12 Core Functions of Substance Abuse Counseling

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Screening (Core Function #1)

The process by which a client is determined appropriate and eligible for admission to a particular program.

Assessment (Core Function #4)

The essential first step in determining the possible causes of addiction for the person and the most appropriate treatment modality for his or her needs.

Monitoring, feedback, and evaluation of services (CF #7)

Effective case management for person in need of multiple services requires _______

Information about consultations, diagnosis, treatment, prognosis, and progress (CF #11)

Type of information which should be kept in a client's record.

Determining the problem (CF #8)

The initial stage of crisis intervention

Measurement of progress toward treatment goals (CF #11)

Best assessed by reviewing documentation in progress notes.

Assess degree of risk (CF #8)

The counselor's first step when a client discloses suicidal thoughts.

A Counselor's primary focus in conducting an assessment (CF #4)

Identifying the client's problems and needs, strengths and weaknesses.

Moving too quickly from data collection to treatment planning (CF #4)

A common error made by counselors when conducting an assessment.

Factors to determine eligibility for a particular program (CF #1)

A possible substance abuse or dependence problem, physical condition is appropriate to the level of care provided in the program, mental or medical illness is either ruled out or can be appropriately treated concurrent to substance abuse treatment.

Ways to establish rapport with a client during screening (CF #1)

warmth, encouraging prompts, non-threatening questions, clarifying confusing information, and appropriate self-disclosure.

Techniques to enhance counselor's interviewing style (CF #1)

eye contact, cultural consideration, awareness of gender differences, verbal language, body language, confidentiality, reflective listening, open-ended questions, affirming the client, and use of summarization

Categories of information contained on a screening form (CF #1)

Client data, referral information, presenting problem, acceptancve in program or referral out

Substance abuse or dependence (CF #1)

During the screening process the counselor must decide whether or not the client has a problem with ______

The 6 tasks of the counselor during the screening process (CF #1)

Assemble forms, collect and analyze information from referral source, interview the client, analyze information to determine if the client is appropriate for the program, and make arrangements for referral

Definition of Intake (Core Function #2)

The administrative and initial procedures for admission to a program.

Activities during the intake process (CF #2)

completing forms for eligibility and admission to the program, discussing information about confidentiality, obtaining signed consent forms, taking a substance abuse history, mental health history, family history, and a social history

Information gathered during intake

Will be used to begin a treatment plan.

Circumstances when federal regulations allow disclosure of client information

When client has consented in writing; when disclosure involves internal communications; when communications do not disclose client identifying information; when there is a medical emergency; when a disclosure is court-ordered; when the client commits or threatens to commit a crime against the program or its personnel; when needed by qualified persons authorized to conduct audits, research or program evaluations; or when there is child abuse and neglect

Screening Process

Intake is an extension of the __________

Presenting Problems and Needs

The initial assessment form outlines the ___________ and the client's immediate _________.

Definition of Orientation (Core Function #3)

The process during which the general nature, rules, and regulations of the program are described to the client. In a nonresidential setting, information should alsobe provided on the hours during which services are available.

Orientation (Core Function #3)

May take place before, during, or after screening and intake. It must take place before treatment begins.

Client Rights

Assurance of individualized treatment, competent or qualified staff, personal privacy or dignity, and the right to review his treatment plan.

ASAM Levels of Care

0.5: Early Intervention
I: Outpatient Services
II: Intensive Outpatient Services/Partial Hospitalizaiton
III: Residential/Inpatient Services
IV: Medically Managed Intensive Inpatient Services

Definition of Assessment (Core Function #4)

The procedure by which the counselor/program identifies and evaluates an individual's strengths, weaknesses, problems, and needs for the development of the treatment plan.

Problem areas and conditions evaluated during assessment process

Physiological, behavioral, family, economic, interpersonal, other drug use, employment, and legal

Barriers to effective assessment

client's denial of substance abuse problem and his inability to give an accurate history because of memory problems related to addiction

Family history of substance abuse

Reveals information about family dynamics and the impact of addiction on the family and significant others.

Ethnic minorities and women

Have special needs in treatment that impact the assessment process.

Level of care

The counselor should seek the least restrictive level of intervention/care first.

Questions asked during an oral drug/alcohol history

Age of first use
Heaviest times of use
Dose
Frequency and route of use
Recent pattern of use
Whether tolerance or dependence has developed
History of convulsions or hallucinations
Why the client is seeking help now

Important in structuring setting for taking the verbal history

Make sure there are no interruptions
Make eye contact with the client
Give the client undivided attention

ASAM's dimensional criteria

Acute intoxication and/or withdrawal potential
Biomedical conditions and complications
Emotional/behavioral conditions and complications
Treatment acceptance/resistance
Relapse/continued use potential
Recovery Environment

Definition of Treatment Planning (Core Function #5)

The process by which the counsleor and the client identify and rank problems needing resolution, extablish agreed-upon immediate and long-term goals, and decide on treatment mehtods and resources to be used.

