Enjoy viewing some of the animals who have been rescued with the help of AllCEUs!
Substance Abuse Counselor, Addictions Counselor, Mental Health Counselor, potato, potAto, what what does it all mean?
The department of labor indicates that the need for counselors and, specifically addictions counselors, will continue to increase at a significantly higher pace than many other professions; however, looking at jobs, it seems that a lot of agencies are seeking counselors that are co-occurring competent. (Oh goody, another term) About 15 years ago, the medical and mental health community began to realize that 1) Not all addictions are chemical, and 2) the majority of people have both a mental health issue and an addiction issue to some degree. That gave rise to the development of certifications by IC & RC and states like Connecticut for persons who were competent in treating co-occurring disorders. That is, who understand the emotional, cognitive, social and physiological interaction between mental health issues and addictive behaviors (alcoholism, drug abuse, eating disorders, sexual addictions etc). After working in community mental health for nearly 15 years, I can tell you that people who are licensed mental health counselors, social workers or marriage and family therapists AND certified as addictions counselors are in much higher demand. This is because they have a broad array of knowledge making them very flexible, and they can supervise services provided to Medicaid clients (big money).
Don’t despair. There are a lot of very talented people who would love to be counselors, but do not have the time or desire to endure three years of graduate school and a two year internship. Thankfully, many states have certifications for addictions counselors that do not require years of graduate school. By getting a certification as a substance abuse counselor first, many people are able to “climb the ladder” at their agency, especially if they seek additional training in mental health counseling. The Florida Certification Board for example has a certification for Mental Health Technicians as well as for Addictions Counselors. Additionally, they have caveats for people who only have a bachelors that enable them to achieve the highest level of addictions certification, the CAP.
The majority of states will also allow people to get their training for addictions certification online. Ensure that the online continuing education provider is accepted in your state though. This usually means they are approved by NAADAC (like AllCEUs is) or are specifically approved by your state (California, Connecticut. and Georgia Certification Boards for example have their own approval process).
To get yourself started, you cal look on our approvals page to find links to the various agencies. You can also Google: Addictions Counselor Certification Board and the name of your state. For example: Addictions Counselor Certification Board Virginia will bring up Virginia’s Department of Health Professions who handles the addictions certification and licensing. From there you can review the process for becoming a certified addictions counselor or mental health technician in your state.
Appropriate responses to the needs of returning veterans will include: • A strength- and recovery-based focus • An empowering, skill-training approach • Careful, individualized, respectful, veteran-specific assessment and treatment planning • A primary emphasis on stabilization and development of internal and external resources • Education for veterans and families on the physical, cognitive and emotional aspects of trauma and substance use disorders • Assertive linkage to ongoing support within the community—and in the larger military and veteran community nationwide Effective responses to the needs of veterans with post-employment stress effects include a consistent approach that integrates trauma-informed addictions and mental health care, but what does that mean? It means that when treating a veteran for mental and/or substance use issues the clinician must realize that the traumas experienced have changed how the person feels, reacts and perceives the world. These changes are normal reactions to abnormal events. Unfortunately, they often persist even when the danger is past. This is the mind’s way of making sure the body survives. In order to help consumers to regain a sense of balance, we must create an environment of safety, trustworthiness, choice, collaboration and empowerment.
Safety means ensuring physical and emotional safety not only in the treatment session, but also in veterans’ daily lives. Even Abraham Maslow believed that safety helped form the foundation of mental health and wellness. When people do not feel safe, they are on guard, and they cannot rest well which negatively impacts their health, mood and relationships which could be supportive. So the next question I am often asked, is “What do they need protection from?” They need places where they are not subject to judgement or evaluation, and are not concerned they will have to defend their actions or the actions of the military in general. If they have been deployed for a while, they need a community that can help them feel less like a stranger in a strange world. They need places where people understand what they are going through, who have survived the nightmares, the insomnia and the feeling of utter isolation, not knowing who they can trust. They need to learn the skills to deal with the flashbacks and the nightmares, and to relaxs at the end of the day.
Trustworthiness is developed in the process of creating safety by maintaining clear, appropriate, consistent boundaries and objectives. Many people—veterans included—will not tell you everything until they believe you are trustworthy. Those things that haunt them at 2am are not things they are going to tell just anybody. Throughout the process that led to the PTSD–whether it be one single incident or years of traumas—the person regularly was stripped of their control, second guessed for every move and, often questioned on their decisions. Trauma informed treatment not only relies on consumers learning to trust their therapists, but also on them learning to trust themselves. Failure to keep promises reinforces the notion that the world is an unpredictable, terrifying place. Failure to help consumers see the logic in what they did, or are doing, reinforces the notion that their behavior is unpredictable and they are out of control. Remember to ask yourself what the benefit is to any behavor. Our brains are programmed to survive. How is the behavior helping the person survive. Substance abuse numbs pain and helps people survive until they develop alternate skills. Fear reactions/fleeing protect the person from imminent danger. Explosive anger can neutralize a perceived threat.
