Services Integration
Services Integration
Overview PaPer 6
About COCE and COCE Overview Papers
The Co-Occurring Center for Excellence (COCE), funded through the Substance Abuse and Mental Health Services
Administration (SAMHSA), is a leading national resource for the field of co-occurring mental health and substance use
disorders (COD). COCE’s mission is threefold: (1) to receive and transmit advances in treatment for all levels of COD
severity, (2) to guide enhancements in the infrastructure and clinical capacities of service systems, and (3) to foster
the infusion and adoption of evidence- and consensus-based COD treatment and program innovations into clinical
practice. COCE consists of national and regional experts including COCE Senior Staff, Senior Fellows, Steering Council,
affiliated organizations (see inside back cover), and a network of more than 200 senior consultants, all of whom
join service recipients in shaping COCE’s mission, guiding principles, and approaches. COCE accomplishes its mission
through technical assistance and training delivered through curriculums and materials online, by telephone, and
through in-person consultation.
COCE Overview Papers are concise and easy-to-read introductions to state-of-the-art knowledge in COD. They are
anchored in current science, research, and practices. The intended audiences for these overview papers are mental
health and substance abuse administrators and policymakers at State and local levels, their counterparts in American
Indian tribes, clinical providers, other providers, and agencies and systems through which clients might enter the COD
treatment system. For a complete list of available overview papers, see the back cover.
For more information on COCE, including eligibility requirements and processes for receiving training or technical
assistance, direct your e-mail to coce@samhsa.hhs.gov, call (301) 951-3369, or visit COCE’s Web site at www.coce.
samhsa.gov.
Acknowledgments
or electronically through the following Internet World Wide Web
COCE Overview Papers are produced by The CDM Group,
sites: www.ncadi.samhsa.gov or www.coce.samhsa.gov.
Inc. (CDM), under Co-Occurring Center for Excellence (COCE)
Public Domain Notice
Contract Number 270-2003-00004, Task Order Number 270-
2003-00004-0001 with the Substance Abuse and Mental Health
All materials appearing in COCE Overview Papers, except those
Services Administration (SAMHSA), U.S. Department of Health
taken directly from copyrighted sources, are in the public domain
and Human Services (DHHS). Jorielle R. Brown, Ph.D., Center for
and may be reproduced or copied without permission from
Substance Abuse Treatment (CSAT), serves as COCE’s Task Order
SAMHSA/CSAT/CMHS or the authors.
Officer, and Lawrence Rickards, Ph.D., Center for Mental Health
Recommended Citation
Services (CMHS), serves as the Alternate Task Order Officer.
George Kanuck, COCE’s Task Order Officer with CSAT from
Center for Substance Abuse Treatment. Services Integration.
September 2003 through November 2005, provided the initial
COCE Overview Paper 6. DHHS Publication No. (SMA) 07-4294.
Federal guidance and support for these products.
Rockville, MD: Substance Abuse and Mental Health Services
Administration, 2007.
COCE Overview Papers follow a rigorous development process,
including peer review. They incorporate contributions from
Originating Offices
COCE Senior Staff, Senior Fellows, consultants, and the CDM
Co-Occurring and Homeless Activities Branch, Division of State and
production team. Senior Staff members Michael D. Klitzner,
Community Assistance, Center for Substance Abuse Treatment,
Ph.D., Fred C. Osher, M.D., and Rose M. Urban, LCSW, J.D., co-
Substance Abuse and Mental Health Services Administration, 1
led the content and development process. Richard N. Rosenthal,
Choke Cherry Road, Rockvil e, MD 20857.
M.A., M.D., made major writing contributions. Other major
contributions were made by Project Director Jill G. Hensley, M.A.,
Homeless Programs Branch, Division of Service and Systems
and Senior Fellows Kenneth Minkoff, M.D., David Mee-Lee, M.S.,
Improvement, Center for Mental Health Services, Substance
M.D., and Douglas M. Ziedonis, M.D., Ph.D. Editorial support
Abuse and Mental Health Services Administration, 1 Choke
was provided by CDM staff members Janet Humphrey, J. Max
Cherry Road, Rockville, MD 20857.
