T I P 47 Intensive Outpatient Services Edited

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NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com

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  • Multidimensional/Biopsychosocial Recognizes dual disorders as chronic Values case management Blends evidence-based with community based services
  • 6–30 contact hours per week Individualized step-up and step-down levels of care A minimum duration of 90 days followed by step-down
  • Enhanced services Ambulatory detoxification Childcare Outreach Case Management For more detailed information, see TIP 47, pp. 1–6
  • Screening Assessment Treatment planning Treatment engagement Group, individual and family counseling Psychoeducational programming Integration into support groups
  • Relapse prevention training Substance use screening and monitoring Vocational and educational services Referral to wrap-around services Mentoring?
  • Treatment is available to a wide spectrum of clients Treatment access is straightforward and welcoming (No Wrong Door) Enhance existing motivation Trust is built between the counselor and client Client retention is a priority Individualized assessment and treatment
  • Implements a flexible, chronic/episodic care model Monitor abstinence Help clients integrate into support groups If indicated, use medications to manage co-occurring disorders Educate clients and family members about addiction and recovery Include families, employers, and significant others in the treatment process
  • Seek out and use evidence-based training and materials Improve program administration For more detailed information, see TIP 47, pp. 7–16
  • Bio Housing Health issues Psycho Past/present MH/trauma issues in self/family Past/present SA issues in self/family Past treatment successes/failures Suicide/homicide and family violence Self esteem Coping Skills, strengths and resources
  • Social Relationship with peers Occupational Legal Personal and family involvement Financial
  • Inconsistent ability for abstract /future thinking Impulsive/short attention span Vulnerable to peer influence Frequent emotional fluctuations Lack of involvement in pro-social activities Pessimistic/fatalistic attitudes
  • Level 0.5: Early intervention services Level I: Outpatient services Level II: Intensive outpatient Level III: Residential/inpatient services Level IV: Medically managed intensive inpatient services
  • Treatment frequency and intensity is individualized At least 9 hours per week for 90 days Stages Treatment engagement Early recovery
  • Goals Initiate a treatment contract Resolve acute crises Engage in a therapeutic alliance Involve clients in preparing a treatment plan Duration — A few days to a few weeks
  • Confirm diagnosis, eligibility, and appropriate placement Conduct biopsychosocial assessment Develop treatment plan Provide assessment feedback Explain program rules and expectations Address acute crises Resolve administrative issues Foster therapeutic alliances between client and counselor and group members
  • Begin psychoeducational activities Identify sources of social support With client’s permission, initiate family contacts and education
  • Assessment and treatment plan are completed Client has completely detoxed Client has adequate attendance and participation
  • Goals Abstinence Sustain behavioral changes Identify relapse triggers and develop relapse prevention strategies Identify and begin to resolve personal problems Begin active involvement in a 12-Step or other mutual-help program Duration — 6 weeks to about 3 months
  • Help clients follow their plans to sustain abstinence Assist in identifying and developing strategies for relapse triggers Initiate random drug tests and provide rapid feedback of results Help clients and families integrate into mutual-help programs Assist in developing and strengthening positive social support networks Continue appropriate pharmacotherapy, medical and psychiatric treatments
  • Sustained abstinence for 30 days or longer Completed treatment plan goals Created and implemented a relapse prevention and continuing care plan Participated regularly in a support group Maintained a sober social support network Resolved medical, psychiatric, housing and personal situations that may trigger relapse
  • Step-down/Stage 3 Maintenance Goals Solidify abstinence Use relapse prevention skills Improve emotional functioning Broaden sober social networks Address other problem areas Duration — About 2 months to 1 year
  • Help clients practice relapse prevention skills Teach new coping skills Help identify unmet biopsychosocial needs Assist in locating community resources Encourage support groups participation Emphasize the importance of spirituality/altruistic/sober values Provide feedback on random drug test results Continue treatment plan implementation
  • Sustained abstinence Improved relationships Improved coping and problem solving skills Obtained drug-free, stable housing Continued participation in a support group Obtained assistance with other problems
  • Goals Maintain abstinence and wellness Develop independence from the treatment program Maintain social and support network connections Establish recreational activities Duration —Years, ongoing
  • Assist in developing a plan for continuing recovery Acquaint clients with local resources Encourage attendance at alumni or booster sessions Provide biannual checkups Completion criteria — Clients may need community support for the rest of their lives
  • Assessment Treatment planning Group and individual counseling Psychoeducation Pharmacotherapy Drug testing/monitoring Case management Community based support groups
  • 24-Hour crisis coverage Medical and dental treatment Vocational and employment services Wrap around services
  • Pause the presentation and make a list of all of the issues that your clients have to deal
  • Childcare Transportation Adult education Housing Food Parenting skills Smoking cessation Postpartum support Relationship/couples counseling HIV/AIDS, Hepatitis screening, education, counseling Domestic violence And more….
