Recovery Oriented Systems of Care | Addiction Counselor Review

Recovery Oriented Systems of Care | Addiction Counselor Review


Welcome to the Addiction Counselor Exam
Review. This presentation is part of the Addiction Counselor certification
training. Go to http://www.ALLCEUs.com/certificate-tracks to learn more about
our specialty certificates starting at 149 dollars. Hi everybody and welcome to
case management and service coordination in a recovery-oriented system of care
this is a review for the addiction counselor certification exam we’re going
to start out by talking about the recovery oriented system of care and
service coordination and then we’re going to move on from there so you might
be saying well what is a recovery-oriented system of care
basically it’s creating instead of a single agency or whatever that serves a
few needs of the person it’s creating a system that meets all of the needs of
the person and recognizes that recovery is episodic people will have problems
and then they’ll hit a plateau things will get better they’ll go into
remission whatever you want to call it and then they may need services again
may be different types of services so recovery oriented systems a system of
care is one that provides comprehensive services and is there for the lifetime
of the person it’s not just okay we’re here for you for 16 weeks and then good
luck it affirms the real potential for permanent resolution of behavioral
health problems it offers solutions to behavioral health problems on a
community and cultural level so again it’s not just an agency it’s an entire
community buying in the social service network preferably law enforcement as
well getting churches getting community organizations involved to make sure that
we’re meeting all of the biopsychosocial needs and a lot of times communities you
know social services meets the Bayeux needs the medical the food well those
are the two big ones and sometimes housing but in recovery oriented system
of care we also may need child care transportation recreation other things
for people too you so they don’t feel isolated this is
one of the reasons that a lot of the eldercare drop-in centers have opened in
order to create a place where people can go and socialize with people who share
some sort of similar aspects it’s a shift away from risk management and
relapse prevention toward encouraging clients to self define goals and take
responsibility for achieving them so instead of going okay how can we keep
this person from getting depressed again we’re gonna say how can we help this
person achieve their highest quality of life you know instead of saying we’re
going to prevent them from going backwards we’re going to say how can we
propel them forwards but they need to identify what goals are important and
take responsibility for achieving them and you know we’re there as that safety
net so to speak we’re there to provide resources but they need to be the ones
to actually do the hard work and it’s a shift away from emergency room and acute
care models to one of sustained recovery management which include wraparound
recovery support services this can include drop-in centers case management
social service needs community activities that can be done the the
limits there’s very few limits respite care that’s another big one in the
prevention of child abuse and neglect is to make sure that there are respite care
centers where parents can bring their children for even just a few hours to
get a breather if they need it there’s an emphasis on post treatment monitoring
so when people are in treatment they’re symptomatic we know that or they
wouldn’t be in treatment then when they’re not symptomatic anymore or
they’ve achieved their goals they’re discharged from treatment that’s great
but a recovery-oriented system of care says we don’t just let them get to the
top of the mountain and go well good luck hope you stay up there and don’t
fall a recovery-oriented system of care follows them or monitors or provides
check-ins after treatment to make sure people aren’t starting down towards a
relapse to make sure they’re maintaining their health related behave
to help them achieve their goals you know one of their goals was symptom
remediation they got that but remember we’re not just preventing relapse
we’re propelling forward towards their highest quality of life it provides
stage appropriate recovery education and remember when we talk about stage
appropriate we’re talking about Prochaska and DiClemente stages of
change pre contemplation contemplation preparation action and maintenance it
provides peer recovery coaching it’s not practical to have a therapist calling
and checking in on patients every week for three years after they discharge you
know number one we can’t build for it number two I would have so many clients
I would never do anything but follow-ups so peer recovery coaching and peer
support services in the community is where a lot of the post treatment
monitoring happens as well as primary care physicians who hopefully see their
people at least once a year there’s an emphasis on assertive linkages to
recovery communities we want to make sure that people can connect with other
people who have similar issues depression support anxiety support grief
recovery divorce support early intervention is important if there’s a
problem or re intervention as they say if the person starts to exhibit relapse
warning signs or decompensation we want to be able to get them back into
treatment quickly and not go well there’s a six-week wait you know good
luck hope you can stay stable for that long so early reinter vention says when
we see a problem we’ve got intervention level services if
you look at your a sam that’s you know below outpatient that’s like outpatient
groups where we can get people in so they can start connecting with services
right away before the problem gets bad think about if you have a cut on your
arm early re intervention if you will would
be making sure that if after you come from home from the hospital and you’ve
gotten stitches and everything if you look down one morning and it’s inflamed
and hot and pussy you can get back into the hospital right away
to get it taken care of versus waiting you know five days until your doctor can
get you in to clean it out so that keeps the infection from getting worse
same sort of thing with mental health stuff and it helps people maintain
functional ability in all life activities recovery in illness instead
of recovery from illness what does that mean that means if somebody has major
depression for example or if somebody has a substance use disorder okay
that may be something that they may be dealing with for a good deal of their
life but that doesn’t mean that they can’t have a really high quality of life
so it doesn’t mean that you can’t recover and you can’t have a high
