Primary Care and Co-Occurring
Current evidence suggests that the whole-person approach is the most effective method for providing services and supports to individuals with co-occurring mental and substance use disorders. Sharing information promotes the integration of behavioral health and primary care services.
Several tools are available to guide systems and services planning and inform clinical treatment. Here are some examples:
- Doherty, McDaniel, and Baird Scale This scale focuses on six topical areas. It is sensitive to relatively modest program and practice changes, and it is suitable for pre and post assessments.
- Co-Morbidity Program Assessment Self-Survey—Primary Health (or COMPASS-PH™, a Self-Survey Tool for Primary Health Clinics, Programs, and Teams). This is a quality improvement self-assessment tool. It consists of 15 sections with Likert-scaled items. The survey is intended for primary health settings that are seeking to develop core co-occurring capability in serving individuals and families with co-occurring health and behavioral health needs.
This tool is appropriate at either a clinical or program level for a wide range of settings and organizational approaches. The survey can be completed in two hours, and it provides a set of instructions so that any program can begin its own quality improvement process.
- Dual Diagnosis Capability in Health Care Settings (DDCHCS) Assessment. This tool is built on prior experience and work with companion instruments, including the Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Dual Diagnosis Capability in Mental Health Treatment (DDCMHT), which are currently in use in 33 States. The DDCHCS is used to determine the capability of routine medical services entities, such as primary care, family practice, or emergency departments, to address the needs of persons with co-occurring mental and substance use disorders.
The DDCHCS can be used to design new services or guide and quantify integrated behavioral health quality improvement efforts. The tool consists of 35 scoring items across seven topical areas. Similar to fidelity assessments in the SAMHSA Evidence-Based Practice KIT series, this tool is scored by trained, objective assessors. Assessors conduct interviews with a range of staff, observe the program, and review clinical records and documentation. The assessment can be completed in approximately six hours.
Assessment benefits health care organizations
Health care organizations that have undergone assessments have benefited from the experience in three ways. Organizations can:
1. Identify elements of effective integrated services and supports already in place.
2. Use the information to consider their priorities related to primary care and co-occurring disorders integration.
3. Develop an action plan for implementing quality improvement changes.
Resources and Links
Families, Systems, & Health Vol 21(2) pp.121-133