Choice means allowing consumers to prioritize what issues will be dealt with, when and to what extent. The caveat to this merges with collaboration. While it is certainly advised to maximize consumer input and control, there are some things which may need to be negotiated. When consumers are putting themselves at risk, even before treatment starts, the chances of them engaging in highly dangerous behaviors when they are in the midst of a crisis is much greater. For example, if Johnny is drinking a fifth of whisky each night and chasing it with hydrocodone, I would certainly not recommend delving into deep, emotionally charged issues in a traditional outpatient environment. It is likely when the pain increases, so will the desperation to stop the pain. Johnny first needs to get safe—mixing hydrocodone with whisky is just a slow way of committing suicide. If he can create a support plan that includes a drastic reduction in drinking (preferably 100%) and at least 3 people who will be there to support him, then I might consider working with him on the trauma issues in outpatient. My preference is for people with dual disorders (i.e. PTSD and substance abuse) who live alone or do not have a strong support system to enter into either intensive outpatient or a 3-5 day retreat in which they can have 24-hour access to a therapist and have their medication and substance intake monitored.
Finally, empowerment means providing consumers with the tools to help them create safety, trusting them to do the next right thing and encouraging them to make educated choices regarding their recovery and their life. Empowerment means helping them find positive ways to use the energy they are currently using to try and contain their anger and devastation. In PTSD, people often have a lot of “I should haves.” They cannot change the past, but with the knowledge of what they believe they should have done, what can they do now? That is to say, they cannot change the past, but what can they do to prevent it from happening in the future and/or make ammends if they believe they have done something wrong.
Trauma informed care identifies the trauma, and all of the associated mental, emotional, physical and social changes as the primary cause of people’s mental health and substance abuse issues. Likely things will never be like they were before the trauma, but they can get better. The terapists job is to help people define what “better” looks like, provide needed skills to help the person achieve their goals and empower them to start doing the hard work necessary to recover.
Many of us took a course in multicultural counseling when we were in college. Going through a masters program in rehabilitation counseling and a doctoral program in counseling, I got to take two. The thing I found most interesting is that we are just as biased in our teaching as we are in our daily service provision. The course in rehabilitation counseling focused on counseling people with disabilities. We learned that it is important to respect the fact that persons with disabilities have their own culture. Many people who are born deaf or blind, or who lose that ability at an early age bond with a culture of similarly-abled individuals. The notion of getting their sight or hearing back is completely outlandish. This issues is seen most often when people are faced with the option of getting cochlear implants. There is a stigma in the hearing community about being deaf, but there is also a stigma in the deaf community about regaining (or gaining) hearing. Not only are people faced with being ostracized from the community to which they currently belong, but they also must deal with the uncertainties of the operation and infiltrating a new culture.
Another stellar example of our egocentrism can be seen in how many agencies try to deal with people who are homeless. Don’t get me wrong, especially in today’s economy and social climate, there are many, many people who are homeless who want help. Nevertheless, there are also people who have made a choice to be homeless. One of my colleagues worked in a mission in Washington D.C. for several years. She pointed out that there were many people with whom she worked that had no desire to have a permanent roof over their heads. Some had mental health issues such as schizophrenia or PTSD, but they were legally competent. In some cases, the only way to be comfortable inside was to be on medication that had intolerable side effects. They made the decision to forego the medication and remain homeless. While this is not a choice I personally would be comfortable with, it is really not about me. So, is it ethical to force someone who is homeless to stay in a shelter? Is it ethical to place contingencies on them getting their medication (i.e. If you stay in the shelter, we will provide your medication)? There is a culture in the homeless society. Many of the patients I worked with in community mental health felt most comfortable downtown at the plaza with the people they knew understood them and watched out for them.
CARF and JCAHO want to see if your agency really gets the whole concept of multiculturalism. That is, do you assist people in connecting in the communities and cultures of their choice, or are you trying to force them to behave in more mainstream ways? Race, age, ethnicity, socioeconomic status, disability, gender, family values and educational pursuits are only a few areas in which there might be cultural differences. A culture is a group of people who share similar values and experiences. There is a culture surrounding addiction, eating disorders, mental health issues and even motherhood (why do you think mommy and me groups are so big?) Culture impacts everything from how people perceive the world to which things they perceive as problems and which solutions they might find tolerable.
