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Integrative care strategies for older adults experiencing co-occurring substance use and mental health disorders (I-CARE)…

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Integrative care strategies for older adults experiencing co-occurring substance use and mental health disorders (I-CARE)…

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Content 1
Integrative Care Strategies for Older Adults experiencing Co-occurring Substance Use and
Mental Health Disorders (I-CARE)
A Training for Clinicians Working with Patients 55+ in Addiction Treatment Centers
by
Nicole R. Groschen MSW LICSW
A Capstone Project Presented to the
FACULTY OF THE USC SUZANNE DWORAK-PECK SCHOOL OF SOCIAL WORK
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
Doctor of Social Work
December 2024

2
Contents
Abstract.......................................................................................................................................... 4
Positionality Statement................................................................................................................. 6
Problem of Practice and Literature Review............................................................................... 8
Conceptual/Theoretical Framework ......................................................................................... 15
Methodology ................................................................................................................................ 17
Project Description ..................................................................................................................... 20
Implementation Plan .................................................................................................................. 27
Evaluation Plan........................................................................................................................... 29
Challenges/Limitations............................................................................................................... 30
Conclusions and Implications.................................................................................................... 32
References.................................................................................................................................... 34
Appendix A – Solution Landscape Analysis............................................................................. 45
Appendix B – Design Criteria.................................................................................................... 46
Appendix C – Low Fidelity Prototype ...................................................................................... 48
Appendix D - High Fidelity Prototype A & B .......................................................................... 49
Appendix E - Logic Model ......................................................................................................... 50
Appendix F - Logo ...................................................................................................................... 51
Appendix G - Mockup marketing image with Catch Phrase................................................. 52
Appendix H - Infographic .......................................................................................................... 53

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Appendix I - Line Budget.......................................................................................................... 54
Appendix J – Pretest and Posttest............................................................................................. 55
Appendix K - Action Plan .......................................................................................................... 59

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Abstract
Substance use disorders (SUD) among older adults represent one of the fastest-growing
health concerns in the United States, outpacing all other age groups in the United States, with
one in six older adults struggling with substances. This project focuses on a clinically tailored
training program designed to treat older adults (55+) with co-occurring SUD and mental health
challenges. This initiative seeks to fill crucial gaps in care by delivering patient-centered,
evidence-based interventions to clinicians during the onboarding process after hire, along with
yearly training for staff that work directly with patients. This onboarding program emphasizes a
holistic approach and understanding of the system's dynamics while prioritizing patients'
multifaceted needs and experiences through the systems theory and human-centered design
(HCD) approach. Drawing upon gerontology evidence-based practices to enhance current SUD
programming, this training focuses on developing core skills such as active listening, therapeutic
communication, and dual-diagnosis assessment. The theory of change posits that implementing
this comprehensive training program will yield long-term positive outcomes, including enhanced
patient access to integrated treatment modalities, alleviating financial burdens on geriatric care
systems, and strengthened community support for older adults in recovery from co-occurring
disorders. Recognizing and addressing systemic barriers to treatment access, including structural,
legal, and policy challenges, is integral to the success of this initiative. Continuous evaluation,
stakeholder engagement, and iterative adjustments to the training program are essential to ensure
its ongoing relevance and scalability to improve the quality of care for older adults with cooccurring SUD and mental health issues in residential settings.

5
Acknowledgments
I want to express my deepest gratitude to those who provided unwavering support,
guidance, and encouragement throughout this project.
First and foremost, I am deeply thankful to my review committee. I could not have
achieved my goal without them. To my Chair, Dr. Ron Manderscheid, who provided clear
direction and challenged me to envision the future expansion of this program. I also extend
thanks to my faculty reviewer, Dr. John Clapp, and external design partner, Dr. Edith Gonzalez.
Your valuable time, thoughtful feedback, and constructive suggestions enhanced the quality of
this Capstone project. My colleagues, deserve special thanks for their ongoing consultation, with
special thanks to Christine, Nancy, and Vidya. Their shared knowledge, resources, feedback,
camaraderie, and support throughout this journey cannot be overstated.
I am also grateful to the Hazelden Betty Ford Foundation for their professional support,
which made this research possible. This project would not have been feasible without the
opportunity to research and pilot this program with the clinicians and patients who are directly
impacted by substance use and mental health challenges daily.
Finally, I would like to acknowledge the unwavering support of my family and friends.
Their patience, encouragement, and understanding have been a constant source of strength. I am
incredibly grateful to my spouse, sons, mother, siblings, and closest friends. Your support and
belief in me were crucial to achieving this goal. While no amount of appreciation can fully
convey my gratitude, please know that your support was deeply valued and instrumental in
reaching goals I once thought impossible.

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Positionality Statement
My journey into studying older adults with substance use disorders was unexpected.
Growing up in a rural Scandinavian farming community with strict Evangelical Lutheran beliefs,
I couldn’t imagine anyone using substances, especially an older adult. At this time, I lived with
my grandparents, never seeing alcohol or drugs, totally unaware that my parents struggled with
substance use, which is why I was in my grandparents’ care. As a white female with little
exposure to anything outside of a midwestern cis-normative belief system, my goal was to
escape and explore anything different than what I was raised in, so I joined the military.
After completing my military service, I returned home, but I was different. I wanted more
than what was offered on the farm, which meant more education. To support myself through
college, I took a nursing assistant course and began working in a long-term care facility. I was
surprised by how much I enjoyed working with older adults, though substance use, and mental
health issues were still not on my radar.
Despite learning about the generational substance use in my family, I still did not connect
older adults and substance use. My mother, who was in recovery and active in Alcoholics
Anonymous, often mentioned older friends still struggling with addiction, which sparked my
interest in recovery work during graduate school, leading to a clinical internship at an outpatient
co-occurring clinic.
During my first years working in addiction treatment facilities, I quickly realized how
unprepared I and most of my colleagues were to address the unique needs of older adults. I began
pursuing additional training in grief, life transitions, and generational differences. Around the
same time, I noticed a rise in older adult admissions. Many facilities were ill-equipped to handle
the complex needs of this population, revealing a significant training gap. This led me to the idea

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of developing a training program that could be easily implemented and accessible to a wide
range of providers, aiming to equip all staff to provide care to older adults with substance use
disorders.

