introductory training for use of the ddcat & ddcmht indexes

INTRODUCTORY TRAINING FOR USE OF THE DDCAT & DDCMHT

INDEXES

WHY FOCUS ON CO-OCCURRING DISORDERS?

1. Substance use disorders are common in people with mental health disorders

2. Mental health disorders are common in people with substance use disorders

3. Co-occurring disorders lead to worse outcomes and higher costs than single disorders

4. Evidence-based models exist and can be implemented

5. Providers and consumers want a better system and services

6. Few (<10%) people get the treatments they need.

Courtesy of Mark McGovern, Ph.D.

COMORBIDITY OF SUBSTANCE USE AND SPECIFIC AXIS I PSYCHIATRIC

DISORDERSAny

SubstanceAlcohol

DiagnosisOther Drug Diagnosis

Schizophrenia 47% 4.6 33.7% 3.3 27.5% 6.2

ASPD 83.6% 29.6 73.6% 21.0 42% 13.4

Anxiety disorders 23.7% 1.7 17.9% 1.5 11.9% 2.5

Phobia 22.9% 1.6 17.3% 1.4 11.2% 2.2

Panic disorder 35.8% 2.9 28.7% 2.6 16.7% 3.2

OCD 32.8% 2.5 24% 2.1 18.4% 3.7

Bipolar Disorder 60.7% 7.9 46.2% 5.6 40.7% 11.1

Major depression 27.2% 1.9 16.5%* 1.3 18% 3.8

Regier DA et al. JAMA. 1990(Nov 21);264(19):2511-2518Regier DA et al. JAMA. 1990(Nov 21);264(19):2511-2518

Cocaine 76.1% (11.3) Barbiturates 74.7% (10.8) Hallucinogens 69.2% (8.0) Opiates 65.2% (6.7) Alcohol 36.6% (2.3)

LIFETIME RISK OF ANY MENTAL HEALTH DISORDER BY SUBSTANCE

USE DISORDER

Regier DA et al. JAMA. 1990(Nov 21);264(19):2511-2518Regier DA et al. JAMA. 1990(Nov 21);264(19):2511-2518

Past Year Treatment of Adults with Both Serious Psychological Distress (SPD)

and SUD (2006)

SOURCE: 2007 National Survey on Drug Use and Health, SAMHSA.

39.60

2.8

8.4

49.2

Tx for MH Problems

Tx for SUD Only

Tx for SPD and SUD

No Tx

5.6 Million adults with co-occurring SPD and substance use disorder.

Past Year Treatment of Adults with Both MDE and AUD

SOURCE: 2007 National Survey on Drug Use and Health, SAMHSA.

48.6

1.98.8

40.7

Tx for MDE onlyTx for Alcohol OnlyTx for MDE and AlcoholNo Tx

So, How Do We Treat COD?

TIP 42

Guiding Principles and Recommendations

Six Guiding Principles (SAMHSA, TIP 42)

• Employ a recovery perspective

• Develop a phased approach to treatment

• Plan for cognitive and functional impairments

• Provide access

• Complete a full assessment

• Achieve integrated treatment

- Treatment Planning and Review

- Psychopharmacology

• Ensure continuity of care

Vision of Fully Integrated Treatment

• One program that provides treatment for both disorders

• Mental and substance use disorders are treated by the same clinicians

• The clinicians are trained in psychopathology, assessment, and treatment strategies for both disorders

Vision of Fully Integrated Treatment (continued)

• Treatment is characterized by a slow pace and a long-term perspective

• Providers offer motivational counseling

• 12-Step groups are available to those who choose to participate

• Pharmacotherapies are utilized according to consumers’ psychiatric and other medical needs

• Sensitivity to issues of trauma

Quick Exercise— Levels of Program Capacity

What challenges have you encountered in moving toward the center?

What have you done to overcome these challenges?

BeginningAddiction

Only Treatment

IntermediateAddiction

CODCapable

Fully Integrated

CODIntegrated

IntermediateMental Health

CODCapable

BeginningMental Health

OnlyTreatment

AdvancedAddiction

CODEnhanced

AdvancedMental Health

CODEnhanced

WHY DO WE NEED TO MEASURE CO-OCCURRING CAPABILITY?

