Module 1 Substance Abuse Treatment for Persons with Co-Occurring Disorders Inservice Training Based on A Treatment Improvement Protocol TIP 42 What is a TIP? * Best-practice guidelines for treatment of substance use disorders * Developed by Center for Substance Abuse Treatment (CSAT) * Draws on experience and knowledge of clinical, research, and administrative experts in a particular topic area * Consensus Panel for TIP 42, page xi ATTC Network 2001-2006 Introduction—Module 1 In This Module . . . TIP Exercise—Terms * Read the left column on Page 27 * Discuss with your partner: • Which of these terms have you ever used or heard? • Which of these terms are used in your programs? • What advantages does the term “co-occurring disorders” have over “dual diagnosis” and “dual disorder”? Over the other terms? Co-Occurring Disorders Co-occurring disorders * Refers to co-occurring substance use (abuse or dependence) and mental disorders. Clients said to have co-occurring disorders have: * one or more disorders relating to the use of alcohol and/or other drugs of abuse and one or more mental disorders. Diagnosis of co-occurring disorders (COD) occurs when * at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from the one disorder. Co-Occurring Disorders: Your setting 1. Do these definitions describe clients in your practice/program? (Estimate percentage or describe prevalence) 2. How has serving clients with COD affected your practice/program? 3. What challenges do clients with COD present to your clinical knowledge and skills? Co-Occurring Disorders: Implications * Treatment – Prevalence of COD, multiple problems they create, impact on treatment and treatment outcome, new models/strategies are receiving attention and encouraging treatment innovation * Clinicians & Knowledge Dissemination – Knowledge of both mental health and substance abuse is essential and dissemination of knowledge has become widespread Why a new TIP on Co-Occurring Disorders? * Availability of data * Treatment innovations for other populations with COD * Changes in treatment delivery * Advances in treatment * Recent developments Prevalence of COD * In 2002, 4 million adults met the criteria for both serious mental illness (SMI) and substance dependence and abuse. * An estimated 10 million Americans of all ages and in both institutional and non-institutional settings have COD in any given year. Prevalence of COD among SMI and SA Adult Populations Prevalence and Other Data Data now show: * COD are common in general adult population. * Increased prevalence of people with COD and programs for people with COD. * People with COD are more likely to be hospitalized and the rate may be increasing. * Rates of mental disorders increase as the number of substance use disorders increase. Why a new TIP on Co-Occurring Disorders? * Availability of data * Treatment innovations for other populations with COD * Changes in treatment delivery * Advances in treatment * Recent developments Advances in Treatment of COD * “No wrong door” policy * Mutual self-help for people with COD * Integrated care as a priority for people with severe and persistent mental illness * Development of effective approaches, models, and strategies * Pharmacological advances Recent Developments * National Registry of Effective Programs and Practices (NREPP) * Co-Occurring Disorders State Incentive Grants (COSIG) * Co-Occurring Center for Excellence (COCE) * Report to Congress on the Prevention and Treatment of Co-Occurring Substance Use Disorders and Mental Disorders * Co-Occurring Disorders: Integrated Dual Disorders Treatment Implementation Resource Kit Module 2 Introduction Definitions, Terms and Classification Systems for Co-Occurring Disorders In This Module . . . Review and discuss terms related to: * Substance Use Disorders * Mental Disorders * Clients * Treatment * Programs * Systems The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) * Produced by the American Psychiatric Association (APA). * Establishes criteria for diagnosing specific disorders. * Used by the medical and mental health fields as a reference for diagnosing substance use and mental health disorders. * Provides for a common language for communicating about disorders. Terms Related to Substance Use Disorders * Substance Abuse * Substance Dependence – addiction Terms Related to Mental Disorders Personality Disorders Cluster A: * Involve odd or eccentric behavior. * Includes paranoid, schizoid, and schizotypal personality disorders. Cluster B: * Involve dramatic, emotional, or erratic behavior. * Includes antisocial, borderline, histrionic, and narcissistic personality disorders. Cluster C: * Involve anxious, fearful behavior. * Includes avoidant, dependent, and obsessive-compulsive personality disorders. Psychotic Disorders * Delusions * Hallucinations * These clients constitute what is commonly referred to as the serious and persistent mentally ill population * Schizophrenia – Paranoid type – Disorganized type – Catatonic type – Undifferentiated type – Residual type Mood and Anxiety Disorders * Mood disorders – Depression – Mania – Bipolar disorder * Anxiety disorders – Social phobia – Panic disorders – Post traumatic stress disorder (PTSD) Terms Related to Clients * Person-centered terminology * Terms for co-occurring disorders * Diagnosis vs. symptoms Terms Related to Treatment Levels of Service Terms Related to Treatment Quadrants of Care Terms Related To Treatment * Interventions * Integrated Interventions * Episodes of Treatment * Integrated Treatment * Culturally Competent Treatment * Integrated Counselor Competencies Terms Related to Programs Key Programs * Mental health-based programs * Substance abuse treatment programs Program Types * Addiction only services * Dual diagnosis capable * Dual diagnosis enhanced Terms Related to Systems * Substance Abuse Treatment System * Mental Health Services System * Interlinking Systems * Comprehensive Continuous Integrated System of Care Discussion From a client or clinician or system perspective: * How does terminology help and hinder service to clients with co-occurring disorders? * Which of the terms mentioned are most useful to you? Which do you want to know more about? Module 3A Introduction Keys to Successful Programming: Guiding Principles and Core Components TIP Chapter 3 * Module 3A – Guiding principles in treatment – Core components in delivery of services * Module 3B – Improving substance abuse treatment systems and programs – Workforce development and staff support In This Module . . . Delivery of Services Core Components TIP Exercise—Guiding Principles & Core Components 1. In your own words explain your assigned Guiding Principle. – Give examples of how you apply (or need to apply) this principle in your practice or program. 2. In your own words explain your assigned Core Component. – Is this an area of strength or challenge for your agency? Explain. Quick TIP Exercise— Levels of Program Capacity With your group 1. Review Figure 3-2 on page 44 and explanatory text on page 43 (left column). 2. Where on the graph would you place your agency? Why? Module 3B Introduction Keys to Successful Programming: Improving Substance Abuse Treatment Systems & Programs and Workforce Development & Staff Support Delivery of Services Core Components TIP Chapter 3 * Module 3A – Guiding principles in treatment – Core components in delivery of services * Module 3B – Improving substance abuse treatment systems and programs – Workforce development and staff support Improving Substance Abuse Treatment Systems & Programs Challenges include: * How do we organize a system that will provide continuity of care? * How do we access funding for program improvement? * How do we integrate research and practice to give clients the benefit of proven treatment strategies? TIP Exercise—Attitudes & Values Self-Assessment For each item in Figure 3-7 (p. 57) assess yourself based on your observable behavior, the way you think an outside evaluator would assess you. TIP Exercise—Basic Competencies Self-Assessment For each item in Figure 3-8 (p. 58) assess yourself based on your observable behavior, the way you think an outside evaluator would assess you TIP Exercise—Avoiding Burnout Self-Assessment For each item bulleted on page 62 assess how well you take care of yourself by complying with these recommendations Module 4A Introduction Assessment: Screening and Step 1 & Step 2 TIP Chapter 4: Assessment * Module 4A – Introduction, terminology, Step 1–Step 2 * Module 4B – The Assessment Process: Step 3–Step 7 * Module 4C – The Assessment Process: Step 8–Step 12 * Case studies, review of relevant appendices, and key considerations in treatment matching. Screening * Screening for COD seeks to answer a “yes” or “no” question: – Does the substance abuse client being screened show signs of a possible mental health problem? OR – Does the mental health client being screened show signs of a possible substance abuse problem? TIP Exercise— Screening Instruments Option 1: Behavioral Rehearsal & Discussion With your partner, take turns administering whichever instrument is least familiar: TIP Exercise— Screening Instruments Option 2: Review & Discussion Screening Protocol * A professionally designed screening process or protocol establishes precisely . . . – How any screening tools or questions are scored – What constitutes scoring positive for a particular possible problem (“establishing cut-off scores”) – What happens if a client scores in the positive range * and provides the standard forms to document – Results of all later assessments – That each staff member has carried out his or her responsibilities in the process Screening+Assessment Tx Plan * Screening is a process for evaluating the possible presence of a particular problem. * Assessment is a process for defining the nature of that problem and developing specific treatment