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Problem of Practice and Literature Review
The "Advance Long and Productive Lives" Grand Challenge aims to promote healthy
aging and enhance the quality of life for individuals across the lifespan, focusing on aging
populations (Fong et al., 2018). This challenge underlines the profound significance of social
inclusion and community engagement as pivotal avenues to enhance the quality of life for older
adults and recognizes the growing aging population worldwide and the need to address various
social, economic, and health-related issues that older adults may encounter. One area often
overlooked has been substance use disorders (SUDs) and co-occurring mental health disorders in
older adults, resulting in an underserved population with multiple barriers to effective care.
Addressing SUDs for this demographic must involve enhanced training that fosters social
connections, provides opportunities for meaningful engagement, and preserves the dignity of
older adults as they traverse the journey of aging.
In the United States, the proportion of older adults has been increasing as advances in
healthcare, particularly preventative medicine, have fueled longevity (Lin et al., 2023). As life
expectancy continues to grow, age-related challenges within families, communities, and
countries continue to increase. One area that continues to emerge among aging adults is SUDs
and rising addiction. Addiction is an enormous and growing health issue identified recently as
significantly impacting the well-being of older adults and referred to as the "hidden epidemic"
(United Nations News, 2021). The disparity of care that exists for older adults, including the
increase of SUDs in older adults, has not gone unnoticed. The National Institute of Aging (2020)
identifies several strategic directions for research related to aging individuals, including
improving substance use programs that must adapt appropriately to meet the changing needs of
older adults (Specht et al., 2021).

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Several theories may explain the emergence or continuation of SUDs in later life,
including increasing older adult populations with increased life expectancy and normalization of
older adults using substances longer. Historically, older adults were typically not associated with
risky behavior but now are increasingly seeking treatment for SUDs (Grooms & Ortega, 2022)
because of the changing dynamics of the baby boomer generation, those born between 1946 and
1965. Instead of 'maturing out,' a theory first proposed by Charles Winick in 1962 (Snow, 1973),
current individuals in the baby boomer generation have continued to use and abuse substances,
making it the fastest-growing age group with substance use disorders (Lin et al., 2023). Data
from the Treatment Episode Data Set-Admissions (TEDS-A), a national data set on annual
admissions to SUD treatment facilities, show that between 2008 and 2018 (Weber et al., 2022),
the proportion of admissions to SUD facilities for adults aged 55 or over increased from 9.04%
to 15.64%. Relative to younger adults, the number of admissions for older adults grew by 190%
during this period (Lin et al., 2023). It is estimated that 4% of U.S. adults aged 65 years and
older have a SUD.
Retrospective and cross-sectional studies have shown that older adults today have higher
rates of illicit drug use, lower rates of alcohol use disorder, and greater incidence of having two
or more co-occurring SUDs compared to previous generations (Weber et al., 2022). With varying
patterns of substance use, such as non-medical use, problematic use, and substance dependence
involving alcohol, prescription medications, and illicit drugs (Schachman et al., 2024), older
adults are particularly vulnerable to the adverse effects of substances affecting mortality and
comorbid conditions, including physical, cognitive, and mental disorders (Substance Use
Treatment for Older Adults, 2020).

10
Long-held myths and stigmas regarding substance use in older adults have been a barrier
to identifying or treating medication misuse, dependence, or addiction in older adults. The baby
boomer generation has had higher rates of substance use at each stage of life compared to
previous generations (Lin et al., 2023), so addressing these myths and stigmas is essential to
addressing this growing healthcare crisis. There are limited programs currently addressing this
serious and growing healthcare crisis, but the available resources have not been well utilized or
are unknown to the community. The ability to engage and the quality-of-care older adults receive
to address SUDs also depends on several factors that include identification of a cooccurring SUD
and mental health, adequate access to services, economic factors, and ethnicity of the older adult
(Stahler et al., 2016). As noted, an extended life span may be secondary to identifying a SUD
and long-held attitudes surrounding drug use, which are unique to the baby boomers (FenollalMaldonado et al., 2022).
Identifying SUDs in older adults poses challenges, particularly in recognizing associated
chronic health issues (Kuerbis, 2019). Many individuals facing SUD or medication misuse do
not receive the necessary treatment, and SUDs often go unnoticed in primary care (PC) settings,
where timely treatment or referrals can occur (McRae, 2019). Directly incorporating questions
about SUD symptoms on patient questionnaires could be instrumental in improving the
identification of SUDs in this population. (Sayre et al., 2020). Still, because substance misuse is
often overlooked by healthcare professionals, families, and the older adults themselves, health
issues are frequently not identified as being related to substances (SAMHSA, 2020). Healthcare
providers usually are not well-trained in identifying harmful substance use or misuse among
older adults (Bhattacharya et al., 2021).

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Serious health-related issues related to SUDs in the aging population continue to increase
across the United States, but some areas face more challenges than others. Differences in
population densities between urban and rural communities show there has been a heavier toll on
rural than urban communities; the rural communities' access-to-care issues make treating SUDs
more difficult (Tiruneh et al., 2022). In rural areas, the barriers are even more significant than in
urban areas with more supportive services. Although substance use was one of the top ten
priorities of Rural Healthy People 2020 (Bolin et al., 2015), accessing treatment continues to be
challenging in rural regions, which the opioid epidemic has disproportionately impacted
(Saunders et al., 2019). Lack of community support, isolation, and social support (Moon et al.,
2020) are a few factors that impede an older adult from identifying health needs and receiving
proper care in rural settings.
Social issues, such as stigma and fear of criminalization, have grown in salience. In
contrast, systemic problems (Stahler et al., 2016) such as underinsurance or lack of insurance,
lack of treatment facilities, lack of trained health professionals, and poor coordination of care
complicate mitigation efforts for older individuals in rural areas (Conde-Caballero et al., 2021).
Community healthcare models have been successfully introduced in a limited number of rural
settings but are not widely available (Myers et al., 2020). Although prevention is the first step in
protecting persons affected by SUD, prevention programs tailored to older adults are scarce
(Tiruneh et al., 2022).
Part of the wicked problem is administering assessments that accurately assess an SUD in
an older adult. When assessments are administered, there are challenges in screening older adults
for alcohol use or medication misuse (McRae, 2019). Few screenings have been used effectively
with older adults, and not all standardized instruments exhibit good reliability and validity when

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used with older adults (Blow & Barry, 2020). Most assessments use a direct dialogue, resulting
in older adults responding poorly and evading the questioning. Older adults typically respond
better to a more supportive and nonconfrontational approach that provides information focusing
on improved overall health and goals rather than the substances themselves (Cimarolli et al.,
2021). The Veterans Administration Medical Center has identified that older adults are less
motivated to change their substance use because they perceive alcohol or drugs as their 'one last
pleasure' or do not want others to tell them what they can or cannot do (SAMHSA, 2020).
Affordability and access issues stemming from insurance-related barriers remain
prominent (Choi & DiNitto, 2020, Chhatre et al., 2017). Identifying reasons for this low
acceptance and devising solutions could pave the way for more facilities to develop sustainable
and effective programs tailored to the unique psychosocial and health needs of older adults
needing SUD treatment (Han & Moore, 2018). Medicare is the primary insurance provider for
the 52 million Americans aged 65 and older, offering coverage regardless of income, medical
history, or health status (Hellmann, 2022). Despite recent expansions in Medicare Part A services
for residential care, a gap persists in facilities extending these services to older adults. Moreover,
Medicare falls short in financing substance use disorder (SUD) treatment compared to other
payment methods (Cantor et al., 2022). Studies indicate increased wait times for clinical services
due to limited facilities accepting Medicare payments (Centers for Medicare & Medicaid
Services [CMS], 2021, Grooms & Ortega, 2019, Steinberg et al., 2021).
Previous studies analyzing the rates of admissions for SUD treatment have shown a
steady increase in recent decades, but studies beyond 2008 are scarce (Na et al., 2022). Most
programs dedicated or tailored to older adults are primarily in states with larger older adult
populations. However, many states with high proportions of older adults appear to lack sufficient

