Transcript SBIRT and Assessments - Addiction Technology Transfer Center

Alcohol and Drug
Assessments for Clergy
and Pastoral Counselors
Los Angeles Metropolitan Churches
African American Alcohol & Other Drug Council (AAAOD)
and UCLA – Integrated Substance Abuse Programs
Pacific Southwest Addiction Technology Training Center
Faith Based Training Series
Trainer: Cheryl A. Branch, MS
March 16, 2013
Agenda
I:
Open & Welcome – Cheryl A. Branch, PSATTC Trainer
II:
Sign In and Sign Out, CEUs Expectations Read
III. Training – Branch
IV. Break
V.
Training Continues
VI. Q & A
VII. Post Test/GPRA
VIII. Resume Training
VIIII. Break
IX.
Training
Ends
Topics of Discussion
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Screening
Intake
Orientation
Assessment
Assessment Tools
NIDA Risk Factors
Resources
Today’s Training Objective
-Reinforce participants understanding about
alcohol and drug assessment and screening
using evidence-based practices and tools
that will enable clergy and laity to practice
new science in addiction and alcohol
treatment and to encourage faith
communities in LAC to become users of
SAMHSA/CSAT TAPs and TIPs.
Big Picture Goals
• To build a new breed of faith-based
organizations and churches in South LA
through “developmental technical assistance”
to guide their growth and development.
• In order to become providers of health and
human services in their community FBOs must
understand the rules of non-profit business
and evidenced based programming in AOD
services/counseling.
Big Picture Goals
• To Accelerate the dissemination of
evidence-based practices into faith-based
community practices in South LA.
• Particular focus on faith based agencies that
work with offender populations (prison
ministries).
Why Screen & Assess?
Screening, clinical assessment,
and determining a client's
readiness for treatment represent
the beginning of the treatment
process.
NIDA Risk Factors
• Unstable home environment due to parental substance
abuse or mental illness
• Fractured relationship of parents and adolescent/child
• Poor level of supervision of the adolescent's activities
• Peer use of drugs
• Liberal parental attitude of their own drug use or
adolescent's use of drugs
Screening Definition
•
The process by which the client is determined
appropriate and eligible for admission to a
particular program.
• Screening Instruments
– Screening instruments are the objective arm of the
screening procedure, providing uniformity, quality
control, and structure to the process. Some instruments
may be more appropriate than others in certain settings.
Among the more commonly used instruments are the
CAGE questionnaire, the MAST, and the OPI.
Assessment Tools
• CAGE (alcohol)
• ASI (Addiction Severity Index)/CJ ASI
• Screening, Brief Intervention Referral to Treat
Treatment (SBIRT)-CSAT
• Motivational Interviewing Assessment:
Supervisory Tools for Enhancing Proficiency-NIDA
• Visit: CSAT Inventory of Effective Substance
Abuse Treatment Practices
http://csat.samhsa.gov/treatment
Screening
Global Criteria
1.
2.
3.
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5.
Evaluate psychological, social and physiological signs and
symptoms of alcohol and drug abuse.
Determine the client’s appropriateness for admission.
Determine the client’s eligibility for admission or referral.
Identify any co-existing conditions (medical, psychiatric,
physical, etc.) that indicate need for additional professional
assessment and/or service.
Adhere to applicable laws, regulations and agency policies
governing alcohol and other drug abuse services.
The CAGE Questionnaire
• The CAGE questionnaire is a simple but effective
test designed to screen for alcohol abuse. It
consists of four questions:
1. Have you ever felt the need to Cut down on your
drinking?
2. Do you feel Annoyed by people complaining about
your drinking?
3. Do you ever feel Guilty about your drinking?
4. Do you ever drink an Eye-opener in the morning to
relieve the shakes?
The Michigan Alcoholism Screening
Test
• The MAST is a frequently used test that is
more detailed than the CAGE questionnaire.
The MAST consists of 25 questions and can be
used during longer interviews or in holding
and confinement situations. It is a commonly
used indicator of alcoholism.
The Offender Profile Index
• The OPI measures the client's drug use severity as well as
his or her "stakes in conformity" within a variety of
contexts: family support, education, and school
involvement; work, home, and correctional history;
psychological and treatment history; drug use severity; and
HIV-risk behaviors.
• It can be administered in about 30 minutes by an
experienced probation officer, counselor, or other trained
clinician.
• It includes a straightforward grading guide to help interpret
the seriousness of an AOD abuser's problem. A day of
training is required to be able to administer it, and a
training manual is available. The client's numerical score
has a corresponding treatment recommendation.
National Standards
• TAP 21 - Addiction Counseling Competencies: The
Knowledge,
-Skills and Attitudes of
-Professional Practice
• In an effort to maximize certification
Standards in the State of California, while elevating
the level of professionalism within the field,
AAAOD and LAM uses national standards for
substance abuse counseling to educate FB
counselors.
Intake Definition
• The administrative and initial
assessment procedures for admission
Intake
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
9. Rights.
Orientation Definition
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
rights
Orientation
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.
