youth Services (DYS), was created to enhance local options for providing services to juvenile offenders with serious behavioral healthcare needs. Pilot projects that started in a few Ohio counties in early 2000 have grown into a statewide initiative with strong support from additional state and local stakeholders. The projects are designed to transform child-serving systems by enhancing their assessment, evaluation, and treatment of multi-need, multi-system youth and their families. In addition, they provide the Juvenile Court judges an alternative to incarceration.
Considering ICT for your area or agency?
Contact
ICT and Integrated Care Consultant and Trainer
Michael Fox, MA, PCC-S, LCDC-III
Research Associate, Center for Innovative Practices
michael.fox2@case.edu
Considering ICT for your area or agency?
Contact
ICT and Integrated Care Consultant and Trainer
Michael Fox, MA, PCC-S, LCDC-III
Research Associate, Center for Innovative Practices
michael.fox2@case.edu
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Campus Location: 11235 Bellflower Road Room 375 | Cleveland, OH 44106
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Consistent with the Ohio Department of Medicaid’s (ODM) and OhioMHAS, rules to promote high-quality service, the IHBT Fidelity Tool was developed to ensure compliance with IHBT service delivery standards. Providers choosing to bill services under Medicaid’s IHBT bundled rate must be certified. Certification assures minimum fidelity standards are being met.