Gilbert, Michelle Myers, Darlene Colbert, Susan Kimner, and Amy
Conklin.
Publication History
COCE Overview Papers are revised as the need arises. For a
Disclaimer
summary of all changes made in each version, go to COCE’s Web
The contents of this overview paper do not necessarily reflect
site at www.coce.samhsa.gov/cod_resources/papers.htm. Printed
the views or policies of CSAT, CMHS, SAMHSA, or DHHS. The
copies of this paper may not be as current as the versions posted
guidelines in this paper should not be considered substitutes for
on the Web site.
individualized client care and treatment decisions.
DHHS Publication No. (SMA) 07-4294
Printed 2007.
Electronic Access and Copies of Publication
Copies may be obtained free of charge from SAMHSA’s National
Clearinghouse for Alcohol and Drug Information (NCADI),
(800) 729-6686; TDD (for hearing impaired), (800) 487-4889,
EXECUTIVE SUMMARY
This overview paper defines and explains services integration and differentiates services integration from systems
integration. Services integration refers to the process of merging previously separate clinical services at the level of
the individual to meet the substance abuse, mental health, and other needs of persons with co-occurring disorders
(COD). The paper examines issues concerning the context, content, approaches, and processes that promote and
inhibit services integration.
Persons with COD are, by definition, persons with multiple service needs. COCE takes the position that
The interactive nature of COD requires each disorder to be continually assessed and treatment plans adjusted
accordingly. It is a disservice to the person with COD to emphasize attention to one disorder at the expense
of the other. (See COCE Overview Paper 3, Overarching Principles To Address the Needs of Persons With Co-
Occurring Disorders, p. 4).
Effective treatment of persons with COD can only occur when mental health and substance abuse services are,
at least to some degree, integrated. Integrated services can be provided by an individual clinician, a clinical team
that assumes responsibility for providing integrated services to the client, or a program that provides appropriately
integrated services by all clinicians or teams to all clients. The message should always be clear that staff members
will do their best to help people with all their problems.
LITERATURE HIGHLIGHTS
suggested the need for services integration for individuals
with more severe substance use disorders and more severe
The need for integrated services for persons with COD is
mental disorders (Quadrant IV) (see also Overview Paper 1,
apparent in the high community rates of COD (Grant et al.,
Definitions and Terms Relating to Co-Occurring Disorders).
2004; Kessler et al., 1994; Regier et al., 1990), the negative
Most available research has focused on the need for, and
impact of one untreated disorder on recovery from the
the effects of, services integration for those with severe
other (Rosenthal & Westreich, 1999), and the fact that most
substance use and mental disorders (e.g., Drake et al.,
treatment settings are unprepared to effectively manage
2001).
both substance use and mental disorders (SAMHSA, 2002).
In the late 1990s, a four quadrant conceptual framework
Little research has explored services integration for those
(National Association of State Mental Health Program
with less severe disorders. Nonetheless, research supports
Directors [NASMHPD] and National Association of State
the principle that services integration can play an important
Alcohol and Drug Abuse Directors [NASADAD, 1998])
Table 1: Key Definitions
Integration
As used in this paper, integration refers to strategies for combining mental health and
substance abuse services and/or systems, as well as other health and social services to
address the needs of individuals with COD.
Services Integration
Any process by which mental health and substance abuse services are appropriately
integrated or combined at either the level of direct contact with the individual client
with COD or between providers or programs serving these individuals. Integrated
services can be provided by an individual clinician, a clinical team that assumes
responsibility for providing integrated services to the client, or an organized program
in which all clinicians or teams provide appropriately integrated services to all clients.
