(From The Journal of Mental Health Administration,Volume 23, Number 3: Summer, 1996.)

MIDAA Service Manual: Dual Diagnosis, Co-occurring Disorders. (three-ring binder). By Kathleen Sciacca, New York: Sciacca Comprehensive Service Development for Mental Illness, Drug Addiction and Alcoholism,1990, 121 pages, $65.00, (299 Riverside Drive, New York, NY 10025: phone: (212)866-5935)

Survival means many things to many different people. In this time of transition in health care, program and personnel casuality will occur, with a decline in client services and care. No facility or health care provider is immune to cost/benefit scrutiny mandated by shrinking or finite resources, despite an increasing number of clients in need of a variety of services.

Kathleen Sciacca's MIDAA Service Manual for Mental Illness, Drug Addiction and Alcoholism could well be called a survival manual instead of a service manual because it provides a sound structure from which to promote the survival of clients with multiple disorders and provides a framework for personnel trying to make order of the chaos that these clients bring to treatment.

A total of 121 pages of documents range from MIDAA program structure, procedures, and outlines to specific assessment tools (such as pre-group interview forms, the modified CAGE questionnaire, and the Mental Illness Screening Form (MISF) along with other outlines and questionnaires formatted between 25 reinforced loose-leaf tabbed separator pages in a three-ring notebook. The format is ideal for handling ease as well as to provide master forms and documents for reproduction, clinical use and program implementation.

Most sections in the manual work independently and can be used out of sequence, which allows flexibility of program implementation. Implementation can be done gradually if time and personnel are limited. In this case, gradual addition of more components from this manual can be done as resources allow. Being able to start out of sequence is also useful for clients who therapeutically are engaged only by immediate exposure to a group of their peers through the acceptance into a supportive group instead of having to go through the more impersonal (and at times threatening) intake procedure during the often fragile initial contact period with the treatment facility and team.

In addition to flexibility, all sections of the manual contain material that is concise. The visual/tactile experience provided by the indexed separating pages gives a clear start and finish to each section.

Particularly useful portions of this manual include guidelines for presenting case conferences, literature reviews, program presentations, and the bibliography of articles for personnel training. The screening forms are designed to be used in a variety of settings, including screening for mental illness among people who have addictive disorders (MISF) or looking for signs of substance use/abuse problems in individuals with mental illness (DD-CAGE). Finally, standardization of measurable social parameters is done lucidly to ease adaptability to computer applications and potential use for outcome research.

The MIDAA Service Manual is in a unique position to provide mental health and substance abuse practitioners with the ability to generate and organize sound data and look at outcomes in the treatment of individuals with mental illness and substance disorders. The manual is a gem!

Mary K. Miller, M.D.
Staff Psychiatrist
Dual Diagnosis Group
West Jefferson Community Mental Health Center
Jefferson Parish Human Services Authority
Marrero, Louisiana

(NEXT REVIEWS From Psychosocial Rehabilitation Journal, Volume 18, Number 4: Spring, 1995.)

MIDAA Service Manual - Dual Diagnosis, Co-occurring Disorders For: Introduction To The Provision Of Services For Mental Illness Drug Addiction, And Alcoholism (MIDAA) Kathleen Sciacca, M.A., Sciacca Comprehensive Service Development for Mental Illness, Drug Addiction, and Alcoholism, 299 Riverside Dr., New York, N.Y. 10025. (212) 866- 5935. 1990. 3-ring binder. $65.

The dual disorders of mental illness/substance abuse continue to perplex and frustrate many mental illness and addictions treatment programs lacking expertise to treat this illness combination. Although awareness has risen in recent years of the importance of treating both disorders, remarkably few effective programs have been established due to the paucity of good development tools.

Kathleen Sciacca has recently made available an important "How-to" guide: The MIDAA Service Manual. Hopefully, it will be the first of many practical dual disorder development tools. The MIDAA Service Manual is a compilation of materials to be used by professionals in developing mental illness/substance abuse ("dual diagnosis") programs. Sciacca, a dual disorder consultant, has written and lectured extensively on dual disorders for approximately ten years. She has taken her knowledge and compiled it into a flexible format that should benefit both mental illness and addiction programs wishing to improve treatment for the dual disorders population. The primary use of the manual will be in the development and design of mental illness/substance abuse programs, particularly in adding to existing programs.

