TWELVE
CORE FUNCTIONS OF THE
ALCOHOL AND OTHER DRUG ABUSE COUNSELOR
The Case Presentation Method is based on Twelve Core Functions.
Scores on the CPM are based on the Global Criteria for each Core
Function. The counselor must be
able to demonstrate competence by achieving a passing score on the Global
Criteria in order to be certified. Although
the Core functions may overlap, depending on the nature of the counselor’s
practice, each represents a specific entity.
Give specifics throughout and do not supply original definitions.
I.
Screening:
The process by which the client is determined appropriate and eligible
for admission to a particular program.
Global Criteria
1. Evaluate
psychological, social, and physiological signs and symptoms
of alcohol and other drug use and abuse.
2. Determine the client’s appropriateness
for admission or referral.
3. Determine the client’s eligibility
for admission or referral.
4. Identify any coexisting
conditions (medical, psychiatric, physical, etc.) that indicate need for additional
professional
assessment and/or services.
5. Adhere
to applicable laws, regulations and
agency policies governing alcohol and other drug abuse services.
Explanation
This function requires that the counselor consider a variety of factors
before deciding whether or not to admit the potential client for treatment.
It is imperative that the counselor use appropriate diagnostic criteria
to determine whether the applicant’s alcohol or other drug use constitutes
abuse. All counselors must be able
to describe the criteria they use and demonstrate their competence by presenting
specific examples of how the use of alcohol and other drugs has become
dysfunctional for a particular client.
The determination of a particular client’s appropriateness for a
program requires the counselor’s judgment and skill and is influenced by the
program’s environment and modality (i.e., inpatient, outpatient, residential,
pharmacotherepy, detoxification, or day care).
Important factors include the nature of the substance abuse, the physical
condition of the client, the psychological functioning of the client, outside
supports/resources, previous treatment efforts, motivation and philosophy of the
program.
The eligibility criteria are generally determined by the focus, target
population and funding requirements of the counselor’s program or agency.
Many of the criteria are easily ascertained.
These may include the client’s age, gender, place of residence, legal
status, veteran status, income level and the referral source.
Allusion to following agency policy is a minimally acceptable statement
If
the applicant is found ineligible or inappropriate for this program, the
counselor should be able to suggest an alternative
II.
Intake:
The administrative and initial assessment procedures for admission to a
program.
Global Criteria
6. Complete
required documents for admission
to the program.
7. Complete
required documents for program eligibility
and appropriateness.
8. Obtain
appropriately signed consents when
soliciting from or providing information
to outside sources to protect client confidentiality and rights.
Explanation
The intake usually becomes an extension of the screening, when the decision to
admit is formally made and documented. Much
of the intake process includes the completion of various forms.
Typically, the client and counselor fill out an admission or intake
sheet, document the initial assessment, complete appropriate releases of
information, collect financial data, sign a consent for treatment and assign the
primary counselor.
III.
Orientation:
Describing to the client the following:
general nature and goals of the program; rules governing client conduct
and infractions that can lead to disciplinary action or discharge from the
program; in a non-residential program, the hours during which services are
available; treatment costs to be borne by the client, if any; and client rights.
Global Criteria
9. Provide an overview
to the client by describing program
goals and objectives for client
care.
10. Provide an overview to
the client by describing program rules,
and client obligations and rights.
11. Provide an overview to
the client of program operations.
Explanation
The orientation may be provided before, during and/or after the
client’s screening and intake. It
can be conducted in an individual, group, or family context.
Portions of the orientation may include other personnel for certain
specific aspects of the treatment, such as
medication.
IV.
Assessment:
The procedures by which a counselor/program identifies and
evaluates an individual’s strengths, weaknesses, problems and needs for
the development of a treatment plan.
Global Criteria
12. Gather
relevant history from client
including but not limited
to alcohol and other drug abuse using
appropriate interview techniques.
13. Identify methods
and procedures for obtaining corroborative
information from significant secondary sources regarding client’s
alcohol and other drug abuse and psycho-social history.
14. Identify
appropriate assessment tools.
15. Explain
to the client the rationale for the
use of assessment
techniques in order to
facilitate understanding.
16.
Develop a diagnostic evaluation
of the client’s substance abuse and any coexisting conditions based on the
results of all assessments in order to provide an integrated approach to
treatment planning based on the client’s strengths, weaknesses, and identified
problems and needs.