Dual Diagnosis Capable Programs that “address co-occurring mental and substance-related disorders in their
(DDC)
policies and procedures, assessment, treatment planning, program content and
discharge planning” (American Society of Addiction Medicine [ASAM], 2001, p. 362).
Dual Diagnosis Capable Programs that provide unified substance abuse and mental health treatment to clients
(DDE)
who are, compared to those treatable in DDC programs, “more symptomatic and/or
functionally impaired as a result of their co-occurring mental disorder” (ASAM, 2001,
p. 10).
Systems Integration
The process by which individual systems or collaborating systems organize themselves
to implement services integration to clients with COD and their families.
Services Integration
1
role in providing appropriate and effective treatment to
2. What is services integration and how does it fit with
al persons with COD (SAMHSA, 2002). Current programs
other kinds of integration?
can be classified as having basic, intermediate, or advanced
Services integration for COD (see Table 1) is defined as any
capacity for COD treatment, with the highest level being full
process by which mental health and substance abuse services
integration of addiction, mental health, and related services
are appropriately integrated or combined at either the level of
(CSAT, 2005).
direct contact with the individual client with COD or between
providers or programs serving these individuals. Integration
Accepted evidence-based practices such as Integrated
can be implemented by single providers, teams of providers,
Dual Disorders Treatment (Center for Mental Health
or entire programs. Accordingly, services integration can be
Services, 2003), other forms of integrated treatment,
thought of as having two levels (see also Figure 1):
and other promising models in both addiction and
mental health settings have been developed as integrated
• Integrated Treatment, which occurs at the level of the cli-
service strategies for treating COD. For example, Assertive
ent–clinician interaction. (This level of integration might
Community Treatment and cognitive–behavioral
also be called “clinician-level” integration.) Integrated
interventions have produced positive substance abuse
treatment can be provided across agencies, within a pro-
outcomes for persons with COD (McHugo et al., 1999;
gram, or in an individual provider’s office (CSAT, 2005).
Mueser et al., 2003), and research has identified specific
Integrated treatment includes integrated assessment, ac-
pharmacologic treatments for specific pairs of co-occurring
tive treatment, and continuing care, as wel as concrete
conditions (Noordsy & Green, 2003; Rounsaville, 2004).
activities, such as reviewing explicitly with the client how
he or she is dealing with any problem and fol owing any
KEY QUESTIONS AND ANSWERS
set of recommendations.
1. What is meant by “integration” and “integrated”?
• Integrated Programs, which are implemented within an
The terms “integration” and “integrated” appear through-
entire provider agency or institution to enable clinicians
out the literature on COD: for example, systems integration,
to provide integrated treatment for COD. A COD-specific
services integration, integrated care, integrated screening,
integrated program is organized to provide substance
integrated assessment, integrated treatment planning,
abuse, mental health, and sometimes other health and
integrated interventions or treatment, integrated models,
social services to persons with COD.
integrated systems, integration continuum, and so on.
The pervasiveness of “integration” and “integrated” in the
Figure 1: Services Integration and Other Forms of
language of COD reflects the following:
Integration
• The awareness that the co-occurrence of these disorders
is not simply by chance and occurs frequently
• An understanding that there is always a relationship
between the disorders that affects outcomes
• The recognition that effective responses to persons
with either mental illness or substance use disorders are
compatible
The various types of integration listed above refer to differ-
ent service components (e.g., screening, assessment, treat-
ment planning, treatment provision) or levels of the service
system (e.g., individual practitioners, agencies, local systems
of care, States). The specifics of what is to be integrated
and the mechanisms by which integration is accomplished
will, of course, be different for different service compo-
nents and at different levels of care. The primary focus of
integration is always the same—identifying and managing
substance use and mental disorders and the interaction
As shown in Figure 1, integrated treatment and integrated
between them. Integration may also seek to identify and
programs are supported and facilitated by systems
manage related health and social problems. The goal of all
integration. However, unless integrated treatment is
forms of integration is to support integrated treatment for
provided to clients, other forms of integration serve no
the individual client.
purpose. It is important to note that, although col aboration
2
Services Integration
among providers and programs is one important
• Revise policies, practices, and requirements regarding
component of services integration, it is the content and
dispensing and managing medications
structure of the col aboration that supports and facilitates
• Utilize new reimbursement sources and procedures
integrated treatment.