  • TREATMENT ENTRY AND ENGAGEMENT
  • T I P 47 Intensive Outpatient Services Edited

    1. 1. Intensive Outpatient Services: Clinical Issues TIP 47 Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    2. 2. Overview IOT <ul><li>Multidimensional/Biopsychosocial </li></ul><ul><li>Recognizes dual disorders as chronic </li></ul><ul><li>Values case management </li></ul><ul><li>Blends evidence-based with community based services </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    3. 3. Core Features <ul><li>6–30 contact hours per week </li></ul><ul><li>Individualized step-up and step-down levels of care </li></ul><ul><li>Minimum duration of 90 days followed by step-down </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    4. 4. Core Features cont… <ul><li>Enhanced services </li></ul><ul><ul><li>Ambulatory detoxification </li></ul></ul><ul><ul><li>Childcare </li></ul></ul><ul><ul><li>Outreach </li></ul></ul><ul><ul><li>Case Management </li></ul></ul><ul><ul><ul><ul><li>For more detailed information, see TIP 47, pp. 1–6 </li></ul></ul></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    5. 5. Core Services <ul><li>Screening </li></ul><ul><li>Assessment </li></ul><ul><li>Treatment planning </li></ul><ul><li>Treatment engagement </li></ul><ul><li>Group, individual and family counseling </li></ul><ul><li>Psychoeducational programming </li></ul><ul><li>Integration into support groups </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    6. 6. Core Services cont… <ul><li>Relapse prevention training </li></ul><ul><li>Substance use screening and monitoring </li></ul><ul><li>Vocational and educational services </li></ul><ul><li>Referral to wrap-around services </li></ul><ul><li>Mentoring? </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    7. 7. Principles of IOT <ul><li>Treatment available </li></ul><ul><ul><li>wide spectrum of clients </li></ul></ul><ul><li>Treatment access </li></ul><ul><ul><li>straightforward and welcoming </li></ul></ul><ul><ul><li>No Wrong Door </li></ul></ul><ul><li>Enhance existing motivation </li></ul><ul><li>Trust between counselor and client </li></ul><ul><li>Client retention priority </li></ul><ul><li>Individualized assessment and treatment </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    8. 8. Principles cont… <ul><li>Implements flexible, chronic/episodic care model </li></ul><ul><li>Monitor abstinence </li></ul><ul><li>Help clients integrate into support groups </li></ul><ul><li>Medications to manage co-occurring disorders </li></ul><ul><li>Educate clients and family members </li></ul><ul><li>Families, employers, and significant others </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    9. 9. Principles cont… <ul><li>Evidence-based training and materials </li></ul><ul><li>Improve program administration </li></ul><ul><ul><li>For more detailed information, see TIP 47, pp. 7–1 </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    10. 10. Biopsychosocial Assessment <ul><li>Bio </li></ul><ul><ul><li>Housing </li></ul></ul><ul><ul><li>Health issues </li></ul></ul><ul><li>Psycho </li></ul><ul><ul><li>Past/present MH/trauma issues in self/family </li></ul></ul><ul><ul><li>Past/present SA issues in self/family </li></ul></ul><ul><ul><li>Past treatment successes/failures </li></ul></ul><ul><ul><li>Suicide/homicide and family violence </li></ul></ul><ul><ul><li>Self esteem </li></ul></ul><ul><ul><li>Coping Skills, strengths and resources </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    11. 11. Biopsychosocial Assessment cont… <ul><li>Social </li></ul><ul><ul><li>Relationship with peers </li></ul></ul><ul><li>Occupational </li></ul><ul><li>Legal </li></ul><ul><ul><li>Personal and family involvement </li></ul></ul><ul><li>Financial </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    12. 12. Clinical Considerations (Adolescents?) <ul><li>Inconsistent ability for abstract /future thinking </li></ul><ul><li>Impulsive/short attention span </li></ul><ul><li>Vulnerable to peer influence </li></ul><ul><li>Frequent emotional fluctuations </li></ul><ul><li>Lack of involvement in pro-social activities </li></ul><ul><li>Pessimistic/fatalistic attitudes </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    13. 