Substance Abuse Assessment, Treatment, and Monitoring

I. Service Description

Drug addiction is a complex illness. It is characterized by compulsive, at times uncontrollable drug craving, seeking, and use that persist even in the face of extremely negative consequences. For many people, drug addiction becomes chronic, with relapses possible even after long periods of abstinence. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. Treatment does not need to be voluntary to be effective. Strong motivation can facilitate the treatment process. Sanctions or enticements in the family, employment setting, or criminal justice system can increase significantly both treatment entry and retention rates and the success of drug treatment interventions.

Substance abuse negatively affects a parent’s social, emotional and physical functioning. Their ability to provide for their children will be impaired and poses a risk to child development, safety and/or well being. Recognizing the "cloak of secrecy" that often surrounds these families, efforts must be made to open lines of communication and be sensitive to a variety of sources in verifying substance abuse and corroborating the effects on children.

Assessment

Effective treatment attends to multiple needs of the individual, not just his or her drug use. To be effective, treatment must address the individual's drug use and any associated medical, social, psychological, vocational, and legal problems. A face-to-face clinical interview must take place with each referred individual. In-person sessions provide the ability to provide immediate attention to individuals who may be a danger to themselves or others. Tremors, needle marks, dilated pupils, exaggerated movements, yellow eyes, glazed or bloodshot eyes, lack of eye contact, a physical slowdown or hyperactivity, appearance, posture, carriage, and ability to communicate in person are vital components to the clinical interview.

The substance abuse assessment must include:

1. Any associated medical, psychological and social history of the client,

2. An in-depth drug and alcohol use history with information regarding onset, duration, frequency, and amount of use; substance(s) of use and primary drug of choice; associated health, work, family, person, and interpersonal problems; driving record related to drinking or drug use; past participation in treatment programs,

3. Standardized assessment tool for drug/alcohol abuse such as Substance Abuse Subtle Screening Inventory (SASSI), Addiction Severity Index (ASI) Teen Addiction Severity Index (T-ASI), ASI Lite, or the Addiction Society of Medicine Placement Patient Criteria Revised Version II(ASAM PPII), Drug Abuse Screening Test (DAST), Substance Abuse Relapse Assessment (SARA), etc.,

4. Results of urine screen with the requested drug panel.

Reports on non-emergency referrals must be delivered within 30 days of the completion of the assessment. For emergency assessments, it is expected that a verbal report will be provided to the referring office within 72 hours and a written report provided within 14 days after the completion of the assessment with the client. It is expected that a client with a history of homelessness, frequently changing employment and/or instability

in caring for their children will be addressed realistically regardless of an admission of substance abuse. Recommendations regarding the client’s needs must be provided on each assessment. This information should be used to develop an individualized treatment plan with specific strategies for coping with high-risk situations, slips, and relapses.

Treatment & Monitoring

There are many addictive drugs. Treatments for specific drugs can differ and varies depending on the characteristics of the patient. Problems associated with an individual's drug addiction can vary significantly. People who are addicted to drugs come from all walks of life. Many suffer from mental health, occupational, health, or social problems that make their addictive disorders much more difficult to treat. Even if there are few associated problems, the severity of addiction itself ranges widely among people.

A variety of scientifically based approaches to drug addiction treatment exists. Treatment prescribed for all clients must be evidenced based. Drug addiction treatment can include behavioral therapy (such as counseling, cognitive therapy, or psychotherapy), medications, or their combination. Behavioral therapies offer people strategies for coping with their drug cravings, teach them ways to avoid drugs and prevent relapse, and help them deal with relapse if it occurs. When a person's drug-related behavior places him or her at higher risk for AIDS or other infectious diseases, behavioral therapies can help to reduce the risk of disease transmission. Case management and referral to other medical, psychological, and social services are crucial components of treatment for many patients.

Change does not happen all at once. Much of the early change process takes place internally as a person weighs whether change is worth the time and effort required. Treatment must help the client to identify the events that typically precede their substance use, as well as the consequences that may reinforce that use. Individual and/or group treatment to assist the client toward change may include any or all of the following:

Consciousness raising
Self-revelations
Weighing pros and cons
Environmental reassessment
Problem solving
Stimulus control-triggers
Stress
Assertiveness
Refusal skills
Thought management
Cravings and urges
Alternatives to using
Social Support
Identifying needs and resources
Goal Setting
Relapse Prevention Planning
Role play
Role clarification

Following the assessment of each client, the service provider must inform the referring worker of the expected number of treatment sessions to be provided to each client. The service provider must contact the referring worker by phone or email to relay important information regarding the client such as active drug use that affects parenting abilities as situations develop. Copies of treatment plans, progress reports with recommendations for each court hearing and discharge summaries with prognosis and recommendations must be provided to the referring worker in a timely manner. If self-help groups (such as AA/NA) are part of the support of treatment process, the service provider must provide a means to document and verify attendance at such programs. Aftercare plans must be identified for all clients completing outpatient services.

Services must be available to clients who have limited daytime availability. The service provider must identify a plan to engage the client in the process, a plan to work with non-cooperative clients including those who believe they have no problems to address as well as working with special needs clients such as those who are mentally ill or developmentally delayed.

No-show alert forms will be provided by the contracted agency to inform the referring worker of the client’s failure to attend sessions based on five no-shows and ten no-shows. After ten no-shows, the client will be administratively discharged. Any client who is administratively discharged must request a new referral from the referring worker to begin receiving services again.

II. Target Population

Services must be restricted to the following eligibility categories:

1. Children and families who have substantiated cases of abuse and/or neglect, with moderate to high levels of risk and service needs according to the assessment matrix

2. Children with a status of CHINS, and/or JD/JS

3. All adopted children and adoptive families

III. Goals and Outcome Measures

Goal #1

Timely receipt of report to prepare for services/court.