quality of life until this is gone it means okay so you’ve got major
depressive disorder when you get your symptoms under control when it’s in
remission let’s help you achieve your highest quality of life so you’re not
recovering from it you’re accepting that it might be part of your life for a
while and you’re recovering despite it so to speak the goals are to foster
health and resilience activities encourage people to get enough sleep get
good nutrition get good medical care keep on their medications like they’re
supposed to get rest and Recreation and work-life balance all that happy stuff
increase permanent housing and a sense of home and belonging so we want to help
people find a safe place to stay where it is home it’s not just somewhere that
they’re happened to be sleeping at night it feels home which means it feels safe
and it feels like they belong there it ensures gainful employment and access to
education to provide a sense of purpose so we want to make sure we get the
Workforce Development Board involved in the recovery oriented system of care to
ensure that people are getting access if they can work to education or to jobs if
they’re not able to work because of the level of their disability they have
access to volunteer work or supported employment it enhances communities by
increasing the availability of necessary supports from and for peers
family and community so by bringing the recovery oriented system of care
together that means we’re involving peers we’re involving like others and
we’re saying let’s help you support one another you know there’s the
professionals out here when you need them but a lot can be done by sharing
your own support and sharing your own stories and your own successes and it
reduces barriers to social inclusion it helps communities see that people
with addictions and people with depression are not you know problematic
or they’re not weird or different they’re the same it helps educate people
about how prevalent addiction and anxiety and depression and bipolar and
all that stuff really is and encourages them to see the person who has
depression as a person not as a depressed person counselor functions in
recovery oriented systems of care include identifying gaps and services so
you know where I am now there’s no public transportation so that’s one gap
you know getting clients to where they need to go to medical appointments to
counseling appointments to work can be a problem identifying emerging needs and
trends well you know right now in 2018 there’s a huge emerging trend in opiate
abuse and need for education about opiate addiction and treatment options
for opiate abuse and monitoring system effectiveness you know of the people
that enter the system no matter where they come in they come in through social
services or their medical doctor or law enforcement you know probation and
parole however they enter the system are they
successful at getting their symptoms to remit and starting to achieve a high
quality of life as they define it guiding principles of recovery emerge
from hope and our person-centered which include self efficacy and self direction
so the client is going to decide their goals and we are going to help them
develop I can do attitude you know to believe
that they can’t accomplish their goals it’s nonlinear and occurs by a many
pathways recovery doesn’t all wait well it almost never goes in a straight line
and always forward it’s two steps forward one step back three steps
forward a half step back you know it’s kind of like this kind of like doing the
cha-cha more than a straight line and sometimes it takes a hard left turn you
know a client maybe on a good course of recovery I can think of one in
particular that I had she was doing really well in recovery and then she was
diagnosed with metastatic breast cancer well that was a hard left turn so
recovery activities that we’re gonna keep going out this way they got
derailed for a little while until she got her cancer in remission and then she
circled back around but the recovery oriented system of care said all right
we recognize what your needs aren’t right now so let’s figure out what we
can do with your treatment plan in order to continue to help you you know not go
backwards and move forwards at the same time it’s holistic incorporating the
mind body spirit and community a lot of times we forget community in there so
we’re encouraging people to engage their spirituality we’re encouraging people to
engage their community for support and a sense of belonging and a sense of
connectedness it’s supported by peers and allies and allies or counselors and
case workers and all of us professionals that are involved in the process but
it’s also supported by peers we’re peers are out there going hey been there done
that let me give you a helping hand or let me be a sounding board you can
bounce stuff off of it’s supported through relationships and social
networks within the family among peers you know think about 12-step meetings
those are a perfect example of peer support and the 12-step meetings and the
12-step well each different 12-step meeting tends to form their own sort of
little family you have home groups where you form sort of your own family faith
groups are out there to also support these relationships and the community
hopefully you get some buy-in from the politicians from government to support
financially some of the resources that need to be there to provide a
recovery-oriented system of care it’s culturally based and influenced so what
a recovery-oriented system of care looks like in you know the middle of New York
City is going to be different than what one looks like
in the middle of Lebanon Tennessee and that’s okay it’s based on the culture
that’s here and the resources that are here it’s supported by addressing trauma
and based on respect of individual family and community strengths and
responsibilities what’s important in this community what’s important for
people you know what does the client thinks important what does the community
think is important and how can we align those goals how can we make that work
for everybody three core components of a Rusk recovery
oriented system of care collaborate collaborative decision-making and
individual empowerment we don’t do things two or four clients
we talk with them we empower them to do everything they can and we assist them
when needed continuity of services and supports there’s no wrong door
which is what I talked about earlier it doesn’t matter if the person you know
came in contact with law enforcement and that’s how they got referred to
counseling or through social services or through their medical doctor or the
emergency room however they got here they’re here you know we want to make
sure that everybody in that safety net knows how to refer to the different
