DDCMHT – VI. Staffing

VI.A – INTEGRATED PSYCHIATRY

Definition: Programs that offer treatment to individuals with co-occurring disorders offer pharmacotherapy for both the mental health disorder and the substance use disorder 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, decrease the use of potentially addictive medications such as benzodiazepines, and offer medications such as disulfiram, naltrexone, acamprosate, or buprenorphine that are used in the treatment of substance use disorders.

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 – ADDICTIONS SPECIALIZATION

Definition: Mental health programs that offer treatment to individuals with co-occurring disorders employ persons with expertise in substance use disorders to enhance their capacity to treat the complexities of co-occurring disorders.

Source: Program director interview, 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 addiction staff, defined as licensed or certified addiction/substance abuse/alcohol and drug counselors, or other professionals (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 defined as a demonstrated capability to assess and

diagnose substance use disorders, determine treatment needs including appropriate level of care, manage substance-related crises and relapse, and deliver addiction treatments. Clinical staff members are so defined if they carry a caseload, conduct individual or group sessions, or provide clinical supervision or medication management.

 

VI.C – ADDICTIONS CONSULTATION / CLINICAL SUPERVISION

Definition: Programs that offer treatment to individuals with co-occurring substance use disorders provide formal addiction supervision by licensed/certified addiction professionals. These include licensed/certified addiction counselors, or other addiction-competent professionals (LCSW, LPC, LMFT, licensed psychologist, psychiatrist, APRN, or others) for both trained providers of addiction 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,”), specifically the credentials/qualifications of those individuals who provide supervision for addiction services.

 

VI.D – INTEGRATED CASE / UTILIZATION REVIEW

Definition: Programs that offer treatment to individuals with co-occurring substance use disorders conduct co-occurring disorders-specific case reviews or engage in a formal utilization review process of co-occurring disorders 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 substance use issues, specifically the cases of individuals with co-occurring disorders.

 

VI.E – PEER SUPPORTS

Definition: Programs that offer treatment to individuals with co-occurring substance use 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 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.