Community Counselling

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1 Community Counselling Program Standards and Resources january 2005

2 Message from the Minister I am pleased to bring you the Community Counseling Program toolkit. This binder contains program standards and resources you'll use every day, along with some of the forms you'll use most often in your work. The Department of Health and Social Services is committed to the goal of improving well-being in our communities and making our services work better for the people who use them. This means: Babies who are born healthy, without FASD or other preventable disabilities. Children who grow up in healthy families and are able to get the care and nurturing they need from their caregivers. Adults who make healthy choices and are able to ask for help when they need it. Our health and social services professionals need to work together in the best interest of their clients, while maintaining client confidentiality. This binder is only one tool - you will also draw upon your own knowledge and that of your co-workers and others in our integrated system. I invite you to visit the Department's website at for more information on our programs and services. You can also contact the Department's Mental Health Consultants at (867) (addictions) or (867) (mental health). J. Michael Miltenberger Minister of Health and Social Services

3 Contributing Authors Adapted from Nova Scotia Addiction Services Standards Keep Your Dreams Alive September 2002, Nova Scotia Department of Health Jennifer Chalmers and Liz Cayen Chalmers & Associates Consulting Ltd. Rachel Dutton-Gowryluk Department of Health and Social Services Robert Swan Sandy Little Karen Willy Department of Health and Social Services Department of Health and Social Services Department of Health and Social Services Advisory Committee Arlene Jorgensen Program Coordinator, Inuvik Regional Health and Social Service Authority Dave Harder Director of Program, Salvation Army Resource Center Yellowknife Anne McGuire-Smith Anmar Addiction Services Deborah Tynes Director, Social Programs, Inuvik Regional Health and Social Services Authority Ellen Smith Addictions Specialist, Inuvik Regional Health and Social Services Authority Ethel Lamothe Manager, Community Wellness, Deh Cho Health and Social Services Authority Dr. Veronica Horn Manager, Hay River Community Counseling Services, Hay River Health and Social Services Authority Community Counselling Program Standards Revised December 2004 Page 1

4 Jette Finsborg Family & Mental Health Therapist, Fort Smith Health and Social Services Authority Keith Marshall Director, Community/Allied Health Services, Hay River Health and Social Services Authority Kim Inskip Social Work Supervisor, Hay River Health and Social Services Authority Les Harrison Director, Community and Family Services, Yellowknife Health and Social Services Authority Lorraine Tordiff Director, Community Services, Fort Smith Health and Social Services Authority Melvin Larocque Executive Director, Natsejee K eh Treatment Center Kristine Vannebo-Suwala Clinical Supervisor, Natsejee K eh Treatment Center Minnie Letcher Director, Deh Cho Health and Social Services Authority Dr. Ross Wheeler Addictions Specialist, Stanton Mental Health Clinic, Stanton Territorial Health Authority Sylvia Stard Manager, Psychiatric Services, Stanton Territorial Health Authority Tony Simmonds Manager, Family Counseling Services, Yellowknife Health and Social Services Authority Community Counselling Program Standards Revised December 2004 Page 2

5 Table of Contents Page Forward 5 Overview 8 Vision & Principles 9 Scope 10 Definitions 12 Standard One Prevention and Community Education Communication Facilitation of Learning Enhancing Community Health Community Mobilization Advocacy 25 Standard Two Crisis Intervention 26 Standard Three Intake, Assessment and Enhanced Assessment Screening Intake Assessment 29 Standard Four Client Records Case Noting Client Records Records Retention 33 Standard Five Orientation of Services for Clients 34 Standard Six Client Care Plan 35 Standard Seven Referral 37 Standard Eight Follow-up/Aftercare 38 Standard Nine Traditional Healing 39 Standard Ten Integration/Liaison with Other Services 40 Community Counselling Program Standards Revised December 2004 Page 3

6 Standard Eleven Ending Services 41 Standard Twelve Code of Conduct 42 Standard Thirteen Code of Ethics 46 Standard Fourteen Clinical Supervision 48 Standard Fifteen Informed Consent 49 Standard Sixteen Confidentiality 50 Standard Seventeen Information Sharing 51 Standard Eighteen Disruptive Behaviour Management 52 Standard Nineteen Staff Wellness 53 Standard Twenty Legislation 54 Standard Twenty-one Client Complaint 55 Standard Twenty-two Evaluation 56 References 57 Community Counselling Program Standards Revised December 2004 Page 4