13
programs to meet their needs (Choi & DiNitto, 2020). Because of changes in insurance coverage
over the years, only those identified as having comorbid disorders would qualify (Substance Use
Treatment for Older Adults, 2020), and often, those facilities are tailored for people with some
level of dementia and do not include specific substance abuse disorder treatment (Choi &
DiNitto, 2020). Programs specific to treating addiction in older adults have increased in some
areas due to the projections from the research on aging (Cimarolli et al., 2021). Few studies
examine specific interventions when working with older adults who engage in the harmful use of
substances, so the efficacy of current programs compared to a younger adult with an SUD
remains unknown (Kuerbis, 2024).
Currently, in the United States, only 18% of substance use treatment programs are
specifically designed for older adults (Jaqua et al., 2022), and many states do not have programs
to meet the needs of older adults with substance use issues (Cimarolli et al., 2017). Most
programs dedicated or tailored to older adults are primarily in states with larger older adult
populations. However, many states with high proportions of older adults need more programs to
meet their needs (Choi & DiNitto, 2020). Because of changes in insurance coverage over the
years, only those identified as having comorbid disorders would qualify (Substance Use
Treatment for Older Adults, 2020), and often, those facilities are tailored for people with some
level of dementia and do not include specific SUD treatment (Choi & DiNitto, 2020). For
example, according to the New York State Office of Alcoholism and Substance Abuse Services
(OASAS), there are currently only three addiction treatment programs that specialize in treating
older adults with SUDs that are licensed in the state of New York (Office of Addiction Services
and Supports, 2022). SAMHSA (2020) reports that 'one size' cannot fit all when addressing

14
substance use in individuals 50 or older, limiting the number of senior-focused addiction
treatment facilities in the United States.
The National Institute of Aging (2020) accentuates the necessity of research in strategic
directions pertinent to aging individuals, related explicitly to refining SUD residential programs
to align with the evolving needs of older adults (Specht et al., 2021). As the world population
ages and substance use trends change, healthcare providers providing care to older adults in
residential SUD facilities must undergo adaptation and acquire the requisite skills to attend to the
unique requirements of this older cohort (Weber et al., 2022). Evidence-based training for
clinical professionals has been shown to improve interdisciplinary knowledge (Lyon et al., 2010)
and to prepare professionals for the increased demand for multidisciplinary providers (Cleary et
al., 2017). One example is “The Gaining Recovery in Addiction for Community Elders
(GRACE) Project,” which completed a study on the efficacy of age-specific care in an addiction
clinic led by an interprofessional team nurse. The clinical outcomes were superior to those of
mixed-age conventional care (Schachman et al., 2024). Adapting addiction care to address and
tackle the evolving needs of older adults is imperative (Specht et al., 2021). Urgent action is
required to develop tailored programming addressing the unique challenges faced by older adults
grappling with addiction issues.
Understanding SUDs in older adults requires a multidimensional approach with multiple
theoretical frameworks that acknowledge the complex interplay of biological, psychological,
social, and environmental factors across the lifespan. With age, the likelihood of experiencing
illnesses or chronic conditions leading to disability, immobility, or chronic pain rises (Stewart et
al., 2022), and SUDs add to the severe and chronic nature that frequently meet the criteria for
comorbid psychiatric disorders (Newman, 2019). Older adults can experience negative social and

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economic consequences and strain relationships with family, friends, and caregivers, leading to
social isolation and decreased social support. Finally, substance use can contribute to financial
burdens, strained healthcare systems, and increased healthcare costs (Schachman et al., 2024).
The fundamental objective of this capstone is to address co-occurring SUDs and mental health
issues in older adults engaging in a residential treatment setting.
The premature loss of older adults due to medication misuse or addiction presents
significant personal and societal burdens, which necessitate focused interventions from all
healthcare providers involved in caring for individuals aged 55 and older with a SUD and cooccurring mental health conditions. A comprehensive and robust training program for clinical
providers and staff in residential SUD treatment facilities must implemented to tackle this issue.
This training program would focus on equipping professionals with the knowledge and skills
required to navigate the complexities associated with older adults who experience SUD
alongside mental health disorders.
Conceptual/Theoretical Framework
The purpose of this initiative is to enhance the care provided to older adults in a primary
SUD residential treatment setting that also addresses co-occurring mental health issues by
implementing a comprehensive training program. This program will equip practitioners with the
requisite skills for collaborative, community-based, holistic, and person-centered care of older
adults (Schapmire et al., 2018) Utilizing a complex systems theory to address the
biopsychosocial challenges of SUDs (Griffiths, 2005) and integrating a Human-Centered Design
(HCD), the initiative delves into understanding the intricate dynamics of the more extensive
healthcare system while emphasizing the patients' unique needs, experiences, and feedback
(Adam et al., 2020;The Design Justice Network, n.d.). The pivotal question becomes, 'Will the

16
current system of care suffice and be acceptable or is there room for improvement?'. Evidence
has shown that in the field of addiction, an eclectic approach to addressing patient needs is the
most pragmatic way forward when treating a patient with an SUD (Griffiths, 2005). Healthcare
systems have an imminent and imperative responsibility to guarantee that each patient receives
optimal patient-centered, evidence-based care (Khushalani & DePaolo, 2021).
The HCD is about understanding human needs and how a design can respond to those
needs (Melles et al., 2020). The HCD operates as a dynamic practice framework, employing a
three-part cyclical process. The framework involves (1) deriving inspiration by understanding the
experiences and needs of community resource users, (2) generating ideation to create solutions,
and (3) culminating in the execution of community health strategies (Adam et al., 2020).
Incorporating a process model within the HCD framework proves instrumental in the change
process, which can be essential in dealing with today’s complex care challenges (Melles et al.,
2020). The method also facilitates the measurement of short-term to longer-term constructs,
offering a comprehensive framework to tackle implementation challenges and promote
sustainability (Adam et al., 2020; Hendricks et al., 2018)
This project bridges the clinical expertise of staff in a SUD residential treatment program
with the specialized knowledge required for effectively working with older adult populations in
such settings. By addressing this previously overlooked need, as Choi & DiNitto (2020) noted,
the program ensures that the unique needs of older adults receiving SUD treatment are
adequately met through age-specific training initiatives. Offering specialized training for older
adults in a SUD residential setting represents a tailored and integrated approach, proactively
responding to demographic shifts. The program advocates for systemic change, demonstrating an
unwavering commitment to continuous learning, and prioritizes cultural sensitivity and

