DDCMHT – 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.

Resources:

 

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 substance-related 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 substance use 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 to score a 5).

 

IV.D – STAGE-WISE TREATMENT INTERVENTIONS

Definition: Within programs that treat individuals with co-occurring disorders, ongoing assessment of motivation or stage of change/treatment for both substance use and mental health 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, medical records including 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. Also required is an understanding about whether ongoing assessment motivation or stage or change/ treatment for substance use and mental health is part of this continued follow-up. Note: Programs that do not routinely measure motivation or stage of change/ treatment in the initial assessment are not likely to consistently address this issue during the course of treatment.

Resources:

 

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 a policy and procedure manual. In mental health settings, this specifically means policies and procedures regarding the use of medications for substance use disorders, including: 1) medications to treat intoxication states, decrease/eliminate withdrawal symptoms, decrease reinforcing effects of abused substances, promote abstinence, and prevent relapse; and 2) policies about the use of benzodiazepines or other potentially addictive medications.

Source: Interviews (preferably with the 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.

Resources:

 

IV.F – SPECIALIZED PSYCHOSOCIAL INTERVENTIONS

Definition: Programs that treat individuals with co-occurring disorders utilize specific therapeutic interventions and practices that target substance use 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 process groups and individual counseling that focus on barriers to recovery, relapse prevention strategies, and connecting with peer recovery support groups. More advanced clinical interventions for substance use disorders include motivational interviewing techniques, cognitive behavioral interventions specific to substance use problems, and twelve-step facilitation. Another level of specialized and more resource laden practices are integrated interventions for co-occurring disorders (typically for individuals with severe mental illness), which often include assertive outreach strategies, intensive case management approaches, contingency management, and risk reduction strategies.

DDC programs will typically make co-occurring disorder adaptations to standard mental health treatment practices for group, individual, and psycho-educational formats (e.g., adding curriculum on relapse prevention to a depression treatment protocol). DDE programs will typically adapt psychological/behavioral therapies for substance use disorders for patients in mental health treatment programs. DDE programs also attempt to implement the available evidence-based treatments for persons with co-occurring disorders (e.g., Integrated Dual Disorders Treatment). There are presently few such integrated treatments, although many are in the development and testing stages.

Source: Interviews with staff and patients, review of treatment plans, progress notes, treatment schedule and/or curriculum, and observation of group treatment session if available.

Item Response Coding: Coding of this item requires an understanding of the program’s array of services and interventions that focus on substance use concerns, symptoms, and disorders.

Resources:

 

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 patient education groups, group curriculum, treatment plans, and progress notes.

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

Resources:

 

IV.H – FAMILY EDUCATION / SUPPORT

Definition: Programs that offer treatment to individuals with co-occurring disorders provide education and support to family members regarding mental health and substance use disorders. This includes treatment information and the characteristics and features of both types of disorders. This aspect of programming is designed to educate family members 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 as necessary. Family education and support can occur in individual or group formats. Family is broadly defined to include 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 (broadly defined) of individuals with co-occurring disorders.

Resources:

 

IV.I – PEER-LED SUPPORT GROUP RESOURCES

Definition: Mental health programs that offer treatment to individuals with co-occurring disorders provide assistance to individuals in developing a support system through peer recovery support groups. Individuals with co-occurring disorders often face additional barriers in linking with peer support groups. These individuals may require additional assistance, such as being referred, accompanied, or introduced to these groups by clinical staff, designated liaisons, or peer support group 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 support groups.

Resources:

 

IV.J – OTHER PEER RECOVERY SUPPORT SERVICES

Definition: Mental health programs that offer treatment to individuals with a co-occurring substance use 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. (Peer support groups are 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, listing or 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.