Assessment Definition
• 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.
Interrelationships between stages of screening,
assessment, and treatment
Foundation of Assessment
• What in client’s story can you connect to as
counselor?
• Who they are?
• What they really want?
• What do they really need/when are ready?
• Importance of honesty for staff & clients
• Empathetic connections with clients-values
Foundation of Assessment
• Importance of initial meeting
– Story/Strength based discussion
– What place/time in life was the person doing
really well
• Identify that time period and “Begin” there
• Identify strengths & capacity from that time
Role of Motivational Interviewing
Techniques
• Advancing problem recognition, readiness for
action, treatment suitability (availability and
accessibility), and influences that lead to
coercive pressure to seek treatment.
Understanding Self-Efficacy In
Assessment
• Self–efficacy, or the confidence in personal ability,
has been shown to predict a variety of health
behavior outcomes (O’Leary 1985; Grembowski
et al. 1993), including alcohol treatment outcome
(Miller and Rollnick 1991).
• Self–efficacy may increase attention to goal
attainment; thus it is important to measure goal
setting and achievement, as well as other
constructs believed to underlie self–efficacy, such
as the client’s perceptions of personal ability to
overcome barriers to change (Miller 1983).
Strength Based Model
• There are strengths & capacity within that
time period of stability
– Diagnostic goldmine for ASSESSMENT
• Utilize that time period for:
– Screening
– Building blocks for assessment
– Building blocks for treatment planning
Foundation of Assessment
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Change the way we think about people
Build something that is right and different
Practice boundaries and ethics
How well do we know people through
strength-based screenings and assessment
Knowledge, Skills, Attitudes
• Transdisciplinary Foundations – identify the
knowledge and attitudes that underlie
competent practice
• 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
(D) Professional Readiness
(B) Treatment Knowledge
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
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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
Knowledge, Skills, Attitudes
Clinical Evaluation (Screening & Assessment)
12 Core Functions
Screening
Intake
Orientation
Assessment
SBIRT
Screening
1. Screening is a quick, simple way to identify
patients who need further assessment or
treatment for substance use disorders.
2. It does not establish definitive information
about diagnosis and possible treatment
needs.
3. The goal of SBIRT is to make screening for
substance abuse a routine part of medical
care
Screening Process
• A screen should be simple enough that it
can be administered by a wide range of
health professionals.
• It should focus on the substance use
severity (primarily consumption
patterns) and a core group of associated
factors such as legal problems, mental
health status, educational functioning,
and living situation.
Screening Process
• The client's awareness of the
problem, feelings about his or her
substance use, and motivation for
changing behavior may also be
solicited.
Brief Intervention
• Brief intervention is a single session or multiple
sessions of motivational discussion focused on
increasing insight and awareness regarding
substance use and motivation toward
behavioral change.
• Brief intervention can be tailored for variance in
population or setting and can be used as a
stand-alone treatment for those at-risk as well
as a vehicle for engaging those in need of more
extensive levels of care.
Brief Treatment
• Brief treatment is a distinct level of care and is inherently
different from both brief intervention and specialist
treatment.
• Brief treatment is provided to those seeking or already
engaged in treatment who acknowledge problems related
to substance use.
• Brief treatment in relation to traditional or specialist
treatment has increased intensity and is of shorter
duration. It consists of a limited number of highly focused
and structured clinical sessions with the purpose of
eliminating hazardous and/or harmful substance use.
Referral To Treatment
• Referral to specialized treatment is provided to
those identified as needing more extensive
treatment than offered by the SBIRT program.
• The effectiveness of the referral process to
specialty treatment is a strong measure of SBIRT
success and involves a proactive and
collaborative effort between SBIRT providers
and those providing specialty treatment to
ensure access to the appropriate level of care.
Screening Instruments
• Three commonly used screening
instruments are:
1. Alcohol Use Disorders Identification Test
(AUDIT)
2. Alcohol, Smoking, and Substance Involvement
Screening Test (ASSIST)
3. Drug Abuse Screening Test (DAST)
Alcohol Use Disorders Identification
Test (AUDIT)
• — a screening tool developed by the World Health
Organization to identify persons whose alcohol consumption
has become hazardous or harmful to their health. It is a 10item screening questionnaire with 3 questions on the amount
and frequency of drinking, 3 questions on alcohol
dependence, and 4 on problems caused by alcohol. All of the
questions are scored using a 5-point Likert scale.
Alcohol, Smoking and Substance
Involvement Screening Test
• — an instrument developed for the World
Health Organization (WHO) by an
international group of substance abuse
researchers to detect and manage substance
use and related problems in primary and
general medical care settings.
The Drug Abuse Screening
Test (DAST)
• — DAST was designed to provide a brief
instrument to detect drug abuse or
dependence disorders. The DAST
provides a general measure of lifetime
problem severity that can be used to
guide further inquiry into drug-related
problems and to help determine
treatment intensity.