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inclusivity. In doing so, the training will significantly contribute to advancing SUD treatment
practices specifically tailored to the unique needs of older adults, including identifying the
mental health challenges with specific approaches utilizing overlapping techniques (Lyon et al.,
2010).
Methodology
To better understand the wicked problem of older adults 55+ struggling with SUDs,
multiple methods were utilized to gather historical and current information, build a foundation of
knowledge, and identify emerging and changing trends and complex problems. The primary
methods used for information gathering include literature reviews, interviews, surveys, focus
groups, and daily census data collection.
Design thinking.
Initial information gathering included reviewing various types of literature to gather
information to understand the wicked problem, identify persistent problems or gaps within the
recovery community that continue to impact older adults and identify trends. The primary
literature used in this research included peer-reviewed articles, gray literature, popular literature,
conference research presentations, government publications, and trade journals. Due to the
limited number of scholarly articles and few studies of SUDs and older adults, gray literature
provides valuable information supporting additional formal research and expanding the
understanding of the complexity of suds and older adults. These diverse, often uncommonly used
publications broadened the knowledge of the historical context and patterns of substance use in
older generations and how societal changes continue to impact this large and growing cohort.
To research addiction in older adults, five key topics were explored: (1) the growing
older adult population, (2) substance use in older adults, (3) health impacts, (4) current

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interventions and age-specific programs, and (5) financial concerns related to substance use.
Search terms such as "substance use disorder," "addiction," "older adults," "baby boomers," and
"residential treatment facilities" were used and refined as more information emerged. Literature
reviews were conducted using various databases, including USC’s library, Google Scholar, and
the Hazelden Betty Ford Addiction Research Library, with additional resources from government
and nonprofit websites.
An information-gathering plan incorporating stakeholder perspective was developed after
the initial literature review. Interviews were conducted with leaders and care providers at a large
rural mental health and SUD treatment facility to assess their views on addressing SUDs in older
adults. Newly admitted patients over 55 completed surveys on their past recovery experiences
and self-identified needs. At the Age Well conference, Medicare representatives were
interviewed about their knowledge of SUDs in older adults and Medicare-approved providers.
The solution landscape analysis was developed from this information (Appendix A) and
integrates qualitative and quantitative data from interviews, focus groups, and surveys that
engaged leaders, managers, staff, and patients. Employing a service model (Keeley et al., 2013,
pp. 42–43), the innovative training has been tailored to meet the specific needs of patients, with a
primary emphasis on supporting and training direct care staff responsible for older adults in
residential SUD treatment settings.
Design Justice Principles
This project aims to Challenge the current care approaches for older adults in SUD
treatment facilities. Multiple studies have identified significant gaps, beginning with assessing
older adults for an SUD (Blanco & Lennon, 2021), to care disparities already sparse for older

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adults but persistently related to racial and ethnic disparities due to healthcare inequalities and
limited resources (Paun & Loukissa, 2023).
Medicare’s limited coverage of substance use treatment further access issues, as many
facilities have not expanded services to older adults, leading to extended delays in care
(Steinberg et al., 2021). Implementing a universally accessible training program that combines
evidence-based therapies with person-centered care can facilitate the recovery process. The
program can address older adults' unique psychological, emotional, and spiritual dimensions
independent of location or level of care.
Market Analysis
Currently, only 23% of U.S. substance use treatment programs are designed for older
adults, with many states lacking facilities to meet their needs (SAMHSA, 2020; Jaqua et al.,
2022; Cimarolli et al., 2017). For instance, New York has only three licensed programs
specializing in older adults with SUDs (Office of Addiction Services and Supports, 2022). This
shortage reflects a broader issue identified by SAMHSA, which emphasizes that a "one size fits
all" approach is ineffective for those 50 and older (SAMHSA, 2020).
Despite the availability of guidelines like SAMHSA’s TIP 26, which provides evidencebased protocols for addressing SUDs in older adults, implementation in residential treatment
settings remains limited. Current training options, such as webinars on aging and substance use,
offer general guidance but lack specific strategies for clinicians in residential settings.
The market for specialized care is underdeveloped, yet demand is growing as early
intervention and tailored treatment can reduce long-term healthcare costs. Older adults with
SUDs often have comorbid conditions, and effective, early treatment can minimize expensive

20
interventions and improve long-term recovery rates, making it both financially and socially
beneficial for providers to expand services in this area (Stahler et al., 2016; Han et al., 2009)).
Project Description
This project focuses on the development of a thoughtfully designed training program
tailored specifically for professional and clinical staff, strategically aimed at addressing SUDs
and co-occurring MH issues prevalent among the older adult population within residential
treatment settings. This project also implements a training initiative that seeks to confront the
distinctive challenges unique to this demographic, elevating the proficiency of clinicians. The
primary objective is to enhance the overall quality of care, instill inclusivity within the treatment
environment, and cultivate positive outcomes for older adults in recovery. Given that older adults
often have unique needs, it is necessary to equip these professional and clinical providers with
evidence-based strategies that support health mental health and recovery services tailored to this
age group (Lehmann & Fingerhood, 2018; Pincus et al., 2020–2021).
Grand Challenge of Social Work
The primary objective of this initiative is to develop and implement a comprehensive
training program tailored specifically for addressing SUDs in older adults within residential
settings. The goal is to bridge existing gaps in knowledge and practice by providing specialized
training to care providers, staff, and clinicians. The envisioned training program seeks to instill
confidence in staff and elevate the well-being and engagement of older adults grappling with
SUDs in an addiction treatment residential center. By addressing SUDs in older adults and
mitigating the gaps in care, the Grand Challenge to “Advance Long and Productive Lives” (Fong
et al., 2018) is supported, as an older adult without a SUD or co-occurring mental health issues is
a healthier adult and will live a longer and productive life (SAMHSA, 2020;Stewart et al., 2022).

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Clinical professionals engaged with older adults necessitate training to ensure that SUD
programs, particularly in residential settings, can effectively cater to this expanding population's
needs. Treatment options for older adults remain limited, with few programs or healthcare
settings offering specialized interventions (Cantor et al., 2022), and the research on SUDs in
older adults and examples of patients' personal experiences in a residential setting revealed gaps
and 'blind spots' from previous innovations (Keeley et al., 2013). This training initiative holds the
potential to empower additional facilities to establish sustainable and impactful programs,
delivering supportive and nonconfrontational approaches tailored to the distinctive psychosocial
and health needs of older patients struggling with SUDs.
Design Criteria
This training program's key components and core skills are based on established
evidence-based curricula. Malik and Malik (2010) introduced the “Twelve Tips for Developing
an Integrated Curriculum," providing information on establishing working groups, organizing the
teaching and learning materials that address twelve themes of developing innovative strategies
that can be used to change the existing curriculum to an existing integrated platform or that can
also be used to create new curriculum. Additional information regarding the needs of older adults
in a healthcare setting is drawn from existing programs with development processes in
gerontology, mental health training, and SUDs training programs.
The Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment
Improvement Protocol (TIP) 26 (2020) offers comprehensive guidance on evidence-based
screening, assessment, interventions, and services for substance misuse, including SUDs, in older
adults. It is designed for behavioral health service providers, healthcare professionals, older
adults, and those significant in their lives.

