Treatment Planning, Collaboration, and Referral Flashcards
The boring client
Is often boring because they are scared. They desire attention but do not know how to get it. They want to participate but are afraid to take chances and rarely says anything important. Positive reinforcement should be used to encourage participation
The silent client
May be afraid of disclosing information, fear the inability to control the situation, or may be manipulative and trying to control the situation. Counselor can invite client to speak up or remove client if harmful to group
The self-righteous client
Must be right at all costs. May have had a disappointing life with little success. May be quiet in group settings until there is a chance to prove everyone else wrong. Counselor can help by informing other group members about this type of behavior and its causes
The monopolizing client
Demands full attention of counselor and may behave badly to keep counselor’s attention. May give impression that their problems are worse than everyone else’s. Counselor must address this problem before it becomes severe and remind group that listening is an important part of counseling
The hostile client
Hostility can be a cover for fear or result from high levels of stress due to unfair treatment or can feel threatened. Counselor can help the client handle the fear that causes hostility
A multidisciplinary approach
Takes the individual’s specific needs into mind
Integrated counselor competency
The ability of the counselor to combine attitudes, skills, ethics, values, and knowledge to provide appropriate care to clients with co-occurring disorders
Patient care guidelines for level of care
American Society of Addiction Medicine’s Patient Placement Criteria; The Level of Care Utilization System for Psychiatric and Addiction Services; Quadrants of Care
Level of care quadrants: Quadrant 1
Low level substance abuse problem, minor mental health problems; can be treated in outpatient settings for substance abuse or mental health
Level of care quadrants: Quadrant 2
Severe mental disorders, low level substance abuse problem, treated in the mental health system
Level of care quadrants: Quadrant 3
Very severe substance abuse problem and mental problems of low to moderate severity, treated in substance abuse treatment programs
Level of care quadrants: Quadrant 4
Patients with a serious psychiatric disorder and a severe substance abuse problem; patients with a severe substance abuse problem and a severe behavioral health problem such as suicidal or violent behavior; require intensive care in a residential setting for both mental health and substance abuse problems
Consultation is _____. The goal of consultation is to provide _____ for substance abuse.
Meeting with other experts to provide complete and quality care for the client; comprehensive treatment
Signs and symptoms of relapse
Positive memories, recalling the good times; neglecting negative effects; sudden behavior changes; complaints about the ineffectiveness or need for treatment; depression, suicidal ideation, withdrawing from others;; excessively fatigued, lacking sleep; increased levels of stress; increased irritability and moodiness; contact with old friends or environments; avoiding social interactions; decreased participation in treatment; lying; evidence of drug/alcohol use
Risk factors for relapse
Increased risk for relapse in the first 6 months of treatment; long history of substance abuse; history of relapse; lack of family or social support; family history of substance abuse; dual diagnosis; associating with others who use substances; boredom; physical pain; influx of cash; prescription of opioid drugs; believing in controlled use rather than abstinence; reminiscing about drugs/alcohol use and getting high; depression; access to drugs or alcohol; conflict with others; celebration; substituting addictions; failure to develop coping skills for triggers
Techniques to interrupt the relapse process
Limiting distractions; dealing with the truth of addiction; reinforcing the concept of addiction as a disease and relapse a part of recovery; encouraging family participation in therapy; maintaining rules of conduct and accountability; monitoring 12-step progress; intervening immediately when negative behavior happens; maintain a schedule; being alert to manipulation attempts; expecting the client to act responsibly and carry out assigned activities; avoiding pampering or coaxing the client; being honest; encouraging client to complete treatment; assigning clients to learn relaxation techniques; reviewing triggers and methods to avoid them
Detox is often necessary for using drugs in these categories
CNS depressants such as alcohol, opiates, cocaine
Withdrawals from alcohol
Sleep disturbances, tremors, sweating, hallucinations, agitation, high temperature, increased pulse rate, high blood pressure, seizures
Medications useful in treating alcohol withdrawal
Benzodiazepines, barbiturates, beta-blocking drugs
Withdrawals from other CNS depressants (sedatives, hypnotics, anxiolytics)
High blood pressure, convulsions, rapid heartbeat, agitation, headache, cognitive impairment. Abrupt withdrawal from these drugs can be life threatening and detoxing includes gradual reduction of the drug or substitution of a similarly acting drug
Withdrawals from opiates
Raised blood pressure, increased pulse rate, elevated temperature, excessive nasal discharge, nausea and vomiting, stomach cramps, muscle aches
Detoxification from opiates
Involves the substitution of another longer-lasting opioid, such as methadone, and then decreasing gradually
Withdrawals from cocaine
Sleepiness, depression, loss of ability to concentrate, paranoia, decreased energy level
Detoxification from cocaine
Involves stopping the binges. Users are treated in both inpatient and outpatient. Dropout rate is high
Individualized recovery plans include
Personal goals for recovery, steps required to attain goals, list of triggers, coping skills to deal with emotions, prevention strategies such as going to counseling and meetings, self-care activities, commitments that require sobriety such as custody of children, consequences for failure to carry out plan
4 classes of drugs to treat addiction: Agonists
Mimic the effects of the drug and are used to alleviate symptoms of withdrawal (methadone)
