Transcript Document

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
Transdisciplinary Foundations
(A) Understanding
Addiction
(C) Application to
Practice
(B) Treatment
Knowledge
(D) Professional
Readiness
8 Practice Dimensions
Clinical evaluation (assessment/interview)
Treatment planning
Referral
Service coordination
Counseling
Client, family and community education
Documentation
Professional and ethical responsibilities
Addiction Counseling Competencies:
The Knowledge, Skills and Attitudes of Professional Practice
II
III
IV
V
VI
Clinical Evaluation
I
Dimensions of Professional Practice
IV.
III.
II.
I.
Professional Readiness
Application to Practice
Treatment Knowledge
Understanding Addiction
Transdisciplinary Foundations
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)
Screening
Intake
Orientation
Assessment
Treatment Planning
Treatment Planning
Counseling (Individual, Group, Counseling
Families, Couples & Significant Others)
Counseling
Crisis 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 of
established 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
What is Documentation?
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)
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Documentation
Approach
What is the
Problem ?
 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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Is It Working?
Response to
Intervention/
Instruction
Client &
Family
What Are We
going to Do About
It?
Intervention/
Solution
Why Is It
Occurring?
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.
20
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.
21
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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S.O.A.P. Notes,
Objective
• 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?
24
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?
25
S.O.A.P. Notes, Objective
• 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?
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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 Jackson
Cinderella 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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Gillman HIPAA Progress Note
• 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., 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 session
B.
Each day that the consumer is present in a residential or detox
program
C. Each time a consumer is redirected when displaying negative
feelings
D. At the time of discharge
E.
All of the above
Which of the following statements are incorrect?
A.
S = Subjective [Therapist’s view of problems or progress noted,
use consumer’s own words.]
B.
O = Objective [Therapist’s objective observations of the
consumers progress.]
C. A = Assessment [Therapist’s assessment of the consumer’s affect,
mental status, and psychosocial functioning.]
D. P = Plan [Plan for future treatment as it relates to progress noted.]
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Progress Note Test Questions:
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)
A.
All of the above
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Progress Note Test Questions:
Which of the following are elements of the Gillman HIPAA Progress
Note?
A.
Counseling session start and stop time
B.
Modalities of treatment furnished
C. Frequency of modalities furnished
D. Medication prescription and monitoring
E.
All of the above
Which of the following make the Gillman HIPAA Note superior to the
SOAP or DAP note?
A.
It requires the clinician to think in more behavioral terms
B.
It requires the clinician to focus on presenting symptoms
C. It requires the clinician to think about how frequently they have
made a HIPAA violation.
D. It requires the clinician to think about changes to their treatment
plan and recommendations
E.
It requires the clinician to think about the prognosis until the next
treatment session.
34
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.
Core Components of
Comprehensive Services
Medical
Financial
Housing &
Transportation
Core
Treatment
Intake
Assessment
Child
Care
Treatment
Plans
Group/Individual
Counseling
Abstinence
Based
Pharmacotherapy
Mental
Health
Urine
Monitoring
Case
Management
Continuing
Care
Self-Help
(AA/NA)
Family
AIDS /
HIV Risks
Vocational
Legal
Etheridge, Hubbard, Anderson, Craddock, & Flynn, 1997 (PAB)
Educational
An EvidenceBased Treatment
Model for
Improving
Practice
Texas Christian University
38
Elements of a Treatment
Process Model
Patient
Factors
Detox
Psychological
Functioning,
OP-DF
Motivation,
TC/Res
& Problem
Severity
OP-MM
?
Sufficient
Retention
Drug
Use
Crime
Social
Relations
Posttreatment
Cognitive and behavioral
components with therapeutic impact
TCU Treatment Process
Model
Motiv
Early
Engagement
Early
Recovery
Patient
Attributes
at Intake
Program
Participation
Behavioral
Change
Sufficient
Retention
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Post-treatment
Engagement
Simpson, 2001 (Addiction)
“Sequence” of Recovery Stages
Patient
Readiness
for Tx
Program
Participation
Behavioral
Change
Drug
Use
Adequate
Stay in Tx
Therapeutic
Relationship
Crime
Cognitive
Change
Social
Relations
Posttreatment
Targeted Interventions
Get Focused!!
Interventions Should
Maintain This Process
Motiv
Early
Engagement
Early
Recovery
Patient
Attributes
at Intake
Program
Participation
Behavioral
Change
Sufficient
Retention
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Post-treatment
Simpson, 2001 (Addiction)
Induction to Treatment
(Motivational Enhancement)
Motiv
Patient
Attributes
at Intake
Early
Engagement
Early
Recovery
Program
Participation
Behavioral
Change
Problem
Recognition
Desire
for Help
Readiness
for Treatment
Sufficient
Retention
Therapeutic
Relationship
Psycho-Social
Change
Drug
Use
Crime
Social
Relations
Post-treatment
Simpson & Joe, 1993 (Pt); Blankenship et al.,1999 (PJ); Sia, Dansereau, & Czuchry, 2000 (JSAT)
Counseling Enhancements
(Cognitive “Mapping”)
Motiv
Early
Engagement
Early
Recovery
Patient
Attributes
at Intake
Program
Participation
Behavioral
Change
Sufficient
Retention
Therapeutic
Relationship
Psycho-Social
Change
Drug
Use
Crime
Social
Relations
Post-treatment
Dansereau et al., 1993 (JCP), 1995 (PAB); Joe et al., 1997 (JNMD); Pitre et al., 1998 (JSAT)
Contingency Management
(Token Rewards)
Motiv
Early
Engagement
Early
Recovery
Patient
Attributes
at Intake
Program
Participation
Behavioral
Change
Sufficient
Retention
Therapeutic
Relationship
Psycho-Social
Change
Drug
Use
Crime
Social
Relations
Post-treatment
Rowan-Szal et al., 1994 (JSAT); 1997 (JMA); Griffith, Rowan-Szal et al., 2000 (DAD)
Specialized Interventions
(Skills-Based Counseling Manuals)
Motiv
Patient
Attributes
at Intake
Early
Engagement
Early
Recovery
Program
Participation
Behavioral
Change
Supportive
Networks
Sufficient
Retention
Therapeutic
Relationship
Psycho-Social
Change
Drug
Use
Crime
Social
Relations
Post-treatment
Bartholomew et al., 1994 (JPD); 2000 (JSAT); Hiller et al., 1996 (SUM)
Evidence-Based Treatment Model
Induction
Motiv
Patient
Attributes
at Intake
Staff
Attributes
& Skills
Behavioral
Strategies
Family &
Friends
Early
Engagement
Early
Recovery
Program
Participation
Behavioral
Change
Personal Health Services
Supportive
Networks
Sufficient
Retention
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Program
Characteristics
Post-treatment
Enhanced
Counseling
Social Skills
Training
Social Support Services
Simpson, 2001 (Addiction)
Questions?
The
End.
Thank
you!