So how do you know when you are not attending to cultural differences? Your patients may repeatedly tell you (verbally or nonverbally) that you do not understand. Your patients tend to drop out of services within two to four weeks indicating there may have been a lack of rapport. Your patient base is very unidimensional (i.e. all white, middle class, working females). If you are in private practice, this might indicate that this is the population with whom you work best for a variety of reasons. However, if you work in an agency with multiple clinicians and there is still only one narrowly defined population coming in, then it would be worth taking a look at.
Additionally, assess your current patient base. What could you do to make their experience more comfortable? Kid sized chairs and children’s books for parents who bring their children? A separate, quiet waiting area for patients who cannot take the noise? Appointments outside of banker’s hours for people who work all day? Reading material in both English and Spanish? Waiting areas that are conducive to those in wheelchairs, with canes or seeing eye dogs? A mobile app or live help button on your website that indicates the current wait time?
All of these things can assist you in getting prepared for CARF or JCAHO accreditation, and improve your patient’s experiences.
Did you know that since we are approved by the National Board for Certified Counselors (NBCC) and NAADAC, the Association for Addictions Professionals, that most states will accept our courses for CEUs?
All of our courses are NBCC and NAADAC approved.
Not everyone learns the same, so we should provide trainings to meet the needs of every learner. ??Makes sense right? Unfortunatley many executive managers, human resources people and even trainers miss this wee little point. Some people do not learn in lecture format. At a company where I used to work, they thought the best way to teach how to use the new electronic medical record was to lecture us on it. It was like trying to learn to play the piano without being allowed to touch the keys. Then when they did let us try it, the instructors would inevitably get lost and make mistakes. Not real comforting when the teacher is saying “Hmmm not really sure how I got here.” Anyhow…there are many differnet learning styles. We will briefly review each one and what you need to include in a course to help each person learn.
First: Auditory, visual and/or kinesthetic. This is how people take in information. To complicate things, not everyone learns everything the same way. While I can be very in-tune and follow a person in a counseling session, if you try to tell me how to run a computer program or (Heaven forbid) drive somewhere—all bets are off. I need to see it and do it. Once I have driven somewhere once, I have no problem doing it again. Thank you GPS. In a classroom, this means providing a written outline, paper for note taking, using visual aids and having people discuss and apply the information to scenarios, or answer questions about the material.
Secondly: Active or reflective learners. Some of us think while we talk, others think and then talk. Active learners need to be engaged in the process, answering questions, filling in worksheets etc. Reflective learners will take it all in, digest it, then tell you what they have learned. It is helpful to take 3 or 5 minute breaks every 15 or 20 minutes to allow people to review the information, come up with any questions.
Third, there is a reason the military keeps meetings to under an hour. People zone out. There is a point of diminishing returns at which people just cannot handle anymore input—especially highly technical or complex material. If you have to have longer trainings, make sure to have accommodations for those who just constitutionally cannot sit still for that long. Have them help with the presentation. Break into small group activities every 20 minutes or so.
Finally teach the knowledge, skills and abilities you want them to learn. Too often teaching is reduced to a series of definitions (knowledge). Leadership is…. Good teams… However, many people who have gotten to a leadership position can define these terms, it is operationalizing them that they need to learn (skills and abilities). They know what morale is, but they need help figuring out how to improve it in their departments. It is sort of like therapy. Your patients would be very disappointed if they came into your office, and you told them what depression was, then dismissed them. They came because they want to learn how to deal with it.
So in short, individualize training the way you already individualize treatment and you will find great success!
Giving and receiving Information is probably the primary skill required of leaders. There is no other leadership or management skill that can compensate for poor communication skills. There are four aspects to communication: Receiving it, processing it, retrieving it, and giving it.
When receiving information, it is important to pay attention to both verbal and nonverbal cues. It is thought that 80% of our communication is nonverbal. People can say whatever you want (or they think you want) to hear, but a lot of times, their nonverbals give away their true feelings. Similarly, people giving information may assume that the person receiving the information already knows certain things, or defines things in the same manner. Think about the difference between what a “clean room” means to you versus your 8 year old child. Consider how differently two people may define “being prepared ahead of time,” getting work done in a “timely fashion,” or “being on time.” If you are not careful, facts will be forgotten or distorted. This is because both the individual sending and the person receiving the information may unintentionally obscure the message.
