IDDT Global Organizational Elements

For an 18-minute introduction to Integrated Treatment for Co-Occurring Disorders, navigate to the YouTube Integrated Treatment for Co-Occurring Disorders Playlist link, and click on the 1st video option on the menu entitled, “Introductory Video – English” (also available in a Spanish version).

Click on this link to view or download the short version of the IDDT Global Organizational Index Scale (also known as the “Organizational Characteristics” of the IDDT Model).

G1. Program Philosophy

Definition

The program is committed to a clearly articulated philosophy consistent with IDDT, based on the following 5 sources:

    • Program leader
    • Senior staff (e.g., executive director, psychiatrists)
    • Practitioners providing IDDT services
    • Clients and/or family members
    • Written materials (e.g., brochures)

G2. Eligibility/Client Identification

Definition

1. For IDDT implemented in a mental health center: All clients in the community support program, crisis clients, and institutionalized clients are screened using standardized tools or admission criteria that are consistent with IDDT.

2. For IDDT implemented in a service area: All clients within the jurisdiction of the services area are screened using standardized tools or admission criteria that are consistent with IDDT.

    • The target population refers to all adults with severe mental illness (SMI) served by the provider agency (or service area) who have a co-occurring substance use disorder.  If the agency serves clients at multiple sites, then assessment is limited to the site or sites that are targeted for IDDT. If the target population is served in discrete programs (e.g., case management, residential, day treatment, etc.), then ordinarily all adults with SMI and co-occurring substance use disorders would be included in this definition.
    • The intent is to identify any and all for who could benefit from IDDT. For Integrated Dual Disorder Treatment, the admission criteria are specified by the EBP and specific assessment tools are recommended.
    • Screening typically occurs at program admission, but for a program that is newly adopting IDDT, there should be a plan for systematically reviewing clients already active in the program.

> Click here to view or download the Screening, Assessment, and Treatment Planning for Persons With Co-Occurring Disorders Overview Paper 2 from SAMHSA’s Co-Occurring Center for Excellence

> See also Appendix G: Screening and Assessment Instruments, on pages 487-495 of SAMHSA’s TIP 42: Substance Abuse Treatment for Persons With Co-Occurring Disorders.

> See also Appendix H: Sample Screening Instruments, on pages 497-499 of SAMHSA’s TIP 42, Substance Abuse Treatment for Persons With Co-Occurring Disorder TIP 42: Substance Abuse Treatment for Persons With Co-Occurring Disorderss.

> See also a copy of Ken Minkoff’s MIDAS screening instrument (Mentally Ill Drug and Alcohol Screening).

> See also a copy of Norman Hoffman’s UNCOPE screening instrument.

> See also the DSM-5 criteria for diagnosing Substance Use Disorder.

 

G3. Penetration

Definition

Penetration is defined as the percentage of clients who have access to an EBP as measured against the total number of clients who could benefit from the EBP.  Numerically, this proportion is defined by:  (# of clients receiving an EBP) divided by (# of clients eligible for the EBP). As in the preceding item, the numbers used in this calculation are specific to the site or sites where the EBP is being implemented.

G4. Assessment

Definition

All EBP clients receive standardized, high quality, comprehensive, and timely assessments.

    • Standardization refers to a reporting format that is easily interpreted and consistent across clients.
    • High quality refers to assessments that provide concrete, specific information that differentiates between clients.  If most clients are assessed using identical words, or if the assessment consists of broad, non-informative checklists, then this would be considered low quality.
    • Comprehensive assessments include: history and treatment of medical, psychiatric, and substance use disorders, current stages of all existing disorders, vocational history, any existing support network, and evaluation of bio-psycho-social risk factors.
    • Timely assessments are those updated at least annually.

> Click here to view or download the Screening, Assessment, and Treatment Planning for Persons With Co-Occurring Disorders Overview Paper 2 from SAMHSA’s Co-Occurring Center for Excellence

> See also Chapter 4: Assessment, on pages 65-71 of SAMHSA’s TIP 42: Substance Abuse Treatment for Persons With Co-Occurring Disorders.

> See also Appendix G: Screening and Assessment Instruments, on pages 487-495 of SAMHSA’s TIP 42: Substance Abuse Treatment for Persons With Co-Occurring Disorders.

> See also a copy of the URICA instrument (University of Rhode Island Change Assessment scale).

> See also a copy of Miller & Tonigan’s SOCRATES instrument (Stage Of Change Readiness And Treatment Eagerness Scale).

> See also a copy of the Substance Abuse Treatment Scale (SATS) and the adapted Mental Illness Treatment Scale (MITS), also known as the Stages of Treatment, along with a description of its supporting research and rationale.

> See also the University of New Mexico’s Center on Alcoholism, Substance Abuse, and Addictions (CASAA) Readiness Ruler.

> See also the American Society of Addiction Medicine (ASAM) Severity Index.

> For an 32-minute introduction to Integrated Treatment for Co-Occurring Disorders, navigate to the YouTube Integrated Treatment for Co-Occurring Disorders Playlist link, and click on the 6th video option on the menu entitled, “Practice Demonstration Video – Assessment”.

G5. Individualized Treatment Plan

Definition

For all EBP clients, there is an explicit, individualized treatment plan (even if it is not called this) related to the EBP that is consistent with assessment and updated every 3 months.  “Individualized” means that goals, steps to reaching the goals, services/ interventions, and intensity of involvement are unique to this client.  Plans that are the same or similar across clients are not individualized.  One test is to place a treatment plan without identifying information in front of the supervisor and see if they can identify the client.

> Click here to view or download the Screening, Assessment, and Treatment Planning for Persons With Co-Occurring Disorders Overview Paper 2 from SAMHSA’s Co-Occurring Center for Excellence.