In-depth discussions of these and other issues related to
3. What are the benefits and chal enges associated with
managing organizational change are provided by Fixsen
integrated services from a programmatic, clinical, and
and colleagues (2005).
consumer viewpoint?
Given the high numbers of clients with COD seeking
4. What types of outcomes can be expected from ser-
substance abuse or mental health services, failure to address
vices integration?
COD in either substance abuse or mental health programs is
Research evidence supports the claim that services
tantamount to not responding to the needs of the majority
integration leads to better client outcomes. For example,
of program participants. From this perspective, providing
McLel an and associates (1998) report that clients receiving
integrated services is fundamental to providing quality care.
integrated services in addiction treatment settings are more
likely to complete treatment and have better posttreatment
Benefits. A core set of benefits of services integration to
outcomes. For clients with severe COD, integrated services
programs, clinicians, and consumers can be identified:
have been shown to increase engagement in treatment
• Improved client outcomes (see Question 4)
and days of abstinence and reduce psychotic symptoms
• Improved adherence to treatment plans where both
(Barrowclough et al., 2001; Drake et al., 1997, 2001;
substance abuse and mental illness interventions are
Hel erstein et al., 1995; Jerrel & Ridgely, 1995). For these
supported
clients, onsite integration may be required since delivery in
• Improved efficiency because consumers do not have to
multiple settings is associated with a rapid and significant
shuffle between providers and clinicians do not have to
decrease in treatment retention (Hellerstein et al., 1995).
make referrals and maintain communications among
providers
A small but encouraging literature addresses the
integration of primary care services with services for people
Additional benefits to consumers include
with COD (Grazier et al,. 2003; Lester et al., 2004; Weisner
• Better integrated information rather than conflicting
et al., 2001). For example, individuals with substance-
advice from several sources
related medical or psychiatric conditions show a higher
• Improved access to services through “one-stop
rate of abstinence in integrated substance abuse and
shopping”
primary care treatment than those receiving nonintegrated
services (Weisner et al., 2001).
Additional benefits to programs and clinicians include
• Opportunities for agency and professional growth
Models focusing on populations such as homeless or
• Workforce development
criminal justice clients have been developed through local
• Less frustration and increased job satisfaction
advocacy. For example, there are housing programs that
serve clients with COD with varying levels of treatment
Challenges. From the perspective of the consumer, there
integration—including supportive housing programs
are few, if any, disadvantages to services integration. From
that access COD services, contingency-managed access
the perspective of programs and clinicians, implementation
to housing, housing first models that provide services
of integrated services involves many of the same challenges
once clients have housing, and modified therapeutic
as any other form of organizational change and develop-
communities where homeless shelter occupants receive
ment. These may include the need to
onsite COD treatment (SAMHSA, 2005).
• Identify and respond to gaps in workforce competencies,
certifications, and licensure
5. How does one decide what services to integrate?
• Proactively address staff concerns related to changes in
Services integration minimally means providing integrated
roles and responsibilities
substance abuse and mental health screening, assessment,
• Institute modifications in record keeping to
treatment planning, treatment delivery, and continuing
accommodate COD
care, either at the level of direct contact with the client or
• Modify facilities to meet additional needs (e.g., space for
between providers or programs serving these individuals.
individual or group counseling)
Services integration is a process. Accordingly, any step
• Revise staffing patterns and work schedules
to increase access to and coordination with the services
• Reconcile differences in confidentiality regulations,
needed by clients with COD is a step toward the ultimate
policies, and practices between substance abuse and
goal of unifying service delivery and better outcomes for
mental health
Services Integration
3
persons with COD. Individuals with COD typical y have a
for treating COD in the context of different licensing and
wide range of other health and social service needs (New
certification standards.
