To foster the implementation of integrated approaches for New York State residents with co-occurring mental health and substance abuse conditions.

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Technical Assistance is available to individual provider agencies and to groups of agencies on request. This type of consultation is usually requested to formulate a response to a specific challenge or problem, or to assist in a particular area of co-occurring capability. Technical assistance is tailored to suit the requestor, and is typically a combination of on- and off-site consultation to achieve the goals of the particular project most efficiently. Each request results in technical assistance that is modified according to the requestor’s strengths and to concentrate on those areas in which improvements are needed, so as to arrive at an overall improvement in integrated care and in the ability of the program[s] to serve persons with co-occurring conditions.

Technical Assistance Request Form

CEIC welcomes requests for technical assistance, whether an on-site co-occurring capability assessment, or to assist with a specific project to advance existing co-occurring capabilities. The process follows a planning format, which permits both CEIC and the requestor to track the progress of the request. Agencies are encouraged to submit individual requests within a broader strategic goal that will enable surrounding services in other agencies to benefit. Requests from providers in counties associated with an existing co-occurring disorders project, or in counties where a CEIC forum has not been scheduled in the near future, are most suitable for individual technical assistance and optimize the use of CEIC resources.

Please complete and submit. If you have any questions please contact Michael Chaple @ (212) 845-4539. You will be contacted within 5 working days of receipt of this form.

* First Name: * Last Name: * Email: Name of Organization: Title/Position: Address: City: State: Zip: County: Select County Albany Allegany Bronx Broome Cattaraugus Cayuga Chautauqua Chemung Chenango Clinton Columbia Cortland Delaware Dutchess Erie Essex Franklin Fulton Genesee Greene Hamilton Herkimer Jefferson Kings (Brooklyn) Lewis Livingston Madison Monroe Montgomery Nassau New York (Manhattan) Niagara Oneida Onondaga Ontario Orange Orleans Oswego Otsego Putnam Queens Rensselaer Richmond (Staten Island) Rockland Saratoga Schenectady Schoharie Schuyler Seneca St. Lawrence Steuben Suffolk Sullivan Tioga Tompkins Ulster Warren Washington Wayne Westchester Wyoming Yates Outside NY Phone: Type of Request: Select Type of Request 1. General Inquiry 2. Information/Materials 3. Off-Site Expert Consultation 4. On-Site Expert Consultation 5. Training 6. Speakers/Conference Presentations 7. DDCAT/DDCMHT Assessment 8. Other (specify) Narrative Description of Request: 200 character max Requesting Organization Entity Type: Select Organization Type 1. Mental Health Clinic 2. Substance Abuse Clinic 3. County/Region How Learned of CEIC: Select Source 1. State Agency Press Release 2. Center Marketing Materials 3. State Agency 4. Professional Organization 5. Provider Association 6. Other (specify) Comments: 200 character max

* = Required Field