Integration

Define Integrated Services and Treatment

Once systems agree on a shared vision, it is important to define how services and treatment will be provided in an integrated way. Many states have found the following tools and resources helpful in defining integrated services and treatment:

• Integrated Treatment for Co-Occurring Disorders is a part of SAMHSA's Evidence-Based Practices KIT Series. Formerly called Integrated Dual Disorders Treatment, the model and corresponding benchmark measures are used in many states to guide mental health agencies in developing co-occurring capability. Dartmouth Psychiatric Research Center continues to test and enhance the model. Dartmouth has partnered with Hazelton to produce additional resources on this model.
• Substance Abuse Treatment For Persons with Co-Occurring Disorders TIP 42 is a part of SAMHSA's Treatment Improvement Protocol (TIP) series. The protocol is used in many states to guide substance abuse treatment agencies in developing co-occurring capability and training practitioners.
• Dual Diagnosis Capability in Addiction Treatment (DDCAT) and Mental Health Treatment (DDCMHT) are process measures to guide addiction treatment settings in developing co-occurring capability. Parallel measures are available for mental health treatment settings. Agencies use these measures and the corresponding guides to identify strengths and weaknesses, create action plans and implement changes.
• Comprehensive, Continuous, Integrated System of Care (CCISC) is a model that can be used by either mental health or substance abuse service organizations seeking to become co-occurring capable. The model is based on eight principles and includes 12 steps that promote systems, services and treatment integration. The guide for this model includes tools for assessing organizational and practitioner competencies.

Establish Benchmarks and Measure Progress

States have used these resources and tools to develop specific guidance and criteria for agencies and practitioners. Many states have adopted or adapted a combination of measures to set benchmarks and assess progress over time.

States have used measures to:

• Determine which aspects of integrated treatment are already in place
• Define priorities for change
• Determine training needs
• Inform service planning by comparing progress between agencies
• Target resources

Agencies use measures to:

• Guide quality improvement
• Establish concrete action steps
• Provide feedback to practitioners
• Gauge progress over time

Defining integrated services and setting benchmarks helps states and agencies maintain a focus on the goals of integration. Demonstrating results using standardized measures also helps when building wide-spread consensus for integration and seeking new funding streams.

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Resources and Links

• Integrated Treatment for Co-Occurring Disorders Evidence-Based Practices KIT

  Available for download at this site, the KIT provides practice principles, benchmark measures, and suggestions from successful programs for integrating co-occurring disorder treatment at mental health agencies.

• Treatment Improvement Protocol (TIP) Series 42 Substance Abuse Treatment for Persons With Co-Occurring Disorder

  Treatment Improvement Protocols (TIPs), developed by the Center for Substance Abuse Treatment, part of the Substance Abuse and Mental Health Services Administration within the U.S. Department of Health and Human Services, are best-practice guidelines for the treatment of substance use disorders. This TIP identifies key elements of programming for co-occurring disorders in substance abuse treatment agencies, including screening, assessment, diagnosis, medication, and staffing.

• Assessing the capacity of addiction and mental health treatment services to address co-occurring substance use and psychiatric disorders: DDCAT Index and DDCMHT Index

  The Dual Diagnosis Capability in Addiction Treatment (DDCAT) Index is a measure designed to assess the capacity of addiction treatment programs and services to treat co-occurring disorders, resulting in categorizing services as Addiction Only Services, Dual Diagnosis Capable, or Dual Diagnosis Enhanced. The Dual Diagnosis Capability in Mental Health Treatment (DDCMHT) is an adaptation of the DDCAT for application in mental health settings. At this website, many resources about the DDCAT and the DDCMHT, including toolkits, scoring manuals, and presentations of findings, are available.

• Comprehensive, Continuous, Integrated System of Care Model Description

  The Comprehensive, Continuous, Integrated System of Care (CCISC) model for providing services to treat co-occurring disorders is designed to improve treatment capacity in systems of care. This summary describes the four basic characteristics of the CCISC model, its eight principles of treatment, and its 12 steps for implementation.

• Development and Application of an Index of Dual Diagnosis Capability in Addictions Treatment

  Authors of the DDCAT present the tool