agencies so clients can get connected with the appropriate resources easily
because in a rusk and in any community when you start getting 15 20 services
together it can get a little bit overwhelming sometimes especially to
someone who is struggling just to deal with life on life’s terms
so that’s where we step in and we go alright let me help you get these
referrals and get you on the right path once they start making progress forward
they generally feel in power and take on more of the responsibilities
themselves and services are available for as long as needed it’s not a well
you have eight authorized sessions so let’s see what we can do and then you’re
on your own it may be you have eight authorized
sessions and then I need to refer you somewhere else or to a different program
because you know a lot of private practitioners can’t just do pro bono
services and totally get that but a rasca allows for opportunities and
options so a person doesn’t just kind of hit a wall and drop and it’s also based
on service quality and responsiveness services are evidence-based you know we
want to provide things that have there they may not be evidence-based best
practices you know we may not be using every single one of those but there’s
research evidence that says this works and it’s available to you
it’s developmentally and culturally appropriate gender-specific
trauma-informed family focused and staged appropriate so for some of these
four evidence-based do you want to go to tip 42 which will help you look learn
about treating persons with co-occurring disorders for trauma-informed there is a
tip and I can’t remember what tip number it is but there is a treatment
improvement protocol through Samsa on working with people with trauma and
staged appropriate that’s tip 35 which is motivational interviewing which will
walk you through the steps of the different types of interventions that
are useful for each stage of change recovery management in a
recovery-oriented system of care treatment doesn’t need to be voluntary
but success depends on personal engagement my first job out of college
out of graduate school was working as the liaison to probation and parole so
all of my clients were involuntary they were there because the judge said they
had to be well that’s wonderful but you know they weren’t gonna make much
progress if I wasn’t able to get them personally engaged so it became a matter
of me figuring out how to helped them see how this might work for
them one they wanted to get off probation well in order to do that they
had to complete my program so that was step one they would at least show up but
I wanted them to do more than show up I wanted them to get engaged so – what can
you what can you get out of this what can I teach in these groups because I
had the luxury of being able to you know prove provide a fair amount of different
topics in groups but what types of topics are meaningful as long as you’re
paying for counseling you might as well get something out of it what can I help
you work on and if they didn’t have anything specific we would work on
something general like motivation or coping skills but we would apply it to
their everyday life and say okay now how could this improve next week full
recovery often comes from episodic nonlinear treatment so remember get
better leave treatment for a while be in the community something else happens
they may need treatment again may not be mental health treatment it may be
medical treatment but we need to make sure that the person is healthy mind
body and spirit in order to prevent any sort of relapse previous treatment and
relapse is not indicative of a poor prognosis previous treatment and relapse
means we missed something you know there was not a adequate support network or we
didn’t adequately identify all of the presenting issues generally relapse is
viewed as evidence of the severity of the condition rather than a cause for
discharge so if you’re working with a client in outpatient and they relapse it
just breaks my heart especially if they’re in intensive outpatient but in
any program regardless at the level of intensity if they relapse that means
that that behavior whatever they did was more rewarding serve the purpose
solve the problem better than what we were offering so we need to back up and
go okay didn’t realize that you were in that much pain or you know this wasn’t
working for you we need to figure out an their way to meet that need but relapse
is a learning opportunity and evidence of the severity of the condition I know
I said that twice but it’s important recovery management is a time sustained
recovery focused collaboration between consumers and service providers so we’re
working together in a team with our clients with the goal of stabilizing and
managing the ebb and flow of co-occurring disorders until full
recovery is achieved or self management as possible
some people may experience full recovery never have another episode wonderful
some people get to the point where they’re in remission and self-management
is possible and then you know if they have another episode then they can
re-enter the re-enter the system recovery management spans three phases
pre recovery identification and engagement recovery initiation and
stabilization and recovery maintenance so pre recovery identification and
engagement is your outreach and your intervention services where we you know
the social worker at social services realizes that mom needs to come in and
need some assistance with substance abuse or something so she sends Sally
over to be assessed and enrolled in a substance abuse program so then we we
get Sally and it’s our job to assess and engage once she’s engaged then we can
initiate treatment and help her get stabilized and then hope her in that
maintenance period for a little while then discharge and discharge her back to
that recovery oriented system of care to the community where she can maintain her
recovery so all of this in order to make this happen requires a great amount of
service coordination and case management so service coordination is a client
level collaborative process designed to help individuals access needed services
did you know how overwhelming it can get for us figuring out who to refer to and
stuff it’s even more overwhelming for clients
select the most appropriate services we need as clinicians and case managers we
need to be aware of what the requirements are and what the
appropriate referral is for each individual agency I don’t want to refer
somebody to a program just to have them get there and the program says oh you
don’t qualify for these services so it’s important that I make good referrals
which means I need to know I need to be really familiar with the different
agencies in my system of care facilitate linkage with those services now
depending on the client the severity of their problems we may assist them in
