The 12 Core Functions Mike Yow NPM MA

The 12 Core Functions Mike Yow, NPM, MA, LCAS NCAARF May 4 th 2018

Objectives • To offer a brief over view of the 12 core functions utilized by IC & RC and the NCSAPPB that underpin the credentialing process for those seeking a substance abuse certification in NC. • To create a forum for open discussion around certification issues and general discussion about Substance Use Disorder (SUD) treatment in NC and the Country.

Agenda 8: 30 – 8: 45 Introductions 8: 45 – 9: 15 Brief history substance abuse treatment the NCSAPPB and the certification process 9: 15 – 10: 15 Core functions 1 -6 10: 15 – 10: 45 Break 10: 45 – 11: 45 Core Functions 7 -12 11: 45 -12: 00 question’s & open discussion

A Brief History • • • Benjamin Rush, M. D. The Physician-General of the Continental Army and a signer of the Declaration of Independence suggested in the 18 th century that “chronic drunkenness was a progressive medical condition. ” He referred to it as “suicide perpetuated gradually. ” He also went on to identify some key characteristics behaviors of those “afflicted. ” These signs included, “radical personality shifts when drinking, medical consequences of chronic drinking and a tendency toward drunkenness transmitted inter-generationally within Families. ” Around the same time, an English physician by the name of Thomas Trotter published an essay titled, “Essay, Medical, Philosophical and Chemical Drunkenness” where he claimed excessive drinking was “a sort of illness. ” There was a great deal of debate around these positions, often cited as the foundations of the medical model or “disease concept” of alcoholism. In 1952 the AMA defined Alcoholism as a medical condition and in 1956 stated, “the alcoholic should be treated as a sick person. ” In 1952, the APA began to differentiate between “abuse” and “dependence” in the DSM. (The DSM actually has roots dating back to the 1880 census where there began an attempt to categorize psychiatric disorders. In 1917 a “committee of statistics, ” which would later become the APA, began work on a standardized “Manual” of mental illness. ” We have been doing this a looooong time!!

History cont’d * Asylums and “Inebriate Homes” began to open up in the 2 nd half of the 19 th century. • • Drug Prohibition movements began in the early 20 th century resulting in the Harrison Act, criminalizing drug use and sweeping up providers trying to help those suffering with addiction issues. Prohibition of Alcohol passed in 1919 became law in January 1920 through an amendment to the US Constitution. That law was repealed in 1930. (discussion? ) Alcoholics Anonymous found in 1935, a high water mark for mutual aid societies that had been existence for many years prior to AA. The first of two Federal “Narcotic Farms” opened in the US involving the Federal Government in the treatment of addiction for the first time. ( more discussion? ) Any of this sounding familiar? ? ? Beginning in the 1970’s discussions were beginning in the NC drug & alcohol treatment community and professional organizations as they stood at the time about the need for program accountability and peer review processes in order to gain respect, credibility and recognition from other healthcare professionals. Organizations like APNC, which was founded in 1960 and ADAP (Association of Drug Abuse) took the lead in these discussions. There was a state exam given by the State Personnel System, but there were concerns on how it did not measure Competency.

History Cont’d • • APNC & ADAP appointed a study committee to investigate the establishment of an independent peer review board for those voluntarily seeking a certification. These two groups evolved into a single purpose which resulted in the establishment of the NC Alcoholism Certification Board, Inc in 1976. IN 1978, the NC Drug Abuse Professional Certification Board was established. These were 2 independent, but co-operative boards. They were both nonprofit and nonpartisan. Practitioners validated their existence by applying for their certifications and they were funded through fees and state supported grants. They both has volunteer boards. In 1984 both boards met with representatives of the Dept. of Human Resources, the division of MH/DD/SA to discuss merging the 2 boards into what became the NCSAPPB In 1994 the by-laws were changed so board members were elected by members. Also in 1994 the NC General Assembly established the NCSAPCB as a statutorily-based, independent credentialing board thereby “protecting the public from incompetent SA practioners. ” In 1997 NCSAPCB added an advanced credential, LCAS, with a degree requirement. In 1999 they added the CCS. In 2005 the General Assembly passed a statute to give the board practice protection, enacting full licensure and changing the name of the Board to the NCSAPPB. And here we are!

Becoming a CSAC (Certified Substance Abuse Counselor) • • Get registered with the NCSAPPB • “The applicant is to practice at least 10 hours in each of the core functions (120 hours) receiving 1 hour of supervision for every 10 hours practice. The remaining 180 hours of this practicum shall be practiced in the core function areas. ” • Each applicant must also complete 270 clock hours of Board-approved education and training in core function and core competencies. 190 of these hours must be substance abuse specific. 80 hours can be general skill building. 25 % of these hours can be in-service hours where an applicant works. Up to 50% can be independent study hours. These hours must include 6 hours of blood-borne pathogen training, 6 hours of ethics training and 6 hours of special population training covering either nicotine dependence, psychopathology, evidence-based treatment approaches or substance abuse issues in veteran or older adult populations. • When these criteria are met the applicant will take a written exam, and once passed will be granted deemed status as a CSAC. • YAAAY!! “Applicants shall complete a 300 hour practicum supervised by a credentialed supervisor, with a signed supervision contract in place. The practicum shall cover all 12 Core Functions of counseling. ”

The 12 Core Functions

SCREENING Screening is the process by which a client is determined appropriate and eligible for admission to a particular program. Global Criteria 1) Evaluate psychological, social and physiological signs/symptoms of substance 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 coexisting conditions (medical, psychiatric, physical, etc) that may indicate a need for additional professional assessment and/or services. 5) Adhere to applicable laws, regulations and agency policies governing substance abuse services.

