CTB Live Stream YouTube

Alrighty, everybody. Welcome to today's presentation of the addiction counselor exam review. This is the final installment on our addiction counselor exam review series that is based on the addiction counselor exam review text. I'm really encouraging y' all to submit questions, and I will create a few additional presentations to answer any questions that, you know, I may not have answered or I didn't answer the way in as much depth as you wanted in order to help you prepare for your addiction counselor exam. So again, please, below you can submit questions, and I will put all those together, and next week I will do a user input presentation. So on we go with case management service coordination. So today we're going to define referral and service coordination within the context of case management. We'll explore why case management is necessary. And I know at a lot of agencies you work at or you will work at, you're not going to have case managers. So you need to know how to do case management because it just. It has to be done. We're going to identify the different approaches to case management. We'll identify the case manager's role in service coordination. We'll define service planning and identify challenges and solutions to collaboration. So service coordination, that's really, you know, the crux of case management. Case managers are there to work with clients in a collaborative process to help them access needed services. And this is not just counseling. This can be medical, housing, transportation, you name it. Anything a client needs in order to achieve his or her highest quality of life, we're going to try to connect them with. We're not necessarily, and a lot of times not able to provide it. But there are providers in the community, most likely, who already do provide that service. So we are the ones that serve as the linkage. We're going to help connect those two people together. We'll help them select the most appropriate services because, you know, it's not one size fits all. A lot of times, how do you choose the right doctor, how do you choose the right treatment program? You know, what services do you really need? We'll facilitate the linkages with those services and promote continued retention in those services by monitoring participation. So we don't just link them and go, okay, toodles. Been real. You know, we want to link them, then we want to follow up and go, how's it going? Is this meeting your needs? If not, what else do we need to do? Or do we need to look elsewhere? We want to make sure that we don't just, you know, give them a number and send them out the door. Because that's not case management. We want to coordinate multiple services when necessary, such as addiction counseling, mental health counseling, psychiatry, and primary care. You know, I, I've worked with all four of those on many, many cases and advocate with the client for continued participation. The case manager has even more contact in many cases than the clinician with the client. And we have way more contact with the client than maybe the psychiatrist or the primary care physician. So it's really important for the case manager to be alert to, to waning motivation and advocate for their continued participation. It's also important for the case manager to advocate for continued participation. If a program is saying, you know what, I think it's time to discharge, the case manager might be able to point out a few reasons why this client is not ready for discharge yet or not ready for step down. So case managers are in large part advocates for clients. Objectives of case management are to ensure continuity of care. We want to make sure that everybody on the team is on the same page, and we want to make sure that, you know, the client is accessing and able to access all the services that he or she needs. We provide accessibility by establishing relationships with gatekeepers. And this can include insurance companies. This can include, you know, if you're making a referral to maybe a teaching hospital, you know, who is the gatekeeper there, who decides when the appointments are and who gets accepted, and all that kind of thing. You want to develop contracts or memorandums of understanding, abbreviated MOUs, which specify available slots. So, for example, the detox unit that I used to run, we had 16 beds, but we always had four slots for adolescents. So, you know, we knew that we had to make sure that we could accommodate at any particular time up to four adolescents. And we need to identify in those memorandum of understanding consequences for failure to implement specified activities or procedures. So if we fail to maintain those four beds and those four beds were needed, you know, we could potentially lose our contract with the state. So, you know, it was big, bad mojo. But in other memorandum memoranda of understanding between agencies, it could just hurt the working relationship. You may start, get. Stop getting referrals from them, they may stop taking referrals from you. You know, it could close a door onto an, on. On an avenue of treatment that your clients may need. So memoranda of understanding really spell out, this is what we as an agency do. This is what we as an agency are willing to commit to do to your, for your clients, for your referrals. And this is what you as the other agency are going to do in return. This is how it's, you know, we're going to cooperate. Accountability. And you do want to be careful when you write those, because there's a lot of patient brokering issues that can come out of that if it's not done correctly. You know, you don't want to guarantee that you're going to send all your referrals somewhere, but that's a whole different course. That's ethics. So make sure that the memoranda of understanding is very clear and there's no exclusive benefit. So