Implementation of a Multi-Modal Training Program for the Management of Comorbid Mental Disorders in Drug and Alcohol Settings: Pathways to Comorbidity Care (PCC)

Abstract

Objectives

We aimed to evaluate the impact of the Pathways to Comorbidity Care (PCC) training program for alcohol and other drugs (AOD) clinicians to improve the management of comorbidity.

Methods

A controlled before-and-after study using PCC training was conducted across 6 matched sites in Australia including 35 clinicians. Controls received standard workplace training. PCC training included seminar presentations, workshops conducted by local “clinical champions,” individual clinical supervision, and access to an online information portal. We examined (a) identification (screening, assessment) and treatment (treatment, referral) of comorbidity in practice (N = 10 clinical files per clinician), (b) self-efficacy, knowledge, and attitudes of clinicians.

Results

Significant improvements were observed in the PCC group but not the control sites with regards to the rate of clinical files showing identification of comorbidity (+50% v −12% change from baseline, respectively; [X² (1, N = 340) = 35.29, p = .01] with only a trend for improvements in the rate of files demonstrating treatment of comorbidity [X² (1, N = 340) = 10.45, p = .06]. There were significant improvements in the PCC relative to the control group for clinician self-efficacy, F(1,33) = 6.40, p = .02 and knowledge and attitudes of comorbidity monitoring, F(1,33) = 8.745, p = .01.

Conclusions

The PCC training package may help improve identification of comorbidity, self-efficacy, and attitudes toward screening and monitoring of comorbidity in drug and alcohol settings.

Keywords:

• Comorbidity
• implementation science
• mental disorders
• substance use

Acknowledgments

The authors would like to thank the clinicians at each site for participating in this project.

Disclosure statement

The authors declare that they have no competing interests.

Ethical approval

Ethical approval for the study was obtained from the Human Ethics Review Committees of the Sydney Local Health District, South Western Sydney Local Health District, Central Coast Local Health District, Hunter New England Research Ethics and Governance Office which covered two participating services, and Mid North Coast Local Health District (X16-0440 and HREC/16/RPAH/624).

Author contributions

K.M., A.B., P.H., and M.T. contributed to study conception and design, supervision of the project, data analysis, and data interpretation. E.L., G.U., K.W., and V.G. contributed to study coordination, clinician recruitment, data collection, data maintenance (cleaning and checking) data analysis and data interpretation, and writing of the manuscript. V.G. contributed as Senior Clinical Psychologist and contributed to study implementation and data interpretation. C.M., K.L.M., and M.T. provided the resources associated with the National Comorbidity Guidelines. A.D., D.R., S.C., and M.E. contributed as site investigators. All authors have approved the final manuscript.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Additional information

Funding

This study was supported by a Translational Research Grant from the New South Wales Health (PH, KM, and AB), a Translational Research Fellowship (KM), a Research Training Program (EL), and MRFF/NHMRC Practitioner Research Fellowship (PH). The authors wish to thank our clinical colleagues who assisted with recruitment at the participating centers. The Comorbidity Guidelines was funded by the Australian Government Department of Health.