An Experimental Investigation of an Innovative Community Treatment Model for Persons with a Dual Diagnosis (DD/MI)

Abstract

Habilitative services for persons with mental retardation who suffer from significant mental health problems are deficient in availability, accessibility, and adequacy. An active treatment case management model was developed and compared with the model of service delivery used by the involved agency for persons with dual diagnoses at pretreatment and at one, two, and three years of treatment. This study used a randomized experimental design, with participants assigned to two community treatment model to determine whether the active treatment model was more effective in increasing independent functioning skills and decreasing the maladaptive behaviors of participants. Results revealed increment improvement in treatment outcome with the active treatment model as compared to the traditional model of case management services. The active treatment model was more effective, with increased functional behaviors and decreased maladaptive behaviors. The active model showed promise in helping participants to move to less staff intensive day and residential settings. Implications for rehabilitation counseling practice and future applied research in rehabilitation were discussed. As persons with mental retardation continue to move from institutional settings to the community, rehabilitation service providers are increasingly aware that flexible and innovative service alternatives are essential to address their varied needs. This growing awareness has revealed that persons with mental retardation are a heterogeneous group, requiring an array of habilitative programs delivered in a broad range of supportive environments (Coelho, 1990). One notable result of the shift in service delivery environments is that many persons with mental retardation are in need of community mental health services for psychiatric problems (Fletcher, 1988). Persons with mental retardation develop mental illness or emotional disturbances about twice as frequently as persons not similarly labeled (Eaton & Menolascino, 1982; Menolascino & Stark, 1984; Menolascino & Potter, 1989). Estimates suggest that 20-39% of persons with mental retardation suffer from some form of diagnosable emotional disturbance compared to a general population's prevalence rate of 16-20% (Menolascino, 1989; Menolascino, Newman, & Stark, 1983; Reiss, 1990). The complexity of a dual diagnosis of mental retardation and mental illness presents a persistent challenge to rehabilitation service delivery systems, requiring specialized services to meet appropriately the needs of these persons. Generally, persons who are among the dually diagnosed population represent a significant group of persons who are not only underserved, they are poorly served by the mental health service system (Campbell & Malone, 1991; Galligan, 1990). There are well-documented incidents of abuse, over-medication, and in many sectors of the mental health system, a general lack of interest in working for this population (Rinck, Guidry, & Calkins, 1989). Thus, the full inclusion of persons with mental retardation into the community is increasingly challenging the field of rehabilitation (Coelho & Kelley, 1990). There is a need to develop innovative models for the provision of habilitative services to persons within the dually diagnosed population if their needs are to be appropriately met (Coelho & Kelley, 1989; Galligan, 1990). Services and supports in the community must consider psychiatric, medical, educational, vocational, residential and recreational needs. Traditional methods of treatment proven effective in treating either group separately (e.g., psychotherapy, behavior modification, psychotropic drugs, specialized residential and day programs and combined approaches) will not automatically work in treating the unique needs of persons who are dually diagnosed (Menolascino & Stark, 1984). There is no prevalent consensus on the merit of one treatment strategy over another (Goff, 1986). …