1 Core Functions
In the 1980s, a consortium of states developed the core functions during a time when the field was undergoing a push toward standardized education and training. This was an important era in terms of recognizing the need for professional standards in this unique and growing field. The global criteria, which provide essential guidance for how to fulfill the criteria, were added over time and reflect current standards for counselors in the field.
The 12 core functions are fundamental to understanding the work of the addictions counselor and their integral role in the field. They outline the duties performed by substance use disorder counselors, while also detailing a roadmap of how the functions work in a treatment setting. Each function is described below, followed by the global criteria that define the function and an explanation of how they work in practice.
TWELVE CORE FUNCTIONS OF THE ALCOHOL AND OTHER DRUG ABUSE COUNSELOR
I. SCREENING: The process by which the client is determined appropriate and eligible for admission to a particular program.
Global Criteria:
- Evaluate the psychological, social, and physiological signs and symptoms of alcohol and other drug abuse.
- Determine the client’s appropriateness for admission or referral.
- Determine the client’s eligibility for admission or referral.
- Identify any coexisting conditions (medical, psychiatric, physical, etc.) that indicate the need for additional professional assessment and/or services.
- Adhere to applicable laws, regulations, and agency policies governing alcohol and other drug abuse services.
Explanation:
This function requires the counselor to consider a variety of factors before deciding whether or not to admit the potential client for treatment. It is imperative that the counselor use appropriate diagnostic criteria to determine whether the applicant’s alcohol or other drug use constitutes abuse. All counselors must be able to describe the criteria they use and demonstrate their competence by presenting specific examples of how the use of alcohol and other drugs has become dysfunctional for a particular client. The determination of a particular client’s appropriateness for a program requires the counselor’s judgment and skill and is influenced by the program’s environment and modality (i.e., inpatient, outpatient, residential, pharmacotherapy, detoxification, or daycare). Important factors include the nature of the substance abuse, the physical condition of the client, the psychological functioning of the client, outside support/ resources, previous treatment efforts, motivation, and the philosophy of the program. The eligibility criteria are generally determined by focus, target population, and funding requirements of the counselor’s program or agency. Many of the criteria are easily ascertained. These may include the client’s age, gender, place of residence, legal status, veteran status, income level, and the referral source. Making a reference to agency policy is a minimally acceptable statement. If the client is found ineligible or inappropriate for this program, the counselor should be able to suggest an alternative.
II. INTAKE: The administrative and initial assessment procedures for admission to a program.
Global Criteria:
- Complete the required documents for admission to the program.
- Complete the required documents for program eligibility and appropriateness.
- Obtain appropriately signed consents when soliciting information from, or providing information to, outside sources to protect client confidentiality and rights.
Explanation:
The intake usually becomes an extension of the screening, when the decision to formally admit is documented. Much of the intake process includes the completion of various forms. Typically, the client and counselor fill out an admission or intake sheet, document the initial assessment, complete appropriate releases of information, collect financial data, sign a consent for treatment, and assign the primary counselor.
III. ORIENTATION: Describing to the client the following: general nature and goals of the program; rules governing client conduct and infractions that can lead to disciplinary action or discharge from the program; in a non-residential program, the hours during which services are available; treatment costs to be borne by the client, if any; and client rights.
Global Criteria:
- Provide an overview to the client by describing program goals and objectives for client care.
- Provide an overview to the client by describing program rules and client obligations and rights.
- Provide an overview to the client of program operations.
Explanation:
The orientation may be provided before, during, and/or after the client’s screening and intake. It can be conducted in an individual, group, or family context. Portions of the orientation may include other personnel for certain specific aspects of treatment, such as medication.
IV. ASSESSMENT: The procedures by which a counselor/program identifies and evaluates an individual’s strengths, weaknesses, problems, and needs for the development of a treatment plan.
Global Criteria:
- Gather relevant history from client, including but not limited to, alcohol and other drug abuse using appropriate interview techniques.
- Identify methods and procedures for obtaining corroborative information from significant secondary sources regarding client’s alcohol and other drug abuse and psycho-social history.
- Identify appropriate assessment tools.
- Explain to the client the rationale for the use of assessment techniques in order to facilitate understanding.