contacting the agency and making the referral or we may make it for them and
say okay you’ve got an appointment you know with doctor so-and-so on Tuesday at
3 p.m. whenever possible it is a lot more
empowering and more likely that the client is going to show up if they make
the appointment themselves sometimes they need to do it when they’re in your
office because they’re intimidated by calling and making an appointment but
whenever possible we facilitate these linkages we make sure they get in
connection with the right person instead of having to call and go through a
switchboard of options going I don’t know if you’re the right person that
talked to facilitating linkages gets them directly to the right extension to
the right person to do what they need to do case management promotes continued
retention and services by monitoring participation
you know we check in make sure they’re going to their appointments make sure
that this service is helping them if not what what else needs to happen we
coordinate multiple services when necessary and advocate for continued
participation sometimes the agency will say well our census is full and we’ve
got a waiting list I need to discharge this person and as a case manager or a
clinician it may become up to us to advocate for that person to stay in
services for another certain period of time in order to prevent relapse
objectives of case management include maintaining continuity of care so we’re
not just discharging and then referring and going well I hope that went well
we’re making sure that the handoff goes smoothly and that every time a client is
referred the handoff goes smoothly and every organization involved in that
clients care knows what every other organization is doing there’s a single
point of contact which is the case manager usually and we keep good records
so we’re not duplicating services and we’re not contouring contradicting each
other either case management establishes relationships with gatekeepers like I
was talking about we know what the requirements are at each program so we
know who an appropriate referral would be we develop contracts or memorandums
of understanding which specify available slots so for example I may work with a
day treatment drop-in center and I may develop a Memorandum of Understanding
where they insure me they will always have three slots available for our
clients that way I know I once I reach that three level then I can’t refer
there anymore because they have clients coming in from other providers but they
will take up to guarantee that they will have slot a slot for up to three of my
clients at any one time and mo use also identify consequences for failure to
implement specified activities or procedures so if I refer Sally over to
this drop-in center and she gets there and they say we can’t admit you were
full right now and I know that I’ve only got one patient in that program and they
promised me three slots then I have sort of a leg of to stand on just go back to
that organization and go the contract says now what the consequences are are
between your CEO and and the executives and the legal team but a lot of times it
really benefits people to be in these recovery oriented systems of care to
keep their slots full so they don’t want to get booted case management ensures
accountability following up on the referral with the client and the
referral source measuring outcomes with client satisfaction client outcomes and
service issue outcomes like did involving this client
with this service reduced the number of days that they were in residential you
know that’s obviously a good thing and it works case management works on the
principle of efficiency know the system and make it work
case management is necessary because of poor courts poor service coordination
lack of service continuity and difficulty of clients negotiating the
gap between services without case management you have fifteen independent
organizations operating with their own rules regulations and kind of in
isolation and when you have a case manager it helps coordinate these
services to make sure clients are getting the right services at the right
time at the right intensity and making sure that clients are able to access
them without getting lost in the mix the case manager acts as the human link
between the client and service providers we’re out there we’re holding the
clients hand and we reach out and we grab that agency’s hand and we link them
together and and so on and so forth we develop contracts with providers for
identified services control case management funds act as a single point
of entry for clients and develop missing service elements so if you can have a
case management organization serving as your single point of entry that doesn’t
negate no wrong door that means if somebody comes in from
Social Services and needs assistance they will refer to the case management
agency and the case manager will assess this person and say let’s figure out
what all your needs are so I can help you develop a plan and we can figure out
how to link you in with things and case managers also develop missing service
elements if transportation is a missing service element the case management
agency will figure out you know is there a way we can work with local churches
for example that have church buses to facilitate tree facilitate
transportation you know maybe one week a month one week a month
or a quarter each church volunteers to do transportation service coordination
and case management approaches include intensive assertive community treatment
which is comprehensive multidisciplinary and community-based the act program as
you may know it or the fact program case managers go out into the community visit
clients at their homes check on their medications you know they go to the home
make sure it’s clean make sure you know the client is bathing or whatever count
their meds to make sure that they’re taking their pills and check in with
them each week at least sometimes more often in order to assure that they’re
stable and not needing additional services clinical case managers can
provide counseling and some intervention services strengths strengths based case
managers obviously identify clients strengths and help them build on those
and in order to achieve their highest quality of life brokerage case managers
coordinate services but they provide few if any services so brokerage case
managers are the people that say come to me let me figure out where to refer you
to and they refer out they don’t do any of the case management they don’t do any
psychoeducation none of that stuff they are a
coordinator and that’s it integrated case management is family focused and
strengths based and it uses an independent facilitator to bring all
relevant people including providers family and natural supports to the table