7 Forward The Northwest Territories, the land of the Dene, Métis and Inuit comprises 587,000 square miles of land and fresh water. Ancestors of the Dene and Inuit people have inhabited it for thousands of years. Over the years many other cultures and people have come to the north to live. The early Aboriginal inhabitants were hunters and gatherers who lived distinctive cultures and lifestyles, lived in balance with their natural surroundings, created order in their relationship with the environment around them and had an intimate relationship with the land. The various cultural groups such as (Chippewyan, Cree, Tli Cho [Dogrib], Gwich in, Inuvialuit) existed largely in isolation of one another. The close relationships and interdependency on other members of the same cultural group served to reinforce a strong cultural identity within each group. Approximately 500 years ago Europeans arrived on the North American continent, leading to the exploitation of the vast natural resources and Christianizing of Aboriginal people. The European colonists brought different values, philosophies and lifestyles that negatively impacted many of the First Nations and Inuit cultures comprising the North American continent. This contact drastically affected their lifestyles, worldview and sense of self. Due to the remoteness of the Northwest Territories geography, the First Nations and Inuit peoples were sheltered from the destructive aspects of colonization until the first part of the 20th century. However, the eventual contact changed and continues to affect the entire cultural dynamics of the Aboriginal people in the Northwest Territories. Today the NWT is home to 41,872 people (20,963 First Nation and Inuit persons and 20,909 European/other descent. There are 11 distinctive language/cultural groups officially recognized: Chippewyan, Cree, Tli Cho (Dogrib), English, French, Gwich in, Inuinnaqtun, Inuktitut, Inuvialuktun, North Slavey, and South Slavey. One of the most devastating consequences of contact was the formation and implementation of the residential school system. This was not an arbitrary decision made by governments and churches but a decision that deliberately and systematically assimilated and acculturated the First Nations people. The residential school system routinely separated First Nations children from their families and traditional lifestyles, often for many years. This school system did not focus on traditional values and lifestyles but imposed European cultural values on its students in a misguided attempt to assimilate the culture of the First Nations people. The abusive nature of this system have only been recently documented and acknowledged. This system denied aboriginal children their Community Counselling Program Standards Revised December 2004 Page 5

8 traditional roots, the connection with their past and their sense of identity. After many years of residing in residential schools, children were returned to their parents without the skills to pursue a traditional lifestyle that would assist them in their daily activities of living and/or survival. In many cases they were unable to adequately speak their mother tongue. Consequently, many of the returning residential students had difficulty fitting back into their communities and also had difficulty fitting into the European culture as well. As a result there were a significant number of First Nations and Inuit people who felt they did not fit into either culture and were deemed the lost generation. Such circumstances combined with a lack of cultural identity and knowledge/skills has manifested itself in addictions, mental health and family violence problems/issues. Various studies and reports commissioned by the Government of the Northwest Territories over the past several years have made recommendations for system reform, particularly in the areas of addictions, mental health and family violence services. In the present climate of complex social problems involving multiple services the government has created the integrated service delivery model (ISDM), which ensures communities will receive the full range and access of health and social services. Its approach is consistent with the national primary health care model that most of Canada s southern jurisdictions have implemented over the years. The GNWT also embraces this practice but terms it primary community care. ISDM has identified six core services that all residents of the NWT can expect to access through collaborative, multidisciplinary teams originating in primary community care teams at the community, regional or territorial levels. Since 2003, mental health and addiction services have officially been identified as one of the six core services and hence program/service reform initiatives. New funding has been identified to support the ongoing work in building a more progressive mental health and addiction services system. Prevention and counseling services were identified as a priority throughout consultations with communities and service providers. Community counseling programs (CCP) have thus been funded to support new positions in the delivery of community based counseling programs in mental health, addictions and family violence. The NWT mental health and addiction services consultation group, consisting of over 25 health and social service clinicians, managers and non-government organizations, has collaborated and produced this community counseling program standards and toolkit manual to ensure NWT-wide accountability and standardization of counseling programs based on best practices. The CPP staff and management will use this manual in the administration of the program. Ongoing work and consultations ensue in the continuation and support of the community counseling programs in the NWT. One of the areas of concentration Community Counselling Program Standards Revised December 2004 Page 6

9 is the consultation with NWT elders, spiritual leaders and First Nations groups in ensuring that traditional culture and traditional knowledge is respected and incorporated in the provision of mental health and addiction services. Community Counselling Program Standards Revised December 2004 Page 7

