Section 2 Practice Dimensions
PD 1 Clinical Evaluation
Elements
Definition: The systematic approach to screening and assessment of individuals thought to have a substance use disorder, being considered for admission to addiction-related services, or presenting in a crisis situation.
Element: Screening
Screening is the process by which the counselor, the client, and available significant others review the current situation, symptoms, and other available information to determine the most appropriate initial course of action, given the client’s needs and characteristics and the available resources within the community.
Competency 24
Establish rapport, including management of a crisis situation and determination of need for additional professional assistance.
Knowledge
- Importance and purpose of rapport building.
- Rapport-building methods and issues.
- The range of human emotions and feelings.
- What constitutes a crisis.
- Steps in crisis prevention and management.
- Situations and conditions for which additional professional assistance may be necessary.
- Available sources of assistance.
Skills
- Demonstrating effective verbal and nonverbal communication in establishing rapport.
- Accurately identifying the client’s beliefs and frame of reference.
- Reflecting the client’s feelings and message.
- Recognizing and defusing volatile or dangerous situations.
- Demonstrating empathy, respect, and genuineness.
Attitudes
- Recognition of personal biases, values, and beliefs and their effect on communica- tion and the treatment process.
- Willingness to establish rapport.
Competency 25
Gather data systematically from the client and other available collateral sources, using screening instruments and other methods that are sensitive to age, developmental level, culture, and gender. At a minimum, data should include current and historic substance use; health, mental health, and substance-related treatment histories; mental and functional statuses; and current social, environmental, and/or economic constraints.
Knowledge
- Validated screening instruments for substance use and mental status, including their purpose, application, and limitations.
- Concepts of reliability and validity as they apply to screening instruments.
- How to interpret the results of screening.
- How to gather and use information from collateral sources.
- How age, developmental level, culture, and gender affect patterns and history of use.
- How age, developmental level, culture, and gender affect communication.
- Client mental status—presenting features and relationship to substance use disorders and psychiatric conditions.
- How to apply confidentiality rules and regulations.
Skills
- administering and scoring screening instruments.
- Screening for physical and mental health status.
- Facilitating information sharing and data collection from a variety of sources.
- Communicating effectively in emotionally charged situations.
- Writing accurately, concisely, and legibly.
Attitudes
- Appreciation of the value of the data-gathering process.
Uses of The Competencies
In Nebraska, The Competencies is used as a resource for instructors teaching core classes preparing students for State certification. It also is used as supplemental reading for students in these courses and other continuing education programs sponsored by the Prairielands ATTC.
Competency 26
Screen for psychoactive substance toxicity, intoxication, and withdrawal symptoms; aggression or danger to others; potential for self-inflicted harm or suicide; and co-occurring mental disorders.
Knowledge
- Symptoms of intoxication, withdrawal, and toxicity for all psychoactive substances, alone and in interaction with one another.
- Physical, pharmacological, and psychological implications of psychoactive substance use.
- Effects of chronic psychoactive substance use or intoxication on cognitive abilities.
- Available resources for help with drug reactions, withdrawal, and violent behavior.
- When to refer for toxicity screening or additional professional help.
- Basic concepts of toxicity screening options, limitations, and legal implications.
- Toxicology reporting language and the meaning of toxicology reports.
- Relationship between psychoactive substance use and violence.
- Basic diagnostic criteria for suicide risk, danger to others, withdrawal syndromes, and major psychiatric conditions.
- Mental and physical conditions that mimic drug intoxication, toxicity, and withdrawal.
- Legal requirements concerning suicide and violence potential and mandatory reporting for abuse and neglect.
Skills
- Eliciting pertinent information from the client and relevant others.
- Intervening appropriately with a client who may be intoxicated.
- Assessing suicide and/or violence potential using an approved risk-assessment tool.
- Assessing risks of abuse and neglect of children and others.
- Preventing and managing crises in collaboration with health, mental health, and public safety professionals.
Attitudes
- Willingness to be respectful toward the client in his or her presenting state.
- Appreciation of the importance of empathy in the face of feelings of anger, hopelessness, or suicidal or violent thoughts and feelings.
