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Los Angeles Metropolitan Churches and PSATTC with Faith Based Training
May 4, 2013
Topics of Discussion
• Introduction of the TAP 21• Introduction of the Scope of
Professional Practice• Foundations for Addiction
Professionals• 12 Core Competencies for Clergy
Training Objective
Teach participants about core competencies that will enable clergy
and other pastoral ministers to practice new science in addiction and alcohol treatment and to encourage faith communities in LAC to become
users of SAMHSA TAPs and TIPs.
Purpose of Certification
• Assure the public a minimum level of competency for quality service
• Give community workers professional status and recognition to qualified addiction professionals through a process that examines demonstrated work competencies (Workforce Development for Target Population)
National Standards• TAP 21 - Addiction Counseling
Competencies: The Knowledge,
Skills and Attitudes of
Professional Practice• In an effort to standardize the process of
certification in the State of California, while elevating the level of professionalism within the field, AAAOD and LAM uses national standards for substance abuse counseling.
Knowledge, Skills, Attitudes
• Transdisciplinary Foundations – identify the knowledge and attitudes that underlie competent practice—(i.e. cultural competence and peer-based)
• Skills may vary across disciplines but the knowledge and attitudes provide a basis of understanding that should be common to all addiction professionals
(A) Understanding Addiction
(B) Treatment Knowledge
(C) Application to Practice
(D) Professional Readiness
Transdisciplinary Foundations
Clinical evaluation (assessment/interview)
Treatment planning
Referral
Service coordination
Counseling
Client, family and community education
Documentation
Professional and ethical responsibilities
8 Practice Dimensions
IV. Professional ReadinessIII. Application to PracticeII. Treatment Knowledge I. Understanding Addiction
Dimensions of Professional Practice
Addiction Counseling Competencies:The Knowledge, Skills and Attitudes of Professional Practice
Clin
ical
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omm
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Pro
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Transdisciplinary Foundations
I II III IV V VI VII VIII
Comparison of the Eight Practice Dimensions of Addiction Counseling Competencies (KSA’s) With the 12 Core
Functions
Knowledge, Skills, Attitudes 12 Core Functions
Clinical Evaluation (Screening & Assessment)
ScreeningIntakeOrientationAssessment
Treatment Planning Treatment Planning
Counseling (Individual, Group, Counseling Families, Couples & Significant Others)
CounselingCrisis Intervention
Service Coordination (Implement Treatment Plan Consulting, Continuing Assessment & Treatment Planning)
Case Management
Client, Family and Community Education
Client Education
Referral Referral
Documentation Reports and Record Keeping
Professional and Ethical Responsibilities
Consultation with Other Professionals
Similarities/differences?KSA’s 12 Core Functions
Service coordination
The administrative, clinical,
and evaluative activities that bring the client, treatment services, community agencies, and other resources together to focus on issues and needs identified in the treatment plan.
Case Management
Activities intended to bring services, agencies, resources, or people together within a planned framework of action toward the achievement ofestablished goals. It may involve liaison activities and collateral contacts.
12 Core Competencies for Clergy & Other Pastoral Ministers
1. Be Aware of the:– Generally accepted definition of alcohol and drug dependence– Societal Stigma attached to alcohol and drug dependence
2. Be knowledgeable about the:- Signs of alcohol and drug dependence- Characteristics of withdrawal- Effects on the individual and the family- Characteristics of the stages of recovery
3. Be aware that possible indicators of the disease may include: among others: marital conflict, family violence, suicide, hospitalization or encounters with the criminal justice System
12 Core Competencies for Clergy & Other Pastoral Ministers
4. Understand that addiction erodes and blocks religious and spiritual development
5. Be aware of the potential benefits of early intervention to the:- addicted person- family system- affected children
12 Core Competencies for Clergy & Other Pastoral Ministers
7. Be able to communicate and sustain:- An appropriate level of concern- Messages of hope and caring
8. Be familiar with and utilize available community resources to ensure a continuum of care for the: - addicted person- family system- affected children
12 Core Competencies for Clergy & Other Pastoral Ministers
9. Have a general knowledge of and exposure to:- 12-step programs (i.e. Free-N-One, AA, NA, CA,
Alateen)- Other groups
10. Be able to acknowledge and address values, issues, and attitudes regarding alcohol and drug use and dependence in:- Oneself- One’s own family
12 Core Competencies for Clergy & Other Pastoral Ministers
11. Be able to shape, form and educate a caring congregation that welcomes and supports persons and families affected by alcohol and drug dependence
12. Be aware of how prevention strategies can benefit the larger community
Deep Dive
Documentation Competency
18
Basic Definition: The act or an instance of the supplying of written documents or supporting references or records.Most commonly used for developing treatment plan Goals & Objectives;
• Goals are the hoped for—to be achieved in the best possible world.
