A Systems Measurement Tool for CCISC Outcome Fidelity and Implementation (CO-FIT)

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The CO-FIT™ is designed to help systems of care monitor and measure success in CCISC implementation for individuals and families with co-occurring mental health and substance use conditions, and other complex needs. The tool reviews success in meeting each of these consumer-driven standards: Welcoming, Accessibility, Integration, Continuity, and Comprehensiveness, using a combination of specific outcome measures and implementation (process) measures based on the CCISC model and the 12 Steps of CCISC Implementation.

For the purpose of the use of the CO-FIT™ to measure progress in systemwide CCISC implementation, a system may be defined as any organized behavioral health service delivery system, such as an entire state, a specific region within the state, a county, a network of agencies, or a single complex agency. Systems can also be defined by payor source, such as the Medicaid system, the state-funded system, the county-operated system, or by target population, such as the child and adolescent system. The use of the CO-FIT™ must be directed carefully to assessment of the specific system that is the target of systems change, and the boundaries between that system and other collaborative systems must be clearly demarcated. In some instances, a large system such as a state may be implementing CCISC statewide, but implementation is mediated through regional or county behavioral health subsystems. In such a situation, it may make sense for each subsystem to use the CO-FIT™ to evaluate its own progress, and then create a state-level composite.

The CO-FIT™ has two key sections: Implementation (process) and Outcome, which includes sections on welcoming, accessibility, integration, continuity, and comprehensiveness. Systems are likely to see progress in their implementation scores before seeing comparable progress in their outcome scores.

The CO-FIT™ is intended for use as a tool to measure progress in system implementation of the CCISC model. As such, it is ideally scored first at the beginning of the change process to measure the system baseline. Ideally, the CO-FIT™ will be scored annually or semi-annually, either as a system self-audit involving system leadership, providers, change agents, and stakeholders, or through a formal systems audit conducted via system-level quality improvement personnel.