SECTION VII TECHNICAL COMPETENCIES REPORT

Transcription

1 Competencies for Canada s Substance Abuse Workforce SECTION VII TECHNICAL COMPETENCIES REPORT

2 This package was published by the Canadian Centre on Substance Abuse (CCSA). Suggested citation: Canadian Centre on Substance Abuse. (2014). Competencies for Canada s substance abuse workforce. Ottawa, ON: Canadian Centre on Substance Abuse. This is a living document, which CCSA may revise and update to reflect the latest evidence and research. Canadian Centre on Substance Abuse, 2014 For additional copies, contact CCSA, 75 Albert St., Suite 500 Ottawa, ON K1P 5E7 Tel.: competencies@ccsa.ca ISBN

3 SECTION VII TECHNICAL COMPETENCIES REPORT TABLE OF CONTENTS INTRODUCTION VII 1 GLOSSARY OF KEY TERMS VII 3 TECHNICAL COMPETENCY DEFINITIONS VII 4 USING THE TECHNICAL COMPETENCIES VII 7 VII 8

4 ACKNOWLEDGEMENTS The Canadian Centre on Substance Abuse (CCSA) gratefully acknowledges the significant contributions and support received from people working in the field who participated in focus groups across Canada. CCSA especially thanks all its partners who so graciously allowed and encouraged staff to participate in the focus groups. The research means nothing if the end result is not meaningful to the people for whom it is intended and CCSA could not produce a meaningful report without the input from the focus groups. CCSA also thanks members of the National Advisory Group on Workforce Development (comprised of representatives from key national organizations and provincial/territorial governments) and other experienced directors and managers who participated in reviews of both sets of competencies. These documents can also be downloaded as a PDF at Ce document est également disponible en français sous le titre : Compétences pour les intervenants canadiens en toxicomanie

5 Competencies for Canada s Substance Abuse Workforce TECHNICAL COMPETENCIES REPORT VII 1 INTRODUCTION When work began on the Competencies for Canada s Substance Abuse Workforce, the Canadian Centre on Substance Abuse (CCSA) committed to updating them as necessary because competencies are dynamic and the substance abuse field changes over time. The second version of the Technical Competencies fulfills this commitment and reflects developments over the past few years: CCSA s review of recent literature revealed new or reinforcing evidence for successful substance use treatment. Through discussions with stakeholders, we gained a clearer understanding of the distinction between Technical Competencies and Behavioural Competencies. As a result, we moved three Technical Competencies to the Behavioural Competencies (Diversity and Cultural Responsiveness, Ethics and Professionalism, and Teamwork). Conflict Management, a Technical Competency in version one, was considered so integral to other competencies that it was removed as a specific competency and relevant behaviour indicators were incorporated into other competencies. Professionals in the substance abuse field began to change the language of engagement with clients to remove disempowering words. For example: mental health problems was replaced by mental health issues, which reflects a more neutral view that individuals can encounter stresses rendering them less able to cope for a period, but good mental health can return without being treated by medication. Treatment evolved to increase focus on clients strengths, capabilities and resources. It is generally accepted in the field that treatment must engage and be driven by clients and incorporate their goals and success measurements. This strengthbased approach recognizes that relapse can occur, and is an opportunity to build toward success, not a failure. Technical Competencies Compared with Behavioural Competencies Organizations and individuals who use the Competencies for Canada s Substance Abuse Workforce have told us that keeping the Technical and Behavioural Competencies separate is useful, so they remain distinct although linked categories. The two types of competencies are defined as follows: Technical Competencies are the specific, measurable knowledge and skills required to apply technical principles and information in a job function. Technical Competencies are usually learned in an educational environment or on the job. They are the what of a job and sometimes are called hard skills. Counselling is one example of a Technical Competency. Behavioural Competencies are the specific, measurable knowledge, skills and values required to perform effectively in a job function. Behavioural Competencies are typically learned and developed through life experiences. They are the how of performing a job and are sometimes called soft skills. Interpersonal rapport/savvy is one example of a Behavioural Competency.

