Previous research suggests that providsuch as lack of administrative support, lack of clarity of mission, difficulty in sering treatment interventions to individuals with co-existing mental health and subvice system integration, or lack of commitment to clinical oversight (Teague et al., stance abuse diagnoses is extremely challenging (Teague, Drake, & Ackerson, 1995). 1995; Drainoni & Bachman, 1995). However, if model fidelity can be maintained, Giving attention to program implementation may avoid subsequent problems in then client outcomes may be improved (McHugo, Drake, Teague, & Xie, 1999). service delivery and also may improve outcomes for consumers with this dual diagTherefore, organizational implementation barriers should be addressed during pronosis. Jerrell and Ridgely (1999) suggest that clients with dual diagnosis, who regram development to improve program outcomes (Teague et al., 1995; Mueser, ceive well-implemented case management services, attain higher psychosocial funcBond, Drake, & Resnick, 1998; McGrew, Bond, Dietzen, & Salyers, 1994). tional status than those receiving less wellimplemented services. Inconsistent fidelity Massachusetts state agencies, with support from the federal government, develto dual-diagnosis treatment models may result from several organizational barriers, oped a statewide infrastructure to address some of these issues as they collaborated in developing a service system for people with co-occurring mental illness and subSara S. Bachman, Ph.D., is Assistant Professor stance abuse disorder. This new initiative at Boston University School of Social Work in was based on the Comprehensive, ContinBoston, Massachusetts. Kenneth Duckworth, uous and Integrated System of Care M.D., is Deputy Commissioner of Clinical and Professional Services in the Department of (CCISC) model. The CCISC, an exemMental Health, Commonwealth of Massachuplary practice conceptualized by Minkoff setts. (1991), focuses on all adults with co-occurAddress for correspondence: Sara S. Bachring psychiatric and substance abuse disorman, Ph.D., Assistant Professor, Boston University School of Social Work, 264 Bay State Road, ders. In this project, the conceptual frameBoston, MA 02215. E-mail: sbachman@bu.edu. work was adapted specifically for adults