so integrated case management really brings the community and the support
systems in instead of just having the agencies involved we’re bringing
everybody to the table the team then works in partnership with the family to
create a safety based comprehensive plan addressing the needs of all family
members recognizing that you know mental illness or substance abuse affects
everybody in the family and if somebody else in the family starts to become
symptomatic with something you know it’s going to negatively impact the whole
family system so what does the family how can we provide a resilient family to
support the identified patient and each other case management offers a single
point of contact for clients if client driven and strengths based and involves
advocacy between services with seemingly contradictory requirements to serve the
best interest of the clients so we want to look at you know if you combine law
enforcement with counseling and and this is your problem solving courts for
example yeah you know I would rather my clients didn’t go back to jail
but sometimes you know we need to work together in order to increase motivation
and help clients achieve what they need to achieve with aid we advocate with
agencies families legal systems and legislative bodies and we may recommend
sanctions to encourage client compliance and motivation case management is
community-based for the most part with the accept with the exception of
brokerage case management its pragmatic it meets the client where they are it
says in this point in time what needs do you have we’re not going to look at over
here or back then what do you need right now we’ll worry about the future in the
future it is anticipate ory based on the natural course of the clients presenting
issues so we identify where the client is right now and then we speculate you
know if they’re needing to go into intensive residential right now for 60
days okay we also know that they’re going to get discharged from intensive
residential in 60 days and they’re going to need to have somewhere to go after
that so a case manager would start working on that at the beginning so they
were assured that they had something lined up or help the client have
something lined up for when they get out of treatment it’s flexible to individual
needs and culturally sensitive the case managers role is to coordinate manage
link advocate and support clients in their quest to maximize their quality of
life and achieve as much independence as possible basic prerequisites to be a
case manager can you establish rapport are you a good
listener can you establish a therapeutic alliance can you maintain boundaries and
this can be really hard sometimes to maintain boundaries and not try to tear
caretaker or parent or you know overly become overly involved in a client’s
case so you need to be able to maintain boundaries and say you need to be
empowered to do this case managers have to be non-judgmental recognize the
importance of family social networks and community in the process of recovery
understand the variety of insurance and payment options available because in
order to access all these services they got to be paid for somehow so case
managers are typically experts on how can we get that funded they understand
culture and respond in a culturally sensitive manner they understand the
value of an interdisciplinary approach to treatment case managers you know are
the first to tell you that generally for somebody to recover they need multiple
different types of services so we need to look at them from a biopsychosocial
environmental perspective and case managers serve as both facilitator of
referrals and an advocate for the client as a facilitator the case manager
composes the team figures out what resources are needed who’s going to be
on the team notifies everybody in the team of meetings because we all need to
get together now with you know the computer and technology now we can do
virtual meetings so people don’t have to haul their butts all the way to one
particular place and lose a bunch of billable hours but they do need to
participate in the meetings the facilitator the case manager chairs the
meeting they’re the one who’s coordinating everything they’re not
going to tell the doctor what to do and the counselor what to do but they are
going to take all this information and figure out how it all weaves together
and help resolve any disputes or whatever between the different agencies
they maintain team focus on the client you know this is not about who’s going
to make the most money or who needs a slot filled it’s about what does the
client need at this point in time and ensures clients desires and needs are
adequately represented and considered so it’s important for the case manager to
stand up and go no Sally said she really didn’t want to go to residential or
Sally said she was really not ready to discharge from from residential for all
these reasons so we need to stand up and say this is what the client really wants
ideally empowering the client to write a narrative or at least bullet points
about all the reasons that they want this and that it’s imperative to their
recovery so we can help them learn how to advocate for themselves even if
they’re not in the team meeting we can present that for them
service coordination and referral referral is the process of facilitating
the clients use of available resources and support systems to meet needs
identified in assessment and treatment planning it involves identifying needs
of the clients which cannot be met by the agency regardless of whether the
client is receiving case management services so if you’re a clinician and
you don’t have a case manager that you can refer to you still make referrals we
make referrals all the time and referrals are important in appropriate
referrals may lead to drop out if clients hopes get up and then they’re
denied access to services so again so important that you know why it’s
important to go there and you make sure the handoff goes well I don’t want to
refer somebody I remember my doctor referred me to ob/gyn at one point and I
went there and I sat for three and a half hours in the waiting room after my
appointment time and nobody said boo or could tell me when the next when I was
going to get seen so I finally left and I was like no I’m gonna find my own
referral source from now on so it’s important to remember you know that
everybody has to play on the team and the client can’t be denied access for
services or ignored you know inadequate follow-up also leads
to premature dropout so we need to followup with the clients and go how did
that go did you feel like this person was able to help you etc if not you know
let me understand what went wrong and I can give you a different referral
counselors must know resources in their community the processes for making the
