I. CLINICAL EVALUATION

The systematic approach to screening and assessment.
 

A. SCREENING  

The process through which counselor, client and available significant others determine the most appropriate initial course of action, given the client's needs and characteristics, and the available resources within the community.

1. Establish rapport, including management of crisis situation and determination of need for additional professional assistance. 

Knowledge

1. Importance and purpose of rapport building.
2. Rapport-building methods and issues.
3. The range of human emotions and feelings.
4. What constitutes a crisis.
5. Steps in crisis management.
6. Situations in which additional professional assistance may be necessary.
7. Available sources of assistance.

Skills

1. Demonstrating effective verbal and nonverbal communication.
2. Accurately identifying client's frame of reference.
3. Reflecting clientís feelings and message.
4. Recognizing and defusing volatile or dangerous situations.
5. Demonstrating empathy, respect, and genuineness.

Attitudes

1. Recognition of personal biases, values, and beliefs, and their effect on communication and the treatment process.
2. Willingness to establish rapport.

 

2. 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 history; mental status; and current social, environmental, and/or economic constraints. 

Knowledge

1. Validated screening instruments, including their purpose, application, and limitations.
2. Concepts of reliability and validity as they apply to screening instruments.
3. How to interpret the results of screening.
4. How to gather and use information from collateral sources.
5. How age, developmental level, culture, and gender effect patterns and history of use.
6. How age, developmental level, culture, and gender effect communication.
7. Client mental status: - presenting features, - relationship to substance abuse and psychiatric disorders.
8. How to apply confidentiality regulations.

Skills

1. Administering and scoring screening instruments.
2. Screening for physical and mental health status.
3. Gathering information and collecting data.
4. Communicating appropriately.
5. Writing accurately, concisely, and legibly.

Attitudes

1. Appreciation of the value of the data gathering process.

 

3. Screen for psychoactive substance toxicity, intoxication, and withdrawal symptoms; aggression or danger to others; potential for self-inflicted harm or suicide; and coexisting mental health problems.   

Knowledge

1. Symptoms of intoxication, withdrawal, and toxicity for all psychoactive substances, alone and in interaction with one another.
2. Physical, pharmacological, and psychological implications of psychoactive substance use.
3. Effects of chronic psychoactive substance use or intoxication on cognitive abilities.
4. Available resources for help with drug reactions, withdrawal, and violent behavior.
5. When to refer for toxicity screening or additional professional help.
6. Basic concepts of toxicity screening options, limitations, and legal implications.
7. Toxicology reporting language and the meaning of toxicology reports.
8. Relationship between psychoactive substance use and violence.
9. Basic diagnostic criteria for suicide risk, danger to others, withdrawal syndromes, and major psychiatric disorders.
10. Mental and physical conditions that mimic drug intoxication, toxicity, and withdrawal.
11. Legal requirements concerning suicide and violence potential.

Skills

1. Eliciting relevant information from the client.
2. Intervening appropriately with a client who may be intoxicated.
3. Assessing suicide and/or violence potential.
4. Managing crises.

Attitudes

1. Willingness to be respectful toward the client in his or her presenting state.
2. Appreciation of the importance of empathy in the face of feelings of anger, hopelessness, suicidal or violent thoughts, and feelings.
3. Appreciation of the importance of legal obligations.

 

4. Assist the client in identifying the impact of substance use on his or her current life problems and the effects of continued harmful use or abuse. 

Knowledge

1. The progression and characteristics of substance use disorders.
2. The effects of psychoactive substances on behavior, thinking, feelings, health status, and relationships.
3. Denial and other defense mechanisms in client resistance.

Skills

1. Establishing a therapeutic relationship.
2. Demonstrating effective communication skills.
3. Determining and confirming the effects of substance use on life problems with the client.
4. Assessing client readiness to address substance use issues.
5. Interpreting the clientís perception of his or her experiences.

Attitudes

1. Respect for the clientís perception of his or her experiences.

 

5. Determine the client's readiness for treatment and change as well as the needs of others involved in the current situation.     

Knowledge

1. Current validated instruments for assessing readiness to change.
2. Treatment options.
3. Stages of readiness.
4. Stages of change models.
5. The role of family and significant others in supporting or hindering change.

Skills

1. Assessing client readiness for treatment.
2. Assessing extrinsic and intrinsic motivators.

Attitudes

1. Acceptance of non-readiness as a stage of change.
2. Appreciation that motivation is not a pre-requisite for treatment.
3. Recognition of the importance of the clientís self assessment.

 

6. Review the treatment options that are appropriate for the client's needs, characteristics, goals, and financial resources. 

Knowledge

1. Treatment options and their philosophies and characteristics.
2. Appropriate treatment options for client needs.

Skills

1. Eliciting and determining relevant client characteristics, needs, and goals.
2. Making appropriate recommendations for treatment.

Attitudes

1. Recognition of oneís own treatment biases.
2. Appreciation of various treatment approaches.

 

7. Apply accepted criteria for diagnosis of substance use disorders in making treatment recommendations.   

Knowledge

1. The continuum of care and the available range of treatment modalities.
2. Current DSM or other accepted criteria for substance use disorders, including strengths, and limitations of such criteria.
3. Use of commonly accepted criteria for client placement into levels of care.
4. Multi-axis diagnostic criteria.

Skills

1. Using current DSM or other accepted diagnostic standards.
2. Using appropriate placement criteria.
3. Obtaining information necessary to develop a diagnostic impression.

Attitudes

1. Recognition of personal and professional limitations of practice, based on knowledge and training.
2. Willingness to base treatment recommendations on the clientís best interest.

 

8. Construct with client and appropriate others an initial action plan based on client needs, preferences, and resources available.    

Knowledge

1. Appropriate content and format of the initial action plan.
2. Client needs and preferences.
3. Available resources for admission or referral.

Skills

1. Developing the action plan in collaboration with the client and appropriate others.
2. Documenting the action plan.
3. Contracting with the client concerning initial action plan.

Attitudes

1. Willingness to work collaboratively with clients and others.

 

9. Based on initial action plan, take specific steps to initiate an admission or referral and ensure follow-through.      

Knowledge

1. Admission and referral protocols.
2. Resources for referral.
3. Ethical standards regarding referrals.
4. Appropriate documentation.
5. How to apply confidentiality regulations.

Skills

1. Communicating clearly and appropriately.
2. Networking and advocating with service providers.
3. Negotiating and advocating client admissions to appropriate treatment resources.
4. Facilitating client follow-through.
5. Documenting accurately and appropriately.

Attitudes

1. Willingness to renegotiate.

 

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Email: no@nattc.org | Revised March 1998