Guiding Principles

In order to provide welcoming, accessible, integrated, continuous, and comprehensive services to individuals with co-occurring substance and psychiatric disorders Bay-Arenac Behavioral Health Authority (BABHA) has agreed to adopt the Comprehensive, Continuous, Integrated System of Care (CCISC) model for designing systems change to improve outcomes within the context of existing agency resources This model is based on the following eight clinical consensus best practice principles (Minkoff, 1998, 2000) which espouse an integrated clinical treatment philosophy that makes sense from the perspective of both the mental health system and the substance disorder treatment system:

1. Co-occurring Disorders are an expectation, not an exception. This expectation has to be included in every aspect of system planning, program design, clinical procedure, and clinician competency, and incorporated in a welcoming manner into every clinical contact.
   

2. The core of treatment success in any setting is the availability of empathic, hopeful treatment relationships that provide integrated treatment and coordination of care during each episode of care, and, for the most complex consumers, provide continuity of care across multiple treatment episodes.
   

3. Assignment of responsibility for provision of such relationships can be determined using the four quadrant national consensus model for system level planning, based on high and low severity of the psychiatric and substance disorder.
   

4. Within the context of any treatment relationship, case management and care, based on the individual's impairment or disability, must be balanced with empathic detachment/confrontation, and opportunity for contingent learning, based on the individual's goals and strengths, and availability of appropriate contingencies. A comprehensive system of care will have a range of programs that provide this balance in different ways.
   

5. When mental illnesses and substance disorders co-exist, each disorder should be considered primary, and integrated dual primary treatment is required. Both disease processes should be understood as exacerbating the symptom profile of the other, including the course and vulnerability to rapid deterioration.
   

6. Mental illness and substance dependence are both examples of chronic, biopsychosocial disorders that can be understood using a disease and recovery model. Each disorder has parallel phases of recovery (acute stabilization, engagement, and motivational enhancement, prolonged stabilization and relapse prevention, rehabilitation and growth) and stages of change. Treatment must be matched not only to diagnosis, but also to phase of recovery and stage of change. Appropriately matched interventions may occur at almost any level of care.
   

7. Consequently, there is no one correct co-occurring disorder program or intervention. For each individual, the proper treatment must be matched according to quadrant, diagnosis, disability, strengths/supports, problems/contingencies, phase of recovery, stage of change, and assessment of level of care. In a CCISC, all programs are co-occurring disorder programs that at least meet minimum criteria of co-occurring disorder capability, but each program has a different "job", that is matched, using the above model, to a specific cohort of consumers.
   

8. Similarly, outcomes must be also individualized, including reduction in harm, movement through stages of change, changes in type, frequency, and amounts of substance use or psychiatric symptoms, improvement in specific disease management skills and treatment adherence.