6 NEW FEATURES IN VERSION TWO VII 2 That the Technical Competency of counselling is more effective when combined with the Behavioural Competency of interpersonal rapport/savvy demonstrates how the two sets of competencies complement each other. The Behavioural Competencies inform the Technical Competencies; one set should not be used in isolation from the other. Development Process for the Competencies When CCSA started researching competencies for the substance abuse treatment field in 2006, we realized that extensive work was needed to define them. We began with Technical Competencies because they are easier to observe and measure, publishing the first version of them in We then turned to Behavioural Competencies and published a report on them in 2010, along with guides, interview forms and performance measurement tools to assist organizations in using them. CCSA began research on the second version of the Technical Competencies in We had already transferred four Technical Competencies to the Behavioural Competencies. We refined and expanded the remaining 14 Technical Competencies with additional behaviour indicators and added three new competencies. As with the previous competencies work, after we completed research on a draft of the second version of the Technical Competencies, we asked focus groups across Canada to review them. Most of the focus groups were composed of frontline treatment service and program delivery staff. However, because of the importance of including concurrent disorders, CCSA hosted focus groups of mental health workers and nurses. Further, recognizing that the Competencies for Canada s Substance Abuse Workforce extends beyond organizations that provide treatment services, we convened a focus group of probation officers and another of people with lived experience. All the focus groups provided key feedback in shaping version two of the Technical Competencies to increase inclusivity, ensure consistent terminology, increase clarity and reflect treatment of concurrent disorders. In total, 12 focus groups were held, with over 110 participants. New Features in Version Two Focus on Substance Use The focus of the Technical Competencies, version two, is substance use, which encompasses abuse, dependency, disorder, misuse and addiction. In this version, efforts have been made to use terminology that is meaningful to treatment providers without emphasis on a clinical or disease model. Research from other countries and anecdotal information garnered from participants in the focus groups indicate that treating problematic gambling and smoking can be successful using similar approaches and strategies as for treating substance use. Substance-Related and Addictive Disorders, a factsheet from the American Psychiatric Association (2013), indicates that research on pathological gambling has led to gambling disorder being included in the Diagnostic and Statistical Manual of Mental Disorder (fifth edition) and states that gambling disorder is similar to substance-related disorders in clinical expression, brain origin, comorbidity, physiology, and treatment. Trauma-specific Care vs. Trauma-informed Care One of the Technical Competencies is titled Trauma-specific Care, chosen to indicate that treatment providers discuss with clients the cause or causes of their trauma and assist clients to identify and incorporate in their lives ways to cope effectively with the effects of trauma so that clients build a bank of coping mechanisms that increase the quality of their lives. In addition to this competency, behaviour indicators throughout a number of the Technical Competencies also reference Trauma-specific Care. Trauma-informed Care 1 is provided by the whole organization. It is a systematic approach to caring for clients, doing the right thing before a client is even in the room to increase the client s feeling of safety, choice and control. Trauma-informed care does not include talking about the underlying trauma. 2 Sequencing the Competencies Understanding Substance Use and Understanding Concurrent Disorders are two foundational Technical Competencies that underpin all the other competencies in this report. They are set out first and the remaining Technical Competencies are then listed in alphabetical order. The focus groups were clear that substantive knowledge in the two foundational Technical Competencies is essential for everyone working in this field, although the level of proficiency required differs depending on the work an individual performs. 1 For a comparison between trauma-informed services and trauma-specific services and an organizational checklist, see Trauma Informed Practice Guide. Victoria: BC Centre of Excellence for Women s Health, For more information on trauma-informed care, see Nancy Poole and Lorraine Greaves, eds., Becoming Trauma Informed. Toronto: Centre for Addiction and Mental Health, 2012.

7 GLOSSARY OF KEY TERMS VII 3 GLOSSARY OF KEY TERMS Certain words and phrases have a meaning specific in this report. Those words are defined below, reflecting the environment and context in which treatment providers deliver services and programs. Assessment (see also Screening) In-depth, ongoing process to inform the therapeutic approach. The practitioner engages the client; gathers information; establishes the presence or absence of a problem; identifies strengths and problem areas; and monitors issues such as client readiness to change, the need for crisis intervention or specialist practitioner intervention, and family support. Client Individual or family seeking assistance and support to eliminate substance use or to deal with substance use issues. Concurrent Disorders A combination of substance use and a diagnosed mental health problem. Examples of concurrent disorders are: A drinking problem and an anxiety disorder Cannabis dependence and schizophrenia Heroin dependence and borderline personality disorder Evidence-informed Treatment approaches guided by the best available research and practice-based knowledge. Evidence-informed treatment approaches allow for innovation while incorporating lessons learned from existing research literature and being responsive to cultural backgrounds, community values and individual preferences. Evidence-based practices are treatment approaches validated by some form of documented scientific evidence. Family (see also Social Support) Individuals or groups who constitute family both in the traditional sense and in a broader sense that includes any configuration of significant others in the client s past, present or future and who can either support or undermine the client s treatment goals. Mental Health Issues Undiagnosed imbalance in mental health resulting in reduced ability to deal with stress, difficulties and people, and often leading to inappropriate or unhelpful coping mechanisms. (Although sometimes called mental health problems, this phrase was discarded as pejorative by focus groups validating this version of the Technical Competencies.) Symptoms are likely discussed between a client and a treatment provider and coping mechanisms are encouraged to aid the client in moving toward better mental health. Mental Illness Psychiatric disorder or mental-health impairment, diagnosed by a specialist practitioner, that requires treatment, often including medication. Screening (see also Assessment) Brief initial process to identify the risks associated with a client s substance use and any related concerns. Social Support (see also Family) Individuals or groups who constitute social networks, Elders, community systems and any configuration of significant others in the client s past, present or future, and who can either support or undermine the client s treatment goals. Specialist Practitioner Refers to psychiatrists, psychologists and other regulated clinicians who can diagnose mental illness and are licensed to prescribe medications. Substance Use The self-administration of a psychoactive substance (WHO, 2006). For the Technical Competencies, substance use includes abuse, dependency, addiction and misuse of both licit and illicit substances, and some emphasis on substance use prevention and health promotion. Trauma Experiences that overwhelm an individual s capacity to cope. Such experiences include trauma early in life (e.g., child abuse and neglect, witnessing violence) and later traumatic experiences (e.g., accidents, war, natural disasters). Mental Health Continuum of psychological and emotional well-being along which an individual moves periodically without having a mental illness. The World Health Organization (WHO) defines mental health as a state of well-being in which an individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.