Explanation
Although assessment is a continuing process, it is generally emphasized
early in treatment.
It usually results from a combination of focused interviews,
testing and/or record reviews.
The counselor evaluates major life area (i.e., physical health,
vocational development, social adaptation, legal involvement and psychological
functioning) and assesses the extent to which alcohol or drug use has interfered
with the client’s functioning in each of these areas.
The result of this assessment should suggest the focus of treatment.
V.
Treatment Planning:
Process
by which the counselor and the client identify and rank problems needing
resolution; establish agreed upon immediate
and long-term goals; and decide upon a treatment process and the resources to be
utilized.
Global Criteria
17. Explain
assessment results to client in an
understandable manner.
18. Identify
and rank problems based on
individual client needs in the written treatment plan.
19.
Formulate agreed upon immediate
and long-term goals using behavioral
terms in the written treatment plan.
20.
Identify the treatment methods
and resources to be utilized as
appropriate for the individual client.
Explanation
The treatment contract is based on the assessment and is a product of a
negotiation between the client and the counselor to assure that the plan is
tailored to the individual’s needs. The language of the problem, goal, and
strategy statements should be specific, intelligible to the client and expressed
in behavioral terms. The statement of the
problem concisely elaborates on a client’s need
identified previously. The goal
statements refer specifically to the identified problem and may include on
objective of a set of objectives ultimately intended to resolve or mitigate the
problem. The goals must be
expressed in behavioral terms in order for the counselor and client to determine
progress in treatment. Both
immediate and long-term goals should be established.
The plan or strategy is a specific activity that links the problem with
the goal. It describes the
services, who will perform them, when they will be provided, and at what
frequency. Treatment planning is a
dynamic process and the contracts must be regularly reviewed and modified as
appropriate.
VI.
Counseling:
(Individual, Group, and Significant Others):
The utilization of special skills to assist individuals, families or
groups in achieving objectives through exploration of a problem and its
ramifications; examination of attitudes and feelings; consideration of
alternative solutions; and
decision-making.
Global Criteria
21. Select the counseling
theory(ies) that apply(ies).
22. Apply technique(s)
to assist the client, group, and/or family in exploring problems
and ramifications.
23. Apply technique(s)
to assist the client, group, and/or family in examining the client’s behavior,
attitudes, and/or feelings if appropriate in the treatment setting.
24. Individualize
counseling in accordance with cultural, gender, and lifestyle differences.
25. Interact
with the client in an appropriate therapeutic
manner.
26. Elicit solutions
and decisions from the client.
27. Implement
the treatment plan.
Explanation
Counseling is basically a relationship in which the counselor helps the
client mobilize resources to resolve his or her problem and/or modify attitudes
and values. The counselor must be
able to demonstrate a working knowledge of various counseling approaches.
These methods may include Reality Therapy, Transactional Analysis,
Strategic Family Therapy, Client Centered Therapy, etc.
Further, the counselor must be able to explain the rationale for using a
specific approach for the particular client.
For example, a behavioral approach might be suggested for clients who are
resistant and manipulative or have difficulty anticipating
consequences and regulating impulses. On
the other hand, a cognitive approach may be appropriate for a client who is
depressed, yet insightful and articulate.
Also, the counselor should explain his or her rationale for choosing a
counseling approach in an individual, group or significant other context.
Finally, the counselor should be able to explain why a counseling
approach or context changed during treatment.
VII.
Case Management:
Activities which bring services, agencies, resource, or people together
within a planned framework of action toward the achievement of established
goals. It may
involve liaison activities and collateral contacts.
Global Criteria
28. Coordinate
services for client care.
29. Explain the rationale
of case management activities to the client.
Explanation
Case management is the coordination of a multiple services plan.
Case management decisions must be explained to the client.
By the time many alcohol and other drug abusers enter treatment they tend
to manifest dysfunction in a variety of areas.
For example, a heroin addict may have hepatitis, lack job skills and have
a pending criminal charge. In this
case, the counselor might monitor his medical treatment, make a referral to a
vocational rehabilitation program and communicate with representatives of the
criminal justice system.
The
client may also be receiving other treatment services such as family therapy and
pharmacotherapy, within the same agency. These
activities must be integrated into the treatment plan and communication must be
maintained with the appropriate personnel
VIII.
