Health Care Delivery System: A Case Study

My current practicum at the Johnson Unit of Sacred Heart Medical Center while enrolled in the Portland State University Masters in Social Work Program has been, thus far, a rewarding and enriching experience. The focus of this paper will be my observations of the Unit and will overlay the information from readings and presentations from classes. I will develop concepts that I think could be useful if integrated into the behavioral health service delivery system of SHMC and the Johnson Unit. Substance abuse is the most common and clinically significant comorbid disorder among adults with severe mental illness, (Drake, et al). Since the problem of dual diagnosis became clinically apparent in the early 1980’s, researchers have established
Dual diagnoses treatments combine or integrate mental health and substance abuse interventions at the level of the acute care interaction. The health care delivery system has moved rapidly toward endorsing integrated treatment approaches for patients with dual diagnosis, (Center for Mental Health Services, 1994; Osher and Drake; 1996). An integrated treatment program utilizes the professional strengths of the team approach, which SHMC embraces. As treatment for severe mental disorders are typically provided by multi-disciplinary treatment teams that include a range of different professionals; psychiatrist, registered nurse, master level clinicians and case-managers, treatment for dual diagnosed patients should also be provided this model. Because the educational and prescriptive message is integrated, there is no need for the patient to reconcile two messages, thus the approach is
Carney and associates compared results of the Time Line Follow Back over a 30-day interval with results of the ASI 's 30-day assessment of alcohol use in a sample of 79 outpatients with severe mental illness. They found an excellent level of agreement between the two assessment instruments (kappa coefficient of .79), and a correlation of .75 between the two approaches on the number of days respondents reported that they had been drinking. The Time Line Follow Back procedure may actually yield higher estimates of drinking behaviors than the ASI for a 30-day interval. Given that even moderate amounts of alcohol or other substance use may lead to adverse consequences for persons with severe mental illness, the Time Line Follow Back appears to offer a highly promising assessment approach that should be further examined in future