Project Background
Rationale
Chemical dependency disorders are common among people with mental health disorders. According to the 2005 National Survey on Drug Use and Health (NSDUH), there were an estimated 24.6 million adults with serious psychological distress in the past year (11.3 percent of all adults in the US). Among those adults with serious psychological distress, 21.3 percent (5.2 million) were dependent on or abused illicit drugs or alcohol. Among the 5.2 million adults with a co-occurring mental health and chemical dependency disorder, only 8.5 percent received treatment for both mental health problems and chemical dependency treatment. A recent DOHMH prevalence report estimates that 166,000 New York City adults and older adolescents (aged 15-54) have co-occurring substance use and psychiatric disorders annually.
Aim
The primary goal of this continuous quality improvement (CQI) project was to help clinicians improve the screening and assessment of chemical dependency disorders in adult consumers receiving care in ambulatory mental health treatment programs. The long-term goal was to improve treatment for consumers with co-occurring mental health and chemical dependency disorders.
Development
This CQI project was developed through a consensus-building process initiated in 2004. National experts were consulted and a workgroup of local stakeholders (community providers, consumers, advocates, family members and DOHMH staff) met regularly to help design this project. The workgroup selected a chemical dependency screening instrument and constructed indicators so that programs can monitor their project progress over time.
Implementation
This CQI project required that the screening instrument be administered at intake and that clinicians discussed the results of the screen with consumers. For those consumers who screened positive, clinicians provided or made arrangements for a comprehensive chemical dependency assessment. Clinicians utilized the results of those assessments to identify those consumers who had chemical dependency disorders and, when chemical dependency treatment was indicated, clinicians included chemical dependency-related treatment goals in the treatment planning process. The treatment plan included a determination of the suitability, need, motivation, willingness and barriers to chemical dependency treatment. As needed and with the consumer’s consent, clinicians made referrals for chemical dependency treatment services.
Programs participating in their second year of this CQI Project built upon the successes of their first year as they worked towards greater improvements in coordinating care for those consumers with co-occurring mental health and chemical dependency disorders. Participants also screened current consumers with the screening instrument at a treatment plan review, and provided or made arrangements for assessment and treatment planning, if necessary.
The mental health treatment programs that implemented and fully participated in this project as part of Quality IMPACT also met the criteria for the DMH co-occurring disorders screening program audit standard requirement. This audit standard requirement commenced July 1, 2007 and continues to be part of contracted programs’ audit requirements despite the conclusion of this CQI project on March 1, 2008.
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Screening Materials
Participating programs are required to implement the Modified Simple Screening Instrument for Substance Abuse (MSSI-SA)1. The MSSI-SA is available in two versions: a consumer self-administered questionnaire and a clinician-administered interview. The self-administered version is available in English as well as in Spanish, Chinese, Creole, Korean, and Russian:
1The Simple Screening Instrument for Substance Abuse (SSI-SA) has been modified by the New York City Department of Mental Hygiene to include prescription and over-the-counter medications/drugs (see Question 1b, Question 2 and directions on the screen). The rest of the screen, including the scoring range, remains unchanged. For more information about the unmodified SSI-SA, see TIP 42, Substance Abuse Treatment for Persons with Co-Occurring Disorders (Center for Substance Use Treatment 2004).
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Level I Project Materials
Workbook
Project Data Sheets
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Level II Project Materials
Workbook
Project Data Sheets
Additional Indicator Data Sheets
Expand Screening
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Audit Standard Materials
These materials are optional for Mental Health programs not participating in the “Screening and Assessment of Chemical Dependency Disorders of Adults in Mental Health Treatment Programs” project, but fulfilling the “Screening Adults for Co-occurring Chemical Dependency Disorders” audit requirement which commenced July 1, 2007.
Data Sheets
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