By: Katie Kena, MSW, LCSW, Senior Director, Integrity House
Integrity House was recently recognized as an NJBIZ Health Care Hero in the Ambulatory Health Care category. While we are proud of the recognition, what matters most to me is what it represents: years of learning, alongside the people we serve, what it actually takes to help someone stay connected to care.
Because staying connected is harder than it looks from the outside.
In my experience, disengagement rarely announces itself. It tends to arrive quietly. A missed appointment becomes two. Someone who was present and engaged last week seems unfocused and somewhere else this week. Their participation in group sessions becomes more tentative. These moments are easy to write off as lack of motivation or readiness. But after years in this field I have come to see them differently. They are clinical signals. And if the model around someone is not designed to notice them early, by the time they stop showing up it is too late.
Research on treatment engagement consistently identifies poor therapeutic alliance, mistrust of the system, and limited insight into the need for treatment as primary drivers of early dropout. For people managing co-occurring substance use and mental health conditions, those dynamics are compounded by everything else they are carrying. A housing situation that has become unstable. A physical health issue that has gone unaddressed. The weight of justice involvement, financial stress, or the absence of anyone reliable to lean on. Research shows that these pressures can disrupt treatment engagement and worsen outcomes in ways that are often invisible until someone has already stepped away from care.
What I have learned is that you cannot wait for those pressures to surface as a crisis. The support has to already be in place.
That is the care model we have built at Integrity House. Clinical care that includes psychiatric services, medication-assisted treatment, nurse care management, housing stabilization support, and physical health screening under one coordinated system. Evidence-based approaches including Cognitive Behavioral Therapy, Dialectical Behavior Therapy, Motivational Interviewing, Contingency Management, and trauma-informed care, delivered by a team that is close enough to someone’s full situation to notice when something is shifting. For individuals where gambling disorder is part of the picture alongside substance use and mental health needs, screening and treatment are already embedded rather than treated as a separate issue to address somewhere else.
The integration matters because the signals of disengagement rarely arrive in isolation. When a housing situation destabilizes, the case manager is already part of the treatment team. When a physical health issue surfaces, medical providers are already a part of the conversation. When participation starts to change, there is someone already close enough to notice and respond.
Among clients admitted to Integrity House’s outpatient program between July and October 2025, 98% remained in treatment at 30 days, 94% at 90 days and 89% at 180 days demonstrating what is possible when a model is designed to support the full complexity and scope of what someone is managing.
For organizations seeking support for individuals with complex behavioral health needs, the critical question is no longer what services are available, but whether the provider’s model is equipped to recognize and respond when someone starts to pull away. The programs making the greatest difference are the ones identifying warning signs early, before disengagement turns into crisis.
Katie Kena, MSW, LCSW, is Senior Director at Integrity House, where she oversees the Integrity Certified Behavioral Health Clinic. A licensed clinical social worker with certifications in EMDR, DBT, and Trauma-Focused Cognitive Behavioral Therapy, she serves as an Advisory Board Member for the National Council for Mental Wellbeing’s CCBHC-Expansion Grantee National Training and Technical Assistance Center.