1. Generic terms “integrated” or “enhanced” are “feel good” rhetoric but lack specificity.

2. Systems and providers seek guidance,objective criteria and benchmarks for providing

the best possible services.3. Patients and families should be informed aboutthe range of services, to express preferences andmake educated treatment decisions.

4. Change efforts can be focused and outcomes ofthese initiatives assessed.


SPECIFIC AIMS

1. To develop an index that can objectively determine the dual diagnosis capability of addiction treatment services.

2. To develop practical operational benchmarks on key dimensions, and to determine if changes can be made & measured.

3. To identify change strategies that are particularly effective for enhancing the dual diagnosis capability of addiction treatment services

DDCAT INDEX: DEVELOPMENT

• Practical program level policy, practice and workforce benchmarks: Based on scientific literature and expert consensus

• Observational methodology: Interviews; Document review; Social, environmental & cultural ethnography (vs. self-report)

• Iterative process of measure refinement: Field testing and psychometric analyses

• Materials: Index, manual, toolkit & Excel workbook for scoring and graphic profiles


IS THERE A CONCEPTUAL MODEL THAT COULD GUIDE RESEARCH AND

PRACTICE FOR ADDICTION TREATMENT?

• The American Society of Addiction Medicine (ASAM) Patient Placement Criteria Second Edition Revised (PPC-2R) outlined the framework for a model

• The ASAM-PPC-2R is designed for addiction treatment services

• The ASAM-PPC-2R patient placement criteria have been widely adopted in public and private community addiction treatment

ASAM TAXONOMY OF DUAL DIAGNOSIS SERVICES

(ASAM, 2001)

• ADDICTION ONLY SERVICES (AOS); MENTAL HEALTH ONLY (MHOS)

• DUAL DIAGNOSIS CAPABLE (DDC)

• DUAL DIAGNOSIS ENHANCED (DDE)

ADDICTION ONLY SERVICES (AOS); MENTAL HEALTH ONLY

(MHOS)

Programs that either by choice or

for lack of resources, cannot

accommodate patients who have

psychiatric illnesses that require

ongoing treatment, however

stable the illness and however

well-functioning the patient.Courtesy of Mark McGovern, Ph.D.

DUAL DIAGNOSIS CAPABLE (DDC)

Programs that have a primary focus

on the treatment of substance-

related disorders OR mental health

disorders, but are also capable of

treating patients who have relatively

stable diagnostic or sub-diagnostic

co-occurring mental health

problems.Courtesy of Mark McGovern, Ph.D.

DUAL DIAGNOSIS ENHANCED (DDE)

Programs that are designed to

treat patients who have more

unstable or disabling co-occurring

mental disorders in addition to

their substance-related disorders.Courtesy of Mark McGovern, Ph.D.

DETERMINING DUAL DIAGNOSIS CAPABILITY BY ADDICTION

TREATMENT PROVIDER SURVEY

Addiction Only Services (AOS) 97 (23.0%)

Dual Diagnosis Capable (DDC) 275 (65.3%)

Dual Diagnosis Enhanced (DDE) 49 (11.6%)

(n=453)(McGovern et al, 2006b)

THE NEED FOR A MORE OBJECTIVE ASSESSMENT OF

ADDICTION TREATMENT SERVICES’

DUAL DIAGNOSIS CAPABILITY• ASAM offers the road map, but no

operational definitions for categories or services

• Fidelity: Adherence to an evidence-based practice or model

• Fidelity scales: Objective ratings of adherence in mental health services research

• Can we apply fidelity scale methods to estimate dual diagnosis capability?

APPLYING THE FIDELITY SCALE METHODOLOGY FOR A

MORE OBJECTIVE ASSESSMENT OF DUAL DIAGNOSIS CAPABILITY

• Site visit (yields data beyond self-report)

• Multiple sources: • 1) Documents and materials• 2) Ethnographic observation

3) Interviews with staff and patients• Unit of analysis: Program

• “Triangulation” of dataCourtesy of Mark McGovern, Ph.D.

