Intake and Orientation | Addiction Counselor Exam Review

Hey everybody and welcome to the addiction counselor exam review. Today we're going to be talking about intake and orientation. Now this doesn't sound like a lot of fun, but this is where you really start beginning to develop rapport and engagement with your clients. So this is one of the most important parts of treatment and in order to do it well, there are some things you got to remember. So the first part is screening and assessment. In order to get somebody into your facility, they need to first generally be screened. And if a screening determines that there's potentially a problem, then they go for a more in depth assessment. So during the screening and assessment process, you want to demonstrate verbal and nonverbal skills to establish rapport and promote engagement. So what does that mean? That means don't be looking at your notebook all the time. Look, look up. Treat the person like a person. Establish rapport. Let them know that you actually care about them and their welfare and you want to do what's in their best interest. They're not just your 4 o'. Clock. Discuss with the clients the rationale, purpose and procedures associated with screening and assessment. Before you start asking questions, you're asking them to be vulnerable. Before you start asking questions, let them know why you're asking, how, how this information is going to be used and what this process is going to be like. If you're going to be asking really sensitive questions or if you're just going to be asking a few general questions and you'll be done in five minutes. Assess the client's immediate needs, including detoxification. You can get a pretty good idea from just looking at the client's non verbals whether they need detox, but you want to assess their immediate needs. This can include housing, this can include food, this can include medical care. I've had clients come in with a variety of different needs and it's important that we identify those when we're doing the screening so we can make appropriate referrals. Administer evidence based screening and assessment instruments to determine the client's strengths and needs. You want to use something that's pretty standardized. Now a lot of your assessment instruments are semi structured interviews. So they give you questions but you have room to expand. You know, if the client says, oh yes, I was abused as a child, you know, you can explore that a little bit. You don't want to explore too much in the assessment because you may re traumatize the client, but you want to use tools that are, like I said, standardized. So you're using the same thing with each client and they Produce effective information. You don't want to just walk in with a notebook and go, all right, let's chat for a while. Obtain relevant history to establish eligibility and appropriateness of services. So you need to know things. Where I came from in Florida, if somebody was pregnant, if they had small children at home, if they were a needle user, if they were HIV positive, they got priority for admission based on state guidelines for state funding. So those were things that were important to gather when trying to identify appropriateness of services. If I'm talking to the person and establishing a history and I learned that they've got three small children at home and no family to rely on to speak of, residential may not be the most appropriate recommendation for them. So it's important to understand the person and to individualize their treatment recommendations. Screen for physical needs, medical conditions and co occurring mental health issues. If you're in a substance abuse facility, I will tell you the chances are really dagum good that the person is also going to have some co occurring depression or anxiety if they have started to get sober, if they realize that they need to make a change. They're in a period of mini crisis right now, which brings with it some depression and anxiety. Does it mean they've got recurrent major depressive disorder? Not necessarily. But if they are experiencing depressive symptoms right now, we need to help them address those things because they ain't going to stay clean and sober very long if they are hurting that much. We need to help them make sure they can address all of their presenting issues, interpret results of screening and assessment, and integrate the information to formulate a diagnostic impression and determine the appropriate course of action. So when you get to that last page of the intake, that is your diagnostic impression or whatever it's called your cumulative assessment, it's called different things in different places. Don't just spit out the same stuff that's already in the file. This is the time when you weave it all together and you say, you know, this is the patient. These are the strengths she has, these are the issues that she's got presenting, these are her diagnoses as evidenced by and this is the recommended course of action because we want to have all that in there. It's a summary of everything that you've learned and why you're making the recommendations you're making during the intake. The intake is just the process of enrolling a client in a specific course of treatment. A series of activities is completed that's designed to organize information about the client and their significant others. Most, most insurance Companies require the involvement of family. However, the patient defines family. And in reality, recovery is going to be much more successful if the person has significant others involved that can help them in the process. Intake also ensures eligibility for