- Appreciation of the importance of legal and administrative obligations.
Competency 27
Assist the client in identifying the effect of substance use on his or her current life problems and the effects of continued harmful use or abuse.
Knowledge
- The progression and characteristics of substance use disorders.
- The effects of psychoactive substances on behavior, thinking, feelings, health status, and relationships.
- Denial and other defense mechanisms in client resistance.
Skills
- Establishing a therapeutic relationship.
- Demonstrating effective communication and interviewing skills.
- Determining and confirming with the client the effects of substance use on life problems.
- Assessing client readiness to address substance use issues.
- Interpreting the client’s perception of his or her experiences.
Attitutudes
- Respect for the client’s perception of his or her experiences.
Competency 28
Determine the client’s readiness for treatment and change as well as the needs of others involved in the current situation.
Knowledge
- Current validated instruments for assessing readiness to change.
- Treatment options.
- Stages of readiness.
- Stages-of-change models.
- The role of family and significant others in supporting or hindering change.
Skills
- Assessing client readiness for treatment.
- Assessing extrinsic and intrinsic motivators.
- Assessing the needs of family members including children for appropriate levels of care and providing support; recommending followup services.
Attitudes
- Acceptance of nonreadiness as a stage of change.
- Appreciation that motivation is not a prerequisite for treatment.
- Recognition of the importance of the client’s self-assessment.
Competency 29
Review the treatment options that are appropriate for the client’s needs, characteristics, goals, and financial resources.
Knowledge
- Treatment options and their philosophies and characteristics.
- Relationship among client needs, available treatment options, and other community resources.
Skills
- Eliciting and determining relevant client characteristics, needs, and goals.
- Making appropriate recommendations for treatment and use of other available community resources.
- Collaborating with the client to determine the best course of action.
Attitudes
- Recognition of one’s own treatment biases.
- Appreciation of various treatment approaches.
- Willingness to link client with a variety of helping resources.
Competency 30
Apply accepted criteria for diagnosis of substance use disorders in making treatment recommendations.
Knowledge
- The continuum of care and the available range of treatment modalities.
- Current diagnostic and statistical manual of mental disorders (dsm) or other accepted criteria for substance use disorders, including strengths and limitations of such criteria.
- Use of commonly accepted criteria for client placement into levels of care.
- Multiaxis diagnostic criteria.
Skills
- Using current DSM or other accepted diagnostic standards.
- Using appropriate placement criteria.
- Obtaining information necessary to develop a diagnostic impression.
Attitudes
- Recognition of personal and professional limitations of practice, based on knowledge and training.
- Willingness to base treatment recommendations on the client’s best interest and preferences.
Uses of The Compentencies
The Office of Alcoholism and Substance Abuse Services uses the International Certification and Reciprocity Consortium/Alcohol and Other Drug Abuse, Inc.’s examination for Alcohol and Other Drug Abuse Counselors as the standard of minimum competence for counselors seeking a credential in New York State. This examination is based on the 12 Core Functions of alcoholism and substance abuse counselors, which are consistent with the practice dimensions and competencies outlined in The Competencies.
Competency 31
Construct with the client and appropriate others an initial action plan based on client needs, client preferences, and resources available.
Knowledge
- Appropriate content and format of the initial action plan.
- The client’s needs and preferences.
- Available resources for admission or referral.
Skills
- Developing the action plan in collaboration with the client and appropriate others.
- Documenting the action plan.
- Contracting with the client concerning the initial action plan.
Attitudes
- Willingness to work collaboratively with the client and others.
Competency 32
Based on the initial action plan, take specific steps to initiate an admission or referral and ensure follow through.
Knowledge
- Admission and referral protocols.
- Resources for referral.
- Ethical standards regarding referrals.
- Appropriate documentation.
- How to apply confidentiality rules and regulations.
- Clients’ rights to privacy.
Skills
- Communicating clearly and appropriately.
- Networking and advocating with service providers.
- Negotiating and advocating client admis- sions to appropriate treatment resources.