DUAL DIAGNOSIS CAPABILITY IN ADDICTION TREATMENT (DDCAT)

INDEX: DEVELOPMENT & FEASIBILITY

• Index (instrument) construction• Feedback from experts in dual-diagnosis

treatment and research, state agency administrators, addiction treatment providers, and fidelity measure experts

• Field testing the DDCAT index 1.0 (2003)

• Site visits in programs • Found to be doable, useful information

for providers and psychometrically sound

DDCAT PSYCHOMETIC PROPERTIESReliability

• Median alpha = .81 (Range .73 to .93)• Inter-rater reliability (MO): .76• Inter-rater reliability (LA): .84• Kappa (MO) = .67 (median)• Sensitivity to change (CT): p < .05 @ 9 months

Validity• Correlation with IDDT Fidelity Scale: Median = .69 (.38 to .82)• Relationship with psychiatric severity levels at admission:

Increasing access for persons with co-occurring disorder from AOS to DDC to DDE level programs (p<.001)

(Gotham et al, 2004; McGovern et al, 2006, 2007; Brown & Comaty, 2007)

DUAL DIAGNOSIS CAPABILITY IN MENTAL HEALTH TREATMENT

(DDCMHT) INDEX

• Designed by Drs. Heather Gotham, Jessica Brown & Joseph Comaty as companion to DDCAT but for use in mental health programs.

• Common metric and method: 35 items, 7 dimensions, programs categorized as Mental Health Only Services (MHOS), DDC or DDE

• More likely presentation of QIII patients in mental health system (than addiction treatment system)

• Makes comparisons between systems possible

DUAL DIAGNOSIS CAPABILITY IN MENTAL HEALTH TREATMENT

(DDCMHT) INDEX

• Focus on substance use capable services within a mental health program

• Compares with the Integrated Dual Disorder Treatment model (IDDT) and fidelity scale (which focus on specialized team within a program/agency)

• Less data are presently available• Being used in statewide change

initiatives in Louisiana, Missouri, New York and Vermont

DDCAT & DDCMHT (3.2): 7 DIMENSIONS

& CONTENT OF 35 ITEMSDimension Content of items

I Program Structure

Program mission, structure and financing, format for delivery of mental health or addiction services.

II Program Milieu

Physical, social and cultural environment for persons with psychiatric or substance use problems.

III Clinical Process: Assessment

Processes for access and entry into services, screening, assessment & diagnosis.

IV Clinical Process: Treatment

Processes for treatment including pharmacological and psychosocial evidence-based formats.

V Continuity of Care

Discharge and continuity for both substance use and psychiatric services, peer recovery supports.

VI Staffing Presence, role and integration of staff with mental health and/or addiction expertise, supervision process

VII Training Proportion of staff trained and program’s training strategy for co-occurring disorder issues.

DDCAT/DDCMHT INDEX RATINGS

1 - Addiction Only Services(AOS) or

Mental Health Only Services (MHOS)

2 -3 - Dual Diagnosis Capable (DDC)4 -5 - Dual Diagnosis Enhanced

(DDE)

DDCAT/DDCMHT DATA COLLECTION:SOURCE, DIMENSION & TIME

ALLOCATION

• Meet with agency leadership (I, VI, VII)(30’) • Tour of program (II, III)(30’)• Meet with clinicians and other staff (III-VI)

(30’)• Meet with patients (II, V)(30’) • Observe clinical interaction or team meetings

when possible (II-V)(30’)• Review documents including medical records,

brochures, program schedules, any patient/family handouts, policy & procedure manual (I-V)(60’)

I. PROGRAM STRUCTURE

I.A. Primary treatment focus as stated in mission

statementDDCAT:Is the stated focus addiction only, primarily addiction (with an acknowledgement of psychiatric problems) or dual diagnosis?

DDCMHT:Is the stated focus mental health only, primarily mental health (with acknowledgement of substance use problems) or dual diagnosis?


I.B. Organizational certification and licensure

What does licensure/certification permit?

Are there impediments to providing certain types of services?

Are these impediments real?


