CLINICAL PATHWAYS Lorain County Alcohol and Drug Abuse

CLINICAL PATHWAYS Lorain County Alcohol and Drug Abuse Services, Inc.

ODADAS CLINICAL PLACEMENT PROTOCOL FOR LEVEL OF CARE Dimension 1 Level of Intoxication and Withdrawal Potential Dimension 2 Biomedical Conditions and/or Complications Dimension 3 Emotional/Behavioral/Cognitive Conditions and/or Complications Dimension 4 Level of Treatment Acceptance or Resistance Dimension 5 Relapse Potential Dimension 6 Recovery Environment Critical Life Areas Living Arrangements Social Environment Family History and Support Current or Prior Mental Health Treatment or Conditions Prior Addiction Treatment History Legal Involvement Education Employment Victimization History and Issues Medical Status and Conditions

Treatment Areas • Alcohol and Drug Abuse • Alcohol and Drug Dependence • Homelessness / Housing • Relationship Issues • Victimization Issues • Employment • • Transportation Education Mental Health Issues Client Grief Reaction Anger Issues Criminal Thinking Medical Condition / Problems

ALCOHOL AND DRUG DEPENDENCE Levels of Functioning Levels of Dysfunction Client in denial and not motivated. Client motivated but lacks skills/supports. Client has been taught skills and requires monitoring of his/her utilization of resources/skills. Client has been in recovery/ treatment and yet continues to experience relapses.

AOD DEPENDENCE Levels of Dysfunction • Client in denial and not motivated • Client motivated but lacks skills / supports • Client has skills and requires monitoring of his/her utilization of resources/skills • Client has been in recovery/treatment and yet continues to experience relapses

AOD DEPENDENCE 1 Condition • Client in denial and not motivated Objective • The Client will understand their emotional / cognitive defenses: will move from denial to acceptance of their illness.

AOD DEPENDENCE 2 Condition • Client motivated but lacks skills / supports Objective • The Client will develop behaviors / skills that will support their recovery.

AOD DEPENDENCE 3 Condition • Client has been taught skills and requires monitoring of his/her utilization of resources/skills Objective • The Client will consistently practice behaviors / skills that indicate acceptance of recovery.

AOD DEPENDENCE 4 • Condition: Client has been in recovery/treatment and yet continues to experience relapses • Objective: Client will have an understanding of what has contributed to relapses and developed a plan to prevent in the future. Client will demonstrate skills, behaviors, and attitudes necessary to implement the plan successfully.

ALCOHOL AND DRUG DEPENDENCE Levels of Improved Functioning Client will understand their emotional/ cognitive defenses: will move from denial to acceptance of their illness. Client will develop behaviors/skills that will support their recovery. Client will consistently practice behaviors/skills that indicate acceptance of recovery. Client will have an understanding of what has contributed to relapses and developed a plan to prevent in the future. Client will demonstrate skills, behaviors, and attitudes necessary to implement the plan successfully.

CLINICAL PATHWAY AOD 1 The Client will understand their emotional / cognitive defenses: will move from denial to acceptance of their illness. • CNL will educate Client about the progressive patterns and effects of addiction through lectures and readings. • Client will be assigned to discuss consequences and feelings related to the circumstances that brought him/her into treatment in group, individual and/or family counseling. • Client will explore how his/her behaviors, attitudes, and life situations parallel what he/she has learned about the disease of addiction through self-exploratory assignments. (AOD History or 20 Harmful Consequences) • Client will present these assignments in group for feedback and approval by staff and peers. • CNL will prepare the Family for an Intervention.

CLINICAL PATHWAY AOD 2 The Client will develop behaviors / skills that will support their recovery. • Client will explore in group how addiction was used to escape from stress, physical and emotional pain, and boredom and solicit suggestions from staff and peers. • Client will complete AA first-step worksheet and present to staff and peers for feedback and approval. • Client will be educated to 12 -Step Recovery Principles. • Client will be assigned to attend 12 -Step Meetings, get a Sponsor, and identify a Home Group. Client will process progress and issues with staff and peers. • Client will learn improved problem solving techniques, coping strategies, and communication skills through lecture, readings, role playing, and other behavior rehearsal sessions. • Client will be educated about relapse and relapse prevention.