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The design criteria identifying this training program's musts, could, shoulds, and wants
were developed based on the established evidence-based curriculum (Appendix B). The program
must train staff upon hire and yearly to ensure older patients receive the best care with insight
into the challenges they face.
Prototype Description
Two prototypes were developed from the design curriculum. First, the low-fidelity
prototype (Appendix C) was created, outlining the training program, the pilot's location, the
target audience, and the goal of the training. The low-fidelity prototype also outlined the topics
to be addressed and added additional information for each topic. Finally, the prototype identified
how the training would be delivered, feedback regarding the program's efficacy, possible
financial support, and initial ideas on expanding the program with continued economic stability.
Based on this outline, a mid-fidelity prototype training was developed and tested. Two
training pilots were conducted to enhance the skills of providers working with older adults who
have a SUD. The first pilot was conducted at Hazelden Betty Ford Foundation in Center City,
MN, an extensive nonprofit SUD treatment program with eight licensed alcohol and drug
counselors (LADC). The second pilot involved providers from Ecumen, one of the United States'
largest and oldest non-profit senior housing and services companies.
The results from the two pilots produced similar findings regarding confidence in
working with older adults who have SUDs, though from different perspectives. Providers felt
more knowledgeable post-training but did not achieve a high level of confidence in working with
older adults with SUDs. Despite this, 100% of the participants reported learning something new,
and the information was rated as very or extremely helpful for understanding the issues regarding
older adults and SUDs and communicating with patients and families.

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The pilots highlighted two primary challenges: tailoring training to different levels of
care and incorporating real-life scenarios to enhance effectiveness and confidence when working
with families of older adults. To address these challenges, a core training program with
supplementary materials related to various care levels is recommended. Additionally,
incorporating family dynamics into training can better equip providers to handle complex
situations involving older adults with SUDs. While the training introduced new knowledge and
was well received, it revealed the need for more specific confidence-building training methods
that address the unique challenges of working with older adults who struggle with SUDs and
their families.
From this feedback, the High-Fidelity Prototype was created. The High-Fidelity
Prototype is an interactive onboard training program for clinicians working with adults 55+ in
co-occurring SUD and mental health treatment programs (Appendix D). This program is
designed to be updated with new research with the ability to adapt the current training to a yearly
refresher training. Delivered through an interactive PowerPoint presentation with a companion
manual for facilitators, the training focuses on practical approaches to help clinicians address the
unique challenges older adults face.
Effectiveness was measured with a pretest and post-test questionnaire using Survey
Monkey to assess the participants' initial knowledge compared to the knowledge they learned
from the training. The pretest link was provided two days before the two-hour training, and the
post-test link immediately after the training was complete. Both tests included multiple-choice,
true/false, and one open-ended question, with the pretest featuring two additional questions to
gauge prior experience working with older adults or any age-specific training.

24
Two main challenges were identified in this training: (1) Participant Engagement and (2)
Varying levels of participant knowledge. Because this was a virtual training, it was a challenge
to keep participants attention. It was also identified that participants all have differing levels of
knowledge regarding SUDs, mental health, and working with older adults. Because future
participants will have various levels of knowledge regarding SUDs and older adults, the training
needs to be adaptable and easily modified to ensure future participants, regardless of
background, will benefit from the information in this training.
Theory of Change
Research and information on implementing age-specific training for staff, particularly in
hospital and nursing settings, have shown a significant improvement in confidence and
competence when working with older adults (Stanbridge et al., 2012). Lee et al. (2019)
researched multiple brief training sessions aimed at enhancing nurses' knowledge, attitudes, and
confidence in providing care for older adults with depression in long-term care facilities,
revealing significant differences between groups regarding improvements in knowledge of latelife depression, attitudes towards depression, and confidence in providing depression care.
Another study by McRae (2019) focused on nursing staff attending a training program for
completing age-specific assessments for patients aged fifty-five and older admitted to a
residential primary SUD treatment center in Minnesota.
This body of research hypothesizes that implementing and applying insights from tailored
training programs in SUD residential facilities will lead to positive long-term outcomes focusing
on understanding how to effectively engage patients from a human-centric approach to positively
impact patients' support systems and living experiences within communities. This includes

25
improved patient access to specialized programming, reduced financial strain on geriatric care
systems, and enhanced support for families and communities assisting older adults in recovery.
Revised Logic Model
To develop this program, the Logic Model (Appendix E) was revised and outlines the
necessary steps to ensure that the information presented in the training is current to integrate
evidence-based practices for co-occurring SUDs effectively. A multidisciplinary team with
expertise in gerontology, medicine, mental health, and SUDs was involved in the program's
design. The goal is to continue and adopt age-sensitive practices and treatments that meet the
specific needs of older adults, equipping providers to effectively address this demographic's
unique concerns and mitigate adverse effects associated with SUDs.
Ethical Considerations
Several ethical considerations regarding age-specific training were identified. First,
patient autonomy must be balanced with family involvement (Ogbonna & Lembke, 2019).
Working with older adults who struggle with memory issues, anxiety, and emotions will require
additional family support for reassurance and emotional support. While family support can be
beneficial, families with a history of SUDs may take advantage of the older adults' vulnerability.
A second ethical concern is the act of ‘othering. ‘The training may inadvertently create a
bias towards older adults, resulting in the clinician believing they needed the training because
there was something intrinsically inferior or wrong with the older adults in care (Akbulut &
Razum, 2022). Formalized programs and training based on age may lead to a clinician feeling
that an older adult needs ‘special handling,’ resulting in an older adult experiencing
disempowerment and a disadvantage, particularly if an organization overemphasizes their older
age (Zubair & Norris, 2015).

26
Lastly, patients who would otherwise not be appropriate to engage in SUD care for
cognitive reasons are accepted for treatment because their clinicians had been involved in this
training. Older adults who misuse substances are at increased risk for specific problems with
thinking (also called cognitive impairment or cognitive disorders) that are a direct result of active
substance use but will improve once a person abstains from use (SAMHSA, 2020). However, for
older adults who misuse substances, difficulties with cognition and other brain functions can be
more severe and will not resolve with abstinence. Continuing to provide care to an older adult
hoping for improvement without neurocognitive testing will delay the appropriate care and
support they need outside of substance use.
Research shows positive outcomes from existing age-specific programs addressing
SUDs. For instance, 60 percent to 85 percent of older adults who participated in age-specific
inpatient treatment programs were still abstinent 12 months after leaving treatment (SAMHSA,
2020). As the population of older adults with SUDs continues to grow, there is an urgent demand
to expand residential programs tailored to address SUDs. These programs should integrate health
and social care components to cater to this demographic's multifaceted needs. Developing
innovative service delivery models is crucial to broaden access to these programs for older adults
(Choi & DiNitto, 2020).
Lastly, all three pilot programs showed increased participant confidence in working with
older adults, supported by positive patient feedback. A survey of forty-two older adults engaged
in the pilot training reported a 93% positive response, highlighting the benefits of having
providers who understood their concerns and offered an age-specific space for discussion,
separate from mixed-age groups. Given the current success rates and ongoing research