services, completes basic data collection, identifies barriers and assets. So what might be some barriers? If you're talking about any form of outpatient or intensive outpatient treatment, transportation can be a barrier. Their job can be a barrier. If you're working with somebody who has shifts that change on a week to week basis, that can be a barrier to getting to treatment. Or if you have someone who works day shift Monday through Friday and Your program is 9am to noon Monday through Friday, that's a barrier to treatment. So we want to identify those barriers and figure out workarounds. Another big barrier is often children. If the person is responsible for children in the home, then they may need childcare or, you know, they may not be able to get there because they can't afford child care. You know, we need to look at all these things. We also want to look at their assets, though. What do they have going for them? Who do they have that's supportive? Do they have transportation? Do they have a job? Do they have the desire to get better? Do they have some knowledge about what's going on? What are these assets they have that we can build on to help them towards their recovery journey? Then the final part of the intake is establishing a treatment approach. You don't do this on your own. You do this with the client. You say, okay, we've gone through this and we've done this scoring sheet called the asam. And you know, this is what my recommendations are and this is why. What do you think? And this is where we get an idea about where the client is in terms of readiness for change. And hopefully you've been listening through the intake to identify if they're in Pre contemplation preparation, etc. But this final step is, you know, kind of what seals the deal when you make your recommendations and the person either says, yes, I'm on board, or nah, not yet, or I don't have a problem. I don't know why you're making those recommendations. So those are some different reactions you can get, but this is when we're figuring out what the recommended course of treatment is. Intake is primarily administrative in nature. You're not going to do counseling during this. You may have a few moments where you have to pause and do a little bit of counseling. But this is not a counseling counseling session. And I tell clients that from the very beginning, we've got to get some paperwork out of the way. And I really hate feeling like I'm interrogating you, but in order to get you enrolled in the program, we need to do that. So intake is not the time when you want to go into depth into traumas or in depth into anything else that's going on. The only real exception to this is if you learn they have suicidal ideation, homicidal ideation, or, or they are in danger, like in a domestically violent relationship, then you will probably need to put that other stuff aside and focus on the safety and well being of your client. Intakes do need to be standardized that way there's no accusation that one person got admitted over another person because of biases. If everybody's asked the same questions and you use the ASAM on everybody and yada yada, then you can present the data and say these are the objective reasons why this person was admitted and this person got put on a waiting list. Intake is an extension of the screening and assessment process and can be used to engage the client in treatment and enhance motivation for change. This is when we start talking and presenting our assessment of what's going on, what we see happening with the client and getting the client to clarify for us. We start putting the ball in their court, going, you know, I'm not going to force you to do anything. And I tell my clients that from the very beginning when they come in. This is an intake. I'm going to make recommendations, but we're going to decide together what the best course of action is for you. So I'm not going to force you to do anything. You know, assuming that I can say that orientation is the next step and it can be conducted in individual, family or group settings and is completed after the intake. After you've decided this person is coming to the program, then we need to orient them to describes the schedule, the goals and the rules and responsibilities for treatment, the hours of service, what to do about medication, what the policies are with drug testing, treatment costs and client rights. So these are all things that need to be covered. And it's recommended strongly that this be all these things be part of a written informed consent that is gone over with the client. Not all clients read very well and is initialed and signed by the client. Now in Florida, and I use Florida statutes because that's where I came from, you want to look in your state of origin to find out information about client rights. But in Florida, the client rights statute is 381.026. And it says that clients have the right to individual dignity, confidentiality, non discriminatory services. And that means that we cannot discriminate against them based on age, race, gender, sexual orientation or disability. We can't discriminate against them based on prior service departures. So if they've left AMA before, we can't hold that against them. We can't hold it against them if they've had multiple relapses or no relapses. We can't hold it against them if they're on certain psychotropics that are prescribed by a physician. And we can't hold it against them if they don't have the ability to pay. Now that's for public agencies that are receiving state funding. But all of these have to be taken into consideration. And Florida thinks it's so important that they've made it part of the