MC3 Value: Co-Occurring Capability

Co-occurring capability refers to the helping environment. It is defined as the capacity of a substance abuse, mental health, or other helping environment to provide integrated services to all individuals and families who present for care. This capability is evident in particular policies, procedures, screenings, assessments, program content, treatment planning, discharge planning, interagency relationships, community resources, and staff competencies. Every helping environment can develop co-occurring capability in the context of its unique mission, design, licensure, and resources.

Co-occurring competency refers to an individual who provides a helping relationship. It is the set of knowledge, skills, and attitudes/attributes (KSAs) necessary to successfully respond to people with co-occurring needs and includes how the helper performs job duties, meets responsibilities, and addresses the needs of individuals and families with co-occurring issues or other complex concerns.

Examples of Indicators:

  • Appropriate screening and assessment for co-occurring issues is evident at intake and throughout their participation in services.
  • Organizational policies and procedures which use language that acknowledges the complex and co-occurring issues of individuals seeking help.
  • Licensure and/or certifications of organizations and individuals within organizations reflect the needs of the individuals they help (e.g., an individual has both mental health and substance abuse licenses).
  • Organizations require training and provide supervision in co-occurring issues.
  • To the extent feasible, appropriate co-occurring services are integrated into current programming (e.g., a mental health treatment program adding a Relapse Prevention group for substance use).
  • Organization staff familiarizes themselves with appropriate available community resources, and this resource list is consistently updated.
  • Individuals’ satisfaction with the agency’s co-occurring capabilities is assessed through surveys, focus groups, in-depth interviews, and consumer advisory panels.
  • Integrated Treatment Fidelity Scale: Part of SAMHSA’s Evidence Based Practice KIT (Knowledge Informing Transformation), this assessment contains items covering 14 domains regarding a programs fidelity to Integrated Dual Disorders Treatment, including questions about whether services are provided in a multidisciplinary team, stage-wise interventions are utilized, pharmacological treatment for SUDs is provided, health promotion interventions are utilized, etc.
  • General Organizational Index: Part of SAMHSA’s Evidence Based Practice KIT (Knowledge Informing Transformation), this assessment contains items covering 12 domains regarding an organization’s ability and capacity to implement any EBP, and thus is not specific to IDDT. Some of the agency-wide operating procedures it is designed to assess include program philosophy, training plans for each provider, and supervision capacity and capability.
  • AC-OK: Developed by Andrew Cherry at the University of Oklahoma, the AC-OK is a 15-item assessment designed to screen for the possible presence of co-occurring disorders. There are six questions on substance use issues and nine on mental health.
  • DAST: Originally developed by Harvey Skinner in 1982, based on the Michigan Alcohol Screening Test (MAST), the DAST contains 10 items (20 and 28 item versions are also available) assessing both consumption of illegal drugs and questions about social and physiological consequences drug use.
  • AUDIT: Developed by the World Health Organization to assist in the screening process for unhealthy drinking, the AUDIT contains 10 items assessing both consumption of alcohol within the past year, as well as questions about consequences of alcohol consumption (e.g., failure to maintain social roles, concerns expressed by others).
  • Kessler 6 (K-6): Originally developed by David Kessler at Harvard to distinguish individuals with severe mental illness from those without in large epidemiological studies. Each survey contains questions about general psychological distress symptoms, as well as questions about the impact of these symptoms on daily functioning.
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