- Develop a diagnostic evaluation of the client’s substance abuse and any coexisting conditions based on the results of all assessments in order to provide an integrated approach to treatment planning based on the client’s strengths, weaknesses, and identified problems and needs.
Explanation:
Although assessment is a continuing process, it is generally emphasized early in treatment. It usually results from a combination of focused interviews, testing, and/or record reviews. The counselor evaluates major life areas (i.e., physical health vocational development, social adaptation, legal involvement, and psychological functioning) and assesses the extent to which alcohol or drug use has interfered with the client’s functioning in each of these areas. The results of this assessment should suggest the focus of treatment.
V. TREATMENT PLANNING: The process by which the counselor and client identify and rank problems needing resolution; establish agreed upon immediate and long-term goals; and decide upon a treatment process and the resources to be utilized.
Global Criteria:
- Explain assessment results to the client in an understandable manner.
- Identify and rank problems based on individual client needs in the written treatment plan.
- Formulate agreed upon immediate and long-term goals using behavioral terms in the written treatment plan.
- Identify the treatment methods and resources to be utilized as appropriate for the individual client.
Explanation:
The treatment contract is based on the assessment and is a product of negotiation between the client and counselor to be sure the plan is tailored to the individual’s needs. The language of the problem, goal, and strategy statements should be specific, intelligible to the client, and expressed in behavioral terms. The statement of the problem concisely on a client need identified previously. The goal statements refer specifically to the identified problem and may include one objective or set of objectives ultimately intended to solve or mitigate the problem. The goals must be expressed in behavioral terms in order for the counselor and client to determine progress in treatment. Both immediate and long-term goals should be established. The plan or strategy is a specific activity that links the problem with the goal. It describes the services, who will provide them, when they will be provided, and at what frequency. Treatment planning is a dynamic process and the contracts must be regularly reviewed and modified as appropriate.
VI. COUNSELING: (Individual, Group, and Significant Others): The utilization of special skills to assist individuals, families, or groups in achieving objectives through exploration of a problem and its ramifications, examination of attitudes and feelings; consideration of alternative solutions; and decision-making.
Global Criteria:
- Select the counseling theory or theories that apply.
- Apply technique(s) to assist the client, group, and/or family in exploring problems and ramification.
- Apply technique(s) to assist the client, group, and/or family in examining the client’s behavior, attitudes, and/or feelings if appropriate in the treatment setting.
- Individualize counseling in accordance with cultural, gender, and lifestyle differences.
- Interact with the client in an appropriate therapeutic manner.
- Elicit solutions and decisions from the client.
- Implement the treatment plan.
Explanation:
Counseling is basically a relationship in which the counselor helps the client mobilize resources to resolve his or her problem and/or modify attitudes and values. The counselor must be able to demonstrate a working knowledge of various counseling approaches. These methods may include Reality Therapy, Motivational Interviewing, Strategic Family Therapy, Client-Centered Therapy, etc. Further, the counselor must be able to explain the rationale for using a specific approach for the particular client. For example, a behavioral approach might be suggested for clients who are resistant and manipulative or have difficulty anticipating consequences and regulating impulses. On the other hand, a cognitive approach may be appropriate for a client who is depressed, yet insightful and articulate. Also, the counselor should explain his or her rationale for choosing a counseling approach in an individual, group, or family context. Finally, the counselor should be able to explain why a counseling approach or context changed during treatment.
VII. CASE MANAGEMENT: Activities that bring services, agencies, resources, or people together within a planned framework of action toward the achievement of established goals. It may involve liaison activities and collateral contacts.
Global Criteria:
- Coordinate services for client care.
- Explain the rationale of care management activities to the client.
Explanation:
Case management is the coordination of a multiple services plan. Case management decisions must be explained to the client. By the time many alcohol and other drug abusers enter treatment, they tend to manifest dysfunction in a variety of areas. For example, a heroin addict may have hepatitis, lack job skills, and have a pending criminal charge. In this case, the counselor might monitor his medical treatment, make a referral to a vocational rehabilitation program and communicate with representatives of the criminal justice system. The client may also be receiving other treatment services such as family therapy and pharmacotherapy, within the same agency. These activities must be integrated into the treatment plan and communication must be maintained with the appropriate personnel.