law. Clients have a right to quality services. So we're not just going to stick them in a room and say, good luck, we're going to provide high quality services. They have the right to communication. Now in the beginning, with informed consent. And informed consent is so important, communication can be limited. Sometimes people need a week or so break from the people in the outside world, especially in residential. So their mail and their phone calls may be limited for a period of time, but that has to be part of the orientation and the informed consent. You can't just get somebody in there and go, oh, by the way, you don't get to communicate with the outside world for the next month. That doesn't work. They have the right to personal effects, unless those personal effects would infringe upon the right of another patient or is medically or programmatically contraindicated for documented medical safety or programmatic reasons. So personal effects that might fall into this may include certain perfumes. You know, there are a lot of people who are sensitive to perfumes now. So there are a lot of treatment programs that have said you can't have perfume. You know, a picture of your kid is not going to infringe upon the right of anyone else. Guitars, musical instruments, you know, those are generally allowed because they're generally not going to infringe upon the right of any other patients. And it can make your patient feel more secure. Personal effects may be temporarily held by the agency but must be returned at the end of treatment. So sometimes when people check in, we collect their cell phones and some of their higher ticket items like musical instruments, and we keep them safe. And if the client wants to access them, they have to Check them out. Minors have the right to be educated. Actually, they have to be educated. So schooling needs to be provided during a certain number of hours of the day. Clients do have the right to counsel, especially if there are involuntary proceedings. If they're being committed against their will, they have a right to counsel and they have a right to what's called habeas corpus. That means they have a right to see the entire intake and all of the evidence of what is being alleged so they can defend themselves and they can say, you know what? No, I don't deserve to be here. I don't need to be here. Specifically, in Florida, patients have the right to a prompt and reasonable response to a question or request. Now, this comes up a lot in treatment, not just residential, but in outpatient and iop. So you want to make sure that if a client asks you a question, you get back with them in a prompt manner. You don't say, I'll get to it, or I'll find out later and then not get back to them. Give them a date and time. I'll find out for you by tomorrow when you come into treatment, or I'll find out for you this week and I'll give you a call on Monday. Let them know when you're going to call them back. A patient receiving care in a healthcare facility or in a provider's office has the right to bring any person of his or her choosing to the patient. Accessible areas of the healthcare facility or provider's office to accompany the patient while the patient is receiving inpatient or outpatient treatment or is consulting with his or her healthcare provider unless doing so would risk the safety or health of the patient, other patients or staff of the facility. So that's a little bit wonky, especially in residential, because you can't decide that, oh, I want to have my significant other with me throughout treatment. But what it's saying is when you're having your individual sessions, for example, if you want your significant other to come, then the client has the right to have their significant other there. If they want to have their pastor come and be part of their treatment, then they have the right to have their pastor come, unless doing so would risk the safety or health of the patient. Now, you have to remember, especially in substance abuse facilities, you also have the standard of CFR 42. So we need to make sure we're protecting confidentiality. So a lot of times the non patients are not allowed back into the patient wing. They have to stay in the area of the therapeutic offices, the lobby, that sort of thing. A patient has the right to refuse treatment and the right to express grievances to a healthcare provider, a health care facility or the appropriate state licensing agency regarding alleged violations of patients rights. And I will tell you it will happen. If something happens and patients get angry, they will file grievances and they may even call their ombudsman or even call the state Department of Children and Families. It happens. It doesn't necessarily mean you did anything wrong overtly. You know, probably there was a better way to handle the situation, but it doesn't necessarily mean you did anything wrong. One of the best ways to head this off is to always make sure that when clients ask a question or when you give a directive, you give a reason for it. I need you to do this because or we're going to make this happen because so clients understand what's going on and they don't feel like you're just saying because I said so. Because I can make you dance like a puppet if I want to. You want clients to feel like they're empowered in their own treatment. If you do that, 80% of the time you will head off grievances. They may not be happy with you, but they're probably not going to call Department of Children and families. The other 20% of the time it may be unavoidable because that client may have enough other stuff going on with them that they feel a need to try to assert