10 Overview The Northwest Territories have a deep appreciation for wellness and have much strength to draw on in the promotion of wellness for all. We have strong traditions of culture and community, dedicated paid and volunteer caregivers and government at all levels working hard to make positive changes in themselves, their families and their communities. Many Northerners, like people everywhere, use alcohol and drugs to deal with their problems. Some have been traumatized by family violence, residential school abuse, suicide and other losses. Addictions, mental health and family violence services operate in many communities separately even though some of us may need help with more than one problem. By addressing these three wellness services in one integrated service, we can find ways to improve services so that people s needs are better met. (Working Together for Community Wellness, March 2001) In 2002, the Department of Health and Social Services developed the Integrated Service Delivery Model (ISDM), which is based on the principles and vision established in Shaping Our Future: A Strategic Plan for Health and Wellness (1998) and reinforced in the NWT Health and Social Services System Action Plan (2001). In ISDM, services integration and collaboration are rooted in a Primary Community Care (also known as Primary Health Care in Canadian provinces) approach to service delivery. ISDM identifies six core services available to health and social services clients in the NWT: o Diagnostic and Curative Services o Rehabilitation Services o Protection Services o Continuing Care Services o Promotion and Prevention Services o Mental Health and Addictions Services The Community counselling programs have been the first basket of services implemented in the new Mental Health and Addiction Services action plan. These services are accessible to all residents of the Northwest Territories through their health and social service authorities. The program is designed to provide public education/health promotion activities and clinical counseling services in the areas of addiction, mental health and family violence. An appreciation and recognition of different cultural groups based on different values, languages, celebrations, rituals, and histories are important in this diverse territory. These program standards are designed to reflect inclusion of all individuals. Community Counselling Program Standards Revised December 2004 Page 8

11 Vision As set out in the Department of Health and Social Services Strategic Plan (1998) and reinforced in the Minister s Action Plan (2001), the NWT s vision for health and social services delivery is that: Our children will be born healthy and raised in a safe family and community environment, which supports them in leading long, productive, and happy lives. Principles The ISDM inherently includes two sets of principles. The first set is the broad principles articulated in Shaping Our Future: A Strategic Plan for Health and Wellness (1998): o Personal responsibility o Basic needs o Sustainability o Continuum of care o Universality o Prevention-oriented system o People-oriented system The second set of principles are the specific ISDM principles recently developed by the ISDM Task Team Health and Social Services and articulated in the Task Team s report (ISDM 2004): o Patient and client focus o Ease and equitable access to services o Competent care o Information driven o A sustainable and single system of services o Personal responsibility o Adaptability o Accountability o Transparency in communications Community Counselling Program Standards Revised December 2004 Page 9

12 Scope and Purpose This document sets out program standards for the community counselling programs throughout the Northwest Territories, as part of mental health and addictions services. It has been authored by a variety of consultants and overseen by an advisory committee consisting of health and social service authority staff and a variety of non-government organizations/services in consultation from stakeholders in NWT communities. Program standards are intended to provide guidance for quality service delivery and reduce variations across the NWT while maintaining flexibility by adapting approaches unique to regions and communities. General characteristics to which standards can be applied should reflect the following characteristics: 1. realistic; 2. achievable; 3. in plain language; 4. based on current knowledge and practices in the subject area; and 5. indicative of acceptable performance and amenable to be measurable. 1 Further, characteristics of standards define boundaries and appropriate conduct (ethics) and guide a program. 2 A program standard can be defined as a generally accepted written expectation for the community counselling program, which can be judged against established criteria or standard measurements. Standard measurements indicate the performance requirements to achieve the standard. An objective should be observable or measurable. Standards are usually developed by each specific discipline such as nursing, social work and psychology. The Standards Council of Canada (1999) notes that standards should be based on the consolidated results of science, technology, and experience, and aimed at the promotion of optimum community benefits. 1 Saskatchewan Association of Social Workers, White and Popvits, 2001 Community Counselling Program Standards Revised December 2004 Page 10

13 The community counseling program standards are expected to: 1. Promote a better protection of the public including individuals, families and communities; 2. Improve the quality and quantity of community counselling services; 3. Establish program expectations so that accountability for practice can be maintained; 4. Seek to provide uniformity in the quality, quantity and accessibility of community counselling services to residents of the NWT; and 5. Monitor, evaluate and improve the Community Counselling Programs These Program Standards comprise: o Operational definition; o Objectives; and o Standard measurements specific to a section of the community counseling program The following program standards have been developed: Prevention and Community Education Crisis Intervention Screening, Intake, and Assessment Case Noting Orientation of Services for Clients Client Care Plan Referral Follow-up/After Care Traditional Knowledge Integration/Liaison with Other Services Ending Services Code of Conduct Code of Ethics Clinical Supervision Informed Consent Confidentiality Information Sharing Disruptive Behaviour Management Staff Wellness Legislation Client Complaint Evaluation Community Counselling Program Standards Revised December 2004 Page 11