8 TECHNICAL COMPETENCY DEFINITIONS VII 4 TECHNICAL COMPETENCY DEFINITIONS The 17 Technical Competencies in version two are listed below, along with definitions and notes to help readers understand the changes made for this version. For all Technical Competencies, some behaviour indicators were refined and new ones added. Competency Title Definition Notes on the Competency Understanding Substance Use (in v. 1 was Understanding Use, Abuse, and Dependency) Understanding Concurrent Disorders (in v. 1 was Mental Health) Case Management Client Referral NEW Community Development Counselling Background or contextual knowledge of substance use, as defined in the Competencies, required to properly inform more specific aspects of a professional s work with clients and their families. Knowledge and skills required to properly inform more specific aspects of a professional s work with clients with co-occurring substance use and mental illness, or substance use and mental health issues. Facilitating a substance use client s movement within and between service providers. It includes maintaining accurate documentation, sharing client information appropriately and collaborating with other services providers. Collaborating with substance use clients, services and supports to identify and access the best available resources to meet clients needs. Working together to identify community needs and resources, and to plan and support or guide collective action. Applying a comprehensive range of evidence-informed counselling styles, techniques and methodologies aimed at improving the overall well-being of substance use and concurrent disorders clients. The choice of substance use reflects a research perspective that this phrase encompasses use, misuse, abuse, dependency and addiction. This is 1 of 2 foundational competencies. This competency recognizes that many treatment providers are not licensed clinicians, but must be conversant with concurrent disorders so they can serve clients effectively. This is 2 of 2 foundational competencies. This competency is closely linked to the competencies Client Referral and Record Keeping and Documentation. This competency reflects increased recognition of the importance of being able to access a wide range of pertinent resources. This competency is closely linked to Case Management and Treatment Planning. Community development is expected to be planned and implemented collaboratively with community leaders where possible and appropriate, although this is not clearly stated in the definition of the competency. This competency is closely linked to Outreach. Treatment providers use a range of methods and adapt or revise them in keeping with new knowledge, promising or best practices, and learning from application in practice to ensure that the counselling is strength-based and always focused on the client and his or her needs. This competency is closely linked to Family and Social Support, Trauma-specific Care and Treatment Planning.

9 TECHNICAL COMPETENCY DEFINITIONS VII 5 Competency Title Definition Notes on the Competency Crisis Intervention Family and Social Support Group Facilitation Medications (in v. 1 was Pharmacology) Outreach Prevention and Health Promotion (prevention of substance use) Recognizing and responding effectively when a substance use or concurrent disorders client or associated group or community is in an unstable, risky, dangerous or potentially dangerous situation. Working with clients and individuals and groups most affected by the client s substance use and most able to either support or undermine the client s treatment goals. Using evidence-informed approaches to work effectively with substance use and concurrent disorders clients in group settings. The knowledge and skills required to understand and use medications in the treatment of clients with substance use or concurrent disorders and to understand and respond to the impact that medications could have on the client. Designing and delivering substance use and concurrent disorders services in the community to a broad range of clients, including those who might otherwise not seek or have access to those services. Engaging with substance use and concurrent disorders clients, their families and their communities to encourage the adoption of knowledge, behaviours, values and attitudes that promote personal and community well-being. This competency does not indicate a requirement for crisis intervention training; however, it could be worthwhile as a professional development opportunity for staff requiring this competency. Sometimes, the client is not the individual with a drug problem and might be a family member. Sometimes, the client is the individual with a drug problem and their family is not supportive of their attempts to stop using substances. For a full explanation of family, see the Glossary of Key Terms. This competency is closely linked to Counselling. Originally, this competency was titled Pharmacology; however, the focus groups found that term was not helpful. Most treatment providers are not licensed to prescribe or dispense medications. As a result, the emphasis in this competency is on knowledge. For example, recognizing when medication is having an adverse effect and knowing how best to respond to increase the client s success. In organizations where treatment providers are licensed, most behaviour indicators for this competency can be adjusted to reflect appropriate actions. This competency is closely linked to Community Development. This competency recognizes that many treatment providers also work in prevention. 3 3 For more information on prevention and health promotion work, look for the prevention workforce competencies that will be available from CCSA in spring They will focus on working with youth.

