Top

Administration and Policy in Mental Health and Mental Health Services Research

Published in:

01-07-2008

Evaluation of Treatment Programs for Dual Disorder Individuals: Modeling Longitudinal and Mediation Effects

Authors: Thomas D. Fletcher, Jennifer L. Cunningham, Robert J. Calsyn, Gary A. Morse, W. Dean Klinkenberg

Published in: Administration and Policy in Mental Health and Mental Health Services Research | Issue 4/2008

Abstract

This study evaluated the effectiveness of the three approaches for treating dual disorder clients who were homeless at intake: integrated assertive community treatment (IACT), assertive community treatment only (ACTO), and standard care (SC). Multilevel Random Coefficient Modeling (MRCM) was used to analyze longitudinal effects and to identify mediators of significant treatment effects. The outcome variables were consumer satisfaction, stable housing, psychiatric symptoms, and substance abuse. The eight mediators were service utilization variables: program contacts, phone contacts, substance abuse contacts, assistance with activities of daily living, transportation assistance, help finding permanent housing, help with emotional problems, and medication assistance. The 191 eligible participants were randomly assigned to one of the three conditions and followed for a period of 30 months. Both ACTO and IACT produced better outcomes than SC on consumer satisfaction and stable housing. There were no differences on any of the outcome variables between ACTO versus IACT when comparing main effects. However, there were several treatment by time interactions. In addition, there were many mediation effects.

We acknowledge that spurious interactions are unlikely (Evans 1985). Therefore, we note the exact P-values and allow the reader to determine the importance of the effects when interactions are significant at the P < .1 level. We retain the convention of P < .05 when reporting the main effects.

American Psychiatric Association. (2000). Diagnostic and statistical manual for mental disorders (DSM-IV-IR). Washington, D.C.: American Psychiatric Association.

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1171–1182. doi:10.1037/0022-3514.51.6.1173.CrossRef

Biesanz, J. C., Deeb-Sossa, N., Papadakis, A. A., Bollen, K. A., & Curran, P. J. (2004). The role of coding time in estimating and interpreting growth curve models. Psychological Methods, 9, 30–52. doi:10.1037/1082-989X.9.1.30.PubMedCrossRef

Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness—critical ingredients and impact on patients. Disease Management & Health Outcomes, 9, 141–159. doi:10.2165/00115677-200109030-00003.CrossRef

Brekke, J. S., Long, J. D., Nesbitt, N., & Sobel, E. (1997). The impact of service characteristics on functional outcomes from community support programs for persons with schizophrenia. Psychiatric Services, 50, 464–475.

Carey, K. B., Coco, K., & Simons, J. (1996). Concurrent validity of clinicians’ ratings of substance abuse among psychiatric outpatients. Psychiatric Services, 47, 842–847.PubMed

Cleveland, W. S. (1993). Visualizing data. Murray Hill, NJ: AT&T Bell Laboratories.

Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.

Drake, R. E., McHugo, G. J., Clark, R. E., Teague, G. B., Xie, H., Miles, K., et al. (1998a). Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: A clinical trial. American Journal of Orthopsychiatry, 68, 201–215. doi:10.1037/h0080330.PubMedCrossRef

Drake, R. E., Mercer-McFadden, C., Mueser, K. T., McHugo, G. J., & Bond, G. R. (1998b). A review of integrated mental health and substance abuse treatment for patients with dual disorders. Schizophrenia Bulletin, 24, 589–608.PubMed

Drake, R. E., Essock, S. M., Shaner, A., Carey, K. B., Minkoff, K., Kola, L., et al. (2001). Implementing dual diagnoses services for clients with severe mental illness. Psychiatric Services, 52, 469–476. doi:10.1176/appi.ps.52.4.469.PubMedCrossRef

Drake, R. E., Mueser, K. T., Brunette, M. F., & McHugo, G. J. (2004). A review of treatments for people with severe mental illness and co-occurring substance use disorders. Psychiatric Rehabilitation Journal, 27, 360–374. doi:10.2975/27.2004.360.374.PubMedCrossRef

Essock, S. M., Mueser, K. T., Drake, R. E., Covell, N. H., McHugo, G. J., Frisman, L. K., et al. (2006). Comparison of ACT and standard case management for delivering integrated treatment for co-occurring disorders. Psychiatric Services, 57, 185–196. doi:10.1176/appi.ps.57.2.185.PubMedCrossRef

Evans, M. G. (1985). A Monte Carlo study of the effects of correlated method variance in moderated multiple regression analysis. Organizational Behavior and Human Decision Process, 36, 305–323. doi:10.1016/0749-5978(85)90002-0.CrossRef

First, M. B., Gibbon, M., Spitzer, R. L., & Williams, J. B. W. (1996). User’s guide for the structured clinical interview for DSM-IV Axis I disorders (research version 2.0). New York: American Psychiatric Publishing Inc.

