DDCAT – VI. Staffing

VI.A – INTEGRATED PSYCHIATRY

Definition: Programs that offer treatment to individuals with co-occurring disorders offer pharmacotherapy for both mental health and substance use disorders through the services of prescribing professionals. These programs may have a formal relationship with a psychiatrist, physician, or nurse practitioner (or other licensed prescriber) who works with the clinical team to increase medication compliance, to decrease the use of potentially addictive medications such as benzodiazepines, and to offer medications such as disulfiram, naltrexone, or acamprosate that may help to reduce addictive behavior.

Source: Interviews with program director and clinical staff (and prescriber if possible)

Item Response Coding: Coding of this item requires an understanding of the specific competencies of the prescribing professional and his or her level of involvement with the clinical treatment team.

 

VI.B – MENTAL HEALTH SPECIALIZATION

Definition: Addiction treatment programs that offer treatment to individuals with co-occurring disorders employ clinical staff with expertise in mental health to enhance their capacity to treat the complexities of mental health disorders that co-occur with substance use disorders.

Source: Interview with leadership and clinicians, review of staff composition.

Item Response Coding: Coding of this item requires an understanding of the program’s clinical staff composition, particularly the number of licensed, certified and/or competent mental health staff  (e.g., LCSW, LPC, LMFT, licensed psychologist, psychiatrist, APRN, or others with education and experience equivalent to a master’s degree). In addition, professionals need at least two years of supervised experience in assessing and treating patients with co-occurring disorders, to the point where certification or autonomy has been achieved and competence established. Competence is defi      as a demonstrated capability to assess and diagnose mental health disorders, determine treatment needs including appropriate level of care, prevent and manage mental health crises, and deliver mental health treatments. Clinical staff are so defined if they carry a caseload, conduct individual or group sessions, or provide clinical supervision or medication management.

 

VI.C – MENTAL HEALTH CONSULTATION / CLINICAL SUPERVISION

Definition: Programs that offer treatment to individuals with a co-occurring mental health disorder provide formal mental health supervision by a licensed professional (i.e., LCSW, LPC, LMFT, licensed psychologist, psychiatrist, APRN) for both trained providers of mental health services who are unlicensed or who have insufficient competence or experience in the treatment setting, and licensed providers who are developing fidelity to evidence-based practices.

Source: Interview with clinical supervisors, staff composition.

Item Response Coding: Coding of this item requires an understanding of the program’s supervision structure, e.g., frequency, duration, supervision “tree,” etc., specifically the credentials/qualifications of those individuals who provide supervision for mental health services.

 

VI.D – INTEGRATED CASE / UTILIZATION REVIEW

Definition: Programs that offer treatment to individuals with a co-occurring mental health disorder conduct co- occurring disorder-specific case reviews or engage in a formal utilization review process of co-occurring disorder cases in order to continually monitor the appropriateness and effectiveness of services for this population.

Source: Interview with clinicians, agency documents.

Item Response Coding: Coding of this item requires an understanding of the program’s formal process for reviewing mental health issues, specifically the cases of individuals with co-occurring disorders.

 

VI.E – PEER SUPPORTS

Definition: Programs that offer treatment to individuals with co-occurring mental health disorders maintain staff or a formalized relationship with volunteers who can serve as co-occurring disorders peer/alumni supports.

Source: Interviews with clinicians and patients, staff and volunteer composition.

Item Response Coding: Coding of this item requires an understanding of the program’s staff composition and the availability of staff or volunteers as peer/alumni supports, specifically the presence of individuals in recovery from co-occurring disorders.