I.C. Co-ordination and collaboration with mental

health or addiction servicesDDCAT:How & where are psychiatric services provided? Through relationships or integrated? Are these relationships formalized & documented?

DDCMHT:

How & where are addiction treatments provided? Through relationships or integrated? Are these relationships formalized & documented?


I.D. Financial incentives.

How do billing structures limit or incentivize services for persons with

addiction and/or psychiatric disorders?

II. PROGRAM MILIEU

II.A. Routine expectation of and welcome to treatment for both

disorders.

What patients are expected and welcomed?How is this reflected in agency documents?

II. PROGRAM MILIEU

II.B. Display and distribution of literature and patient educational materials.

What kind of information is posted on walls, on display in waiting areas, and included in patient & family handouts and printed materials?

III. CLINICAL PROCESS: ASSESSMENT

III.A. Routine screening methods for psychiatric or substance use symptoms

DDCAT:Are there routines or systems to screen for psychiatric problems? Are screening instruments used?Are procedures systematic?

DDCMHT:Are there routines or systems to screen for substance use problems?

Are screening instruments used?Are toxicological data gathered?


III.B. Routine assessment if screened positive for

psychiatric symptoms

If a patient screens positive, are more detailed assessments triggered?

Are these assessments formalized & integrated?


III.C. Psychiatric and substance use diagnoses made and

documented

If assessments are conducted, are psychiatric diagnoses made in addition to

the substance use disorder? Are substance use disorder diagnoses made

in addition to the psychiatric disorder?


III.D. Psychiatric and substance use history reflected in

medical record.

Are the chronologies and treatment course of disorders gathered (and

recorded)?


III.E. Program acceptance based on symptom acuity: Low,

moderate, highDDCAT:What happens to patients who call or present for services with stable psychiatric symptoms? Or, unstable ones?

DDCMHT:What happens to patients who call or present for services with substance use in remission? Or, active substance use or intoxication? of addiction treatment?


III.F. Program acceptance based on severity and persistence of

disability: Low, moderate, highDDCAT:

What happens to patients with histories or records of severe and persistent psychiatric problems? Severe mental illness?

DDCMHT:What happens to patients with histories or records of severe substance dependence, and repeated patterns of compulsive use?


III.G. Stage-wise assessment

Is stage of motivation assessed and documented?

Is motivation to change and to use treatment assessed for both substance

use and mental health problems?

IV. CLINICAL PROCESS: TREATMENT

IV.A. Treatment plans

Do treatment plans show an equivalent and

integrated focus on both substance use and

psychiatric disorders, or do they primarily focus on substance use (DDCAT) or psychiatric (DDCMHT) issues only?


IV.B. Assess and monitor interactive courses of both disorders.

Are changes and/or progress with status and symptoms of both psychiatric and substance use disorders followed

(and noted)?


IV.C. Procedures for psychiatric or substance use

emergencies and crisis management

Are there definite protocols for psychiatric or substance use crises

and/or those at high-risk?


IV.D. Stage-wise treatment

Is stage of motivation assessed on an ongoing basis?

Can treatment be revised based upon changes in motivation?

Are assessments and treatments focused on differential stages in patient motivation to

change (and get help with) both mental health and

substance use problems?


IV.E. Policies and procedures for medication evaluation,

management, monitoring and compliance

Are medications acceptable?Are certain medications unacceptable?Are medications routine & integrated?

Are psychiatric and/or addiction medications available?


IV.F. Specialized interventions with

mental health (DDCAT) or addiction (DDCMHT) contentDDCAT:

Are therapies available that focus on addiction only, generic psychological concerns, or focused on specific psychiatric disorders (in addition to substance use treatments)?

DDCMHT:Are therapies available that focus on mental health only, generic lifestyle or behavioral concerns or on specific substance use disorders?


IV.G. Education about co-occurring psychiatric

disorder and or substance use and integrated treatment

Is information available on how substance use impacts a psychiatric disorder and vice versa?

Is information available about how co-occurring disorders affect treatment and

recovery?


IV.H. Family education and support

Are family members provided information on how substance use impacts a psychiatric disorder and

vice versa?What kind of support is available for

families on these issues?


