Description of the Index
The Dual Diagnosis Capability in Mental Health Treatment Index—referred to as the DDCMHT—is a benchmark instrument for assessing mental health treatment program capacity for persons with co-occurring mental health and substance use disorders (see the Downloads page for a copy of the instrument). The DDCMHT is a parallel instrument to the Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index.
The DDCMHT has been in development since 2004, and it is based upon a fidelity assessment methodology. Fidelity scale methods have been used to ascertain adherence to and competence in the delivery of evidence-based practices. This methodology has been used to assess the implementation of Integrated Dual Disorder Treatment (IDDT) by mental health programs. IDDT is an evidence-based practice for persons with co-occurring disorders in mental health settings who suffer from severe and persistent mental illnesses (Mueser et al., 2003). The DDCMHT uses a methodology similar to the IDDT Fidelity Scale, but has been specifically developed to be broader in scope than the specific core components of that scale. Accordingly, the DDCMHT is intended to assess co-occurring capability at any mental health program or service setting, not just a specific treatment team that may be implementing IDDT. The DDCMHT is also appropriate for mental health settings that do not treat a severely mentally ill population (e.g., mood, anxiety, PTSD, Axis II disorders) and those that are based in settings other than outpatient (e.g., hospital, residential, partial hospital).
The DDCMHT evaluates 35 program elements that are subdivided into seven dimensions.
- The first dimension is Program Structure. This dimension focuses on general organizational factors that foster or inhibit the development of co-occurring disorders treatment.
- Program Milieu is the second dimension, and it focuses on the culture of the program and whether the staff and physical environment are receptive and welcoming to persons with co-occurring disorders.
- The third and fourth dimensions are referred to as the Clinical Process dimensions (Assessment and Treatment). These examine whether specific clinical activities achieve specific benchmarks for co-occurring disorders assessment and treatment.
- The fifth dimension is Continuity of Care, which examines the long-term treatment issues and external supportive care issues commonly associated with persons who have co-occurring disorders.
- The sixth dimension is Staffing, which examines staffing patterns and operations that support co-occurring disorders assessment and treatment.
- The seventh dimension is Training, which measures the appropriateness of training and supports that facilitate the capacity of staff to treat persons with co-occurring disorders.
The DDCMHT draws heavily on the taxonomy of addiction treatment services outlined by the American Society of Addiction Medicine (ASAM) in the ASAM Patient Placement Criteria Second Edition Revised (ASAM-PPC-2R, 2001). This taxonomy provided brief definitions of Addiction Only Services (AOS), Dual Diagnosis Capable (DDC), and Dual Diagnosis Enhanced (DDE). The ASAM-PPC-2R provided brief descriptions of these services, but did not advance operational definitions or pragmatic ways to assess program services. The DDCAT utilizes these categories and developed observational methods (fidelity assessment methodology) and objective metrics to ascertain the dual diagnosis capability of mental health treatment services for persons with co-occurring disorders: MHOS, DDC, or DDE.