13. ASAM Levels <ul><li>Level 0.5: Early intervention services </li></ul><ul><li>Level I: Outpatient services </li></ul><ul><li>Level II: Intensive outpatient </li></ul><ul><li>Level III: Residential/inpatient services </li></ul><ul><li>Level IV: Medically managed intensive inpatient services </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    14. 14. Key Aspects of IOT/Level II <ul><li>Treatment frequency and intensity is individualized </li></ul><ul><ul><li>At least 9 hours per week for 90 days </li></ul></ul><ul><li>Stages </li></ul><ul><ul><li>Treatment engagement </li></ul></ul><ul><ul><li>Early recovery </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    15. 15. Treatment Engagement <ul><li>Goals </li></ul><ul><ul><li>Initiate a treatment contract </li></ul></ul><ul><ul><li>Resolve acute crises </li></ul></ul><ul><ul><li>Engage in a therapeutic alliance </li></ul></ul><ul><ul><li>Involve clients in preparing a treatment plan </li></ul></ul><ul><li>Duration — A few days to a few weeks </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    16. 16. Engagement Activities <ul><li>Confirm diagnosis, eligibility, appropriate placement </li></ul><ul><li>Conduct biopsychosocial assessment </li></ul><ul><li>Develop treatment plan </li></ul><ul><li>Provide assessment feedback </li></ul><ul><li>Explain program rules and expectations </li></ul><ul><li>Address acute crises </li></ul><ul><li>Resolve administrative issues </li></ul><ul><li>Foster therapeutic alliances </li></ul><ul><ul><li>Client, counselor, group members </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    17. 17. Engagement Activities cont… <ul><li>Begin psychoeducational activities </li></ul><ul><li>Identify sources of social support </li></ul><ul><li>Initiate family contacts and education </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    18. 18. Phase 1 Completion Criteria <ul><li>Assessment and treatment plan completed </li></ul><ul><li>Client completely detoxed </li></ul><ul><li>Client adequate attendance and participation </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    19. 19. Early Recovery <ul><li>Goals </li></ul><ul><ul><li>Abstinence </li></ul></ul><ul><ul><li>Sustain behavioral changes </li></ul></ul><ul><ul><li>Identify relapse triggers and develop relapse prevention strategies </li></ul></ul><ul><ul><li>Identify and begin to resolve personal problems </li></ul></ul><ul><ul><li>Begin active involvement in a 12-Step or other mutual-help program </li></ul></ul><ul><li>Duration — 6 weeks to about 3 months </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    20. 20. Counselor Activities <ul><li>Help clients follow their plans to sustain abstinence </li></ul><ul><li>Assist identify and develop strategies for relapse triggers </li></ul><ul><li>Initiate random drug tests and provide rapid feedback of results </li></ul><ul><li>Help clients and families integrate into mutual-help programs </li></ul><ul><li>Assist develop and strengthen positive social support networks </li></ul><ul><li>Continue appropriate pharmacotherapy, medical, psychiatric treatments </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    21. 21. Completion Criteria <ul><li>Sustained abstinence for 30 days or longer </li></ul><ul><li>Completed treatment plan goals </li></ul><ul><li>Created and implemented a relapse prevention and continuing care plan </li></ul><ul><li>Participated regularly in a support group </li></ul><ul><li>Maintained a sober social support network </li></ul><ul><li>Resolved medical, psychiatric, housing, personal situations that may trigger relapse </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    22. 22. Outpatient Treatment (Level I) <ul><li>Step-down/Stage 3 Maintenance </li></ul><ul><li>Goals </li></ul><ul><ul><li>Solidify abstinence </li></ul></ul><ul><ul><li>Use relapse prevention skills </li></ul></ul><ul><ul><li>Improve emotional functioning </li></ul></ul><ul><ul><li>Broaden sober social networks </li></ul></ul><ul><ul><li>Address other problem areas </li></ul></ul><ul><li>Duration — About 2 months to 1 year </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    23. 