Outcome Measures:

1. For non-emergency assessments: 100% of the written reports will be received by referring worker 14 days after the completion of the assessment with the family.

2. For emergency assessments: 100% of Verbal reports will be received by the referring worker within 72 hours; written report received by the referring worker 14 calendar days after the assessment with the family.

Goal #2

Recommendations relevant and based on documentation in the body of the report.

Outcome Measures:

1. 100% of recommendations prepared as a result of the assessment are appropriate based on interviews, observations, review of other records, and completion of test instruments.

2. Abstinence or decrease use of alcohol or drugs.

3. Improvement of work or improvement of educational status

4. Stable living situation.

5. Decrease involvement with the criminal justice system

Goal #3

Drug screens will be provided to the referring worker in a timely fashion.

Outcome Measures:

1. 100% of positive reports will be reported verbally by phone, voice mail or email within 24 hours of receiving the results of the urine screen. Written reports of the urine screen will be mailed/faxed to the referring worker within 24 hours of receipt of laboratory results.

Decreasing evidence of illicit drugs in drug screens.

Goal #4

No-show alert forms based on five no-shows and ten no-shows will be provided to the referring worker.

Outcome Measures:

1. 100% of no-show alerts will be provided to referring worker immediately following the select number of no-shows. After 10 no-shows, the client will be discharged from services.

2. Retention – Improvement in length of stay in treatment.

Goal #5

Referring worker will be provided treatment plan and sessions needed for progress to occur for each client referred.

Outcome Measures:

1. 100% of referred clients will have a treatment plan developed following the assessment with the treatment plan provided to the referring worker within 10 days of completion.

Goal #6

DCS and client satisfaction with services

Outcome Measures:

1. DCS satisfaction will be rated 4 and above on the Service Satisfaction Report.

2 .80% of the clients who have completed substance abuse assessment and treatment services will rate the services “satisfactory” or above.

IV. Qualifications

Minimum Qualifications:

1. Master’s degree in social work, counseling or psychology with at least three years experience providing substance abuse services and a current license issued by the Indiana Social Worker, Marriage and Family Therapist and Mental Health Counselor Board, as one of the following: 1) Clinical Social Worker, 2) Marriage and Family Therapist, or 3) Mental Health Counselor or whose program is certified by the Division of Mental Health Administration to provide addiction services, or

2. An alcohol and drug abuse counselor certified by the Indiana Counselors Association on Alcohol or by the Drug Abuse (ICAADA), or by the Indiana Association for Addiction Professionals (IAAP), or by the National Association of Alcoholism and Drug Abuse Counselors Certification Commission (NAADAC), or by the International Certification Reciprocity Consortium/Alcohol and Other Drug Abuse (ICRC), or by the National Board of Certified Counselors, Inc and Affiliates/Master Addictions Counselor (NBCC).

3. Sample collection does not require the services of a certified drug abuse counselor. The person providing this service must be highly training in sample collection and the chain of custody procedures to document the integrity and security of the specimen from time of collection until receipt by the laboratory.

Supervision/consultation is to include not less than one (1) hour of face to face supervision/consultation per 20 hours of direct client services provided, nor occur less than every two (2) weeks.

Services will be conducted with behavior and language that demonstrates respect for socio-cultural values, personal goals, life-style choices, as well as complex family interactions; services will be delivered in a neutral valued culturally competent manner.

V. Billable Units

Face to face time with the client:

(Note: Members of the client family are to be defined in consultation with the family and approved by the DCS. This may include persons not legally defined as part of the family)

Includes client specific face-to-face contact with the identified client/family during which services as defined in the applicable Service Standard are performed.

Includes crisis intervention and other goal directed interventions via telephone with the identified client family.
Includes Child and Family Team Meetings or case conferences initiated or approved by the DCS for the purposes of goal directed communication regarding the services to be provided to the client/family.

Reminder: Not included is routine report writing and scheduling of appointments, collateral contacts, court time, travel time and no shows. These activities are built into the cost of the face-to-face rate and shall not be billed separately.

For hourly rates, partial units may be billed in quarter hour increments only. Partial units to be billed are to be rounded to the nearest quarter hour using the following guidelines: 8 to 22 minutes = .25 billable hours, 23 to 37 minutes = .50 billable hours, 38 to 52 minutes = .75 billable hours, 53 to 60 minutes = 1.00 billable hours. All billed time must be associated with a family/client.

Per person per group hour

When DCS clients are referred to groups where most of the clients are non-DCS referrals. This is available when the nature of the group or the geographic location does not support a group composed of primarily DCS clients

Drug Screens

Actual cost of the screens. The provider is to present a list of the drug screens available with the total cost of each drug screen or set of drug screens. The DCS will specify which drug screen or screens they are authorizing for each client on the authorizing referral form.

Translation or sign language

Services include translation for families who are non-English language speakers or hearing impaired and must be provided by a non-family member of the client. Dollar for dollar amount.

VI. Rates

Face to Face Rate: $118.00 (Minus 10% January 01, 2010)

VII. Case Record Documentation

Necessary case record documentation for service eligibility must include:

A completed, dated, signed DCS referral form authorizing service
Documentation of regular contact with the referred families/children
Written reports no less than quarterly or more frequently as prescribed by DCS.

VIII. Service Access

Services must be accessed through a DCS referral. Referrals are valid for a maximum of twelve (12) months unless otherwise specified by the DCS. Providers must initiate a reauthorization for services to continue beyond the approved period.

NOTE: All services must be pre-approved through a referral form from the referring DCS FCM or DCS Service Consultant.