anyway, accountability is another thing that case managers do. We follow up with referrals both with the client and with the referral source. You know, if I refer John over to primary care or pain management, I'm going to follow up with John when he comes back to see me or when I go to see him to see how it went. But I'm also going to follow up with the referral source to say, don show up. Did John show up on time? Was this an appropriate referral? Was this useful? Yada yada. Because I don't want to send them inappropriate referrals. I want to make sure that both the referral source and the client are happy. I want to measure outcomes with client satisfaction, client outcomes, and service system outcomes, such as a reduction in the cost to treat. So if Normally it costs $15,000 to treat this client for a month, but we decide to start referring out for certain other services so we don't have to provide them, that will lower the cost to treat potentially for us, but are we still getting the same client outcomes and client satisfaction? And case managers help with efficiency because it's the case manager's job to know the system and to make it work. So you're the one out there just really making sure that everything's, you know, flowing smoothly. Case management is necessary because of poor coordination, poor service coordination, lack of service continuity, and the difficulty clients have negotiating the gap between services. We had a lot of struggles referring to certain agencies where I came from, and those agencies I won't name. Hopefully, things have improved. But there were a couple agencies. We knew that if a client had to interact with them, it was going to be a big headache. So it was important for us to establish a contact person over there that we could call. Thankfully, our attending physician was married to their attending physician, so it was a little easier. But it was important for us to have a contact person over there. In order to cut through all the red tape, we need to provide structure where the case manager acts as the Human link between the client and service providers. And we also are potentially the core agency that develops contracts with providers for identified services. So we're kind of figuring out who offers what and then we've got a menu of options before us and that's what we're doing. We're kind of brokering out. Sometimes the core agency that's providing the case management may control case management funds. So, you know, they may be the ones that are deciding who is eligible for case management and who isn't. They act as a single point of entry for clients. So if somebody needs case management, they will come in this way or you know, ideally this is the place that people enter the system. Now this doesn't happen a lot, especially in a recovery oriented system of care where we adhere to that no wrong door philosophy. That means people can come in from anywhere, from the jail, from social services, wherever. We do want to make sure that they get funneled, you know, wherever they come in from initially, they get funneled to a single place, if you will, that, you know, can help disseminate things. So we don't have repetition of, you know, somebody went to a mental health counselor, did an assessment, now they need to go to a substance abuse counselor and do an assessment and all these other things. So we want to act as a single point of contact, if you will. And we can help develop missing service elements because we can look at all of the services that are available on that menu and say, oh, transportation is missing. And that's a big issue for our clients. So case managers are on the ground and we're able to identify service needs that can facilitate client success. So there are multiple different approaches to case management. The brokerage approach, which I already kind of mentioned, they coordinate services and provide few if any services themselves. They're the ones that are just kind of sitting there like the cashier at McDonald's going, okay, what do you want to order from the menu? They can provide some stabilization and empowerment. They're going to, you know, help the client potentially connect with those resources, you know, do a warm handoff. But they're not going to provide the services themselves. Then you have integrated case management. This is family focused and strengths based and uses an independent facilitator to coordinate all relevant people, including providers, family and natural supports. This team then works in partnership with the family, with the family to create safety based comprehensive treatment plans addressing the needs of all family members. This is a very family based system because guess what, your person probably doesn't live alone. So we need to integrate Everybody that's in that person's immediate household and anybody they consider their family or immediate supports. So we can make sure that those people are getting their needs met. Because caregivers have needs too. Case management offers a single point of contact for clients, is client driven, strength based, involves advocacy both between services with seemingly contradictory requirements to serve the best interest of the client. So if you've got perfect example, we used to have clients who would need mental health services, you know, crisis stabilization, and they'd also need detoxification. And it was a hot potato because the CSU did not want to handle a client who was under the influence. And the detox unit wasn't able to handle a client who was potentially a threat to himself or someone else. So there was generally a back and forth, and it required a lot of advocacy from the program director between the two of them to decide what was in the best interest of the client. Where did this client need to be? It involves advocacy with agencies, you know, workforce development, law