23. Counselor activities <ul><li>Help clients practice relapse prevention skills </li></ul><ul><li>Teach new coping skills </li></ul><ul><li>Help identify unmet biopsychosocial needs </li></ul><ul><li>Assist locate community resources </li></ul><ul><li>Encourage support groups participation </li></ul><ul><li>Emphasize importance of spirituality/altruistic/sober values </li></ul><ul><li>Provide feedback on random drug test results </li></ul><ul><li>Continue treatment plan implementation </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    24. 24. Completion Criteria <ul><li>Sustained abstinence </li></ul><ul><li>Improved relationships </li></ul><ul><li>Improved coping/problem solving skills </li></ul><ul><li>Obtained drug-free, stable housing </li></ul><ul><li>Continued participation in support group </li></ul><ul><li>Obtained assistance with other problems </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    25. 25. Stage 4: Continuing Community Care <ul><li>Goals </li></ul><ul><ul><li>Maintain abstinence and wellness </li></ul></ul><ul><ul><li>Develop independence from treatment program </li></ul></ul><ul><ul><li>Maintain social and support network connections </li></ul></ul><ul><ul><li>Establish recreational activities </li></ul></ul><ul><li>Duration —Years, ongoing </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    26. 26. Counselor Activities <ul><li>Assist in developing a plan for continuing recovery </li></ul><ul><li>Acquaint clients with local resources </li></ul><ul><li>Encourage attendance at alumni or booster sessions </li></ul><ul><li>Provide biannual checkups </li></ul><ul><li>Completion criteria — Clients may need community support forever </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    27. 27. Services (or Linkages) in IOT <ul><li>Assessment </li></ul><ul><li>Treatment planning </li></ul><ul><li>Group and individual counseling </li></ul><ul><li>Psychoeducation </li></ul><ul><li>Pharmacotherapy </li></ul><ul><li>Drug testing/monitoring </li></ul><ul><li>Case management </li></ul><ul><li>Community based support groups </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    28. 28. Services (or Linkages) in IOT Cont… <ul><li>24-Hour crisis coverage </li></ul><ul><li>Medical and dental treatment </li></ul><ul><li>Vocational and employment services </li></ul><ul><li>Wrap around services </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    29. 29. *Discussion Forum* <ul><li>Pause the presentation </li></ul><ul><li>List of all of the issues that your clients have to deal with. </li></ul><ul><li>Take a moment to post your responses in the discussion forum. </li></ul><ul><li>Thank you </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    30. 30. Answer <ul><li>Childcare </li></ul><ul><li>Transportation </li></ul><ul><li>Adult education </li></ul><ul><li>Housing </li></ul><ul><li>Food </li></ul><ul><li>Parenting skills </li></ul><ul><li>Smoking cessation </li></ul><ul><li>Postpartum support </li></ul><ul><li>Relationship/couple counseling </li></ul><ul><li>HIV/AIDS, Hepatitis screening, education, counseling </li></ul><ul><li>Domestic violence </li></ul><ul><li>And more…. </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    31. 31. TREATMENT ENTRY AND ENGAGEMENT Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    32. 32. Intake <ul><li>Screening </li></ul><ul><ul><li>Solicit client’s perception of the problem </li></ul></ul><ul><ul><li>Explores client’s expectations/hopes </li></ul></ul><ul><ul><li>Support commitment to change </li></ul></ul><ul><ul><li>Offer hope </li></ul></ul><ul><ul><li>Assess readiness for change </li></ul></ul><ul><ul><li>Complete Simple Screening Instrument from TIP 11 at www.health.org </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    33. 33. Assessment <ul><li>Biopsychosocial assessment </li></ul><ul><ul><li>Mental health (past, present, consequences, interventions) </li></ul></ul><ul><ul><li>Substance abuse (past, present, consequences, interventions) </li></ul></ul><ul><ul><li>Family history of MH and SA </li></ul></ul><ul><li>Integrated summary </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    34. 