A 1999 review of inmate records by Beaver County Jail correctional officers found that nearly 20 percent of the inmates had a combination of mental health and substance abuse disorders. In 2001, the Pennsylvania Office of Mental Health and Substance Abuse Services and the Bureau of Drug and Alcohol Programs issued a joint solicitation for MISA projects and selected five counties for funding. Beaver County was awarded funds to develop one of the five pilot programs and was the only county to use a forensic model. Program staff completed core and advanced training in co-occurring disorders. Staffing for the program consists of a clinical director, a psychiatrist (16 hours per week), 2 full-time therapists with experience in mental health and substance abuse, and an administrative assistant. Under State licensure regulations, the program must keep a staff-to-inmate ratio at or below 1-to-30. Implementation of the forensic MISA program in the jail involves the four primary components of identification, screening, placement, and follow-up services which are achieved through the administration of the Screening Interview for Initial Placement (SIIP). This is followed by treatment and transition back into the community. An individualized treatment plan is developed by the treatment team, with consultation of the psychiatrist and cooperative participation by the offender. Clients receive three types of treatment: individual therapy, life skills/relapse education, and treatment groups. Over the first 2 years of the project, it has operated as envisioned. Since the pilot program began, only one inmate has refused to begin the recommended course of treatment. Challenges have been related primarily to clients being quickly released from jail without firm aftercare plans in place.