Ken Minkoff came to our community a number of years ago. Dr. Minkoff’s area is co-occurring disorders- helping health care systems meet the needs of those with mental health AND substance use issues (who are many). I came away from his visit with a much deeper understanding of co-occurring disorders. I also came away with CCISC.

Services should be measured by CCISC; are they Comprehensive, Continuous and Integrated? (the final letters standing for “System of Care”) ACT is, by its very nature CCI; if a client needs help with housing,  meds, education and employment, that’s what the team does.

CCISC Webpage

ACT is not the only resource needed in a community. But this measure of services being continuous, comprehensive and integrated is the right one. Most mental health issues – mood problems, anxiety, psychotic symptoms, eating disorders, PTSD – aren’t short term ones. We don’t yet have interventions that can be dished out in walk-in clinics or one-stop settings.

Minkoff describes that

In a CCISC process, every program and every person delivering clinical care engages … to become welcoming, recovery- or resiliency-oriented, and co-occurring capable.  Further, every aspect of clinical service delivery is organized on the assumption that the next person or family entering service will have multiple co-occurring conditions, and will need to be welcomed for care, inspired with hope, and engaged in a partnership to address each and every one of those conditions in order to achieve the vision and hope of recovery.”

I especially like Minkoff’s emphasis on all clinicians developing “universal competency, including attitudes and values, as well as knowledge and skill”.   For years I was an inpatient psychiatrist who would tell patients “Well Joe, I can help you with the schizophrenia, but the alcohol and drug stuff isn’t my area so you’ll have to go elsewhere for that.” What a disservice I did to my patients; as if they could fragment off pieces of themselves for the convenience of, or because of the limitations of their psychiatrist.

I’m delighted that, in the 2685 words on Minkoff’s webpage, the word ‘chronic’ appears only once! That word has a pernicious, disempowering effect on clients and care providers. It should be expunged from our vocabularies. Long lasting, long term, long-standing – I’m okay with all of these, but chronic – NO!

Minkoff, in point #2 writes The foundation of a recovery partnership is an empathic, hopeful, integrated, strength-based relationship.” The C word does the opposite.

If you’re in a position of responsibility for effecting system change in your agency or community, make Minkoff’s page a ‘favorite’ in your browser.  Call it up and review it before every meeting where system change is going to be discussed.  Then go into those meetings asking yourself – Is what we’re discussing CCISC and, if not, how do we get it there?

Shalom Coodin

Click here > CCISCmodel < for the pdf/ printer friendly version of Minkoff’s page



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