los angeles metropolitan churches and psattc with faith based training may 4, 2013

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

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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


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


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


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


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

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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!

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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.

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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.

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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.]

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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!

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• 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

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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?

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• 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

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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.]

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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

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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)

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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)

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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.]

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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:

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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


Motiv

Simpson, 2001 (Addiction)

Early Engagement

Early Recovery

ProgramParticipation


TherapeuticRelationship


BehavioralChange

BehavioralChange

Psycho-SocialChange

Psycho-SocialChange

Engagement

AdequateStay in Tx

Posttreatment

DrugUse

DrugUse

CrimeCrime

SocialRelations

SocialRelations



BehavioralChange

CognitiveChange

PatientReadiness

for Tx

“Sequence” of Recovery Stages

Targeted InterventionsGet Focused!!


SufficientRetentionSufficientRetention

Early Engagement

Early Recovery

Post-treatment

DrugUse

DrugUse

CrimeCrime

SocialRelations

SocialRelations





BehavioralChange

BehavioralChange

Psycho-SocialChange

Psycho-SocialChange



Motiv

Interventions Should Maintain This Process

SufficientRetention

Early Engagement

Early Recovery

Post-treatment

DrugUse

Crime

SocialRelations



BehavioralChange

Psycho-SocialChange


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



BehavioralChange

Psycho-SocialChange


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



BehavioralChange

Psycho-SocialChange


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



BehavioralChange

Psycho-SocialChange


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





BehavioralChange

BehavioralChange

Psycho-SocialChange

Psycho-SocialChange



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


Questions?The End.

Thank you!

los angeles metropolitan churches and psattc with faith based training may 4, 2013

Documents

treatment professionals

treatment systems

alcohol treatment

professional standards

development of tap

substance abuse counseling

peerbased skills

important attc document