Purpose Integrated Dual Diagnosis Treatment (IDDT), an Evidence-Based Practice (EBP) designed for persons with co-occurring mental illness and substance use disorders, was developed for delivery in outpatient settings and has been implemented widely throughout the Unites States. Inpatient treatment for this population has historically not been integrated nor delivered by staff with expertise in both disorders, posing barriers to consistency across treatment settings. As early as 1998, however, some early innovators in Ohio's Integrated Behavioral Healthcare System (IBHS) were experimenting with small inpatient SAMI programs that utilized core IDDT elements.

The Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence (SAMI CCOE) provides consultation, training, and evaluation support for programs implementing IDDT. Because the evidence associated with IDDT or any EBP is based on delivering the intervention as it was designed, the measurement of fidelity to the model is a critical element of successful implementation. Though the IDDT Fidelity Scale is used to evaluate outpatient programs, an instrument to measure adherence to an inpatient adaptation did not exist. This poster presents the results of the initial phase of adapting the outpatient IDDT Fidelity Scale for inpatient use.

Methods Investigators employed the methods that Carol Mowbray and colleagues outlined as necessary in developing fidelity criteria and measures. First, they examined the outpatient IDDT Fidelity Scale, which defines elements of the IDDT model and criteria for assessing fidelity to each. Next, the team reviewed the literature associated with implementation of the outpatient model. Finally, the investigators used qualitative data gathered via the CCOE's fidelity evaluation activities with outpatient providers and expert observations of practitioners working with experimental inpatient SAMI programs. SAMI CCOE and state level researchers and trainers together with clinicians from inpatient SAMI programs formed a collaborative workgroup that addressed elements of the original IDDT model needing adaptation for inpatient implementation. These efforts led to the development of the IDDT Fidelity Scale: Inpatient Adaptation.

Results The workgroup identified three categories of fidelity index items: 1) model components that fit both the outpatient and inpatient settings (e.g. “Identification of dually diagnosed patients”); 2) outpatient model components that needed to be adapted to fit the inpatient setting (e.g. “Outreach”); and 3) elements of inpatient integrated treatment that did not appear in the outpatient model (e.g. “Discharge planning”). The three categories then produced the IDDT Fidelity Scale: Inpatient Adaptation. The revised fidelity scale includes eleven organizational items and thirteen treatment items.

Implications for Practice Continuity of care is critical in the lives of all people with health concerns. For those with co-occurring mental health and substance use disorders, both of which are typically chronic and relapsing, inconsistency across treatment settings presents major barriers to recovery. Adapting an evidence based practice with demonstrated effectiveness in outpatient services systems to the inpatient environment is an important step toward facilitating that continuity.