c2 mod 6 components of tx

8/11/2019 C2 Mod 6 Components of TX

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MODULE 6—COMPONENTS OF

TREATMENT: THE CONTINUUM OF

CARE

Treatment for Substance Use

Disorders — The Continuum of Care

for Addiction Professionals

The Colombo Plan Asian Centre for Certification and Education of Addiction Professionals Training Series

Curriculum 2



6.3

Continuum of Care

The whole range of services a client may

receive directly from a treatment program or

coordinated by the treatment program



6.4

Module 6 Learning Objectives

Provide a general description of an effective

continuum of care for SUDs

Identify differences between screening and

assessment

Describe detoxification options



6.5

Learning Objectives—Part II

Define case management

Name and briefly describe at least five

interventions typically offered in primary SUD

treatment

Name and briefly describe four types of groups

often used in SUD treatment



6.6

Learning Objectives—Part III

Name and briefly describe the self-

help/mutual-help options available in the

community/area

Define continuing care

Apply the concept of continuum of care by

identifying an appropriate continuum for a

client via a case study



6.7

Four Parts of a Continuum of Care

Pretreatment

Primary treatment

Case management

Continuing care, including ongoing recovery

management



6.8

Pretreatment Components

Outreach

Screening and brief intervention

Assessment and treatment planning

Detoxification



6.9

Outreach Definition

Reaching out to build connections from one

group or program to another

Extension of services or assistance to persons

or groups not previously served



6.10

SUD Outreach

Organized efforts to identify and screen

individuals who may have a problem with

substance use

Photo credit: Family Health International, Hanoi,

Vietnam



6.11

Outreach Goals

Establish contact

Build trust

Develop relationships

Provide needed health care linkages

Engage individuals in SUD brief interventions

or treatment



6.12

Why Outreach?

Because many people who use substances

see treatment programs as:

Intimidating

Difficult to get to

Too rigid or judgmental in their approach

Irrelevant to an individual’s immediate needs

Too costly



6.13

Outreach Methods and Settings

Community education with other agencies

Talking with those who use substances at

homeless shelters, HIV or other medical

clinics, community centers, and drop-incenters

Education and screening at schools, social

centers, and clinics



6.14

Other Outreach Efforts

Paraprofessionals can go where substance

use is encouraged, such as dance clubs

Peer educators can visit places frequented by

those who use substances

Medical staff can provide brief interventions

and referrals wherever they work



6.15

Screening Purpose

Screening tries to identify only whether a

problem exists and whether further

assessment is needed



6.16

Screening vs. Assessment

Screening tries to identify only whether a

problem exists and what follow-up is needed

Assessment tries to identify as closely as

possible the nature of an SUD and otherissues and the level of intervention that may

be needed



6.17

Validity of a Screening Instrument

The degree to which the instrument actually

measures what it claims to measure

Internationally validated instruments:

The AUDIT, a 10-item screening tool for alcohol

The Alcohol, Smoking, and Substance

Involvement Screening Test (ASSIST)



6.18

Other Screening Instruments

Many other instruments have been designed

for adults and adolescents

See Resource Page 6.1 for additional

screening instruments that have not beenvalidated for use with all populations



6.19

Screening

Screening

No or LowRisk

No FurtherIntervention

ModerateRisk

BriefIntervention

Severe Riskor ActiveAddiction

Assessmentand PrimaryTreatment



6.20

Brief Intervention

Focuses on increasing a person’s insight into

and awareness of substance use and

behavioral change

Can be provided through a single session ormultiple sessions of motivational interventions

by SUD or other professional or peer staff



6.21

Assessment Goals

Provide a foundation for treatment planning

Establish a baseline for measuring a client’s

progress

Prioritize a client’s problems

Set priorities for treatment and case

management interventions

Identify client strengths and other recoverycapital that can support recovery



6.22

Assessment Tasks

Engaging the client

Obtaining the client’s history

Collecting data on the client

Observing the client during the first visit



6.23

Areas of Assessment—Part I

The client’s reason for seeking treatment and

his or her opinion of the problem

Current and past substance use and drug

treatmentFamily history of substance use

Medical conditions or complications



6.24

Areas of Assessment—Part II

Risk of withdrawal and need for supervised

detoxification

Suicide, health, and other crisis risk

assessmentEmotional/behavioral/cognitive status,

including the presence of a mental disorder

Educational and vocational background



6.25

Areas of Assessment—Part III

Legal status

Readiness to change

Natural supports within the family, workplace,

and community

Relapse or continued-use potential

Recovery environment (e.g., living situation,

barriers and supports for recovery)



6.26

Assessment Methods

Clinical interview

Assessment interventions

Collateral sources, with client’s permission:

Family

Friends

Employer

Referral sourcesUrine or other testing for substances



6.27

Treatment Plan

An individualized outline for treatment and

services based on the client’s specific needs



6.28

Treatment Plan Identifies Needs That

Will be addressed during treatment

Require referral to other treatment providers

Will be deferred to a later time



6.29

Effective Treatment Plan

Individualized

Flexible

Realistic

Simple

Useful

Solution focused

Clear

Responsive to changes and progress



6.30

Treatment Planning

Determining the level of care the client needs

and is willing to accept

Includes

Intensity

Duration

Setting



6.31

Treatment Planning Determinations

This first step of treatment planning includes

determining whether:

The program can meet the client’s needs or

should be referredTreatment for co-occurring mental or medical

disorders is needed

The client is in need of supervised detoxification



6.32

Detoxification

The process of:

Stopping substance use

Clearing the substance from the body

Managing the withdrawal syndrome



6.33

Withdrawal

The particular signs and symptoms, the

intensity of them, and the risk involved in

withdrawal depend on:

The substance usedThe amounts taken over time

The length of time the substance was used

regularly



6.34

Medications to Help with Detox

Medications can help with detoxification from:

Opioids

Benzodiazepines

BarbituratesOther sedatives



6.35

Goals of Detoxification

To provide a safe withdrawal from substances

of dependence and to enable the person to

become drug free

To provide a withdrawal that is humaneTo prepare the person for ongoing treatment



6.36

Types of Detoxification Services

Outpatient, home-based, or residential

services without medication but with

psychosocial support (social detox)

Outpatient services with medication andperiodic monitoring (medication-supported)

Inpatient services with medication (medically-

managed)



6.37

Detoxification

Detoxification is ONLY a first step toward

recovery; it is NOT treatment

S ll E i P t t t



6.38

Small-group Exercise: Pretreatment

Components

Summarize the key elements of your assigned

content area

Write these key elements on newsprint to be

used for a 3-minute presentationWrite these key elements on white paper to

post on the “Continuum of Care” wall graphic



6.39

Break15 minutes



6.40

Case Management

An integral part of treatment

Ongoing

recovery

Screening and

Assessment



6.41

Case Management

The coordination of professional, social,

and medical services to assist people with

complex needs, often for long-term care

and protection



6.42

Case Management — Purpose

Monitor transitions of clients between levels

of care to assure there are no gaps in service

Coordinate the range of services needed by

clientsServe as a single point of contact for each

client to find and mobilize needed resources



6.43

Case Management

Services tend to be scattered

or difficult to access



6.44

Case Management

Case managers help put the pieces together

for clients



6.45

Case Management Functions

Assessment

Service planning

Linkage and referral

Monitoring

Advocacy



6.46

Assessment and Service Planning

Assessment and service planning are closely

related to the initial assessment and treatment

plan discussed earlier

A case management plan can be incorporatedinto a client’s overall treatment plan or can be

done as a separate process



6.47

Linkage and referral

Linkage and referral are critical because no

one program can meet all of a client’s needs

Inter-program case management connects

programs to one another to provide moreservices to clients



6.48

Linkage and Referral

Through linkages and referrals, counselors

can help clients obtain:

Treatment for mental disorders

Family therapyChild care

Transportation



6.49

Linkage and Referral—II

Housing assistance

Financial assistance

Legal assistance

HIV/AIDS or other medical testing and careEducational or vocational services



6.50

Monitoring Functions

A case manager:

Ensures that the client engages in services and

monitors the client’s progress

Identifies barriers and works with the client andreferral sources to overcome them

Coordinates communication with the

multidisciplinary team



6.51

Advocacy

Speaking out on issues of concern to apply

influence on behalf of a person or persons



6.52

Advocacy: Where?

Case managers interact with many systems to

advocate for their clients, including:

Other organizations

Health care providersThe legal system

Families



6.54

Large-group: Advocacy Questions

How has advocacy fit into the work you do with

your clients?

In what ways does the concept of advocacy fit

or not fit into the context of your communities?What difficulties have you encountered while

advocating for your clients?