There are several ways you can insure that the information you receive will be accurate:
· Take notes. Always write down key information received including what it to be done, how often, by whom and any deadlines.· Repeat back what you think you heard the person say. Say something like “Okay, just to make sure I got everything, you need me to….”
· Ask questions and clarify vague terms with examples or deadlines. For example, my former boss used to say “I need this ASAP.” To me that meant before the close of business, and I should clear everything off of my calendar to get “this” done. After a couple of years, I learned that it really meant within a week or so. When he would tell me he needed something ASAP, I would say something like “I have a couple of other things pending, will it be okay if you have it by next Monday.” Most of the time he said yes, and I was a lot less stressed.
While you may think you understand what you think you heard, you may in fact have gotten it totally wrong. Clarify and verify! To encourage good communication, you need to encourage others to speak freely.
· Show interest by leaning forward, paying attention, nodding in agreement, taking notes, putting your phone on vibrate and so forth.
· Listen to new ideas with interest. If you are a visual learner (you need to read it or see it) or a reflective learner (you need to get the information and ponder for a bit) then make sure your staff knows that. Few things are more frustrating for staff than to tell you an idea they are really excited about and feel like they are getting brushed off. Again, dates are important. Tell the person “Sam, that sounds like a really amazing idea. Can you please write it up for me and I’ll take a look at it and get back to you on Wednesday?” That will be received much better than “Sounds like a good idea. I’ll think about it”
Information you receive needs to be “stored” so you can retrieve it later. At the most basic level, we need to retrieve information from our memory.
Creating good memory pathways:
· Hear it (listening and talking), see it (take notes, follow powerpoints) , apply it (ask yourself, how can I use this information? Make up scenarios). Most people are a blend of different learning styles. The more different ways you receive the information, and the more senses are involved, the stronger the memory can be.
· Make it matter. There is a very strong emotional component to memory. We remember those things we care about and discard those that just take up space. I am one of the least sentimental people in the world. About the only holidays or anniversaries I remember are Christmas, Easter and Thanksgiving. I envy some of my fellow managers who can remember everyone’s birthdays and anniversaries. Hallmark holidays matter to them. I have really tried to make myself care, but I don’t, and I forget. Another example is your address. When you are living there, it matters and you remember it. When you move, eventually you forget. The take home message is that if you want to remember something, make it meaningful to you.
There are many other different ways to store and retrieve information such as computers, date books, PDAs and cell phones. The medium is not as important as what your write and how you store the information. You can employ a variety of methods to help you remember details, including note-taking, repeating back, memorization, and mnemonic devices. I have my life diligently set out in my iphone calendar so it alerts me to every meeting and every task. That may be too rigid for some, but it fits with my temperament.
When giving information, use as many senses as possible (seeing, hearing, touching or manipulating). In addition,
· Speak clearly.
· Use language that everyone understands. No jargon.
· Vary your tone, volume and pace.
· Provide an overview at the beginning, then move from the general to the specific. For example: (General) “Today we are going to learn how to bake a cake. Follow along at your station and refer to your cookbook if you get behind” (Specific) “Open your cookbook to page 485. Step 1: Preheat the oven to 365 degrees. Step 2…”
· Use visuals— charts, handouts, diagrams and encourage note taking
· Look at the listener to identify signs of confusion, boredom or frustration.
Encourage two-way flow—ask questions to help them mentally manipulate the information and have them ask questions of you. Use feedback and reflective listening to keep your verbal and non-verbal communication in sync. Take notes of the main questions and comments and review your notes soon afterwards so you can modify or append the message as necessary. I often review my notes and send out a meeting summary to everyone who was there.
If you practice all of these basic communication skills, you will often find that your subordinates very much want to do what you ask, but in the past you have been unclear. When I was in college I had a professor who taught my statistics class using the book that he wrote. Things that were trivial and basic to him were things we still did not know. He would fail to teach the basics then get irritable that we were all failing the class (The high score on one test was a 67%). Chances are, you have “written the book” on how you want your department to be run. Make sure your subordinates have all of the basic information before just assuming they are being disobedient. This will greatly lessen everyone’s stress.
Example is not the main thing in influencing others, it is the only thing. ~ Albert Schweitzer
The very essence of leadership is that you have to have a vision. ~ Theodore Hesburgh
Leaders must be close enough to relate to others, but far enough ahead to motivate them. ~ John Maxwell
People ask the difference between a leader and a boss. . . The leader works in the open, and the boss in covert. The leader leads, and the boss drives. ~ Theodore Roosevelt
The manager asks how and when; the leader asks what and why. ~ Warren Bennis
Leadership should be born out of the understanding of the needs of those who would be affected by it. ~ Marian Anderson
Leadership: The art of getting someone else to do something you want done because he wants to do it.~ Dwight D. Eisenhower
Preparing for CARF or JCAHO means embracing the basic principles of what they stad for not only in your manuals, but also in the way you treat your consumers, employees and external stakeholders. The following are the “big three” for CARF which guide the rest of the standards.