enforcement, you know, the whole kit and caboodle, families, legal systems and legislative bodies. It may involve the recommendation of sanctions to encourage client compliance and motivation. So sometimes, especially in your problem solving courts like drug court and mental health court, you may have a case manager who is assigned to each client who makes recommendations to the court based on the client's progress in treatment. Case management is community based and pragmatic. That means it meets the client literally and figuratively, where the client is, if they are ready for treatment, or if they're not quite ready for treatment, or if they're in aftercare and they need, you know, to maintain their relapse prevention plan. But we go into the community, they're not coming into the clinic. We're going into the community to see how they're doing. It's anticipatory, based on the natural course of the client's presenting issues. So if you know that you're working with a client who has bipolar disorder, is anticipating that there may be another resurgence of symptoms at some point. So we want to make sure that the client has the ability to access services should they start to decompensate. It's flexible to individual needs and culturally sensitive. So the case manager's role, and I said this when I was doing tip 42 yesterday, we use very specific language when we're writing case management notes because there are certain agencies, reimbursement providers, whatever you want to call them, who are very specific about what they will reimburse for case management. So we're going to use Words like linkages, advocacy and management, not other words. Because we want to help clients manage, link, advocate and get support in order to maximize their quality of life and achieve as much independence as possible. So a case manager has certain basic competencies that they need to have. You need to be able to establish rapport, just like a counselor. You need to have an awareness of how to maintain boundaries and be nonjudgmental. Just like a counselor. You need to recognize the importance of family, social networks and the community in the whole process of recovery. You know, yes, the person has to be willing to do the next right thing, but they also need support from whatever they define as family as well as the community in which they choose to reside. Case managers need to understand a variety of insurance and payment options available, and that includes things like patient assistance programs to help clients access medication when they can't afford it. They need to understand culture and respond in a culturally sensitive manner. Understand the value of an interdisciplinary approach to treatment. So the case manager is not, you know, sometimes is not necessarily a clinician. So, but even if they are, you know, we need to respect this interdisciplinary approach, recognizing that most clients have physical health needs. They may have pain needs, they may have mental health needs, they may have addiction needs, and they may also have social, environmental needs. So we need to think of Maslow's hierarchy and make sure that we've got providers that can help clients meet all of their basic Maslovian needs. And case managers can serve both as a facilitator for referrals and an advocate. Like I talked about earlier, as a facilitator, the case manager composes the team. You know, we help the client figure out what things they need, what services they need. And then we may reach out to those agencies and say, I have a referral for you and this composes the team. We notify participants of team meetings. Now, thankfully, with, you know, a lot of HIPAA compliant chat available now, it's easier to do these meetings. You don't have to find a room and everybody travels there and everything. So these meetings are a easier. Everybody just logs on to VC or something like that in order to participate. The facilitator, the case manager, will often chair the meeting to make sure that everything is getting said and everybody has a chance to speak. They maintain team focus on the client, not on what this agency needs or, you know, the funding priorities of this agency. We need to focus on the client. What does the client need? And if you don't have money to do it, how can we help get it paid for. And we want to ensure clients desires and needs are adequately represented and considered. Referral. You know, we've been talking about service coordination and I keep talking about referrals and that's something that a case manager does. And referral is the process of facilitating the client's use of available services and support systems to meet the needs identified in their assessment or treatment planning. Any referral you make, you're going to need to link back to a treatment plan goal or the assessment in some way to identify why does this person need this service at this time. It involves identifying needs of the clients which cannot be met by a particular agency. And this is true regardless of whether the client is receiving case management services. Even if you don't have a case manager on staff and there's no hope of one as counselors, a lot of times we have to do case management services because that's necessary to help clients, you know, start on this forward path. So we need to be willing and aware of services and providers that are in the community that we can make referrals to. Inappropriate referrals may lead to dropout. If clients hopes get up, then they're denied access to services. So if you refer somebody over to the housing department to get Section 8 housing and they're told there's a six month wait list, they may just kind of throw their hands up and get frustrated. So you need to be contacting those agencies and talking before you send somebody over on a wild goose chase. An inadequate follow up with the client as well as the