10 TECHNICAL COMPETENCY DEFINITIONS VII 6 Competency Title Definition Notes on the Competency Program Development, Implementation and Evaluation Record Keeping and Documentation NEW Screening and Assessment Trauma-specific Care NEW Treatment Planning Developing and implementing new substance use programs, modifying existing programs to respond to identified needs and evaluating the outcomes of new or revised programs. Creating and maintaining accurate, up-todate, comprehensive client records able to withstand legal scrutiny. Selecting, administering and interpreting the results of evidence-informed tools and methods to measure a client s substance use and related concerns, and inform the care and treatment plan. Interacting with substance use clients to identify and consider the impact that overwhelmingly negative events have on functioning and the ability to cope, and then developing and delivering interventions that emphasize safety, choice and personal control. Collaboratively developing a treatment plan based on screening and assessment findings, ensuring that activities and resources reflect the client s needs, strengths and goals. The process also includes monitoring, evaluating, planning for discharge and updating the treatment plan so that it reflects the client s evolving needs and goals. This competency helps to inform staff about the range of program-related activities they could be expected to participate in and to equip staff to participate more effectively in needs assessment as well as program development, implementation and evaluation. This competency reflects the increasing importance of robust record keeping. This competency is closely linked to Case Management. This competency is closely linked to Case Management, Counselling and Treatment Planning. As research on trauma has increased, so has the realization that substance use and mental health issues often develop or increase as a result of trauma. This competency is closely linked to Counselling. This competency is closely linked to Counselling, Case Management and Client Referral.

11 USING THE TECHNICAL COMPETENCIES VII 7 USING THE TECHNICAL COMPETENCIES For each Technical Competency, there is a definition and four levels of proficiency: Introductory, Developing, Intermediate and Advanced. A full explanation of the proficiency levels is found in the Overview of Competencies for Canada s Substance Abuse Workforce. The Technical Competencies can be used to create or refine job descriptions and profiles, interview candidates, assess candidate suitability and experience, set employee performance expectations, and evaluate employee performance. They are also useful to individuals who wish to self-assess their skills and determine how they can best further develop their skills. Tools to Support Use of Technical Competencies 4 To assist organizations using the second version of the Technical Competencies, CCSA has provided in a separate section a series of interview questions for each competency. There are four questions for each competency, one for each level of proficiency, and each question links to particular behaviour indicators for that level of proficiency. The questions are examples that can be used as is or adapted to reflect an organization s specific needs. By providing these sample questions, CCSA anticipates that organizations can more easily create additional questions that reflect behaviour indicators for specific jobs or functions within a particular organization. Readers wishing to consider what Competencies users have said about incorporating them into practices can view the seven related videos, which discuss ease of use, benefits of use, curriculum and other topics. CCSA will continue to develop other resources as requested by partners and users of the Competencies. 4 An additional resource, Guide to Culturally Relevant Behaviour Indicators for the Technical Competencies, produced jointly by CCSA and the National Native Addiction Partnership Foundation (NNAPF), will be available by spring 2015.

