Training in dual diagnosis interventions (the COMO Study)

Randomised controlled trial

Elizabeth Hughes, Shamil Wanigaratne, Kevin Gournay, Sonia Johnson, Graham Thornicroft, Emily Finch, Jane Marshall, Neil Smith

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

BACKGROUND: Despite the high prevalence of co-morbid substance use among mental health service users (dual diagnosis), very few mental health workers in the UK have had training and/or clinical experience to equip them to deliver targeted interventions to this client group.

METHOD: In a randomised controlled trial of training for dual diagnosis interventions, 79 case managers from 12 community mental health teams in South London were randomly allocated to either receive training and follow-up supervision (experimental group) or no training and supervision (control group). Baseline measures of attitude, self-efficacy and knowledge were collected prior to randomisation, and were repeated at 18 months post-training. An intention to treat analysis of follow-up data (adjusted for baseline score for that outcome and team) was performed.

RESULTS: At 18 months post-training, the AAPPQ (The Alcohol and Alcohol Problems Perception Questionnaire) total score was did not differ significantly between the two groups (adjusted difference 7.43 [95% CI -0.86 to 15.71], p = 0.08). There were significant differences in favour of the experimental group on 2 of the 6 subscales of the AAPPQ: 'adequacy of knowledge and skills in working with alcohol" (adjusted difference 3.598 [95% CI 1.03 to 6.16], p = 0.007) and "self-esteem in working with alcohol" (adjusted difference 3.00 [95% CI 0.46 to 5.54], p = 0.021). In addition there were significant improvements for the experimental group on "Knowledge About Dual Diagnosis" (adjusted difference 2.00 [95% CI 0.80 to 3.22], p = 0.002) and "Self-Efficacy Scale" (adjusted difference 13.55 [95% CI 8.00 to 26.86], p = 0.001). The effect of membership of teams was added to the analysis of covariance and this changed the results for only one variable: "self-esteem working with drinkers" was no longer significant.

CONCLUSION: A brief training course in dual diagnosis interventions had a significant effect on secondary measures of knowledge and self-efficacy that was detectable at 18 months post-training. Improvements in attitudes towards working with drinkers and drug users in mental health settings failed to reach statistical significance. Future research should explore the effects of dose of dual diagnosis training, and the successful integration of skills gained into routine care.

TRIAL REGISTRATION: ISRCTN98891022 14th March 2007.

Original languageEnglish
Pages (from-to)12
JournalBMC Psychiatry
Volume8
Issue number12
DOIs
Publication statusPublished - 27 Feb 2008
Externally publishedYes

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Dual (Psychiatry) Diagnosis
Randomized Controlled Trials
Alcohols
Self Efficacy
Mental Health
Self Concept
Intention to Treat Analysis
Mental Health Services
Random Allocation
Drug Users
Control Groups

Cite this

Hughes, E., Wanigaratne, S., Gournay, K., Johnson, S., Thornicroft, G., Finch, E., ... Smith, N. (2008). Training in dual diagnosis interventions (the COMO Study): Randomised controlled trial. BMC Psychiatry, 8(12), 12. https://doi.org/10.1186/1471-244X-8-12
Hughes, Elizabeth ; Wanigaratne, Shamil ; Gournay, Kevin ; Johnson, Sonia ; Thornicroft, Graham ; Finch, Emily ; Marshall, Jane ; Smith, Neil. / Training in dual diagnosis interventions (the COMO Study) : Randomised controlled trial. In: BMC Psychiatry. 2008 ; Vol. 8, No. 12. pp. 12.
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Hughes, E, Wanigaratne, S, Gournay, K, Johnson, S, Thornicroft, G, Finch, E, Marshall, J & Smith, N 2008, 'Training in dual diagnosis interventions (the COMO Study): Randomised controlled trial', BMC Psychiatry, vol. 8, no. 12, pp. 12. https://doi.org/10.1186/1471-244X-8-12

Training in dual diagnosis interventions (the COMO Study) : Randomised controlled trial. / Hughes, Elizabeth; Wanigaratne, Shamil; Gournay, Kevin; Johnson, Sonia; Thornicroft, Graham; Finch, Emily; Marshall, Jane; Smith, Neil.

In: BMC Psychiatry, Vol. 8, No. 12, 27.02.2008, p. 12.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Training in dual diagnosis interventions (the COMO Study)