BASICS
• Brief Alcohol Screening and Intervention of College
Students (BASICS): A Harm Reduction Approach, is a
preventive intervention for college students 18 to 24 years
old.
• It is aimed at students who drink alcohol heavily and have
experienced or are at risk for alcohol-related problems such
as poor class attendance, missed assignments, accidents,
sexual assault, and violence.
• BASICS is conducted over the course of only two interviews,
and these brief, limited interventions prompt students to
change their drinking patterns.
•
Dimeff, L. A., Baer, J. S., Kivlahan, D. R., & Marlatt, G. A. (1999). Brief Alcohol Screening and Intervention for
College Students (BASICS): A harm reduction approach. New York, NY: The Guilford Press.
Principles of Effective Treatment
”First things first”
1. No single treatment is appropriate for all
2. Treatment needs to be readily available
3. Effective treatment attends to the multiple
needs of the individual
4. Treatment plans must be assessed and
modified continually to meet changing needs
5. Remaining in treatment for an adequate period
of time is critical for treatment effectiveness
Principles of Effective Treatment
6. Counseling and other behavioral therapies
are critical components of effective
treatment
7. Medications are an important element of
treatment for many patients
8. Co-existing disorders should be treated in an
integrated way
9. Medical detox is only the first stage of
treatment
10. Treatment does not need to be voluntary to
be effective
Principles of Effective Treatment
11. Possible drug use during treatment must
be monitored continuously
12. Treatment programs should assess for
HIV/AIDS, Hepatitis B & C, Tuberculosis and
other infectious diseases and help clients
modify at-risk behaviors
13. Recovery can be a long-term process and
frequently requires multiple episodes of
treatment
- NIDA (1999) Principles of Drug Addiction Treatment
Get Over the Barriers!
• Administrative philosophy
• Organizational policy
• System structure
• Unclear literature
• Agency staff
• Client population
So, how do you
decide what to do?
What Is Our Goal?
• To provide persistent, incremental
improvements in the quality and
effectiveness of substance abuse
treatment which results in better quality
recovery for more people.
An Evidence-Based
Treatment Model for
Improving Practice
Source: Texas Christian University
54
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
Vocational
Case
Management
Continuing
Care
Educational
Self-Help
(AA/NA)
Family
AIDS /
HIV Risks
Legal
Etheridge, Hubbard, Anderson, Craddock, & Flynn, 1997 (PAB)
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
Patient
Attributes
at Intake
Early
Engagement
Early
Recovery
Program
Participation
Behavioral
Change
Sufficient
Retention
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Posttreatment
Engagement
Simpson, 2001 (Addiction)
“Sequence” of Recovery Stages
Patient
Readiness
for Tx
Program
Participation
Behavioral
Change
Adequate
Stay in Tx
Therapeutic
Relationship
Cognitive
Change
Drug
Use
Crime
Social
Relations
Posttreatment
Targeted Interventions
Get Focused!!
Interventions Should
Maintain This Process
Motiv
Patient
Attributes
at Intake
Early
Engagement
Early
Recovery
Program
Participation
Behavioral
Change
Sufficient
Retention
Therapeutic Psycho-Social
Relationship
Change
Drug
Use
Crime
Social
Relations
Posttreatment
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
Posttreatment
Simpson & Joe, 1993 (Pt); Blankenship et al.,1999 (PJ); Sia, Dansereau, & Czuchry, 2000 (JSAT)
Counseling Enhancements
(Cognitive “Mapping”)
Motiv
Patient
Attributes
at Intake
Early
Engagement
Early
Recovery
Program
Participation
Behavioral
Change
Sufficient
Retention
Therapeutic
Relationship
Psycho-Social
Change
Drug
Use
Crime
Social
Relations
Posttreatment
Dansereau et al., 1993 (JCP), 1995 (PAB); Joe et al., 1997 (JNMD); Pitre et al., 1998 (JSAT)
Contingency Management
(Token Rewards)
Motiv
Patient
Attributes
at Intake
Early
Engagement
Early
Recovery
Program
Behavioral
Participation
Change
Explain treatment
components, practice
Sufficient
Retention
Therapeutic
Relationship
Psycho-Social
Change
Drug
Use
Crime
Social
Relations
Posttreatment
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
Posttreatment
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
Posttreatment
Enhanced
Counseling
Social Skills
Training
Social Support Services
Simpson, 2001 (Addiction)
Resources:
1.Brief Interventions and Brief Therapies for Substance Abuse
SAMHSA TIP #34 provides rich resources for varied and diverse
provision of brief intervention.
2.Brief Interventions and Brief Therapies for Substance Abuse
SAMHSA TIP #34 provides rich resources for varied and diverse
provision of brief treatment.
3.The NNED is supported by the Substance Abuse and Mental
Health Services Administration, National Institutes of
Health/National Center on Minority Health and Health Disparities,
and the Annie E. Casey Foundation
Home •
4.SAMHSA Glossary of Terms
Questions?
"And we know that all
things work together for
good to them that love
God, to them who are
called according to His
purpose."
Romans 8:28