12 UNDERSTANDING SUBSTANCE USE VII 8 UNDERSTANDING SUBSTANCE USE: Background or contextual knowledge of substance use, as defined in the Competencies, required to properly inform more specific aspects of a professional s work with clients and their families. Explains what substance use is and: The extent to which it is a problem in Canada The bio-psycho-social-spiritual factors that contribute to or protect against it That it occurs along a continuum Describes the types of illicit drugs, tobacco and legal medications often used improperly or illegally, and cites the street names for these substances in the professional s locale Explains that many factors have an impact of both the substance use client and the client s family, and identifies some of those key factors including for example, stigma, background of family violence and cultural-historial factors like Indian Residential Schools Explains the concepts for harm reduction approaches Explains how mental illness and mental health issues affect the prevention, diagnosis and treatment of substance use Explains the kinds of mental illnesses or mental health issues often experienced by clients with concurrent disorders Applies evidence-informed approaches to identify the severity of the client s substance use and any other issues (e.g., problem gambling, tobacco use) Explains the range of factors that can aggravate or protect against the development of substance use problems, and works with clients to identify such factors in their cases, for example: Age, gender, gender identity and sexual orientation Social support Biological markers and genetic vulnerability Historical, social and cultural factors Explains the prevalence of concurrent disorders and histories of trauma in substance use clients, and applies this knowledge in working with clients Explains in general terms the impact that stigma, trauma and cultural and historical events can have on clients, and applies this understanding in working with clients Explains the concepts of the family and social supports as systems with the potential to either support or undermine the client, and the type of impact a client s substance use often has on the family as a system Consults evidence-informed resources, including the Diagnostic and Statistical Manual of Mental Disorder, to develop and apply an enhanced understanding of clients with concurrent disorders Explains in general terms withdrawal management and treatment and relapse prevention approaches, and applies this knowledge in working with clients Explains in general terms how and why medications are used in the treatment of substance use and integrates a practical and level-appropriate knowledge of medications when working with clients Explains and applies an understanding of the different factors (like physiological and mental health) that work alone or together to aggravate or mitigate risk, and how these factors may vary in different populations and cultures Accesses current research and integrates and applies this knowledge when developing and adapting evidence-informed treatment approaches Works with complex or sensitive cases requiring a sophisticated understanding of: Most aspects of substance use and concurrent disorders Different cultures and various populations Works with clients using medications likely to have an impact on mood, behaviour and cognitive functioning Participates in planning and conducting research on current trends in all aspects of the prevention, diagnosis and treatment of substance use and concurrent disorders Supervises or coaches others in developing their knowledge of causality, prevention, diagnosis and treatment of substance use and concurrent disorders, and integrating this new knowledge into their work with clients Supervises or coaches colleagues working with complex and sensitive cases requiring a sophisticated understanding of all aspects of substance use and concurrent disorders Initiates, facilitates or participates in collaborative research that: Advances knowledge about prevention, screening and assessment, and treatment of substance use Explores the range of social, political, economic, spiritual and cultural factors likely to have an impact on substance use Contributes to professional development and exchanges of current knowledge on substance use and concurrent disorders Develops new tools, techniques and support materials that assist the substance use workforce Advocates for the development and implementation of public policy designed to minimize risk while enhancing resiliency Advocates for funding of research and programs designed to improve the lives of substance abuse clients

13 UNDERSTANDING SUBSTANCE USE VII 9 UNDERSTANDING SUBSTANCE USE: Background or contextual knowledge of substance use, as defined in the Competencies, required to properly inform more specific aspects of a professional s work with clients and their families. Explains in general terms the impact that medications and other drugs can have on one another, and applies this understanding in working with clients Monitors information about current research to update and enhance the knowledge base applied when interacting with clients

14 UNDERSTANDING CONCURRENT DISORDERS VII 10 UNDERSTANDING CONCURRENT DISORDERS: Knowledge and skills required to properly inform more specific aspects of a professional s work with clients with co-occurring substance use and mental illness or substance use and mental health issues. Explains a beginning understanding: What is meant by mental health and mental illness and the difference between them Factors that contribute to their presence in the general and in specific populations and cultures The stigma that is often associated with mental illness and mental health issues, and how that may vary in different populations and cultures The relationship between mental illness and mental health issues and co-occurring substance use That many substance use clients have co-occurring mental illness or mental health issues That many substance use clients have histories of trauma, which can have an impact on their substance use and treatment Describes how concurrent disorders impact problem gambling, including: Outlining how substance use problems, mental illness and mental health issues affect the prevention, diagnosis and treatment of problem gambling Listing the kind of substance use problems, mental illnesses or mental health issues often experienced by clients with problem gambling Explains the major categories of mental illness and of mental health issues and the signs and symptoms of each Explains frequent causes of and treatments for the categories cited Provides objective descriptions of the behaviour of clients showing signs and symptoms of suspected mental illness or mental health issues when referring them to or consulting with specialist practitioners Collaborates with clients to integrate results of consultations or referrals in clients treatment plans Integrates trauma-informed approaches into treatment strategies Integrates practical, level-appropriate knowledge of medications into treatment strategies Collaborates with clients to identify the impact of stigma and how to address it and address the host of other personal and systemic factors that either contribute to or protect against the development of concurrent disorders Monitors evidence-informed knowledge about the best approaches to treating concurrent disorders and working with people who have these disorders Explains the impact of and relationship between different cultural values and stigma on clients with concurrent disorders and collaborates with client to address these issues Develops and implements evidenceinformed strategies that appropriately address: The relative severity of both the client s substance use and mental illness or mental health issues The specific needs related to the client s cultural context The full range of the client s challenges (e.g., physical health, housing, finances) The need to collaborate with a variety of others Collaborates with colleagues in integrating knowledge with practice Collaborates with other agencies and service providers to address challenges like employment and housing Engages in cross-training opportunities with other professionals Supervises or coaches other professionals working with clients with concurrent disorders Collaborates and takes a leadership role in developing and implementing a seamless, evidence-informed approach across all sectors and disciplines to the delivery of services to clients with concurrent disorders Collaborates and takes a leadership role initiating or facilitating cross-training opportunities with specialist practitioners Advocates for, facilitates and contributes to collaborations between the full range of professionals involved in diagnosing and treating clients with concurrent disorders Advocates for, initiates, facilitates or participates in research focused on the appropriate integration of treatment for co-occurring substance use and mental illness or mental health issues