27
evaluating completion and satisfaction, the outlook is optimistic that this program will
significantly benefit patients, their families, and the clinicians providing care.
Implementation Plan
The EPIS Framework model is particularly well-suited for guiding the implementation of
this innovative training program timeline addressing SUDs and co-occurring issues in older
adults within residential settings. The model's strength lies in its comprehensive approach to
identifying the specific needs and challenges of older adults with a primary SUD. This model
aligns with the initial needs assessment and literature review, ensuring a deep understanding of
the wicked problem. The EPIS Framework facilitates the development and execution of the agetailored curriculum, offering a structured pathway for refining the program based on continuous
feedback. Lastly, regarding sustainability, the model provides a foundation for scaling the
training across diverse residential settings, emphasizing the longevity and impact of the
intervention as outlined in the Logic Model (Appendix E) The EPIS Framework aligns to create
a lasting, scalable model for enhancing SUD treatment for older adults in residential care (Epis
Framework, n.d.)), as represented in the 20-month action plan (Appendix J).
The training is ready to be implemented as an in-person training presentation, a virtual inperson training presentation, or a marketing presentation. The target market for this training is
residential addiction treatment centers. The initial pilot was completed at the Hazelden Betty
Ford Foundation, Center City campus, where around 25% of patients are age 55+.
Once the initial results and enhancements have been implemented, the subsequent steps
involve integrating the program into the staff onboard training at this facility. A tracking system
will monitor the program's attendance, progress, and completion. Staff will complete a pre-test
and post-test to evaluate the effectiveness of the training. Additionally, discharge questionnaires

28
will be distributed to patients to gather feedback on whether the services provided addressed
their concerns, met their expectations, and contributed to an improved overall wellness. An
onboard training program requires human resource and organizational training involvement to
ensure all compliance and managerial standards are met.
Next would be to expand the program and initiate a full-scale implementation in a
broader range of residential settings. Collaboration with additional facilities will lead to
integrating the program into other SUD treatment protocols, with scalability so that the quality of
the training is not compromised. Creating a website with a logo (Appendix F) catchphrase
(Appendix G) and will provide updated information regarding the training options and additional
outreach resources to supplement and market the program. An infographic is used to highlight
the concerns and catch potential users’ attention (Appendix H). Speaking engagements will also
be available to promote the training and give the stakeholders a deeper understanding of its
importance in supporting their employees and patients.
During this phase, this training will be expanded to multiple online platforms, such as
PESI, inc., and various forums or conferences, such as Minnesota Association of Resources for
Recovery and Chemical Health (MARRCH), to share best practices, research findings, and
innovations in providing specific knowledge-based SUD treatment approaches for co-occurring
disorders in the older population. This expansion would continue into community engagement
initiatives, such as workshops, support groups, and outreach programs, further strengthening the
support system for older adults with SUDs and fostering a sense of community and connection
beyond the training program.
A two-line-item budget outlines the start-up budget, and a first-year annual budget
(Appendix I) identifies the general costs to support this program during its development and

29
ongoing yearly expenses to support expansion and sustainability. Funding comes from various
sources but will rely primarily on fees derived from training, the training program itself, and
grants. Various grants are being offered to fund programs addressing the healthcare needs of
aging adults. Two examples of organizations that could support the program are the Substance
Abuse Prevention & Treatment Block Grant (SABG) and the Health Resources & Services
Administration (HRSA). Both have funded programs that train practitioners to provide care for
individuals in need of mental health and SUD/OUD prevention, treatment, and recovery services
(Health Resources & Services Administration [HRSA], 2023; SAMHSA, 2023).
Evaluation Plan
Research on SUDs and older adults is limited, but current reports by Medicare suggest
that SUD status in Medicare claims is associated with a 70% increase in costs (Fairman et al.,
2017)). Medicaid also identifies that individuals with untreated alcohol use disorders use twice as
many healthcare resources and incur double the costs compared to those with treated alcohol use
disorders (NIH, 2020). Furthermore, research and reports suggest a potential 30% decrease in
medical expenses with three years of abstinence, emphasizing the role of interventions supported
by heightened staff knowledge and training (CMS, 2021)
Although it is not feasible to strictly use this specific research to measure a program's
impact on a patient's social change, there is information from the Butler Center of Research that
tracks patient outcomes. The Butler Center for Research publishes advanced statistical internal
reports for Hazelden Betty Ford Foundation program leaders, offering advanced insight into data
trends and providing empirical recommendations for ongoing program improvement and
effectiveness. This information would identify the outcomes of older patients who engaged with
clinicians in the age-specific training.

30
The initial data collection would be from the pretest and post-tests (Appendix I) This
identifies concerns regarding the training itself. This will not determine if the information has
long-term value but will indicate if clinicians find it valuable for them to work better with older
adults with SUDs.
The second data collection would be the patients' perception of care. This could be
completed during the discharge process. With this information, the program could immediately
identify areas of concern or dissatisfaction from the patients engaging with the providers.
Continuous evaluation processes, including participant and stakeholder feedback,
facilitate real-time adjustments to the training program, ensuring ongoing relevance and
effectiveness. By systematically implementing this action plan (Appendix K), the program will
become a sustainable and scalable model that positively influences SUD treatment for older
adults in residential settings. From this information, a successful program will show higher work
satisfaction and confidence in staff working with older adults, and the information from the data
collection will show patients have increased life satisfaction, improved relationships, and overall
stability.
Challenges/Limitations
Structural barriers emerge as the most prevalent obstacles, encompassing issues related to
treatment providers, legal constraints, and policy limitations (Farhoudian et al., 2022). With an
increase in older adults' admissions for SUD treatment, the problem continues and is exacerbated
by systemic issues and societal bias. Blanco and Lennon (2021) identified gaps in the initial
assessment intakes of older adults in healthcare settings in more than 50 percent of cases,
resulting in treatment delays of more than ten years after disorder onset and difficulty
determining the appropriate level of care. These unique age-related barriers, such as older clients

31
being less likely to communicate substance use problems, further complicate the landscape
(SAMHSA, 2020).
Older adults who have historically been self-reliant can resist seeking help and pose
distinct challenges as symptoms often mirror the aging process. Providers must be adept at
distinguishing between normal aging and substance-induced effects (Cimarolli et al., 2017),
adding to the complexity of addressing SUDs and substance's impact on sensory, cognitive, and
physical symptoms (Resources for Integrated Care, 2019). Despite the escalating prevalence of
SUD among older adults, recent admissions to treatment facilities and associated patient
characteristics remain inadequately documented (Na et al., 2022), and additional training is
needed to provide the appropriate healthcare services and SUD treatment to older adults.
Disparities in the availability and accessibility of SUD facilities for older adults are
evident. States with larger older adult populations may have more facilities for older adults yet
still need more programs to meet their needs (Choi & DiNitto, 2020). Medicare, the primary
insurer of individuals 65 and older, covers SUD treatment (Medicare Rights, 2023); however,
only 38% of substance-use treatment facilities accept Medicare as a payment source (Choi &
DiNitto, 2020). This shortcoming is related to Medicare's failure to finance SUD treatment
effectively compared to other payment methods (Cantor et al., 2022).
Persisting affordability and access challenges stemming from insurance-related barriers
(Chhatre et al., 2017; Choi & DiNitto, 2020) underscore the necessity for comprehensive staff
training across all facilities. These primary considerations and limitations highlight the crucial
need for age-specific training within residential facilities, emphasizing the imperative for staff
engagement in such training to serve this demographic effectively.