34. Treatment Planning <ul><li>Involve the client </li></ul><ul><li>Observable, measurable goals </li></ul><ul><li>Sequential, subgoals with a timeline </li></ul><ul><li>Link with necessary resources </li></ul><ul><ul><li>For more detailed information, see TIP 47, pp. 59–91 </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    35. 35. FAMILY-BASED SERVICES Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    36. 36. Engagement <ul><li>Reasons for resistance </li></ul><ul><ul><li>Domestic violence </li></ul></ul><ul><ul><li>Shame </li></ul></ul><ul><ul><li>Fear of revealing family secrets </li></ul></ul><ul><ul><li>Resentments </li></ul></ul><ul><li>Methods </li></ul><ul><ul><li>Involve family in the intake (with permission) </li></ul></ul><ul><ul><li>Offer written invitations to participate </li></ul></ul><ul><ul><li>Family-only educational groups </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    37. 37. Family Services <ul><li>Family education </li></ul><ul><li>Multifamily groups </li></ul><ul><li>Family therapy </li></ul><ul><ul><li>Individual </li></ul></ul><ul><ul><li>Couples </li></ul></ul><ul><ul><li>Child-focused </li></ul></ul><ul><li>Family retreats </li></ul><ul><li>Support groups (Al-Anon, etc) </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    38. 38. Family Clinical Issues <ul><li>Trust reestablishment </li></ul><ul><li>Having fun </li></ul><ul><li>What do we tell the Jones’ </li></ul><ul><li>Resentment of the consuming nature of recovery---from the bottle to the meetings </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    39. 39. Client Retention <ul><li>Understand treatment history </li></ul><ul><li>Use motivational techniques </li></ul><ul><li>Flexible scheduling </li></ul><ul><li>Use the group to engage the client </li></ul><ul><li>Network with those involved in the client’s recovery </li></ul><ul><li>Deliver services throughout treatment </li></ul><ul><li>Leave an open door/Don’t give up </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    40. 40. Relapse Strategies <ul><li>Educate families and client about symptoms, causes, effects, interactions of: </li></ul><ul><ul><li>co-occurring disorders </li></ul></ul><ul><ul><li>relapse </li></ul></ul><ul><ul><li>recovery </li></ul></ul><ul><li>Identify relapse triggers and interventions early </li></ul><ul><li>Develop a relapse prevention plan </li></ul><ul><li>Use behavioral contracts </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    41. 41. Family Substance Use <ul><li>Be aware </li></ul><ul><li>Discuss the meaning and impact of the behavior on the patient </li></ul><ul><li>Provide treatment information </li></ul><ul><li>Assist patient in finding new housing </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    42. 42. Group Treatment <ul><li>Develop group cohesion </li></ul><ul><ul><li>Rituals (with caution) </li></ul></ul><ul><ul><li>Emblem/mascot </li></ul></ul><ul><ul><li>Explore group response to drop-out or relapse </li></ul></ul><ul><ul><li>Maintain a group of 8-12 </li></ul></ul><ul><ul><li>Develop group rules/expectations: Communication, attendance, behavior, etc.) </li></ul></ul><ul><ul><li>Remove ambivalent or precontemplative clients </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    43. 43. Withdrawn Clients <ul><li>Discuss lack of participation with the client </li></ul><ul><li>Assess for learning/cognitive disabilities </li></ul><ul><li>Pair clients with buddies (universally) </li></ul><ul><li>Incorporate buddy activities </li></ul><ul><li>Evaluate for mental health issues (depression, social phobia etc.) </li></ul><ul><li>Provide alternative methods for participation </li></ul><ul><li>Ensure an environment of safety </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    44. 44. Safety in Group <ul><li>No tolerance for drugs or weapons </li></ul><ul><li>No tolerance for drug-related activity </li></ul><ul><li>No unauthorized persons on site </li></ul><ul><li>Have clients sign a code of conduct stating that violence will result in termination </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    45. 45. Clients Under the Influence <ul><li>Assess the client’s need for acute care or detoxification </li></ul><ul><li>Review the rules with the client </li></ul><ul><li>Instruct the client to return when abstinent </li></ul><ul><li>Arrange for safe transportation home </li></ul><ul><li>Write or call the client to invite him or her to return to treatment </li></ul><ul><li>Discuss the substance use during the next session </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    46. 