1. Integrated Treatment for Co-Occurring Disorders
An Evidence-Based Practice

2. Why Integrated Treatment for Co-Occurring Disorders?
Community Health Centers of Southern Iowa (CHCSI) is the only Federally Qualified Health Center (FQHC) in the state of Iowa that has also been designated as a Community Mental Health Center (CMHC). CHCSI offers both mental health and substance abuse services….why not Integrated Treatment for Co-Occurring Disorders??

3. Integrated Treatment Recovery Model
Hope is critical
Services and treatment goals are consumer- driven
Unconditional respect and compassion for consumers is essential
Integrated treatment specialists are responsible for engaging consumers and supporting their recovery

4. Integrated Treatment Recovery Model (continued)
Integrated treatment is associated with the following positive outcomes:
Reduced substance use
Improvement in psychiatric symptoms and functioning;
Decreased hospitalization
Increased housing stability
Fewer arrests and
Improved quality of life
-(Drake et al.,2001)

5. Implementation Process
2013 – Onsite TA with Dr. Ken Minkoff and Dr. Christie Cline : Multi-occurring capabilities within CHCSI (Behavioral, SA, Senior Mgmt) – Participation in CCISC Multi-Occurring Conditions Training June 2015 – CHCSI hosts Dr. Ken Minkoff at annual CHCSI all staff training

6. Implementation Process
Oct – Formal decision to pursue Integrated Treatment for Co-Occurring Disorders Oct – Readiness Assessment Jan – Action planning begins, continues quarterly thereafter Jan – Change Companies Training Feb – Implementation of Integrated Treatment for Co-Occurring Disorders

7. Costs
Initial Training Ongoing Training Implementation Materials Staff Time Marketing Oversight/Supervision Costs Internal/External Fidelity Assessment

8. Associated Costs
Change Companies 3 day, Train the Trainer : Paid for by South Central Behavioral Region = $7,300 (included 3 community health centers as well as other SA agencies in the area Complete set of Facilitator Journals $ per set Complete set of Participant Journals $39.95 per set, individual journals range from $2.70-$6.30 per journal

9. Associated Costs
Mental Health Block Grant: $19,426 dedicated to development of policies, procedures, staff time and internal fidelity assessments Other Costs: Marketing/Brochures Hosting Family Educational Nights Additional journals/check pads

10. Integrated Treatment KIT
Getting Started

11. Integrated Treatment KIT (continued)
Building Your Program

12. Integrated Treatment KIT (continued)
Training Frontline Staff
Module 1: Basic Elements and Practice Principles
Module 2: Practical Knowledge of Common Substances
Module 3: Stages of Treatment and Core Processes
Module 4: Practical Skills for Integrated Treatment
Module 5: Service Formats

13. Integrated Treatment KIT (continued)
Evaluating Your Program

14. Integrated Treatment KIT (continued)
Additional KITS: The Evidence Using Multimedia Brochure (English & Spanish) How to Use the EBP KIT

15. Integrated Treatment Team
All consumers in the Integrated Treatment program receive care from a multidisciplinary team:
Substance Abuse Counselor
Nurse/Psychiatric Facilitator
Psychiatrist
Mental Health Provider
Case Manager/Care Coordinator

16. Training Needs
All Integrated Treatment team members receive initial and ongoing training to maintain fidelity to co-occurring guiding principles

17. Interactive Journaling
Managing Co-occurring Disorders Through the use of Interactive Journaling®, this cognitive-behaviorally based series provides structure, knowledge and coping strategies in a single resource to individuals who have co-existing mental health and substance-related conditions. It also addresses the needs of individuals who are facing legal problems resulting from criminal behavior.
Serves as a tool to support Integrated Treatment for Co-Occurring Disorders
Provides consistent curriculum and messaging
Consistent with the practice principles for Integrated Treatment for Co-Occurring Disorders
Application focus – education alone is not effective in creating lasting change
Rule of Thirds – each page of the journals balances text, graphics, and interactive questions
Graphics for Visual Learners
30 Second Rule – slower readers should be able to read the core content in 30 seconds or fewer
7th grade reading level
Emphasis on Thoughts, Feelings and Beliefs – Consistent with Cognitive Behavioral Therapy
Combines Interactive Journaling, Motivational Interviewing and Cognitive Behavioral Therapy (CBT)

18. Fidelity
Integrated Treatment Fidelity Scales, Protocol and Scoring Sheets included in the Evaluating Your Program KIT CHCSI conducts internal review bi-annually Results from internal review result in action plan bi-annually Continuous improvement in achievable areas is emphasized

19. Additional Resources
For more information about Integrated Treatment for Co-Occurring Disorders and other evidence-based practices, visit
For more information about Interactive Journaling, visit