Preparing to Treat Addictions and Co-Occurring Psychiatric Disorders: Programs Must Attend to the Associated Administrative Issues to Be Effective
Muchowski, Patrice M., Lemieux, Paul R., Hillis, Susan B., Behavioral Healthcare
The existence of co-occurring psychiatric disorders within the addicted population has been well documented. Current estimates suggest that 50--75 percent of persons presenting to substance abuse treatment facilities suffer from co-occurring mental health disorders (SAMHSA, 2005). As AdCare Hospital evaluated and expanded its capacity to treat persons with co-occurring psychiatric disorders, several administrative issues were identified.
AdCare Hospital is a 114-bed acute care hospital dedicated to the treatment of persons with addictions. Because AdCare is a hospital, patients with co-occurring medical conditions have long been admitted. More recently patients with co-occurring psychiatric illnesses have been admitted and successfully treated within the structure of our existing treatment program.
The specific administrative issues that AdCare has addressed include data analysis, workforce development, fiscal concerns, and collaboration with psychiatric treatment providers.
Analyze and Understand Your Data
Annually, AdCare conducts a demographic review of patient discharges and patient outcomes such as AMAs, administrative discharges, and transfers. These data are analyzed for trends that may suggest programmatic needs, identify cost issues, and reflect length of stay concerns. AdCare's data have indicated an increased number of patients with co-occurring disorders over the past several years. Further analysis measured patient outcomes for this population. In our analysis, AdCare focused on psychiatric transfers. It was determined that patients were being transferred when suicidal ideation was expressed, but were often cleared psychiatrically and returned. AdCare developed a standardized suicide risk assessment, which is conducted when suicidal ideation is expressed, and several procedures which allow for better management of suicidal ideation. These reduced the need for transfers. Programs could analyze other outcomes such as administrative discharges. Patients may be discharged for rule infractions or behaviors symptomatic of an unmanaged psychiatric illness, which could be more aggressively managed within the treatment program.
Thorough data analyses often lead to programmatic changes that require new or additional resources in the workforce. Staff training is a necessary but insufficient component for addiction treatment facilities treating co-occurring disorders. AdCare has found that training must be coupled with ongoing supervision and small group tutorials that review current clinical issues. Training and supervision are more effective if extended beyond direct clinical staff to secondary caregivers (aides, patient care assistants, crisis intervention counselors). Training and data may suggest the need to attract staff with more experience in mental health treatment to bolster effective treatment services.
Treatment of co-occurring disorders does have fiscal implications. …