In recognition of the need for public health and substance abuse treatment providers to understand each other's domains, the Georgia Department of Health sought and received support from SAMHSA's Center for Substance Abuse Treatment (CSAT) and the Centers for Disease Control and Prevention (CDC) to collaboratively develop and deliver a series of workshops to bring together staff from the State's public health and substance abuse treatment agencies. After this successful experience with Cross-Training, CSAT and CDC, along with the Health Resources and Services Administration (HRSA), in 1998 expanded the commitment to promote and build the Cross-Training efforts. Under an interagency agreement, the current Initiative provides training and technical assistance to agencies in States and local communities across the U.S., Puerto Rico, and the Virgin Islands.

The Cross-Training Initiative initially focused on:

• Providing training and technical assistance to State and local infectious disease and substance abuse health care delivery systems so that they could collaborate to more effectively serve individuals who are at high risk of having concurrent conditions;

• Providing a "blended," three- to five-member training team, representing disciplines and agencies in the locality where training is being provided, to conduct the workshops; and

• Creating synergy among providers, so that they could learn with and from each other, share best practices, and explore how providers' personal beliefs and perspectives about patients' behavior may affect treatment.

In 1999, agency officials from CSAT, CDC, and HRSA decided to modify the Initiative to focus even more on developing collaboration across systems and building service capacity, as well as transmitting content and skills to individuals who provide care. The following objectives were outlined:

• To include outcome measures of systemic changes resulting from the training in order to measure the results and effects of training;

• To focus on components of integrated, comprehensive care as opposed to viewing the two-day workshops as a definitive course about all the aspects of HIV/AIDS, STD, or other infectious disease treatment, or as a comprehensive course on substance abuse treatment;

• To modify the curriculum to address the characteristics of the patients seen by the local or State programs participating in the workshop and the peculiarities of the funding streams supporting these programs;

• To direct attention to helping participants recognize the attitudinal differences that cause polarization and hinder agencies' attempts to work together;

• To emphasize building the capacity of communities to plan and conduct the training in a multi-disciplinary team model; and

• To involve participants from criminal justice and mental health systems.

Currently, the Initiative offers a variety of resources, including: Technical assistance; a facilitated collaborative planning process; interactive, multidisciplinary training workshops; curriculum materials tailored to the local community; support for capacity building and system integration; and comprehensive evaluation.