resort the referral the limitations what the cost is who can access those
services the requirements you know if somebody has to be clean drug-free for
30 days and have transportation or whatever the requirements are to
participate in the program sometimes programs have requirements of
they cannot have certain mental health disorders or be on certain medications
it’s important to know that and you need to know confidentiality counselor should
visit referral agencies initially and get to know them and then send me
annually after that this is not always possible what we used to do in my clinic
was we would divide up the different referral agencies and we would go and
each person would visit four of them semi-annually that was doable each
person going to all 27 agencies semi-annually was not doable potential
problems and referrals can arise from differences in agency functioning
differences in eligibility criteria inadequate data sharing conflicting
treatment plans and it’s important to remember that moving between agencies
may interrupt continuity of care so for example one of the biggest eligibility
issues for example you may have a lot of programs in your community that accept
Medicaid whatever it’s called in your state here it’s called 10 care in
Florida it’s called Medicaid but there are also a lot of
treatment centers that don’t accept Medicaid so it’s important to make sure
that even though you both serve clients a bit similar some socioeconomic status
you know the treatment center may have state funding dollars to provide
services whereas you provide services that are funded by Medicaid
so just important to know potential referral sources marriage and family and
mental health counselors abuse and trauma counseling resources primary care
women’s health nutrition Dietetics holistic practitioners pain management
legal services this can include criminal as well as
civil you know child custody domestic violence etc financial counseling
helping people get out of bankruptcy figure out how to make their make their
bills housing career counseling and educational planning we want to make
sure we can help them become financially independent and religious spiritual and
faith support this is not an exhaustive list but these are some of the big ones
that we need to know how to refer clients to in order to meet their
biopsychosocial needs and help them be think about Maslow’s hierarchy they have
to have those biological and safety needs met before they can make much
progress with depression or substance abuse potential referral sources include
also include career counseling and educational planning LGBTQ support
12-step meetings and there are 12-step meetings for depression there are
12-step meetings for a lot of things not just alcoholism the Veterans
Administration know what services they provide people sometimes need referrals
for child care whether it be all the time child care or child care while
they’re in treatment and transportation potential reasons why we might make a
referral if your agency doesn’t provide that service and your your agency is not
going to provide all those services I just listed the counselor may not be the
best person to provide the service services for example issues of sexual
identity issues require special training working with small children require
special training I don’t have training and play therapy so I would make a
referral to a play therapist the counselor believes there might be a
conflict of interest if somebody comes in and you know that you know their
husband’s brother or something you might need to make a referral when I
worked at the clinic that I worked at in Florida my husband was a full-time law
enforcement officer so whenever law enforcement officers
came in especially ones from his department but any of them that came in
I generally recused myself from their case even if they entered one of my
programs the counselor recognizes the need for a different level of care if
you’re an outpatient therapist and you recognize your client really needs
intensive outpatient or residential then you’re probably gonna make a referral
the counselor should explain the rationale for any referrals to
facilitate participation why is it that you’re referring me to this dentist or
this doctor or this chiropractor or whatever it is and generally it’s pretty
obvious but we want to make sure that clients understand why why it’s
important and how it will benefit their recovery from their mental health issue
familiarize the client with the agency to quell their anxieties what’s it going
to be like when I walk in there is it this big building is it this little
building is that one person is it this huge clinic what’s what should I expect
contact the referral source in the clients presence or have the client
contact the referral source in your presence so you can give them a little
support when they’re making the appointments have the clients scheduled
the actual appointment this is one of the biggest reasons for client no-shows
if somebody makes an appointment for them at a time that they find is
inconvenient so they don’t show up give the client the contact name and number
and the agency address so after all this is done right all the information down
and give it to the client document the referral and follow-up in the client
record you want to make sure to follow up both remember with the client and
whoever you referred the client to just to make sure that both of you or
everybody’s on the same page dual diagnosis or co-occurring disorders
indicates the presence of both mental health and addiction issues people with
co-occurring issues often experience more severe emotional social and
physical problem than someone with only one issue medical
mental health and addictive disorders all influence each other think about
somebody who’s got chronic pain from fibromyalgia you know that can lead them
to feeling depressed and hopeless which can trigger an addiction relapse it can
also make them overuse painkillers in order to get relief from the pain so I
mean they all interact so a relapse or a problem in any one area could
precipitate relapse in all of the areas Yuson withdrawal of substances can both
cause mood social and physical conditions if you’ve seen anybody in
detox you know that their mood can get pretty erratic and they don’t feel well
and it can impact social relationships you know their friends who are still
using you know it’s gonna they’re gonna have to figure out how to negotiate that
and they may have alienated some of the people who didn’t use and they want to
build that back up but during this period of addiction you know there are
mood social and physical complications there is a continuum of the disorder you
know and all disorders from depression to addiction in terms of the severity
