COCE Vision Statement
The senior team of the COCE developed the vision statement to frame the approach for the COCE. Therefore, the vision statement served as the guiding document for operating COCE and is cross referenced throughout this Web site.
Section 1: The COCE Vision, Mission, And Target Audience
Section 2: COCE Content Framework
Section 3: Core Products And Services
Section 4: The COCE Approach
Section 5: Structure Of The COCE
Section 6: Technology Transfer And Sustainability
INTRODUCTION
During the last decade, co-occurring disorders (COD) have received considerable attention from the substance abuse and mental health clinical and treatment research communities. As a result, COD is now better defined, and the treatment needs of individuals with COD can be better addressed. New and innovative approaches to prevention, assessment, and treatment have been developed and tested, and a substantial body of evidence- and consensus-based practice has become available. There is a pressing need to disseminate these practices and to support their adoption and ongoing use by practitioners, administrators, and policymakers with responsibility for service delivery to persons with COD.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has identified as one of its highest priorities the improvement of treatment and services for individuals with co-occurring mental and substance abuse disorders. To meet this goal, SAMHSA created the Co-Occurring Center for Excellence (COCE) as a vital link between the agency and States, communities, and providers. COCE provided the technical, informational, and training resources needed for the dissemination of knowledge and the adoption of evidence-based practices in systems and programs that serve persons with co-occurring disorders.
SECTION 1: THE COCE VISION, MISSION, AND TARGET AUDIENCE
COCE Vision and Mission
The COCE vision (Figure 1) was to create a true Center for Excellence for the substance abuse and mental health treatment fields—a Center that served as a national resource to these fields and advanced treatment and services for people with COD. The COCE mission was to:
- Receive, generate, and transmit advances in substance abuse and mental health treatment that address mental health and substance use disorders at all levels of severity and that can be adapted to the unique needs of each client.
- Guide enhancements in the infrastructure and clinical capacities of the mental health and substance abuse service systems.
- Foster the infusion and adoption of evidence- and consensus-based treatment and program innovation into clinical and organizational practice.
Central to the vision depicted in Figure 1 is the COD service system (elaborated below under Target Audiences) and the many other critical inputs to the work of the COCE. These other inputs include SAMHSA's mission and priorities; mental health, substance abuse, and COD research; State and Federal policy; State and local experience and innovation; and consumer needs and perspectives.
FIGURE 1: VISION OF THE COCE
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Target Audience
As mentioned above, the COD service system was the primary target audience for the COCE, with early emphases on Co-Occurring State Incentive Grants (COSIG) and Policy Academy States. This system is depicted in Figure 2 as concentric boxes representing the various, interconnected, and interacting services that must be mobilized to meet the needs of people with COD—substance abuse treatment, mental health treatment, criminal justice, education, health, homelessness/housing, HIV/AIDS, tuberculosis, and other social service needs.
FIGURE 2: TARGET AUDIENCES AND SPECIFIC OBJECTIVES
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The COD service system also includes the legislative and regulatory context of service delivery and the broad, overarching norms and culture of practice. At the center of this system is the person with COD and his or her family, friends, and significant others. This serves as a reminder that the person with COD is the sole reason for the system's existence and for the COCE. Henceforth, each concentric box in Figure 2 will be referred to as a level of the COD service system.
SECTION 2: COCE CONTENT FRAMEWORK
To guide its work, the COCE developed a framework that locates the key topics in COD along three dimensions: (1) Services and Service Systems, (2) Infrastructure, and (3) Special Populations. COCE uses this framework in planning its activities.
- Services and Service Systems include providers and the services they offer, the nature and structure of the organizations and systems in which services are delivered, and the interrelationships among various providers, organizations, and systems.
- Infrastructure includes the wide variety of national, State, and local policies, programs, and resources that support, facilitate, catalyze, and otherwise contribute to the work of service providers and service systems.
- A third dimension, Special Populations, identifies groups who, by virtue of demography, medical comorbidity, or other characteristics or circumstances, may require special services, special service settings, or special accommodations to reap the full benefit of COD-related services.
