Implementing the Comprehensive, Continuous, Integrated System of Care Model for Individuals with Co-Occurring Disorders: Preliminary Findings from a Residential Facility Serving Homeless Individuals

Harrison, Melissa; Moore, Kathleen A.; Young, M. Scott; Flink, Daryl; Ochshorn, Ezra

doi:10.1080/15504260802072305

Cited by 7 publications

(4 citation statements)

References 25 publications

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“…The sample studied by Aguilera et al [ 38 ] differed in ethnicity from all others due to its location (Honduras). Five studies included homeless individuals only [ 30 , 31 , 37 , 48 , 51 ] and two focused on clients involved in the criminal justice system [ 39 , 47 ]. Information about clients' socio-demographics was incomplete for a number of study reports [ 33 , 39 , 45 , 46 , 52 , 53 ].…”

Section: Resultsmentioning

confidence: 99%

“…Four studies investigated participants with posttraumatic stress disorder or histories of abuse in addition to mental health problems [ 40 - 43 ] and another focused on personality disorders [ 47 ]. The ten remaining studies reported affective or anxiety disorders as the most common mental illnesses [ 33 , 35 , 36 , 38 , 44 , 48 , 50 , 51 , 53 , 54 ].…”

Section: Resultsmentioning

confidence: 99%

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Dual diagnosis clients' treatment satisfaction - a systematic review

2011

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BackgroundThe aim of this systematic review is to synthesize existing evidence about treatment satisfaction among clients with substance misuse and mental health co-morbidity (dual diagnoses, DD).MethodsWe examined satisfaction with treatment received, variations in satisfaction levels by type of treatment intervention and by diagnosis (i.e. DD clients vs. single diagnosis clients), and the influence of factors other than treatment type on satisfaction. Peer-reviewed studies published in English since 1970 were identified by searching electronic databases using pre-defined search strings.ResultsAcross the 27 studies that met inclusion criteria, high average satisfaction scores were found. In most studies, integrated DD treatment yielded greater client satisfaction than standard treatment without explicit DD focus. In standard treatment without DD focus, DD clients tended to be less satisfied than single diagnosis clients. Whilst the evidence base on client and treatment variables related to satisfaction is small, it suggested client demographics and symptom severity to be unrelated to treatment satisfaction. However, satisfaction tended to be linked to other treatment process and outcome variables. Findings are limited in that many studies had very small sample sizes, did not use validated satisfaction instruments and may not have controlled for potential confounders. A framework for further research in this important area is discussed.ConclusionsHigh satisfaction levels with current treatment provision, especially among those in integrated treatment, should enhance therapeutic optimism among practitioners dealing with DD clients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Dual diagnosis clients' treatment satisfaction - a systematic review

2011

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“…The program's focus was primarily on treatment of substance use disorders until 2003, when the CCISC model was implemented. Longitudinal fidelity data were obtained with the COMPASS (Minkoff & Cline, 2001) throughout the course of the project, and results published elsewhere (Harrison, Moore, Young, Flink, & Ochshorn, 2008) indicated that the program evidenced good fidelity to the CCISC service delivery model throughout the course of the project. Mental health services were provided through a contractual arrangement with a local mental health provider who came to the residential facility to conduct group counseling and individual therapy.…”

Section: Ccisc-rtmentioning

confidence: 99%

Comparing Two Service Delivery Models for Homeless Individuals With Complex Behavioral Health Needs: Preliminary Data From Two SAMHSA Treatment for Homeless Studies