control and control their own treatment, even if it's not in the best interest of their treatment program. A patient has the right to know the name, function and qualifications of each healthcare provider who's providing medical services to the patient. The patient may request such information from his or her responsible provider or the healthcare facility in which he or she is receiving medical services. So patients have the right to know the name of everybody who's seeing their information and working with them. Everybody from the techs all the way up to the CEO of the agency. If they want to know who those people are, that's their right. They have the right to know what patient support services are available in the facility. Do you have HIV counseling available? Do you have nursing staff available? Do you have a recreational therapist available? Do you have child care available? You know what types of services are are available that they can take advantage of. They have the right to be given information concerning their diagnosis, planned course of treatment, alternatives, risks and prognosis. Unless medically inadvisable or impossible to give this information to the patient. It's rare that it's inadvisable or impossible to give this information to the patient. So what we want to make sure is that we're telling the client what's going to happen. You know, if you're enrolling them in a methadone program, what does that look like? What are their responsibilities going to be? What types of treatment will they be exposed to? You know, so they can make an informed choice about yes, that's okay or no. You know, some clients are not okay with hypnosis, for example. So if your program does that, they may go, yeah, not. We had a program at the residential facility that I worked at where we had acupuncturists come in that would work with the clients. And acupuncture is a evidence based practice for addiction. And not all clients were okay with acupuncture and that was okay. They had the right to refuse that type of treatment, but we needed to let them know. This is why we're bringing these people in. This is why we think it's a good activity for you. These are the risks. This is what we think you'll get out of it. Let them make the choice. Healthcare providers shall respect patients legal right to own or possess a firearm and should refrain from unnecessarily harassing a patient about firearm ownership during an examination. Okay, so this usually comes up if the patient is expressing any sort of suicidal or homicidal ideation. But if you're talking to a patient and they say that they're an avid hunter, that doesn't mean they're a danger to themselves. So it's important to respect their legal right to own a gun. And then, you know, you need to consider if they're suicidal or homicidal, what steps need to be taken in order to make sure that they're safe. But remember, you know, just because somebody has a gun in the house doesn't mean they'll use it. And just because somebody doesn't have a gun in the house doesn't mean they're safe. They have butcher knives in the house, they have rope and belts in the house. There are ways they can kill themselves. So it's more important to focus on their state of mind and their personal safety than on specifically what implements are there. Recovery management focus collaboration between traditional and non traditional service providers and clients with the goal of stabilizing and actively managing the ebb and flow of symptoms and sort of the recovery management mantra. That means we're going to have clients come in and it's going to be episodic. You know, they'll come in for, maybe for residential, and then they'll step down to IOP and then they'll step down to outpatient. And then maybe something happens and they need to come back to outpatient and then they'll discharge to their physician for a while who manages their medications, and then maybe they need to come back into outpatient for a little while. So there's going to be an ebb and flow of symptoms as life happens. But recovery management means we all talk together and figure out what's going on with the client and we maintain continuity of care so the person can get back into the system easily and can manage their recovery. So they're not, you know, once they're discharged, you don't want them to have to wait eight weeks on a waiting list before they can get back in. Recovery goals are more than treatment goals. Recovery goals seek to reduce and eliminate symptoms instead of just stabilize the person. So stabilization is the old way. The new way is to reduce and eliminate symptoms and help clients learn how to manage them. The old way was to meet established outcomes. The new way with the recovery management focus is to improve wellness and health. We want to really help this person thrive and grow. And the recovery management focus helps the client rejoin and rebuild life in the community. Instead of just reducing vulnerabilities and increasing resilience, we want them to get out there and get involved and be productive and as productive as they want to be and integrated as they want to be into that community. So recovery management has multiple components of recovery. Number one is abstinence and symptom reduction. Number two is improved psychological and physical health. And number three is improved relationships. We want to help them develop that support system so they feel like they're loved and they're cared for and they've got somebody to lean on when life hands them lemons. Recovery is a process of change through which an individual achieves abstinence as well as improved health, wellness and quality of life. It's