32
Conclusions and Implications
As the older adult population with SUDs increases, there is a pressing need to expand
programs tailored to addressing SUDs at the residential level of care. Programs should integrate
health and social care components to address the complex needs of this demographic.
Developing innovative service delivery models is essential to enhance access to these programs
for older adults (Choi & DiNitto, 2020). Effective treatment options that include specific
interventions remain scarce. Few healthcare settings provide tailored interventions despite older
adults with SUDs exhibiting treatment outcomes as good or better than younger populations
(Agrawal et al., 2022; Law, 2022). Family members and medical professionals have essential
roles in supporting, finding resources, or developing more effective programs to address SUDs in
older adults, and older adults must be involved in their treatment planning (Emiliussen et al.,
2019). The action plan outlines the program's future evolution and expansion (Appendix J).
Refinement will remain an essential part of the program, remaining relevant and useful for staff
working with older adults. As the program evolves and develops, ongoing community
engagement will be vital to raise awareness, ensure sustainability, and secure financial support.
This innovative project bridges the clinical expertise of staff in a substance use disorder
(SUD) residential treatment program with the specialized knowledge required for effectively
working with older adult populations in such settings. By addressing this previously overlooked
need, as Choi & DiNitto (2020) noted, the program ensures that the unique needs of older adults
receiving SUD treatment are adequately met through age-specific training initiatives. Offering
specialized training for older adults in a SUD residential setting represents a tailored and
integrated approach, proactively responding to demographic shifts. The program advocates for
systemic change, demonstrating an unwavering commitment to continuous learning, and

33
prioritizes cultural sensitivity and inclusivity. In doing so, the training will significantly
contribute to advancing SUD treatment practices specifically tailored to the unique needs of
older adults, including identifying the mental health challenges with specific approaches utilizing
overlapping techniques (Lyon et al., 2010).
To support age-specific programs, providers need additional training regarding the
unique challenges of older adults with SUD, particularly in residential settings of care, which
historically has not worked with a large older adult population. Discrimination and stereotyping
of individuals with SUDs need to be addressed in healthcare settings to ensure that patient's
healthcare needs are quickly and accurately identified during the initial stages of care.
Developing and implementing evidence-based approaches to social determinants of health will
be vital in improving the health of older adults (Blanco & Lennon, 2021). These would include
training in effective educational and counseling interventions, comparing the effectiveness of
SUD treatments, developing ways of engaging families in prevention, treatment, and recovery
practices, and finding follow-up care to support recovery (Tiruneh et al., 2022).
In conclusion, as Medicare expands as a funding source, access to SUD treatment for
older adults will no longer be limited by location. This program will ensure that the critical care
older adults struggling with cooccurring SUDs and mental health will have access to more
widely available programs. As training for SUDs in older adults continues to grow, it will help
dispel myths and reduce the stigma associated with substance use, allowing individuals, families,
and communities to receive the essential care they deserve. Demonstrating positive outcomes
from this training will encourage other facilities to adopt it as a sustainable, practical, and
compassionate approach tailored to older adults' unique psychosocial and health needs.

34
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45
Appendix A – Solution Landscape Analysis
Solution Landscape Analysis
Design Criteria
Features
Solution #1
Develop training
program that
includes age
specific
approaches and
Motivational
interviewing.
Solution
#2
Implement
a training
program
Solution #3
Provide medical
care from
admission to
discharge. MAT
and psychotropic
approaches
specific to older
adults
Solution #4
Work with
compliance
to meet
federal ADA
criteria.
Address the unique
challenges and
concerns of older
adults with a SUD
and /or cooccurring MH
disorder.
X X X X
Mandate a training
program for all
employees
working in direct
care of patients in
a SUD and/or cooccurring MH
treatment facility.
X X X
Co-occurring
services for
substance use
disorders (SUD)
and mental health
(MH). Groups and
individual
services.
X X
Develop a safe and
accessible
residential
environment with
24/7 care.
X X

46
Appendix B – Design Criteria
Design Criteria
Develop a training program for staff working with older adults, 55+ engaging in cooccurring
residential programming for a substance use disorder (SUD) and mental health (MH) concerns.
CRITERIA WIDER OPPORTUNITY SPACE
MUST • Develop a training
program that
addresses the unique
challenges and
concerns of older
adults with a SUD and
/or co-occurring MH
disorder.
• Implement the training
program.
I. for all employees
working in direct care
of patients in a SUD
and/or co-occurring
MH treatment facility.
• Provide age specific
co-occurring services
for substance use
disorders (SUD) and
mental health (MH).
Groups and individual
services.
• Develop a safe and
accessible residential
environment with 24/7
care.
Mandate training upon hire.
Yearly training mandated.
Special training for MH providers and Licenses
alcohol and drug counselors.
Ensure that the residential facility meets all ADA
Title II, Title 42 requirements for older adults.
COULD • Specialized
approaches for
managing chronic
pain.
• Partner with research
institutions to explore
innovative treatments,
interventions.
• Implement a peer mentorship after completing
SUD treatment.
• Long term aftercare to address challenges related
to recovery and relapse prevention.
• Have vetted relationships with providers in the
community that understand SUD and health care
concerns for aging adults.

47
• Encourage patients to
take leadership roles
in the residential
program.
• Incorporate
complementary and
holistic therapies to
support recovery
(yoga, massage, etc.).
II.
SHOULD • Involve families and
loved ones in the
recovery process.
• Ongoing medical
services to support
patients during
treatment.
• Initial and thorough
medical assessments
at admissions with
knowledge in caring
for older adults that
have SUD and MH
challenges.
• Explore the use of technology to support
treatment and recovery in the community.
• Establish partnerships with local organizations.
• Explore transitional housing solutions after.
• Extend family education and support programs.
WON’T • One-Size-Fits-All
Approach.
• Neglect Co-occurring
Conditions
• Use existing
interventions designed
for younger
populations.
Ignore the community connections and resources.