- Facilitating client followthrough.
- Documenting accurately and appropriately.
Attitudes
- Willingness to renegotiate.
Uses of The Competencies
The Competencies is being used in a series of scale validation studies by Alicia Wendler of the Mid-America ATTC and Tamera Murdock and Johanna Nilsson of the University of Missouri–Kansas City to develop the Addiction Counseling Self-Efficacy Scale (ACSES). The 32-item ACSES assesses addiction counselors’ perceptions of their self-efficacy for addiction counseling skills and includes five subscales:
- Executing specific addiction counseling skills
- Assessment, treatment planning, and referral skills
- Working with various co-occurring mental disorders
- Group counseling skills
- Basic counseling microskills.
The researchers reported adequate internal consistency of the scale with a sample of 451 addiction counselors. Preliminary validity evidence for the scale was determined through two exploratory factor analyses, and the scale was found to be sensitive to counselor experience and degree levels.
Element: Assessment
Assessment is an ongoing process through which the counselor collaborates with the client and others to gather and interpret information necessary for planning treatment and evaluating client progress.
Competency 33
Select and use a comprehensive assessment process that is sensitive to age, gender, racial and ethnic culture, and disabilities that includes but is not limited to:
- History of alcohol and drug use
- Physical health, mental health, and addiction treatment histories
- Family issues
- Work history and career issues
- History of criminality
- Psychological, emotional, and worldview concerns
- Current status of physical health, mental health, and substance use
- Spiritual concerns of the client
- Education and basic life skills
- Socioeconomic characteristics, lifestyle, and current legal status
- Use of community resources
- Treatment readiness
- Level of cognitive and behavioral functioning.
Knowledge
- Basic concepts of test validity and reliability.
- Current validated assessment instruments and protocols.
- Appropriate use and limitations of standardized instruments.
- The range of life areas to be assessed in a comprehensive assessment.
- How age, developmental level, cognitive and behavioral functioning, racial and ethnic culture, gender, and disabilities can influence the validity and appropriateness of assessment instruments and interview protocols.
Skills
- Selecting and administering appropriate assessment instruments and protocols within the counselor’s scope of practice.
- Introducing and explaining the purpose of assessment.
- Addressing client perceptions and provid- ing appropriate explanations of issues being discussed.
- Conducting comprehensive assessment interviews and collecting information from collateral sources.
Attitudes
- Respect for the limits of assessment instruments and one’s ability to interpret them.
- Willingness to refer for additional specialized assessment.
Comptency 34
Analyze and interpret the data to determine treatment recommendations.
Knowledge
- Appropriate scoring methodology for assessment instruments.
- How to analyze and interpret assessment results.
- The range of available treatment options.
Skills
- Scoring assessment tools.
- Interpreting data relevant to the client.
- Using results to identify client needs and appropriate treatment options.
- Communicating recommendations to the client and appropriate service providers.
Attitudes
- Respect for the value of assessment in determining appropriate treatment plans.
Competency 35
Seek appropriate supervision and consultation.
Knowledge
- The counselor’s role, responsibilities, and scope of practice.
- The limits of the counselor’s training and education.
- The supervisor’s role and how supervision can contribute to quality assurance and improvement of clinical skills.
- Available consultation services and roles of consultants.
- The multidisciplinary assessment approach.
Skills
- Recognizing the need for review by or assistance from a supervisor.
- Recognizing when consultation is appropriate.
- Providing appropriate documentation.
- Communicating oral and written information clearly.
- Incorporating information from supervi- sion and consultation into assessment findings.
Attitudes
- Commitment to professionalism.
- Acceptance of one’s own personal and professional limitations.
- Willingness to continue learning and improving clinical skills.
Competency 36
Document assessment findings and treatment recommendations.
Knowledge
- Agency-specific protocols and procedures.
- Appropriate terminology and abbreviations.
- Legal implications of actions and documentation.
- How to apply confidentiality rules and regulations and clients’ rights to privacy.
Skills
- Providing clear, concise, and legible documentation.
- Incorporating information from various sources.
