Southeast Human Service Center is a behavioral health treatment clinic in Fargo, North Dakota. In the early 2000s, the staff was seeing more clients with both severe mental health and substance abuse issues. Many were dying. 

In 2006, they reached out to a center within Case Western Reserve University (CWRU) for help. 

The Center for Evidence-Based Practices (CEBP) is a data and research lab in CWRU’s Begun Center for Violence and Prevention Research and Education. CEBP, which evaluates effective addiction treatment programs, suggested the North Dakota clinic try a new approach: Integrated Dual Diagnosis Treatment (IDDT).  

In IDDT, mental health services and addiction treatment services work together to provide care and to support the client in building safe and trusting relationships in their recovery process. In the early 2000s, this was not a widespread treatment practice. The Cleveland lab, which specializes in helping centers provide this care, trained the clinic’s staff in dual diagnosis treatment.

Rick Kruszynski, director of CEBP, said in a recent interview that the clinic was able to provide its clients “a quality of life that seemed impossible.”

Over time, the clinic’s hospitalization, emergency room visit and incarceration rates decreased significantly. Housing stability and employment improved. 

“Their outcomes were off the charts,”  Kruszynski said. “Now, we are aiming to do that same technique on a much grander scale in our own state to improve our population’s health.” 

In May, CWRU received a $6 million state grant to establish a Substance Use Disorders Center of Excellence. This center will focus on providing further training to addiction care providers while also building a more robust network of behavioral health care providers to ensure that resources are more accessible. 

“With the rise in overdose deaths in Ohio, a lingering opioid epidemic and a surge in methamphetamine abuse, we are seeing a lot more drug related deaths,” said Kruszynski, who will lead the new effort. “Support for this kind of work is crucial in solving a problem and having continuing access to education, tools and technology in place for providers to make sure needs get met.” 

Since 2015, there’s been a 279% increase in fentanyl-related deaths in the United States, according to the National Institutes of Health of Drug Overdose rates and the Centers for Disease Control and Prevention. Ohio has the fourth highest overdose rate in the nation. Eighty-one percent of overdose deaths in 2020 in Ohio involved opioids and the combination of fentanyl and other illicit drugs, according to data from the Ohio Department of Health. 

CWRU was awarded funding from the federal Substance Abuse and Mental Health Services Administration–it will give the Cleveland group $6 million in American Rescue Plan Act dollars over three years to fund the center for excellence. 

The first round of trainings the center will offer statewide begins early fall and will continue over the next few years. The hope is that each wave of training and engagement with nonprofit organizations and healthcare systems will create a sense of community among network providers to share resources and engage in conversations about how to better support those in crisis. 

Center of Excellence offers hope to help local addiction treatment centers

An estimated 600,000 Ohioans have a serious mental illness, and nearly 900,000 residents struggle with a substance use disorder, according to the Ohio Department of Mental Health and Addiction services. 

The demand for behavioral health services rose statewide by 353% between 2013-2019, while the health workforce increased by only 174%. The state health department estimates that nearly 2.4 million Ohioans live in areas with too few behavioral health professionals. 

The COVID-19 pandemic and its lockdown also accelerated the mental and behavioral health crisis in the state, leaving addiction treatment providers racing to keep up with the growing need for care. 

This increase in demand, sparse staffing, and an evolving healthcare workforce have strained the behavioral health system statewide and locally. It is something that Daniel Lettenberger-Klein, CEO of Stella Maris, knows firsthand. Stella Maris is one of Cleveland’s oldest and largest addiction treatment providers. Klein said that 95% of the center’s clients are low-income. 

“Over the last several years, with the ongoing opioid epidemic and pandemic going on simultaneously, we really were challenged to think about a new hybrid model of care,” Klein said. 

“Connectivity is crucial for us and our work,” he added. “It was put under strain because of the pandemic and because the type of recovery model we use is a community based, therapeutic [model] where everybody’s living together in a relationship together, and that for us is really at the foundation of effective recovery programming. 

Now other organizations can benefit from the training and education that Stella Maris’ staff gained from working with the CWRU group.

Having Case Western in our backyard ultimately makes us a pilot and model for others,” Klein said. “It’s taking a necessary step first towards legitimizing [this work] and having the data and information that can change communities and help us meet needs faster.” 

For Klien, it’s also more than just recognizing the work: It’s the opportunity to connect with organizations across the state. 

“We can all get better, and we should be getting better to make sure the clients get everything that they deserve and more,” Klein said. “But having the support of an academic institution just helps speed up that process and create more dialog in our community.”

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Health Reporter (she/her)
Candice, a Cleveland Documenter since 2020, has been a freelance writer whose reporting and digital media work have appeared in The Daily Beast, VICE, Cleveland Magazine and elsewhere. She has written about health, equity and social justice.