DDCAT – IV. Clinical Process: Treatment

IV.A – INTEGRATED TREATMENT PLANS

Definition: In the treatment of individuals with co-occurring disorders, the treatment plans indicate that both the mental health disorder as well as the substance use disorder will be addressed.

Source: Review of treatment plans.

Item Response Coding: Coding of this item requires an understanding of the program’s treatment planning process as well as any standardized procedures and formats used in treatment planning.

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IV.B – MONITORING OF DISORDER INTERACTION

Definition: In the treatment of persons with co-occurring disorders, the continued assessment and monitoring of substance use and mental health disorders as well as the interactive course of the disorders is necessary.

Source: Medical records.

Item Response Coding: Coding for this item requires an understanding of the program’s process and procedures for monitoring co-occurring disorders.

 

IV.C – PROTOCOLS FOR ACTIVE USE / RELAPSE

Definition: Programs that treat individuals with co-occurring disorders use specific clinical guidelines to manage crisis and mental health emergencies, according to documented protocols.

Source: Interviews with clinicians, policy and procedure manual.

Item Response Coding: Coding of this item requires an understanding of a program’s specific clinical protocols used to manage mental health crises or concerns. Consider the program’s level of care when coding, meaning that the criteria are met as could be expected from the program’s level of care (e.g., programs do not need to be residential/inpatient setting to score a 5).

 

IV.D – STAGE-WISE TREATMENT INTERVENTIONS

Definition: Within programs that treat individuals with co-occurring disorders, ongoing assessment of readiness to change contributes to the determination of continued services which appropriately fit that stage in terms of treatment content, intensity, and utilization of outside agencies.

Source: Interviews with clinicians, review of treatment plans/reviews and progress notes.

Item Response Coding: Coding of this item requires an understanding of the program’s protocol for the continued assessment and monitoring of the individual as well as whether the stages of change assessment is part of this continued follow-up. Note: Programs that do not routinely assess the stage of motivation in the initial assessment will likely not consistently address this issue during the course of treatment.

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IV.E – PHARMACOLOGICAL SUPPORT FOR ADDICTIONS TREATMENT

Definition: Programs that treat individuals with co-occurring disorders are capable of evaluating medication needs, ensuring access to a prescriber when needed, coordinating and managing medication regimens, monitoring for adherence to regimens, and responding to any challenges or difficulties with medication compliance, as documented in policy/procedure.

Source: Interviews (preferably with a prescriber), policy and procedure manual, and medical records.

Item Response Coding: Coding of this item requires an understanding of the program’s medication management policies and procedures as well as an understanding of the prescribers’ job description.

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IV.F – SPECIALIZED PSYCHOSOCIAL INTERVENTIONS

Definition: Programs that treat individuals with co-occurring disorders utilize specific therapeutic interventions and practices that target specific mental health symptoms and disorders. There is a broad array of such interventions and practices that can be effectively integrated into treatment. Some interventions can be generically applied by programs. These interventions might include stress management, relaxation training, anger management, coping skills, assertiveness training, and problem solving. In some cases, addiction treatment programs may already use some of these techniques in the treatment of substance use disorders. More advanced interventions that could be applied to persons with co-occurring disorders include adaptations of evidence based addiction treatments  (e.g., brief motivational or cognitive behavioral therapies, to target specific disorders such as PTSD, depression, anxiety disorders, and Axis II disorders.

This DDCAT item pertains to psychosocial or behavioral interventions for persons with co-occurring disorders in addiction treatment settings. Frequently, providers wish to focus on medications as the primary option for treatment of the mental health disorder. Medications can be FDA-approved medications for the most common disorders in addiction treatment (mood, anxiety, PTSD, bipolar disorder). However, these disorders are at least if not more responsive to psychosocial/behavioral interventions in terms of clinical efficacy and durability of response. Accordingly, this is an opportunity for addiction treatment providers, with and without medication resources, to develop or enhance services along these lines. DDC programs will typically incorporate generic interventions for co-occurring disorders in group, individual and psycho-educational formats. However, DDE programs will also routinely adapt psychological/ behavioral therapies for addiction disorders for use with patients with co-occurring mental health disorders, delivering therapies in a targeted and systematic (manual-guided) fashion. DDE programs also attempt to implement the available integrated treatments for persons with co-occurring disorders (e.g., Seeking Safety, Dialectical Behavior Therapy—Substance Abuse, or other integrated therapies for co-occurring disorders). There  are presently few such treatments, although many are in the development and testing stages.

Source: Interviews with clinicians and patients, review of treatment plans, progress notes, group schedule and group curriculum, and observation of group.

Item Response Coding: Coding of this item requires an understanding of the program’s interventions for individuals with co-occurring disorders that focus on mental health concerns, symptoms, and disorders.

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IV.G – INTEGRATED CLIENT EDUCATION

Definition: Programs that offer treatment to individuals with co-occurring disorders provide education about mental health and substance use disorders, including treatment information and the characteristics, features, and interactive course of both types of disorders.

Source: Interviews with staff and patients, review of schedules of psycho-educational groups, group curriculum, and progress notes.

Item Response Coding: Coding of this item requires an understanding of the program’s educational components that address mental health disorders.

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IV.H – FAMILY EDUCATION / SUPPORT

Definition: Programs that offer treatment to individuals with co-occurring disorders provide education and support to family members regarding co-occurring disorders. This includes treatment information and the characteristics and features of both types of disorders. This is offered to educate collaterals about realistic expectations, the interactive course of the disorders, and the positive prospects for recovery. It is also designed to provide a supportive environment for family members to address specific concerns and be involved in the individual’s treatment planning as necessary. Family education and support can occur in individual  or group formats. Family is broadly defined to include any significant others and members of support systems.

Source: Interviews with clinicians and patients, schedule of group therapies and support groups, and review of treatment plans and progress notes.

Item Response Coding: Coding of this item requires an understanding of the program’s educational and supportive components for the family or significant others that address co-occurring disorders.

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IV.I – PEER-LED SUPPORT GROUP RESOURCES

Definition: Addiction treatment programs that offer treatment to individuals with co-occurring disorders provide assistance in developing a support system through peer recovery support groups. Individuals  with mental health symptoms and disorders often face additional barriers in linking with peer recovery support groups. These individuals may require additional assistance such as being referred/ accompanied/ introduced to peer recovery support groups by clinical staff, designated liaisons, or mutual aid group peer volunteers. Additional interventions may be required to help individuals find peer support groups with accepting attitudes toward people with co-occurring disorders and toward the use of psychotropic medication.

Source: Interviews with clinicians and patients, schedule or calendar of available peer recovery support groups, and review of treatment plans and progress notes.

Item Response Coding: Coding of this item requires an understanding of the mechanism through which individuals, specifically those with co-occurring disorders, are linked with peer recovery support groups.

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IV.J – OTHER PEER RECOVERY SUPPORT SERVICES

Definition: Addiction programs that offer treatment to individuals with a co-occurring mental health disorder encourage and support the use of peer supports and role models that include consumer liaisons, alumni groups, etc. Assistance is provided to individuals in developing  a support system that includes the development of relationships with individual peer supports (in addition to peer support groups described in the previous item.) For the purpose of this item, peer is defined as a person with a co-occurring disorder.

Source: Interviews with clinicians and patients, review of treatment plans, calendar of available peer recovery supports, understanding of onsite peer recovery supports, consumer liaisons, and alumni staff.

Item Response Coding: Coding of this item requires an understanding of the availability of co-occurring disorders-specific peer supports and role models.