4 classes of drugs to treat addiction: Antagonists
Block the effects of the drug and prevent its psychoactive actions
4 classes of drugs to treat addiction: Antidipsotropics
Causes adverse reactions to the consumption of the drug (antabuse)
4 classes of drugs to treat addiction: Psychotropics
Controls the symptoms of withdrawals (anxiolytics, antipsychotics, antidepressants)
Stages of recovery: Initiation
The client makes a commitment to control the addiction and enters treatment or attempts to without help
Stages of recovery: Early abstinence
The first 90 days; Client may have withdrawal symptoms and is at risk for relapse because of physical and psychological cravings. The client needs to learn coping skills to avoid further addiction
Stages of recovery: Maintenance
After the first 90 days; The client should focus on avoiding relapse and learning about triggers; may need to improve relationships and anger management; this stage may last up to 5 years
Stages of recovery: Advanced recovery
The client has been clean for 5 years but must remain vigilant and attend AA/NA meetings, support groups, or counseling
Early remission
Substance abuse diagnosis criteria have been met but not fulfilled for at least three months but not more than one year
Sustained remission
Substance abuse diagnosis criteria have been met but not fulfilled for one year or longer
Maintenance therapy
A replacement medication that can be taken to avoid withdrawal symptoms (nicotine patches, methadone); The client could still be in remission from substances while on maintenance therapy
Residential programs
Require client to live onsite and is useful for those who need a stable environment or have a serious substance use issue
Inpatient hospital treatment programs
Residential treatment in a hospital setting
Therapeutic community programs
Residential program that provides a highly structured environment and focuses on self-help. Ex-addicts are often employed as counselors
Outpatient non-methadone treatment programs
Private clinics, mental health centers, private practice; clients are treated in the community
Combined settings programs
Treating the client on both an inpatient and outpatient basis
3 programs for people with co-ocurring disorders
Addiction only, dual diagnosis capable, dual diagnosis enhanced
Addiction only programs accommodate _____
Only clients with substance abuse problems
Dual diagnosis capable programs are _____
Set up to primarily deal with substance abuse problems but can also accommodate individual with mental health problems
Dual diagnosis enhanced programs place an emphasis on _____
Treating mental disorders, the integration of mental health treatment services, and substance abuse treatment services
Behavioral modification is a treatment approach that uses _____
Positive and negative consequences to shape behavior
Medicaid
A federal and state run system that provides health care coverage for low income individuals
Medicare
Is part of the social security system and provides coverage to individuals over the age of 64 and individuals with disabilities. Part A covers hospital care and hospice care. Part B provides supplementary services at cost and is not mandatory
HMOs
Cover basic and supplementary care under a fixed, prepaid fee schedule
A _____ is an organization set up to join different treatment programs and their associated services to work toward common goals
System; Substance abuse treatment centers may interact with organizations dealing with social services or with the justice system
Substance abuse treatment systems are concerned with _____
Stabilization, treatment, rehabilitation, and relapse prevention
Mental health systems provide _____
Crisis intervention, stabilization treatment, ongoing treatment, and rehabilitation support
Rational Recovery
An educational company that publishes Addictive Voice Recognition Technique to aid substance abusers in self-recovery
Addictive Voice Recognition Technique is based on the following ideas _____
Most people can recover with professional help or recovery groups; A commitment to abstinence can lead to abstinence; Recovery from addiction is easier than it is made out to be; The role of a counselor is to convince the individual that he/she can quit; A group setting is not the most effective way to quit drug use; Becoming intoxicated is a personal decision; An individual can learn to identify himself/herself as a non-user
Moderate Management
Is a group that provides support for individuals who wish to cut back their drinking to a point where it no longer causes problems; MM is a self-help program and members are provided with information on managing alcohol use; This is a possible goal for those who drink too much but are not dependent on alcohol
Women for Sobriety
Founded the New Life program; uses 13 positive statements to encourage women to learn a new lifestyle and to overcome alcoholism; Founded on the idea that female alcoholics are different from male alcoholics and need a different type of help
Secular Organization for Sobriety or Save Our Selves or SOS
Welcome both drug and alcohol users; based on the idea that sobriety and religion are separate issues; The individual is responsible for his/her own sobriety and given credit for maintaining sobriety
Self-Management and Recovery Training or SMART
Helps individuals who want to overcome any kind of addictive behavior; Addiction is not viewed as a disease but seen as a maladaptive behavior pattern
Self-Management and Recovery Training or SMART uses the four points in the program _____
Maintaining motivation to stay clean, dealing with cravings, problem solving with rationality, creating a balanced lifestyle
The Minnesota Model
Is an adaptation of the 12-step program used to treat both alcohol and drug abuse; highly structured system that includes detox, psychological assessment, group and individual meetings, lectures; 21, 28, or 60 day residential versions
_____ recognizes that abstinence may not always be attainable so the goal should be to use substances more _____
The harm-reduction model; responsibly
_____ focuses on what is observed rather than opinions
Objective documentation
A _____ provides a chronological report of the client’s condition, treatment, and responses
Narrative
_____ is a problem-oriented form of charting that establishes goals, expected outcomes, needs, and compiling a list of problems.
