DDCAT – I. Program Structure


Definition: Programs that offer treatment for individuals with co-occurring disorders should have this philosophy reflected in their mission statements.

Source: Agency or program brochure or in frames on walls of offices or waiting areas.

Item Response Coding: Coding of this item requires an understanding and review of the program’s mission statement, specifically as it reflects a co-occurring disorders orientation.



Definition: Organizations that provide integrated treatment are able to provide unrestricted services to individuals with co-occurring disorders. These organizations do so without barriers that have traditionally divided the services for mental health disorders from the services for substance use disorders. The primary examples of organizational barriers include licenses or certifications of clinics or programs that restrict the types of services that can be delivered.

Source: Interview with agency or program director or prior knowledge of applicable rules and regulations.

Item Response Coding: Coding of this item requires an understanding and review of the program’s license or certification permit and specifically how this document might selectively restrict the delivery of services on a disorder-specific basis.



Definition: Programs that transform themselves from ones that only provide services for substance use disorders into ones that can provide integrated services typically follow a pattern of staged advances in their service systems. The steps indicate the degree of communication and shared responsibility between providers who offer services for mental health and substance use disorders. The following terms are used to denote the stepwise advances and originate from SAMHSAs Co-Occurring Measure (2007).

Minimal coordination, consultation, collaboration, and integration are not discrete points, but bands along a continuum of contact and coordination among service providers. “Minimal coordination” is the lowest band along the continuum, and integration the highest  band. Please note that these bands refer to behavior, not to organizational structure or location. “Minimal coordination” may characterize provision of services by two persons in the same agency working in the same building; “integration” may exist even if providers are in separate agencies in separate buildings.

Minimal coordination:

“Minimal coordination” treatment exists if a service provider meets any of the following: (1) is aware of the condition or treatment but has no contact with other providers, or (2) has referred a person with a co-occurring condition to another provider with no or negligible follow-up.


Consultation is a relatively informal process for treating persons with co-occurring disorders, involving two or more service providers. Interaction between or among providers is informal, episodic, and limited. Consultation may involve transmission of medical/clinical information, or occasional exchange of information about the person’s status and progress. The threshold for “consultation” relative to “minimal coordination” is the occurrence  of any interaction between providers after the initial referral, including active steps by the referring party to ensure that the referred person enters the recommended treatment service.


Collaboration is a more formal process of sharing responsibility for treating a person with co-occurring conditions, involving regular and planned communication, sharing of progress reports, or memoranda of agreement. In a collaborative relationship, different disorders are treated by different providers, the roles and responsibilities of the providers are clear, and the responsibilities of all providers include formal and planned communication with other providers. The threshold for “collaboration” relative to “consultation” is the existence of formal agreements and/or expectations for continuing contact between providers.


Integration requires the participation of substance abuse and mental health services providers in the development of a single treatment plan addressing both sets of conditions, and the continuing formal interaction and cooperation of these providers in the ongoing reassessment and treatment of the client. The threshold for “integration” relative to “collaboration” is the shared responsibility for the development and implementation of a treatment plan that addresses the co-occurring disorder. Although integrated services may often be provided within a single program in a single location, this is not a requirement for an integrated system. Integration might be provided by a single individual, if s/he is qualified to provide services that are intended to address both co-occurring conditions.

Source: Interviews with agency director, program clinical leaders, and clinicians. Some documentation may also exist (e.g., a memorandum of understanding).

Item Response Coding: Coding of this item requires an understanding of the service system and structure of the program, specifically with regard to the provision of mental health as well as addiction treatment services. An understanding of the SAMHSA terms defined above is also necessary. The DDCAT scoring directly corresponds to those definitions.



Definition: Programs that are able to merge funding for the treatment of substance use disorders with funding for the treatment of mental health disorders have a greater capacity to provide integrated services for individuals with co-occurring disorders.

Source: Interview with agency director, knowledge of regional rules and regulations.

Item Response Coding: Coding of this item requires an understanding of the program’s current funding streams and the capacity to receive reimbursement for providing services for substance use and mental health disorders.