The Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index

Transcription

1 The Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index Heather J. Gotham, PhD, 1 Jessica L. Brown, PhD, 2 Joseph E. Comaty, PhD, MP, 2,3 Mark McGovern, PhD 4 & Ronald E. Claus, PhD 5 1 Mid-America ATTC, University of Missouri-Kansas City 2 Louisiana Department of Health and Hospitals 3 Dept. of Psychology, Louisiana State University 4 Dartmouth Medical School 5 Missouri Institute of Mental Health AHSR 2009

2 Addiction services in mental health Addiction health services are provided in diverse settings such as primary care, corrections, and mental health. In fact, clients with co-occurring substance use and mental health disorders present most frequently to mental health programs.

3 Past Year Mental Health Care among Adults Aged 18 or Older with Both Serious Psychological Distress and a Substance Use Disorder: 2007 SAMHSA. (2008). Results from the 2007 national survey on drug use and health: National findings (Office of Applied Studies, NSDUH Series H-34, DHHS Publication No. SMA ). Rockville, MD.

4 The Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Index Need for fidelity/capability tools for COD in Mental Health settings Assess COD capability of mental health programs that are not specifically implementing IDDT Need to compare capability across primary mental health and addiction treatment programs Parallel instrument to the Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index Began by revising DDCAT items into mental health terms Then further refined items to fit mental health treatment settings

5 Current Study Goals Examine the DDCMHT s reliability and validity Describe mental health program capability across six states

6 Method Three data sources Combined data of 67 agencies across 6 states from a Robert Wood Johnson grant Inter-rater reliability data from Louisiana COSIG project DDCMHT and IDDT scores from Missouri COSIG and Missouri Foundation for Health projects Like the DDCAT, the DDCMHT s 35 items are rated following a treatment program site visit Ethnographic observation Structured interviews with agency directors and staff Document review

7 DDCMHT: 7 DIMENSIONS, 35 ITEMS Dimension Content of items I Program Structure Program mission, structure and financing, format for delivery of substance abuse services. II Program Milieu Physical, social and cultural environment for persons with substance use disorders. III IV Clinical Process: Assessment Clinical Process: Treatment Processes for access and entry into services, screening, assessment & diagnosis. Processes for treatment including pharmacological and psychosocial evidence-based formats. V Continuity of Care Discharge and continuity for both substance use and psychiatric services, peer recovery supports. VI Staffing Presence, role and integration of staff with substance abuse treatment expertise, supervision process VII Training Proportion of staff trained and program s training strategy for co-occurring disorder issues.

8 DDCMHT INDEX RATINGS Mental Health Only Services (MHOS) serve clients with no or minimal co-occurring disorders Dual Diagnosis Capable (DDC) serve clients with low severity substance use Dual Diagnosis Enhanced (DDE) serve clients with more severe, unstable substance use disorders

9 DDCMHT: Reliability (n = 67) Dimension # Items Cronbach s Alpha I Program Structure 4.79 II Program Milieu 2.68 III Clinical Process: Assessment 7.78 IV Clinical Process: Treatment V Continuity of Care 5.76 VI Staffing 5.64 VII Training 2.53

10 Inter-rater Reliability Louisiana COSIG study Brown & Comaty, mental health sites, 17 addiction sites 3 raters per site DDCMHT (N=527 total expected observations) ICC(2,1) =.829 (95% Confidence Interval ) DDCAT (N=388 total expected observations) ICC(2,1) =.843 (95% Confidence Interval )

11 Construct Validity Construct validity was demonstrated by a large positive correlation with the Integrated Dual Disorders Treatment (IDDT) Fidelity Scale. Missouri COSIG and Missouri Foundation for Health data 22 mental health treatment sites across the state IDDT Fidelity Scale Total Score and DDCMHT Total Score, r =.70

12 DDCMHT (N=67) - Program Characteristics Sites across 6 states (1 23 per state) 66 of 67 are not-for-profit 61 only offer outpatient services (the other 6 offer a combination of outpatient, partial hospital, or inpatient) Most sites are general programs; 2 focus on adolescents, 1 focuses on clients with HIV 62% are time-unlimited programs

13 DDCMHT PROGRAM CATEGORIES: FIVE STATE SUMMARY (n=67) Criterion method: 80% or more items meet that level

14 DDCMHT PROGRAM CATEGORIES FIVE STATE SUMMARY (n=67) Scale method: based on overall score

15 Results The DDCMHT showed acceptable item level and inter-rater reliability. Construct validity was demonstrated by moderate positive correlation with the Integrated Dual Disorders Treatment (IDDT) Fidelity Scale. Almost all of the programs provided services at the Mental Health Services Only level, only one-tenth provided services at the Dual Diagnosis Capable level.

16 Conclusions Data across several states suggest that many mental health programs are at a relatively low level of capability Results from this important new tool, the DDCMHT, can be used with programs in implementation planning and with states or nationally to affect policy change DDCMHT Index and Scoring Manual are available for download at:

17 Contact Heather J. Gotham, PhD Jessica Brown, PhD Joseph Comaty, PhD, MP Mark P. McGovern, PhD edu Ronald E. Claus, PhD This work was supported by SAMHSA/CSAT Grant TI15347, Robert Wood Johnson Foundation Substance Abuse Policy Research Program 63110, and the Missouri Foundation for Health (a philanthropic organization whose vision is to improve the health of the people in the community it services)