- Preparing and clearly presenting, in oral and written form, assessment findings to the client and other professionals within the bounds of confidentiality rules and regulations.
Attitudes
- Recognition of the value of accurate documentation.
Uses of The Competencies
The Competencies has been used as a training standard for the Licensed Chemical Dependency Counselor credential in Texas. The competencies were infused not only into academic course work, but also into three levels of supervised work experience. A companion evaluation tool was developed to monitor mastery of the competencies.
In addition, a number of colleges and universities across Texas have infused the knowledge, skills, and attitudes from The Competencies into their addiction counseling coursework and curricula. Many have changed course descriptions, learning outcomes, and course objectives.
Bibliography
PD 1 Clinical Evaluation: Screening
Allen, j.p., & litten, r.z. (1998). Screening instruments and biochemical screening tests. In a.w. graham, t.k. schultz, & b.b. wilford (eds.) Principles of addiction medicine (2nd ed.). Chevy chase, md: american society of addiction medicine, 263-271.
American psychiatric association (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, dc: american psychiatric press.
Anton, r.f., litten, r.z., & allen, j.p. (1995). Biological assessment of alcohol consumption. In j.p. allen & m. Columbus (eds.) Assessing alcohol problems: a guide for clinicians and researchers. Niaaa treatment handbook series, no. 4. Bethesda, md: national institute on alcohol abuse and alcoholism, 31-39.
Ball, s.a., & kosten, t.a. (1998). Diagnostic classification systems. In a.w. graham, t.k. schultz, & b.b. wilford (eds.) Principles of addiction medicine (2nd ed.). Chevy chase, md: american society of addiction medicine, 279-290.
Bradley, k.a., boyd-wickizer, b.a., et al. (1998). Alcohol screening questionnaires in women: a critical review. Jama, 280(2):166-171.
Cherpital, c.j. (1998). Differences in performance of screening instruments for problem drinking among blacks, whites, and hispanics in an emergency room population. Journal of studies on alcohol, july:420-426.
Connors, g.j. (1995). Screening for alcohol problems. In j.p. allen & m. Columbus (eds.) Assessing alcohol problems: a guide for clinicians and researchers. Niaaa treatment handbook series, no. 4. Bethesda, md: national institute on alcohol abuse and alcoholism, 17-29.
Cooney, n.l., zweben, a., & fleming, m.f. (2002). Screening for alcohol problems and at-risk drinking in health-care settings. In r.k. hester & w.r. miller (eds.) Handbook of alcoholism treatment approaches (3rd ed.). Boston: allyn & bacon, 45-60.
Finn, p. (1994). Addressing the needs of cultural minorities in drug treatment. Journal of substance abuse treatment, 11(4):325-337.
Hser, y. (1995). A referral system that matches drug users to treatment programs: existing research and relevant issues. Journal of drug issues, 25(1):209-224.
Knight, j.r., sherritt, l., et al. (2002). Validity of the crafft substance abuse screening test among adolescent clinic patients. Archives of pediatrics and adolescent medicine, 156(6):607-614.
Knight, j.r., sherritt, l., et al. (2003). Validity of brief alcohol screening tests among adolescents: a comparison of the audit, posit, cage, and crafft. Alcohol, clinical and experimental research, 27(1):67-73.
Maisto, s.a., & mckay, j.r. (1995). Diagnosis. In j.p. allen & m. Columbus (eds.) Assessing alcohol problems: a guide for clinicians and researchers. Niaaa treatment handbook series, no. 4. Bethesda, md: national institute on alcohol abuse and alcoholism, 41-54.
Maisto, s.a., & saitz, r. (2003). Alcohol use disorders: screening and diagnosis. American journal on addictions, 12:s12-s25.
Mee-lee, d., miller, m.m., & shulman, g.d. (1996). Patient placement criteria for the treatment of substance-related disorders (2nd ed.). Chevy chase, md: american society of addiction medicine.
Miller, w.r., & rollnick, s. (1991). Motivational interviewing: preparing people to change addictive behavior. New york: guilford press.
