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
1What 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
2Presenters
- 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
3Failing 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.
4Rate 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.
5Rate 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).
6Understanding 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.
7The 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).
8Missing 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.
9Missing 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.
10Barriers 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.
11Effective 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.
12A 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.
13Eliminating 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.
14The Reliability and Validity of the AC-OK Screen
for Co-Occurring Disorders (Mental Health,
Trauma Related Mental Health Issues Substance
Abuse)
15AC-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.
16The 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.
17Screen 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).
18Screen 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.
19Definition 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).
20Validity 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.
21The 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.
225 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).
23Disadvantages
- 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.
24Strengths 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
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