15 UNDERSTANDING CONCURRENT DISORDERS VII 11 UNDERSTANDING CONCURRENT DISORDERS: Knowledge and skills required to properly inform more specific aspects of a professional s work with clients with co-occurring substance use and mental illness or substance use and mental health issues. Explains that substance use professionals need to: Learn about mental illness and mental health issues Know of and use the most important evidence-informed references and resources that should inform their learning, including for example, the Diagnostic and Statistical Manual of Mental Disorder, the Mental Health Act, mental status examinations Understand that family, social support and a host of other broad determinants of health can either contribute to or protect against the development of concurrent disorders Practice within the confines of their knowledge and consult and collaborate with others as required Engages with all clients, their families and social supports courteously, responsively and non-judgmentally. Supports or assists other more senior internal professionals working with clients with concurrent disorders of vary-ing levels of severity

16 CASE MANAGEMENT VII 12 CASE MANAGEMENT: Facilitating substance use client s movement within and between service providers. It includes maintaining accurate documentation, sharing client information appropriately and collaborating with other services providers. Assists case management colleagues in an administrative or support capacity Engages courteously and professionally with others Explains how case management is related to screening, assessment and treatment planning Explains the process for referral to and from other service providers, including protocols that determine how, when and with whom information and documentation should be shared Explains the benefits of and process for conducting case conferences and teleconferences, and the situations in which each is appropriate Adheres to all legislation, guidelines, procedures and protocols about client confidentiality and professional ethics Establishes and maintains constructive working relationships with clients and their families, and with both internal and external colleagues Monitors a range of resources to become familiar with current service options available to clients and maintains up-to-date records of available services and resources Consults with clients to match them with and refer them to the most appropriate available services and supports, using information obtained through the screening and assessment processes Initiates and participates in case conferences and teleconferences, and promptly conducts all necessary follow-up Uses or considers using tele-health sites and online tools (e.g., video conferencing) to facilitate case management activities Collaborates with clients and their families and social supports on case management recommendations and activities Advocates for clients when working with related services and supports Establishes and maintains therapeutic rapport with clients to help them adhere to treatment plans Establishes and maintains treatment plans as part of a multi-disciplinary team, as appropriate Evaluates ongoing treatment plans with clients, adjusting plans as appropriate Establishes constructive relationships with a broad range of internal and external services and supports, using these relationships to facilitate client referrals Works with the clients to motivate them to make and follow-through on decisions about treatment planning Consults regularly with others, internally and externally, to facilitate coordinated and collaborative case management Supervises or coaches others in: Undertaking general case management tasks Evaluating complex treatment plans and collaborating with clients and other resource to make changes as required Innovating solutions when conventional strategies have been unsuccessful Ensuring compliance with case management protocols and changing protocols when necessary Reviews counsellors case management documentation Approves provision of case-management documentation to the client and other collaborators, on a case-by-case basis Initiates and facilitates case conferences and teleconferences, as appropriate

17 CLIENT REFERRAL VII 13 CLIENT REFERRAL: Collaborating with substance use clients, services and supports to identify and access the best available resources to meet clients needs. Develops knowledge of and maintains relationships with referral resources Builds and maintains a network of resources available for meeting client needs Collaborates with the client about potential referral options, discussing priorities, expectations and required actions Helps complete documents required for the referral process Adheres to all legislation, guidelines, procedures and protocols about client confidentiality and professional ethics Builds awareness of role and organizational mandate with referral sources Is conversant with potential referral resources through such activities as visiting sites, networking and studying websites and publications Assesses the client s readiness and motivation to participate in referral services and works with the client to enhance readiness Initiates collaboration with referral sources as appropriate Coordinates referral services and supports to provide seamless care for clients Advocates for client when necessary Maintains a network of referral sources appropriate to the needs of clients with complex histories Collaborates with clients to enhance their motivation to take responsibility for, engage in and follow-up on the referral process Maintains contact with the clients and referral source to facilitate successful treatment and evaluate the outcome of the referral Advocates with referral agencies on behalf of clients Builds and enhances referral capacity by networking with external senior-level colleagues Establishes protocol and method for collecting client satisfaction data Oversees the referral process to ensure that mutually beneficial relationships are established Reviews referral records for accuracy, completeness, timeliness and compliance with legal and clinical requirements Investigates situations in which clients or referral sources report inappropriate, unsatisfactory or incomplete referrals