14 DEFINITIONS Corsini, Ray. (2002). The dictionary of psychology. New York, NY: Brunner-Routledge. Addiction Assessment Assessment Tools Bio-Psycho-Social Model 1. Over-dependence on any substance, person, activity, procedure, etc. 2. Physiological dependence, usually on a drug, characterized by increased bodily tolerance and withdrawal symptoms. Acute withdrawal symptoms occur if the substance is sharply reduced or stopped. 3. Psychological dependence, a strong and compelling need for something such as companionship, entertainment, attention, activity, travel, sexual encounters. When such needs are strong and unusual and continued despite harmful effects to self or others, a person is considered medically or psychologically impaired. The appraisal or estimation of the level or magnitude of some attribute of a person. The assessment of human behavior and mental processes involves observations, interviews, rating scales, checklists, inventories, projectives, and psychological tests. A specific method of acquiring data in psychological assessment, such as a questionnaire, a behavioural observation coding system, and psychophysiological inventory. (Intake forms, Beck Depression Inventory, Trauma Symptom Inventory, Suicidal Ideation Checklist, SASSI-2). The interactions of biological, psychological, cognitive, social, developmental, environmental and cultural variables are considered to explain addictions. Addiction is a primary illness that is progressive developmentally from growing tolerance and dependence to a loss of control to deterioration of bio-psycho-social health. This model combines all models into a single model and directs that people working in the field of addictions must thoroughly assess clients, develop multiple hypotheses to explain the client s problem based on that assessment, avoid trying to fit the client into a rigid definition of addiction and use a variety of interventions to address the needs of the client. At this time, this model may be most useful. Community Counselling Program Standards Revised December 2004 Page 12

15 Case Manager Client Client Care Planning Assignment of a health care provider to assist a client in assessing health and social service systems and to ensure that all required services are obtained. 3 Term frequently used by social workers, counsellors, and counselling psychologists to refer to individuals receiving treatment or services. Patient is usually employed by psychiatrists, psychoanalysts, and some clinical psychologists. A process involving sequential decisions, with weighting of information concerning patient characteristics, treatment context, relation variables and strategies and techniques. Clinical Supervision Has three main purposes: 1. to nurture the counselors professional development 2. to promote development of specific skills and competencies and 3. to raise the level of accountability in counselling services and programs. Code of Ethics A set of standards and principles of professional conduct. Concurrent Disorder Also referred to as dual disorders and sometimes cooccurring disorders. Refers to a combination of mental/emotional problems experienced together with the abuse of substances such as alcohol and drugs. Confidentiality Consultation A principle of ethics requiring employees to restrict all information provided by patients, except in situations in which the safety of the patient or other people is threatened by withholding such information. Under some circumstances, confidential or privileged communication must be disclosed, for example when interests of children are paramount. A situation in which a person who has special experience and knowledge meets with another person or other persons to offer advice or give an opinion. For example, a psychologist advising a school teacher on how to deal with behavioural problems in the classroom. 3 Morrison-Valfre, 2001 Community Counselling Program Standards Revised December 2004 Page 13

16 Counselling A process of defining, understanding and addressing a specific problem, as well as advice and suggestions given by a person acknowledged as being an expert in one or more areas, such as marriage, substance dependency or career. Crisis Intervention Short term, active assistance that provides emotional first aid for clients and victims of trauma with the goal of assisting individuals and families to manage the immediate crisis situation and return to pre-crisis levels of functioning. Cultural Diversity Disorder An appreciation and recognition of different cultural groups based on varying behaviours, values, languages, celebrations, rituals, and histories. Diversity as it relates to culture includes actions taken by individuals, organizations, and communities to reflect inclusion and representation of diverse groups. Synonym for mental disease. Dual Relationships A situation that exists when people have two different relationships with each other. Duty to Report Duty to Warn Emotional Abuse Evaluation A person who has information of the need of protection of a child shall, without delay, report the matter a) to a child protection worker; or b) if a child protection worker is not available, to a peace officer or an authorized person. 4 The legal and moral obligation of a counselor (health care provider) to notify the appropriate authorities as defined by governing systems and/or the potential victim when there is serious danger or threat of a client inflicting injury on self or others. Any injury to the emotional or intellectual capacity of an individual. Overall measurement of the progress of a client, patient, student, team, or other persons in a designated task. 4 Child and Family Services Act, NWT 1997 Community Counselling Program Standards Revised December 2004 Page 14

