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Psychiatr Clin North Am. 2004 Dec;27(4):727-43.

Changing the world: the design and implementation of comprehensive continuous integrated systems of care for individuals with co-occurring disorders.

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  • 1Department of Psychiatry, Harvard Medical School, Cambridge Hospital, 1493 Cambridge Street, Cambridge, MA 02138, USA.


This article has described the CCISC model and the process of implementation of systemic implementation of co-occurring disorder services enhancements within the context of existing resources. Four projects were described as illustrations of current implementation activities. Clearly, there is need for improved services for these individuals, and increasing recognition of the need for systemic change models that are effective and efficient. The CCISC model has been recognized by SAMHSA as a consensus best practice for system design, and initial efforts at implementation appear to be promising. The existing toolkit may permit a more formal process of data-driven evaluation of system, program, clinician, and client outcomes, to better measure the effectiveness of this approach. Some projects have begun such formal evaluation processes, but more work is needed, not only with individual projects, but also to develop opportunities for multi-system evaluation, as more projects come on line.

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