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VII A.All staff members have basic training in attitudes, prevalence, common signs and symptoms, detection and triage for co-occurring disorders

Element Details

Definition:

Programs that provide treatment to individuals with co-occurring substance use disorders ensure that all agency staff who have contact with patients have basic training in co-occurring disorders. For the purpose of this item, basic training minimally includes understanding one’s own attitudes, the prevalence of co-occurring disorders and their screening and assessment, common signs and symptoms of these disorders, and triage/brief interventions and treatment decision-making. Staff includes positions such as outpatient receptionists and intake workers, as well as residential third shift and weekend staff.

Source:

Interviews with clinical leadership and clinicians, review of strategic training plan, and staff training records.

Item Response Coding:

Coding of this item requires an understanding of the program’s requirements for basic skills and training with regard to co-occurring disorders, and knowledge of the number of staff who have completed this training.

  • Mental Health Only Services = (SCORE-1): No staff have basic training (0% trained). The program’s staff have no training and are not required to be trained in basic co-occurring disorder issues.

  • (SCORE-2): Variably trained, no systematic agency training plan or individual staff member election (1 -24% of staff trained). The program encourages basic co-occurring disorders training but has not made this a part of their strategic training plan. A portion of the program’s staff are trained as a result of management’s encouragement or individual staff interest.

  • Dual Diagnosis Capable = (SCORE-3): Certain staff trained, encouraged by management and with systematic training plan (25-50% of staff trained). The program’s strategic training plan requires basic training in co-occurring disorders for certain staff. And: At least 25 percent of all program staff are trained in attitudes, prevalence, screening and assessment, common signs and symptoms, and triage/brief interventions, and treatment decision-making for co-occurring disorders.

  • (SCORE-4): Many staff trained and monitored by agency strategic training plan (51-79% of staff trained). The program’s strategic training plan requires the majority of staff to have basic training in co-occurring disorders. And: The majority of staff are trained. The program uses the plan to monitor the number of staff who are trained and to ensure they receive ongoing co-occurring disorders training, typically on an annual basis.

  • Dual Diagnosis Enhanced = (SCORE-5): Most staff trained and periodically monitored by agency strategic training plan (80% or more of staff trained). The program’s strategic training plan requires all staff to have basic training in co-occurring disorders. And: At least 80 percent of all staff are trained in attitudes, prevalence, screening and assessment, common signs and symptoms, and triage and treatment decision-making for co-occurring disorders. The program periodically monitors the number of staff members who are trained and uses the strategic training plan to ensure that this number is maintained despite staff turnover.
Enhancing MHOS Programs

Training is the principal mechanism to impart new information and a necessary step toward practice change. Research into the successful adoption of new technologies has generally found that training alone is of limited value in sustaining change in practice or behavior. MHOS program staff members typically have variable exposure to information about co-occurring disorders and the prevalence of substance use disorders.

DDC programs have made commitments to have certain staff trained in basic issues pertaining to co-occurring disorders: attitudes, prevalence, screening and assessment, common signs and symptoms, triage/brief interventions, and treatment decision making. These trainings might be strategically directed using existing training budgets or release time and are incorporated into a training plan. This basic training is not just for designated clinical staff but beneficial for all persons who come in professional contact with patients. Residential program aides, who may have the most direct contact with patients, are often neglected in training programs. As an example of how to incorporate training into an existing structure, one program provides nine in-service training sessions a year and has committed 1/3 of these to co-occurring disorders. Clinical supervisors, clinicians, residential aides, and front office administrative support staff all attend.

DDC level programs, as part of a strategic training plan, have an increasing number of staff members who are trained in understanding their attitudes, the prevalence, screening, assessment, common signs and symptoms, and triage/brief interventions and therapeutic needs of persons with co-occurring disorders.

An excellent introduction to the topic of workforce development can be found in the SAMHSA Co-Occurring Center for Excellence (COCE) Workforce Development and Training: Technical Assistance (TA) Report for the Co-Occurring State Incentive Grants (COSIGS) September 9, 2005, Updated June 2008, available at http://homeless.samhsa.gov/(S(mizsnr455dukej55bgx342z4))/ResourceFiles/4xcn5gxr.pdf.

Enhancing DDC Programs

Whereas DDC programs have focused on training certain staff on basic issues pertaining to co-occurring disorders, the DDE program has all or almost all staff trained in basic issues as a result of a regularly monitored implementation of its strategic training plan. Much like a DDC level program, administrators strategically direct staff training and incorporate the cost of doing so into existing allocations wherever possible. In support of this goal, the Recovery Resources Program incorporated information on co-occurring disorder basics and related agency policies into its new employee orientation process.

In contrast to the DDC program, the DDE program intentionally plans and ensures that at all times at least 80% of all staff are trained in basic issues related to co-occurring disorders.