Los Angeles Metropolitan Churches and PSATTC with Faith Based Training May 4, 2013

1. The TAP 21 Competencies and 12 Competencies for Clergy and Other Pastoral Ministers Los Angeles Metropolitan Churches and PSATTC with Faith Based Training May 4, 2013

2. Topics of Discussion • Introduction of the TAP 21 • Introduction of the Scope of Professional Practice • Foundations for Addiction Professionals • 12 Core Competencies for Clergy

3. 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.

4. 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)

5. 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.

6. 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

7. (A) Understanding Addiction (B) Treatment Knowledge (C) Application to Practice (D) Professional Readiness Transdisciplinary Foundations

8. 8 Practice Dimensions Clinical evaluation (assessment/interview) Treatment planning Referral Service coordination Counseling Client, family and community education Documentation Professional and ethical responsibilities

9. Addiction Counseling Competencies: The Knowledge, Skills and Attitudes of Professional Practice Professional & Ethical Responsibilities Service Coordination Clinical Evaluation Documentation Counseling Referral I II III IV V VI VII VIII Client, Family, & Community Education Treatment Planning Referral Dimensions of Professional Practice • IV. Professional Readiness • III. Application to Practice • II. Treatment Knowledge • I. Understanding Addiction Transdisciplinary Foundations

11. Service coordination The administrative, clinical, and evaluative activities that bring the client, treatmentservices, community agencies, and other resources together to focus on issues and needs identified in the treatment plan. Similarities/differences?KSA’s 12 Core Functions 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. 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

13. 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

14. 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

15. 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

16. 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

17. Deep DiveDocumentation Competency

18. 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)

19. Documentation Approach 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!

20. 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.

21. 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.

22. 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.]

23. 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!

24. 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?

25. 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?

26. 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?

27. 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.]

28. 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

29. 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)

30. 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)

31. What makes the Gillman HIPAA Note superior to the SOAP or DAP • It requires the clinician to think in more behavioral terms. • It requires the clinician to focus on presenting symptoms/indicators/barriers. • It requires the clinician to think about functional environments that the consumer finds more meaningful to express their psychopathology. • It requires the clinician to think about the progress made since the last session. • It requires the clinician to think about how the above data might change their diagnostic thinking. • It requires the clinician to think about changes to their treatment plan and recommendations. • It requires the clinician to think about the prognosis until the next treatment session. (Gillman., 50)

32. Progress Note Test Questions/Discussions: Which of the following is an indication for a progress note? • Following each clinical session • Each day that the consumer is present in a residential or detox program • Each time a consumer is redirected when displaying negative feelings • At the time of discharge • All of the above Which of the following statements are incorrect? • S = Subjective [Therapist’s view of problems or progress noted, use consumer’s own words.] • O = Objective [Therapist’s objective observations of the consumers progress.] • A = Assessment [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.]

33. Progress Note Test Questions: Which of the following is an incorrect example of a DAP progress note entry? • 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) • 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) • 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) • Plan: Only client’s second day in treatment, continue with current plan. (P) • All of the above

34. Progress Note Test Questions: Which of the following are elements of the Gillman HIPAA Progress Note? • Counseling session start and stop time • Modalities of treatment furnished • Frequency of modalities furnished • Medication prescription and monitoring • All of the above Which of the following make the Gillman HIPAA Note superior to the SOAP or DAP note? • It requires the clinician to think in more behavioral terms • It requires the clinician to focus on presenting symptoms • It requires the clinician to think about how frequently they have made a HIPAA violation. • It requires the clinician to think about changes to their treatment plan and recommendations • It requires the clinician to think about the prognosis until the next treatment session.

35. 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.

36. Back to Basics

37. Group/Individual Counseling Urine Monitoring Core Treatment Abstinence Based Case Management Intake Assessment Pharmaco-therapy Continuing Care Treatment Plans Self-Help (AA/NA) Core Components of Comprehensive Services Medical Financial Mental Health Housing & Transportation Vocational Child Care Educational Family Legal AIDS / HIV Risks Etheridge, Hubbard, Anderson, Craddock, & Flynn, 1997 (PAB)

38. An Evidence-Based Treatment Model for Improving Practice Texas Christian University

39. Elements of a Treatment Process Model Detox Patient Factors ? OP-DF Sufficient Retention Drug Use PsychologicalFunctioning, Motivation, & ProblemSeverity TC/Res Crime Social Relations OP-MM Posttreatment Cognitive and behavioralcomponents with therapeutic impact

40. Motiv Patient Attributes at Intake TCU Treatment Process Model Early Engagement Early Recovery Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Post-treatment Engagement Simpson, 2001 (Addiction)

41. Drug Use Crime Social Relations Posttreatment “Sequence” of Recovery Stages Patient Readiness for Tx Program Participation Behavioral Change AdequateStay in Tx Therapeutic Relationship Cognitive Change Targeted Interventions Get Focused!!

42. Interventions Should Maintain This Process Motiv Patient Attributes at Intake Early Engagement Early Recovery Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Post-treatment Simpson, 2001 (Addiction)

43. Early Engagement Early Recovery Motiv Patient Attributes at Intake Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Post-treatment Induction to Treatment(Motivational Enhancement) ProblemRecognition Desirefor Help Readinessfor Treatment Simpson & Joe, 1993 (Pt); Blankenship et al.,1999 (PJ); Sia, Dansereau, & Czuchry, 2000 (JSAT)

44. Early Engagement Early Recovery Motiv Patient Attributes at Intake Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Post-treatment Counseling Enhancements(Cognitive “Mapping”) Dansereauet al., 1993 (JCP), 1995 (PAB); Joe et al., 1997 (JNMD); Pitreet al., 1998 (JSAT)

45. Early Engagement Early Recovery Motiv Patient Attributes at Intake Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Post-treatment Contingency Management(Token Rewards) Rowan-Szalet al., 1994 (JSAT); 1997 (JMA); Griffith, Rowan-Szalet al., 2000 (DAD)

46. Early Engagement Early Recovery Motiv Patient Attributes at Intake Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Post-treatment Specialized Interventions(Skills-Based Counseling Manuals) Supportive Networks Bartholomew et al., 1994 (JPD); 2000 (JSAT); Hiller et al., 1996 (SUM)

47. Motiv Patient Attributes at Intake Program Characteristics Staff Attributes & Skills Evidence-Based Treatment Model Behavioral Strategies Induction Family & Friends Personal Health Services Supportive Networks Early Engagement Early Recovery Program Participation Behavioral Change Sufficient Retention Drug Use Crime Therapeutic Relationship Psycho-Social Change Social Relations Post-treatment Enhanced Counseling Social Skills Training Social Support Services Simpson, 2001 (Addiction)

48. Questions? The End. Thank you!