you know you can have mild depression you can have what we used to call
substance abuse but mild substance use disorder – very very severe it varies in
its chronicity people with major depressive disorder may have one episode
every couple of years other people may have two or three episodes per year and
the disability or degree of impairment in functioning so some people and this
kind of goes with severity but not always if you have how much does this
impact your ability to work I mean somebody who has a severe major
depressive episode once every three years probably will not have the degree
of impairment that someone who has a mild case of depressive disorder or
persistent depressive disorder will experience because they’re
depressed most of the time for extended periods of time which will impact their
work differently so they actually even though the severity is less the
chronicity may contribute to significant disability treatment plans are designed
with the provider to identify treatment objectives necessary to achieve goals
every single agency is going to have their own version of a service plan or a
treatment plan but the case manager needs to compile all of this and create
sort of a master recovery plan a service plan service plan is an umbrella
document which ties together all of the treatment plans from various providers
and the short term goals and objectives because if you’ve got 15 people working
or agencies working with this person they’re gonna have 15 different
treatment plans and they’re probably gonna be sitting there going I don’t
know what to do first there’s not enough hours in the day so the case manager can
help them sit down and look and say all right let’s figure out what needs to be
done first what’s step one step two step three and break it down so it’s not so
overwhelming to the client the comprehensive service plan provides long
term goals where do we hope to go what does a rich and meaningful life look
like to you but current status narrative so we can see where we’re starting from
and the identification of required services supports and resources so this
is when the case manager says all right in order to get Jon from here point A to
point B these are the services supports and resources he’s going to need and
this is the order I’m going to make the referrals linkages goes beyond providing a list of
resources and involves developing a network of known resources and contacts
so we’re not just referring people out going well there are these three people
over here I found on the web we actually have interacted with these
agencies we’re familiar with their their services and we have a contact there so
we can link the person remember I said you’re it’s kind of like holding the
clients hand and holding the providers hand and putting their hands together
we’re actually making that linkage we’re not just going here good luck linking monitoring and adverse advocacy
is the foundation for successful implementation and is based on
interdisciplinary team planning effort and this includes the client if you’re
making this treatment plan without the client then you miss the boat somewhere
because they need to be the driving force behind every treatment and service
plan the client will help decide goals and priorities as will the team the team
helps assign responsibilities for each goal because the clients probably not
going to do everything by him or herself and everybody on the team including the
client reach consensus in the overall approaches and objectives service coordination encompasses
administrative clinical and evaluative activities that bring the client
treatment services community agencies and other resources together to focus on
needs in an identified recovery plan so case manager does service coordination
we’re kind of pulling the different strings or if you want to think of it as
a big big machine in a in a factory or flipping the different switches at
different times service coordination includes case management which
collaborates with the client and their significant others coordination of
treatment and referral services to address issues contributing to and
caused by addictive behaviors liaison activities with community resources so
we’re constantly engaging going how can we help you how can you help us how can
we make this process go more smoothly an ongoing evaluation of treatment progress
and client needs service coordination in addition to case management also
involves client advocacy the tasks of service coordination include initiating
and collaborating with the referral source creating a warm referral so I’m
not just calling this agency for the first time going hey I’m doctor Snipes
you know I know you’ve never met me before but I have this client who needs
your services so I’m gonna give him your number and let him call you that’s cold
the person doesn’t know you and they still don’t know anything about the
client a warm referral is you know you’ve already established a connection
with the agency they kind of know who you are and you call up and I have this
client obviously within the bounds of HIPAA I have this client Sam Smith who
I’ve referred to your agency here his main presenting issues just so you can
open a file and be ready for him service coordination also involves obtaining
reviewing and interpreting all relevant screening assessment and treatment
planning information so again we’re gathering from all the players in the
in the team to figure out exactly what’s going on we confirm client eligibility
for admission and continued readiness for change for any of these resources so
we’re monitoring their eligibility and their motivation if we don’t think
they’re ready to do this if their motivation is waned they’re saying I
don’t think I need to go there we’re gonna let the team know and we’re going
to adjust the service plan accordingly or hopefully we can increase their
motivation but we want to complete necessary administrative procedures for
admission and coordinate all treatment activities with services provided to the
client by other resources so again we’re just making sure that the right switches
get flipped at the right time we establish realistic recovery
expectations including the nature of services we let them know what it’s
going to be like you know we don’t want them to think it’s going to be a
cakewalk or a vacation but we don’t want them to think it’s going to be like jail
either so let them know what this programs gonna be like what are the
program goals and procedures what are the rules regarding client conduct the
client rights and responsibilities a general schedule of treatment activities
the costs of treatment and facts impacting their duration of treatment
now where I used to work this was what we did in orientation but if you’ve got
a case manager who’s serving as your single point of contact they can do this