The manual is a useful collage of development tools such as rating scales, questionnaires, and program design materials. It contains the kind of technical information many mental illness and addiction professionals need and want. The materials are direct and to the point: no tediously long scales or questionnaires are included. The outlines and instructional memorandums include substance use questionnaires, mental illness symptom questionnaires, treatment level guides for various consumer symptom levels, and progress review scales, to name a few. Particularly useful are the pre-group assessment questionnaires which target dual disorder consumers into appropriate treatment levels. Professionals will be able to "pick and choose" which development tools they find most useful.

Although the guide is comprehensive, there are a few things that might be improved. The organization may be too loose for some dual disorder "beginners." Notably missing is the lack of a glossary; such terms like C.A.M.I. and M.I.C.A. as well as scales like C.A.G.E. are not defined. While it may be assumed that professionals should know the difference between the C.A.M.I. (Chemically Abusing Mentally Ill) and M.I.C.A. (Mentally Ill Chemical Abusing), many will probably not. An important article explaining these terms is listed only as a reference.

Despite minor shortcomings, at $65, this manual is an extremely good bargain for the many public and private agencies on today's tight budgets who need a comprehensive, streamlined, collection of tools to implement or add a mental illness/substance abuse track to their programs. It should be equally useful for addiction professionals as well as mental health professionals Any program seeking to develop effective dual disorder services should have this manual, one of the few tools that addresses both mental illness and substance abuse with equal skill and expertise.

Edward G. Francell, Jr., LMSW
Director of Research & Development
Cobb/Douglas Community Service Board
Marietta, Georgia

Integrated Treatment for Mental Illness, Drug Addiction And Alcoholism Across Alaska. Dual Diagnosis, Co-Occurring Disorders.

Kathleen Sciacca, M.A., Sciacca Comprehensive Service Development for Mental Illness, Drug Addiction, and Alcoholism, 299 Riverside Dr., New York, N.Y. 10025. (212) 866- 5935. Video VHS standard 1/2 inch tape. Cost $79.95 per copy.

Kathleen Sciacca has produced a companion piece to her MIDAA manual: Introduction to the Provision of Services For Mental Illness, Drug Addiction and Alcoholism in this useful video. With background music that includes haunting strains of chants from Native American Alaskan tribes, the work of implementing a statewide program for dual diagnosis clients in Alaska is described clearly. Alaska, like many other states, has a high prevalence of persons who experience co-morbidity of severe and persistent mental disorders and addiction to mind altering substances. This presents a tremendous challenge to health professionals who see the ineffectiveness of past attempts to control dual diagnosis symptoms and help repair disrupted lives. In this video, we hear a story of planned change process that turned the ongoing frustration into a stirring of hope. Conversations with the MIDAA Alaska program director, the Community Mental Health Center staff and satisfied consumers demonstrate the process of implementing a sequenced, structured program in a painless fashion. This video can be used to orient administrators, program directors and others to an effective way to engage and treat dual diagnosis persons. Its content includes a) elements of getting the program started and issues inherent in treating this population in both urban and rural settings; b) outlines of various profiles of persons who have dual or multiple disorders as well as definitions developed by Ms. Sciacca; c) samples of direct clinical content provided by excerpts from a training seminar; d) an inter-agency model of training and program development adapted to teleconference training across Alaska; e) outcomes and future directions. This video may be viewed in segments as program implementation proceeds. The overall technical quality of the video is good except for five minutes of footage from the training seminar. This piece was flawed by a low buzzing sound which distracted from the content. The still life photography of Alaska was breathtaking and enhanced the viewer's pleasure. I recommend this video to mental health professionals who have the budget and the will to change services. The video, like the manual, is an excellent tool in the struggle to provide cost effective, successful programs for dually diagnosed clients.

Claire Griffin-Francell, RN, MS
NAMI Curriculum & Training Network

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