Improving the Dual Diagnosis Capability of Addiction and Mental Health Treatment Services: Implementation Factors Associated With Program Level Changes

Abstract

OBJECTIVE: This study examined implementation factors associated with addiction and mental health treatment program improvement in services to persons with co-occurring substance use and psychiatric disorders. There were two primary aims: (a) to articulate factors associated with successful program change and (b) to determine whether the effective factors are different by program type. METHODS: Eighty-six programs (addiction treatment n = 54; mental health treatment n = 32) were assessed at baseline and 18-month follow-up using the Dual Diagnosis Capability in Addiction Treatment (DDCAT; McGovern, Matzkin, & Giard,

Coexisting addiction and mental health practices of a national addiction workforce

“…Services and organisational structures have a critical role to play in leading a culture change to address CEP through standardised guidelines and protocols, staff training, supervision, mentoring, and, importantly, collaboration across addiction and mental health services in order to provide integrated systems of care (Brouselle et al, 2010;Gotham et al, 2010;McGovern, Lambert-Harris, McHugo, Giard, & Mangrum, 2010).…”

Leadership and Licensure for Drug Treatment and the Implementation of Co-Occurring Disorder Treatment in Community Mental Health Centers

“…Our main dependent variables were drawn from the Dual Diagnosis Capability in Mental Health Treatment instrument, which measures mental health programs’ capacity to appropriately serve clients with CODs by evaluating program structure, program milieu, clinical processes (for both assessment and treatment), continuity of care, staffing, and training (Gotham et al, 2010; McGovern et al, 2010; McGovern, Matzkin, & Giard, 2007; Sacks et al, 2013; SAMHSA, 2012). Instrument items were modified to be delivered in a survey format, similar to other nationwide studies (SAMHSA, 2012).…”

“…Yet the multiple treatment components (e.g., appropriate program structure, program milieu, clinical processes, continuity-of-care procedures, staffing, and training) needed to provide quality care to individuals with CODs are unavailable in many mental health treatment settings across the nation (Chandler, 2009; Gotham, Claus, Selig, & Homer, 2010; McGovern, Lambert-Harris, McHugo, Giard, & Mangrum, 2010; Padwa, Larkins, Crevecoeur-MacPhail, & Grella, 2013; Sacks et al, 2013). Only about 4% of individuals with CODs receive integrated evidence-based interventions designed to address both mental health and substance use conditions (Drake & Bond, 2010), and on the rare occasions that such services are delivered, it is usually with low fidelity (Chandler, 2009).…”

“…Studies have also underscored the importance of improvements in domains related to program structure, program milieu, assessment, treatment, and continuity of care (McGovern et al, 2010; Padwa et al, 2013) and delivering brief dual-disorder treatment via a continuing-care approach at the community level (Drake, Mueser, Brunette, & McHugo, 2004). Experts have also suggested that programs can improve their COD treatment capacity by restructuring treatment processes to give equal weight to both substance abuse and mental health issues (Drake et al, 2004; Grella & Stein, 2006).…”

The Predictive Validity of the Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index

“…Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions of 12 months after the initial (baseline) assessment determined that the DDCAT measure, used in combination with related technical assistance (e.g., on-site feedback, a written report providing observations along with a series of recommendations for improving integration, and the development of an implementation plan), was associated with significant increases in dual diagnosis capability (e.g., Gotham et al, 2010;McGovern, Lambert-Harris, McHugo, Giard, & Mangram, 2010;Sacks et al, 2013). None of the work with the DDCAT to date has examined whether a program's capability to deliver integrated mental health and substance abuse treatment services affects treatment engagement among clients.…”