IV.I. Specialized interventions to facilitate use of peer support groups in planning or during

treatment

In facilitating the connection to peer recovery support groups,

how are psychiatric disorders considered?How are substance use disorders considered?

Are specialized introductions available?


IV.J. Availability of peer recovery supports for

patients with CODs

Are peer supports and role models available for patients with co-occurring

substance use and psychiatric disorders?If so, are they on or off site, integrated

with programming?

V. CONTINUITY OF CARE

V.A. Co-occurring disorder addressed in discharge

planning process

Is recovery from both psychiatric and substance use

disorders considered when developing a discharge plan?


V.B. Capacity to maintain treatment continuity

How is treatment terminated or continued?

Is this equivalent for both addiction and psychiatric disorders?


V.C. Focus on ongoing recovery issues for both disorders

Are the disorders seen as acute or chronic, short-term or long-term,

primary or secondary? How is recovery envisioned and planned?


V.D. Facilitation of peer support groups for COD is

documented and a focus in discharge planning, and connections are insured to community peer recovery support groups.

Is the potential increased peer support group linkage difficulty for the person with a

psychiatric disorder anticipated and planned for?

How is it dealt with?


V.E. Sufficient supply and compliance plan for

medications is documented

How is the need for continued prescribing and medication supply dealt

with?Are both psychiatric and addiction

medications made available?

VI. STAFFING

VI.A. Psychiatrist or other physician or prescriber of psychotropic (DDCAT) or addiction (DDCMHT) medications

What is the relationship with a psychiatrist, physician, or nurse

practitioner (or other licensed prescribers)?

VI. STAFFING

VI.B. On site clinical staff members with mental health (DDCAT) or

drug and alcohol (DDCMHT) licensure or competency

Are any staff licensed to provide mental health services?

Addiction services?Co-occurring services?

What percentage of all staff?

VI. STAFFING

VI.C. Access to mental health (DDCAT) or addiction (DDCMHT)

supervision or consultation

What is the arrangement for mental health or addiction treatment supervision and/or

consultation for non-licensed staff?

VI. STAFFING

VI.D. Case review, staffing or utilization review procedures emphasize and support COD

treatment.

Is there a protocol to review the progress or process of

treatments for psychiatric and substance use disorders?

VI. STAFFING

VI.E. Peer/Alumni supports are available with co-occurring

disorders

Are role models available for persons with

co-occurring addiction and psychiatric disorders?

VII. TRAINING

VII.A. Direct care staff members have basic training in prevalence, common

signs & symptoms, screening and assessment for psychiatric symptoms and disorders (DDCAT) and substance

use symptoms and disorders (DDCMHT).

Who has basic training in screening & assessment?

Is training documented?

VII. TRAINING

VII.B. Direct care staff are cross-trained in mental health and

substance use disorders, including pharmacotherapies & have

specialized training in treatment of persons with COD.

Who is trained?Is staff training guided and monitored?

What percentage of all staff?

DDCAT/DDCMHT EXCEL WORKBOOK:

SUMS & AVERAGES SCORES, GRAPHIC PROFILE

• Complete “face” page of Excel workbook • Transfer scores from rating scale onto

Excel workbook scoring page (no need to calculate dimension averages)

• Review dimension averages and program categorization: AOS/MHOS, DDC or DDE

• Review DDCAT/DDCMHT profile line graph

DDCAT/DDCMHT INDEX:SUMMARY & FEEDBACK

• Parallel process to clinical interaction: In both respect and tone MI/MET like

• Assessing organizational stage/targets of change

• Affirmation of strengths• Elicit concerns and/or areas of potential

growth and perceived barriers• Discuss potential strategies for enhancement• Format: Verbal and/or written (Integrative

summary letter and graphic profile)