A matrix of the three dimensions and their major headings is shown in Figure 3. Some of the cells in the matrix are of greater current interest to the COD field than others. Despite this variability, this matrix is critical because it serves as a reminder that services and service systems, the infrastructure that supports them, and the populations they serve are connected—each dimension can only be fully understood within the context of the other two.
FIGURE 3: KEY CONTENT AREAS OF THE COCE
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SECTION 3: CORE PRODUCTS AND SERVICES
COCE's products and services were the vehicles by which it interacted with the field. The core products and services of the COCE were:
- Overview papers and technical reports
- Technical assistance and training
- The COCE Web site
- Meetings and conferences
- Pilot evaluation of the Performance Partnership Grant (PPG) measures
Overview Papers and Technical Reports
Central to the COCE approach was a series of overview papers and technical reports addressing key COD topic areas. The overview papers and technical reports summarize the science base for each topic they address and make recommendations for practice, systems, and State and local laws and regulations that support treatment and prevention systems. These papers and reports were used as the basis for all COCE products and services.
The overview papers and technical reports served several central functions. First, as already discussed, they formed the link between the COD scientific literature and COCE products and services. Through the overview papers and technical reports, the rationale for all COCE products and services can be traced back to the science base in COD.
Second, they articulated the COCE approach to COD treatment and prevention. As such, they operationalized excellence in the areas they address. Thus, for example, consultants providing TA in a given area were asked to conform their recommendations to those presented in the relevant overview paper.
Third, and most important, the overview papers were distributed to the field to inform constituent activities in a particular area.
|
Services and Services Systems |
Infrastructure |
|---|---|
| Definitions, Terminology, and Nosology | Financing Mechanisms |
| Overarching Principles | Certification and Licensure |
| Screening, Assessment, and Treatment Planning | Systems Integration |
| Evidence- and Consensus-Based Practices | Services Integration |
| Workforce Development and Training | Information Sharing |
| Evaluation and Monitoring | |
| Epidemiology of Co-Occurring Disorders | |
| Treatment Techniques | |
| Special Settings | |
| Special Populations | |
| Prevention |
The overview papers and technical reports also formed the basis of a series of publications on the COCE Web site (see below) or in the literature. Taken together, these publications constitute a "short course" on COD treatment and prevention that would complement the COD TIP, the COD Resource Kit, and other major references in the field.
Technical Assistance (TA) and Training
The COCE provided technical assistance and training to enhance infrastructure development and clinical capacities to provide effective COD services. TA and training are arguably the most potent (as well as the most resource intensive) methods for technology transfer that were available to COCE in realizing its mission. Certain considerations were deemed essential in achieving excellence in the delivery of COCE TA and training:
- Address barriers to implementing recommended practices or procedures
- Include all relevant system representatives in a TA/training event to increase the extent to which recommendations are implemented
- Emphasize system support strategies that will sustain changes in practice
- Assess the role potential recipients may play in the delivery of service
- Recognize that the impact of TA/training will be greatly
increased when there exists the potential for impact beyond the
immediate recipients. Relevant examples include:
- TA to a provider that is respected and looked to for leadership by other providers in the State
- TA or training that will result in the accelerated implementation of a newly emergent approach
- Training of high-level policymakers from multiple States in a region.
The COCE Web Site
For many in the field, the COCE Web site served as an initial contact with the Center. Accordingly, the Web site reflects the excellence that will be COCE's hallmark. From a technical perspective, this means a Web site that is attractively designed, easy to navigate, and reliably hosted. More importantly, however, the Web site must also be engaging, rewarding to use, and a repository of interesting and relevant information.
The COCE Web site has cataloged the information resources of the COCE on all aspects of COD, highlight innovative programs, and alert the field to new information and relevant meetings and conferences. The universal and immediate access offered by the Web site provided a critical boost to the technology transfer process by allowing change agents (e.g., TA providers, cross-trainers) and the field (e.g., practitioners, administrators, policymakers) to access relevant information in real time, before enthusiasm for particular ideas wanes or other considerations divert attention. The Web site supported those who receive TA and training and served as a tool for knowledge transfer to others with Internet access. To this end, the Web site (1) helped clarify users' interests and concerns, (2) guided users to relevant information, and (3) provided users with help and support in understanding and using information. In this sense, the COCE Web site served as an expert system rather than simply as a repository of information.