VIII. CRISIS INTERVENTION: Those services which respond to an alcohol and/or other drug abuser’s needs during acute emotional and/or physical distress.
Global Criteria:
- Recognize the elements of the client crisis.
- Implement an immediate course of action appropriate to the crisis.
- Enhance overall treatment by utilizing crisis events.
Explanation:
A crisis is a decisive, crucial event in the course of treatment that threatens to compromise or destroy the rehabilitation effort. These crises may be directly related to alcohol or drug use (i.e., overdose or relapse) or indirectly related. The latter might include the death of a significant other, separation/divorce, arrest, suicidal gestures, a psychotic episode or outside pressure to terminate treatment. If no specific crisis is presented in the written case, rely on and describe a past experience with a client. Describe the overall picture–before, during and after the crisis. It is imperative that the counselor be able to identify the crises when they surface, attempt to mitigate or resolve the immediate problem and use negative events to enhance the treatment efforts, if possible.
IX. CLIENT EDUCATION: Provision of information to individuals and groups concerning alcohol and other drug abuse and the available services and resources.
Global Criteria:
- Present relevant alcohol and other drug use/abuse information to the client through formal and/or informal processes.
- Present information about available alcohol and other drug services and resources.
Explanation:
Client education is provided in a variety of ways. In certain inpatient and residential programs, for example, a sequence of formal classes may be conducted using a didactic format with reading materials and films. On the other hand, an outpatient counselor may provide relevant information to the client individually or informally. In addition to alcohol and drug information, client education may include a description of self-help groups and other resources that are available to the clients and their families. The applicant must be competent in providing specific examples of the type of education provided to the client and the relevance to the case.
X. REFERRAL: Identifying the needs of a client that cannot be met by the counselor or agency and assisting the client to utilize the support systems and community resources available.
Global Criteria:
- Identify need(s) and or problem(s) that the agency and/or counselor cannot meet.
- Explain the rationale for the referral to the client.
- Match client needs and/or problems to appropriate resources.
- Adhere to applicable laws, regulations and agency policies governing procedures related to the protection of the client’s confidentiality.
- Assist the client in utilizing the support systems and community resources available.
Explanation:
In order to be competent in this function, the counselor must be familiar with community resources, both alcohol and drug and others, and should be aware of the limitations of each service and if the limitations could adversely impact the client. In addition, the counselor must be able to demonstrate a working knowledge of the referral process, including confidentiality requirements and outcomes of the referral. Referral is obviously closely related to case management when integrated into the initial and on-going treatment plan. It also includes, however, aftercare of discharge planning referrals that take into account the continuum of care.
XI. REPORT AND RECORD KEEPING: Charting the results of the assessment and treatment plan, writing reports, progress notes, discharge summaries and other client-related data.
Global Criteria:
- Prepare reports and relevant records integrating available information to facilitate the continuum of care.
- Chart pertinent ongoing information pertaining to the client.
- Utilize relevant information from written documents for client care.
Explanation:
The report and record-keeping function is important. It benefits the counselor by documenting the client’s progress in achieving his or her goals. It facilitates adequate communication between co-workers. Is assists the counselor’s supervisor in providing timely feedback. It is valuable to other programs that may provide services to the client at a later date. It can enhance the accountability of the program to its licensing/funding sources. Ultimately, if performed properly, it enhances the client’s entire treatment experience. The applicant must prove personal action in regard to the report and record-keeping function.
XII. CONSULTATION: Relating with in-house staff or outside professionals to assure comprehensive, quality care for the client.
Global Criteria:
- Recognize issues that are beyond the counselor’s base of knowledge and/or skill.
- Consult with appropriate resources to ensure the provision of effective treatment services.
- Adhere to applicable laws, regulations, and agency policies governing the disclosure of client-identifying data.
- Explain the rationale for the consultation to the client, if appropriate.
Explanation:
Consultation is meetings for discussion, decision-making, and planning. The most common consultation is the regular in-house staffing in which client cases are reviewed with other members of the treatment team. Consultations may also be conducted in individual sessions with the supervisor, other counselors, psychologists, physicians, probation officers, and other service providers connected to the client’s case.