• Objectives are: measurable, specific, achievable–Objectives should contain:
» 1) Client name/identifying info/number
» 2) # persons to be served and/or participate
» 3) time frame from start to finish
» 4) expected measurable tasks to complete
» 5) geographic location (optional)
What is Documentation?
Documentation Approach
Client & Family
What is the Problem ?
Why Is It Occurring?
What Are We going to Do About It?
Intervention/ Solution
Is It Working?
Response to Intervention/ Instruction
Must clearly define need for treatment plan/case management and document it daily, weekly, monthly, annually.
Increasingly, the Addiction Counselor must also work with the inter-disciplinary team to establish the treatment plan (MHT; MD).
This team is composed of the consumer, case manager, FQHC/medical provider, mental health therapist and/or other natural supports such as family and friends.
Service coordination is top priority!
19
20
Progress Note Documentation
• There should be a progress note documented following each clinical session, for each day that the consumer is present in a residential or detox program, and at the time of discharge.
• Progress notes must be signed by the author, and have their credentials clearly documented.
21
Progress Note Documentation
• Progress notes must contain the date of the session and the length of time of the session, with either a beginning and ending time or a total time spent with the consumer.
• Progress notes can be written in several different formats, three discussed here are the SOAP, the DAP and the Gillman HIPAA Progress Note.
22
S.O.A.P. Notes
• S = Subjective [Consumer’s view of problems or progress noted, use consumer’s own words.]
• O = Objective [Therapist’s objective observations of the consumers progress.]
• A = Assessment [CM/Counselor/Therapist’s assessment of the consumer’s affect, mental status, and psychosocial functioning.]
• P = Plan [Plan for future treatment as it relates to progress noted.]
23
S.O.A.P. Notes, Subjective• Use the “S”
section to document the consumers view of the problem and their progress in goal attainment.
CONSISTENTLY!
24
• Use the “O” section to document your objective observations of the consumer’s behavior and personal appearance.
• Was the consumer appropriate, hypervigilant, hostile, hypoactive, distracted, hyperactive, suspicious or argumentative?
• Did the consumer have hallucinations? If so, were they auditory, visual, or command?
• Was the consumer delusional, paranoid, or persecutory?
• Was suicidal or homicidal ideation present?
S.O.A.P. Notes, Objective
25
S.O.A.P. Notes, Assessment• Use the “A” section to document your
views of the consumer’s employability, mental status, and social functioning.
• Was the consumer blunted, sad, flat, angry, suspicious, euphoric, ashamed, depressed, anxious, fearful or experiencing dillusions?
26
• Use the “P” section to plan for the consumer’s future housing/treatment etc.
• Do you and the treatment team continue with the current treatment plan, or do you need a chance to update the treatment plan in light of a documented problem or event?
• Has it been 90 days since the last ASI or SDS and does the consumer need to update these assessments?
• Has it been 90 to 120 days since the last treatment plan update and is it time to update the treatment plan?
S.O.A.P. Notes, Objective
27
D.A.P. Notes• D = Data [CM/Counselor/Therapist’s
observations, what the clinician saw and heard, quote statements made by the consumer.]
• A = Assessment [The staff/therapists assessment of the consumer’s job status, education, parenting, mental status and psychological functioning.]
• P = Plan [Plan for future treatment as it relates to progress noted and updating of the treatment plan.]
28
Example D.A.P. Note• Consumer Name: Clark Kent• Date: February 03, 2005• Time in Group:1 hour• (D) Client attended and took part in group today, second day in
group. Client reports fear of losing his wife and job if he does not get sober. Reported also fear that he will be unable to remain sober. He reports 4 days sobriety.
• (A) Client’s mental and psychological functioning were appropriate, no suicidal or homicidal ideation, per client. Affect and mood sad and depressed, sometimes tearful. Participation in group was active and appropriate.
• (P) Plan: Only client’s second day in treatment, continue with current plan.
Cinderella JacksonCinderella Jackson, Certified Case Manager (CCM)/CAS II
29
Gillman HIPAA Progress Note• This is a new system used to document behavioral therapy notes
created by Peter B. Gillman, PhD, in response to the HIPAA regulations around psychotherapy notes.