SOAP (subjective data - client’s statement of problem, objective data - observations, assessment - determination of possible causes, plan of action - short and long-term goals and immediate plan of care)
_____ is a problem-oriented form of charting similar to SOAP but less complex. It combines the use of flow sheets with progress notes and a list of problems
PIE (problem, intervention, evaluation)
_____ is focused charting that includes documentation about health problems, changes in condition, concerns or events, focusing on data about the condition, the action taken by the counselor, and the response
Focus/DAR (Data, action, response)
Instead of simply noting a client engaged in an activity, the _____ of the activity should be noted, such as “exercised for 30 minutes”
Duration
The _____ events occur should be accurately reported to help identify patterns of behavior, such as cravings occurring throughout the day
Time
6 stages of counseling: During the _____, the counselor collects as much information as possible from as many sources as possible
Information gathering stage
6 stages of counseling: The _____ includes assessing the nature of the problem, investigating contributing factors, and determining whether or not the client is a good match for the counselor
Evaluation stage
6 stages of counseling: _____ involves providing information so the client can decide whether or not to continue treatment
Feedback
6 stages of counseling: As part of the _____, the counselor and client agree upon the length of treatment, what to expect from each other, and the goals of treatment
Counseling agreement
6 stages of counseling: The _____ involves working toward the stated goals
Changing behavior stage
6 stages of counseling: The _____ occurs when the therapist and client agree that the improvements are evident and that the continuation of treatment is not necessary
Termination stage
_____ ensures that the listener actually hears what is being said. It conveys interest in the speaker and makes him/her feel comfortable
Attentive listening
_____ uses small phrases to encourage the speaker to continue
Minimal encouragers
_____ is repeating the speaker’s words back to him or her to clarify statements
Parroting
_____ is rephrasing the speaker’s statements to show the listener understands what the speaker is saying
Paraphrasing
_____ is commenting on what was said and implied in a conversation to provide feedback for the speaker
Reflecting with interpretations
_____ is pointing out discrepancies between the client’s true self and and view of himself/herself. These discrepancies can be seen by comparing the client’s verbal statements and nonverbal behavior
Confrontation
_____: Ability to establish a trusting relationship with the client
Attending skills
_____: Identifying variables relevant to the problem
Concreteness
_____: Distinguishing between what the client says and what the client feels
Distinguishing content from feelings
_____: Knowing how to conduct a session without leading the patient
Probing
_____: Feeling what the patient is feeling
Accurate empathy
_____: Remaining true to yourself
Genuineness
_____: Treating the patient as a worthy individual
Respect
Attending Skills: Physical attending skills
Keeping a comfortable distance, maintaining face to face and relaxed posture, keeping eye contact
Attending Skills: Psychological attending skills
Observing the client’s physical characteristics and tone of voice, choice of words, and themes of conservation
Attending Skills: Self-attending skills
Counselor’s awareness of the impression he or she is making
Attending Skills: Responding skills
Responding appropriately and letting the client know the counselor is interested and listening
_____ is the opposite of vagueness and involves stating problems and issues in specific terms
Concreteness: Encouraging the client to acknowledge “I slept in this morning and missed work” rather than saying “I always mess up”
The three components of interpreting
Addressing the client’s ideas and restating them; adding counselor’s ideas to the client’s ideas; going over these ideas with the client
