Keywords

Codman Award, dual diagnosis, MIDA, performance improvement, system redesign

 

Authors

  1. Hayes, Randy A.
  2. Andrews, Natalie
  3. Baron-Jeffrey, Michael
  4. Conley, Cate
  5. Gridley, Khristine
  6. Norman, Robert
  7. Wright, George

Abstract

This study details how the Sinnissippi Center, Inc., identified, eliminated, or modified barriers to accessing services for MISA (mentally ill and substance abusing) consumers to improve their level of functioning. Barriers and impediments to MISA consumers receiving the full range of services were identified; specific systems changes and modification and clinician help were implemented; and process measures, functional measures, and comparison measures were taken, as was fidelity to the improved service model. Comparison measures showed a significantly lowered dropout rate (5.5% versus 65%) for the MISA-specific group and improved functioning over the comparison group. Process measures showed a significantly lowered use of emergency services, reduced emergency psychiatric hospitalizations, increased sobriety, decreased global assessment of functioning ranges, and an increased length of service. Functional measures showed a 199% increase in the 11 functional areas when averaged. Fidelity testing showed an average of 72% fidelity to the revised MISA services model. This study concludes that improved access to MISA-specific services significantly increases these consumers' quality of life.

 

Mentally ill and substance abusing (MISA) consumers are considered to be some of the most difficult of all behavioral health consumers for whom to provide service. Functional life areas that are degraded by the consumer's mental illness are further destroyed by use of addictive substances. Frequently, MISA consumers have had difficulty maintaining housing because of poor self-care (both in housekeeping and bill paying) abilities and skills. They may have had frequent run-ins with the law stemming from problems related to either their mental illness or their addictive use or both. They have had difficulties with their relationships because of behaviors (eg, delusional or paranoid thinking) exacerbated through addictive use. Frequently family, friends, and neighbors, if not law enforcement officials, are clamoring "to have something done" about these consumers.

 

However, psychiatric and treatment appointments that could help to modify symptoms are often missed by the consumer. Thus medication that could control psychiatric symptoms and thus improve functional levels is also missed or inadequately used. Further, the MISA consumers seem to have little or no commitment to treatment for the mental illness or the addictive behavior. Thus other treatment services to provide therapy or needed skill development are also missed. Year after year the MISA consumer comes in and out of services, displaying no improvement in functional areas. Indeed, the consumer's condition steadily declines.