6.55

Small-group Tasks

Summarize the key elements of your case

management component

Write these key elements on newsprint to be

used for a 2-minute presentationWrite these key elements on white paper to

post under the “Continuum of Care” wall

graphic



6.56

Group Counseling Purpose

Provides opportunities for clients to develop

communication and socialization skills

Creates an environment in which clients help,

support, and confront one another Introduces structure and discipline into the

often chaotic lives of clients

Provides healthful norms and a supportiveenvironment



6.57

Group Counseling Purpose—Part II

Helps clients broaden understanding of their

recovery capital and barriers to recovery

Supports individual assessment of critical risk

and protective factors Advances individual recovery

Provides a venue for group leaders to transmit

new information, teach new skills, and guideclients as they practice new behaviors



6.58

Group Counseling Cautions

Some clients should never be assigned to the

same groups:

Perpetrators and victims of domestic violence

must be in separate groupsNeighbors, friends, relatives, spouses, or

significant others should not be assigned to the

same group (with the exception of family groups)

Group size between 8 and 15 members

Meet no more than 1.5 hours



6.59

Small-group Tasks

Prepare a brief presentation on your assigned

types of groups

Use newsprint, markers, colored paper —be

creative!Summarize key elements on white paper to

post on the wall graphic

*Psychoeducation: Resource Page 6.3

* All other types of groups: Resource Page 6.4



6.60

Lunch60 minutes

Group Counseling Is Not for



6.61

Group Counseling Is Not for

Everyone

Some socially anxious or very introverted

clients cannot tolerate groups well

Some clients with severe mental disorders

cannot participate in groupsClients who violate group principles or who

cannot control their impulses might respond

better to individual counseling



6.62

Individual Counseling Focus

Individual counseling sessions vary depending

on:

The type of program

The client’s stage of recovery The client’s individual needs

Photo credit: Family Health International, Hanoi,

Vietnam



6.63

Individual Counseling Content—Part 1

A counselor may:

Ask how the client is feeling

Ask the client about reactions to a recent group

meetingExplore how the client spent time since the last

session



6.64

Individual Counseling Content—Part 2

A counselor may:

Inquire about drug use

Ask whether there are any urgent issues

Review treatment plans and coping strategies Address fears and anxieties related to change



6.66

Ending a Session

A counseling session usually ends with a

summary of the client’s plans and a schedule

for the next few days

Primary Treatment—Other



6.67

Primary Treatment Other

Components

Testing for drug use

Pharmacotherapy

Orientation to mutual-help groups



6.68

Substance Testing

Testing can:

Verify, contradict, or add to a client’s self -report of

substance use

Identify a relapse to substance useHelp assess the efficacy of the treatment plan

and the current level of care

Encourage abstinence



POCT Di d t P t II



6.72

POCT Disadvantages—Part II

Require secure storage facilities and regularstaff training

Usually cannot be used in court

Can be misleading (as can laboratory testing)in monitoring abstinence if not testing for an

entire array of drugs

Ph th I U d T



6.73

Pharmacotherapy Is Used To…

Aid in acute withdrawal or tapering

Discourage use of a substance by reducing its

reinforcing properties or by creating negative

effects when the substance is used Aid early recovery by reducing cravings or

counteracting longer-term symptoms of

withdrawal

Ph th O i id



6.74

Pharmacotherapy: Opioids

One of the best-known pharmacotherapies foropioids is methadone

Methadone can be used short term, to aid

withdrawal, or long term as a maintenancetherapy

Not always available or even legal

Ph th



6.75

Pharmacotherapy

Typically used along with counseling and othertreatment services, not in place of them

Counseling

& OtherServices

Pharmaco-therapy

M t l H l P



6.76

Mutual-Help Programs

Mutual-help programs are alternatives orenhancements to professional counseling

Participants in mutual-help groups support and

encourage one another to become or staydrug free

12-Step programs are perhaps the best known

of mutual-help programs



AA d NA M ti T



6.78

AA and NA Meeting Types

Can be open or closed to the public

Discussion meetings—leader shares a topic

Speaker meetings—speaker shares his or her

story12-step study meetings discuss a particular

step

Sponsorship



6.79

Sponsorship

A sponsor is an AA or NA member who:

Has had successful experience with the program

Works personally with a member with less

experience

Other 12-Step Mutual-Help Programs



6.80

Other 12-Step Mutual-Help Programs

Marijuana Anonymous

Cocaine Anonymous

Nicotine Anonymous

12-Step Programs for Family and Friends



6.81

12-Step Programs for Family and Friends

Nar-Anon (for all family members)

Al-Anon (for adult or older adolescent family

members and friends)

Alateen (for older children and youngeradolescents)

Alatot (for young children)

12-Step Program Research



6.82

12-Step Program Research

Research results are mixed on whether theyare an effective program of recovery

But they are very difficult to study due to:

ConfidentialityVoluntary nature blocks controlled studies

12-Step Programs Are Not for



6.83

Everyone

Some people are uncomfortable with thespiritual aspects of the programs

Those who have difficulty in group and social

situations may not be able to effectively use agroup recovery program

Other Mutual Help Programs



6.84

Other Mutual-Help Programs

Women for Sobriety

SMART (Self-Management and Recovery

Training) Recovery

Rational RecoveryCelebrate Recovery (Christian)