referral source often leads to premature dropout. So we need to make sure that the referral source is keeping tabs on the client and we need to make sure that the client is getting their needs met and if not, figure out how to help them do that. Counselors and case managers must know resources in their community, including the processes for getting enrolled in whatever services are offered. Any limitations, such as diagnostic limitations or insurance limitations, requirements to get in the program. You know, if you're trying to get somebody in a day treatment program or in a clubhouse type program, you need to know what the requirements are to be admitted to that program. And you need to be aware of confidentiality in talking to those referral sources. You know, you can't be without a release of information. You know, you really don't want to be disclosing client information to referral sources. Now there are some very, very, very limited caveats in HIPAA for coordination of care, but it's always best to get a signed release of information before you start contacting referral sources. Counselors and case managers should visit referral agencies initially to find out what they do and what the agency's like. So you know what you're sending your client to and also semi annually after that. And you may be laughing, going, yeah, right, yeah, it doesn't happen like that. This is the ideal world. You should, even if you don't visit the referral agency semi annually, you should at least call your contact person and touch base and go, are services still available? Have you added any programs and remind them of your program and make sure they're still good to go. Potential problems in referrals include differences in agency funding. So if one agency only takes Medicaid and your agency is state funded and you have a client that doesn't have Medicaid, then you're not going to be able to refer a bunch of clients to them. There may be differences in eligibility. So an agency whose eligibility is pregnant and postpartum women is not going to be able to serve your 23 year old male client. So we need to make sure that you, you know, the population I serve, the referrals I make are appropriate to that agency. For example, in a place where I came from, right now, currently the only sober living houses are available to male veterans. That's it. So you know, in terms of eligibility, if you're not a male veteran, you can't get into those places. So don't even refer somebody there. Inadequate data sharing is another potential problem in referrals because, you know, you refer somebody over and they get to that referral source and the referral source is like, I've never heard of you before, you know, or they try make the person go through an entire assessment over again so they're having to redo that two hour process. Conflicting treatment plans can be another problem, which is where the case manager really needs to step in and advocate to make sure we can cooperate and coordinate the treatment plans, ensure that moving between agencies doesn't interrupt the continuity of care. You don't want somebody to not be doing well in iop, get referred to residential, discharged from IOP and not able to get into residential for three weeks. That's not going to be really helpful. So we need to make sure that there's continuity of care in these handoffs. Potential referral sources include marriage and family and mental health counselors, abuse and trauma counseling resources, and this includes your rape crisis center and those types of places. Primary care, women's health, nutritional referrals, holistic practitioners, pain Management, legal services, financial counseling. You know, some clients will need to declare bankruptcy or maybe they're going through a divorce and they need to figure out their finances, housing, career counseling and educational planning and religious, spiritual and faith support. And there are other things that will come up. I had a client recently who was trying to get out of a very violent domestic relationship and needed to come up with money for first last insecurity so she could leave and didn't know where to come up with that. So we called Information and Referral, United Way Information and Referral and found out some resources and you can also go online and find out some resources that would meet that client's particular need. So sometimes you got to be creative in trying to figure out where you can get the resources your client needs. Potential referral sources and this is refer out and get referrals from career counseling and educational planning. Make sure to have a relationship with your workforce development board. Religious, spiritual and faith support. A lot of churches not only provide faith based support, but they also have food pantries, clothing closets and other things. So you want to find out what's out there. LGBTQ support what kind of support groups are out there? 12 step meetings There are tons of different types of 12 step meetings from schizophrenics Anonymous to Alcoholics Anonymous. Their meetings are listed online. Know what's available in your area and their locations. Also know about Smart Recovery meetings and Celebrate Recovery meetings and any other type of support group meetings that are out there, including mental health support and grief support. Be aware of what your Veterans Administration offers in your area. You may have a VA hospital or you may not. So you need to know what kind of services are there for Veterans and who takes tricare. You need to be aware of child care resources not only for parents to have their kids in child care after school while they're working, but what resources are there so the parent doesn't have to bring the child to their counseling appointments or their doctor's appointments or whatever. And we also need to know what transportation options are out