Improving the Dual Diagnosis Capability of Addiction and Mental Health Treatment Services: Implementation Factors Associated With Program Level Changes

Abstract

OBJECTIVE: This study examined implementation factors associated with addiction and mental health treatment program improvement in services to persons with co-occurring substance use and psychiatric disorders. There were two primary aims: (a) to articulate factors associated with successful program change and (b) to determine whether the effective factors are different by program type. METHODS: Eighty-six programs (addiction treatment n = 54; mental health treatment n = 32) were assessed at baseline and 18-month follow-up using the Dual Diagnosis Capability in Addiction Treatment (DDCAT; McGovern, Matzkin, & Giard, 2007) or Dual Diagnosis in Mental Health Treatment (DDCMHT; Gotham, Claus, Selig, & Homer, 2010) indexes. At follow-up, program leaders were surveyed about implementation factors that may have accounted for changes in capability. RESULTS: Both addiction and mental health programs significantly improved dual diagnosis capability during the study period. Factors associated with positive change in addiction treatment programs included organizational and contextual components, use of the commonly recommended implementation strategies, and deploying evaluation methods. In mental health programs only the evaluation methods factor was uniquely significant, although the use of a variety of methods overall was associated with improvement. CONCLUSIONS: Both mental health and addiction treatment programs can enhance dual diagnosis capable services through a variety of implementation approaches. This study provides data to the emerging discipline of implementation science and suggests avenues for future research. (Journal of Dual Diagnosis, 6:237–250, 2010)

KEYWORDS:

• Co-occurring disorders
• quality improvement
• integrated treatment
• implementation science

ACKNOWLEDGMENTS

This research was supported by a grant from the Robert Wood Johnson Foundation Substance Abuse Policy Research Program (Grant #63110). The authors acknowledge Therese Brockway, the DDCAT /DDCMHT Learning Community, and in particular the state leadership, treatment program staff, and patients from agencies in Connecticut, Louisiana, Minnesota, Missouri, and Vermont.