Meetings and Conferences
Meetings and conferences provided a unique vehicle for achieving COCE's dissemination of state-of-the-art best practices and clinical interventions. In addition to the opportunity for training, seminars, presentations, and so on, conferences and meetings provided an opportunity for formal and informal researcher/practitioner and practitioner/practitioner networking. This networking potential was demonstrated in meetings attended by COCE staff and staff of the Co-Occurring State Incentive Grants (COSIGs). At these meetings, COCE staff had the opportunity to listen directly to the TA, training, and materials development needs of the COSIGs and made appropriate adjustments in COCE's short-term priorities. Grantees had the opportunity to learn of each other's strengths and to identify resources in other States that may be of use.
Future COCE Products and Services
It was anticipated that COCE products and services would evolve over time. Some possible future directions included:
- In-depth state-of-the-science materials, including fact sheets, brochures or monographs, program briefs and newsletters on specific aspects of COD.
- A "Scholars in Residence" program where senior COD researchers, practitioners, administrators, and/or policymakers spend an extended period (e.g., several months) at COCE. During this period, the participants would complete a project (book, article, monograph, course curriculum, etc.) using COCE resources and consulting with COCE senior staff.
SECTION 4: THE COCE APPROACH
The COCE approach was anchored by the current COD science and consensus base. (Figure 4).
FIGURE 4: COCE SCIENCE TO SERVICE / SERVICE TO SCIENCE PROCESS
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The COD evidence and consensus base represents several decades of research and practice. However, it has been summarized in a relatively small number of recent SAMHSA publications: the Center for Substance Abuse Treatment's forthcoming Treatment Improvement Protocol (TIP) Substance Abuse Treatment for Persons With Co-Occurring Disorders and other relevant TIPs, the Center for Mental Health Services' forthcoming Co-Occurring Disorders: Integrated Dual Disorders Treatment Implementation Resource Kit , SAMHSA's Report to Congress on the Prevention and Treatment of Co-Occurring Substance Abuse Disorders and Mental Disorders, and The President's New Freedom Commission on Mental Health report Achieving the Promise: Transforming Mental Health Care in America. These publications formed the basis for COCE's work in its early years, with newer sources added or substituted as they became available.
From this base, COCE developed a set of overarching principles to be applied to all COCE work. Three sets of principles were included: client-oriented, organization-oriented, and staff-oriented. Examples of these principles include the centrality of the affected person and his or her family, friends, and significant others to all service decision-making, and the importance of the partnership between science and service.
SECTION 5: STRUCTURE OF THE COCE
The COCE professional staff and consultants represented a variety of
disciplines including substance abuse treatment, clinical psychology,
developmental psychology, psychiatry, social work, sociology, program
administration, financing, organizational psychology, and law. In
addition to COD, areas of staff expertise included health systems,
health policy, healthcare finance, workforce development, child and
adolescent health, special populations issues, survey research, and
program evaluation.
- A National Steering Council constituted by SAMHSA that advised SAMHSA and COCE on developing, planning, communicating, and disseminating information on the range of issues involved in co-occurring disorders.
- An in-house Expert Leadership Group that ensured the accuracy and integrity of scientific and clinical content and provided high-level training and technical assistance (TA) services as appropriate.
- Senior Fellows composed of the Nation's leading COD experts who advised and assisted the Expert Leaders in carrying out their functions.
- Fellows "At-Large" composed of experts in specific aspects of COD treatment or prevention who provided input on specific COCE content.
- A Senior Management Team that oversaw COCE activities and products.
- A Senior Clinical/Technical Team that planed and coordinated COCE's training and TA, including the provision of direct TA/training services as appropriate.
- Subcontractors and Selected Consultants who conducted TA and training, based on COCE overview papers and reports.
These seven groups were assigned to three overlapping domains of responsibility, which ensured the integration of the various activities of the COCE:
- Planning, management, and accountability were vested in the National Steering Council, Expert Leadership Group, Senior Management Team, and Senior Clinical/Technical Team. The planning, management, and accountability domain was responsible for charting the direction of the COCE, ensuring that COCE responded to the needs of SAMHSA and the field, maintaining liaison with SAMHSA, coordinated with other SAMHSA science-to-service initiatives (such as the Addiction Technology Transfer Centers [ATTCs] and Centers for the Application of Prevention Technologies [CAPTs]), managed the resources of the COCE, and prepared reports and deliverables related to project management.