Freedom Commission on Mental Health, 2003). Providers
may need to help clients access general health services,
Other service strategies that facilitate integration include
HIV/AIDS services, legal aid, English as a second language
referral networks (“no wrong door”), physical and temporal
classes, nutrition services, vocational rehabilitation, or
proximity (e.g., services provided by the same clinician or
employment assistance (SAMHSA, 2005). The choice of
in the same setting), and care coordination (e.g., services
which services to integrate may be guided by practical
provided by a team of providers from different domains
considerations, program philosophy, stakeholder needs
who take joint responsibility for the client).
and concerns, or any other legitimate inputs into program
decisionmaking.
With severe disorders, it is clearly advantageous to integrate
mental health and substance abuse treatment programs
In an ideal world, persons with COD would be provided
into a unified, seamless service. In programs serving persons
“one-stop shopping” for all their substance abuse, mental
with less severe COD, integration may not need to be as
health, medical, and psychosocial needs. From a practical
comprehensive, as the ful array of services may not be
perspective, perhaps the best rule is when a service need
indicated for the population served (SAMHSA, 2005).
becomes apparent among a significant proportion of
clients (e.g., housing services), the relevant services should
8. What do integrated services look like in practice?
probably be considered for integration. A “bottom-up”
There is no one organizational chart for services integration.
clinical approach can document the need for integrated
Integrated services may be implemented using a wide
services through comprehensive client assessment.
variety of staffing configurations and agency formats that
meet the overal goal of integrated screening, assessment,
6. Are there some services that should not be integrat-
treatment planning, treatment provision, and continuing
ed?
care.
There is no reason, in principle, why any service that might
be needed by a particular client population cannot be
As can be seen in Figure 2, any given service integration
integrated with the provision of COD services. As discussed
initiative can be defined by some combination of three
in Question 5, COD services have been successful y
components: (1) a set of services (minimally substance
integrated with a variety of other health and human
abuse and mental health) that are integrated, (2) whether
services.
services are integrated within or across settings, and (3)
whether integrated services are provided by one or more
7. How are integrated services designed and imple-
providers.
mented?
The design and implementation of integrated services may
So, for example, integration of substance abuse and mental
depend on the severity of substance abuse and mental
health services can be accomplished when both types of
disorders in a specific population as well as their additional
services are provided by the same professional or when
medical and psychosocial needs (see Question 5). The
optimal integrated service design meets the clinical needs of
Figure 2: Integrated Services
people with COD with a treatment team that coordinates
al pertinent aspects of care. Especial y for those with
serious disorders, an integrated service design co-locates
that care (SAMHSA, 2002). Such an approach means that
a range of services is provided, including provisions for
medication management, case management, addiction
counseling, and psychosocial rehabilitation.
Since most existing services are not proactively designed to
take COD-specific service needs into account, integration
usual y requires a retrofit, with the addition of new services.
One advantage to this approach is that programs can
build on their current knowledge, skil s, and strengths
while expanding gradual y (SAMHSA, 2003). Incremental
approaches allow treatment facilities and providers to
simplify and change licensing and certification requirements
4
Services Integration
a substance abuse and mental health professional
10. What types of organizational structures and pro-
collaborate in the care of a client with COD. In the latter
cesses inhibit or promote services integration?
case, the substance abuse and mental health professionals
The implementation of services integration will face the
can be located in the same setting or agency or in
same organizational challenges associated with imple-
different settings. As one begins to consider services other
menting any new practice (see Fixsen et al., 2005). Strong
than substance abuse and mental health, chances are that
leadership is key.
multiple providers and agencies will need to be involved.