CLINICAL PATHWAY AOD 3 The Client will consistently practice behaviors / skills that indicate acceptance of recovery. • Client will develop a Relapse Prevention Plan and present to staff and peers for feedback and approval. • Client will develop a Recovery Plan and present to staff and peers for feedback and approval. • Client will be connected to any identified Community Support identified through Treatment Plan (GED/Vocational Prep, Mental Health Professional, Medical Professional, Housing Assistance, etc. ) • Client will be admitted to Continuing Care Phase of Treatment. • Client will report level of compliance with Recovery Plan and any issues that are relapse risk to his/her CNL, Aftercare Group, and Sponsor on a weekly basis.

CLINICAL PATHWAY AOD 4 Client will have an understanding of what has contributed to relapses and developed a plan to prevent in the future. Client will demonstrate skills, behaviors, and attitudes necessary to implement the plan successfully. • CNL will educate Client to Relapse and Relapse Prevention through lectures and readings. • Client will complete a Relapse History and Chronological History of Critical Incidents. • Client will complete a Coping Skills/Problem Solving Skills analysis. • CNL will work with Client to strengthen any deficits noted in Coping Skills/Problem Solving through teaching, coaching, strategizing. • Client will take Relapse History to group for feedback from staff and peers. • Client will develop a Relapse Prevention Plan based on staff and peers feedback to be approved by staff, peers, family, and sponsor. • Client will develop a Relapse Contract with CNL, family and sponsor.

ANGER ISSUES Levels of Functioning Levels of Dysfunction Client presents with aggressive and hostile tendencies that may impede recovery and treatment. (Continuous) Client lacks control over anger outbursts. (Intermittent) Client has been arrested for assaultive/ aggressive behaviors towards others. (Intermittent)

CLINICAL PATHWAY ANGER ISSUES 1 Client will understand identify difference between healthy and unhealthy ways of expressing anger. • CNL will educate Client regarding the Anger and Coping Skills through lecture and readings. • Client will complete assignments including: – Identifying__unhealthy ways that he/she deals with stress and anger and identify__alternatives. – Identifying__ways that AOD use has affected feelings. – Identifying feelings that he/she has experienced surrounding use. • CNL will teach anger management techniques including relaxation and stress reduction techniques or refer to anger management classes. • CNL will consult with Client’s Anger Management teacher to coordinate care. • Client will discuss anger issues in group therapy and solicit feedback from peers. • Client will develop an Anger Relapse Prevention Plan to be included in his/her Recovery Plan and approved by staff and peers.

CLINICAL PATHWAY ANGER ISSUES 2 Client will consistently practice behaviors/skills of handling angry feelings in more acceptable and appropriate ways. • CNL will educate Client regarding Feelings, Emotional Defenses, and Coping Skills through lecture and readings. • Client will complete assignments including: – Identifying__unhealthy ways that he/she deals with stress and anger and identify__alternatives. – Identifying relationship between outbursts and natural consequences he/she has experienced. – Recognizing and identifying indicators that he/she experiences prior to an outburst and methods to deescalate prior to the outburst. • Client will present assignments in group for feedback and support. • CNL will teach anger management techniques including relaxation and stress reduction techniques or refer to anger management classes. • Client will develop an Anger Relapse Prevention Plan to be included in his/her Recovery Plan and approved by staff and peers.

CLINICAL PATHWAY ANGER ISSUES 3 Client will develop communication skills that will assist in dealing with feelings of anger. • CNL will assess if there is a relationship between AOD use and assaultive/aggressive behaviors. • If assaultive/aggressive behaviors occur only during use refer to plan Anger #2. • If assaultive/aggressive behaviors occur independent of AOD use or have a history that predates the onset of AOD use then CNL will refer Client for Mental Health Evaluation. • CNL will consult with MH Evaluator to coordinate services.

UNEMPLOYMENT Levels of Functioning Levels of Dysfunction Client is disabled and not employable at this time. Client lacks job skills and behaviors that permit him/her to maintain steady employment Client possesses job skills but is not satisfied with types of jobs he/she is trained to do. Client is unemployed, has job skills, and wants to enter the job market.

UNEMPLOYMENT Levels of Improved Functioning Client will be assessed for possible alternative employment or capabilities. Client will develop sufficient job skills to be eligible for employment and will develop behaviors that will support his/her maintaining employment. Client will develop career objectives and develop a plan to follow career path. Client will utilize appropriate resources to obtain employment. Client will obtain employment.

CLINICAL PATHWAY UNEMPLOYMENT 1 Client will be assessed for possible alternative employment or capabilities. • CNL will refer Client to the Bureau of Vocational Rehabilitation for an employment evaluation. • CNL will contact BVR to coordinate AOD services with BVR services.

