What a Difference 5 Minutes can make in the Lives of Children and Adults: Screening for the Co-Occurring Disorders of Mental Health and Substance Abuse - PowerPoint PPT Presentation

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What a Difference 5 Minutes can make in the Lives of Children and Adults: Screening for the Co-Occurring Disorders of Mental Health and Substance Abuse

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Title: What a Difference 5 Minutes can make in the Lives of Children and Adults: Screening for the Co-Occurring Disorders of Mental Health and Substance Abuse


1
What a Difference 5 Minutescan make in the Lives
ofChildren and Adults Screening for the
Co-Occurring Disorders of Mental Health and
Substance Abuse
  • The 2007 Zarrow
  • Mental Health Symposium

2
Presenters
  • Mary E. Dillon, MSW, Ed.D
  • OU OK-COSIG Associate Evaluator, Tulsa.
  • Andrew L. Cherry, DSW, ACSW
  • Oklahoma Endowed Professor of Mental Health
  • University of Oklahoma, School of Social Work,
    Tulsa.
  • OU OK-COSIG Project Evaluator
  • L. D. Barney, ICAADC, MSW Student,
  • University of Oklahoma, Norman Campus.
  • OK-COSIG Program Specialist, ODMHSAS, OKC

3
Failing People with a Co-occurring Disorder
  • The evidence from the field is that people with
    the co-occurring disorders of Mental Health,
    Trauma related Mental Health Issues and Substance
    Abuse are NOT benefiting from traditional mental
    health and substance abuse treatment.
  • The evidence that current options are ineffective
    comes in the form of multiple treatment failures,
    years of lost productivity, and higher levels of
    involvement in the justice system.

4
Rate of Incidence Adults
  • The need for better treatment options for people
    with a co-occurring disorder received critical
    support when the 2002 National Survey on Drug Use
    and Health in the United States reported that
    over 22 of adults with a serious mental illness
    and those who abuse alcohol or other drugs have a
    co-occurring problem of mental health and
    substance abuse.

5
Rate of Incidence Children
  • A substantial number of children and adolescents
    also experience substance abuse disorders, mental
    disorders, or co-occurring disorders. A study of
    mental health service use among youth reveals
    that nearly 43 of youth who receive mental
    health services in the United States have been
    diagnosed with a co-occurring disorder (CMHS,
    2001).

6
Understanding Co-Occurring Disorders
  • The time between the onset of a mental disorder
    and a subsequent substance abuse disorder
    represents an important window of opportunity
    in which a co-occurring disorder may be prevented
    (Ziedonis, 1995). It suggests not only the value
    of early diagnosis and treatment of mental
    disorders in youth, but also the critical role
    for alcohol and drug testing as an important tool
    for prevention, early identification and
    intervention.

7
The Window of Opportunity
  • More than 40 of youth, ages 11 to 17, who had
    either a substance use diagnosis or moderate to
    severe functional impairment as a result of
    substance use, reported problems that included
    involvement with the police, missing school or
    work, changing friends to those who drink or use
    drugs, getting into arguments with family and
    friends, and getting in trouble in school
    (Manteuffel et al., 2002).

8
Missing the Window
  • When an adolescent is acting out, most parents
    hope that it is a drug related behavior, rather
    than a mental health disorder. However, we as
    clinicians need to screen the adolescent for a
    co-occurring disorder, and if indicated, help
    parents explore both issues. If we dont we are
    missing a window of opportunity and it may be
    another 8 to 10 years before the adolescent is
    diagnosed with a co-occurring disorder.

9
Missing the Window
  • When an adolescent is acting out, most parents
    hope that it is a drug related behavior, rather
    than a mental health disorder. However, we as
    clinicians need to screen the adolescent for a
    co-occurring disorder, and if indicated, help
    parents explore both issues. If we dont we are
    missing a window of opportunity and it may be
    another 8 to 10 years before the adolescent is
    diagnosed with a co-occurring disorder.

10
Barriers to Treatment
  • Children and adolescents with co-occurring
    substance abuse disorders and mental disorders,
    and their families face special challenges to
    treatment. In part, the challenges arise because
    more knowledge is needed about the prevalence
    (rates) of co-occurring substance abuse disorders
    and mental disorders among children and
    adolescents. We also need developmentally
    appropriate assessment standards to help in the
    screening and diagnostic process.

11
Effective Interventions
  • While children and adolescents with co-occurring
    substance abuse and mental health disorders are
    not simply small adults, some of the treatment
    issues are similar. As with adults, co-occurring
    disorders in children and adolescents vary in
    level of severity as with adults, assessment is
    an ongoing process. Youth should be able to move
    back and forth across the level of care continuum
    based on their progress and changes in
    environment.

