1SASSI-III Substance AAbuse Subtle Screening Inventory
Brief and easy to use
94% accuracy in test with those with substance misuse disorders
Free telephone service
2Change plan/treatment plan
Change plan - defining a client's goals and strategies for achieving them; the treatment plan is part of the change plan
Treatment plans are individualized and treatment should be customized to the individual. Treatment plan should be collaborative
3Four phases of treatment (Palliative Care, Stabilization, Rehabilitation, Maintenance)
Could you describe each stage?
1. Palliative care
-This type of care is given when?
-What does it aim to prevent?
-2 goals of it is to strengthen what?
2. Stabilization
-Some individuals might need what before formal treatment in this phase?
-Goal is to increase what two things in this stage?
-What services should you try to initiate in this stage?
-Do most clients need to progress to a higher elvel of care?
3. Rehabilitation
- Clients are engaged with what at this stage?
-Goal is to create what at this stage?
-What should you initiate at this stage and what variables should you consider alongside it?
-This stage is typically done after _____ is conducted
4. Maintenance
-What should you support at this stage?
-What should be clarified at this point?
-Implentation of an ____ ____ should be done
- Encourage these three things during maintenance!
Lastly.... can clients be at any one of these stages without needing a facility? Are they fluid?
1. Palliative Care
-Given typically prior to treatment
-Prevent death or further harm
-Goal is to connect or strengthen connection with the care system
-Goal to motivate client to enter treatment
2. Stabilization
-Some indiviudals might need detoxification before engaging in formalized treatment
-Goal is to enhance retention and further increase motivation
-Try to initiate case management services if needed (housing for the homeless, figuring out where client could go long term for care, figuring out what level of care the client needs, etc)
-Many clients don't even need to level up to higher levels of care in treatment facilities)
3. Rehabilitation
-Individual engages in formalized substance abuse treatment in this stage
-Goal to establish a therapeutic relationship
-INitiate treatment plan (who can watch kids while you're at a facility, who can take care of your pets while you're away, how do we keep your job, etc).
-Engage family members in treatment process
-Follows assessment
**Clients can be at any of these stages without necessarily needing a facility, palliative care, stabilization, etc)
Maintenance
-Support motivation for maintenance fo change
-Negotiate and clarify goals
-Implement maintenance plan
-Encourage support group attendance, involvement, and spirituality
-Encourage spiritual development
4Determining Level of Care
1. What is treatment matching the method of?
-Natural Matching and Clinical Judgment
2. Can clients just typically go to whatever treatment level they want to?
Treatment matching is the method of placing people in the appropriate level of care, with consideration to the person's specific needs, issues, and concerns
-Natural matching
-Clinical judgement : Decision Rules ASAM
Minimal level is usually approved first because of insurance reasons
5ASAM - Patient Placement Criteria of the American Society of Addiction Medicine
Six levels of care
Dimension 1 - acute intoxication and withdrawal potential
D2 - Biomedical Conditions and Complications
D3 - Emotional, behavioral, or cognitive conditions/complications
D4 - Readiness to change
D5 - Relapse, continued use, or continued problem potential
D6 - Recovery/living environment
Not great in validity, especially in terms of placing people
6Who Decidese What level of care they recieve? (stepped care, Informed choice)
Stepped Care - the least intensive care first
Informed Choice - Allow the client to make the decision
7Overview of Treatment Plans
1. Based on what?
-Based on information gathered during the assessment with the client
8Purposes of a treatment plan
-What does a treatment plan prioritize?
-What does a treatment plan select for goals?
-What does a treatment plan identify/consider?
-What does it do over time?
-prioritizes short and long-term goals (what can we do now? what can we do later?)
-Selects interventions for goals
-Identifies barriers (what could hinder treatment?)
-Monitors progress over time
9Treatment PLanning with the chemically dependent
1. What is the primary goal of substance use/abuse treatment?
2. What should you make sure to evaluate before implementing interventions?
Primary goal is cessation of substance abuse or decrease of use
Important to evaluate the stage of change the client is in and the interventions necessary relative to it.
10Think big picture!
True or false: Focusing on treating the client's drug use is the only concern drug counselors have to deal with
Build a portfolio: Why?
Rarely is it just a drug treatment
Do they need medical assistance, educational services, HIV/AIDS treatment, legal services, family services
Build a portfolio of resources for your clients
Spreadsheet that shit!
11Short-term goals
Short-term goals are typically between what range of months?
What should the short-term goals be focused on?
Generally considered goals which can be met in 6 months
Primary goals should be related to precipitating problem
12Treatment Plan
1. Developed from what?
2. Multi..... fill in the blank
3. Treatment plan captures the clients _____ , ______, and their ______
4. Contain what two major components?
5. Designates the frequency of what?
-Developed from assessment
-Multidisciplinary approach
-reflects client's presenting needs and indicates the person's strengths & limitations
-Contains goals, interventions
-specifies frequency of treatment contact
13Qualities of well-foormed treatment goals
Define SMART goals!
Salient and meaningful to the client
SMART
-Specific - direct, detailed, meaningful
-Measurable - can be quantified and tracked
-Attainable -realistic and client possesses ability to do it
-Relevant - your goal alligns with your company mission
-Time-based - Your goal has a deadline
Appropriate for projected treatment period
14Treatment Strategies
1. Help the client identify pros and cons of....
2. Help client identify....
3. Keep a log of....
4. Discuss _____ (which can make usage worse) and ____________ (which can decrease usage)
5. Establish a reduction of ______or try to promote a temporary _________!
Evaluation of the pros and cons of the substance usage
Identification of negative consequences of use
Substance use log
Discuss triggers and evaluate alternative environments for social ties
Establish short-term abstinence or reduction in use
15Motivational Interviewing
Elicit self-motivational statements
Listen with empathy and reflectively
Ask open-ended questions
Affirm the client
Roll with resistance
Reframe - restate the client's perceptions "I got way too drunk, but I ended up feeling pretty okay the next day" "Sounds like you realize you had more than you should have"
Sustain talk vs change talk
16Motivation to change --- FRAMES
SBIRT
FRAMES
Feedback of information from assessment
Responsibility for change
advice to change
Menu of strategies for change
empathy
self-efficacy