Some organizational issues are specific to services integra-
The ASAM Patient Placement Criteria, Second Edition,
tion. An integrated organizational chart, shared assess-
Revised (ASAM, 2001) describes two levels of integrated
ment tools, and integrated policy manuals will facilitate
programs for people with COD: Dual Diagnosis Capable
the process of integrating services (NASMHPD & NASA-
(DDC) and Dual Diagnosis Enhanced (DDE) (see definitions,
DAD, 1998). Services integration will be more difficult if
Table 1). See also COCE Overview Paper 1, Definitions and
there is a lack of funds for cross-training, lack of incentives
Terms Relating to Co-Occurring Disorders.
for clinicians to cross-train, outdated policies that do not
support COD treatment, and efforts at cost contain-
In practice, the arrangement through which services
ment that impede the treatment of more severe disorders
integration is achieved will be dictated by local availability
(SAMHSA, 2002). At the systems level, services integration
of services, fiscal feasibility, capacity to coordinate, and
is facilitated by regulatory guidelines that allow mental
administrative support.
health and substance abuse funds to be combined or
that provide specific guidelines and instructions for how
9. How does one set the context for services integra-
to provide integrated treatment within the context of the
tion?
existing funding mechanisms (Minkoff & Cline, 2004).
Services integration is the natural outgrowth of basic
principles that form the foundation of COCE’s approach
11. How can staff burnout in integrated settings be
to the care of persons with COD. Clear articulation of
avoided?
these principles and wide consensus among stakeholders
Staff burnout presents a particular challenge in provid-
regarding their importance are key steps toward setting
ing integrated services. “Compassion fatigue” may occur
the context for services integration. As noted in the
when the pressures of work erode a counselor’s spirit and
Executive Summary, services for persons with COD must
outlook and interfere with the counselor’s personal life.
respond to the reality that “the interactive nature of COD
To lessen the possibility of burnout when working with a
requires each disorder to be continually assessed and
demanding caseload that includes clients with COD, TIP
treatment plans adjusted accordingly.”
42 (Substance Abuse Treatment for Persons With Co-Oc-
curring Disorders [CSAT, 2005]) recommends that clini-
Organizations that articulate client-centered values,
cians providing COD services work within a team structure
remove barriers, and allow staff to take appropriate risks
rather than in isolation, have opportunities to discuss feel-
and establish new relationships are vital for transforming
ings and issues with other staff who handle similar cases,
services, including services integration. By contrast, rigidity,
be given a manageable caseload, and receive supportive
bureaucratic restraints, insufficient collegial support,
and appropriate supervision.
change-averse culture, and demoralized staff will impede
services integration (Corrigan et al., 2001). “Top-down”
12. What are the specific challenges to services integra-
strategic decisions that are guided more by power
tion from a substance abuse perspective?
structures, ingrained routines, and established resource
configurations will inhibit services integration (Garvin &
The substance abuse professional or agency may have
Roberto, 2001; Rosenheck, 2001).
beliefs that must be addressed to implement integrated
services. These include the belief that mental health prob-
Finally, workforce development is key to setting the
lems are secondary to substance abuse and will improve
context for services integration. Clinicians will profit
when substance use is discontinued, and that medications
from training in integrated screening, assessment, and
should not be used with persons in recovery.
treatment strategies for both mental and substance use
disorders. Training in case management will facilitate
The specific responsibilities that staff in substance abuse
coordination with other non-substance abuse or mental
agencies may undertake with clients depend on the licens-
health services (McLellan et al., 1998).
es and/or certifications they hold. Licenses and certifica-
tions define the scope of practice for given disciplines, and
Services Integration
5
they differ by State and profession. Al staff members can
that are important to the consumer are important to the
provide integrated services consistent with their licenses.
program and its clinicians. It also requires the program
For example, although substance abuse counselors in most
and clinicians to recognize and respect the complexities of
States cannot treat mental disorders included in the DSM-
the consumer’s substance abuse, psychosocial, and health
IV-TR or prescribe medications for these disorders, they can
needs and to ensure they are prepared to address a variety
monitor client behavior for signs that medication regimens
of issues either in-house or through referrals.
are being followed and educate and motivate clients re-
garding the importance of taking their medications.