recommendations for addressing the problem. * A comprehensive assessment serves as the basis for an individualized treatment plan. The treatment plan must be matched to individual needs. Step 1: Engage the Client * “No wrong door” * Empathic detachment * Person-centered assessment * Sensitivity to culture, gender, and sexual orientation * Trauma sensitivity Module 4B Introduction Assessment: Step 3–Step TIP Chapter 4: Assessment * Module 4A – Screening and Step 1–Step 2 * Module 4B – The Assessment Process: Step 3–Step 7 * Module 4C – The Assessment Process: Step 8–Step 12 12 Step Assessment Process 1: Engage the client 2: Identify & contact collaterals to gather additional information 3: Screen for & detect COD 4: Determine quadrant & locus of responsibility 5: Determine level of care 6: Determine diagnosis Screening * Screening for COD seeks to answer a “yes” or “no” question: – Does the substance abuse client being screened show signs of a possible mental health problem? OR – Does the mental health client being screened show signs of a possible substance abuse problem? Step 3: Screen and Detect COD Screen for: * Acute safety risk * Past and present mental health symptoms/disorders * Past and present substance abuse disorders * Cognitive and learning deficits * Past and present victimization and trauma Screening for Substance Use Disorder (Mental Health settings) * Substance abuse symptom checklists * Substance abuse severity checklists * Formal screening tools that work around denial * Screening of urine, saliva, or hair samples 12 Step Assessment Process 1: Engage the client 2: Identify & contact collaterals to gather additional information 3: Screen for & detect COD 4: Determine quadrant & locus of responsibility 5: Determine level of care 6: Determine diagnosis Step 4: Determine Quadrant and Locus of Responsibility Determination of SMI Status * What is the State’s criteria for SMI? * How is eligibility established? * Is the client already receiving mental health priority services? * Does the client appear to be eligible? Step 4: Determine Quadrant and Locus of Responsibility TIP Exercise— Cases & Quadrants of Care With your partner: * Select one case (Maria M., or George T., or Jane B.) on pp. 69 and 70. * Change or add information that would result in assignment of that case to a different quadrant. 12 Step Assessment Process 1: Engage the client 2: Identify & contact collaterals to gather additional information 3: Screen for & detect COD 4: Determine quadrant & locus of responsibility 5: Determine level of care 6: Determine diagnosis Level of Care Instruments ASAM PPC 2R - Dimensions * Acute Intoxication and/or Withdrawal Potential * Biomedical Conditions and Complications * Emotional, Behavioral, or Cognitive Conditions and Complications (includes risk) * Readiness to Change * Relapse, Continued Use, or Continued Problem Potential * Recovery/Living Environment 12 Step Assessment Process 1: Engage the client 2: Identify & contact collaterals to gather additional information 3: Screen for & detect COD 4: Determine quadrant & locus of responsibility 5: Determine level of care 6: Determine diagnosis Step 6: Determine Diagnosis * Principle 1—Diagnosis is established more by history than by current symptom presentation. * Principle 2—It is important to document prior diagnoses and gather information related to current diagnoses. * Principle 3—It is almost always necessary to tie mental symptoms to specific periods of time in the client’s history, in particular times when active substance use disorder was not present. 12 Step Assessment Process 1: Engage the client 2: Identify & contact collaterals to gather additional information 3: Screen for & detect COD 4: Determine quadrant & locus of responsibility 5: Determine level of care 6: Determine diagnosis TIP Exercise—Step 7 Application to Case Examples * Review with your partner the case on p. 89 OR the case on p. 90. * In your opinion, how useful was the determination of disability and functional impairment: – For the counselor? – For the client? Assessing Functional Capability * Is the client capable of living independently? If not, what types of support are needed? * Is the client capable of supporting himself financially? Through what means? If not, is the client disabled or financially dependent on others? * Can the client engage in reasonable social relationships? Are there good social supports? If not, what interferes, and what supports are needed? * What is the client’s level of intelligence? Is there a developmental or learning disability? Cognitive or memory impairments? Limited ability to read, write, or understand? Difficulties focusing and completing tasks? Module 4C Introduction Assessment: Step 8–Step 12 TIP Chapter 4: Assessment * Module 4A – Screening and Step 1–Step 2 * Module 4B – The Assessment Process: Step 3–Step 7 * Module 4C – The Assessment Process: Step 8–Step 12 12 Step Assessment Process 