Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Toolkit Version 4.0 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Mental Health Services www.samhsa.gov DDCMHT Dual Diagnosis Capability in Mental Health Treatment Toolkit Acknowledgements This document was produced for the Substance Abuse and Mental Health Services Administration (SAMHSA) by Westat under the Co-Occurring Mental Health and Substance Abuse Disorder (COD) Knowledge Synthesis, Product Development, and Technical Assistance (CODI) contract (reference number 283-07-0610). Charlene E. Le Fauve, PhD, Tison Thomas, MSW, Jayme S. Marshall, MS, and Deborah Stone, PhD served as the Government Project Officers. At Westat, Mary Anne Myers, PhD served as the CODI Project Director and Nina Hamburg, MBA served as the CODI Project Manager. Other Westat project staff included Tina Marshall, PhD, Chandria Jones, MPH and Shoma Ghose, PhD. Michelle Steinley- Bumgarner developed the DDCAT Excel Scoring Spreadsheet, which was adapted by Kathryn Kulbicki for the DDCMHT and DDCHCS. Kirsten Riise contributed to the DDCMHT Manual, which preceded this toolkit. Jason Davis produced the layout and design. Disclaimer The views, opinions, and content of this publication are those of the authors and contributors and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS. Public Domain Notice All material appearing in this publication is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without specific, written authorization from the Office of Communications, SAMHSA, HHS. Electronic Access and Copies of Publication This publication may be downloaded or ordered at http://store.samhsa.gov. Or call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español). Recommended Citation Substance Abuse and Mental Health Services Administration, Dual Diagnosis Capability in Mental Health Treatment Toolkit Version 4.0. HHS Publication No. SMA-XX-XXXX, Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011. Originating Office XXXXXXXX Substance Abuse and Mental Health Services Administration 1 Choke Cherry Road Rockville, MD 20857 HHS Publication No. SMA-XX-XXXX. Printed 2011 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Mental Health Services www.samhsa.gov Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Toolkit Version 4.0 September 2011 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Substance Abuse and Mental Health Services Administration Center for Mental Health Services www.samhsa.gov DDCMHT Toolkit Authors Heather J. Gotham, PhD Rhonda Kincaid, MEd Joseph E. Comaty, PhD, MP Associate Research Professor Consultant Director, Division of Quality Mid-America ATTC Affiliated with the Connecticut Management Kansas City, MO Department of Mental Health & Office of Behavioral Health Addiction Services Louisiana Department of Health and Ron Claus, PhD Hartford, CT Hospitals Senior Study Director Baton Rouge, LA Westat Chantal Lambert-Harris, MA Rockville, MD Research Associate Jessica L. Brown PhD Dartmouth Medical School Director of Policy and Planning Julienne Giard, MSW Concord, NH Office of Behavioral Health Consultant Louisiana Department of Health & Affiliated with the Connecticut Mark P. McGovern, PhD Hospitals Department of Mental Health & Product Development Workgroup Baton Rouge, Louisiana Addiction Services Chair Hartford, CT Associate Professor of Psychiatry Dartmouth Medical School Lebanon, New Hampshire Measurement Refinement orkgroup MembersW Janet Bardossi, LCSW Alysa Fornarotto-Regenye, MSW, Chantal Lambert-Harris, MA President LCADC, DRCC, CPS Research Associate Bardossi and Associates, Inc. COD / Best Practice Specialist Dartmouth Medical School Portland, Oregon New Jersey Department of Human Concord, NH Services, Division of Mental Health & Ron Claus, PhD Addiction Services Mark P. McGovern, PhD Measurement Refinement Workgroup Trenton, NJ Associate Professor of Psychiatry Chair Dartmouth Medical School Senior Study Director Heather J. Gotham, PhD Lebanon, New Hampshire Westat Associate Research Professor Deborah K. Nieri, MS Rockville, MD Mid-America ATTC Project Coordinator II, Co-occurring Kansas City, MO State Incentive Grant Joseph E. Comaty, PhD, MP South Carolina Department of Mental Director, Division of Quality Rhonda Kincaid, MEd Health Management Regional Manager Columbia, South Carolina Office of Behavioral Health Community Services Division Louisiana Department of Health and Office of the Commissioner Randi Tolliver, PhD, CADC Heartland Center for Systems Change Hospitals CT Department of Mental Health and Heartland Health Outreach Baton Rouge, LA Addiction Services Chicago, IL Hartford, CT Phil Welches, PhD, Clinical Psychologist Clinical Director Gateway Foundation Chicago, Illinois iv Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) Toolkit Table of Contents Acknowledgements Table of Contents I. Introduction ......................................................................................................................... 1 A. Introduction to Co-occurring Disorders and Integrated Services ............................................. 3 1. Literature Support and Report to Congress ...................................................................... 3 2. Fidelity and Patient Outcomes ...................................................................................... 4 3. Benchmark Measures ................................................................................................... 4 4. Terminology and Acronyms ............................................................................................ 5 B. Description of the Index ................................................................................................... 5 C. Development and Psychometric Studies.............................................................................. 6 D. Toolkit Organization .......................................................................................................... 7 II. Applications ....................................................................................................................... 9 A. System and Regulatory Agencies ........................................................................................ 9 B. Treatment Providers ........................................................................................................ 10 C. Health Services Researchers ............................................................................................ 11 D. Families and Individuals Seeking Services ........................................................................ 11 III. Methodology ................................................................................................................... 13 A. Observational Approach and Data Sources ....................................................................... 13 B. The Site Visit ................................................................................................................. 13 C. Cautions Regarding Self-evaluation .................................................................................. 14 D. Training Program Quality Assurance Staff ........................................................................ 15 E. Training Raters to Conduct the DDCMHT .......................................................................... 15 1. Didactic Training ........................................................................................................ 15 2. Shadowing ................................................................................................................ 16 3. The DDCMHT Vignette ................................................................................................ 16 IV. Scoring and Profile Interpretation ...................................................................................... 17 A. Scoring Each DDCMHT Item ............................................................................................ 17 B. Scoring the DDCMHT Index ............................................................................................. 18 C. Creating Scoring Profiles ................................................................................................. 18 D. Feedback to Programs .................................................................................................... 19 V. DDCMHT Index: Scoring and Program Enhancement ............................................................ 21 VI. Epilogue .......................................................................................................................... 97 Introduction v Table of Contents VII. Appendices ..................................................................................................................... 99 A. Dual Diagnosis Capability In Mental Health Treatment (DDCMHT) Index Version 4.0 ........... 101 B. Frequently Asked Questions (FAQ) ................................................................................. 115 C. No or Low Cost Enhancements to Increase Co-Occurring Capability ................................... 117 D. The Site Visit ..............................................................................................................