FUTURE DIRECTIONS
In addition, some issues associated with clients with mental
disorders may be less familiar to substance abuse treatment
Although there is scientific literature regarding the treat-
providers. These include the symptoms of mental disorders;
ment of people with severe COD, there is little research-
the overlap of these symptoms with those of addiction,
based guidance for the treatment of people with less
intoxication, or withdrawal; and techniques for distinguish-
severe COD (SAMHSA, 2003). Future research can inform
ing mental disorders from substance abuse symptoms.
the development of specific integrated interventions for
Substance abuse treatment staff may also need to become
specific combinations of substance use disorders and
more comfortable responding to key issues in recovery from
mental disorders, methods for integrating non-substance
mental disorders, such as the key role of medications and
abuse or mental health services, and the development
the importance of accepting partial recovery as a legiti-
of integrated interventions for specific populations and
mate treatment goal for persons with severe mental health
service settings.
problems.
CITATIONS
13. What are the specific challenges to services integra-
tion from a mental health perspective?
American Society of Addiction Medicine. (2001). Patient
The mental health professional or agency may also have
placement criteria for the treatment of substance-related
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disorders: ASAM PPC-2R. 2d - Revised ed. Chevy Chase,
services, including the belief that substance abuse prob-
MD: Author.
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Barrowclough, C., Haddock, G., Tarrier, N., Lewis, S.
addition, some issues associated with clients with substance
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may also need to become more comfortable responding
to such substance abuse recovery issues as denial, working
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with a coerced client, abstinence, enabling, relapse, and
occurring disorders: Integrated dual disorders treatment
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14. What should one do to convey to consumers that
Treatment Improvement Protocol (TIP) series no. 42 (DHHS
they are in an integrated services program?
Publication No. (SMA) 05-3992). Rockville, MD: Substance
For many consumers with a history of COD, entering an in-
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Corrigan, P. W., Steiner, L., McCracken, S. G., Blaser, B.,
are working with helpers who “get it” and who are not
& Barr, M. (2001). Strategies for disseminating evidence-
trying to put aside issues that the consumers know or sense
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Minkoff, K., Kola, L., Lynde, D., Osher, F. C., Clark, R. E., &
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Rickards, L. (2001). Implementing dual diagnosis services
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to her or him as a whole person. This means that issues
52(4), 469–476.
6
Services Integration
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Minkoff, K., & Cline, C. A. (2004). Changing the world: The
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8
Services Integration
COCE Senior Staff Members
The CDM Group, Inc.
National Development & Research Institutes, Inc.
Rose M. Urban, LCSW, J.D., Executive Project Director
Stanley Sacks, Ph.D.
Jill G. Hensley, M.A., Project Director
John Challis, B.A., B.S.W.
Anthony J. Ernst, Ph.D.
JoAnn Sacks, Ph.D.
Fred C. Osher, M.D.
Michael D. Klitzner, Ph.D.
National Opinion Research Center at the
Sheldon R. Weinberg, Ph.D.
University of Chicago
Debbie Tate, M.S.W., LCSW
Sam Schildhaus, Ph.D.