there to help people get to their appointments. Is there a Medicare van? Again, some churches will do transportation, especially for homebound elderly, that type of thing, to help them get to their doctor's appointments. So no. What services can be provided in your community? Potential reasons you may need to make a referral if your agency does not provide that service. If you don't provide transportation or child care or primary care, you need to know who does. The counselor may not be the best person to provide the service, such as you know, if the client is struggling with sexual identity issues, and that is not something that you have enough competence in where you feel like you can be ethical in treating that client, you may need to refer, you may be able to not refer and just consult. But you know, be aware that there are some issues that you just may not be trained in. If your, if your counselor has, or your client has PTSD and wants to try emdr. If you're not trained in emdr, obviously you can't do it. So you need to know who to refer to. If the counselor believes there might be a conflict of interest. So you know, and it happens in big towns and small towns where occasionally there's a conflict of interest and you may need to refer out or the counselor may recognize the need for a different level of care. So if the client, and when I say counselor here, it can be counselor or case manager. If the client is struggling at their current level of care to have a rich and meaningful life, they're struggling with their depression or their schizophrenia or their addiction, they may need a more intensive level. Likewise, if the client has been doing an intensive level and they're ready to step down, you may need to know what agencies are your step down options. The counselor or case manager should explain the rationale for any referrals to facilitate participation. Don't just hand your client a list of people to contact and go contact these people and they can help you. Let's talk about why. How is it related to the treatment plan and the assessment? Familiarize the client with the agency to quell any anxiety. So what is it like when you go in there? Who are you going to meet with? What can the client expect that first meeting? So they're not going, do I plan for three hours or 30 minutes or you know, what am I supposed to be doing? Contact the referral source in the client's presence. You know, this helps. And sometimes if the client can make the contact themselves, that's even better. But contact the referral source in the client's presence so the client knows you made the contact and they feel confident that that agency knows to expect them. Have the client schedule the actual appointment. So you may call pain management and say, you know, I've got this client, Sally Jo, who I'm going, who I'm referring over to you, she's going to call you this week to set up an appointment. And you know, ideally you have a contact person there where you can communicate with and get all the pertinent information to that person and then have Sally Jo, call and make, make his or her, well, her own appointment. Give the client the contact name and number and the agency address so they don't have to go on Google, they don't have to go to Yelp. They can just look at the card and go, okay, I'm supposed to call this person and set an appointment, document the referral and follow up with the client and the provider and put it in the client record. When you follow up, note that you made the referral on 11 2, you followed up on 119 with the client who said she had an appointment on 1114, and you followed up with the provider on 1114 or whatever. But you want to document the dates and times that you follow up with those people to demonstrate continuity of care. It doesn't have to be a super detailed note, but you do need the dates and times. Dual diagnosis or co occurring disorders indicates the presence of both mental health and addiction issues. People with co occurring issues often experience more severe emotional, social and physical problems than someone with only one issue. And it's important for everybody to remember that medical, mental health and addictive disorders all influence each other. So let's think about it. If somebody has, you know, a chronic illness that causes them pain, that could contribute to guilt, anxiety, frustration, depression, they may try to self medicate with addictive behaviors or addictive substances. So I mean there's the addiction and the mental health there. If they're engaging in addictive behaviors or using addictive substances, it can impact them medically, but it can also contribute to depression and anxiety. If they've got a mental health disorder like schizophrenia, they may not take care of themselves physically, so they may have some medical issues. And the medications they're on for the schizophrenia may need to be monitored to prevent any medical problems and they may be more likely to develop addictive disorders. So we do want to recognize that all of these things interact and when one thing gets exacerbated and it's probably going to make the other two worse. Use and withdrawal can cause both mood, social and physical conditions. So we need to pay attention whether you're, again, whether you're a counselor or a case manager. Disorders vary in terms of severity. It can be mild, you know, not a huge problem to severe, where the person needs to be hospitalized. It can be chronic like all the time, every day, or it can be sporadic episodes, you know, every six to nine months. Or it can be sporadic, like once a month this happens, or every weekend the person is binging. And disorders vary in terms of their disability and Degree of impairment in functioning. So some people can drink a fifth of alcohol and have a pretty severe alcohol problem, but they're still going to work, whereas