• The Gillman HIPAA Progress Note contains the following elements:– Counseling session start and stop time– Modalities of treatment furnished– Frequency of modalities furnished– Medication prescription and monitoring– Results of any clinical tests or assessments– Summary of Symptoms– Summary of Functional Status– Summary of Progress– Summary of Diagnosis– Summary of Treatment Plan– Summary of Progress
(Gillman., 50)
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• Use the following questions to obtain the information you need to complete this type of progress note:
– What symptoms did my client bring to me today?– What is the impact on their functional status?– What progress did the client make since the last
session?– How does this change my diagnostic thinking?– What is my treatment plan and recommendation for
the next treatment period?– What is the prognosis for this period of time?
Gillman HIPAA Progress Note
(Gillman., 50)
31
What makes the Gillman HIPAA Note superior to the SOAP or DAP
1. It requires the clinician to think in more behavioral terms.
2. It requires the clinician to focus on presenting symptoms/indicators/barriers.
3. It requires the clinician to think about functional environments that the consumer finds more meaningful to express their psychopathology.
4. It requires the clinician to think about the progress made since the last session.
5. It requires the clinician to think about how the above data might change their diagnostic thinking.
6. It requires the clinician to think about changes to their treatment plan and recommendations.
7. It requires the clinician to think about the prognosis until the next treatment session.
(Gillman., 50)
32
Progress Note Test Questions/Discussions:
Which of the following is an indication for a progress note?A. Following each clinical sessionB. Each day that the consumer is present in a residential or detox
programC. Each time a consumer is redirected when displaying negative
feelingsD. At the time of dischargeE. All of the above
Which of the following statements are incorrect?F. S = Subjective [Therapist’s view of problems or progress noted,
use consumer’s own words.]G. O = Objective [Therapist’s objective observations of the
consumers progress.]H. A = Assessment [Therapist’s assessment of the consumer’s affect,
mental status, and psychosocial functioning.]I. P = Plan [Plan for future treatment as it relates to progress noted.]
33
Which of the following is an incorrect example of a DAP progress note entry?
A. Client attended and took part in group today, second day in group. Client reports fear of losing his wife and job if he does not get sober. Reported also fear that he will be unable to remain sober. He reports 4 days sobriety. (D)
B. Client attended and took part in group today, second day in group. He reports 4 days sobriety, Affect and mood sad and depressed, sometimes tearful, continue with current plan. (A)
C. Client’s mental and psychological functioning were appropriate, no suicidal or homicidal ideation, per client. Affect and mood sad and depressed, sometimes tearful. Participation in group was active and appropriate. (A)
D. Plan: Only client’s second day in treatment, continue with current plan. (P)
E. All of the above
Progress Note Test Questions:
34
Which of the following are elements of the Gillman HIPAA Progress Note?A. Counseling session start and stop timeB. Modalities of treatment furnishedC. Frequency of modalities furnishedD. Medication prescription and monitoringE. All of the above
Which of the following make the Gillman HIPAA Note superior to the SOAP or DAP note?F. It requires the clinician to think in more behavioral termsG. It requires the clinician to focus on presenting symptomsH. It requires the clinician to think about how frequently they have
made a HIPAA violation.I. It requires the clinician to think about changes to their treatment
plan and recommendationsJ. It requires the clinician to think about the prognosis until the next
treatment session.
Progress Note Test Questions:
What Is Goal of Documentation?
• To provide persistent, incremental improvements in the quality and effectiveness of substance abuse treatment which results in better quality recovery for more people.
• To advance skills, knowledge, understanding and adoption of evidence based practices by community and faith based programs in SLA.
Back to
Basics
Core Components of Comprehensive Services
MedicalMental Health
Vocational
Educational
LegalAIDS /
HIV Risks
Financial
Housing & Transportation
Child Care
Family
Continuing Care
Case Management
Urine Monitoring
Self-Help(AA/NA)
Pharmaco-therapy
Group/Individual Counseling
AbstinenceBasedIntake
Assessment
Treatment Plans
CoreTreatment
Etheridge, Hubbard, Anderson, Craddock, & Flynn, 1997 (PAB)
An Evidence-Based Treatment
Model for Improving Practice
38
Texas Christian University
Elements of a Treatment Process Model
SufficientRetentionSufficientRetention?
