Screening

Screening allows the service provider to assess if an individual with a substance use disorder shows signs of a mental disorder or whether an individual with a mental disorder demonstrates signs of substance abuse.

Standard screening procedures and instruments are used for initial screening and follow-up assessments.

The program provides mental health professionals with education about the epidemiology of co-occurring substance abuse and appropriate techniques for screening and assessment.

Substance abuse programs and personnel are provided screening procedures for the full range of mental disorders that may present in clients in treatment in their facilities.

Assessment

Assessment includes evaluation, diagnosis as to severity of illness, and motivation for treatment.

Assessment also addresses a broad range of other medical, psychological, and social problems presented by the client.

Valid and reliable assessments are utilized by the program.

Program placement and treatment interventions must be matched to the needs of each individual.

Assessment includes the initial steps of treatment—forming a relationship, bringing problems into the open, discussing treatment options, and setting treatment limits— which are all within the context of ongoing respect and acceptance of the individual.

Staged interventions

Processes are present that describe the development of a therapeutic alliance.

Staff coordinate multiple treatment systems in planning for the client’s care.

Program philosophy, policies, and procedures show evidence of recovery-oriented activities.

The therapeutic alliance includes maintaining a recovery perspective, managing countertransference, monitoring psychiatric symptoms, using supportive and empathic counseling, employing culturally appropriate methods, and increasing support, organization, and structure.

Interventions include individuals, groups, and families.

Psychopharmacologic interventions

Policies and procedures address poor medication adherence.

Individual and group therapies are employed to support clients in appropriately managing their medication regimen.

Psychopharmacologic interventions (cont’d)

Special precautions are employed to determine the interactive effects of psychoactive medications and illicit drug or alcohol use.

Policies and procedures address the interplay among substances of abuse, psychoactive medications, and medications used to treat substance abuse.

Staff have a working knowledge of drug interactions across classes of medications and between therapeutic medications and substances of abuse, and the differences in response to medications by racial and ethnic groups.

Motivational interventions

Program philosophy includes approaches that help individuals become ready to participate in treatment, such as illness self-management.

Program interventions include motivational enhancement techniques.

Motivational enhancement techniques are matched to the client’s stage of recovery (Transtheoretical Stages of Change Model, Prochaska & DiClemente).

Program interventions are built upon the five key principles of motivational enhancement: 1) express empathy; 2) note discrepancy between current and desired behavior; 3) avoid argumentation; 4) refrain from directly confronting resistance; and encourage self-efficacy or the individual’s belief that he or she has the ability to change.

Cognitive/behavioral approaches

Cognitive-behavioral therapy (CBT) is employed by the treatment team with both individuals and groups.

A focus of CBT is relapse prevention.

Program goals include providing education about the nature and treatment of substance abuse and mental disorders, helping clients come to terms with their illnesses, encouraging clients to offer and receive support from each other as part of their recovery efforts, helping clients develop the desire for abstinence and then attaining it, and ensuring compliance with treatment plans, especially medications.

Therapeutic Community and Modified Therapeutic Community

The concept of therapeutic community (TC) is employed by the treatment staff and views drug abuse as a disorder of the entire individual necessitating a focus on conduct, attitudes, moods, values, and emotional management.

The treatment staff employ the principles and methods of modified therapeutic communities (MTC), where four types of interventions are provided: 1) community enhancement (to promote affiliation with the community); 2) therapeutic/educative activities (to promote expression and instruction); 3) community/clinical management (to maintain a safe environment); and 4) vocational activities (to operate community facilities and prepare for employment).

Therapeutic Community and Modified Therapeutic Community (cont’d)

Programs and services are adapted for those clients with co-occurring disorders; the TC model is modified to provide increased flexibility, decreased intensity, and greater individualization of the plan of care.

Performance metrics include drug use, employment, psychological functioning, and involvement in criminal activity.

Assertive Community Treatment (ACT)

This outpatient treatment model is employed by program staff and includes the following core components: community-based services, assertive engagement with active outreach, high intensity services, small caseloads, continuous 24-hour responsibility, team approach (full team takes responsibility for all clients on the caseload), multidisciplinary team that reflects integration of services, close work with other community support systems, and continuity of staffing.

The program provides for basic needs such as housing, supportive stable functioning in the community, and direct and integrated mental health and substance abuse services.

Specialty activities have been added to the ACT model to treat clients with co-occurring disorders, which include direct substance abuse treatment interventions (often through the inclusion of a substance abuse counselor on the multidisciplinary team), a team focus on clients with co-occurring disorders, treatment groups for individuals with co-occurring disorders, and modifications of traditional mental health interventions that include a strong focus on the interrelationships between substance abuse and mental health issues (e.g., skills training that addresses social situations involving substance abuse).

Housing and employment services

Policies and procedures guide the health professional in helping clients access a broad array of services to stabilize their living conditions and sustain their recovery.

Job training is provided, including comprehensive assessment, ongoing case management, housing, supportive services, job training and job placement services, and follow-up.

Consumer involvement

The program philosophy includes client involvement in self-help groups.

Consumers have input into program development and individual plans of care.

Dual recovery/Self-help programs

Continuing care is a critical component of the program.

12-step and non-12-step programs are utilized by the program and its clients.

TOTALS

Summary of Findings (summarize areas where adherence criteria were not met):

Opportunities for Improvement (summarize opportunities for improvement, including corrective action steps, accountability, and target completion dates):