46. Client Privacy <ul><li>Releases are required before you… </li></ul><ul><ul><li>Acknowledge that a client is a program participant (but you can listen) </li></ul></ul><ul><ul><li>Share any information </li></ul></ul><ul><ul><li>Transfer a phone call to the client </li></ul></ul><ul><ul><li>Take a message for the client </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    47. 47. HIV Status Withheld from Partner <ul><li>Ensure that the client is aware of how HIV/AIDS is transmitted </li></ul><ul><li>Discuss feelings of fear, embarrassment, and guilt about revealing HIV status </li></ul><ul><li>Educate family and client about HIV </li></ul><ul><li>Help the client and partner discuss the issue </li></ul><ul><li>Refer the client to HIV/AIDS counseling </li></ul><ul><li>Provide referrals for support groups </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    48. 48. Treatment-Life Balance <ul><li>Recovery is first priority </li></ul><ul><li>Now is not the time to make up for the past by taking on too much </li></ul><ul><li>Ensure a balanced lifestyle </li></ul><ul><ul><li>Treatment-Family-Work-Honey Do’s-Self </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    49. 49. “ Unavoidable” People Triggers <ul><li>Identify high-risk situations </li></ul><ul><li>Encouraging the client to distance himself from co-workers/family who use substances </li></ul><ul><li>Using role plays to practice refusal skills </li></ul><ul><li>Encouraging the client to transfer to another work environment </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    50. 50. Boundary Issues <ul><li>Gifts </li></ul><ul><ul><li>Evaluate </li></ul></ul><ul><ul><ul><li>Cost </li></ul></ul></ul><ul><ul><ul><li>Cultural significance </li></ul></ul></ul><ul><ul><ul><li>Timing </li></ul></ul></ul><ul><ul><ul><li>Motivations (for giving and accepting) </li></ul></ul></ul><ul><ul><li>Refer to organizational policy </li></ul></ul><ul><li>Sponsorship/Dual Relationships </li></ul><ul><li>Socialization outside of treatment </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    51. 51. 12-Steps: Strengths <ul><li>Meetings that are free, widely available, supportive, and specialized </li></ul><ul><li>Emphasizes an array of recovery tasks in cognitive, spiritual, and health realms </li></ul><ul><li>Is effective with clients from diverse backgrounds </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    52. 52. 12 Steps: Challenges <ul><li>Difficult to monitor compliance with step tasks </li></ul><ul><li>Difficult for some clients to accept a higher power </li></ul><ul><li>Small communities may have difficulty supporting 12-Step meetings or dual recovery meetings </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    53. 53. Cognitive Behavioral Approach <ul><li>Emotional and behavioral reactions are learned </li></ul><ul><li>New reactions can be taught </li></ul><ul><li>Clients learn to recognize and respond to SA/MH triggers </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    54. 54. CBT: Strengths <ul><li>Engages clients in therapy and learning </li></ul><ul><li>Manualized </li></ul><ul><li>Suitable for diverse clients </li></ul><ul><li>Provides structured relapse prevention strategies </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    55. 55. CBT: Challenges <ul><li>May require adjustments for clients with poor cognitive skills </li></ul><ul><li>Requires counselor training </li></ul><ul><li>Requires motivation </li></ul><ul><li>Has homework assignments </li></ul><ul><li>Developed for individual counseling </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    56. 56. Motivational Interviewing <ul><li>Motivational interviewing (MI) and motivational enhancement therapy (MET) </li></ul><ul><li>Acknowledge that substances have rewarding properties </li></ul><ul><li>Paired with strengths-based problem solving strategies </li></ul><ul><li>Counselors act as coaches </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    57. 