Perspectives from the Field: Behavioral Health Providers' Preparedness for Treating Co-Occurring Disorders

Background.  Of the approximately 9 million American adults who experience co-occurring substance use and mental health disorders (COD), fewer than 10 percent receive treatment for both conditions (SAMSHA, 2010).  Treatment for each disorder has traditionally occurred either sequentially or concurrently (Mueser, 2003), but some states, recognizing numerous benefits of integrated treatment for client health and longevity (SAMSHA, n.d.), have begun requiring COD certification for providers serving this population.  The current state of the COD-related behavioral health workforce has been characterized as perilous, highlighting the critical need to train providers to meet the increasing demand for integrated services (Hoge, et al., 2013).  Yet, very little empirical literature considers providers’ perspectives on such training or the extent to which providers consider themselves prepared to deliver competent COD treatment.

Methods.  To address this gap, this study examined providers’ COD-related practice experiences and the factors associated with needing additional COD training.  A statewide convenience sample of behavioral health providers was recruited in one Midwestern state from January to June, 2013. Respondents completed an 88-item self-administered survey assessing demographic and professional characteristics, treatment settings, training experiences, frequency of COD service provision, experience treating each condition, confidence in treating COD, and perceived future training needs.

Results.  The sample (n=740) was predominantly white (91.6%) and distributed fairly equally across all age categories up to age 60. Most respondents had either Bachelors (37.8%) or Masters (43.6%) degrees representing multiple disciplines (33.1% Alcohol & Drug Counseling; 26.6% Social Work; 16.4% Psychology; 23.9% other).  Fewer than 10% of providers reported being “very confident” in their ability to treat co-occurring disorders, while slightly more (14.4%) reported being “not at all confident.”  Providers’ confidence for treating co-occurring disorders was not associated with perceived need for future COD-related training.  Providers in mental health agencies desired more COD-specific training (z=-2.76, p=.006) and overall training (z=-2.65, p=.008) than providers from other settings.  Consistently, providers with degrees in Alcohol and Drug Counseling reported needing significantly less COD-specific and overall training (z=2.87, p=.004; z=3.28, p=.001) than providers from other disciplines.  Neither past training nor current frequency of working with COD clients were associated with future training needs, but providers with more extensive overall experience in mental health, substance abuse, and COD were all more likely to endorse needing more COD training.  However, regression analysis revealed that this previous practice experience and other factors significant at the bivariate level explained only a negligible amount of variance in future training needs.

Conclusions and Implications.  Providers in this sample indicated less than optimal confidence in their ability to treat COD, yet desire for more COD-related training varied significantly by agency setting and discipline.  While development of effective training and continuing education is imperative for social workers and other behavioral health professionals who address co-occurring disorders in practice, this variability suggests that contextual factors specific to disciplines and treatment settings require further exploration.  Implications of study findings for social work research and practice will be discussed in tandem with broader efforts to improve wellbeing and longevity for individuals with co-occurring disorders.