Prochaska, j.o., diclemente, c.c., & norcross, j.c. (1992). In search of how people change: applications to the addictive behaviors. American psychologist, 47:1102-1114.
Rydz, d., shevell, m.i., et al. (2005). Developmental screening. Journal of child neurology, 20(1):4-21.
Schafer, j., & cherpitel, c.j. (1998). Differential item functioning of the cage, tweak, bmast, and audit by gender and ethnicity. Contemporary drug problems, 25(2):399-409.
Schorling, j.b., & buchsbaum, d.g. (1997). Screening for alcohol and drug abuse. Medical clinics of north america, 81(4):845-865.
Zimmerman, m., sheeran, t., et al. (2004). Screening for psychiatric disorders in outpatients with dsm-iv substance use disorders. Journal of substance abuse treatment, 26(3):181-188.
PD 1. Clinical Evaluation: Assessment
Adesso, v.j., cisler, r.a., et al. (2004). Substance abuse. In m. Hersen (ed.) Psychological assessment in clinical practice: a pragmatic guide. New york: brunner-routledge, 147-173.
Albanese, m., & khantzian, e. (2001). The difficult-to-treat patient with substance abuse. In m.j. dewan & r.w. pies (eds.) The difficult-to-treat psychiatric patient. Arlington, va: american psychiatric publishing, inc., 273-298.
Annis, h.m., sobell, l.c., et al. (1996). Drinking-related assessment instruments: cross-cultural studies. Substance use & misuse, 31(11&12):1525-1546.
Armstrong, t.d., & costello, e.j. (2002). Community studies on adolescent substance use, abuse or dependence and psychiatric comorbidity. Journal of consulting and clinical psychology, 70(6):1224-1239.
Barker, s.b., kerns, l.l., & schnoll, s.h. (1996). Assessment of medical history, health status, intoxication, and withdrawal. In b.j. rounsaville, f.m. tims, et al. (eds.) Diagnostic source book on drug abuse research and treatment. Rockville, md: national institute on drug abuse, 35-48.
Carey, k.b. (2002). Clinically useful assessments: substance use and comorbid psychiatric disorders. Behaviour research & therapy, 40:1345.
Carey, k.b., & correia, c.j. (1998). Severe mental illness and addictions: assessment considerations. Addictive behaviors, 23(6):735-748.
Carroll, k.m., & rounsaville, b.j. (2002). On beyond urine: clinically useful assessment instruments in the treatment of drug dependence. Behaviour research & therapy, 40:1329.
Center for substance abuse prevention (1993). Maternal substance use assessment methods reference manual: a review of screening and clinical assessment instruments for examining maternal use of alcohol, tobacco and other drugs. Csap special report 13. Rockville, md: substance abuse and mental health services administration.
Dennis, m.l., dawud-noursi, s., et al. (2003). The need for developing and evaluating adolescent treatment models. In s.j. stevens & h.r. morral (eds.) Adolescent substance abuse treatment in the united states. New york: haworth press, 3-35.
Dennis, m.l., & stevens, s.j. (2003). Maltreatment issues and outcomes of adolescents enrolled in substance abuse treatment. Child maltreatment, 8(1):3-6.
Dinitto, d.m., & crisp, c. (2002). Addictions and women with major psychiatric disorders. In s.l.a. straussner & s. Brown (eds.) The handbook of treatment for women. San francisco: jossey-bass, 423-450.
Donovan, d.m. (1995). Assessments to aid in the treatment planning process. In j.p. allen & m. Columbus (eds.) Assessing alcohol problems: a guide for clinicians and researchers. Niaaa treatment handbook series 4. Bethesda, md: national institute on alcohol abuse and alcoholism, 75-122.
Donovan, d.m. (1999). Assessment strategies and measures in addictive behaviors. In b.s. mccrady & e.e. epstein (eds.) Addictions: a comprehensive guidebook. New york: oxford university press, 187-215.
Donovan, d.m., & marlatt, g.a. (eds.) (2005). Assessment of addictive behaviors (2nd ed.).New york: guilford press.