other people are barely functioning. So we need to understand, you know, how severe is the problem, how much is it impairing the person's ability to function and what does the course look like? Are they using all the time, some of the time, or are they depressed all the time or intermittently? Because that's going to change the types of services that this person probably needs. Now, service planning is the word we use basically for treatment planning and case management. Service plans are designed with the provider to identify the treatment objectives, or treatment plans are designed with the provider to identify treatment objectives necessary to achieve goals. Service plans are umbrella documents which tie together all of the treatment plans from various providers. So you may have a mental health treatment plan, a substance abuse treatment plan, a pain management treatment plan, and a treatment plan for diabetes. So the service plan will tie all those together to make sure there's no conflicting goals. And the case manager will help the team define short term goals and objectives that help the person move forward in each area. The structure of the comprehensive service plan identifies long term goals. You know, we're going to identify what we hope this client will get out of being involved in case management. And all these services provide a current status, narrative, you know, your comprehensive assessment, whatever you want to call it, and then identify required services, supports and resources to help the client meet those long term goals, given their current status. Linking, monitoring and advocacy are those three things that a case management case manager does. And linkages goes beyond just providing a list of resources. Remember I said you're the human contact that connects those two people. So you need to make sure that you develop a network of known resources and contacts so you can basically help them shake hands. You know, you don't want to just say here's a list that's not a linkage. A linkage is actually connecting the client with a person. The foundation for successful implementation is based on interdisciplinary team planning effort. And this team includes the client. We're not just doing all these things behind the scenes and telling the client what to do next. We're involving the client in this process to decide their goals and priorities, to assign responsibilities for each goal, and to reach consensus in the overall approaches. So for example, you know, if you've got this team going, and for substance, the client is addicted to opiates and you've got a pain management physician on there and a mental health clinician on there, and not everybody is good with the methadone program. You know, we need to reach consensus in the overall approach for how we're going to address the pain as well as the opiate addiction. Service coordination encompasses administrative, clinical and evaluative activities that bring the client, treatment services, community agencies, and other resources together to focus on the needs identified in the recovery plan. So this service plan provides service coordination. Service coordination includes case management and collaboration with the client and significant others, coordination of treatment and referral services to address issues contributing to and caused by their addictive or mental health behaviors, liaison activities with community resources, you know, going out, touching base every six months, and ongoing evaluation of treatment progress and client needs. So that's the case management part. Client advocacy is another part in service coordination where sometimes case managers have to advocate with one agency or the other to make sure that service plan comes to fruition. Tasks of service coordination include initiating and collaborating with referral sources, providing a warm referral. And what that means is you're not just calling up and saying, Jim Bob will be at your facility on Tuesday, you're calling up the agency and saying, I've got this client, his name's Jim Bob. He's got these presenting issues. 36 year old white male, yada yada, yada. So when Jim Bob arrives, they have the basic information they need to get him started instead of having to start from jump. In service coordination, you also obtain, review and interpret all relevant screening, assessment and treatment planning information. So it's important for case managers to understand the lingo and the basic issues from a bunch of different disciplines. So you may have to, in that team meeting, have a session where each provider is explaining exactly what they need to have happen. You want to confirm client eligibility for admission and continued readiness for change. No sense sending them somewhere if they're not motivated to do anything. Complete necessary administrative procedures for admission and coordinate all treatment activities with services provided to the client by other resources. So again, if the client is going to pain management and then has to go for an mri, you want to make sure that you're helping to coordinate all those treatment activities. You also want to establish realistic recovery expectations, including the nature of services. Be very upfront. This is that informed consent. What kind of services are you going into? What are the program goals, what are the program procedures, the schedule, you know, when does it meet, what services are offered, what are the rules regarding client contact, the client rights and responsibilities, the schedule of treatment activities, the costs of treatment, this is very important to tell them up front, and facts that impact the Duration of treatment. So, you know, Maybe it's a 28 day program, but what might constitute an extension or what might get the client to be discharged sooner so they're aware of what they're walking into. Types