The attempt at systems integration can be overwhelming, often because agencies do not have the information, tools, and resources necessary to begin working together seamlessly when clients need overlapping services. Many agencies also could use help from a skilled facilitator of systems integration processes.

Integrating the services of formerly independent agencies can be as difficult as caring for patients with the intersecting conditions. It is difficult enough for a provider to get a patient with HIV infection and mental illness who uses drugs intravenously to see all the providers necessary. It is more difficult when agency requirements and practices stymie efficient referral or cross-agency case management, especially when the client has become receptive to care.

Agencies having difficulty making collaboration work in day-to-day practice can benefit from "Cross-Training," in which facilitators help them look at local problems and help them find solutions.

When staff and managers from all the agencies attend locally tailored Cross-Training workshops together, managers can see the implications of agency policies on the efforts of staff to provide services effectively. And staff gain an understanding of the need for policies.

Working together, with help from facilitators, participants can fine tune policies to facilitate effective care. Seamlessness may be an impossibility, but better services for the client with concurrent conditions results.