Integrated Dual Disorder Treatment Implementation in a Large State Sample.

Area of Science:

• Psychiatry
• Public Health
• Health Services Research

Background:

• Individuals with co-occurring illnesses face significant risks in criminal justice, housing, employment, and hospitalization.
• High-fidelity evidence-based models, such as integrated dual disorder treatment (IDDT), are crucial for improving outcomes in this population.

Purpose of the Study:

• To analyze the implementation fidelity of Integrated Dual Disorder Treatment (IDDT) across a large, state-wide sample.
• To assess changes in IDDT fidelity over time and identify specific components that facilitate or hinder implementation.

Main Methods:

• A descriptive analysis of secondary data from IDDT fidelity reviews conducted between 2006 and 2012 in one state.
• Statistical analysis of fidelity scores from baseline, second, and third reviews to determine significant improvements.
• Assessment of inner-rater reliability to ensure data consistency.

Main Results:

• Total IDDT fidelity significantly improved from baseline to the second review (p < .001) and from the second to the third review (p < .001).
• Adequate inner-rater reliability was achieved by the second review.
• Specific areas like practice penetration and family interventions showed lower fidelity, while multidisciplinary teams, integrated treatment specialists, and time-unlimited services scored higher.

Conclusions:

• Implementing IDDT requires time, but fidelity significantly improves from baseline to the third review.
• While overall fidelity increases, significant variance exists between different components of the treatment model.
• Sustained focus on specific lower-fidelity areas and leveraging high-fidelity components can optimize IDDT effectiveness.