This report presents the results of RAND’s evaluation of a Navy initiative to improve care for co-occurring psychological health and substance use disorders among service members.

The co-occurrence of psychological health and substance use disorders, often referred to as co-occurring disorders (CODs), is common. The estimated prevalence of psychiatric disorders among individuals with substance use disorders varies, ranging from 7 percent to 35 percent in general population studies, and from 17 percent to 70 percent in studies of clinical samples (Flynn and Brown, 2008). Individuals with COD typically have worse treatment outcomes and increased risk of mortality when compared with...

The CODP integrates several evidence-based approaches to treatment for CODs, including motivational enhancement therapy (MET), twelve-step facilitation (TSF), and cognitive behavioral therapy (CBT). It uses evidence-based principles from IDDT, a program for individuals with severe mental disorders and co-occurring SUDs, as well. Research has shown that MET, TSF, CBT, and IDDT result in significant improvement in symptoms for clients with CODs (Baker et al., 2012; Boden and Moos, 2009; Frisman et al., 2009; Glasner-Edwards et al., 2007; Kushner et al., 2013; McGovern et al., 2008).

The CODP materials include modules to guide clinic administrators in enhancing their clinic’s capability to...

In this chapter, we describe the procedures, measures, and analyses used to understand the CODP training, its implementation, and barriers and facilitators to implementation. We took a comprehensive approach to answering the evaluation questions using both qualitative and quantitative methods. Specifically, we used five research procedures: analysis of CODP administrative data, key informant discussions, web survey of CODP trainees, telephone discussions with SARP staff, and site visits at selected SARPs. In this chapter we first describe the CODP administrative data and use the information gained from those data to describe the cohort of individuals who received CODP training between October...

In this chapter, we describe the SARP staff members who participated in the web survey and discussions.

A total of 36 individuals completed the survey. Thirteen were active duty or in an active status (36 percent), and 23 were retired service members (64 percent). Compared to nonrespondents, respondents were more likely to be retired service members (χ2(1) = 6.48,p= .01). Demographics of the survey respondents are shown in Table 4.1. Respondents were predominantly male, non-Hispanic white, retired service members. The majority of survey respondents (75 percent, n = 27) were Navy alcohol and drug counselors (ADCs). Six were...

In this chapter, we describe CODP trainee and key informant perceptions of the Hazelden training program and materials. We include results from the survey of SARP staff members who participated in the CODP training, discussions with SARP staff, and discussions with key informants.

To describe the implementation of the CODP, we sought to understand key informant and trainee (SARP staff) views about the quality and usefulness of the CODP training and materials. We examined quantitative data from the survey and qualitative data from SARP staff and key informant interviews.

Respondents generally agreed that the practice sessions, instructions, and examples from...

In this chapter, we focus on identifying which program elements were implemented and sustained at treatment sites. We include results from the survey of SARP staff members who participated in the CODP training, discussions with SARP staff, and discussions with key informants.

Respondents reported that certain CODP materials were used regularly (Figure 6.1). The highest mean level of usage was reported for the ICT binder (M = 2.5, SD = 1.4, with response options ranging from 0 for never to 4 for weekly), and the lowest for the Medication Management binder (M = 1.1, SD = 1.3). Figure 6.2 illustrates...

In this chapter, we identify facilitators and barriers to successful implementation of the CODP. In addition to understanding overall levels of implementation of the CODP materials, we sought to understandwhythe CODP, and particular components of it, were more or less likely to be implemented than others. We include results from the survey of SARP staff members who participated in the CODP training, discussions with SARP staff, discussions with key informants, and the site visits.

Survey respondents generally agreed that the CODP materials were useful and of high quality (Workshop Assessment Quality and Utilization score: M = 41.9 [possible...

In this chapter, we describe the degree to which Navy SARPs are capable to provide integrated care for CODs. We include results from the survey of SARP staff members who participated in the CODP training and the site visits. The level of integrated care provided at SARPs was assessed using the DDCAT. The DDCAT was completed via selfreport on the survey for those who identified themselves as serving in an administrative role within their SARP (N = 16). Two of the 16 DDCAT respondents came from the same SARP. Therefore, the DDCAT findings from the web survey represent 15 different...

This evaluation had two main aims: (1) to understand the CODP training approach and program goals and (2) to describe the implementation of the CODP, including trainee perceptions of the training, implementation of specific program elements, facilitators and barriers to successful implementation of the CODP, and programs’ capability to provide integrated care. This chapter summarizes the key findings from the evaluation and describes limitations that should be considered in interpreting our results. Finally, we offer suggestions for improving future CODs clinician training efforts and improving care for CODs.

The Hazelden Co-Occurring Disorders Clinician Training Program is an evidence-based program that...