1: Engage the client 2: Identify & contact collaterals to gather additional information 3: Screen for & detect COD 4: Determine quadrant & locus of responsibility 5: Determine level of care 6: Determine diagnosis 12 Step Assessment Process 1: Engage the client 2: Identify & contact collaterals to gather additional information 3: Screen for & detect COD 4: Determine quadrant & locus of responsibility 5: Determine level of care 6: Determine diagnosis 12 Step Assessment Process 1: Engage the client 2: Identify & contact collaterals to gather additional information 3: Screen for & detect COD 4: Determine quadrant & locus of responsibility 5: Determine level of care 6: Determine diagnosis Cultural Assessment—COD * Three important issues for those with COD: – Not fitting into the treatment culture (do not fit into either substance abuse or mental health treatment culture) and conflict in treatment – Cultural and linguistic service barriers – Problems with literacy 12 Step Assessment Process 1: Engage the client 2: Identify & contact collaterals to gather additional information 3: Screen for & detect COD 4: Determine quadrant & locus of responsibility 5: Determine level of care 6: Determine diagnosis 12 Step Assessment Process 1: Engage the client 2: Identify & contact collaterals to gather additional information 3: Screen for & detect COD 4: Determine quadrant & locus of responsibility 5: Determine level of care 6: Determine diagnosis TIP Exercise—Stages of Change 12 Step Assessment Process 1: Engage the client 2: Identify & contact collaterals to gather additional information 3: Screen for & detect COD 4: Determine quadrant & locus of responsibility 5: Determine level of care 6: Determine diagnosis TIP Exercise—Plan Treatment With your group, use format on p. 96 to . . . * Plan treatment for: – Maria M. (pp. 69, 87, 89, 92) or Jane B. (pp. 70, 83, 91) * Address at least two (2) problems * Include for each: – Related information (strengths, cultural issues, etc.) – Stage of readiness to change – Recommended interventions – Goals Module 5A Introduction Strategies for Working with Clients with Co-Occurring Disorders: Guidelines for a Successful Therapeutic Alliance 12 Step Assessment Process 1. Engage the client 2. Identify & contact collaterals to gather additional information 3. Screen for & detect COD 4. Determine quadrant & locus of responsibility 5. Determine level of care 6. Determine diagnosis In This Module . . . * Module 5A – Review guidelines for maintaining a successful therapeutic relationship with a client who has COD * Module 5B – Examine techniques for working with clients with COD TIP Exercise— Advice to the Counselor With your partner(s): 1. Imagine you are a person with COD receiving services. 2. Review your assigned Advice to the Counselor text box. 3. Which two (2) recommendations would you most want your provider to follow? Why? TIP Exercise—Report Out * State the Guideline you examined. * Read aloud all of the recommendations. * State which two (2) your group chose. * Give reasons for your group’s choice and summarize any discussion that took place. Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support Potential for Harm * Ask explicitly about suicide or the intention to do harm to someone else when the client assessment indicates that either is an issue. * Monitor clients who express such thoughts closely. * Ask about suicidal thoughts and plans as a routine part of every session with a suicidal or depressed person. * Immediately follow up appointments missed by an acutely suicidal person. * Review discussion of suicidality in Chapter 8 and in Appendix D of TIP 42. Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support Confrontation “The heart of confrontation is not the aggressive breaking down of the client and his or her defenses, but feedback on behavior and the compelling appeal to the client for personal honesty, truthfulness in interacting with others, and responsible behavior.” Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support Guidelines for Developing Successful Therapeutic Relationships 1. Develop and use a therapeutic alliance to engage the client in treatment 2. Maintain a recovery perspective 3. Manage countertransference 4. Monitor psychiatric symptoms 5. Use supportive and empathic counseling 6. Employ culturally appropriate methods 7. Increase structure and support Module 5B Introduction Strategies for Working with Clients with Co-Occurring Disorders: Techniques for a Working with Clients with COD In This Module . . . * Module 5A – Guidelines for a successful Therapeutic Relationship with a Client who has COD * Module 5B – Techniques for Working with Clients with CO Key Techniques for Working With Clients Who Have COD 1. Motivational enhancement consistent with the client’s stage of change. 2. Contingency management techniques to address specific target behaviors. 3. Cognitive-behavioral therapeutic techniques. 