Helping Programs Enhance Their Co-occurring Disorder Services: A Model for Success
Many clients seeking care for their substance use disorder also have co-occurring mental health disorders – and vice versa. Treating both types of conditions at the same time by providing quality integrated services is more effective than treating each disorder separately.
Yet while integrated care has been increasingly prioritized, it remains an often elusive goal. An estimated 17 million adults in the United States live with co-occurring mental health (MH) and substance use disorders (SUD), yet only 5.7% of these individuals receive treatment for both disorders (NSDUH, 2020).
So, what is getting in the way?
- We have a divided system of care where MH and SUD services are often funded separately and governed by different administrative rules.
- There is a long list of system-, program-, clinical-, and client-related barriers to integration of services.
- “Integrated care” has become a buzzword and isn’t always clearly defined.
While the list of barriers to integrating SUD and MH services is long, providers remain interested in and committed to better serving this population, something evidenced by a group of Oregon SUD providers who signed up for a year-long Northwest ATTC intensive technical assistance project aimed at enhancing their programs’ capacity to serve clients with co-occurring disorders.
How was this project designed?
The project was divided into phases aligning with Gregory Aarons and colleagues’ EPIS model for implementing innovative practices:
- The Exploration phase involved securing leadership buy-in, assessing the programs’ existing co-occurring disorder services capacity using the Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index, and providing a detailed summary report with program-specific recommendations for enhancing the level of integration.
- The Preparation and Implementation phases involved leaderships’ participation in a NIATx Change Leader Academy featuring learning sessions and monthly coaching calls with an experienced NIATx coach.
- The Sustainment phase involved delivery of a final DDCAT site review to evaluate progress and document sustainability efforts.
Participating programs worked on a variety of change projects ranging from increasing mental health referrals, to matching treatment to stages of change for both MH and SUD conditions, to increasing the availability of co-occurring disorder group counseling.
For example, Grants Pass Treatment Center (ORTC, LLC) increased their identification of mental health needs and referral to MH services within the first thirty days of treatment from 14% to 72% by increasing collaboration and coordination with mental health agencies, adding MH screening, and increasing the focus on mental health issues in case consultations.
What were the results?
The project’s goal, to improve co-occurring disorder services for clients using an intensive technical assistance process, was achieved with noteworthy results. The mean DDCAT score at the beginning (baseline) of the project was 3.21; this score had increased to 3.86 by the end of the project. Additionally, at baseline, just 30% of the programs were dual diagnosis capable, while at the final review, that figure had grown to 71%.
This suggests that future clients will be offered useful integrated services to address their co-occurring MH and SUD challenges, a very exciting outcome for all involved.
Supporting the renewed interest in integration of MH and SUD services, this project provides a model for helping programs to align policy, practice, and training efforts to support co-occurring disorder services.
Want to learn more about this project? Download our report.