18 COMMUNITY DEVELOPMENT VII 14 COMMUNITY DEVELOPMENT: Working together to identify community needs and resources, and to plan and support or guide collective action. Accesses literature related to community development and substance use service delivery systems Explains principles of community development (e.g., sustainable, inclusive, equitable) Explains the role of community members in initiating and supporting community development activities Acts as first-line point of contact for community members Courteously engages with, encourages and responds to all community members and stakeholders Maintains contact with community resources and referral sources Works collaboratively and develops rapport with community members and groups Establishes and maintains contacts and networks to further community involvement in developing and delivering services to enhance community wellbeing Promotes fairness and good judgment in planning and undertaking community development activities Builds awareness in the community about the needs of substance use and concurrent disorder clients Collaborates with clients and others most affected to: Assess and prioritize their needs, issues and resources Generate collaborative solutions to community challenges Promote community ownership of constructive change Encourages community leaders to consider the voice of people with lived experience in community development activities Collaborates with clients and those most affected to: Leverage community capacity Ensure that programs and services are culturally sensitive Generate solutions to complex community development issues Mobilizes and supports community members to: Take a proactive role in developing evidence-informed health promotion practices and policies Reduce stigma associated with substance use Promote a healthy lifestyle Performs or participates in needs assessments by collecting, analyzing and interpreting relevant community data, in partnership with other community members Incorporates relevant research findings and knowledge of determinants of health into program planning Provides leadership in shaping an organizational vision and service delivery system that reflects best practices in community development Provides leadership in developing and implementing evidence-informed community health promotion practices and policies Communicates and collaborates with key stakeholders, within and outside the community, such as subject matter experts, to obtain their input on and commitment to engage in relevant policy and program development Incorporates relevant research findings and knowledge of determinants of health into program planning Assesses new community initiatives and if resources and circumstances permit approves those consistent with best practices in community development

19 COUNSELLING VII 15 COUNSELLING: Applying a comprehensive range of evidence-informed counselling styles, techniques and methodologies aimed at improving the overall well-being of substance use and concurrent disorders clients. Assists counsellors in an administrative or support capacity Observes experienced staff providing services and facilitating groups Explains: Evidence-informed individual and group counselling approaches and techniques such as motivational interviewing and cognitive behavioural therapy The importance of building rapport when working with clients to enhance their motivation Relapse, risk and protective factors The importance of collaborative treatment Life skills conducive to recovery, like managing personal finances The range of approaches that can enhance counselling (e.g., mutual help, self-help and psychotherapy) Interacts with each client to facilitate that client s recovery and avoid retraumatization Uses plain language in all client communication Participates in creating a safe environment Adheres to all legislation, guidelines, procedures and protocols about client confidentiality and professional ethics Describes the signs and symptoms of problem gambling, including common cognitive distortions, financial impacts and legal issues Collaborates with clients to: Establish and maintain counselling relationships characterized by courtesy, warmth, genuineness, empathy and concreteness Understand the impact that the family as a system can have on the client s substance use Enhance their motivation and readiness to change by effectively applying skills such as rolling with resistance, being empathetic and supporting self-efficacy Develop coping strategies to deal with challenging circumstances Matches client s unique needs and life challenges to appropriate treatment and support options (e.g., harm-reduction approaches, outpatient or aftercare programs) Delivers brief interventions for clients, when and if required Integrates evidence-informed counselling approaches based on each client s comprehensive assessment and treatment plans, when working with individuals and with groups Adapts counselling approach to meet each client s unique needs (e.g., family counselling, vocational counselling) Collaborates with clients to develop and implement evidence-informed relapse prevention plans Monitors all clients, especially those with a higher relapse risk, to identify symptoms of relapse and take proactive steps during counselling to prevent relapse Collaborates with the client to facilitate the development of life skills associated with the recovery process Collaborates with other practitioners to provide integrated care for clients Engages in self-analysis with clinical supervisor to recognize personal or professional limitations that can impede ability to work constructively with clients and mediate and resolve those limitations Applies a broader range of evidenceinformed counselling approaches appropriate to the needs of not just individuals and groups, but also couples and families Responds constructively and effectively to significant counselling challenges like aggression and thoughts of suicide Engages clients in discovering the connection between their substance use and their experiences Collaborates with client to address behaviours that are inconsistent with recovery Selects and adjusts approaches to counselling based on the severity of both substance use and mental illness or mental health issues Prioritizes client access to treatment based on signs and symptoms of relapse Describes the signs and symptoms of problem gambling, including common cognitive distortions financial impacts and legal issues Engages with clients who present with complex backgrounds and needs Applies mastery of substance use counselling theory and skills when working with clients Innovates counselling approaches based on theory, research, trends, promising practices and new knowledge Advocates for and integrates the use of technology to provide counselling services, especially to rural and remote clients Collaborates with professionals in other fields of study to gather insight on alternative approaches to counselling Supervises or coaches colleagues to promote best practices in all aspects of counselling and awareness of the needs of specialized populations