of services that are going to be coordinated, physical health, physical or mental health. Physical health, including any issues related to liver function, hepatitis, brain functioning, HIV, tuberculosis, STDs. Any of that needs to be addressed. Job skills, employment opportunities, interpersonal skills like communication, training and education needs, legal services, housing services, food. Remember Maslow, you got to have that bottom level before you can focus on anything else. So food, childcare and transportation service coordination is essential to prevent clients from falling through the cracks and foster a more holistic view of the client. It's not just a person with an addiction. So you may be in a team meeting and somebody's complaining that the client was a no show because they couldn't find a sitter and you know that they were being non compliant, they should have found a sitter ahead of time and had a backup plan and yada, yada, yada. Well, there are two ways to look at it. You can look at it as non compliance or you can look at it as the person being a responsible parent. They had a sitter and the sitter backed out at the last minute or they weren't able to find a sitter and they knew they couldn't leave the kid home alone. You know, there are two ways to look at it. So we want to foster a holistic view of the client and recognize that they've got multiple demands. They're probably an employee. They're probably, you know, they could be a parent. They, you know, they may have a lot of different roles when something happens. When a client does something that we don't like, you know, just for lack of a better word, we need to step back and go. What was the function of that behavior? Why did that client choose that behavior as being more important or more rewarding than what I wanted him to do? And in this case, maybe the person truly needed to take care of their kid. We also need to look at if it's habitual no shows. We need to look at other reasons why this client may be no showing for that service. It could be poor rapport and engagement. There's a lot of reasons, but we do need to step back and go. The client is doing the best they can with the tools they have at this point in time. So why did they make this choice? Why was this current choice more rewarding than what I wanted them to do. Challenges in service coordination. A lot of agencies use different assessment tools. I know the assessment tool we used was created by our chief operating officer, so nobody else used it. And so when people went to different agencies, they had to go through the same basic information with each provider over and over and over again. We couldn't just send them a packet and they copy it. So these different assessment tools produce a fragmented picture of the client unless these different tools are integrated, which ideally the case manager can do. But it's better if you just have a uniform assessment that everybody uses for general intake. And, you know, this obviously creates frustration for the client if they're like, didn't I just answer these questions with that provider over there? Other challenges include agreeing which agency or clinician is lead or the primary contact for the client and other agencies. The lead agency uses a holistic assessment that meets the needs of all associated agencies when possible. So if you are the lead agency and you're doing this assessment, you need to make sure that you're asking the questions that the mental health provider needs asked and that the medical provider needs asked, etc. Other challenges include funding and eligibility barriers, such as there are a lot of places that won't provide services to people with a felony, difficult to treat clients, and differing staff credentials. Challenges to collaboration and service coordination can occur at three levels. One is personal, so attitudes and attributes of the people working there toward the clients that you're referring professional differing theoretical beliefs or approaches to treatment, addiction and mental health issues, and the use of jargon. So, you know, professionally you may. A physician may see treatment of addiction very differently than a addictions counselor, who also may see treatment of addiction very differently than a mental health counselor or a social worker. So we need to understand our professional attitudinal differences or our professional worldview. And organizational challenges could include not recognizing the need for a partnership. Just saying, you know, we don't need the. This formal stuff, just call us. A lot of times you do need a formal partnership. A lack of a shared mission, lack of ownership by senior management, lack of trust between agencies. If you've worked in an agency, you know, this exists a lot of times because we're competing for the same dollars, Unclear guidelines for collaboration, and a lack of a process for monitoring and managing collaborative processes. So you have, you know, an informal agreement because there wasn't a recognized need for a partnership, Senior management's really divorced from it, and a couple of referrals go south, and then there starts to be hard feelings on in both agencies, which leads to a breakdown in the system because there was no monitoring, no collaboration, and no leadership involvement. Alrighty, like I said before, this concludes our series for the Addiction Counselor Exam review. In depth podcasts and videos of all the topics we reviewed can be found on our YouTube channel@allce.com YouTube or as episodes in the Counselor Toolbox podcast. If there are areas you would like additional information on and please, I'm encouraging you, please do please send a Support ticket to supportlce.com or note it in the comments below. And I will create future podcasts for this series based on viewer questions. Alrighty everybody, have a great day.