1	Client, Treatment, and Program Factors Related to Outcomes of Individuals with Co-occurring Disorders in Substance Abuse Treatment
2	Background Mental health and substance abuse treatment in Los Angeles County has historically been provided in separate and divergent service systems Several countywide initiatives have aimed to improve communication, coordination, and collaboration across the 2 systems Service partnerships have been developed between MH and AOD providers in the same area, using differing models of service delivery
3	UCLA Dual Diagnosis Study Project Aims To assess characteristics of AOD treatment programs associated with different models of service delivery and treatment approaches for individuals with co-occurring disorders To compare differences in attitudes, beliefs, and perceptions between administrators and staff in MH and AOD programs regarding treatment for this population To evaluate treatment outcomes of clients with COD who receive treatment from AOD programs with different models of service delivery
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5	Research Questions Do AOD treatment programs with different models of service delivery vary in: treatment approach & orientation relationships with other service providers What are differences between administrators and staff in MH and AOD programs regarding: treatment approaches & attitudes perceptions of service delivery system What are client treatment outcomes at 6 months following treatment?
6	Methods Interviews and surveys were conducted with administrators of 16 residential AOD treatment programs and 10 mental health programs in Los Angeles County Staff (N = 252) in these programs, who had direct contact with dually diagnosed clients, were surveyed Clients (N = 400) sampled from the AOD treatment programs were assessed at treatment entry, 6-month follow-up, and 12-month follow-up Focus groups (n = 7) were conducted with program staff, clients, & community stakeholders
7	Treatment Orientations/ Service Delivery Models of AOD Treatment Programs
8	Analyses Factor analysis was used to construct 4 scales of treatment orientations using data from administrator and staff surveys Scales were standardized with a range 0-10 and alpha reliability coefficients were computed Scales were dichotomized at the mean and bivariate analyses were conducted of their association with other program characteristics (e.g., linkage and referral patterns, model of service delivery)
9	Alpha Reliability of Treatment Orientation Scales Administrators Staff TC/12-step 0.82 0.66 Rehab/education 0.75 0.78 Counseling 0.75 0.75 Dual Diagnosis 0.77 0.24
10	TC/12-Step Treatment Orientation It is very important to confront clients when they are in denial about their substance use We use positive reinforcement with clients (provide positive feedback and support)^* We conduct task-oriented and problem-solving groups^* We encourage clients to create an environment that supports their recovery (friends, living situation, location) Attending self-help or 12-step groups is an essential component of an individual’s recovery plan^* Although individual counseling is helpful, it is essential that clients participate in group counseling % of program staff who are recovering substance abusers
11	Rehab/Education Treatment Orientation Education/vocational needs assessment is provided^* Basic education in reading and writing is provided^* High-school or GED preparation provided^* Educational/employment counseling is provided Help with resume and job interviewing skills is provided Co-ordination of on- and off-site services is important
12	Counseling Treatment Orientation Although 12-step groups are helpful, it is essential that clients also go for counseling at a program like ours The majority of dually diagnosed clients have a history of trauma/violence Group counseling is provided^* Family counseling is provided^* Anger management is provided Individual counseling is provided^*(staff scale only)
13	Dual Diagnosis Treatment Orientation Percentage of dually diagnosed clients in program is > 25% Program excludes mentally ill individuals (reverse coded) Program uses over 3 psych tests in assessment A program’s rules should be made more flexible for dually diagnosed clients The only way to make an accurate diagnosis of a mental disorder is if the client is clean/sober for at least one month (reverse coded) Medication management is an important service Job placement is provided to clients
14	Scores on Treatment Orientation Scales
15	Program Models of Service Delivery to Individuals with COD
16	Summary of Findings Programs higher on the dual-diagnosis orientation were more likely to send information to other programs Programs higher on the counseling orientation were more likely to: receive information from other programs use an integrated model of service delivery get client referrals from mental health agencies have clients who are concurrently receiving social services
17	Summary of Findings Programs higher on the TC/12-step orientation were more likely to: get client referrals from mental health agencies get client referrals from the criminal justice system Programs using a more integrated model of service delivery were more likely to get client referrals from county dual-diagnosis outreach teams
18	Client Treatment Outcomes- Preliminary Findings
19	Client Data Collection
20	Client Characteristics at Treatment Admission
21	Client Characteristics at Treatment Admission
22	Diagnosis of Mental Disorder¹
23	Alcohol/Drug Dependence¹
24	Treatment History
25	Differences Among Gender/Diagnostic Groups Males Higher rates of legal supervision and property crime Higher rates of dependence on alcohol, cannabis, & opioids Females Higher rates of prostitution Higher service needs overall, particularly for family- and trauma-related needs Females with psychotic disorders had greatest needs for basic/survival services
26	Treatment Outcome at 6-month Follow-up (N = 350)
27	Predictors of Positive Treatment Outcomes at 6-month Follow-up (Odds Ratios)
28	Predictors of Positive Treatment Outcomes at 6-month Follow-up (Odds Ratios)
29	Program Service Delivery Model Ratings (1 = Parallel to 5 = Integrated)
30	Variables That Were Not Related to Treatment Outcome Client Factors Type of psychiatric disorder or type of substance use Legal, housing, or physical health status Degree of family assistance
31	Conclusions Preliminary outcome analyses showed that client, treatment, and program-related factors uniquely contributed to predicting outcomes of clients with COD Clients who were older, Hispanic, never married, employed, and who had lower levels of psychological distress and quality of life at admission had better outcomes Longer treatment retention, more services received, satisfaction with mental health services, and treatment in more integrated programs were associated with better outcomes Treatment planning needs to emphasize retention, aftercare, and comprehensive service delivery
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