long term and wellness centered, not disease centered. Wellness centered. We're not going to focus on stopping alcohol. We're going to focus on becoming the person you want to be. We which probably means stopping alcohol, but it's a positive thing we're looking at. It involves ongoing growth and self discovery and creation of a new identity. Who am I? What do I want to be? Where do I want to be six months from now? In order to help people do this, we have to provide them relapse prevention education so they don't end up back here as quickly. They may end up, back, they may have a relapse, their symptoms may resurge at some point, and that's okay, we can get them back into the system, but we want to help them prevent as many relapses as possible. We want to make sure they have access to medications and other treatments necessary to maintain their wellness and continue their growth process. We want to make sure they can connect with mutual self help so they've got a foundation from which they can grow. Encourage exercise and nutrition and proper activities of daily living to prevent vulnerabilities, to help them be as healthy and happy as they possibly can be. Encourage spiritual practices and affiliations in clients that are embracing of that in order to help them develop a sense of authenticity with themselves and connection with other people. Help them find supported community activities that they can engage in so they feel a connection with. When people feel like they're isolated, like nobody cares, like nobody would notice if they dropped off the face of the earth, then they're more likely to have a resurgence of symptoms. When they feel connected to the community, when they feel like they've got a purpose, then they are more likely to stay on that wellness and growth path. Help them access homeopathic and naturopathic remedies if that's what they choose. So know where your resources are for aromatherapy, for acupuncture, for naturopaths in your community. And consider helping them connect with cultural healers if they believe that would help them in their recovery process. As counselors, we help clients formulate recovery goals. And a lot of times clients are coming from that old way of thinking where they're trying to get rid of something, they're trying to stop being an alcoholic, they're trying to get rid of their depression. So we're going to help them formulate their recovery goals in terms of what do you want? Where are we going? What's our destination? Let's not worry about where we've been. Let's look at what is our destination. We'll help them identify objectives to meet those goals. Facilitate linkages to support services to help them achieve their goals. We'll help them establish measures to mark progress. Those are those little goals, those little achievements that they'll do so they can see that, yeah, I'm moving along. We will monitor their progress in order to make sure they're continuing to move forward. And we want to monitor their motivation to make sure that they're not waning in their motivation. Pull out some motivational enhancement exercises. If clients start kind of faltering a little bit we provide support and encouragement because not every day is going to be a good day and we want to help them embrace that and see their strength and their ability to get through the rough times as well as to revel in the good times and help them create emergency relapse prevention plans. So when they are triggered for some reason, they have something written down and handy that they can access to prevent them from making an impulsive decision. Peer recovery support links professional treatment with natural support networks in a structured way to maximize the likelihood of long term success. Peer based recovery support provides non professional and non clinical assistance by people who are experientially credentialed. Now a lot of states, state of Florida included, actually has a certification process for peer support people. So it is more of a professional position than it used to be. So peer recovery in Florida you can get certified as a peer recovery specialist that can give you a little bit of knowledge to help take your personal knowledge and help others with it. Peer recovery services may be offered while a patient awaits entry into treatment, during treatment to provide a connection to the community and after treatment to assist the person in managing recovery. So this can be a great step down person. It's a step down from the clinician to the peer recovery support person. So common pathways to recovery. If the person is in the community using, then they may end up in the recovery process. If they're in the community and not using, but they're having trouble staying clean and sober, they may come into treatment. If they're incarcerated, they may seek out treatment. And if they're in treatment, obviously there's a part of them that may want to recover. So we need to meet each client where they are and address the needs that they have at that particular point in time. Now people can seek recovery from any of these different stages via self help, peer support or formal treatment. And ideally when we get them into a recovery oriented system of care, they're going to have access to all of this self help, peer support and formal treatment. So 12 principles of recovery that you need to remember. There are many pathways to recovery. Not everybody's going to do it the same way. Some people will go to a methadone clinic, some people will start out with mental health treatment. Some people will embrace the 12 steps, some people won't. It doesn't mean that they're not going to recover. Everybody