48
Appendix C – Low Fidelity Prototype
Low Fidelity Prototype

49
Appendix D - High Fidelity Prototype A & B
A - Training Manual
https://1drv.ms/w/c/8323bd0365e909d5/EaTkPyDKNpZDrUnYSY6JOu4Bc_0T5_fzWz5vI
H37LeNNlg?e=Rgvvt4
B- Companion Power Point
https://1drv.ms/p/c/8323bd0365e909d5/EfVmxRNPvRtAjwv0p98_98Bn0aNlI4n16m5mVOjbUacsg?e=rw8Hcf

50
Appendix E - Logic Model

51
Appendix
F
- Logo

52
Appendix G - Mockup marketing image with Catch Phrase

53
Appendix H - Infographic

54
Appendix I - Line Budget
Start up Estimated
Cost/year
Planning and Design 0
Build a website 500
Technology tools
Computer
Webcam
Microphone
2000
Internet 1080
Marketing 1000
Travel cost 500
Learning Management
System (LMS)
250
1
st year Estimated
Cost/year
Revenue
Training updates 0 Speaking
engagement
300
Website maintenance 300 e-learning Unknown
Technology tools/updates 500 Grant Unknown
Internet 1080
Marketing 500
Travel cost 500
Learning management system
(LMS)
250

55
Appendix J – Pretest and Posttest
Pretest and Posttest
Integrative Care Strategies for Older Adults experiencing Co-occurring Substance Use and
Mental Health Disorders Pretest.
1. Have you ever worked with older adults (55+ years) in your clinical practice?
o Yes
o No
2. Have you received any formal training on substance use disorders in older adults?
o Yes
o No
3. How often should older adults be screened for substance use disorders when visiting a health
care provider?
o Always- every visit
o Sometimes - once every few years
o Rarely - only when there is a concern
o Never - substances are not a big enough concern
4. Current screening tools are effective in identifying possible substance use disorders in older
adults?
o True
o False
5. Which 4 substances are most commonly misused or abused by older adults? (Select all that
apply)
o Alcohol
o Opioids
o Over-the-counter medications
o Illicit drugs
o Tobacco
o Benzodiazepines
o Methamphetamine
6. What is a barrier that older adults face related to getting support when experiencing cooccurring disorders or a substance use disorder.
o Stigma
o Limited age appropriate programs
o Inadequate screening
o Lack of awareness
o All of the above
7. What are the main protective factors for older adults that may develop a substance use
disorder? (check all that apply)
o Committed relationship.
o Independence
o Access to basic human needs
o Age specific approaches to care
o Living in assisted living or long-term care

56
8. CHIME is an effective framework to utilize when working with older adults in early
recovery?
o True
o False
9. The family is best supported by...... (check all that apply)
o Providing resources about community services
o Providing support emotionally and spiritually
o Not worrying the family with the patient’s substance use disorder
o Telling the family to spend all their extra time with their loved one.
o Setting clear boundaries
10. The best self-care includes.....
o Taking a day to do your nails.
o Going out all night to hang with friends.
o Treating yourself to sugary treats everyday
o Having a daily routine to focus on your mind, body, and spirit.
o Isolating
Copy of Integrative Care Strategies for Older Adults experiencing Co-occurring Substance Use
and Mental Health Disorders Post training.
1. How often should older adults be screened for substance use disorders when visiting a health
care provider?
o Always- every visit
o Sometimes - once every few years
o Rarely - only when there is a concern
o Never - substances are not a big enough concern
2. Current screening tools are effective in identifying possible substance use disorders in older
adults?
o True
o False
3. Which 4 substances are most commonly misused or abused by older adults? (Select all that
apply)
o Alcohol
o Opioids
o Over-the-counter medications
o Illicit drugs
o Tobacco
o Benzodiazepines
o Methamphetamine
4. What is a barrier that older adults face related to getting support when experiencing cooccurring disorders or a substance use disorder.
o Stigma
o Limited age appropriate programs
o Inadequate screening
o Lack of awareness
o All of the above

57
5. What are the main protective factors for older adults that may develop a substance use
disorder? (check all that apply)
o Committed relationship.
o Independence
o Access to basic human needs
o Age specific approaches to care
o Living in assisted living or long-term care
6. CHIME is an effective framework to utilize when working with older adults in early
recovery?
o True
o False
7. The family is best supported by...... (check all that apply)
o Providing resources about community services
o Providing support emotionally and spiritually
o Not worrying the family with the patient’s substance use disorder
o Telling the family to spend all their extra time with their loved one.
o Setting clear boundaries
8. The best self-care includes.....
o Taking a day to do your nails.
o Going out all night to hang with friends.
o Treating yourself to sugary treats everyday
o Having a daily routine to focus on your mind, body, and spirit.
o Isolating
9. How would you rate the overall quality of the training?
o Excellent
o Good
o Average
o Poor
o Very Poor
10. Was the information provided in the training helpful for your work?
o Extremely helpful
o Very helpful
o Moderately helpful
o Slightly helpful
o Not helpful at all
11. What is one thing you will take away from this training?
12. What aspects of the training did you find most beneficial? (Select all that apply)
o Content
o Presentation
o Interactive activities
o Real-life examples
o Q&A sessions

58
13. Do you have any suggestions for improving future training sessions?

59
14.
Appendix
K
- Action Plan

Abstract (if available)

Abstract Full title: Integrative care strategies for older adults experiencing co-occurring substance use and mental health disorders (I-CARE): a training for clinicians working with patients 55+ in addiction treatment centers. Abstract: Substance use disorders (SUD) among older adults represent one of the fastest-growing health concerns in the United States, outpacing all other age groups in the United States, with one in six older adults struggling with substances. This project focuses on a clinically tailored training program designed to treat older adults (55+) with co-occurring SUD and mental health challenges. This initiative seeks to fill crucial gaps in care by delivering patient-centered, evidence-based interventions to clinicians during the onboarding process after hire, along with yearly training for staff that work directly with patients. This onboarding program emphasizes a holistic approach and understanding of the system's dynamics while prioritizing patients' multifaceted needs and experiences through the systems theory and human-centered design (HCD) approach. Drawing upon gerontology evidence-based practices to enhance current SUD programming, this training focuses on developing core skills such as active listening, therapeutic communication, and dual-diagnosis assessment. The theory of change posits that implementing this comprehensive training program will yield long-term positive outcomes, including enhanced patient access to integrated treatment modalities, alleviating financial burdens on geriatric care systems, and strengthened community support for older adults in recovery from co-occurring disorders. Recognizing and addressing systemic barriers to treatment access, including structural, legal, and policy challenges, is integral to the success of this initiative. Continuous evaluation, stakeholder engagement, and iterative adjustments to the training program are essential to ensure its ongoing relevance and scalability to improve the quality of care for older adults with co-occurring SUD and mental health issues in residential settings.

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Creator Groschen, Nicole (author)

Core Title Integrative care strategies for older adults experiencing co-occurring substance use and mental health disorders (I-CARE)…

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

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Degree Conferral Date 2024-12

Publication Date 10/29/2024

Defense Date 10/29/2024

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