57. MI: Strengths <ul><li>Client centered and relevant to clients’ interests </li></ul><ul><li>Focus on realistic goals </li></ul><ul><li>Encourage self-efficacy and self-sufficiency </li></ul><ul><li>Emphasize positive support </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    58. 58. MI: Challenges <ul><li>Rely on clients’ capabilities and self-awareness </li></ul><ul><li>Are incompatible with common problem-oriented assessment instruments </li></ul><ul><li>Require staff training and supervision </li></ul><ul><li>May be difficult to combine with disease or therapeutic community-oriented approaches </li></ul><ul><li>Were developed as individual approaches </li></ul><ul><li>Do not specify session content </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    59. 59. Therapeutic Community <ul><li>The whole treatment community is the therapeutic agent </li></ul><ul><li>Addiction is a disorder of the whole person </li></ul><ul><li>Recovery is a developmental process entailing mutual help and social learning </li></ul><ul><li>Phased Treatment </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    60. 60. TC: Strengths <ul><li>Effective for people with long histories of addiction and antisocial behavior </li></ul><ul><li>Effective in teaching clients how to achieve goals </li></ul><ul><li>Can reduce recidivism </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    61. 61. TC: Challenges <ul><li>May be too confrontational </li></ul><ul><li>Requires staff training </li></ul><ul><li>Difficult for clients with co-occurring disorders </li></ul><ul><li>Must have an effective mix of clinicians and recovering staff </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    62. 62. The Matrix Model <ul><li>Integrates several techniques (CBT, 12-Step, MET) </li></ul><ul><li>Emphasizes group work over individual sessions </li></ul><ul><li>Primary therapist or counselor coordinates the client’s treatment </li></ul><ul><li>The client–family relationship is critical </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    63. 63. Core Matrix Components <ul><li>Early recovery groups </li></ul><ul><ul><li>first month of treatment </li></ul></ul><ul><ul><li>focus on teaching cognitive tools for managing cravings and structuring time </li></ul></ul><ul><li>Family education sessions </li></ul><ul><ul><li>Focus on the causes of addiction and biopsychosocial effects </li></ul></ul><ul><li>Relapse prevention groups </li></ul><ul><ul><li>focus on cognitive and behavioral change </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    64. 64. Core Matrix Components cont… <ul><li>Social support groups </li></ul><ul><ul><li>Provide networking, social support, modeling </li></ul></ul><ul><li>Urine Testing </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    65. 65. Matrix: Strengths <ul><li>Integrates a CBT, family involvement, psychosocial education, 12-Step support, and urine testing </li></ul><ul><li>Manualized </li></ul><ul><li>Effective with people dependent on stimulants </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    66. 66. Matrix: Challenges <ul><li>May require modification of material for clients with impaired cognitive functioning </li></ul><ul><li>Requires special staff training and supervision </li></ul><ul><li>May not appeal to all clients </li></ul><ul><li>May not allow for treatment of other non-drug-specific problems </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    67. 67. Community Reinforcement and Contingency Management <ul><li>Based on operant conditioning </li></ul><ul><li>Use small, frequent incentives (e.g., vouchers) to reward clients </li></ul><ul><li>Rewards are rewarding to the client </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    68. 68. CR/CM: Strengths <ul><li>Reduce drug use significantly </li></ul><ul><li>Combine readily with other interventions </li></ul><ul><li>Can be implemented with low-cost incentives including donations </li></ul><ul><li>Have extensive scientific support </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    69. 