Examples of significant problems or issues that may be identified on a treatment plan

Lack of support in home environment, lack of interests that support sobriety, prior sexual abuse, marital difficulties, adult child of addicted parent(s), lack of alcohol-free peer group, recent death of significant other, lack of confidence in ability to make new friends

Client input

_______ into the treatment plan is essential for its success.

Treatment Plan Objectives

Must be stated in concrete, behavioral terms so that the client's progress can be clearly measured.

A Treatment Plan must describe

Services to be offered, who will provide the services, where they will take place, and how often they are to occur

Benefits of utilizing a solution-focused model

The client establishes an increased sense of self-worth and becomes more investing in accomplishing the treatment goals.

Treatment Planning (Core Function #5)

Should be individualized and based on the client's particular problems and needs.

Vicarious Learning

Occurs in groups by means of observation, identification with another person's work and modeling.

Individual needs can be met in group by

Enlarging the individual concern to a common theme so all members can relate to it.

Client Expectations in group

Should be clarified early in the process in order to prevent frustration, which leads to dropping out or disruptive behavior.

Group Cohesiveness

Sense of togetherness

Development of socializing techniques

Interpersonal interactions

Existential Factors

Self-responsibility

Universiality

Applies to all

Imitative Behavior

Role Modeling

Instillation of Hope

Look toward the future

Catharsis

Release of emotions

Corrective recapitulation of family

Corrects behavior patterns

Imparting Information

New data

Feedback

Interpersonal learning

Altruism

Caring about others

Groups with diverse ethnic and cultural memberships

The counselor must guard against the anger, frustration, or isolation that minorities may feel in group.

Minority group members

If they don't feel safe in groups, their ability to progress through the necessary stages of group development can be inhibited.

Definition of Case Management (Core Function #7)

The activities that bring services, agencies, resources, or people together within a plannedframework of action toward the achievement of established goals.

Good case management

Ensures transfer to appropriate level of care at the appropriate time.

Interdisciplinary Team

Can include a physician, psychiatrist, registered nurse, program manager, program director, clinical supervisor, mental health professionals such as a psychologist, social worker, substance abuse counselor, and family therapist

Treatment Team

Assists the client to achieve the goals outlined in the treatment plan.

Major areas addressed in case management

Health problems, psychological testing, family therapy, continuing education, special therapy groups, and legal issues

Reasons to explain rational of case management to client

Promotes ownership of treatment, instills motiviation, elicits input and concerns, and provides clarity to the client

Role of case management in treatment process

Pervades the treatment process and is a component of all core functions.

Definition of Crisis

Any significant event during the treatment process that threatens to jeopardize or destroy the treatment effort. Crises have many causes and may or may not be related to alcohol or other drug use.

Definition of Crisis Intervention (Core Function #8)

Those services which respond to an alcohol and/or other drug abuser's needs during acute emotional and/or physical distress.

Examples of a Situational Crisis

Death of a loved one, serious illness, positive test result for HIV infection

Examples of a Developmental Crisis

Retirement, Marriage

Examples of an Intrapsychic Crisis

Suicidal thoughts, identity confusion

Example of an Existential Crisis

Feeling of emptiness

Typical reactions to a crisis

Shock, anxiety, intellectualization

Types of Trauma

Situational- the circumstances cause the upset
Developmental- the process of growing through life stages can cause upset
Intrapsychic- thoughts and feelings cause upset
Existential- sense of emptiness and lack of purpose in life can cause upset

Crisis Intervention Steps

Establish rapport
Gather relevant data
Reframe the crisis into a solvable problem
Help client examine realistic options
Contact resources
Arrange for follow-up

Empathy

Necessary quality in a crisis counselor

People at greater risk for suicide

men, alcoholics, person who has lost someone, someone who takes drugs, person recently diagnosed with HIV infection, lesbian and gay youth

Client Education (Core Function #9)

The provision of information to individuals and groups concerning alcohol and other drug abuse and the available services and resources.

Designing an educational program

One should consider the range of problems in the population and the differences in learning abilities.

Styles of Learning

Auditory, visual, kinesthetic

Client education material

Should be presented in a style that is respectful of cultural, racial, ethnic, and sexual diversity among substance abusers.

Areas of awareness to consider when designing an educational program on cultural diversity

Pluralistic orientation, cultural knowledge, consciousness-raising, and experiential training

Definition of Counseling (Core Function #6)

The utilizaiton of special skills to assist individuals, families, or groups in achieving objectives through exploration of a problem and its ramifications; examination of attitudes and feelings; consideration of alternative solutions; and decision making.

Definition of Referral (Core Function #10)

The identification ofthe client's needs that cannot be met by the counselor or angency and assisting the client to use the support systems and community resources available.

Unbundling

To provide all the needed services to meet the client's unique needs regardless of what agency provides the care.

Competence in referral

The ability of the counselor to recognize personal limits and/or the limits of the program in meeting the needs of the client.

Referral Information

Agency philosophy, program structure, and administrative information

Opportunities to evaluate client's need for referral

Screening, intake, assessment, treatment planning

A signed consent for release of information should include _____

Name of client; name of agency releasing the information; name of agency receiving the information; nature of the information being released; purpose for the release of information; specific date, event, or condition terminating consent

Definition of Record Keeping (Core Function #11)

Charting the results of the assessment and treatment plan, writing reports, progress notes, discharge summaries, and other client-related data.

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