- Content leadership was vested in the Expert Leadership Group, Senior Fellows, and Selected Fellows. As can be seen in Box 1, these three groups included many of the Nation's top researchers and clinicians in COD, and offered expertise across all aspects of COD treatment, prevention, systems development, and policy. Responsibilities within the content domain included translating the needs of the field into priorities for COCE's work, generating issues to be addressed by the COCE, ensuring that the latest science and clinical approaches are used in developing COCE content, and reviewing all COCE products for scientific and clinical accuracy.
- Implementation was the responsibility of the Senior Management Team, Senior Clinical Technical Team, and the Selected Consultants and Subcontractor pool. Implementation included delivery of training and TA, the use of technology transfer principles and practices, and development and study of new application strategies, as well as the production of materials, development and maintenance of the COCE Web site, and coordination of meetings and conferences.
SECTION 6: TECHNOLOGY TRANSFER AND SUSTAINABILITY
Technology Transfer Model and Objectives
COCE followed a technology transfer model echoed in every major discussion of the dissemination of innovation over the last century. This model was based on principles and practices well established by the scientific literature on technology transfer (see Box 2). Using these principles and practices was the cornerstone of COCE TA and application activities.
The COCE had articulated primary objectives for each component of the COD service system. Short-term objectives related to the adoption of evidence- and consensus-based practices in the COD service system. Short-term objectives focused on establishing the preconditions for adoption of evidence- or consensus-based practices (e.g., changing attitudes, reducing barriers, developing organizational supports, increasing readiness). However, the science of technology transfer teaches that long-term support is needed to ensure that innovation becomes an accepted and institutionalized approach to practice. Thus, COCE's long-term objectives related to the incorporation and maintenance of change over time.
COCE Sustainability
Achieving excellence in any field is a long-term process involving many partners and players. Indeed, it can be argued that excellence is not an end-state, but rather is an ongoing process of improvement, refinement, and adjustment to a changing world. SAMHSA's COCE was slated to last 5 years. One key component of the COCE's work during this period was to develop networks among and enhance the capabilities of other technology transfer entities involved in COD treatment and prevention. These networks would increase the training and technical assistance resources available to the field, both in the near term (the 5 years of the COCE contract) and in the long run. COCE also promoted the partnership of COD scientists and practitioners as the accepted model for progress in the field. In this way, the COCE seeked to contribute to the development of a system of COD science-to-service and service-to-science that will be self-sustaining.
Built into the design of the COCE was a strategy for the development of networks with other entities active in the fields of mental health and substance abuse. As shown in Figure 5 and this vision statement, the COCE's work relied on close partnerships with other SAMHSA technology transfer initiatives (ATTCs, CAPTs) and with professional organizations key to the mental health and substance abuse field through subcontractors, consultants, and the COCE National Steering Council.
FIGURE 5: COCE SUSTAINABILITY
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These organizations and individuals enriched the COCE knowledge base and provided expertise in the needs of particular provider groups, special populations, and traditionally undeserved geographic areas (e.g., rural, frontier). As such, they had a particularly important role to play as intermediaries and boundary spanners, increasing the credibility and relevance of COD-related innovation to diverse local settings.
As further shown in Figure 5, part of COCE's work was be to recruit new partners, both directly and through the activities of current partners, to build a national network devoted to excellence in COD programs and systems.
Conclusion
COCE seeked to guide and impact services, programs, and policies in the COD field, create a culture where science and service are seen as equal partners, and most importantly, make a difference in the lives of persons with COD and their families, friends, and significant others. The COCE vision was to create a Center that belonged to and advanced the field while infusing evidence- and consensus-based practices and innovation into clinical programs and services to improve client outcomes. COCE staff were committed to working with SAMHSA, and other COD-related initiatives, and to establishing this Center for Excellence to benefit the field.
This document presented a vision for SAMHSA's COCE that allowed attainment of these goals. Although much detail has been presented, the vision itself is simple:
COCE became a preeminent center whose shared goal was excellence in COD treatment and prevention services and systems.
