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1. Can I use the DDCMHT to rate my whole agency?

The DDCMHT is intended to rate an individual program. Using the DDCMHT to produce a single agency-level rating is not recommended. If the entire agency is scored, the rater is forced to consider practices that differ and diverge across multiple programs, usually resulting in scores that are not meaningful or helpful. An examination of separate capability ratings across multiple programs within an agency, however, can assist leadership in understanding variations in agency practice patterns. Such variation may be intentional, but also may signal the need to initiate quality improvement activities to establish consistency across programs within an agency.

2. What do the DDCMHT results tell me?

The DDCMHT results will tell you the level of co-occurring capability in a program. Each of the 35 items in the DDCMHT is scored on a 1 to 5 scale, with 5 reflecting the highest co-occurring capability. An average score is obtained for each of the seven domains in the DDCMHT. An overall score ranks the program at the Mental Health Only Services (MHOS), Dual Diagnosis Capable (DDC), or Dual Diagnosis Enhanced (DDE) level.

3. Is the DDCMHT a psychometrically valid instrument?

Yes. Please see the Psychometric Studies section and the journal articles by McGovern et al. (2007) and Gotham et al. (2010) listed on the References section of this site.

4. Is there an easy way to do the scoring?

Yes. An Excel workbook (available for download) accepts DDCMHT item scores and calculates the program’s average domain scores, an overall average score, and the categorical rank (i.e., MHOS, DDC, or DDE). In addition, the workbook creates several graphic displays.

5. Who can administer the DDCMHT?

Behavioral health professionals can be trained to administer the DDCMHT by others with experience doing these assessments. Training typically involves a didactic component, one or more observations of an assessment, and practice with supervision and feedback.

6. How long does it take to do a DDCMHT assessment?

Typically, a DDCMHT assessment takes from four to eight hours. Requesting documents for review in advance of the visit can reduce the amount of time required at the program location. The number of charts reviewed can also impact the length of the visit.

7. Can I ask programs to rate themselves on the DDCMHT?

It is not recommended that programs use the DDCMHT to rate themselves. Bias in DDCMHT self-ratings has been documented, with higher self-rated scores observed compared to ratings by an external assessor (e.g., Lee & Cameron, 2009; please see the References section). Research also documents a “learning curve” before raters consistently and accurately use this measure (Brown & Comaty, 2007). The DDCMHT items and anchors can generate valuable discussion among staff and provide the basis for programs to increase their co-occurring capability.

8. What is the incentive for programs to participate in a DDCMHT assessment?

Each program receives concrete feedback on its co-occurring capability as expressed by its policies, assessment and treatment services, staffing, and training, combined with information on how to increase that capability. Increased co-occurring capability may lead to improved services for clients. Given widespread expectations for programs to improve their performance in co-occurring disorders, programs find the DDCMHT assessment and results valuable. Some state or regional funding agencies offer financial incentives for achieving a DDC or DDE rating.

9. How long does it take a program to improve their scores on the DDCMHT?

It depends. As described on the Applications section, a comprehensive implementation plan based on the results of an initial DDCMHT can facilitate change by including targeted strategies for change, identifying persons responsible for leading each task, and setting target dates for completion. Other components of a successful change process often include an overall “champion” or change agent for the program, a steering committee to support the efforts over time, targeted training and technical assistance, connections with peers (i.e., other programs) also working on these kinds of changes for support and lessons learned, and ongoing quality assurance (e.g., semi-annual or annual follow-up DDCMHT assessments).

10. How can I find out more about how others are using the DDCMHT?

Dr. Mark McGovern of Dartmouth Medical School, the primary author of the DDCAT, chairs the national DDCAT/DDCMHT Collaborative, which meets monthly by conference call to discuss ways that states and programs are using the DDCMHT to improve their policies and practices. He can be reached at if you are interested in joining the Collaborative.