Community Behavioral Health

Co-Occurring Initiative

Welcoming Statement

Services provided by and through Department of Social Services will be welcoming, accessible, integrated, and responsive to the complex needs of individuals and families experiencing co-occurring disorders/conditions.

The welcoming response shall be apparent within all levels of care, across all agencies and throughout all phases of the recovery process (e.g. engagement, screening, assessment, treatment, rehabilitation, discharge planning, and continuing care). The welcoming process will convey recognition of the necessity to address co-occurring disorders/conditions within service delivery in order to affect the most successful outcomes that assist individuals and families in achieving long-term recovery.

DSS will also engage in welcoming all stakeholders including individuals and families seeking recovery, the provider network and other state partners to join DSS in improving the quality of care within the service delivery system. DSS will work in partnership to ensure individual and families are proactively welcomed for care wherever and whenever they present.

Finally, DSS is committed to the development and monitoring of outcomes measurements that support the recovery process for individuals and families with co-occurring disorders/conditions.

DSS welcomes other systems/entities to formulate expectations toward welcoming individuals and families with co-occurring conditions as it relates to those individuals and families who receive care under multiple systems including the DSS provider network.


The following definitions reflect the progress made with transformational activities across the state. The items defined are general in purpose to assist in referencing the work around co-occurring disorders as part of systems transformation. These definitions are working definitions and will serve as a basis for future refinement for use within Administrative Rules. It is also expected that the list of definitions will expand as transformational efforts continue.

  • Co-occurring Issues (also termed Co-occurring Conditions, Co-occurring Disorders and Dual Diagnosis): An individual has co-occurring behavioral health issues if he or she has any combination of any mental health or any substance use problem, even if the issues have not yet been diagnosed. Other co-occurring conditions include trauma issues, problem gambling, medical and developmental disabilities. Co-occurring behavioral health issues also apply to families ("families with co-occurring issues" or "co-occurring families") where one member has one kind of problem, such as a child with an emotional disturbance, and another member has another kind of problem, such as a family member or caregiver with a substance use issue.
  • Co-occurring Capability: For any type of program, within the mission and resources of that program, recovery-oriented co-occurring capability involves designing every aspect of that program at every level on the assumption that the next person "coming to the door" of the program is likely to have co-occurring issues and needs, and they need to be welcomed for care, engaged with empathy and the hope of recovery, and provided what they need in a person-specific and integrated fashion in order to make progress toward having a happy productive life. Recovery oriented co-occurring capability necessitates that all care is welcoming and person-centered. This dynamic approach to service and care is attuned to people and families with diverse goals, strengths, histories and cultures. Co-occurring capability involves looking at all aspects of program design and functioning in order to embed integrated policies, procedures and practices in the operations of the program to make it easier and more routine for each clinician to deliver integrated care successfully.
  • Co-occurring Competency: For any person delivering care to individuals and families with co-occurring issues or other complex concerns, recovery-oriented co-occurring competency involves developing core attitudes/values and knowledge/skills so that the care provider becomes a helpful, hopeful, and skillful partner to the individuals and families with co-occurring issues in his or her caseload. These attitudes/values and knowledge/skills are core competencies of the person's job, applied in the program in which he or she works. Further, these core competencies are applied in accordance with that person's level of training, licensure, and experience. An individual providing care to individuals and families with co-occurring issues does not need to have multiple licenses or special certification to become co-occurring competent; co-occurring competency is achievable by individuals with one license, two licenses or no license at all, including peer specialists, residential aides, case managers, and support staff who may be working directly with individuals or families with co-occurring issues.
  • Screening for Co-Occurring Disorders: The purpose of screening is to determine the likelihood that a person has a co-occurring, substance use only or mental heath only disorder. The purpose is to establish the need for an in-depth assessment, not to establish the presence or specific type of such a disorder. Screening is a formal process that typically is brief and occurs soon after the client presents for services.
  • Integrated Assessment: An integrated assessment consists of gathering information and engaging in a process with the client that enables the provider to establish the presence or absence of a co-occurring disorder/condition; determine the client's readiness for change for each problem; identify client strengths or problem areas that may affect the processes of treatment and recovery, and engage a person in the development of an appropriate treatment relationship. The purpose of the assessment is to establish (or rule out) the existence of a clinical disorder or service need and to work with the client to develop a treatment and service plan.
  • Integrated Treatment: Treatment is a means of providing, in any setting, appropriately matched interventions through a relationship with one clinician or two or more clinicians working together within one program or a network of services. Services appear seamless to the individual or family participating in services.