Planning Treatment and Assessing Recovery in Participants With Dual Diagnosis: Preliminary Evaluation of a New Clinical Tool

abstract

Objective: Integrated treatment for people with co-occurring mental illness and substance use disorder would be enhanced by a simple, recovery-oriented instrument to plan treatment and monitor progress toward dual recovery. This paper describes the development of a clinical instrument, the WestBridge Dual Recovery Inventory, and presents a preliminary evaluation of its usability. Methods: In collaboration with participants in treatment, family members, clinicians, and program leaders, we developed an inventory on dual recovery and then examined its utility through a series of iterative steps. First, we tested the inventory for inter-rater reliability among 10 program participants (rated independently by the first and last author). Second, we examined concordance by having a separate group of 10 program participants and their care managers complete the inventory independently. Third, we observed 3 care managers and 10 participants working together to complete the inventory as part of routine care during the quarterly assessment; we evaluated shared decision making based on the process they used to resolve differences and on a brief survey completed by program participants as the end of the session. Finally, to measure the inventory's capacity to detect change over time, we analyzed the ratings from admission to one year for 43 participants with quarterly assessments available for that time period. Results: The WestBridge Dual Recovery Inventory assesses 14 domains of recovery, each rated on 5-point scales. Inter-rater reliability was high (Kappa = .82 to 1.00); agreement between independent ratings by care managers and participants varied considerably (Kendall's tau = −.83 to +.87); and collaborative ratings demonstrated high scores on shared decision making. Participants improved significantly on 11 of 14 domains during the initial residential treatment phase (admission to six months) and sustained gains during outpatient assertive community treatment (6 to 12 months). Conclusions: This preliminary assessment of the WestBridge Dual Recovery Inventory suggests that it reliably assesses dual recovery, facilitates shared decision making, and captures changes over time. The inventory appears to be usable, well received by participants and care managers, specific for program goals, and sensitive to changes in the participants. Recovery measures may need to be program-specific.

Keywords:

• Dual recovery
• serious mental illness
• assessment

Acknowledgments

The authors thank the clinical and administrative staff at WestBridge for their contribution to this report and the care that they provide to the participants described in this evaluation, and Dr. Gary Bond, Dr. Greg McHugo, and Dr. Haiyi Xie for their expertise on measurement and statistics.

Disclosures

Dr. Noel has no conflict of interest and no additional income to report. Ms. Woods is the chief executive officer at WestBridge and receives income from WestBridge. Mr. Routhier is the chief financial officer at WestBridge and receives income from WestBridge. Dr. Drake works as a part-time researcher at WestBridge.

Funding

WestBridge funded development and independent evaluation.