CLINICAL PATHWAY UNEMPLOYMENT 2 Client will develop sufficient job skills to be eligible for employment and will develop behaviors that will support his/her maintaining employment. • CNL will refer Client to BVR or Department of Job and Family Services for Job Training. • CNL will contact Lorain County Department of Job and Family Services to coordinate services with DJFS caseworker. • Client will be assigned to identify current behaviors that sabotage his/her employment. • Client will develop a Relapse Prevention Plan for sabotaging behaviors and present to staff and peers for approval.

CLINICAL PATHWAY UNEMPLOYMENT 3 Client will develop career objectives and develop a plan to follow career path. 1. Client will complete assignments designed to identify his/her ideal job. 2. Client will research careers that closely align with ideal job characteristics. 3. Client will be referred for aptitude testing through DJFS 4. Client will be referred for Career Counseling through Lorain County Community College or another Career placement service. 5. Client will present a plan for following career path and present to staff and peers for feedback.

CLINICAL PATHWAY UNEMPLOYMENT 4 Client will utilize appropriate resources to obtain employment. Client will obtain employment. • Client will be referred to Lorain County Community College or other job placement service. • Counselor will coach client how to utilize newspaper and internet in job search. • Client will develop resume and present to staff and peers for feedback. • Client will practice interviewing skills with staff and peers.

RELATIONSHIP ISSUES Levels of Functioning Levels of Dysfunction Client has a history of unhealthy/broken relationships. Client has not been able to maintain healthy relationships. Client doesn’t understand or is in denial of how his/her addiction has affected the relationship. Client recognizes relationship damage and is willing to address in treatment. Client has limited ability to recognize others needs. Client relationships have been damaged due to addictive behaviors/ attitudes but relationship is still intact.

RELATIONSHIP ISSUES Levels of Improved Functioning Client understands the difference between healthy (functional) and unhealthy (dysfunctional) relationships. Client understands what behaviors/attitudes contribute to the relationship problems and he/she develops the motivation to change. Client develops skills to communicate effectively including: A. The ability to express oneself so their needs are understood. B. The ability to actively listen so others needs are understood. Client develops and practices behaviors/skills that defer personal wants in favor of the relationships needs.

CLINICAL PATHWAY RELATIONSHIPS 1 Client understands the difference between healthy (functional) and unhealthy (dysfunctional) relationships. • CNL will educate client to the dynamics of healthy and unhealthy relationships through lecture and readings. • Client will complete assignments to better understand his/her history/behaviors in unhealthy relationships including: – Chronological history of significant relationships and behaviors that led to breakup – Client’s expectations of a significant relationship • CNL will refer client and S/O to ongoing marital counseling

CLINICAL PATHWAY RELATIONSHIPS 2 Client understands what behaviors/attitudes contribute to the relationship problems and he/she develops the motivation to change. • CNL will educate client and family about codependency. • Family will complete an Intervention List to be shared with Client in Family Therapy session. • Client and Family will report to peer group their codependent behaviors/attitudes and seek groups feedback and support. • Client will complete assignments including listing behavioral changes he/she commits to make to restore his/her relationship to a desired level of functioning. • Client will take Relapse History to group for feedback from staff and peers. • Client and Family will complete a Relationship Recovery Plan to be included in the Client’s Recovery Plan to be approved by staff and peers.

CLINICAL PATHWAY RELATIONSHIPS 3 Client develops skills to communicate effectively including: A. The ability to express oneself so their needs are understood. B. The ability to actively listen so others needs are understood. • CNL will educate Client about Codependency and Communication through lecture and assignments. • Client and S/O will identify how they currently communicate verbal and nonverbal affection and identify how they would like to. • Client and Family will report to peer group their codependent behaviors/attitudes and seek groups feedback and support. • Client and S/O will complete assignment on Active Listening. • Client and S/O will develop a Relationship Recovery Plan that includes specific communication meetings and methods.

CLINICAL PATHWAY RELATIONSHIPS 4 Client develops and practices behaviors/skills that defer personal wants in favor of the relationships needs. • CNL will educate Client about Codependency and Relationships through lectures and readings. S/O will attend Family Treatment Sessions with Client. • Client and S/O identify relationship needs from relationship wants and agreed methods for prioritizing and meeting or deferring. • Client and S/O will develop an action plan that identifies other addictive behaviors and other relationship problems and means of addressing them. • Client and S/O will develop a Relationship Recovery Plan that includes utilization of other 12 Step Recovery such as Alanon.