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How can CEIC help us increase the co-occurring capability of our programs?
My agency wants technical assistance from CEIC.
On-site DDCAT/DDCMHT – Dual Diagnosis Capability in Addiction [or in Mental Health] Treatment – surveys are conducted to measure capability of individual mental health and substance abuse programs. Programs are recruited in Regions/Counties, initially in conjunction with a Leadership Forum. The site visit not only measures the current level of co-occurring capability, but also provides recommendations and opportunities for advancing and improving capabilities. The survey generates an individual report that includes the program’s score, along with suggestions for increasing its co-occurring capability within existing resources.
Why Measure Capability?
“Integrated care” is a term that lacks specificity and is often misunderstood. Typically presented as the only model, “full integration” of services (a program that treats both mental health and substance use conditions fully and equally) is rarely achieved, partly because the staffing and other resources necessary to integrate services for “the other disorder” within an existing program is usually lacking. An on-site assessment of capability will define the current level of integrated care, while enabling development of a strategic plan for building co-occurring capability that uses programmatic strengths and takes resource limitations into account.
In working with hundreds of programs across New York State, CEIC has found that providers usually underestimate their current level of co-occurring capability. When CEIC conducts an on-site assessment of co-occurring capability, the existing level of service integration is determined, and a strategic plan to improve capability is developed, building on programmatic strengths and considering resource limitations. After the site visit, CEIC technical assistance specialist generates a confidential comprehensive report that supplies the provider with details of the capability level and all observations and recommendations. Each provider who completes an on-site assessment is eligible for follow-up technical assistance to promote continued progress in the integration of care. Links to other funded opportunities and to other statewide initiatives offering co-occurring competency training are also available.
In reality, programs whose history and culture are much closer to single service (delivering services primarily for one condition, with few, if any, services for the other condition) are more likely to achieve an intermediate level of integration (“Dual Diagnosis Capable,” or “DDC,” also called “co-occurring capable”). As the CEIC initiative began, the co-occurring capability of most outpatient clinics was somewhere between single-service (Addiction or Mental Health Only Services, “AOS” or “MHOS”) and DDC. Ultimately, New York State is expected to have a system of outpatient care comprised of providers whose delivery of integrated services will be ranked from co-occurring capable (DDC) to enhanced (DDE).
On-Site DDCAT/DDCMHT Surveys
Once a cohort of provider agencies is constituted, CEIC schedules an on-site Dual Diagnosis Capability in Addiction [or in Mental Health] Treatment (DDCAT or DDCMHT) assessment with each agency. The site visit is a technical assistance activity, which lasts about three (3) hours, and includes meetings with key administrative and clinical staff, a review of program materials, and direct observation of clinical activities. At the conclusion of the site visit, each agency receives a preliminary impression of their capability; shortly thereafter, CEIC compiles a written report with detailed observations and recommendations for increasing co-occurring capability that is sent to the agency along with the program score sheet and its corresponding graphic representation. With very few exceptions, the response to these TA site visits has been highly positive.
The DDCA[MH]T index assesses agencies across seven dimensions and provides an “Overall Score.” The indexes provide the structure for “building co-occurring capability” in identifying the seven areas and the items that describe the content (35 in all) as follows:
| # | Dimension | Content of Items |
|---|---|---|
| I | Program Structure | Program mission, structure & financing, format for delivery of mental health or addiction services |
| II | Program Milieu | Physical, social & cultural environment for persons with psychiatric or substance use problems |
| III | Clinical Process — Assessment (includes Screening) | Processes for access & entry into services, screening, assessment & diagnosis |
| IV | Clinical Process — Treatment | Processes for treatment including pharmacological & psychosocial evidence-based formats |
| V | Continuity of Care | Discharge & continuity for both substance use and psychiatric services, peer recovery supports |
| VI | Staffing | Presence, role & integration of staff with mental health and/or addiction expertise, supervision process |
| VII | Training | Proportion of staff trained & program’s training strategy for co-occurring disorder issues |
The DDCA[MH]T rates programs on a 1-5 scale –
- Addiction or Mental Health Only Services (AOS or MHOS);
- Dual Disorder Capable (DDC); and
- Dual Disorder Enhanced (DDE).
CEIC Experience in New York State. To get a sense of the average overall capability of New York State outpatient clinics, CEIC analyzed a group of 95 programs from 6 regions of New York State, which were available because they were slated to receive technical assistance from CEIC (a “convenience sample,” rather than a “representative sample,” which would have been composed to be representative of all programs and all counties statewide). The analysis indicated that outpatient programs are, for the most part, operating between “Addiction or Mental Health Only Services” (AOS / MHOS) and “Dual Disorder Capable” (DDC) services (an average overall score of 2.65). The average on all seven dimensions was below 3 (ranging from 2.40 for “Training” to 2.97 for “Assessment”). Scores were highest for assessment (which includes screening), continuity of care, and staffing, and lower for program structure, program milieu, treatment, and training. These results will continue to be updated as time goes by.
With the information gained from the on-site surveys, agencies can isolate areas in need of improvement, and can design a plan that will increase their co-occurring capability while allocating available resources to achieve the greatest advantage for the least cost. CEIC will work with programs, in groups and individually, to assist in reaching their co-occurring capability goals.
Site Visit Information and Frequently Asked Questions (e.g., Why measure capability?) – Site Visit Description & FAQs
Overview Information on the “Dual Diagnosis in Addiction (and in Mental Health) Treatment” Indexes
Information and Materials on the “Dual Diagnosis in Addiction (and in Mental Health) Treatment” Indexes
DDCAT Materials –
Index (version 3.2)
Scoring Manual
Toolkit
Index Program Description Form (v3.2)
Excel Scoring & Profile Workbook (v3.2)
DDCMHT materials –
Index (version 3.2)
Scoring Manual
Index Program Description Form (v3.2)
Excel Scoring & Profile Workbook (v3.2)
| Dual Diagnosis Capability in Addiction [or in Mental Health] Treatment DDCAT - Addiction, DDCMHT - Mental Health | ||
|---|---|---|
| 1 | DDCAT | Index (Version 3.2) |
| 2 | DDCAT | Scoring Manual |
| 3 | DDCAT | Toolkit |
| 4 | BOTH | Index Program Description Form (v3.2) |
| 5 | DDCMHT | Index Version 3.2 |
| 6 | DDCMHT | Scoring Manual |
| 7 | BOTH | Excel Scoring and Profile Workbook (v3.2) |
General /
Technical Assistance
Michael Chaple, Ph.D.
Project Coordinator
(212) 845-4539
chaple@ndri.org
On-Site DDCAT/DDCMHT Surveys
Site Visit Description & FAQs
Overview Information
Overview Information & Materials from Dartmouth “Addiction Treatment Services Research”
Dartmouth’s Addiction Treatment Services Research
DDCAT Survey Materials:
Index
Scoring Manual
Toolkit
Program Description
Excel Workbook
DDCMHT Survey Materials:
Index
Scoring Manual
Program Description
Excel Workbook