Date Issued: November 3, 2014
RECIPIENT
- All OASAS-Certified Service Providers
- Local Governmental Units (LGUs)
PURPOSE:
To encourage the adoption of a validated screening tool for identifying persons that may have a co-occurring mental health disorder who are receiving chemical dependence treatment in OASAS-certified settings.
BACKGROUND ON OASAS CO-OCCURRING DISORDER INITIATIVES
Since 1998, OASAS and the state Office of Mental Health have collaborated on a series of policy and programming initiatives to improve care to persons with co-occurring mental health and addictive disorders (PCODs). Both agencies have endorsed the New York Model, a conceptual model that place PCODs into four quadrants, based on the severity of their disorders, and recommends the approach to be taken across service systems to treat PCODs in each quadrant successfully. The New York Model was subsequently endorsed by SAMHSA in 1999.
The two agencies also endorsed a Statement of Principles and Values, and convened a Quadrant IV Task Force, whose report in 2001, Treating Co-Occurring Mental Health and Addictive Disorders in New York State: A Comprehensive View, continues to inform the agencies’ collaborative ventures (the New York Model and the Statement of Principles and Values are included in the Quadrant IV Task Force report, which is available from OASAS).
The interagency initiative has focused on two broad goals:
- To improve care to persons with the most severe mental health and addictive disorders through integration and inter-system coordination of care.
- To improve the proficiency of both systems of care to identify and engage PCODs.
To improve the coordination and integration of care for persons in Quadrant IV, the two agencies:
- Established an Interagency Workgroup on Co-Occurring Disorders (IWCD), which meets monthly to discuss the agencies' collaborative efforts.
- Jointly supported a demonstration project in select counties, the Dual Recovery Coordinator (DRC) Demonstration Project. The Project funds 12 DRCs in 14 counties and New York City. Within their counties, the Dual Recovery Coordinators work to develop more seamless and integrated systems of care through training, technical assistance and infrastructure development.
To improve the proficiency of both systems to identify and engage PCODs, OASAS and OMH collaborated in several areas:
- In 2001-2002, the agencies jointly supported a statewide training initiative for experienced clinicians. A ten session series was held in six regions across the state. Over 600 clinicians statewide participated in this training series. Each agency endorsed a program model for treating PCODs. OMH adopted the Integrated Dual Diagnosis Treatment model, developed by Robert Drake and his colleagues at Dartmouth. OASAS adapted the American Society of Addiction Medicine’s PPC 2R program guidelines for Dual Disorder Capable and Dual Disorder Enhanced programming for PCODs. Both agencies supported a validation study of a mental health screen for use in substance abuse service settings and a substance abuse screen for use in mental health service settings.
This Local Service Bulletin focuses on the implementation of the mental health screen in OASAS-certified settings.
BACKGROUND ON THE MODIFIED MINI SCREEN (MMS)
The Nathan Kline Institute's Center for the Study of Public Mental Health conducted a validation study of the mental health screen. The screen, sometimes referred to as the "Modified Mini Screen" (MMS), is a 22 item questionnaire designed to identify persons whose current mental health status indicates a need for a more thorough assessment by a licensed practitioner. The MMS is not a diagnostic or an assessment tool. It can be administered by any clinician in about 15 minutes and asks general questions that have been demonstrated to be effective in identifying individuals who may have Mood Disorders, Anxiety Disorders or Psychotic Disorders. The answers to these twenty-two questions yield a score that a program and a counselor can use to determine if the person needs further assessment of his/her mental health.
As part of the study, the MMS and the validation interview were administered to 338 adults in 17 OASAS sites, including outpatient, residential, methadone and inpatient settings. The validation study found that the MMS performed reasonably well for both men and women in OASAS settings. Similar findings for the screen were also noted when administered in criminal justice and shelter settings.
OASAS decided to promote the use of the MMS after a pilot study of the instrument in an urban methadone program, a suburban outpatient program and a rural residential treatment program confirmed that the counselors, supervisors and medical staff in the programs found the tool to be useful in identifying persons in need of a further assessment of their mental health needs.
