23  Case Management | Addiction Counselor Exam Review

23 Case Management | Addiction Counselor Exam Review

Welcome to the addiction counselor exam
review. This presentation is part of the addiction counselor certification
training. Go to https//www.ALLCEUs.com/certificate – tracks/ to learn more about
our specialty certificates starting at 149 dollars. 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 gonna have case managers so you need need to know how to
do case management because it just it has to be done we’re gonna identify the
different approaches to case management will identify the case managers role in
service coordination will 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 the linkage we’re gonna 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 will 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 then maybe the psychiatrist or the primary care physician so it’s
really important for the case manager to be alert 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 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 and 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 mo use which specify available slots so for
example the detox unit that I used to run we had 16 beds but we always had 4
slots for adolescents so you know we knew that we had to make sure that we
could accommodate at any particular time up to 4 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 4 beds and those 4 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 getting stopped getting referrals from
them they may stop taking referrals from you you know it could close a door on to
it 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 refer 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 gonna 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 gonna follow up with the
referral source to say you know did Sean Don show that did John show up on time
was this an appropriate referral was this useful yada yada
because I don’t want to send them in appropriate referrals so I want to make
sure that both the referral source and the client are happy we 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 Gordon 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 cup agencies we knew that if a client had to
interact with them it was going to be a big headache so it wasn’t 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 and that’s what we’re doing we’re
kind of brokering out sometimes the core agency that’s providing the case
management make 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 ok 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 ok so 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 you know their
family or immediate supports so we can make sure that those people are getting
their needs met because caregivers have needs to 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 a 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 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 kaboodle 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 clients 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 anticipate ori based on the natural
course of the clients presenting issues so if you know that you’re working with
a client who it has bipolar disorder you know isn’t 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 managers 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
Linc 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 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 non-judgmental 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
recent 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 Maslow V&E
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 lot
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 clients 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 not 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 in appropriate
referrals may lead to drop out 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 waitlist
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 followup 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 and 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 agencies like so you know what you’re sending your client to and also
semi-annually after that and you may be laughing going here 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 our service is still available have you added any
programs and remind them of your program and make sure they’re still good to go
potential problems and 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 twenty three or twenty three-year-old male
client so we need to make sure that 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
they’re 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 sources like I’ve never heard of you before you know or they try
to 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 you know 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 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 in 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 and security 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 clients 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 referrals from career counseling and educational planning make
sure to be 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 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 schizophrenic synonymous 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 know 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 childcare 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 confidence 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 you know your
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 err 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 is has been
doing an intensive level and they’re ready to step down you may need 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 gonna
meet with what can i 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
clients 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
clients present so the client knows you made the contact and they feel confident
that that agency knows to expect them have the clients 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 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 followup
note that you made the referral 11:2 you followed up on eleven nine with
the client who said she had an appointment on eleven fourteen and you
followed up with a provider on eleven fourteen 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 in 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 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 it’s probably going to
make the other two worse use and withdrawal can both 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 too severe where the person
needs to be hospitalized it can be chronic like all the time every day
or it can be sporadic episodes every six to nine months or it can be a
sporadic like every once a month this happens for 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 but 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 a methadone program you know we need to reach consensus and 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 an
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
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 your court 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 set 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 upfront 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
mental health physical health including you know 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 you know 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 back-up 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 you know truly needed to take care of their
kid we also need to look at you know if it’s habitual no-shows we need to look
at other reasons why this client may be no showing for that service and 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
and over again we couldn’t just send them a packet and they copy it so these
different assessment tools produced 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 often 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 are
approaches to treatment of 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 all this formal stuff just call us no 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
from 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 all righty 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 at
all CEUs comm slash 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 support
at all CEUs comm 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 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 formats online multimedia self-study self-study
+ live webinars or 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 at all CEUs dot-com go to all CEUs dot-com / a sir that’s all CEUs
dot-com / AC er to learn more



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