COCE National Steering Council
Richard K. Ries, M.D., Chair, Research Community
Andrew D. Hyman, J.D., National Association of State
Representative
Mental Health Program Directors
Richard N. Rosenthal, M.A., M.D., Co-Chair, Department
Denise Juliano-Bult, M.S.W., National Institute of
of Psychiatry, St. Luke’s Roosevelt Hospital Center;
Mental Health
American Academy of Addiction Psychiatry
Deborah McLean Leow, M.S., Northeast Center for
Ellen L. Bassuk, M.D., Homelessness Community
the Application of Prevention Technologies
Representative
Jennifer Michaels, M.D., National Council for
Pat Bridgman, M.A., CCDCIII-E, State Associations of
Community Behavioral Healthcare
Addiction Services
Lisa M. Najavits, Ph.D., Trauma/Violence Community
Michael Cartwright, B.A., Foundations Associates,
Representative
Consumer/Survivor/Recovery Community
Annelle B. Primm, M.D., M.P.H., Cultural/Racial/Ethnic
Representative
Populations Representative
Redonna K. Chandler, Ph.D., Ex-Officio Member,
Deidra Roach, M.D., Ex-Officio Member, National
National Institute on Drug Abuse
Institute on Alcohol Abuse and Alcoholism
Joseph J. Cocozza, Ph.D., Juvenile Justice Representative
Marcia Starbecker, R.N., M.S.N., CCI, Ex-Officio
Gail Daumit, M.D., Primary Care Community
Member, Health Resources and Services
Representative
Administration
Raymond Daw, M.A., Tribal/Rural Community
Sara Thompson, M.S.W., National Mental Health
Representative
Association
Lewis E. Gallant, Ph.D., National Association of State
Pamela Waters, M.Ed., Addiction Technology Transfer
Alcohol and Drug Abuse Directors
Center
Andrew L. Homer, Ph.D., Missouri Co-Occurring State
Mary R. Woods, RNC, LADAC, MSHS, National
Incentive Grant (COSIG)
Association of Alcohol and Drug Abuse Counselors
COCE Senior Fellows
Barry S. Brown, M.S., Ph.D., University of North
Stephanie Perry, M.D., Bureau of Alcohol and Drug
Carolina at Wilmington
Services, State of Tennessee
Carlo C. DiClemente, M.A., Ph.D., University of
Richard K. Ries, M.D., Dual Disorder Program,
Maryland, Baltimore County
Harborview Medical Center
Robert E. Drake, M.D., Ph.D., New Hampshire-
Linda Rosenberg, M.S.W., CSW, National Council for
Dartmouth Psychiatric Research Center
Community Behavioral Healthcare
Michael Kirby, Ph.D., Independent Consultant
Richard N. Rosenthal M.A., M.D., Department of
David Mee-Lee, M.S., M.D., DML Training and
Psychiatry, St. Luke’s Roosevelt Hospital Center
Consulting
Douglas M. Ziedonis, M.D., Ph.D., Division of
Kenneth Minkoff, M.D., ZiaLogic
Psychiatry, Robert Wood Johnson Medical School
Bert Pepper, M.S., M.D., Private Practice in Psychiatry
Joan E. Zweben, Ph.D., University of California -
San Francisco
Affiliated Organizations
Foundations Associates
Pacific Southwest Addiction Technology Transfer Center
National Addiction Technology Transfer Center
Policy Research Associates, Inc.
New England Research Institutes, Inc.
The National Center on Family Homelessness
Northeast/IRETA Addiction Technology Transfer Center
The George Washington University
Northwest Frontier Addiction Technology Transfer Center
COCE Overview Papers*
“Anchored in current science, research, and practices in the field of co-occurring disorders”
Paper 1: Definitions and Terms Relating to Co-Occurring Disorders
Paper 2: Screening, Assessment, and Treatment Planning for Persons With Co-Occurring Disorders
Paper 3: Overarching Principles To Address the Needs of Persons With Co-Occurring Disorders
Paper 4: Addressing Co-Occurring Disorders in Non-Traditional Service Settings
Paper 5: Understanding Evidence-Based Practices for Co-Occurring Disorders
Paper 6: Services Integration
Paper 7: Systems Integration
*Check the COCE Web site at www.coce.samhsa.gov for up-to-date information on the status of overview papers in
development.
For technical assistance:
visit www.coce.samhsa.gov, e-mail coce@samhsa.hhs.gov, or call (301) 951-3369
A project funded by the
Substance Abuse and Mental Health Services Administration’s
Center for Mental Health Services and Center for Substance Abuse Treatment