All people have the right to be treated with dignity and respect
Before you can assess the environment to see if it treats people with dignity and respect, you need to define who and what you are talking about. What people? Consumers? Referral Sources? Staff Members? Community Members? CARF would probably say that you need to be concerned about all of these. Then you need to look at each of those groups and identify what constitutes dignity and respect for each of them.
First, Identify who your “people” are. What age, race, ethnicity, socioeconomic status, educational level, disability, or different abilities, etc. Make a list of these groups. Then define what constitutes dignity and respect (or lack there of) for them. For example, in some cultures, direct eye contact is considered disrespectful, while in others it is a sign of respect. One strategy for this is to ensure that your agency has effective training on multicultural verbal and nonverbal communication and cultural norms for the populations you serve. Another example of a dignity issue would be working with consumers who cannot read well to identify what could be done to help them complete the intake forms and feel less self-conscious and agitated. One strategy might be having the forms available (in both regular font and large print and in the languages of the persons served) on the website and at your office so they could fill them out at home. Yet another example is when someone who is hearing impaired prefers to communicate through sign language rather than wear a hearing aid. So, make sure interpreters are available. Finally, at one clinic I consulted with, the people in wheel chairs had to use the entrance in the back of the building, because that was the only ramp. Consumers reported feeling like second-class citizens not being able (allowed) to use the front door. Of course, once management realized this issue, they built a ramp (It was a larger clinic, so that was not an excessive financial burden). These are just a few examples. Now that you have figured out what you are trying to assess, you can conduct a survey and ask your “people” what you currently do that makes them feel respected and treated with dignity, and what areas need improvement. It is vital to do this with at least the consumers and staff. From there your executive management committee can prioritize improvements.
All people should have access to needed services that achieve optimal outcomes
Again, before you can even start to assess the environment, you need to define what optimal outcomes are in order to identify the needed services. For example, a clubhouse program for persons who are severely mentally ill will not define their optimal outcomes the same way as an outpatient program for adults with depression. Yes, you want both groups of consumers to achieve their highest quality of life in the least restrictive environment, but what that looks like will vary greatly. This is where patient placement criteria and wrap around services become so important. Providing the best care in a residential setting for 60 days is great, but really loses a lot if the person is simply discharged to a once-per-week group with no place to live and no easing back into the stresses of day-to-day life. Think about the last time you started a new job. You had intensive orientation, but (hopefully) you were then provided a mentor for the next few weeks to help you learn the ropes. If not, you probably made a lot more mistakes. When we are talking about people’s recovery and quality of life, many times they cannot afford to make mistakes.
Again, identify each group of people. (Do not forget the staff) What services or tools does each group need access to in order to achieve optimal outcomes? What are optimal outcomes for each group? With staff it is easy. You will be looking at their billable hours, consumer satisfaction, improvement and retention rates. You will also examine the average duration of employment with your agency. Staff often cite that they need things like improved communication; additional training; and more interdepartmental cooperation. With consumers, you will need to identify what the benchmarks are for each group (i.e. independent living, employment, staying clean, successful program completion, staying out of the hospital or jail etc.) Often times these benchmarks will already be being tracked by your agency for funding purposes. Consumers often cite needing things such as access to more services including case management; employment opportunities; affordable housing and transportation.
All people should be empowered to exercise informed choice
This is the third principle, however, it is probably the one most agencies focus on the most. Informed choice means telling the consumer about the array of options, why you are making the recommendations that you are making and allowing them to choose from the available programs. This information must be presented in a way that is understandable to the consumer. We use the American Society of Addictions Medicine (ASAM-PPC). I go through the ASAM criteria and we talk about each component so the consumer understands the rationale behind my recommendations. It is important that, when possible, consumers feel that they made the ultimate decision for the type of treatment they would receive. In the end, they need to sign a document which verifies that each program option was explained to them, the clinician’s recommendations were explained to them and the potential risks and benefits were explained to them.
Finally, it is important to use rapid cycle change processes when trying to implement changes. Make small changes and try it on a small scale, such as in one clinic or department, re-assess in two weeks to a month to see the change (for better or worse). Evaluate the outcomes and decide to either expand the initiative; modify and re-test or scrap it and start over. By starting small and reassessing quickly, you save valuable time and money.