Young

Clark

Moore

et al. 2009

Journal of Dual Diagnosis

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Assertive Community Treatment (ACT) and the Comprehensive, Continuous, Integrated System of Care (CCISC) are two models for delivering services to homeless persons with complex behavioral health needs. This quasi-experimental study presents preliminary data comparing these two programs. The first program was based out of a community mental health center and utilized the ACT model of care with supported housing (ACT-SH), and the second program was based out of a substance abuse treatment agency and used the CCISC model of care in a residential treatment facility (CCISC-RT). Participants completed clinical assessment interviews at baseline before being admitted to the programs and then 6 months later. Measures included the Brief Symptom Inventory (BSI) to measure mental health symptoms; the Treatment Services Needed and Received (TSNR) to assess service needs, utilization, and levels of unmet needs; and a tool assessing employment, housing, and past-month substance use. Results indicated that participants in both interventions reported significant reductions in substance use and mental health symptoms, although the CCISC-RT program was 287 Downloaded by [McMaster University] at 09:45 26 November 2014 288 M. S. Young et al.associated with slightly greater reductions in mental health symptoms. Both programs were also associated with significant improvements in residential stability, although participants in the ACT-SH program were more likely to own or rent their own residence 6 months following program enrollment. This study indicates that both the ACT and CCISC models of care can be successfully implemented to serve homeless individuals with behavioral health needs. Although the CCISC-RT program was based in a residential treatment facility and delivered a greater intensity of behavioral health services than the ACT-SH program, results indicate that either approach can successfully be used to assist homeless individuals in obtaining a variety of needed services, reducing their substance use and mental health symptoms, and attaining a stable residence.

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“…However, more proximal outcomes (e.g., depression, anxiety) in relation to BPD have been largely unexplored, despite the fact that they occur at rates ranging from 25% to 61% in residential treatment facilities and are 4.7 times more prevalent in addictions samples than in community samples (Hasin & Nunes, 1997; Huang et al, 2006; Kessler et al, 2003; Nunes, Sullivan, & Levin, 1997; Regier et al, 1990; Rounsaville et al, 1991). These findings have important implications for treatment settings, as many residential addictions facilities have begun to treat both SUDs and the comorbid psychopathology that may contribute to relapse (e.g., anxiety, depression; Harrison et al, 2008; Kosten, Rounsaville, Kleber, 1986; Moore, Young, Barrett, & Osborn, 2009; Willinger et al, 2002; Yong, Barrett, Engelhardt, & Moore, under review). It is possible that BPD features serve as an additional barrier to treatment due to their impact on the maintenance of these forms of comorbid psychopathology.…”

mentioning

confidence: 97%

Unidirectionality Between Borderline Personality Disorder Traits and Psychopathology in a Residential Addictions Sample: A Short-Term Longitudinal Study

Webber

Kiselica

Arango

et al. 2015

Journal of Personality Disorders

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Borderline personality disorder (BPD) is a barrier to treatment, yet the relationship between BPD features and other psychopathology symptoms in a residential addictions treatment samples is understudied. Using a sample of adults enrolled in a residential drug treatment facility measured at baseline and 2–3 month follow-up, we examined the prospective relationship between BPD features and five indices of psychopathology: depression, anxiety, interpersonal sensitivity, hostility, and psychoticism, as well as psychopathology global severity. There was no effect of time on any of the forms of psychopathology, but females reported higher levels of BPD features, anxiety symptoms, and interpersonal sensitivity than males. A series of latent change score models indicated that BPD features predicted increases in all psychopathology scales at follow-up, while the reverse was not true. These results suggest that targeting BPD features in residential drug treatment facilities may reduce the emergence of new psychopathology in the short-term.

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Implementing the Comprehensive, Continuous, Integrated System of Care Model for Individuals with Co-Occurring Disorders: Preliminary Findings from a Residential Facility Serving Homeless Individuals

Abstract: This study assessed the effectiveness of an evidence-based

Cited by 7 publications

References 25 publications

Dual diagnosis clients' treatment satisfaction - a systematic review

Dual diagnosis clients' treatment satisfaction - a systematic review

Comparing Two Service Delivery Models for Homeless Individuals With Complex Behavioral Health Needs: Preliminary Data From Two SAMHSA Treatment for Homeless Studies

Unidirectionality Between Borderline Personality Disorder Traits and Psychopathology in a Residential Addictions Sample: A Short-Term Longitudinal Study

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