20 CRISIS INTERVENTION VII 16 CRISIS INTERVENTION: Recognizing and responding effectively when a substance use or concurrent disorders client or associated group or community is in an unstable, risky, dangerous or potentially dangerous situation. Defines crisis and explains the principles of evidence-informed crisis intervention Develops and maintains a network of resources and supports available for clients in crisis Explains the risk factors and signs and symptoms associated with suicide and other substance use-related harms If risk factors, signs or symptoms appear to be present in a client, notifies more senior professionals or relevant services and support systems Identifies the essential components of evidence-informed models of crisis prevention action plans Describes the subtle and overt signs of crisis Establishes a physically and emotionally safe environment for each client in crisis based on that client s unique needs Discusses risks associated with substance use with clients, and refers clients in crisis to appropriate resources and supports Collaborates with clients and their families to create plans for crisis prevention and intervention Collaborates with clients and their families to assess and improve the skills they can use to cope during times of crisis Monitors client s emotional state and responds appropriately Calms escalating and potentially volatile situations, using a range of verbal and non-verbal communication skills Supports clients in crisis, promoting safety and stability for them and their families Implements crisis prevention plans where required Responds quickly and effectively to clients in crisis, intervening as appropriate at each stage of crisis Monitors factors, such as medications, that might contribute to a client crisis and takes appropriate actions, such as referring the client to a practitioner who can prescribe medications, to attend to these factors Assesses and monitors clients at risk of suicide and other substance userelated harms, and initiates appropriate interventions or referral, as required Re-assesses and revises client s treatment plan following a crisis, as necessary Employs clinical expertise to work with clients to identify underlying factors that contribute to a crisis and to develop strategies to cope with those factors Employs a range of sophisticated intervention strategies and creative solutions to stabilize complex crisis situations Supervises or coaches other professionals to enhance their crisis intervention skills Monitors research and introduces new evidence-informed crisis management approaches and techniques, as appropriate

21 FAMILY AND SOCIAL SUPPORT VII 17 FAMILY AND SOCIAL SUPPORT: Working with clients and individuals and groups most affected by the client s substance use and who are most able to either support or undermine the client s treatment goals. Explains why and how family and social supports are important parts of effective treatment and relapse prevention planning Explains the impact that substance use can have on a client s family and the impact family can have on a client s substance use Explains community resources available to the client and the client s family Engages with the client to identify all parties the client considers to be family Engages with the client s family in a courteous, helpful and professional manner Collaborates with the client and the client s family members to: Identify dynamics that help or hinder the development of balanced, healthy relationships Assess the needs of all and factor them into treatment plans for the client and, when appropriate, the client s family Works with the client s family members to facilitate: Their understanding of the impacts that substance use or concurrent disorders are likely to have on the client and them Their understanding of the need to take care of themselves Their ability to access services they need, referring them to other resources, as required Assesses clients with children or other dependents to identify risks to the safety and well-being of those dependents, and when assessed risks are high, takes appropriate next steps, such as contacting the Children s Aid Society, subject to protocols that govern confidentiality Works with the client to identify and implement actions that will lead to improved family relationships Assesses the health of the family as a system and works with the family to increase its cohesion and build support for client efforts to develop and implement an effective treatment plan Provides couple and family therapy for those affected by problem gambling Assists in stabilizing couples and families affected by problem gambling, including providing problem gambling information and helping re-establish trust Works with the client and the client s family to: Screen and assesses the client s family to identify risks related to substance use or concurrent disorders Develop treatment plans for family members as required, including consultations and referrals when appropriate Works with clients to develop a deeper understanding of the family as a system, and to identify changes that could be made to improve the well-being of the family and each family member Conducts interventions in complex situations in which multiple factors or risks are likely to have an impact on one another Supervises or coaches others: In the development and application of evidence-informed family interventions Working with complex challenges with a client s family Promotes the value of family wellness