Classifying substance use disorder treatment facilities with co-located mental health services: A latent class analysis approach

Abstract

Background The Affordable Care Act calls for increased integration and coordination of behavioral health services, as people with co-occurring disorders (CODs), meeting criteria for both substance use and psychiatric disorders, are overrepresented in treatment samples. Nationwide estimates of mental health (MH) service co-location in substance use disorder (SUD) treatment facilities are needed. We empirically derived a multiple-indicator categorization of services for CODs in SUD treatment facilities. Methods We used latent class analysis to categorize 14,037 SUD treatment facilities in the United States and territories included in the 2012 National Survey of Substance Abuse Treatment Services. Latent class indicators included MH screening and diagnosis, MH support services, psychiatric medications, groups for CODs, and psychosocial approaches. Multinomial logistic regression compared facility-identified primary focus (i.e., SUD, MH, mix of SUD-MH, and general/other) and other facility characteristics across classes. Results A four-class solution was chosen with the following classes: Comprehensive MH/COD Services (25%), MH without COD Services (25%), MH Screening Services (21%), and Limited MH Services (29%). The former two classes with co-located MH services were less likely to report a SUD-primary focus than the latter classes reporting only MH screening or Limited MH Services. Only the Comprehensive MH/COD Services class also had a high probability of providing special groups for CODs. Conclusions Approximately half of SUD treatment facilities were in classes with co-located mental health services, but only a quarter provided comprehensive COD services. Future studies should assess differences in patient experiences and treatment outcomes across facilities with and without COD services.

Demographic and psychiatric correlates of compulsive sexual behaviors in gambling disorder

“…Overall, we found that individuals who present with the dual diagnosis of GD + CSB evidence greater psychopathology compared to those with a sole diagnosis of GD. Unfortunately, treatments tailored for comorbid conditions are often the exception rather than standard clinical care (Mauro, Furr-Holden, Strain, Crum, & Mojtabai, 2016;Sacks et al, 2013). Thus, co-occurring diagnoses complicate treatment delivery, which are often designed for single diagnoses.…”

The association of psychiatric comorbidity with treatment completion among clients admitted to substance use treatment programs in a U.S. national sample

“…Yet, integrating substance use and mental health care remains a challenge due to the historical separation of systems of care, funding streams, and treatment ideologies that have limited coordination between services and providers (Mason et al, 2016). Despite the recent expansion of training materials, such as SAMHSA’s Substance Abuse Treatment for Persons with Co-occurring Disorders, Treatment Improvement Protocols (TIPs) (Substance Abuse and Mental Health Services Agency, 2016), only a minority of substance use treatment facilities offer comprehensive mental health care services that meet the needs of their clients (Mauro et al, 2016; Mojtabai, 2004). …”

“…Other studies have also found low rates of screening for psychiatric comorbidity in substance use treatment programs: a recent analysis found that while approximately 88% of facilities that participated in the 2012 National Survey of Substance Abuse Treatment Services reported having clients with co-occurring mental health and substance use disorders, as many as 29% do not have screening procedures for psychiatric disorders (Mauro et al, 2016). Requiring more thorough mental health screening and assessment in substance use facilities is fundamental both for record keeping and for the design of appropriate clinical interventions to address the needs of patients.…”

Specialist healthcare services for UK care home residents: a latent class analysis

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