Competency 5: Evidence-Based Individual, Group, and Family Treatment

Skill 5A: Able to identify core elements of successful treatment for individuals with co-occurring disorders.

• Per Minkoff, understand that for each person, the correct integrated treatment intervention must be individualized according to diagnosis, phase of recovery/treatment, level of functioning and/or disability associated with each disorder, and level of acuity, dangerousness, motivation, capacity for treatment adherence, and availability of continuing empathic treatment relationships and other recovery supports.
• Understand that effective programs incorporate the following:
  • Integrated treatment: one disorder does not present as “primary”, both conditions are addressed.
  • Stage-wise treatment: Different services offered at different stages of treatment.
  • Assertive Outreach: remove obstacles to accessing treatment through outreach efforts, often meeting individuals in their own homes or community settings.
  • Motivational Interventions: interventions that help clients become ready for change.
  • Counseling: once individuals are motivated to manage their own illness, they address skills and supports to control the symptoms.
  • Social Support: strengthen social networks
  • Long-term perspective: recognize that long term stability may not be achieved quickly and incorporates contingency plans that address and prevent relapse.
  • Comprehensive: address multiple factors including medication, benefits, housing, and employment and allow for other levels of treatment when appropriate.
• Cultural Sensitivity and Competence: implement modifications for cultural and other local circumstances.

Resources for Skill 5A

• Dual Diagnosis: An Integrated Model for the Treatment of People with Co-occurring Psychiatric and Substance Disorders in Managed Care Systems
• Integrated Treatment for Co-Occurring Disorders : An Evidenced Bsed Practice

Skill 5B: Able to inform others of the evidenced-based treatment options available to children and adults with co-occurring disorders.

• Familiarity with widely used Evidence-based Practices for Children and Adolescents with co-occurring disorders such as:
  • Functional Family therapy (FFT)
  • Multi-systemic Therapy (MST)
  • Therapeutic Foster Care (TFC) and Multidimensional Treatment Foster Care (MTFC)
  • Parent- Child Interaction Therapy (PCIT)
• Familiarity with widely used Evidence-based Practices for Adults with Co-occurring disorders such as:
  • Assertive Community Treatment
  • Family Psychoeducation
  • Illness Management and Recovery
  • Integrated Dual Disorders Treatment
  • Motivational Enhancement Therapy
  • Cognitive Behavioral Therapy (CBT)
  • Medication Management
  • Medication Assisted Treatment
  • Eye Movement Desensitization and Reprocessing (EMDR)
  • Dialectal Behavioral Therapy
  • Seeking Safety
  • Trauma Recovery Empowerment Model (TREM)
  • Supported Employment
  • Permanent supportive housing
• Self-help and peer support services

Resources for Skill 5B

• Alaska Department of Health and Human Services-Evidence Based Practice Continuum Guidelines
• What are the Treatments for Comorbid Substance Use Disorders and Mental Health Conditions?
• Integrated Systems and Services for People with Co-Occurring Mental Health and Substance Use Conditions: What’s Known, What’s New, and What’s Now? August 2019-Interventions that Work pages 12-21

Skill 5C: Able to incorporate evidenced based interventions into practice.

• Knowledge of evidenced based interventions that are frequently used in the treatment of client’s with co-occurring disorders.
  • Co-Occurring Psychoeducation for clients, families and concerned others that is comprehensive, diversity sensitive, and provided at a time and location that is easily accessible.
  • Group treatment designed to teach life enhancement skills such as identifying life goals, drug refusal, stress management, relaxation training, recreation, health, social skills, assertiveness training, problem solving, anger management, employment, self-help and peer support, etc.
  • Cognitive Behavioral Interventions specific to recognizing and altering thoughts associated with internal and external cues that trigger craving and lead to use.
  • Cognitive Behavioral Interventions and other intervention models aimed at overcoming barriers to relationship and other social involvement; e.g., teaching and coaching social and other needed coping skills in both an individual and group format.
  • Relaxation techniques and other stress reduction methods.
  • 12-step facilitation and other peer support groups like Double Trouble
• Trauma Informed Approach to Treatment.

Resources for Skill 5C

• Common Barriers and Strategies to Support Effective Health Care Teams for Integrated Behavioral Health

Skill 5D: Able to promote interventions that address overall positive health outcomes.

• Understand the importance of ensuring individuals are linked to routine disease screening and scheduled immunizations to encourage health.
• Understand the importance of promoting health interventions such as smoking cessation, weight control, regular exercise, and blood pressure monitoring.
• Understand the importance of incorporating harm-reduction strategies to minimize risk of STI transmissions and overdoses

Resources for Skill 5D

• Clinical Preventive Services Across the Life Stages
• Physical Health and Mental Wellbeing
• Harm Reduction Principles