17 Family Violence Harm Reduction Health and Social Services Authority Healthy Living This is a term that includes the many different forms of abuse, mistreatment or neglect that elders, adults, youth, or children may experience in their intimate, family, extended family or dependant relationships. An approach to addictions rehabilitation that emphasizes reduction of harm from the effects of substance abuse; it may be inclusive of abstinence from substances but often is not. A useful model for substance abusers who are young, chronic and binge type drinkers. A governing structure established under the Hospital Insurance and Health and Social Services Administration Act. A balanced way of living that includes good nutrition, sleep, exercise and other behaviours that are consistent with good health such as leisure, relaxation and spirituality. Informed Consent Permission by a client given without coercion to a researcher or practitioner to perform a procedure after receiving clear information about it, including knowing that the procedure is voluntary and that the participant may withdraw at any time, what the procedure entails (including its risks, possible benefits, and alternatives), and any consequences of withholding consent. Ethical practice requires that such consent be obtained from the participant (or a responsible representative) in all psychological research and medical or other therapeutic procedures. Intake Mental Health Promotion The initial interview between a potential client and a member of the therapeutic team that usually begins the counselling process. The promotion of healthy coping and adjustment strategies for living in an acceptable way. Mentally healthy people are able to successfully carry out the activities of daily living, solve problems, set goals, adapt to change, and enjoy life. They are self-aware, directed, and responsible for their actions. Community Counselling Program Standards Revised December 2004 Page 15

18 Mental Illness/ Disorder A substantial disorder of thought, mood, perception, orientation or memory, any of which grossly impairs judgment, behaviour, the capacity to recognize reality or the ability to meet the ordinary demands of life. Mental retardation or learningdisabilities do not of themselves constitute mental disorders. 5 Mental Illness Prevention The prevention of disturbances in one's psychological/emotional abilities to cope effectively with the tasks of life. Physical Abuse Prevention Any non-accidental infliction of a physical injury on another individual. Efforts to control the occurrence or reduce the severity of undesirable phenomena such as mental disorders, birth defects, delinquency and crime, environmental disasters, drug addiction, accidents, and physical disease. Primary Community Care Team All service providers at the community level, which will establish collaborative processes for working together to meet client needs. This may include non-government organizations (NGO) partners. Relapse Risk Factor Re-occurrence of symptoms of a disease or disorder after a period of improvement. A behavior/exposure that is statistically related in some way to an outcome. E.g. a tragic event of depression can be risk factors that lead to the completion of a suicide. Screening The first contact with a client, which subsequently determines the use of service. Sexual Abuse Standard Any sexual act imposed upon an individual who lacks the emotional, maturational and cognitive development to consent to such an act. Criteria which performances are judged or evaluated; may be arbitrarily set or based on prior performance. 5 Mental Health Act, NWT, 1988 Community Counselling Program Standards Revised December 2004 Page 16

19 Standard Measurements Trauma Treatment A sign that indicates the performance requirements to achieve the standard. A standard measurement should be observable and measurable. The result of a painful event, physical or mental, and causing immediate damage to the body or shock to the mind. Psychological traumas include emotional shocks. Administration of appropriate measures, for example, drugs or counselling, designed to relieve the symptoms of a condition or disorder. Community Counselling Program Standards Revised December 2004 Page 17

20 STANDARD ONE PREVENTION AND COMMUNITY EDUCATION Prevention, health promotion and community education are community-based programming that address the full continuum of risks based on accurate, current information. Evidence-based, effective strategies are focused on substance use and/or gambling, mental health issues and family trauma issues. 1.1 COMMUNICATION Communication can be defined as the exchange and sharing of information, attitudes, ideas or emotions. It includes a combination of media, interpersonal communication and events used to communicate health information (University of Toronto, Health Communication Unit, 1998). Objectives 1 To create awareness about the impact and the harms associated with substance use and abuse, family trauma and ill mental health and effects on individuals, families and communities. 2 To promote knowledge and awareness of available prevention and treatment programs and services. 3 To respond on a timely basis to emerging addiction, mental health and family trauma issues on territorial and local levels with accurate, current, and valid information. 4 To use strategies and interventions to promote and maintain good mental health and to deal with issues related to addictions and family trauma. Community Counselling Program Standards Revised December 2004 Page 18

21 Standard Measurements 1 All requests for public information are responded to in 5 business days. 2 The volume of public education is reported annually for each Regional Health and Social Services Authority, as follows: Number of requests for information print items and the number distributed Number of radio exposures (broadcasts x listening audience) Number of television exposures (broadcasts x listening audience) Number of print media exposure (articles, news, special issues, advertisements of services x circulation) 3 Information regarding risk factors contributing to addictions, mental health issues and family trauma issues is made accessible to communities. 4 The Health and Social Services Authority standard for communication is followed. Community Counselling Program Standards Revised December 2004 Page 19

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