AOS/MHOS

DDC

DDE

DDCAT/DDCMHT PROFILE: PRACTICAL GUIDANCE FOR

PROVIDERS

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

I. ProgramStructure

II. ProgramMilieu

III. ClinicalProcess:

Assessment

IV. ClinicalProcess:Treatment

V. Continuityof Care

VI. Staffing VII. Training

DDCAT/DDCMHT INDEX: PROVIDER EXPERIENCES

• Very positive• Appreciate concrete suggestions about

potential enhancement of services • Requests for specific information: training,

screening measures, evidence-based treatments

• Verification of real financial constraints• Curiosity about other programs, states• Interest in measuring change over time• Value use of graphic DDCAT/DDCMHT

profiles

DDCAT/DDCMHT INDEXES:SELF-ADMINISTERED

FORMATS

• Several efforts to utilize DDCAT index as self-administered measure: Economic, practical, less intensive resource issue

• Balancing accuracy with practicality• Projects underway in: MA, NJ, Australia,

IN• Comparison data available only for the

Australian sample, and previous research in CT

DDCAT: SELF VS. INDEPENDENT RATINGS (n=14

agencies in Australia)

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

5.00

Hobar

t

Wodo

nga

Mac

kay

Brisba

ne

Canbe

rra

Canbe

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CPer

th

Man

durah

Darwin

Baseline DDCAT Score Self DDCAT Score

USING THE DDCAT/DDCMHT TO GUIDE AND MEASURE

CHANGE

• Use of the DDCAT/DDCMHT as assessment method at baseline and as a measure of change over time.

• Formal implementation and change plan development

• Co-Occurring State Incentive Grant (COSIG) initiatives

• Private non-profit agencies: CQI process• Use within NIATx change process

AOS

DDC

DDE

DDCAT PROFILE: An Outpatient Program in Baton Rouge

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

I. ProgramStructure

II. ProgramMilieu

III. ClinicalProcess:

Assessment

IV. ClinicalProcess:Treatment

V. Continuityof Care

VI. Staffing VII. Training

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

ProgramStructure

ProgramMilieu

ClinicalProcess:

Assessment

ClinicalProcess:

Treatment

Continuity ofCare

Staffing Training

AOS

DDC

DDE

DDCAT/DDCMHT PROFILE CASE STUDY:

UNDERACHIEVING PROGRAM

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

Program

Structure

Program

Milieu

Clinical

Process:

Assessment

Clinical

Process:

Treatment

Continuity of

Care

Staffing Training

AOS

DDC

DDE

DDCAT/DDCMHT PROFILE CASE STUDY:

OVERACHIEVING PROGRAM

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5P

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ram

Str

uct

ure

Pro

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Cli

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Ass

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Cli

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Tre

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ent

Co

nti

nu

ity

of

Car

e

Sta

ffin

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Tra

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IOP-Adult IOP-Adolescent Methadone Maintenance

DDCAT PROFILES: 3 programs within a single

agency DDE

DDC

AOS

DEVELOPING A PROGRAM IMPLEMENTATION OR CHANGE PLAN USING DDCAT/DDCMHT DATA

1. Identify the DDCAT/DDCMHT dimension (Goal)

2. Identify the DDCAT/DDCMHT item(s) (Objectives)

3. Identify the “Intervention” 4. Identify the responsible persons5. Identify the Target Date6. Identify Measurable Outcomes

DRAFT IMPLEMENTATION PLAN FOR THE BATON ROUGE

PROGRAM

D GOAL OBJECTIVEII Progra

mMilieu

Make milieu more welcoming; Provide handouts to patients, families; Change some items on walls.

IV Clinical:Treatment

Develop educational group for patients on common psychiatric disorders, include segment in family night.

VII

Training

Get all existing staff basic training in COD issues; Add to new staff in-service orientation.