PatientFactorsPatientFactors
PsychologicalFunctioning,
Motivation,
& ProblemSeverity
Cognitive and behavioralcomponents with therapeutic impact
Posttreatment
DrugUse
DrugUse
CrimeCrime
SocialRelations
SocialRelations
Detox
OP-DF
TC/Res
OP-MM
TCU Treatment Process Model
Sufficient Retention Sufficient Retention
Post-treatment
DrugUse
DrugUse
CrimeCrime
SocialRelations
SocialRelations
PatientAttributesat Intake
PatientAttributesat Intake
Motiv
Simpson, 2001 (Addiction)
Early Engagement
Early Recovery
ProgramParticipation
ProgramParticipation
TherapeuticRelationship
TherapeuticRelationship
BehavioralChange
BehavioralChange
Psycho-SocialChange
Psycho-SocialChange
Engagement
AdequateStay in Tx
Posttreatment
DrugUse
DrugUse
CrimeCrime
SocialRelations
SocialRelations
ProgramParticipation
TherapeuticRelationship
BehavioralChange
CognitiveChange
PatientReadiness
for Tx
“Sequence” of Recovery Stages
Targeted InterventionsGet Focused!!
Simpson, 2001 (Addiction)
SufficientRetentionSufficientRetention
Early Engagement
Early Recovery
Post-treatment
DrugUse
DrugUse
CrimeCrime
SocialRelations
SocialRelations
ProgramParticipation
ProgramParticipation
TherapeuticRelationship
TherapeuticRelationship
BehavioralChange
BehavioralChange
Psycho-SocialChange
Psycho-SocialChange
PatientAttributesat Intake
PatientAttributesat Intake
Motiv
Interventions Should Maintain This Process
SufficientRetention
Early Engagement
Early Recovery
Post-treatment
DrugUse
Crime
SocialRelations
ProgramParticipation
TherapeuticRelationship
BehavioralChange
Psycho-SocialChange
PatientAttributesat Intake
Motiv
Induction to Treatment(Motivational Enhancement)
Simpson & Joe, 1993 (Pt); Blankenship et al.,1999 (PJ); Sia, Dansereau, & Czuchry, 2000 (JSAT)
ProblemRecognition
Desirefor Help
Readinessfor Treatment
SufficientRetention
Early Engagement
Early Recovery
Post-treatment
DrugUse
Crime
SocialRelations
ProgramParticipation
TherapeuticRelationship
BehavioralChange
Psycho-SocialChange
PatientAttributesat Intake
Motiv
Counseling Enhancements
(Cognitive “Mapping”)
Dansereau et al., 1993 (JCP), 1995 (PAB); Joe et al., 1997 (JNMD); Pitre et al., 1998 (JSAT)
SufficientRetention
Early Engagement
Early Recovery
Post-treatment
DrugUse
Crime
SocialRelations
ProgramParticipation
TherapeuticRelationship
BehavioralChange
Psycho-SocialChange
PatientAttributesat Intake
Motiv
Contingency Management(Token Rewards)
Rowan-Szal et al., 1994 (JSAT); 1997 (JMA); Griffith, Rowan-Szal et al., 2000 (DAD)
SufficientRetention
Early Engagement
Early Recovery
Post-treatment
DrugUse
Crime
SocialRelations
ProgramParticipation
TherapeuticRelationship
BehavioralChange
Psycho-SocialChange
PatientAttributesat Intake
Motiv
Specialized Interventions (Skills-Based Counseling Manuals)
Bartholomew et al., 1994 (JPD); 2000 (JSAT); Hiller et al., 1996 (SUM)
SupportiveNetworks
SufficientRetentionSufficientRetention
Early Engagement
Early Recovery
Post-treatment
DrugUse
DrugUse
CrimeCrime
SocialRelations
SocialRelations
ProgramParticipation
ProgramParticipation
TherapeuticRelationship
TherapeuticRelationship
BehavioralChange
BehavioralChange
Psycho-SocialChange
Psycho-SocialChange
PatientAttributesat Intake
PatientAttributesat Intake
Motiv
Evidence-Based Treatment Model
EnhancedCounseling
BehavioralStrategies
Social SkillsTraining
Family &Friends
SupportiveNetworks
SupportiveNetworks
Induction Personal Health Services
Social Support Services
ProgramCharacteristics
ProgramCharacteristics
StaffAttributes
& Skills
StaffAttributes
& Skills
Simpson, 2001 (Addiction)
Questions?The End.
Thank you!