IMPLEMENTATION OF THE MODIFIED MINI SCREEN
Although OASAS regulations do not specifically require that a mental health screen be done on new clients, the regulations do require that a mental health history and current status be reported within 30 days. Moreover, the current PAS-44 form requires the counselor to complete four questions related to the client's mental health status and history, one of which asks whether the client currently has a mental illness. A standardized, validated mental health screen will assist the counselor in answering these questions, and will bring some uniformity to a clinical practice that is a critical first step in identifying the needs of clients with co-occurring disorders. The MMS results can be used with the client in formulating an individualized treatment plan, which is required of outpatient programs by regulation within 30 days. SAMHSA's Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders (2002) and CSAT's TIP 42, Substance Abuse Treatment for Persons With Co-Occurring Disorders (2005) both recommend screening activities as part of a "No Wrong Door" approach to care for persons with co-occurring disorders. Moreover, the OASAS Dual Disorder Capable (DDC) program guidelines, which are based on ASAM's Patient Placement Criteria-2nd Edition Revised (PPC-2R) program guidelines for co-occurring disorders, also recommend that a mental health screening process be in place.
To assist providers in the adoption of the MMS, OASAS has taken the following actions:
- A User's Guide has been developed as a training aid in the implementation of the screen. The User's Guide and the MMS can be found on the OASAS website.
- An Implementation Plan guide has been developed to assist administrators and clinical leadership in thinking through the programmatic and clinical issues that need to be addressed to implement the MMS successfully. The Implementation Plan guide can also be found on the OASAS website. The Implementation Plan will help programs to develop written policies and procedures around screening, as recommended by the OASS DDC program guidelines.
- OASAS Field Office staff has received training on the MMS. Providers implementing the screen should complete the Implementation Plan and forward it to their Field Office representative, so that he/she might collaborate with the program in the implementation process.
- For those Local Government Units with a Dual Recovery Coordinator, the DRC is available to train programs and assist them in implementing the MMS.
- The Performance and Practice Improvement Unit at OASAS is also available to assist programs in working through any issues impeding the implementation of the MMS.
- OASAS has requested technical assistance from CSAT to train Master Trainers in the use of the MMS. As part of the same technical assistance request, OASAS is seeking assistance to upgrade its curriculum on co-occurring disorders, to incorporate the MMS and the OASAS DDC Program Guidelines into the course.
- OASAS will be conducting regional forums in June and July of 2005 for Program Directors and their Chief Clinical Officers to orient them to the MMS and to discuss its implementation.
- Providers who adopt the MMS may use its implementation as the voluntary objective required by OASAS as part of its annual Workscope Objective Attainment System.
REQUIREMENTS AND RESPONSIBILITIES
OASAS strongly encourages its certified programs to adopt this validated mental health screen as a regular clinical practice. The tool has been validated in OASAS settings, and feasibility testing has demonstrated the instrument to be a counselor and client-friendly tool that can assist clinicians and clients in treatment planning that leads to successful recovery.
If a program opts to use the screen, it must complete the Implementation Plan and submit it to its Field Office representative. The Implementation Plan covers key areas to be addressed before the MMS is introduced. Without adequate planning, which includes the review or development of follow-up procedures for those clients who screen positive, the Modified Mini Screen should not be implemented.
OASAS-Certified Programs with New York City Contracts
The New York City Department of Health & Mental Hygiene's Quality Impact Project (QIP) has included the implementation of the Modified Mini Screen as a project option for its contracted substance abuse providers, beginning in June '05. OASAS and the City have collaborated on the QIP for the MMS to ensure consistency in their approaches and expectations of providers, and to reduce provider burden where possible. Providers participating in the City QIP on the MMS do not have to submit a separate Implementation Plan to the OASAS Field Office for review. Completion of the QIP requirements will be sufficient for meeting OASAS' expectations in implementing the MMS.
FURTHER INFORMATION
Providers interested in adopting the MMS should contact their Field Office representative, and plan to attend the regional forums or make other arrangements to receive the training on the mental health screen.
Providers may also contact Ms. Susan Brandau, who is coordinating the training and adoption activities for the MMS. Ms. Brandau can be reached at:
OASAS
1450 Western Ave.
Albany, NY 12203
(518) 485-2107
Providers may also contact a Dual Recovery Coordinator for assistance with implementing the MMS, if their program resides in a county with a DRC.