orientation piece for you and make sure that the client is on board with
everything before they begin with your program types of services that we want
to look for mental health physical health including you know people with
substance use issues may have liver issues including hepatitis brain issues
including alcoholic dementia as well as cognitive deficits from fetal alcohol
issues HIV tuberculosis STDs the whole range they need a comprehensive physical
evaluation and access to services job skills employment opportunities
interpersonal skills helping them learn how to effectively
communicate assertively communicate and manage their frustration and either
anxiety or aggression because sometimes that when people are detoxing or in
early recovery their frustration their patience fuse is about that thin or that
small so we want to make sure that they have effective interpersonal skills to
get them through even when they’re feeling like they’re barely getting
through the day training in education legal services housing services food
child care and transportation service coordination is essential to prevent
clients from falling through the cracks it fosters a more holistic view of the
client as not just a person with an addiction or a person with depression
but a person so you know sometimes in the old way of doing if the client
no-shows because they can’t find the sitter the old way would say well
they’re being non-compliant the new way would say you know what maybe they’re
being a responsible parent because they’re taking care of their kid and yes
it would have been ideal to have a backup but if the sitter calls five
minutes before they’re supposed to be there and says I’ve got strep throat
sometimes there’s nothing you can do so we want to view the client in terms of
and all the clients behaviors in terms of why did the client do this and what
does it possibly mean and obviously we want to look at you know how does this
make sense and how was this the best choice that the client saw at that point
in time challenges to collaboration and service coordination include the use of
a different assessment tools at each agency to gather the same information it
can produce a fragmented picture of the client unless it’s all integrated
because the vocational rehab is going to get different information than mental
health is going to get so they’re all getting different bits and pieces if you
use the same instrument or the same instruments plural then the client has
to tell the same exact thing like 17 different times and that gets
frustrating and a lot of times clients will drop out because they’re just like
I can’t do this again agreeing with which agency or clinician
is the lead or primary contact for the client and other agencies is another
collaboration issue case managers you know if you can have a Memorandum of
Understanding that has identifies for example the case manager as being the
primary point of contact that can help in order to figure out who’s who’s lead
who’s the one that’s you know coordinating or directing this other
challenges can include funding and eligibility barriers for example some
places will not admit persons with a forcible felony so you need to know what
services are out there so if you can’t refer to this treatment center because
the person has a forcible felony then what treatment center can you refer to
there may be difficult to treat clients and differing staff credentials where
they’re arguing over the best way to treat a client so that can make
collaboration a little bit difficult but ideally the case manager or the you know
team lead is able to help negotiate these differences challenges can occur
at three levels personal challenges including attitudes and attributes you
know if you are a psychiatrist and you think that every client needs to have 60
days of clean time in an unrestricted environment before they can be on
antidepressants and then you have a addiction counselor who says there’s no
way my clients going to get 60 days of clean time in an unrestricted
environment unless he’s on antidepressants then you’re gonna have
difficulty because your attitudes are different about how to treat things and
and what’s necessary professionally you may have different theoretical beliefs
or approaches to treatment of addiction one may be tough love the other one may
be strengths based empowerment and organizational challenges we’re
different zatia pnes don’t recognize the need for
a partnership so they don’t want to play with your recovery-oriented system of
care they’re like if you need us refer to us but i don’t have time for all your
meetings lack of a shared mission lack of ownership by senior management and
ownership means senior management says this is my team and i will be
responsible for what happens and what my agency does you know and I will make
sure that we own up to our contracts and facilitate these referrals a lack of
trust between agencies which often happens after senior management lacks
ownership where agencies have gotten into partnerships before and one has not
fulfilled their end of the bargain so then there’s no trust that anything’s
going to happen or they’ve gotten into partnerships before and one agency has
demanded to have their way the whole time
unclear guidelines for collaboration and lack of a process for monitoring and
managing the collaborative process so we need to make sure that just like in a
family counseling session we are regularly checking in with every single
team player to make sure that they’re getting their needs met they’re getting
the resources they need etc and we’re communicating effectively so recovery
oriented systems of care provide a basically a lifelong a safety net for
people in order to help them achieve their highest quality of life the goal
is to help people live with learn how to live with any disorder that they may
have and achieve their highest quality of life we recognize that treatment is
not linear it is episodic and it can go up and down and sometimes it can take a
hard left the recovery oriented system of care has services that are able to
meet all of the needs of people and that includes and services include the
involvement of family community spiritual leaders as well as the
individual to make sure that you know everybody is
getting their needs met in an affordable way because like I said we can’t provide
24/7 clinical services to everybody who might possibly need some which is why
community support groups and intervention level groups and you know
community based activities and supports are really really helpful already I hope
this gave you some things to think about for recovery oriented system of care
case management service coordination and referral for prepare preparing for your
addiction counselor certification exam

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