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IV A.Treatment plans

Element Details

Definition:

In the treatment of individuals with co-occurring disorders, the treatment plans indicate that both the mental health disorder as well as the substance use disorder will be addressed.

Source:

Review of treatment plans.

Item Response Coding:

Coding of this item requires an understanding of the program’s treatment planning process as well as any standardized procedures and formats used in treatment planning.

  • Mental Health Only Services = (SCORE-1): Address mental health only (addiction not listed).Within the program, the treatment plans focus exclusively on mental health disorders.

  • (SCORE-2): Variable by individual clinician, (i.e., plans vaguely or only sometimes address co-occurring substance use disorders). Within the program, the treatment plans for individuals with co-occurring disorders do not often or specifically address substance use disorders, while the mental health disorders are more comprehensively targeted. The variability is likely due to individual clinician preferences/competencies or resource/time constraints.

  • Dual Diagnosis Capable = (SCORE-3): Plans routinely address both disorders although mental health disorders addressed as primary, substance use disorders as secondary with generic interventions. Within the program, the treatment plans of individuals with co-occurring disorders routinely (at least 80 percent of the time) address both the substance use and mental health disorders. Although mental health treatment planning tends to be more specific and targeted, substance use concerns are regularly addressed, albeit in a non-specific fashion (e.g., “maintain abstinence”).

  • (SCORE-4): Plans routinely address substance use and mental health disorders; equivalent focus on both disorders; some individualized detail is variably observed. Within the program, the treatment plans for individuals with co-occurring disorders routinely (at least 80 percent of the time) address both the substance use and mental health disorders. And: Treatment plans routinely consider both the substance use and mental health disorders equally. However, individualized objectives and interventions specific to each disorder are not consistently incorporated.

  • Dual Diagnosis Enhanced = (SCORE-5): Plans routinely address both disorders equivalently and in specific detail; interventions in addition to abstinence are used to address substance use disorder. Within the program, the treatment plans of individuals with co-occurring disorders routinely (at least 80 percent of the time) and equally address both substance use and mental health disorders with clear, specific, measurable objectives and individualized interventions that systematically target symptoms of the specific disorders. And: The interventions used by the program include both psychosocial and pharmacological treatments.

Enhancing MHOS Programs

Treatment planning is the culmination of a process of assessment and the interaction between the program and the patient. Goals agreed to by both, using a shared decision-making approach, are generally agreed to be most associated with success, as illustrated by research on therapeutic alliance in psychotherapy. MHOS programs, whether by screening, assessment or even diagnosis, may identify addiction problems but routinely do not address these same addiction problems in the treatment plan.

To score at the DDC level, these addiction problems need to be identified, and then targeted by at least generic treatment interventions. The problems are then monitored for treatment response. Interventions may include psychoeducational or therapy groups addressing substance use issues, engagement in appropriate addiction or co-occurring self-help groups, or relapse prevention groups. Although mental health problems may continue to be the major focus of the treatment plan, addiction problems and disorders are increasingly listed.

Enhancing DDC Programs

In order for DDC programs to transition to DDE on this item, there must be a documented and equivalent focus on treatment planning for both mental health and substance use disorders. A review of records finds this to be normative, and interventions are generally provided “in house.” In the case of both disorders as problems, the objectives are clear, measurable, and specific (rather than overly broad or generic). One defining characteristic of the DDE program is the use of interventions in addition to self-help engagement to address and leverage an addiction problem. These interventions may be identified when connected with treatment plan goals. Interventions are also associated with specific staff members who will deliver them and monitor patient progress.

Joan T’s treatment plan identified her problems with prescription narcotics and PTSD. In addition to a series of goals and interventions associated with PTSD, the goal for her continuing prescription narcotic abuse was also specified and included motivational enhancement therapy and maintaining a diary of antecedents, behaviors, and consequences of her use of these medications to manage her PTSD symptoms.