Ten years of implementation: Assertive Community Treatment and Integrated Dual Disorder Treatment in a statewide system

The prevalence and seriousness of co-occurring mental health and substance use disorders are significant public health issues facing our communities. Individuals with co-occurring disorders have worse outcomes in important areas, including physical health, employment, incarceration, and housing, and are often more difficult to engage in effective treatment. Equally important, however, are the multiple examples of impressive recovery journeys for individuals with even the most severe co-occurring illnesses, often in collaboration with treatment providers who support that recovery. Implementation and sustainability of evidence-based practices, which are associated with improved outcomes in areas of hospitalization, incarceration, employment, and treatment engagement, is an individual recovery and policy imperative. Yet, the implementation of these complex practices involving multiple practitioners from different disciplines can be challenging for systems of care. Training, systemic changes, and fidelity monitoring can be components to enhance implementation. In one state, the implementation, support, and fidelity measurement of two multi-disciplinary practices for the treatment of co-disorders, Integrated Dual Disorder Treatment (IDDT) and Assertive Community Treatment (ACT), is studied. Iterative steps to implementation over a ten-year period are examined. Lessons learned for research, policy, and training of teams to assist people in achieving recovery are reviewed.