STATEWIDE DDCAT/DDCMHT CHANGE

Vermont Program Capability

17

9

4

12

0

2

4

6

8

10

12

14

16

18

2007 2008

Nu

mb

er

of

pro

gra

ms

MentalHealth/Addiction OnlyServices

Dual DiagnosisCapable

RWJ FUNDED MULTI-STATE LEARNING

COLLABORATIVE

• Purpose: To learn from one another’s experience and efforts to improve services for persons with co-occurring disorders (policy, practice & workforce); Most have in common the use of DDCAT/DDCMHT measures

• Data sharing agreement; Combined data set (9 states)

• 13 “official” member states (+ LA County); 10 active (+LA County)

• One face-to-face meeting (2007); Monthly conference calls since

• Focus varies: Measure specific issues; successful and unsuccessful projects; sustainability questions

COLLABORATIVE DATABASE: ADDICTION TREATMENT PROGRAMS

(n=170)

Level of Care N (%)

Outpatient 45 (26%)

Intensive Outpatient

46 (27%)

Residential 70 (41%)

Inpatient 1 (1%)

Methadone Maintenance

8 (5%)

COLLABORATIVE : MENTAL HEALTH TREATMENT

PROGRAMS (n=58)

Level of Care N (%)

Outpatient 53 (91%)

Partial Hospitalization

3 (5%)

Inpatient 2 (4%)

DDCAT/DDCMHT BASELINE PROGRAM CATEGORIES

DDCAT (n=170)

80%

19% 1%

AOS DDC DDE

DDCMHT (n=58)

93%

7%

MHOS DDC DDE

DDCAT/DDCMHT PROGRAM CATEGORIES:

BASELINE AND 9-12 MONTH FOLLOW-UP

DDCAT Baseline (n=71)

87%

13%

AOS DDC DDE

DDCAT Follow-up (n=71)

63%

37%

AOS DDC DDE

DDCMHT Baseline (n=45)

96%

4%

MHOS DDC DDE

DDCMHT Follow-up (n=45)

69%

31%

MHOS DDC DDE

DDCAT CHANGES BY DIMENSION (n=71)

Baseline Follow-up t-value

Dimensions Mean (sd)

Mean (sd)

I. Program Structure

2.66 (1.06)

3.13 (0.95)

-5.48***

II. Program Milieu

2.68 (0.56)

3.30 (0.75)

-8.99***

III. Assessment 2.78 (0.65)

3.22 (0.65)

-9.07***

IV. Treatment 2.35 (0.56)

2.72 (0.57)

-7.83***

V. Continuity of care

2.61 (0.79)

2.97 (0.85)

-5.63***

VI. Staffing 2.90 (0.82)

3.21 (0.85)

-5.31***

VII. Training 2.30 (0.74)

2.78 (0.81)

-5.20***

Overall 2.61 (0.61)

3.04 (0.64)

-10.98***

***p<.001

DDCMHT CHANGES BY DIMENSION (n=45)

Baseline Follow-up t-value

Dimensions Mean (sd)

Mean (sd)

I. Program Structure

2.73 (1.00)

3.52 (0.98)

-5.16***

II. Program Milieu

2.88 (0.85)

3.82 (0.72)

-8.56***

III. Assessment 2.78 (0.47)

3.47 (0.47)

-8.21***

IV. Treatment 2.12 (0.45)

2.72 (0.50)

-9.10***

V. Continuity of care

2.30 (0.78)

2.86 (0.56)

-6.24***

VI. Staffing 2.50 (0.64)

3.22 (0.70)

-7.70***

VII. Training 2.23 (0.60)

2.96 (0.88)

-6.15***

Overall 2.51 (0.55)

3.22 (0.56)

-9.17***

***p<.001

RESOURCES FOR QUALITY IMPROVEMENT

• DDCAT Toolkit http://dms.dartmouth.edu/prc/dual/pdf/ddcat_toolkit.pdf

Operational definitions for all 35 DDCAT benchmarks and specific suggestions, with real examples, of how to move from AOS to DDC or DDC to DDE scores

• Hazelden CDP Clinical Administrators Guidebook

http://www.hazelden.org/OA_HTML/ibeCCtpItmDspRte.jsp?item=13480&sitex=10020:22372:US

Operational definitions for all of both the DDCAT and DDCMHT items, practical suggestions, examples, and actual tools for quality improvement



Sherry LarkinsResearch Sociologist

Integrated Substance Abuse ProgramsUCLA

(310) [email protected]

introductory training for use of the ddcat & ddcmht indexes

Documents

cooccurring disorders

single disorders

substance use disorders

mental health disorders

worse outcomes

higher costs

ddcat ddcmht indexes

better system