Millati Islami

Native American Wellbriety Movement

Women for Sobriety and Rational Recovery



6.85

Women for Sobriety and Rational Recovery

Both based in rational-emotive-behavioralprinciples

Women for Sobriety believes that women with

alcohol use disorders require a different kind ofrecovery program than do men

Rational Recovery has no mutual-help groups,

but provides online educational supports to

address irrational beliefs

SMART Program



6.86

SMART Program

Off-shoot of Rational Recovery

Focuses on motivation, urges, thoughts,

feelings, behaviors, and satisfactions

Teaches increasing self-reliance, rather thanpowerlessness

Uses no sponsors

Celebrate Recovery



6.87

Celebrate Recovery

One of several Christian-based recoveryprograms based on Bible scriptures and

worship

Typically address a variety of issues, notmerely SUDs

Replaces the sponsor with the pastor/priest

and the congregation as a support network

Millati Islami



6.88

Millati Islami

World-wide fellowship of men and women joined together on the “Path of Peace”

Based on spiritual principles of the Quran

Groups combine requirements of both Al-Islamand 12-step approach to addressing all SUDs

Native American Wellbriety



6.89

Movement

Created by White Bison Society in response tolack of success of American Indians in regular

treatment and recovery programs

Based on the 12-Step model, but rooted intraditional culture, spirituality, and rituals

Awareness of Mutual-Help Programs



6.90

Awareness of Mutual-Help Programs

Counselors need to be familiar with self- andmutual-help programs in their areas so that

they can:

Orient clients to what is availableEncourage clients to try different programs

Assist clients in selecting a useful support

program

Advocate for group creation where not available

Other Components of Treatment



6.91

Other Components of Treatment

Medically managed treatment and generalhealth services

Treatment for mental disorders

General schooling for adolescents or youngadults

Other Components of Treatment—

P t II



6.92

Part II

Employment skills training

Child care for group or individual sessions

Transportation to treatment activities and/or

mutual-help group meetings



6.93

Break15 minutes

Small-group Exercise: Primary Treatment —

Oth C t



6.94

Other Components

15-minute discussion on how these componentsare incorporated into SUD treatment in your

community:

Testing for drug usePharmacotherapy

Mutual-help groups

Other components

List 3 findings in each area

Reporter will have 1 minute to share findings in

each component

Continuing Care Plan



6.95

Continuing Care Plan

Documented plan of action developed beforedischarge or transfer to another level of care

Structured, goal-oriented list of services

Developed jointly by client and counselor Includes recovery capital and possible

challenges

Continuing Care Goals



6.96

Continuing Care Goals

Sustain abstinence

Develop continuing recovery supports

Gain community living

Continuing Care Goals—Part II



6.97

Continuing Care Goals Part II

Gain employment skills

Gain education

Obtain employment or schooling

Obtain counseling for co-occurring mentaldisorders

Continuing Care Goals—Part III



6.98

Continuing Care Goals Part III

Develop a deeper understanding of self andothers

Increase responsibility

Work on resolving family difficultiesConsolidate, reinforce, and become

comfortable with life changes

Integration into the community with ameaningful role

Continuing Care Groups



6.99

Continuing Care Groups

Exploring substance-free social andrecreational activities

Continued work on life skills, such as solving

problemsRelapse prevention training

Health and wellness

Education and career planningSupportive counseling

Leadership skills development

Continuing Care Supports



6.100

Continuing Care Supports

Mutual-help group attendance

Individual therapy

Treatment/medication management for mental

disordersMethadone maintenance

Phone therapy or monitoring

Continuing Care Supports—Part II



6.101

Continuing Care Supports Part II

Religious/spiritual institutions

Cultural traditions and values that support

recovery

Periodic home visits or booster sessions Intensive case management monitoring and

supports

Job training or other schooling

The Colombo Plan Asian Centre for Certification and Education of Addiction Professionals Training Series



MODULE 6—COMPONENTS OF

TREATMENT: THE CONTINUUM OF

CARE

Treatment for Substance Use

Disorders — The Continuum of Care

for Addiction Professionals

Curriculum 2

Continuing Care Supports—Small-

Group Exercise



6.103

Group Exercise

15 minutes to list existing resources on whitepaper

15 minutes to list wished for services on

newsprintReporter will have 3 minutes to report out each

list

Small-Group Exercise: Continuum of

Care Case Study Assignments



6.104

Care Case Study Assignments

Read your assigned case study

Take a few minutes to “dress” your figure

appropriately, using the markers

Develop a presentation that illustrates your“client’s” movement through an appropriate

continuum of care

Use your assigned case study as a starting

point, then add information about the person’s

movement through the continuum (as needed)



Break15 minutes

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