T2 - Randomised controlled trial

AU - Hughes, Elizabeth

AU - Wanigaratne, Shamil

AU - Gournay, Kevin

AU - Johnson, Sonia

AU - Thornicroft, Graham

AU - Finch, Emily

AU - Marshall, Jane

AU - Smith, Neil

PY - 2008/2/27

Y1 - 2008/2/27

N2 - BACKGROUND: Despite the high prevalence of co-morbid substance use among mental health service users (dual diagnosis), very few mental health workers in the UK have had training and/or clinical experience to equip them to deliver targeted interventions to this client group.METHOD: In a randomised controlled trial of training for dual diagnosis interventions, 79 case managers from 12 community mental health teams in South London were randomly allocated to either receive training and follow-up supervision (experimental group) or no training and supervision (control group). Baseline measures of attitude, self-efficacy and knowledge were collected prior to randomisation, and were repeated at 18 months post-training. An intention to treat analysis of follow-up data (adjusted for baseline score for that outcome and team) was performed.RESULTS: At 18 months post-training, the AAPPQ (The Alcohol and Alcohol Problems Perception Questionnaire) total score was did not differ significantly between the two groups (adjusted difference 7.43 [95% CI -0.86 to 15.71], p = 0.08). There were significant differences in favour of the experimental group on 2 of the 6 subscales of the AAPPQ: 'adequacy of knowledge and skills in working with alcohol" (adjusted difference 3.598 [95% CI 1.03 to 6.16], p = 0.007) and "self-esteem in working with alcohol" (adjusted difference 3.00 [95% CI 0.46 to 5.54], p = 0.021). In addition there were significant improvements for the experimental group on "Knowledge About Dual Diagnosis" (adjusted difference 2.00 [95% CI 0.80 to 3.22], p = 0.002) and "Self-Efficacy Scale" (adjusted difference 13.55 [95% CI 8.00 to 26.86], p = 0.001). The effect of membership of teams was added to the analysis of covariance and this changed the results for only one variable: "self-esteem working with drinkers" was no longer significant.CONCLUSION: A brief training course in dual diagnosis interventions had a significant effect on secondary measures of knowledge and self-efficacy that was detectable at 18 months post-training. Improvements in attitudes towards working with drinkers and drug users in mental health settings failed to reach statistical significance. Future research should explore the effects of dose of dual diagnosis training, and the successful integration of skills gained into routine care.TRIAL REGISTRATION: ISRCTN98891022 14th March 2007.

AB - BACKGROUND: Despite the high prevalence of co-morbid substance use among mental health service users (dual diagnosis), very few mental health workers in the UK have had training and/or clinical experience to equip them to deliver targeted interventions to this client group.METHOD: In a randomised controlled trial of training for dual diagnosis interventions, 79 case managers from 12 community mental health teams in South London were randomly allocated to either receive training and follow-up supervision (experimental group) or no training and supervision (control group). Baseline measures of attitude, self-efficacy and knowledge were collected prior to randomisation, and were repeated at 18 months post-training. An intention to treat analysis of follow-up data (adjusted for baseline score for that outcome and team) was performed.RESULTS: At 18 months post-training, the AAPPQ (The Alcohol and Alcohol Problems Perception Questionnaire) total score was did not differ significantly between the two groups (adjusted difference 7.43 [95% CI -0.86 to 15.71], p = 0.08). There were significant differences in favour of the experimental group on 2 of the 6 subscales of the AAPPQ: 'adequacy of knowledge and skills in working with alcohol" (adjusted difference 3.598 [95% CI 1.03 to 6.16], p = 0.007) and "self-esteem in working with alcohol" (adjusted difference 3.00 [95% CI 0.46 to 5.54], p = 0.021). In addition there were significant improvements for the experimental group on "Knowledge About Dual Diagnosis" (adjusted difference 2.00 [95% CI 0.80 to 3.22], p = 0.002) and "Self-Efficacy Scale" (adjusted difference 13.55 [95% CI 8.00 to 26.86], p = 0.001). The effect of membership of teams was added to the analysis of covariance and this changed the results for only one variable: "self-esteem working with drinkers" was no longer significant.CONCLUSION: A brief training course in dual diagnosis interventions had a significant effect on secondary measures of knowledge and self-efficacy that was detectable at 18 months post-training. Improvements in attitudes towards working with drinkers and drug users in mental health settings failed to reach statistical significance. Future research should explore the effects of dose of dual diagnosis training, and the successful integration of skills gained into routine care.TRIAL REGISTRATION: ISRCTN98891022 14th March 2007.

KW - Adult

KW - Alcoholism

KW - Case Management

KW - Community Mental Health Services

KW - Comorbidity

KW - Curriculum

KW - Diagnosis, Dual (Psychiatry)

KW - Female

KW - Humans

KW - Inservice Training

KW - London

KW - Male

KW - Mental Disorders

KW - Mentors

KW - Middle Aged

KW - Professional Competence

KW - Self Concept

KW - Journal Article

KW - Randomized Controlled Trial

UR - https://bmcpsychiatry.biomedcentral.com/

U2 - 10.1186/1471-244X-8-12

DO - 10.1186/1471-244X-8-12

M3 - Article

VL - 8

SP - 12

JO - BMC Psychiatry

JF - BMC Psychiatry

SN - 1471-244X

IS - 12

ER -

Hughes E, Wanigaratne S, Gournay K, Johnson S, Thornicroft G, Finch E et al. Training in dual diagnosis interventions (the COMO Study): Randomised controlled trial. BMC Psychiatry. 2008 Feb 27;8(12):12. https://doi.org/10.1186/1471-244X-8-12