Kenny, D. A., Calsyn, R. J., Morse, G. A., Klinkenberg, W. D., Winter, J. P., & Trusty, M. L. (2004). Evaluation of treatment programs for persons with severe mental illness: Moderator and mediator effects. Evaluation Review, 28, 294–324. doi:10.1177/0193841X04264701.PubMedCrossRef

Lukoff, D., Nuechterlein, K. H., & Ventura, J. (1986). Manual for the expanded brief psychiatric rating scale. Schizophrenia Bulletin, 2, 594–602.

MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104. doi:10.1037/1082-989X.7.1.83.PubMedCrossRef

MacKinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007). Mediation analysis. Annual Review of Psychology, 58, 593–614. doi:10.1146/annurev.psych.58.110405.085542.PubMedCrossRef

Morse, G. A., Calsyn, R. J., Allen, G., & Kenny, D. (1994). Helping the homeless mentally ill: What variables mediate and moderate successful outcomes? American Journal of Community Psychology, 22, 661–683. doi:10.1007/BF02506898.PubMedCrossRef

Morse, G. A., Calsyn, R. J., Klinkenberg, W. D., Helminiak, T. W., Wolff, N., Drake, R. E., et al. (2006). Treating homeless clients with severe mental illness and substance use disorders: Costs and outcomes. Community Mental Health Journal, 42, 377–404. doi:10.1007/s10597-006-9050-y.PubMedCrossRef

Mueser, K., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness. A review of research on use management. Schizophrenic Bulletin, 24, 37–74.

Phillips, S. D., Burns, B. J., Edgar, E. R., Mueser, K. T., Linkins, K. W., Rosenheck, R. A., et al. (2001). Moving ACT into standard practice. Psychiatric Services, 52(6), 771–779. doi:10.1176/appi.ps.52.6.771.PubMedCrossRef

Pinheiro, J. C., & Bates, D. M. (2000). Mixed-effects models in S and S-Plus. New York: Springer.

Pinheiro, J. C., Bates, D. M., DebRoy, S., & Sarkar, D. (2006). NLME: Linear and nonlinear mixed effects models (R package version 3.1–73) [Computer software].

Ployhart, R. E., Holtz, B. C., & Bliese, P. D. (2002). Longitudinal data analysis: Applications of random coefficient modeling to leadership research. Leadership Quarterly, 13, 455–486. doi:10.1016/S1048-9843(02) 00122-4.CrossRef

Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. J., et al. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. Journal of American Medical Association, 264, 2511–2518. doi:10.1001/jama.264.19.2511.CrossRef

Singer, J. D., & Willet, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York: Oxford University Press.

Snijders, T. A. B., & Bosker, R. (1994). Modeled variance in two-level models. Sociological Methods & Research, 22, 342–363. doi:10.1177/0049124194022003004.CrossRef

Tukey, J. W. (1977). Exploratory data analysis. Reading, MA: Addison-Wesley.

Winter, J. P., & Calsyn, R. J. (2000). The Dartmouth Assertive Community Treatment Scale (DACTS): A generalizability study. Evaluation Review, 24, 319–338.

Title: Evaluation of Treatment Programs for Dual Disorder Individuals: Modeling Longitudinal and Mediation Effects
Authors: Thomas D. Fletcher
Jennifer L. Cunningham
Robert J. Calsyn
Gary A. Morse
W. Dean Klinkenberg
Publication date: 01-07-2008
Publisher: Springer US
Published in: Administration and Policy in Mental Health and Mental Health Services Research / Issue 4/2008
Print ISSN: 0894-587X
Electronic ISSN: 1573-3289
DOI: https://doi.org/10.1007/s10488-008-0170-2

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of Treatment Programs for Dual Disorder Individuals: Modeling Longitudinal and Mediation Effects

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2008

Medicare Inpatient Treatment for Elderly Non-dementia Psychiatric Illnesses 1992–2002; Length of Stay and Expenditures by Facility Type

Social Disadvantage and the Mental Health of Military Personnel Returning from Iraq and Afghanistan

A Common Factors Approach to Improving the Mental Health Capacity of Pediatric Primary Care

When Programs Benefit Some People More than Others: Tests of Differential Service Effectiveness

What is a Mental Health Clinic? How to ask Parents about Help-seeking Contacts Within the Mental Health System

Enhancing the Net Benefits of Disseminating Efficacious Prevention Programs: A Note on Target Efficiency with Illustrative Examples