12 Steps for Clinicians Developing Co-Occurring Competency

(printable version)

These steps are based on the principles of CCISC (Minkoff and Cline, 2004), and can be taken by any clinician within the scope of his or her existing job category.

1.    Welcoming

Welcome the person who has co-occurring issues; thank him for coming, and let him know you are glad to get to know him as he is.

2.    Hope

Ask the person about her goals for a happy life, and inspire hope that you will work to help her achieve that vision.

3.    Integration

In the course of conversation, screen for issues in multiple life domains (mental health, substance abuse, trauma, court, etc.) and practice screening in the flow of the conversation.

4.    Empathy

Ask the person to describe in detail his experience with each of the issues he is confronting, and empathize fully with what it feels like to be having such experiences.

5.    Strengths

Ask the person to identify a period of recent success in relation to her issues, and describe in detail how she was successful and what she was experiencing (e.g., mental health issues during a period of sobriety—what they were and how they were managed).

6.    Quadrant

Review the person’s story and complex needs, and determine: Does he have co-occurring issues? (yes, no, maybe) What quadrant (1-4) is he in? (Practice distinguishing between abuse and dependence; SPMI and less serious mental health issues.)

7.    Integrated Primary Problem/Specific Treatment

List the person’s issue(s), and list a specific day-at-a-time set of recommendations to help her succeed. Discuss with the person how she attempts to follow each set of recommendations on a given day. Include recommendations in other areas, like medical issues, probation, etc.

8.    Stage of Change

Identify the stage of change for each identified issue that may affect the person’s goals for happiness. Write down, in the person’s own words, a stage-matched goal for each issue. Practice establishing an empathic connection with persons in earlier stages of change.

9.    Skills and Supports

For any identified issue during a period of success, identify in detail with the person the specific skills that he used to be successful, including asking for help or using supports.

10.  Skill-Based Learning

Use one manual for teaching co-occurring skills, and practice one exercise with a person that is connected to her life. For example, work with a person in an addiction setting on managing mental health symptoms on any day, or work with a mental health client on refusing drugs from a friend.

11.  Positive Rewards

Identify small steps of progress for each issue, and provide strong positive reward for those small steps, such as a “round of applause for one day of sobriety.”

12.  Recovery Support

Identify a place where the person can receive recovery support for each problem —whether from peers, family, or others—and discuss in detail how he can improve asking for help.