Crisis Intervention:
Those services which respond to an alcohol and/or other drug abuser’s
needs during acute emotional and/or physical distress.
Global Criteria
30. Recognize
the elements of the client crisis.
31.
Implement an immediate course
of action appropriate to the
crisis.
32. Enhance
overall treatment by utilizing
crisis events.
Explanation
A crisis is a decisive, crucial event in the course of treatment that
threatens to compromise or destroy the rehabilitation effort.
These crises may be directly related to alcohol or drug use (i.e.,
overdose or relapse) or indirectly related.
The latter might include the death of a significant other,
separation/divorce, arrest, suicide gestures, a psychotic episode or outside
pressure to terminate treatment. If
no specific crisis is presented in the Written Case, rely on and describe a past
experience with a client. Describe
the overall picture-before, during, and after the crisis.
It
is imperative that the counselor be able to identify the crises when they
surface, attempt to mitigate or resolve the immediate problem and use negative
events to enhance the treatment efforts, if possible.
IX.
Client Education:
Provision of information to individuals and groups concerning alcohol and
other drug abuse and the available services and resources.
Global Criteria
33. Present relevant
alcohol and other drug use/abuse information to the client through formal
and/or informal processes.
34. Present information
about available alcohol and other drug services
and resources.
Explanation
Client education is provided in a variety of ways.
In certain inpatient and residential programs, for example, a sequence of
formal classes may be conducted using a didactic format with reading materials
and films. On the other hand, an
outpatient counselor may provide relevant information to the client individually
or informally.
In addition to alcohol and drug information, client education may include
a description of self-help groups and other resources that are available to the
clients and their families. The
applicant must be competent in providing specific examples of the type of
education provided to the client and the relevance to the case.
X.
Referral:
Identifying the needs of a client that cannot be met by the counselor or
agency and assisting the client to utilize the support systems and community
resources available.
Global Criteria
35. Identify need(s)
and/or problem(s) that the agency
and/or counselor cannot
meet.
36. Explain
the rationale for the referral to
the client.
37. Match
client needs and/or problems to
appropriate resources.
38. Adhere to
applicable laws, regulations and agency policies governing
procedures related to the protection of the client’s
confidentiality.
39. Assist the client
in utilizing the support systems
and community resources available.
Explanation
In order to be competent in this function, the counselor must be familiar with
community resources, both alcohol and drug and others, and should be aware of
the limitations of each service and if the limitations could adversely impact
the client. In addition, the
counselor must be able to demonstrate a working knowledge of the referral
process, including confidentiality requirements and outcomes of the referral.
Referral
is obviously closely related to case management when integrated into the initial
and on-going treatment plan. It
also includes, however, aftercare or discharge planning referrals that take into
account the continuum of care.
XI.
Report and Record Keeping:Charting
the results of the assessment and treatment plan, writing
reports, progress notes, discharge summaries and other client-related
data.
Global Criteria
40. Prepare
reports and relevant records
integrating available information to
facilitate the continuum of care.
41. Chart
pertinent ongoing information
pertaining to the client.
42. Utilize
relevant information from written
documents for client care.
Explanation
The report and record keeping function is
important. It benefits the
counselor by documenting the client’s progress in achieving his or her goals.
It facilitates adequate communication between co-workers.
It assists the counselor’s supervisor in providing timely feedback.
It is valuable to other programs that may provide services to the client
at a later date. It can enhance the
accountability of the program to its licensing/funding sources.
Ultimately, if performed properly, it enhances the client’s entire
treatment experience. The applicant
must prove personal action in regard to the report and record keeping function.
XII.
Consultation With Other Professionals in Regard to Client
Treatment/Services:
Relating with in-house staff or outside professionals to assure
comprehensive, quality care for the client.
Global Criteria
43. Recognize
issues that are beyond the
counselor’s base of knowledge
and/or skill.
44. Consult
with appropriate resources to ensure
the provision of effective treatment services.
45. Adhere
to applicable laws, regulations and
agency policies governing the disclosure
of client-identifying data.
46.
Explain the rationale
for the consultation to the client,
if appropriate.
Explanation
Consultations are meetings for discussion, decision-making and planning.
The most common consultation is the regular in-house staffing in which
client cases are reviewed with other members of the treatment team.
Consultations may also be conducted in individual sessions with the
supervisor, other counselors, psychologists, physicians, probation officers, and
other service providers connected to the client’s case.
