CADRE San diego and ccisc

San Diego County CADRE is committed to improving the lives of people with mental health and substance use issues. 

This Web site shares the story of our vision-driven system "transformation" process for re-designing San Diego County's behavioral health and related service delivery systems. The transformation process takes place AT EVERY LEVEL and includes areas of policy, program, procedure, and practice in all organizations and providers. 

The ultimate goal of San Diego County CADRE is to help develop an entire system of care that is welcoming, recovery-oriented, integrated, trauma-informed, and culturally competent. The ultimate goal is to most effectively meet the needs of individuals and families with multiple co-occurring conditions of all types, including mental health, substance abuse, medical, cognitive, housing, legal, parenting, etc. We help them to make progress to achieve the happiest, most hopeful, and productive lives they possibly can. Read SAMHSA's working definition of recovery from Mental and Substance Use Disorders.

The CADRE is comprised of county staff and providers who are committed to the Comprehensive, Continuous, Integrated System of Care (CCISC) model of service delivery. CCISC facilitates stystem change through collaboration among all service providers:


The Comprehensive, Continuous, Integrated System of Care (CCISC) model for organizing services for individuals with co-occurring psychiatric and substance disorders (ICOPSD) is designed to improve treatment capacity for these individuals in systems of any size and complexity, ranging from entire states, to regions or counties, networks of agencies, individual complex agencies, or even programs within agencies. The model has the following four basic characteristics:

System Level Change

The CCISC model is designed for implementation throughout an entire system of care, not just for implementation of individual program or training initiatives. All programs are designed to become dual diagnosis capable (or enhanced) programs, generally within the context of existing resources, with a specific assignment to provide services to a particular cohort of individuals with co-occurring disorders. 

Implementation of the model integrates the use of system change technology with clinical practice technology at the system level, program level, clinical practice level, and clinician competency level to create comprehnsive system change.

Efficient Use of Existing Resources

The CCISC model is designed for implementation within the context of current service resources, however scarce, and emphasizes strategies to improve services to ICOPSD within the context of each funding stream, program contract, or service code, rather than requiring blending or braiding of funding streams or duplication of services. 

It provides a template for planning how to obtain and utilize additional resources should they become available, but does not require additional resources, other than resources for planning, technical assistance, and training.

Incorporation of Best Practices

The CCISC model is recognized by SAMHSA as a best practice for systems implementation for treatment of ICOPSD. An important aspect of CCISC implementation is the incorporation of evidence based and clinical consensus based best practices for the treatment of all types of ICOPSD throughout the service system.

Integrated Treatment Philosophy

The CCISC model is based on implementation of principles of successful treatment intervention that are derived from available research and incorporated into an integrated treatment philosophy that utilizes a common language that makes sense from the perspective of both mental health and substance disorder providers. 

This model can be used to develop a protocol for individualized treatment matching, that in turn permits matching of particular cohorts of individuals to the comprehensive array of dual diagnosis capable services within the system. 




Co-occurring issues and conditions are an expectation, not an exception



The foundation of a recovery partnership is an emphatic, hopeful, integrated, strength-based relationship



All people with co-occurring conditions are not the same, so different parts of the system have responsibility to provide co-occurring-capable services for different populations



When co-occurring issues and conditions are present, each issue or condition is considered to be primary



Recovery involves moving through stages of change and phases of recovery for each co-occurring condition or issue



Progress occurs through adequately supported, adequately rewarded skill-based learning for each co-occurring condition or issue



Recovery plans, interventions, and outcomes must be individualized. Consequently, there is no one correct dual-diagnosis program intervention for everyone.



CCISC is designed so that all policies, procedures, practices, programs, and clinicians become welcoming, recovery- or resiliency oriented, and co-occurring capable.



In alignment with our values that reflect welcoming, empowered, and helpful partnerships throughout our system of care, we hope you will find this site informative, helpful, practical, and most of all: inspiring and motivating!