> Click here for the SAMHSA IDDT Toolkit’s chapter on Treatment Planning.

> Click here to view or download the guide for Matching Stages of Change and Treatment to Treatment Goal, Intervention, and Technique.

> Click here to view or download the one-page Process for Strengths-Based, Recovery-Oriented Treatment Planning.

>> See also the University of New Mexico’s Center on Alcoholism, Substance Abuse, and Addictions (CASAA) What I Want From Treatment checklist.

> Click here to view or download the Harm Reduction Change Scale.

G6. Individualized Treatment

Definition

All IDDT clients receive individualized treatment meeting dual recovery goals. “Individualized” treatment means that steps, strategies, services/interventions, and intensity of involvement are focused on specific client goals and are unique for each client.  Progress notes are often a good source of what really goes on.  Treatment could be highly individualized despite the presence of generic treatment plans.

An example of a low score on this item for Integrated Dual Disorders Treatment: a client in the engagement phase of recovery is assigned to a relapse prevention group and constantly told he needs to quit using, rather than using motivational interventions.

> Click here to view or download a copy of a Decisional Balance Worksheet.

> Click here to view or download a copy of a Chain Analysis Worksheet.

G7. Training

Definition

All new practitioners receive standardized training in the EBP (at least a 2-day workshop or its equivalent) within 2 months of hiring. Existing practitioners receive annual refresher training (at least 1-day workshop or its equivalent).

> Click here to view or download the Training Frontline Staff: Integrated Treatment for Co-Occurring Disorders manual, part of the SAMHSA IDDT Toolkit.

> See also Appendix I: Selected Sources of Training, on pages 513-516 of of SAMHSA’s TIP 42: Substance Abuse Treatment for Persons With Co-Occurring Disorders.

>See also the 10 web-based interactive learning modules on various Co-Occurring Mental Health and Substance Use Disorders Treatment Competencies including the following:

> See also the University of South Florida’s No Fee Training Series, offering a comprehensive overview for practitioners on topics related to assessing and treating persons with co-occurring disorders. A certificate of completion is available at no cost. The topics covered include the following:

Understanding the Needs of Persons with Co-Occurring Disorders
Issues and Techniques in the Assessment of Co-Occurring Disorders
Creating Treatment Programs for Persons with Co-Occurring Disorders
Evidence-based Treatment Models for Persons with Co-Occurring Disorders
Responsive Services and Supports for Persons with Co-Occurring Disorders
Adolescents and Co-Occurring Disorders
Co-Occurring Disorders among Older Adults
Women and Co-Occurring Disorders
Co-Occurring Disorders in Persons in the Justice System

G8. Supervision

Definition

EBP practitioners receive structured, weekly supervision from a practitioner experienced in the particular EBP.  The supervision can be either group or individual, but CANNOT be peers-only supervision without a supervisor.  The supervision should be client-centered and explicitly address the EBP model and its application to specific client situations.

Administrative meetings and meetings that are not specifically devoted to the EBP do not fit the criteria for this item.  The client-specific EBP supervision should be at least one hour in duration each week.

G9. Process Monitoring

Definition

Supervisors/program leaders monitor the process of implementing the EBP every 6 months and use the data to improve the program.  Process monitoring involves a standardized approach, e.g., use of a fidelity scale or other comprehensive set of process indicators.  An example of a process indicator would be systematic measurement of how much time individual case managers spend in the community versus in the office.  Process indicators could include items related to training or supervision.  The underlying principle is that whatever is being measured is related to implementation of the EBP and is not being measured to track billing or productivity.

G10. Outcome Monitoring

Definition

Supervisors/program leaders monitor the outcomes of EBP clients every 3 months and share the data with EBP practitioners in an effort to improve services.  Outcome monitoring involves a standardized approach to assessing clients.

> Click here to view or download one example of the Client Outcomes – Quarterly Report Form for COD/IDDT services.

> Click here to view or download a copy of SAMHSA’s National Outcome Measures (NOMs) domains.

G11. Quality Assurance (QA)

Definition

The agency’s QA Committee has an explicit plan to review the EBP or components of the program every 6 months.  The steering committee for the EBP can serve this function.  Good QA committees help the agency in important decisions, such as penetration goals, placement of the EBP within the agency, hiring/staffing needs.  QA committees also help guide and sustain the implementation by reviewing fidelity to the EBP model, making recommendations for improvement, advocating/promoting the EBP within the agency and in the community, and deciding on and keeping track of key outcomes relevant to the EBP.

> Click here to view or download a copy of Case Western Reserve University’s Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence (SAMI CCOE) “Implementing IDDT: A Step-by-Step Guide to Stages of Organizational Change”.

G12. Client Choice Regarding Service Provision

Definition

All clients receiving EBP services are offered a reasonable range of choices consistent with the EBP; the EBP practitioners consider and abide by client preferences for treatment when offering and providing services.

Choice is defined narrowly in this item to refer to services provided.  This item does not address broader issues of client choice, such as choosing to engage in self-destructive behaviors.

To score high on this item, it is not sufficient that a program offers choices.  The choices must be consonant with EBP.  So, for example, a program implementing supported employment would score low if the only employment choices it offered were sheltered workshops.

A reasonable range of choices means that EBP practitioners offer realistic options to clients rather than prescribing only one or a couple of choices or dictating a fixed sequence or prescribing conditions that a client must complete before becoming eligible for a service.

Sample of Relevant Choices in IDDT:

    • Group or individual interventions
    • Frequency of DD treatment
    • Specific self-management goals

> Click here to view or download a copy of the COD: IDDT Quality of Life Self-Assessment.