4. Relapse prevention techniques. 5. Repetition and skills-building to address deficits in functioning. 6. Facilitate client participation in mutual self-help groups. Motivational Interviewing (MI) Motivational Interviewing (MI) is a “client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.” Key Techniques for Working With Clients Who Have COD 1. Motivational enhancement consistent with the client’s stage of change. 2. Contingency management techniques to address specific target behaviors. 3. Cognitive-behavioral therapeutic techniques. 4. Relapse prevention techniques. 5. Repetition and skills-building to address deficits in functioning. 6. Facilitate client participation in mutual self-help groups. Key Techniques for Working With Clients Who Have COD 1. Motivational enhancement consistent with the client’s stage of change. 2. Contingency management techniques to address specific target behaviors. 3. Cognitive-behavioral therapeutic techniques. 4. Relapse prevention techniques. 5. Repetition and skills-building to address deficits in functioning. 6. Facilitate client participation in mutual self-help groups. Key Techniques for Working With Clients Who Have COD 1. Motivational enhancement consistent with the client’s stage of change. 2. Contingency management techniques to address specific target behaviors. 3. Cognitive-behavioral therapeutic techniques. 4. Relapse prevention techniques. 5. Repetition and skills-building to address deficits in functioning. 6. Facilitate client participation in mutual self-help groups. Relapse Prevention “. . . a central element of all clinical approaches to relapse prevention is anticipating problems that are likely to arise in maintaining change and labeling them as high-risk situations for resumed substance use, then helping clients to develop effective strategies to cope with those high-risk situations without having a lapse.” Key Techniques for Working With Clients Who Have COD 1. Motivational enhancement consistent with the client’s stage of change. 2. Contingency management techniques to address specific target behaviors. 3. Cognitive-behavioral therapeutic techniques. 4. Relapse prevention techniques. 5. Repetition and skills-building to address deficits in functioning. 6. Facilitate client participation in mutual self-help groups. Key Techniques for Working With Clients Who Have COD 1. Motivational enhancement consistent with the client’s stage of change. 2. Contingency management techniques to address specific target behaviors. 3. Cognitive-behavioral therapeutic techniques. 4. Relapse prevention techniques. 5. Repetition and skills-building to address deficits in functioning. 6. Facilitate client participation in mutual self-help groups. Module 6A Introduction Traditional Settings and Models: Essential Programming for Clients with COD Review 5B Techniques— Working with Clients Who Have COD In This Module . . . * Module 6A – Essential Programming & General Considerations for Treatment of Clients with COD * Module 6B – Outpatient Substance Abuse Treatment Programs for Clients with COD * Module 6C – Residential Substance Abuse Treatment Programs for Clients with COD Discussion— Modifications to Group Work With your partner or small group discuss: * What 3 modifications would you advise a novice counselor to make when conducting group therapy with clients with COD? Modifications to Group Quick TIP Exercise— 7 Recommendations With your group: * Rank-order the seven (7) recommendations in order of importance. * Be prepared to give your reasons. Discussion—List Revision With your partner or group 1. Renumber your group’s list of seven (7) recommendations in order of importance (if you wish to change the order). 2. Are there any essential program elements you would add? Discussion—List Revision Option for Administrators With your partner or group 1. Renumber your group’s list of seven (7) recommendations in order of importance (if you wish to change). 2. Does your program reflect these seven (7) recommendations? In this order? Module 6B Introduction Traditional Settings and Models: Outpatient Substance Abuse Treatment Programs for Clients with COD Chapter 6 Modules * Module 6A – Essential Programming & General Considerations for Treatment of Clients with COD * Module 6B – Outpatient Substance Abuse Treatment Programs for Clients with COD * Module 6C – Residential Substance Abuse Treatment Programs for Clients with COD 7 Essential Elements & General Considerations In This Module . . . * Outpatient Substance Abuse Treatment Programs for Clients with COD – Designing – Implementing – Evaluating – Sustaining – Examples of programs Designing Outpatient Programs for Clients with COD * Screening and assessment * Centralized intake * Reassessment * Referral and Placement * Engagement * Discharge Planning * Continuing Care Quick TIP Exercise Review “Improving Adherence of Clients with COD in Outpatient Settings” (p. 147). Discharge Planning * Housing * Case management services * Medication management * Relapse prevention * Positive peer networks – Mutual self help groups * Advocacy involvement Continuing Care Clients with COD often require long-term continuity of care that: Evaluating Outpatient Programs for Clients with COD 1. Define operational goals in terms of the client behaviors 2. Decide on study clients and sampling 3. Locate and/or develop instruments 4. Develop plan for data collection 5. Develop plan for analysis and reporting Nine Essential Features of ACT 1. Services provided in the community 2. Assertive engagement with active outreach 3. High intensity of services 4. Small caseloads 5. Continuous 24-hour responsibility 6. Team approach 7. Multidisciplinary team, reflecting integration of services 8. Close work with support systems 9. Continuity of staffing ICM Activities and Interventions * Engage client to facilitate process & connect with community-based treatment programs * Assess needs, identify barriers & facilitate access to treatment * Offer practical assistance & facilitate linkages * Make referrals * Advocate for client * Monitor progress * Provide counseling & support * Crisis intervention * Assist in facilitating communication between service providers TIP Exercise—Act / ICM Grid * In small groups, use the information in your TIP text to complete the handout grid for the model you have been assigned (ACT or ICM). Module 6C Introduction Traditional Settings and Models: Residential Substance Abuse Treatment Programs for Clients with COD Chapter 6 Modules * Module 6A – Essential Programming & General Considerations for Treatment of Clients with COD * Module 6B – Outpatient Substance Abuse Treatment Programs for Clients with COD * Module 6C – Residential Substance Abuse Treatment Programs for Clients with COD 7 Essential Elements & General Considerations In This Module . . . * Residential Substance Abuse Treatment for Clients with COD – Designing – Implementing – Evaluating – Sustaining – Examples of programs Designing Residential Programs for Clients with COD * Intake * Assessment * Engagement * Continuing Care * Discharge Planning TIP Exercise—Design In groups or with partners: 1. Read recommendations on your topic. 2. Think about how these activities are conducted in your programs. 3. Describe what could stay the same and what would need to change in your program to meet the recommendations for COD programs. Intake Steps 1. Written referral 2. Intake interview 3. Program review 4. Team meeting Assessment Areas * Substance abuse evaluation * Mental health evaluation * Health and medical evaluation * Entitlements * Client status Continuing Care Discharge Planning * Housing * Case management services * Medication management * Relapse prevention * Positive peer networks – Mutual self help groups * Advocacy involvement Staffing Recommendations * Program director * Secretary * Program supervisor * 10 line staff * Clinical coordinator * Nurse practitioner (half-time) * Entitlements counselor (half-time) * Vocational rehabilitation counselor (half-time) * Consultive arrangements for medical, psychiatric, and psychological input or care Quick TIP Exercise—Training 1. With your partner, look over the questions in Figure 6-3 (pp. 167–168). 2. Substitute the treatment model used in your workplace for each “TC” in the questions. 3. Which questions can you answer easily? 4. Which are you less sure of? Evaluating Residential Programs for Clients with COD 1. Define operational goals in terms of the client behaviors 2. Decide on study clients and sampling 3. Locate and/or develop instruments 4. Develop plan for data collection 5. Develop plan for analysis and reporting Sustaining Residential Programs for Clients with COD For quality control, the CQI staff uses: * Observation * Key informant interviews * Resident focus groups * Standardized instruments * Staff review Therapeutic Community (TC) Module 7A Introduction Special Settings and Specific Populations: Acute Care and Other Medical Settings, and Dual Recovery Mutual Self-Help Groups Chapter 6 Modules * Module 6A – Essential Programming & General Considerations for Treatment of Clients with COD * Module 6B – Outpatient Substance Abuse Treatment Programs for Clients with COD * Module 6C – Residential Substance Abuse Treatment Programs for Clients with COD In This Module . . . * Module 7A – Acute care and other medical settings – Dual recovery and mutual self help programs * Module 7B – Specific populations with COD: homeless, criminal justice, women TIP Resources * TIP 16—Alcohol and Other Drug Screening of Hospitalized Trauma Patients * TIP 19—Detoxification from Alcohol and Other Drugs * TIP 24—A Guide for Substance Abuse Services for Primary Care Physicians * TIP 34—Brief Interventions and Brief Therapies for Substance Abuse TIP Exercise—Dual Recovery In groups review your assigned topic, then answer: 1. Is this topic ever an issue for COD clients in your agency? 