69. CR/CM: Challenges <ul><li>May be difficult to keep clients clean when incentives are terminated </li></ul><ul><li>Can be labor intensive </li></ul><ul><li>Require staff training and frequent client attendance </li></ul><ul><li>Require sufficiently large rewards to have continuing appeal </li></ul><ul><li>Does not emphasize importance of long-term supports </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    70. 70. SPECIFIC POPULATIONS Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    71. 71. Criminal Justice <ul><li>Special Issues </li></ul><ul><ul><li>Employment </li></ul></ul><ul><ul><li>Finances </li></ul></ul><ul><ul><li>Housing </li></ul></ul><ul><ul><li>Transportation </li></ul></ul><ul><ul><li>Education/LD </li></ul></ul><ul><ul><li>Co-Occurring Disorders </li></ul></ul><ul><ul><li>HIV/TB/Hepatitis </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    72. 72. CJ Integrated Treatment <ul><li>Counselors work with justice system to define: </li></ul><ul><ul><li>Discharge criteria </li></ul></ul><ul><ul><li>Use of drug-test results </li></ul></ul><ul><ul><li>Consequences for noncompliance and/or relapse </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    73. 73. Working with the Courts <ul><li>Identify </li></ul><ul><ul><li>Each partners’ responsibilities </li></ul></ul><ul><ul><li>Consequences for professional’s noncompliance </li></ul></ul><ul><ul><li>The types, content and schedule of reporting </li></ul></ul><ul><ul><li>Definitions of critical incidents that require the IOT program to notify the justice agency </li></ul></ul><ul><li>For more information see http://ndci.org </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    74. 74. Women <ul><li>Special Issues </li></ul><ul><ul><li>Violence </li></ul></ul><ul><ul><li>Mental Health </li></ul></ul><ul><ul><li>Parenting/custody </li></ul></ul><ul><ul><li>Childcare </li></ul></ul><ul><ul><li>Special needs children: FASD, preemies </li></ul></ul><ul><ul><li>Welfare </li></ul></ul><ul><ul><li>Pregnancy </li></ul></ul><ul><ul><li>Relationships </li></ul></ul><ul><ul><li>Gender Insensitivity </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    75. 75. Adolescents <ul><li>Adolescents may require habilitation rather than rehabilitation </li></ul><ul><li>Short attention spans </li></ul><ul><li>Limited future perspectives </li></ul><ul><li>Limited abilities to think abstractly </li></ul><ul><li>May require parental consent for treatment </li></ul><ul><li>More than half of adolescents with addictions also have psychiatric disorders </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    76. 76. Cultural Competence <ul><li>Holistic worldview—reconnection with the larger universe </li></ul><ul><li>Spirituality </li></ul><ul><li>Independence vs. Interdependence </li></ul><ul><li>Verbal and Nonverbal Communication </li></ul><ul><li>Multiple learning styles </li></ul><ul><li>Respect and dignity </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    77. 77. Specific Cultures <ul><li>Hispanics/Latinos </li></ul><ul><li>African Americans </li></ul><ul><li>Native Americans </li></ul><ul><li>Asian Americans and Pacific Islanders </li></ul><ul><li>Persons with HIV/AIDS </li></ul><ul><li>Lesbian, gay, and bisexual clients </li></ul><ul><li>Persons with physical and cognitive disabilities </li></ul><ul><li>Rural populations </li></ul><ul><li>Homeless populations </li></ul><ul><li>Older adults </li></ul><ul><li>Criminal Justice </li></ul><ul><ul><li>For more detailed information, see TIP 47, pp. 179–204 </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    78. 78. Resources <ul><li>www.ncadi.samhsa.gov </li></ul><ul><li>http://www.nimh.nih.gov/health/publications/index.shtml </li></ul><ul><ul><li>Many resources in English and Spanish </li></ul></ul><ul><li>Culturally competent substance abuse services annotated bibliography http://www.attc-ne.org/pubs/ccsat.pdf </li></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC
    79. 79. Summary <ul><li>IOP has many challenges but provides flexibility </li></ul><ul><li>Most effective if used in conjunction with contracts/rewards and a phased up/down approach </li></ul><ul><li>Integrates community resources to relieve some of the burden </li></ul><ul><ul><li>See also TIP 46 Administrative Issues </li></ul></ul>Copyright 2008-2012 AllCEUs.com A subsidiary of CDS Ventures, LLC

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