Los Angeles Metropolitan Churches African American Alcohol & Other Drug Council (AAAOD)

1. 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

2. 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

3. Topics of Discussion • Screening • Intake • Orientation • Assessment • Assessment Tools • NIDA Risk Factors • Resources

4. 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 practicenew science in addiction and alcohol treatment and to encourage faith communities in LAC to become users of SAMHSA/CSAT TAPs and TIPs.

5. 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.

6. 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).

7. TRAINING

8. Why Screen & Assess? Screening, clinical assessment, and determining a client's readiness for treatment represent the beginning of the treatment process.

9. 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

10. 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.

11. Assessment Tools • CAGE (alcohol) • ASI (Addiction Severity Index)/CJ ASI • Screening, Brief Intervention Referral to Treat Treatment (SBIRT)-CSAT • Motivational Interviewing Assessment: Supervisory Toolsfor Enhancing Proficiency-NIDA • Visit:  CSAT Inventory of Effective Substance Abuse Treatment Practices http://csat.samhsa.gov/treatment

12. Screening Global Criteria • 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.

13. The CAGE Questionnaire • The CAGE questionnaire is a simple but effective test designed to screen for alcohol abuse. It consists of four questions: • Have you ever felt the need to Cut down on your drinking? • Do you feel Annoyed by people complaining about your drinking? • Do you ever feel Guilty about your drinking? • Do you ever drink an Eye-opener in the morning to relieve the shakes?

14. 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.

15. 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.

16. 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.

17. Intake Definition • The administrative and initial assessment procedures for admission

18. Intake Global Criteria • Complete required documents for admission to the program. • Complete required documents for program eligibility and appropriateness. • Obtain appropriately signed consents when soliciting from or providing information to outside sources to protect client confidentiality and • Rights.

19. 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

20. Orientation Global Criteria • Provide an overview to the client by describing program goals and objectives for client care. • Provide an overview to the client by describing program rules and client obligations and rights. • Provide an overview to the client of program operations.

21. 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.

22. Interrelationships between stages of screening, assessment, and treatment

23. 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

24. 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

25. 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.

26. 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).

27. 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

28. Foundation of Assessment 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

29. 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

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

31. 8 Practice Dimensions Clinical evaluation (assessment/interview) Treatment planning Referral Service coordination Counseling Client, family and community education Documentation Professional and ethical responsibilities

32. 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

34. SBIRT

36. Screening • Screening is a quick, simple way to identify patients who need further assessment or treatment for substance use disorders. • It does not establish definitive information about diagnosis and possible treatment needs. • The goal of SBIRT is to make screening for substance abuse a routine part of medical care

37. 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.

38. 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.

39. 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.

40. Brief Treatment • Brief treatment is a distinct level of care and is inherently differentfrom 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.

41. 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.

42. Screening Instruments • Three commonly used screening instruments are: • Alcohol Use Disorders Identification Test (AUDIT) • Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) • Drug Abuse Screening Test (DAST)

43. 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 10-item 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.

44. 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.

45. 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.

46. 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.

47. Principles of Effective Treatment

48. 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

49. 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

50. 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