Fleming, m.f. (2002). Identification and treatment of alcohol use disorders in older adults. In a.m. gurnack, r. Atkinson, & n. Osgood (eds.) Treating alcohol and drug abuse in the elderly. New york: springer publishing, 85-108.
Garito, p.j. (2002). Assessing and treating psychiatric comorbidity in chemically dependent analysis. In d. O’connell, e. Beyer, et al. (eds.) Managing the dually diagnosed patient: current issues and clinical approaches (2nd ed). New york: haworth press, 153-185.
Gavetti, m.f., & constantine, m.g. (2001). Assessment and treatment of alcoholism in older adults: considerations for mental health clinicians. Journal of psychiatry in independent practice, 2(3):61-71.
Graham, k., brett, p.j., & bois, c. (1995). Treatment entry and engagement: a study of the process at assessment/referral centers. Journal of contemporary drug problems, 22(1):61-104.
Guthmann, d., & sandberg, k. (1998). Assessing substance abuse problems in deaf and hard of hearing individuals. American annals of the deaf, 143(1):14-19.
Hyams, g., cartwright, a., & spratley, t. (1996). Engagement in alcohol treatment: the client’s experience of, and satisfaction with, the assessment interview. Addiction research, 4(2):105-123.
Kaminer, y. (2004). Dually diagnosed teens: challenges for assessment and treatment. Counselor, 5(2):62-68.
Knight, d.k., & simpson, d.d. (1999). Family assessment. In p.j. ott, r.e. tarter, & r.t. ammerman (eds.) Sourcebook on substance abuse: etiology, epidemiology, assessment, and treatment. Boston: allyn & bacon, 236-247.
Kramer, k.l., robbins, j.m., et al. (2003). Detection and outcomes of substance use disorders in adolescents seeking mental health treatment. Journal of the american academy of child and adolescent psychiatry, 42(11):1318-1326.
Lewis, j.a. (2005). Assessment, diagnosis, and treatment planning. In r.h. coombs (ed.) Addiction counseling review: preparing for comprehensive, certification, and licensing examinations. Mahwah, nj: lawrence erlbaum associates, 357-379.
Meyers, k., hagan, t.a., et al. (1999). Critical issues in adolescent substance use assessment. Drug and alcohol dependence, 55(3):235-246.
National institute on drug abuse (nida) (1994). Assessing drug abuse among adolescents and adults: standardized instruments. Clinical report series. Rockville, md: nida.
Oslin, d.w., & holden, r. (2002). Recognition and assessment of alcohol and drug dependence in the elderly. In a.m. gurnack, r. Atkinson, & n. Osgood (eds.) Treating alcohol and drug abuse in the elderly. New york: springer publishing, 11-31.
Read, j.p., bollinger, a.r., & sharkansky, e. (2003). Assessment of comorbid substance use disorder and posttraumatic stress disorder. In p. Ouimette & p.j. brown (eds.) Trauma and substance abuse: causes, consequences, and treatment of comorbid disorders. Washing- ton, dc: american psychological association.
Rotgers, f. (2002). Clinically useful, research validated assessment of persons with alcohol problems. Behaviour research & therapy, 40:1425.
Schwartz, r.c., & smith, s.d. (2003). Screening and assessing adolescent substance abuse: a primer for counselors. Journal of addictions & offender counseling, 24:23-34.
Stasiewicz, p.r., & bradizza, c.m. (2002). Alcohol use disorders. In m. Hersen & l.k. porzelius (eds.) Diagnosis, conceptualization, and treatment planning for adults: a step-by-step guide. Mahwah, nj: lawrence erlbaum associates, 271-290.
Winters, k.c. (2001). Assessing adolescent substance use problems and other areas of functioning: state of the art. In p.m. monti, s.m. colby, & t.a. o’leary (eds.) Adolescents, alcohol, and substance abuse: reaching teens through brief interventions. New york: guilford press, 80-108.
Winters, k.c., latimer, w.w., & stinchfield, r. (2002). Clinical issues in the assessment of adolescent alcohol and other drug use. Behaviour research & therapy, 40(12):1443-1456.