2. If any participate in 12-Step groups, what has been their experience with this issue? 3. What could be done to address this issue in your agency? In your community? Module 7B Introduction Special Settings and Specific Populations: Homeless, Criminal Justice, Women In This Module . . . * Module 7A – Acute care and other medical settings – Dual recovery and mutual self help programs * Module 7B – Specific populations with COD: homeless, criminal justice, women TIP Resources * TIP 17—Planning for Alcohol and Other Drug Abuse Treatment for Adults in the Criminal Justice System * TIP 21—Combining Alcohol and Other Drug Abuse Treatment With Diversion for Juveniles in the Justice System * TIP 30—Continuity of Offender Treatment for Substance Use Disorders From Institution to Community Upcoming TIPs * Substance Abuse Treatment for Adults in the Criminal Justice System * Substance Abuse Treatment: Addressing the Specific Needs of Women http://www.treatment.org/ TIP Exercise—Population Jigsaw 1. Read about your assigned population and answer handout questions. 2. Regroup so there is a 1, 2, 3, and 4 in your small group. 3. Take turns teaching each other what you’ve learned. 4. Report out on group’s discussion. Module 8A Introduction A Brief Overview of Specific Mental Disorders and Cross-Cutting Issues: Suicidality, Nicotine Dependence, and Personality Disorders Module 7 * Module 7A – Acute care and other medical settings – Dual recovery and mutual self help programs * Module 7B – Specific populations with COD: homeless, criminal justice, women Chapter’s Format * Disorder category (i.e. Personality, Mood, Anxiety, Psychotic) – What counselors should know about this category and substance abuse * Specific disorders within each category – What counselors should know about substance abuse and the specific disorder – Diagnostic features and criteria from the DSM-IV-TR – Case study – Advice to the counselor In This Module . . . TIP Exercise— Group Assignments Group 1—Suicidality (pp. 214–216) – Appendix D, pp. 326–333 Group 2—Nicotine Dependence (pp. 216–220) – Appendix D, pp. 333–347 Group 3—Borderline Personality (pp. 220–224) – Appendix D, pp. 353–359 Group 4—Antisocial Personality (pp. 224–226) – Appendix D, pp. 359–368 TIP Exercise— What Counselors Should Know, Diagnostic Features & Criteria, Advice to the Counselor, & Case Study Module 8B Introduction A Brief Overview of Specific Mental Disorders and Cross-Cutting Issues: Mood & Anxiety Disorders, Schizophrenia & Other Psychotic Disorders Chapter’s Format * Disorder category (i.e. Personality, Mood, Anxiety, Psychotic) – What counselors should know about this category and substance abuse * Specific disorders within each category – What counselors should know about substance abuse and the specific disorder – Diagnostic features and criteria from the DSM-IV-TR – Case study – Advice to the counselor In This Module . . . TIP Exercise—Assignments Group 1—Mood Disorder – Diagnosis pp. 227–228 – Discussion pp. 226–230; and 369–383 Group 2—Anxiety Disorder – Diagnosis p. 230 – Discussion pages same as Mood Disorder Group 3—Schizophrenia – Discussion pp. 231–235; and 385–400 TIP Exercise—Role Play With your group: * Review the text’s sections on your assigned diagnosis and related information. * Create a 3–5 minute role-play script that illustrates key information. – A scene likely to play out in your practice – All group members must have a role * Teach us by performing your role play. Module 8C Introduction A Brief Overview of Specific Mental Disorders and Cross-Cutting Issues: ADHD, PTSD, Eating Disorders, Pathological Gambling In This Module . . . TIP Exercise—Assignments Group 1—AD/HD (pp. 235–237) – Appendix D, pp. 402–408 Group 2—PTSD (pp. 238–240) – Appendix D, pp. 408–416 Group 3—Eating Disorders (pp. 240–246) – Appendix D, pp. 417–425 Group 4—Pathological Gambling (pp. 246–248) – Appendix D, pp. 425–436 TIP Exercise— Panel Presentation With your group: * Review the text’s sections on your assigned diagnosis and related information. * Create a 3–5 minute panel presentation on: “How to Recognize and Work with Substance Abuse Clients Who Also Have ______ Disorder ” – Features to look for – Prevalence, assessment, and engagement – Practical information on working with client Module 9 Introduction Substance-Induced Disorders Chapter 8 What Every Counselor Should Know Types of medications: * Antipsychotics * Antimanic * Antidepressants * Antianxiety * Stimulants * Narcotics * Antiparkinsonian * Hypnotics * Addiction treatment In This Module . . . * Substance-Induced Disorders – Description • Alcohol • Caffeine • Cocaine and Amphetamines • Hallucinogens • Nicotine • Opioids • Sedatives – Diagnostic Considerations – Case Studies – Appendix F TIP Exercise— Substance-Induced Disorders With your group: * Review the text’s sections on the assigned substance. * Use your handout to create a brief case study.