Innovative Conversations | An Overview of Integrated Co-occurring Treatment (ICT) with the CIP’s Mike Fox

Combining experiences from mental health and substance abuse direct treatment, systemic and contextual coordination, and teaching with research-driven data, Mike works with demonstrated practices to assist professionals and communities decrease risk to individuals and help families.

He provides educational training and consultation to professionals working with youth and families with co-occurring mental health and substance abuse issues, including the Integrated Co-Occurring Treatment Model (ICT) model developed by the Center for Innovative Practices.

Previously, Mike worked in the addictions field of counseling with adults and later provided treatment to co-occurring youth in home-based settings. Mike also teaches college courses in psychology, addictions and human development.

Integrated Co-occurring Treatment (ICT) is an integrated treatment approach embedded in an intensive home-based method of service delivery, providing a core set of services to youth with co-occurring disorders of substance use and serious emotional disability, as well as providing services to the families caring for them.

ICT providers work with adolescents ages 12 to 17.5 – youth exhibiting co-occurring mental health and substance use disorders – while also providing intervention that impacts the contextual factors that are affected by the youth’s co-occurring disorders. Thus, ICT requires both youth and family participation which means at least one parent/guardian needs to be involved in the intervention process.

The ICT model has proven successful in improving treatment outcomes for youth and families, the outcomes including:

  • Decreased substance use disorder symptoms
  • Decreased mental health disorder symptoms
  • Decreased juvenile justice charges and placements
  • Decreased out-of-home placements
  • Improved school functioning
  • Improved family functioning
  • Improved community functioning and involvement
In the fall of 1999, with the support of the Ohio Department of Mental Health (ODMH) and the Center for Family Studies at the University of Akron convened a group of state, university, and community experts (including youth and families) to develop an integrated treatment program especially designed for adolescents with co-occurring disorders and their families.The guidelines for the model development were that services had to include a system of care service philosophy, including the centrality of partnerships with youth and family, as well as the following components:1) Cultural mindfulness
2) Integrated treatment approach
3) Home-based intervention service delivery mechanism
4) Developmentally appropriate
5) Components that are grounded in prior empirical research
6) Theoretically and conceptually driven

In 2005, the Center for Family Studies developed a partnership with the Center for Innovative Practices (CIP) to disseminate ICT and to further develop and refine the model.The Center for Innovative Practices is one of the Ohio Department of Mental Health’s Coordinating Centers of Excellence. As of July 2007, the Center for Innovative Practices is the central location for the development, dissemination, and future research on ICT.Recently, ICT was recognized nationally as a promising program model in the Blueprint for Change: A Comprehensive Model for the Identification and Treatment of Youth with Mental Health Needs in Contact with the Juvenile Justice System (The National Center for Mental Health and Juvenile Justice, 2007).

Currently, ICT is being implemented in four sites nationally. These sites are located in Akron, Ohio; Cuyahoga County, Ohio; Kalamazoo, Michigan; and McHenry County, Illinois. A past ICT site is located in Salinas, California.

The central goals of ICT for the individual are risk reduction, appropriate developmental functioning in major life domains, symptom reduction, improved family functioning, relapse prevention, and ongoing recovery and resilience. A co-occurring disorder exists when an individual experiences mental and substance use disorders at the same time. Although these disorders may exist independently, they interact within the individual to the extent that one exacerbates the other. In youth with co-occurring disorders, this interaction underpins the complexity of symptom patterns and behaviors, which adversely affects youth’s functioning in developmentally important life domains. To further complicate matters, the presence of co-occurring disorders in youth, particularly substance use, impacts brain development. Contextual factors – such as peers, family, school, neighborhood, and the risk and protective factors associated with them – play a mediating role in youth behaviors, use patterns, and the recovery trajectory. As a result, youth with co-occurring disorders are an extremely diverse group, making sustained recovery a significant challenge.The ICT core treatment components consist of:

  • Providers embodying a system of care service philosophy, including ongoing collaboration, persistence, and engagement of the youth and family
  • Interventions that are rooted in an intensive home-based service delivery model
  • Services utilizing an integrated treatment and case conceptualization process designed to increase clinicians’ ability to provide the appropriate level of intensity, integration, and balance when delivering interventions to youth with co-occurring disorders.

Additional IHBT Resources

Researchers at the Ohio Department of Mental Health and Addiction Services identify questions of importance to the agency and the public behavioral health system and lead studies that can inform planning priorities, disparities and quality of care. Major statewide research has been conducted on services and outcomes for adults with serious mental illness, as well as children/adolescents with serious emotional disturbances, and youth and young adults in transition.
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
The Behavioral Health Juvenile Justice (BHJJ) initiative, a shared effort of the Ohio Department of Mental Health and Addiction Services (OhioMHAS) and the Ohio Department of Youth Services (DYS), was created to enhance local options for providing services to juvenile offenders with serious behavioral healthcare needs. Pilot projects that started in a few Ohio counties in early 2000 have grown into a statewide initiative with strong support from additional state and local stakeholders. The projects are designed to transform child-serving systems by enhancing their assessment, evaluation, and treatment of multi-need, multi-system youth and their families. In addition, they provide the Juvenile Court judges an alternative to incarceration.


Michael Fox

Technical Assistance

Winter and Spring 2020 Wraparound Training Schedule for ENGAGE 2.0

Wraparound Ohio presents a series of trainings throughout the state from January through June 2020: Click here to view schedule

Urban Zen Integrative Therapy (UZIT) | View Webinar and Learn More |
Trauma-Informed Biographical Timelines (TIBT) | View Webinar and Learn More |

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Resources for Wraparound Services

WraparoundOhio is dedicated to identifying evidenced-based and promising practices for dissemination to clinicians and families. Below is a comprehensiveof suggested organizations and sites which provide tools for youth, young adults, parents, and caregivers. Click Here for Resources

FROM Ohio Department of Mental Health and Addiction Services
Youth and Young Adults in Transition Links
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Protocols for Supporting Youth and Young Adults in Transition
| Click Here o Learn More |

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