has a different path that they're going to take. Recovery is self directed and empowering. We want people to help. We want to help people feel like they're Growing and they're moving and they're doing positive things for themselves. We don't want them to feel like we're doing it to them. We want them to feel agency and ownership in what happens. Recovery involves personal recognition of the need for change. We cannot force anyone to change, so they have to recognize the need for change. Recovery is holistic. Yes, we can help them stop using and you know, get the alcohol out or whatever. But recovery involves helping them feel better emotionally, help them change their stinking thinking patterns and silence that internal critic that's telling them that they're always going to be a screw up. Recovery is physical. It helps their brain rebalance the neurotransmitter so they can feel happy again and they can see colors and, and feel excitement. It helps their body get healthy again so they have energy and they're not feeling sick and in pain all the time. Recovery is social because it helps them develop healthy support systems. Recovery is an environmental because it helps them arrange their environment to be self promoting and self growing instead of self defeating. So we want to get out the stuff in the environment that could be potentially toxic or harmful. Recovery has cultural dimensions, so we need to be sensitive to that. Recovery exists on a continuum of improved health and wellness. So when people first come into treatment, they come into detox. For example, when they move over to the treatment wing, they are detoxed. That is part of the continuum. After 30 days, their brain, the fog is starting to lift. They're moving along the continuum. After 90 days, they're starting to get their energy back and their mood is starting to stabilize a little bit and they're maybe having more energy to maybe not exercise yet, but to do some activities. So they're moving further along the continuum. But each step along the way is a step toward improved health and wellness. Recovery emerges from hope and gratitude. If people don't have hope, they're not going to recover. They need to see that there is a light at the end of the tunnel. Recovery involves a process of healing and redefinition. The person has to forgive themselves for things they've done. They have to grieve the losses they've experienced. They have to address any depression or anger they have. They have to heal their body while they heal their mind and, and they have to redefine themselves because a lot of times when people come into treatment, they feel really bad about themselves and they have very not nice adjectives to use to describe themselves. We want to change that description in their recovery. Recovery involves addressing discrimination and transcending shame and stigma to help them feel empowered to make changes in their life. Recovery is supported by peers and allies and involves rejoining and rebuilding a life in the community. So we need to make sure that our community is welcoming to people and supportive of people in recovery. And finally, recovery is a reality. It's not a myth that exists. People can find recovery. People can deal with their substance abuse issues, their addictive behaviors, their mood issues, and live a happy, healthy, meaningful life. So formal treatment begins with the development of an individualized treatment plan with the client. Treatment plans are continually updated and reassessed to address developing treatment needs and match them with community resources. That's that whole recovery approach that we were talking about. Counselors communicate client needs to referral sources to ensure a smooth transition and engage in follow up and advocacy. So we want to kind of be there behind the scenes, empowering clients to go connect with these referral sources, do what needs to be done. But we want to make sure that we're following up and ensuring that the connection happened and it went okay. And if not, then we can try to facilitate improving that connection. The counselor must document treatment progress, outcomes, continuing care plans, and use multiple pathways of recovery. So it's not just one way. We need to be open to the fact that people recover in different ways. So if they want to use a cultural healer, if they want to use naturopathic approaches, if they want to use medication assisted therapy, that that's okay. You know, we need to be open to each person's individuality. So that was your sort of brief review on the intake and orientation process. A lot of that stuff is sort of mundane, but it's really important for you to remember for your addiction counselor exam. So please feel free to review it. If you're listening to this as a podcast, the video is on our YouTube channel@YouTube.com allceducation that's a L L C E U S Education. All of us at all ceus wish you great success on your exam. Once you're certified or licensed, please remember to visit all CEUs for all of your continuing education needs. We offer unlimited CEUs for $59 for addiction and mental health counselors, social workers, and marriage and family therapists. If you're still thinking about becoming an addiction counselor, all CEUs offers the training you need in three different formats. You can choose online multimedia, self study, self study plus live webinars, or even face to face weekend intensives, which meet one weekend per month for 12 months. We can even present a training series at your facility. Just email support@allce.com to schedule it. To learn more, you can also visit allce. Com Acer. That's allce. Com Acer. Thank you.