Implementing integrated treatment for co‐existing substance use and severe mental health problems in assertive outreach teams: training issues

Abstract

This study sought to evaluate systematically training and implementation of a specific integrated treatment approach for co-occurring problem substance use and mental health within existing assertive outreach (AO) teams. The AO team was treated as a whole unit rather than as individual clinicians. They were provided with training and supervision to deliver a cognitive--behavioural integrated treatment approach. In a quasi-experimental time-lag design three teams were trained immediately and two others after an 18-month delay. There was evidence that teams acquired confidence and skills relevant to working with combined problems and that these gains were maintained over time. These results were replicated in the two teams trained after the delay. This study suggests that training mental health staff to use an integrated treatment approach is well received and produces lasting changes in confidence and skills. However, there are a number of issues related to staff training, shifting attitudes and implementation of integrated approaches into routine mental health practice. These issues are considered and suggestions made for staff training.

Acceptability and applicability of Cue Exposure Therapy as a relapse prevention intervention for individuals who have substance misuse and mental health problems

“…The DoH (2002) have stated that in order to perpetuate the use and adaptation of substance misuse techniques 'Ongoing supervision is crucial to ensure that new ideas are embedded in daily work and that staff feel supported in their practice'. This study supports findings from UK research by Graham (2004), Holland (1998) and Maslin et al (2001) that training has a significant impact on psychiatric practitioners' skills and confidence in working with dual diagnosis.…”

“…However, the results show that few of the study participants had any addiction work experience. The number of participants who indicated they had either had a placement or had worked in drug and/or alcohol teams was small and is in line with findings from other studies (Graham, 2004;Holland, 1998).…”

“…Manley in mental health probably gives professionals greater insight into the needs of the client. Some authors (Graham, 2004;Henry et al, 1996) have noted that professional's attitudes towards substance-misusing clients are significant in affecting willingness to intervene with this client group. However, Richmond and Foster (2003) noted that 'level of experience in mental health or substance misuse, and number of substance misuse training days were not associated with non-stereotyping, permissiveness, non-moralism, treatment optimism and treatment intervention'.…”

Dual Diagnosis Competency among Addiction Treatment Staff: Training Levels, Training Needs and the Link to Retention

“…This result is encouraging given the fact that previous studies showed specific training programmes to be successful in improving practitioners' DD competency levels [9,10] . It has been widely acknowledged that the treatment needs of individuals with co-morbidity are heterogeneous and often require coordination of multiple interventions.…”

Exploring the attitudes of staff working within mental health settings toward clients who use cannabis

“…Participants in the current study belonged to teams that had received training in an integrated treatment approach (Graham, 2004;Graham et al, 2004) and have ongoing support to facilitate its implementation. Integrated treatment approaches aim to integrate substance-use problems into the routine treatment of psychosis.…”