DDCAT Summary Report Agency Name:

Review Date: Fiscal Year: .

Agency Name
Program Name
Mailing Address
Telephone / Fax: / Email:
Contact Person
Review Date
Reviewers

Program CharacteristicsSize of ProgramMental Health

Payments received (Program)# of Admissions/last fiscal yearOutpatient

Self pay Capacity (highest # serviceable)Partial hospital/Day Program

Private health insuranceAverage length of stay (in days)Inpatient

MedicaidPlanned length of stay (in days)

Medicare# of unduplicated clients/yearExclusive program/Admission criteria requirement

State financial insuranceAdolescents

Military insuranceAgency TypeCo-occurring MH & SU disorders

PrivateHIV/AIDS

Other Funding sources Public Gay & Lesbian

Other public fundsNon-ProfitSeniors/Elders

OthersGovernment operatedPregnant/post-partum

Veterans Health AdministrationWomen

Primary Focus of AgencyResidential setting for patients and their children

Addiction treatment servicesLevel of Care Men

Mental Health (MH) ServicesASAM-PPC-2R (Addiction) DUI/DWI

Mix of addiction & MH servicesOutpatientCriminal justice clients

General health servicesIOP/Partial HospitalAdult General

HospitalResidential/Inpatient

Medically Managed Intensive Inpatient

OMT: Opioid Maintenance

D: Detoxification

PROGRAM STRUCTURE / Score / Recommendations
IA
Mission Statement
IB
Organizational Certification and Licensure
IC
Collaboration with Mental Health Services
ID
Financial Incentives
Agency Work Plan Activity (Developed from Reviewer Recommendations):
Sum Total= / /4 / SCORE=
PROGRAM MILIEU / Score / Recommendations
IIA
Routine Expectation and Welcoming
IIB
Display and Distribution of Literature
Agency Work Plan Activity (Developed from Reviewer Recommendations):
Sum Total= / /2 / SCORE=
ASSESSMENT / Score / Recommendations
IIIA
Routine Screening Methods for Mental Health Symptoms
IIIB
Routine Assessment if Screened Positive
Agency Work Plan Activity (Developed from Reviewer Recommendations):
IIIC
Mental Health and Substance Use Diagnosis
IIID
Mental Health and Substance Use History Reflected in Record
IIIE
Program Acceptance Bases on Psychiatric Symptom Acuity
IIIF
Program Acceptance Based on Severity of Persistence and Disability
IIIG
Stage-Wise Assessment
Agency Work Plan Activity (Developed from Reviewer Recommendations):
Sum Total= / /7 / SCORE=
TREATMENT / Score / Recommendations
IVA
Treatment Plans
IVB
Assess and Monitor Interactive Courses of Both Disorders
IVC
Procedures for Mental Health Emergencies and Crisis Management
IVD
Stage-Wise Treatment
IVE
Policies and Procedures for Medication Management
IVF
Specialized Interventions with Mental Health Content
IVG
Education about Mental Health Disorder, Treatment and interaction with Substance Use Disorders
IVH
Family Education and Support
IVI
Specialized interventions to facilitate use of peer support groups in planning or during treatment
IVJ
Availability of Peer Recovery Supports with Co-occurring Disorders
Agency Work Plan Activity (Developed from Reviewer Recommendations):
Sum Total= / SCORE=
CONTINUITY OF CARE / Recommendations
VA
Co-occurring Disorders Addressed in Discharge Planning
VB
Capacity to Maintain Treatment Continuity
VC
Focus on Ongoing Recovery Issues for Both Disorders
VD
Specialized interventions to Facilitate Use of Community-Based Peer Support Groups During Discharge Planning
VE
Sufficient Supply and Compliance Plan for Medication
Agency Work Plan Activity (Developed from Reviewer Recommendations):
Sum Total= / SCORE=
STAFFING / Recommendations
VIA
Psychiatrist/Prescriber of Psychotropic Medications
VIB
On Site Clinical Staff with Mental Health Licensure, Competency of Substantive Experience
VIC
Access to Mental Health Supervision or Consultation
VID
Case Review, Staffing or Utilization Review Emphasizes and Supports Co-occurring Disorder Treatment
VIE
Peer/Alumni Supports Available with COD
Agency Work Plan Activity (Developed from Reviewer Recommendations):
Sum Total= / /5 / SCORE=
TRAINING / Score / Recommendations
VIIA
All Staff Members Have Basic Training in COD
VIIB
Clinical Staff Members Have Advanced Specialized Training in Integrated Treatment of COD
Agency Work Plan Activity (Developed from Reviewer Recommendations):
Sum Total= / /2 / SCORE=

Scoring Summary

DDCAT Index Program Category DDCAT Index Program Category:

Scale Method:Criterion Method:

OVERALL SCORE % CRITERIA MET FOR AOS

(Sum of Scale Scores /7) (# OF “1” OR >18/35) .

Dual Diagnosis Capability:% CRITERIA MET FOR DDC

(# OF “3” OR > 17/35) .

AOS (1 - 1.99)

AOS/DDC (2-2.99)% CRITERIA MET FOR DDE

DDC (3–3.45)(# OF “5” OR > 0/35) .

DDC/DDE (3.5–4.49)

DDE (4.5–5.0)HIGHEST LEVEL OF DD CAPABILITY

(80% or more)_____

______

DDCAT Lead Reviewer Date

______

DWMHA Clinical Practice Improvement LeadDate

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