INTAKE Intake is the administrative and initial assessment procedure for admission to a program. Global Criteria 1) 2) 3) 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.

ORIENTATION Orientation is describing to a client the following: general nature and goals of the program; rules governing client conduct and infractions that can lead to disciplinary actions or discharge form the program; the hours of operation of a program and hours services are available; treatment costs to be borne by a client when warranted; and client rights. Global Criteria 1) Provide an overview to the client by describing program goals and objectives for client care. 2) Provide an overview to the client by describing program rules, client obligations and client rights. 3) Provide an overview of program operations.

ASSESSMENT Assessment are 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 1) 2) 3) 4) 5) Gather relevant history from the client including but not limited to substance use and abuse using appropriate interview techniques. Identify methods and procedures for obtaining corroborative information from significant secondary sources regarding client’s substance use and abuse and psycho-social history. Identify appropriate assessment tools. Explain to the client the rationale for the use of assessment techniques in order to facilitate understanding. Develop a diagnostic evaluation of the clients substance use and 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 clients strengths, weaknesses and identified problems and needs.

• TREATMENT PLANNING Treatment Planning is the process by which a 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 utilized. • Global Criteria 1) Explain assessment results to the client in understandable manner. 2) 3) 4) Identify and rank problems based on individual client needs in the written treatment plan. Formulate agreed upon immediate and long-term goals using behavioral terms in the written treatment plan. Identify the treatment methods and resources to be utilized as appropriate for the individual client. (Remember…treatment plans are living documents and should reflect ongoing client needs and changes during the course of treatment. )

• COUNSELING Counseling: (Individual, group and significant others): The Utilization of special skills to assist individuals, families or group 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 1) Select the counseling Theory(ies) that apply(s). 2) Apply techniques to assist the client, group and/or family in exploring problems and 3) 4) 5) 6) 7) ramifications. Apply techniques to assist client, group and/or family in examining client’s behavior, attitudes and /or feelings if appropriate to the treatment setting. Individualize counseling in accordance with cultural, gender and lifestyle differences. Interact with the client in an appropriate therapeutic manner. Elicit solutions and decisions from the client. Implement the treatment plan. (don’t get bogged down in talking about theories you are not versed and/or trained in!!)

CASE MANAGEMENT • Case Management: Activities which 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. • Global Criteria 1) Coordinate services for client care. 2) Explain the rationale of case management activities to the client. (GET RELEASES SIGNED…!!)

CRISIS INTERVENTION • Crisis Intervention are those services which respond to an substance abuser’s needs during acute emotional and/or physical distress. • Global Criteria 1) Recognize the elements of the client crisis. 2) Implement an immediate course of action appropriate to the crisis. 3) Enhance overall treatment by utilizing crisis events.

REFERRAL • Referral is 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 1) Identify need(s) and/or problem(s) that the agency and/or counselor cannot meet. 2) Explain the rationale for the referral to the client. 3) Match client need(s) and or problem(s) to appropriate resources. 4) Adhere to applicable laws, regulations and agency policies governing procedures related to the protection of the client's confidentiality. 5) Assist the client in utilizing the support systems and community resources available. (Again…get releases signed!! Comply with HIPPA!)

CLIENT EDUCATION • Client Education is the provision of information to individuals and groups concerning substance use and abuse and the available services and resources. • Global Criteria 1) Present relevant substance use and abuse information to the clients through formal and/or informal processes. 2) Present information about available substance use and abuse services and resources.

REPORT AND RECORD KEEPING • Report and Record Keeping is charting the results of the assessment and treatment plan, writing reports, progress notes, discharges summaries and other client related data. • Global Criteria 1) Prepare reports and relevant records integrating available information to facilitate the continuum 2) of care. Chart pertinent ongoing information pertaining to the client. (If it ain’t documented it didn’t happen!!!)

CONSULTATION WITH OTHER PROFESSIONALS IN REGARD TO CLIENT TREATMENT/SERVICES • CONSULTATION…Is the process of relating with in-house staff or outside professionals to assure comprehensive, quality care for the client. • Global Criteria 1) Recognize issues that are beyond the counselor’s base of knowledge and/or skill. 2) Consult with appropriate resources to ensure the provision of effective treatment services. 3) Adhere to applicable laws, regulations and agency policies governing the disclosure of clientidentifying data. 4) Explain the rationale for the consultation to the client, if appropriate. (Know your limits!! And get releases signed where needed!!)

TIPS • PRACTICE SELF-CARE!!!! • STAY ALERT TO CHANGES IN THE FIELD • READ NCSAPPB EMAILS AND BE AN ADVOCVATE • GET GOOD SUPERVISION!!!

REFERECNCES NCSAPPB Credentialing Procedures Manual 12 Core functions of the AODA Counselor from the IC&RC Slaying the Dragon: The History of Addiction Treatment and Recovery in America by William L. White. 1998. 4 th ed. Chestnut Health Systems/Lighthouse Institute. Bloomington, IL.