Considering costs: Balance resources with needs
After evaluating their program, some agencies will make a conscious decision to achieve either the Dual Diagnosis Capable (DDC) or Dual Diagnosis Enhanced (DDE) levels.
Financial resources may not be an obstacle for some treatment providers, either through existing funding, grant support, or as an investment. See Funding opportunities.
Most agencies, however, will not be able to take every step to enhance their treatment services. Choices need to be made. Some of the benchmarks identified in the DDCAT and DDCMHT evaluations have costs attached to them, whereas others do not.
Cost of increasing medical capacity
The most significant costs to implement change to increase capacity for treating co-occurring disorders is hiring and/or increasing the number of hours for physicians or prescribers. The estimates include the potential for a contractual or consulting relationship with a prescriber for a significant block of time (one or more full days per week). The presence of this person would leverage at least three benchmarks.
| Cost-range chart |
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A benchmark chart gives the potential range in costs for implementation of each DDCAT and DDCMHT dimension.
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Cost of policy change
Changes in program policy that would affect licensure and certification, as well as financial processes, may also be cost-driven. The application costs for these certifications and licenses vary by state. The up-front cost to prepare materials and make programmatic changes (such as in policy and procedure manuals) is generally less than the license or certificate itself.
Cost of staff changes
Other high cost changes include clinical and staffing changes necessary to support an increase in the range of acceptance of patients for treatment with less regard for acuity. This may involve the capacity to manage more acute psychiatric or substance-related states and the necessary staff to observe, supervise, and treat patients. Qualified nursing personnel may be needed. Programs may also need to consider alterations to the physical settings.
Cost of program materials
Hazelden resources vary in size, structure, and cost. Many include multimedia components andother user-friendly elements that help engage professionals and make implementation easy. Some examples of our key behavioral health resources include:
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Co-occurring Disorders Program, a multi-component curriculum for the fully integrated treatment of co-occurring disorders across the client continuum of care.
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Hazelden Co-occurring Disorders Series, with diagnosis-specific components consisting of a DVD, CD-ROM, facilitator's guide, client workbook, video discussion guide, and family pamphlet.
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Cognitive Behavioral Therapy for PTSD curriculum for addiction professionals, and the DVD,
A Guide for Living with PTSD.
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The
Rational Emotive Behavior Therapy Program (REBT), a curriculum with nine topic-specific modules on such topics as anger, depression, shame, and perfectionism.
Identify the program level you would like to achieve
Some experts have suggested that all programs should be at least Dual Diagnosis Capable (DDC). Some costs will likely be associated with movement from Addiction Only Services (AOS) or Mental Health Only Services (MHOS) to DDC. Some agency directors may want to strive for Dual Diagnosis Enhanced (DDE) capability, and even more costs will likely be associated with movement from DDC- to DDE-level services.
Many states and providers are voluntarily seeking to achieve a DDC-level status at minimum. In the near future, many states may require that programs are at least DDC in order to maintain funding. Other states may offer incentives to DDC and DDE programs.
Not all treatment programs will likely ever be or need to be DDE. A rational model suggests that a certain number of programs should be DDE, however. What this portion is has not been determined. Thus every community and every provider must make their own assessment of needs and available resources for AOS, MHOS, DDC, and DDE services.
Initiate change
The majority of changes can be implemented with very little financial cost. The cost becomes more a matter of motivation, time, and the effort to change direction.
Given this fact, the changes that any program intends to make may not be as resource-driven or limited as one might think. The task instead becomes deciding -- preferably through consensus of stakeholders associated with the program -- what changes are desired and who is responsible for seeing them through.