12
A Major Barrier
  • One of the major barriers to identifying people
    with a co-existing disorder has been the cost
    involved in assessment.
  • This process has typically required two
    assessments. One assessment focused on mental
    health disorders.
  • The second focused on substance abuse disorders.

13
Eliminating Some of the Burden
  • To eliminate part of this burden, a
    rapid-response screen was developed. The AC-OK
    Screen for Co-Occurring Disorders (Mental Health,
    Trauma Related Mental Health Issues Substance
    Abuse) is intended to help determine if the
    person requesting help needs to be clinically
    assessed for a co-existing mental health and
    substance abuse problem.

14
The Reliability and Validity of the AC-OK Screen
for Co-Occurring Disorders (Mental Health,
Trauma Related Mental Health Issues Substance
Abuse)
15
AC-OK Screen forCo-Occurring Disorders
  • The findings that support the reliability and
    validity of this screen are based on the
    responses of 3,608 people who were screened
    between February and November of 2006. The
    participants were seeking treatment from one of
    four mental health centers, one of three
    substance abuse treatment providers, or one of
    two programs that treat people with a
    co-co-occurring disorder.

16
The Psychometric Properties of the Screen
  • The process used to determine the psychometric
    properties of this screen was first to verify
    that the questions in each of the subscales
    (mental health and substance abuse items) were
    conceptually related and if they could be reduced
    in number.
  • The Factor Analysis Extraction procedure helped
    answer these questions. The Varimax rotated two
    factor solution indicates that there are two
    clearly separate conceptual dimensions and the
    number of items in the two scales could not be
    reduced. The factor solution also accounted for
    57.25 of the variance among those being screened.

17
Screen Reliability
  • Second, Cronbach Alpha coefficients were used as
    a statistical measure of the internal consistency
    of each of the two subscales.
  • The Cronbach Alpha for the Mental Health screen
    was very good (a .79).
  • The Cronbach Alpha for the Substance Abuse Screen
    was excellent (a .89).

18
Screen Sensitivity Specificity
  • Sensitivity and specificity were examined against
    the Client Assessment Record (CAR) assessment,
    the Addiction Severity Index (ASI) assessments,
    and the Axis I primary and secondary diagnoses
    (see Tables 1 2). In this population, the
    AC/OK Screen (which takes five minutes to
    administer) agreed with the CAR_substance abuse
    scale in 90.5 of cases that the individual
    needed to be fully assessed for a co-occurring
    disorder.

19
Definition Sensitivity and Specificity
  • Sensitivity, the fraction of those with the
    mental health or substance abuse disorders
    correctly identified by the screening tool
    (Blume, 2002).
  • Specificity, the fraction of those without a
    mental health or substance abuse disorder
    correctly identified by the screening tool
    (Blume, 2002).

20
Validity of the Screen
  • The AC/OK Screen agreement with the ASI
    psychiatric scale was even more impressive. The
    AC/OK Screen agreed with the ASI psychiatric
    scale in 96 of the cases that the individual
    needed a full assessment for a co-occurring
    disorder. Finally, the AC/OK Screen (which takes
    five minutes to administer) agreed with the
    DSM-IV diagnosis of a co-occurring disorder in
    91 of the cases.

21
The Percentage of People Identified by the AC-OK
Screen
  • The AC/OK Screen identified approximately 72 of
    all people applying for treatment as needing a
    full assessment to determine if the person has a
    co-occurring disorder. This is estimated to be
    as much as twice the number of people who will be
    diagnosed with a co-occurring disorder after a
    full clinical assessment for both a mental health
    and substance abuse problem.

22
5 Minutes Can Make a Difference
  • What difference can 5 minutes make to a person
    who is seeking help for a co-existing disorder?
    Determining that a person has a co-existing
    disorder when he or she first asks for help can
    save an average of four and a half years of that
    persons life.
  • In this data there is over a four year (4.4 yrs)
    difference in the average age of people in this
    study seeking treatment in a substance abuse
    treatment program (32.87 yrs) and those seeking
    help from a program providing treatment for a
    co-existing disorder (37.31 yrs).

23
Disadvantages
  • People with a co-occurring disorder are also
    slightly more likely to be involved in the
    criminal justice system. More people with a
    co-occurring disorder tend to enter treatment
    struggling with suicidal ideations. They tend to
    have more problems with substance abuse than
    others entering treatment for addiction.

24
Strengths on Which to Build aLong Term Recovery
  • Yet, people with a co-occurring disorder are
    likely to have fewer problems with psychoses and
    anxiety disorders. They usually have a higher
    level of education. And, they tend to be more
    committed to treatment (based on the percentage
    of voluntary admissions, and the high number who
    complete treatment) (See http//faculty-staff.ou
    .edu/C/Andrew.L.Cherry-1.Jr/AC-CODScreenPg.htm

25
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